Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99m single-photo emission CT

We compared coronary dual-source computed tomography angiography (corDSCTA) with technetium-99m single-photon emission computed tomography (SPECT) for the detection of myocardial perfusion abnormalities. Fifty-five consecutive patients underwent both gated myocardial perfusion SPECT and corDSCTA, the latter during a single arterial-phase injection of contrast agent. The perfusion defects visualised by corDSCTA correlated with the findings of rest/stress SPECT. Abnormal findings on stress SPECT, which were due to either ischaemia or infarct, were found in 24 patients. In comparison to SPECT at rest, corDSCTA detected perfusion defects with a sensitivity and specificity of 100% and 78%, respectively. Compared to SPECT at stress, the sensitivity and specificity values of corDSCTA were 83.3% and 90.3%, respectively. On corDSCTA , the average attenuation values of perfusion defects that corresponded to chronic infarcts (-8.5+/-22.2 HU) were significantly lower (p = 0.002) than those of non-infarct-related perfusion defects (43.1+/-17.5 HU). Using rest/stress SPECT is the gold standard for the diagnosis of myocardial ischaemia, corDSCTA was able to diagnose ischaemic disease (defined as the presence of high-grade stenotic CAD (>or=50% luminal narrowing)) with a sensitivity and specificity of 59% and 89%, respectively, in patients with no known history of myocardial infarction (n = 4). Thus, corDSCTA may serve as a diagnostic tool for the detection of perfusion abnormalities (first) visualised by SPECT. There appears to be a limited correlation between coronary stenotic disease and SPECT findings.

Factors affecting β-ODAP content in Lathyrus sativus and their possible physiological mechanisms

A neuroexcitatory non-protein amino acid, β-N-oxalyl-L-α,β-diaminopropionic acid (β-ODAP), present in the seeds of the hardy legume crop grass pea (Lathyrus sativus L.), was considered responsible for human lathyrism. The levels of β-ODAP were reported to vary in different tissues during plant development, and to be affected by a wide range of environmental stresses. In this paper, dynamic changes in β-ODAP level at specific stages of plant development as well as the influences of various environmental factors, including nutrient deficiency, drought, salinity, toxic heavy metals, and Rhizobium symbiosis on β-ODAP levels were analyzed, highlighting the relationship between changes in β-ODAP concentrations and Rhizobium growth. Possible mechanisms underlying β-ODAP accumulation are proposed and future research is suggested.

Could a loss of memory T cells limit responses to hepatitis C virus (HCV) antigens in blood leucocytes from patients chronically infected with HCV before and during pegylated interferon-alpha and ribavirin therapy?

The proportions and activation status of T cells may influence responses to hepatitis C virus (HCV) and treatment outcome in patients receiving pegylated interferon (IFN)-alpha/ribavirin therapy. We confirmed that IFN-gamma enzyme-linked immunospot (ELISPOT) responses to HCV are poor in HCV patients and showed that responses to HCV and cytomegalovirus (CMV) antigens decrease during therapy. This was most apparent in patients with sustained virological response (SVR). Baseline frequencies of CD4+ effector memory (TEM) T cells were lower in SVR than non-SVR. Proportions of CD4+ and CD8+ TEM and terminally differentiated effector memory (TEMRA) T cells declined on therapy in SVR, as did proportions of Fas+ CD8+ TEMRA T cells. Baseline frequencies of programmed death (PD)-1-expressing CD4+ TEM and TEMRA T-cells were higher in SVR. Therapy increased percentages of PD-1+ CD4+ central memory (TCM) T cells and PD-1+ CD8+ TEM and TEMRA T cells in SVR. We conclude that successful therapy depletes circulating antigen-specific CD4+ T cell responses. This paralleled decreases in proportions of effector memory T cells and higher percentages of CD4+ TCM T cells expressing PD-1.

Early Diagnosis of Acute Myocardial Infarction by Bedside Multimarker Test at an Emergency Department in Hong Kong

Introduction

Cardiac biomarker measurement can aid diagnosis of acute myocardial infarction. The present study evaluates the efficacy and efficiency of point-of-care multimarkers measurement of myoglobin, creatine kinase (CK-MB) and troponin in identifying patients with acute myocardial infarction.

Method

We prospectively enrolled consecutive patients (N=105) in the emergency department who were being evaluated for possible acute myocardial infarction. Point-of-care testing (POCT) of myoglobin, CK-MB and troponin I (TnI) was performed in all patients. Central laboratory measurement of troponin I was also performed simultaneously. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and receiver operating characteristic (ROC) curve were evaluated.

Result

The specificity and positive likelihood ratio of TnI (POCT) and TnI (laboratory) were 98%, 13.0 and 98%, 21.8 respectively. The areas under curve of the ROC curve of TnI (POCT) and TnI (laboratory) were 0.692 and 0.725 respectively.

Conclusion

A high positive likelihood ratio for acute myocardial infarction through point-of-care testing can help timely diagnosis and just-in-time appropriate management for patients presenting with chest pain.

Preoperative and intraoperative risk factors for prolonged intensive care unit stay after aortic arch surgery

OBJECTIVE

The present study was performed to evaluate preoperative and intraoperative risk factors for prolonged intensive care unit (ICU) stay after aortic arch surgery.

DESIGN

A retrospective study. Prolonged ICU stay was defined as >5 days (120 hours).

SETTING

Cardiovascular operating rooms and the ICU.

PARTICIPANTS

Adults requiring aortic arch surgery with deep hypothermic circulatory arrest plus antegrade selective cerebral perfusion.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

After 11 patients who underwent 1-stage total or subtotal aortic replacement were excluded, 298 patients were enrolled in the study. The average age of patients was 44.9 +/- 10.7 years with male predominance (74.8%). Sixty-one patients (20.5%) stayed longer than 5 days in the ICU. Univariate analyses found age, body mass index, New York Heart Association classification, preoperative serum creatinine, creatinine clearance, emergency, inotropes, cardiopulmonary bypass time, myocardial ischemia time, and fresh-frozen plasma transfused intraoperatively were significantly associated with prolonged ICU stay (p < 0.05). Independent risk factors for prolonged ICU stay were found to be New York Heart Association classification (class III and IV), emergency, inotropes used intraoperatively, and prolonged cardiopulmonary bypass time (p < 0.05).

CONCLUSION

The authors identified 4 preoperative and intraoperative risk factors for prolonged ICU stay. This is helpful to identify patients with increased risk for prolonged ICU stay, implement specific strategies, and allocate medical resources.

Comparative responses in rare minnow exposed to 17beta-estradiol during different life stages

Present in the excrement of humans and animals, 17beta-estradiol (E(2)) has been detected in the aquatic environment in a range from several nanograms to several hundred nanograms per liter. In this study, the sensitivities of rare minnows during different life stages to E(2) at environmentally relevant (5, 25, and 100 ng l(-1)) and high (1000 ng l(-1)) concentrations were compared using vitellogenin (VTG) and gonad development as biomarkers under semistatic conditions. After 21 days of exposure, VTG concentrations in whole-body homogenates were analyzed; the results indicated that the lowest observed effective concentration for VTG induction was 25 ng l(-1) E(2) in the adult stage, but 100 ng l(-1) E(2) in the larval and juvenile stages. After exposure in the early life stage, the larval and juvenile fish were transferred to clean water until gonad maturation. No significant difference in VTG induction was found between the exposure and control groups in the adults. However, a markedly increased proportion of females and appearance of hermaphrodism were observed in the juvenile-stage group exposed to 25 ng l(-1) E(2). These results showed that VTG induction in the adult stage is more sensitive than in larval and juvenile stages following exposure to E(2). The juvenile stage may be the critical period of gonad development. Sex ratio could be a sensitive biomarker indicating exposure to xenoestrogens in early-life-stage subchronic exposure tests. The results of this study provide useful information for selecting sensitive biomarkers properly in aquatic toxicology testing.

Radiosensitization effect of luteolin on human gastric cancer SGC-7901 cells

The radiosensitizing effects of luteolin were studied in the gastric cancer cell line SGC-7901. SGC-7901 cells were treated with luteolin or/and irradiation, and radiosensitizing effects were assessed by colony-forming assay with cells and nude mice. In order to study the underlying mechanism, the levels of apoptosis-related proteins, the activities of caspase-3 and -9, and the production of PGE2 were measured. The results showed that luteolin could enhance irradiation-induced colonogenic inhibition and the activities of Caspase-3 and -9. The remarkable down-regulation of Bcl-2 and release of cytochrome C were also observed. In addition, significantly reduced production of PGE(2) was observed in luteolin plus radiation treatment by ELISA, as well as decreased expression levels of VEGF and HIF-1 alpha. Finally, luteolin significantly enhances the radioresponse of human tumors transplanted into nude mice. Our results indicate that luteolin may be a promising radiosensitizer for use in the treatment of gastric cancer.

Simultaneous occurrence of structure-directed and particle-resonance-induced phononic gaps in colloidal films

We report on the observation of two hypersonic phononic gaps of different nature in three-dimensional colloidal films of nanospheres using Brillouin light scattering. One is a Bragg gap occurring at the edge of the first Brillouin zone along a high-symmetry crystal direction. The other is a hybridization gap in crystalline and amorphous films, originating from the interaction of the band of quadrupole particle eigenmodes with the acoustic effective-medium band, and its frequency position compares well with the computed lowest eigenfrequency. Structural disorder eliminates the Bragg gap, while the hybridization gap is robust.

Non-invasive prediction of the degree of liver fibrosis in patients with hepatitis C using an ultrasound contrast agent. A pilot study

It has been shown that the severity of hepatic fibrosis in patients with hepatitis C can be predicted non-invasively by measuring intrahepatic circulatory time (IHCT) using a microbubble agent with spectral Doppler analysis. The aim of this study was to assess whether this technique is reproducible using a third-generation microbubble agent and contrast harmonic imaging, which are becoming the standard ultrasound techniques in all radiology departments. Twenty-three untreated patients with hepatitis C, who had undergone a recent liver biopsy, were studied prospectively. Based on their histological fibrosis score, patients were divided into four groups (fibrosis levels 1-4). Contrast harmonic imaging was carried out after an intravenous bolus of a microbubble agent (Optison; Amersham Health, Milwaukee, WI, USA). IHCT was calculated by measuring the difference between the hepatic vein and hepatic artery microbubble arrival times. The IHCT was compared with the degree of fibrosis. Significant differences were shown between the groups for IHCT. There were significant differences between fibrosis levels 1 and 3 and between fibrosis levels 1 and 4. This study has shown that calculation of IHCT using a third-generation microbubble agent and contrast harmonic imaging can differentiate mild fibrosis from more severe degrees of fibrosis in patients with hepatitis C.

Phonon dispersion and nanomechanical properties of periodic 1D multilayer polymer films

We report on the first systematic study of phonon propagation in nanostructured composite polymer multilayer films as a function of periodicity and composition using Brillouin light scattering and numerical simulations. The high sensitivity of phonon dispersion to structure and composition allows the probing of the mechanical properties down to the single-layer level. We observe a strikingly different dependence of the longitudinal and shear moduli on confinement effects in the polymer nanolayers. In addition, temperature dependent measurements of sound velocities reveal the presence of distinct glass transition temperatures, indicative of phonon localization in films with large layer thicknesses in agreement with theoretical predictions.

Small-for-size syndrome secondary to outflow block of the segments V and VIII anastomoses--successful treatment with trans-splenic artery embolization: a case report

Despite the rapid expansion of living donor liver transplantation (LDLT) in the adult population over the last few years, small-for-size syndrome (SFSS) has emerged as an important clinical problem. We have herein reported a patient who developed clinical evidence of prolonged cholestasis and intractable ascites after a small-for-size right lobe LDLT. The SFSS was attributed to outflow block of segments V and VIII anastomoses with severe portal overperfusion injury. It was successfully treated by reduction of portal pressure and blood flow after trans-splenic arterial ligation. We recommend that trans-splenic artery embolization, a technically simple procedure, be applied to treat portal overperfusion injury in SFSS.

Inflammatory myofibroblastic tumor of the bladder in children: what can be expected?

Inflammatory myofibroblastic tumor of the bladder is an uncommon condition of unknown neoplastic potential. In adults the tumor is seen in association with instrumentation of the lower genitourinary tract, while in children it appears to run an idiopathic course. Its clinical and radiological presentation in children resembles sarcoma. The case of a 10-year-old girl with inflammatory myofibroblastic tumor is presented, outlining the histological and immunhistochemical features to allow differentiation between sarcomas, the most important differential diagnosis. An outcome meta-analysis of the literature identified 35 cases of inflammatory myofibroblastic tumor in the bladder of children. Conservative surgery is the strategy of choice. There is no evidence of recurrence or metastasis at a median follow up of 1.5 years.

Impairment of Na(+),K(+)-ATPase in CD95(APO-1)-induced human T-cell leukemia cell apoptosis mediated by glutathione depletion and generation of hydrogen peroxide

Human T-cell leukemia is a malignant disease that needs various regimens of cytotoxic chemotherapy to overcome drug resistance. Recently, Na(+),K(+)-ATPase has emerged as a potential target for cancer therapy. However, its exact signaling pathway in human T-cell leukemia cell death has not been well defined. In the current study, we found CD95(APO-1) was able to trigger the internalization of plasma membrane Na(+),K(+)-ATPase in Jurkat cells or primary T cells as a mechanism to suppress its activity. This internalization was closely relevant to intracellular glutathione (GSH) depletion in Jurkat cells downstream of Fas-associated death domain protein (FADD) and caspase 8. GSH depletion in Fas L-treated Jurkat cells induced the generation of hydrogen peroxide (H(2)O(2)), which subsequently increased the serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit. Exogenous H(2)O(2) even mimicked the effect of Fas L to upregulate the serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit and suppress Na(+),K(+)-ATPase activity. Overall, our results indicate that CD95(APO-1) induces the FADD- and caspase 8-dependent internalization of Na(+),K(+)-ATPase through intracellular GSH loss, and the subsequent generation of H(2)O(2)-mediated serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit. Taken together, this study presents a novel regulatory mechanism of Na(+),K(+)-ATPase in CD95(APO-1)-mediated human T-leukemia cell apoptosis.

T helper cell population and eosinophilia in nasal polyps

OBJECTIVE

To analyze the immunological pattern of nasal polyposis in patients with and without allergy, the percentages of CD4+ cells expressing intracellular interferon-gamma and interleukin-4 (T helper [T(H)] type 1 and 2 cells) were measured by flow cytometry in samples from patients with nasal polyps.

METHODS

Samples from 32 patients (16 atopic, 16 nonatopic) were studied. The fresh nasal polyp samples were prepared in single cell suspension for flow cytometry. Eosinophils were counted in hematoxylin-and-eosin-stained sections of all the samples.

RESULTS

T(H)1 cells were predominant in all the nasal polyps, with no significant differences in the mean (+/-SD) percentages of T(H)1 cells between the 2 groups (46.28% +/- 14.95% vs 38.25% +/- 9.16%, P > .05). The mean percentage of T(H)2 cells in the polyps from the atopic patient group was significantly greater than in polyps from nonatopic group (7.34% +/- 2.54% vs 0.63% +/- 0.31%, respectively; P < .01); the eosinophil count was significantly higher in atopic patient polyp samples (54.5 +/- 15.76 eosinophils/HPF) than in nonatopic ones (14.38 +/- 5.6 eosinophils/HPF, P < .01). The mean percentage of T(H)1 cell correlated with eosinophil count in the polyp samples overall (r = 0.80, P < .01).

CONCLUSIONS

T(H)1 cells were predominant in nasal polyp tissue. Polyps from atopic patients had more T(H)2 cells and eosinophils than nonatopic patients' polyps did. Eosinophil recruitment in nasal polyposis is probably associated with T(H)2 cell infiltration. Nonatopic and atopic patients' polyps have different immunological patterns.

Temperature During Cardiopulmonary Bypass: The Discrepancies Between Monitored Sites

We performed studies in patients to determine whether temperature recordings from sites commonly monitored during hypothermic cardiopulmonary bypass adequately reflect cerebral temperature. In Study I (n = 12), temperatures monitored in the jugular bulb (JB) were compared with those recorded in the nasopharynx, esophagus, bladder, and rectum. In Study II (n = 30), temperature was also monitored in the arterial outlet of the membrane oxygenator. A calibrated recorder continuously and simultaneously recorded all temperatures. Study I found large temperature discrepancies between the JB and all other body sites during cooling and rewarming. There was considerable interindividual variability in the degree of discrepancy between the JB and other sites. Study II produced similar results but also showed that JB temperature reached equilibration with the temperature of blood entering the patient via the arterial outlet of the membrane oxygenator after cooling for 3.3 +/- 1.3 min and after rewarming for 16.5 +/- 5.5 min. Analysis of variance revealed that this arterial outlet site had the smallest average discrepancy of all temperature sites relative to the JB site (P < 0.001). In summary, temperatures measured in body sites over-estimated JB temperature during cooling and under-estimated it during rewarming, whereas arterial outlet blood temperature provided a good approximation.

Pegylated liposomal doxorubicin and platinum in patients with advanced ovarian cancer in late relapse (>6 months)

15035

Background: Platinum and doxorubicin have different mechanisms of action, show no cross-resistance, and their toxicities do not overlap. Because pegylated liposomaI doxorubicin (Lipo-Dox was manufactured by TTY Biopharm Company Ltd. in Taiwan) appears to be a promising form of delivering doxorubicin with decrease of some of the most problematic toxicities, a combination with platinum should be assessed. Methods: An open-label, non-comparative, single center phase II clinical trial. Eligible patients must have histologically proven advance ovarian cancer with two-dimensioned measurable disease or evaluable disease (defined as CA-125 ≥ 40 U/ml), who have been treated with one or two previous platinum- and taxane-based regimen. All patients will hospitalize for 24 hours for treatment. The dose of platinum is fixed (cisplatin at 75 mg/m2 or carboplatin at AUC=5) on D1 and the initial dose of pegylated liposomaI doxorubicin (Lipo-Dox) is 35 mg/m2 on D2 at a 4-week interval. Results: Twenty patients were enrolled from July 2002 to January 2004 and follow up until June 2004. All eligible patients are assessable for response and toxicity. The overall response rate was 80%. Of the 20 patients eligible for response evaluation, 10 (50%) patients had a complete response, 6 (30%) had partial response, 3 (15%) were with stable disease, and 1 (5%) showed progressive disease. An overall response (OR) was achieved in 80% of patients. In patients achieving an OR based on WHO criteria, median CA125 levels declined from 142 U/ml (range, 13–3670 U/ml) during the baseline to 26.5 U/ml (range, 5–375 U/ml) during the last cycle. Median time to response was 65 days (range, 12–188 days). Median duration of response was 471 days (range 146–1085 days). Furthermore, the median time to progression was 481 days (range, 138–1136 days). The main toxicity was myelosuppression, with grade 3 and 4 neutropenia in 3 patients, anemia in 4 patients, and leukopenia in 2 patients. Conclusions: Based on effectiveness and toxicity advantages, the combination of pegylated liposomaI doxorubicin (Lipo-Dox) and platinum should be considered in patients with advanced ovarian cancer in late relapse.

No significant financial relationships to disclose.

Basal Blood Flow in Complex Regional Pain Syndrome Does Not Necessarily Indicate Vasoconstrictor Nerve Activity

OBJECTIVES

To quantitatively investigate simultaneous skin blood flow and sweating in a patient with complex regional pain syndrome.

METHOD

Using one probe, skin blood flow and sweating were measured on the affected and non-affected sides at baseline and after activation of sympathetic system in a 47-year-old woman with complex regional pain syndrome type I of the left hand.

RESULTS

Basal sweating, sympathetic sweat response, basal blood flow, sympathetic flow response, and attrition rate of blood flow (the ratio of sympathetic flow response to basal blood flow) of the affected side were greater than those on the non-affected side.

CONCLUSIONS

Although sympathetic nerve activity (sympathetic flow response) appeared greater on one side, basal blood flow was also greater on that side. These contradictory results suggest that some factor or factors increase basal blood flow despite a higher sympathetic nerve tone on the side. Comparing basal blood flow on one side to the contralateral side does not necessarily indicate lesser vasoconstrictor nerve activity on that side. Advantages of simultaneous measurement of skin blood flow and sweating with a single probe may make the method useful.

The spectrum of vibration modes in soft opals

Numerous vibrational modes of spherical submicrometer particles in fabricated soft opals are experimentally detected by Brillouin light scattering and theoretically identified by their spherical harmonics by means of single-phonon scattering-cross-section calculations. The particle size polydispersity is reflected in the line shape of the low-frequency modes, whereas lattice vibrations are probably responsible for the observed overdamped transverse mode.

Effect of monoenergetic neutron irradiation on the postnatal development of the cochlea in C3H/HeN mice

To investigate the toxic effect of neutrons at energies of approximately 1MeV on the ear, we exposed 7-day-old mice to 1.0 Gy of monoenergetic neutrons (1.026 MeV) or (137)Cs gamma rays, and assessed subsequent morphological changes in the inner ear by light and scanning electron microscopy. Monoenergetic neutrons, but not gamma rays, caused acute changes in the ear. The epithelium of the greater epithelial ridge in the organ of Corti had disappeared by 72 hr post-irradiation, as a result of epithelial apoptosis observed 6 hr post-irradiation. Radiation could induce apoptotic cell death of the epithelium of the greater epithelial ridge at 3 or 4 days of age. Protruding structures were detected on the surface of the hair cells by 72 hr post-irradiation. The neutron-irradiation also caused the apoptotic cell death of epithelial cells at the nasal conchae, and subsequent acute otitis media continued until 10 weeks of age.

Reaching the nonlinear regime of Raman amplification of ultrashort laser pulses

The intensity of a subpicosecond laser pulse was amplified by a factor of up to 1000 using the Raman backscatter interaction in a 2 mm long gas jet plasma. The process of Raman amplification reached the nonlinear regime, with the intensity of the amplified pulse exceeding that of the pump pulse by more than an order of magnitude. Features unique to the nonlinear regime such as gain saturation, bandwidth broadening, and pulse shortening were observed. Simulation and theory are in qualitative agreement with the measurements.

Esophageal atresia and achalasialike esophageal dysmotility

A 14-year-old boy presented with regurgitation, malnutrition, and chronic lung insufficiency with a history of successful repair of esophageal atresia and tracheoesophageal fistula in the newborn period. Barium swallow and manometry results showed achalasia. Hellar operation with antireflux procedure resulted in complete symptomatic relief. Histology and immunohistochemistry including PGP9.5, MAP5, cKit, and nNOS of myotomy specimen showed intact innervation. Although esophageal dysmotility after esophageal atresia repair usually is caused by gastroesophageal reflux and incoordination of peristalsis, the possibility of achalasia should also be considered, because a casual relationship between esophageal atresia and achalasia may exist.

Anomalies associated with oesophageal atresia in Asians and Europeans

Oesophageal atresia (OA) is often associated with anomalies of other systems. The genetic contribution to the formation of the VACTERL association is not clear. The objective of this study was to evaluate the incidence of associated anomalies in two different racial populations. The associated anomalies in neonates with OA managed in an Asian and a European paediatric surgical centre from 1982 to 1998 were reviewed. Non-Asian and non-European patients were excluded from the respective centres. The incidence of anomalies was compared using Fisher's exact test, taking #E5/E5# below 0.05 as statistically significant. Forty-eight consecutive Asian (25 boys and 23 girls) and 34 consecutive European patients (20 boys and 14 girls) were included in the analysis. The percentage of patients with at least one associated anomaly was 50% and 74% in the Asian and European populations, respectively, which was significantly different (#E5/E5#=0. 04). There was no statistically significant difference in the incidence of associated cardiovascular (29% vs 39%), anorectal (11% vs 18%), and musculoskeletal (16% vs 22%) anomalies, duodenal atresia (4% vs 3%), or Down's syndrome (3% vs 6%) between the two populations. However, the European patients had a significantly higher incidence of urogenital (UG) anomalies (26% vs 4%, #E5/E5#=0.006), the most common being agenesis (n=4) and dysplasia (n=3) of one or both kidneys. Hereditary factors may influence the incidence of associated anomalies in children with OA, particularly of the UG system. However, environmental factors cannot be excluded.