Presence Of TR Research Articles

Echocardiographic assessment of right heart function in the presence of TR: Is right heart strain the answer?

Abstract Background Right heart function is challenging to assess with echocardiography due to the complex anatomy and load dependence. To complicate the assessment, significant tricuspid regurgitation flatters the right ventricle. These complexities have led to the need for other modalities and invasive measures of RV function to complement clinical decision-making and risk profiling. Speckle tracking can assess subtle anomalies and appears to be promising for right heart assessment. We assessed right heart strain against classic echocardiographic measures of RV function (TAPSE, RVS’ and fractional area change (FAC)) and invasive measures of RV function (right ventricular stroke work index (RVSWI) and Pulmonary Artery Pulsatility index (PAPi)), in patients with severe TR and without, to see strain reclassifies the assessment of RV function from "normal" to impaired and to assess the prognostic value of right heart strain. Methods A single-centre retrospective analysis of data from 262 consecutive patients (age 74 ±11.2 years old; male 53%) with both right heart catheterization (RHC) and TTE. Clinical data was gathered from patient files, and outcomes of heart failure hospitalisation or death were recorded. Echocardiographic evaluation was completed on commercially available GE ultrasounds and data was stored on a dedicated workstation for offline analysis (EchoPAC version 112.99). Statistical analysis was performed using SAS 15.1. Results Over a median follow up of 34 ±15 months 99 events occurred. 53% of patients had severe TR. RV free wall strain reclassified RV function as impaired in 73% of patients with "normal" RV function as determined by FAC (p value 0.005), and in 71% of patients with normal RVS’ (p value 0.03) with severe TR. Using invasive measures, RVSWI reclassified RV function as abnormal when compared to TAPSE in 53% of patients (p value 0.02). PAPi reclassified RV function as impaired compared to TAPSE in 53% of patients (p value of 0.009). In patients with TR 3+, right atrial strain reclassified presence of right heart dysfunction in 91% of patients compared to TAPSE >17 (p value 0.01) and in 95% of patients compared to RVS’ (p value 0.004). In patients with moderate or less TR, RV strain reclassified 66% as having RV dysfunction with normal FAC (p value 0.003) and reclassified 61% of patients with RV dysfunction in patients with a normal RVS (p value 0.03). Invasive measures did not reclassify RV function assessment in patients with moderate or less TR. In patients with and without TR, RV strain and invasive measures were in accordance. Abnormal RV strain (>-23%) was associated with an adverse prognosis HR 3.63 (1.43 – 9.22). Conclusion In the presence of severe TR, right heart strain helps to reclassify RV function, comparable to invasive measures. Abnormal right heart strain is strongly associated with prognosis and its utility should be confirmed in prospective studies.

Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation

Echographic evaluation of the cardiopulmonary unit may be difficult in the presence of TR. Purpose: To assess the variation of simple and combined echographic parameters analysing the cardiopulmonary unit according to the severity of TR. Echographic images were reviewed in 179 patients to assess TR grade according to Hahn's 5 grades classification. Classical morphological (RV end diastolic length and area), function [TAPSE, RVFAC, S’,RVFWS (RV free wall longitudinal strain)] and load [PASP,TRTVI (TR Time-velocity integral)] parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI × RVFWS), morphology and load (load adaptation index = TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI = RV-RA mean pressure gradient × RVFWS/indexed RAED area × 10–2) and morphology-load-function index (MLF = RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (> 3) or low (< 6) surgical risk of mortality according to TRISCORE. Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20 ± 0.09; grade 2: 0.15 ± 0.08; grade 3: 0.10 ± 0.05, grade 4: 0.09 ± 0.08; grade 5: 0.05 ± 0.04 P = 0.000; MLF: grade 1: 7.56 ± 2.06; grade 2: 6.57 ± 2.14; grade 3: 4.85 ± 2.29, grade 4: 4.79 ± 3.17; grade 5: 3.06 ± 1.82 P = 0.000) and had the best predictive value for TRISCORE (MMI: AUC = 0.889 P = 0.000 for low risk, 0.855 P = 0.000 for high risk; MLF: AUC = 0.873 P = 0.000 and 0.822 P = 0.000). Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (Fig. 1).

Impact of right ventricular impairment on morbidity and mortality in takotsubo syndrome-a meta-analysis of observational trials.

The impact of right ventricular impairment (RVI) on the morbidity and mortality of patients with Takotsubo syndrome (TTS) is well-debated. We conducted a meta-analysis to evaluate the mortality and morbidity risk associated with RVI compared with those without RVI in patients with TTS. A comprehensive search was performed in PubMed and Embase from inception to April 19, 2019. Our primary outcome of interest was in-hospital and long-term mortality. Other outcomes of interest were acute heart failure, left ventricular systolic function, tricuspid and mitral regurgitation, and length of hospital stay (LOS). We are reporting our outcomes as a cumulative odds ratio (OR). After an initial search, 10 studies with 1210 subjects were included in the quantitative analysis. Mean follow-up was 31months. The odds of in-hospital and long-term mortality in TTS patients with and without RVI were not significantly different (p = 0.13 and 0.40). In TTS patients without RVI, the odds of acute heart failure, and mitral and tricuspid regurgitation were significantly lower at an OR of 0.26 (p < 0.0001), 0.40 (p = 0.0001), and 0.52 (p = 0.02) respectively. TTS patients with RVI had significantly lower mean LVEF (34% vs 41%, p = 0.03) and numerically higher mean LOS (9.5days vs 7.6days, p = 0.52) compared with those without RVI. The presence of RVI represents a severe form of TTS disease spectrum, characterized by severely reduced LVEF, higher incidence of MR and presence of TR. Although there was a trend toward increased in-hospital and long-term mortality, RVI in TTS does not portend worse survival.

Circulating CD19+CD24hiCD38hi regulatory B cells as biomarkers of response to methotrexate in early rheumatoid arthritis.

The protagonism of regulatory B cells seems to vary along the course of the disease in murine models of inflammatory conditions. Decreased numbers of circulating regulatory CD19+CD24hiCD38hi transitional (cTr) B cells have been described in patients with long-standing RA, thus our objective was to examine the frequency and evolution of cTr B cells in the peripheral blood of early RA (ERA) patients. Freshly isolated peripheral blood mononuclear cells from 48 steroid- and DMARD-naïve ERA patients with a disease duration of <24 weeks and 48 healthy controls (HCs) were examined by flow cytometry. Co-cultures of isolated memory B cells were established with autologous T cells in the absence or presence of Tr B cells. As compared with HCs, ERA patients demonstrated an increased frequency of cTr B cells. cTr B cells of ERA patients and HCs displayed an anti-inflammatory cytokine profile and were able to downregulate T cell IFN-γ and IL-21 production, together with ACPA secretion in autologous B/T cell co-cultures. Basal frequencies of cTr B cells above the median value observed in HCs were associated with a good EULAR response to MTX at 12 months [relative risk 2.91 (95% CI 1.37, 6.47)]. A significant reduction of cTr B cells was observed 12 months after initiating MTX, when the cTr B cell frequency was no longer elevated but decreased, and this was independent of the degree of clinical response or the intake of prednisone. An increased frequency of regulatory cTr B cells is apparent in untreated ERA and the baseline cTr B cell frequency is associated with the clinical response to MTX at 12 months.

Comparison of right ventricular measurements and SFRV in fetuses with and without tricuspid regurgitation at 11+0 and 13+6 weeks’ gestation

Objectives: To compare right ventricular dimensions and systolic shortening fraction of the right ventricle (SFRV) in fetuses with tricuspid regurgitation (TR [+]) to those without tricuspid regurgitation (TR [−]).Methods: Unselected patients presenting for first trimester screening between 11 + 0 and 13 + 6 weeks’ gestation were examined for the presence or absence of fetal tricuspid regurgitation using a standard approach. Only euploid fetuses without structural anomalies were included in the study. The heart was examined with the aid of M-mode using a previously described method. The right ventricular diastolic diameter (RVDD) and right ventricular systolic diameter (RVSD) were measured on stored M-mode images and the SFRV was calculated using the following formula [(RVDD−RVSD)/RVDD] × 100.Results: A total of 69 fetuses (n = 44 (TR [−]); n = 25 (TR [+])) were examined. The two groups were similar in maternal age, gestational age and nuchal translucency (NT) measurements. The SFRV was noted not to change with gestational age and there was no statistical difference between the two groups. Both the RVDD and the RVSD increased with gestational age. The calculated delta RVDD was statistically larger in the TR [+] group (mean: 0.29, CI 95%: 0.054–0.532) than the TR [−] group (mean: 0.013, CI 95%: −0.128 to 0.154) (p < 0.05). This was not true for the delta RVSD: TR [+] (mean: 0.17, CI 95%: 0.015–0.325) versus TR [−] group (mean: 0.035, CI 95%: −0.061 to 0.131). However, there was a trend towards larger RVSD in the TR [+] group (p = 0.13).Conclusions: The presence of TR appears to be associated with an increased RVDD in normal fetuses between 11 + 0 and 13 + 6 weeks’ gestation.

Impacto prognóstico da recorrência local em pacientes com câncer inicial de mama submetidas a tratamento conservador

OBJETIVO: investigar o impacto da recorrência local no prognóstico de pacientes com câncer de mama em estágio inicial tratado com cirurgia conservadora. MÉTODO: foi realizado estudo de coorte retrospectivo incluindo 192 pacientes com câncer de mama em estágio inicial submetidas a tratamento conservador. Utilizando critérios clínicos e patológicos (tempo para recorrência, local da recorrência e tipo histológico) classificamos as pacientes em três grupos. O grupo de recorrência local verdadeira (RLV), o grupo de novo tumor primário (NP) e o grupo livre de recorrência local (LRL). Foi comparada a evolução entre os diferentes grupos. RESULTADOS: menor idade e uma maior proporção de pacientes na pré-menopausa foram observas no grupo NP. A presença de RLV foi o mais importante fator prognóstico sendo que 40% das pacientes deste grupo desenvolveram doença metastática sincrônica à recorrência local. Doença metastática ocorreu em 28,5% e 4,7% nos grupos NP e LRL, respectivamente (p&lt; 0,0001). A taxa de sobrevida global em cinco anos foi de 75% no grupo RLV, 100% no grupo NP e 98,2% no grupo LRL (p&lt; 0,0001). Tipo histológico, margens cirúrgicas, metástase em linfonodos axilares e expressão de receptores hormonais não foram preditores de recorrência local. Pacientes que não foram submetidas a hormonioterapia adjuvante e a idade foram os mais importantes fatores preditores de recorrência local. CONCLUSÃO: recorrência local verdadeira é um fator prognóstico em pacientes com câncer de mama inicial tratado com cirurgia conservadora. A idade é o mais importante fator na recorrência local neste grupo de pacientes. O alto risco recorrência local nestas pacientes é um fator limitante da cirurgia conservadora.

Thyroid hormone positively regulates the enterocyte differentiation marker intestinal alkaline phosphatase gene via an atypical response element.

Thyroid hormone (T3) is a critical regulator of intestinal epithelial development and homeostasis, but its mechanism of action within the gut is not well understood. We have examined the molecular mechanisms underlying the T3 activation of the enterocyte differentiation marker intestinal alkaline phosphatase (IAP) gene. RT-PCR and Western blotting showed that thyroid hormone receptors TRalpha1 and TRbeta1 were expressed in human colorectal adenocarcinoma Caco-2 cells. Northern blotting detected expression of two IAP transcripts, which were increased approximately 3-fold in response to T3. Transient transfection studies with luciferase reporter plasmids carrying various internal and 5' deletion mutations of the IAP promoter localized a putative thyroid hormone response element (TRE) to a region approximately 620 nucleotides upstream (-620) of the ATG start codon. EMSAs using TRalpha1-retinoid X receptor alpha (RXRalpha) on sequential 5' and 3' single nucleotide deletions defined the TRE between -632 and -612 (5'-TTGAACTCAgccTGAGGTTAC-3'). Compared with the consensus TRE, the IAP-TRE is novel in that it contains an everted repeat of two nonamers (not hexamers) separated by three nucleotides. Neither TRalpha1 nor RXRalpha binds to the IAP-TRE; however, TRbeta1 binds to this TRE with minimal affinity. In the presence of TR and RXRalpha, only the TR-RXRalpha heterodimer binds to the IAP-TRE. Mutagenesis of either nonamer abolishes the biological activity of IAP promoter. We have thus identified a novel response element that appears to mediate the T3-induced activation of the enterocyte differentiation marker, intestinal alkaline phosphatase.

Effect of five flavonoid compounds isolated from leaves of Diospyros kaki on stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils

Background: The crude drug “kaki-yô” is a traditional medicine used in Japan as a hypotensive drug. Methods: The effect of five flavonoid compounds isolated from the leaves of Diospyros kaki was investigated on the stimulus-induced superoxide generation and phosphorylation of tyrosine residues of protein in human neutrophils. The five compounds examined were kaempferol 3- O-β- d-galactopyranoside (TR), kaempferol 3- O-β- d-glucopyranoside (AS), isorhamnetin 3- O-β- d-glucopyranoside (IS), quercetin 3- O-β- d-galactopyranoside (HY), quercetin 3- O-β- d-glucopyranosyl-(6→1)-α- l-rhamnopyranoside (RU). Results: When the cells were preincubated with these five compounds, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed in a concentration-dependent manner. The arachidonic acid (AA)-induced superoxide generation was suppressed by TR, AS, HY and RU. On the other hand, the superoxide generation was weakly enhanced by IS in low concentration (5–20 μmol/l), but was suppressed in high concentration (50 μmol/l). The superoxide generation induced by phorbol 12-myristate 13-acetate (PMA) suppressed the TR, IS, HY and RU, but AS gave no effect. When the cells were incubated with fMLP in the presence of TR, IS and RU, fMLP-induced tyrosyl phosphorylation of 45-kDa proteins of the cells was dose-dependently suppressed in parallel to the suppression of fMLP-induced superoxide generation. These five flavonoids showed almost no hemolytic effect even at a concentration of 500 μmol/l. Conclusion: Flavonoid compounds suppressed stimulus-induced superoxide generation and tyrosyl phosphorylation and may have pharmaceutical application.

Trypanosomatidae from wild mammals in the neotropical rainforest of French Guiana.

The initial filling of the reservoir behind the Petit Saut hydro-electric dam, on the Sinnamary River in French Guiana, threatened the terrestrial and arboreal animals living in the neotropical rainforest being flooded. During a rescue programme between 24 October and 12 November in 1994, many of these animals were checked for infection with trypanosomatids. Overall, 45 blood samples and 54 skin biopsies were collected from 53 mammals (of 13 species representing five orders) and blood samples were also taken from each of nine reptiles (six species from four families). When the skin biopsies and the buffy-coats from the blood samples were cultured in NNN medium, 10 of the cultures, each initiated with mammalian blood, were found to be positive for trypanosomatids. Multilocus enzyme electrophoresis (MLEE) on cellulose acetate plates, with 20 enzyme systems, was then used to investigate each of the positive cultures. The results were analysed by clustering from a genetic distance matrix, using the unweighted pair group method with arithmetic averages (UPGMA), and applying a bootstrap procedure to Wagner parsimony trees. A stock obtained from Didelphis marsupialis was identified as a zymodeme of Trypanosoma cruzi (Miles' zymodeme 1) known to cause Chagas disease in French Guiana. Five stocks (one each from Bradypus tridactylus, Tamandua tetradactyla and Alouatta seniculus and two from Saguinus midas) were of a single zymodeme close to Trypanosoma rangeli reference stock RGB. This is the first confirmation of the presence of Tr. rangeli in French Guiana, and the first time that it has been identified, by iso-enzyme analysis, in the neotropical primates A. seniculus and S. midas. Two other stocks, isolated from Choloepus didactylus, were related to Endotrypanum schaudinni reference stock LEM 2790. Although the remaining stocks, one from C. didactylus and the other from A. seniculus, clustered together on UPGMA and in a Wagner tree, they did not appear to be related to any of the reference stocks included in the UPGMA dendrogram.

DNA bending by the silencer protein NeP1 is modulated by TR and RXR.

NeP1 binds to the F1 silencer element of the chicken lysozyme gene and, in the presence of TR, v-ERBA or RAR, synergistically represses transcriptional activity. This repression involves a silencing mechanism acting independently of the relative promoter position. Here we show that NeP1 alone can induce a significant directed bend on DNA. The chicken homologue of human NeP1, CTCF, shows identical binding and bending properties. In contrast, the isolated DNA binding domain of CTCF efficiently binds DNA, but fails to confer bending. Similarly, the TR-RXR hetero- or homodimer, binding adjacent to NeP1 at the F2 sequence, do not show significant DNA bending. The binding of the T3 ligand to TR changes neither the magnitude nor the direction of the NeP1 induced bend. However, when all factors are bound simultaneously as a quaternary complex, the TR-RXR heterodimer changes the location of the bend center, the flexure angle and the bending direction.

Infection urinaire à Trichosporon inkin

Summary We report a case with urinary fungal due to Trichosporon inkin was diagnosed in a 49 years old man. The diagnosis was assessed by the presence of Tr. inkin in the urinary marked improvement occured after 6 months treatment with fluconazole.

Fluorescence Reaction AmongN-(Phenyl)-N-(4-Methylquinolinyl) Amine Derivatives, Hydrogen Peroxide and Cobalt(II), and its Application

Abstract The fluorescence reactions among seven N-(phenyl)-N-(4-methylquinolinyl)amine derivatives, hydrogen peroxide as a redox agent and cobalt (II), in the presence or absence of various surfactants, were systematically investigated. The order of the relative fluorescence intensities (R. fl. Int.) of these fluorescence products were N-(4′-hydroxyphenyl)-N-(4-methylquinolinyl)amine (IV), N-(2′-hydroxyphenyl)-N-(4-methyl quinolinyl)amine(11) > 3′-hydroxy-4 ′-carboxyphenyl)-N-(4- methylquinolnyl)amine(MQAB)(VII))> N-(3′-hydroxyphenyl)-N-(4 methylguinolinyl)amins(III) > N-(phsnyl)-N-(4-methylquinolinyl)amine(I)) >N-(4′-carboxyphenyl)-N-(4-methylquinolinyl)amine(V) >N-(3′-carboxyphenyl)-N-(4-methylquinolinyl)amine(VI)- fluorescence products. Especially, the R.fl.Int. using (IV) in the presence of cationic surfactants inbssic media was most large and stable, and asimple, rapid and eensitive spect- rofluorometric method for the determination of cobalt(II) using (IV) and hydrogen peroxide in the presence of tr...