Oxidative Stress and Low-Grade Inflammatory Status as Cardiometabolic Risk Factors in Italian Occupational Overweight/Obese Subjects

Obesity is associated with increased risk of cardiometabolic diseases. Adipocytokines (e.g. leptin), produced by the endocrine function of adipose tissue, can contribute to cardiometabolic risk in overweight and obese people. Oxidative stress, imbalance between oxidants and antioxidants, is considered a cardiovascular risk factor. High serum oxidized LDL (oxLDL) levels, marker of lipid peroxidation, a primary cause of atherosclerosis, can contribute to its progression. The aims of this study are to assess markers of oxidative status and cytokine profile and evaluate their role as cardiometabolic risk factors and possible correlations. In this cross-sectional study, we enrolled 76 occupational overweight-obese adults (46 females, 30 males; aged 46.8±9.5; BMI 33.7±4.8 kg/m2) without any previous cardiovascular disease. Oxidative status was measured by evaluating serum Reactive Oxygen Species (ROS) levels, Total Antioxidant Capacity (TAC) and oxLDL concentrations. All subjects' soluble cytokine and adhesion molecule levels were evaluated by cytofluorimetric method and compared with 35 controls matched for sex and age. ROS and oxLDL levels were high in 84% and 92% of the study population, respectively, despite adequate TAC (68%). Female ROS levels were significantly higher than those of males (414±99.3 vs 318±48.2 UCarr, p<0.0001), while their oxLDL levels were lower (95.3±22 vs 105.2±19.4 U/L, p=0.1). Leptin and sICAM-1 (intracellular adhesion molecule involved in leukocyte migration to inflamed area) levels of the study population were significantly higher than those of controls (93.8±89.1 vs 25.3±23 ng/mL, p=0.0002 and 505.8±236.7 vs 339.2±119.6 ng/mL, p=0.0009, respectively). Overweight/obese occupational subjects showed oxidative stress conditions accompanied by low chronic inflammatory status, possibly contributing to increased cardiometabolic risk.

Erythroid differentiation and maturation from peripheral CD34+ cells in liquid culture: cellular and molecular characterization

In vitro models of human erythropoiesis are useful in studying the mechanisms of erythroid differentiation from BFU-E to mature erythrocytes both in normal and pathological conditions. Most of the available in vitro liquid cultures are from cell lines or are limited by the production of few erythroid cells mixed with myeloid cells. Here we describe an erythroid liquid culture system starting from CD34(+)-enriched cells obtained from peripheral blood. CD34(+) cells were cultured for 21 days in different conditions. Precisely stem cell factor (SCF, 20 ng/mL) and IL-3 (10 ng/mL) were added at starting point plus Epo (3 U/mL) at day 0 or 7 of culture with or without cyclosporine A (Cy; 1 mg/mL). In all the conditions, the highest recovery was obtained at day 14 of culture. Epo and Cy added at day 0 produced the highest cell expansion (170-fold mean amplification of the initial cell input by day 14) and recovery of erythroid cell. Sixty seven percent of the cells were GP(+) at day 7 and 97% by day 14 respectively. Most of the cells were proerythroblasts at day 7 and mature erythroblasts at day 14 (>90% were benzidine(pos)). The presence of Cy favoured erythroid differentiation and maturation and reduced the percentage of non-erythroid CD45(+) cells (2% with Cy versus 5% without Cy). Cells cultured with Epo and Cy reproduced erythropoiesis also at the molecular level. The results suggest that in 14 days different steps of human erythropoiesis from peripheral CD34(+) cells could be reproduced, with high recovery of highly purified erythroid cells. The high number and purity of erythroid cells produced from a small amount of peripheral blood make this method useful for studying either normal or pathological erythropoiesis.

The effects of prolonged cardiopulmonary bypass on cell-mediated immunity

Studies of T-cell subsets (CD3+, CD4+, CD8+, CD8+ CD57+ cells), lymphocyte response to concanavalin A (Con A), phytohaemoagglutinin (PHA) and the alterations of white cell membranes shown by scanning electronic microscope (SEM) in 51 patients who underwent cardiac operation were performed. Out of these 51 unselected patients, for 16, duration of CPB was < or = 110 min (group A), while for the other 35 (group B) it was prolonged (> 110 minutes). Although variations of the lymphocyte subset observed between groups A and B were slightly significant (p < 0.05 before CPB and on postoperative day 7), the T-cell reactivity in group B in comparison to that of group A did not normalize by postoperative day 7 regardless of stimulation with PHA or with Con A. With the use of the SEM, the folded aspect of lymphocyte surface decreased after surgery in about 71% (group A) and 78% (group B) of the observed cells. The outcome of the immunological effects given by our studies could have been due to an elongated CPB even if there need to be taken into consideration multifactorial influences, i.e. biological, pharmacological and hormonal hypotheses, and rapid changes in CPB-micro-environment.

Cardiac myxomas: results of 14 years' experience

From January 1968 to July 1983, 38 patients with an intracardiac myxoma underwent surgical excision of the tumor at our Institution. There were 15 males and 23 females, ranging in age from 17 to 68 years (mean 47.7). In all but 2 patients, the presence of an intracardiac myxoma was documented preoperatively by angiographic and/or echocardiographic study. The first 2 patients of this series were referred with the diagnosis of mitral stenosis, and the myxoma was an unexpected surgical finding. In 32 cases (84.2%) the myxoma was located in the left atrium, in 4 (10.5%) in the right atrium and in 2 (5.3%) in the right ventricle. Surgery was performed on an emergency basis in 36 patients. Two patients (5.2%) both with a left atrial myxoma, died after surgery: one died intraoperatively of hemorrhage and the other after one month of bowel infarction. Follow-up of the 36 survivors ranges from 3 months to 14.5 years (average 5.2 yr); all were controlled by means of clinical and echocardiographic investigations, and no evidence of tumor recurrence was detected. Surgery for intracardiac myxoma, which should be undertaken on an emergency basis, carries a low operative risk; excision of the tumor appears to be curative with no recurrences at long-term follow-up; non-invasive tools are of the utmost importance in both the preoperative assessment and follow-up of these patients.

Delayed cardiac tamponade following open heart surgery. Analysis of 12 patients

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.