Total Circumference Research Articles

(246) - Incremental Value to Coronary Angiography by Optical Coherence Tomography for Detection and Interpretation of Cardiac Allograft Vasculopathy

Optical coherence tomography (OCT) is a novel high-resolution intravascular imaging modality that may add important insights regarding coronary pathology in heart transplantation (HTx) patients. We aimed to characterize cardiac allograft vasculopathy (CAV) phenotypes by OCT, and to evaluate the utility of OCT for CAV severity assessment. The study included 172 vessels from 62 HTX patients. OCT was acquired using Lunawave OCT (Terumo, Jp) aiming at longest possible pullbacks ensuring acquisition of proximal segments. A total of 11158 frames were analyzed at approximately 1 mm intervals. Plaque and bright spot analysis were performed by delineating circumferential borders measuring angulation of total circumference in analyzed frames. Plaques were classified as (a) lipid (lipid pools and thin-cap fibroatheromas), (b) calcifications, or (c) layered complex plaques. Vessel layer assessment included measurements of lumen, intimal, and media area. OCT analysis was performed using a prototype of QCU-CMS software (LUMC, the Nl). Based on angiography, vessels were divided into: No CAV (n=113), mild/moderate CAV (below 70% stenosis; n=39), severe CAV (above 70% stenosis; n=20). The intersection point of sensitivity and specificity in ROC curves were used to define optimal cut-off points for plaque and vessel measurements between the CAV groups. The three OCT parameters with best discriminative ability between no versus mild/moderate CAV were mean lumen/intima ratio (AUC 0.89), maximal intima/media ratio (AUC 0.85), and degree of layered complex plaques (AUC 0.82). Based on cut-off values for these three parameters, 45/113 (40%) vessels with no CAV could be reclassified as mild/moderate CAV. The three parameters with best discriminative ability between mild/moderate versus severe CAV was mean intima/media ratio (AUC 0.81), lumen/intima ratio (0.80), and degree of bright spots (AUC 0.71). Based on cut-off values for these three parameters, 16/39 (41%) vessels with mild/moderate CAV could be reclassified as severe CAV. OCT provides important information on pathogenesis and enables detection of plaque compositions associated with CAV and increasing severity of CAV before detectable by angiography. Thus, OCT may potentially serve as a tool for therapeutic guidance in HTx patients.

Factors affecting in vitro shoot-tip culture of banana

Various factors affecting in vitro shoot-tip culture of banana were examined to standardize the suitable culture media, as well as the culture environment. Three local cultivars identified for experiments, viz., 'Amritsagar' (AAA), 'Bharatmoni' (AAA) and 'Kanaibasi' (AA), have high potential in terms of plant growth, yield and fruit quality in commercial cultivation. Shoot tips from 3-month-old suckers of these cultivars were selected as explants source and were cultured on modified MS medium containing different concentrations and combinations of auxins and cytokinins, along with some other supplements, and incubated under different temperatures. Highest frequency of explant survival, regrowth and highest multiplication of shoots was observed on modified MS medium with 5 mg L-1 6-benzylaminopurine, 1 mg L-1 indole-3-acetic acid (IAA), 2 g L-1 activated charcoal and 50 mg L-1 casein hydrolysate, at a temperature of 27°C. About 20 shoots per plant could be achieved in this medium within 6-8 weeks of culture. Healthy roots were induced by subculturing shoots on half-strength MS medium supplemented with 2 mg L-1 of indole-3-butyric acid within 15 days of incubation. Regenerated plantlets were transferred to soil after hardening. After attaining the average height of 25 cm, the plants were transferred in the field. The plants showed vigorous growth in terms of total leaves per plant, total leaf area, pseudostem circumference and height of the plants. Preliminary results show that the quality and the productivity of the in vitro-derived plants are superior in comparison to conventional sucker-derived plants.

Phenotypic variation of flowering and vegetative morphological traits along the distribution for the endemic species Yucca capensis (Agavaceae)

Phenotypic variation across the geographic range of a species depends upon genetic differences within and between populations as well as environmental heterogeneity. Estimating the variation in morphological and reproductive traits and determining the influence of abiotic factors on the expression of phenotype is particularly important in endemic species as a means of inferring their response to different environmental scenarios. This study analyzes the interpopulation variation in oral and vegetative traits of Yucca capensis Lenz and their relation to altitude and precipitation. At 2 different sites total plant length, stem length, stem circumference, rosette length, rosette diameter, leaf length and leaf width were measured and the number of plants with inflorescences and fruits was recorded. The results showed higher coefficients of variation for plant length, stem length and rosette length and lower coefficients of variation for leaf length and width. All of the vegetative traits differed significantly between sites. It was found that 31 % and 12 % of the plants produced inflorescences and fruits respectively and inflorescence production differed between sites, presenting a positive relation with average annual precipitation. This study shows that there is large phenotypic variation in vegetative traits and that levels of rainfall have a clear influence on the production of reproductive structures throughout the geographic range of the endemic species Y. capensis .

Autoregressive spatial analysis and individual tree modeling as strategies for the management of Eremanthus erythropappus

The objectives of this study were to apply statistical techniques to discriminate fertilization treat- ments of Eremanthus erythropappus (DC.) MacLeish. through autoregressive modeling, and to develop individual tree models for diameter and crown area (CA) projection to define management strategies for candeia plantations sub- jected to different fertilization treatments. This is an important tree species originating from the Brazilian Atlantic Rain forest and Savannah biomes, intensively used in the cosmetic industry. Nonetheless, to date, research has not addressed the management of natural stands or plan- tations of the species. Our experiment was located in Baependi, Minas Gerais, Brazil, and comprised of four randomized blocks and 13 treatments. The treatments consisted of 12 different regimes of fertilization plus a control. Each sample plot was composed of 50 plants plus two border plants in a planting spacing of 2.5 9 2.0 m and undergoing pruning at 5 and 6 years of age. Starting in the second year, total tree height (H) and circumference (at 1.30 m from the ground or breast height, CBH) were measured every 6 months. Starting in the fifth year CA was measured. Tree growth varied by fertilization strategy. Differences were detected by using an autoregressive approach, considering that standard statistical methods were not powerful enough to detect significant differences. Three growth groups were formed, and maximum growth was obtained for treatment 10 (NPK, 8-28-16). Manage- ment guidelines are provided based on individual tree models for different fertilization levels.

The effect of loading and ethnicity on annual changes in cortical bone of the radius and tibia in pre-pubertal children

Background: It is unclear what effect habitual physical activity or ethnicity has on annual changes in bone size and strength in pre-pubertal children.Aim: To determine whether the annual relative change in bone size and strength differed between high and low bone loaders and also between black and white pre-pubertal children.Subjects and methods: Peripheral quantitative computed tomography (pQCT) scans of the 65% radius and tibia were completed on 41 black and white children (15 boys, 26 girls) between the ages of 8–11 years, at baseline and 1 year later. Children were categorised into either a high or low bone loading group from a peak bone strain score obtained from a bone-specific physical activity questionnaire. Total area (ToA), cortical area (CoA), cortical density (CoD), strength-strain index (SSI), periosteal circumference (PC), endosteal circumference (EC) and cortical thickness (CT) were assessed.Results: There was no difference in annual relative change in radial or tibia bone size and strength between the low and high bone loaders. Black children had a greater annual relative change in CoD (p = 0.03) and SSI (p = 0.05) compared to the white children.Conclusion: Children who performed high bone loading activities over a 1-year period had similar bone growth to children who did low bone loading activities over the same period. Rapid maturational growth over this period may have resulted in bone adapting to the strains of habitual physical activity placed on it. Black children may have greater tibial bone strength compared to white children due to a greater annual increase in cortical density.

Circumferential cryoablation in a strictured esophagus: a feasibility and dose-finding study in a porcine model after inducing stenosis by endoscopic mucosal resection.

In the treatment of early esophageal Barrett's neoplasia, radiofrequency ablation may be hindered by stenosis due to prior endoscopic resection (ER). The flexible balloon-based circumferential CryoBalloon Ablation System (CBAS) may overcome this problem by the conformability of the compliant balloon which might enable circumferential cryoablation in a stenosis. The aim of the current study was to evaluate the feasibility of the CBAS as well as the dose-response effect of cryoablation in a strictured esophagus model. In six pigs, a stenosis was induced by ER (3 cm in length, 75% of circumference) in the proximal, mid, and distal esophagus. After 28 days, cryoablation with the CBAS was performed, with the length of ablation time (6, 8, or 10 seconds) randomly assigned per stricture location within the esophagus. Four days post-ablation, the esophagi were harvested for histopathological assessment of the percentage of the total circumference affected by cryoablation and the maximum depth of necrosis. At 28 days, all 18 ER areas had transformed into strictures with ±50% of its original diameter remaining. In 9 of 18 strictures, more than one attempt for cryoablation was necessary due to displacement of the balloon. Histopathological evaluation showed a wide range in circumferential uniformity (0-100%) and maximum necrosis depth (epithelium to external proper muscle layer) of cryoablation, both independent of ablation times. Deepest ablation effects were seen at the center of the resection-induced scar. This first generation CryoBalloon Focal Ablation System was not feasible for ablation within severe stenoses, since it results in inconsistent circumferential uniformity of cryoablation with subsequent differences in depth of ablation. Further research with a next generation CBAS in a more realistic stricture model is warranted.

Studies on LED Wavelength to Enhance Growth and Bio-active Compounds of Carrots

LED의 적색, 백색, 청색 파장의 비율을 조절한 후 당근에 조사 하여 당근의 생육과 당근의 생리활성 물질인 β-carotene의 함량을 증진시키는 파장을 탐색하였다. Light emitting diode (LED) 혼합 파장(적색:청색:백색=8:1:1)을 조사하였을 때, 당근의 총 무게와 뿌리의 둘레길이를 증가시켰으나, 뿌리 무게나 길이는 효과적이지 않았다. β-carotene의 함량 분석에서도 LED 혼합 파장은 대조광인 형광등보다 낮은 값을 나타내었다. β-carotene의 함량을 증진시키는 LED의 파장을 연구하기 위해 단색 파장, 적색과 청색 혼합 파장, 일반 형광등을 당근에 조사하여 β- carotene의 함량을 분석하였다. 15W LED 단색 파장을 조사하였을 때, 445 nm와 650 nm에서 높은 값을 나타내었고(445 nm=9.8, 650 nm=9.3 mg/g dried weight), 적색과 청색 혼합 파장에서는 6:4로 혼합한 혼합 광에서 가장 높은 값을 나타내었다 (10.48 mg/g dried weight). LED 혼합 파장(적색:청색:백색=8:1:1)은 당근의 생육에서만 긍정적인 영향을 미쳤고, α-carotene 함량을 증가시키기는 하였으나 β-carotene의 함량에서는 그 효과가 미미했다. 추가적으로 당근의 생리활성 물질을 증진시키는 LED 파장을 연구하였을 때, LED 혼합 파장(650 nm : 445 nm=6:4)이 당근의 성장과 α-carotene과 β-carotene 함량을 가장 효과적으로 증가시킨 것으로 나타났다. LED 청색 파장이 주황빛을 나타내는 생리활성 물질인 β-carotene과 α-carotene 함량을 증가시키는데 영향을 미치는 것으로 사료된다. 본 실험에서는 사전연구에서 적색 비율이 높았던 LED 혼합 파장(적색:청색: 백색=8:1:1)이 청색을 나타내는 적채의 anthocyanins의 함량을 높였던 결과와 유사하게 나타났다. LED 혼합 파장(적색:청색: 백색=8:1:1)에서 적색의 비율을 낮추고 청색 파장의 비율을 높였을 때(적색:청색=6:4), β-carotene의 함량을 증가시킴을 알 수있었다. LED를 조사하여 작물을 재배할 경우, 재배 작물과 반대되는 색의 파장의 비율을 높여 LED의 파장을 혼합 시켜 조사하면 작물의 생리활성 물질의 합성을 향상시킬 것으로 기대한다. LED를 조사한 당근의 생육 및 색도, 생리활성 물질 함량에 대해 연구가 많이 되어있지 않으므로 본 연구가 후에 당근의 품질을 향상시키는 연구에 도움을 줄 것으로 사료된다.

CRECIMIENTO INICIAL DE CLONES PROMISORIOS DE Hevea brasiliensis (Willd. ex A. Juss.) Müll. Arg. EN SISTEMA AGROFORESTAL EN CAQUETÁ, COLOMBIA

<p><span>Este estudio tuvo como objetivo evaluar el crecimiento inicial de tres clones de caucho (</span><em>Hevea brasiliensis</em><span>) (FX 4098, FDR 5788, y el testigo IAN 873) en cuatro sistemas de siembra con copoazú (</span><em>Theobroma grandiflorum</em><span>) y plátano Hartón (</span><em>Musa </em><span>AAB) en dos localidades de Caquetá (Amazonia colombiana). En cada zona se siguió un diseño de bloques completos al azar con tres repeticiones y un arreglo en parcelas divididas, el cual se analizó mediante un modelo lineal general mixto. En los años 1 y 2 después del establecimiento del cultivo de caucho se evaluaron los índices de crecimiento: altura total (AT), circunferencia del tronco (CT), área de copa (AC) e índice de área foliar (IAF). CT fue la variable que más se correlacionó con los distintos índices de crecimiento (</span><em>r</em><span> ≥ 0.94). La variación temporal y clonal, así como el sistema de siembra implementado fueron los factores que más influyeron en los cuatro índices de crecimiento (p < 0.01). Solo hubo diferencias significativas entre las dos localidades para AC (p < 0.05). La interacción clon x sistema fue significativa para IAF (p < 0.01). Luego de 2 años, los mayores índices de crecimiento se observaron en el clon FX 4098 (AT = 4.43 m; CT = 13.00 cm; AC = 4.62 m2; IAF = 1.37), y en dos de los tres sistemas agroforestales (AT ≥ 4.08 m; CT ≥ 11.43 cm; AC ≥ 4.01 m2; IAF ≥ 1.54) en comparación con el sistema testigo (monocultivo).</span></p>

The morphometric measurements of the gross structural changes of mitral valve in valvular stenosis with or without regurgitation

Rheumatic mitral stenosis is still a cardiac problem in developing countries. Reconstructive and replacement surgery of the diseased valves are often needed. Most of the studies on stenotic mitral valves are echocardiographic one. Morphometric measurements of the stenotic mitral valve and comparison with that in the normal mitral valve is done in this study. Thirty seven hearts of normal adult-male unclaimed dead-bodies from the mortuary of Forensic Medicine, Dhaka Medical College, Dhaka; and twelve surgically excised stenotic mitral valves of the adult-male cardiac patients from the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh were studied in fresh condition. The detail morphometric findings were compared between two groups. Though the total annular circumference was similar in both groups, yet the effective orifice area reduced significantly in stenotic valves. The anterior leaflet-area was increased, but the posterior leaflet-area was decreased in the stenotic valves. The thickness of the stenotic leaflets and chordae tendineae were increased compared to that in normal valves. The knowledge of the pathological changes of the valves would help to understand the exact pathophysiological mechanisms involved in the cardiac valve diseases.Faridpur Med. Coll. J. 2014;9(1): 7-11

Factors affecting sphincter-preserving resection treatment for patients with low rectal cancer.

The aim of the present study was to identify the factors associated with the use of sphincter-preserving resection (SPR) surgery for the treatment of low rectal cancer. A total of 330 patients with histopathologically confirmed low rectal cancer were divided into two groups, namely the abdominoperineal resection (APR) and sphincter-preserving (SP) groups. For SPR factor analysis, the χ2 test was performed as the univariate analysis, while a logistic regression test was conducted as the multivariate analysis. Of the 330 patients, 192 cases (58.18%) received SPR surgery and 138 cases (41.82%) underwent an APR. Univariate analysis results revealed that the sphincter-preserving factor was significantly associated with age, gender, ethnicity, body mass index (BMI), total infiltrated circumference, distance of the tumor from the anal verge (DTAV), depth of invasion and tumor grade (P<0.05). However, there were no statistically significant associations with family medical history, diabetes history, venous tumor embolism, growth type, tumor length, lymphatic metastasis and level of preoperative carcinoembryonic antigen (P>0.05). Multivariate analysis indicated that the sphincter-preserving factor was strongly associated with DTAV and the depth of invasion, with significant statistical difference (P<0.05). Therefore, selecting SPR surgery for patients with low rectal cancer is dependent on age, gender, ethnicity, BMI, the total infiltrated circumference, DTAV, depth of invasion and tumor grade. In addition, DTAV and the depth of invasion are independent risk factors for the selection of SPR surgery.

MP14-13 WEIGHING IN ON ACTIVE SURVEILLANCE: IMPACT OF OBESITY ON PATIENT COUNSELING

INTRODUCTION AND OBJECTIVES: The association between body mass index (BMI) and prostate cancer (PC) risk is mixed. Some have speculated that this relates to the fact that BMI is only a moderate measure of adiposity and that perhaps better measures (total percent body fat) or that central adiposity (waist circumference) may better correlate with PC risk. We tested multiple measures of adiposity and PC risk using prospectively collected and measured data from men undergoing prostate biopsies in a Veterans Affairs hospital. We hypothesized that on the aggregate level, BMI, total percent body fat and waist circumference would be highly correlated and that all would be associated with aggressive PC, but not overall incidence. METHODS: We used data from a case-control study among veterans between 2007 and 2012 undergoing prostate biopsy at the Durham Veterans Affairs. The sample consisted of 323 (46%) with biopsy-positive PC (cases) and 375 (54%) biopsy negative (controls). We abstracted Gleason score and race from the records. Weight, height, and waist circumference were measured by trained personnel. Body fat was measured using bio-impedance. We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to test the association between adiposity measures and PC risk. Multinomial logistic regression was used to examined high-grade PC (Gleason 7e10) vs. low-grade (2e6) vs. no-PC. RESULTS: BMI was strongly related to percent body fat (Spearman, r1⁄40.81) and waist circumference (r1⁄40.87). Men with higher BMI had significantly higher TRUSprostate volumes, percent body fat, and waist circumference. In both adjusted and unadjusted logistic regression analyses, all three adiposity measures were unrelated to total PC risk (all p>1⁄40.14). However, when stratified by Gleason score, all adiposity measures were associated with a significantly increased risk of high-grade disease (all p 1⁄40.35). CONCLUSIONS: BMI, body fat and waist circumference are all highly correlated with each other and all were significantly associated with aggressive PC, but not overall PC risk. Despite individual differences in these measures, this study supports the continued use of BMI in epidemiological studies of obesity and PC.

The improvement of metabolic control after using metformin in patients with type 1 diabetes mellitus and excessive visceral fat tissue treated with intensive insulin therapy—pilot study

The use of exogenous insulin and incorrect nutritional habits are conducive to obesity and excess weight. This leads to the development of insulin resistance, even in patients with type 1 diabetes mellitus. The aim of this study was to assess the effects of metformin as adjunctive therapy on anthropometric parameters and metabolic control in patients with type 1 diabetes mellitus. The study included a group 45 patients with elevated adipose tissue content as measured by electrical bioimpedance. Thirty-nine patients (11 males and 28 females) of the group fulfill the study protocol. The mean age was 33.5 ± 11.9 years and duration of diabetes 12.6 ± 7.4 years. Metformin was administered for at least 6 months at a mean dose of 1032 ± 718 mg/day. Application of metformin resulted in a statistically significant reduction in total adipose tissue (4.8 ± 4.0 vs. 2.9 ± 4.4 kg, p = 0.03), waist circumference (96.4 ± 9.5 vs. 89.1 ± 11.1 cm, p = 0.003), and VAI (4.1 ± 2.4 vs. 2.5 ± 1.8, p = 0.006). Reduction in insulin requirement (0.7 ± 0.1 vs. 0.6 ± 0.2 units/kg/day, p = 0.02), fasting glycemia (166.5 ± 52.5 vs. 135.7 ± 48 mg/dl, p = 0.01), and postprandial glycemia (196.9 ± 74.3 vs. 137.1 ± 37.5 mg/dl, p = 0.00002) was also observed. In addition, decrease in triglyceride serum concentration (128.2 ± 52.9 vs. 94.0 ± 32.1 mg/dl, p = 0.002) and non-HDL cholesterol (154.5 ± 41.3 vs. 130.0 ± 39.7 mg/dl, p = 0.01) was achieved. Addition of metformin to insulin therapy of patients with type 1 diabetes mellitus and elevated adipose tissue content is safe and may lead to measurable clinical benefits.

Two-spring model for active compression textiles with integrated NiTi coil actuators

This paper describes the development and implementation of a two-spring model to predict the performance of hybrid compression textiles combining passive elastic fabrics and integrated NiTi shape memory alloy (SMA) coil actuators. An analytic model that treats passive fabric-SMA coil systems as conjoined linear springs is presented to predict garment passive and active counter-pressure as a function of 11 design variables. For a fixed SMA coil design (encompassing five design variables), the model predicts that passive fabric material modulus, initial length, width and thickness determine both passive counter-pressure magnitude and activation stroke length, and that passive and active pressures are highly dependent on the relative unstretched lengths of the conjoined SMA-fabric system compared to the total limb circumference. Several passive fabrics were tested to determine their moduli and to generally assess the fabric linearity model assumption: two fabrics (spandex and neoprene) were found to behave linearly up to 200% strain, while two other fabrics (flat polyester elastic and a tri-laminate Lycra) were found to be nonlinear in the same strain envelope. Five hypothetical compression tourniquet designs are presented using experimentally determined fabric characteristics and previously studied SMA actuators developed at MIT. The performance of each tourniquet design is discussed with a specific focus on mechanical counter-pressure (MCP) space suit design requirements, with designs presented that achieve the full MCP design specification ( 29.6 kPa) while minimizing ( 5 mm) garment thickness. The modeling framework developed in this effort enables compression garment designers to tailor counter-pressure and activation stroke properties of active compression garments based on a variety of design parameters to meet a wide range of performance specifications.

Effects of Endurance and Endurance Strength Training on Body Composition and Physical Capacity in Women with Abdominal Obesity

Aims: To compare the effects of endurance training with endurance strength training on the anthropometric, body composition, physical capacity, and circulatory parameters in obese women. Methods: 44 women with abdominal obesity were randomized into groups A and B, and asked to perform endurance (A) and endurance strength training (B) for 3 months, 3 times/week, for 60 min. Dual-energy X-ray absorptiometry and Graded Exercise Test were performed before and after training. Results: Significant decreases in body mass, BMI, total body fat, total body fat mass, and waist and hip circumference were observed after both types of intervention. Marked increases in total body lean and total body fat-free mass were documented in group B. In both groups, significant increases in peak oxygen uptake, time to exhaustion, maximal work rate, and work rate at ventilatory threshold were accompanied by noticeably decreased resting heart rate, resting systolic blood pressure, and resting and exercise diastolic blood pressure. No significant differences were noticed between groups for the investigated parameters. Conclusion: Our findings demonstrate evidence for a favorable and comparable effect of 3-month endurance and endurance strength training on anthropometric parameters, body composition, physical capacity, and circulatory system function in women with abdominal obesity.

Commentary on ‘Predictors of Failure of Closure in Percutaneous EVAR Using the Prostar XL Percutaneous Vascular Surgery Device’

Actual outer diameter corresponding to the size given by the manufacturer in mm Size in Fr given by manufacturer 12F 14F 16F 18F 20F 22F In their paper, Rijkee et al. evaluated predictors of failure of closure in percutaneous endovascular aneurysm repair (P-EVAR) using the Prostar XL Percutaneous Vascular Surgery Device (Abbot Vascular, Santa Clara, CA, USA) in a consecutive series of 154 percutaneous accesses performed in 84 patients over a 40 month period. The team was experienced: P-EVAR was performed in 69% of the population treated. The pre-operative status of the common femoral artery (CFA) was properly evaluated on computed tomography (CT) scan, and puncture was systematically performed under per-operative ultrasound guidance to control the site of puncture and to avoid severe calcifications and atheromatous plaques. The authors demonstrated that the use of the Prostar XL device in P-EVAR was safe and feasible, with a success rate of 93.5% in a selected population excluding patients with circumferentially calcified femoral access sites or CFA stenosis. Failure to close access sites was defined as the need for conversion to conventional femoral cutdown to stop bleeding or correct vessel obstruction. In an attempt to predict failures, two potential new factors: (i) a specific calcification and location score system, and (ii) the SA-ratio (the ratio between sheath and CFA diameters) were proposed. This newly introduced calcification quantity and location score system evaluated the degree of arterial wall calcification on CT angiography, which was defined in a percentage of total wall circumference: grade I ( 50%, except circumferentially calcifications). Calcification location was classified as none or posterior, scattered anterior, and fully anterior, but this classification failed to predict failure. This result is probably related to the fact that the authors did the right thing by excluding patients with circumferentially calcified and stenotic CFAs, and puncturing under ultrasound guidance avoiding calcifications and then favoring femoral cut down in non-favorable CFAs. The other indicator was the SA ratio. The SA ratio was demonstrated to be a significant predictor of failure with a

The role of natural supplement of apple vinegar and syrup in the management of type 2 diabetes mellitus

Introduction: The increased risk of coronary artery disease in diabetics could be explained by the lipoprotein irregularities associated with diabetes mellitus. The primary aim of this study is to examine the role of apple vinegar and syrup in the management of type 2 diabetes mellitus.Methods: The interventional study included 500 participants (195 men and 305 women) with dyslipidemia and prediabetes or type 2 diabetes mellitus, aged 50-70 years, living in Sarajevo area. Patients were recruited from 5 outpatient diabetes counselling departments and treated with natural apple vinegar and syrup supplementation over a period of five weeks. The patients have been evaluated before treatment and 5 weeks after the treatment. During the study, dosage of drugs for diabetes or prediabetes was not changed.Results: After 5 weeks of supplementation with apple vinegar and syrup waist circumference (p=0.016), total cholesterol (p=0.01), low density lipoprotein (LDL) cholesterol (p=0.008) and triglycerides (p=0.019) were significantly reduced, as well as blood pressure (-14%). Study results show decrease of mean fasting blood levels of glucose, but statistically not significant (p=0.058). The body mass index also decreased insignificantly (p=0.089). The high density lipoprotein cholesterol level was not increased significantly after supplementation (p=0.26).Conclusion: According to our results, apple vinegar has important role in reduction of total cholesterol levels, triglycerides, LDL cholesterol and waist circumference in patients with type 2 diabetes. Also, it has positive effect on blood pressure.

Body mass index, body fat, and nutritional status of patients with heart failure: The PLICA study

Nutritional assessment may help to explain the incompletely understood obesity paradox in patients with heart failure (HF). Currently, obesity is usually identified by body mass index (BMI). Our objective was to assess the prognostic influence of undernourishment in HF outpatients. Two published definitions of undernourishment were used to assess 214 ambulatory HF patients. Definition 1 included albumin, total lymphocyte count, tricipital skinfold (TS), subscapular skinfold, and arm muscle circumference (AMC) measurements (≥2 below normal considered undernourishment). Definition 2 included TS, AMC, and albumin (≥1 below normal considered undernourishment). Patients were also stratified by BMI and body fat percentage and followed for 2 years. All-cause death or HF hospitalization was the primary endpoint. Based on BMI strata, among underweight patients, 60% and 100% were undernourished by Definitions 1 and 2, respectively (31% and 44% among normal-weight, 4% and 11% among overweight, and 0% and 3% among obese patients, respectively, according to the two definitions). The most prevalent undernourishment type was marasmus-like (18% of the total cohort). Undernourishment by both definitions was significantly associated with lower event-free survival. Following multivariable analysis, age, NYHA functional class, NTproBNP, and undernourishment (hazard ratio [HR] 2.25 [1.11-4.56] and 2.24 [1.19-4.21] for Definitions 1 and 2, respectively) remained in the model. In this cohort, BMI and percentage of body fat did not independently predict 2-year event-free survival. Nutritional status is a key prognostic factor in HF above and beyond BMI and percentage of body fat. Patients in normal BMI range and even in overweight and obese groups showed undernourishment. The high mortality observed in undernourishment, infrequent in high BMI patients, may help to partly explain the obesity paradox. Proper undernourishment assessment should become routine in patients with HF.

Leaf and Fruit Yield Performance of &lt;i&gt;Telfairia occidentalis&lt;/i&gt; Hook F. (Fluted Pumpkin) as Influenced by Fruit Size

An experiment to ascertain the influence of fruit size on the yield of fluted pumpkin (Telfairia occidentalis Hook F.) was conducted in 2011 and 2012 at Nsukka. The mature fruits of T. occidentalis were graded into three length groups: large (more than 50 cm), medium (34-50 cm) and small (less than 34 cm). The experiment was laid out in randomized complete block design with six replications. The following data were collected: length of the longest vine, number of leaves/plant, vine diameter, marketable leaf and fruit yield. Data collected were subjected to analysis of variance while Genotype by Genotype x Environment interaction biplot was used to show which-won-where among the groups. Significant means were separated using Fisher’s least significant differences. Medium sized fruits gave the highest marketable leaf yield that was significantly higher than the small sized fruits in both years. Small sized fruits were significantly (p&lt;0.05) lower in total leaf yield, fruit weight/hectare, fruit circumference (33.9 cm) and length (22 cm). The biplot explained 100% of the variation in the fruit sizes. Large sized fruits were the best performer in fruit length, while medium sized fruits performed better in total marketable leaf yield, average fruit weight, number of fruits/hectare and total fruit weight/hectare. The highest Benefit Cost Ratio of 1.2 and 2.6 in 2011 and 2012, respectively were obtained from medium sized fruits Medium sized fruit are recommended in favour of small sized fruit for leaf and fruit production, having higher economic returns.

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation.

The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.

Abstract 17269: Extracelllular Protein Disulfide Isomerase Reshapes Vascular Architecture Against Constrictive Remodeling

INTRODUCTION: Vascular remodeling orchestrates a complex network of signaling pathways responsible for pathological changes in many vascular diseases such as atherosclerosis. We investigated the role of endoplasmic reticulum chaperone Protein Disulfide Isomerase (PDI) and the extracellular PDI (ecPDI) pool in vascular caliber and architecture during vascular repair and remodeling after injury (AI). METHODS AND RESULTS: After rabbit iliac artery balloon injury, PDI is markedly increased at mRNA and protein levels (25-fold vs. basal 14 days AI), with increase in both intracellular and ecPDI. Silencing PDI by siRNA in vitro induced ER stress markers upregulation and apoptosis (assessed by TUNEL assay). PDI knockdown also upregulated proliferation marker PCNA and decreased differentiation marker calponin-C. Furthermore, ecPDI inhibition prevents injury-increased hydrogen peroxide generation and decreases arterial nitrate (NO3-) level. EcPDI neutralization in vivo with PDIAb-containing perivascular gel from days 12-14AI promoted 25% decrease in vascular caliber at arteriography and similar decreases in total vessel circumference at optical coherence tomography, without changing neointima, indicating increased constrictive remodeling. EcPDI neutralization promoted striking changes in collagen, with switch from circumferential to radial fiber orientation towards a more rigid fiber type. Collagen type I and III were decreased after ecPDI inhibition in arteries 14 days AI. Cytoskeleton architecture was also disrupted, with loss of stress fiber coherent organization and switch from thin to medium-thickness actin fibers. In human coronary atheromas, PDI expression inversely correlated with constrictive remodeling. There was decreased PDI expression in media and intima from plaques exhibiting constrictive remodeling and, conversely, enhanced PDI expression in media of plaques depicting outward remodeling. CONCLUSIONS: Thus, PDI is highly upregulated after injury and reshapes matrix and cytoskeleton architecture to support an anticonstrictive remodeling effect. Such findings suggest an important role for PDI in lumen maintenance during vascular remodeling.