Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy.

Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4-37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function

Doctor-patient care relationship in genetic cardiomyopathies: An exploratory study on clinical consultations

BackgroundThe present study aims to explore the setting of consultation and communication between physicians and patients affected by genetic cardiomyopathies, investigating how the two parts of the therapeutic relationship participate and share information.Methods and results45 adult patients affected by various cardiomyopathies took part in a prospective case study while attending consultations at a cardiologic outpatient clinic constituting an Italian referral centre for cardiomyopathies. A researcher observed the consultations, which were audio-recorded and transcribed. Transcripts were coded and an analysis of setting, type of communication implemented and participation of doctors and patients in terms of word-count and type of questions/answers was carried out. Overall word-count was significantly higher for physicians than for patients (t(44) = 9,506; pConclusionsFindings emphasize patients' need for adequate time and space to share their subjective illness experience with the physician, within an approach informed by the insights and recommendations of Narrative Medicine. These findings are instrumental to improving the specific clinical setting for individuals with genetic cardiomyopathies

Mission X: Train Like an Astronaut Pilot Study

Mission X: Train Like an Astronaut is an international educational challenge focusing on fitness and nutrition as we encourage students to "train like an astronaut." Teams of students (aged 8-12) learn principles of healthy eating and exercise, compete for points by finishing training modules, and get excited about their future as "fit explorers." The 18 core exercises (targeting strength, endurance, coordination, balance, spatial awareness, and more) involve the same types of skills that astronauts learn in their training and use in spaceflight. This first-of-its-kind cooperative outreach program has allowed 14 space agencies and various partner institutions to work together to address quality health/fitness education, challenge students to be more physically active, increase awareness of the importance of lifelong health and fitness, teach students how fitness plays a vital role in human performance for exploration, and inspire and motivate students to pursue careers in STEM fields. The project was initiated in 2009 in response to a request by the International Space Life Sciences Working Group. USA, Netherlands, Italy, France, Germany, Austria, Colombia, Spain, and United Kingdom hosted teams for the pilot this past spring, and Japan held a modified version of the challenge. Several more agencies provided input into the preparations. Competing on 131 teams, more than 3700 students from 40 cities worldwide participated in the first round of Mission X. OUTCOMES AND BEST PRACTICES Members of the Mission X core team will highlight the outcomes of this international educational outreach pilot project, show video highlights of the challenge, provide the working group s initial assessment of the project and discuss the future potential of the effort. The team will also discuss ideas and best practices for international partnership in education outreach efforts from various agency perspectives and experience

217 MECHANISMS OF ACTION OF ESE1, A NOVEL TRANSCRIPTIONAL REGULATOR OF CARTILAGE REMODELING, IN MMP-13 REGULATION

Ischemic preconditioning (IPC) limits myocardial infarct size through the activation of the PI3K-Akt signal cascade; however, little is known about the roles of individual PI3K isoforms in cardioprotection. We aimed, therefore, to elucidate the role of the PI3K alpha isoform in cardioprotection Pharmacological PI3K alpha inhibition was assessed in isolated-perfused mouse hearts subjected to ischemia/reperfusion injury (IRI), either during the IPC procedure or at reperfusion. PI3K alpha inhibition abrogated the IPC-induced protective effect at reperfusion, but not when given only during the IPC protocol. These results were confirmed in an in vivo model. Moreover, pharmacological PI3K alpha activation by insulin at reperfusion was sufficient to confer cardioprotection against IRI. In addition, PI3K alpha was shown to be expressed and activated in mouse cardiomyocytes, mouse cardiac endothelial cells, as well as in mouse and human heart tissue. Furthermore, PI3K alpha was shown to mediate its effect though the inhibition of mitochondrial permeability transition pore opening. In conclusion, PI3K alpha activity is required during the early reperfusion phase to reduce myocardial infarct size. This suggests that strategies specifically enhancing the alpha isoform of PI3K at reperfusion promote tissue salvage and as such, and could provide a direct target for clinical treatment of IRI.Fundacion Rafael del Pino FONDECYT 3160298 British Heart Foundation Cancer Research UK C23338/A15965 UK NIHR University College London Hospitals Biomedical Research Centr