Minerva medica最新文献

Background: Oxidative stress induced by cigarette smoke compounds is one of the factors responsible for bronchial inflammation and airway structural remodeling. On the other side, the individual antioxidant capacity is variable and representative of the body's immune defenses' state. The aim of this study is to detect the level of oxidative stress and anti-oxidant capacity in smokers, comparing COPD with non-COPD patients. To determine the variables associated with oxidative stress.

Methods: Fifty-four patients were assessed by spirometry and questionnaires such as CAT, mMRC, Fagestrom's. The exhaled carbon monoxide (eCO) was measured in order to assess smoking exposure. Serum vitamin-D level was also detected. All patients underwent treatment for smoking cessation by Cytisine, an alkaloid partial agonist of the nicotinic acetylcholine receptor. The diagnosis of COPD was determined based on FEV1/FVC ratio <70%. Oxidative stress and anti-oxidant capacity were determined on a saliva sample using commercial assays, after the last cigarette smoked. Data were analyzed using non-parametric statistical tests.

Results: In the overall population, the average value of the pack-years index was 40, the Fagestrom's mean value was 5, BMI was 26, exhaled CO (eCO) was 27 ppm. Comparing the two subgroups, COPD and no-CODP, they were comparable in age, Fagestrom's, pack-years. They obviously differed in the functional variables. The d-ROMs value was significantly higher in smokers who had not developed COPD (P<0.01). This group had a lower level of vitamin D than the COPD group (P<0.03), a different value of cigarettes/day (P<0.0001) as well as the value of eCO were detected (P<0.01). In multiregression analysis d-ROMs value is correlated with pack-years and cigarette/day values. d-ROMs, cigarettes/day, vitamin D value were factors affecting COPD.

Conclusions: Our results confirm that tobacco smoking causes oxidative stress, and it is associated with pack-years index and cigarettes/day. COPD patients with a high vitamin D level are protected from oxidative stress.

Background: Asthma and rhino-conjunctivitis are frequently triggered by sensitization to airborne allergens, particularly grass pollens. This study aimed to assess whether age, sex, and living environment influence allergen-specific IgE responses to grass pollen components, using a molecular diagnostic approach.

Methods: A total of 772 patients referred to the Allergology outpatient clinic for suspected grass pollen allergy were enrolled. Allergen-specific IgE levels were measured using the ImmunoCAP ISAC microarray. Patients were stratified into nine groups based on age, sex, and city of residence (Milan, Pavia, and surrounding rural/suburban areas). Sensitization to nine grass pollen components (Cyn d 1, Phl p 1, Phl p 2, Phl p 4, Phl p 5, Phl p 6, Phl p 7, Phl p 11, and Phl p 12) was analyzed.

Results: Sensitization patterns varied by sex, age group, and place of residence. Male patients showed higher IgE positivity for Phl p 2 and Phl p 6. Overall, the highest sensitization rates were observed in adolescents and in patients living in Milan. Cyn d 1, Phl p 1, Phl p 4, and Phl p 5 showed widespread sensitization across all groups, though rates were higher in males and in urban areas.

Conclusions: This cross-sectional study highlights that demographic and environmental factors - particularly sex, age, and urban living - can influence IgE sensitization to grass pollen components. These findings emphasize the relevance of molecular diagnostics in understanding allergy epidemiology and support the hypothesis that environmental exposure, including air pollution, may affect sensitization profiles.

Introduction: Hypertension (HT) is a leading modifiable risk factor for cardiovascular disease, but resting blood pressure (BP) measurements often miss hypertensive episodes during daily activities, affecting 10-15% of adults. A hypertensive response to exercise (HRE), characterized by abnormally high systolic BP (SBP) increases, is associated with future arterial HT and cardiovascular events, even in normotensive individuals and athletes. Despite its clinical significance, definitions of HRE vary widely, leading to inconsistent incidence estimates. The aim of this study was to collect available values of HRE and investigate definitions for HRE.

Evidence acquisition: This systematic review followed PRISMA guidelines, conducting a comprehensive search of MEDLINE and Embase from 1974 to 2024. The search included studies on normotensive adults and athletes with or without HRE, focusing on BP cutoffs across exercise modalities and intensities. Eligible study designs included original research studies of any design, while reviews, case reports, and meta-analyses were excluded. Data extraction and synthesis involved multiple reviewers to ensure accuracy, with results presented in narrative and tabular formats.

Evidence synthesis: A total of 25 studies with 15,391 participants (weighted mean age 50 years, 28.3% female, 5.4% athletes) were analyzed, encompassing various study designs, including cross-sectional, case-control, cohort, and longitudinal studies. Exercise test protocols included treadmill (14 studies), bicycle ergometry (seven), shuttle/runs (three), and hand-grip strength (one), with most studies utilizing peak exercise intensities and automated BP measurements. Cut-offs for HRE varied, with most studies using SBP thresholds of ≥210 mmHg for men and ≥190 mmHg for women, though some studies proposed higher thresholds or included diastolic BP criteria. Definitions and methodologies for HRE were heterogeneous, reflecting variability across studies. Age, sex, fitness level, and test protocols significantly influence BP response, yet these factors are mostly omitted in the definition of HRE, with older adults and postmenopausal women showing exaggerated responses. Athletes exhibit higher peak SBP during exercise due to increased peak exercise cardiac output and augmented muscular strength enabling the athletes to push peak SBP higher, but thresholds applied are often the same as for non-athletes, underscoring the need for fitness-specific cut-offs. Variations in test protocols, measurement methods, and reliance on legacy cut-offs, which have been reproduced over decades further complicate consensus on standardized thresholds.

Conclusions: Standardized, phenotype-specific criteria are essential to improve diagnostic accuracy and guide clinical recommendations in HRE.

The serum uric acid to HDL cholesterol ratio (UHR) has emerged as a novel biomarker linking metabolic dysfunction and inflammation. Elevated UHR reflects a complex interplay between oxidative stress, endothelial dysfunction, and lipid metabolism, contributing to systemic inflammation and disease progression. Recent studies suggest that UHR may serve as a predictive marker for cardiometabolic risk, offering potential advantages over traditional lipid and uric acid measurements alone. However, the underlying mechanisms remain incompletely understood, and standard reference values have yet to be established. Further research is needed to elucidate the causal relationships and assess the clinical utility of UHR in disease risk stratification and management. Understanding the role of UHR in metabolic and inflammatory pathways could enhance early detection and intervention strategies for at-risk individuals. This review elaborates the role of UHR in various metabolic and inflammatory conditions, including type 2 diabetes mellitus, diabetic chronic complications, metabolic syndrome, cardiovascular disease, insulin resistance, and chronic inflammatory states.

The gut microbiome, comprised of diverse microorganisms, plays a critical role in maintaining metabolic, immune, and digestive health. This dynamic ecosystem is highly influenced by external factors such as diet, genetics, environmental factors, and even medication use, including antibiotics. Iron, already bioavailable in the Archean Ocean, is one of the most abundant elements on Earth. All organisms compete or collaborate to obtain iron, demonstrating its relevance in the biological and physiological processes essential to the maintenance of metabolic homeostasis. The bidirectional relationship between the intestinal microbiota, and the host organism in obtaining iron influences both the metabolism of the host, and that of the microbiota. Bacteria in microbiota affects the absorption of iron by the organism, while factors such as iron deficiency or excess in the host modify bacterial biodiversity, its taxonomic composition and its functions. These changes impact bacterial virulence, influencing systemic iron levels, tissue storage and glucose metabolism in the host organism. Patients with changes in glucose metabolism and insulin resistance often present imbalances in iron regulation and alterations in the profile of their intestinal microbiota. The interaction between microbiota, iron and glycemia represents an emerging field of research, standing out as a promising area for nutritional and therapeutic interventions to promote metabolic health. This review explores the relationship between iron metabolism and gut microbiota, highlighting its impact on glucose metabolism.

Introduction: Frozen-thawed embryo transfer (FET) has become a widely adopted method in assisted reproductive technology (ART), thanks to the advancements in vitrification techniques. FET now accounts for a significant proportion of ART cycles, but there is still no clear consensus on the optimal protocol for endometrial preparation. This review aims to evaluate the reproductive outcomes of three commonly used FET protocols: natural cycle (NC), modified natural cycle (mNC), and artificial cycle (AC), with a focus on implantation rates, clinical pregnancy rates (CPR), live birth rates (LBR), and obstetric complications such as hypertensive disorders of pregnancy (HDP) and preeclampsia (PE).

Evidence acquisition: Studies published between 2014 and 2024 were reviewed and compared across these protocols.

Evidence synthesis: The results show that NC and mNC protocols are associated with higher CPR and LBR compared to AC. AC, on the other hand, is linked to an increased risk of HDP and PE, likely due to the absence of a functional corpus luteum (CL), which plays a vital role in early pregnancy support.

Conclusions: The presence of a CL appears to be crucial for minimizing obstetric complications, making NC and mNC preferable options. Future research is needed to refine FET protocols, focusing on personalized approaches to endometrial preparation that optimize both pregnancy outcomes and maternal health.

Introduction: Experimental research sequentially identified reperfusion (in 1972) and conditioning (in 1986) as the two most powerful interventions for reducing acute myocardial infarct (AMI) size following acute coronary occlusion. These discoveries led to further experimental studies on optimal myocardial salvage and intensive clinical efforts to translate these interventions into the management of patients. This umbrella review of systematic reviews addresses the state of research on the effectiveness of pharmacological and interventional conditioning protocols to modulate the impact of ischemia and reperfusion in experimental animals and patients and the comparability of results in experimental animals and humans. This umbrella review documents the paradox of the experimental success of conditioning strategies in the experimental arena and equivocal clinical results of the application of the same conditioning strategies in patients.

Evidence acquisition: The review was conducted using the reporting guideline for overviews of reviews of healthcare interventions codified in the PRIOR statement (https://www.equator-network.org/reporting-guidelines/reporting-guideline-for-overviews-of-reviews-of-healthcare-interventions-development-of-the-prior-statement/).

Evidence synthesis: The results are summarized in the PRISMA format. A discussion is provided of known and unknown factors responsible for the lack of progress in identifying and implementing interventions to further reduce morbidity and mortality from ischemic heart disease, as well as a practical strategy to achieve timely reperfusion in a larger number of patients experiencing acute coronary syndrome.

Conclusions: While awaiting further research to develop a third window of cardioprotection, the most practical approach today is to reduce the morbidity and mortality from IHD is to mount a public education campaign to get the 50% of acute coronary syndrome (ACS) patients with prodromal AMI to the hospital to institute timely reperfusion therapy which has a proven to be the most effective therapy to limit the extend of myocardial damage in patients with IHD. However, the possibility has been raised that the human myocardium may have a genetically determined, primordial non-responsiveness to cardioprotective interventions that exists beyond the established recognized confounding factors. Primordial genetic factors may be particularly difficult to overcome.