Increase in QRS amplitudes is better than N-terminal pro-B-type natriuretic peptide to predict clinical improvement in decompensated heart failure

Background

We aimed to investigate the correlation between ECG QRS voltage changes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and clinical improvement in decompensated heart failure (DHF).

Methods and results

DHF patients (n = 56) with a mean age of 67.5 ± 12.6 years showed limb QRS amplitude increase and NT-proBNP level decrease with clinical improvement (p < 0.001). Significant correlation was found between percent changes (Δ%) in body weight and Δ% in QRS voltages of aVR, aVF, DII, ΣQRSI + II and ΣQRS (all limb-leads) (r = − 0.40; r = − 0.35; r = − 0.32; r = − 0.30; r = − 0.30 respectively, p < 0.05). No correlation was found between Δ% in NT-proBNP and body weight (r = − 0.23, p = 0.09). Δ% NT-proBNP was correlated with Δ% QRS voltage only in aVR (r = − 0.312, p = 0.019). In ROC analysis, ≥ 0.5 mm increase in aVR QRS voltage was found to predict ≥ 5 kg weight loss with a sensitivity of 74% and specificity of 62% (p = 0.013, AUC: 0.699).

Conclusions

Increase in QRS voltages especially in aVR was found to be more sensitive than NT-proBNP to predict clinical improvement in DHF.     

Efficacy of zoledronic acid treatment in Paget disease of bone

Summary

Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease. We retrospectively reviewed remission and relapse statuses of 12 patients with Paget disease. Remission was achieved in all patients after treatment. We recommend zoledronic acid in the first-line treatment of Paget disease.

Introduction

Paget disease is a disease of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture and bone deformity. Bisphosphonates are used in symptomatic Paget disease of bone. Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease.

Methods

In this study, we retrospectively reviewed the remission and relapse statuses of 12 patients with Paget disease of bone who were seen as outpatients between October 2011 and October 2013.We evaluated alkaline phosphates, osteocalcin, and deoxypyridinoline levels measured before and at 6th, 12th, and 18th months of treatment.

Results

Pretreatment and posttreatment values for alkaline phosphates, deoxypyridinoline, and osteocalcin were as follows: 473?±?256 U/L, 14.99?±?7.63 mmol/L, 21.09?±?3.18 ng/ml, and 82?±?13 U/L, 5.14?±?1.11 mmol/L, and 8.57?±?4.31 ng/ml. Remission was achieved in all patients after treatment. The levels indicated that remission continued at 12th and 18th months of treatment. There was statistically significant difference between pretreatment and posttreatment values. No statistically significant difference between the levels measured at 6th, 12th, and 18th months of treatment was detected.

Conclusion

We recommend zoledronic acid in the first-line treatment of Paget disease of bone in achieving and maintaining remission.     

Interrelationship between noninvasive predictors of atherosclerosis: transthoracic coronary flow reserve, flow-mediated dilation, carotid intima-media thickness, aortic stiffness, aortic distensibility, elastic modulus, and brachial artery diameter

BACKGROUND: In this study, we searched for a correlation between transthoracic coronary flow reserve (CFR) and well-established surrogates of coronary atherosclerosis. METHODS: The study was conducted on 136 healthy subjects (mean age: 39.9 +/- 7.3 years) who were free of coronary risk factors. Transthoracic echocardiography was used to measure the aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM). High-resolution ultrasound was used to measure brachial artery endothelium-dependent and independent vasomotion and carotid intima-media thickness (IMT). In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. RESULTS: All of the parameters significantly correlated with each other except brachial endothelium-independent dilation. CFR correlated significantly with brachial endothelium-dependent dilation (EDD) (r = 0.302, P < 0.01), carotid IMT (r =-0.388, P < 0.01), brachial artery diameter (r = 0.340, P < 0.01), AoD (r = 0.275, P < 0.01), AoS (r =-0.299, P < 0.01), and AoEM (r =-0.30,7 P < 0.01). Carotid IMT correlated significantly with brachial EDD and modestly with brachial artery diameter, AoD, AoS, and AoEM.In multivariate analysis, carotid IMT (beta=-0.323, P < 0.0001) and brachial artery diameter (beta = -0.259, P = 0.001) were significant independent predictors of CFR. The left ventricular mass index (beta= 0.371, P < 0.0001), brachial EDD (beta = -0.232, P = 0.002), and CFR (beta = -0.228, P = 0.003) were significant predictors for IMT. CONCLUSION: Transthoracic CFR correlated significantly with well-established noninvasive predictors of atherosclerosis, and we suggest that it can be used as a surrogate for coronary atherosclerosis.     

The effect of interleukin-10 on acute pancreatitis induced by cerulein in a rat experimental model.

To investigate whether interleukin-10, a potent anti-inflammatory cytokine, could have a therapeutic effect on rats on that were made pancreatitis by cerulein. Thirty Wistar Albino rats were randomized into sham, pancreatitis, and therapy groups (n = 10 in each). Nothing was applied to the sham group; pancreatitis by inject-ing cerulein (50 micro/g/kg/h) was induced in the pancreatitis and therapy groups. Interleukin-10 (10.000 U) was injected at 1 and 4 h after pancreatitis inductions in the therapy group. The rats were sacrificed at postoperative hour 24. The following parameters were investigated: the leukocyte count, blood glucose, amylase, lipase and tumor necrosis factor-alpha levels in the blood samples; histopathological search, and wet/dry weight ratios of the pancreas tissues. The ratio of wet/dry pancreatic tissue weight, serum tumor necrosis factor-alpha, amylase and lipase lev-els, and histologic damage scores in the pancreatitis and therapy groups were significantly higher when they were compared with the sham group(p < .01). However, all of these values were significantly lower in the therapy groups than in the pancreatitis group (p < .01). Interleukin-10 decreases pancreatic tissue injury induced by cerulein-induced pancreatitis in rats. Nevertheless, more experimental studies are needed to compare endogenous interleukin-10 with exogenous interleukin-10 effects before clinical usage of this drug.     

Ergothioneine pretreatment protects the liver from ischemia-reperfusion injury caused by increasing hepatic heat shock protein 70

BACKGROUND: Reperfusion of the liver after ischemia induces the expression of the heat shock genes and the synthesis of the heat shock proteins (HSP). We studied the effects of the natural antioxidant ergothioneine (EGT) treatment on the expression of HSP70 in ischemic-reperfused (IR) liver. METHODS: Adult male Wistar rats were randomly divided into three groups: Sham group given standard laboratory chow and water for 3 weeks followed by sham operation; Control group given standard laboratory chow and water for 3 weeks followed by liver IR injury; EGT group given standard laboratory chow supplementation l-ergothioneine (1.2 mg/kg/d body weight) administered by gavage and water for 3 weeks followed by liver IR injury. Ten rats from each group were killed to determine serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactic dehydrogenase (LDH), tissue malondialdehyde (MDA), HSP70 levels, and histologic changes at 30, 60, and 120 min of reperfusion, respectively. Survival was followed for 1 week. RESULTS: IR caused significant increase in serum AST, ALT, LDH, and tissue MDA levels. As compared with the control group, animals treated with EGT experienced a significant decrease in serum AST, ALT, and LDH levels in all reperfusion periods. Tissue MDA levels in animals receiving EGT were significantly reduced as compared with control group at 30 min and 60 min after reperfusion. After ischemia, reperfusion caused a remarkable production of HSP70 in the control group. When the rats were pretreated with EGT, the levels of HSP70 increased significantly in their livers after reperfusion compared with the control group. Liver injury in the EGT-treated animals was lower to that in the control group. The 7-day survival rate was significantly improved (from 50% to 80%) by EGT pretreatment. CONCLUSION: HSP70 has been shown to induce tolerance against warm IR injury in rat livers. EGT pretreatment protects the liver from IR injury by over-expression of HSP and the subsequent suppression of lipid peroxidation.     

Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery

We present the successful use of perioperative non-invasive mechanical ventilation in a morbidly obese pregnant woman with bronchial asthma, severe preeclampsia and pulmonary edema undergoing an emergency cesarean delivery with spinal anesthesia. The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery.     

Evaluation of Cutaneous Findings in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Preliminary Study

Attention deficit hyperactivity disorder (ADHD) is characterized by attention, concentration, mobility, and impulse control problems and is among the most frequently seen psychiatric disorders during childhood. Our aim was to evaluate cutaneous findings in children and adolescents with ADHD. In our study we found that onychophagy, traumatic skin changes, atopy and related symptoms, certain birthmarks, and acne were frequent cutaneous findings in children with ADHD. Although a limitation is the lack of a control group, ADHD is very common, and our study suggests that further studies of cutaneous findings and ADHD are warranted.     

A New,T-Shaped Adaptor for Easy,Quick and Efficient Fat Harvesting During Liposuction

Although there is a controversy about success and failure of autologous fat tissue transfers, it is a widely accepted method for soft tissue augmentation and is performed by many plastic surgeons as well as dermatologists all around the world. Its advantages are that it does not cause reactions, its absorption rates have been reduced by increased knowledge, experience, and techniques, it can yield good, long-term results, and there are now preservation techniques that allow reinjections when necessary. However, no single ideal technique has been determined. In this paper a new, simple, T-shaped adaptor for easy, quick, and efficient fat harvesting during liposuction is described. This study not only describes the clinical use of the adaptor, but also histologically examines its effects on fat cells under various vacuum pressures (-250 mmHg, -500 mmHg, -700 mmHg). The study shows that the cell structure of fat tissue harvested under medium power (with vacuum pressures of -250 mmHg and -500 mmHg) is not disrupted, while that of tissue harvested with a vacuum pressure of -700 mmHg was traumatized and occasional cell wall fragmentation occurred. In conclusion, it is shown that the T-shaped adaptor allows harvesting of the desired amount of fat tissue without causing trauma to fat cells when it is used with medium-power suction.     

Contribution of vitamin C administration for increasing lipolysis

This experiment was designed to investigate whether addition of vitamin C to the solution used in tumescent technique of liposuction might increase lipolysis and whether increased fibrosis might improve skin retraction where liposuction did not work properly and the skin had poor retraction ability. Eighteen Sprague-Dawley rats were used in two groups. Both inguinal fat pads of rats with their vascular structures were elevated and the right inguinal fat pad was injected with 1 cc tumescent solution as a control and the left fat pad with a 1 cc vitamin C-tumescent solution. Histopathological examination showed that all fat pads injected with tumescent solution had normal adipocytes. Those injected with vitamin C-tumescent were shown to have extreme fibrosis and occasional adipocytes.