non-MS Group Research Articles

Follicular fluid cytokine composition and oocyte quality of polycystic ovary syndrome patients with metabolic syndrome undergoing in vitro fertilization

PurposeTo provide insights into the correlation among lipid metabolism, cytokine profiles in the follicular fluid (FF) and embryo quality of women with Polycystic Ovary Syndrome (PCOS) with metabolic syndrome (MS). MethodsNinety women undergoing in vitro fertilization (IVF) treatment were recruited, including 60 PCOS patients (PCOS non MS and PCOS MS) and 30 age-matched controls. Individual FF samples were analyzed using the cytometric multiplex immunoassay. ResultsIn the FF, the PCOS MS group was associated with higher, total cholesterol (TC), triglyceride (TG) and lower high-density lipoprotein (HDL) concentrations compared with that in the control group (P<0.05). The FF tumor necrosis factor-α (TNF-α) level in the PCOS MS group was 3.89±1.18ng/mL, which was significantly higher compared with the control (2.94±1.02ng/mL) and PCOS non-MS groups (3.05±1.21ng/mL) (P=0.002), while the granulocyte colony-stimulating factor (G-CSF) level in the PCOS MS group (4.18±1.33ng/mL) was lower compared with the control (5.61±1.82ng/mL) and PCOS non-MS groups (5.32±1.91ng/mL) (P=0.004). The FF G-CSF showed a trend toward negative relationship with TG and TC; TNF-α concentration was positively associated with TG. The percentage of top-quality embryo decreased in the PCOS MS group than in the other two groups (20% vs. 38.4% and 34.6%). ConclusionsIn conclusion, there was an elevated lipolysis condition within the FF of PCOS MS patients and the TNF-α and G-CSF levels in FF were associated with top-quality embryo percentage. TNF-α and G-CSF may be the key cytokines involved in the mechanism of decreased embryo development potential in PCOS MS patients.

Observational study of metabolic syndrome among renal transplant recipients in Kasr Al-Aini School of Medicine: a single-center study

IntroductionThe metabolic syndrome (MS) is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. Recent studies suggest that MS is common after kidney transplantation, also possibly being predictive of allograft loss and poor allograft function.ObjectivesWe studied the prevalence of MS in Egyptian kidney transplant recipients (from Kasr Al-Aini School of Medicine) and its correlation with C-reactive protein (CRP), serum uric acid (UA), alkaline phosphatase (ALP), different immunosuppressive intakes, and hepatitis C virus (HCV) in these patients.Patients and methodsThe present cross-sectional study was conducted in 2012 on 100 renal transplant recipients, 68 male (68%) and 32 female (32%), with stable kidney function (serum creatinine=1.5±1 mg/dl) in King Fahd Unit, Cairo University. All clinical and laboratory data were recorded, including serum creatinine, UA, cholesterol, triglyceride (TGL), low-density lipoprotein, high-density lipoprotein (HDL), ALP, CRP, and HCV Abs. The presence of MS was determined using NCEP-ATP III criteria, with BMI used in place of waist circumference.ResultsPatients were divided into two groups – MS (group 1): 26 patients, 12 female (46.2%) and 14 male (53.8%), with a mean age of 34.46±9.69 years; and non-MS (group 2): 74 patients, 20 female (27%) and 54 male (73%), with a mean age of 27±8.33 years. There was a highly significant correlation (P≤0.001) between CRP and MS, BMI and diabetes mellitus, whereas the correlation between CRP and hypertension, ALP, HCV Abs, alanine aminotransferase (ALT), TGLs level, and HDL was insignificant.ConclusionMetabolic syndrome is prevalent in post-renal transplant patients. Serum CRP concentration correlates positively with metabolic syndrome in kidney transplantation patients. The age, weight, BMI, systolic and diastolic BP, serum triglycerides, ALT of MS group were significantly higher than in non-MS group. The duration of hypertension in the MS cases was significantly longer than in non-MS cases.

Prevalence of the metabolic syndrome in kidney transplant recipients: A single-center study.

Metabolic syndrome (MS) is characterized by a combination of cardiovascular (CV) risk factors (hypertension, dyslipidemia, obesity, and alterations in glucose homeostasis). Insulin resistance is suggested to be the common pathogenic background. This syndrome is also a risk factor for diabetes and chronic kidney disease. In renal transplant recipients, MS has been shown to be an independent risk factor for chronic allograft dysfunction, graft failure, new-onset diabetes, and CV disease. We performed a cross-sectional study on 106 stable renal transplant recipients to detect MS between January 2013 and August 2013. This syndrome was diagnosed according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. Patients with history of diabetes mellitus were excluded from the study. In this group of patients, 56 (52.8%) had MS. There were 32 males (57.1%) and 24 females (42.9%). The mean age of the MS group was significantly higher than the non-MS group. The mean serum creatinine was higher in the MS group than the non-MS group, but there was no significant difference between them (P >0.05). The calculated glomerular filtration rate was also similar in the two groups (P >0.05). The patients with MS had higher body weight (64.61 ± 14.17 kg vs. 58.76 ± 11.70 kg, P <0.05) and also higher body mass index (BMI) (P <0.05). The prevalence of BMI >25 kg/m2 in the MS group was 75% versus 25% in the non-MS group (P <0.05). Since MS is an important and common risk factor in renal transplant recipients, we have to try to prevent it by educating the patients to control it by modifying their lifestyle. Efforts toward promoting healthy diets, physical activity, and blood pressure control must be undertaken.

The study of the correlation between serum uric acid and insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric, clinical and biochemical parameters and fasting serum C-peptide were measured and retrospectively studied.All patients were divided into groups based on the levels of uric acid and on metabolic syndrome diagnosis or not. Results Among a total of 728 patients, the proportion of hyperuricemia was 26.9%(196 /728), and metabolic syndrome(MS)was 64.6%.The levels of body mass index(BMI), waist circumference(WC), systolic pressure(SBP), diastolic pressure(DBP), triglyceride(TG), fasting C-peptide, HOMA(C-Peptide)were significantly higher in hyperuricemia group than in normal uric acid group, while the level of HDL was lower in hyperuricemia group than in normal uric acid group.The proportion of MS was statistically higher in hyperuricemia group(81.6%)than in normal uric acid group(58.3%, P<0.05). Groups Ⅰ, Ⅱ, Ⅲ, Ⅳ-the four quartiles of serum uric acid from low-to high-level were correlated with MS component number of 2.1±1.0, 3.1±1.1, 3.3±1.2, 3.7±0.8, separately, and with HOMA(CP)of 3.7±0.8, 3.7±0.8, 4.0±0.6, 4.1±0.9, separately(all P<0.05). When all patients were divided into groups based on with or without MS, the level of uric acid in MS group was(377.3±43.5)μmol/L, and the proportion of hyperuricemia was 34.0%(160/470), and HOMA(CP)was 3.90±0.72, all were significantly higher than those of non-MS group[(318.2±47.9)μmol/L, 14.0%(36/258), 3.64±0.67]. The levels of serum uric acid in groups with 1-5 components of MS were(285.0±62.8)μmol/L, (335.7±62.7)μmol/L, (367.1±45.0)μmol/L, (377.9±40.2)μmol/L, (389.8±46.6)μmol/L, and HOMA(CP)was 3.6±0.6, 3.7±0.7, 3.9±0.8, 3.9±0.7, 4.3±0.7 separately(P<0.05). Serum uric acid was positively correlated with age, WC, BMI, TG, SBP, fasting C-peptide, and HOMA(CP), while negatively correlated with glycosylated hemoglobin(HbA1C), high density lipoprotein cholesterol(HDL-C). Binary logistic regression showed that the OR value of MS was 1.033 with the increase of serum uric acid, and 95%CI: 1.026-1.041, P<0.05. Conclusions Serum uric acid is correlated with insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes.Hyperuricemia might be a new risk factor for MS. Key words: Diabetes, type 2; Hyperuricemia; Metabolic syndrome X

Application of body composition analysis in patients with obese polycystic ovary syndrome and metabolic syndrome

Objective To explore the prevalence andrelevant factors of metabolic syndrome (MS) in obese patients with polycystic ovary syndrome (PCOS), and the relationship with the body composition measured by bioelectrical impedance analysis (BIA). Methods A retrospective analysis was conducted with the questionnaire responses, blood biochemical examination, and body composition analysis results in 90 obese PCOS patients who accepted weight management in Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, from April 2013 to July 2015. We calculated homeostatic model assessment insulin resistance index (HOMA-IR), visceral fat index (VAI) and lipid accumulation index (LAP); identified patients with MS using the International Diabetes Federation consensus definition issued in 2005. Measurement data were compared using t-test; categorical data were compared using chi-square test; relevant factors of MS wereidentified using Logistic regression analysis. Results The mean body mass index (BMI) of the obese PCOS patients was (32.89 ±3.39)kg/m2; the MS prevalence was 64.44% (58/90). The MS group had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), fasting insulin level, HOMA-IR, LAP and VAI compared to the non-MS group (all P< 0.05); lower high density lipoprotein cholesterol (HDL-C)than in the non-MS group (P<0.05); higher lean body mass index (LBMI)than in the non-MS group [(18.83 ± 1.73)kg/m2vs. (17.96 ± 1.33)kg/m2,t=2.46, P=0.02]. The other body composition indexes showed no statistically significant differences between the two groups. Multivariate Logistic regression analysis found that MS was positively correlated with SBP (OR=1.20, 95% CI=1.08-1.33)and VAI (OR=3.12, 95% CI=3.12-7.25), but not with any body composition index. Conclusions Over half of obese PCOS patients have MS, and those with MS present with more severe dyslipidemia, insulin resistance (IR) and higher levels of VAI, LAP and LBMI. The presence of MS in obese PCOS patients may be positively correlated with SBP and VAI, but not with the body composition measured by BIA. Obese PCOS patients need to strictly control their weight. BIA method may not be applicable for PCOS patients with BMI≥34 kg/m2. Key words: Obesity; Polycystic ovary syndrome; Metabolic syndrome; Bioelectrical impedance analysis; Body composition

Correlation between metabolic syndrome and uric acid stone composition

Objective To study the relationship between metabolic syndromes and uric acid calculi. Methods We retrospectively analyzed medical records of 640 adult patients, who were diagnosed as renal calculi and finished the stone composition analysis. Among them, 394 cases were male and 246 were female. The average age was (50.9±12.8)years old. According to the diagnostic criteria of the MS, the patients were divided as metabolic syndrome group (metabolic syndrome group /MS group and non-metabolic syndrome group (non MS group); the MS group had a total of 238 cases including 151 males and 87 females. The average age was (54.1±11.0)years old. There were 402 cases in non MS group, including 243 males and 159 females, with an average age of (49.1±13.4)years old. We obtained corresponding metabolic indices. By comparing the differences between each group, the statistic were analyzed with SPSS. Results In the MS group, 42 cases was diagnosed with uric acid stones, and the non-MS group with 8 cases diagnose with uric acid stones. The MS included obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides. In the patients obtained, 123 had the 4 kinds of metabolic diseases at a time, and 23(18.7%) cases were diagnosed as uric acid stones. 115 patients had the 3 kinds of metabolic diseases in which 19(16.5%) cases were uric acid stones. 190 patients had 2 kinds of metabolic diseases and 5(2.6%) cases were uric acid stones. 137 patients had only one kinds of metabolic disease in which 3 were uric acid stones. The multivariate Logistic regression analysis showed that, after the correction of gender and age, obesity patients own the OR as 1.10(0.98-1.24)(P=0.018), high blood sugar had the OR as 1.72(1.19-1.92)(P=0.006), high glycerin three fat had the OR as 0.71(0.48-1.09)(P=0.032) and high HDL-C was 0.15(0.03-0.65)(P=0.01). Conclusions The metabolic syndromes including obesity, hyperglycemia and dyslipidemia obviously might influenced the formation of uric acid calculi. Key words: Metabolic syndrome; Uric acid calculi; Renal stones

Metabolic syndrome and psoriasis severity in South-East Asian patients: An investigation of potential association using current and chronological assessments.

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re-evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non-MS group. Similar to the previous study, no significant differences were identified between metabolic and non-metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P=0.018) and interventions (P=0.028) were significantly higher in metabolic patients than in non-metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P=0.012), pustular or erythrodermic psoriasis episodes (P=0.049), and interventions (P=0.005). Body mass index of 23kg/m2 or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.

Association of metabolic syndrome with serum fibroblast growth factor 21 in kidney transplanted patients.

Introduction: Fibroblast growth factor 21 (FGF21) is a metabolic regulator with multiple beneficial effects on glucose and lipid homeostasis and insulin sensitivity. Objectives: The aim of this study was to investigate the relation between the serum level of FGF21 with and metabolic syndrome (MS) in kidney transplant recipients. Patients and Methods: We performed a cross-sectional study on 86 stable renal transplant recipients to detect possible relation between serum FGF21 level and MS during October 2014 and Mach 2015. Patients with past history of diabetes mellitus were excluded. Results: There were 43 patients in each group with and without MS. Totally, they were 52 (60.5%) male and 34 (39.5%) female. The mean age of the MS group was significantly higher than that of non-MS group. There was not significant difference between mean serum creatinine level and glomerular filtration rate (GFR) between two groups (P > 0.05). The MS patients had higher weight and body mass index (BMI) (P < 0.05). The prevalence of BMI >25 kg/m2 in MS group was 25 (58.8%) versus non-MS group that only 10 (23.3%) had this condition (P < 0.05). The mean of FGF21 level in MS and non-MS groups was 1.23 ± 0.67 ng/l and 1.18 ± 0.71 ng/l, respectively (P > 0.05). There was not significant difference of serum FGF21 level between MS and non-MS patients (P > 0.05). Conclusion: While the elevated serum FGF21 level was found in subjects with insulin resistant states, however, this study revealed that serum FGF21 levels were not significantly increased in renal transplanted recipients with MS as compared with non-MS group.

Vitamin D receptor biochemical and genetic profiling and HLA-class II genotyping among Lebanese with multiple sclerosis — A pilot study

BackgroundMultiple sclerosis (MS) is an autoimmune demyelinating disease affecting mostly young adult females with multifactorial etiology. Recent studies suggested that adequate vitamin D levels may lower the risk of developing MS. ObjectivesOur aim was to explore the relationship between vitamin D receptor (VDR) polymorphism, HLA-DR locus genotype, and serum vitamins D and A levels in the Lebanese population. MethodsFifty MS patients were recruited for this study. The control group consisted of 48 healthy and 51 patients with other neurological disorders (non-MS). Biochemical analysis included serum 25 hydroxyvitamin D (25OHD) and vitamin A. Molecular analysis targeted VDR genotypes (ApaI, TaqI and BsmI) and low resolution HLA typing for DRB1 locus. ResultsHealthy and non-MS groups had comparable parameters and were combined into one control group. No significant differences were found between MS and control groups for VDR genotypes. The frequency of HLA-DRB1*15 was significantly higher in MS patients (22%) compared to controls (8%) (p=0.018). Odds ratio for MS in the presence of DRB1*15 allele was 3.21 (p=0.018). Cosegregation with A (ApaI) and b (BsmI) alleles did not influence the risk for MS. 25OHD levels were significantly higher in MS patients compared to controls (p=0.002), due to more frequent oral supplementation (p=0.005). Vitamin A levels were comparable between the two groups. When all parameters were included in a logistic regression model adjusted for supplementation, only HLA-DRB1*15 (OR=3.42; p=0.027) contributed significantly to MS risk. ConclusionThere was no association between serum vitamin D or A or VDR genotypes and MS. HLA-DRB1*15 was the major factor imposing more than 3 folds greater risk for developing MS among Lebanese.

V1/V2 Neutralizing Epitope is Conserved in Divergent Non-M Groups of HIV-1.

Highly potent broadly neutralizing monoclonal antibodies (bNAbs) have been obtained from individuals infected by HIV-1 group M variants. We analyzed the cross-group neutralization potency of these bNAbs toward non-M primary isolates (PI). The sensitivity to neutralization was analyzed in a neutralization assay using TZM-bl cells. Twenty-three bNAbs were used, including reagents targeting the CD4-binding site, the N160 glycan-V1/V2 site, the N332 glycan-V3 site, the membrane proximal external region of gp41, and complex epitopes spanning both env subunits. Two bispecific antibodies that combine the inhibitory activity of an anti-CD4 with that of PG9 or PG16 bNAbs were included in the study (PG9-iMab and PG16-iMab). Cross-group neutralization was observed only with the bNAbs targeting the N160 glycan-V1/V2 site. Four group O PIs, 1 group N PI, and the group P PI were neutralized by PG9 and/or PG16 or PGT145 at low concentrations (0.04-9.39 μg/mL). None of the non-M PIs was neutralized by the bNAbs targeting other regions at the highest concentration tested, except 10E8 that neutralized weakly 2 group N PIs and 35O22 that neutralized 1 group O PI. The bispecific bNAbs neutralized very efficiently all the non-M PIs with IC50 below 1 μg/mL, except 2 group O strains. The N160 glycan-V1/V2 site is the most conserved neutralizing site within the 4 groups of HIV-1. This makes it an interesting target for the development of HIV vaccine immunogens. The corresponding bNAbs may be useful for immunotherapeutic strategies in patients infected by non-M variants.

Reliability and Validity of Ratings of Perceived Exertion in Persons With Multiple Sclerosis

ObjectiveTo test the reliability and validity of using the Borg rating of perceived exertion (RPE) scale (ratings 6–20) in persons with multiple sclerosis (PwMS). DesignNonrandomized repeated measures. SettingResearch laboratory. ParticipantsVolunteer sample (N=27) comprised of 16 PwMS (10 women) and 11 age-matched persons without multiple sclerosis (MS) (6 women). Clinical measures included symptomatic fatigue, depression, and MS functional capacity. InterventionsA submaximal cycling test was performed to estimate maximal capacity. Participants then pedaled for 2 minutes at 50% and 60% of predicted maximal oxygen consumption per unit time (V˙o2), and physiological measures and RPE were obtained (week 1: response protocol). One week later, participants replicated the prescribed V˙o2 using the RPE range from week 1 (week 2: reproduction protocol). V˙o2, heart rate, and respiratory quotient were measured continuously; RPE and workload were measured every minute; and blood lactate and mean arterial pressure were measured after exercise. Main Outcome MeasuresRPE, workload, V˙o2, and heart rate from week 1 to week 2. ResultsPwMS had greater fatigue (P<.01) and disability (P<.001). Baseline measures were similar between groups and weeks. During exercise, RPE, workload, V˙o2, and heart rate were similar between groups. Both groups had an intraclass correlation coefficient >.86 for RPE, workload, and V˙o2. The intraclass correlation coefficient was comparatively lower for heart rate for both groups (MS group: .72, non-MS group: .83). RPE was highly correlated with V˙o2 (r=.691, P<.001) and workload (r=.700, P<.001) for the MS group. ConclusionsResults suggest that RPE can be reliably reproduced, is valid, and may be used in exercise prescription in mildly to moderately impaired PwMS during cycling exercise.

Evaluation oF Epicardial Fat and Carotid Intima-Media Thickness in Obese Children.

Background:Epicardial fat has a role in cardiovascular diseases.Objectives:To assess epicardial fat and its relation with carotid intima-media thickness (IMT) in obese adolescents with metabolic syndrome (MetS).Patients and Methods:The study included 60 obese adolescents and 25 control subjects. According to the presence or absence of MetS, obese subjects were divided into two subgroups. We measured weight, height, calculated Body Mass Index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure and biochemical parameters (fasting glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol, High sensitivity C-reactive protein, fasting insulin, a homeostasis model assessment index of insulin resistance. plus an echocardiographic examination with measurement of epicardial adipose tissue thickness (EATT).Results:Left ventricular mass index measurements were significantly higher in MetS group than both non-MS and control groups. The MetS and non-MetS obese patients had significantly higher carotid IMT in comparison to the control group. Carotid IMT measurements were significantly higher in MetS group had than both non-MetS and control groups. Also, EATT was significantly increased in patients with MetS compared to control group. Among MetS obese group, EATT was positively correlated with body mass index-standard deviation score, waist circumference, fasting glucose, fasting insulin, insulin resistance, triglyceride levels, left ventricular thickness, left ventricular mass index and myocardial performance index. EATT was found to be the only predictor of carotid IMT.Conclusions:EATT is closely related to carotid IMT and early cardiac dysfunction in obese adolescents with MetS.

Brain activation patterns and cognitive processing speed in patients with pediatric-onset multiple sclerosis

ABSTRACTObjective: This study aimed to determine the extent and pattern of brain activation elicited by a functional magnetic resonance imaging version of the Symbol Digit Modalities Test (fMRI–SDMT), a task of information processing speed, in pediatric-onset multiple sclerosis (MS) patients as compared to sex- and age-matched non-MS self-reported healthy individuals. Method: Participants included 20 right-handed individuals aged 13–24 years with pediatric-onset MS (mean age = 19 years, 15 female) and 16 non-MS self-reported healthy individuals. All participants underwent a 3.0-tesla MRI scan with structural (T1; T2; proton density, PD; fluid-attenuated inversion recovery, FLAIR) and fMRI–SDMT acquisition. Participants were instructed to indicate with a button press whether a single pairing of a symbol to a number matched any of those shown in a key that displays nine possible pairings. Results: Response time (p = .909) and accuracy (p = .832) on the fMRI–SDMT did not differ between groups. However, the MS group demonstrated lower overall activation than the non-MS group in the right middle frontal gyrus (p = .003). Within the MS group, faster response time was associated with greater activation of the right inferior occipital, anterior cingulate, right superior parietal, thalamus, and left superior occipital cortices (all p < .05). A significant interaction effect was demonstrated, indicating that faster response time was associated with greater activation of the left superior occipital region in the pediatric MS group than in the non-MS group (p = .002). Conclusions: Attenuated activation of frontal regions was observed in this cohort of pediatric-onset MS patients when performing the fMRI–SDMT, even in the absence of behaviorally detectable deficits. Within the MS group only, faster response time elicited greater activation, suggesting this to be an adaptive mechanism that may contribute to limiting the impact of disease-related structural pathology.

Is Metabolic Syndrome Associated with Obstructive Sleep Apnea in Obese Adolescents?

To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents. In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI). Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2-2.4) and total AHI was 0.9 (0.2-2.5) in the MS group; these values were 0.9 (0.25-3.55) and 0.9 (0.3-3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05). In our study, we did not find an association between MS and sleep apnea in obese adolescents.

Abstract 13951: Right Anterior Oblique in Addition to Left Anterior Oblique Projections Are Useful to Implant Right Ventricular Pacemaker Lead Into Mid-Septum and Achieve More Physiological Pacing

Introduction: It has been reported that it is difficult to implant right ventricular (RV) leads to the true mid-septum using conventional fluoroscopic criteria. Thus, we investigated which is the best method to achieve the true RV mid-septum using 3 dimensions (3D) reconstruction of 64-slice multidetector computed tomography (64 MDCT). Methods and Results: We retrospectively analyzed 33 patients in whom we intended to place RV lead into the septum using conventional fluoroscopic criteria, 40 degree left anterior oblique (LAO40), and performed 64 MDCT later. 3D reconstruction of 64 MDCT revealed that the right ventricular lead was anchored on the true mid-septum in 10 patients (only 30%; MS group, n=10), anterior wall in 19 patients, and free wall in 4 patients (non-MS group, n=23). After implantation of the pacemaker, we evaluated the predictive value of MS group when we used electrocardiography criteria (q wave or negative QRS complex in lead I), 90 degree left lateral (LL90) view and 30 degree right anterior oblique (RAO30) view using 3D reconstruction of 64 MDCT in addition to LAO view. As shown in a table, the method using both LAO and RAO views was the best to achieve the true RV mid-septum among these methods. MS group had significantly shorter paced QRS duration and ΔQRS (paced QRS-own QRS) than non-MS group (139±21.9ms vs. 155.3±10.9ms, p=0.03 and 24.2±21.2ms vs. 55.5±9.1ms, p=0.0001). Conclusions: The true mid-septum RV pacing could achieve more physiological pacing. Not only confirming rightward orientation in LAO view but also aiming the middle of the cardiac silhouette in the RAO view may be a simple and accurate way to achieve the true RV mid-septum positioning.

Resistant Strains of Enterotoxigenic Staphylococcus aureus; Unknown Risk for Multiple Sclerosis Exacerbation.

Background:Despite all advances in neurological sciences, there are unknown aspects in the epidemiology of multiple sclerosis (MS). Based on this hypothesis, the enterotoxigenic strains of Staphylococcus aureus (S. aureus) are possible risk factors for exacerbations of MS.Objectives:The present study was carried out to investigate the role of resistant strains of enterotoxigenic S. aureus in MS exacerbation.Materials and Methods:Two-hundred nasal swab samples were collected from non-MS (n = 80), MS stable (n = 60) and MS exacerbation (n = 60) groups. Samples were cultured and those that were S. aureus-positive were analyzed for the presence of enterotoxins, using polymerase chain reaction (PCR). Antimicrobial susceptibility was performed using disk diffusion method.Results:Ninety out of 200 nasal samples (45%) were positive for S. aureus. The highest levels of nasal colonization were seen in MS exacerbation group (68.33%). The most commonly detected enterotoxins were sea (30%), sec (15.55%) and seb (11.11%). There were significant differences between S. aureus colonization and type of samples (P = 0.026) and, also, between type of samples and prevalence of enterotoxins (P = 0.022). The highest levels of enterotoxigenic genes were seen in MS exacerbation group. The S. aureus strains had the highest levels of resistance against tetracycline (80%), ampicillin (72.22%), methicillin (66.66%), erythromycin (66.66%), oxacillin (63.33%), trimethoprim-sulfamethoxazole (61.11%) and cotrimoxazole (55.55%).Conclusions:Our findings should raise awareness about the role of sea and sec enterotoxins, in resistant strains of S. aureus, as a risk factor for MS exacerbation. It is better to keep MS patients away from polluted environments of hospitals and health centers.

Comparison of the bioMérieux NucliSENS EasyQ HIV-1 v2.0–HIV-1 RNA quantification assay versus Abbott RealTime HIV-1 and Roche Cobas TaqMan HIV-1 v2.0 on current epidemic HIV-1 variants

BackgroundAn improved version of the bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 has been introduced to overcome the underquantification observed with previous versions, especially with non-B HIV-1 subtypes. ObjectivesComparing bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 versus Roche Cobas CA/CTM v2.0 and Abbott RealTime HIV-1 assays for HIV-1 group M and non-M (N, O, P) viral load measurement. Study designThe three assays were tested in parallel on 103HIV-1 group M plasma samples, and on non-group M HIV-1 culture supernatants. ResultsValues obtained for the 103HIV-1 group M plasma samples tested with bioMérieux assay showed good overall correlation compared to the 2 others. The Roche Cobas assay gave higher values than the bioMérieux assay, while Abbott and bioMérieux both displayed similar results. However, analysis showed a wider dispersion in results when comparing the bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 and the other 2 techniques. All data taken into account, we observed frequent discrepancies in quantification, of the plasma samples and major differences above 1log in 10/72 (13.8%). The quantification of non-M HIV groups in culture supernatant has shown variable results, with better quantification of HIV-O and of HIV-N respectively with the Abbott assay and the bioMérieux assay. ConclusionsThe bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 showed improved sensitivity to non-B HIV-M subtypes compared to previous versions. Notwithstanding, we observed frequent discrepancies and a wide dispersion in results when comparing bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 and the other 2 techniques.

The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis.

Trigeminal neuralgia (TN) is more common in multiple sclerosis (MS) patients than in the general population and among the former has an incidence of approximately 2%. The pathophysiology of TN in MS patients is believed to be caused by a demyelinating plaque at the root entry zone, and therefore procedures that cause direct nerve damage are thought to be the most effective surgical modality. The authors aimed to compare the efficacy of percutaneous balloon compression (PBC) in TN patients with and without MS. Retrospectively collected clinical data on 80 consecutive patients who underwent 144 procedures and who received PBC for TN treatment between January 2000 and January 2010 were analyzed. The cohort included 17 MS and 63 non-MS patients. The mean age at first operation was significantly younger in the MS group compared with the non-MS group (59 years vs 72 years, respectively, p < 0.0001). After a mean follow-up of 43 months (MS group) and 25 months (non-MS group), the symptom recurrence rate following the first operation was higher in the MS group compared with that in the non-MS group (86% vs 47%, respectively, p < 0.01). During long-term follow-up, more than 70% of MS patients required multiple procedures compared with only 44% of non-MS patients. Excellent or satisfactory outcomes were not significantly different between the MS and non-MS cohorts, respectively, at 1 day postoperatively (82% vs 91%, p = 0.35), 3 months postoperatively (65% vs 81%, p = 0.16), and at last follow-up (65% vs 76%, p = 0.34). A similar incidence of postoperative complications was observed in the 2 groups. PBC is effective in the treatment of trigeminal neuralgia in patients with MS, but, compared with that in non-MS patients, symptom recurrence is higher and requires multiple procedures.

PP.29.03

Objective: Data on prevalence of metabolic syndrome (MS) in rural regions are still inconclusive and several reports showed it to be higher in urban than in rural areas. The aim of this study was to determine the prevalence of MS in a rural, continental Croatian part comparing 3 most widely used definitions of MS (NCEP-ATPIII; IDF and WHO). Design and method: We enrolled 1118 (713 female, 405 male) participants from 12 continental, villages. NCEP-ATPIII, IDF and WHO definition were used. Blood pressure was measured according to the ESH/ESC guidelines. Results: In the whole group the prevalence of MS was highest using the IDF definition (IDF vs. NCEP ATPIII vs. WHO (48.6% vs. 44.1% vs. 20.1%, p < 0.03, respectively). Women had more frequently MS (NCEP-ATPIII vs. IDF vs. WHO = 47.4% vs. 57.8% vs. 21.6%;) than men (NCEP-ATPIII vs. IDF vs. WHO = 37.5,4% vs. 51.8% vs. 17.9%) regardless which definition was used (all p < 0.05). We failed to find significant differences between MS and non-MS groups in age. In the whole MS group pathologic waist circumference was present in 81% of examines i.e. visceral obesity was the most prominent finding. Women had pathological waist circumference and men hyperglycaemia and as the most prominent component of MS. Importantly, examinees that did not fulfil criteria for MS also frequently had risk factors: hypertension (37%), viscearal obesity (28%), low HDL cholesterol (6.3%), hyperglycemia (8.1%) and hyperthriglicerydemia (37.3%). Salt intake was very high in the whole group (10.6 gram) without differences between MS and non-MS groups pointing on poor lifestyle habits and inappropriate diet. Conclusions: The prevalence of metabolic syndrome in Croatian continental rural population is high according to NCEP-ATPIII and IDF definition. WHO definition is obsolete. Visceral obesity is the main component of MS. Even farmers without MS frequently have risk factors due to bad lifestyle and diet indicating that this population need to be educated.

High prevalence of metabolic syndrome in a mestizo group of adult patients with primary hyperparathyroidism (PHPT).

BackgroundPrimary hyperparathyroidism (PHPT) and metabolic syndrome (MS) have been independently related to cardiovascular morbidities, however this association is still controversial. Mexican population has a high prevalence of metabolic syndrome, however its frequency seems to be even higher than expected in patients with PHPT.MethodsWe retrospectively reviewed the charts of patients that underwent parathyroidectomy for PHPT in a referral center and used the criteria from the National Cholesterol Educational Program (NCEP)/Adult Treatment Panel III (ATP III) to define MS before surgery. We compared the characteristics between the patients with and without MS.Results60 patients were analyzed, 77% were female and 72% had a single parathyroid adenoma. MS was present in 59% of the patients, this group was significantly older (57 vs. 48 years, p = 0.01) and they had lower iPTH (115 vs. 161 ng/ml, p = 0.017). Other parameters did not show differences.ConclusionsMS is frequent in our population diagnosed with primary hyperparathyroidism, adverse cardiovascular parameters are common and significant differences in calcium metabolism compared to the non-MS group are present.