Plaque blush,branch location,and calcification are angiographic predictors of progression of mild to moderate coronary stenoses

Background

Angiographic predictors of plaque progression are weak and few: length, irregular surface, turbulence, low shear, and (in some studies) eccentricity and calcification. Having noted plaques that briefly retained dye after angiography, we interpreted these as plaques with a fissured surface or neovascularization and hypothesized that progression would be predicted by “plaque blush.”

Methods

Plaques (<50% diameter stenosis) in 68 pairs of angiograms, 5.6 ± 4.8 months apart, were reviewed by 2 blinded observers. The presence of plaque blush, calcification, clot (mobile defect), eccentricity, and a branch point location were compared between progressing (≥20% stenosis increase) and nonprogressing plaques.

Results

Sixteen lesions in 15 patients progressed from 29% ± 13% to 68% ± 14% over a period of 8.1 ± 7.9 months. Patients with and without progression were similar in sex, age, congestive heart disease risk factors, medications, interval between angiograms, clinical presentation, and initial stenosis severity. By logistic regression, plaque blush (BL) (P = .002), calcification (CA) (P = .024), and a branch (BR) point location (P = .001) predicted plaque progression. The odds ratio for plaque progression (ORp) was calculated as ORp = e^{2.5 × BL + 1.8 × CA + 2.6 × BR}. Using an ORp of 1/3, the model has 81% sensitivity and 77% specificity. A second analysis in which each progressive lesion was compared with proximal and distal lesions and with one in a different coronary artery yielded similar results.

Conclusions

In mild to moderate coronary stenoses, studied retrospectively, plaque blush (a new sign) and a branch point location were strong predictors of plaque progression, whereas calcification was a weak predictor of progression.     

Docosahexaenoic acid prevents resistance to antiepileptic drugs in two animal models of drug-resistant epilepsy

Objectives: One-third of epileptic patients are resistant to antiepileptic drugs. Few clinical studies with small sample size indicate that polyunsaturated fatty acids could control drug-resistant epilepsy. We examined the efficacy of acute and chronic administration of docosahexaenoic acid (DHA) in two animal models of drug-resistant epilepsies, i.e. 6-Hz psychomotor seizures in mice and lamotrigine (LTG)-resistant kindled rats.

Methods: Mice received a single injection of DHA (300?µM, i.c.v.) along with phenytoin (PHT) or LTG (i.p.). Six-Hz electroshock (0.2?milliseconds rectangular pulse width, 3?seconds duration, 44?mA current) was given 15 minutes after DHA, and seizure behaviors were recorded. In LTG-resistant kindled rats, a single dose of DHA (300?µM, i.c.v.) was administered with LTG, and seizure parameters were measured. In chronic treatment, mice received DHA (0.1?g/day, orally) for 30 days. Then, a single dose of LTG or PHT was administered to mice and 6-Hz-induced seizures were recorded. In rats, DHA (1?µM, i.c.v.) was administered during kindling development and effect of LTG in DHA-pretreated LTG-resistant kindled rats was verified.

Results: LTG and PHT did not inhibit 6-Hz seizures in mice after single injection of DHA. However, LTG and PHT inhibited 6-Hz seizures in mice that received DHA for 1?month. Acute or chronic administration of DHA to LTG-resistant kindled rats led to the suppression of kindled seizure parameters by LTG.

Discussion: DHA removes the ‘inherent resistance’ of 6-Hz seizures to PHT and LTG, and prevents the development of pharmacodynamic tolerance to LTG in LTG-resistant kindled rats. DHA might have potential to be used as add-on therapy in patients with refractory epilepsy.     

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility. This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine‐touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

Identification of Potential Biomarkers in the Peripheral Blood Mononuclear Cells of Relapsing–Remitting Multiple Sclerosis Patients

Inflammation - Multiple&nbsp;sclerosis&nbsp;(MS)&nbsp;is described as an immune disorder with inflammation and neurodegeneration. Relapsing–remitting MS (RRMS) is one of the most...     

Hypoglycemic effect of aqueous shallot and garlic extracts in rats with fructose-induced insulin resistance

The present study has been carried out to investigate the effect of aqueous extract of shallot (Allium ascalonicum) and garlic (Allium satium) on the fasting insulin resistance index (FIRI) and intraperitoneal glucose tolerance test (IPGTT) of fructose-induced insulin resistance rats. Male albino Wistar rats were fed either normal or high-fructose diet for a period of eight weeks. Fasting blood glucose level, fasting blood triglyceride level, FIRI, and the area under the glucose tolerance curve were significantly elevated in fructose-fed animals. Fructose-induced insulin resistance rats treated by aqueous shallot or garlic extract (500 mg/kg body weight/day, i.p.) for duration of eight weeks. Control animals only received normal saline (0.9%). The results showed that neither shallot nor garlic extracts significantly altered the FIRI and the IPGTT at the fourth week after treatment. The fasting blood glucose in fructose-induced insulin resistance animals has been significantly decreased in 8-week treated animals by both shallot and garlic extracts. Shallot extract administration, but not garlic extract, for a period of eight weeks can significantly improve the intraperitoneal glucose tolerance and diminish the FIRI. These results indicate that shallot and garlic extracts have a hypoglycemic influence on the fructose-induced insulin resistance animals and aqueous shallot extract is a stronger hypoglycemic agent than the garlic extract.     

Experimental Investigation of Left Ventricular Flow Patterns After Percutaneous Edge‐to‐Edge Mitral Valve Repair

Mitral valve percutaneous edge‐to‐edge repair (PEtER) is a viable solution in high‐risk patients with severe symptomatic mitral regurgitation. However, the generated double‐orifice configuration poses challenges for the evaluation of the hemodynamic performance of the mitral valve and may alter flow patterns in the left ventricle (LV) during diastole. This in vitro study aims to evaluate the hemodynamic modifications following a simulated PEtER. A custom‐made mitral valve was developed, and two configurations were tested: (i) a single‐orifice valve with mitral regurgitation and (ii) a double‐orifice mitral valve configuration following PEtER. The hemodynamic performance of the valve was evaluated using Doppler echocardiography and catheterization, while the flow patterns in the LV were investigated using particle image velocimetry (PIV). The tests were run at a stroke volume of 65 mL and a heart rate of 70 bpm. PEtER was found to significantly reduce the regurgitant volume (15 vs. 34 mL). There was a good agreement between Doppler and catheter transmitral pressure gradients (peak gradient: 9 vs. 7 mm Hg; mean gradient: 4 vs. 3 mm Hg) as well as an excellent agreement between maximal velocity measured by Doppler and PIV (1.60 vs. 1.58 m/s). Vortex development in the LV during diastole was significantly different after repair. PEtER significantly increased the amplitude of Reynolds and viscous shear stresses, as well as the number of high shear regions in the LV, potentially promoting thromboembolism events.     

Epidemiology of outpatient burns in Tehran: An analysis of 4813 cases

This study aims to demonstrate the epidemiologic characteristics of outpatient burn injuries in Tehran. This cross-sectional study was performed over a 1-year period in a referral burn centre in Tehran and included all outpatient burns. The required data were recorded by two trained physicians. Of the 4813 studied patients, including 293 infants, 2901 patients (60%) were male (P < 0.001). The mean age of the adult patients was 31.3 ± 18.3 years, while for infants it was 10.68 ± 2.27 months. In all age groups and both genders, scalding was the most common aetiology. Majority of the burns were non-intentianal (n = 4808) and 70.5% of the injuries occurred at home. Housewives consisted of 24% of the burn patients. With respect to the site of burn, multiple injuries were the most frequent (53%) followed by upper extremities (37%). Most of the burns (96%) were partial thickness. Significant association was present between the aetiology and depth of burn (P < 0.001). The mean affected total body surface area (TBSA) was 3.16 ± 2.92% and there was significant association between burnt TBSA and the mechanism of injury (P < 0.001). In conclusion, it seems that women aged 21–30 years and children younger than 10 years are at greater risk of these injuries and therefore should be the target for preventive strategies.