Caimi G

Leukocyte count, diabetes mellitus and age are strong predictors of stroke in a rural population in southern Italy: an 8-year follow-up

Stroke incidence rates in the Mediterranean area are higher compared to northern European countries. In this study, we present the 8-year prospective data from a small rural Sicilian town. This population, consisting of 1351 subjects (622 males and 729 females), is homogeneous for ethnic background with traditional healthy dietary habits and shows low cholesterol mean levels. We found that the risk of stroke was significantly associated with the record of at least one previous neurological symptom (PNS), such as lack of strength, loss of vision or speech or possible drop attacks, and high hematocrit in males, and to high body mass index (BMI) and waist-hip ratio (WHR), diabetes, hypertension, high leukocyte count in females. We also documented age-related differences: stroke was associated in younger subjects (age<65 years) with diabetes, high BMI, high uric acid levels and in older patients (age>/=65 years) with high WHR, hypertension, diabetes, PNS, leukocyte count and hematocrit above the 95th percentile. Multivariate analysis demonstrated an independent association between stroke and age, diabetes, leukocyte count, hypertension and PNS. In conclusion, in this rural Sicilian population, the incidence rate of stroke is 1.72 cases per 1000/year in the subjects between 40 and 75 years of age. The risk factors associated with stroke are different in younger and older subjects. Leukocyte count, as an expression of an undergoing inflammatory process, may have a relevant role at least in the elderly.

Oxidative Stress in Young Subjects With Acute Myocardial Infarction: Evaluation at the Initial Stage and After 12 Months

In 105 subjects (97 men and 8 women) aged <46 years (mean age 39.6 ± 5.5 years), with recent acute myocardial infarction (T1), thiobarbituric acid reactive substances and total antioxidant status were determined; NO production was evaluated by measuring the nitrite and nitrate (NOx) concentration. The patients with acute myocardial infarction were subdivided according to the main risk factors, number of risk factors, and extent of coronary lesions. The evaluation was repeated after 12 months (T2). In these subjects, thiobarbituric acid reactive substances and NOx were significantly increased and total antioxidant status was significantly decreased at T1. In single risk factor, only NO metabolites were significantly lower in acute myocardial infarction subjects who smoke than in subjects who do not. Subdividing the subjects according to the number of risk factors and number of stenosed coronary vessels, there were no significant differences between the subgroups. At T2, thiobarbituric acid reactive substances and NOx were decreased and total antioxidant status was increased, but all parameters were still altered.

Acute Ischemic Stroke

BACKGROUND AND PURPOSEnSeveral reports have considered the role of systemic leukocytes in acute ischemic stroke (AIS). Initially, greater attention was focused on the leukocyte count and subsequently on their adhesiveness, aggregation, rheology, and activation. The aim of this study was the evaluation of certain polymorphonuclear leukocyte (PMN) parameters, reflecting their rheology and activation, in subjects with AIS.nnnMETHODSnIn a group of 19 subjects with AIS and in a control group of 18 subjects with asymptomatic vascular atherosclerotic disease, we evaluated the PMN membrane fluidity and cytosolic Ca(2+) concentration at baseline and after in vitro chemotactic activation with 4-phorbol 12-myristate 13-acetate (PMA) and N-formyl-methionyl-leucyl-phenylalanine (fMLP).nnnRESULTSnFrom the obtained data, it is evident that at baseline only PMN membrane fluidity distinguishes control subjects from AIS subjects. After PMN activation with PMA and fMLP, prolonged for 5 and 15 minutes, we found an increase in PMN cytosolic Ca(2+) concentration and a decrease in PMN membrane fluidity only in subjects with AIS.nnnCONCLUSIONSnThese findings emphasize that in subjects with AIS a functional alteration of systemic PMN cells is clearly expressed during chemotactic activation, although the mechanism of this abnormality is not yet explained.

Erythrocyte deformability evaluated by laser diffractometry in polycythemia vera

We evaluated the erythrocyte deformability in a group of subjects with polycythemia vera (PV) using a Rheodyn-SSD Laser Diffractometer, at the shear stresses of 6, 12, 30 and 60 Pa. Our data showed a significant decrease of red cell deformability, expressed as elongation index (EI), in PV subjects compared with normal controls. These results suggest that the hyperviscosity syndrome accompanying this myeloproliferative disease may be considered a mixed form, resulting from the association of a polycythemic condition with a sclerocythemic disorder.

Erythrocyte deformability and nitric oxide metabolites in athletes before and after a cardiopulmonary test

Objective:To evaluate erythrocyte deformability, nitric oxide metabolites, and their modifications induced by exercise in athletes who practised different sports. Design:This evaluation was effected before and after cardiopulmonary test, using a cycloergometer. Setting:The study was performed in the Department of Internal Medicine, Cardiovascular and Renal Diseases of the University of Palermo. Participants:We enrolled 62 male athletes who practised endurance (n = 23), mixed (n = 20), and power (n = 19) sports and 20 sedentary male subjects as controls. Assessment of Risk Factors:No subject had diabetes or hypertension or dyslipidemia. Five control subjects and 14 athletes were smokers. Main Outcome Measures:Erythrocyte deformability was examined as elongation index (EI) using a diffractometer. The nitric oxide metabolites (nitrite + nitrate = NOx) were evaluated employing the Griess reagent. Results:In the whole group, an increase in EI and NOx was present. Subdividing the whole group into 3 subgroups, we noted an increase in EI and NOx only in endurance and mixed athletes. The EI before and after the cardiopulmonary test significantly decreased in the whole group and in power athletes but not in endurance and mixed athletes. Before and after the test, NOx did not significantly change in the whole group and in the 3 subgroups. Conclusions:In athletes who practised endurance and mixed sports, we observed an increase of NOx level and an increase of erythrocyte deformability. The latter did not change after an exercise test in the same subgroups, whereas it decreased in power athletes.

Nitric oxide metabolites (nitrite and nitrate) in young patients with recent acute myocardial infarction

Nitric oxide (NO) has a role in the pathophysiology of acute and chronic cardiovascular events. We studied the plasma concentration of NO stable end products (nitrite and nitrate--NOx) in 43 patients aged<46 years, with recent acute myocardial infarction (AMI). The evaluation was effected at the initial stage, after 3 and 12 months. We subdivided the patients into subgroups according to the number of the main cardiovascular risk factors and to the extent of coronary disease. In the whole group the NOx concentration was initially increased and progressively decreased after 3 and 12 months, remaining at both times significantly higher than in control subjects. The patients with more risk factors had a significantly higher NOx concentration. In conclusion, the persisting high NOx concentration in AMI patients is the expression of a prolonged inflammatory condition and is significantly influenced by the simultaneous presence of several cardiovascular risk factors.

Relationship between elastase and total antioxidant status in young subjects with recent myocardial infarction.

In a group of young subjects with acute myocardial infarction (AMI) (68 men and 7 women; mean age 39.6+/-5.7 years) we examined the plasma concentration of elastase, the thiobarbituric acid-reactive substances (TBARS) and the total antioxidant status (TAS) at the initial stage of AMI. In this group we found an increase of elastase (p<0.001) and TBARS (p<0.001) and a decrease of TAS (p<0.001). A statistical correlation was observed in the whole group of AMI patients between plasma elastase and TAS (p<0.01) and this correlation was more statistically significant in patients with more risk factors and not in those with more involved vessels.