Massimo A. Mariani

Severe Aortic Stenosis and Myocardial Function Diagnostic and Prognostic Usefulness of Ultrasonic Integrated Backscatter Analysis

Background—The aim of this study was to assess the myocardial reflectivity pattern in severe aortic valve stenosis through the use of integrated backscatter (IBS) analysis. Patients with aortic stenosis (AS) were carefully selected in the Department of Cardiology. Methods and Results—Thirty-five subjects (AS: valve orifice ≤1 cm2; 12 female; mean age, 71.8±6.2 years) and 25 healthy subjects were studied. All subjects of the study had conventional 2D-Doppler echocardiography and IBS. Backscatter signal was sampled at the septum and posterior wall levels. Patients with AS were divided into 2 groups: 16 patients with initial signs of congestive heart failure and a depressed left ventricular systolic function (DSF) (ejection fraction [EF] range, 35% to 50%) and 19 asymptomatic patients with normal left ventricular systolic function (NSF) (EF >50%). Myocardial echo intensity (pericardium related) was significantly higher at the septum and posterior wall levels in DSF than in NSF and in control subjects. IBS variation, as an expression of variation of the signal, appeared to be significantly lower in AS with DSF than in NSF and in control subjects, at both the septum and posterior wall levels. Patients with DSF underwent aortic valve replacement, and, during surgical intervention, a septal myocardial biopsy was made for evaluation of myocardium/fibrosis ratio. Abnormally increased echo intensity was detected in left ventricular pressure overload by severe aortic stenosis and correlated with increase of myocardial collagen content (operating biopsy). Conclusions—One year after aortic valve replacement, we observed a significant reduction of left ventricular mass, and, only if pericardial indexed IBS value (reduction of interstitial fibrosis) decreased, it was possible to observe an improvement of EF and of IBS variation.

Aneuploidy and diploidy rates in sperm of five men after three-colour hybridization: indication of X chromosome-associated autosome 2 aneuploidy

The frequencies of aneuploidy and diploidy for chromosomes 2, X and Y in sperm nuclei of five nonsmoking normal donors were assessed by three-colour fluorescence in situ hybridization. We detected neither significant interindividual variability nor age effect (age range of the study group: 26-38 yr) on the mean frequencies of aneuploid and diploid sperm. Nullisomic sperm were observed more frequently than disomic sperm. In addition, sex chromosomal meiotic nondisjunction occurred at a higher rate than autosomal nondisjunction, and disomic sperm for the sex chromosomes were formed mainly by errors in the second meiotic division. Our data indicate that diploidy occurs at a very low frequency in comparison with aneuploidy. Furthermore, the overall proportion of X-bearing sperm nuclei aneuploid for chromosome 2 is significantly higher than that of Y-bearing sperm (0.14% vs. 0.05%, respectively; p < 0.001). This finding adds further evidence that autosomal aneuploidy can be preferentially associated with the presence of one of the two gonosomes.

Different growth conditions for peripheral blood endothelial progenitors

PURPOSE To compare different growth conditions for endothelial progenitor cells (EPCs) from peripheral blood mononuclear cells (PBMNCs). METHODS AND MATERIALS PBMNCs of healthy volunteers were cultured on fibronectin as follows: M199 with VEGF, bFGF, IGF-I; the same medium with bovine retina-derived extract (RDE); freshly isolated or depleted of adherent cells PBMNCs in HUVEC conditioned medium; DiI-stained PBMNCs with HUVECs (1:4 ratio) in Ml99 with RDE. PBMNCs were analysed by FACS using mAbs for endothelial markers. EPCs migration was determined using a modified Boyden chamber assay and VEGF as chemoattractant. EPCs were seeded alone or with HUVECs on Matrigel to assess in vitro angiogenesis. RESULTS With growth factors, numerous cell clusters appeared within 1 week. Spindle-shaped and attached cells sprouted, differentiating in endothelial cell (EC)-like cells within 2 weeks and forming cobblestone-like monolayers within 3 weeks. With RDE, numerous large cell clusters appeared within 1 week, but the number of cells with an EC morphology decreased during culture. FACS confirmed the endothelial phenotype and attached cells were able to migrate in response to VEGF. When nonadherent cells were cultured in HUVEC conditioned medium, they proliferated readily and EPCs were induced while freshly isolated cells neither proliferated nor induced EPCs. FACS analysis of the cocultures showed the presence of double-labeled PBMNCs expressing endothelial antigens. Capillary-like structures were observed on Matrigel only from cocultures and PBMNCs were able to incorporate in these networks. CONCLUSIONS PBMNCs are able to differentiate in EPCs when stimulated with appropriate culture conditions (growth factors, HUVEC conditioned medium, HUVECs).

P‐Wave Signal‐Averaged Electrocardiogram Predicts Atrial Fibrillation After Coronary Artery Bypass Grafting

Background: AF is one of the most common complications after CABG. The aim of the study was to identify the risk factors for postoperative AF.

Current indications for elective surgical treatment of dilated ascending aorta : A new formula

The question as to when is the right time to operate on a dilated ascending aorta has not yet been definitively answered. In cases of rupture or a Stanford type A dissection, operative intervention provides the only chance for the patient to survive. In cases of increased aortic size, the indication for surgery or follow-up needs a standardized process that takes into account all available patient data. Currently, however, there is not complete agreement as to which criteria to use to solve this problem. By calculating the right time for elective surgery, when the operative risk is lower than the risk of dilationrelated complications, it could be ideally possible to avoid urgent surgical procedures on the ascending aorta. For this reason, a simple and quick method to determine the correct operative timing on the basis of clinical and echocardiographic findings would be useful to the surgeon. Currently, the size of the aorta and the underlying aortic pathologic process are considered the most important factors in predicting complications. The aim of this study is to move from the current criteria of indication for aortic surgery (the mean cutoff diameter) to a standard method of indication for elective surgery with echocardiographic measurements and few simple data obtained from the individual patient’s clinical history. To reach this goal, we reviewed the literature data in a synthesis and then developed a new formula.

Endothelial progenitor cells induction by short-term stimulation with phytohaemagglutinin of mononuclear cells

BACKGROUND The identification of circulating endothelial progenitors cells (EPCs) in the adult has forced to reconsider how new blood vessels grow in physiological and pathological conditions. Neovascularization during adult life has long been attributed to angiogenesis only. However, recent studies have revealed that peripheral blood EPCs may be recruited and incorporated into sites of active neovascularization. PURPOSE To verify that EPCs are induced from peripheral blood mononuclear cells (PBMCs) and bone marrow derived mononuclear cells (BMMCs) upon short-term stimulation with phytohaemoagglutinin (PHA), a potent T-cell mitogen. METHODS PBMCs and BMMCs were isolated from healthy donors. Freshly isolated or depleted of adherent cells (one day and three days of adherence) mononuclear cells (MCs) were cultured in RPMI, 10% FBS, containing PHA (10 microl/10(6) cells) for 24 h. After stimulation with PHA, clusters of adherent cells were further propagated in M199 containing L-glutammine, Hepes, 20% FBS, heparin, antibiotics and bovine retina extract for 1 and 2 weeks. PBMCs and BMMCs cultured without PHA stimulation served as controls. FACS of EPCs was performed on attached cells after 7 and 14 days of culture. RESULTS AND CONCLUSION After stimulation of MCs with PHA for 24 h, many cells clusters were observed and around these clusters some adherent EC-like cells were observed. These cells were ovoid but a very little of these were elongated in morphology, however their number and size gradually increased during culture. However a longer time was needed for obtaining EPCs from MCs harvested after adherence. Thus this indicates that short-term signals provided by PHA must be sufficient for MCs to express the ligands necessary for the induction of EPCs but signals from monocytes/macrophages are important for a more rapid differentiation.