Incidence of persistent renal dysfunction after contrast enhanced coronary CT angiography in patients with suspected coronary artery disease

Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast agents used in computed tomography angiography (CTA). The aim of this study was to evaluate whether persistent renal dysfunction occurs in patients undergoing coronary CTA for suspected stable coronary artery disease (CAD). From a cohort of 957 patients undergone coronary CTA, we identified 402 patients with plasma creatinine levels collected before and within 6 months after CTA. According to the definition of CIN, patients with a ≥25?% increase in plasma creatinine after CTA were evaluated. The post-CTA measurements in 402 patients (195 men, age 62.9?±?9.3 years) were performed at a median of 99 days after CTA. On average, there was no change in plasma creatinine level between the pre- and post-CTA measurements (75.8?±?16.0 and 75.7?±?16.4 µmol/L, respectively; P?=?0.63) but both increases and decreases were commonly detected. Fourteen (3.5?%) patients had a ≥25?% increase in plasma creatinine levels after CTA. A more detailed evaluation of these patients revealed that in 4 patients the increase was explained by other morbidities, whereas in 9 patients the creatinine level returned to the previous levels at later follow-up (median time to normalization: 311 days). Only in 1 (0.2?%) remaining patient, there was a persistent increase in plasma creatinine level, possibly related to the iodine contrast agent exposure. Alterations in plasma creatinine concentration occur frequently. Persistent renal dysfunction attributable to iodine contrast agent exposure is rare in patients referred to coronary CTA for suspected CAD.     

Changes in cardiovascular autonomic regulation among elderly subjects: follow-up of sixteen years

BACKGROUND: Previous cross-sectional studies have suggested that cardiac autonomic regulation, measured as heart rate (HR) variability, is altered upon ageing, and that altered HR variability may predict mortality. However, there are no longitudinal follow-up reports of the changes of HR dynamics in elderly subjects. AIM & METHOD: This study was designed to examine the longitudinal changes in the spectral, fractal, and complexity measures of HR variability in a random sample of 41 elderly subjects (mean age 69+/-4 years), who underwent repeated 24-hour Holter recordings at the baseline and after 16 years' follow-up. Several cardiovascular risk factors were determined at the baseline. RESULTS: A time-domain index, standard deviation of N-N intervals (SDNN) (142+/-34 msec versus 133+/-50 msec, not significant (NS)), and the high frequency spectral component of HR variability (219+/-222 msec(2)versus 268+/-287 msec(2), NS) did not change during the follow-up. The low frequency power (LF) of HR variability decreased from 678+/-654 msec(2) to 436+/-651 msec(2) (P<0.01). Among the fractal HR variability indexes, the power-law slope (ss) (-1.31+/-0.20 versus -1.47+/-0.21, P<0.001) and the short-term fractal exponent a1 (1.16+/-0.19 versus 1.06+/-0.18, P<0.01) decreased significantly. Approximate entropy remained unchanged. CONCLUSIONS: The magnitude of total HR variability and the respiratory vagal modulation of HR do not change over time in the elderly. However, the spectral and fractal characteristics of HR behavior still undergo alterations upon ageing.     

Endoscopic papillectomy,single-centre experience

Background

Endoscopic removal of benign tumours of papilla is increasing. Our aim was to evaluate the outcome of endoscopic resection of papillary tumours.

Methods

In the years 2000–2012, 61 papillectomies were performed in Helsinki University Central Hospital. The cases were analysed retrospectively.

Results

There were 35 patients with benign tumour of papilla without familial adenomatous polyposis (FAP), 16 patients with FAP and 10 patients with ampullary cancer. Jaundice and bile duct dilation were risk factors for malignancy (p < 0.001). In benign tumours, the recurrence rate was 25.5 %. In 5/51 benign tumour cases (9.8 %), a pancreaticoduodenectomy was performed. The remaining cases were treated endoscopically. Neither tumour size, resection in one piece or piecemeal technique, nor coagulation of resection margins had an effect on the development of residual tumour. The total complication rate was 24.6 %. Pancreatitis developed in six patients (9.8 %, 3 mild and 3 moderate). In benign tumour cases, pancreatic stent decreased pancreatitis rate (p = 0.045). In cases where only a pancreatic sphincterotomy was performed, the risk of pancreatitis was high 4/7 (57 %). Bleeding was the most common complication (18 %). Only one patient was operated due to complication, a post-papillectomy bleeding. In six out of seven non-operated cancer patients, the disease progressed.

Conclusion

Endoscopic papillectomy is an effective procedure for treating benign papillary tumours. Jaundice and bile duct dilation are more common in malignant tumours. Pancreatic stent decreases the risk of post-papillectomy pancreatitis. Pancreatic sphincterotomy without stenting carries a high risk of pancreatitis. For papillary cancer, surgery is recommended.     

Pediatric solid organ transplantation and osteoporosis: a descriptive study on bone histomorphometric findings

Background

Organ transplantation may lead to secondary osteoporosis in children. This study characterized bone histomorphometric findings in pediatric solid organ transplant recipients who were assessed for suspected secondary osteoporosis.

Methods

Iliac crest biopsies were obtained from 19 children (7.6–18.8 years, 11 male) who had undergone kidney (n?=?6), liver (n?=?9), or heart (n?=?4) transplantation a median 4.6 years (range 0.6–16.3 years) earlier. All patients had received oral glucocorticoids at the time of the biopsy.

Results

Of the 19 patients, 21 % had sustained peripheral fractures and 58 % vertebral compression fractures. Nine children (47 %) had a lumbar spine BMD Z-score below ?2.0. Histomorphometric analyses showed low trabecular bone volume (< ?1.0 SD) in 6 children (32 %) and decreased trabecular thickness in 14 children (74 %). Seven children (37 %) had high bone turnover at biopsy, and low turnover was found in 6 children (32 %), 1 of whom had adynamic bone disease.

Conclusions

There was a great heterogeneity in the histological findings in different transplant groups, and the results were unpredictable using non-invasive methods. The observed changes in bone quality (i.e. abnormal turnover rate, thin trabeculae) rather than the actual loss of trabecular bone, might explain the increased fracture risk in pediatric solid organ transplant recipients.     

Comparison of DXA and MRI methods for interpreting femoral neck bone mineral density.

The aim of the study was to improve the practical implementation of the dual X-ray absorptiometry (DXA) by converting the areal bone mineral density BMD (BMD(areal)) to volumetric BMD using magnetic resonance (MR) imaging (MRI) because a failure to control for the femoral neck size can lead to erroneous interpretation of BMD values. We also evaluated the feasibility of MR T2* relaxation time in assessing bone mineral status of the femoral neck. Twenty-eight randomly selected 47- to 64-yr-old healthy men were studied. The men had neither unilateral nor bilateral hip osteoarthritis according to radiographs. Bone width, mineral content (BMC), BMD(areal), and apparent volumetric BMD (BMD(vol)) of the right femoral neck were measured with DXA. The BMD(vol) was calculated by approximating the femoral neck to be cylindrical with a circular cross-section (Vol(dxa)). Volumetric measurements from MR (Vol(mri)) images of the femoral neck were also used to create a BMD measure that was corrected for the femoral neck volume (BMD(mri)). T2* measurements were performed with a 1.5-T scanner (Siemens Magnetom 63SP, Erlangen, Germany). A single 10-mm-thick coronal slice was generated on the femur with a repetition time of 60 ms, and nine echo times (4-20 ms) were used to derive T2* values. Vol(mri) correlated positively (r = 0.828, p < 0.001) with Vol(dxa). However, the Vol(mri) of the femoral neck was 18% lower than the Vol(dxa). Similarly, the BMD(mri) was related to the BMD(vol) (r = 0.737, p < 0.001). Because of the difference in the volumetric measures, the BMD(mri) of the femoral neck was 21% higher than the BMD(vol) (p < 0.001). T2* relaxation time showed a significant negative correlation with BMC, BMD(areal), BMD(vol), and BMD(mri) (r = -0.423 to -0.757, p < 0.05-0.001). In conclusion, these results are evidence that DXA-derived volume approximations by the cylinder with circular cross-section geometry may lead to lower DXA-derived BMD(vol) values, as compared to true MRI-derived volumetric bone mineral density. Thus, the BMD(vol) may not be an accurate method to calculate the true volumetric BMD in the femoral neck. Our results also suggest that the MRI-derived T2* method may be used to approximate the BMD in the proximal femur.     

Treatment of rheumatoid arthritis with imatinib mesylate: clinical improvement in three refractory cases

BACKGROUND. Imatinib mesylate is an inhibitor of a few tyrosine kinases including KIT, which is an important growth factor receptor of mast cells. AIM. To study the efficacy and safety of imatinib in the treatment of rheumatoid arthritis. METHOD. Three patients with severe rheumatoid were treated with imatinib for 12 weeks. The number of tender and swollen joints, patient-assessed disease activity and pain as assessed by a visual analogue scale, a health assessment questionnaire (HAQ) score, serum C-reactive protein (CRP) and blood erythrocyte sedimentation rate (ESR) were used as the primary outcome measures. RESULTS. All outcome measures improved. The swollen joint count decreased in all patients, and the tender joint count in two of the three patients. The patients reported less pain and disease activity, and the HAQ scores improved. Serum CRP and blood ESR improved in two patients. One patient interrupted therapy due to a rash. CONCLUSIONS. Imatinib mesylate may have considerable anti-rheumatic efficacy. The mechanism of action is not known, but one possible target for the action of imatinib is inhibition of the KIT receptor on mast cells.     

Relation of aromatase gene polymorphism and hormone replacement therapy to serum estradiol levels,bone mineral density,and fracture risk in early postmenopausal women*

BACKGROUND. After the menopause, estrogen synthesis from androgens and androgen precursors by aromatase is the main source of circulating estrogens. AIM. To evaluate whether aromatase gene (CYP19)polymorphism affects circulating estradiol (E[Formula: See Text])levels, bone mineral density (BMD), BMD change or fracture risk. METHODS. A 5-year randomized hormone replacement therapy (HRT) trial on 331 early postmenopausal women (mean baseline age 52.7?±?2.3 years). The participants consisted of two treatment groups: the HRT group (n?=?151) received a sequential combination of 2?mg estradiol valerate and 1?mg cyproterone acetate with or without vitamin D[Formula: See Text], 100-300?IU?+?93?mg calcium as lactate/day, and the non-HRT group (n?=?180) received 93?mg calcium alone or in combination with vitamin D[Formula: See Text], 100-300?IU/day for 5 years. BMD was measured from lumbar spine and proximal femur (DXA) before and after the 5-year trial. All new symptomatic, radiographically defined fractures were recorded during the follow-up. The polymorphism (intron 4 TTTA repeat) of CYP19 was evaluated after PCR amplification of the polymorphic site. CYP19 polymorphism was divided into three repeat groups: short (length of 7 or 8 in both alleles; n?=?135), long (length of 11 or higher in both alleles; n?=?47), and medium (rest of the values; n?=?149). RESULTS. Of the baseline characteristics, only physical activity was associated with CYP19 polymorphism (P?=?0.04) and a borderline significance was observed with previous fractures (P?=?0.05). In the HRT or non-HRT groups, the 5-year serum E[Formula: See Text] change was not associated with CYP19 polymorphism (P?=?0.87 and 0.74, respectively). Further, the polymorphism did not influence the calculated annual changes of lumbar or femoral neck BMD during the 5-year follow-up in the HRT (P?=?0.60 and 0.17, respectively) or non-HRT (P?=?0.92 and 0.80, respectively) groups. In all, 28 women sustained 33 fractures during the follow-up. The CYP19 polymorphism was not significantly associated with fracture risk (P?=?0.89 and 0.23 respectively; Cox proportional hazards model) in the HRT or non-HRT groups. CONCLUSIONS.CYP19 polymorphism was not associated with circulating E[Formula: See Text] levels, BMD values, or fracture risk in these early postmenopausal Finnish women. If such an association exists in women, it may become apparent in older age groups.     

Characterization of microbial metabolism of Syrah grape products in an in vitro colon model using targeted and non-targeted analytical approaches

Purpose

Syrah red grapes are used in the production of tannin-rich red wines. Tannins are high molecular weight molecules, proanthocyanidins (PAs), and poorly absorbed in the upper intestine. In this study, gut microbial metabolism of Syrah grape phenolic compounds was investigated.

Methods

Syrah grape pericarp was subjected to an enzymatic in vitro digestion model, and red wine and grape skin PA fraction were prepared. Microbial conversion was screened using an in vitro colon model with faecal microbiota, by measurement of short-chain fatty acids by gas chromatography (GC) and microbial phenolic metabolites using GC with mass detection (GC–MS). Red wine metabolites were further profiled using two-dimensional GC mass spectrometry (GCxGC-TOFMS). In addition, the effect of PA structure and dose on conversion efficiency was investigated by GC–MS.

Results

Red wine exhibited a higher degree of C1–C3 phenolic acid formation than PA fraction or grape pericarp powders. Hydroxyphenyl valeric acid (flavanols and PAs as precursors) and 3,5-dimethoxy-4-hydroxybenzoic acid (anthocyanin as a precursor) were identified from the red wine metabolite profile. In the absence of native grape pericarp or red wine matrix, the isolated PAs were found to be effective in the dose-dependent inhibition of microbial conversions and short-chain fatty acid formation.

Conclusions

Metabolite profiling was complementary to targeted analysis. The identified metabolites had biological relevance, because the structures of the metabolites resembled fragments of their grape phenolic precursors or were in agreement with literature data.