52 research outputs found

    Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support

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    Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed

    Strategies for preventing group B streptococcal infections in newborns: A nation-wide survey of Italian policies

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    Insights into the evolution of mammalian telomerase: Platypus TERT shares similarities with genes of birds and other reptiles and localizes on sex chromosomes

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    Background The TERT gene encodes the catalytic subunit of the telomerase complex and is responsible for maintaining telomere length. Vertebrate telomerase has been studied in eutherian mammals, fish, and the chicken, but less attention has been paid to other vertebrates. The platypus occupies an important evolutionary position, providing unique insight into the evolution of mammalian genes. We report the cloning of a platypus TERT (OanTERT) ortholog, and provide a comparison with genes of other vertebrates. Results The OanTERT encodes a protein with a high sequence similarity to marsupial TERT and avian TERT. Like the TERT of sauropsids and marsupials, as well as that of sharks and echinoderms, OanTERT contains extended variable linkers in the N-terminal region suggesting that they were present already in basal vertebrates and lost independently in rayfinned fish and eutherian mammals. Several alternatively spliced OanTERT variants structurally similar to avian TERT variants were identified. Telomerase activity is expressed in all platypus tissues like that of cold-blooded animals and murine rodents. OanTERT was localized on pseudoautosomal regions of sex chromosomes X3/Y2, expanding the homology between human chromosome 5 and platypus sex chromosomes. Synteny analysis suggests that TERT co-localized with sex-linked genes in the last common mammalian ancestor. Interestingly, female platypuses express higher levels of telomerase in heart and liver tissues than do males. Conclusions OanTERT shares many features with TERT of the reptilian outgroup, suggesting that OanTERT represents the ancestral mammalian TERT. Features specific to TERT of eutherian mammals have, therefore, evolved more recently after the divergence of monotremes.Radmila HrdličkovĂĄ, Jiƙí Nehyba, Shu Ly Lim, Frank GrĂŒtzner, Henry R Bose J

    Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

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    Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a lifetime risk of one in 350 people and an unmet need for disease-modifying therapies. We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels. The combination of all ALS-associated signals reveals a role for perturbations in vesicle-mediated transport and autophagy and provides evidence for cell-autonomous disease initiation in glutamatergic neurons

    Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions.

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    The travelling options currently available allow an increasingly large number of individuals, including sedentary people, the elderly and diseased patients, to reach high altitude (HA) locations, defined as locations higher than 2500 m above sea level (asl),1S i.e. the altitude above which many of the physiological responses that represent challenges for the human body start developing. Physiological acclimatization mechanisms impose an increased workload on the cardiovascular system, but the actual risk of adverse cardiovascular events associated with HA exposure is still a debated issue. The aim of this article is to review the available evidence on the effects of HA in cardiovascular patients and to address their risk of developing clinically relevant events. This was done through multiple Medline searches on the PubMed database, with the main aim of promoting a generally safe access to mountains. Searched terms included a combination of either ‘high altitude’ or ‘hypobaric hypoxia’ plus each of the following: ‘physiology’, ‘maladaption’, ‘cardiovascular response’, ‘systemic hypertension’, ‘pulmonary hypertension’, ‘ischaemic heart disease’, ‘cardiac revascularisation’, ‘heart failure’, ‘congenital heart disease’, ‘arrhythmias’, ‘implantable cardiac devices’, ‘stroke’, ‘cerebral haemorrhage’, ‘exercise’, ‘sleep apnea’. Compared with a previous review article on this topic,2S we now include the most recent data on hypoxia-induced changes in left ventricular (LV) systolic and diastolic function, lung function and ventilation control, blood coagulation, and on the effects of pharmacological interventions. We also offer an update on the clinical and pathophysiological findings related to the exposure to altitude of patients with pre-existing cardiovascular conditions (ischaemic heart disease, heart failure, and arterial and pulmonary hypertension).</p
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