Changes in peripheral blood T-cell balance after percutaneous tumor ablation

Purpose: To evaluate the changes in T-cell balance in peripheral blood following percutaneous tumor ablation.

Material and methods: Patients underwent thermal ablation including radiofrequency (n?=?9) and microwave ablation (n?=?5), or cryoablation (n?=?5). Target tumors were located in the lung (n?=?7), soft tissue (n?=?5), liver (n?=?4), and bone (n?=?3). Patient peripheral blood samples were collected before and within 14?days after ablation. Peripheral blood populations of cytotoxic T-cells (CTL), type-1 (T_h1) and type-2 helper T-cells (T_h2), and regulatory T-cells (T_reg) were measured using flow cytometry. Changes in CTL/T_reg and T_h1/T_h2 ratios before and after ablation therapy were compared using paired t-tests.

Results: Peripheral blood CTL population (27.5?±?2.1% to 30.2?±?2.5%, p?reg ratios (18.8?±?3.7% to 21.6?±?3.6%, p?reg ratios was found after heat-based ablation (18.0?±?4.4% to 21.6?±?4.7%, p?p?=?.92). T_h1/T_h2 ratio (13.7?±?3.0% to 17.2?±?3.5%, p?=?.12) remained unchanged after ablation.

Conclusion: Ablation therapy alters the T-cell balance by increasing the systemic CTL/T_reg, ratio. Heat-based ablation might be a more effective approach than cryoablation to enhance systemic anti-tumor immunity.     

Influence of patient related factors on number of mesenchymal stromal cells reached after in vitro culture expansion for clinical treatment

Background: Number of stromal cells injected in patients with ischaemic heart disease (IHD) may be of importance for the treatment efficacy, which in turn may be influenced by various patient-related factors. In this study, we investigate whether patient-related factors influence the number of autologous stromal cells reached after in vitro culture expansion for clinical therapy.

Methods: Culture expansion data from 111 patients with IHD treated with autologous stromal cells in three clinical trials were used. We correlated the final cell count after two passages of cultivation with different patient factors.

Results: There was a significant relation between body mass index (BMI) and the number of adipose derived stromal cells (ASCs) reached after culture expansion and for all patients included into the three studies (r?=?0.375, p?=?.019 and r?=?0.200, p?=?.036, respectively). Moreover, there was a significantly higher number of ASCs reached in patients with hypertension compared to those without hypertension and for all patients overall (68.8?±?39.6?×?10⁶ vs. 39.1?±?23.6?×?10⁶, p?=?.020 and 62.0?±?55.0?×?10⁶ vs. 29.0?±?19.3?×?10⁶, p?<?.001, respectively). The same tendency was seen with bone marrow derived mesenchymal stromal cells (MSCs) in patients with hypertension compared to those without hypertension (58.4?±?61.8?×?10⁶ vs. 22.6?±?13.3?×?10⁶, p?<?.001) and in males compared to females (56.4?±?61.5?×?10⁶ vs. 30.9?±?27.9?×?10⁶, p?=?.041). Moreover, a significant negative correlation between left ventricular ejection fraction and number of MSCs was found (r?=??0.287, p?=?.017).

Conclusions: Patient related factors such as BMI, hypertension and gender may influence the number of MSCs reached after in vitro culture expansion.     

Clinical and genetic determinants of chronic visual pathway changes after methanol - induced optic neuropathy: four-year follow-up study

Context: Methanol poisoning induces acute optic neuropathy with possible long-term visual damage.

Objective: To study the dynamics and key determinants of visual pathway functional changes during 4 years after acute methanol poisoning.

Methods: A total of 42 patients with confirmed methanol poisoning (mean age 45.7?±?4.4 years) were examined 4.9?±?0.6, 25.0?±?0.6, and 49.9?±?0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping.

Results: Abnormal VEP P1 latency was registered in 18/42 right eyes (OD) and 21/42 left eyes (OS), abnormal N1P1 amplitude in 10/42 OD and OS. Mean P1 latency shortening during the follow-up was 15.0?±?2.0?ms for 36/42 (86%) OD and 14.9?±?2.4?ms for 35/42 (83%) OS, with maximum shortening up to 35.0?ms. No significant change of mean N1P1 amplitude was registered during follow-up.

A further decrease in N1P1 amplitude ≥1.0 mcV in at least one eye was observed in 17 of 36 patients (47%) with measurable amplitude (mean decrease ?1.11?±?0.83 (OD)/?2.37?±?0.66 (OS) mcV versus ?0.06?±?0.56 (OD)/?0.83?±?0.64 (OS) mcV in the study population; both p?ApoE4 allele carriers had lower global and temporal RNFL thickness and longer initial P1 latency compared to the non-carriers (all p?p?r?=?0.384; p?=?.013) and brain hemorrhages (r?=?0.395; p?=?.011).

Conclusions: Improvement of optic nerve conductivity occurred in more than 80% of patients, but evoked potential amplitude tended to decrease during the 4 years of observation. ApoE4 allele carriers demonstrated lower RNFL thickness, longer P1 latency, and more frequent methanol-induced brain damage compared to non-carriers.     

Quasi-experimental evaluation of a home care model for patients with stroke in China

Purpose: To evaluate the effectiveness of a modified home care model in China.

Methods: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n?=?168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n?=?173) who received routine care.

Results: Modified home care was associated with shorter acute hospitalisation (11.29?±?2.18 vs. 12.36?±?4.33 d, p?=?0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p?=?0.004] and ability to perform daily activities (38.25?±?10.22 vs. 32.08?±?10.32, p?=?0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p?=?0.02].

Conclusions: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China.

• Implications for Rehabilitation

• Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China.

• The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation.

• Home care models for stroke survivors should be adapted to local healthcare policies and resources.

     

Evaluation of Clostridium difficile Infection with PET/CT Imaging in a Mouse Model

Purpose

Existing clinical or microbiological scores are not sensitive enough to obtain prompt identification of patients at risk of complicated Clostridium difficile infection (CDI). Our aim was to use a CDI animal model to evaluate 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography ([¹⁸F]FDG-PET) as a marker of severe course of infection.

Procedures

CDI was induced with cefoperazone for 10 days followed by clindamycin 1 day before C. difficile inoculation. Mice were divided into wild type (n?=?6), antibiotic without infection (AC n?=?4), h001-infected (n?=?5, ribotype 001), and h027-infected (n?=?5, ribotype 027). Two days after inoculation, [¹⁸F]FDG-PET was acquired. Weight, general animal condition, and survival were monitored daily for 9 days.

Results

h001 group showed symptoms for 4 days with 0 % mortality and a similar colon uptake than control animals (h001 0.52?±?0.20, WT 0.42?±?0.07, and AC 0.36?±?0.06). The h027 group showed symptoms up to 7 days, with 66.7 % of mortality 4 days after infection, and significantly higher colon uptake (0.93?±?0.38, p?<?0.05). Clinical score was associated to colon and cecum uptake (rho?=?0.78, p?=?0.0001) (rho?=?0.73, p?=?0.0003).

Conclusion

High toxin producer ribotype 027 induced more severe CDI infections, correlating with higher colon and cecum [¹⁸F]FDG uptake. Colon uptake may purportedly serve as early predictor of CDI severity.

     

Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis

Abstract

Background: Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients’ quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients’ satisfaction after OMF surgery. Materials and methods: Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n?=?30, mandibular fractures n?=?26, wisdom tooth removal n?=?40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5?d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients’ objective feeling and satisfaction was queried. Results: Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2?d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5?cm?±?4.3; T3: 62.5?cm?±?4.2; T4: 61.6?cm?±?4.2) than in the no-KT group (T2: 67.6?cm?±?5.0; T3: 67.0?cm?±?5.0; T4: 64.8?cm?±?4.8) at T2 (p?<?0.001), T3 (p?<?0.001), and T4 (p?=?0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5?±?2.0 (p?=?0.006); T2: 1.7?±?2.0 (p?<?0.001); T3: 1.5?±?2.3 (p?=?0.004); T4: 0.6?±?1.1 (p?=?0.001) compared to the no-KT group (T1: 3.8?±?2.5; T2: 3.5?±?2.7; T3: 2.9?±?2.2; T4: 1.6?±?1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: ?0.08?cm?±?0.49 (p?=?0.025); T2-BL: 0.07?cm?±?0.59 (p?=?0.012); T3-BL: 0.20?±?0.63 (p?=?0.013); T4-BL: 0.42?±?0.59 (p?=?0.003)) compared to the no-KT group (T1-BL: ?0.47?cm?±?0.86; T2-BL: ?0.39?cm?±?0.84; T3-BL: ?0.24?±?0.89; T4-BL: ?0.13?±?1.02). Conclusion: KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients’ quality of life.     

CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques

Objective: To evaluate the one step technique compared with the Seldinger technique in computed tomography (CT) fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.

Material and methods: Seventy-six consecutive patients (49 men, 27 women; mean age 63.5 years, range 19–87 years) with abdominal and pelvic abscess were included in this study. Drainages were performed with the one step (n?=?46) and with the Seldinger (n?=?48) technique between September 2012 and June 2014.

Results: The technical success and clinical success rates were 95.8% and 93.5%, respectively, for the one step group, and 97.8% and 95.7%, respectively, for the Seldinger group. The mean procedure time was significantly shorter with the one step than with the Seldinger method (15.0?±?4.3?min, range 10–29?min vs. 21.0?±?9.5?min, range 13–54?min, p?Conclusion: The one step technique was easier and faster than the Seldinger technique. The effectiveness of both techniques was similar for the CT fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.     

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors

Purpose: The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.

Material and methods: A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n?=?8) or conventional laparoendoscopic nephrectomy (C-N; n?=?8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.

Results: Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0?±?26.7?min versus 188.6?±?36.4?min; p?=?.025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4?±?14.4?ml versus 65.6?±?45.2?ml; p?=?.047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.

Conclusions: Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.     

Tympanic membrane temperature decreases during head up tilt: relation to frontal lobe oxygenation and middle cerebral artery mean blood flow velocity

Introduction: Changes in blood flow influence temperature of surrounding tissues. Since the internal carotid artery (ICA) and internal jugular vein (IJV) neighbor the tympanic membrane, changes in their blood flow most likely determine changes in tympanic membrane temperature (TMT). We sought to evaluate the relationship between changes during a head-up tilt (HUT) induced reduction in cerebral blood flow (CBF) and TMT.

Methods: Ten male subjects (age 19–28 years) underwent 50° HUT until presyncope. A non-contact infrared sensor in the ear canal targeted the tympanic membrane. Changes in CBF were monitored by transcranial Doppler which determined the mean blood flow velocity in the middle cerebral artery (MCA V_mean) and by near infrared spectroscopy assessed frontal lobe oxygenation (S_cO₂), while skin blood flow (SkBF) was evaluated by laser Doppler flowmetry.

Results: During HUT, TMT decreased by 0.6?°C (median; range 0.2 to 1.6?°C) related to a decrease in MCA V_mean (51.0?±?6.7 to 34.3?±?5.8?cm/sec (mean?±?SD); r?=?0.518, p?=?.002) and S_cO₂ (78.6?±?5.4% to 69.0?±?5.7%; r?=?0.352, p?=?.043), but not to SkBF (120?±?78 to 69?±?37 PU; r?=?0.245, p?=?.142).

Conclusion: During an orthostatic challenge TMT decreases and the decrease is related to a reduction in CBF as indicated by MCA V_mean and S_cO₂, but not to SkBF. We consider TMT holds potential for non-invasive assessment of changes in cerebral perfusion.     

Clock drawing and rehabilitation outcome in hip fracture patients

Purpose.?To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE).

Methods.?This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (>23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed.

Results.?Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89?±?13.7 vs. 94.9?±?11.6, p?=?0.007; 61.6?±?11.1 vs. 65.7?±?9.6, p?=?0.022 respectively); LOS was significantly longer (28.2?±?7.9 vs. 25.3?±?8.5, p?=?0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62?±?0.35 vs. 0.77?±?0.45, p?=?0.036; 0.61?±?0.34 vs. 0.75?±?0.42, p?=?0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p?=?.027).

Conclusions.?The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.     

Perceived sexual satisfaction among women with drug-dependent husbands in Iran

Abstract

Background: Sexual satisfaction is known as one of the most important components of relationship satisfaction and quality of life. The present study aimed to evaluate the associated parameters of sexual satisfaction among female spouses of male drug dependents as one of the hidden populations in Iran.

Method: A total of 138 women with drug-dependent husbands were included in this cross-sectional study. Sociodemographic characteristics, anxiety and depression scores, sexual function and emotional parameters were entered into a stepwise linear regression model to find the possible predictors.

Findings: Mean age, marital length and spousal drug use length were 35?±?8, 14?±?10 and 12?±?8 years, respectively. Perceived lack of security [p?<?0.001, B?=?0.630, 95%?confidence interval (CI)?=?0.364–0.897], history of physical abuse by husband (p?<?0.001, B?=?0.297, 95%?CI?=?1.912–5.771) and marital length (p?=?0.003, B?=?0.142, 95%?CI?=?0.048–0.236) were found to be significantly associated with sexual satisfaction among female spouses of male drug dependents in Iran.

Conclusion: Results of the current study highlight the need for more attention to environmental and sociocultural parameters as the associated parameters of sexual satisfaction among female spouses of male drug dependents. Further research is needed with respect to a multidimensional evaluation of sexual satisfaction among this vulnerable hidden population in Iran, especially to find causative relations.     

Laser speckle contrast imaging of forehead cutaneous blood flow during carotid endarterectomy as a potential non-invasive method for surrogate monitoring of cerebral perfusion

Monitoring cerebral perfusion is important for goal-directed anesthesia. Taking advantage of the supply of the supraorbital region and Glabella from the internal carotid artery (ICA), we evaluated changes in cutaneous blood flow using laser speckle contrast imagining (LSCI) as a potential method for indirect real-time monitoring of cerebral perfusion. Nine patients (8 men, mean age 70 years) underwent eversion carotid endarterectomy under local anesthesia. Cutaneous blood flow of the forehead was monitored using LSCI. During clamping of the common carotid artery (CCA), ipsilateral supraorbital region and Glabellas cutaneous blood flow dropped from 334?±?135 to 221?±?109 AU (p?=?0.023) (AU: arbitrary flux units) and from 384?±?151 to 276?±?107 AU (p?=?0.023), respectively, whilst the contralateral supraorbital region cutaneous blood flow remained unchanged. The supraorbital cutaneous blood flow did not change significantly following reperfusion of the external carotid artery (ECA) (221?±?109 to 281?±?154 AU; p?=?0.175) and ICA (281?±?154 to 310?±?184 AU; p?=?01). A comparable trend for Glabella followed ECA (276?±?107 to 342?±?170 AU; p?=?0.404) and ICA (342?±?170 to 352?±?191 AU; p?=?01) reperfusion. In patients undergoing carotid endarterectomy under local anesthesia, LSCI of the supraorbital and Glabella regions reflected clamping of the CCA but did not distinguish reperfusion of the ICA from that of the ECA.

     

Effects of a Community-Based Tai Chi Program on Balance,Functional Outcomes,and Sensorimotor Function in Older Adults

Abstract

Aims: Examine effects of a community Tai Chi program on measures of balance and sensorimotor function.

Methods: In a pretest and post-test design, balance was measured in older adults (N?=?344; 73.4?±?7.4?years) with 30-s chair stand, timed-up-and-go, and 4-stage balance test following a 12-week community-based Tai Chi intervention. Balance and sensorimotor measures, including hip abductor electromechanical delay and hip proprioception, were measured in a smaller sample of older adults (n?=?11; 67.3?±?3.7?years).

Results: Balance improved (p?<?0.0001) following intervention compared to pretest. Similarly, participants in the smaller sample showed improvements at post-test (p?<?0.05) in electromechanical delay and lower extremity proprioception, but no bone density or muscle mass changes.

Conclusions: These preliminary results suggest that a community-based Tai Chi program improves balance in older adults. In a smaller sample, Tai Chi resulted in additional sensorimotor changes, specifically faster hip abductor muscle contraction speed and improved hip proprioception.     

Leukotriene-mediated neuroinflammation,toxic brain damage,and neurodegeneration in acute methanol poisoning

Context: The role of neuroinflammation in methanol-induced toxic brain damage has not been studied.

Objective: We studied acute concentrations and the dynamics of leukotrienes (LT) in serum in hospitalized patients with acute methanol poisoning and in survivors.

Methods: Series of acute cysteinyl-LT and LTB4 concentration measurements were performed in 28/101 hospitalized patients (mean observation time: 88?±?20?h). In 36 survivors, control LT measurements were performed 2 years after discharge.

Results: The acute maximum (C_max) LT concentrations were higher than concentrations in survivors: C_max for LTC4 was 80.7?±?5.6 versus 47.9?±?4.5?pg/mL; for LTD4, 51.0?±?6.6 versus 23.1?±?2.1?pg/mL; for LTE4, 64.2?±?6.0 versus 26.2?±?3.9?pg/mL; for LTB4, 59.8?±?6.2 versus 27.2?±?1.4?pg/mL (all p?p?p?p?p?The follow-up LT concentrations in survivors with and without CNS sequelae did not differ (all p?>?0.05). The mean decrease in LT concentration was 30.9?±?9.0?pg/mL for LTC4, 26.3?±?8.6?pg/mL for LTD4, 37.3?±?6.4?pg/mL for LTE4, and 32.0?±?8.8?pg/mL for LTB4.

Conclusions: Our findings suggest that leukotriene-mediated neuroinflammation may play an important role in the mechanisms of toxic brain damage in acute methanol poisoning in humans. Acute elevation of LT concentrations was moderate, transitory, and was not followed by chronic neuroinflammation in survivors.     

Change in the new psychoactive substances associated with Emergency Department acute toxicity presentations associated with the introduction of the UK 2016 Psychoactive Substances Act

Objectives: In May 2016, the Psychoactive Substances Act (PSA) came into effect in UK making it an offence to produce or supply new psychoactive substances (NPS). The aim of this study was to determine whether this was associated with a change in Emergency Department (ED) presentations with acute NPS toxicity.

Method: ED presentations to our inner-city hospital in London, UK, with acute NPS toxicity in the 12 months before and after the PSA introduction [June 2015–May 2016 (2015/2016) and June 2016–May 2017 (2016/2017)] were obtained from our database. The following data were extracted: (i) demographics; (ii) NPS(s) self-reported [categorized as synthetic cannabinoids (SC), cathinones, and “other NPS”)]; and (iii) month of presentation.

Results: There were 1884 presentations with recreational drug toxicity, 447 (23.7%) involved NPS. There was no difference in the overall proportion of presentations involving an NPS in 2015/2016 [n?=?196 (22.3%)] and 2016/2017 [251 (24.9%); (p?=?.48)]. There were a mean?±?SD of 16.3?±?3.7 NPS-related presentations per month in 2015/2016 and 20.9?±?9.2 in 2016/2017; there was no significant change in overall monthly NPS-related presentations between these periods (p?=?.15). However, mean?±?SD monthly SC-related presentations increased from 2015/2016 (5.9?±?2.5) to 2016/2017 (17?±?9.8); p?=?.004. Mean monthly cathinone-related presentations decreased from 2015/2016 (8.8?±?4.2) to 2016/2017 (3.8?±?2.7); p?=?.001. There was no significant change in monthly mean “other NPS” presentations from 2015/2016 (1.8?±?2.2) to 2016/2017 (0.5?±?0.8); p?=?.062. Between 2015/2016 and 2016/2017, SCs as a proportion of NPS-related presentations increased (r?=?.90) whilst cathinones decreased (r?=??0.82).

Conclusion: NPS present front-line health services with unique challenges, and the PSA 2016 represents a major legislative effort in UK to limit their availability and supply. The burden of NPS use on this inner-city ED remains large 12 months after this legislation has come into force, with evolving patterns of NPS use.     

Serum level of interleukin-6 (IL-6) and N-terminal propeptide of procollagen type I (PINP) in patients with liver diseases

Introduction: The aim of this study was to evaluate the concentration of interleukin-6 and N-terminal propeptide of procollagen type I and their relationship in liver diseases of different etiologies.

Material and methods: Serum samples were obtained from 30 healthy volunteers and patients suffering from alcoholic cirrhosis (AC) – 31, non-alcoholic cirrhosis (NAC) – 28 and toxic hepatitis (HT) – 23 patients. Cirrhotic patients were classified according to Child–Pugh score. IL-6 and PINP concentrations were determined according to the electrochemiluminescence immunoassay.

Results: The mean serum IL-6 concentration was significantly higher in AC (mean?±?SD:21.52?± 15.01?pg/mL), NAC (20.07?±?32.12?pg/mL) and HT (15.14?±?17.18?pg/mL) when compared to the control group (C) (1.67?±?0.42?pg/mL) (Mann–Whitney U test: p?p?p?=?.020 and p?p?p?=?.022, respectively). IL-6 and PINP concentrations appeared to vary depending on the severity of liver damage (p?p?p?Conclusions: We conclude that serum concentrations of IL-6 and PINP change in liver diseases, and those changes reflect the severity of liver disease.     

Arterial stiffness in fertile women with metabolic syndrome

Introduction: Although metabolic syndrome (MetS) is evidently associated with the risk of cardiovascular disease (CVD), recently its use has been questioned. We studied the utility of MetS diagnosis when estimating individual CVD risk.

Methods: We compared 27 fertile women with MetS and 27 counterparts without the syndrome, matched pairwise according to well-known risk factors of CVD. Pulse wave velocity (PWV) and central blood pressure (cBP) were determined noninvasively via a SphygmoCor device. Arterial compliance was measured noninvasively with an HDI/PulseWave^TMCR-2000 arterial tonometer.

Results: PWV (7.1?±?2.5 versus 6.5?±?1.1 m/s, p?=?.037), and both systolic (120.9?±?12.2 versus 111.5?±?16.0?mmHg, p?=?.031) and diastolic cBP (81.3?±?8.5 versus 74.1?±?11.2?mmHg, p?=?.035) were higher in the MetS group. Systemic arterial compliance values were lower in both large (15.1?±?8.0 versus 16.1?±?4.4?mL/mmHg?×?10, p?=?.034) and small arteries (7.1?±?2.5 versus 9.3?±?3.2?mL/mmHg?×100, p?=?.010) in women with MetS.

Conclusions: Fertile women with MetS had increased arterial stiffness, as measured by three different methods. Our results highlight the utility of MetS when revealing increased individual CVD risks in fertile-aged women.

• Key messages

• Women with MetS have increased arterial stiffness when measured by different methods.

• MetS is a useful clinical tool to assess increased cardiovascular risk, particularly among fertile-aged women.

     

A Multi-Ligand Imaging Study Exploring GABAergic Receptor Expression and Inflammation in Multiple Sclerosis

Purpose

The γ-aminobutyric acid (GABA) is the main inhibitory neurotransmitter and essential for normal brain function. The GABAergic system has been shown to have immunomodulatory effects and respond adaptively to excitatory toxicity. The association of the GABAergic system and inflammation in patients with multiple sclerosis (MS) remains unknown. In this pilot study, the in vivo relationship between GABA_A binding and the innate immune response is explored using positron emission tomography (PET) with [¹¹C] flumazenil (FMZ) and [¹¹C]-PK11195 PET (PK-PET), a measure of activated microglia/macrophages.

Procedures

Sixteen MS patients had dynamic FMZ-PET and PK-PET imaging. Ten age-matched healthy controls (HC) had a single FMZ-PET. GABA_A receptor binding was calculated using Logan reference model with the pons as reference. Distribution of volume ratio (VTr) for PK-PET was calculated using image-derived input function. A hierarchical linear model was fitted to assess the linear association between PK-PET and FMZ-PET among six cortical regions of interest.

Results

GABA_A receptor binding was higher throughout the cortex in MS patients (5.72?±?0.91) as compared with HC (4.70?±?0.41) (p?=?0.002). A significant correlation was found between FMZ binding and PK-PET within the cortex (r?=?0.61, p?<?0.001) and among the occipital (r?=?0.61, p?=?0.012), parietal (r?=?0.49, p?=?0.041), and cingulate (r?=?0.32, p?=?0.006) regions.

Conclusions

A higher GABA_A receptor density in MS subjects compared with HC was observed and correlated with innate immune activity. Our observations demonstrate that immune-driven GABAergic abnormalities may be present in MS.

     

Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability

Purpose: The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart^®) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs).

Method: Fifty-eight participants wore ActiHeart^® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart^®. Results were compared by means of correlation analyses. The level of agreement was presented with Bland–Altman plots.

Results: Objective PA (ActiHeart^®) was higher (225.57?±?91.96?min/week) than IPAQ-S PA reported by care-givers (177.06?±?309.17?min/week). Weak significant correlations were observed between the ActiHeart^® and IPAQ-S instruments for sedentary behavior (r?=?0.31; p?=?0.04); no significant correlations for light (r=??0.04; p?=?0.8), moderate (r=??0.07; p?=?0.63), or vigorous PA (r=??0.2; p?=?0.18) were found. Limited agreement between objectively determine PA (ActiHeart^®) and IPAQ-S was found.

Conclusion: IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort.

• Implications for Rehabilitation

• Persons with intellectual disability (ID) report insufficient physical activity for health benefits.

• Physical activity is often determined by means of subjective proxy reporting.

• Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID.

• Exercise interventions should be based on objective physical activity measurements.

     

Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Abstract

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer.

Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20?mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184).

Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p?=?.038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p?=?.07). The total procedure time was 96.6?±?28.2 and 72.8?±?24.2 (min) with a significant difference (p?=?.027).

Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.