Serum uric acid levels correlate with filling pressures in systolic heart failure

The authors studied the relationship between liver function tests and serum uric acid level with clinical and hemodynamic profiles in heart failure. Fifty patients (aged 44±15 years; 74.5% men) with an ejection fraction (EF) <35% were enrolled and clinical assessment was performed. Hemodynamic indices (including pulmonary arterial pressure [PAP], pulmonary capillary wedge pressure [PCWP], and cardiac index were studied by standard Edwards Lifesciences Swan-Ganz catheters, and liver function tests and serum uric acid level were measured simultaneously. Fifty age- and sex-matched controls with normal EF were also studied. A total of 73% of patients had ischemic cardiomyopathy. Mean uric acid level was 7.2±3.8 mg/dL and was significantly higher than in the control group (P value<.001). In multivariate analysis, uric acid correlated significantly with PAP (r=.5, P<.001) and PCWP (r=.4, P=.002) and was also associated with clinical signs of rales, edema, paroxysmal nocturnal dyspnea (r=.5, P=.01), and New York Heart Association class (r=.4, P=.005). Uric acid level was also correlated inversely with left ventricular EF (r=.27, P=.006). Elevated uric acid levels in patients with systolic heart failure is associated with impaired clinical and hemodynamic profile and might be used as a noninvasive indicator of elevated left ventricular filling pressures.     

Basal ganglia atrophy in prodromal Huntington's disease is detectable over one year using automated segmentation

Future clinical trials of neuroprotection in prodromal Huntington's (known as preHD) will require sensitive in vivo imaging biomarkers to track disease progression over the shortest period. Since basal ganglia atrophy is the most prominent structural characteristic of Huntington's pathology, systematic assessment of longitudinal subcortical atrophy holds great potential for future biomarker development. We studied 36 preHD and 22 age-matched controls using a novel method to quantify regional change from T(1) -weighted structural images acquired 1 year apart. We assessed cross-sectional volume differences and longitudinal volumetric change in 7 subcortical structures-the accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus. At baseline, accumbens, caudate, pallidum, and putamen volumes were reduced in preHD versus controls (all P < .01). Longitudinally, atrophy was greater in preHD than controls in the caudate, pallidum, and putamen (all P < .01). Each structure showed a large between-group effect size, especially the pallidum where Cohen's d was 1.21. Using pallidal atrophy as a biomarker, we estimate that a hypothetical 1-year neuroprotection study would require only 35 preHD per arm to detect a 50% slowing in atrophy and only 138 preHD per arm to detect a 25% slowing in atrophy. The effect sizes calculated for preHD basal ganglia atrophy over 1 year are some of the largest reported to date. Consequently, this translates to strikingly small sample size estimates that will greatly facilitate any future neuroprotection study. This underscores the utility of this automatic image segmentation and longitudinal nonlinear registration method for upcoming studies of preHD and other neurodegenerative disorders.     

Intragenic DNA polymorphism analysis of DMD/BMD dystrophy gene for carrier and prenatal diagnosis in 60 Iranian healthy individuals

Duchenne and Becker muscular dystrophies (DMD/BMD) are allelic, x-linked neuromuscular disease resulting from mutations in dystrophin gene. DMD is the most severe and frequent inherited but still incurable disease in males. About two-third of such patients have large deletions or duplications that can be identified by multiplex polymerase chain reaction (PCR). In one-third of remaining cases, a linkage analysis that involves DNA markers of intragenic dystrophic gene is considered a rapid and simple method for carrier detection and prenatal diagnosis. In the present study, we investigated frequency and heterozygosity of three polymorphic restriction sites and also four highly polymorphic (CA)(n) repeat microsatellites loci within hot spots region of human dystrophin gene in 60 healthy Iranian populations. Our findings indicated that the allele frequencies of pERT87-8/TaqI, pERT87-15/BamHI, and pERT87-15/XmnI were 0.23/0.77, 0.221/0.779, and 0.239/0.761, respectively. Among these three polymorphic sites, pERT78-15/XmnI locus had the highest heterozygosity with frequency of 47.17%. We also found that STR49 had the highest heterozygosity among four polymorphic microsatellites. These findings are useful in linkage analysis of Iranian DMD families in both carrier detection and prenatal diagnosis.     

Chemical stimulation of the lateral hypothalamus induces conditioned place preference in rats: Involvement of OX1 and CB1 receptors in the ventral tegmental area

Orexinergic projection originated from the lateral hypothalamus (LH) to the ventral tegmental area (VTA) has an important role in the acquisition of morphine conditioned place preference (CPP). However, little if any is known about the function and/or effect of orexin on CPP in rats. In the present study, we investigated the direct effect of orexinergic neurons on acquisition of CPP by chemical stimulation of LH and involvement of orexin-A and CB1 receptors within the VTA in development of reward-related behaviors. 129 adult male albino Wistar rats weighing 220-320 g were unilaterally implanted by two separate cannulae into the LH and VTA. The CPP paradigm was done; conditioning score and locomotor activity were recorded by Ethovision software. The results showed that unilateral intra-LH administration of carbachol (62.5, 125 and 250 nmol/0.5 μl saline) as a cholinergic agonist, during conditioning phase, induced CPP in a dose-dependent manner. The maximal effect was shown at the dose of 250 nmol (P<0.001) compared to vehicle (saline) group. However, intra-VTA administration of SB334867 as a selective orexin-A receptor antagonist (0.1, 1 and 10 nmol/0.3 μl DMSO) and AM251 (5, 25 and 125 nmol/0.3 μl DMSO) as a CB1 receptor antagonist, just 5 min before carbachol during the 3-day conditioning phase, could dose-dependently inhibit the development of LH stimulation-induced CPP in the rats. It is supposed that the orexinergic projection from LH to VTA is involved in LH chemical stimulation-induced CPP and orexin-A receptor in the VTA has a substantial role in this phenomenon. Our findings also suggest the existence of cross-talk between cannabinoid and orexinergic systems within the VTA in conditioned place preference paradigm.     

Cystic artery localization with a three-dimensional angiography vessel tracking system compared with conventional two-dimensional angiography

Purpose

During transcatheter hepatic therapy, the cystic artery feeding the gallbladder may inadvertently be exposed to tumor therapy. Localization of the cystic artery may help prevent exposure. The objective of this study was to compare the application of a vessel tracking system software based on three-dimensional (3D) angiography versus standard two-dimensional (2D) angiography for identifying the cystic artery and its origin.

Materials and Methods

A software system that can rapidly localize the cystic artery from a 3D common hepatic angiogram was applied in 25 patients and was compared with manual localization of the cystic artery with conventional 2D digital subtraction common hepatic angiograms.

Results

With the vessel tracking software prototype, 28 cystic arteries were retrogradely tracked in 25 of 25 cases. The origin sites were correctly located by the software in 27 of 28 cystic arteries, with one mistracked as a result of streak artifact. By contrast, on standard 2D hepatic angiography, the cystic artery was deemed visible with certainty in 12 of 25 cases (P < .001). The vessel tracking system revealed a 56% prevalence of extraanatomic distribution by the cystic artery, with the most common supply going to segment 5 liver parenchyma.

Conclusions

The 3D vessel rapid tracking system has advantages over conventional 2D hepatic angiography in revealing the cystic artery and its origin site. It is also an important tool to identify the complete distribution of the cystic artery without superselective angiography. Supply to adjacent hepatic parenchyma or tumor by the cystic artery is not insignificant and should be considered during hepatic therapies.     

The role of gated myocardial perfusion scintigraphy (GMPS) in myocarditis: a case report and review of the literature

Acute myocarditis is one of the most challenging diagnoses and treatments in cardiology. The acute viral myocarditis diagnosis is usually based on high suspicion, history taking, and physical examination. Likewise, the use of chest radiography, electrocardiography (ECG), and echocardiography is helpful in making a final diagnosis, but all are non-specific. In addition, in imaging query, magnetic resonance imaging (MRI) depicts some degree of cardiac inflammation in the course of myocarditis. Myocardial perfusion imaging (MPI) has also been shown to be useful in diagnosis, and this noninvasive technique diminishes the need for myocardial biopsy. The current study presents the diagnostic and prognostic role of MPI in a 25-year-old patientwith suspected myocarditis. The patient underwent gated-technetium- 99m-lablled, methoxyisobutyl isonitrile, single photon emission computed tomography (Gated 99mTc-MIBI SPECT) that showed nonheterogeneous absorption with remarkable decreased radiotracer uptake in the myocardium in both stress and rest phases. In addition, the gated mode demonstrated decreased wall motion and thickening of the myocardium with a sum motion score (SMS) of 28, a sum thickening score (STS) of 15, and a measured LVEF of 34%. The study concludes that 99mTC-MIBI SPECT imaging is a useful modality in the preparation of supplementary diagnostic and prognostic information in viral myocarditis.     

Blood safety concerns in the Eastern Mediterranean region

Blood transfusion is a life-saving component of health care systems. Nevertheless, it can also be a quick and easy method of exposing patients to risks, particularly the transmission of infectious agents to recipients. Despite substantial improvements in the safety of transfusion services worldwide, the presence of paid and replacement blood donors are still of cause concern for ensuring sustainable safe blood donations. Although the Eastern Mediterranean region consists of a heterogeneous group of countries that vary in their levels of development, they all share common concerns regarding blood safety. In the region, concerns regarding the spread of Hepatitis B and C through blood transfusion continue to exist. Therefore, there is an urgent need for further improvements in both organization and safety measures of blood transfusion activities in the region. Although establishing a centralized blood transfusion system might not be achievable in the short term in some of the countries in the region, the implementation of centralized test kit procurement, data collection, and donation testing could be considered feasible approaches.     

Hepatitis D virus infection in Isfahan, central Iran: Prevalence and risk factors among chronic HBV infection cases

Background

Hepatitis D virus (HDV) is dependent on hepatitis B virus (HBV) infection. Acute infection with HDV can occur simultaneously with acute HBV infection or be superimposed onto a chronic HBV infection.

Objectives

This study aimed to identify cases of HDV and determine its prevalence in patients with chronic HBV infection for the first time study in Isfahan, central Iran.

Patients and Methods

In a cross-sectional study in 2009, 346 who had been diagnosed for at least 6 months with chronic HBV were enrolled consecutively. Anti-HDV was measured by ELISA in the serum of these patients.

Results

The study included 245 males (70.8%) and 101 (29.2%) females with a mean age of 39 ± 12.4 years. Anti-HDV was present in 8 (3.5%) HBe antibody-positive patients (p = 0.36) and in 2 (2.3%) HBe antigen-positive cases (p = 0.68). No association was found between hepatitis D and probable risk factors.

Conclusions

This study demonstrates that the prevalence of HDV infection is higher in patients who are positive for HBeAb compared those who are HBeAg-positive. Therefore, most HDV antibody-positive cases in Isfahan are HBV/HDV superinfections but not coinfections.     

Effect of intersubject variability of extrathoracic morphometry, lung airways dimensions and respiratory parameters on particle deposition

Objective

The structure of extrathoracic passages, variability of tracheobronchial (TB) airways and alveolar dimensions and individual variations of breathing pattern exhibit significant intersubject variations, which affect extrathoracic deposition and, in further consequence, the fraction of inhaled particles actually reaching the thoracic region. The present study was conducted to quantify the intersubject variability of lung deposition fractions caused by the fluctuations in these three major sources of intersubject variability.

Methods

To quantify intersubject variability of extrathoracic, thoracic and total deposition fractions (TDF), different combinations of the three sources of variability were simulated to identify the most important factors. Deposition fractions of inhaled particles were computed by the stochastic airway generation model IDEAL. The dimensions of the respiratory airways were scaled in proportion to age and height of the subject to calculate TDFs.

Results

The variability of deposition fractions increased with the stepwise addition of influencing factors and the resulting standard deviations ranged up to 30%. While some combinations enhanced the effects of individual factors on deposition by up to 40%, others seemed to compensate each other with only a minor effect on deposition.

Conclusion

The present study attempts to quantify experimentally observed intersubject variability of regional deposition fractions caused by individual variations of nasal and oral geometry, lung airway dimensions and breathing patterns in healthy lungs, serving as a baseline for subsequent calculations for diseased lungs, e.g. asthma, COPD, and emphysema, which may further increase intersubject variabilities of medically relevant depositions.