Control Group Of Healthy Patients Research Articles

Cardiac remodeling and inflammation detected by magnetic resonance imaging in COVID-19 survivors

BackgroundConcerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19. MethodsAdult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity. ResultsOf 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced. ConclusionAmong COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging–detected signs of cardiac remodeling, partially reversed during follow-up, were high.

Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study

BackgroundRadiomorphometric indices measured on Dental Panoramic Radiography (DPR) can reflect Bone Mineral Density (BMD). The aim of our study is to evaluate changes in DPR radiographic markers in patients undergoing antiresorptive therapy with denosumab and correlate them to BMD and serum bone turnover markers (BTM).MethodsWe evaluated two radiomorphometric indices: Mandibular Cortical Width (MCW) and Panoramic Mandibular Index (PMI), in patients undergoing antiresorptive therapy with denosumab at T0 (before starting the therapy) and at T1 (after 12 months), comparing results with a control group of healthy patients who performed two DPRs at a one-year time distance. Correlation analysis was performed in the denosumab group, as well as ROC curves were obtained for both indices.ResultsThe study included 18 patients and 21 controls according to specific inclusion and exclusion criteria, matched by gender and age. Both MCW and PMI were significantly lower at T0 in the denosumab group, consistently with lower BMD. MCW showed significant correlation with femoral and lumbar DEXA and was significantly lower in patients with osteoporosis compared to osteopenia. Only PMI index increased significantly in the denosumab group from T0 to T1. After one year (T1), there weren’t any differences between patients and controls for both indices. No significant correlations were found with BTMs. Sensitivity and specificity for MCW and PMI were also calculated.ConclusionsOur results show how CMW shows sufficient sensitivity and specificity to be used as a radiographic marker to screen and intercept patients with osteoporosis. PMI seems to be able to reflect changes in response to antiresorptive therapy with denosumab. Further studies are needed to confirm our hypothesis.

Can elderly patients regain their preoperative functional level after distal radius fracture type A? Results from a fracture register study using PROM.

Although distal radius fractures (DRFs) are the most common fractures of the human body, there are still ongoing debates concerning the treatment for type A fractures, especially in elderly patients. In spite of good clinical outcomes, it remains unclear whether elderly patients, especially, could regain the preoperative functional level of the wrist. Therefore, we have quantified wrist function within a retrospective study design using patient-reported outcome measures (PROM) and we have analyzed the influence of age between control and patient collective and young vs. old, respectively. The retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined by using a self-assessment questionnaire called the Munich Wrist Questionnaire (MWQ) according to the patient-related outcome measurements PROM. We could enroll 110 patients and controls, and the average follow-up was 66 months. Subgroup matching induced similar age group distribution: in both groups, 7 individuals <30 years, 67 between 31 and 64 years, 29 between 65 and 79 years, and 7 individuals >80 years, were enrolled, respectively. In the fracture group, women were significantly older than men (59 ± 15 vs. 47 ± 17 (M ± SD). There was no significant difference between the control and the patient groups (96 ± 6 vs. 95 ± 7). The function was significantly different between controls and patients <30 years (100 ± 1 vs. 98 ± 2). In the control group, there was a functional difference in the age group <30 compared with 65-79 and >80 and in the age group 30-64 compared with 65-79 and >80. In the control group, the function was found to be significantly decreasing with advancing age, whereas in the patient group, this influence was absent. A correlation analysis showed a worse function with increasing age in the control group and therefore a negative correlation. In the fracture group, a similar result could not be obtained. Age has a relevant influence on wrist function. Although the wrist function decreases significantly with aging, in the patient group, this influence is absent, and the functional results after surgery are excellent. Even elderly patients can regain their preoperative functional level.

Application of SNOT-22 test and visual analogue scale in quality of life evaluation in patients with allergic rhinitis.

Chronic nasal congestion in patients with allergic rhinitis can lead to sleep disorders and to sleep apnoea which, in combination with fatigue, can induce systemic effects, including irritability, weakness, malaise, and decreased appetite, growth retardation in adolescents, resulting in severe worsening of quality of life. Also, allergic rhinitis can affect social life, school performance, and productivity, especially in patients with severe disease. The aim of the present case-control study was to investigate the impact of quality-of-life impairment and the main contributing symptoms in patients with allergic rhinosinusitis. During the survey from January to December 2018, 139 participants (111 with allergic rhinitis and 28 controls) were enrolled in the study. Participants in the clinical and control groups were invited to complete a quality-of-life questionnaire for patients with sino-nasal pathology (SNOT-22). For results, a comparison in terms of eye affecting itching, burning, redness, and tearing sensation, a 10-grade visual analogue scale table was presented. Comparing the clinical and control groups of healthy patients in the first SNOT-22, the value was significantly elevated as expected. The mean score (SNOT-22 total score) of the twenty-two symptom scores in patients was 2.52±0.93 (0-5); by comparison, the value in the control group was only 0.64±0.11, with the difference being statistically significant (p=0.001). The results of the visual analogue scale for which the patients were asked to note the level of eye impairment: redness, burning, itching, and tearing that contributed to their negative sense of the quality of life, were eloquent. A statistically significant difference was found between participants with intermittent and persistent forms (6.06±0.20 vs. 3.00±0.25, p=0.001), and between the entire clinical group with AR and the healthy controls included in the study (4.48±0.22 versus 0.21±0.03, p=0.000). Summarising the results of our study and the available literature, we have concluded that nasal congestion and the abundance of secretions are symptoms that disrupt mostly the quality of life in AR patients and significantly affect the quality of sleep and are inevitable consequences of both daytime tone and productivity.The rich palette of symptoms that lead to deterioration of the mental and physical well-being of those affected by AR necessitates the need to sharpen the attention of professionals working for this type of pathology in order to strive to detail and differentiate the specific complaint and degree of quality of life deterioration.

The prognostic importance of neutrophil-to-lymphocyte ratio in testicular cancer.

Testicular cancer is mostly seen in young men. We planned this study that neutrophil-lymphocyte ratio (NLR) would help us predict the prognosis of the patients, except known markers such as AFP, hCG, and LDH. Between 2015 and 2020, we conducted our study on 152 patients undergoing radical orchiectomy in our clinic. We divided our patients into good, moderate, and poor prognostic groups. We also created a control group of healthy patients of similar ages. We evaluated the NLR results in preoperative peripheral blood statistically among these groups. We found a significant difference between the control group and the patient group, and between the good and moderate/poor prognostic groups for preoperative NLR. This study created the opinion that preoperative NLR will help us predict the prognosis of patients.

Editors' note: Motor speech patterns in Huntington disease

In the article “Motor speech patterns in Huntington disease,” Drs. Diehl et al. identified 4 distinct presentations of dysarthria in patients with Huntington disease (HD) based on the evaluation of audio recordings of 48 patients by 6 trained raters. The authors postulated that these distinct presentations may be due to divergent pathologic processes. In response, Drs. Rusz and Tykalova argue that the findings of a patient subgroup characterized by an abnormally fast speaking rate was at odds with prior evidence indicating slow speech rate in HD. They note that patients with a bradykinetic phenotype have previously been shown to have a slower speaking rate than those with a choreatic phenotype, challenging the authors' explanation of fast speaking rate as being related to hypokinetic dysarthria. Besides noting the absence of a control group of healthy patients for comparison, they also contend that the remaining 3 HD dysarthric subgroups may simply reflect overall disease progression. Responding to these comments, the authors cite prior work reporting a higher rate of speech in patients with HD and argue that the studies cited by Drs. Rusz and Tykalova relied on acoustic measures that may only weakly correlate with perceptual ratings of dysarthric speech. They note that the trained raters were asked to rate speech relative to what they considered normal, and that their study identified CAG repeats and Unified HD Rating Scale motor scores as differing significantly across speech subgroups. This exchange highlights potential challenges with reconciling acoustic-based and rater-based phenotyping of speech patterns in neurologic disease. In the article “Motor speech patterns in Huntington disease,” Drs. Diehl et al. identified 4 distinct presentations of dysarthria in patients with Huntington disease (HD) based on the evaluation of audio recordings of 48 patients by 6 trained raters. The authors postulated that these distinct presentations may be due to divergent pathologic processes. In response, Drs. Rusz and Tykalova argue that the findings of a patient subgroup characterized by an abnormally fast speaking rate was at odds with prior evidence indicating slow speech rate in HD. They note that patients with a bradykinetic phenotype have previously been shown to have a slower speaking rate than those with a choreatic phenotype, challenging the authors' explanation of fast speaking rate as being related to hypokinetic dysarthria. Besides noting the absence of a control group of healthy patients for comparison, they also contend that the remaining 3 HD dysarthric subgroups may simply reflect overall disease progression. Responding to these comments, the authors cite prior work reporting a higher rate of speech in patients with HD and argue that the studies cited by Drs. Rusz and Tykalova relied on acoustic measures that may only weakly correlate with perceptual ratings of dysarthric speech. They note that the trained raters were asked to rate speech relative to what they considered normal, and that their study identified CAG repeats and Unified HD Rating Scale motor scores as differing significantly across speech subgroups. This exchange highlights potential challenges with reconciling acoustic-based and rater-based phenotyping of speech patterns in neurologic disease.

Evaluation of Drug Susceptibility of Microorganisms in Odontogenic Inflammations and Dental Surgery Procedures Performed on an Outpatient Basis.

Bacterial infections are the most common cause of purulent soft tissue inflammations in the head and neck area. These bacteria are also responsible for the majority of inflammatory complications after third molar removal. The key to success of antibacterial treatment in both cases is the use of an appropriate antibacterial agent. The aim of the study was to evaluate the susceptibility profile of bacteria isolated from material collected from patients with intraoral odontogenic abscesses. The test material consisted of swabs taken from the odontogenic abscesses, after their incision and drainage. Another swab was collected from the lesion area, 10 days after the initial visit. Results were compared with an identical study conducted on a control group of healthy patients, who had undergone third molar removal. Bacteria identified in this study consisted of aerobic and anaerobic strains, both Gram-positive and Gram-negative. According to the EUCAST guidelines, none of the tested antibiotics was recommended for all identified bacteria. The percentage of bacterial strains sensitive to amoxicillin and clavulanic acid was 78.13% and 81.48% in the study and control groups, respectively, whereas, the percentage of those sensitive to clindamycin was 96.43% and 80.00%, respectively. For Gram-negative aerobic bacteria, gentamicin and ciprofloxacin were among medications affecting all cultured species. 100.00% of strains were found to be susceptible to these antibiotics. Statistically significant relationship between the presence of Gram-negative aerobic strains and the occurrence of complications was found. In the case of the most frequently occurring bacteria in the study, amoxicillin with clavulanic acid and clindamycin were shown to be very effective. In cases of severe purulent odontogenic inflammations, it is recommended to use a combination of antibiotics. Amoxicillin with ciprofloxacin and clindamycin with cefuroxime seem to be the proper choices based on the results of this study.

Changes in Gene Expression of Selected Genes in Patients with Type 1 Diabetes and Pancreas Transplant in Peripheral Blood

BackgroundDiabetes is an autoimmunologic disease that may have a different background. The aim of our study was to show that type 1 diabetes is accompanied by changes in gene expression in peripheral blood mononuclear cells. We analyzed the genes characteristic of pancreatic islet cells and genes playing a big part in autoimmune diseases and cancer. DesignThe study included 21 patients and was performed to examine the expression of 9 genes. The patients were divided into 3 research groups: people with type 1 diabetes, people with diabetes after pancreas transplant, and a control group of healthy patients. To assess the level of expression, RNA material was obtained from peripheral blood collected from individuals qualified for the study. ResultsThe results of the study showed many interesting changes in the expression level of the analyzed genes. It was demonstrated that CASR gene expression was significantly higher in transplant patients than in diabetic patients. Differences in the level of activity are also noted in genes that take part in autoimmune diseases. ProposalProfiling gene expression in peripheral blood samples may be a useful and noninvasive diagnostic tool that allows early detection of changes leading to the onset or resumption of diabetes.

Role of the Aspergillus-Specific IgG and IgM Test in the Diagnosis and Follow-Up of Chronic Pulmonary Aspergillosis

BackgroundChronic pulmonary aspergillosis (CPA) has a high rate of misdiagnosis and has been reported to have an increasing rate of morbidity and mortality. In this article, we assessed the serum Aspergillus-specific IgG and IgM test in the diagnosis of patients with CPA.MethodsA prospective study was conducted from January 2016 to July 2017 in Nanjing Jinling Hospital. Serum samples were collected from CPA patients (178 sera, 82 patients) and from non-aspergillosis patients (125 sera) with community-acquired pneumonia (CAP), active tuberculosis, bronchiectasis or lung tumors. Additionally, we included a control group of healthy patients(50 sera). Aspergillus-specific antibody detection was performed using a Dynamiker ELISA kit, and the results were compared with the value of galactomannan (GM) in bronchoalveolar lavage fluid (BALF).ResultsThe sensitivity and specificity of the Aspergillus-specific IgG antibody in the diagnosis of CPA were 84.1 and 89.6%, respectively. These values were slightly higher compared to those obtained for the sensitivity and specificity using the BALF GM test (79.1 and 84.2%, respectively). However, the sensitivity and specificity of Aspergillus-specific IgM antibody were only 43.9 and 87.2%, respectively. Moreover, the positive rate of IgG in patients with subacute invasive aspergillosis (SAIA) was 87%, compared to the positive rates of IgG in CPA patients sick for 3–6 months (80.0%), 6–9 months (81.8%) and ≥9 months (80.0%). Meanwhile, the positive rate of IgM in SAIA patients was 63%, compared to the positive rate of IgM in CPA patients sick for 3–6 months (46.7%), 6–9 months (0%) and ≥9 months (0%), respectively. Furthermore, serum IgG levels decreased gradually in the majority of CPA patients who showed positive response to antifungal therapy, and IgG levels increased in two CPA patients when their disease worsened.ConclusionA serum Aspergillus-specific IgG test is a valuable tool for the diagnosis of CPA and SAIA, while an Aspergillus-specific IgM test is only modestly specific for the diagnosis of SAIA. Overall, the variation trend of Aspergillus-specific IgG levels may reflect the therapeutic effectiveness in the long-term follow-up of CPA.

PB2296 SURVEILLANCE BREAST SCREENING PROGRAMS FOR PATIENTS WHO UNDERWENT CHEST RADIATION THERAPY (LYMPHOMA SURVIVORS)

Background:Women who underwent chest radiation therapy (CRT) during pediatric/young‐adult age have an increased breast cancer (BC) risk. The cumulative BC incidence in women who underwent CRT is 13‐20%, higher than the incidence observed in the young female general population. BC is diagnosed on average about 15 years after CRT at about 40 years of age, compared with about 61 years in the non‐exposed female general population.Aims:From January 2018 to December 2018, a group of consecutive 46 patients (45 females, 1 male), aged between 23 and 62 (mean 44), who underwent CRT at least in the previous 8 years, underwent breast clinical, ultrasound (US) and mammographic examinations.Methods:Breast density at US was evaluated according to the BIRADS lexicon (homogeneous‐fat; homogeneous‐fibroglandular; heterogeneous) and compared with a control group of healthy patients (n = 46) with similar demographic features. Any statistical significant difference was searched by t‐student test for unpaired samples. The incidence of breast cancer in the examined series was assessed.Results:Among the examined series, 10/46 (22%) patients with homogeneous, 20/46 (43%) with fibroglandular and 16/46 (35%) with heterogeneous density were found. In the control group, 8/46 (17%) patients with homogeneous, 21/46 (46%) with fibroglandular and 17/46 (37%) with heterogeneous density were found. No significant difference occurred among the two groups of patients (p &gt; 0.05). 4/46 (3 females, 1 male) patients were affected by breast cancer (invasive ductal carcinoma, n = 3; ductal carcinoma in situ, n = 1) with a 9% incidence.Summary/Conclusion:A surveillance breast imaging protocol should be strongly recommended to patients with a previous CRT. Breast cancer incidence seems to be higher compared with general population. No significant effect on US breast density seems to exist in CRT patients. Future research should be directed at examining the underlying cancer biology and etiology of treatment induced cancers, as well as inherent and treatment‐induced genetic susceptibility of HL survivors.

Proteomic pattern of cervico-vaginal fluid (CVF) in an ovarian cancer diagnosis - pilot study.

High grade serous ovarian cancer (HGSC) is the most common type of ovarian cancer and is responsible for about 90% of ovarian cancer deaths. The diagnostic tests currently used do not increase the detection rates for ovarian cancer. There is a great necessity to develop new and non-invasive diagnostic tests for ovarian cancer (OC). Cervico-vaginal fluid (CVF) seems to be a potential and valuable source of biomarkers for genital tract diseases including ovarian cancer. The aim of our pilot study was to undertake a preliminary proteomic analysis of CVF derived from ovarian cancer patients and to compare these with results from a control group. We analysed and compared samples from a group of ovarian cancer patients and a control group of healthy patients. The study used MALDI-TOF coupled with nanoLC and ClinProTools software for MS, MS/MS spectra collection and proteomic analysis. We identified 404 different proteins in the OC group and 417 proteins in the control group. 239 of the proteins were found to be common to both study groups, 165 proteins were unique to the OC subjects, and 178 proteins were unique to the control subjects. We selected three proteins as the OC markers with the greatest potential: cysteine-rich secretory protein 3, fibronectin and Ly6/PLAUR domain-containing protein 3. The proteins we selected seem to possess great potential as markers for the screening and early detection of OC, especially in non-invasive and low-cost diagnostic tests. However, our findings require more advanced and validated proteomic analysis to confirm the suitability of the selected proteins in everyday medical diagnoses.

Sleep Apnea

Background: Sleep apnea is a condition that interrupts breathing while sleeping, usually caused by an obstruction blocking the back of the throat so that the air cannot reach the lungs. The brief cessation in breath automatically forces individuals to wake up and restart breathing. This can happen many times during the night, making it hard for the body to get enough oxygen, and impacts the sleep quality. It is the most common type of sleep disorder breathing.Objectives: The present study was designed to investigate the effects of obstructive sleep apnea (OSA) on different mental, physical and nervous disorders which are manifested in such patients. This study would not only benefit in ascertaining the causes of OSA through assessment of higher mental functions of autonomic and peripheral nervous systems but also in the development of algorithm for estimation of degree of damage to the nervous system with severity of OSA.Methods: A total of 1365 consecutive participants participated in this study at the Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana State, India for suspected sleep disordered breathing (SDB) between October 2012 and February 2016. In this cohort, 1140 participants were deemed ineligible, as per the inclusion criteria. Therefore, 225 patients were considered in the study along with 75 control subjects, who were healthy individuals. The cohort was diagnosed by an experienced pulmonologist for the symptoms of snoring and daytime somnolence. The data included documentation of age, gender, weight, height, BMI, waist and neck circumference, and clinical data such as history of apnea, insomnia, dyslipidemia, hypertension, and coronary heart disease. All participants underwent overnight polysomnography (PSG) in sleep laboratory. The cognitive function tests consisted of mini-mental state examination and by employing the depression questionnaire (Using Zung self report depression scale). The autonomic function tests were performed. Variabilities in heart rate were determined. Brain natriuretic peptide (BNP) levels in the blood were measured.Results: The study group had an AHI ≥5 per hour of sleep while the control group had AHI &lt;5 per hour of sleep. Overall, patients in the OSA cohort were older compared to those in the Control cohort. The overnight polysomnography values indicated distinct differences among the parameters of the analysis depending upon the category of the patient (i.e., mild, moderate and severe). Oxygen saturation in blood during both REM and NREM sleep stages clearly indicated lower oxygen in patient cohort than the control group. The cognitive function tests revealed that in comparison to the control group, OSA patients had significantly impaired cognition. OSA patients had significantly higher (p ≤0.05) depression. Motor action, muscle action potential and nerve action potential was significantly lower (p ≤0.05) than that of the control group of healthy patients. The plasma BNP in OSA patients was significantly higher (p ≤0.05) than control subjects. RR intervals in the patient group were significantly shorter than in the control group. The blood pressure of the OSA patients in general was relatively higher than the control group, both during the postural response and in handgrip test.Conclusions: Among the enrolled individuals, those with severe OSA were affected in all faculties, namely, cognitive abilities and health attributes; and had high BNP levels in their blood. In aggregate, OSA patients can be alleviated from the syndrome, if accurate diagnosis is made on time. This study developed an algorithm which would aid the clinicians in early detection of OSA symptoms and mitigate the prognosis of the syndrome. Journal of Gandaki Medical CollegeVolume, 09, Number 2, July December 2016, 29-37

Malformaciones congénitas en mujeres sometidas a técnicas de reproducción asistida

ObjectiveTo determine the rate of occurrence of birth defects and adverse perinatal outcomes in infertile patients undergoing assisted reproduction techniques. Material and methodWe conducted a retrospective case-control study that included patients undergoing assisted reproduction techniques (IVF, ICSI, CAI, OVODON) in 2013 and a control group of healthy patients who delivered in the same dates. Patients were drawn from the database of the Human Reproduction Unit. Morphological data were obtained from Astraia ultrasound software. The data analysed were collected from the Drago operating system. The statistical analysis was conducted with the SPSS 22.0 statistical package. ResultsThere were 619 patients, of which 38 were excluded due to lack of data. There was a significantly higher percentage of women aged 35-40 years (P<.05) in the cases group. The most frequently used technique was IVF (55.3% of single pregnancies and 16.5% of twin pregnancies). The male factor accounted for 32.9%. A total of 1.2% of controls had a PAPP-A MoM less than 0.3 and all cases showed a PAPP-A greater than 0.3 MoM (P<.05). There were no statistically significant differences between cases and controls in any of the variables studied in relation to defects identified in the morphological ultrasound. The cases group showed more frequent admission to the neonatology ward and neonatal intensive care unit and lower pH values; both these differences were statistically significant (P<.05). ConclusionAnalysis of the different assisted reproduction techniques and their relationship to foetal malformations did not show an increased risk of defects among infants conceived with assisted reproductive techniques compared with newborns resulting from spontaneous conception.

The Second to Fourth Digit Ratio in Acne Vulgaris.

Androgen hormones are thought to play a leading role in acne vulgaris (AV). The 2D:4D digit ratio refers to the ratio of the length of the second finger (index finger) to that of the fourth finger (ring finger). It is thought that the balance between fetal testosterone and fetal estrogen during the prenatal period largely determines this ratio, which does not change with age in the postnatal period. Patients with no other disease except AV and a control group of healthy patients were included in the study. Sex, age, family history, age of onset, and duration of disease in patients diagnosed with AV were recorded. The lengths of the patients' second and fourth fingers were measured using a digital caliper with a resolution of 0.01 mm. Hormone levels were also measured. When the 2D:4D ratio for the right hand and the left hand (separately) as well as the average (mean) 2D:4D ratio of both hands in male and female patients were compared with those of the control group, no statistically significant difference was observed. The right 2D:4D ratio of female patients was positively correlated with free androgen index percentage and prolactin values and negatively correlated with sex hormone-binding globulin. The left 2D:4D ratio of female patients was found to be positively correlated with disease duration and follicle-stimulating hormone values. The 2D:4D ratio was not significantly different between the group with AV and the control group independent of sex. Also, we did not observe a significant association with age of onset, severity of disease, or family history.

Impaired Coronary Flow Reserve in Patients with Indeterminate Form of Chagas’ Disease

Previous studies suggest that microvascular abnormalities may contribute to the pathogenesis of Chagas' heart disease. Coronary flow reserve (CFR) expressed by the maximum achievable flow relative to baseline flow in the coronary microcirculation, may be useful in identifying patients who may be developing cardiac manifestations of the disease. This study aims to assess the CFR in patients with indeterminate form of Chagas' disease, and also to identify the determinants of CFR. Sixty-four asymptomatic patients (37% male; age 49.9±11.5years) with normal cardiovascular exams classified as in indeterminate form of Chagas' disease underwent transthoracic dipyridamole (0.84mg/kg in 6min) stress echocardiography, and were compared with a control group of healthy patients. Coronary flow reserve was assessed on left anterior descending artery using pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. A treadmill exercise test was performed to rule out ischemia. All patients had good functional capacity assessed by exercise testing with peak oxygen consumption (VO2 ) of 28±11mL/kg per minute, similar to the controls. There were no differences in the echocardiographic parameters of diastolic and systolic left ventricular function and right ventricular function between the patients and controls. Coronary flow reserve was significantly lower in Chagas' disease patients than those in healthy individuals (1.9±0.4 vs. 2.6±0.5; P<0.001). Several factors were correlated with the CFR, including age, ejection fraction, left ventricular diastolic function, heart rate recovery, and the presence of Chagas' disease. In a multivariate analysis, age and positive serology for Chagas' disease were independent factors associated with the CFR. Coronary flow reserve was impaired in Chagas' disease patients in the indeterminate form compared with healthy individuals with similar clinical features. Among all variables tested, age and positive serology for Chagas' disease were independent factors associated with the CFR.

Deriving Clinically Useful Visual Evoked Potential Measurements from 120 Sector Multi-Focal Visual Evoked Potential Sequences (P07.259)

Objective: To characterize a high precision and clinically useful paradigm for multifocal, digitally generated, visual evoked potential responses. Background Conventional visual evoked potential techniques are performed with sophisticated, multi-focal stimulators, coupled with digital amplifiers that generate a heterogeneity of cortical responses, with wide variability when compared to the traditional black and white CRT stimulators. While contemporary stimulators represent a technical refinement capable of yielding multi-focal data, with high spatial resolution using m-sequence patterns, no paradigm has been validated to produce a physiologic signature commensurate with the p-100 metric. Design/Methods: Patients with a history of unilateral optic neuritis, along with a control group of healthy patients with no known ophthalmic or neurologic disease, were scanned using the Veris FMS3 Stimulator with a Grass Digital Amplifier. Patients were tested using a 7 minute 120 sector m-sequence multi-focal visual evoked potential test. A standard template was used for each patient. Each electrode was monitored for impedance. The Veris Scientific software was used to formulate an analysis paradigm that would yield valid and reproducible signatures reflecting visual cortical responses. Various combinations of analysis patterns were tested. Results: ROC curves were utilized to assess sensitivity and specificity of data. By dividing the central 20 degrees into three rings, and deriving a single wave form for each of the corresponding geometries, a simulated and reproducible metric was derived, the application of which was confirmed as a highly sensitive and specific discriminator for differentiating normal vs abnormal cortical responses. Conclusions: While multi-focal VEP techniques have impressive spatial resolution, and appear to have utility for confirming pathophysiologic evidence for unilateral visual system dysfunction, the results are not yet comparable to the conventional gold standard p-100 metric. Our proposed technique was effective in segregating geometric ring ratios into a single codified waveform metric, from which normative values can be established. Supported by: DADS Foundation, VIRAGH Family Foundation. Disclosure: Dr. Conger has nothing to disclose. Dr. Conger has nothing to disclose. Dr. Frohman has received personal compensation for activities with Biogen Idec and Teva Pharmaceuticals. Dr. Balcer has received personal compensation for activities with Biogen Idec, Vaccinex and Bayer as a consultant and has received honoraria from Biogen Idec and Novartis. Dr. Calabresi has received personal compensation for activities with Teva, Biogen Idec, Novartis, Genzyme, Johnson & Johnson, and Vertex. Dr. Calabresi has received research support from Biogen Idec, Teva, EMD Serono, Vertex, Genentech, Abbott, and Bayer. Dr. Beh has nothing to disclose. Dr. Greenberg has received personal compensation for activities with DioGenix, Greater Good Foundation, Biogen Idec, Serono, Inc., Sanofi-Aventis Pharmaceuticals, Inc., the Multiple Sclerosis Association of America and Teva Neuroscience as a consultant and/or speaker. Dr. Greenberg holds stock and/or stock options in Diogeix. Dr. Greenberg has received research support from Guthy-Jackson Charitable Foundation, Amplimmune, Inc. and the Accelerated Cure Project. Dr. Frohman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, Acorda Therapeutics, Novartis, Astellas, and Abbott Laboratories, Inc.

Early Diagnosis of Hepatocellular Carcinoma by Multiple microRNAs: Validity, Efficacy, and Cost-Effectiveness

Early Diagnosis of Hepatocellular Carcinoma by Multiple microRNAs: Validity, Efficacy, and Cost-Effectiveness

Hepatocyte growth factor in hepatic allograft biopsies: an immunohistochemical study

Hepatocyte growth factor (HGF) is a multipotent growth factor that is a powerful stimulator of DNA synthesis in a variety of cell types, especially hepatocytes. This factor is produced by nonparenchymal cells in the liver, presumably Kupffer cells, Ito cells, and sinusoidal endothelial cells. Research has shown that HGF is involved in tissue regeneration, wound healing, normal tissue growth, tumor progression, embryogenesis, and tumor invasion. Elevated serum levels of HGF have been documented in patients with acute renal failure and in renal transplant recipients; however, the importance of HGF in liver transplantation is unknown. The aim of this study was to determine whether induction of HGF expression is associated with acute rejection in liver transplants. We assessed the presence and density of HGF in hepatic allograft biopsy specimens compared with those from a control group of healthy patients.