Propionibacterium acnes endocarditis in a native valve complicated by intraventricular abscess: a case report and review.

Propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.     

Cardiac Papillary Fibroelastoma: case report and review of the literature

Primary cardiac tumors are very rare. Cardiac Papillary Fibroelastoma (CPF) is the third most common primary tumor of the heart and most commonly affects cardiac valves. Those tumors appear like a "sea anemone" with multiple papillary fronds attached to the endocardium by a short stalk. It generally occurs as a single structure and is typically found on the atrial aspect of atrioventricular valves or either side of the semilunar valves. We report a case of aortic valve papillary fibroelastoma which was found on autopsy in a patient with normal coronary artery with evidence of myocardial and cerebral ischemic damage and sudden death.     

Quantification of Left Ventricular Twisting Mechanics by Velocity Vector Imaging in an Animal Model of Pericardial Adhesions

Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics. We designed an animal model of constrictive pericarditis to determine how pericardial-epicardial adhesions impair LV twisting mechanics. In eight open-chest pigs, the heart was exposed while preserving the pericardium. We simulated early constrictive pericarditis by pericardial constriction and patchy adhesions induced with instant glue and pericardial-epicardial stitches. Using Velocity Vector Imaging™ (VVI), LV magnitudes of twisting and untwisting were measured along with hemodynamic data at baseline and after the experimental intervention. Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. Magnitude of LV untwisting rate decreased from –80 ± 23°/s to –26 ± 10 °/s (p = 0.0009). LV twisting rate dropped from 78 ± 20°/s to 40 ± 8°/s (p = 0.0039) and LV twist magnitude decreased from 9 ± 2° to 5 ± 2 ° (p = 0.0081). Patchy pericardial adhesions are associated with reductions in LV untwisting rate and twisting magnitude, consistent with a negative impact of constrictive pericarditis on systolic and diastolic function. Impairments in LV twisting mechanics may have a diagnostic role in the detection of early stages of constrictive pericarditis. (E-mail: belohlavek.marek@mayo.edu)     

High prevalence of HIV infection associated with incarceration among community-based injecting drug users in Tehran, Iran

OBJECTIVES: To determine the prevalence and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran. METHODS: In October 2004, 213 IDUs were recruited from a drop-in center and its neighboring parks and streets in Tehran. Participants were interviewed using a structured questionnaire regarding their sociodemographics and HIV risk characteristics, and specimens of oral mucosal transudate were collected and tested for HIV-1 antibodies. Data were analyzed using chi and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of HIV-1 infection was 23.2% (48 of 207) among male injecting drug users. In the multivariable analysis, a history of shared drug injection inside prison (OR, 2.45; 95% CI, 1.01-5.97) and that of multiple incarcerations (OR, 3.13; 95% CI, 1.08-9.09) were associated with significantly higher prevalence of HIV-1 infection. CONCLUSIONS: The prevalence of HIV-1 infection has reached an alarming level among IDUs in Tehran, with incarceration-related exposures revealed to be the main correlates of HIV-1 infection. Urgent and comprehensive harm reduction programs for drug users in prison and those in the community in Tehran are of prime importance to prevent further transmission of HIV infection.     

The impact of literacy enhancement on asthma-related outcomes among underserved children

STATEMENT OF PROBLEM: Despite the availability of improved healthcare access, self-management programs, disease management protocols, and advances in pharmacologic and immunotherapy therapy, the prevalence of asthma in the urban inner city remains one of the major health disparities in the United States. Additionally, sustainability of effective intervention programs after the funding has ended remains a significant issue for asthma programs. OBJECTIVE: This study examines the effectiveness of a longitudinal intervention program that was designed with the assumption that improved literacy plays a role in improving asthma-related health outcomes among high-risk children with the most severe forms of asthma. METHODS: A longitudinal intervention over 6 months prospectively addressed the literacy and asthma self-management skills of 110 minority children in South Los Angeles utilizing weekly Saturday-school format. RESULTS: The results demonstrated that there was a statistically significant decrease in both hospitalization and emergency department (ED) visits during the intervention. In addition, all the children showed significant improvement in their reading level and self-efficacy. Multivariate logistic analysis demonstrated that enhanced self-efficacy was directly related to decreased hospitalizations and ED visits. CONCLUSION: This intervention demonstrated that literacy enhancement is an important factor in improving self-efficacy and impacting asthma-related outcomes. Improved literacy is a sustainable factor that will not only improve asthma outcomes but will enhance the potential for educational success.     

Immunological role of CD4<Superscript>+</Superscript>CD28<Superscript>null</Superscript> T lymphocytes,natural killer cells,and interferon-gamma in pediatric patients with sickle cell disease: relation to disease severity and response to therapy

Sickle cell disease (SCD) is associated with alterations in immune phenotypes. CD4⁺CD28^null T lymphocytes have pro-inflammatory functions and are linked to vascular diseases. To assess the percentage of CD4⁺CD28^null T lymphocytes, natural killer cells (NK), and IFN-gamma levels, we compared 40 children and adolescents with SCD with 40 healthy controls and evaluated their relation to disease severity and response to therapy. Patients with SCD steady state were studied, focusing on history of frequent vaso-occlusive crisis, hydroxyurea therapy, and IFN-gamma levels. Analysis of CD4⁺CD28^null T lymphocytes and NK cells was done by flow cytometry. Liver and cardiac iron overload were assessed. CD4⁺CD28^null T lymphocytes, NK cells, and IFN-gamma levels were significantly higher in patients than controls. Patients with history of frequent vaso-occlusive crisis and those with vascular complications had higher percentage of CD4⁺CD28^null T lymphocytes and IFN-gamma while levels were significantly lower among hydroxyurea-treated patients. CD4⁺CD28^null T lymphocytes were positively correlated to transfusional iron input while these cells and IFN-gamma were negatively correlated to cardiac T2* and duration of hydroxyurea therapy. NK cells were correlated to HbS and indirect bilirubin. Increased expression of CD4⁺CD28^null T lymphocytes highlights their role in immune dysfunction and pathophysiology of SCD complications.     

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.