P-646 IVF outcomes of embryos with abnormal PGT-A biopsy previously refused transfer – a prospective cohort study

Study question

Will patients who have embryos diagnosed as abnormal by preimplantation genetic testing for aneuploidy (PGT-A) choose to have those embryos transferred after those embryos were refused transfer at other institutions and what are the potential clinical outcomes of those transfers?

Summary answer

Many patients have selected embryos with PGT-A abnormal trophectoderm biopsies transferred since these embryos can still offer a chance of live birth.

What is known already

PGT-A is a widely practiced method of selecting embryos for transfer based on biopsy of a few cells. Many clinical practices refuse to transfer PGT-A abnormal embryos even when there are no other “normal” embryos available.

Study design, size, duration

This is a prospective cohort of 69 couples who, since 2014, moved a total of 444 PGT-A abnormal embryos previously refused transfer at their parent institutions to our practice. Among these, 50 patients have, thus far, undergone 57 transfer cycles of 141 embryos.

Participants/materials, setting, methods

Embryos diagnosed at other institutions by PGT-A as abnormal (mostly using next generation sequencing) were moved to our academically affiliated private fertility and research center in New York City. Female age at retrieval was 41.35 ± 3.98 years, 74% were Caucasian, 12% Asian and 10% were of African descent. All embryos identified as PGT-A abnormal among prospectively identified couples were recorded in our center’s registry.

Main results and the role of chance

Among the 144 embryos transferred 102 (72.3%) had only 1 or 2 chromosomal abnormalities, 30 (21.3%) had 3 or more and 9 (6.4%) were “undiagnosed” because of degraded DNA, yet still had been refused transfer. Transfer of PGT-A abnormal embryos resulted in 8 live births, 11 miscarriages and no voluntary terminations. One child was born with a segmental duplication and required repair of coarctation of the aorta as a newborn. Many couples with only PGT-A abnormal embryos are willing to have their PGT-A abnormal embryos transferred and such transfers can result in establishment of ongoing euploid pregnancies and live births.

Limitations, reasons for caution

Findings in this case series may not be representative of the wider population of couples undergoing IVF with PGT-A in general. Not all abnormal phenotypes present in the immediate postnatal period so it will be important to continue to follow the development of these children.

Wider implications of the findings

PGT-A can result in a clinics refusal to transfer embryos with abnormal PGT-A biopsies, even those with mosaic findings, consequently large numbers of infertile women are prematurely advised that their only chance of motherhood is through third-party egg-donation.

Trial registration number

Not applicable

P-645 Intra-ovarian injection of autologous platelet-rich plasma (PRP) in poor prognosis IVF patients within 1 year of treatment: a cohort study

Study question

Does intraovarian injection of platelet-rich plasma (PRP) change parameters of ovarian function in patients with evidence of diminished ovarian reserve?

Summary answer

Over one year of follow-up there was no evidence of a positive effect of PRP treatment on ovarian function.

What is known already

Several authors have previously reported positive outcomes and improved response in ovarian function after treatment with PRP. However, thus far, no randomized controlled trials and few cohort studies have been published.

Study design, size, duration

This is a longitudinal cohort study following ovarian response among 80 patients with low functional ovarian reserve (LFOR) defined by AMH < 1.1 ng/mL, FSH > 12 mIU/mL or at least one prior IVF cycle with ≤ 3 oocytes for one year before and one year after intraovarian treatment with PRP.

Participants/materials, setting, methods

1.5 cc of PRP was injected into the cortex of ovaries in an average 12 injections per ovary. Beginning one month after their PRP treatment, patients underwent one or more cycles of ovulation induction for IVF. Outcome measures were endocrine response, and numbers of oocytes and embryos produced in by patients in response to a maximal gonadotropin stimulation before and after PRP treatment.

Main results and the role of chance

In this study women between ages 28 and 54 failed to demonstrate statistically significant outcome benefits from intra-ovarian PRP. Two very poor-prognosis 40-year-old patients with prior failed IVF cycles at other IVF centers that never reached embryo transfer, however, achieved pregnancy in an IVF cycle following PRP treatment for an ongoing pregnancy rate of 4.7% if a patient following PRP achieved retrieval of at least 1 oocyte with IVF.

Limitations, reasons for caution

This is an observational study of patients who performed poorly in past ovulation induction cycles, thus any improvement observed could have been accounted for by regression to the mean. The occurrence of two pregnancies in this group could be secondary to eventual success following a string of previous failures.

Wider implications of the findings

Even extremely poor prognosis will occasionally achieve a successful outcome from IVF. Uncontrolled case series cannot provide sufficient evidence to support routine use of an intervention like PRP. Future studies demand the use of well- controlled randomized trials.

Trial registration number

NCT04275700

201 Correlation between metaphase II oocyte cytoplasmic granulation patterns and intracytoplasmic sperm injection fertilization outcome in older patients

Cytoplasmic granulation is frequently observed in human MII oocytes in fertility clinics from women requiring early egg retrieval (also called highly individualized egg retrieval, with hCG trigger at lead follicle size 16.0-18.0mm or even less) to avoid premature luteinization. Early retrieval is mostly done for older women (≥36 years old) or younger women with premature ovarian aging. However, only limited reports have focused on detailed analysis of the patterns of cytoplasmic granulation and their correlation with the quality of human oocytes. The aim of this report was to evaluate correlation between granulation patterns of human MII oocytes from early retrieval and the corresponding fertilization rates from intracytoplasmic sperm injection (ICSI). Each MII oocyte was imaged when ICSI was performed. The granulation pattern of each oocyte was reviewed, evaluated, and categorized by the same person as non-granulation (NG, homogeneous, sandy pattern, no granulation or granulation area <1/8 of total cytoplasm), central granulation (CG, ring pattern, a cluster of granules in centre with size >1/4 of oocyte diameter), uneven granulation (UG, sandy-rocky pattern, granulation area >1/8 but <3/4 of total cytoplasm), and dispersed granulation (DG, rocky pattern, granulation area >3/4 of total cytoplasm). Fertilization (pronucleus count, PN) results were then extracted from medical records and matched to the granulation categories. In total, 1759 oocytes done with ICSI in year 2018 were analysed. Fertilization (<2PN, 2PN or >2PN) rates of each group (n=381, n=1222, n=156, respectively) were calculated. Student's t-test was used for group-group comparison analysis. Compared with the NG group, the UG and CG groups had lower 2PN rates (67.2% vs. 84.6%; P<0.001; 73.0% vs. 84.6%; P<0.05; respectively) and the DG group had a much lower 2PN rate (43.3% vs. 84.6%; P<0.001). The UG and CG groups had higher <2PN rates (24.8% vs. 12.1%; P<0.001; 24.3% vs. 12.1%; P<0.001; respectively), and the DG group had a much higher <2PN rate (41.1% vs. 12.1%; P<0.001) than the NG group. For >2PN rates, both UG and DG groups were higher than the NG group (8.0% vs. 3.3%; P<0.05; 15.6% vs. 3.3%; P<0.001; respectively), whereas the DG group was higher than the UG group (15.6% vs. 8.0%). These data demonstrated that dispersed granulation was the worst pattern for fertilization. Interestingly, many of the uneven-granulation group oocytes could become homogeneous (non-granulation) after hours or overnight IVM culture, suggesting that uneven granulation might be a sign of incomplete cytoplasmic maturity. Technically, performing ICSI through the less-granulation side was easier because of less resistance to membrane breaking and to pushing sperm out. Discovering the molecular nature of the granules and related cytoskeleton structures would extend our understanding of their existence and improve treatments by adjusting stimulation and trigger accordingly.

Influence of follicular fluid and cumulus cells on oocyte quality: clinical implications

An equilibrium needs to be established by the cellular and acellular components of the ovarian follicle if developmental competence is to be acquired by the oocyte. Both cumulus cells (CCs) and follicular fluid (FF) are critical determinants for oocyte quality. Understanding how CCs and FF influence oocyte quality in the presence of deleterious systemic or pelvic conditions may impact clinical decisions in the course of managing infertility. Given that the functional integrities of FF and CCs are susceptible to concurrent pathological conditions, it is important to understand how pathophysiological factors influence natural fertility and the outcomes of pregnancy arising from the use of assisted reproduction technologies (ARTs). Accordingly, this review discusses the roles of CCs and FF in ensuring oocyte competence and present new insights on pathological conditions that may interfere with oocyte quality by altering the intrafollicular environment.

Investigation of the in-plane and out-of-plane electrical properties of metallic nanoparticles in dielectric matrix thin films elaborated by atomic layer deposition

Pt nanoparticles in a Al₂O₃ dielectric matrix thin films are elaborated by means of atomic layer deposition. These nanostructured thin films are integrated in vertical and planar test structures in order to assess both their in-plane and out-of-plane electrical properties. A shadow edge evaporation process is used to develop planar devices with electrode separation distances in the range of 30 nm. Both vertical and planar test structures show a Poole-Frenkel conduction mechanism. Low trap energy levels (<0.1 eV) are identified for the two test structures which indicates that the Pt islands themselves are not acting as traps in the PF mechanism. Furthermore, a more than three order of magnitude current density difference is observed between the two geometries. This electrical anisotropy is attributed to a large electron mobility difference in the in-plane and out-of-plane directions which can be related to different trap distributions in both directions.

181 CYTOSKELETAL AND CHROMOSOMAL ORGANIZATION IN DEVELOPMENTALLY ARRESTED EQUINE ZYGOTES AFTER INTRACYTOPLASMIC SPERM INJECTION

Intracytoplasmic sperm injection (ICSI) has been developed as a clinical procedure in the equine industry. Not all sperm-injected oocytes develop into embryos; however, the causes of developmental failure after equine ICSI have not been studied. Our objective was to use confocal microscopy to evaluate sperm-injected equine oocytes from young and old mares that did not cleave in a clinical ICSI program, to study the hypothesis that cleavage failure is associated with cytoskeletal and chromosomal alterations and affected by mare age. Oocytes were collected from the dominant follicles of young (Y; 5–15 years old) and old (O; 20–24 years old) oestrous mares approximately 24 h after administration of deslorelin and hCG. At approximately 44 h after deslorelin and hCG administration, oocytes were injected using frozen-thawed sperm from various stallions. Injected oocytes (n = 15) that failed to cleave by 24 to 48 h were fixed in microtubule stabilization buffer extraction fixative (MTSB-XF) and stained for DNA, α/β tubulin, acetylated α-tubulin, and f-actin. Confocal z-stacks were obtained using a Zeiss LSM 5 microscope (Carl Zeiss Microscopy LLC, Thornwood, NY), and images were assessed for cytoskeletal structures and chromosome organisation using the Zeiss LSM image browser. Potential zygotes (Y: n = 6 and O: n = 9) were categorized for (1) 2 sets of chromosomes, (2) misaligned chromosomes, (3) oversized spindles (approximately twice the size of an MII spindle), and (4) actin bubbling. The number of zygotes in each category for Y and O mares were compared by Fisher's exact test. Some samples were included in more than 1 morphological category. Two separate sets of chromosomes were observed in 1 of 6 and 4 of 9 injected oocytes from Y and O mares, respectively (P = 0.58), with development stopping before fusion of male and female pronuclei. Misaligned chromosomes were present in 2 of 6 and 7 of 9 oocytes from Y and O mares, respectively (P = 0.14). Oversized spindles were observed in more Y than O potential zygotes (5 of 6 and 2 of 9, respectively, P = 0.04), representing fusion of male and female pronuclei before developmental arrest. Multiasters were associated with the oversized spindles in potential zygotes from Y (2 of 6) and O (2 of 9) mares (P = 1), with microtubule activity potentially associated with the first mitotic division. Structures associated with actin bubbling tended (P = 0.12) to be higher in uncleaved zygotes from Y than O mares (5 of 6 and 3 of 9, respectively). Of the 15 injected oocytes, 10 arrested after fusion of male and female pronuclei. We have previously observed a high incidence of chromosomal misalignment in metaphase II oocytes from old mares. In the small number of potential zygotes that were studied, chromosomal misalignment tended (P = 0.14) to be higher for old mares. Other observations, such as oversized spindles and actin bubbling, appeared to be more prevalent in the potential zygotes of Y than O mares; these observations could be associated with normal development or post-ovulatory aging of the oocyte. Additional work will focus on the roles of actin and microtubules in remodelling the cytoplasm and organizing the chromosomes after fertilization in the horse and on the role of maternal aging in fertilization failure.

Isolated and preclinical impairment of left ventricular filling in insulin-dependent and non-insulin-dependent diabetic patients

BACKGROUND

Diabetes mellitus can induce a pattern of myocardial pathology known as specific diabetic cardiomyopathy, even if this is not clearly specified.

HYPOTHESIS

The aim of our study was to evaluate the presence of preclinical myocardial damage in insulin- and non-insulin-dependent diabetic patients and controls by assessment with Doppler echocardiography.

METHODS

Twenty insulin-dependent diabetic (IDDM) patients, 10 non-insulin-dependent diabetic (NIDDM) patients, and 12 healthy individuals (C) as controls, matched for age, gender, and without overt cardiovascular disease, were assessed in this study.

RESULTS

Systolic function parameters presented normal values in the three groups, with the exception of a slight reduction in ventricular volume indices in the NIDDM group. Diastolic function was clearly impaired in both groups of patients versus that in healthy controls. In particular, ventricular filling was impaired in the NIDDM compared with the IDDM patients, especially the peak early filling rate E (p < 0.001). Moreover, in the IDDM group, the duration of diabetes (p < 0.01) and glycosilated hemoglobin value (HbA1C, p < 0.02) were higher than in the NIDDM group. Multiple regression analysis showed a significant inverse correlation between HbA1C and peak late filling rate A (R2 = 0.28) in both groups of patients and a direct correlation between velocity time integral E and age, duration of diabetes, and HbA1C (R2 = 0.46). The two groups presented a small, homogeneous number of cases with initial microangiopathy and borderline autonomic neuropathy, associated with microalbuminuria. Doppler echocardiography showed an early impairment of left ventricular filling, as well as an early preclinical alteration of myocardial function in diabetic patients, especially in the NIDDM group.

CONCLUSION

These early signs of cardiomyopathy could constitute a predisposing condition toward the high cardiac morbidity and mortality rate in diabetic patients.

Permeability of human oocytes to ethylene glycol and their survival and spindle configurations after slow cooling cryopreservation

BACKGROUND

To develop novel cryopreservation methods, we estimated the permeability coefficients Lp (hydraulic conductivity) and P(EG) (cryoprotectant permeability) of mature human oocytes after exposure to ethylene glycol (EG) and tested the efficiency of a multi-step slow cooling protocol based on this cryoprotectant.

METHODS

Oocytes were perfused with 1.5 mol/l EG for 10 min. Oocyte volume at each time point was calculated and normalized to the original volume. Slow cooling was conducted by exposing oocytes to increasing EG concentrations (0.5, 1.0 and 1.5 mol/l n = 155) or 1.5 mol/l of propane-1,2-diol (PrOH) n = 102. Oocytes which survived cryopreservation n = 80 and fresh oocytes n = 73 were prepared for confocal microscopy analysis of the meiotic spindle.

RESULTS

During EG exposure, oocytes underwent an abrupt 50% volume reduction. Complete recovery of the initial volume was not observed. From the values of a best fit plot, the coefficients Lp = 0.82 +/- 0.29 microm min(-1) atm(-1) (mean +/- SD) and P(EG) 0.10 +/- 0.01 microm s(-1) were generated. Survival rates after freezing with EG were lower than with PrOH (51.6 versus 71.5%, respectively, P < 0.05). The frequencies of normal spindle configuration were lower in frozen EG and frozen PrOH oocytes compared with fresh oocytes (53.8, 50.9 and 66.7%, respectively, P < 0.05).

CONCLUSIONS

The oocyte plasmalemma possesses limited permeability to EG and EG exposure causes considerable osmotic stress. However, post-thaw rates of survival and normal meiotic spindle organization may be preserved by protocols which are designed in order to minimize osmotic stress.

Sucrose concentration influences the rate of human oocytes with normal spindle and chromosome configurations after slow-cooling cryopreservation

BACKGROUND

Recently described slow-cooling cryopreservation protocols involving elevated sucrose concentration have improved survival frequencies of human oocytes, potentially overcoming a major hurdle that has limited the adoption of oocyte storage. Because implantation rates of embryos from frozen oocytes remain generally low, it is still debated whether, irrespective of survival rates, this form of cryopreservation leads inevitably to the disruption or complete loss of the metaphase II (MII) spindle.

METHODS

Human oocytes with an extruded polar body I (PBI) were cryopreserved using a slow-cooling method including 1.5 mol/l propane-1,2-diol (PrOH) and alternative sucrose concentrations (either 0.1 or 0.3 mol/l) in the freezing solution. Fresh control and frozen-thawed survived oocytes were analysed by confocal microscopy to evaluate MII spindle and chromosome organizations.

RESULTS

Of the 104 oocytes included in the unfrozen group, 76 (73.1%) displayed normal bipolar spindles with equatorially aligned chromosomes. Spindle and chromatin organizations were significantly affected (50.8%) after cryopreservation involving lower sucrose concentration (61 oocytes), whereas these parameters were unchanged (69.7%) using the 0.3 mol/l sucrose protocol (152 oocytes).

CONCLUSIONS

Partial disruption of the MII spindle and associated chromosomes accompanies inadequate cryopreservation during slow cooling. However, protocols adopting higher sucrose concentration in the freezing solution promote the retention of an intact chromosome segregation apparatus comparable in incidence to freshly collected oocytes.

Surgical repair of thoracic aortic aneurysms: results and complications

Between January 1990 and February 2001 a total of 323 patients underwent following operations at our Institution: respectively 256 on the ascending aorta, 13 on the transverse arch and 54 on thoracic descending aorta. Sixteen patients with thoracic aortic aneurysms underwent endovascular stent graft implantation. The overall in-hospital mortality was respectively: 7% for ascending aortic aneurysms, 7.7% in the aortic arch aneurysms group and 5.5% for descending aortic aneurysms. The mortality was greater in case of emergency surgery and in the subgroup of patients with acute type A dissection. Stroke with permanent dysfunction occurred in 1.5% of ascending aneurysms, 7.7% of arch aneurysms and in 3.7% of thoracic descending aneurysms. In the latter group, all the major neurological events were related to conventional surgical procedures only: really no mortality or neurological morbidity occurred with endovascular stent graft implantation. Even if modern physiologic monitoring devices and new surgical techniques have been developed in the last years, the treatment of thoracic aortic aneurysms remains challenging. Endoluminal placement of stent grafts has developed as an alternative procedure for the treatment of thoracic aortic aneurysms, even if longer term follow-up is still necessary to fully define the efficacy of this approach.

Cardiac Troponin T to evaluate myocardial protection via intermittent cold blood or continuous warm blood cardioplegia in coronary artery bypass grafting

BACKGROUND

The aim of our study was to evaluate the efficacy of myocardial protection during coronary artery bypass grafting (CABG) in cold blood intermittent (CBIC) and warm continuous blood cardioplegia (WCBC). To assess myocardial necrosis, Troponin T, a structural protein belonging to the troponin complex, was measured. Troponin T is released in the blood stream 4 hours after myocardial damage, and it does not cross-react with the isomeric form of the skeletal muscle.

METHODS

Our study involved 20 consecutive patients, scheduled for isolated CABG. They were divided into two groups: the first group (10 patients; 8 m, 2 f) underwent surgery with the use of CBIC, the second group (10 patients; 9 m, 1 f) with WCBC. The serum levels of cardiac Troponin T (cTn-T) were all <0.2 microg/l before operation.

RESULTS

In the CBIC the mean cTn-T peaked on the 1st day after CABG, in the WCBC group the first peak occurred in the 2nd hour after arrival in the intensive care unit, and the second peak occurred on the 4th day postoperatively. The mean serum cTn-T was lower in the WCBC vs CBIC group from the 1st to the 5th day postoperatively, with a statistical difference on the 1st day (p<0.05). In the CBIC group either the cTn-T peak values (r=0.77; p<0.02) or area under the concentration curve of cTn-T release (r=0.85; p<0.004), were directly correlated with the aortic cross-clamping time. This was not demonstrated in the WCBC. CPK and CK-MB peaked in both groups 6 hours after arrival in the intensive care unit and on the 1st day postoperatively, with higher values at 6 hours in the WCBC group (p<0.05). The CK-MB/CPK ratio was significantly lower in the WCBC group at the six hours (p<0.05).

CONCLUSIONS

The results of this preliminary study suggest that fewer necrosis markers are released during CABG in the WCBC group; in the CBIC group the release of cTn-T whether measured by peak serum level or by area under the curve, shows a statistically significant correlation with cross-clamping time. Warm blood cardioplegia is safe and supplies adequate myocardial protection during CABG; the more prolonged cross-clamping is, the more myocardial protection is afforded by WCBC.

[Doppler echocardiographic study of left ventricular function in patients with systemic lupus erythematosus]

This study was aimed at investigating abnormalities in left ventricular size and function in patients with systemic lupus erythematosus without overt cardiovascular manifestations, in order to detect a very early impairment in myocardial function. Seventeen females and 1 male with systemic lupus erythematosus of 4 to 20 year duration and without clinical evidence of heart disease were studied. Twelve healthy volunteers, matched for age, sex and quatelet index, were utilized as controls. Each patient had a two-dimensional M-mode echocardiographic and Doppler examination. In patients with systemic lupus erythematosus there was an increase in left ventricular ejection fraction (p < 0.001), a slight reduction of end-diastolic volume index and a significant decrease of end-systolic volume index (p < 0.001). In the same patients we also found prolongation of the isovolumic relaxation time (p < 0.02), a clear impairment of diastolic filling parameters. Peak E velocity was lower (p < 0.01), peak A velocity was higher (p < 0.01), with a clear lowering, of the corresponding E/A ratio (p < 0.001) in patients with systemic lupus erythematosus.

Hemodynamic, respiratory, and metabolic effects of medium-chain triglyceride-enriched lipid emulsions following valvular heart surgery

STUDY

A lipid emulsion containing 10 percent medium-chain triglycerides (MCT) and 10 percent long-chain triglycerides (LCT) was infused at a rate of 1 ml/kg/h (3.3 mg/kg/min) for 2 h, in 12 patients (2 males, 10 females; mean age, 54 +/- 3 (SEM) years; range, 34 to 67 years) 24 h after open-heart surgery (mitral valve replacement).

METHODS

Hemodynamic factors (pulmonary and radial artery indwelling catheters), oxygen and carbon dioxide partial pressures, oxygen saturation, oxygen delivery and consumption, and intrapulmonary shunt fraction were obtained before, during, and after lipid infusion (for 2 h), at 30-s intervals, along with some metabolic indexes (triglycerides, free fatty acids, glucose, insulin, lactate, acetoacetate).

RESULTS

No statistically significant changes in heart rate, cardiac index, systemic and pulmonary pressures and resistances, central venous and pulmonary capillary pressures, or arterial oxygen partial pressure were observed during infusion. Arterial carbon dioxide partial pressure values were constantly reduced throughout and after the end of lipid infusion, as compared with baseline values, while oxygen consumption was increased significantly without any change in oxygen delivery. No adverse effects on intrapulmonary shunt fraction were observed. Statistically significant increases of triglycerides, free fatty acids, acetoacetate and insulin (peak values at end of the lipid infusion) were found in comparison with baseline values. Plasma glucose increased significantly during lipid infusion and remained higher than baseline values until the end of the study. Lactate levels were unchanged except for a slight decrease at the end of the study, without any derangement of acid-base equilibrium. Neither arrhythmias nor adverse clinical reactions were observed as a consequence of lipid infusion.

CONCLUSIONS

Fat emulsions containing both MCT and LCT, when given at 3.3 mg/kg/min for 120 min following valvular heart surgery, do not exert negative cardiopulmonary effects, and could represent a source of rapidly metabolized substrates.

[Effects of total laryngectomy on the quality of life: a study on certain psychological aspects]

The importance of certain psychological aspects during post-surgical rehabilitation of laringectomized patients is being more and more emphasized in research on the subject. The aim of this study is to consider a group of 55 patients who had undergone a total laryngectomy 6 to 48 months previously. The patients studied spoke using an esophageal voice and were chosen from among a group of 400 operated in our Department. This investigation was carried out not only from an organic point of view but took into consideration the consequence of such an important disability in the personal psychological, social, domestic and relational sphere as well. The study was carried out through a partially guided interview whose aim was to obtain anamnestic information regarding psychological symptoms present at the moment of the interview, the amount of understanding of the patients and their relatives concerning the diagnosis and the signs of sinergy. The Zung scale for self-evaluation of depression and the STAI scale for state and trait anxiety were employed. Through a careful scrutiny of the data, it appeared that the quality of life was the main problem, above all because such a problem is an inevitable consequence of lost vocal functionality. We found that the overall average score of the Zung scale was 31.6% (A patient who obtains a score higher than 40% is considered depressed). Twelve patients among those we examined were above this threshold level. The score of the STAI scale partially overlapped those obtained by a control group made up of patients suffering from anxiety disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

[Critical myocardial ischemia in systemic lupus erythematosus. Case report]

We present the clinical case of a 26-year-old woman, suffering systemic lupus erythematosus for 15 years, who suddenly had coronary heart disease with angina pectoris on mild effort. Thallium 201 exercise test demonstrated clearcut anteroseptal and apical perfusion defects, whereas repeated echocardiography showed a hypokinetic anteroseptal segment; ECG also reported new Q wave in lead V4. After stronger corticosteroid and immunosuppressive treatment, angina pectoris attenuated and perfusion defects disappeared within few months. We hypothesize a coronary artery vasculitis in the course of systemic lupus erythematosus, probably associated with early coronary artery atherosclerosis.

[Assessment of perioperative myocardial damage based on circulating heavy chain myosin fragments]

To evaluate myocardial damage induced by coronary bypass surgery, to construct a reference data set in postoperative patients and to ascertain the impact of perioperative myocardial infarction on myosin release from sarcolemmal membrane we serially measured levels of serum fragments of myosin heavy chains by means of monoclonal antibody immunoradiometric assay (MYOSIN IRMA ERIA Pasteur). After surgery serum levels of myosin increased from third postoperative day and peaked on seventh day. Peak myosin levels did correlate with enzymatic activities of CPK (r = 0.69; p < 0.001) and of CPK-MB (r = 0.75; p < 0.001). Six patients suffered postoperative myocardial infarction: in these patients myosin levels were significantly different from those without infarctions (3651 +/- 1569 versus 699 +/- 206 ng/ml; p < 0.01). No correlation could be demonstrated between cardiopulmonary bypass time or aortic cross clamp duration. The rise of myosin levels observed in nearly all patients suggests a minor intraoperative damage to the contractile apparatus that sometimes is diagnosed as myocardial infarction and often does not meet clinical diagnostic criteria.

[Arterial blood pressure in a population of Italian clerical workers. Correlation with other coronary risk factors]

Distribution of arterial blood pressure and prevalence of hypertension have been reported in 172 subjects (568 males and 144 females), derived from screening of a bank clerks population. 99 subjects were found to be hypertensive: 46 (46.4 p. 100) were aware of being hypertensive, 24 (24.3 p. 100) resulted to be under treatment and only in 5 subjects blood pressure values were effectively controlled. The relationships between arterial blood pressure and some recognized or suspected coronary risk factors were also determined by multiple regression analysis. Age, heart rate, body mass index, glycemia after loading, turned out the variables most correlated with blood pressure. The multiple regression analysis showed that overall evaluation of coronary risk factors explained up to 21 p. 100 of the systolic blood pressure variation and to 17 p. 100 of diastolic pressure in male subjects, while for women the obtained values were 34 p. 100 and 24 p. 100 respectively. After a critical evaluation of different parameters able to affect arterial blood pressure, the difficult approach to hypertension preventive and therapeutic problems was emphasized.

Different prognostic value of exercise electrocardiogram in men and women

In 1,455 subjects (947 men and 508 women) who underwent a bicycle ergometer stress test for evaluation of atypical chest pain, the incidence of coronary events (definite myocardial infarction or sudden death) was assessed by the life table method. The follow-up period ranged from 3 to 7 years (mean 5.2 years). In men with positive exercise test (ischemic ST depression greater than or equal to 1 mm), the 5-year incidence of coronary events was 18.3%, compared with 1.9% in negative responders. In women with positive response, the 5-year incidence of coronary events was 4.6%; in negative responders, it was 0.3%. The poor predictive value of ischemic ST responses to exercise in women is emphasized.

[Epidemiological study on coronary risk factors in a population of clerks in Parma. Methods of research and 1st results]

After a review of current literature, the AA. present the purposes and the methods of an epidemiological study on coronary risk factors in selected bank-clerks of Parma, in view to correlate the dietary factors, possible methabolic alterations, psychical behaviour, social and environmental position and coronary risk evaluated by electrocardiographic stress test. In this respect, the AA. report and discuss, as example of the reliability and validity of the investigative model followed, the preliminary results observed in the 274 subjects up to this time controlled.