Effect of Aneurysm and Bicuspid Aortic Valve on Layer-Specific Ascending Aorta Mechanics.

BACKGROUND: Previous studies have not examined the participation of intimal, medial, and adventitial layers in providing mechanical strength to the ascending thoracic aortic aneurysm (ATAA) wall compared with the nonaneurysmal aorta. In this study we compared the mechanical properties of intact wall and its layers among ATAAs and nonaneurysmal aortas, with explicit consideration of the effects of valve morphology; that is, bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV), and aortic quadrant. METHODS: Whole ATAAs were taken from patients undergoing elective repair and nonaneurysmal aortas from age-matched autopsy subjects. These were cut into 2 circumferential and longitudinal tissue strips for the intact wall and its layers per quadrant, permitting examination of the aortic wall as a multilayered structure. Tissue underwent tensile testing for determination of failure properties. RESULTS: Intact wall and layer-specific failure stretches (ie, extensibilities) were significantly greater in nonaneurysmal and BAV-ATAA than in TAV-ATAA, unaccounted for by elastin/collagen content changes. Intact wall failure stress (ie, strength) was significantly greater in BAV-ATAA than in TAV-ATAA, in analogy with medial failure stress. Failure stress and stretch associated negatively with age in most subject groups, layers, and intact wall, but failure stretch correlated positively with residual stretch (ie, structural bonds between layers). CONCLUSIONS: No mechanical vulnerability of BAV-ATAA was found, corroborating current conservative guidelines regarding the management of bicuspid aortopathy. Weakening and added vulnerability was found in patients with valvular deficiency, aortic root aneurysm, hypertension, and hyperlipidemia. Aging led to increased susceptibility to dissection initiation or full rupture, or both, in both patient classes.

Effects of aneurysm on the mechanical properties and histologic structure of aortic sinuses.

BACKGROUND: Aortic root aneurysms are relatively uncommon but their rupture is a detrimental event with acute hemodynamic compromise and high mortality, and there are few available data on their mechanical properties, although aneurysm rupture occurs when hemodynamic stresses exceed wall strength. This study aimed to fill this gap by examining the effect of aneurysm on the mechanical and structural properties of aortic sinuses. METHODS: Sinus tissue was procured from 16 aneurysmal patients during surgical repair and from 18 age-matched nonaneurysmal autopsy subjects, and grouped by age (young versus old), region (left versus right versus noncoronary), and direction (circumferential versus longitudinal). The tissue was submitted to histologic evaluation of elastin/collagen contents and to mechanical testing beyond rupture for the determination of failure properties and material characterization by the Fung-type model. RESULTS: Contrasting the direction-dependent (anisotropic) material constants and failure properties, and the primarily circumferential reinforcement of elastin/collagen fibers in healthy sinuses, near-similar (isotropic) properties and arbitrarily aligned fibers were found in the aneurysmal right and left coronary sinuses, together with less anisotropic properties in the aneurysmal noncoronary sinus. Variations between aneurysmal and healthy sinuses were comparable in young and old subjects. The former displayed significantly higher failure stress, failure stretch, and peak elastic modulus, justified by their increased elastin/collagen contents. CONCLUSIONS: We submit evidence of more isotropic histomechanical properties in the aneurysmal sinuses that seem consistent with the more axisymmetric stresses exerted on them owing to their more spherical shape, compared with the nondilated healthy sinuses that presented marked anisotropic properties.

Current aspects of penal surgical liability in Greece.

The surgeon may face in every day practice issues that may render him liable. The legal liability usually emerges due to the negligence exhibited during the preoperative, the operative and the postoperative stage. The surgeon, as any doctor, isn't liable for the result, but he is responsible for the correct diagnosis and therapeutic treatment, always according to the principles of the Medical science and to the possibilities available to him in every specific case (facilities and time). The continuous education about the issues of his speciality, the adaptation of scientifically approved techniques, the correct monitoring of the patient, both preoperatively and postoperatively, and finally the good communication with the patient are necessary for the proper practice of Medicine; but also constitute the "shield" of the surgeon against any possible legal conflict.

Relationship between alcohol consumption and control of hypertension among elderly Greeks. The Nemea primary care study.

BACKGROUND: The aim of this study was to evaluate the significance of alcohol intake in relation to blood pressure control in treated subjects and to determine if there is a causative link between alcohol and inadequate control of hypertension. METHODS: Our study population comprised 637 elderly individuals who reside in Nemea and in four other villages located in Corinthia, Peloponnesus, of which 615 were included in the analysis. The average age was 73.5±6.15 years. A special epidemiological questionnaire was completed by each participant and the blood pressure (BP) was measured according to a predefined protocol. Odds ratios were calculated and adjusted for potential confounders. RESULTS: The overall prevalence of hypertension was 69.1%, 70.7% in men and 67.0% in women. In total, 11% of the hypertensives were not aware of having hypertension. Of those who were aware of having hypertension 91.0% were being treated. Among treated hypertensives 49.1% had systolic BP<140 mmHg and diastolic BP<90 mmHg. Only heavy drinking (>300 g/week) was found to be related with hypertension control. CONCLUSIONS: Our study showed that the level of control among the elderly, in a Greek population, is positively associated with alcohol intake only for heavy drinking. The role of alcohol consumption in hypertension in the elderly needs further investigation.

Smoking in prison: a hierarchical approach at the crossroad of personality and childhood events.

BACKGROUND: Smoking has long been considered part of prison culture and studies have shown a high prevalence of smoking within correctional facilities. METHODS: A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. To assess current smoking habits, a hierarchical approach was adopted. The underlying conceptual framework included: (i) demographic parameters, (ii) adverse childhood history (physical abuse, parental neglect, parental divorce, alcoholism in the family, sexual abuse and psychiatric condition in the family), (iii) education, personality traits, such as impulsivity (Barrat Impulsivity Scale-11), aggression (Buss-Perry Aggression Questionnaire and Lifetime History of Aggression), and personal history of mental disease, (iv) prison-related features (duration of sentence, sentence already served and change in smoking habits during imprisonment). RESULTS: Eighty percentage of the study sample reported current smoking; 43.4% disclosed deterioration in their smoking habits during imprisonment. The hierarchical approach pointed to: (i) adverse childhood events, i.e. alcoholism in the family [adjusted odds ratio (OR) = 6.29, 95% confidence interval (CI): 2.44-16.25], psychiatric condition in the family (adjusted OR = 4.10, 95% CI: 1.31-12.84), physical abuse (adjusted OR = 2.90, 95% CI: 1.30-6.46), parental neglect (adjusted OR = 2.66, 95% CI: 1.19-5.95), parental divorce (adjusted OR = 2.14, 95% CI: 1.00-4.56), and (ii) impulsivity (adjusted OR = 2.26, 95% CI: 1.12-4.58) as independent risk factors. In addition, deterioration of smoking habits during imprisonment exerted an effect of borderline significance (adjusted OR = 2.02, 95% CI: 0.97-4.24). CONCLUSIONS: Heavy smoking in prison principally integrates two components: unfavourable childhood and current personality traits (impulsivity).

Muscle LIM protein interacts with cofilin 2 and regulates F-actin dynamics in cardiac and skeletal muscle.

The muscle LIM protein (MLP) and cofilin 2 (CFL2) are important regulators of striated myocyte function. Mutations in the corresponding genes have been directly associated with severe human cardiac and skeletal myopathies, and aberrant expression patterns have often been observed in affected muscles. Herein, we have investigated whether MLP and CFL2 are involved in common molecular mechanisms, which would promote our understanding of disease pathogenesis. We have shown for the first time, using a range of biochemical and immunohistochemical methods, that MLP binds directly to CFL2 in human cardiac and skeletal muscles. The interaction involves the inter-LIM domain, amino acids 94 to 105, of MLP and the amino-terminal domain, amino acids 1 to 105, of CFL2, which includes part of the actin depolymerization domain. The MLP/CFL2 complex is stronger in moderately acidic (pH 6.8) environments and upon CFL2 phosphorylation, while it is independent of Ca(2+) levels. This interaction has direct implications in actin cytoskeleton dynamics in regulating CFL2-dependent F-actin depolymerization, with maximal depolymerization enhancement at an MLP/CFL2 molecular ratio of 2:1. Deregulation of this interaction by intracellular pH variations, CFL2 phosphorylation, MLP or CFL2 gene mutations, or expression changes, as observed in a range of cardiac and skeletal myopathies, could impair F-actin depolymerization, leading to sarcomere dysfunction and disease.

Ascending thoracic aortic aneurysms are associated with compositional remodeling and vessel stiffening but not weakening in age-matched subjects.

OBJECTIVE: We sought to examine in age-matched subjects the biomechanical and compositional remodeling associated with ascending thoracic aortic aneurysms according to region and direction. METHODS: Whole, fresh, degenerative ascending thoracic aortic aneurysms were taken from 26 patients (age, 69 +/- 2 years; maximum aortic diameter, 5.9 +/- 0.3 cm) during elective surgical intervention, and 15 nonaneurysmal ascending thoracic aortas were obtained during autopsies (age, 66 +/- 3 years; maximum aortic diameter, 3.3 +/- 0.2 cm). These were cut into anterior, right lateral, posterior, and left lateral regions, and circumferentially and longitudinally oriented specimens were prepared. The aortic specimens were submitted to histomorphometric and biomechanical studies, including measurement of failure strain (ie, extensibility), failure stress (ie, strength), and peak elastic modulus (ie, stiffness). RESULTS: Wall elastin, but not collagen content, decreased in aneurysmal specimens, displaying lower wall thickness and failure strain, higher peak elastic modulus, and equal failure stress than control specimens in the majority of regions and directions. Similar differences were noted in pooled data from all regions. Regional variations in mechanical parameters were mostly found in longitudinally oriented tissue. Circumferential specimens showed higher failure stress and peak elastic modulus but equal failure strain than longitudinal specimens. CONCLUSIONS: Our findings contradict previous studies on ascending thoracic and abdominal aortic aneurysms, suggesting that the former might not cause weakening but rather only stiffening and reduction in tissue extensibility and elastin content. Marked heterogeneity was evident in healthy and aneurysmal aortas. The present data offer insight into the pathogenesis of aneurysm dissection. Information on directional and regional variations is pertinent because dissections develop circumferentially and bulging preferentially occurs in the anterior region.

Atypical kawasaki disease presenting with symptoms from the genitourinary system: an autopsy report.

Symptoms from the genitourinary system are unusual in Kawasaki disease (KD). Renal involvement is even rarer and it is confirmed by biopsy when the person is alive. We describe the case of an 11-year-old boy admitted to the hospital complaining about prolonged fever (5 days) and hematuria. His urinalysis showed also pyuria, proteinuria and urinary renal tubular epithelial cells concentrations. During the next days, the patient presented limb edema. After almost 2 weeks of hospitalization the patient was transferred to the intensive care unit because of melena and intense abdominal pain. Upon admission, the patient collapsed and died. The diagnosis of KD was established during autopsy. The macroscopical and histopathological examination of the heart showed increased dimensions and weight and multiple thrombi in the coronary arteries with intramural dense polymorphonuclear inflammatory infiltration and necrosis. Histological examination of the kidneys revealed normal glomerulus, mild expansion of mesangial matrix, interstitial infiltration with lymphocytes, plasmatocytes and eosinophiles, normal vessels and normal immunofluorescence.