Chronic inflammation: A key role in degeneration of bicuspid aortic valve

INTRODUCTION

Bicuspid aortic valve (BAV) is the most common congenital valvular heart defect resulting from abnormal aortic cusp formation during heart development, where two of the three normal and equal sized cusps fuse into a single large cusp resulting in a two cusps aortic valve. Over the past years, much interest has been given in understanding the pathogenesis of BAV and its complications. In this review, we focused on the role of inflammation, involved in the degeneration of BAV and the development of its complications.

ROLE OF INFLAMMATION

From a pathophysiological point of view, BAV may rapidly progress into aortic stenosis (AS) and is related to aortopathy. Several histopathologic studies have demonstrated that the development and progression of alterations in bicuspid aortic valve are related to an active process that includes: oxidative stress, shear stress, endothelial dysfunction, disorganized tissue architecture, inflammatory cells and cytokines. These factors are closely related one to each other, constituting the basis of the structural and functional alterations of the BAV.

CONCLUSION

Chronic inflammation plays a key role in the degeneration of BAV. Severe aortic stenosis in bicuspid aortic valves is associated with a more aggressive inflammatory process, increased inflammatory cells infiltration and neovascularization when compared to tricuspid AS. These findings might help to explain the more frequent onset and rapid progression of AS and the heavy aortic valve calcification seen in patients with BAV.

Evaluating the efficacy of current treatments for reducing postoperative ileus: a randomized clinical trial in a single center

AIM

Postoperative ileus has been considered an inevitable consequence of abdominal surgery. The aim of the study was to investigate the efficacy of same treatments in resolving postoperative ileus in various surgical approaches.

METHODS

A total of 360 patients underwent abdominal surgery, and was divided into four groups: videolaparoscopic cholecystectomy, laparotomic colo-rectal surgery, laparotomic Hartmann procedure, laparotomic gastric surgery. In each group, patients received different postoperative treatments: chewing gum, olive oil, both, and water. Each group was compared with a control group.

RESULTS

In patients who underwent videolaparoscopic cholecystectomy, median postoperative first passage of flatus and stool in the water group was 10 and 34 hours, respectively (P=0.006, P=0.021) and significantly earlier than in the control group (median postoperative 24 and 72 hours). Postoperative stay for the water group was lower (median day 1, 3rd interquartile 2.5) compared with control (median day 3; 3rd interquartile 7.0, P=0.01). In patients who underwent gastric surgery, median postoperative first passage of stool in the olive oil and chewing gum group was 48 hours, significantly earlier than in the control (median postoperative hour 120, P=0.04). Median time to first passage of flatus and stool was also earlier in the other groups compared with the control group, though this difference was not significant.

CONCLUSION

Chewing gum, olive oil or both do not induce a relevant reduction of ileus after surgery. Water may be a safe and inexpensive option in reducing ileus. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT01869231).

Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis

OBJECTIVE

To assess the clinical efficacy of chondroitin sulfate (CS) in comparison with the nonsteroidal antiinflammatory drug (NSAID) diclofenac sodium (DS) in a medium/longterm clinical study in patients with knee osteoarthritis (OA).

METHODS

This was a randomized, multicenter, double blind, double dummy study. 146 patients with knee OA were recruited into 2 groups. During the first month, patients in the NSAID group were treated with 3 x 50 mg DS tablets/day and 3 x 400 mg placebo (for CS) sachets; from Month 2 to Month 3, patients were given placebo sachets alone. In the CS group, patients were treated with 3 x 50 mg placebo (for diclofenac) tablets/day and 3 x 400 mg CS sachets/day during the first month; from Month 2 to Month 3, these patients received only CS sachets. Both groups were treated with 3 x 400 mg placebo sachets from Month 4 to Month 6. Clinical efficacy was evaluated by assessing the Lequesne Index, spontaneous pain (using the Huskisson visual analog scale), pain on load (using a 4 point ordinal scale), and paracetamol consumption.

RESULTS

Patients treated with the NSAID showed prompt and plain reduction of clinical symptoms, which, however, reappeared after the end of treatment; in the CS group, the therapeutic response appeared later in time but lasted for up to 3 months after the end of treatment.

CONCLUSION

CS seems to have slow but gradually increasing clinical activity in OA; these benefits last for a long period after the end of treatment.

[Evaluation of a new non-steroidal anti-inflammatory agent in degenerative osteo-articular pathology]

Cinnoxicam (Sinartrol) was used in 20 patients with inflammatory-degenerative osteoarticular diseases. The new NSAID was administered by oral or rectal route once daily for a standard 15-day period. The treatment brought about a significant improvement in the clinical variables considered (spontaneous pain at rest and on movement and functional limitation), which was observed within a few days of starting therapy. Tolerance was good, only a few slight side-effects having been reported.

Epidemiology of hip fractures in Siena, Italy, 1975-1985

A survey of 1567 fractures of the proximal end of the femur due to minor trauma occurring in elderly people was performed. The fracture incidence rate per 100,000 individuals in the population at risk was calculated. Hip fracture prevailed in women with a sex ratio of women to men of 3.81; in both sexes the incidence was more closely related to age than any other factor. The incidence rate of fracture increased significantly in women during the period from 1975 to 1985, whereas there was no significant increase in men during this time. This change may be related to the continuing trend toward a greater proportion of elderly women in the population. The incidence rate in men showed a long-cycle periodic behavior correlated with the long-cycle trend of cloud cover and rainfall; it is possible that precipitation and a greater occurrence of femoral fractures might be interrelated in men. This parallelism was not evident in women. In women the rise in fracture rate was not continuous but decreased periodically. The zeniths of fracture incidence were preceded two years by a decrease in temperature and an increase in cloud cover and rainfall, suggesting a possible relationship between fractures and the diminution of ultraviolet radiation.