Ascending aorta disruption after thoracic blunt trauma

Blunt traumatic aortic injury is the second leading cause of death after motor vehicle accident. The most frequent localisation of aortic lesion is the isthmus, especially in those patients who survive the accident. Here we report a case of blunt traumatic aortic injury with unusual localisation and modality. A 31 years old man sustained a motorcycle accident, being run over by a car. Computed tomography scan showed an atypical ascending aorta lesion, confirmed by intraoperative finding. The patient underwent emergency ascending aorta replacement with Dacron tubular graft. The patient was discharged well on 35th postoperative day, after multiple maxillofacial surgeries for concomitant injuries

Apical ballooning syndrome without myocardial necrosis: proof of concept from a case report.

The "apical ballooning" is a cardiac syndrome characterized by acute extensive but reversible akinesia of the apex and mid part of the left ventricle (LV), without obstructive coronary artery disease (CAD), triggered by emotional or physical stress, accompanied by chest pain and/or dyspnoea, electrocardiographic changes mimicking acute coronary syndromes (ACS), and minimal but, to date, obligatory release of cardiac enzymes. Today the precise aetiology remains unknown, but prognosis is generally excellent. We hereby report a unique case of a 60-year-old woman presenting with transient wide anterolateral akinesia and severe LV dysfunction with persistently normal myocardial markers, despite the extent of wall motion abnormalities. This clinical vignette is the first proof of the concept that timely recognition and management may be able to prevent myocardial necrosis in patients with apical ballooning syndrome

CXCR4 deregulated expression in Notch3-induced T cell leukemia

Background: Constitutive activation of Notch signaling is one of the major causes of acute T cell lymphoblastic-leukemia (T-ALL). The oncogenic function of Notch3 in T-ALL was demonstrated by a murine model in our laboratory, characterized by enforced expression of the Notch3 active form (N3-IC) in immature thymocytes (N3-ICtg). Deregulated proliferation and maturation at the preT/T transition phase and constitutive activation of preTCR were observed in N3-ICtg mice. Cooperative signaling among the preTCR, CXC chemokine receptor (CXCR) 4 and Notch are required for double-negative (DN) to double-positive (DP) T cell differentiation (β- selection). CXCR4 and its ligand (SDF-1) promote DN thymocytes survival, regulate the migration during the DN/DP transition and have been recently suggested to play a role in the pathogenesis of T-ALL. Methods: Freshly isolated thymocytes were analysed by FACS and RTPCR was performed in sorted DN T cells. Results: FACS experiments demonstrated a decrease of CXCR4+ cells in DN-gated thymocytes of N3-ICtg mice with respect to wt, not attributable to any reduction of DN cell numbers in N3-ICtg mice.Furthermore, reduced CXCR4 gene transcription was observed in selected DN thymocytes of N3-ICtg with respect to wt mice. Notch3 may disrupt early events in preT-cell progressive maturation accompanied by altered migration through the thymus, as further supported by reduced EpCAM expression, a homotypic adhesion molecule. In contrast, CXCR4 expression per cell was increased in DP-gated cells of N3-ICtg. Conclusions: We hypothesize that Notch3 may deregulate positioning and degrees of immature thymocytes in early steps of T-ALL development

Prognostic impact of diabetes and prediabetes on survival outcomes in patients with chronic heart failure: a post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial

Background-The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.Methods and Results-We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n= 2852), pre-DM (n= 2013), and non-DM (n= 2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively).Conclusions-Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P<0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P<0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633