Comparison of two- and three-dimensional transthoracic echocardiography in the assessment of trabeculations and trabecular mass in left ventricular noncompaction

Twenty-one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 +/- 5.5 g) was significantly greater than 2DTTE (mean 7.3 +/- 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 +/- 3.3) was also significantly greater than 2DTTE (mean 3.76 +/- 1.2, P < 0.0001). The values for inter- and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.     

Behavioural measures in frontotemporal lobar dementia and other dementias: the utility of the frontal behavioural inventory and the neuropsychiatric inventory in a national cohort study

BACKGROUND: Distinguishing between patients with frontotemporal lobar dementia (FTLD) and other dementing illnesses remains a difficult task for many clinicians. In this study, we aimed to provide further evidence for the construct validity of the frontal behavioural inventory (FBI) and assess its utility in differentiating FTLD patients from other groups using data from the Canadian Collaborative Cohort of Related Dementias (ACCORD) study. METHOD: Baseline scores on the FBI and neuropsychiatric inventory (NPI) were compared among several clinical groups (n = 177). RESULTS: The FBI discriminated a higher percentage of FTLD patients (>75% correct classification) from Alzheimer's disease and other groups compared to the NPI (54.2%). CONCLUSION: This study provides good evidence for convergent validity between the FBI and NPI (r = 0.72), indicating that both measures capture similar psychopathology in this nationwide cohort.     

Benign and malignant lesions in the human breast depicted with ultrahigh resolution and three-dimensional optical coherence tomography

Institutional review board approval at the participating institutions was obtained. Informed consent was waived for this HIPAA-compliant study. The study purpose was to establish the correspondence of optical coherence tomographic (OCT) image findings with histopathologic findings to understand which features characteristic of breast lesions can be visualized with OCT. Imaging was performed in 119 specimens from 35 women aged 29-81 years with 3.5-microm axial resolution and 6-microm transverse resolution at 1.1-microm wavelength on freshly excised specimens of human breast tissue. Three-dimensional imaging was performed in 43 specimens from 23 patients. Microstructure of normal breast parenchyma, including glands, lobules, and lactiferous ducts, and stromal changes associated with infiltrating cancer were visible. Fibrocystic changes and benign fibroadenomas were identified. Imaging of ductal carcinoma in situ, infiltrating cancer, and microcalcifications correlated with corresponding histopathologic findings. OCT is potentially useful for visualization of breast lesions at a resolution greater than that of currently available clinical imaging methods.     

Prevalence of human immunodeficiency virus and its association with hepatitis B,C, and D virus infections among incarcerated male substance abusers in Taiwan

Taiwan has been facing a rising epidemic of human immunodeficiency virus (HIV) infection since 2004. Injection drug users comprised 38.5% of accumulated HIV cases by 2007. This cross‐sectional study investigated the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and HIV infection in 753 male substance users who were detained in a detoxification center in Taoyuan, Taiwan. The subjects were enrolled into the study consecutively between February and October, 2005. The seroprevalence rates of HIV antibodies, HCV antibodies, and HBV surface antigens among all subjects, and HDV antibodies among HBV carriers were 6.9% (95% confidence interval [CI]: 5.19–8.95), 30.5% (95% CI: 27.23–33.93), 16.9% (95% CI: 14.24–19.71) and 13.7% (95% CI: 8.19–21.04), respectively. Subjects in the heroin injection group had significantly higher rates of HIV infection, HCV infection and HDV superinfection (25.5%, 89.6%, and 38.7%) than those in the heroin non‐injection group (0.9%, 24.5%, and 6.25%), the methamphetamine group (0.3%, 8.1%, and 6.7%), and the club drug group (1%, 3%, and 0%; P < 0.001). The odds of HCV, HIV, or HDV infection were 74.7, 63.8, and 11.1 higher, respectively, for heroin injection drug users than for non‐injection drug users (P < 0.0001). Compared to HIV‐negative individuals, the odds of being a heroin injector and the odds of HCV co‐infections were 64‐fold and 149‐fold higher, respectively, in HIV‐positive individuals. The impact of HBV, HCV, and HDV infection on the HIV epidemic in Taiwan should be monitored closely. J. Med. Virol. 81:973–978, 2009. © 2009 Wiley‐Liss, Inc.     

Simvastatin protects against cholestasis-induced liver injury

Background:

Bile duct obstruction is associated with hepatic accumulation of leukocytes and liver injury. The aim of this study was to evaluate the effect of simvastatin on cholestasis-induced liver inflammation and tissue damage.

Experimental approach:

C57BL/6 mice were treated with simvastatin (0.02 and 0.2 mg·kg⁻¹) and vehicle before and after undergoing bile duct ligation (BDL) for 12 h. Leukocyte recruitment and microvascular perfusion in the liver were analysed using intravital fluorescence microscopy. CXC chemokines in the liver were determined by enzyme-linked immunosorbent assay. Liver damage was monitored by measuring serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Hepatic levels of myeloperoxidase (MPO) were also determined.

Key results:

Administration of 0.2 mg·kg⁻¹ simvastatin decreased ALT and AST by 87% and 83%, respectively, in BDL mice. This dose of simvastatin reduced hepatic formation of CXC chemokines by 37–82% and restored sinusoidal perfusion in cholestatic animals. Moreover, BDL-induced leukocyte adhesion in sinusoids and postsinusoidal venules, as well as MPO levels in the liver, was significantly reduced by simvastatin. Notably, administration of 0.2 mg·kg⁻¹ simvastatin 2 h after BDL induction also decreased cholestatic liver injury and inflammation.

Conclusions and implications:

These findings show that simvastatin protects against BDL-induced liver injury. The hepatoprotective effect of simvastatin is mediated, at least in part, by reduced formation of CXC chemokines and leukocyte recruitment. Thus, our novel data suggest that the use of statins may be an effective strategy to protect against the hepatic injury associated with obstructive jaundice.     

Issues affecting specialty career paths in dermatology

As the field of medicine changes, physicians deal with ever-increasing challenges and pressures. An overview of broad career paths within the specialty of dermatology is presented and important issues affecting these subspecialty tracks are discussed. These issues include increasing regulatory controls, the medical liability crisis, competitive forces, corporate and global outsourcing threats, managed care, and reimbursement.     

Structure-activity relationships of beta-MSH derived melanocortin-4 receptor peptide agonists

The recent emergence of obesity as a major health threat in the industrialized world has intensified the search for novel and effective pharmacologic treatment. The proopiomelanocortin (POMC)-melanocortin 4 receptor (MC4R) axis has been shown to regulate food intake and energy homeostasis and is considered among the most promising antiobesity targets. Our initial efforts in this area have focused on affinity and selectivity directed optimization of the native beta-MSH(5-22) sequence and resulted in the discovery of a potent MC4R agonist: Ac-Tyr-Arg-[Cys-Glu-His-D-Phe-Arg-Trp-Cys]-NH(2) (10). Subcutaneous administration of this peptide produced an excellent in vivo efficacy in reducing food intake and increasing fat metabolism. Additionally, suppression of food intake was observed in wild type but not in MC4R deficient mice, suggesting that the effects observed in the wild type mice were mediated through MC4R signaling. Subsequent optimization efforts led to the identification of a novel series of disulfide constrained hexapeptides as exemplified by Ac-[hCys-His-D-Phe-Arg-Trp-Cys]-NH(2) (100). These cyclic hexapeptides showed a further improved potency in binding MC4R and an enhanced selectivity over MC1R. At a dose of 0.07 mg/kg analog 102 reduced food intake by 38% and increased fat utilization by 58% in rats. These cyclic peptides provide novel and enhanced reagents for the elucidation of melanocortin receptors biology and may find applications in the treatment of obesity and related metabolic disorders.     

Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Pericardial Disease

We studied 19 patients with pericardial disease using two‐dimensional and three‐dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE a more comprehensive assessment of pericardial effusion can be made and both the parietal and visceral layers of the pericardium can be visualized en face and examined for pathologies and fibrin deposits. In our series of patients, 3DTTE was superior to 2DTTE in uncovering mass lesions involving the pericardium such as tuberculous granulomas and metastatic disease. Furthermore, it provided a better assessment of the nature of pericardial lesions, such as pericardial and mediastinal hematomas, pericardial cysts, and metastatic disease to the pericardium by sequential cropping of the 3D data sets and visualizing the interior of the lesions in a manner not possible with 2DTTE. It was also valuable in determining the extent of pericardial calcification in pericardial constriction and in measuring the size of pericardial masses. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of pericardial diseases and that it provides incremental knowledge to the echocardiographer. (ECHOCARDIOGRAPHY, Volume 26, November 2009)