Time and Frequency Repolarization Domains in Elderly Candidates to Transcatheter Aortic Valve Replacement.

Background and aim: Aortic valve stenosis (AVS) is a well-known risk factor for sudden cardiac death. Therefore, some non-invasive, electrocardiographic markers are capable to stratify the risk of sudden death at rest and during light mental challenge [mini-mental state examination (MMSE) administration]. Method: We compared short period RR, QT and Te intervals variability in 42 candidates to and 12 age-matched hypertensive control patients at rest and during mental challenge. Results: At rest, AVS patients showed a higher QT standard deviation (sd), QT low frequency power (LF), QT High Frequency (HF), Tpeak-Tend intervals sd (Te sd) and Te HF than the control group. During mental challenge AVS group showed a decrease of RR mean and RR HF, expressed in normalized units (NU), and an increase of RR total power (TP), RR LF, RR LF NU, RR LF, HF ratio (LF/HF). During this same mental test, QT sd, QT LF, QT HF, Te sd, Te LF, Te HF, QT variability index (VI), TeVI, QT normalized variance (VN) were higher in AVS patients than the control group. During mental challenge Te LF (r:0.825, p<0.05) was significantly associated to: serum albumin (ß:-0.473, p<0.001), MMSE (ß:-0.267, p:0.038), diastolic blood pressure (ß:-0.443, p:0.03) and cardiac index (ß:-0.303, p:0.029). Conclusion: AVS patients showed temporal dispersion of ventricular repolarization phase, useful maker to individuate high risk patients. MMSE administration induced a sympathetic sinus activation and vagal deactivation in AVS subjects. Frailty and mental function influenced Te HF and Te LF.

Short-Period Temporal Dispersion Repolarization Markers in Elderly Patients with Decompensated Heart Failure.

Objectives: Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of electrocardiogram (ECG) repolarization phase. In the past, short period repolarization-dispersion parameters were used as makers of mortality risk in different heart diseases, yet. Aim of this work was to evaluate risk of mortality or worsening condition in CHF elderly subjects by mean of these repo-larization variables. Method: An observational, prospective cohort study was performed, collecting 5 minutes ECG recordings to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp) and T peak to T end (Te) in 117 decompensated CHF (age range: from 49 to 103 years). 30-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. Results: A total of 27 patients (23%) died during the 30-day follow-up (overall mortality rate 23%). Te mean (odd ratio (OR): 1.04, 95% confidence limit (Cl 7u): 1.02-1.09, p<0.01), NT-pro BNP (OR: 1.00, 95% cl: 1.00-1.00, p<0.01) and LVMI (OR : 0.98, 95% cl: 0.96-0.10, p<0.05) were associated to risk of mortality at the multivariable logistic analysis. On the contrary, the same statistical analysis selected TeSD (OR: 1.36, 95% cl: 1.16-1.59, p<0.001) and LVEF (OR: 0.91, 95% cl: 0.87-0.95, p<0.001) as marker of decompensated CHF. Conclusion: In decompensated CHF elderly subjects, Te mean seem be associated to mortality and TeSD could be considered a risk factor for CHF worsening and complications. These evidences could provide useful tools for telemonitoring CHF elderly patients, amelio-rating treatments and outcomes.

Expression of vascular endothelial growth factor in human dysfunctional temporomandibular joint discs.

A high density of blood vessels is found in specimens of temporomandibular joint (TMJ) disc at any stage of internal derangement of the joint, but the factors responsible for angiogenesis in the disc have not been described. The purpose here was to investigate, in human TMJ discs, the expression of vascular endothelial growth factor (VEGF), a multifunctional cytokine that contributes to angiogenesis. Specimens, free of significant morphological alterations and with varying degrees of disc tissue degeneration/regeneration, were studied by immunohistochemistry for VEGF in order to correlate immunohistochemical with histopathological findings. In normal discs and discs with minor pathological changes, fibroblast-like cells, fibrochondrocytes and chondrocyte-like cells were either not or only weakly immunostained by VEGF antibody. In disc specimens from internal derangement of the TMJ with significant tissue degeneration/regeneration, VEGF was consistently expressed. In these specimens, immunoreaction products for VEGF were observed both in the disc and in the endothelial cells of newly formed vessels. This VEGF immunolocalization is consistent with the stimulation of angiogenesis and the morphogenesis and differentiation of chondrocytes. Therefore VEGF expression by disc chondrocyte-like cells might reflect the action of the cytokine as an inducer of angiogenesis and as an autocrine signal for cells of the chondrogenic lineage.

[Melanosomes, melanocytes and keratinocytes in the human epidermis in incontinentia pigmenti]. / Melanosomi, melanociti e cheratinociti nell'epidermide umana con incontinenza del pigmento.

A functioning epidermal melanin unit implies a melanocyte capable of transferring melanosomes to keratinocytes; this requires not only melanocytes with adequate dendrites but also "receptive" keratinocytes. Skin with incontinentia pigmenti was examined by electron microscopy. Premelanosomes were occasionally found within keratinocytes and deposits of extracellular granular material that came from vacuolar degeneration of keratinocytes adjacent to melanocytes.

[A histological study of the meniscal insertion of the external pterygoid muscle]. / Studio istologico dell'inserzione meniscale del muscolo pterigoideo esterno.

The paper reports a study of the relationship between the upper head of the pterygoid muscle and the temporomandibular joint disc. Using optical microscopy, TMJ serial sections of 10 human embryos and fetuses aged from 6 to 22 weeks were examined. From the observation of serial sections, it appears that from the start of histogenesis the lateral pterygoid muscle is in contact with the condylar blastema and later with the disc and the condyle. A fibrous attachment was detected between the muscle tendon and the meniscus, and oxytalan and elastic fibres were observed near this attachment.

[Histological study of synchondroses and of the nasal capsule in the human fetal cranium]. / Studio istologico delle sincondrosi e della capsula nasale nel cranio fetale umano.

The aim of this paper is to describe the development and growth of the middle-line cranial base synchondrosis and nasal septal cartilage of human fetuses. The sample consisted of 25 human fetuses aged from 9 weeks to 6 months. The samples were decalcified and processed in paraffin. Sections were cut at 10 mu and stained with Mallory staining. Histomorphological observation pointed out the presence and development of cranial base synchondrosis and nasal septal cartilage. As far as synchondrosis cell zone layers in endochondral growth sites are described moreover a caudorostral gradient in growth rate was observed. Functional connexions between the cartilaginous nasal capsule and the developing maxillae and premaxillae have been examined. The main connection was found to consist of the anterior septopremaxillary ligament running from the anterior border of the nasal septum posteroinferiorly to blend with premaxillary periosteum and interpremaxillary suture.

[The cervical third of deciduous teeth. An ultrastructural study of the heard tissues by SEM]. / Il terzo cervicale dei denti decidui. Studio ultrastrutturale dei tessuti duri al MES.

As information on amelocemental junction of deciduous teeth is limited, this topographical area was investigated by scanning electron microscopy (SEM) to verify differences from that of permanent teeth. Twenty-six carious and non-carious human maxillary and mandibular primary teeth were placed in a fixative immediately after extraction. Pulpal tissue was removed from the pulpal chambers and root. The primary teeth blocked onto stubs and all specimens were platinum coated and examined by SEM. In these specimens an overlapping of cementum onto to enamel and an edge to edge relationship was dominant. No gaps between enamel and cementum were observed. The amelocemental junction of deciduous teeth seem to differ to that described for permanent teeth.

[Histomorphology of secondary cartilage in human fetal mandibles]. / Istomorfologia delle cartilagini secondarie della mandibola in feti umani.

The aim of this study was to provide a histomorphological analysis of some secondary cartilages of mandible and temporal bone as observed in human fetuses 18-22 weeks old. The behavior of cartilage was studied in both these regions, which were decalcified, cut at 10 mu, stained with Mallory staining and examined by optical microscopy. In mandible symphysis menti and condylar cartilage were described. The symphysis appeared to be formed by a fibrous cartilagineous structure surrounded by membranous bone. This structure seems be round in the caudal sections and ovoidal in the rostral sections with the major axis perpendicular to the mean sagittal plane. Meanwhile the condyle is formed by secondary cartilage which may be appreciated in this development stage 5 zona. Secondary cartilage was observed also in the temporal bone nearby the primitive glenoid fossa. The development and the importance of these cartilagineous structures are discussed.

["Carious" and "noncarious" lesions of the hard dental tissues. Ultrastructural (SEM) and microanalytical (EDS) analyses of teeth from the 3rd century B.C]. / Le lesioni "cariose" e "non cariose" dei tessuti duri dentali. Analisi ultrastrutturale (MES) e microanalitica (EDS) in denti del III s.a.C.

The study was carried out on 80 teeth (70 of permanent dentition and 10 of primary one) of mandibular and maxillary bones. The teeth owned to subjects lived in the III c.b.C. in Sicily, and they were found in Naxos necropolis. The teeth were examined as far as carious and non carious lesions, then they were prepared for instrumental analyses by Scanning Electron Microscopy (SEM) and Energy dispersed X ray spectrometry (EDS). To an objective examination of the sample no caries were detected in the teeth sample apart one tooth, on the other hand there was an extensive occlusal abrasion, from a macroscopic point of view there were no difference as far teeth morphology. SEM examination pointed out all around dentinal tubules a circle of sclerotic dentin as reaction to occlusal wear. The amelocemental junction showed from a ultramicroscopic point of view an overlap of cementum onto enamel. EDS analysis pointed out a higher P concentration on the crown versus the root in all the teeth of the sample.

[Cutaneous histopathologic changes in laboratories working in the processing of petroleum]. / Modificazioni isotopatologiche cutanee in lavoratori addetti alla movimentazione di prodotti petroliferi.

Petroleum and its derivatives are a complex mixture of many constituents in varying proportions, such as polycyclic aromatic hydrocarbons, alcohols, ethers and additives. It is well established that petroleum derivatives are absorbed through the skin but exposure has not been quantified. Manifestations of cutaneous exposure vary from squamous cell carcinoma to irritative contact dermatitis such as occurs in the workplace. The aim of the investigation was to evaluate cutaneous histomorphological alterations in a group of 10 healthy workers occupationally exposed to repeated and low amounts of gasoline for a prolonged period. Histological examination and immunocytochemical techniques were performed after taking punch biopsies. The results showed the presence of perivascular lympho-plasma cell infiltration and leucocyte cells scattered in the dermal layer. A mild increase in epidermal Langerhans cells was also observed while the detection of the Ki-67 antigen in keratinocytes gave a normal appearance. In conclusion, the overall histomorphological and immunological features was not specific, but resembled skin reactions due to several irritative agents. Such skin alterations can lead to contact dermatitis.

Hepatocyte growth factor receptor, c-Met, in human embryo salivary glands. An immunohistochemical study.

Salivary gland morphogenesis involves complex, coordinated events that include epithelial-mesenchymal interactions. Mesenchymal-epithelial transition factor (c-Met) is the hepatocyte growth factor (HGF) receptor. The latter is a hepatotropic factor originally identified in rat serum and platelets. It is essential in fetal tissue development, where it regulates complex morphogenetic processes including extracellular matrix invasion, cell migration, cell polarization and tubulogenesis. The c-Met/HGF system is believed to participate in epithelial-mesenchymal interactions during development. Twelve human embryonic minor salivary glands were studied by immunohistochemistry to investigate the role of c-Met in human salivary gland development. Strong c-Met immunopositivity in the glands demonstrated that the molecule is involved in their development and suggested a role for the c-Met/HGF system in this process.

[Structure and ultrastructure of the human TMJ meniscus]. / Struttura ed ultrastruttura del menisco dell'ATM umana.

This ultrastructural study is concerned on demonstrating the presence and the distribution of the elastic system fibers in human TMJ disc. Oxytalan and pre-elastic fibers were found to occur in the anterior, intermediate and posterior band of the disc. These fibers run parallel to collagen fibers in the outer portion of the disc while in the deeper portion they were canted compared to collagen fibers arrangement. The presence of an elastic system fibers in human TMJ disc it is plausible to assume that it enables the disc to resist to a wider range of reversible deformation.

[Histo-ontogenetic study of the major salivary glands and Chievitz's organ]. / Studio isto-ontogenetico sulle ghiandole salivari maggiori e dell'organo di Cheivitz.

Salivary glands development has been studied by optical microscopy in 8 fetuses aged from 8 to 20 weeks of fetal life. From the observation of the sections obtained we can assume that submandibular gland is the first gland to be detectable, later the parotid gland and then the sublingual gland. In tight connection with the parotid gland Chievitz organ has been demonstrated. It is not known whether this organ may or may not contribute to parotid gland.

Heat Shock Protein 27 is overexpressed in the skin of bitumen exposed workers. Early observations.

The skin of road pavers is exposed to a large number of compounds such as asphalt, bitumen, amines, polymers, oils, solvents, sand, gravel, crushed rock, mineral wad, ultraviolet light and heat. In order to verify an up-regulation of HSP27, determined by the above mentioned stimuli, we studied, immunohistochemically, the forearm skin of a sample of road pavers occupationally exposed. A total of 25 punch biopsies (3 mm diameters) was obtained from the foream skin of road paver workers (n=16) and a control group (n=5) not exposed. Specimens were sectioned (thickness: 3-4 micron ) and processed for immunohistochemistry. For localization of HSP27, a mouse anti-HSP27 monoclonal antibody was used. In punch biopsies of bitumen exposed workers, HSP27 immunostaining was hemogeneously detected in the whole epidermis including basal cell layer. Immunoreaction products were observed mostly in cytoplasm but also in nuclei. Staining intensity was stronger (grade 3 or 4) than that revealed in normal skin sample.

[Histology of the cartilage of the human fetal condyle]. / Aspetto istologico del tessuto cartilagineo del condilo fetale umano.

The Authors have examined with optical microscopy the articular cartilages from the supero-posterior area of the mandibular condyles of ten TMJ of 5 human fetuses. In this study have been shown the cellular components of the 3 outer areas of the condyle. Further it has been pointed out that the fibrous lining of the cartilage is not only composed of collagen fibrils, proteoglycans and fibroblasts but also contains elastic fibers.

[Light microscope study of human dental morphogenesis]. / Studio al microscopio ottico sulla morfogenesi dentaria umana.

Human teeth morphogenesis was studied by optical microscopy from the 10th to 20th week of fetal life. Enamel, dentin and pulp development were analyzed. An important observation on mandibu teeth arises from this investigation that consists in a biforcation of mandibular ossification in two branches, this could allow to the teeth to develop inside the mandibular arch.

Immunolocalization of vimentin and alpha-smooth muscle actin in dysfunctional human temporomandibular joint disc samples.

The expression of vimentin and alpha-smooth muscle (alpha-SM) actin was examined in 10 human temporomandibular joint (TMJ) disc samples, with internal derangement and in two control specimens, in order to evaluate the phenotypic characteristics of TMJ disc cells in relationship to histological findings. This was accomplished by means of monoclonal antibodies specific for vimentin and alpha-SM actin and immunocytochemical technique. The study, revealed that every disc cell constantly expressed vimentin. Scattered alpha-SM actin positive cells could be appreciated in normal TMJ discs and tissues with minor pathological findings. In TMJ discs with severe alterations, i.e. tears and clefts, almost fibroblast-like cells, fibrochondrocytes and chondrocyte-like cells were strongly immunolabelled by anti-alpha-SM actin antibody. According to these findings it can be assumed that vimentin is expressed by all disc cell populations and it appears not to be influenced by any disease condition of the disc; on the other hand the up-regulation alpha-SM actin immunolabelling seems to be correlated to histopathological findings of tears and clefts. Cells, with a contractile phenotype, close to such defects, could be involved in disc tissue contraction and repair. The plasticity of disc cell populations which evolve towards a different phenotype when subjected to action of macro- and micro-environmental factors is also supported.

[Changes in the TMJ in the intrauterine and extrauterine period of life]. / Evoluzione dell'ATM umana nel periodo della vita intrauterina ed extrauterina.

The aim of this work is the study of hte prenatal and postnatal development of the human temporomandibular joint. Ten of human embryos and fetuses and six joint of young children were sectioned sagittally and frontally, decalcified where necessary and stained using Mallory and Cajall-Callengo techniques. At the eighteen gestational week the condylar blastema became evident, the temporal blastema appeared later. At the twenty-second week all the structure of the joint were present, but the morphogenesis was not completed as one could observe from the preparations the Meckel's cartilage. A key observation from the study of features and embryos was that the condylar cartilage wasn't uniformly distributed on the condylar surface bur it was located in posterior-lateral area. At birth TMJ showed some characteristics typical of this period such as : a flat temporal component a disc with blood vessels and a condyle with connective-vascular channels. These characteristics will disappear later in the life at about 3-5 years.