Determinants of Myocardial Strain in Experimental Chronic Myocardial Infarction

We evaluated the relationships between regional myocardial strain measured by speckle tracking echocardiography and viability, fibrosis, hypertrophy and oxygen consumption in the infarcted or remote myocardium in a pig model of chronic myocardial infarction (MI). Thirteen farm pigs with surgical occlusion of the left anterior descending coronary artery and five sham-operated pigs were studied 3 mo post-MI. Computed tomography revealed significant left ventricle remodeling. Reduced radial or circumferential strain identified areas of transmural infarction (area under the curve: 0.82 and 0.79, respectively). In the remote non-infarcted area, radial strain correlated inversely with the amount of fibrosis (r?=?–0.66, p?=?0.04) and myocyte hypertrophy (r?=?–0.68, p?=?0.03). Radial strain rate inversely correlated with myocardial resting oxygen consumption assessed with ¹¹C-labeled acetate positron emission tomography (r?=?–0.71, p?=?0.006). In conclusion, myocardial strain and strain rate reflect fibrosis, hypertrophy and oxygen consumption of the remote areas after MI.     

Substance use by adolescents in the Western Developmental Region of Nepal

The health and well-being of adolescents is threatened by the use of psychoactive substances, such as tobacco, alcohol or other intoxicating substances. This study, carried out in 2011, explored substance use among 12–18-years-olds in the Western Developmental Region of Nepal, with 408 participants drawn from one urban school and two rural schools. Our aim was to identify the prevalence of psychoactive substance use, describe the related reasons, exposures and consequences and to discover the associations between substance use and various background factors. We evaluated the adolescents’ substance use with the Adolescents’ Substance Use Measurement and this showed that 10.5% of the adolescents used tobacco and 22.3% used alcohol and other intoxicants. Smoking and tobacco use was associated with gender, age and whether the fathers and grandparents smoked or drank and the use of intoxicants was associated with living in an urban area, the mother’s occupation and the father’s use of intoxicants. The adolescents at highest risk were older males and there was an association with the mother’s substance use. Our findings suggest that prevention programmes that tackle substance use among adolescents should focus on such factors as gender, age, living in urban areas and exposure at home.     

Quality of life and economic burden of illness in very early arthritis. A population based study in southern Sweden

OBJECTIVE: To measure health related quality of life (HRQOL) in patients with very early arthritis in a population based study in southern Sweden, and to compare HRQOL at baseline between the different diagnostic groups. Further, we investigated whether HRQOL at baseline correlated with the costs the patients incurred during the study. METHODS: Seventy-one adult patients with arthritis of less than 3 months' duration were referred from primary health care centers to rheumatologists. HRQOL was measured with the Arthritis Impact Measurement Scales (AIMS) and EuroQol at baseline. A comparison of HRQOL measures at baseline and the costs the patients incurred during the study was conducted in 56 of the patients. RESULTS: Twenty-seven (38%) patients had reactive arthritis (ReA), 17 (24%) undifferentiated arthritis, 15 (21%) rheumatoid arthritis (RA), 4 (6%) psoriatic arthritis, and the rest (11%) other diagnoses. Statistically significant differences were found between the 4 patient groups concerning the AIMS subscales of dexterity, household activity, activities of daily living (ADL) and pain, the patients with RA being most severely affected. There were no statistically significant differences between the 4 diagnosis groups concerning the EuroQol utility and EuroQol visual analog scale (VAS) scores. Of the AIMS subscales, the mobility, physical activity, household activity, ADL, and pain subscales correlated significantly with the incurred costs. Also the EuroQol utility scores and EuroQol VAS scores correlated significantly with the costs. Only the AIMS household activity subscale predicted the costs in the regression analysis. CONCLUSION: Patients with RA had significantly worse scores in the AIMS dexterity, household activities, ADL, and pain subscales compared to patients with other arthritides very early in the disease. The EuroQol generic quality of life instrument was less sensitive in detecting differences between patients with early arthritis than the disease-specific AIMS instrument. There was a correlation between the costs and the EuroQol utility scores and EuroQol VAS scores during the very first months of the disease, as well as with costs and the AIMS subscales of mobility, physical activity, household activity, ADL, and pain.     

Sizes of dental arches and general body growth up to 6 years of age in children with isolated cleft palate

Development of the dental arches and height and weight at the ages of 3 yr and 6 yr were studied longitudinally in 60 children with isolated cleft palate (CP) and in 50 noncleft (NONC) children. Retrospective comparisons were also made in the CP group with arch size at the age of 0.2 yr and 1.8 yr. Anterior width at 0.2 yr of age was associated with canine width at the age of 3 yr (r = 0.70) and 6 yr (r = 0.60). Change in maxillary posterior width from 3 yr to 6 yr of age was related to the extension of the cleft, so that in the group with total cleft this dimension diminished. Measured in standard deviation scores (SDS), the means of maxillary width at canines and primary second molars in CP children varied from −1.0 to −2.0 and mandibular dimensions from -0.6 to -1.4. Discrepancy in arch depth diminished with age. Body size differed less from normal than the size of the dental arches. At 3 yr of age the height was −0.4 SDS in CP boys and −0.5 SDS in CP girls, but at 6 yr of age only −0.1 SDS in both boys and girls. Correlations between body size and the size of the dental arches were generally low (r < 0.20) both in CP and NONC children. The small size of the dental arches in CP children does not seem to be merely a reflection of the overall smaller size of CP children.     

Combination of pegylated IFN-α2b with imatinib increases molecular response rates in patients with low- or intermediate-risk chronic myeloid leukemia

Biologic and clinical observations suggest that combining imatinib with IFN-α may improve treatment outcome in chronic myeloid leukemia (CML). We randomized newly diagnosed chronic-phase CML patients with a low or intermediate Sokal risk score and in imatinib-induced complete hematologic remission either to receive a combination of pegylated IFN-α2b (Peg-IFN-α2b) 50 μg weekly and imatinib 400 mg daily (n = 56) or to receive imatinib 400 mg daily monotherapy (n = 56). The primary endpoint was the major molecular response (MMR) rate at 12 months after randomization. In both arms, 4 patients (7%) discontinued imatinib treatment (1 because of blastic transformation in imatinib arm). In addition, in the combination arm, 34 patients (61%) discontinued Peg-IFN-α2b, most because of toxicity. The MMR rate at 12 months was significantly higher in the imatinib plus Peg-IFN-α2b arm (82%) compared with the imatinib monotherapy arm (54%; intention-to-treat, P = .002). The MMR rate increased with the duration of Peg-IFN-α2b treatment (< 12-week MMR rate 67%, > 12-week MMR rate 91%). Thus, the addition of even relatively short periods of Peg-IFN-α2b to imatinib markedly increased the MMR rate at 12 months of therapy. Lower doses of Peg-IFN-α2b may enhance tolerability while retaining efficacy and could be considered in future protocols with curative intent.     

Fractal scaling properties of heart rate dynamics and myocardial efficiency in dilated cardiomyopathy

Introduction  

Since altered heart rate (HR) fluctuations provide prognostic information in heart failure, we examined the associations between HR dynamics, myocardial efficiency and perfusion, among patients with dilated cardiomyopathy.