Hyperlactataemia is commonly used as a diagnostic and prognostic tool in intensive care settings. Recent studies documented that serial lactate measurements over time (or lactate clearance), may be clinically more reliable than lactate absolute value for risk stratification in different pathological conditions. While the negative prognostic role of hyperlactataemia in several critical ill diseases (such as sepsis and trauma) is well established, data in patients with acute cardiac conditions (i.e. acute coronary syndromes) are scarce and controversial. The present paper provides an overview of the current available evidence on the clinical role of lactic acid levels and lactate clearance in acute cardiac settings (acute coronary syndromes, cardiogenic shock, cardiac surgery), focusing on its prognostic role.

Heavily calcified lesions may be difficult to dilate adequately with conventional balloons and stents, which causes frequent periprocedural complications and higher rates of target lesion revascularisation (TLR). High-pressure non-compliant balloon angioplasty may be of insufficient force to modify calcium and, even when successful, may be limited in its ability to modify the entire calcified lesion. Scoring and cutting balloons hold theoretical value but data to support their efficacy are lacking and, because of their high lesion crossing profile, they often fail to reach the target lesion. Rotational and orbital atherectomy target superficial calcium; however, deep calcium, which may still impact on vessel expansion and luminal gain, is not affected. Intravascular lithotripsy (IVL), based on lithotripsy for renal calculi, is a new technology which uses sonic pressure waves to disrupt calcium with minimal impact to soft tissue. Energy is delivered via a balloon catheter, analogous to contemporary balloon catheters, with transmission through diluted ionic contrast in a semi-compliant balloon inflated at low pressure with sufficient diameter to achieve contact with the vessel wall. With coronary and peripheral balloons approved in Europe, peripheral balloons approved in the USA and multiple new trials beginning, we review the indications for these recently introduced devices, summarise the clinical outcomes of the available trials and describe the design of ongoing studies.

Abstract.Introduction.Vitamin D deficiency (VDD) is a common condition among several populations in the world. VDD is associated with higher incidence of immune system disorders and faster progression of some infectious diseases. Vitamin D is known to be of physiological importance, it is considered an essential micronutrient for the bone health and plays a beneficial role in the prevention and/or treatment of a number of chronic diseases. Vitamin D has a complex action on the immune system. Results. Evidence that vitamin D protects against tuberculosis has been supported by in vitro, epidemiological and some preliminary clinical studies. Vitamin D has a potential effect on HIV (human immunodeficiency virus) and plays a crucial role in the defence against respiratory infections. Conclusions. Vitamin D supplementation could be a low-cost, practical method to protect groups of people with high incidence of those diseases. Public health education should stress the need for adequate dietary intake of vitamin D in those vulnerable groups.Key words: VDD, Vitamin D deficiency, tuberculosis, HIV, respiratory infections. Riassunto (Il ruolo potenziale della vitamina D nella prevenzione e terapia della tubercolosi e delle malattie infettive).Introduzione. La carenza di vitamina D è una condizione comune in numerosi gruppi di popolazione nel mondo. Essa risulta associata a un'elevata incidenza dei disturbi del sistema immunitario e a una più veloce progressione di alcune malattie infettive. Oltre ad essere un micronutriente essenziale per la salute dell'apparato scheletrico, la vitamina D riveste un ruolo importante nei processi fisiologici e nella prevenzione e/o terapia di numerose patologie croniche. Essa svolge un'azione complessa sul sistema immunitario. Risultati. La dimostrazione che la vitamina D protegge contro la tubercolosi è stata supportata da studi in vitro, epidemiologici e da alcuni dati clinici preliminari. La vitamina D ha un effetto potenziale sull'HIV (sindrome da immunodeficienza acquisita) e svolge un ruolo fondamentale nelle infezioni respiratorie. Conclusioni. La somministrazione di vitamina D può essere un metodo pratico, a basso costo per proteggere gruppi specifici di popolazione con elevata incidenza delle suddette malattie. L'educazione sanitaria pubblica dovrebbe mettere in risalto la necessità di una adeguata assunzione di vitamina D in tutti i gruppi vulnerabili.Parole chiave: carenza di vitamina D, tubercolosi, HIV, infezioni respiratorie.

Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.

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