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.

     

Cannula-guided snare with endoclip to assist in endoscopic submucosal dissection: an in vivo animal study

Background and objective: Assisted endoscopic submucosal dissection (ESD) with mucosal traction remains a challenge. This study explored an approach to assist in esophageal, gastric, colonic, and rectal ESD through a cannula-guided snare with endoclips (CSC-ESD), and aimed to preliminarily evaluate its feasibility in an in vivo porcine model.

Material and methods: Forty-seven digestive tract mucosae in six pigs were resected using CSC-ESD. The operative time, operative success rate, en bloc resection rate, and intraoperative complications were evaluated.

Results: The mean diameter of 12 resected esophageal mucosae was 4.4?±?1.7?cm and the mean operative time was 24?±?8?min. The mean diameter of 20 resected gastric mucosae was 3.8?±?0.9?cm and the operative time was 35?±?8?min. The mean diameter of 15 resected colonic and rectal mucosae was 3.6?±?1.0?cm and the operative time was 34?±?8?min. In all 47 resected mucosae, the en bloc resection rate was 100%, the operative success rate was 100%, and the intraoperative perforation rate was 4.3% (2/47) in the colon. No mucosal bruising or massive bleeding occurred during surgery.

Conclusion: The results indicated that this novel assistive method is feasible in esophageal, gastric, colonic and rectal ESD. The further research is worthwhile.     

A randomized comparative trial of OTSC and Padlock for upper GI hemostasis in a standardized experimental setting

Introduction: Upper gastrointestinal bleeding (UGIB) is the key emergency situation in clinical endoscopy and is traditionally treated with injection, thermal or through the scope clipping therapy. Mortality rates are in the range of 8–10% and demand new treatment approaches. The Over-The-Scope Clip (OTSC^®) has been described as a very effective hemostatic device in UGIB. We compared OTSC with the Padlock? device in an established pre-clinical setting.

Material and methods: Our test-bed consisted of the biohybrid EASIE model using soft silicone tubes, tunneled into the gastric wall and surfacing at a mucosa defect, representing the bleeding site. After successful deployment of the OTSC and Padlock devices on the spurting ulcer bleed (Forrest Ia) the vessel tubes were pressurized with a manometer to 120?mmHg. Tight closure at this pressure was defined as successful hemostasis (primary endpoint). N?=?11 procedures were done with each device. Statistical testing was done using Fisher’s exact test. Sample size was adjusted to an assumed α-error of 5% (two-sided test) and a power of 80%.

Results: Technically correct placement of the respective hemostatic device was achieved in all procedures. A statistically significant difference was found in the primary endpoint. In OTSC the success proportion was 100%; 11/11 (95% KI 74.1% to 100%); in Padlock it was 0%; 0/11 (95% KI 0%–25.8%). This means that no bleeding was stopped by Padlock. The mean value of perfusion pressure resistance was 300?mmHg (cut-off) for OTSC and 9.2?±?8.4?mmHg for Padlock.

Discussion: Our data on hemostatic function of OTSC coincide with the clinical literature and earlier pre-clinical studies in the EASIE model, which is widely accepted as a realistic and effective simulation system for clinical conditions. The inability of Padlock to stop hemorrhage may be due to design differences and, thus, its limitation in providing tight sealing of the clipped tissue.

Conclusion: Different types of endoscope-tip mounted clips have different performances. OTSC consistently stops simulated spurting bleeding, Padlock fails to do so. These differences are statistically significant.     

Novel approach of laparoscopic and endoscopic cooperative surgery (LECS) for cholecystectomy

Background: Endoscopic submucosal dissection (ESD) techniques, such as generating an artificial space between digestive tract layers for safer dissection, were thought to be safer for the resection of organs in cholecystectomy. We investigated whether combinations of endoscopic techniques and laparoscopic techniques could be performed more safely and rapidly.

Material and methods: Laparoscopic and endoscopic cooperative-cholecystectomy (LEC-chole) and conventional laparoscopic cholecystectomy (Lapa-chole) were performed in six dogs. Operation time was defined as the time from the creation of the first port to the retrieval of the resected gallbladder (GB); and GB bed dissection time was the time from local injection of natural saline to the clipping of the cystic duct. The main roles of the endoscope in LEC-chole were to obtain a sufficient cutting space via local injection of natural saline to the GB bed and to monitor the operative view without laparoscopic camera, thus omitting the umbilical port.

Results: The operation times were 60?±?18.3?minutes for LEC-chole and 95?±?7.0 for Lapa-chole (p?=?.036). The GB bed dissection times were 31?±?8.54?minutes in LEC-chole and 50.6?±?7.37?minutes in Lapa-chole (p?=?0.048). There were significant differences in liver damage and bleeding (p?=?0.116), but there were no significant differences in one-month survival.

Conclusions: The application of LEC-chole may be expanded to cholecystectomy.     

Comparison of two methods for endoscopic full-thickness resection of gastrointestinal lesions using OTSC

Abstract

Background and aims: The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques.

Material and methods: This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2).

Results: Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83?±?34.97?min in Group 1 which is significantly longer than that of Group 2 (p?=?.0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% (p?=?.338), respectively. VAS scores of Group 1 immediately after the operation and after 24?h are significantly higher than those of Group 2 (p?=?.047 and p?=?.009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2.

Conclusion: EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.     

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.     

Activated charcoal significantly reduces the amount of colchicine released from Gloriosa superba in simulated gastric and intestinal media

Background: Poisoning with Gloriosa superba, a plant containing colchicine, is common in Sri Lanka.

Objectives: This study was to estimate release of colchicine from 5?g of different parts of Gloriosa superba in simulated gastric and intestinal media, and examine the binding efficacy of activated charcoal (AC) to colchicine within this model.

Methods: A USP dissolution apparatus-II was used to prepare samples for analysis of colchicine using HPLC.

Results: Cumulative colchicine release from tuber in gastric media at 120?minutes was significantly higher (2883?μg/g) than in intestinal media (1015?μg/g) (p?Conclusions: The tuber released the highest quantity of colchicine. The colchicine release and elapse time to achieve saturated, equilibrium dissolution mainly depends on physicochemical properties of plant part. Significant in vitro binding of colchicine to AC suggests that AC has a role in decontamination of patients presenting to hospital after ingestion of Gloriosa superba.     

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.     

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.     

It is time for a better clip applier – 3 mm,percutaneous, non-crushing and locking

Introduction: Since the advent of laparoscopy there have been attempts to minimize abdominal wall incisions. For this purpose smaller instruments have been produced. Our aim was to develop the first 3?mm percutaneous clip applier and to make it better than the standard clips of today.

Material and methods: The ClipTip clip is made of Nitinol and has a crocodile shaped jaws, which when apposed effectively seal vessels. The shaft operates as a retractable needle permitting percutaneous insertion. Closing, reopening and reclosing is possible. The physical properties of the device were compared to three commercially available clip appliers. Surgeries were performed on porcine animals by experienced surgeons.

Results: In comparison to available clips, the superiority of the ClipTip is a combination of wide effective length alongside the ability to withstand strong forces. In live animal studies the Cliptip was inserted into the peritoneal cavity without any injuries. Vessels were ligated successfully and no clip dislodgement or leakage occurred.

Conclusions: We developed the next generation clip applier with better properties. Advantages include its length, the needleoscopic caliber, non-crushing effect, locking mechanism and wide aperture. The device has performed safely and effectively in pre-clinical tests. Further studies are planned in humans.     

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

Context: Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined.

Objective: We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning.

Methods: The study was designed as observational cohort study. The mean time for an increase of 1?mmol/L HCO₃^–, 0.01 unit arterial blood pH, and the total time for correction of HCO₃^– were determined in IHD- and CRRT-treated patients.

Results: Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79?±?0.10 versus 7.05?±?0.10; p?=?0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO₃^– correction correlated with arterial blood pH (r=??0.511; p?=?0.003) and creatinine (r?=?0.415; p?=?0.020). There was association between the time to HCO₃^– correction and dialysate/effluent and blood flow rates (r=??0.738; p?r=??0.602; p?The mean time for HCO₃^– to increase by 1?mmol/L was 12?±?2?min for IHD versus 34?±?8?min for CRRT (p?p?=?0.024). The mean increase in HCO₃^– was 5.67?±?0.90?mmol/L/h for IHD versus 2.17?±?0.74?mmol/L/h for CRRT (p?Conclusions: Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.     

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.     

Influence of videogames and musical instruments on performances at a simulator for robotic surgery

Objective: To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS).

Materials and methods: A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS.

Results: Subjects from group 3 achieved the best performances on overall score: 527.09?±?130.54 vs. 493.73?±?108.88 (group 2), 472.72?±?85.31 (group 1), and 403.13?±?99.83 (group 4). Statistically significant differences (p?p?=?.009) and for time of completion (p?=?.044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98?±?122.71 vs. 470.25?±?92.31), but without statistically significant difference (p?=?.646).

Conclusions: The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.     

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.     

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.     

Evaluation of a new smartphone optical blood pressure application (OptiBP™) in the post-anesthesia care unit: a method comparison study against the non-invasive automatic oscillometric brachial cuff as the reference method

We compared blood pressure (BP) values obtained with a new optical smartphone application (OptiBP?) with BP values obtained using a non-invasive automatic oscillometric brachial cuff (reference method) during the first 2 h of surveillance in a post-anesthesia care unit in patients after non-cardiac surgery. Three simultaneous BP measurements of both methods were recorded every 30 min over a 2-h period. The agreement between measurements was investigated using Bland–Altman and error grid analyses. We also evaluated the performance of the OptiBP? using ISO81060–2:2018 standards which requires the mean of the differences?±?standard deviation (SD) between both methods to be less than 5 mmHg?±?8 mmHg. Of 120 patients enrolled, 101 patients were included in the statistical analysis. The Bland–Altman analysis demonstrated a mean of the differences?±?SD between the test and reference methods of?+?1 mmHg?±?7 mmHg for mean arterial pressure (MAP),?+?2 mmHg?±?11 mmHg for systolic arterial pressure (SAP), and?+?1 mmHg?±?8 mmHg for diastolic arterial pressure (DAP). Error grid analysis showed that the proportions of measurement pairs in risk zones A to E were 90.3% (no risk), 9.7% (low risk), 0% (moderate risk), 0% (significant risk), 0% (dangerous risk) for MAP and 89.9%, 9.1%, 1%, 0%, 0% for SAP. We observed a good agreement between BP values obtained by the OptiBP? system and BP values obtained with the reference method. The OptiBP? system fulfilled the AAMI validation requirements for MAP and DAP and error grid analysis indicated that the vast majority of measurement pairs (≥?99%) were in risk zones A and B.

Trial Registration ClinicalTrials.gov Identifier: NCT04262323.

     

Hemolysis may cause false negative results and underdiagnosis of celiac disease when measuring anti-tissue transglutaminase antibodies in serum by immunoassays

Abstract

Aims. Patients with type 2 diabetes have increased arterial stiffness and a high incidence of cardiovascular disease compared with non-diabetics. Arterial stiffness and central waveforms can be assessed by carotid-femoral pulse wave velocity (PWV) and pulse wave analysis (PWA) using the SphygmoCor device. These methods can potentially improve cardiovascular risk stratification in the future. However, a prerequisite is acceptable reproducibility. The objective of this study was to assess the intra- and inter-observer reproducibility of PWV and PWA indices in patients with type 2 diabetes using the SphygmoCor device. Methods. Two trained observers (A and B) each undertook two PWA and two carotid-femoral PWV recordings in random order in 20 patients with type 2 diabetes under standardized conditions on the right side of the patients. Observer A also made double recordings on the left side. The mean of the two recordings was used for inter-observer comparison. Data were analyzed by Bland-Altman plots. Results. The mean intra-observer differences (± 2SD) on the right side for observer A and B, respectively, were 0.0 ± 2.8 mmHg and 0.3 ± 3.2 mmHg (aortic systolic blood pressue (BP)), 0.0 ± 1.2 mmHg and 0.1 ± 1.0 mmHg (aortic diastolic BP), ? 1.1 ± 3.2% and 1.1 ± 9.6% (central augmentation index (Aix)), ? 1.6 ± 6.6% and 0.1 ± 9.0% (Aix normalized to heart rate 75 beats/min (Aix@HR75)) and 0.1 ± 1.8 m/s and 0.0 ± 1.6 m/s (PWV). The mean inter-observer differences (± 2SD) were ? 2.6 ± 13.0 mmHg (aortic systolic BP), ? 2.1 ± 7.4 mmHg (aortic diastolic BP), ? 0.8 ± 8.4% (Aix), ? 1.5 ± 7.4% (Aix@HR75) and ? 0.3 ± 1.6 m/s (PWV). Left-vs-right comparison showed comparable results (observer A). Conclusions. PWA and PWV assessed with the SphygmoCor device are characterized by good reproducibility in patients with type 2 diabetes.     

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.     

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.