Biomedical subjects
Publications and source records attributed to S Bosi.
We report the synthesis of three novel, versatile fullerene intermediates whose main feature is the presence of an amino end group. Simple condensation reactions of these intermediates under standard conditions produce new derivatives that are useful for applications in materials science and medicinal chemistry.
We report the isolation and characterization of bisadducts of fulleropyrrolidine derivatives. The compounds were characterized by means of a variety of spectroscopic techniques, including ES-MS, UV-vis, (1)H NMR, and (13)C NMR. The whole series of bisadducts was separated for the first time in the case of the bispyrrolidines, and the determination of their structure was obtained by NMR spectroscopy with the help of HMQC and HMBC techniques.
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Positively charged fullerene derivatives, moderately soluble in water:DMSO 9:1, have been tested using three strains of Mycobacterium spp. Some compounds inhibit the growth of Mycobacterium tuberculosis, a human clinical isolate, particularly virulent and resistant, at doses as low as 5 microg/mL.
BACKGROUND: The aim of this study was to compare the prognostic efficacy of cardiac troponin T (cTnT) and I (cTnI) in patients with clinical unstable angina. METHODS: We studied 74 patients with chest pain at rest, electrocardiographic evidence of myocardial ischemia, and normal (<6.7 ng/mL) values of creatine kinase-MB. cTnT was measured with a commercial assay (cutoff level 0.1 ng/mL) and cTnI with a preliminary research application (cutoff level 3.1 ng/mL). All patients had blood drawn at baseline and 8 hours thereafter. The prospectively defined end point was the proportion of patients identified by each assay as having myocardial damage. RESULTS: cTnT and cTnI were elevated in the same percentage of patients (18 of 74; 24%). Overall, 23 patients had elevations of 1 or both markers. In 13 there were elevations of both. Ten patients had elevations of only one (5 for each marker). In 51 patients, no elevations were present. Death or nonfatal myocardial infarction was more frequent in patients with elevated cTnI (27.7% vs 5.3%; P =.02) than those with normal values. The prognostic influence of cTnT was less (17% vs 8.5%; P =.2). However, the difference between the 2 markers when compared directly was not statistically significant (27.7% vs 17%; P = NS). CONCLUSIONS: These data indicate that both markers identify myocardial damage in equal numbers of patients with clinical unstable angina. Patients with elevations had a worse short-term outcome. The significance of the minor differences in prognostic value will require additional studies.
OBJECTIVE: To assess the prognostic value of a history of hypertension in patients with acute myocardial infarction (AMI) treated with thrombolysis. DESIGN: Retrospective adjusted analysis of outcome data of patients with AMI randomly allocated to treatment in a controlled study of alteplase versus streptokinase and heparin versus no heparin. SETTING: A highly representative sample (about 90%) of Italian Coronary Care Units. PATIENTS: Patients with (n = 3306) and without (n = 7406) a history of treated hypertension. MAIN OUTCOME MEASURES: Morbidity and mortality during hospital stay and the next 6 months. RESULTS: Patients with a history of hypertension had a significantly higher mortality, both in hospital and during the next 6 months. The difference persisted also after a multivariate analysis including all major prognostic factors for in-hospital and 6-month mortality, respectively. Left ventricular failure and recurrent ischaemic events (angina and re-infarction) were also significantly more frequent in hypertensives both during their hospital stay and during follow-up study. CONCLUSIONS: A history of hypertension is a negative independent prognostic factor after acute myocardial infarction treated with thrombolysis.
OBJECTIVE: To assess the response of internal mammary artery (IMA) flow of hypertensive hearts to nitroprusside infusion. METHODS: Fifteen patients were studied with a high-frequency duplex Doppler probe from the supraclavicolar approach. All the patients had undergone coronary artery bypass surgery with an IMA graft into the left anterior descending artery. The investigated patients were normotensives (controls, n = 5) and hypertensive with a normal (group 1, n = 5) or a hypertrophic (group 2, n = 5) left ventricle. Values of the left ventricular mass index were 102 +/- 11 g/m2 in controls, 115 +/- 18 g/m2 in group 1 and 153 +/- 8 g/m2 in group 2. The IMA flow volume was studied at baseline and continuously during nitroprusside infusion. The arterial blood pressure was measured each minute by a cuff sphygmomanometer. In each patient we considered the peak flow volume (percentage increment from baseline) and the flow volume at the end point (the lowest tolerated diastolic blood pressure). RESULTS: Nitroprusside infusion induced a comparable flow-volume increment in controls (38 +/- 27%) and in group 1 (24 +/- 11%). Conversely, the flow-volume increment was trivial in group 2 (6 +/- 6%). At the end point, the flow volume was similar to the baseline value in controls (with diastolic blood pressure 67 +/- 9 mmHg) and in group 1 (diastolic blood pressure 61 +/- 4 mmHg), whereas the flow volume declined significantly from baseline (by 23%) in group 2 at a perfusion pressure of 79 +/- 9 mmHg. CONCLUSION: Hypertensive patients with a normal left ventricular mass exhibit a coronary flow behaviour similar to that of normotensives in response to a nitroprusside infusion. Conversely, hypertrophic hypertensives show a blunted nitroprusside-induced coronary vasodilator response and are much more vulnerable to coronary flow reductions in the face of hypotension. This dynamic assessment of flow patterns can be obtained non-invasively by duplex Doppler monitoring of IMA graft flow.
OBJECTIVE: To assess the feasibility, safety and efficacy of thrombolysis in the Emergency Room of a Rural Hospital with no Coronary Care Unit, and subsequent transfer to the Coronary Care Unit of a City Hospital. DESIGN: Prospective study, controlled with two parallel groups of consecutive patients (Group 1: Rural Hospital, Group 2: CCU Ravenna) and administration of Anistreplase 30 intravenous unit. SETTING: Rural Emergency Rooms which transmitted the electrocardiogram by cardiotelephone to the Ravenna Coronary Care Unit (average distance 35 km; range: 17-50 km). PATIENTS: 280 (Group 1: 102 patients, Group 2: 178 patients) with suspected acute myocardial infarction and with no contra-indications to fibrinolysis, within 6 h of onset of symptoms. MAIN OUTCOME MEASURES: time saving, accuracy of diagnosis, adverse events, left ventricular function and survival. RESULTS: the median pain to needle time was 90' in Group 1 and 165' in Group 2 (P < 0.001). Accuracy of diagnosis for acute myocardial infarction was 91% and 100%, respectively. Complications were rare and none occurred during transfer. The creatine phosphokinase peak of Group 1 was lower than Group 2 (1389 vs. 2186 IU/l; P < 0.001). The echocardiographic Wall Motion Abnormality Score Index of Group 1 was lower than Group 2 (3.571 vs. 5.589; P < 0.001). Mortality at 35 days in Group 1 was 7.5% vs. 10.7% in Group 2 (-30%; P = n.s.). CONCLUSIONS: The Emergency Room physician, in close collaboration with the cardiologist, supplied a very high standard of pre-Coronary Care Unit diagnosis and therapy. Administration of Anistreplase in the rural Emergency Room brought about a significant reduction of pain to needle time, a significant improvement in left ventricular function and a reduction in mortality.
We monitored ST segment continuously for at least 3 h after the beginning of lytic treatment in 103 patients undergoing early coronary thrombolysis for acute myocardial infarction in order to ascertain whether this technique, which has been shown to be useful to assess recanalization of the infarct-related artery, is also able to identify the improvement in left ventricular function associated with successful reperfusion. Global left ventricular function (assessed in the 30 degrees right anterior oblique projection with the area/length method) and infarct zone wall motion (studied with the centerline method) were evaluated at least 4 weeks after the event. Reperfusion was thought to be achieved when ST segment elevation dropped > 50% relative to the most abnormal peak documented at any time in the study. Eighty patients (78%) met the criterium for successful reperfusion (group 1), and 23 (22%) did not (group 2). Both groups had similar clinical and angiographic characteristics. All indexes of global left ventricular function were significantly better in group 1 than in group 2 patients (end-diastolic volume: 176 +/- 51 vs. 209 +/- 76 ml, end-systolic volume: 66 +/- 40 vs. 97 +/- 55 ml, ejection fraction: 65 +/- 13 vs. 57 +/- 11%, respectively, all P < 0.02). Also the severity (-1.6 +/- 1.3 vs. -2.6 +/- 1.01 S.D./chord, respectively, P < 0.001) and the extension of hypokinesia in the infarct zone (number of chords with > 2 S.D.: 13 +/- 16 vs. 28 +/- 17, respectively, P < 0.0001) were less in group 1 than in group 2 patients. Furthermore, in reperfused patients, both global left ventricular function and regional wall motion were better in those admitted < 60 min from onset of pain. In conclusion, patients with rapid ( > 50%) decrease of ST segment elevation have smaller infarct size and better global left ventricular function than patients without electrocardiographic signs of reperfusion as assessed by continuous ST segment monitoring. This suggests that this non-invasive technique is a powerful tool able to identify patients most benefiting from thrombolytic therapy.
During the short while of 5 years, between 1984 and 1985, two large clinical trials have been performed in Italy concerning fibrinolytic therapy in Acute Myocardial Infarction: GISSI 1 and GISSI 2. They made possible to evaluate the evolution of demographic and clinical features, the in-hospital mortality rate, and the causes of death of a huge number of patients admitted to CCU throughout the whole country. Out of 31,826 patients with acute myocardial infarction admitted to 176 CCU participating to the GISSI 1 16.9% were 75 years old and 24.7% were females; 21.8% and 26.4% were the percentages in the 38,086 patients admitted to the 223 CCU participating in the GISSI 2. Despite the higher prevalence of the two demographic characteristic with the worse prognosis, the in-hospital mortality rates were respectively 12.2% in the GISSI 1 and 10.0% in the GISSI 2 studies, with a statistically significant decrease (RR 0.84; C.L. 0.80-0.88). The significant decrease in the in-hospital mortality concerns also the patients populations selected according to the same criteria of inclusion in the two trials (within 6 hours from the onset of symptoms and with only ST elevation at the ECG of admission) and to the treatment with fibrinolytic drug (SK or rtPA). As a matter of fact 468 patients died of the 4,696 (10.0%) treated with SK in the GISSI 1 against 1,092 patients of 12,381 (8.8%) enrolled in the GISSI 2 and treated with SK or rtPA (RR 0.87; L.C. 0.78-0.98). The reduction of in-hospital mortality may be explained by some differences in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Some ECG criteria and the radiologic method of Westcott are evaluated against echocardiography in the left atrial enlargement. ECG shows generally a very good sensitivity (72%); particularly when the diameter is more than 5 cm. The radiologic findings show significant correlative indexes in normal and in softly enlarged atria. In atria greater than or equal to 5 cm the method is not so precise; the reasons are discussed on an anatomical basis. We acknowledge an important place to the ECG described criteria and to the Westcott method in the depistage of the left atrium enlargement.
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