Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study

Objectives

To determine whether severity of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis quantitatively assessed in individuals with diabetes mellitus (DM)-2 correlate with increased coronary heart disease (CHD) risk using non-invasive markers.

Methods

We conducted a single-centre, prospective, cross-sectional study in 100 consecutive diabetic individuals without known CHD recruited between March 2013 and September 2014. History, physical examination, serum markers, cardiac computed tomography (CT), magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) and MR elastography (MRE) were obtained for 95 participants. Written informed consent was provided. Institutional review board approved this study. Spearman rank correlation was performed to assess for correlations. Multiple linear regression model determined independent predictors of epicardial adipose tissue (EAT) volume.

Results

A p value < 0.05 determined statistical significance. The EAT volume was higher in the NAFLD group, defined as MR-imaging PDFF ≥ 5 %, compared to the non-NAFLD group (126.5 ml (IQR 80.9) versus 85.4 ml (IQR 44.7), p=0.002). MR imaging-PDFF correlated with EAT (r=0.42, p < 0.0001). MR imaging-PDFF and liver fibrosis were independently associated with EAT.

Conclusions

Higher liver fat content and liver fibrosis may portend worse cardiovascular risk in diabetics.

Key Points

? EAT volume is higher in diabetic individuals with NAFLD. ? Liver fat content is positively correlated with EAT. ? Liver fat content and liver fibrosis were independently associated with EAT. ? Higher liver fat content and fibrosis may adversely affect cardiovascular risk.

     

Familial aggregation of endometriosis in a large pedigree of rhesus macaques

BACKGROUND: Endometriosis occurs in several non-human primate species that have menstrual cycles. This study investigated the prevalence and familial aggregation of endometriosis in one of those species, the rhesus macaque. METHODS: Between 1978 and 2001, 142 animals with endometriosis were identified from necropsy and surgical records and through the use of magnetic resonance imaging (MRI) at the Wisconsin National Primate Research Center, Madison, USA. All cases were used to build one large multigenerational pedigree and nine nuclear families comprising 1602 females in total. By 2002, the pedigrees contained 124 cases diagnosed at necropsy; 17 at surgery and three at MRI. Female animals that had died aged > or = 10 years without endometriosis, had both ovaries until at least 1 year prior to death, and had a full necropsy, were considered unaffected. RESULTS: The prevalence of endometriosis among necropsied animals aged > or = 10 years in the colony was 31.4% [95% confidence interval (CI) 26.9-35.9%]; prevalence increased with rising age and calendar age at death. Familial aggregation of endometriosis was strongly suggested by a significantly higher average kinship coefficient among affecteds compared with unaffecteds (P < 0.001) and a higher recurrence risk for full sibs (0.75; 95% CI 0.45-1.0) compared with maternal half sibs (0.26; 95% CI 0.10-0.41) and paternal half sibs (0.18; 95% CI 0.02-0.34). The segregation ratio among affected mothers (44.2%) was not significantly higher compared with unaffected mothers (36.6%). CONCLUSIONS: The results support familial aggregation of endometriosis in the rhesus macaque, and indicate that this is a promising animal model for the investigation of mode of inheritance, the location of potential genetic susceptibility loci and the influence of environmental factors.     

Coronary arteries anomalous aortic origin on a computed tomography angiography population: prevalence,characteristics and clinical impact

Anomalous aortic origin of coronary arteries (AAOCA) is one of the most frequent causes of cardiovascular sudden death among the young population. We aimed to determine the prevalence and anatomic characteristics of AAOCA in a population referred to computed tomography angiography (CTA) and to describe the clinical prognosis of these findings at middle term follow-up. From a total of 3539 CTA, 53 were found to have AAOCA. This population was compared to an age and gender matched control group (n = 106) from the same CTA list. A telephone follow-up to determine cardiac events was conducted, with a mean follow-up of 45.9 ± 28.2 months. Prevalence of AAOCA was 1.5 %. The most common AAOCA was an origin of the right coronary artery (RCA) from the left coronary sinus, followed by an origin of the left circumflex artery (LCX) arising from the right coronary sinus. All patients with an anomalous origin of the RCA had an interarterial course. Four additional patients were found to have an interarterial course: 1 with an anomalous origin of LCX and 3 with an anomalous origin of the left main coronary artery (LMCA). At follow-up there were 33 (21.2 %) cardiac events, 9 (17.6 %) on the AAOCA group and 24 (22.9 %) on the control group (p = 0.46). Cardiac events and cardiovascular deaths were not related to any particular AAOCA or to interarterial courses. Among an adult population referred to CTA, AAOCA were not related with worse middle term prognosis when compared to an age- and gender- matched population.     

Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future?

Several multicenter trials have demonstrated the high diagnostic accuracy and clinical efficacy of modern coronary computed tomography angiography (CTA) when utilized to evaluate symptomatic patients with low-to-intermediate pretest probability of coronary artery disease (CAD). However, coronary CTA remains a purely anatomic test and further assessment with invasive coronary angiography or other non-invasive tests are occasionally required, with subsequent inherent risks and costs to patients and healthcare systems. Recently, remarkable advances in multidetector computed tomography technology has significantly improved temporal and spatial resolution of coronary CTA. In the past decade, initially in animal models and then in humans, stress myocardial perfusion imaging by computed tomography (CTP) evolved and is being increasingly studied. It is the purpose of this review to highlight recent updates in the CTP literature and try to figure how to place CTP in CAD management in the near future.     

The influence of vacuum mixing on methylmethacrylate liberation from acrylic cement powder

Polymethylmethacrylate (PMMA) bone cement is a biomaterial used to anchor prostheses during joint replacement surgery. Residual methylmethacrylate monomer (MMA) may be related with the cytotoxic effect of PMMA. The aim of the present paper was to investigate the effect of two different cement mixing methods: hand stirring at atmospheric pressure and under partial vacuum (0.330 and 0.154 bar) on residual monomer liberation in phosphate buffer saline solution from acrylic cement powder. Residual MMA content was determined by high-performance liquid chromatography. Mathematical models were applied to experimental dissolution data revealing that monomer release was significantly reduced in bone cement powder obtained at 0.154 bar vacuum pressure compared to the other mixing conditions. The kinetic models applied are consistent with a simple diffusion mechanism of the monomer from the polymer matrix.     

Cell therapy and satellite centers: The cardiovascular cell therapy research network experience

Due to the changing population in patients with myocardial infarction, recruiting patients in clinical trials continues to challenge clinical investigators. The Cardiovascular Cell Therapy Research Network (CCTRN) chose to expand the reach and power of its recruitment effort by incorporating both referral and treatment satellite centers. Eight treatment satellites were successfully identified and they screened patients over a two year period. The result of this effort was an increase in recruitment, with these treatment satellites contributing 30% of the patients to two of the three Network studies. The hurdles that these satellite treatment centers faced and how they surmounted them provide instruction to clinical research groups eager to expand to satellite systems and to health care practitioners who are interested in taking part in multicenter clinical trials.