Clinical value of relative quantification ultrasound elastography in characterizing breast tumors

ObjectivesTo evaluate ultrasound elastography (USE) using strain ratio (SR), a relative quantification approach for breast lesions characterization.MethodsOne hundred forty-seven consecutive patients with a total of 156 breast lesions underwent USE. Technical accuracy was assessed automatically. For SR evaluation a rounded ROI was depicted inside fat (F), glandular tissue (G) and inside the lesion (L), preferably at the same depth. R1, mean value of the G and F ratio, stands for in background tissue composition elasticity. R2; mean value of L/F stands for in lesion elasticity, both evaluated in arbitrary unit (au). Two-years follow-up and pathology results were standard of reference. Mann–Whitney test, ROC analysis and Chi-square with Yates correction were used.ResultsWith the exception of 27 cysts, 17 malignant and 112 benign lesions were found. R1 values were 1.6 ± 0.7 au and 1.2 ± 0.9 au (p = 0.015 NS); R2 values were 6.1 ± 2.5 au and 1.9 ± 1.3 au (p < 0.001) for malignant and benign lesions, respectively. A threshold of 3.3 au showed a sensitivity and specificity of 88% and 87%, respectively with an AUC of 93%. Fifteen false positive and two false negative were detected.ConclusionRelative quantification of ultrasound elastography allows to find high levels of diagnostic accuracy in characterizing breast tumors above all in downgrading BI-RADS 3 and 4 lesions.     

Contrast-enhanced ultrasound (CEUS) assessment of superselective uterine fibroid embolization (SUFE): Preliminary experience

PurposeThe use of superselective uterine fibroid embolization (SUFE) requires imaging techniques that can be used to verify the success of the procedure. The purpose of our study was to analyze the potential value of pre- and post-treatment contrast-enhanced ultrasonography (CEUS) for assessing the outcome of SUFE and for posttreatment follow-up.Materials and methodsWe studied twelve women undergoing SUFE for uterine fibroids. In those with multiple fibroids, only the three largest were considered in this study. A total of 21 lesions (size range 3.5–9.0 cm, mean 5.2 cm) were examined. Each myoma was examined immediately before and after SUFE (while the patient was still in the angiography room) with transabdominal CEUS performed after intravenous administration of a single bolus of contrast agent. The follow-up protocol included CEUS evaluation one month after treatment and CEUS plus dynamic magnetic resonance (MR) studies six months after treatment.ResultsIn 20/21 cases, postembolization CEUS revealed total fibroid devascularization. The remaining lesion (in a woman with multiple lesions) showed persistent vascularization after SUFE. These findings were all consistent with angiographic data. No recurrences were observed during the six-month follow-up. One patient reported the reappearance of symptoms 18 months after SUFE, and CEUS showed the persistence of intralesional vascularization.ConclusionsCEUS is effective for assessing the completeness of vascular occlusion following SUFE for uterine fibroids. CEUS findings correlate with clinical results observed one and six months after treatment. Compared with dynamic MR, CEUS is reliable and cost-effective.     

AgNORs count and DNA ploidy in liver biopsies from patients with schistosomal liver cirrhosis and hepatocellular carcinoma

ObjectivesArgyrophilic nucleolar organizer regions (AgNOR) proteins are a set of argyrophilic nucleolar proteins that accumulate in highly proliferating cells, whereas their expression is very low in nonproliferating cells. The present study aimed to investigate the potential of DNA flow cytometry (FCM) and AgNORs count in the assessment of cellular kinetics of liver cirrhosis and hepatocellular carcinoma.Design and methodsSmall-needle liver biopsies (217) were included and were taken from 84 patients with hepatocellular carcinoma (HCC) (one biopsy from tumor lesion and the other from residual nontumor) liver tissues. Only one biopsy was taken from 49 patients with liver cirrhosis. One part of biopsy was subjected to flow cytometry, and the other, to histopathology and AgNORs counting.ResultsAn aneuploidy was shown in 44.5% of liver cirrhosis and in 78.6% of tumor sites. Aneuploid HCC cases showed high AgNORs count compared with diploid cases (3.407 ± 1.18 vs. 1.74 ± 0.9). An extremely significant increase in AgNORs count in tumor lesion (P < 0.001) was found compared with residual liver tissues, liver cirrhosis and normal liver (3.89 ± 0.827, 1.49 ± 0.52, 1.62 ± 0.29, and 1.3 ± 0.17, respectively). In liver cirrhosis, dysplasia showed a significant relationship with ploidy (P < 0.001) and AgNORs count (P < 0.05).ConclusionAgNORs count and DNA ploidy analysis of core biopsy specimens are useful in the assessment of cellular kinetics of liver cirrhosis and hepatocellular carcinoma.     

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins

AimsThe adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario.MethodsForty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10 min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2 min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately.ResultsThe mean compression rate between ventilation pauses was 137 ± 18 compressions per minute (cpm) without and 98 ± 2 cpm with metronome guidance (p < 0.001). The mean number of chest compressions actually performed was 104 ± 12 cpm without and 79 ± 3 cpm with the metronome (p < 0.001). The mean compression depth during the scenario was 46.9 ± 7.7 mm without and 43.2 ± 6.3 mm with metronome guidance (p = 0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth (p = 0.09 for difference for percentage of compression with correct depth).ConclusionsMetronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.     

Variability of the glycemic response to single food products in healthy subjects

BackgroundMany studies on the health effects of the glycemic index (GI) are confounded by differences in the intakes of other macronutrients and fibre. Little data exist about the within- and between-subject variability of the GI.ObjectiveOur objectives were therefore (i) to calculate the GI of eight commonly used food products with similar macronutrient and fibre composition, but with different sources of carbohydrates, (ii) to examine the inter- and intra-individual variability of the incremental area under the curve (iAUC) after consuming the reference solution, and (iii) to compare the effect of three different methods on 2-h postprandial blood glucose responses.DesignFour groups of 10 healthy subjects consumed in random order the increased (iGI) and decreased GI (dGI) variants and twice a glucose solution. All products consisted of 25 g available carbohydrates (CHO). For the fruit drink, glucose values were simultaneously analyzed using venous and capillary blood samples, and by using a continuous glucose monitoring system (CGMS).ResultsThe GIs for increased and decreased variants were (mean ± standard error of the mean (SEM)) 69 ± 15 and 40 ± 4 for bread, 86 ± 14 and 48 ± 8 for a fruit drink, 51 ± 12 and 20 ± 4 for cake, and 63 ± 17 and 37 ± 10 for a cookie. The inter- and intra-individual coefficient of variation (CV) of the iAUCs of the reference solution was large and varied respectively between 13 and 38%, and between 33 and 80%.ConclusionsThese data suggest that the GI is difficult to use at the individual level.     

Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest

IntroductionCerebral perfusion is compromised during cardiopulmonary resuscitation (CPR). We hypothesized that beneficial effects of gravity on the venous circulation during CPR performed in the head-up tilt (HUT) position would improve cerebral perfusion compared with supine or head-down tilt (HDT).MethodsTwenty-two pigs were sedated, intubated, anesthetized, paralyzed and placed on a tilt table. After 6 min of untreated ventricular fibrillation (VF) CPR was performed on 14 pigs for 3 min with an automated CPR device called LUCAS (L) plus an impedance threshold device (ITD), followed by 5 min of L-CPR + ITD at 0° supine, 5 min at 30° HUT, and then 5 min at 30° HDT. Microspheres were used to measure organ blood flow in 8 pigs. L-CPR + ITD was performed on 8 additional pigs at 0°, 20°, 30°, 40°, and 50° HUT.ResultsCoronary perfusion pressure was 19 ± 2 mmHg at 0° vs. 30 ± 3 at 30° HUT (p < 0.001) and 10 ± 3 at 30° HDT (p < 0.001). Cerebral perfusion pressure was 19 ± 3 at 0° vs. 35 ± 3 at 30° HUT (p < 0.001) and 4 ± 4 at 30° HDT (p < 0.001). Brain–blood flow was 0.19 ± 0.04 ml min⁻¹ g⁻¹ at 0° vs. 0.27 ± 0.04 at 30° HUT (p = 0.01) and 0.14 ± 0.06 at 30° HDT (p = 0.16). Heart blood flow was not significantly different between interventions. With 0, 10, 20, 30, 40 and 50° HUT, ICP values were 21 ± 2, 16 ± 2, 10 ± 2, 5 ± 2, 0 ± 2, −5 ± 2 respectively, (p < 0.001), CerPP increased linearly (p = 0.001), and CPP remained constant.ConclusionDuring CPR, HDT decreased brain flow whereas HUT significantly lowered ICP and improved cerebral perfusion. Further studies are warranted to explore this new resuscitation concept.     

Prevalencia de las úlceras de pierna en la provincia de Cuenca: un estudio en Atención Primaria

ObjectiveTo determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment.MethodObservational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected.ResultsIn total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n = 36), diabetic foot 0.145‰ (n = 19), and arterial ulcer 0.061‰ (n = 8).The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p = .365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p = .037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64 + age group.The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm², respectively, with a recurrence rate of 74.7%.ConclusionsThe prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.     

Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized,double-blind controlled trial

BackgroundLidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain.ObjectiveTo compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain.DesignProspective, double-blind, randomized controlled trial.SettingThe 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea.ParticipantsA total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group.MethodsAll three groups received 2% propofol with an effect-site target at 3 μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30 s after 1% lidocaine 30 mg. The local warming group received 2% propofol after warming of the intravenous access site for 1 min using 43 °C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI).ResultsPain VCS of the LA group (mean ± SD, 1.11 ± 0.45) was significantly reduced (U = −3.92, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group (mean ± SD, 0.76 ± 0.44) was significantly reduced (U = −5.17, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U = −3.33, p = .001]. Pain NRS of the LA group (mean ± SD, 4.31 ± 2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63–3.00; p = .003) compared to the control group (mean ± SD, 6.13 ± 2.39). Pain NRS of the LW group (mean ± SD, 3.06 ± 2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63–4.51; p < .009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09–2.42; p = .035). SPI of the LA group (mean ± SD, 64.1 ± 16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64–15.1; p = .016) compared to the control group (mean ± SD, 72.5 ± 9.56). SPI of the LW group (mean ± SD, 55.0 ± 16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8–24.0; p < .001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02–17.1; p = .028).ConclusionLocal warming of the intravenous access site by 43 °C forced air for 1 min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.     

Effect of implementation of new resuscitation guidelines on quality of cardiopulmonary resuscitation and survival

BackgroundDuring cardiopulmonary resuscitation (CPR), advanced life support (ALS) providers have been shown to deliver inadequate CPR with long intervals without chest compressions. Several changes made to the 2005 CPR Guidelines were intended to reduce unnecessary interruptions. We have evaluated if quality of CPR performed by the Oslo Emergency Medical System (EMS) improved after implementation of the modified 2005 CPR Guidelines, and if any such improvement would result in increased survival.Materials and methodsRetrospective, observational study of all consecutive adult cardiac arrest patients treated during a 2-year period before (May 2003–April 2005), and after (January 2006–December 2007) implementation of the modified 2005 CPR Guidelines. CPR quality was assessed from continuous electronic recordings from LIFEPACK 12 defibrillators where ventilations and chest compressions were identified from transthoracic impedance changes. Ambulance run sheets, Utstein forms and hospital records were collected and outcome evaluated.ResultsResuscitation was attempted in 435 patients before and 481 patients after implementation of the modified 2005 CPR Guidelines. ECGs usable for CPR quality evaluation were obtained in 64% and 76% of the cases, respectively. Pre-shock pauses decreased from median (interquartile range) 17 s (11, 22) to 5 s (2, 17) (p = 0.000), overall hands-off ratios from 0.23 ± 0.13 to 0.14 ± 0.09 (p = 0.000), compression rates from 120 ± 9 to 115 ± 10 (p = 0.000) and ventilation rates from 12 ± 4 to 10 ± 4 (p = 0.000). Overall survival to hospital discharge was 11% and 13% (p = 0.287), respectively.ConclusionQuality of CPR improved after implementation of the modified 2005 Guidelines with only a weak trend towards improved survival to hospital discharge.     

Stability of plasma adrenocorticotrophic hormone (ACTH): Influence of hemolysis,rapid chilling,time, and the addition of a maleimide

ObjectivesThe aim of this study was to examine the effects of hemolysis, rapid chilling, time, and the addition of a maleimide on the stability of human plasma ACTH measurements.Design and methodsPartially hemolyzed EDTA blood (n = 10), initially at 37 °C, was centrifuged at 4 °C either immediately or after rapid chilling in ice/water. Plasma ACTH was then measured either immediately, or after 1 h at 22 °C with or without the addition of 2 mM N-phenyl maleimide (NPM).ResultsFor 0.2% hemolysis compared to no hemolysis, the mean (±SEM) loss with immediate centrifugation and immediate ACTH measurement was 11 ± 1%. This loss was significantly (p < 0.002) reduced to 6 ± 1% by an initial rapid chilling of the samples. For analysis after 1 h at 22 °C, the addition of NPM decreased the loss of ACTH from 15 ± 2% to 2 ± 2% (p < 0.002).ConclusionRapid chilling, prompt analysis, and addition of NPM can each reduce the interference of hemolysis in the measurement of plasma ACTH concentrations.     

A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model

AimPulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous insufflation of oxygen at three levels of pressure, resulting in tri-level pressure ventilation (TLPV). We hypothesized that TLPV improves gas exchange and haemodynamics compared to manual gold standard ventilation (GSV).MethodsIn 14 pigs, ventricular fibrillation was induced and automated CPR performed for 10 min with either TLPV or GSV. After defibrillation, CPR was repeated with the other ventilation method. Gas exchange and haemodynamics were monitored. Data are presented as mean ± standard error of the mean.ResultsTLPV was superior to GSV for PaO₂ (163 ± 36 mmHg difference; P = 0.001), and peak AWP (−20 ± 2 cmH₂O difference; P = 0.000) and higher for mean AWP (8 ± 0.2 cmH₂O difference; P = 0.000). TLPV was comparable to GSV for CPP (5 ± 3 mmHg difference; P = 0.012), VCO₂ (0.07 ± 0.3 mL/min/kg difference; P = 0.001), SvO₂ (4 ± 3%-point; P = 0.001), mean carotid flow (−0.5 ± 4 mL/min difference; P = 0.016), and pH_a (0.00 ± 0.03 difference; P = 0.002). The PaCO₂ data do not provide a conclusive result (4 ± 4 mmHg difference).ConclusionWe conclude that the ventilation strategy with a tri-level pressure cycle performs comparable to an expert, manual ventilator in an automated-CPR swine model.     

Effect of different calcineurin inhibitors on AOPP and TAS after kidney transplantation

ObjectivesLittle is known about the influence of calcineurin inhibitors on advanced oxidation protein products (AOPP) and total antioxidant status (TAS) after renal transplantation.Design and methodsAOPP and TAS were evaluated in transplanted patients on different calcineurin inhibitors. Thirty-five patients were treated with cyclosporine A (group A) and 33 with tacrolimus (group B).ResultsOver 6 months, the mean levels of AOPP in group A decreased from 205.9 ± 125.7 to 140.9 ± 78.9 µmol/L and TAS from 1.89 ± 0.30 to 1.75 ± 0.27 mmol/L. In group B, the mean levels of AOPP decreased from 196.5 ± 123.9 to 129.6 ± 63.8 µmol/L and TAS from 1.80 ± 0.39 to 1.78 ± 0.23 mmol/L.ConclusionNo significant differences in AOPP and TAS were found with respect to treatment. The only exception was the higher mean concentration of AOPP at month 1 in group A (p = 0.026).     

Effects of anticoagulants on human plasma soluble corin levels measured by ELISA

BackgroundRecently, soluble corin was detected in human plasma. In patients with heart failure, plasma corin levels were lower than that of normal controls. In this study, we analyzed experimental conditions for measuring plasma or serum corin by an immunoassay.MethodsSerum and plasma corin levels were measured by ELISA. Effects of different anticoagulants (EDTA, heparin and sodium citrate) on plasma corin levels were examined.ResultsCorin levels in serum were similar to that in plasma with heparin (950 ± 305 vs. 929 ± 301 pg/ml, n = 40, p = 0.73), but were significantly higher than those in plasma with sodium citrate (735 ± 237 pg/ml, p < 0.01) or EDTA (716 ± 261 pg/ml, p < 0.001). Native and recombinant human corin proteins were stable in human plasma with EDTA at 4 °C or underwent freezing-and-thawing. In 348 healthy Chinese individuals, plasma corin levels ranged from 216 to 1663 pg/ml. The levels were higher in males than that in females (842 ± 283 vs. 569 ± 192 pg/ml, p < 0.001).ConclusionSoluble corin was stable in plasma samples. Plasma soluble corin levels vary depending on anticoagulants used. Samples containing heparin had significantly higher levels of corin than that in samples with EDTA or sodium citrate.     

The role of hypercytokinemia in the pathophysiology of tumor lysis syndrome (TLS) and the treatment with continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF)

ObjectiveTo examine the role of hypercytokinemia in the pathophysiology of tumor lysis syndrome (TLS) and the efficacy of continuous hemodiafiltration in the treatment of TLS.Design and settingRetrospective observational study in a general intensive care unit of a university hospital.PatientsFour patients with hematological disorder developing TLS after the treatment of anti-tumor chemotherapy.InterventionsContinuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) was performed at the onset of TLS. Blood samples were collected daily after ICU admission, and clinical parameters and blood levels of cytokines were evaluated.Measurements and resultsAll four patients underwent induction anti-tumor chemotherapy, during which they developed hyperuricemia, hyperkalemia, and acute renal failure. Two of them also developed multiple organ failure. Serum levels of tumor necrosis factor (TNF) -alpha, interleukin-6 (IL-6), and IL-10 prior to the initiation of PMMA-CHDF were 102 ± 85 pg/mL, 1097 ± 546 pg/mL, and 98 ± 83 pg/mL, respectively (mean ± SD). After three days of PMMA-CHDF treatment, corresponding blood levels were 37 ± 55 pg/mL, 326 ± 511 pg/mL, and 9 ± 8 pg/mL, respectively. Thus, all cytokine levels were significantly decreased by three days of PMMA-CHDF treatment (p < 0.05, paired t-test). Following three days of PMMA-CHDF treatment, blood urea nitrogen (BUN) and serum creatinine (Cre.) were significantly decreased (pre/post BUN 42.3 ± 15.4/16.5 ± 8.4 mg/dL, p < 0.05, pre/post Cre. 2.7 ± 1.2/1.2 ± 0.6 mg/dL, mean ± SD, p < 0.05). Furthermore, the clinical condition of each patient was improved after the treatment of PMMA-CHDF, and all of four patients were survived.ConclusionHypercytokinemia plays a pivotal role in the pathophysiology of TLS and PMMA-CHDF may be an effective therapeutic modality for TLS patients not only as renal replacement therapy but also as a cytokine modulator.     

Twenty-four-hour profiles of urinary excretion of calcium,magnesium, phosphorus,urea, and creatinine in healthy prepubertal boys

ObjectivesAvailable data on 24-h urinary solute excretion in healthy children are sparse. We thus documented the daily and overnight variations of urinary electrolytes (calcium, magnesium, and phosphorus), urea, and creatinine in prepubertal (Tanner stage I) boys.Design and methodsNine voluntary healthy prepubertal boys aged 10.8 ± 0.11 years participated in this study. Concentrations of variables were quantified in daytime samples (collected between 07:00 h ± 30 min and 21:00 h ± 30 min) and nighttime samples (collected between 21:00 h ± 30 min and 07:00 h ± 30 min) in spring, during a period of 24-h every 3 h.ResultsSignificant differences were found between daytime and nighttime excretion of calcium (p < 0.05), magnesium (p < 0.001), phosphorus (p < 0.01), and urea (p < 0.05), with high concentrations during the night. The 24-h solute/creatinine ratio was 0.072 ± 0.008 mg/mg for calcium, 0.069 ± 0.008 mg/mg for magnesium, 0.698 ± 0.070 mg/mg for phosphorus, and 0.017 ± 0.001 g/mg for urea. Statistically significant correlation analyses showed that urea and creatinine were positively associated with body mass index (BMI) (R = 0.790, p = 0.0113 for urea; R = 0.889, p = <0.0013 for creatinine) and weight (R = 0.717, p = 0.0297 for urea; R = 0.978, p = < 0.001 for creatinine). The other urinary variables were independent of BMI and body mass.ConclusionThese data are of interest for the diagnosis of certain renal disease in prepubertal children.     

Reference range of thyroid function (FT3, FT4 and TSH) among Indian adults

ObjectivesTo generate thyroid hormone reference norms using electro-chemiluminescence technique.Design and methodsCross sectional study on apparently normal 4349 Delhi adults (18–86 years). Predetermined exclusion criteria (goiter, hypoechogenicity or nodularity on ultrasound, elevated anti-thyroid peroxidase antibody, hypo or hyperthyroidism and family history of thyroid dysfunction) excluded 2433 subjects leaving 1916 (916 males and 1000 females) as the reference population.ResultsMean age and BMI of the reference population were 41.2 ± 18.1 years and 24.5 ± 4.4 kg/m² respectively. Median urinary iodine excretion was 233.6 μg/L (79–458;3rd–97th centile). The population was categorized into various age groups (18–30, 31–40, 41–50, 51–60, 61–70 and ≥ 70 years). Overall FT3 and FT4 values in the reference population irrespective of age, ranged from 2.4–8.8 (mean 4.6 ± 0.9) pmol/L and 10.1–24.8 (mean 15.40 ± 2.0) pmol/L, respectively. Mean TSH value in the reference population was 2.2 ± 0.9 mIU/L which was significantly lower than that of total population (3.8 ± 6.1; p < 0.001).ConclusionFT3 values were observed to be significantly higher in men than women (p = 0.001). The centiles (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) of FT3, FT4 and TSH were derived for reference purposes in Indian adults. This community based study in Indian adults has established mean reference intervals for FT3, FT4 and TSH for different age groups for both sexes separately using strict exclusion criteria. These can be used as reference norms for Indian adults.     

Clinical screening of oropharyngeal dysphagia in patients with ALS

ObjectiveIt is a major issue to diagnose and detect oropharyngeal dysphagia in the early stage of ALS in order to avoid pulmonary and nutritional complications. The aim of this study was to validate a simple clinical test, the Volume-Viscosity Swallow Test (V-VST), to detect oropharyngeal dysphagia in this population.Patients and methodsTwenty patients were included in this study (mean age: 66.1 ± 8.13, six women). All patients had their swallowing function assessed by videofluoroscopy and V-VST.ResultsAmong these 20 patients, 15 presented oropharyngeal dysphagia, diagnosed by videofluoroscopy, and five had normal swallowing. Norris score was lower in patients with oropharyngeal dysphagia compared to the patients with normal swallowing (27 ± 6 versus 36 ± 2; P = 0.003). Among the 15 patients with oropharyngeal dysphagia, 14 had abnormal V-VST, and only one had normal V-VST. The sensibility of V-VST to detect oropharyngeal dysphagia in these patients with ALS was of 93%, and the specificity was of 80% (P = 0.007). There was no significant difference between the two populations for ALSFRS score (22 ± 6 versus 20 ± 6) and body mass index (BMI) (26 ± 6 versus 26 ± 6 kg/m²).ConclusionThe V-VST presented good sensibility and specificity. It may be interesting to use it systematically for the detection of oropharyngeal dysphagia in ALS, after confirming these results on a wider patient sample.     

Heart-type fatty acid binding protein is an early marker of myocardial damage after radiofrequency catheter ablation

ObjectivesRadiofrequency (RF) ablation of arrhythmias induces myocardial damage and release of biomarkers. This study aimed to assess the kinetics of heart-type fatty acid-binding protein (h-FABP), a cytosolic protein released after myocardial injury incurred by both atrial and ventricular RF ablation, compared to other markers of myocardial injury.Design and methodsh-FABP, cTnI, CK-MB_mass and myoglobin were evaluated in 30 patients with atrial or ventricular tachyarrhythmias before, immediately after and at 3, 6 and 24 h after the procedure.Resultsh-FABP increased immediately after the procedure in all subjects (6.6 ± 1.2 μg/L vs 2.7 ± 0.3, p < 0.001) but increased significantly only in ventricular ablations. The peak of h-FABP significantly correlates with the values of time for mean power of RF application in both the entire patient cohort and in ventricular ablations.Conclusionsh-FABP may be an early parameter for monitoring RF-induced lesions and the site of ablation was relevant for biomarker increase.