Increases in blood flow of the female rabbit urethra following low dose estrogens

The effects of low doses (0.05 to 20 micrograms./kg.) of estradiol-17 beta (E2) and estriol (E3) on blood perfusion in the genitourinary tissues were examined two and 24 hours after an intra-arterial injection into rabbits. Whereas 0.05 microgram./kg. E2 or E3 caused no detectable change, 0.5 microgram./kg. of either E2 or E3 markedly increased blood flow measured after two hours in urethra, vagina and uterus. No significant increase in the blood flow in the urinary bladder or the ureters was observed. With 20 micrograms./kg. E2 or E3 a much greater increase (10 to 25-fold) in the blood flow in the urethra, vagina and uterus was observed after two hours. At this time a small increase (about two-fold) could also be measured in urinary bladder and ureters. Twenty-four hours after this treatment (20 micrograms./kg. E2 or E3), the blood flow in the urinary organs was not significantly different from the pretreatment values but it was still significantly elevated in uterus and vagina. These data show that the blood flow in the female urethra is just as sensitive to low doses of estrogens as uterus and vagina. Both E2 and E3 seem to be equally effective in increasing blood perfusion in the urogenital tissues.     

Further study of genetic interactions: Loss of short arm material in patients with ring chromosome 4 changes developmental pattern of del(4)(q33)

Segment 4q33 is not considered a probable location of a gene related with limb deficiency by Roberts and Tabin [Am J Hum Genet 55:1–6, 1994]; however, the occurrence of ectrodactyly or its equivalents in at least 9 published cases of monosomy 4q33 suggests probable location of one of these genes in that region. Ulnar ray defects and/or ectrodactyly were the prevailing forms. An additional loss of the tip of 4p in patients with ring chromosome 4 leads to a change of limb deficiency type: 8 of 9 patients with r(4) and limb deficiency had radial ray defects. Therefore, interactions between a proposed ½ dose “ectrodactyly” gene on 4q33 and some ½ dosage genes on distal 4p (or disturbed cellular homeostasis due to a ring chromosome 4) can change the developmental pattern of limb deficiency. Possible mechanisms and significance of the Phenomenon are discussed. © Wiley-Liss, Inc.     

Chronic Total Occlusion Interventions: Update on Current Tips and Tricks

Purpose of Review

To summarize novel techniques and developments in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Recent Findings

Using an algorithmic, step-by-step approach can help overcome several complex CTO lesions subsets, such as proximal cap ambiguity, ostial location, in-stent occlusion, bifurcations, balloon uncrossable and undilatable lesions. Similarly, an algorithmic approach can help prevent and optimally treat CTO PCI-related complication, such as perforation, radiation, and contrast-induced nephropathy.

Summary

Continual update and reassessment of each operator’s algorithm for performing CTO PCI can lead to improved outcomes.

     

Executive function mediates effects of white matter hyperintensities on episodic memory

This study examined the relationship between white matter hyperintensities (WMH) and executive functioning on episodic memory in a group of older adults who were cognitively normal or diagnosed with MCI or dementia. Volumetric magnetic resonance imaging (MRI) measures of total brain volume, white matter hyperintensity volume, and hippocampal volume along with age, education, and gender were evaluated as predictors of episodic memory. WMH were found to influence both episodic memory and executive functioning independently of other variables. The influence WMH on episodic memory was mediated by executive functioning and was completely eliminated when the interaction between executive functioning and hippocampal volume was entered in the regression model. The results indicate that executive functioning mediates the effects of WMH on episodic memory but that executive functioning and hippocampal volume can also interact such that executive functioning can exacerbate or ameliorate the influence of hippocampal volume on episodic memory.     

The story vs the storyteller: Factors associated with the effectiveness of brief video‐recorded patient stories for promoting opioid tapering

BackgroundNarrative communication is often more persuasive for promoting health behaviour change than communication using facts and figures; the extent to which narrative persuasiveness is due to patients’ identification with the storyteller vs engagement with the story is unclear.ObjectiveTo examine the relative impacts of patient engagement, age concordance and gender concordance on perceived persuasiveness of video‐recorded narrative clips about opioid tapering.MethodsPatient raters watched and rated 48 brief video‐recorded clips featuring 1 of 7 different storytellers describing their experiences with opioid tapering. The dependent variable was clips’ perceived persuasiveness for encouraging patients to consider opioid tapering. Independent variables were rater engagement with the clip, rater‐storyteller gender concordance and rater‐storyteller age concordance (<60 vs ≥60). Covariates were rater beliefs about opioids and opioid tapering, clip duration and clip theme. Mixed‐effects models accounted for raters viewing multiple clips and clips nested within storytellers.ResultsIn multivariable models, higher rater engagement with the clip was associated with higher perceived persuasiveness (coefficient = 0.46, 95% CI 0.39‐0.53, P < .001). Neither age concordance nor gender concordance significantly predicted perceived persuasiveness. The theme Problems with opioids also predicted perceived persuasiveness.ConclusionHighly engaging, clinically relevant stories are likely persuasive to patients regardless of the match between patient and storyteller age and gender. When using patient stories in tools to promote health behaviour change, stories that are clinically relevant and engaging are likely to be persuasive regardless of storytellers’ demographics.Patient or public contributionPatients were involved as storytellers (in each clip) and assessed the key study variables.     

<Emphasis Type="Italic">NBS1</Emphasis> variant I171V and breast cancer risk

The NBS1/p95 protein has a pivotal role in the sensing and repair of chromosome breaks. A missense mutation in the NBS1 gene, I171V, has recently been associated with a ninefold increased risk of breast cancer in Polish patients. Positive associations have also been reported for leukaemia and larynx cancer suggesting that I171V could be a more general susceptibility factor for malignancies. We investigated the prevalence of this mutation in two large hospital-based case-control series from Germany and from the Republic of Belarus. The I171V substitution was detected in 20/1,636 Byelorussian breast cancer patients and in 18/1,014 Byelorussian controls (OR: 0.68; 95%CI: 0.36–1.30, P = 0.3). The I171V substitution was furthermore detected in 10/1,048 German breast cancer patients and in 7/1,017 German controls (OR: 1.39; 95%CI: 0.53–3.67, P = 0.7). There were no significant differences between I171V carriers and non-carriers among the cases with regard to age at diagnosis, family history or bilateral occurrence of disease. A meta-analysis of all hitherto available studies did not reveal a difference in the prevalence of I171V between breast cancer cases and controls (OR: 1.05; 95%CI: 0.64–1.74, P = 0.9). We conclude that the I171V substitution is unlikely to constitute a strong risk factor for breast cancer in our study populations. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Improvement of MRI-functional measurement with automatic movement correction in native and transplanted kidneys

PURPOSE: To improve 2D software for motion correction of renal dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to evaluate its effect using the Patlak-Rutland model. MATERIALS AND METHODS: A subpixel-accurate method to correct for kidney motion during DCE-MRI was evaluated on native and transplanted kidneys using data from two different institutions with different magnets and protocols. The Patlak-Rutland model was used to calculate glomerular filtration rate (GFR) on a voxel-by-voxel basis providing mean (Kp) and uncertainty (sigma(K(p))) values for GFR. RESULTS: In transplanted kidneys, average absolute variation of Kp was 6.4% +/- 4.8% (max = 16.6%). In native kidneys average absolute variation of Kp was 12.11% +/- 6.88% (max = 25.6%) for the right and 11.6% +/- 6% (max = 20.8%) for the left. Movement correction showed an average reduction of sigma(K(p)) of 6.9% +/- 6.6% (max = 21.4%) in transplanted kidneys, 30.9% +/- 17.6% (max = 60.8%) for the right native kidney, and 31.8% +/- 14% (max = 55.3%) for the left kidney. CONCLUSION: The movement correction algorithm showed improved uncertainty on GFR computation for both native and transplanted kidneys despite different spatial resolution from the different MRI systems and different levels of signal-to-noise ratios on DCE-MRI.