Summary: Background: Accelerated progression of atherosclerosis and increased cardiovascular risk have been described in immune‐mediated disorders, but few data are available in coeliac disease.Aim: To evaluate instrumental and biochemical signs of atherosclerosis risk in 20 adults at first diagnosis of coeliac disease and after 6–8 months of gluten‐free diet with mucosal recovery.Methods: We analysed total, high‐density lipoprotein (HDL) and low‐density lipoprotein (LDL) cholesterol, triglycerides, homocysteine, C‐reactive protein, folate and vitamin B12; ultrasound measurement of carotid intima‐media thickness (IMT) and endothelium‐dependent dilatation were both carried on at diagnosis and after gluten withdrawal. Twenty‐two healthy members of the hospital staff served as matched controls for vascular examinations.Results: At baseline, mean total and HDL‐cholesterol (HDL‐C) were both within normal range, while mean LDL‐cholesterol concentration was slightly increased; diet was associated with an increment in total and HDL‐C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001) and a significant improvement in total/HDL‐C ratio (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02). Mean plasma homocysteine was elevated and not influenced by diet. C‐reactive protein significantly decreased with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05). At baseline, in coeliacs, IMT was increased (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), while endothelium‐dependent dilatation was decreased (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). Both parameters improved after gluten abstinence.Conclusions: Adults with coeliac disease seem to be at potentially increased risk of early atherosclerosis as suggested by vascular impairment and unfavourable biochemical risk pattern. Chronic inflammation might play a determining role. Gluten abstinence with mucosal normalisation reverts to normal the observed alterations.

Objective: Whether blood eosinophils (bEOS) in chronic obstructive pulmonary disease (COPD) are associated with disease progression is a topic of debate. We aimed to evaluate whether the differential white blood cell (WBC) count, symptoms and treatment may predict lung function decline and exacerbations in COPD patients. Methods: We retrospectively examined stable COPD patients with a minimum follow-up of 3 years at our outpatients' clinic. We collected information about lung volumes (FEV1, FVC), the total and differential WBC count, acute exacerbations of COPD (number in the 12 months before the beginning of the study=AE-COPD-B, and during the follow-up=AE-COPD-F), smoking status and treatment. FEV1 decline and AE-COPD-F were described by using a generalized linear model and a 2-level random intercept negative binomial regression, respectively. The models included eosinophil and neutrophil counts as potential predictors and were adjusted by sex, age, smoking status, AE-COPD-B, treatment with bronchodilators and inhaled corticosteroids (ICS). Results: Sixty-eight patients were considered, 36 bEOS- (<170 cells/µL, the median value) and 32 bEOS+ (=170 cells/µL). ?FEV1 was higher in bEOS+ than bEOS- (34.86 mL/yr vs 4.49 mL/yr, p=0.029). After adjusting for potential confounders, the eosinophil count was positively (ß=19.4; CI 95% 2.8, 36.1; p=0.022) and ICS negatively (ß=-57.7; CI 95% -91.5,-23.9; p=0.001) associated with lung function decline. bEOS were not found to be associated with the number of AE-COPD-F. Conclusion: In stable COPD patients, a higher level of blood eosinophils (albeit in the normal range) predicts a greater FEV1 decline, while ICS are associated with a slower progression of airflow obstruction.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19), in which coagulation abnormalities and endothelial dysfunction play a key pathogenic role. Tissue factor (TF) expression is triggered by endothelial dysfunction. Activated factor VII-antithrombin (FVIIa-AT) complex reflects indirectly FVIIa-TF interaction and has been proposed as a potential biomarker of prothrombotic diathesis. FVIIa-AT plasma concentration was measured in 40 patients (30 males and 10 females; 64.8 ± 12.3 years) admitted with SARS-CoV-2 pneumonia during the first pandemic wave in Italy. Two sex- and age-matched cohorts without COVID-19, with or without signs of systemic inflammation, were used to compare FVIIa-AT data. The FVIIa-AT plasma levels in COVID-19 patients were higher than those in non-COVID-19 subjects, either with or without inflammation, while no difference was observed among non-COVID-19 subjects. The association between COVID-19 and FVIIa-AT levels remained significant after adjustment for sex, age, C-reactive protein, renal function, fibrinogen, prothrombin time and activated partial thromboplastin time. Our results indicate that SARS-CoV-2 infection, at least during the first pandemic wave, was characterized by high FVIIa-AT levels, which may suggest an enhanced FVIIa-TF interaction in COVID-19, potentially consistent with SARS-CoV-2-induced endotheliopathy.

Background: Duplex ultrasonography (DUS) of the extracranial arteries is essential for the primary and secondary prevention of ischemic stroke and the diagnosis of other cerebrovascular pathologies. The aim of the Italian Society for Vascular Investigation (SIDV) is to provide a standardised approach for the ultrasound evaluation of extracranial arterial disease. Methods: A multidisciplinary SIDV expert panel conducted a comprehensive literature search and performed a narrative review of the recent medical literature; the updated operative procedures were subsequently developed through a consensus-driven process that included dedicated meetings and national congress sessions for discussion and validation. Results: This document outlines a comprehensive approach to the ultrasound evaluation of extracranial arteries, detailing techniques such as Brightness Mode (B-mode), Colour Doppler, Power Doppler, contrast-enhanced ultrasound (CEUS), micro-vascular flow imaging (MVFI), and Three-Dimensional (3D) ultrasound. The text provides an in-depth discussion of clinical indications, technical protocols, plaque characterisation, stenosis quantification, and hemodynamic criteria. Emerging technologies are also examined for their potential to improve cerebrovascular risk stratification. Conclusions: The updated SIDV operative procedures for the ultrasound evaluation of extracranial cerebrovascular disease are intended to serve as a valuable reference for clinicians and vascular laboratories.