The comparison of high and standard definition computed tomography techniques regarding coronary artery imaging

ObjectiveThe aim was to compare coronary high-definition CT (HDCT) with standard-definition CT (SDCT) angiography as to radiation dose, image quality and accuracy.ResultsThe intraclass correlation coefficient (ICC) of measured vessel attenuation values in SDCT between the two radiologists was exceedingly good. The ICC was higher in HDCT. The radiation dose of HDCT was higher than that of SDCT. The mean tube current was 180 (mA) in HDCT and 147(mA) in SDCT with the same tube voltage (kVp). There was no significant difference between image quality.ConclusionHDCT has a higher radiation dose but has much more atenuation and the spatial resolution which improve measurement accuracy for imaging coronary arteries.     

Reliability of a semi-automated 3D-CT measuring method for tunnel diameters after anterior cruciate ligament reconstruction: A comparison between soft-tissue single-bundle allograft vs. autograft

BackgroundPost-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method.MethodsThirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at one year after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined.ResultsIn femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922–0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982–0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875–0.985). The combined inter-observer ICC was 0.970 (95% CI: 0.987–0.917). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p = 0.013) as well as in the femoral tunnels (p = 0.007).ConclusionsTo our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at one-year follow-up.Level of evidenceLevel II, Prospective comparative study.     

Gender differences and long-term clinical outcomes in patients with chronic total occlusions of infrainguinal lower limb arteries treated from retrograde access with peripheral vascular interventions

PurposeWe sought to investigate gender-related differences in clinical outcomes after peripheral vascular interventions (PVIs) from retrograde access in patients with chronic total occlusions (CTOs) of the infrainguinal arteries.Patients and methodsA total of 939 consecutive patients undergoing PVI were enrolled in the study. Patients with peripheral artery diseases (PAD) and CTOs were treated with PVI from retrograde access according to the local protocol. The participants were divided according to gender. Retrograde access included distal puncturing to reach the CTO. The mean follow-up lasted 1,144.9 ± 664.3 days. Baseline characteristics, procedural and long-term outcomes were compared according to gender.ResultsWomen represented 37.4% of the study population, and more frequently suffered from hypertension (92% vs. 86%, p = 0.001) and diabetes (54% vs. 46%, p = 0.02). Males more often presented with chronic obstructive pulmonary disease (14.8% vs. 6.8%, p = 0.0003), coronary artery disease (45.4% vs. 32.7%, p = 0.0001), smoking (60.4% vs. 45%, p = 0.007) and prior PVI (25% vs. 17%, p = 0.005). The Kaplan-Meier survival curves at 5 years did not reveal gender-related differences in mortality (p = 0.8), whereas men were at a significantly higher risk of re-PVI during the follow-up period (p = 0.047). Male gender was an independent predictor of re-PVI (Hazard ratio: 1.276; 95% confidence interval: 1.015–1.614, p = 0.03).ConclusionMales are at increased risk of re-PVI compared to females with PAD and CTOs of infrainguinal arteries treated with PVI from retrograde access.     

Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with monocyte subsets in patients with stable coronary artery disease

BackgroundProprotein convertase subtilisin/kexin type-9 (PCSK9) is an enzyme promoting the degradation of low-density lipoprotein receptors (LDL-R) in hepatocytes. Inhibition of PCSK9 has emerged as a novel target for lipid-lowering therapy. Monocytes are crucially involved in the pathogenesis of atherosclerosis and can be divided into three subsets.ObjectiveThe aim of this study was to examine whether circulating levels of PCSK9 are associated with monocyte subsets.MethodsWe included 69 patients with stable coronary artery disease. PCSK9 levels were measured and monocyte subsets were assessed by flow cytometry and divided into classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14+CD16++; NCM).ResultsMean age was 64 years and 80% of patients were male. Patients on statin treatment (n = 55) showed higher PCSK9-levels (245.4 (206.0–305.5) ng/mL) as opposed to those without statin treatment (186.1 (162.3–275.4) ng/mL; p = 0.05). In patients on statin treatment, CM correlated with circulating PCSK9 levels (R = 0.29; p = 0.04), while NCM showed an inverse correlation with PCSK9 levels (R = -0.33; p = 0.02). Patients with PCSK9 levels above the median showed a significantly higher proportion of CM as compared to patients with PCSK9 below the median (83.5 IQR 79.2–86.7 vs. 80.4, IQR 76.5–85.2%; p = 0.05). Conversely, PCSK9 levels >median were associated with a significantly lower proportion of NCM as compared to those with PCSK9 <median (10.2, IQR 7.3-14.6 vs. 14.3, IQR 10.9–18.7%; p = 0.02). In contrast, IM showed no association with PCSK9 levels.ConclusionsWe hereby provide a novel link between PCSK9 regulation, innate immunity and atherosclerotic disease in statin-treated patients.     

Three Dimensional Quantitative Coronary Angiography Can Detect Reliably Ischemic Coronary Lesions Based on Fractional Flow Reserve

Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha''ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm², %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

Graphical Abstract

相似文献   

超低对比剂剂量和流率在头颈部CT血管造影中的应用

目的:探讨双层探测器光谱CT在对比剂低耐受度患者头颈部CT血管造影（CTA）检查中应用超低对比剂剂量和流率扫描的优势。方法:收集对比剂低耐受度患者40例（观察组）,对比剂用量20 mL,流率2 mL/s,所得图像行40 keV单能谱重建;选取同期普通患者40例（对照组）,对比剂用量50 mL,流率5 mL/s;两组患者体质量均在70 kg以下。比较两组患者图像的主观评分、CT值、信号噪声比（SNR）、对比噪声比（CNR）和辐射剂量。结果:两组动脉显影图像主观评分比较差异无统计学意义（P>0.05）;在主动脉弓水平,观察组图像CT值、SNR和CNR均显著高于对照组（P<0.05）;在双侧颈总动脉分叉处及双侧大脑中动脉M1段,两组图像CT值比较差异无统计学意义（P>0.05）,但观察组图像SNR和CNR值均显著高于对照组（P<0.05）;观察组和对照组间容积CT剂量指数、剂量长度乘积、有效辐射剂量比较差异均无统计学意义（P>0.05）。结论:双层探测器光谱CT在低耐受度患者头颈CTA检查中应用超低对比剂剂量和流率的扫描方案可以满足诊断需求,降低了对比剂肾病、对比剂外渗等副作用风险,且未增加辐射剂量。     

Preventive Effect of Pretreatment with Intravenous Nicorandil on Contrast-Induced Nephropathy in Patients with Renal Dysfunction Undergoing Coronary Angiography (PRINCIPLE Study)

Purpose

To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography.

Materials and Methods

This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate <60 mL/min. Nicorandil 12 mg dissolved in 100 mL of 0.9% saline was administered intravenously for 30 minutes just prior to coronary angiography in the nicorandil group. The same volume of only saline was given to the control group. The primary end-point was the incidence of CIN, defined as >0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline.

Results

The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6±69.1 mL vs. 126.9±74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58±24.07% vs. 0.96±17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01±0.43 mg/mL vs. 0.02±0.31 mg/mL, p=0.005).

Conclusion

Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.     

Long-Term Safety and Efficacy of Prolonged Dual Antiplatelet Therapy according to Baseline Anemia after Percutaneous Coronary Intervention

PurposeWe aimed to evaluate the outcomes of prolonged dual antiplatelet therapy (DAPT) depending on baseline anemia after percutaneous coronary intervention (PCI).Materials and MethodsAmong the 1470 study participants, 448 (30.5%) were classified as having baseline anemia. We categorized the study population according to baseline anemia and DAPT duration: ≤12-month (m) DAPT (n=226) vs. >12-m DAPT (n=222) in anemic patients, and ≤12-m DAPT (n=521) vs. >12-m DAPT (n=501) in non-anemic patients.ResultsDuring a follow-up of 80.8 (interquartile range 60.6–97.1) months, anemic patients showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (26.9% vs. 17.1%, p<0.001) and major bleeding (9.8% vs. 5.1%, p=0.006). Among the non-anemic patients, prolonged DAPT was associated with a reduced rate of MACCEs [inverse probability of treatment weighting (IPTW) adjusted hazard ratio (HR), 0.78; 95% confidence interval (CI), 0.63–0.96; p=0.019] without an increase in major bleeding (IPTW adjusted HR, 1.12; 95% CI, 0.75–1.68; p=0.574). However, prolonged DAPT was not related to the incidence of MACCEs (IPTW adjusted HR, 1.11; 95% CI, 0.88–1.39; p=0.387), with increased major bleeding (IPTW adjusted HR, 2.01; 95% CI, 1.32–3.06; p=0.001) among anemic patients.ConclusionAlthough extended DAPT led to a reduction in MACCEs in non-anemic patients, it was related to increased major bleeding without reducing MACCEs in anemic patients.     

Comparison of Liver Transplantation and Liver Resection for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Type I and Type II

PurposeThe aim of this study was to compare the efficacy of liver transplantation (LT) and liver resection (LR) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to investigate risk factors affecting prognosis.Materials and MethodsA total of 94 HCC patients with PVTT type I (segmental PVTT) and PVTT type II (lobar PVTT) were involved and divided into LR (n=47) and LT groups (n=47). Recurrence-free survival (RFS) and overall survival (OS) were compared before and after inverse probability of treatment weighting (IPTW). Prognostic factors for RFS and OS were explored.ResultsTwo treatment groups were well-balanced using IPTW. In the entire cohort, LT provided a better prognosis than LR. Among patients with PVTT type I, RFS was better with LT (p=0.039); OS was not different significantly between LT and LR (p=0.093). In subgroup analysis of PVTT type I patients with α-fetoprotein (AFP) levels >200 ng/mL, LT elicited significantly longer median RFS (18.0 months vs. 2.1 months, p=0.022) and relatively longer median OS time (23.6 months vs. 9.8 months, p=0.065). Among patients with PVTT type II, no significant differences in RFS and OS were found between LT and LR (p=0.115 and 0.335, respectively). Multivariate analyses showed treatment allocation (LR), tumor size (>5 cm), AFP and aspartate aminotransferase (AST) levels to be risk factors of RFS and treatment allocation (LR), AFP and AST as risk factors for OS.ConclusionLT appeared to afford a better prognosis for HCC with PVTT type I than LR, especially in patients with AFP levels >200 ng/mL.     

Coronary computed tomography angiography evaluation of plaque morphology and its relationship to HDL and total cholesterol to HDL ratio

BackgroundWhile population studies have demonstrated that high density lipoprotein cholesterol (HDL-C) and the ratio of total cholesterol to HDL (TC/HDL) improve cardiovascular risk prediction, the mechanism by which these parameters protect the cardiovascular system remains uncertain.ObjectiveTo investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with the morphology of coronary artery plaque as determined by coronary computed tomography angiography (CCTA).MethodsThis is a cross-sectional study involving 190 subjects with stable coronary artery disease. Semi-automated plaque analysis software was utilized to quantify plaque and plaque volumes are presented as total atheroma volume normalized (TAV_norm). Multivariate regression models were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes.ResultsOf the 190 subjects the average (SD) age was 58.9 (9.8) years, with 63% being male. After adjustment for cardiovascular risk factors, HDL- C (>40 mg/dl) is inversely associated with fibrous (p = 0.003), fibrous fatty (p = 0.007), low attenuation plaque (LAP) (p = 0.007), total non-calcified plaque (TNCP) (p = 0.002) and total plaque (TP)(p = 0.004) volume. Furthermore, the TC/HDL ratio (> 4.0) is associated with fibrous (p = 0.047) and total non-calcified plaque (p = 0.039), but not with fibrofatty, LAP, dense calcified plaque, or TP volume.ConclusionThere is a strong association between low HDL-C levels and increasing TC/HDL ratio with certain types of coronary plaque characteristics, independent of traditional risk factors. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C and the TC/HDL ratio's clinical relevance in coronary artery disease management.     

Minimal Stimulation Using Gonadotropin Combined with Clomiphene Citrate or Letrozole for Intrauterine Insemination

PurposeTo evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles.ResultsThe clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002).ConclusionOur findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.     

多排螺旋CT低剂量扫描高分辨率重建在新型冠状病毒肺炎筛查中的应用

目的:探讨多排螺旋CT（MDCT）低剂量扫描高分辨率重建在新型冠状病毒肺炎（COVID-19）筛查中的应用价值。方法:选取2020年2月1日~3月1日间就诊的66例疑似COVID-19肺炎患者作为研究对象,将66例患者随机平均分为2组,分别实施胸部常规剂量CT扫描（n=33, 120 kV, 300 mAs）和胸部低剂量CT扫描（n=33,100 kV,70 mAs）,其中常规剂量组采用512×512矩阵,低剂量组采用1 024×1 024矩阵。同时对胸部低剂量组用4种不同权重的迭代算法进行处理（30%、50%、70%、90%）,对比两种检查模式的辐射剂量和图像质量。结果:低剂量组的有效辐射剂量为（1.81±0.14） mSV,与常规剂量组（6.83±0.68） mSV相比降低73.5%（P<0.05）;采用1 024大矩阵、90%权重迭代算法的低剂量组图像的CNR、SNR均略低于采用512常规矩阵、90%权重迭代算法的常规剂量组,但差异无统计学意义（SNR:5.11±0.75 vs 5.38±0.41,CNR:5.37±0.33 vs 5.44±0.51, P>0.05）;低剂量组患者的肺窗、纵膈窗图像质量主观评分低于常规剂量组,但差异无统计学意义（肺窗:3.30±0.72 vs 3.39±0.78;纵膈窗:3.15±0.90 vs 3.36±0.82, P>0.05）。结论:使用MDCT进行胸部低剂量扫描,同时采用高分辨率重建技术及90%权重迭代算法可用于COVID-19肺炎筛查,可在保证图像质量的前提下显著降低患者所受辐射剂量。     

Circulating Anti-Elastin Antibody Levels and Arterial Disease Characteristics: Associations with Arterial Stiffness and Atherosclerosis

PurposeElastin is a major arterial structural protein, and elastin-derived peptides are related to arterial change. We previously reported on a novel assay developed using aortic elastin peptides; however, its clinical implications remain unclear. In this study, we assessed whether anti-elastin antibody titers reflect the risk of coronary artery disease (CAD) or its characteristics.ResultsThe median blood level of anti-elastin was significantly lower in the CAD group than in the controls [197 arbitrary unit (a.u.) vs. 63 a.u., p<0.001]. Levels of anti-elastin were significantly lower in men and in subjects with hypertension, diabetes mellitus, hyperlipidemia, or high hfPWV. Nevertheless, anti-elastin levels were not dependent on atherothrombotic events or the angiographic severity of CAD. In a multivariate analysis, male sex (β=-0.38, p<0.001), diabetes mellitus (β=-0.62, p<0.001), hyperlipidemia (β=-0.29, p<0.001), and AI (β=-0.006, p=0.02) were ultimately identified as determinants of anti-elastin levels.ConclusionLower levels of anti-elastin are related to CAD. The association between antibody titers and CAD is linked to arterial stiffness rather than the advancement of atherosclerosis.     

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

PurposeData comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris.ResultsMajor adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041–5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039–4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057–14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106–0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035–0.703, p=0.016).ConclusionElective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.     

Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study

PurposeThis study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR).Materials and MethodsIn total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared.ResultsDevice success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960).ConclusionTAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.     

Association between the Red Cell Distribution Width and Vasospastic Angina in Korean Patients

PurposeThe association between the red cell distribution width (RDW) and vasospastic angina (VSA) has not been elucidated. We investigated the association of the RDW with the incidence and angiographic subtypes of VSA in Korean patients.ResultsThe VSA group had a higher RDW than the non-VSA group (12.9±0.8% vs. 12.5±0.7%, p=0.013). The high RDW level demonstrated an independent association with the high incidence of VSA [second tertile: hazard ratio (HR) 1.96 (1.13–2.83), third tertile: HR 2.33 (1.22–3.47), all p<0.001]. Moreover, the highest RDW tertile level had a significant association with the prevalence of the mixed-type coronary spasm [HR 1.29 (1.03–1.59), p=0.037].ConclusionThe high level of RDW was significantly associated with the prevalence of VSA and the high-risk angiographic subtype of coronary spasm, suggesting that a proactive clinical investigation for VSA could be valuable in Korean patients with an elevated RDW.     

Variations in the cannabinoid receptor 1 gene predispose to migraine

In animal models endogenous cannabinoids have an inhibitory effect on trigeminovascular activation through the cannabinoid receptor 1 (CB1), although there is no evidence of the potential role of CB1 in human migraine. In this study we applied single marker association and haplotypic trend regression analysis to investigate the relationship between the CB1 gene (CNR1) and headache with migraine symptoms (nausea, photophobia and disability, measured by the ID-migraine questionnaire). We identified our controls (CO = 684) as those who have not reported ID-migraine symptoms at all and defined migraine headache sufferers (M = 195) as those who reported all three symptoms. The CNR1 was covered by 10 SNPs located throughout the gene based on haplotype tagging (htSNP) and previous literature. Our results demonstrated a significant haplotypic effect of CNR1 on migraine headaches (p = 0.008, after permutation p = 0.017). This effect was independent of reported depression or drug/alcohol abuse although using neuroticism in the analysis as covariant slightly decreased this association (p = 0.027, permutated p = 0.052). These results suggest a significant effect of CNR1 on migraine headaches that might be related to the alteration of peripheral trigeminovascular activation. In addition, this is the first study to demonstrate the effectiveness of using trait components combinations to define extreme phenotypes with haplotype analysis in genetic association studies for migraine. However, further studies are needed to elucidate the role of CNR1 and the cannabinoid system in migraine.     

A comparative study of the effects of yoga and clinical Pilates training on walking,cognition, respiratory functions,and quality of life in persons with multiple sclerosis: A quasi-experimental study

ObjectiveThe purpose was to investigate the effects of yoga and clinical Pilates training on walking, respiratory muscle strength, cognition, and quality of life and compare the effects of two popular exercise methods in persons with multiple sclerosis (pwMS).MethodsTwenty-eight pwMS (Pilates group = 16, yoga group = 12) received the program once a week for eight weeks in addition to home exercises. At baseline and the end of the training, participants underwent assessments. The outcome measures were walking speed, mobility, balance confidence, respiratory muscle strength, cognition, and quality of life.ResultsFollowing the program, there was no significant difference in mobility (p = 0.482), perceived walking quality (p = 0.325), respiratory muscle strength (maximum inspiratory pressure: p = 0.263, maximum expiratory pressure: p = 0.866), and cognition (Symbol Digit Modalities Test: p = 0.324, California Verbal Learning Test-II: p = 0.514, Brief Visuospatial Memory Test-Revised: p = 0.279) between the two groups. Improvements were higher in balance confidence (p = 0.006), walking speed (p = 0.004), and quality of life (p = 0.019) in the clinical Pilates group compared to the yoga group.ConclusionThis study showed positive effects in walking and respiratory aspects in pwMS who received yoga and clinical Pilates training. Pilates training was superior in improving walking speed, quality of life, and balance confidence compared to yoga training.     

Adverse Impact of Intraoperative Conversion on the Postoperative Course Following Laparoscopic Pancreaticoduodenectomy

PurposeThe aim of the current study was to evaluate the adverse clinical impact of intraoperative conversion during laparoscopic pancreaticoduodenectomy (LPD).Materials and MethodsThe medical records of patients who underwent pancreaticoduodenectomy (PD) were retrospectively reviewed. Perioperative clinical variables were compared between patients who underwent converted PD (cPD) and initially planned open PD (OPD) to investigate the clinical impact and predictive factors of intraoperative conversion during LPD.ResultsA total of 171 patients were included. Among them, 31 patients (19.3%) were found to have intraoperative conversion during LPD. Failure of progression due to severe adhesion (12 patients, 7%) and major vessel invasion (7 patients, 4%) were the two most frequent reasons for conversion. On multivariate analysis, age [Exp(β)=1.044, p=0.044] and pancreatic texture [Expa(β)=2.431, p=0.039) were found to be independent factors for predicting intraoperative conversion during LPD. In comparative analysis with the OPD group, the cPD group had a longer operation time (516.8 min vs. 449.9 min, p=0.001), higher rate of postoperative hemorrhage (12.1% vs. 0.85%, p=0.008), higher reoperation rate (9.1% vs. 0%, p=0.01), and higher cost (21886.4 USD vs. 17168.9 USD, p=0.018).ConclusionIntraoperative conversion during LPD can have an adverse clinical impact on the postoperative course following LPD. Appropriate patients selection and improvement of surgical techniques will be crucial for unnecessary intraoperative conversion and safe LPD.     

Role of ITPA and SLC28A2 genes in the prediction of anaemia associated with protease inhibitor plus ribavirin and peginterferon in hepatitis C treatment

BackgroundAnaemia is a common side-effect of ribavirin (RBV) use that overwhelms management of hepatitis C when protease inhibitors are added.AimTo assess the pharmacogenomic impact of candidate genes SLC28A2, SLC28A3 and ITPA on anaemia in patients receiving triple therapy.MethodsPatients (n = 161) with chronic hepatitis C genotype 1 treated with telaprevir (n = 95) or boceprevir (n = 66) were included. Using RT-PCR we genotyped ITPA (rs1127354, rs7270101) and SLC28A3 (rs56350726, rs10868138) and SLC28A2 (rs11854484). Clinically significant anaemia (CSA) was diagnosed when at least one of the following criteria was observed: (a) haemoglobin <8.5 g/dL during treatment; (b) blood transfusion required; (c) erythropoietin administered.ResultsCSA occurred in 44% (69/157) of patients and was associated with SLC28A2 rs11854484 [CC/CT genotypes: 33% (26/78) vs. TT genotype: 56% (36/64); p = 0.006]. Further, the needed for blood transfusion was related to genotype [CC: 0% (0/18) vs. CT: 13% (8/61) vs. TT: 27% (17/64); p = 0.016]. Similarly, ITPA rs1127354 genotypes [AA/AC: 19% (3/16) vs. CC: 45% (61/135; p = 0.060] were linked to CSA. In multivariate analysis, SLC28A2 rs11854484 TT genotype (OR:2.33;95%CI:1.10–4.95; p = 0.027), female sex (OR:2.54;95% CI:1.13–5.71;p = 0.024) and Hb drop at week 4) OR: 1.36; 95CI%: 1.11–1.67; p = 0.003) were independently associated with CSA. Similarly, ITPA rs1127354 genotypes [AA/AC: 16% (3/19) vs. CC: 63% (85/134); p = 0.0001] and ITPA rs6051702 genotypes [CC/CA: 46% (26/57) vs. CC: 65% (60/93); p = 0.023] were related to Hb drop of >3g/dL at week 4.ConclusionsIn patients receiving first generation protease inhibitors, genotype SLC28A2 rs11854484 predicts CSA, and helps to identify a subgroup of patients with better tolerance of triple therapy.