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Napoli, Italy

Russo V.,The Second University of Naples | Rago A.,The Second University of Naples | Politano L.,The Second University of Naples | Della Cioppa N.,Monaldi Hospital | And 4 more authors.
Europace | Year: 2012

Aims: Atrial Preference Pacing (APP) is a pacemaker (PM) algorithm that supports a continuous atrial stimulation instead of a spontaneous atrial rhythm to prevent supraventricular tachyarrhythmias. The role of the APP in the prevention of atrial fibrillation (AF) is still controversial. The aim of our study was to evaluate the effect of preventive atrial pacing on AF incidence in myotonic dystrophy type I patients during a 12-month follow-up period. Methods and results: We studied 40 patients with myotonic dystrophy type 1 (MD1) who underwent dual-chamber PM implantation for first- and second-degree atrioventricular block. After a 1-month stabilization period, they were randomized to APP algorithm programmed OFF or ON for 6 months each, using a cross-over design. The number of AF episodes during active treatment (APP ON phases) was lower than those registered during no treatment (APP OFF phases). No statistically significant difference was found in AF episodes duration between the two phases. During the APP OFF phases and APP ON phases, the atrial pacing percentage was 0 and 98%, respectively, while the ventricular pacing percentage did not show statistically significant difference (10 vs. 8%, P = 0.2). Atrial premature beats count was significantly greater during APP OFF phases than during APP ON phases. Lead parameters remained stable over time and there were no lead-related complications. Conclusions: Based on these 12-month follow-up data, it is concluded that APP is an efficacy algorithm for preventing paroxysmal AF in MD1 patients who underwent dual-chamber PM implantation for atrioventricular conduction disorders. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. Source

Vicini C.,Oral Surgery Unit | Leone C.A.,Monaldi Hospital | Montevecchi F.,Oral Surgery Unit | Dinelli E.,Forte-IT | And 2 more authors.
ORL | Year: 2014

Aims: To assess the role of transoral robotic surgery (TORS) in managing failures of conventional transoral laser microsurgery (TLM) in cases with difficult laryngeal exposure. Methods: Retrospective analysis of 3 patients with difficult laryngeal exposure treated with TORS. All 3 cases failed to be managed by conventional TLM after repeated attempts by experienced surgeons. In 2 cases, the initial disease was laryngeal cancer treated by a cricohyoidoepiglottopexy, with an obstructing residual epiglottis. The last case was a bilateral Reinke disease submitted to repeated TLM procedures, producing multiple supraglottic and glottic scars. In all cases, the difficult exposure was produced by a combination of concurrent elements including insufficient mouth opening, short and stiff neck, macroglossia and high-positioned larynx. Results: Two patients were exposed by means of a Davis Meyer mouth gag. The other patient was managed by a Feyh-Kastenbauer device. The key of the success was the possibility to work 'around the corner' (30° angle view) where straight alignment of the larynx was impossible. Conclusions: Where possible, a TORS approach should be considered complementary to TLM in cases of very difficult or even impossible conventional transoral laryngoscopic approach. © 2014 S. Karger AG, Basel. Source

Di Meglio F.,University of Naples Federico II | Castaldo C.,University of Naples Federico II | Nurzynska D.,University of Naples Federico II | Romano V.,University of Naples Federico II | And 5 more authors.
Journal of Molecular and Cellular Cardiology | Year: 2010

Epithelial-mesenchymal transition is implicated in the remodelling of tissues during development and in the adult life. In the heart, it gives origin to progenitors of fibroblasts, coronary endothelium, smooth muscle cells, and cardiomyocytes. Moreover, epicardially-derived cells determine myocardial wall thickness and Purkinje fibre network. Recently, the presence of numerous cardiac stem cells in the subepicardium of the adult human heart has been described and the hypothesis that epicardially-derived cells can contribute to the population of cardiac stem cells in the adult heart has been advanced. In an effort to test this hypothesis and establish a possible link between epicardium, epicardially-derived cells and cardiac stem cells in the adult human heart we have examined epicardial mesothelial cells in the normal and pathological adult human heart with ischemic cardiomyopathy in vivo and we have induced and documented their epithelial-mesenchymal transition in vitro. Noticeably, epicardial cells were missing from the surface of pathological hearts and the cells with the expression of epithelial and mesenchymal markers populated thick subepicardial space. When the fragments of epicardium from the normal hearts were cultured on the specific substrate formed by extracellular matrix derived from cardiac fibroblasts, we obtained the outgrowth of the epithelial sheet with the mRNA and protein expression characteristic of epicardium. TGFβ induced cellular and molecular changes typical of epithelial-mesenchymal transition. Moreover, the epicardially-derived cells expressed CD117 antigen. Thus, this study provides evidence that cardiac stem cells can originate from epithelial-mesenchymal transition of the epicardial cells in the adult human heart. © 2010 Elsevier Ltd. Source

Weisz S.H.,University of Liege | Magne J.,University of Liege | Dulgheru R.,University of Liege | Caso P.,Monaldi Hospital | And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2014

Background In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (β index). The aim of this study was to investigate the relationship between carotid and aortic β index, left ventricular (LV) function, plasma brain natriuretic peptide (BNP) level, and symptoms in patients with AS. Methods Comprehensive echocardiography including Doppler tissue imaging of the mitral annulus was performed in 53 patients with AS (aortic valve area < 1.2 cm2) and preserved LV ejection fractions (50%). Carotid β index was automatically derived from ultrasound wall tracking of the right carotid artery. The mitral E/e′ ratio was used to estimate LV filling pressures. Results Carotid β index was higher in women than in men and was significantly correlated with age (P <.0001), diastolic arterial pressure (P =.046), pulse pressure (P =.006), and systemic arterial compliance (P =.001). Interestingly, carotid β index was significantly correlated with E/e′ ratio (P <.0001) and plasma BNP level (P =.011). In multivariate regression analysis, carotid β index was an independent predictor of E/e′ ratio (P <.0001) and of BNP level (P =.02). Moreover, carotid β index was significantly higher in symptomatic patients (P =.009). Aortic β index was significantly correlated with carotid β index (P <.0001), E/e′ ratio (P =.004), and BNP (P <.001) and was significantly higher in symptomatic patients (P =.037). Conclusions In patients with moderate to severe AS and preserved LV ejection fractions, the presence of increased carotid artery and aortic stiffness, assessed using carotid and aortic β index, is independently associated with elevated LV filling pressures, BNP level, and symptoms. © 2014 by the American Society of Echocardiography. Source

Montaldo P.,The Second University of Naples | Rosso R.,Monaldi Hospital | Chello G.,Monaldi Hospital | Giliberti P.,Monaldi Hospital
Journal of Perinatology | Year: 2014

Objective:To investigate whether creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) can be used to predict neurodevelopmental outcome at 18 months in infants with perinatal asphyxia (PA). The diagnostic value of cTnI to assess myocardial dysfunction was considered as well.Study Design:Retrospective study of 178 neonates admitted with PA. cTnI concentrations measured within 12 h of birth were compared with medium-term outcome assessed with the Bayley Scales of Infant Development. cTnI concentrations measured within 12 h of birth were compared with clinical grade of hypoxic-ischemic encephalopathy (HIE) and with duration of inotropic support. Two-dimensional Doppler and color Doppler findings were recorded. Fractional shortening, tricuspid and mitral regurgitation were evaluated.Result:A statistically significant correlation between cTnI concentration and BSID-II score was found (mental development index r -0.69, P<0.05 and psychomotor development index r -0.39, P<0.05). There was no statistically significant correlation between CK-MB and BSID-II score (P>0.05).Serum cTnI concentrations and duration of inotropic support were significantly greater with increasing severity of PA. cTnI was negatively correlated with fraction shortening (r -0.64; P<0.05). The severity of tricuspid regurgitation was correlated with the cTnI concentration (r 0.61; P<0.05).Conclusion:In asphyxiated neonates, cTnI concentrations within 12 h of birth correlate with medium-term outcome. Early cTnI concentration correlates with severity of HIE, myocardial dysfunction and with Bayley II scores at 18 months. © 2014 Nature America, Inc. Source

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