Spotlight on islands: on the origin and diversification of an ancient lineage of the Italian wall lizard Podarcis siculus in the western Pontine Islands.

Groups of proximate continental islands may conceal more tangled phylogeographic patterns than oceanic archipelagos as a consequence of repeated sea level changes, which allow populations to experience gene flow during periods of low sea level stands and isolation by vicariant mechanisms during periods of high sea level stands. Here, we describe for the first time an ancient and diverging lineage of the Italian wall lizard Podarcis siculus from the western Pontine Islands. We used nuclear and mitochondrial DNA sequences of 156 individuals with the aim of unraveling their phylogenetic position, while microsatellite loci were used to test several a priori insular biogeographic models of migration with empirical data. Our results suggest that the western Pontine populations colonized the islands early during their Pliocene volcanic formation, while populations from the eastern Pontine Islands seem to have been introduced recently. The inter-island genetic makeup indicates an important role of historical migration, probably due to glacial land bridges connecting islands followed by a recent vicariant mechanism of isolation. Moreover, the most supported migration model predicted higher gene flow among islands which are geographically arranged in parallel. Considering the threatened status of small insular endemic populations, we suggest this new evolutionarily independent unit be given priority in conservation efforts.

Validation of the 3-lead tele-ECG versus the 12-lead tele-ECG and the conventional 12-lead ECG method in older people.

We compared the diagnostic accuracy of 3-lead tele-ECGs to both 12-lead tele-ECGs and a conventional 12-lead ECG device (the gold standard). The subjects were older people (n = 107) with a mean age of 66 years. The overall agreement between two cardiologists on interpreting the 3-lead tele-ECG recordings was 97% (kappa = 0.96, P < 0.001) and it was 91% for the 12-lead tele-ECGs (kappa = 0.90, P < 0.001). We also found excellent agreement on the interpretation of the 3-lead tele-ECGs compared to the gold standard: 98% (kappa = 0.96, P < 0.001) and for the 12-lead tele-ECG compared to the gold standard: 98% (kappa = 0.96, P < 0.001). Bland-Altman plots showed that the apparent differences between the techniques were not clinically relevant. The use of a 3-lead tele-ECG device may be useful for reducing the delay in treating specific heart disease conditions, e.g. in older people affected by chronic heart disease who need frequent ECG monitoring.

[The role of molecular biology in the diagnosis and treatment of cardiovascular diseases]. / Il ruolo della biologia molecolare nella diagnosi e terapia delle malattie cardiovascolari.

The aim of this review is to emphasize the role of molecular biology in the diagnosis and therapy of major cardiomyopathies and cardiovascular risk factors. Therefore, we have underlined the genes responsible for or associated with these diseases while highlighting a role in the response to therapy (pharmacogenomics). Cardiovascular diseases and its related risk factors were divided into monogenic and polygenic forms. Monogenic forms are much rarer in clinical practice. However, polygenic forms along with most risk factors are of important clinical interest due to their high frequency in the general population. The added value of genetic testing is to provide an individual risk profile assessed in each patient and not only derived from epidemiological data. The prognosis of patients with the same risk profile, assessed using current clinical and medical history data, is often very different. An accurate prediction of the clinical course of cardiovascular disease in each patient will be the best therapeutic approach (tailored medicine) and will also result in a significant cost reduction for national healthcare systems (effective therapy).

Tako-tsubo-like syndrome with atypical clinical presentation: case report and literature review.

A 78-year-old woman presented herself at emergency for the appearance of severe dyspnea. An electrocardiogram showed signs of inferior and anterior necrosis, and laboratory tests showed a small increase of myocardial cytonecrosis enzymes. An echocardiogram detected a reduction of global systolic function (ejection fraction [EF] approximately 40%) as well as akinesia of the apex, interventricular septum middle segments, and anterior and anterolateral walls, with basal segments showing compensatory hyperkinesia. The coronarography showed a coronary tree substantially free from significant lesions. The patient was transferred to the cardiology unit of our hospital. Based on the contained increase of the cardiac enzymes, the absence of coronary lesions, and the presence of typical echocardiography alterations, we suspected a Tako-tsubo-like syndrome. On deeper anamnestic investigation, an event of strong emotional stress emerged preceding the hospital admission that confirmed the pathology, even though it is atypical to see clinical presentation a long time after a stressful event.

Myocardial bridging: A 'forgotten' cause of acute coronary syndrome - a case report.

During a stress test, an asymptomatic 40-year-old man showed an ST depression above 4 mm and a horizontal ST depression above 2 mm in the V3 to V6 precordial leads during the recovery phase, without symptoms related to myocardial ischemia. After several days, he experienced recurrent episodes of oppressive retrosternal pain with radiation to the interscapular region, associated with stress dyspnea. Stress myocardial scintigraphy using technetium sestamibi was performed, which showed a modest push-pull deficit of perfusion in the septal-anterior basal area associated with a small deficit of perfusion in the apical region.The patient was admitted to hospital with a diagnosis of unstable angina. Repeated episodes of chest pain appeared during this period, which were partially relieved with the administration of sublingual nitrate. There were no significant changes in the electrocardiogram or cardiac enzyme levels. Coronary angiography showed initial parietal hypertrophy with normal segmentary kinesis and global systolic function and, most importantly, the presence of a systolic narrowing (myocardial bridging) of the middle one-third of the left anterior descending artery from the likely intramyocardial route. There was no significant stenosis of the remaining coronary tracts.Myocardial bridges have traditionally been considered a benign condition, but recent studies have demonstrated that the clinical complications can be dangerous; these complications include acute coronary syndromes, arrhythmias (including supraventricular tachycardia and ventricular tachycardia), exercise-induced atrioventricular conduction blocks, transient ventricular dysfunction and sudden death.