Soluble HLA class I and HLA-DR plasma levels in patients with anterior uveitis

Anterior uveitis (AU) is an autoimmune disease frequently associated with HLA-B27 antigen. Because of the immune regulatory properties of soluble human leukocyte antigen (sHLA) molecules, we quantified sHLA class I (sHLA-I) and sHLA-DR plasma levels in HLA-typed AU patients (n = 60). Randomly selected healthy individuals (n = 128) and HLA-B27 antigen-positive individuals (n = 24) with HLA phenotype frequencies similar to the HLA-B27 antigen-positive AU patients served as control panels. As expected, HLA-B27 phenotype was significantly increased in AU patients (n = 60), compared to healthy controls. Mean sHLA-I levels in AU patients were slightly higher than in randomly selected healthy controls. Regarding AU subgroups, elevated sHLA-I levels were only found in HLA-B27 antigen-negative patients. Compared to controls, sHLA-DR levels were significantly increased in AU patients and the subgroups of HLA-B27 antigen-negative and -positive patients but not Fuchs' heterochromic cyclitis (FHC). AU patients negative for HLA-B27 antigen with a chronic course had higher sHLA-DR levels than those with an acute course. The presence of associated systemic diseases in AU patients was related to elevated sHLA-DR levels. Secretion of sHLA-DR in blood differs among the various forms of AU. Systemic immune activation was present in AU but not in FHC.     

用于研究DLA－DRB1基因分型的寡核苷酸引物对的选择

我们用ＰＣＲ－ＲＦＬＰ法研究ＤＬＡⅡ类基因。为寻找合适的引物，用四对不同的引物：ＤＬＡ－ＤＲ－ＳＰ／Ｓｔｏｐ，ＤＬＡ－ＤＲ－ＳＰ／Ｐ３，ＨＬＡ－ＤＲＢ－ＧＨ４６／５０及ＨＤＡ－ＤＲＢ－ＡＭＰ－Ａ／Ｂ进行了一系列扩增。只有引物对ＨＬＡ－ＤＲＢ－ＡＭＰ－Ａ／Ｂ获得了满意的结果。其类似核苷酸序列在ＤＬＡ－ＤＲＢｃＤＮＡ的核苷酸序列内被发现，特异性也为Ｓｏｕｔｈｅｒｎｂｌｏｔ杂交分析所证实。内切酶ＨａｅⅢ和ＨｉｎｆⅠ酶解后显示出ＤＬＡ－ＤⅡ类基因高度的多态性和等位基因特异的多态性带型。揭示该引物对是目前用ＰＣＲ－ＲＦＬＰ法研究ＤＬＡ－ＤＲＢ１基因较理想的、实用的引物。     

Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions

Coronary computed tomography angiography (CTA) may be helpful to manage patients with chronic coronary occlusions. The aim of this study was to determine the sensitivity and specificity of CTA to detect the presence and extent of coronary collaterals as compared to invasive coronary angiography (ICA). We retrospectively evaluated 26 patients who underwent both coronary CTA and ICA within 3 weeks and demonstrated a total coronary occlusion (TIMI grade 0) in one of the major coronary arteries. CTA was performed using a 64-slice multidetector CT. The presence, and extent of collateralization was assessed by two blinded observers using the Rentrop classification for ICA. CTA accurately identified the presence and location of all 26 total occlusions. The presence of any collaterals was accurately detected in 21/23 patients [sensitivity 91% (CI: 71–98%)] and the absence in three patients [specificity 100% (CI: 29%–100%)]. The sensitivity of coronary CTA to identify patients with collateralization increased from 91 to 94% (CI: 71–99%) and 100% (CI: 59–100%) for collaterals Rentrop grade 2 and 3 in ICA, respectively. Coronary CTA accurately detects the presence of any coronary collateralization in patients with total occlusions. Although CT technology is currently limited in the assessment of individual collaterals and smaller vessels, it may be helpful in the management of patients with total occlusions.     

The impact of the right ventricular lead position on response to cardiac resynchronization therapy

Introduction: Left ventricular (LV) lead placement to the latest contracting area (concordant LV lead) is associated with better response to cardiac resynchronization therapy (CRT) compared to a discordant LV lead. However, the effect of the right ventricular (RV) lead site on CRT response is unclear. We investigated the relationship of the RV and LV lead positions on CRT response. Methods: In 131 CRT patients, the LV lead was positioned preferentially in a lateral or posterolateral vein and the RV lead to either the RV septum (RVS, n = 55) or RV apex (RVA, n = 76). The latest site of contraction was determined with two‐dimensional speckle tracking radial strain imaging and patients had a concordant LV lead position if pacing the latest segment, and discordant if not. Response was defined as ≥15% reduction in LV end systolic volume (LVESV) at 6‐month follow‐up. Results: There were no significant differences in mean reduction of LVESV at follow‐up (RVS vs RVA: ?23.3 ± 16% vs 22.1 ± 18%, P = 0.70) or rate of responders (58.2% vs 57.9%, P = 0.97) between the two groups. In patients with a concordant LV lead (n = 71), the response rate was significantly higher than those with a discordant lead (76.1% vs 36.7%, P < 0.001). There were no differences in outcomes in patients with a concordant or discordant LV lead according to the RV lead location. Conclusion: The extent of LV reverse remodeling following CRT is not related to the RV lead position, but is significantly higher in patients with a concordant LV lead. (PACE 2011; 34:467–474)     

Comparison of multidetector computed tomography and two-dimensional transthoracic echocardiography for left ventricular assessment in patients with heart failure

Along with coronary evaluation, 64-slice multidetector computed tomography (MDCT) permits comprehensive assessment of left ventricular (LV) anatomy and function; however, how it compares with 2-dimensional transthoracic echocardiography (TTE) in patients with heart failure (HF) is not known. In this study, we compared 25 patients with ejection fractions of <45% who underwent TTE and MDCT. The global ejection fraction by TTE versus MDCT was 36 +/- 8% versus 38 +/- 12% (r = 0.67, p = NS). The mean LV end-diastolic and end-systolic diameters by TTE and MDCT were 56 +/- 8 and 46 +/- 9 mm and 58 +/- 12 and 47 +/- 11 mm, respectively (r = 0.71 and 0.77, respectively, both p >0.20). The mean lateral and septal wall thicknesses by TTE and MDCT were 10 +/- 1.4 and 11 +/- 1.5 mm and 10 +/- 1.3 and 10 +/- 1.4 mm (r = 0.77 and 0.76, respectively, both p >0.20). The mean LV end-diastolic and end-systolic volumes and stroke volume by TTE and MDCT were 123 +/- 45, 78 +/- 31, and 44 +/- 21 ml and 140 +/- 58, 92 +/- 43, and 48 +/- 24 ml, respectively (r = 0.62, 0.67, and 0.60, respectively, all p >0.20). The regional wall motion assessment correlation was good between the 2 modalities (kappa = 0.61). The interobserver correlation between the 2 MDCT readers ranged from good (r = 0.72 for LV end-diastolic volume) to excellent (r = 0.84 for septal wall thickness). In conclusion, MDCT provides comparable results to TTE for LV structure and functional assessment among patients with HF.     

Analytic approaches to establish the diagnostic accuracy of coronary computed tomography angiography as a tool for clinical decision making

Although 64-slice multidetector coronary computed tomography angiography (CTA) has been reported to have excellent test characteristics for the detection of significant coronary artery disease, current analytic approaches may not appropriately reflect the process of clinical decision making. Thirty-seven patients (29 men; mean age 63 +/- 11 years) who underwent coronary CTA for clinical indications followed by invasive coronary angiography within 4 weeks were studied. Computed tomography angiograms were analyzed independently for the presence of significant coronary artery stenosis (>or=50% luminal narrowing) by 2 observers blinded to invasive coronary angiographic results. The diagnostic test performance of coronary CTA was determined with and without inclusion of unassessable segments. Because stenosis could not be excluded in unassessable segments, these segments were counted as positive for stenosis. Sensitivity, specificity, and positive (PPV) and negative predictive values of CTA for detecting significant stenoses on assessable segments were 85% (51 of 60, 95% confidence interval [CI] 76% to 94%), 99% (414 of 416, 95% CI 99 to 100), 96% (95% CI 51 of 53), and 98% (95% CI 414 of 423), respectively. Overall, 13% of coronary segments (70 of 546) were not assessable using CTA (heavy calcium in 48 segments). By including these segments, PPV decreased from 96% to 60% (74 of 123), whereas sensitivity improved from 85% to 89% (95% CI 74 of 83). In conclusion, the clinical utility of coronary CTA may be limited by a low PPV in patients with a high prevalence of coronary artery disease.