Ocular pressure waveform reflects ventricular bigeminy and aortic insufficiency

Ocular pulse amplitude (OPA) is defined as the difference between maximum and minimum intraocular pressure (IOP) during a cardiac cycle. Average values of OPA range from 1 to 4 mmHg. The purpose of this investigation is to determine the source of an irregular IOP waveform with elevated OPA in a 48-year-old male. Ocular pressure waveforms had an unusual shape consistent with early ventricular contraction. With a normal IOP, OPA was 9 mmHg, which is extraordinarily high. The subject was examined by a cardiologist and was determined to be in ventricular bigeminy. In addition, he had bounding carotid pulses and echocardiogram confirmed aortic insufficiency. After replacement of the aortic valve, the bigeminy resolved and the ocular pulse waveform became regular in appearance with an OPA of 1.6–2.0 mmHg. The ocular pressure waveform is a direct reflection of hemodynamics. Evaluating this waveform may provide an additional opportunity for screening subjects for cardiovascular anomalies and arrhythmias.     

Development of a novel explant culture method for the isolation of mesenchymal stem cells from human breast tumor

Background: Mesenchymal stem cells (MSCs) were isolated from various sources, including various types of tumors. However choosing an appropriate isolation method is an important step in obtaining cells with optimal quality and yield in companion with economical considerations. The purpose of this study was to isolate more pure MSCs from human breast tumor tissue by a modified explant culture method.

Methods and Materials: The tumor tissues (n = 8) were cut into 1 to 3-mm cube-like pieces (explant). Each explant was placed in a well of 24-well format plates, cultured in Dulbecco’s Modified Eagle’s medium (DMEM), and maintained at 37°C with 5% humidified incubator. Morphological phenotypes of the cells were surveyed by an inverted microscope and wells with rather homogenous fibroblast-like morphology cell were considered as positive and selected for more expansion and characterization.

Results: A total of 185 wells, 63.7% of wells were positive that were chosen for expansion. Flowcytometry analysis demonstrated that isolated cells were positive for CD73, CD44, CD29, CD105, and CD90 but negative for CD11b, CD45, CD34, and HLA?DR. In addition, cells possessed the capability of multipotential differentiation into osteoblasts and adipocytes.     

Myxopapillary ependymoma of the conus medullaris presenting with intratumoral hemorrhage during weight lifting in a teenager

Intratumoral hemorrhage within a myxopapillary ependymoma of the conus medullaris and cauda equina is rare. Most patients with myxopapillary ependymoma present insidiously, but they may present with hemorrhage or cauda equina syndrome. Limited number of case reports available has described this condition only in adult patients. We report our experience with intratumoral hemorrhage of myxopapillary ependymoma of the conus medullaris during weight lifting in a 15-year-old boy.     

CXC ligand 13 in rheumatoid arthritis and its relation to secondary Sjögren’s syndrome

Aim of the workThe aim of the present study was to measure the level of the chemokine CXC ligand 13 protein (CXCL13) in the plasma and unstimulated saliva of rheumatoid arthritis (RA) patients in order to find out its role in the disease activity and its relation to secondary Sjögren’s syndrome (sSS).Patients and methodsThe study was conducted on thirty rheumatoid arthritis patients attending the Outpatient Clinic of Rheumatology and Rehabilitation department of Ain shams University Hospitals. The patients’ group had been classified into group (1) which included fifteen RA patients associated with sSS diagnosed according to the American–European Consensus Group Classification Criteria and group (2) which included fifteen RA patients not associated with sSS. Ten healthy subjects were included as a control group. Patients were subjected to full history taking, clinical examination, and laboratory detection of CXCL13 level in the plasma and saliva of patients as well as the control groups using ELISA technique. Assessment of disease activity in RA patients was done using the disease activity score (DAS28).ResultsPlasma levels of CXCL13 were significantly higher in RA patients than control group (p < 0.001). Plasma levels of CXCL13 were significantly correlated with the RA disease activity (r = 0.677, p < 0.001) and disease duration (r = 0.406, p < 0.05), while the salivary levels were higher in those with sSS and correlated with sSS disease duration (r = 0.536, p < 0.05). A highly significant correlation was found between salivary CXCL13 and severity of sSS (r = 0.816, p < 0.001). Salivary levels of CXCL13 above 110 pg/ml may diagnose sSS with sensitivity 80% and specificity 84%.ConclusionThe results of this preliminary study point out the importance of CXCL13 as a marker for RA disease activity, its role in diagnosing sSS, and estimation of sSS severity.     

Value of carotid intimal–medial thickness as independent predictor of endothelial dysfunction in uremic patients

Background and aim of the workCardiovascular mortality and morbidity are significantly higher among uremic patients. Although the carotid intimal–medial thickness (C-IMT) as a predictor of endothelial dysfunction (ED) has a prognostic value that has been well demonstrated as an independent predictor of future cardiovascular events, its value in uremic patients need to be re-assisted in our locality. The aim of the work is to investigate a correlation between the brachial artery reactivity test (BART) and the carotid intimal–medial thickening (C-IMT) and their value as independent predictors of endothelial dysfunction in uremic patients.Subjects and methodsThe study involved 70 uremic patients, 40 men and 30 women, 36–56 years old, 40 of them on regular hemodialysis (HD) and 30 on conservative therapy, in addition to 30 healthy persons as a control group. They were selected from the General Medicine and Nephrology Departments, Al-Azhar Assiut University and Assiut University Hospitals over a period of 2 years. All of them were subjected to detailed history, thorough clinical examination, laboratory investigations including complete blood picture, renal function tests (urine analysis, blood urea, and serum creatinine), lipid profile, serum calcium and serum phosphorus, parathyroid hormone (PTH), fasting blood glucose, electrocardiography (ECG), high resolution B-mode ultra-sonography for C-IMT evaluation and brachial artery reactivity test (BART), and abdominal ultra-sonography.ResultsThe results of the present study showed: (1) uremic patients are at an increased risk for carotid atherosclerotic lesions, with significant increase in C-IMT than controls with more significant increase in HD patients. (2) Uremic patients are characterized by impaired endothelium dependent dilatation of the brachial artery (highly significant reduction in flow-mediated dilatation (FMD%)), an abnormality related to the renal failure severity and to the hemodialysis doses. The endothelial dysfunction in the brachial artery was more pronounced in HD patients than in patients on conservative therapy. (3) Significant positive correlation between increased C-IMT and reduction of the brachial FMD%. (4) Significant relation between C-IMT and plaque prevalence and HD duration, while no relations recorded between brachial FMD with HD duration.Conclusion(1) The study confirmed that carotid IMT and brachial artery FMD can be used in interventional studies in which cardiovascular risk is modified and increased in the uremic patients. (2) There was negative correlation between brachial FMD and C-IMT in the uremic patients.