Cardiac damage in hypertensive patients with inverse white coat hypertension. Hospitalet study

BACKGROUND: Few studies have assessed the relationship between ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH). OBJECTIVES: To determine the frequency of IWCH in untreated grade 1-2 hypertension and to assess possible differences in cardiac damage among patients with IWCH, white coat hypertension (WCH) and the rest of patients with grade 1-2 hypertension. PATIENTS AND METHODS: Two hundred and eleven patients with grade 1-2 hypertension were sequentially included. A good quality 24-h ambulatory BP monitoring was obtained in 204 patients (age: 41 +/- 12 years, 56% males). IWCH was defined as a daytime systolic and/or diastolic BP higher than diagnostic office systolic and/or diastolic BP, respectively. WCH was defined as a daytime BP < 135/85 mmHg. A good quality echocardiogram was obtained in 174 patients. We considered left ventricular hypertrophy a left ventricular mass index (LVMI) > or = 125 g/m2. RESULTS: We found IWCH in 29 subjects (14%), and WCH in 68 (33%). Office BP in patients with IWCH was in an intermediate position between WCH and the rest of grade 1-2 hypertension patients. The IWCH patients showed 24-h, daytime and night-time BP higher than the other groups. Left ventricular mass was significantly greater in patients with IWCH than in the other grade 1-2 hypertension patients after adjusting for age, gender, body mass index, smoking and office BP (regression coefficient 28.14, 95%CI: 7.36-48.91). CONCLUSION: IWCH is independently associated with higher values of left ventricular mass in patients with grade 1-2 hypertension.     

Altitude exposure in sports: the Athlete Biological Passport standpoint

The Athlete Biological Passport (ABP) is principally founded on monitoring an athlete's biological variables over time, to identify abnormal biases on a longitudinal basis. Several factors are known to influence the results of these markers. However, the manner in which the altitude factor is taken into account still needs to be standardized. Causal relationships between haematological variables should be correctly integrated into ABP software. In particular, modifications of haematological parameters during and after exposure to different altitudes/hypoxic protocols need to be properly included within detection models. Copyright © 2013 John Wiley & Sons, Ltd.     

A method of analyzing procoagulant activity in monocytes at single cell level

BACKGROUND AND OBJECTIVES: Procoagulant activity (PCA) of monocytes is known to play a pivotal role in a variety of physiologic and pathophysiologic processes, such as disseminated intravascular coagulation, atherosclerosis, arterial and venous thromboembolism, cancer-related hypercoagulability and immunopathologies. Until now, PCA has been studied by clotting assays of a whole cell population or at single cell level by analyzing tissue factor antigen, the protein that initiates PCA but does not always correlate with it. Here, we describe a new simple flow cytometric method that allows the PCA of monocytes to be studied at a single cell level by quantifying the fibrin formed around the cells in suspension. DESIGN AND METHODS: Purified fibrinogen was tagged with FITC and added to a recalcified developer plasma containing suitable amounts of heparin in order to inhibit the expansion of clotting, thus limiting the formation of fibrin to the surface of cells with PCA. With appropiate amounts of heparin, in 10 min, large sea urchin-like cells with fibrin needles around some monocytes were formed and, after fixation, cytofluorimetrically analyzed. RESULTS: Blood mononuclear cells isolated and immediately analyzed showed less than 0.1% sea urchin cells. Adherence alone, lipopolysaccharides or ionomycin stimulated expression of PCA in a dose- and time-dependent relationship: after 30 min, 1-3% of the MNC showed PCA, and after 20 h this reached 5-10%. Density separation of monocytes showed that different stimulators act on different maturation stages. Subjects with diabetes express more monocytes with PCA than normal subjects after 30 min stimulation. INTERPRETATION AND CONCLUSIONS: This method allows PCA analysis of monocytes at single cell level and requires only a low number of cells. The signal produced by the fluorescent fibrin is strong and easily analyzed by flow cytometry. The method is suitable for analyzing blood from patients with different pathologies and many conditions under different stimuli.     

Combination Lower Lip Prosthesis Retained by an Intraoral Component

Patients who have had a partial or full surgical resection of the maxillary or mandibular lip experience difficulties with articulation of speech, swallowing, and salivary control. This is further complicated by significant alterations in facial esthetics and lowered self‐esteem. This clinical treatment will describe the fabrication of a two‐piece tooth‐retained maxillofacial prosthesis. An intraoral retentive portion and an extraoral section restoring lip anatomy were attached by retentive elements. This prosthesis restored the patient's esthetics, oral function, and self‐esteem.     

The effect of age on the relationship of pulse pressure and left ventricular mass in untreated patients with mild to moderate hypertension

Aim: To study the relationship between left ventricular mass (LMV) and pulse pressure (PP) in mild to moderate hypertensive patients according to age and gender. Design and Methods: Two hundred and eleven patients aged 18-65 years, 56% males, with untreated mild to moderate hypertension, were included. A 24-h ambulatory blood pressure (BP) profile was recorded in 204 patients. In 174 of them, an echocardiogram of good quality was obtained. PP was defined as the difference between systolic and diastolic BP. Results: Statistically significant differences were observed in office and ambulatory PP according to the age, with a greater PP among hypertensive subjects younger than 30. Globally, there was a significant correlation between LVM and PP, either with clinical PP ( r = 0.17, p = 0.024) or with ambulatory PP (24-h PP: r = 0.18, p = 0.016). When stratifying by age group, the stronger correlations were observed in patients younger than 30. When stratifying by gender, previous results were applicable to men, but, in women, no correlation was observed between PP and LVM in either age group. Conclusions: an increased PP was observed in hypertensive patients younger than 30 in comparison with middle-aged hypertensive patients. The correlation between LVM and PP was stronger in younger male hypertensive patients, but not in female.     

Modulation of chemokine receptor expression and chemotactic responsiveness during differentiation of human naive T cells into Th1 or Th2 cells

Chemokines and their receptors direct movements and encounters of lymphocytes and professional APC into specific microenvironments of lymphoid tissues. Chemokine receptors such as CCR7, CXCR5 and CCR4 that are differentially expressed and modulated in distinct subsets of T cells contribute to establish functionally and spatially segregated microenvironments within secondary lymphoid tissues where T cell activation and differentiation occur. Here, we have explored the modulation of CCR7, CCR4, CCR8 and CXCR5 expression and chemotactic responsiveness to their ligands during commitment of human naive T cells along the Th1 or Th2 differentiation pathway in vitro. Our results document that activation of human naive T cells and differentiation in Th1 or Th2 cells result in progressive down-modulation of CCR7 expression and CCL19 responsiveness. By contrast, expression of CCR4 and responsiveness to CCL22 is rapidly induced at the early stages of both Th1/Th2 cell development. However, while CCR4 expression is further up-regulated upon differentiation into Th2 cells, it is lost on fully differentiated Th1 cells. CCR8 is detected at later time points than CCR4 and exclusively on differentiated Th2 cells as revealed by analysis of mRNA expression and responsiveness to CCL1. Expression of CXCR5 is transiently induced at the early stages of Th cell differentiation, but with distinct kinetics in developing Th1 and Th2 cells. Analysis of human tonsillar CD4(+) T cells reveals a consistent pattern of chemotactic responsiveness and chemokine receptor expression in distinct transitional stages of human T cell activation and differentiation in vivo.     

Efectos de la impresión 3D en la planificación quirúrgica de las cardiopatías congénitas

Introduction:

Congenital heart disease makes up for 30% of all congenital anomalies. The prevalence is 8/1,000 live newborns, without predominance of gender. Imaging methods such as echocardiography, angiography, computed tomography or magnetic resonance imaging must be routinely used in congenital heart disease. The mentioned methods can provide virtual reconstructions in volumetric reconstruction or in three dimensional (3D), but only 3D-printed heart models can provide real 3D tactile replicas of cardiac anatomy.

Objective:

To make 3D printed heart models in order to provide real 3D tactile replicas of the cardiac anatomy that allow a detailed visualization from all possible perspectives, either of extracardiac or intracardiac structures.

Methods:

This information is useful for surgical decision making, especially in patients with complex cardiac defects. DICOM, edited in a software package “3D slicer 4.3” and exported for printing in file format (.stl).

Results and conclusions:

With 3D printing, the intracardiac and extracardiac anatomy can be evaluated in detail with real-scale cardiac models of the patient, avoiding unexpected findings. This technique is very useful especially in complex congenital heart defects, since it allows precise planning of the surgical procedure.Key words: Congenital heart disease, Cardiac imaging, Three dimensional printing, Surgical planning