Developmental differences in myocardial transmembrane Na+ transport: Implications for excitability and Na+ handling

KEY POINTS

Previous studies showed that myocardial preparations from immature rats are less sensitive to electrical field stimulation than adult preparations. Freshly-isolated ventricular myocytes from neonatal rats showed lower excitability than adult cells, e.g., less negative threshold membrane potential and greater membrane depolarization required for action potential triggering. In addition to differences in mRNA levels for Na⁺ channels isoforms and greater Na⁺ current (I_Na ) density, Na⁺ channel voltage-dependence was shifted to the right in immature myocytes, which seems to be sufficient to decrease excitability, according to computer simulations. Only in neonatal myocytes did cyclic activity promote marked cytosolic Na⁺ accumulation, which was prevented by abolition of systolic Ca²⁺ transients by blockade of Ca²⁺ currents. Developmental changes in I_Na may account for the difference in action potential initiation parameters, but not for cytosolic Na⁺ accumulation, which seems to be due mainly to Na⁺ /Ca²⁺ exchanger-mediated Na⁺ influx.

ABSTRACT

Little is currently known about possible developmental changes in myocardial Na⁺ handling, which may have impact on cell excitability and Ca²⁺ content. Resting intracellular Na⁺ concentration ([Na⁺ ]_i ), measured in freshly-isolated rat ventricular myocytes with CoroNa-green, was not significantly different in neonates (3-5 days old) and adults, but electrical stimulation caused marked [Na⁺ ]_i rise only in neonates. Inhibition of L-type Ca²⁺ current by CdCl₂ abolished not only systolic Ca²⁺ transients, but also activity-dependent intracellular Na⁺ accumulation in immature cells. This indicates that the main Na⁺ influx pathway during activity is the Na⁺ /Ca²⁺ exchanger, rather than voltage-dependent Na⁺ current (I_Na ), which was not affected by CdCl₂ . In immature myocytes, I_Na density was 2-fold greater, inactivation was faster, and the current peak occurred at less negative transmembrane potential (E_m ) than in adults. Na⁺ channel steady-state activation and inactivation curves in neonates showed a rightward shift, which should increase channel availability at diastolic E_m , but also require greater depolarization for excitation, which was observed experimentally and reproduced in computer simulations. Ventricular mRNA levels of Na_v 1.1, Na_v 1.4 and Na_v 1.5 pore-forming isoforms were greater in neonate ventricles, while decrease was seen for the β1 subunit. Both molecular and biophysical changes in the channel profile may contribute to the differences in I_Na density and voltage-dependence, and also to the less negative threshold E_m in neonates, compared to adults. The apparently lower excitability in immature ventricle may confer protection against the development of spontaneous activity in this tissue. Abstract figure legend Little is currently known about possible developmental changes in myocardial Na⁺ transport, which may have impact on cell excitability and other physiological aspects. At the mRNA level, neonatal rat ventricle expresses a greater variety of Na⁺ channel isoforms than in adults. In immature ventricular cardiomyocytes, Na⁺ current (I_Na ) density was greater, but voltage-dependence is shifted to less negative potentials than in adults. This should increase channel availability at diastolic membrane potential, but also require greater depolarization for excitation, which was observed experimentally and reproduced in computer simulation. We also observed that electrical stimulation caused marked intracellular Na⁺ accumulation only in neonates, which was abolished when Ca²⁺ transients and the Na⁺ /Ca²⁺ exchanger (NCX) were inhibited by Cd²⁺ + Ni²⁺ . Thus, it seems that the main Na⁺ influx pathway during activity in neonates is the NCX, rather than voltage-dependent I_Na , which was not affected by these blockers. This article is protected by copyright. All rights reserved.

Mitochondrial Substrate Utilization Regulates Cardiomyocyte Cell Cycle Progression

The neonatal mammalian heart is capable of regeneration for a brief window of time after birth. However, this regenerative capacity is lost within the first week of life, which coincides with a postnatal shift from anaerobic glycolysis to mitochondrial oxidative phosphorylation, particularly towards fatty-acid utilization. Despite the energy advantage of fatty-acid beta-oxidation, cardiac mitochondria produce elevated rates of reactive oxygen species when utilizing fatty acids, which is thought to play a role in cardiomyocyte cell-cycle arrest through induction of DNA damage and activation of DNA-damage response (DDR) pathway. Here we show that inhibiting fatty-acid utilization promotes cardiomyocyte proliferation in the postnatatal heart. First, neonatal mice fed fatty-acid deficient milk showed prolongation of the postnatal cardiomyocyte proliferative window, however cell cycle arrest eventually ensued. Next, we generated a tamoxifen-inducible cardiomyocyte-specific, pyruvate dehydrogenase kinase 4 (PDK4) knockout mouse model to selectively enhance oxidation of glycolytically derived pyruvate in cardiomyocytes. Conditional PDK4 deletion resulted in an increase in pyruvate dehydrogenase activity and consequently an increase in glucose relative to fatty-acid oxidation. Loss of PDK4 also resulted in decreased cardiomyocyte size, decreased DNA damage and expression of DDR markers and an increase in cardiomyocyte proliferation. Following myocardial infarction, inducible deletion of PDK4 improved left ventricular function and decreased remodelling. Collectively, inhibition of fatty-acid utilization in cardiomyocytes promotes proliferation, and may be a viable target for cardiac regenerative therapies.

MEF2C repressor variant deregulation leads to cell cycle re-entry and development of heart failure

Background

A pathophysiological link exists between dysregulation of MEF2C transcription factors and heart failure (HF), but the underlying mechanisms remain elusive. Alternative splicing of MEF2C exons α, β and γ provides transcript diversity with gene activation or repression functionalities.

Methods

Neonatal and adult rat ventricular myocytes were used to overexpress MEF2C splicing variants γ+ (repressor) or γ-, or the inactive MEF2Cγ+23/24 (K23T/R24L). Phenotypic alterations in cardiomyocytes were determined by confocal and electron microscopy, flow cytometry and DNA microarray. We used transgenic mice with cardiac-specific overexpression of MEF2Cγ+ or MEF2Cγ− to explore the impact of MEF2C variants in cardiac phenotype. Samples of non-infarcted areas of the left ventricle from patients and mouse model of myocardial infarction were used to detect the expression of MEF2Cγ+ in failing hearts.

Findings

We demonstrate a previously unrealized upregulation of the transrepressor MEF2Cγ+ isoform in human and mouse failing hearts. We show that adenovirus-mediated overexpression of MEF2Cγ+ downregulates multiple MEF2-target genes, and drives incomplete cell-cycle reentry, partial dedifferentiation and apoptosis in the neonatal and adult rat. None of these changes was observed in cardiomyocytes overexpressing MEF2Cγ-. Transgenic mice overexpressing MEF2Cγ+, but not the MEF2Cγ-, developed dilated cardiomyopathy, correlated to cell-cycle reentry and apoptosis of cardiomyocytes.

Interpretation

Our results provide a mechanistic link between MEF2Cγ+ and deleterious abnormalities in cardiomyocytes, supporting the notion that splicing dysregulation in MEF2C towards the selection of the MEF2Cγ+ variant contributes to the pathogenesis of HF by promoting cardiomyocyte dropout.

Funding

São Paulo Research Foundation (FAPESP); Brazilian National Research Council (CNPq).

Abstract 425: Role of MLF1 in Cardiomyocyte Cell Cycle Regulation

The neonatal mammalian heart is capable of significant regeneration after cardiac injury. However, that ability is lost in the early postnatal period, coinciding with the development of cardiomyocyte cell cycle arrest. Myeloid leukemia factor 1 (MLF1) is a protein expressed in hematopoietic cells, skeletal muscle and cardiac muscle. In hematopoietic cells, MLF1 is thought to be a negative cell cycle regulator, possibly acting through a p53-dependent mechanism. However, the role of MLF1 in the cardiovascular system is not well understood. Here, we describe MLF1 as a regulator of cardiomyocyte cell cycle progression. We first examined the expression pattern of MLF1 in neonatal mouse heart. MLF1 protein specifically expresses in the nucleus, and the expression level increases from P1 to P7 as revealed by quantitative PCR and Western Blot. To elucidate a potential role of Mlf1 in cardiomyocyte proliferation, we silenced Mlf1 in neonatal rat ventricle myocytes (NRVMs) which showed increased cardiomyocyte proliferation by staining with a mitosis marker phospho-Histone 3 (pH3). Then we generated an inducible cardiac-specific Mlf1 knockout mouse model and assessed for the prolongation of the proliferative window by echocardiography, cell size analysis, and immunostaining for cell cycle markers. Staining the Mlf1 KO hearts with proliferation markers, pH3 to determine mitosis and Aurora B kinase to determine cytokinesis, indicated that deletion of Mlf1 resulted in increased cardiomyocyte proliferation. It also showed improvement in left ventricular systolic function following myocardial infarction by echocardiography. In contrast, overexpression of MLF1 in heart showed decreased cardiac function as quantified by ejection fraction. These results identify MLF1 as a negative cell cycle regulator of cardiomyocyte proliferation.

Relationship between ecological condition and ecosystem services in European rivers, lakes and coastal waters

We quantify main ecosystem services (i.e. the contribution of ecosystems to human well-being) provided by rivers, lakes, coastal waters and connected ecosystems (riparian areas and floodplains) in Europe, including water provisioning, water purification, erosion prevention, flood protection, coastal protection, and recreation. We show European maps of ecosystem service capacity, flow (actual use), sustainability and efficiency. Then we explore the relationship between the services and the ecosystem condition at the European scale, considering the ecological status of aquatic ecosystems, reported under the EU Water Framework Directive, as a measure of the ecosystem integrity and biodiversity. Our results indicate that a higher delivery of the regulating and cultural ecosystem services analysed is mostly correlated with better conditions of aquatic ecosystems. Conversely, the use of provisioning services can result in pressures on the ecosystem. This suggests the importance of maintaining good ecological condition of aquatic ecosystems to ensure the delivery of ecosystem services in the future. These results at the continental scale, although limited to the ecosystem services under analysis, might be relevant to consider when investing in the protection and restoration of aquatic ecosystems called for by the current EU water policy and Biodiversity Strategy and by the United Nations Sustainable Development Goals.

Prevalence and predictive factors of moderate/severe liver steatosis in chronic hepatitis C (CHC) infected patients evaluated with controlled attenuation parameter (CAP)

A novel controlled attenuation parameter (CAP) using FibroScan^® has been developed for assessment of liver steatosis. The aim was to evaluate the frequency and associated factors for moderate/severe steatosis evaluated by CAP in CHC patients submitted to transient elastography (TE) by FibroScan^® . CHC patients underwent TE with CAP evaluation. The classification of steatosis was defined as: CAP < 222 dB/m  =  S0; CAP ≥ 222 dB/m and <233dB/m  =  S1; ≥233 dB/m < 290dB/m  =  S2 and >= 290 dB/m  =  S3. The prevalence of moderate/severe steatosis (CAP ≥ S2) and the related independent factors were identified by a logistic regression analysis. A significance level of 5% was adopted. 1104 CHC patients, 85% genotype-1 were included (mean age 55 ± 11 years; 46% male, mean BMI 25 ± 4 Kg/m² ). Systemic arterial hypertension and type 2 diabetes mellitus prevalences were 39% and 17%, respectively. Liver stiffness measurement ≥ 9.5 kPa was observed in 39% of patients and steatosis was identified in 50% (S1 = 7%, S2 = 28% and S3 = 15%). The variables independently associated with moderate/severe steatosis were: male gender (OR=1.35; P = .037; 95% CI:1.01-1.81); systemic arterial hypertension (OR=1.57; P = .002; 95% CI:1.17-2.10) and BMI (OR=1.17; P < .01;95% CI:1.12-1.22). In conclusion, when CAP was adopted as a tool to detect steatosis, genotype 1 CHC patients presented a high prevalence of moderate/advanced steatosis. In these patients, liver steatosis was associated mostly to metabolic factors (arterial hypertension and high BMI).

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

BACKGROUND

Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis.

AIM

To determine how to use CAP in interpreting liver stiffness measurements.

METHODS

This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP.

RESULTS

Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis.

CONCLUSIONS

Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

αB-crystallin interacts with and prevents stress-activated proteolysis of focal adhesion kinase by calpain in cardiomyocytes

Focal adhesion kinase (FAK) contributes to cellular homeostasis under stress conditions. Here we show that αB-crystallin interacts with and confers protection to FAK against calpain-mediated proteolysis in cardiomyocytes. A hydrophobic patch mapped between helices 1 and 4 of the FAK FAT domain was found to bind to the β4-β8 groove of αB-crystallin. Such an interaction requires FAK tyrosine 925 and is enhanced following its phosphorylation by Src, which occurs upon FAK stimulation. αB-crystallin silencing results in calpain-dependent FAK depletion and in the increased apoptosis of cardiomyocytes in response to mechanical stress. FAK overexpression protects cardiomyocytes depleted of αB-crystallin against the stretch-induced apoptosis. Consistently, load-induced apoptosis is blunted in the hearts from cardiac-specific FAK transgenic mice transiently depleted of αB-crystallin by RNA interference. These studies define a role for αB-crystallin in controlling FAK function and cardiomyocyte survival through the prevention of calpain-mediated degradation of FAK.

Abstract 187: αB-crystallin Interacts And Prevents Stress-activated Proteolysis Of Focal Adhesion Kinase In Cardiomyocytes

Focal adhesion kinase (FAK) contributes to cellular homeostasis under stress conditions. Here, we show that αB-crystallin confers protection to FAK against calpain-mediated proteolysis under mechanical stress in cardiomyocytes. Biochemical assays, chemical cross-linking coupled to mass spectrometry experiments, mutational analyses and Förster resonance energy transfer (FRET) were combined to investigate the basis of FAK and αB-crystallin interaction. A hydrophobic patch mapped between helices 1 and 4 of the FAK FAT domain was found to bind to the β4-β8 groove of αB-crystallin. Such an interaction requires FAK tyrosine 925 and is enhanced following its phosphorylation by Src, which occurs upon FAK stimulation by mechanical stress. αB-crystallin silencing results in calpain-dependent FAK depletion and in increased apoptosis of cardiomyocytes. The overexpression of a myc-FAK construct or treatment with a calpain inhibitor (E64) restored the survival of cardiomyocytes depleted of αB-crystallin. The association between FAK and αB-crystallin was also demonstrated to occur in response to pressure overload in rat left ventricle. The myocardial depletion of αB-crystallin by siRNA results in enhanced apoptosis of cardiomyocytes and myocardial fibrosis in overloaded hearts. These alterations were markedly attenuated in the overloaded left ventricles of transgenic mice with cardiac specific FAK expression. These findings define a novel mechanism by which αB-crystallin controls FAK function, with impact on cardiomyocyte survival and cardiac remodelling in response to stress.

Abstract 307: Structural Characterization of Calcineurin A-Calsarcin 1 Assembly

Signaling by the calcium-dependent phosphatase calcineurin (Cn) plays key roles in regulating cardiac development, hypertrophy, and pathological remodeling. Cn binds to and is negatively regulated by calsarcins (CS), a family of muscle-specific proteins. However, the molecular mechanisms involved in the inhibition of Cn by CS remain unclear. Understanding the architecture and structure of Cn-CS complex is critical to unravel the regulation of Cn by CS. Here we combined biochemical assays, chemical cross-linking coupled to mass spectrometry experiments (MS/MS), mutational analysis and a modeling strategy for structural characterization of CnA-CS1 assembly. The MS/MS data obtained from the cross-linked peptides of both proteins were used to guide an in silico docking of their polypeptide models. The protein complex models with the smallest estimated binding energy were clustered according to structural similarity and submitted to molecular dynamics simulation. The interacting surface of CnA was mapped in a pocket between the 1st and 3rd α-helixes and surrounding loops, while the corresponding surface of CS1 was mapped to the carboxyterminal loops within the Leu179-Phe185, Phe195-Ser199 and Thr250-Leu264 regions. Notably, the region of CnA that interacts with CS1 was found to be located in close proximity, but not coincident, to the β-sheet 14, the main binding site for the PxIxIT sequence of NFAT. Experiments performed with several CnA (FLAG-CnA) and CS1 (myc-CS1) mutants were used to validate the structural model of the CnA-CS1 assembly. The Lys40 (CnA) and Glu254 (CS1) residues were identified as critical for the complex stability. The model that emerges from this study supports the notion that CS1 interacts with an allosteric site to inhibit the activity of CnA. Alternatively, the close proximity of the CS1 to NFAT interacting site supports an interference of CS1 on the ability of CnA to bind and activate NFAT.

Abstract 304: Crystal Structure Of Fak/mef2 Complex Reveals The Role Of Fak In The Regulation Of Mef2 Transcription Factor

Members of MEF2 (Myocyte Enhancer Factor 2) family of transcription factors are major regulators of cardiac development and homeostasis. Their functions are regulated at several levels, including the association with a variety of protein partners. We have previously shown that FAK (Focal Adhesion Kinase) regulates the stretch-induced activation of MEF2 in cardiomyocytes. But, the molecular mechanisms, involved in this process, are unclear. Here, we integrated biochemical, imaging and structural analyses to characterize a novel interaction between MEF2 and FAK. An association between MEF2 and FAK was detected by co-immunoprecipitation in the extracts of stretched cardiomyocytes (10%, 60Hz, 2 hours). MEF2 and FAK staining were co-localized in the nuclei of stretched cells. Pull down assays indicated that the Focal Adhesion Targeting (FAT) domain is sufficient to confer FAK interaction with MEF2. Gene reporter assays indicated that the interaction with FAK enhances the MEF2C transcriptional activity in cultured cardiomyocytes. Also, we present a 2.9-Å X-ray crystal structure for the FAK_FAT domain bound to MEF2C (1-95), comprised by the MADS box/MEF2 domain. The structural information, when used in combination with biochemical studies, small-angle X-ray scattering (SAXS) data and reporter gene assay, lead to a mechanistic model describing how FAK binds to MEF2C and stimulates its transcription function in cardiomyocytes. We further validated this model by showing that the binding of FAK to MEF2C is essential for the hypertrophy of cardiomyocyte in response to mechanical stress. Our results present FAK as a new positive regulator of MEF2, implicated in the fine control of the signal transduction between focal adhesions and the nucleus of cardiac myocytes during mechanical stress.

A role for focal adhesion kinase in cardiac mitochondrial biogenesis induced by mechanical stress

We studied the implication of focal adhesion kinase (FAK) in cardiac mitochondrial biogenesis induced by mechanical stress. Prolonged stretching (2-12 h) of neonatal rat ventricular myocytes (NRVM) upregulated the main components of mitochondrial transcription cascade [peroxisome proliferator-activated receptor coactivator-1 (PGC-1α), nuclear respiratory factor (NRF-1), and mitochondrial transcription factor A]. Concomitantly, prolonged stretching enhanced mitochondrial biogenesis [copy number of mitochondrial DNA (mtDNA), content of the subunit IV of cytochrome oxidase, and mitochondrial staining-green fluorescence intensity of Mitotracker green] and induced the hypertrophic growth (cell size and atrial natriuretic peptide transcripts) of NRVM. Furthermore, the stretching of NRVM enhanced phosphorylation, nuclear localization, and association of FAK with PGC-1α. Recombinant FAK COOH-terminal, but not the NH(2)-terminal or kinase domain, precipitated PGC-1α from nuclear extracts of NRVM. Depletion of FAK by RNA interference suppressed the upregulation of PGC-1α and NRF-1 and markedly attenuated the enhanced mitochondrial biogenesis and hypertrophic growth of stretched NRVM. In the context of energy metabolism, FAK depletion became manifest by a reduction of ATP levels in stretched NRVM. Complementary studies in adult mice left ventricle demonstrated that pressure overload upregulated PGC-1α, NRF-1, and mtDNA. In vivo FAK silencing transiently attenuated the upregulation of PGC-1α, NRF-1, and mtDNA, as well as the left ventricular hypertrophy induced by pressure overload. In conclusion, activation of FAK signaling seems to be important for conferring enhanced mitochondrial biogenesis coupled to the hypertrophic growth of cardiomyocytes in response to mechanical stress, via control of mitochondrial transcription cascade.

MEF2C silencing attenuates load-induced left ventricular hypertrophy by modulating mTOR/S6K pathway in mice

Background

The activation of the members of the myocyte enhancer factor-2 family (MEF2A, B, C and D) of transcription factors promotes cardiac hypertrophy and failure. However, the role of its individual components in the pathogenesis of cardiac hypertrophy remains unclear.

Methodology/Principal Findings

In this study, we investigated whether MEF2C plays a role in mediating the left ventricular hypertrophy by pressure overload in mice. The knockdown of myocardial MEF2C induced by specific small interfering RNA (siRNA) has been shown to attenuate hypertrophy, interstitial fibrosis and the rise of ANP levels in aortic banded mice. We detected that the depletion of MEF2C also results in lowered levels of both PGC-1α and mitochondrial DNA in the overloaded left ventricle, associated with enhanced AMP:ATP ratio. Additionally, MEF2C depletion was accompanied by defective activation of S6K in response to pressure overload. Treatment with the amino acid leucine stimulated S6K and suppressed the attenuation of left ventricular hypertrophy and fibrosis in the aforementioned aortic banded mice.

Conclusion/Significance

These findings represent new evidences that MEF2C depletion attenuates the hypertrophic responses to mechanical stress and highlight the potential of MEF2C to be a target for new therapies to cardiac hypertrophy and failure.

The water quality of the Ria de Aveiro lagoon, Portugal: from the observations to the implementation of a numerical model

Ria de Aveiro is a very important area of the Portuguese coast, which has been under an increasing anthropogenic pressure for several decades and, contributes to the degradation of the lagoon's water quality. This work presents both a characterisation of the water quality of the Ria de Aveiro lagoon, using physical, chemical and biological experimental data, and an implementation of a numerical model for the water quality of the lagoon. The ultimate goal is to obtain an accurate numerical model able to simulate major water quality features of the lagoon under the influence of different forcing conditions. Data analysis reveals good correlations between the salinity and almost all the water quality variables as well as between the different variables. The maximum biochemical oxygen demand concentration (BOD) depends on the light intensity, the temperature and the river inputs. The main vulnerable areas of the lagoon, from the water quality point of view, seem to be the far end of the main channels, where low dissolved oxygen concentration (DO) and high BOD concentrations are observed. The numerical model of the Ria de Aveiro has reproduced both winter-spring and spring-summer events related to the lagoon water quality as well as its main pattern. Both data and modelling results show that the BOD5 concentrations (where the subscript '5' means that the BOD measurements were conducted for five days, without inhibitor of nitrification) are driven by the river influence, during the winter-spring period, and by the biological activity during the spring-summer period. The DO concentrations show high values in the spring-summer period and smaller concentrations in the winter-spring period at the far end of the lagoon. The application of the model to the study of scenarios has demonstrated the role of nutrients and light in the phytoplankton growth, the relationship between DO and phytoplankton concentrations, as well as the effect of the BOD degradation in the ammonia (NH4) regeneration.

Towards good ecological status of surface waters in Europe--interpretation and harmonisation of the concept

The Water Framework Directive (WFD) is a new legislative framework to manage, use, protect, and restore surface water and groundwater resources and coastal waters in the European Union (EU). The aim is to ensure sustainable water management and to reach good water quality by 2015. The assessment of the ecological status and setting of the practical management goals require several steps. The process has started with the characterisation of the river basins including identification of surface water bodies and types, and identification of significant anthropogenic pressures and impacts. The water bodies will be classified in five quality classes (high, good, moderate, poor, bad) based on the Ecological Quality Ratio, which is a ratio between reference conditions and measured status of the biological quality elements. The normative criteria for high, good and moderate ecological status described in the WFD need to be made operational because those will be used to set the practical quality targets for surface water management. National ecological assessment systems and classifications will be harmonised through the WFD intercalibration exercise in order to ensure an equal level of ambition in achieving good surface waters status all over Europe.

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

OBJECTIVE

Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding.

METHODS

We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coefficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%.

RESULTS

Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%), while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale.

CONCLUSION

Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

Relationship between apparent optical properties and photosynthetic pigments in the sub-alpine Lake Iseo

The aim of the present study was the evaluation of methods for estimating the content of bio-physical parameters in lake water on the basis of spectral reflectance measured above water surface, in particular the estimation of chlorophyll-a (chl-a) concentrations. Data sets considered refer to some sampling point located in the sub-alpine meso-eutrophic Lake Iseo, surveyed six times over the period March-July and once in November 1998, as these months were very important for the characterization of the springtime algal bloom, which affect the lake waters yearly. At each point station, limnological observations (chlorophyll, total suspended solids, Secchi disk depth) were conducted simultaneously with optical measurements. The latter consisted of water leaving radiance measured by means of a spectroradiometer above the water surface; moreover, a standard reflector radiance was also measured to obtain the water reflectance. Reflectance spectra were transformed according to two well-documented models and correlated to water quality parameters, to investigate their performances as retrieval algorithms under different conditions and referring to different analytical methods. Results outline the sensitivity of the models to chl-a concentrations, different phytoplankton composition, and the sampling depth.

Dental erosion: diagnostic-based noninvasive treatment

Lesions that result from dental erosion can be difficult to recognize--particularly when abrasion and attrition are also present. Consequently, dental erosion is often misdiagnosed and mistreated by radical restorative modalities that compromise the vitality of the pulp. This article provides clinicians with knowledge concerning the diagnosis of the complex lesions of dental wear and demonstrates the conservative treatment of this condition. Two cases that exhibit marked tooth wear in anterior teeth and their subsequent restoration utilizing occlusal principles and composite resin are presented.

Endoscopic foraminotomy using MED system in cadaveric specimens

STUDY DESIGN

Four cadavers had cervical foraminotomies performed at noncontiguous levels using either the standard open technique or the microendoscopic technique.

OBJECTIVES

To evaluate the feasibility of using a minimally invasive technique for posterior decompression of cervical disc disease.

SUMMARY OF BACKGROUND DATA

Even though the anterior approach is more commonly performed for the treatment of cervical disc disease, the posterior approach has distinct advantages in selected cases of foraminal stenosis and posterolateral disc herniation. Current technique, however, requires extensive muscle dissection, and is, therefore, subject to significant morbidity.

METHODS

Each of four cadavers had posterior cervical foraminotomies performed using either the MICROENDOSCOPIC (MED) technique, or the standard open technique. Three noncontiguous levels were decompressed using one technique, and the other technique was used for the adjacent contralateral decompression. Each specimen was then evaluated with postoperative myelogram/CT and open dissection. Laminotomy size, length of root decompressed, and percentage of facet removed were measured.

RESULTS

Average vertical diameter decompression and percentage of facet removed were significantly greater for the MED technique than for the open technique. Transverse diameter of the laminotomy area and the average length of decompressed root were not significantly different between the techniques.

CONCLUSION

Posterior cervical foraminotomy, using the microendoscopic technique, is technically feasible and may be applicable to the treatment of foraminal stenosis and laterally located cervical disc herniation. Studies in live animals are currently examining techniques for hemostasis.

Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy

OBJECTIVE

We review the anatomy of the mesial temporal lobe region, establishing the relationships among the intraventricular, extraventricular, and surrounding vascular structures and their angiographic characterization. We also demonstrate the clinical application of these anatomic landmarks in an anatomic temporal lobectomy plus amygdalohippocampectomy.

METHODS

Fifty-two adult cadaveric hemispheres and 12 adult cadaveric heads were studied, using a magnification ranging from 3x to 40x, after perfusion of the arteries and veins with colored latex.

RESULTS

The intraventricular elements are the hippocampus, fimbria, amygdala, and choroidal fissure; the extraventricular elements are the uncus and parahippocampal and dentate gyri. The uncus has an anterior segment, an apex, and a posterior segment that has an inferior and a posteromedial surface; the uncus is related medially to cisternal elements and laterally to intraventricular elements. The anterior segment is related to the proximal sylvian fissure, internal carotid artery, proximal M1 segment of the middle cerebral artery, proximal cisternal anterior choroidal artery, and amygdala. The apex is related to the oculomotor nerve, uncal recess, and amygdala; the posteromedial surface is related to the P2A segment of the posterior cerebral artery inferiorly, to the distal cisternal anterior choroidal artery superiorly, and to the head of the hippocampus and amygdala intraventricularly. The choroidal fissure is located between the thalamus and fimbria; it begins at the inferior choroidal point behind the head of the hippocampus and constitutes the medial wall of the posterior two-thirds of the temporal horn.

CONCLUSION

Not only is the knowledge of these relations useful to angiographically characterize the mesial temporal region, but it has also proven to be of extreme value during microsurgeries involving this region.

Effect of washers on reverse torque displacement of dental implant gold retaining screws

STATEMENT OF THE PROBLEM

Gold screw loosening is a frequent problem that affects dental implants.

PURPOSE

This study determined the effect of spring washers on gold screw displacements during applied removal torque in dental implants.

MATERIAL AND METHODS

A 3-unit fixed partial denture was cast in semiprecious alloy and fixed to 2 dental implants with gold-retaining screws. Implants were embedded in acrylic resin and restrained from movement. A miniature load sensor was attached to a torque controller handpiece to accurately measure the time and torque needed to completely loosen the gold screws. Rotational displacements were calculated for 4 experimental setups, involving washers placed on (a) both, (b) the mesial, (c) the distal, and (d) no implants. Screw displacement data were compared between implants in all 4 combinations by means of paired t tests.

RESULTS

Gold screws with underlying conical spring washers underwent on average up to 35% (14.1 microm) more rotational displacement during applied removal torque than those without washers.

CONCLUSION

Inclusion of a conical spring washer significantly increased the amount of rotational displacement needed to completely loosen an implant gold retaining screw.

Numerical analysis of a dental implant system preloaded with a washer

Gold screw loosening is a problem that frequently affects dental implants. The application of a preload has been the main means of preventing loosening. However, this measure has not been able to eliminate its occurrence. In this study the effect of a washer in a Brånemark-type implant on the loosening conditions of the retaining screw was investigated using a finite element simulation. The simulation indicated that a washer may significantly increase the tolerance of a screw against loosening. This is accomplished by increasing the tolerance of the implant against deformation. The addition of a customized washer to a dental implant system may offer a very simple and inexpensive solution for the persistent problem of screw loosening.

The Tetrahymena chaperonin subunit CCT eta gene is coexpressed with CCT gamma gene during cilia biogenesis and cell sexual reproduction

We report here the cloning and the characterization of the T. pyriformis CCT eta gene (TpCCT eta) and also a partial sequence of the corresponding T. thermophila gene (TtCCT eta). The TpCCt eta gene encodes a protein sharing a 60.3% identity with the mouse CCT eta. We have studied the expression of these genes in Tetrahymena exponentially growing cells, cells regenerating their cilia for different periods and during different stages of the cell sexual reproduction. These genes have similar patterns of expression to those of the previously identified TpCCt gamma gene. Indeed, the Tetrahymena CCT eta and CCT gamma genes are up-regulated at 60-120 min of cilia recovery, and in conjugation when vegetative growth was resumed and cell division took place. Our results seem to indicate that both CCT subunits play an important role in the biogenesis of the newly synthesized cilia of Tetrahymena and during its cell division.

In vitro study of enamel erosion caused by soft drinks and lemon juice in deciduous teeth analysed by stereomicroscopy and scanning electron microscopy

The erosion caused in vitro by cola-type and guaraná-type beverages (the latter is a soft drink sold in Brazil), and a canned lemon juice on the enamel of human deciduous teeth was analyzed. Morphological analysis of affected enamel was done using stereomicroscopy and scanning electron microscopy (SEM). The harmful effect of all test products on deciduous enamel was clearly demonstrated. Stereomicroscopy showed loss of gloss and an alteration in normal color of enamel, with irregular loss of dental tissue in variable degrees. Such a loss became more serious as the time of incubation increased. Different degrees of solubilization of enamel prisms were demonstrated by SEM, affecting initially the sheaths and the heads of prisms and later their tails. Areas of erosion increased in proportion to the time of incubation. All the products showed a great erosive potential on human deciduous dental enamel.

Clinical and laboratory techniques for repair of fractured porcelain in fixed prostheses: a case report

A technique used to repair the abutment tooth of a fixed partial metal-ceramic prosthesis is described. This prosthesis extended from the maxillary central incisor to the left canine. The whole porcelain facial aspect of the central incisor had been fractured. Following a reduction of the metallic structure, a single porcelain crown was bonded to that area. The repair was quick, less expensive and less difficult than removal of the prosthesis and fabrication of a replacement, and provided excellent esthetic and functional results.

The use of natural teeth to make removable partial prostheses and complete prostheses: case reports

Human natural teeth were used in manufacturing two complete prostheses and two partial removable dentures in three patients. All four prostheses continue to function satisfactorily. The practitioner, by utilizing the patient's natural teeth in preference to artificial teeth, achieves an excellent means of solving the patient's esthetic problems.

Coronal fracture with invasion of the biologic width: a case report

To repair a coronal fracture with invasion of the biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured tooth was performed, and the crown was reattached to the tooth remnant with a composite resin system. Results after 6 years revealed optimal periodontal health and reasonable esthetics.