Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction

Background:

Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD).

Methods:

We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m⁻²), overweight (25–29.9 kg m⁻²), obese (30–39.9 kg m⁻²) and morbidly obese (⩾40 kg m⁻²). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD.

Results:

The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years.

Conclusions:

In patients with normal LVEF, higher BMI was independently associated with worsening DD.

Acute and chronic thoracic aortic disease: surgical considerations

Acute thoracic aortic aneurysm is one of the most life-threatening vascular disorders recognized to date. The majority of these aortic ruptures rapidly end in mortality, with 50% of patients suffering death before reaching the hospital. Thus, acute management through surgical intervention is often indicated, especially in cases of ascending aortic rupture. Physical examination is critical in making the diagnosis, as clinical signs and symptoms often vary depending on the location of the dissection. Clinicians should have a low threshold for including thoracic aortic dissection in their differential diagnosis, especially when a patient presents with acute onset chest or back pain. In this report, we discuss the different categories of aortic dissections and the current treatment modalities for each. These include endovascular aortic repair, which has become a viable treatment modality in certain cases of type B dissection. Offering a less invasive approach, the technique known as thoracic endovascular repair currently affords a treatment option to a patient population who would have otherwise been deemed non-surgical candidates. Hybrid thoracic endovascular aortic repair has also become a pertinent surgical technique, and successful outcomes have been demonstrated when it is employed to repair ascending aortic aneurysms. We also describe our Acute Aortic Treatment Center, a rapid multicentric triage system for the management of acute aortic pathologies, which has resulted in significant improvements in patient outcomes.

Primary brain tumours and specific serum immunoglobulin E: a case-control study nested in the European Prospective Investigation into Cancer and Nutrition cohort

BACKGROUND

Case-control studies suggest that patients with allergic diseases have a lower risk of developing glioma but not meningioma or schwannoma. However, those data can be differentially biased. Prospective studies with objective measurements of immunologic biomarkers, like immunoglobulin E (IgE), in blood obtained before cancer diagnosis could help to clarify whether an aetiological association exists.

METHODS

The present case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) measured specific serum IgE as a biomarker for the most common inhalant allergens in 275 glioma, 175 meningioma and 49 schwannoma cases and 963 matched controls using the ImmunoCAP specific IgE test. Subjects with an IgE level ≥0.35 kUA/l (kilo antibody units per litre) were classified as sensitized by allergens. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by adjusted conditional logistic regression models for each tumour subtype. The effect of dose-response relationship was assessed in five increasing IgE level categories to estimate P-values for trend.

RESULTS

The risk of glioma was inversely related to allergic sensitization (OR = 0.73; 95% CI 0.51-1.06), especially pronounced in women (OR = 0.53; 95% CI 0.30-0.95). In dose-response analyses, for high-grade glioma, the lowest OR was observed in sera with the highest IgE levels (P for trend = 0.04). No association was seen for meningioma and schwannoma.

CONCLUSION

The results, based on serum samples prospectively collected in a cohort study, provide some support for the hypothesis that individuals with allergic sensitization are at reduced risk of glioma and confirm results from previous case-control studies.

AFOMP Policy Statement No. 3: recommendations for the education and training of medical physicists in AFOMP countries

AFOMP recognizes that clinical medical physicists should demonstrate that they are competent to practice their profession by obtaining appropriate education, training and supervised experience in the specialties of medical physics in which they practice, as well as having a basic knowledge of other specialties. To help its member countries to achieve this, AFOMP has developed this policy to provide guidance when developing medical physicist education and training programs. The policy is compatible with the standards being promoted by the International Organization for Medical Physics and the International Medical Physics Certification Board.

Pilot study on the efficiency of the biostimulation with autologous plasma rich in platelet growth factors in otorhinolaryngology: otologic surgery (tympanoplasty type I)

When otologic procedures that involve tympanic membrane repairs are performed, biomaterials or biological tissues as normal as grafts are used. At the moment, biological material from the own patient is used with varying success rates. The procedure used and the patient's tissue repair capabilities tend to determine the outcome. We present a preliminary study on tympanic membrane perforation repairs using an autograft obtained by manipulating platelet degranulation and the coagulation cascade and reinforced with a seal using platelet growth factors. We present three cases in which we used this procedure. The results will be valued based on the tympanic perforation closure index. With this study, we want to assess the effectiveness of tympanic perforation repairs with this technically simple method. If this method was objectively proved to be effective, it would lead to lower patient morbidity and sanitary costs.

Cytotoxic effects of Argentinean plant extracts on tumour and normal cell lines

In the search for possible new anti-cancer agents, we investigated the effects of 75 aqueous and methanol extracts from 41 Argentinean plant species. The effect in cell growth was evaluated in the LM2 mammary adenocarcinoma cells. In a second stage, the highly active selected extracts were assayed in 3 other tumour cell lines: melanoma B16, bladder MB49 and lung A549; and 3 normal cell lines: mammary Hb4a and keratinocytes PAM212 and HaCat. Eight methanol extracts were found to be highly cytotoxic: Collaea argentina leaf, Iochroma australe leaf, Ipomoea bonariensis flower, Jacaranda mimosifolia flower, Solanum amygdalifolium flower, Solanum chacoense leaf, Solanum sisymbriifolium flower and Solanum verbascifolium flower. However, extract inhibition on cell growth was highly dependent on cell type. In general, except for the highly resistant cell lines, the inhibitory concentrations 50% were in the range of 10-150 μg/ml The eight extracts highly inhibited cell growth in a concentration-dependent manner, and in general the methanol extracts were always more active than the aqueous. Murine cells appear to be more sensitive than human cells to the cytotoxic action of the plant extracts. The human melanoma B16 line was the most resistant to four of the extracts. In terms of selectivity, S. verbascifolium was the species which showed most selectivity for tumour cells. Overall, this is one of the first studies focusing on southern South American native plants and their biological effects. Since some species of 5 genera analyzed have been reported to possess different degrees of alkaloid content, we examined microtubule structures after extract treatments. The eight extracts induced destabilization, condensation and aggregation of microtubules in LM2 cells, although no depolarization, typical of Vinca alkaloids damage was observed. In a near future, antitumour activity of purified fractions of the extracts administered at non-toxic doses will be assayed in transplantable murine tumour models.

Late-onset intestinal perforation in the setting of posttransplantation microangiopathy: a case report

Intestinal perforation in the setting of posttransplantation microangiopathy (TMA) is a very rare event and might be considered a terminal event of intestinal microangiopathy (i-TMA), a rather rarely recognized posttransplantation complication, as it overlaps with the more common intestinal graft-versus-host disease (GVHD). Cases of i-TMA described in literature occurred within with first 100 days posttransplantation or shortly thereafter. In this report, we describe a case of late-onset intestinal perforation that occurred in the setting of systemic microangiopathy more than a year after allogeneic transplantation. In our case, the patient poorly responded to treatment secondary to refractory mircoangiopathy.

In vivo fluctuation of Tax, Foxp3, CTLA-4, and GITR mRNA expression in CD4(+)CD25(+) T cells of patients with human T-lymphotropic virus type 1-associated myelopathy

HTLV-1 Tax expression exerts an inhibitory effect on the Foxp3 transcription factor in CD4(+)CD25(+) T-regulatory cells (Treg). For a better understanding of the role of Tax mRNA in the gene expression of cellular markers we measured Tax, Foxp3, CTLA-4, GITR, TGF-β, and IL-10 mRNA in Treg cells of 50 patients with human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP; 27 women and 23 men; mean age: 56.7 years). The control group consisted of 23 non-infected subjects (12 women and 11 men) with a mean age of 51.3 years. Real-time PCR was used to measure mRNA of Tax proteins and several cellular markers of Treg function. Determinations revealed a high level of Tax mRNA in HAM/TSP (124.35 copies/100 CD4(+)CD25(+) T cells). Foxp3, GITR, and CTLA-4 mRNA levels were lower in HAM/TSP patients (mean ± SD, 22.07 ± 0.78, 9.63 ± 0.36, and 4.54 ± 0.39, respectively) than in non-infected controls (47.15 ± 12.94, 22.14 ± 1.91, and 21.07 ± 2.31). Both groups had similar levels of TGF-β and IL-10. An inverse relationship was found between Tax levels and Foxp3, CTLA-4, and GITR levels. Conversely, there was a direct correlation between levels of Foxp3, GITR, and CTLA-4. Disease severity and evolution time did not correlate with Tax or Foxp3 levels. The present results suggest that Tax and Foxp3 mRNA vary with the same degree of disease severity in HAM/TSP patients. Tax fluctuations may affect CTLA-4 and GITR expression via the Foxp3 pathway, causing virus-induced dysfunction of CD4(+)CD25(+) T cells in HAM/TSP patients.

[Tuna (Thunnus thynnus) glazed with hydrocolloids as alternative of edible coatings and storaged at -10 degrees C]

Numerous studies have been focused to natural ingredients to maintain the quality and shell life of foods. Edibles coating, biodegradable ingredients, such as hydrocolloids and proteins can be used for coating fish with the purpose to suppress changes of quality during frozen storage. At the present time several developing of edibles packing, like glaze using hydrocolloids, (gelatin, carrageen, starch), that besides acts as protective film for food, they are economic, can be ingested by the consumer without toxicity risk, help to preserve organoleptics and nutritional characteristics of the product and, being biodegradable they contribute to the conservation of the atmosphere. The objective of the present study was to evaluate the incorporation ofhydrocolloids in the glazing tuna process as alternative of packing, to enhance its physical and chemical characteristics. Samples of tuna was glazed incorporating to its solutions of carrageen at 0.05, 0,1 and 0.15%, and gelatin at 0.5, 1%. The samples were shaped as square (15 cm3), frozen al -30 degrees C and glazed incorporating hydrocolloids submerging the sample its solutions at 0 degrees C by 30 seconds and storage at -10 degrees C by 0, 15 and 30 days. Proximal analysis results, soluble proteins, TBA, and color showed that all the samples glazed with hydrocolloids decrease deterioration of the tuna products respect to samples glazed without hydrocolloids; concluding that glazing adding hydrocolloids protects tuna for loss humidity and delays degradation of proteins. Moreover, carrageen shows to a better performance at the concentrations of 0.05% compared with the gelatin and the starch.

Lack of association of PTPN22, STAT4 and TRAF1/C5 gene polymorphisms with cardiovascular risk in rheumatoid arthritis

OBJECTIVES

To determine whether the PTPN22, STAT4 and TRAF1/C5 gene polymorphisms may be implicated in the development of cardiovascular (CV) events and subclinical atherosclerosis manifested by the presence of endothelial dysfunction or increased carotid intima-media thickness (IMT) in a series of Spanish patients with rheumatoid arthritis (RA).

METHODS

Six hundred and twelve patients fulfilling the 1987 American College of Rheumatology classification criteria for RA, seen at the rheumatology outpatient clinics of Hospital Xeral-Calde, Lugo, and Hospital San Carlos, Madrid, were studied. Patients were genotyped using predesigned TaqMan single nucleotide polymorphism genotyping assays. Moreover, between March and December 2007, a subgroup of unselected RA patients with no history of CV events was studied for the presence of subclinical atherosclerosis by the assessment of the endothelial function (n=126) and the carotid artery IMT (n=110) by ultrasonography studies.

RESULTS

No significant differences in the allele or genotype frequencies for the PTPN22, STAT4 and TRAF1/C5 gene polymorphisms between RA patients with or without CV events were found. It was also the case when we analysed the potential influence of the genotypes in the presence of endothelial dysfunction or increased carotid artery IMT of patients with RA.

CONCLUSIONS

Our results do not show that the PTPN22, STAT4 and TRAF1/C5 gene polymorphisms may confer a direct risk of CV disease in patients with RA.

Poloxamer 407 microspheres for orotransmucosal drug delivery. Part II: In vitro/in vivo evaluation

Aim of this research was to evaluate novel microspheres based on poloxamer 407, alone or in mixture with Gelucire(®) 50/13, as possible buccal delivery system for atenolol (AT). The microspheres have been prepared by spray congealing and investigated to assess AT in vitro delivery through cellulose membranes and ex vivo permeation using porcine buccal mucosa. The microparticles were tested as such or directly compacted to obtain tablets. For comparison the physical mixtures, tablets of the physical mixtures and an AT solution were examined. Finally, the microparticles were sublingually administered in rabbits to evaluate AT pharmacokinetics compared to a market oral tablet (reference). The AT release from microspheres through the synthetic membrane was delayed with respect to the drug solution, more markedly when microparticles contained poloxamer as unique adjuvant; this formulation enhanced AT transmucosal permeation. The enhancement effect of poloxamer was confirmed by the permeation experiments on the corresponding physical mixture. Tabletting hindered both release through cellulose membranes and transmucosal permeation of drug. In vivo studies revealed that the absolute bioavailability of microsphere formulations was higher than that of reference in spite of a lower dosage of drug, suggesting a possible dose reduction by AT microparticles orotransmucosal administration.

Metal-protein binding losses in proteomic studies by PAGE-LA-ICP-MS

Some experiments to study the influence of electrophoresis conditions and subsequent LA-ICP-MS (laser ablation-inductively coupled plasma mass spectrometry) determination of two metal-binding proteins with different metal-protein affinities (superoxide dismutase, containing Cu and Zn, and alcohol dehydrogenase, containing Zn) are performed. In metal-binding proteins with weak metal-protein affinities, metal losses can happen during electrophoretic separation. It has been demonstrated that the detection of these metals bound to the proteins depends, not only on the nature of the electrophoretic process (naturing or non-denaturing) and post-separation gel treatment, but also on the trailing ion chosen and current applied in the electrophoretic method used. Non-denaturing methods are preferred to denaturing ones in the case of alcohol dehydrogenase being BN-PAGE (Blue Native-Polyacrylamide Gel Electrophoresis) with the use of Tricine as trailing ion the most recommended method. The concentration obtained for Zn in ADH applying BN-PAGE-LA-ICP-MS was 2.6+/-0.30 mg g(-1) very close to the one obtained for ADH solution by ICP-MS (3+/-0.23 mg g(1)). For superoxide dismutase either denaturing or non-denaturing electrophoresis conditions can be used, but a denaturing method based on the use of Tricine as trailing ion is recommended to preserve metals-protein binding when the use of non-denaturing conditions must be avoided. The found concentration for Cu and Zn in SOD after applying SDS-Tris-Tricine-PAGE-LA-ICP-MS was 2.5+/-0.33 and 2.4+/-0.37 mg g(-1) respectively, more or less close (especially for Cu) to the one obtained in SOD solution by ICP-MS (3+/-0.21 and 3.7+/-0.32 mg g(-1) for Cu and Zn). We observe that as higher current is applied the possibility of metal-protein binding losses is higher. In all cases staining of the gel prior to LA-ICP-MS is not recommended.

Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes

BACKGROUND

Bariatric surgery is associated with the rapid improvement of type 2 diabetes (T2DM). Here we report an exploratory trial of a completely endoscopic, removable, duodenal-jejunal bypass liner (DJBL) intended to treat T2DM.

METHODS

Obese T2DM subjects were randomized to receive a DJBL (n = 12) or sham endoscopy (n = 6) in a 24-week study, extended up to 52 weeks. Measurements included weights, hemoglobin A1c (HbA(1c)), meal tolerance testing, fasting glucose, and seven-point glucose profiles. Subjects' diets were adjusted in the first 2 weeks to obtain similar weight loss during this period.

RESULTS

Subjects had baseline HbA(1c) of 9.1 +/- 1.7% and body mass index of 38.9 +/- 6.1 kg/m(2) (+/- SD). In the completer population by week 1, change in fasting glucose in the DJBL arm was -55 +/- 21 mg/dL versus +42 +/- 30 mg/dL in the sham arm (P < or = 0.05; +/- SE); the seven-point glucose profiles were reduced in the DJBL arm but not in the sham arm. Mean postprandial glucose area under the curve was reduced in the DJBL arm by 20% and increased 17% in the sham arm (P = 0.016). At week 12, HbA(1c) change was -1.3 +/- 0.9% in the DJBL arm and -0.7 +/- 0.4% in the sham arm (P > 0.05), and at 24 weeks, values were -2.4 +/- 0.7% in the DJBL arm and -0.8 +/- 0.4% in the sham arm (P > 0.05). Device migrations required endoscopic removal prior to reaching 52 weeks.

CONCLUSIONS

The DJBL rapidly normalized glycemic control in obese T2DM subjects, a promising development in the search for novel therapies less invasive than bariatric surgery.

Low levels of endothelial progenitor cells correlate with disease duration and activity in patients with Behçet's disease

OBJECTIVES

We tested whether Behçet's disease (BD) is characterized by alterations of circulating endothelial progenitor cells (EPCs),which are involved in vascular homeostasis and repair.

METHODS

We enrolled 30 BD patients and 27 matched healthy controls. EPCs were defined and measured by flow cytometry according to the expression of CD34, CD133 and KDR.

RESULTS

We show that BD patients had significantly lower levels of CD34+KDR+ and CD34+CD133+KDR+ EPCs than controls. We found significant negative correlations between EPC phenotypes and BD duration, while there were positive correlations between CD34+KDR+ EPCs and both BD activity scores and C-reactive protein. The lower EPC levels with increasing disease duration was shown in univariate analysis and in multivariable analysis adjusted for possible confounders.

CONCLUSION

This is the first report that BD is associated with progressive EPC decline. Reduction of EPCs may represent a mechanism of induction and/or progression of vascular injury in these patients.

Dhat Syndrome: A Systematic Review

Background:

Dhat syndrome is a widely recognized clinical condition from the Indian subcontinent characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. This condition has been considered to be a culture-bound syndrome, and may be considered to be a culturally manifestation of depression or anxiety.

Aims:

The purpose of this paper was to perform a systematic review of published literature on Dhat syndrome.

Methods:

A review of the literature on Dhat syndrome until July 2008, without any language restriction was conducted by a search of the MEDLINE and PsycLIT indexing services using the following key words:Dhat syndrome, semen loss anxiety and loss of semen syndrome. Inclusion criteria were any case-control or cross-over study.

Results:

Twenty-three studies were identified, of which 10 met the inclusion criteria. There were 8 cross-over and 2 case-control studies. The reviewed studies included a total number of 680 cases and 93 controls. Patients included in these studies were mostly unmarried, young males (25.4 years old;18-45 years) from a poor socio-economic status. Majority of the studies involved patients from the Indian subcontinent. Some studies reported concomitant depressive symptoms (50%), anxiety (40%), fatigue (30%) and sexual problems (40%). Only 4 studies reported information about treatment (psychotherapy and pharmacotherapy).

Conclusions:

There was a high degree of heterogeneity among the studies reviewed. In conclusion, Dhat syndrome appears to be commonly associated with depression, anxiety and somatic symptoms. More studies are warranted related to the various treatment approaches for this condition.

Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery

BACKGROUND

The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss.

METHODS

In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD.

RESULTS

Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p < 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted.

CONCLUSION

The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.

Medical physics aspects of cancer care in the Asia Pacific region

Medical physics plays an essential role in modern medicine. This is particularly evident in cancer care where medical physicists are involved in radiotherapy treatment planning and quality assurance as well as in imaging and radiation protection. Due to the large variety of tasks and interests, medical physics is often subdivided into specialties such as radiology, nuclear medicine and radiation oncology medical physics. However, even within their specialty, the role of radiation oncology medical physicists (ROMPs) is diverse and varies between different societies. Therefore, a questionnaire was sent to leading medical physicists in most countries/areas in the Asia/Pacific region to determine the education, role and status of medical physicists.Answers were received from 17 countries/areas representing nearly 2800 radiation oncology medical physicists. There was general agreement that medical physicists should have both academic (typically at MSc level) and clinical (typically at least 2 years) training. ROMPs spent most of their time working in radiotherapy treatment planning (average 17 hours per week); however radiation protection and engineering tasks were also common. Typically, only physicists in large centres are involved in research and teaching. Most respondents thought that the workload of physicists was high, with more than 500 patients per year per physicist, less than one ROMP per two oncologists being the norm, and on average, one megavoltage treatment unit per medical physicist.There was also a clear indication of increased complexity of technology in the region with many countries/areas reporting to have installed helical tomotherapy, IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy), Gamma-knife and Cyber-knife units. This and the continued workload from brachytherapy will require growing expertise and numbers in the medical physics workforce. Addressing these needs will be an important challenge for the future.

Levels and distribution of DDT in the Cinca River (Spain)

The evolution over time of the levels and distribution of dichlorodiphenyltrichloroethane (DDT) in water, surface sediments, and fish from the River Cinca (Spain), a tributary of the River Ebro, during the period 1999 to 2004, was investigated by means of gas chromatography coupled with mass spectrometry. The sampling site corresponded to a point downstream from Monzón, a heavily industrialized town with drainage into the river. This river has historically been a source of emissions of DDT and its metabolites. The highest levels were found in 1999 and 2000, although the concentrations of organic compounds in sediments and fish have decreased since then. The levels of DDT in water were below the quantification limit during the period of study. The average composition of DDT isomers measured in sediments and fish showed the prevalence of p,p'-DDE, the product of aerobic degradation of p,p'-DDT. Concentrations in fish were compared with sediment samples, and high quotients indicate that they are highly bioavailable.

Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair

The aims of the echocardiographic substudy of this multicenter trial were to evaluate the use of quantitative assessment of mitral regurgitation (MR) severity using serial echocardiography and to assess the efficacy of percutaneous mitral valve repair. Previous surgical repair studies did not use quantitative echocardiographic methods. Results of a percutaneous mitral valve repair clip device in a core echocardiographic laboratory were evaluated. Published parameters for quantifying MR were used in a systematic protocol to qualify patients for study entry and evaluate treatment efficacy at discharge and 6 months after clip repair. Baseline results were presented for 55 patients, and follow-up results, for 49. Ninety-eight percent of required echocardiographic studies were submitted to the core laboratory, and >85% of required measurements were possible. At baseline, mean regurgitant volume was 54.8 +/- 24 ml, regurgitant fraction was 46.9 +/-16.2%, effective regurgitant orifice area was 0.71 +/- 0.40 cm(2), and vena contracta width was 0.66 +/- 0.20 cm. Based on a severity scale of 1 to 4, mean color flow grade was 3.4 +/- 0.7, and mean pulmonary vein flow was 2.8 +/- 1.2. In patients with a clip at 6 months, all measurements of MR severity were significantly decreased versus baseline, with mean regurgitant volume decreased from 50.3 to 27.5 ml (change -22.8 ml; p <0.0001), regurgitant fraction from 44.6% to 28.9% (change -15.7%; p <0.0001), color flow grade from an average of 3.4 to 1.8 (change -1.6; p <0.0001), and pulmonary vein flow from 2.8 to 1.8 (change -1.0; p <0.0018). In conclusion, quantitative assessment of MR is feasible in a multicenter trial, and percutaneous mitral repair with the MitraClip produces a sustained decrease in MR severity to moderate or less for > or =6 months.

Cytokine gene polymorphisms in Colombian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) patients exhibit alterations in cytokine production that may be relevant to SLE pathogenesis. There is evidence that cytokine gene polymorphisms control cytokine production; thus, these polymorphisms may be associated with SLE or its clinical manifestations. To establish the association of tumor necrosis factor alpha (TNF-alpha), transforming growth factor (TGF) beta1, interleukin (IL)-10, and IL-6 gene polymorphisms in Colombian SLE patients and their clinical manifestations, 120 SLE patients and 102 healthy controls were studied. Single nucleotide polymorphisms were studied by sequence-specific primers polymerase chain reaction (SSP-PCR) at: TNFalpha-308 (G/A), TGFbeta1 codon 10 (C/T) and codon 25 (G/C), IL-10 -1082 (G/A), -819 (C/T) and -592 (C/A), and IL-6 + 174 (G/C). Human leukocyte antigen (HLA)-DRbeta1 was typed by SSP-PCR. SLE patients had increased frequency of allele C at TGFbeta1 codon 25 (P = 0.0001, odds ratio (OR): 4.25, 95% confidence interval (CI): 2.17-8.35) and allele A at TNFalpha-308 (P = 0.0004 OR: 3.9, 95% CI: 1.65-5.80) compared with healthy controls. There was higher frequency of GC genotype at TGFbeta1 codon 25 in SLE patients (P < 0.0001). Extended genotypic analysis showed that SLE patients have decreased frequency of TNFalphaLow/TGFbeta1High (0.50) compared with healthy controls (0.80) (P < 0.0001). No association was found between these polymorphisms and SLE clinical manifestations except for Sm and Ro autoantibodies that were associated with TNFalpha allele A. There is an association between TNFalpha-308A/TGFbeta1 codon 25C with SLE susceptibility in Colombian population. This association may result in a highly inflammatory response with a decrease regulatory function mediated by TNFalpha and TGFbeta1, respectively. The TNFalpha-308A/TGFbeta1 25C genotype may be one component of genetic susceptibility to SLE in Colombian population.

Absorption, metabolism, and excretion of 14C gimatecan (LBQ707) after oral administration in patients with advanced cancer

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Background: Gimatecan (Gim), a new potent oral topoisomerase I inhibitor is a lipophilic 7-oxyiminomethyl derivative of camptothecin. Its in vitro cytoxicity is more sustained than CPT-11 and topotecan, it has excellent anti-tumor activity in mouse xenografts, and shown good tolerability with Ph I activity. The study aim was to profile its disposition in cancer patients. Methods: 4 patients with advanced cancer received a single oral 1.5 mg dose of [14C] Gim (60 μCi) followed by standard Gim treatment on Day 15. Whole blood, plasma, urine, and feces were collected over 7 days with spot fecal collections up to Day 19. Total radioactivity was measured by liquid scintillation counting. Gim and metabolite concentrations in plasma and excreta were measured by LC- MS/MS and HPLC with radiometric detection. Results: Gim showed a rapid first-order absorption and a long elimination phase and was well tolerated. The median (range) Tmax for Gim was 1 h (0.5 to 3 h) and mean t1/2 and oral clearance values were 91 h and 0.6 L/h, respectively. Gim was the major moiety and its active metabolite LCF775 (t-butyl-mono-hydroxy Gim) was the main metabolite (albeit minor, 2–9%) in plasma. Trace glucuronide and sulfate metabolites were also detected in plasma. Mean recovery of radioactivity in urine (0-Day 7) and feces (0-Day 11) was 70.5 % (56.2–80.0%) of the dose. Incomplete recovery is attributed to opiates use in 2 patients and incomplete (sporadic) fecal sampling at later timepoints. Fecal excretion (0-Day 11) was prolonged and major in 3/4 patients (46- 73% of the dose, of which 14–23% is the unchanged Gim suggesting the drug is well absorbed). An additional 1.3–3.5% was recovered in spot collections (Days 14, 15 and 19). Urine excretion (0-Day 7) was 7.2–10.3% of the dose in 3 patients, one patient (cachectic, on opiates) excreted only 21% in feces and 46% in urine. Gim and several Gim metabolites (and glucuronide conjugates thereof) were the major components in excreta. Conclusions: Gim and its minor metabolite, LCF775 were the principal pharmacologically active components in plasma. Fecal excretion is the main elimination pathway in most patients. A long half-life (90hr) of Gim, uncomplicated metabolism, and good oral absorption make Gim an attractive candidate for Ph II development.

[Table: see text]

Mosaic structure of foot-and-mouth disease virus genomes

The results of a simple pairwise-scanning analysis designed to identify inter-serotype recombination fragments, applied to genome data from 156 isolates of Foot-and-mouth disease virus (FMDV) representing all seven serotypes, are reported. Large numbers of candidate recombinant fragments were identified from all parts of the FMDV genome, with the exception of the capsid genes, within which such fragments are infrequent. As expected, intertypic fragment exchange is most common between geographically sympatric FMDV serotypes. After accounting for the likelihood of intertypic convergence in highly conserved parts of the FMDV genome, it is concluded that intertypic recombination is probably widespread throughout the non-structural genes, but that recombination over the 2B/C and 3B/C gene boundaries appears to be less frequent than expected, given the large numbers of recombinant gene fragments arising in these genes.

Chylous pericardial effusion after minimally invasive mitral valve repair

We would like to report the first case of chylous pericardial effusion after thymus gland injury in a middle-aged patient who underwent minimally invasive mitral valve surgery, and outline the surgical approach to manage this condition.