Nicola Ferrara - Academia.edu (original) (raw)
Papers by Nicola Ferrara
Alterations in signal transduction pathway of G-protein-coupled receptors (GPCRs) have been found... more Alterations in signal transduction pathway of G-protein-coupled receptors (GPCRs) have been found in the cerebrocortex and in the peripheral cultured tissues of patients with Alzheimer's disease (AD). The G-protein-coupled receptor kinase-2 (GRK2) plays an important role in regulating the GPCRs signaling: its increased expression is associated with receptor desensitization. The aim of this study was to explore GRK2 levels in peripheral lymphocytes of AD patients and to establish a correlation between lymphocyte protein concentrations and the degree of cognitive impairment. GRK2 mRNA and protein expression were evaluated in the lymphocytes of AD patients with mild or moderate/severe cognitive impairment and in age-matched healthy subjects. Both GRK2 mRNA and protein expression were higher in AD patients lymphocytes compared to controls. Furthermore, lymphocyte GRK2 levels were significantly correlated to the degree of cognitive decline. Our preliminary data suggest that GRK2 is involved in GPCRs coupling dysfunction observed in AD patients. Further studies are needed in order to verify whether the lymphocyte GRK2 might be utilized as a novel biomarker in AD diagnosis and clinical monitoring. Experimental and clinical studies have shown that AD is associated with alterations in GPCRs coupling . In particular, a defective G-protein-enzyme coupling and a decreased GPCRdependent adenylyl cyclase activity are recognized as important mechanisms of GPCRs dysfunction in AD [8]. GRK2, a prototypic member of the GRK family, represents a key molecule in GPCRs regulation . This cytosolic enzyme translocates to the membrane through a specific physical interaction with the membrane-bound ␥ subunits of G-proteins inducing a receptor phosphorylation and desensitization. Interestingly, GRK2 is overexpressed in post-mortem hippocampal tissues in AD patients and in rats with chronic brain hypoperfusion . This finding precedes any amyloid deposition representing an *
Journal of the American Geriatrics Society
Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable r... more Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable risk factors for cognitive impairment (CI) for older persons is a very important issue. We examined the cross-sectional relationship between CHF and CI in an older population. A cross-sectional survey. A total of 1339 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. Sociodemographic characteristics were recorded, as was the presence of cardiovascular diseases, including CHF classified according to the New York Heart Association (NYHA) guidelines for disease severity; CI evaluated by means of the Mini-Mental State Examination (MMSE), with a score of <24 indicating impairment; geriatric depression scale (GDS) rating; blood pressure (BP); and heart rate (HR). The final sample numbered 1075; 172 subjects were excluded because of neurological disorders and psychotropic therapy, and 92 were excluded because their BP, HR, or cognitive examination was not recorded. Prevalence of CHF was 8.2%, and 23.0% of subjects scored <24 on the MMSE. The prevalence of CHF in subjects with an MMSE score of <24 and > or =24 was 20.2% and 4.6%, respectively (P < .001). Logistic regression analysis showed that CHF was associated independently with CI by sex, age, educational level, GDS, diabetes, hypertension, alcohol consumption, smoking, atrial fibrillation, systolic and diastolic BP, and HR. The risk of CI was 1.96-fold greater in subjects with CHF (odds ratio: 1.96; 95% confidence interval: 1.07-3.58; P < .028). Systolic BP decrease was correlated negatively with NYHA classes only in subjects with CI (r = -0.981; P < .020), whereas HR increase was correlated positively with NYHA classes only in subjects without CI (r = 0.985; P < .015). In our population, CHF is associated with CI in subjects aged 65 years and older. Systolic BP reduction and the lack of HR increase, related to NYHA classes, might characterize cognitively impaired subjects with CHF.
The goal of the study was to investigated the prevalence of disability, cognitive impairment, dep... more The goal of the study was to investigated the prevalence of disability, cognitive impairment, depressive symptomatology and chronic diseases in a sample of the elderly population. A cross-sectional study was carried out on a random sample from the general population of elderly located in a geographically well defined Mediterranean area of Southern Italy. We examined 1339 subjects. Investigated diseases were: chronic obstructive lung disease, hypertension, arthrosis, diabetes mellitus, neurological disease, myocardial infarction, angina, atrial fibrillation, peripheral artery disease and congestive heart failure. Cognitive status was assessed by means of the Mini-Mental State Examination (MMSE), depression symptomatology was evaluated by Geriatric Depression Scale (GDS) and disability by means of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This methodological study showed that 27.9% had a MMSE score <24 and the score decreased with age in both sexes. A total of 9.8% of the subjects had severe depression (GDS score >20). Comorbidity was evaluated from the past medical history and confirmed by a clinical exam by a physician. Only 8.7% of subjects were found without chronic illness. Median number of diseases was two, with 26.6% declaring four diseases or more. Comorbidity increased with age, an overall slight decrease of the number of diseases being observed in the subjects >85 years old. Subjects disabled in ADL were 7%, while disabled in IADL were 46.7%. The disability prevalence increased with age, affecting more female than male.
Diabetes & Metabolism
ABSTRACT
Diabetes & Metabolism
Congestive heart failure (CHF) is an insulin-resistant state which constitutes the main risk fact... more Congestive heart failure (CHF) is an insulin-resistant state which constitutes the main risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Our study investigated the predictive role of CHF on the development of NIDDM in 1,339 elderly subjects with a mean ( +/- SD) age of 74.2 +/- 6.4 years. CHF had a 9.5% prevalence, and 14.7% of the subjects had NIDDM. After stratification by age, subjects between 80 and 84 years had the highest prevalence of CHF and a total of 29.6% of CHF patients had NIDDM. In multiple logistic regression analysis, CHF was associated with NIDDM [odds ration (OR) = 2.0, 95% confidence interval (CI) - 1.6-2.5] independent of age, sex, family history of diabetes, body mass index, (BMI), waist/hip ratio, and diastolic blood pressure. When only untreated CHF patients were taken into account, the association between CHF and NIDDM was even stronger (OR = 4.0, 95% CI = 3.4-5.8). When untreated CHF patients were grouped into those with low (I and II) and high (III and IV) New York Heart Association (NYHA) classes, the association of CHF and NIDDM was stronger with the worsening of CHF. In a longitudinal study, CHF predicted NIDDM independently of age, sex, family history of diabetes, BMI, waist/hip ratio, systolic and diastolic blood pressure, and therapy for CHF (OR = 1.4, 95% CI = 1.1-1.8). CHF was associated with a higher prevalence of NIDDM and was a risk factor for its development. Elevated FFA concentrations may play a pivotal role.
American Journal of Clinical Nutrition
Background: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to pro... more Background: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. Objective: The objective was to verify whether body mass index (BMI) influences the cardioprotective effect of preinfarction angina in the elderly. Design: We retrospectively studied 820 patients aged ≥ 65 y with acute myocardial infarction by evaluating BMI and major (death and cardiogenic shock) and minor in-hospital outcomes. Results: In-hospital death, cardiogenic shock, and the combined endpoints were not significantly different between elderly patients with and without preinfarction angina. Interestingly, in-hospital death, cardiogenic shock, and the combined endpoints were significantly fewer in elderly patients with than without preinfarction angina in the subset of patients with the lowest BMI (P < 0.01, < 0.01, and < 0.01, respectively). Regression analysis showed that preinfarction angina did not protect against in-hospital death when analyzed in all patients independently of BMI, whereas it was protective in the subset of patients with the lowest BMI (odds ratio: 0.06; 95% CI: 0.00, 0.54). Conclusions: Preinfarction angina does not protect against inhospital death, cardiogenic shock, or the combined endpoints in elderly patients with acute myocardial infarction. With stratification by quartiles of BMI, the protective effect of preinfarction angina is preserved in elderly patients with the lowest BMI.
The Journal of clinical endocrinology and metabolism, Jan 25, 2015
The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of deme... more The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of dementia is not well defined, especially in the elderly, where the assessment of CNS function is challenging. The aim of this systematic review and meta-analysis was to evaluate the possible effect of sHT on cognitive decline and the risk of dementia. Cognitive function was the primary outcome, evaluated as composite endpoint of incidence or prevalence of dementia or difference of Mini Mental State Examination (MMSE), Wechsler Adult Intelligence Scale and Wechsler Memory Scale-Revised scores. 13 studies were included in the meta-analysis. A significant risk of cognitive alteration was observed only in sHT individuals younger than 75 years: composite endpoint OR 1.56 (CI 95% 1.07-2.27 p=0.02, I(2)=82.5%), risk of dementia OR 1.81 (CI 95% 1.43-2.28 p<0.01, I(2)=35%). Mean serum TSH levels and the OR of composite endpoint were positively correlated. No significant effect of sHT was found whe...
The pneumonia is an inflammatory reaction to infectious agents or their products, that represents... more The pneumonia is an inflammatory reaction to infectious agents or their products, that represents the fourth cause of death in the oldest patients. With respect to the youngest population the pneumonia in the elderly subjects is more severe, requires often hospitalisation, is characterized by a longer length-of-stay and characterized by greater mortality. Together with the age the greater risk factor for its development is the comorbidity that conditions the appearance of complications and the same mortality. In the elderly the annual incidence varies and it is considered that about 2% of the elderly residents in assistential structures is affected from pneumonia. In 30-50% of pneumonias no pathogen agent is identifiable, even though the identified colonization of gram-positive bacteria and gram-negative potentially pathogen is more frequent in the elderly with respect to the youngest population. The most frequent pathogen agents responsible of pneumonias in the elderly are: the Streptococcus pneumoniae, Bacilli Gram-negative, Bacteria Anaerobes, the Haemophilus influences, the Legionella and some virus. In the elderly subjects signs and symptoms of pneumonia are often atypical characterized, beyond cough with production of secretion, from confusion, lethargy, delirium and deterioration of the general condition without fever. For the etiologic diagnosis the secretion cultural examination and the haemocolture would be routinely performed. The chest radiography is the gold standard for patients evaluation. In the treatment of patients affected by pneumonia it is necessary to carry out a global evaluation of the patient considering age, the presence of a pre-existing pathology, a previous antibiotic therapy ect., because such elements are able to change the prognosis of the patient. For the prevention, an essential role, together with the nutritional appearance, is put on the flu and pneumococcic vaccination. The therapy is based on the correct use of the antibiotics, and on the oxygentherapy, the parenteral nutrition , the cardiovascular therapy, etc.
Annals of internal medicine
Journal of Cardiovascular Pharmacology
In 22 patients with stable myocardial ischemia, we prospectively studied the short- and long-term... more In 22 patients with stable myocardial ischemia, we prospectively studied the short- and long-term effects of isosorbide-5-mononitrate (5-ISMN) on dipyridamole-induced myocardial ischemia, the ability of dipyridamole-stress echocardiography to evaluate nitrate tolerance, and the role of activation of the neurohumoral system in nitrate tolerance development, assessed by modifications of catecholamines plasma levels and heart rate variability. After brief treatment with 5-ISMN, dipyridamole-stress echocardiography was negative in 19 of 22 patients (p < 0.001 vs. placebo). During the sustained phase, dipyridamole-stress echocardiography was positive after both placebo and active drug (p = NS vs. placebo). Heart rate variability showed significantly higher values in power of the low frequency (LF) band and low- to high-frequency ratio (L/H), as well as significantly lower values of the power of the high-frequency (HF) band (all p < 0.001) during brief but not during sustained admin...
Frontiers in Physiology
Elderly healthy individuals have a reduced exercise tolerance and a decreased left ventricle inot... more Elderly healthy individuals have a reduced exercise tolerance and a decreased left ventricle inotropic reserve related to increased vascular afterload, arterial-ventricular load mismatching, physical deconditioning and impaired autonomic regulation (the so called "β-adrenergic desensitization"). Adrenergic responsiveness is altered with aging and the age-related changes are limited to the β-adrenergic receptor density reduction and to the β-adrenoceptor-G-protein(s)-adenylyl cyclase system abnormalities, while the type and level of abnormalities change with species and tissues. Epidemiological studies have shown an high incidence and prevalence of heart failure in the elderly and a great body of evidence correlate the changes of β-adrenergic system with heart failure pathogenesis. In particular it is well known that: (a) levels of cathecolamines are directly correlated with mortality and functional status in heart failure, (b) β1-adrenergic receptor subtype is down-regulat...
Clinical and experimental rheumatology
To investigate the effectiveness of etanercept on axial manifestations of a group of patients wit... more To investigate the effectiveness of etanercept on axial manifestations of a group of patients with established psoriatic arthritis (PsA). This was a multicentre observational study. PsA was classified based on the CASPAR criteria. Inclusion criteria were refractory PsA with axial manifestations and suitability for anti TNF-α therapy. Effectiveness was defined according to the ASAS response criteria (BASDAI: 50% relative or absolute change of 20mm and expert opinion in favour of continuation), and on the improvements of BASFI, anthropometric measures, PASI, ESR and CRP at 12 months. PASI 50 and 75 were also assessed, as well as the ACR20 and ACR50 response criteria for patients with peripheral arthritis. Comparisons between baseline and after 12-month treatment were done using the Wilcoxon signed rank test for the end-points considered. The study included 32 patients (25/7 M/F; median age 51yrs; 25th-75th percentiles: 34.5-58.7; median disease duration 14.5 yrs; 25th-75th percentiles...
The Journal of rheumatology. Supplement, 2009
This article summarizes the state of the art of rehabilitation in psoriatic arthritis (PsA). Very... more This article summarizes the state of the art of rehabilitation in psoriatic arthritis (PsA). Very little evidence was available to assess the efficacy of rehabilitation. Some data were borrowed from studies on ankylosing spondylitis. Covering certain aspects of the disease by the standard measure of functioning was difficult. However, rehabilitation was considered by the GRAPPA Group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), as part of treatment of axial PsA.
Cardiologia (Rome, Italy), 1987
Cardiologia (Rome, Italy), 1987
Giornale italiano di cardiologia, 1986
We evaluated the protective effect of Diltiazem from pacing-induced myocardial ischemia in 9 pati... more We evaluated the protective effect of Diltiazem from pacing-induced myocardial ischemia in 9 patients (pts) with coronary heart disease (CAD) and stable effort angina by studying the changes in systemic and coronary hemodynamics during pacing. Hemodynamic parameters were evaluated at baseline and at peak pacing before and after Diltiazem, 25 mg i.v. Diltiazem prevented angina in 6 of 7 pts who presented angina in the control pacing. This beneficial effect was accompanied at peak pacing rate by a significant fall in ST depression, arterial pressure, rate-pressure product and left ventricular (LV) end-diastolic pressure, while no significant changes were observed in LV dp/dt max, coronary blood flow and coronary vascular resistance. Therefore, Diltiazem exerts a protective effect from pacing-induced myocardial ischemia in pts with CAD and stable effort angina, without impairing LV function. This beneficial effect is due to a reduction in myocardial metabolic requirements, rather than ...
Cardioscience, 1990
Ventricular arrhythmias are the most common cause of death among patients with coronary artery di... more Ventricular arrhythmias are the most common cause of death among patients with coronary artery disease; this is more evident in the elderly, who tend to have more severe coronary artery disease and age-dependent modifications of cardiac electrophysiology. Lysophosphoglycerides, which accumulate in the ischemic myocardium, are responsible for oscillatory after-potentials and may contribute to the development of ventricular arrhythmias. The aim of this study was to examine the effects of lysophosphatidylcholine (5 x 10(-5) M) in the absence or presence of epinephrine (10(-6) M) in isolated, perfused hearts from adult (6-12 months old) and senescent (24 months old) rats. Rat hearts (30/group) were randomly divided into four groups each of which included hearts of 6, 12 and 24-month old rats. The groups comprised a control group, a group treated with epinephrine, a group treated with lysophosphatidylcholine and a group treated with both epinephrine and lysophosphatidylcholine. Analysis ...
Cardiologia (Rome, Italy), 1991
Several studies have demonstrated that physiological aging significantly affects cardiovascular f... more Several studies have demonstrated that physiological aging significantly affects cardiovascular function. Experimental researches, conducted on cardiac muscle of senescent animals, have shown a prolongation of both contraction and relaxation times. This phenomenon was explained by a reduced Ca(++)-stimulated ATPase pump activity, responsible for the reduced sarcoplasmic reticulum Ca++ uptake rate. The myofilament response to Ca++ in the aging heart is normal as are peak contractile force production and post-extrasystolic twitch potentiation during continual paired stimulation. On the other hand, the inotropic response to cardiac glycosides and beta-adrenoceptor stimulation is diminished in senescent compared to adult myocardium. This decreased contractility could result mainly from mechanisms controlling Ca++ reuptake from sarcoplasmic reticulum and relaxation time (diastolic phase) rather than those determining force generation and contraction time (systolic phase). Age-related phy...
Bollettino della Società italiana di cardiologia, 1979
Alterations in signal transduction pathway of G-protein-coupled receptors (GPCRs) have been found... more Alterations in signal transduction pathway of G-protein-coupled receptors (GPCRs) have been found in the cerebrocortex and in the peripheral cultured tissues of patients with Alzheimer's disease (AD). The G-protein-coupled receptor kinase-2 (GRK2) plays an important role in regulating the GPCRs signaling: its increased expression is associated with receptor desensitization. The aim of this study was to explore GRK2 levels in peripheral lymphocytes of AD patients and to establish a correlation between lymphocyte protein concentrations and the degree of cognitive impairment. GRK2 mRNA and protein expression were evaluated in the lymphocytes of AD patients with mild or moderate/severe cognitive impairment and in age-matched healthy subjects. Both GRK2 mRNA and protein expression were higher in AD patients lymphocytes compared to controls. Furthermore, lymphocyte GRK2 levels were significantly correlated to the degree of cognitive decline. Our preliminary data suggest that GRK2 is involved in GPCRs coupling dysfunction observed in AD patients. Further studies are needed in order to verify whether the lymphocyte GRK2 might be utilized as a novel biomarker in AD diagnosis and clinical monitoring. Experimental and clinical studies have shown that AD is associated with alterations in GPCRs coupling . In particular, a defective G-protein-enzyme coupling and a decreased GPCRdependent adenylyl cyclase activity are recognized as important mechanisms of GPCRs dysfunction in AD [8]. GRK2, a prototypic member of the GRK family, represents a key molecule in GPCRs regulation . This cytosolic enzyme translocates to the membrane through a specific physical interaction with the membrane-bound ␥ subunits of G-proteins inducing a receptor phosphorylation and desensitization. Interestingly, GRK2 is overexpressed in post-mortem hippocampal tissues in AD patients and in rats with chronic brain hypoperfusion . This finding precedes any amyloid deposition representing an *
Journal of the American Geriatrics Society
Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable r... more Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable risk factors for cognitive impairment (CI) for older persons is a very important issue. We examined the cross-sectional relationship between CHF and CI in an older population. A cross-sectional survey. A total of 1339 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. Sociodemographic characteristics were recorded, as was the presence of cardiovascular diseases, including CHF classified according to the New York Heart Association (NYHA) guidelines for disease severity; CI evaluated by means of the Mini-Mental State Examination (MMSE), with a score of <24 indicating impairment; geriatric depression scale (GDS) rating; blood pressure (BP); and heart rate (HR). The final sample numbered 1075; 172 subjects were excluded because of neurological disorders and psychotropic therapy, and 92 were excluded because their BP, HR, or cognitive examination was not recorded. Prevalence of CHF was 8.2%, and 23.0% of subjects scored <24 on the MMSE. The prevalence of CHF in subjects with an MMSE score of <24 and > or =24 was 20.2% and 4.6%, respectively (P < .001). Logistic regression analysis showed that CHF was associated independently with CI by sex, age, educational level, GDS, diabetes, hypertension, alcohol consumption, smoking, atrial fibrillation, systolic and diastolic BP, and HR. The risk of CI was 1.96-fold greater in subjects with CHF (odds ratio: 1.96; 95% confidence interval: 1.07-3.58; P < .028). Systolic BP decrease was correlated negatively with NYHA classes only in subjects with CI (r = -0.981; P < .020), whereas HR increase was correlated positively with NYHA classes only in subjects without CI (r = 0.985; P < .015). In our population, CHF is associated with CI in subjects aged 65 years and older. Systolic BP reduction and the lack of HR increase, related to NYHA classes, might characterize cognitively impaired subjects with CHF.
The goal of the study was to investigated the prevalence of disability, cognitive impairment, dep... more The goal of the study was to investigated the prevalence of disability, cognitive impairment, depressive symptomatology and chronic diseases in a sample of the elderly population. A cross-sectional study was carried out on a random sample from the general population of elderly located in a geographically well defined Mediterranean area of Southern Italy. We examined 1339 subjects. Investigated diseases were: chronic obstructive lung disease, hypertension, arthrosis, diabetes mellitus, neurological disease, myocardial infarction, angina, atrial fibrillation, peripheral artery disease and congestive heart failure. Cognitive status was assessed by means of the Mini-Mental State Examination (MMSE), depression symptomatology was evaluated by Geriatric Depression Scale (GDS) and disability by means of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This methodological study showed that 27.9% had a MMSE score <24 and the score decreased with age in both sexes. A total of 9.8% of the subjects had severe depression (GDS score >20). Comorbidity was evaluated from the past medical history and confirmed by a clinical exam by a physician. Only 8.7% of subjects were found without chronic illness. Median number of diseases was two, with 26.6% declaring four diseases or more. Comorbidity increased with age, an overall slight decrease of the number of diseases being observed in the subjects >85 years old. Subjects disabled in ADL were 7%, while disabled in IADL were 46.7%. The disability prevalence increased with age, affecting more female than male.
Diabetes & Metabolism
ABSTRACT
Diabetes & Metabolism
Congestive heart failure (CHF) is an insulin-resistant state which constitutes the main risk fact... more Congestive heart failure (CHF) is an insulin-resistant state which constitutes the main risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Our study investigated the predictive role of CHF on the development of NIDDM in 1,339 elderly subjects with a mean ( +/- SD) age of 74.2 +/- 6.4 years. CHF had a 9.5% prevalence, and 14.7% of the subjects had NIDDM. After stratification by age, subjects between 80 and 84 years had the highest prevalence of CHF and a total of 29.6% of CHF patients had NIDDM. In multiple logistic regression analysis, CHF was associated with NIDDM [odds ration (OR) = 2.0, 95% confidence interval (CI) - 1.6-2.5] independent of age, sex, family history of diabetes, body mass index, (BMI), waist/hip ratio, and diastolic blood pressure. When only untreated CHF patients were taken into account, the association between CHF and NIDDM was even stronger (OR = 4.0, 95% CI = 3.4-5.8). When untreated CHF patients were grouped into those with low (I and II) and high (III and IV) New York Heart Association (NYHA) classes, the association of CHF and NIDDM was stronger with the worsening of CHF. In a longitudinal study, CHF predicted NIDDM independently of age, sex, family history of diabetes, BMI, waist/hip ratio, systolic and diastolic blood pressure, and therapy for CHF (OR = 1.4, 95% CI = 1.1-1.8). CHF was associated with a higher prevalence of NIDDM and was a risk factor for its development. Elevated FFA concentrations may play a pivotal role.
American Journal of Clinical Nutrition
Background: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to pro... more Background: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. Objective: The objective was to verify whether body mass index (BMI) influences the cardioprotective effect of preinfarction angina in the elderly. Design: We retrospectively studied 820 patients aged ≥ 65 y with acute myocardial infarction by evaluating BMI and major (death and cardiogenic shock) and minor in-hospital outcomes. Results: In-hospital death, cardiogenic shock, and the combined endpoints were not significantly different between elderly patients with and without preinfarction angina. Interestingly, in-hospital death, cardiogenic shock, and the combined endpoints were significantly fewer in elderly patients with than without preinfarction angina in the subset of patients with the lowest BMI (P < 0.01, < 0.01, and < 0.01, respectively). Regression analysis showed that preinfarction angina did not protect against in-hospital death when analyzed in all patients independently of BMI, whereas it was protective in the subset of patients with the lowest BMI (odds ratio: 0.06; 95% CI: 0.00, 0.54). Conclusions: Preinfarction angina does not protect against inhospital death, cardiogenic shock, or the combined endpoints in elderly patients with acute myocardial infarction. With stratification by quartiles of BMI, the protective effect of preinfarction angina is preserved in elderly patients with the lowest BMI.
The Journal of clinical endocrinology and metabolism, Jan 25, 2015
The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of deme... more The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of dementia is not well defined, especially in the elderly, where the assessment of CNS function is challenging. The aim of this systematic review and meta-analysis was to evaluate the possible effect of sHT on cognitive decline and the risk of dementia. Cognitive function was the primary outcome, evaluated as composite endpoint of incidence or prevalence of dementia or difference of Mini Mental State Examination (MMSE), Wechsler Adult Intelligence Scale and Wechsler Memory Scale-Revised scores. 13 studies were included in the meta-analysis. A significant risk of cognitive alteration was observed only in sHT individuals younger than 75 years: composite endpoint OR 1.56 (CI 95% 1.07-2.27 p=0.02, I(2)=82.5%), risk of dementia OR 1.81 (CI 95% 1.43-2.28 p<0.01, I(2)=35%). Mean serum TSH levels and the OR of composite endpoint were positively correlated. No significant effect of sHT was found whe...
The pneumonia is an inflammatory reaction to infectious agents or their products, that represents... more The pneumonia is an inflammatory reaction to infectious agents or their products, that represents the fourth cause of death in the oldest patients. With respect to the youngest population the pneumonia in the elderly subjects is more severe, requires often hospitalisation, is characterized by a longer length-of-stay and characterized by greater mortality. Together with the age the greater risk factor for its development is the comorbidity that conditions the appearance of complications and the same mortality. In the elderly the annual incidence varies and it is considered that about 2% of the elderly residents in assistential structures is affected from pneumonia. In 30-50% of pneumonias no pathogen agent is identifiable, even though the identified colonization of gram-positive bacteria and gram-negative potentially pathogen is more frequent in the elderly with respect to the youngest population. The most frequent pathogen agents responsible of pneumonias in the elderly are: the Streptococcus pneumoniae, Bacilli Gram-negative, Bacteria Anaerobes, the Haemophilus influences, the Legionella and some virus. In the elderly subjects signs and symptoms of pneumonia are often atypical characterized, beyond cough with production of secretion, from confusion, lethargy, delirium and deterioration of the general condition without fever. For the etiologic diagnosis the secretion cultural examination and the haemocolture would be routinely performed. The chest radiography is the gold standard for patients evaluation. In the treatment of patients affected by pneumonia it is necessary to carry out a global evaluation of the patient considering age, the presence of a pre-existing pathology, a previous antibiotic therapy ect., because such elements are able to change the prognosis of the patient. For the prevention, an essential role, together with the nutritional appearance, is put on the flu and pneumococcic vaccination. The therapy is based on the correct use of the antibiotics, and on the oxygentherapy, the parenteral nutrition , the cardiovascular therapy, etc.
Annals of internal medicine
Journal of Cardiovascular Pharmacology
In 22 patients with stable myocardial ischemia, we prospectively studied the short- and long-term... more In 22 patients with stable myocardial ischemia, we prospectively studied the short- and long-term effects of isosorbide-5-mononitrate (5-ISMN) on dipyridamole-induced myocardial ischemia, the ability of dipyridamole-stress echocardiography to evaluate nitrate tolerance, and the role of activation of the neurohumoral system in nitrate tolerance development, assessed by modifications of catecholamines plasma levels and heart rate variability. After brief treatment with 5-ISMN, dipyridamole-stress echocardiography was negative in 19 of 22 patients (p < 0.001 vs. placebo). During the sustained phase, dipyridamole-stress echocardiography was positive after both placebo and active drug (p = NS vs. placebo). Heart rate variability showed significantly higher values in power of the low frequency (LF) band and low- to high-frequency ratio (L/H), as well as significantly lower values of the power of the high-frequency (HF) band (all p < 0.001) during brief but not during sustained admin...
Frontiers in Physiology
Elderly healthy individuals have a reduced exercise tolerance and a decreased left ventricle inot... more Elderly healthy individuals have a reduced exercise tolerance and a decreased left ventricle inotropic reserve related to increased vascular afterload, arterial-ventricular load mismatching, physical deconditioning and impaired autonomic regulation (the so called "β-adrenergic desensitization"). Adrenergic responsiveness is altered with aging and the age-related changes are limited to the β-adrenergic receptor density reduction and to the β-adrenoceptor-G-protein(s)-adenylyl cyclase system abnormalities, while the type and level of abnormalities change with species and tissues. Epidemiological studies have shown an high incidence and prevalence of heart failure in the elderly and a great body of evidence correlate the changes of β-adrenergic system with heart failure pathogenesis. In particular it is well known that: (a) levels of cathecolamines are directly correlated with mortality and functional status in heart failure, (b) β1-adrenergic receptor subtype is down-regulat...
Clinical and experimental rheumatology
To investigate the effectiveness of etanercept on axial manifestations of a group of patients wit... more To investigate the effectiveness of etanercept on axial manifestations of a group of patients with established psoriatic arthritis (PsA). This was a multicentre observational study. PsA was classified based on the CASPAR criteria. Inclusion criteria were refractory PsA with axial manifestations and suitability for anti TNF-α therapy. Effectiveness was defined according to the ASAS response criteria (BASDAI: 50% relative or absolute change of 20mm and expert opinion in favour of continuation), and on the improvements of BASFI, anthropometric measures, PASI, ESR and CRP at 12 months. PASI 50 and 75 were also assessed, as well as the ACR20 and ACR50 response criteria for patients with peripheral arthritis. Comparisons between baseline and after 12-month treatment were done using the Wilcoxon signed rank test for the end-points considered. The study included 32 patients (25/7 M/F; median age 51yrs; 25th-75th percentiles: 34.5-58.7; median disease duration 14.5 yrs; 25th-75th percentiles...
The Journal of rheumatology. Supplement, 2009
This article summarizes the state of the art of rehabilitation in psoriatic arthritis (PsA). Very... more This article summarizes the state of the art of rehabilitation in psoriatic arthritis (PsA). Very little evidence was available to assess the efficacy of rehabilitation. Some data were borrowed from studies on ankylosing spondylitis. Covering certain aspects of the disease by the standard measure of functioning was difficult. However, rehabilitation was considered by the GRAPPA Group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), as part of treatment of axial PsA.
Cardiologia (Rome, Italy), 1987
Cardiologia (Rome, Italy), 1987
Giornale italiano di cardiologia, 1986
We evaluated the protective effect of Diltiazem from pacing-induced myocardial ischemia in 9 pati... more We evaluated the protective effect of Diltiazem from pacing-induced myocardial ischemia in 9 patients (pts) with coronary heart disease (CAD) and stable effort angina by studying the changes in systemic and coronary hemodynamics during pacing. Hemodynamic parameters were evaluated at baseline and at peak pacing before and after Diltiazem, 25 mg i.v. Diltiazem prevented angina in 6 of 7 pts who presented angina in the control pacing. This beneficial effect was accompanied at peak pacing rate by a significant fall in ST depression, arterial pressure, rate-pressure product and left ventricular (LV) end-diastolic pressure, while no significant changes were observed in LV dp/dt max, coronary blood flow and coronary vascular resistance. Therefore, Diltiazem exerts a protective effect from pacing-induced myocardial ischemia in pts with CAD and stable effort angina, without impairing LV function. This beneficial effect is due to a reduction in myocardial metabolic requirements, rather than ...
Cardioscience, 1990
Ventricular arrhythmias are the most common cause of death among patients with coronary artery di... more Ventricular arrhythmias are the most common cause of death among patients with coronary artery disease; this is more evident in the elderly, who tend to have more severe coronary artery disease and age-dependent modifications of cardiac electrophysiology. Lysophosphoglycerides, which accumulate in the ischemic myocardium, are responsible for oscillatory after-potentials and may contribute to the development of ventricular arrhythmias. The aim of this study was to examine the effects of lysophosphatidylcholine (5 x 10(-5) M) in the absence or presence of epinephrine (10(-6) M) in isolated, perfused hearts from adult (6-12 months old) and senescent (24 months old) rats. Rat hearts (30/group) were randomly divided into four groups each of which included hearts of 6, 12 and 24-month old rats. The groups comprised a control group, a group treated with epinephrine, a group treated with lysophosphatidylcholine and a group treated with both epinephrine and lysophosphatidylcholine. Analysis ...
Cardiologia (Rome, Italy), 1991
Several studies have demonstrated that physiological aging significantly affects cardiovascular f... more Several studies have demonstrated that physiological aging significantly affects cardiovascular function. Experimental researches, conducted on cardiac muscle of senescent animals, have shown a prolongation of both contraction and relaxation times. This phenomenon was explained by a reduced Ca(++)-stimulated ATPase pump activity, responsible for the reduced sarcoplasmic reticulum Ca++ uptake rate. The myofilament response to Ca++ in the aging heart is normal as are peak contractile force production and post-extrasystolic twitch potentiation during continual paired stimulation. On the other hand, the inotropic response to cardiac glycosides and beta-adrenoceptor stimulation is diminished in senescent compared to adult myocardium. This decreased contractility could result mainly from mechanisms controlling Ca++ reuptake from sarcoplasmic reticulum and relaxation time (diastolic phase) rather than those determining force generation and contraction time (systolic phase). Age-related phy...
Bollettino della Società italiana di cardiologia, 1979