Relationship between Serum Magnesium Levels and Cardiovascular Events in Chronic Kidney Disease Patients

Background: Magnesium is an essential ion for all living cells because over 300 enzymes require the presence of magnesium for their catalytic action. To date, no group has evaluated magnesium as a cardiovascular risk factor in chronic kidney disease (CKD) subjects, in which closely interrelated factors and potential confounders such as endothelial dysfunction, insulin resistance (the homeostasis model assessment (HOMA) index) and inflammation (expressed as serum C-reactive protein (CRP) levels) were also considered. Methods: Between March 2006 and December 2010, 283 CKD patients were followed up for time-to-event analysis until the occurrence of fatal or nonfatal cardiovascular events. Endothelium-dependent vasodilatation (flow-mediated dilatation; FMD) and endothelium-independent vasodilatation (nitroglycerin-mediated dilatation) of the brachial artery were assessed noninvasively using high-resolution ultrasound. Results: From the univariate analysis of FMD, it appears that a higher magnesium level is associated with less endothelial dysfunction. When a multivariate analysis was performed, magnesium and estimated glomerular filtration rates (eGFR) maintained a strong positive correlation with FMD, supporting the hypothesis that higher levels of magnesium may protect against endothelial damage. In univariate Cox proportional hazards models, FMD, magnesium, high sensitivity CRP, the HOMA index, eGFR, comorbid diabetes, hypertension, smoking status, systolic blood pressure, serum phosphate and intact parathormone emerged as significant predictors for cardiovascular outcomes. Kaplan-Meier curves showed significantly higher cardiovascular mortality rates in CKD patients whose serum magnesium levels were below 2.05 mg/dl. Conclusions: This observational cohort study showed that magnesium may be an independent predictor of future cardiovascular outcomes and is the first study demonstrating such a role in etiologically diagnosed CKD patients, across different stages.     

Smooth muscle fraction of the round ligament in women with pelvic organ prolapse: a computer-based morphometric analysis

Our objective was to compare the collagen and muscle content of the round ligament of uteri in women with pelvic organ prolapse. We evaluated the tissue samples obtained from the round ligaments of 22 patients with uterine prolapse who underwent vaginal hysterectomy (group A, study) and from 26 patients with no pelvic relaxation in whom total abdominal hysterectomy was performed for benign reasons (group B, controls). Morphometric analysis was performed on histologic cross-sections of the round ligament. Sections from each sample were stained with hematoxylin and eosin and Massons trichrome methods. A computer system was used for morphometric measurements. We used independent samples t-test or Mann-Whitney U test to investigate the difference between the two groups. It was found that the smooth muscle fraction of the round ligament in women with uterine prolapse was significantly decreased compared with that of healthy control subjects and concluded that decreased smooth muscle content may be an important pathogenetic factor in uterine prolapse.Editorial Comment: This paper adds to a body of information showing that smooth muscle content of pelvic floor supporting tissues is reduced in women with pelvic organ prolapse. The morphometric computer analysis seems to be a good technique for determining the percentage of tissue that is comprised of smooth muscle and the percentage of tissue that is comprised of connective tissue. This paper is an extension of work published by Boreham et al., who also assessed smooth muscle in women with pelvic organ prolapse. Additional work remains to be done to determine if loss of smooth muscle volume is a cause or effect of prolapse. It is also clear that smooth muscle content is a reflection of age and menopausal status     

Halofuginone improves caustic-induced oxidative injury of esophagus in rats

Background

The aim of this study is to evaluate the anti-inflammatory and anti-fibrotic effects of halofuginone in caustic esophageal burn injury in rats.

Materials and methods

Corrosive esophageal injury (CEI) was produced in male Wistar albino rats by instilling NaOH solution (1 ml, 37.5%) into the distal esophagus. Rats were decapitated on the 3rd day (early group) or 28th day (late group), and treated daily with either saline or halofuginone (100 µg/kg/day; i.p.), continued on alternate days after the third day. Histopathological evaluation and measurement of nitric oxide (NO), peroxynitrite (ONOO-) and oxygen-derived radicals by chemiluminescence (CL) were made in the distal 2 cm of the esophagus. Non-irrigated proximal esophageal samples were assessed for the levels of nuclear factor (NF)-κB, caspase-3, glutathione (GSH), malondialdehyde (MDA) and myeloperoxidase (MPO) activity.

Results

GSH, MDA, NF-κB and caspase-3 levels, and MPO activity in the proximal esophagus were not different among groups. Increased number of TUNEL (+) cells in the irrigated esophagus of the early and late caustic injury groups was reduced by halofuginone treatment. High microscopic damage scores in both early and late CEI groups were decreased with halofuginone treatment. NO, ONOO- and CL levels, which were elevated in the saline-treated early CEI group, were reduced by halofuginone treatment, but reduced NO and ONOO- levels in the late period of saline-treated group were increased by halofuginone.

Conclusion

In addition to its anti-fibrotic effects, current findings demonstrate that halofuginone exerts antioxidant and anti-apoptotic actions and supports therapeutic potential for halofuginone in CEI-induced oxidative stress.

     

Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

Purpose  

To review our own experience with fine needle aspiration biopsy (FNAB) and frozen section (FS) in thyroid surgery and to assess the value of FNAB and FS in predicting malignancy in patient with thyroid disease.     

Delayed cervical spinal cord injury after high voltage electrical injury: a case report.

High voltage electrical injuries usually cause devastating consequences for patients, most of which result in permanent disability. Spinal cord injury (SCI) caused by high voltage electrical injury is uncommon in the literature. We present a 29-year-old male patient who was diagnosed as having delayed SCI after high voltage electrical injury. The patient developed muscle weakness in the lower extremities with the loss of pinprick sensation below the fifth cervical spinal segment, 2 days after the high voltage electrical injury. Magnetic resonance imaging of the brain, cervical and thoracic spine was normal. Nerve conduction and needle electromyography studies were normal, except for bilateral tibial and left median somatosensory-evoked potentials. The findings on initial examination and neurophysical investigation showed incomplete cervical SCI at the C5 level. He was able to walk with a pair of canes and bilateral ankle-foot orthosis at the end of the 2-month rehabilitation. Follow-up physical and electrophysiological examination of the patient 15 months after injury showed further improvement. The patient was able to walk with a pair of canes without orthoses. Electrophysiological studies are useful instruments in the diagnosis and follow-up of these patients. Early rehabilitation is essential to obtain a favorable outcome in patients with SCI caused by high voltage electrical injury.     

Relationship between atrial septal aneurysms and atrial electromechanical delay

Atrial septal aneurysm (ASA) is a saccular deformity located in the atrial septum. Atrial arrhythmias are common in patients with ASA. Atrial electromechanical delay (AEMD) can be used to evaluate development of atrial arrhythmias in various settings. The aim of the study was to investigate the relationship between ASA, cardiac arrhythmias and AEMD. Seventy patients with ASA served as the study group (30 men; mean age, 33.6 ± 10.9 years) and 70 healthy volunteers served as the control group (34 men; mean age, 31.4 ± 7.8 years). ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurysmal base of ??15 mm; and an excursion of ??10 mm. Inter-AEMD and intra-AEMDs of both atrium were measured from parameters of tissue Doppler imaging. There was no significant difference between the study and control groups in terms of age, gender, left atrium diameter, and left ventricular ejection fraction. Inter-AEMD (50.7 ± 22.5 ms vs. 36.9 ± 12.0 ms) and intra-left AEMD (44.6 ± 17.4 ms vs. 30.7 ± 11.6 ms) were significantly higher in patients with ASA with respect to control group. Inter-AEMD (63.6 ± 20.1 ms vs. 45.1 ± 21.5 ms, P = 0.001), intra-left AEMD (55.3 ± 15.6 ms vs. 40.1 ± 16.2 ms, P = 0.001), diameter of the ASA (19.9 ± 3.6 mm vs. 17.1 ± 2.7 mm, P = 0.001) and P wave dispersion (18.5 ± 6.7 ms vs. 11.8 ± 7.3 ms, P = 0.001) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. Inter-AEMD and intra-left AEMD were found to be significantly prolonged in patients with ASA. Being a non-invasive, inexpensive and simple technique AEMD may provide significant contributions to assess the risk for paroxysmal supraventricular arrhythmia in patients with ASA.