Cardiac protection of Bauhinia championii against reperfusion injury

This study aims to investigate the protective effects of the Bauhinia championii (BC) against ischemia/reperfusion (I/R)‐induced injury in an isolated heart model. Langendorff‐perfused C57BL/6JNarl mice hearts were performed with 30 minutes ischemia and 60 minutes reperfusion by left anterior descending artery ligation. Before reperfusion, boiling water extracts of BC (10 mg/L) was pretreated for 15 minutes. During reperfusion, BC significantly decreased the occurrence of ventricular arrhythmias by lead II electrocardiogram (ECG). Electrophysiological effect of BC was further determined in isolated ventricular myocytes by whole‐cell patch clamp technique. The underlying mechanism may result from its Na⁺ channel blocking activity characterized with reduced rise slope of action potential and Na⁺ current density. Moreover, BC dramatically reduced I/R‐caused infarct size, which was accessed by 2,3,5‐triphenyltetrazolium chloride (TTC) assay. Since BC decreased I/R‐induced myoglobin release and oxidation of Ca²⁺‐calmodulin‐dependent protein kinase, inhibition of myocardial necroptosis may account for the protective effects of BC on myocytes lose. This study indicated that BC may prevent I/R induced ventricular arrhythmias and myocyte death by blocking Na⁺ channels and decreasing necroptosis, respectively. Since most of the available antiarrhythmic remedies have unwanted adverse actions, BC could be a novel candidate for the treatment of myocardial infarction and ventricular arrhythmia.     

Changes in thyroid hormone levels and related gene expressions in embryo–larval zebrafish exposed to binary combinations of bifenthrin and acetochlor

Ecotoxicology - Bifenthrin (BF) and acetochlor (AT) are widely used as an insecticide and herbicide, respectively, which are introduced to the aquatic environment as a natural result. Although the...     

Independent Poor Prognostic Factors for True Progression after Radiation Therapy and Concomitant Temozolomide in Patients with Glioblastoma: Subependymal Enhancement and Low ADC Value

BACKGROUND AND PURPOSE:Subependymal enhancement and DWI have been reported to be useful MR imaging markers for identifying true progression. Our aim was to determine whether the subependymal enhancement pattern and ADC can differentiate true progression from pseudoprogression in patients with glioblastoma multiforme treated with concurrent chemoradiotherapy by using temozolomide.MATERIALS AND METHODS:Forty-two patients with glioblastoma multiforme with newly developed or enlarged enhancing lesions on the first follow-up MR images obtained within 2 months of concurrent chemoradiotherapy completion were included. Subependymal enhancement was analyzed for the presence, location, and pattern (local or distant relative to enhancing lesions). The mean ADC value and the fifth percentile of the cumulative ADC histogram were determined. A multiple logistic regression analysis was performed to identify independent factors associated with true progression.RESULTS:Distant subependymal enhancement (ie, extending >1 cm or isolated from the enhancing lesion) was significantly more common in true progression (n = 24) than in pseudoprogression (n = 18) (P = .042). The fifth percentile of the cumulative ADC histogram was significantly lower in true progression than in pseudoprogression (P = .014). Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were independent factors associated with true progression (P = .041 and P = .033, respectively). Sensitivity and specificity for the diagnosis of true progression were 83% and 67%, respectively, by using both factors.CONCLUSIONS:Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were significant independent factors predictive of true progression.

Glioblastoma multiforme (GBM) is the most common form of malignant primary brain tumor in adults,¹ which is notorious for its intrinsic aggressiveness and a dismal prognosis.^2,3 The current standard treatment for GBM is maximal safe tumor resection followed by radiation therapy with concurrent temozolomide (TMZ) and adjuvant TMZ.⁴Recently, the criteria for assessing therapeutic responses in high-grade gliomas have been updated by the Response Assessment in Neuro-Oncology (RANO) Working Group to address the limitations of the previous guideline.⁵ For instance, contrast enhancement, which has been regarded as a surrogate marker for tumor progression, has been reassessed as a nonspecific finding merely reflecting the passage of contrast material across a disrupted blood-tumor barrier.^6–11 In particular, radiologists and clinicians have increasingly recognized the occurrence of progressive MR imaging lesions immediately after completion of concurrent chemoradiotherapy (CCRT) with TMZ, which spontaneously improved without further treatment other than the adjuvant TMZ.^12–14 The treatment-related reaction is termed pseudoprogression and has received attention as a potential pitfall in the response evaluation. At present, owing to the lack of established findings in conventional contrast-enhanced MR imaging for the differential diagnosis of true progression from pseudoprogression,^9,10 RANO stresses that the diagnosis of true progression can be made within the first 12 weeks after completion of radiation therapy only if most of the new enhancement is located outside the radiation field or if there is pathologic confirmation of progressive disease.⁵During the past few decades, there has been extensive effort to identify imaging biomarkers for tumor progression. Among the many parameters derived from advanced MR imaging techniques, DWI has been consistently reported to be helpful in differentiating tumor progression from treatment-related changes or necrosis.^15–22 Meanwhile, most previous studies pertaining to the role of conventional MR imaging have not shown promising results.^9,23 Nevertheless, a recent study focusing on the conventional MR imaging findings has proposed subependymal enhancement as a useful MR imaging marker for differentiating true progression from pseudoprogression.²⁴ To our knowledge, however, no previous studies have conducted in-depth analysis of the subependymal enhancement, and its potential as an independent predictor for true progression remains elusive.The purpose of the present study was to determine whether the subependymal enhancement pattern and ADC can differentiate true progression from pseudoprogression in patients with GBM treated with radiation therapy and concomitant TMZ.     

低场磁共振成像对强直性脊柱炎的髋关节病变诊断价值

目的探讨低场磁共振成像(MRI)对强直性脊柱炎(AS)髋关节MRI表现,以提高AS的早期诊断。方法对52例AS髋关节的病例进行MRI横、冠状位扫描快速自旋回波(FSE)T2WI,作自旋回波(SE)T1WI,快速自旋回波(FSE-XL)T2WI+脂肪抑制,3D FW FGRE T1WI。男性40例,女性12例,年龄14~58岁,平均30.36岁。结果 52例共104个髋关节有不同程度异常MRI表现,其中累及双侧髋关节47例,单侧5例。MRI表现有:关节积液50例98个髋关节;骨髓水肿19例;关节软骨异常10例;关节面软骨下囊状骨破坏15例;骨质疏松25例;关节间隙狭窄3例;骨质增生和骨赘形成12例;附着点炎症10例。结论 MRI是显示AS的髋关节受累最有效的方法,可用于早期诊断和疾病活动期的评价,为临床治疗、预防提供客观依据。     

Measurement of Opening and Closing Angles of Aortic Valve Prostheses In Vivo Using Dual-Source Computed Tomography: Comparison with Those of Manufacturers' in 10 Different Types

Objective

The aims of this study were to compare opening and closing angles of normally functioning mechanical aortic valves measured on dual-source computed tomography (CT) with the manufacturers'' values and to compare CT-measured opening angles according to valve function.

Materials and Methods

A total of 140 patients with 10 different types of mechanical aortic valves, who underwent dual-source cardiac CT, were included. Opening and closing angles were measured on CT images. Agreement between angles in normally functioning valves and the manufacturer values was assessed using the interclass coefficient and the Bland-Altman method. CT-measured opening angles were compared between normal functioning valves and suspected dysfunctioning valves.

Results

The CT-measured opening angles of normally functioning valves and manufacturers'' values showed excellent agreement for seven valve types (intraclass coefficient [ICC], 0.977; 95% confidence interval [CI], 0.962-0.987). The mean differences in opening angles between the CT measurements and the manufacturers'' values were 1.2° in seven types of valves, 11.0° in On-X valves, and 15.5° in ATS valves. The manufacturers'' closing angles and those measured by CT showed excellent agreement for all valve types (ICC, 0.953; 95% CI, 0.920-0.972). Among valves with suspected dysfunction, those with limitation of motion (LOM) and an increased pressure gradient (PG) had smaller opening angles than those with LOM only (p < 0.05).

Conclusion

Dual-source cardiac CT accurately measures opening and closing angles in most types of mechanical aortic valves, compared with the manufacturers'' values. Opening angles on CT differ according to the type of valve dysfunction and a decreased opening angle may suggest an elevated PG.     

替罗非班对非介入治疗急性非ST段抬高心肌梗死患者的疗效

目的探讨未行早期介入治疗的急性非ST段抬高心肌梗死(NSTEMI)患者替罗非班应用的有效性和安全性。方法选取2013年1月~2014年9月收治的未行早期再灌注治疗NSTEMI患者80例,随机分为对照组和研究组,每组40例,对照组行常规治疗,研究组在对照组治疗方案基础上加用替罗非班治疗,观察两组间死亡、再次心肌梗死及左室射血分数等心血管临床事件的变化及出血情况。结果对照组1例脑出血死亡(P>0.05),研究组无死亡及严重出血事件,随诊再次发生心肌梗死2例,射血分数<40%者3例,明显优于对照组(P<0.05)。结论研究结果表明替罗非班一定程度上改善了NSTEMI患者的临床症状和左室射血功能,但对于主要不良心血管事件的发生率无明显改善。对未行急诊再灌注治疗的STEMI的最佳药物治疗方案制订提供了一定的临床依据,但仍需进一步探索。     

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Background

Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation.

Questions/purposes

We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.

Methods

Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science^™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I²) and publication bias was assessed using forest plots.

Results

There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06–0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06–0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02–1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32–14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40–2.01; p = 0.78) between patients treated with arthroplasty and internal fixation.

Conclusions

Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.