Bidirectional Glenn shunt for right ventricular endomyocardial fibrosis

A 25-year-old man in New York Heart Association functional class IV with right ventricular endomyocardial fibrosis received a palliative bidirectional Glenn shunt. Despite a stormy postoperative convalescence the bidirectional Glenn shunt provided good long-term palliation.     

Adaptive planning using megavoltage fan-beam CT for radiation therapy with testicular shielding

This study highlights the use of adaptive planning to accommodate testicular shielding in helical tomotherapy for malignancies of the proximal thigh. Two cases of young men with large soft tissue sarcomas of the proximal thigh are presented. After multidisciplinary evaluation, preoperative radiation therapy was recommended. Both patients were referred for sperm banking and lead shields were used to minimize testicular dose during radiation therapy. To minimize imaging artifacts, kilovoltage CT (kVCT) treatment planning was conducted without shielding. Generous hypothetical contours were generated on each “planning scan” to estimate the location of the lead shield and generate a directionally blocked helical tomotherapy plan. To ensure the accuracy of each plan, megavoltage fan-beam CT (MVCT) scans were obtained at the first treatment and adaptive planning was performed to account for lead shield placement. Two important regions of interest in these cases were femurs and femoral heads. During adaptive planning for the first patient, it was observed that the virtual lead shield contour on kVCT planning images was significantly larger than the actual lead shield used for treatment. However, for the second patient, it was noted that the size of the virtual lead shield contoured on the kVCT image was significantly smaller than the actual shield size. Thus, new adaptive plans based on MVCT images were generated and used for treatment. The planning target volume was underdosed up to 2% and had higher maximum doses without adaptive planning. In conclusion, the treatment of the upper thigh, particularly in young men, presents several clinical challenges, including preservation of gonadal function. In such circumstances, adaptive planning using MVCT can ensure accurate dose delivery even in the presence of high-density testicular shields.     

Hypocalcaemia,alcohol drinking and viroimmune responses in ART recipients

Metabolic perturbations associated with HIV and antiretroviral therapies are widespread. Unfortunately, research has predominantly focused in cardiometabolic problems, neglecting other important areas. In fact, the immune-calcium–skeletal interface has been understudied despite its potential relevance in people living with HIV (PLWH). Using a case-control methodology, 200 PLWH receiving medical care were enrolled and stratified according to hazardous vs. non-hazardous alcohol intake (HAU vs. non-HAU) and calcium (Ca) levels by analyzing baseline data. The group was chosen to represent relatively "pure" HAU with minimal drug use and no psychiatric diagnoses. With these narrow parameters in place, we found evidence that HAU significantly increases TNF-α levels compared to Non-HAU (2.8 ± 0.6 vs. 1.9 ± 0.3 pg/ml, p = 0.05) and decreases blood Ca levels (9 ± 0.6 vs. 9.4 ± 0.5, p = 0.03). Our analyses also suggest that chronic inflammation, as indicated by increased TNF-α levels, is associated with hypocalcemia (hypoCa <8.6). Despite the limited prevalence of hypoCa, these findings are clinically significant given that hypoCA PLWH exhibited decreased CD4 (253 ± 224 vs. 417.7 ± 281, p = 0.02), B cells (147 ± 58 vs. 248 ± 151, p = 0.03) and NK cells (146.8 ± 90 vs. 229 ± 148, p = 0.008) and elevated CD8 (902.5 ± 438 vs. 699 ± 510, p = 0.09) compared to those with normal calcium. Furthermore, calcium effects on viral load were also evident with hypoCA exhibiting the highest loads (140,187 ± 111 vs. 35,622 ± 7770 HIV copies, p = 0.01). Multivariate analyses confirmed the significance of hypoCa in predicting viroimmune parameters. This paper provides the first evidence that hypoCa accounts for some of the variation in viroimmune measures in HAART recipients and suggests that hypoCa may be mediating alcohol's deleterious effects.     

Lipid patterns and fibrinogen levels of smokers and non-smokers

Hypercholesterolaemia, smoking and elevated levels of fibrinogen are independent risk factors for cardiovascular disease (CVD). The aim of this study was to determine whether smoking indirectly affects the other risk factors, namely cholesterol and fibrinogen levels. Serum lipid patterns and fibrinogen levels were determined in 67 cigarette or beedi smokers and 51 non-smokers in the age group 18 to 50 years. Serum thiocyanate levels were measured as an indirect indicator or smoking exposure. Smokers had significantly higher serum thiocyanate levels than non-smokers. The serum total cholesterol levels in smokers was significantly higher than in non-smokers, but there was no association with the degree of smoking. In contrast, smokers had significantly elevated fibrinogen levels which were positively related to thiocyanate levels, indicating that plasma fibrinogen levels increase in smoking exposure. These results suggest that smoking may increase the risk of CVD by elevating plasma fibrinogen levels.     

NADPH diaphorase (nitric oxide synthase) in a part of the chick brain involved in imprinting

The intermediate and medial part of the hyperstriatum ventrale (IMHV) is a memory system in the chick forebrain in which certain learning-related changes occur after imprinting. We have enquired whether NADPH-diaphorase, a presumed marker for nitric oxide synthase, is present in sections through the IMHV of chicks, either trained with an imprinting stimulus or dark-reared. Very few NADPH-d-positive cells were found in the IMHV(0.37 ± 0.07S.E.M. cells per0.3mm× 0.9mm sampling), in contrast to the palaeostriatum augmentatum (PA)(19.47 ± 0.77). Some stained cells in the PA were closely associated with blood vessels. The results do not support the hypothesis that learning-related changes in the IMHV depend on nitric oxide acting as a retrograde neuronal messenger.