Normal Physical Examination Results Research Articles

Focused assessment with sonography in trauma: experience of Al Jalla Hospital, Benghazi, Libya

Background: Focused assessment with sonography in trauma (FAST) is a commonly used tool in the diagnosis of trauma. The objective of this study is to compare the positive predictive value (PPV) and negative predictive value (NPV) of (FAST) and abdominal-pelvic computed tomography scans (CTAP) in cases of blunt abdominal injury, as well as to assess the need for abdominal surgery. The aims to investigate if any false negative ultrasound studies were associated with significant morbidity. The findings are also compared with previous studies. Methods: The data collected from the registry records of Al Jalla hospital over a two-year period from January 1, 2022, to December 31, 2023. Data on sonographic findings, computed tomography findings, and patient outcomes were collected. Diagnostic characteristics, including predictive values, were calculated. Results: A total of 220 patients were included.190 patients underwent FAST, with 25 (13%) showing positive results. Among 90 patients who underwent CTAP, 18 (20%) showed abnormalities, and 10 (5.3%) patients required surgery. When comparing FAST to CTAP in detecting abnormalities, the PPV and NPV were 0.625 and 0.857, respectively. When comparing FAST to the need for surgery, the PPV and NPV were 0.217 and 0.977, respectively. 4 patients (0.98%) had negative FAST results but still required surgery. No significant adverse outcomes or surgical interventions were observed in patients with normal vital signs, normal initial physical examination, and negative FAST findings who did not undergo CTAP. Conclusions: In patients with an initially normal physical examination and negative FAST results, emergent CTAP may be avoided.

Correlation between preoperative platelet parameters and clinicopathological features of differentiated thyroid cancer

Objective:To investigate the correlation between preoperative platelet parameters and the clinicopathological features of differentiated thyroid cancer. Methods:We retrospectively analyzed the medical records of patients with thyroid tumors admitted to Zhongda Hospital affiliated to Southeast University and healthy adults with normal physical examination results in our hospital from January 2019 to December 2020, and collected their general information and preoperative blood routine data. Patients with undifferentiated thyroid cancer, diabetes, coronary heart disease, hematological diseases, kidney diseases, autoimmune diseases, genetic diseases, infectious diseases, other systemic tumors, hepatitis or cirrhosis, or those taking anticoagulants were excluded. The exclusion criteria for healthy adults were the absence of the above diseases and normal physical examination results. Differences in platelet parameters among the three groups were compared, and the correlation between clinicopathological characteristics of thyroid cancer, accompanying cervical lymph node metastasis, and platelet parameters of patients was analyzed. A multivariate logistic regression model was used to analyze the risk factors of thyroid cancer with cervical lymph node metastasis. Results:A total of 117 cases of differentiated thyroid cancer were collected, including 33 males and 84 females, with an average age of （41.64±12.25） years; 46 patients had benign thyroid tumors, including 15 males and 31 females, with an average age of （41.35±12.52） years; 50 healthy adults with normal physical examination results in our hospital during the same period were also included, including 18 males and 32 females, with an average age of（42.02±9.62） years, without underlying diseases. The platelet count of the differentiated thyroid cancer group was higher than that of the benign thyroid tumor group（t=-2.219, P=0.028） and the normal control group（t=2.069, P=0.04）, while the platelet distribution width of the differentiated thyroid cancer group was lower than that of the benign thyroid tumor group（t=2.238, P=0.027） and the normal control group（t=-2.618, P=0.002）. These differences were statistically significant. Preoperative age ≤45 years（χ²=4.225, P=0.04）, tumor diameter>1 cm（χ²=4.415, P=0.036）, PLT（t=-4.018, P<0.01） increase, and PDW（t=4.568, P<0.01） decrease were significantly correlated with cervical lymph node metastasis of thyroid cancer and had statistical significance. Univariate analysis showed that age ≤45 years（OR=0.447, 95%CI 0.206-0.970, P=0.042）, tumor diameter>1 cm（OR=2.3, 95%CI 1.050-5.039, P=0.037）, PLT（OR=1.012, 95%CI 1.005-1.019, P=0.001）, and PDW（OR=0.693, 95%CI 0.518-0.827, P<0.01） were risk factors for cervical lymph node metastasis of thyroid cancer. The results of multifactorial logistic regression analysis showed that PLT（OR=1.008, 95%CI 1.001-1.016, P=0.026） and PDW（OR=0.692, 95%CI 0.564-0.848, P<0.01） were independent risk factors for thyroid cancer with cervical lymph node metastasis. Conclusion:PLT and PDW may be useful predictive factors for the differentiation of thyroid cancer malignancy and central lymph node metastasis.

Serum Levels of Hcy, sST2 and CA-125 in CHF Patients and Their Correlation with Cardiac Function Classification.

The relationships between serum levels of homocysteine (Hcy), soluble stromelysin 2 (sST2), and tumor-associated cancer antigen 125 (CA-125) and heart failure requires further investigation. The aim of the present study was to evaluate the levels of Hcy, sST2 and CA-125 in patients with congestive heart failure and to correlate these with cardiac function, thereby providing a reference for the clinical diagnosis and treatment of heart failure. Seventy patients with chronic heart failure (CHF) diagnosed between August 2020 and July 2022 were classified into heart failure groups II (n = 25), III (n = 23) and IV (n = 22). Seventy individuals with normal physical examination results were selected as the healthy group. Serum Hcy, sST2 and CA-125 levels for all participants were evaluated and correlated with each other and with cardiac function classification. The diagnostic value of individual Hcy, sST2, CA-125 levels for CHF was evaluated, as well as a combination of these factors. Hcy, sST2, and CA-125 levels were lower in the healthy group than in the heart failure group. Moreover, a progressive increase in Hcy, sST2, and CA-125 levels were observed in heart failure groups II, III, and IV. Individual Hcy, sST2 and CA-125 levels, as well as a combination of these factors, were significantly correlated with cardiac function classification (p < 0.05). Hcy, sST2 and CA-125 levels each showed diagnostic value for CHF, with the three combined having the best diagnostic value. Abnormally high levels of Hcy, sST2 and CA-125 occur in CHF patients and are positively correlated with cardiac function classification. Individual levels of these factors, and particularly a combination of the three, show good sensitivity and specificity for CHF diagnosis that could be widely used in clinical practice.

Levels of Serum IGF-1, HCY, and Plasma BNP in Patients with Chronic Congestive Heart Failure and Their Relationship with Cardiac Function and Short-Term Prognosis.

Objective To investigate the levels of serum insulin like growth factor-1 (IGF-1), homocysteine (HCY), and plasma brain natriuretic peptide (BNP) in patients with chronic congestive heart failure (CCHF) and their relationship with cardiac function and short-term prognosis. Methods A total of 95 patients with CCHF admitted to our hospital from October 2017 to December 2018 were selected as the observation group. Patients conform to grade II∼IV of the New York Heart Association (NYHA) heart function class. At the same time, the people with normal physical examination results were selected as a control group. Serum IGF-1, HCY, and plasma BNP levels were detected in the two groups, and left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were detected in the observation group. According to the follow-up results, the observation group was divided into the subgroup with good prognosis and the subgroup with poor prognosis. The relationship between the levels of serum IGF-1, HCY, and plasma BNP among cardiac function and short-term prognosis were analyzed. Results The serum IGF-1 level of the observation group was lower than that of the control group, and the serum HCY and plasma BNP levels were higher than those of the control group (P < 0.05). Serum IGF-1 level in grade III of NYHA was lower than that in grade II, and serum HCY and plasma BNP levels were higher than those in grade II. Serum IGF-1 level in grade IV was lower than that in grade II and grade III, and serum HCY and plasma BNP levels were higher than those in grade II and grade III (P < 0.05). Serum IGF-1 level was negatively correlated with LVDd and positively correlated with LVEF. Serum HCY and plasma BNP levels were positively correlated with LVDd and negatively correlated with LVEF (P < 0.05). There were 42 patients with poor prognoses (44.21%). Serum IGF-1 levels of patients with poor prognosis were lower than those with good prognosis, and serum HCY and plasma BNP levels were higher than those with good prognosis (P < 0.05). Conclusion The serum IGF-1 level in patients with CCHF decreased, and serum HCY and plasma BNP levels increased. Serum IGF-1, HCY, and plasma BNP were correlated with cardiac function and have some clinical value for short-term prognosis.

The clinical differences between cough variant asthma cells and humoral immunology indicators.

The Purpose of this study was to study and analyze the clinical differences between cough variant asthma (CVA) cells and humoral immunology indicators. For this aim, 73 sick children with CVA were enrolled in this study and were admitted to the Pediatric Inpatient Department of Weifang Maternal and Child Health Hospital for treatment from April 2019 to May 2021. They were divided into the attack stage group (n=45) and the remission stage group (n=28). Meanwhile, 30 children with normal physical examination results were selected as normal controls. Differences in serum levels of TNF-, hs-CRP, IL-4, IL-5, IL-6 and IL-13 were compared among the three groups, as well as the differences in humoral immunology indicators such as T lymphocyte subsets CD3+, CD4+, CD8+, CD4+/ CD8+ and IgA, IgG, IgG, IgM, IgE, IgE and IgG subtypes. Results showed that serum levels of TNF-α and hs-CRP were significantly higher in the attack stage group than those in the remission stage group and normal control group, and the difference was statistically significant (P<0.05). The serum levels of TNF-α and hs-CRP were higher in the remission stage group than those in the normal control group, and the difference was not statistically significant (P>0.05). Serum levels of IL-4, IL-5, IL-6 and IL-13 were significantly higher in the attack stage group than those in the remission stage group and normal control group, and the difference was statistically significant (P<0.05). CD4+ and CD4+/CD8+ were significantly higher in the attack stage group than those in the remission stage group and normal control group, and the difference was statistically significant (P<0.05). The difference in serum levels of IgG1, IgG2 and IgG3 was not statistically significant (P>0.05) among the three groups. While the level of IgG4 subsets in the attack stage group was significantly higher than that in the remission stage group and normal control group, and the difference was statistically significant (P<0.05). Then the cytokines, cells and humoral immunology indicators of CVA patients are not in their normal range. They are involved in the pathogenesis of CVA. The combined detection is of great clinical significance in the diagnosis of early CVA to avoid misdiagnosis and missed diagnosis.

Is there any predictive value of testicular shear wave elastic modulus in testicular functions for varicocele patients?

This study aimed at searching the predictive values of testicular shear wave elastic modulus in testicular functions for varicocele patients. This was a prospective case-control study. We divided the participants into two groups: varicocele group and control group, the latter recruited men with normal physical examination, testicular ultrasound, semen and endocrine results. A total of 97 participants were enrolled: 67 patients in varicocele group, 30 participants in control group. There were statistical differences in left testicular shear wave elastic modulus, left testicular volume, testicular atrophy index, total sperm count, sperm concentration, sperm viability and testosterone between the two groups, between different grades in varicocele group, between different periods in varicocele group. Left testicular shear wave elastic modulus was inversely correlated with total sperm count, sperm concentration, sperm viability and testosterone. Left testicular shear wave elastic modulus cut-off was calculated as 5.235, 5.130, 4.640 and 5.310Kpa using ROC curve according to the abnormalities of total sperm count, sperm concentration, sperm viability and testosterone. When the left testicular shear wave elastic modulus was higher than these values, the corresponding parameter was more likely to be abnormal. Testicular shear wave elastic modulus has predictive values in testicular functions for varicocele patients.

Correlation Between Intestinal Microflora and Gastrointestinal Dysfunction in Elderly Patients with Sepsis

Multiple organ dysfunction syndrome (MODS) is a key factor that leads to death in elderly patients with sepsis. Therefore, early prevention and treatment of gastrointestinal dysfunction (GIDF) in elderly patients with sepsis is an important measure to prevent MODS occurrence. This research explores the correlation between intestinal microflora and GIDF in elderly patients with sepsis and provides ideas for the prevention and treatment of GIDF in elderly patients with sepsis. In this study, 152 patients with sepsis (122 patients with sepsis and GIDF) treated in the Third Affiliated Hospital of Yunnan University of Chinese Medicine from January to September 2019 were selected as the sepsis group and 100 elderly who had normal physical examination results were selected as the control group. The common intestinal microflora of the two groups was compared. Patients with sepsis and GIDF were treated as the GIDF group and the other patients with sepsis were treated as the non-GIDF group. The common intestinal microflora, gastrointestinal indicators, serum inflammatory factors, and immune function indices were compared between the two groups. Correlation analysis of the observed indices with statistical significance was carried out. The results showed 152 patients with sepsis and 122 patients with sepsis and GIDF; thus, the incidence of sepsis with GIDF was 80.26%. The total average score of sepsis with GIDF was 3.61±0.09. There was no statistically significant difference in GIDF scores of patients ages 65–75 and &gt; 75 years old. The number of Bifidobacterium and Lactobacillus in elderly patients with sepsis was lower and the number of Escherichia coli was higher than in the control group. In elderly patients with sepsis, the number of Bifidobacterium and Lactobacillus in the GIDF group was lower and the number of E. coli was higher than in the non-GIDF group. White blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), gastrin (GAS), and diamine oxidase (DAO) in GIDF patients were higher and motilin (MOT), CIT (CIT), CD4+, and CD8+ were lower than in the non-GIDF group. WBC count, PCT, CRP, TNF-α, GAS, and DAO were negatively correlated with the number of Bifidobacterium and Lactobacillus but positively correlated with E. coli. MOT, CIT, CD4+, and CD8+ were positively correlated with the number of Bifidobacterium and Lactobacillus but negatively correlated with E. coli. There was a negative correlation between Bifidobacterium and Lactobacillus and GIDF score and a positive correlation between E. coli and GIDF score. Therefore, the change in the intestinal microflora in elderly patients with sepsis is related to GIDF.

Expression of human cartilage glycoprotein 39 in peripheral blood and tissues in renal cell carcinoma

Objective To investigate the expression of human cartilage glycoprotein 39 (YKL-40) in renal clear cell carcinoma and peripheral blood, and to analyze its correlation with prognosis. Methods A total of 110 patients who underwent radical nephrectomy were enrolled as the observation group, and 50 patients with normal physical examination results were enrolled as the control group. The renal clear cell carcinoma tissues and adjacent tissues were taken after operation, and the expression level of YKL-40 mRNA was detected by real-time fluorescent quantitative polymerase chain reaction (FQ-PCR). Results The level of YKL-40 [(186.9±15.7) μg/L] in the peripheral blood of the observation group before surgery was significantly higher than that of the control group [(115.1±12.5) μg/L] and after surgery [(146.3±13.5) μg/L, t=20.565, 28.478, P 0.05). Multivariate Cox analysis showed that Fuhrman classification [OR(95%CI): 2.335(1.359-10.656)], lymph node metastasis [OR(95%CI): 1.854(1.289-7.659)] and peripheral blood YKL-40 [OR(95%CI): 1.335(1.185-6.987)] were independent factors of OS (P<0.05). Conclusion The level of YKL-40 in peripheral blood of patients with renal clear cell carcinoma is elevated and closely related to OS, which may be a prognostic marker. There was no increase in the level of YKL-40 in cancer tissues, and serum YKL-40 may not be derived from cancer cells. Key words: YKL-40; Renal clear cell carcinoma; Overall survival

Existence of Cervical Discopathy in Non-Cyclic Mastodynia

Background: Mastodynia is a subjective symptom that impairs the quality of life. It may be directly related with breast disorders. Moreover, a substantial rate is caused of reflective pain. Objectives: Non-cyclic mastodynia is multifactorial, and treatment should be planned according to the underlying cause. In this study, we aim to evaluate the existence of cervical discopathy via cervical magnetic resonance imaging (MRI) in the etiology of non-cyclic mastodynia. Methods: The study included 60 patients with normal physical examination results and imaging findings. Management was determined individually in patients. Patients with pathological MRI findings were evaluated by physical therapy, rehabilitation, and neurosurgery specialists, and appropriate treatment was planned. Patients were evaluated with the visual analogue scale (VAS) scoring system at initial presentation and after 1 and 3 months of treatment. Results: The majority of patients had positive findings on MRI (53 [88.4%] vs. 7 [11.6%]). The mean VAS scores at the time of presentation, after 1, and after 3 months of treatment were 7.41, 6.39, and 3.35, respectively. The decrease in the scores was statistically significant (p ≤ 0,01). Conclusions: We suggest that cervical discopathy should be kept in mind in cases of idiopathic non-cyclic mastodynia. Furthermore, cervical discopathy-related mastodynia seems to have a good response to appropriate treatment.

Effect of serum cystatin C and chromogranin A on left ventricular mass index in patients with chronic heart failure

Purpose: To investigate the expression of serum cystatin C (CystC) and chromogranin A (CgA) in chronic heart failure (CHF) patients, and their correlation with left ventricular mass index (LVMI).Methods: CHF patients (135) in the study hospital were randomly selected, and assigned to different groups on the basis of heart function grade (grades II to IV). Grades II, III and IV had 45 patients each. In addition, 45 people with normal physical examination results were assigned to the control group. In all patients, N-terminal natriuretic peptide (NT-proBNP), CysC and CgA were measured. In addition, left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured using transthoracic echocardiography, and the results were used to calculate LVMI values.Results: There were significantly higher levels of CystC and CgA in CHF patients than in control patients (p < 0. 05). In grade IV patients, CystC and CgA levels were higher than the corresponding levels in patients with cardiac function grades II and III, while their levels in grade III patients were higher than in grade II patients (p < 0.05). The results of correlation analysis indicated that serum CgA was positively correlated with serum CystC. Serum CgA and CystC levels in CHF patients were negatively correlated with LVEF, but positively correlated with NT-proBNP and LVMI levels.Conclusion: Serum CgA and CysC are correlated with cardiac function grade and ventricular remodeling in CHF patients. Thus, to some extent, these two indices can be used to measure the degree of ventricular remodeling in CHF individuals.Keywords: Chromogranin A (CgA), Heart failure, Cystatin C (CysC), Left ventricular mass index

Glioblastoma multiforme presenting as postpartum depression: a case report

BackgroundAlterations of mental status are characteristic of psychiatric disorders but may also result from a multitude of organic causes. Generally, physical examination and blood analysis are a part of basic psychiatric differential diagnostics, whereas more sophisticated procedures (for example, brain imaging) are applied only in cases with pathologic diagnostic findings. Our report challenges this approach by describing a case of glioblastoma multiforme presenting as postpartum depression without abnormalities in basic differential diagnostics.Case presentationA 28-year-old white woman who had been in outpatient treatment for postpartum depression was taken to the psychiatric emergency room. The psychopathological assessment, however, showed mild disorientation and severe deficits of long-term memory. Moreover, she complained of stabbing, bilateral headaches, but results of her physical examination and blood analysis were unremarkable. Magnetic resonance imaging of the brain was performed, which showed a contrast-enhanced mass lesion in the left frontal lobe. The patient underwent urgent tumor resection, and histologic results revealed an IDH-mutant glioblastoma multiforme. The patient was discharged with a substantially improved psychopathology and without neurological deficits.ConclusionsThis report adds to the evidence that postpartum depression may have organic causes in some cases, a fact that needs to be considered in the clinical setting. Atypical neurocognitive findings in a psychiatric interview may alone justify brain imaging, despite normal physical examination and blood analysis results.

Expression and clinical significance of serum MMP-7 and PTEN levels in patients with acute myeloid leukemia.

The aim of this study was to examine the changes of serum matrix metalloproteinase-7 (MMP-7) and phosphatase and tension homolog (PTEN) in patients with acute myeloid leukemia (AML) at different time points following treatment. The levels of serum MMP-7 and PTEN were measured from 80 AML patients with a diagnosis of peripheral blood, immune cell phenotype, and bone marrow puncture cytology examination. Among these, there were 20 cases of complete remission, 20 cases of primary untreated patients, 21 cases of incomplete remission, and 19 cases of relapse after remission. In addition, 20 healthy adults with normal physical examination results were enrolled as the control group. Patients were divided into different groups according to the treatment period. Serum MMP-7 and PTEN levels in patients and the healthy control group were measured using an ELISA. Compared with the control group, the levels of MMP-7 of 20 primary untreated patients were significantly increased (P<0.05), while there was no significant difference for the levels of PTEN in the incomplete remission group. A comparison between the control and complete remission groups revealed that the levels of MMP-7 and PTEN in the serum samples of 21 cases of patients with incomplete remission were significantly increased (P<0.05). In addition, the content of MMP-7 in 19 patients in relapse after remission group was significantly higher (P<0.05) than that of the complete remission and healthy control groups, while the levels of serum PTEN did not show significant changes. In conclusion, the level of serum MMP-7 and PTEN in AML patients was closely related to the clinical stage and the degree of disease. The combination of MMP-7 and PTEN may provide theoretical support for the accurate diagnosis, understanding of efficacy, prognosis and improvement of survival rate of AML.

Congenital syphilis in neonates with nonreactive nontreponemal test results

Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies. Retrospective analysis of prospectively collected data from infants born to mothers with syphilis and had a normal examination and a nonreactive nontreponemal test. Some infants had IgM immunoblotting, PCR testing or rabbit infectivity testing (RIT) performed. From 1984 to 2002, 115 infants had a nonreactive serum Venereal Disease Research Laboratory (VDRL)/rapid plasma reagin (RPR) test and a normal physical examination at birth. Among 87 infants born to mothers who had untreated syphilis, 4 had a positive serum IgM immunoblot or PCR test, but none had spirochetes recovered by RIT. Two infants had anemia, one had an elevated serum alanine aminotransferase concentration and one with Down's syndrome had direct hyperbilirubinemia. Among 14 infants born to mothers treated <4 weeks before delivery, none had abnormal laboratory or radiographic tests, although 1 of 11 had a reactive serum IgM immunoblot. Among 14 infants born to mothers treated ⩾4 weeks before delivery, none had abnormal laboratory or radiographic tests. Newborns with normal physical examination and nonreactive nontreponemal test results are unlikely to have abnormalities detected on conventional laboratory and radiographic testing.

SYNCOPE CAUSED BY VENTRICULAR TACHYCARDIA AS A CONSEQUENCE MYOCARDIAL ISCHEMIA – THE CASE REPORT

Syncope, one of the forms of loss of consciousness, occurs because of the general hypoperfusion of the cerebral cortex caused by reduced arterial pressure. Cardiogenic syncopes occur due to structural heart changes or disrhythmia. An elderly man experienced syncope in the street. Due to a previous loss of consciousness he was wearing a holter. Medical emergency team found him conscious with normal ECG and vital parameters. After observation at the Emergency Centre he was referred to a cardiologist with normal physical examination results and without any complaints. Cardiologist admitted him to hospital because of the ECG changes. Coronography performed next day showed a significant stricture in the branches of the left coronary artery and four stents were placed. Holter monitoring after the stent placement did not show any rhythm disorders. Holter monitoring that patient was wearing at the moment of his loss of consciousness, showed episodes of ventricular tachycardia preceded by myocardial ischemia. After revascularization, patient was referred to the Institute for Treatment and Rehabilitation 'Niska Banja. Timely diagnosis and adequate therapy for syncope of cardiogenic origin could prevent severe consequences, the most serious of which is sudden death.

MR Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: Technique and Findings.

The term juvenile idiopathic arthritis (JIA) encompasses a group of arthritides of unknown cause that begin before 16 years of age and last for at least 6 weeks. Temporomandibular joint (TMJ) involvement has been described in up to 87% of children with JIA and has been associated with all JIA subtypes. TMJ involvement is difficult to detect clinically. In one study, 71% of JIA patients with active TMJ synovitis were asymptomatic and 63% had normal physical examination results. Moreover, the main growth center of the mandible is located in the condyle, separated from the joint space by only a thin layer of fibrocartilage. This makes mandibular growth vulnerable to arthritic changes, eventually resulting in facial asymmetry and retrognathia. Therefore, early detection and treatment of TMJ arthritis are paramount to preserving motility and preventing deformity. As clinical symptoms and physical examination results are not good markers of TMJ involvement, imaging plays a key role in diagnosis and treatment monitoring. Magnetic resonance imaging is the technique of choice for the study of TMJ arthritis. It has the advantages of displaying both soft tissue and bone, is the most sensitive technique for detecting acute synovitis, and is the only one able to demonstrate bone marrow edema. In addition, it allows the assessment of changes to the joint over time and evaluation of the effectiveness of therapeutic interventions. ©RSNA, 2017.

A survey on serum lipid profile changes in dogs with tail chasing disorder in Iran

Canine compulsive disorder such as tail-chasing is a syndrome of abnormal behaviors that affects many breeds. This disorder may be associated with serum lipid elevations in dogs, so the objective of the present survey was to characterize serum lipid profile changes in dogs with tail chasing behavior disorder. Twenty seven companion dogs with tail chasing were selected among the referred cases to the Veterinary Hospital of Shahid Chamran University of Ahvaz. The affected dogs were diagnosed on the basis of the dog’s behavioral history (age, frequency and duration of bouts since onset, intensity of the behavior, current or previous medical assessments) and clinical signs. Serum total cholesterol, triglycerides, HDL-C, LDL-C and VLDL-C levels were measured using commercial kits. Twenty seven control dogs were also enrolled on the basis of normal physical examination results, complete blood count and serum biochemistry profiles. Dogs with tail chasing disorder had significantly higher total cholesterol (p 0.05). When all parameters were compared, there was no significant difference between the affected dogs younger and older than one year (p > 0.05). In conclusion, tail chasing disorder may be associated with marked elevations of serum cholesterol, HDL-C and LDL-C levels in dogs. These indices may be used as biochemical parameters of tail chasing disorder in clinical settings.

EVALUATION OF CARDIOLOGIC FUNCTIONS IN CAPTIVE EURASIAN BROWN BEARS (URSUS ARCTOS ARCTOS) IN TURKEY.

The aim of this study was to evaluate the cardiac functions in healthy Eurasian brown bears (Ursus arctos arctos) living in a seminatural area during their active season. Twelve clinically healthy brown bears were selected based on their normal physical examination, hematologic, and serum biochemistry results. These bears were divided into two groups based on age; subadult (<5 yr, n = 4) and adult (≥5 yr, n = 8). After the chemical immobilization (ketamine and xylazine), routine clinical and laboratory examinations were performed. Also, cardiologic examinations were performed using electrocardiogram and echocardiogram. There were no significant differences for the clinical parameters between the two groups including for body temperature, heart and respiratory rates, capillary refilling time, and oxygen saturation. The Q, R, and S wave (QRS) complexes and T wave amplitude were higher (P < 0.05) in the subadult group when compared to those of adult bears. Notching of QRS complexes and peaked T wave were also observed in both groups. Left ventricular diameter at systole and diastole in adult bears was wider (P < 0.05) than that of subadult bears. Subadult bears had reduced aortic diameter compared to adult bears (P < 0.05). Doppler variables of mitral, tricuspid, and aortic inflows between groups were similar; however, pulmonary artery variables such as flow velocity integral, mean velocity, and gradient were higher (P < 0.05) in the subadult group. These results suggest that electrocardiographic and echocardiographic parameters should be evaluated based on the age of brown bears.

Guiding the management of ventricular arrhythmias in patients with left ventricular noncompaction cardiomyopathy: a knowledge gap.

Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. The authors report five cases that emphasize asymptomatic and apparently benign symptoms in patients with LVNC; despite normal physical examination and 12-lead electrocardiogram results, all of these cases unveiled potentially serious clinical consequences. These cases highlight the concern that LVNC patients with mild to moderate left ventricular systolic dysfunction, particularly in the presence of ventricular arrhythmias or a family history of sudden cardiac death, may need consideration for an implantable cardioverter defibrillator (ICD). All potential benefits of an ICD need to be balanced by the risk of device infection, lead and device malfunction, and potential for inappropriate shocks.

Relationship between fibroblast growth factor 21 and thyroid stimulating hormone in healthy subjects without components of metabolic syndrome

Objective To determine the relationship between human fibroblast growth factor 21 (FGF21) and thyroid stimulating hormone (TSH) by testing the level of FGF21, lipid metabolism, and carbohydrate metabolism-related indices, as well as the level of TSH, among metabolic syndrome-free patients with normal physical examination results. Methods An enzyme-linked immunosorbent assay (ELISA) was used to test the levels of serum FGF21 and free fatty acids (FFA) in metabolic syndrome-free patients with normal physical examination results, and electrochemiluminescence (ECLIA) was used to measure TSH, thyroglobulin antibodies (TGAbs), and thyroid peroxidase antibody (TPOAb) levels. Results Three hundred fifty-six metabolic syndrome-free patients (116 males and 240 females; average age, 43±13 years) with normal physical examination results were enrolled. Among the patients with normal physical examination results, FGF21 had a weak relationship with obesity indices, such as the waist circumference (r=0.110, P=0.038), the waist-to-hip ratio (r=0.119, P=0.025), and the triglycerides level (TG; r=0.302, P=0.000), and a weak relationship with blood lipid levels, such as total cholesterol (TCHO; r=0.113, P=0.012) and low-density lipoprotein-cholesterol (LDL-C; r=0.175, P=0.001), but no relationship with TSH (r=–0.023, P=0.666). In addition, the FGF21 levels in thyroid autoantibody-positive and -negative groups were not significantly different. Conclusion Among the metabolic syndrome-free patients with normal physical examination results, FGF21 has no apparent relationship with TSH or thyroid autoimmunity.

The role of thromboxane A2 receptor gene promoter polymorphism in acute cerebral infarction

To investigate the association between thromboxane A2 receptor (TXA2R) gene promoter rs2271875, rs768963 polymorphism and acute cerebral infarction in Chinese Han population. A prospective study was conducted. From October 2009 to May 2013, 223 patients with cerebral infarction (cerebral infarction group) and 142 cohorts with normal physical examination results (control group) from Taizhou City Central Hospital in Zhejiang Province were enrolled. Triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were determined by enzymatic colorimetry, whereas blood glucose was determined with hexokinase. The genotypes of rs2271875 and rs768963 polymorphism in TXA2R gene were detected by the polymerase chain reaction-ligase detection reaction (PCR-LDR) technique. Differences in gender, age, serum TG, TC, HDL-C, LDL-C, concentration of blood glucose, and blood pressure (systolic pressure, diastolic pressure) between cerebral infarction group and control group were compared as well as TXA2R promoter rs2271875, rs768963 genotype and allele frequencies distribution. The significant differences in males (147 cases vs. 57 cases, χ(2)=23.385, P=0.000), serum TG (2.02±1.14 mmol/L vs. 1.56±0.79 mmol/L, t=4.663, P=0.000), blood glucose (6.40±2.50 mmol/L vs. 5.28±0.92 mmol/L, t=6.084, P=0.000), systolic pressure (146.64±21.34 mmHg vs. 135.73±18.09 mmHg, t=5.234, P=0.000), diastolic blood pressure (86.29±11.79 mmHg vs. 80.74±11.23 mmHg, t=4.468, P=0.000) between cerebral infarction patients and controls were found. The results from multi-logistic regression analysis suggested that male was an independent risk factor for cerebral infarction [odds ratio (OR) 3.300, 95% confidence interval (95%CI) 1.905-5.175, P=0.000]. There were statistically significant differences between infarction group and the control group both in aspects of genotype (TT: 0.112 vs. 0.183, TC: 0.498 vs. 0.535, CC: 0.390 vs. 0.282, χ(2)=6.298, P=0.043) and the allele frequency distribution (T: 0.361 vs. 0.451, C: 0.639 vs. 0.549, χ(2)=5.839, P=0.016) of TXA2R gene rs768963. No statistical significant difference was found in rs2271875 in respect of genotype (GG: 0.336 vs. 0.352, GA: 0.480 vs. 0.451, AA: 0.184 vs. 0.197, χ (2)=0.302, P=0.859) and the allele frequency distribution (G: 0.576 vs. 0.577, A: 0.424 vs. 0.423, χ(2)=0.001, P=0.974). Coefficient of both linkage disequilibrium (D') of rs2271875 and rs768963 was 0.684. When the pair was haplotype AT, the frequency in the infarction group was significantly lower than that in the control group (0.034 vs. 0.081, χ(2)=7.883, P=0.005). rs768963 gene mutation, but not that of the rs2271875, showed significant correlation with the occurrence of cerebral infarction. There was a loose linkage disequilibrium between rs2271875 and rs768963 of TXA2R. Haplotype AT reduces the risk of cerebral infarction.