Relationship between the course of depression symptoms and the left ventricular mass index and left ventricular filling pressure in chronic haemodialysis patients

Aim: Multiple measurements of depression symptoms over time were more predictive of cardiovascular mortality than a single time measurement performed at baseline. The aim of this study is to evaluate the association of the course of depression symptoms, based on repeated assessments of depression symptoms over time, with left ventricular mass index (LVMI) and left ventricular filling pressure (LVFP) in patients on haemodialysis (HD). Methods: The level of depression symptoms in 61 patients on HD were prospectively assessed using the Beck Depression Inventory (BDI) at baseline and at three intervals (5, 10, 15 months). Doppler echocardiographic examinations were performed at the end of follow up. Results: At the end of follow up, the patients were divided into three groups according to their course of depression symptoms: non‐depression (n = 21), intermittent depression (n = 23) and persistent depression (n = 17). LVMI and LVFP were significantly increased in the persistent depression symptoms group compared to those of the non‐depression symptoms group and the intermittent depression symptoms group. Persistent depression symptoms were independently associated with LVMI (β‐coefficient = 0.347, P = 0.017) and LVFP (β‐coefficient = 0.274, P = 0.048) after adjustment for age, sex, systolic blood pressure, diastolic blood pressure, diabetes and interdialytic weight gain. Conclusion: In our study, persistent depression symptoms were associated with left ventricular hypertrophy and diastolic dysfunction. Our data may provide a more complete understanding of cardiovascular risk associated with depression symptoms in patients on HD.     

Preexisting pulmonary vein stenosis in patients undergoing atrial fibrillation ablation: a report of five cases

INTRODUCTION: Acquired pulmonary vein (PV) stenosis is a well-known complication following catheter ablation of atrial fibrillation (AF). However, the details of congenital PV stenosis have not been reported in patients who underwent catheter ablation of AF. METHODS AND RESULTS: A total of 178 patients (110 men, age: 54 +/- 11 years) with drug-refractory AF received MRA or multidetector CT (MDCT) before ablation for delineation of PV morphologies. Five PVs in 5 patients (2.8%) showed at least 50% stenosis before ablation. We demonstrated two types of preexisting PV stenosis. Type I is the external compression of PV by the descending aorta, observed in LIPV of the three patients. Type II is the focal narrowing of PV, observed in RSPV of the two patients. CONCLUSION: Preexisting stenosis of PV may be a consequence of congenital focal narrowing or external compression by the adjacent structures. Detection of this condition by 3D CT or MRA before catheter ablation can provide information for planning of ablation strategy and prevent misdiagnosis of ablation-related PV stenosis.     

Prognostic role of right ventricular dilatation and troponin I elevation in acute pulmonary embolism

Acute pulmonary embolism continues to cause significant morbidity and mortality despite advances in diagnosis and treatment. This retrospective analysis aimed to determine whether the combination of elevated troponin I and right ventricular dilatation (RVD) could provide a more powerful predictor for risk evaluation. The study data comprised records of 110 patients with either high-probability ventilation/perfusion lung scan or positive spiral computed tomography. All cause 100-day mortality was 18.2%. The hypotension and RVD variables significantly influenced 100-day mortality. For the combination of RVD and raised troponin I, the 100-day mortality rate was 31%. Notably, the group with elevated troponin I and no RVD had a 100-day mortality rate of only 3.7%. The combination of RVD and elevated troponin had a positive predictive value of 31% and a negative predictive value of 88% for 100-day mortality. Compared with existing reports, conflicting conclusions for the individual prognostic role of elevated troponin I, cancer, and heart failure were obtained. These conflicting conclusions most likely resulted from inappropriate cut-off troponin I values and the modest sample size. In conclusion, the combination of elevated troponin and RVD was able to identify a subset of patients most likely to benefit from aggressive therapy.     

Functional and histologic changes after repeated transcranial direct current stimulation in rat stroke model

Transcranial direct current stimulation (tDCS) is associated with enhancement or weakening of the NMDA receptor activity and change of the cortical blood flow. Therefore, repeated tDCS of the brain with cerebrovascular injury will induce the functional and histologic changes. Sixty-one Sprague-Dawley rats with cerebrovascular injury were used. Twenty rats died during the experimental course. The 41 rats that survived were allocated to the exercise group, the anodal stimulation group, the cathodal stimulation group, or the control group according to the initial motor function. Two-week treatment schedules started from 2 days postoperatively. Garcia, modified foot fault, and rota-rod performance scores were checked at 2, 9, and 16 days postoperatively. After the experiments, rats were sacrificed for the evaluation of histologic changes (changes of the white matter axon and infarct volume). The anodal stimulation and exercise groups showed improvement of Garcia's and modified foot fault scores at 16 days postoperatively. No significant change of the infarct volume happened after exercise and tDCS. Neuronal axons at the internal capsule of infarct hemispheres showed better preserved axons in the anodal stimulation group. From these results, repeated tDCS might have a neuroprotective effect on neuronal axons in rat stroke model.     

Cibenzoline improves coronary flow velocity reserve in patients with hypertrophic obstructive cardiomyopathy

The effect of cibenzoline, a class-Ia antiarrhythmic drug, on coronary flow velocity reserve (CFVR) was examined in patients with hypertrophic cardiomyopathy using transthoracic Doppler echocardiography. Coronary flow velocity reserve was assessed in 11 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic nonobstructive cardiomyopathy (HNCM), before and after the intravenous administration of cibenzoline (1 mg/kg). Coronary hyperemia was induced by an intravenous infusion of adenosine triphosphate and CFVR was calculated as the ratio of hyperemic to basal mean coronary diastolic flow velocity. At baseline, CFVR was significantly correlated with left ventricular outflow tract pressure gradient (LVPG) in patients with HOCM (r = 0.67, P < 0.03). In patients with HOCM, administration of cibenzoline significantly improved impaired CFVR (2.0 ± 0.8 to 3.0 ± 1.0, P < 0.001), and reduced LVPG (55 ± 30 to 23 ± 18 mmHg, P < 0.001), while CFVR remained unchanged in patients with HNCM (2.6 ± 0.9 to 2.9 ± 0.8, P not significant). Cibenzoline not only reduces LVPG but also improves CFVR in patients with HOCM. In addition left ventricular outflow obstruction plays an important role in impaired coronary circulation in patients with HOCM.     

TNF-alpha-secreting monocytes are recruited into the brain of cholestatic mice

Signaling occurs between the liver and brain in cholestatic liver disease, giving rise to sickness behaviors such as fatigue. However, the signaling pathways involved are poorly defined. Circulating inflammatory mediator levels are increased in cholestasis, leading to speculation that they may be capable of activating circulating immune cells that subsequently could gain access to the brain. Indeed, we have identified that at day 10 after bile duct resection-induced cholestasis, there is activation of circulating monocytes that express tumor necrosis factor alpha (TNF-alpha) in conjunction with increased expression of adhesion molecules by cerebral endothelium. Moreover, using intravital microscopy, we have identified markedly enhanced leukocytes rolling along cerebral endothelial cells, mediated by P-selectin, in bile duct-resected (BDR) but not control mice. In addition, we have identified increased infiltration of monocytes (but not lymphocytes) into the brains of BDR mice and found that these infiltrating monocytes produce TNF-alpha. Furthermore, infiltration of TNF-alpha-secreting monocytes into the brains of cholestatic mice is associated with a broad activation of resident brain macrophages to produce TNF-alpha. In conclusion, cholestasis is associated with an activation of cerebral endothelium that recruits TNF-alpha-producing monocytes into the brain. We hypothesize that enhanced TNF-alpha release within the brain may contribute to the development of cholestasis-associated sickness behaviors, including fatigue.     

Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band <Emphasis Type="Italic">positions</Emphasis>

Introduction The load tolerance of conventional plate treatment for bicondylar tibial plateau fractures with the buttress and the tension band positions was compared from biomechanical viewpoints. Materials and methods Fourteen left synthetic tibiae divided into two groups were tested. T-plates in the buttress group were placed on the medial tibial subcondyle and T-plates in the tension band group were placed on the lateral tibial subcondyle. All specimens were evaluated with a Material Testing System (MTS) machine. A linear variance displacement transducer gauge was placed on the medial tibial subcondyle. The anatomic axis of the synthetic femur and the tibia was maintained at 6° varus in the frontal plane. The MTS actuator was set to increase displacement at 3 mm/min. All specimens were evaluated to failure. The relative motion and the ultimate failure load (UFL) between both groups were compared. Results The buttress group had significantly less displacement than the tension band group following the incrementally increased loading (p < 0.001). At failure, the buttress group also had a higher UFL (p < 0.001) and less displacement (p = 0.009) than the tension band group. Conclusion All medial tibial condylar fragments achieved improved stabilization from the medial aspect of the proximal tibia by conventional plates. When conventional plates cannot be placed medially due to skin ailments, lateral placement of conventional plates may have the insufficient stability. Protected weight bearing should be followed strictly.     

Simultaneous determination of p-aminobenzoic acid and its metabolites in the urine of volunteers, treated with p-aminobenzoic acid sunscreen formulation

p-Aminobenzoic acid (PABA) and its metabolites (p-aminohippuric acid, p-acetamidobenzoic acid, and p-acetamidohippuric acid) were detected using high-performance liquid chromatography with an electrochemical (carbon paste) detector (HPLC-ECD). For direct current (dc) mode, with the current at a constant potential, and measurements with suitable experimental parameters, a linear concentration from 0.125 to 1.80 microg/ml was found. The detection limit was approximately 2.0 ng/ml. A carbon paste coulometric detector was used to demonstrate that PABA and its metabolites are electrochemically oxidized in acidic media, and to determine, by analyzing human urine, the percutaneous absorption of PABA and its metabolites. Findings using HPLC-ECD and HPLC with an ultraviolet detector (HPLC-UV) were comparable.