Stigma and illness uncertainty: adding to the burden of sickle cell disease

Background: Persons with sickle cell disease (SCD) experience multiple medical and physical complications; the disease also has numerous effects on their social and emotional well-being. We hypothesized that adults with SCD in Jamaica experience moderate levels of stigma and illness uncertainty and that these experiences may be associated with socio-demographic factors, such as gender, educational status and economic status.

Methods: We surveyed 101 adults with SCD (54.5% female; mean age 31.6?±?10.4 years; 72.2% homozygous SCD) using the Stigma in Sickle Cell Disease Scale (Adult), Mishel Uncertainty in Illness Scale (Adult) and a Socio-Demographic questionnaire.

Results: The mean stigma score was 33.6?±?21.6 (range: 2–91) with no significant difference between males and females (32.3?±?21.3 vs. 34.7?±?21.9; p-value?=?0.58). Illness uncertainty was greater in females than in males, though not statistically significant, (88.7?±?13.5 vs. 82.6?±?19.2; p-value: 0.07). Stigma and uncertainty had a significant positive correlation (r: 0.31; p-value: 0.01). In an age and sex controlled model, stigma scores were lower with higher numbers of household items (coef: ?2.26; p-value: 0.001) and higher in those living in greater crowding (coef: 7.89; p-value: 0.002). Illness uncertainty was higher in females (coef: 6.94; p-value: 0.02) and lower with tertiary as compared with primary education (coef: ?16.68; p-value: 0.03).

Conclusion: The study highlights socioeconomic factors to be significant to the stigma and illness uncertainty experiences in SCD. Efforts by healthcare workers to reduce patient illness uncertainty may have additional impact, reducing their stigma.     

Effect of body weight on fixed dose of diclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Objective: The aim of this study was to assess the influence of patient body weight on the clinical effect of 100?mg diclofenac administered as a single dose for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

Materials and methods: All patients subjected to endoscopic retrograde cholangiopancreatography (ERCP) from 2009 to 2014 were evaluated for inclusion. In total, 772 patients were included of whom 378 (49%) received diclofenac prophylaxis.

Results: In the diclofenac prophylaxis group, body weight was higher in patients with PEP (mean?±?SD: 82?±?18?kg) than in patients without PEP (74?±?18?kg) (p?=?0.029). In patients not receiving prophylaxis, body weight was not associated with the occurrence of PEP (mean?±?SD: 77?±?18 vs 75?±?18?kg, respectively, p?=?0.450). In an adjusted analysis, higher patient body weight was inversely associated with the clinical effect of 100?mg diclofenac for the prophylaxis of PEP.

Conclusions: High patient body weight was associated with a reduced effect of 100?mg diclofenac for prophylaxis of PEP.     

Incidence and predictors of interstitial lung disease (ILD) in Thai patients with early systemic sclerosis: Inception cohort study

Objectives: To determine and compare the prevalence of interstitial lung disease (ILD), the severity of high-resolution computed tomography (HRCT) score and incidence rate (IR) of ILD between the two subsets of early-SSc (systemic sclerosis) patients. We also determined the factors associated with ILD.

Methods: We used an inception cohort of early-SSc patients seen between January 2010 and June 2014. All patients underwent HRCT at study entry and annually thereafter.

Results: One hundred and thirteen patients (66 females and 89 diffuse cutaneous SSc [dcSSc]) with a mean?±?SD age of 53.4?±?8.4 years and mean disease duration of 12.9?±?10.3 months at cohort entry were enrolled. At enrollment, patients with dcSSc had a higher prevalence of ILD (78.7% vs. 45.8%, p?=?0.002), and a higher total HRCT score (10.3?±?9.5 vs. 4.4?±?5.6, p?=?0.001) compared with limited cutaneous SSc (lcSSc). DcSSc patients had a higher IR of ILD than lcSSc patients (58.8 vs.17.3 per 100 person-years, p?<?0.001). Univariable analysis revealed that male gender, presence of anti-Scl 70 and absent anti-centromere antibody was significant predictors of ILD. In Cox-regression analysis, a positive anti-centromere [hazard ratio (HR) 0.09 95% confidence interval (95% CI 0.01–0.73)] was a protective factor.

Conclusions: DcSSc patients had more severe HRCT scores and higher IR of ILD compared with lcSSc patients. Male gender, presence of anti-Scl 70, and absent anti-centromere antibody predicted the future development of ILD in early-SSc patients.     

The variability and burden of severe sleep apnea and the relationship with atrial fibrillation occurrence: analysis of pacemaker-detected sleep apnea

Study objectives

This was a pilot study to evaluate the long-term variability and burden of respiratory disturbance index (RDI) detected by pacemaker and to investigate the relationship between RDI and atrial fibrillation (AF) event in patients with pacemakers.

Methods

This was a prospective study enrolling patients implanted with a pacemaker that could calculate the night-to-night RDI. The mean follow-up was 348?±?34 days. The RDI variability was defined as the standard deviation of RDI (RDI-SD). RDI burden was referred to as the percentage of nights with RDI?≥?26. The patient with RDI?≥?26 in more than 75% nights was considered to have a high sleep apnea (SA) burden. An AF event was defined as a daily AF duration?>?6 h.

Results

Among 30 patients, the mean RDI of the whole follow-up period was 24.5?±?8.6. Nine (30%) patients were diagnosed with high SA burden. Patients with high SA burden had a higher BMI (26.7?±?4.8 vs 23.2?±?3.9, p?=?0.036), a higher prevalence of hypertension (86% vs 39%, p?=?0.031), and a larger left ventricular diastolic diameter (49.2 mm vs 46.7 mm, p?=?0.036). The RDI-SD in patients with a higher burden was significantly greater than that in the patients with less burden (10.7?±?4.9 vs 5.7?±?1.4, p?=?0.036). Linear regression showed that participants with a higher RDI tended to have a higher SD (R?=?0.661; p?<?0.001). The mean RDI (OR?=?1.118, 95%CI 1.008–1.244, p?=?0.044) was associated with AF occurrence.

Conclusion

Using a metric such as burden of severe SA may be more appropriate to demonstrate a patient’s true disease burden.

     

Pulmonary vein isolation using second-generation single-shot devices: not all the same?

Introduction

Single-shot devices have been developed to simplify pulmonary vein isolation (PVI). Randomized studies of the second-generation cryoballoon (CB 2nd) demonstrated excellent results. There are limited data comparing results of circular pulmonary vein ablation catheter (PVAC) with conventional RF ablation or CB for PVI.

Objective

Using a sequential registry cohort and a prospective randomized study, we aimed to compare the acute and long-term results of CB 2nd and PVAC Gold.

Methods

In the registry, consecutive patients with paroxysmal atrial fibrillation (AF) undergoing their first PVI were included. The preferred method used was PVAC Gold in 2014 and CB 2nd in 2015. Subsequently, a randomized study (PVAC vs. CB 2nd) was performed. Ablation success was measured as freedom of AF or atrial tachycardias (AT) off antiarrhythmic drugs.

Results

In the registry cohort, PVAC Gold was used in 60 patients and CB 2nd in 56 patients (age 66?±?11 years, 52% male, LAD 43?±?6). In the randomized study, 20 patients were treated with PVAC Gold and 22 with CB 2nd (age 67?±?9; 43% men, LAD 40?±?7 mm). During a mean follow up of 13.2?±?3.6 months, success was 54% in PVAC Gold patients and 81% in CB 2nd cases (p?=?0.001). In the randomized study 12 months success was 50% versus 86%, p?<?0.05. Complications occurred rare in both groups.

Conclusions

Our registry data and the randomized study both suggest superiority of PVI using CB 2nd as compared with PVI using PVAC Gold.

     

Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease

Objective: The gold standard for diagnosing fibrosis stage in non-alcoholic fatty liver disease (NAFLD) is liver biopsy. The aim of this study was to determine whether contrast-enhanced ultrasonography (CEUS) with transit time measurements could be a non-invasive alternative for differentiating none or mild from severe fibrosis in NAFLD patients. Various serum markers and clinical variables were also evaluated.

Materials and methods: Fifty-eight patients with NAFLD underwent CEUS prior to liver biopsy. All patients were also evaluated according to the Göteborg University Cirrhosis Index (GUCI), the AST-Platelet Ratio Index (APRI), the NAFLD fibrosis score, and the FIB-4 and BARD score.

Results: The hepatic vein arrival time (HV) was shorter in patients with severe fibrosis (25.9?±?4.8 vs 29.5?±?4.7?s, p?=?0.023), and the difference between the hepatic and portal vein (ΔHV–PV) was shorter (2.3?±?2.8 vs 6.4?±?2.8?s, p?p?Conclusions: CEUS and non-invasive scoring systems could exclude severe fibrosis in NAFLD patients.     

Sleepiness in obstructive sleep apnea using hypopneas defined by a 3% oxygen desaturation or arousal but not by 4% or greater oxygen desaturation

Study objectives

This analysis determined the association between obstructive sleep apnea (OSA) with hypopneas defined by a 3% O₂ desaturation or arousal (3%A), but not by a hypopnea criterion of?≥?4% (4%), and subjective sleepiness.

Methods

Data were analyzed from Sleep Heart Health Study participants who had polysomnography (N?=?6307) regarding OSA and subjective sleepiness scores (Epworth Sleepiness Scale, ESS). The apnea hypopnea index (AHI) was classified based on 3% only, 3%A only, and 4% definitions of hypopneas.

Results

Of the 3326 participants without 4% OSA, 67.6% (n?=?2247) had 3%A only OSA. The ESS score was higher in 3%A only OSA than in those without OSA (7.44?±?4.2 vs 7.07?±?4.3, P?=?0.02). Of those without 4% OSA, 40.2% (n?=?1336) had 3% only OSA. The ESS score was higher in those with 3% only OSA than those with no OSA (7.72?±?4.3 vs 7.05?±?4.2, P?<?0.001). A linear regression model demonstrated a trend towards significance for the 3%A only AHI as an independent predictor of ESS when controlled for age, BMI, and sex (P?=?0.051). The association of 3% only AHI with the ESS was stronger (P?=?0.003). However, 23.3% of the participants with hypersomnia would not qualify as having OSA if arousals were excluded from the definition of OSA.

Conclusion

The current study found that the presence and severity of OSA is associated with higher ESS scores in persons with 3%A only OSA. Hence, the use of the 4% hypopnea definition will result in the failure to identify and treat a significant number of individuals with OSA who have subjective sleepiness.

     

Atrial involvement and progression of sinus node dysfunction in non-senile patients: evidences from electroanatomic mapping and long-term follow-up

Purpose

Sinus node inability or conduction disorders of its surrounding atrial myocardium cause sinus node dysfunction (SND). This study aimed to characterize right atrium (RA) substrates and long-term atrial lead performance after pacemaker implantation in non-senile SND patients.

Methods

Eighteen SND patients (53.3?±?9.6 years) controlled by 18 age-matched supraventricular tachycardia patients were consecutively enrolled. The P-wave amplitude (PWA) and P-wave duration (PWD) were measured on surface electrocardiography. Electroanatomic mapping was conducted to assess the bipolar voltage, complex signals, volume, and activation time of RA. Pacemaker implantation was performed in SND patients after mapping.

Results

Compared with controls, SND patients showed significant PWA reduction (0.13?±?0.02 vs. 0.16?±?0.04 mV, p?=?0.017) and PWD prolongation (120.8?±?15.2 vs. 105.2?±?8.6 ms, p?=?0.001). The RA endocardial voltage was lower (1.56?±?0.78 vs. 2.57?±?0.55 mV, p?<?0.001) and activation time was longer (112.1?±?14.9 vs. 90.8?±?12.4 ms, p?<?0.001) in the study group. Atrial lead was anchored at the lower atrial septum in one patient and failed in another due to extensive atrial scarring. During a median follow-up of 86 (57–88) months, one patient lost atrial capturing, and overall atrial sensing was significantly decreased (2.44?±?1.16 vs. 1.87?±?1.01 mV, p?=?0.003).

Conclusions

Atrial involvement was proved and the process was progressive in non-senile SND patients, as demonstrated by diffused RA lower voltage, slower conduction, and the decrease of the atrial lead sensing.

     

Relevance of sleep disturbance to the integrity and characteristics of secondary peristalsis in patients with gastroesophageal reflux disease

Objective: Sleep disturbance is common in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis is important for clearance of the refluxate from the esophagus. We aimed to test the hypothesis whether secondary peristalsis is impaired in GERD patients with sleep disturbance.

Methods: Secondary peristalsis was stimulated with slow and rapid air injections into mid-esophagus in 8 age-matched health controls and 41 patients with GERD. Sleep disturbance was assessed by the Pittsburg Sleep Quality Index (PSQI). Objective sleep measures were assessed by ambulatory actigraphy.

Results: The threshold volume for inducing secondary peristalsis during slow air injection was significantly higher in GERD patients with sleep disturbance than healthy controls (14.3?±?1.2 vs. 8.9?±?0.5?mL, p?<?.05). GERD patients with sleep disturbance had higher threshold volume of secondary peristalsis during rapid air injection than GERD patients without sleep disturbance (5.1?±?0.4 vs. 3.9?±?0.2?mL, p?<?.05) and healthy controls (5.1?±?0.4 vs. 3.6?±?0.2?mL, p?<?.05). There was a negative correlation between PSQI score and peristaltic frequency during rapid air injection (r?=??.39, p?=?.01). Secondary peristaltic amplitude during rapid air injection was negatively correlated with wake after sleep onset (r?=??.34, p?=?.04).

Conclusions: Sleep disturbance is associated with secondary peristaltic response to distension-induced esophageal stimulation in patients with GERD. Our study suggests that sleep disturbance per se may adversely influence the effectiveness of esophageal peristalsis and bolus clearance during sleep in patients with GERD.     

Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients

Objective: Determine the optimal scoring system for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with acute variceal bleeding (AVB). Prediction effects of six scoring systems, AIMS65 score, Glasgow-Blatchford (GBS) score, full Rockall (FRS) score, the model for end-stage liver disease (MELD), the MELD-Na model and the Child-Turcotte-Pugh (CTP) score were analyzed in this study.

Methods: A total of 202 liver cirrhosis patients with AVB were enrolled between 1 January 2014, and 31 December 2014. All subjects were scored according to AIMS65, GBS, FRS, MELD, MELD-Na and CTP scoring systems on the first day of admission. The primary endpoint of the study was 6-week mortality. The prediction effect of these scoring systems for 6-week mortality was compared by ROC curve and the area under the curve (AUC).

Results: The scores of nonsurvival group evaluated by the AIMS65, GBS, FRS, MELD, MELD-Na and CTP (2.6?±?1.1, 12.9?±?2.7, 6.6?±?1.8, 26.9?±?6.5, 31.6?±?9.3, 9.6?±?2.2, respectively) were higher than those of the survival group (1.2?±?1.1, 10.2?±?3.4, 5.1?±?1.6, 21.0?±?6.4, 22.8?±?8.2, 7.7?±?2.0, respectively) (p?Conclusions: AIMS65 and MELD-Na scoring systems are recommended for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with AVB.     

Vasculometabolic effects in patients with congenital growth hormone deficiency with and without GH replacement therapy during adulthood

Purpose

To evaluated the metabolic profiles and vascular properties in congenital growth hormone (GH) deficiency (GHD) and its replacement in adults.

Patients and methods

Cross-sectional study conducted in a single tertiary center for pituitary diseases. Eighty-one adult subjects were divided into three groups: (1) 29 GHD patients with daily subcutaneous GH replacement therapy (GHRT) during adulthood; (2) 20 GHD patients without GHRT during adulthood and (3) 32 controls. Only patients with adequate adherence to others pituitary hormone deficiencies were included. Anthropometric parameters, body composition by dual-energy X-ray absorptiometry, metabolic profiles and vascular properties (carotid intima media thickness, pulse wave velocity and flow-mediated dilation) were compared among the groups.

Results

Waist-to-height ratio (WHR), body fat percentages and fat mass index (FMI) were lower in patients with GHRT than patients without GHRT during adulthood (0.49?±?0.06 vs. 0.53?±?0.06 p?=?0.026, 30?±?10 vs. 40?±?11 p?=?0.003 and 7.3?±?4 vs. 10?±?3.5 p?=?0.041, respectively). In addition, association between longer GHRT and lower body fat percentage was observed (r?=????0.326, p?=?0.04). We found higher triglyceride (113.5?±?62 vs. 78?±?36, p?=?0.025) and lower HDL cholesterol (51?±?17 vs. 66?±?23, p?=?0.029) levels in patients without GHRT during adulthood in comparison to controls. No statistical differences were observed for vascular properties among the groups.

Conclusions

No differences in vascular properties were observed in congenital GHD adult patients with or without GHRT despite patients without GHRT had an unfavorable body composition. GHRT currently remains an individualized decision in adults with GHD and these findings bring new insight into the treatment and follow-up of these patients.

     

Teprenone for the prevention of low-dose aspirin-induced gastric mucosal injury in Helicobacter pylori-negative patients

Abstract

Objectives: Low-dose aspirin is the standard treatment for the prevention of cardiovascular events in at-risk patients. We performed a randomized, placebo-controlled study to determine the efficacy of teprenone for primary prevention of gastrointestinal injury in patients taking LDA for vascular protection.

Methods: Patients were eligible for enrollment if they required aspirin 100?mg/day. Aspirin- naïve patients without gastroduodenal ulcer and Helicobacter pylori infection were randomized to receive teprenone 150?mg/day or placebo for 12?weeks. Primary outcome was assessed by the incidence rate of gastroduodenal ulcer. Secondary outcomes were assessed by the incidence rate of gastric mucosal injury, the improvement in modified Lanza score (MLS), gastrointestinal symptom rating scale (GSRS) and the change of gastric immunohistochemical expression for COX-1.

Results: Total of 130 patients were randomized, 64 in teprenone group and 66 in placebo group. There was no incidence of ulcer after 12?weeks in both groups. Incidence of gastric mucosal injury was higher in placebo group than in teprenone group (40.0 vs. 13.38%, p?=?.039). Mean change of MLS was higher in placebo group than in teprenone group (0.767?±?0.467 vs. 0.271?±?0.158, p?=?.003). Scores of mucosal edema, hyperemia and hemorrhage and the change of GSRS were not different between the two groups. Change of COX-1 immunoreactive score was higher in placebo group than in teprenone group (2.433?±?1.476 vs. 1.233?±?0.955, p?=?.001). There were no treatment-related adverse events.

Conclusions: Teprenone is effective in preventing gastric mucosal injury in patients taking LDA. Preventive effects of teprenone on LDA-related gastroduodenal ulcers require further investigation.     

3.0 T magnetic resonance imaging scanning on different body regions in patients with pacemakers

Purpose

Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers.

Methods

Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists.

Results

Twenty-three MRI scans of different body regions (brain?=?13, lumbar spine?=?4, cervical spine?=?2, and heart?=?4) were performed, and the average time of a scan was 25?±?11 min. No significant changes in sensing amplitude (atrial 3.1?±?1.1 mV vs. 2.9?±?1.2 mV, P?=?0.71; ventricular 9.3?±?3.5 mV vs. 10.2?±?3.4 mV, P?=?0.46), lead impedances (atrial 647?±?146 Ω vs. 627?±?151 Ω, P?=?0.7; ventricular: 780?±?247 Ω vs.711?±?226 Ω, P?=?0.36), or pacing threshold (atrial 0.6?±?0.2 V/0.4 ms vs. 0.6?±?0.2 V/0.4 ms, P?=?0.71; ventricular 0.7?±?0.3 V/0.4 ms vs. 0.7?±?0.2 V/0.4 ms, P?=?0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value.

Conclusion

Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.

     

Children with untreated coeliac disease have sub-clinical cardiac dysfunction: a longitudinal observational analysis

Introduction: We assessed cardiac function (CF) in celiac disease (CD) patients and the effect of gluten-free diet (GFD) on CF.

Methods: Prospective evaluation of CF using conventional and tissue doppler echocardiography in 50 CD patients (age 4.2?±?1.1 years) at diagnosis and after a year of GFD (group 1), 100 CD children (group 2; 47 compliant and 53 non-compliant) in follow-up and 25 healthy controls.

Results: Untreated CD (n?=?50) children had larger left ventricle end diastolic dimension (35.33?±?0.87 vs. 32.90?±?0.91 mm; p?=?.04), reduced (<55%) left ventricular ejection fraction (20% vs. 0%; p?=?.01) and a higher (>0.6) myocardial performance index (MPI, 66% vs. 0%; p ≤ .01) as compared to controls. Re-evaluation after one year with good dietary compliance showed changes in isovolumic relaxation time (72.5?±?4.2 vs. 50.62?±?2.69; p?=?.0001) and deceleration time (121.05?±?10.1 vs. 99.87?±?8.5; p?=?.02), reflecting improved cardiac diastolic function. GFD compliant patients had lower MPI than non-compliant (0.60?±?.03 vs. 0.66?±?.08; p?=?.04), reflecting improvement in load-independent echocardiographic parameters.

Conclusions: Subclinical cardiac dysfunction is common in CD children at diagnosis. Improvement

in echocardiographic parameters occurs with GFD and non-compliant children continue to have

persistent cardiac dysfunction.     

Comparative study of bone marrow and blood plasma levels of IL-2 in aplastic anaemia and their relationship with disease severity

Objectives: Interleukin-2 (alias: IL-2, TCGF, Lymphokine), a type of interleukin, is also a potent signalling molecule in the signalling cascade of the immune-mediated activation of T Lymphocytes leading to the destruction of haematopoietic stem cell (HSC) which is the basis of acquired aplastic anaemia (AAA). The objective was to study the association of IL-2 in the bone marrow plasma (BMP) and peripheral blood plasma (PBP) in AAA patients.

Methods: A total of 52 BMP and PBP-paired samples (both from the same patients) was collected from the confirmed AAA patients and 10 healthy individuals. The level of IL-2 was measured by the quantitative enzyme-linked immunosorbent assay (ELISA). The Mann–Whitney U test was used for statistical analysis.

Results: Significantly increased level of IL-2 was observed in the BMP than PBP of AAA patients. The level of IL-2 in PBP and BMP was found to be very low in the control cases. Considerably increased levels of IL-2 were found in the PBP and BMP of AAA patients as compared to controls (48.54?±?21.89 vs. 1.99?±?1.25 p-value?<?0.00001) and (75.33?±?41.9 vs. 3.12?±?1.82; p-value?<?0.00001) respectively. Among these patients, the IL-2 levels were higher in patients with Very Severe Aplastic Anaemia (VSAA) and Severe Aplastic Anaemia (SAA) than those with Non-severe Aplastic Anaemia (NSAA) in the PBP (65.6?±?23.61 vs. 31.72?±?7.64; p-value 0.00338) and (45.37?±?16.25 vs. 31.72?±?7.64; p-value 0.01468) respectively. Again the IL-2 levels were higher in patients with VSAA and SAA than those with NSAA in the BMP (115.01?±?38.91 vs. 38.32?±?19.49; p-value?<?0.00001) and (66.44?±?23.34 vs. 38.32?±?19.49; p-value 0.0006). The IL-2 level was higher in VSAA than SAA in PBP (65.6?±?23.61vs. 45.37?±?16.25; p-value 0.0114) and BMP (115.01?±?38.91 vs. 66.44?±?23.34; p-value 0.00044).

Conclusion: This study emphasized on the bone marrow and blood plasma levels of IL-2 in aplastic anaemia and their relationship with disease severity. The results indicate towards the fact that IL-2 may have an important association with the marrow failure of AAA patients and thus can help in disease development. Further study is necessary for better understanding.     

Association of coronary artery calcium with severity of myocardial ischemia in left anterior descending, left circumflex, and right coronary artery territories

Background:

An increasing coronary artery calcium score is associated with a higher likelihood of myocardial ischemia.

Hypothesis:

The association of the coronary calcium score with myocardial ischemia in different coronary arteries needed to be investigated.

Methods:

We correlated the coronary artery calcium (CAC) score with the severity of myocardial ischemia diagnosed by myocardial perfusion imaging in the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) territories in 206 patients, mean age 66 years, without cardiac stents or coronary artery surgery.

Results:

The mean CAC score in the LAD coronary artery was 160 ± 218 in patients with no or mild ischemia and 336 ± 379 in patients with moderate or severe ischemia (P = 0.039). The mean CAC score in the LCX coronary artery was 57 ± 117 in patients with no or mild ischemia and 161 ± 191 in patients with moderate or severe ischemia (P = 0.018). The mean CAC score in the RCA was 114 ± 237 in patients with no or mild ischemia and 261 ± 321 in patients with moderate or severe ischemia (P = 0.045). Stepwise linear regression analysis showed that male gender (P < 0.0001), age (P < 0.0001), and moderate or severe ischemia (P = 0.023) were significantly associated with high LAD coronary artery CAC scores. Male gender (P < 0.0001), age (P = 0.0002), and moderate or severe ischemia (P = 0.006) were significantly associated with high LCX coronary artery CAC scores. Male gender (P < 0.0001) and age (P < 0.0001) were significantly associated with high RCA CAC scores.

Conclusions:

Higher CAC scores are significantly associated with moderate or severe ischemia in the LAD and LCX coronary arteries. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Effects of 12 weeks of regular aerobic exercises on autonomic nervous system in obstructive sleep apnea syndrome patients

Introduction

Regular exercise is confirmed as a lifestyle treatment option for all obstructive sleep apnea (OSA) patients. It has beneficial effects other than weight loss, although the mechanisms remain unclear. Autonomic function imbalance plays an important role in OSA, so that it is meaningful to observe the effect of exercise on autonomic function.

Methods

Seventy mild to moderate OSA patients were divided into two groups. The exercise group received a 12-week exercise program prescribed according to their first cardiopulmonary exercise tests, while the control group kept previous lifestyle. All patients underwent blood tests, cardiopulmonary exercise tests, and polysomnography studies at enrollment and at the 12-week’s follow-up.

Results

At the end of 12 weeks, three patients of the exercise group did not complete the program due to lack of adherence. The current study showed 12-week aerobic exercises could improve body mass index (27.6?±?4.7 kg/m² vs. 24.5?±?4.2 kg/m², P?<?0.05), exercise capacities, apnea-hypopnea index (total AHI 20.2?±?7.5 vs. 16.4?±?5.2, P?<?0.05; supine AHI 22.1?±?6.3 vs. 18.3?±?4.9, P?<?0.05), average oxyhemoglobin saturation (AverSpO2), time/percentage SpO2 below 90%, and heart rate recovery (HRR) of OSA patients. Moreover, AverSpO2 change was significantly associated with HRR change in the exercise group.

Conclusions

Our findings suggested regular aerobic exercise had beneficial effects on body mass index, functional capacity, intermittent hypoxia, and parasympathetic tone of OSA patients, and whether parasympathetic tone modification plays a role in improving intermittent hypoxia or not deserves further exploration.

     

Impacts of sinus rhythm maintenance with catheter ablation on exercise tolerance in patients with paroxysmal atrial fibrillation

Background

It has been recently reported that sinus rhythm (SR) maintenance with catheter ablation therapy improves exercise tolerance (ET) in patients with persistent atrial fibrillation (AF). However, it remains to be elucidated whether this is also the case for patients with paroxysmal AF (PAF).

Methods

We enrolled consecutive 54 patients with PAF (age; 63?±?10 [SD] years old, male/female 46/8) and 26 patients with persistent AF (non-PAF) (age; 57?±?12 [SD] years old, male/female 23/3) who underwent AF ablation without recurrence. ET and cardiac function were evaluated by cardio-pulmonary exercise test and ultrasound echocardiography before and 6 months after ablation.

Results

The parameters of cardiopulmonary exercise test were comparable between the 2 groups. When PAF group was divided into 2 groups according to the time since diagnosis, peak oxygen uptake (peak VO₂) before ablation was significantly lower in patients with PAF duration of more than 1 year (n =?26), compared with those with less than 1 year (n =?28) (18.1?±?3.7 vs 21.3?±?5.8 ml/kg/min, P =?0.022). At 6 months after SR maintenance without AF burden, peak VO₂ significantly improved in both PAF (19.8?±?5.1 to 22.0?±?4.8 ml/kg/min, P =?0.0001) and non-PAF (20.6?±?3.9 to 23.4?±?5.0 ml/kg/min, P?<?0.01). Furthermore, the improvement rate of peak VO₂ after successful ablation had a highly significant inverse relationship with peak VO₂ at baseline in patients with PAF (r =???0.48, P =?0.0003).

Conclusions

These results indicate that SR maintenance with ablation improves ET in patients with PAF, especially in those with reduced ET.

     

Inner ear function in patients with obstructive sleep apnea

Objective

Because of their high metabolic activity and low-resting oxygen tension, the organs of the inner ear are vulnerable to hypoxia, a condition that occurs repetitively in obstructive sleep apnea-hypopnea syndrome (OSAHS). The present study aimed to investigate the inner ear function of patients with OSAHS.

Methods

A total of 58 patients with OSAHS (116 ears) and 20 adults without OSAHS were enrolled in the present study. The clinical features, such as air-conduction thresholds, auditory brainstem response (ABR, 11 times/s and 51 times/s stimulation rates), and distorted products otoacoustic emission (DPOAE), were evaluated and compared between these two groups.

Results

Air-conduction thresholds at 4 kHz and 8 kHz were higher in patients with OSAHS compared with controls (P?<?0.001). At the rate of 11 times per second, biauricular wave I latencies and wave V latencies in the OSAHS group were longer than those in the control group (1.51?±?0.13 vs. 1.33?±?0.07 ms, P?<?0.001; 5.65?±?0.23 vs. 5.53?±?0.23 ms, P?=?0.0016). At the rate of 51 times per second, biauricular wave I latencies and wave V latencies in the OSAHS group were longer than those in the control group (1.64?±?0.12 vs. 1.44?±?0.06 ms, P?=?0.0001; 5.92?±?0.26 vs. 5.80?±?0.18 ms, P?=?0.0077). However, there was no significant difference in the wave I and wave V interval between these two groups (P?=?0.10). DPOAE amplitude was significantly reduced in OSAHS patients, although no hearing loss was observed.

Conclusion

High-frequency hearing loss was detected in adults with severe OSAHS, and wave I latencies and wave V latencies of ABR were prolonged.

     

Efficacy of golimumab for preventing large joint destruction in patients with rheumatoid arthritis as determined by the ARASHI score

Objectives: The objective of this study is to investigate the inhibitory effect of golimumab on large joint destruction in patients with rheumatoid arthritis.

Methods: We recruited 45 patients with rheumatoid arthritis and evaluated the radiographic severity of large joint destruction using the assessment of rheumatoid arthritis by scoring of large joint destruction and healing in radiographic imaging (ARASHI) score. We evaluated 450 large joints including the elbow, shoulder, hip, knee, and ankle at baseline and 52 weeks after treatment with golimumab. Rapid radiographic progression (RRP) and rapid radiographic improvement (RRI) were calculated and the correlation between large joint destruction and clinical factors was analyzed.

Results: The mean age of the study population was 61.29?±?14.71 years old, and most patients (91.1%) were female. The mean disease duration was 12.6?±?12.48 years. The cohort included patients in all clinical stages of disease as defined by the Steinbroker criteria (I:7, II:10, III:9, IV:19) as well as clinical classes 2 (n?=?18), 3 (n?=?26), and 4 (n?=?1) and the mean disease activity score-CRP (DAS28-CRP) was 4.431?±?1.044. Patients were treated with methotrexate (mean dose 6.44?±?1.78?mg/week), prednisolone (PSL) (mean dose 1.078?±?1.871?mg/d), and golimumab (44.4% of 100?mg). RRP was evident in 20% of the large joints treated with golimumab, and, therefore, golimumab was effective at inhibiting large joint destruction in 80% of joints. RRI was evident in 33.3% of large joints following golimumab treatment. We also observed that EULAR response criteria significantly correlated with the ARASHI change score at 52 weeks after treatment. The total ARASHI status score significantly correlated with the Sharp–van der Heijde score, but not with the delta total sharp score. Multiple regression analyses revealed that the total ARASHI change score was only correlated with EULAR response criteria significantly.

Conclusions: Golimumab therapy was effective at inhibiting large joint destruction of RA patients who have good clinical response, including higher improvement of the shoulder and ankle joints than other large joints.