RUOLO DELLA BIOPSIA ENDOMIOCARDICA NELLA DIAGNOSI DELLE CARDIOMIOPATIE

Introduction: To improve the endomyocardial biopsy (EMB) diagnostic sensitivity for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), we hypothesized a biopsy sampling focused on selected right ventricle (RV) low-voltage areas identified by electroanatomic voltage mapping. Methods and Results: The study population (22 patients, 10 men; mean age 34 \ub1 10 years) included 11 patients with overt ARVC/D (group A) and 11 patients with suspected ARVC/D (group B), according to both arrhythmic profile and standardized noninvasive diagnostic criteria. In all 22 patients, an RV bipolar voltage mapping was performed with CARTOTM system sampling multiple endocardial sites (262 \ub1 61), during sinus rhythm, with a 0.5\u20131.5 mV color range setting of voltage display. All 11 (100%) group A patients and 8 of the 11 (73%) group B patients (P = nonsignificant [NS]) presented RV low-voltage areas (<0.5 mV). In 8 group A patients and in all 8 group B patients with a pathological RV voltage map, an EMB focused on the low-voltage areas was performed. In 6 (75%) group A patients and in 7 (87%) group B patients (P = NS), voltage mapping-guided EMB was diagnostic for ARVC/D. In the remaining 3 patients, only nonspecific histological findings were observed. Conclusions: The results of our study (1) confirm the high diagnostic sensitivity of RV voltage mapping in patients with overt ARVC/D, (2) document a high prevalence of RV low-voltage areas even in patients with suspected ARVC/D, and (3) demonstrate that in patients with clinical evidence or suspicion for ARVC/D, presenting RV low-voltage areas, EMB guided by voltage mapping may provide ARVC/D diagnosis confirmation

Dexamethasone downregulates autophagy through accelerated turn-over of the ulk-1 complex in a trabecular meshwork cells strain: Insights on steroid-induced glaucoma pathogenesis

Steroid-induced glaucoma is a severe pathological condition, sustained by a rapidly progressive increase in intraocular pressure (IOP), which is diagnosed in a subset of subjects who adhere to a glucocorticoid (GC)-based therapy. Molecular and clinical studies suggest that either natural or synthetic GCs induce a severe metabolic dysregulation of Trabecular Meshwork Cells (TMCs), an endothelial-derived histotype with phagocytic and secretive functions which lay at the iridocorneal angle in the anterior segment of the eye. Since TMCs physiologically regulate the composition and architecture of trabecular meshwork (TM), which is the main outflow pathway of aqueous humor, a fluid which shapes the eye globe and nourishes the lining cell types, GCs are supposed to trigger a pathological remodeling of the TM, inducing an IOP increase and retina mechanical compression. The metabolic dysregulation of TMCs induced by GCs exposure has never been characterized at the molecular detail. Herein, we report that, upon dexamethasone exposure, a TMCs strain develops a marked inhibition of the autophagosome biogenesis pathway through an enhanced turnover of two members of the Ulk-1 complex, the main platform for autophagy induction, through the Ubiquitin Proteasome System (UPS)

A Left Atrial Appendage Closure Combined Procedure Review: past, present and future perspectives

Atrial fibrillation (AF) represents the most common cardiac arrhythmia worldwide; it poses a great burden in terms of quality of life reduction and yearly stroke risk. Left atrial appendage closure (LAAC) is a stroke prevention strategy that has been proven a viable alternative to anti-thrombotic regimens in non-valvular AF patients. LAAC can be performed as a stand-alone procedure or alongside a concomitant AF trans catheter ablation, in a procedure known as "Combined Procedure". Aim of this study is to summarize the scientific evidence backing this combined strategy

Esters and Orthoesters as Alkylating Agents at High Temperature. Applicationsto Continuous-flow Processes

At high temperature (1 80-200 "C) esters, orthoesters, carbonates and orthocarbonates have been found to alkylate acidic compounds via a B,,2 mechanism. Phenol gives anisole with methyl acetate in the presence of potassium carbonate. Thiols and other CH-acidic compounds are also alkylated under such conditions. The results obtained under batch conditions can be repeated under continuous-flow conditions, if the base which promotes the reaction can be used in catalytic amount. Continuous-flow alkylation of thiophenol by methyl acetate on a sodium acetate-type fixed bed, and other alkylations by orthoesters or orthocarbonates on a potassium carbonate catalytic bed, have been achieved

Reaction of the Ambident Electrophile Dimethyl Carbonate with the Ambident Nucleophile Phenylhydrazine

To explore the ambident electrophilic reactivity of dimethyl carbonate (DMC), reactions with the ambident nucleophile phenylhydrazine were investigated. When a Brönsted base was used, selective carboxymethylation occurred at N-1, after that several other compounds were produced selectively utilizing various conditions. Formation of these compounds was explained by using the Hard−Soft Acid−Base (HSAB) theory. Catalysis by some metal salts altered the reactivity of phenylhydrazine, which effected selective carboxymethylation at N-2 of phenylhydrazine instead

Phosgene-free carbamoylation of aniline via dimethyl carbonate

The synthesis of N-phenylcarbamate from aniline and dimethyl carbonate (DMC) in the presence of homogeneous, supported heterogeneous, and heterogeneous catalysts was investigated in batch conditions. First, a selection of homogeneous catalysts was studied and their reactivity in the same reaction conditions was compared to zinc acetate, a catalyst extensively used for this reaction. Then the best homogeneous catalysts were supported on silica or alumina, and the resulting heterogeneous supported catalysts were tested for the carbamoylation of aniline. Finally, several heterogeneous catalysts were investigated. Zinc carbonate basic was shown to be the best catalyst, giving quantitative conversion and selectivity for the N-phenylcarbamate. Its catalytic activity was fully investigated taking into account substrate concentration, amount of catalysts, and temperature influence. Zinc carbonate was also shown to be recyclable, once it was recovered from the reaction mixture and calcinated

Traumi oculari al pronto soccorso oculistico. Ricerca condotta presso la Clinica Oculistica del Policlinico Umberto I di Roma su 81.825 casi in 10 anni. La prevenzione è sempre fondamentale per evitare danni oculari.

Abstract Obiettivo Determinare gli esiti funzionali a distanza dei traumi oculari gravi contusivi e perforanti che hanno necessitato di intervento chirurgico. Metodi Studio retrospettivo, effettuato tra gennaio 2003 e marzo 2013, di 672 pazienti con macrotraumi oculari, giunti al Pronto Soccorso (PS) della Clinica Oculistica, Dipartimento di Oftalmologia del Policlinico Umberto I di Roma. In particolare abbiamo focalizzato l’attenzione sui pazienti con traumi oculari contusivi o “a bulbo chiuso” e perforanti (ferite, corpo estraneo intraoculare – CEIO –, scoppio del bulbo) o “a bulbo aperto”. Risultati Il numero degli accessi per trauma è stato di 81.825 in 10 anni, di cui 672 (0,82%) con un macrotrauma che ha necessitato di intervento medico e chirurgico. Più frequenti (445; 66,18%) i traumi contusivi rispetto ai perforanti (227; 33,82%). Dei perforanti, 105 (46,3%) hanno avuto uno scoppio del bulbo che, assieme ai CEIO (67; 29,7%), sono le principali cause di prognosi infausta per l’occhio traumatizzato. Tra le complicanze più frequenti ci sono state, in ordine, quelle corneali (abrasioni ecc.) (94,2%), l’ipoema (86,3%) e la commotio retinae (edema di Berlin, 85,8%). Gli esiti funzionali a 6 mesi sono variati da visus normale (≤10/10 e >6/10) in 441 pazienti (65,7%), fino a cecità assoluta (MM, PL, NPL) in 57 pazienti (8,3%). L’OTS (ocular trauma score) e la tempestività d’intervento sono risultati essere un indice prognostico importante. Conclusioni Gli esiti funzionali (acuità visiva finale)dei traumi oculari contusivi e perforanti sono incrementabili con l’adeguatezza e la tempestività dell’intervento chirurgico del trauma in sé e delle complicanze che possono presentarsi contemporaneamente o successivamente. I traumi costituiscono una delle principali cause di ipovisione o cecità monoculare nei soggetti giovani adulti

Cyclization reaction of amines with dialkyl carbonates to yield 1,3-oxazinan-2-ones

A number of six-membered cyclic carbamates (oxazinanones) were synthesized from the reaction of a primary amine or hydrazine with a dicarbonate derivative of 1,3-diols in a one-pot reaction, in good yield, short time span, and in the absence of a solvent. The reaction proceeds in two steps: an intermolecular reaction to give a linear intermediate and an intramolecular cyclization to yield the cyclic carbamate. This is the first example of a carbonate reacting selectively and sequentially, firstly at the carbonyl center to form a linear carbamate and then as a leaving group to yield a cyclic carbamate. © 2011 IUPAC

Synthesis of Methyl Carbamates from Primary Aliphatic Amines and Dimethyl Carbonate in Supercritical CO2: Effects of Pressure and Cosolvents and Chemoselectivity

At 130 °C, in the presence of CO2 (5-200 bar), primary aliphatic amines react with dimethyl carbonate (MeOCO2Me, DMC) to yield methyl carbamates (RNHCO2Me) and N-methylation sideproducts (RNHMe and RNMe2). The pressure of CO2 largely influences both the reaction conversion and the selectivity toward urethanes: in general, conversion goes through a maximum (70-80%) in the midrange (40 bar) and drops at lower and higher pressures, whereas selectivity is continuously improved (from 50% up to 90%) by an increase of the pressure. This is explained by the multiple role of CO2 in (i) the acid/base equilibrium with aliphatic amines, (ii) the reactivity/solubility of RNHCO2 - nucleophiles with/in DMC, and (iii) the inhibition of competitive N-methylation reaction of the substrates. Cosolvents also affect the reaction: in particular, a drop in selectivity is observed with polar protic media (i.e., MeOH), plausibly because of solvation effects (through H-bonds) of RNHCO2 - moieties. The reaction shows also a good chemoselectivity: bifunctional aliphatic amines bearing either aromatic NH2 or OH substituents [XC6H4(CH2)nNH2, X ) NH2, OH; n ) 1, 2], undergo methoxycarbonylation reactions exclusively at aliphatic amino groups and give the corresponding methyl carbamates [XC6H4(CH2)nNHCO2Me] in 39-65% isolated yields