External validation of the current scoring systems and derivation of a novel scoring system to predict stone free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm

OBJECTIVE

Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS.

METHODS

Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis.

RESULTS

The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870).

CONCLUSION

The RUSS, S-ReSC and R.I.R.S. scoring systems and Ito's nomogram failed to predict SFS in stones >2 cm. The SFS predictive ability of our new scoring system was higher in >2 cm stones compared to the other scoring systems.

Internalized Stigma, Self-Esteem, Loneliness, and Suicide Probability in Patients with Alcohol Use Disorder in Remission

Objective: It was aimed to investigate internalized stigma, self-esteem, suicide probability, and loneliness in patients with alcohol use disorder (AUD) in remission. Methods: Fifty patients diagnosed with AUD according to DSM-5 diagnostic criteria and 50 healthy volunteers were included in the study. The Structured Clinical Interview for DSM-5 (SCID-5), Suicide Probability Scale (SPS), Rosenberg Self-Esteem Scale (RSS), and University of California Los Angeles Loneliness Scale (UCLA-LS) were administered to all participants. In addition, Internalized Stigma of Mental Illness Scale (ISMIS) was applied to the AUD group. Results: UCLA-LS scores were found to be significantly higher in the AUD group than the control group (p=0.014). RSS scores were found to be significantly lower in the AUD group compared to the control group (p=0.019). The SPS total score and all subscale scores were similar in the AUD group and healthy controls (for all; p>0.05). In the AUD group, as ISMIS scores increased, SPS scores and UCLA-LS scores increased (respectively; p=0.022, p=0.003), while as UCLA-LS scores increased, SPS scores increased and RSS scores decreased (respectively; p=0.005, p=0.001). In the regression analysis, loneliness predicts the probability of suicide in AUD patients. Conclusion: It can be said that even if AUD patients are in remission, they have lower self-esteem and higher levels of loneliness, and the probability of suicide is not different from healthy controls. In addition, it can be said that as internalized stigma increases in AUD patients, the level of loneliness and the possibility of suicide increase.

AB0465 INDIVIDUAL COMPONENTS CONTRIBUTING TO THE ACHIEVEMENT OF ASAS40 RESPONSE IN BIOLOGIC NAÏVE PATIENTS WITH RADIOGRAPHIC axSpA: RESULTS FROM THE COAST-V TRIAL

Background:

Ixekizumab (IXE), an IL-17A antagonist, is effective in patients with radiographic axial spondyloarthritis (rad-axSpA). Assessment in SpondyloArthritis International Society (ASAS) 40 response – the primary study endpoint – was achieved at week (wk) 16 by 48% of those treated with 80mg subcutaneous IXE every 4 wks (Q4W) in the phase 3 COAST V trial (NCT 02696785) 1. Until now, no information has been available on the efficacy of IXE on the components of ASAS40 composite endpoint.

Objectives:

To describe which individual components of ASAS40 drive achievement of efficacy response.

Methods:

This exploratory post-hoc analysis was based on COAST V data. Patients enrolled in COAST V met ASAS criteria for rad-axSpA and were biological disease-modifying antirheumatic drug (bDMARD)-naïve. Patients were assigned 1:1:1:1 to subcutaneous placebo (PBO), IXE Q4W, IXE Q2W or 40 mg adalimumab (ADA). Only data for approved doses are shown.

To reach ASAS40 response, patients must have an improvement of at least 40% and at least 2 units for at least 3 of 4 individual components which define response (patient global assessment of disease activity, spinal pain, inflammation (defined as the mean of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questions 5 and 6), and function (Bath Ankylosing Spondylitis Functional Index - BASFI)), without worsening in the remaining component. We describe the percentage of patients who achieved this change, had an insufficient response, or deteriorated in each component out to wk 16 for IXE Q4W, ADA and PBO. The time course of the change from baseline in individual components of the ASAS response is depicted descriptively per treatment arm by use of the mean and standard deviation. Observed data have been utilised.

Results:

IXE Q4W response at 16 wks was driven by all 4 individual components of the ASAS40 with the largest improvements for patients treated with IXE Q4W seen in inflammation and spinal pain (Figure 1).

At wk 16, at least 50% of all patients treated with IXE Q4W achieved response on spinal pain (60.3%), inflammation (60.3%) and patient global assessment (50%), with 43.6% of patients meeting the response criteria for function (Table 1). The corresponding results for ADA were 43.2%, 47.7% 39.8%, and 35.2%.

Conclusion:

Our findings show that meeting ASAS40 response criterion for an individual component at 16 wks by patients treated with IXE Q4W was broadly similar between individual components. However, a clinically relevant improvement was more frequently observed for the spinal pain and inflammation components.

References:

[1]Dougados, M., et al. (2020). Ann Rheum Dis79(2): 176-185.

Table 1.

Observed changes from baseline (CFB), percentage improvements and response status of patients enrolled in COAST V trial at wk 16

MeasureObserved CFB(SD)Observed % improvement (SD)Improvement >=40% and >=2 unitsn (%)Insufficient responsen (%)Deterioratedn (%)IXE Q4W (N=78) Patient global assessment-2.6 (2.9)32.3 (51.1)39 (50.0)30 (38.5)9 (11.5) Spinal pain-3.3 (2.7)43.4 (34.4)47 (60.3)27 (34.6) 4 (5.1) Inflammation*-3.2 (2.5)46.8 (32.8)47 (60.3)25 (32.0)6 (7.7) Function-2.5 (2.3)39.6 (31.0)34 (43.6)37 (47.4)7 (9.0)ADA (N=88) Patient global assessment-2.6 (2.4)35.2 (33.4)35 (39.8)48 (54.5)5 (5.7) Spinal pain-2.6 (2.4)36.8 (34.7)38 (43.2)44 (50.0)6 (6.8) Inflammation*-2.6 (2.4)38.4 (36.9)42 (47.7)37 (42.0)9 (10.2)Function-2.1 (2.2)35.2 (34.3)31 (35.2)48 (54.6)9 (10.2)PBO (N=86) Patient global assessment-1.5 (2.0)18.0 (37.9)21 (24.4)54(62.8)11(12.8) Spinal pain-1.9 (1.9)25.8 (26.7)23 (26.8)55(64.0)8(9.3) Inflammation*-1.4 (1.9)20.9 (33.9)19 (22.1)53 (61.6)14 (16.3) Function-1.3 (1.8)19.1 (31.6)16 (18.6)51 (59.3)19 (22.1)

*Inflammation is the mean of BASDAI 5 (Morning stiffness severity) and BASDAI 6 (Morning stiffness duration)

Mean baseline values for PBO, ADA and IXE Q4W respectively: Patient global assessment (7.1, 7.1, 6.9), spinal pain (7.4, 7.0, 7.2), inflammation (Q5/6) (6.7, 6.6, 6.5), function (6.3, 6.1, 6.1)

Acknowledgements:

Alan Ó Céilleachair, an employee of Eli Lilly and Company, provided editorial and writing support.

Disclosure of Interests:

Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly and Company, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Gilead, GlaxoSmithKline, Eli Lilly and Company, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly and Company, MSD, Novartis, and Pfizer, Suzan Attar: None declared., Michael J. Nissen Speakers bureau: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis and Pfizer., Consultant of: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis and Pfizer., Grant/research support from: AbbVie, Erica Filippi Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Hagen Russ Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Alper Erdogan Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Yves Schymura Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Eduardo Collantes Estevez Speakers bureau: Novartis, Janssen, Eli Lilly and Company, AbbVie, Paid instructor for: Novartis, Grant/research support from: Eli Lilly and Company, francesco ciccia Speakers bureau: AbbVie, Celgene, UCB, Pfizer, MSD, Amgen, Eli Lilly and Company, Novartis, Sobi, Roche, BMS, Paid instructor for: Novartis, UCB, Pfizer, Consultant of: Novartis, UCB, Pfizer, Grant/research support from: Pfizer, Roche, UCB.

Sociodemographic and clinical characteristics of patients with long-term remission with buprenorphine / naloxone in opiate use disorder

Introduction

Buprenorphine/Naloxone (BP/NLX) is an effective drug combination used in long-term maintenance therapy in opiate use disorder (OUD). In some studies, abstinence over 180 days was defined as long-term remission (1).

Objectives

The aim of this study is to determine the sociodemographic and clinical characteristics of patients in long-term remission with BP/NLX.

Methods

In this study, 30 patients who were followed up with OUD at Akdeniz University Addiction Center and were in remission with BP/NLX for at least 180 days were evaluated retrospectively.

Results

Sociodemographic and clinical characteristics are summarized in table 1.

Conclusions

OUD is associated with lower quality of life and employment rate (2). In our study, the rate of working in a regular job is high. It can be concluded that prolonged remission improves functionality in patients. Although patients are in remission for a long time in terms of opiate use, 20% of patients continue to use cannabis and 10% continue to use cocaine. In a study, there was no difference in productivity and quality of life between BP users with and without current cannabis use. Continued use of cannabis by patients may be related to this condition. However, cannabis use increases many mental illnesses, especially psychosis (4). In patients in remission with BP/NLX, studies should also be carried out to avoid other substances than opiates. In our study, in accordance with the literature (5), no negative effects on kidney and liver functions were observed with long-term BP/NLX treatment. BP/NLX appears to be safe in prolonged use.

Disclosure

No significant relationships.

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Effect of fluid resuscitation on acute lung injury in a rat model of sepsis

AIM

Sepsis is a systemic infection reaction and intravascular volume therapy plays a crucial role in it's treatment. Acute respiratory distress syndrome (ARDS) occurs in the lungs, the most affected organ. This study aimed to investigate the different effects of fluid therapy on ARDS caused by sepsis.

METHOD

To form a sepsis model, cecal ligation and puncture (CLP) procedure were performed on 44 adult rats. Divided into six groups; normal, CLP group, those treated with 40 ml/kg 0.9 % NaCl, 3 % NaCl (hypertonic saline), Ringer Lactate and Hydroxyethyl starch. After 24 hours treatments, histopathological examination of the lungs were done, and the plasma levels of CRP, TNF-α and IL-6 and paO2 were measured.

RESULTS

The scores of all histological parameters of the group treated with hypertonic saline were significantly lower than of the other groups (p < 0.001). Likewise, according to the arterial blood gas results, paO2 was significantly higher (p < 0.01) in the hypertonic saline group compared to the other groups, and paCO2 was significantly lower (p < 0.01). CRP, TNF-α and IL-6 levels of inflammatory markers were also significantly lower in hypertonic saline groups compared to other groups (p < 0.001).

CONCLUSIONS

Our study shows that treatment with hypertonic saline reduces the progression of ARDS in sepsis (Tab. 3, Fig. 4, Ref. 49).

The K+-channel opener NS1619 increases endothelial NO-synthesis involving p42/p44 MAP-kinase

Ca2+-activated K+ channels with large conductance (BKCa) have been shown to play an important role in the regulation of vascular tone. We examined the role of the p42/p44 MAP-kinase (p42/p44MAPK) on nitric oxide (NO) production in human endothelial cells induced by the BKCa-opener NS1619. Using DiBAC-fluorescence imaging a concentration-dependent (2.5-12.5 µM) hyperpolarization induced by NS1619 was observed. A significant increase of intracellular Ca2+-concentration by NS1619 was seen using Fura-2-fluorescence-imaging, which was blocked by 2-APB, or reduction of extracellular Ca2+ (n=30; p<0.05). A cGMP-radioimmunoassay was used to examine NO synthesis. NS1619 significantly increased cGMP levels which was inhibited by LNMMA, iberiotoxin, BAPTA, 2-APB, reduction of extracellular Ca2+, PD 98059, or U0126 (cGMP (pmol/mg protein): NS1619 3.25 ± 0.85; NS1619 + L-NMMA 0.86 ± 0.02; NS1619 + iberiotoxin 0.99 ± 0.09; NS1619 + BAPTA 0.93 ± 0.29; NS1619 + 2-APB 0.99 ± 0.31; NS1619 + Ca2+-reduction 1.17 ± 0.06; NS1619 + PD98059 1.06 ± 0.49; NS1619 + U0126 1.10 ± 0.24; n=10; p<0.05). The phosphorylation of eNOS and p42/p44MAPK was examined by immunocytochemistry. Phosphorylation of p42/p44MAPK was significantly increased after 10 minutes of NS1619 stimulation, whereas eNOS phosphorylation was not changed over a period of 1 to 30 minutes. NS1619-induced hyperpolarization was not affected by treatment with PD 98059 or U0126. Additionally, NS1619 inhibited endothelial proliferation involving a NO-dependent mechanism. Our data demonstrate that NS1619 causes a transmembrane Ca2+-influx leading to an increased NO production involving p42/p44MAPK. This rise of NO formation is responsible for the NS1619 induced reduction of endothelial cell growth.

Home monitoring after ambulatory implanted primary cardiac implantable electronic devices: The home ambulance pilot study

BACKGROUND

The Home Monitoring (HM) system of cardiac implantable electronic devices (CIEDs) permits early detection of arrhythmias or device system failures. The aim of this pilot study was to examine how the safety and efficacy of the HM system in patients after ambulatory implanted primary CIEDs compare to patients with a standard procedure and hospitalization.

HYPOTHESIS

We hypothesized that HM and their modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs.

METHODS

This retrospective analysis evaluates telemetric data obtained from 364 patients in an ambulatory single center over 6 years. Patients were assigned to an active group (n = 217), consisting of those who were discharged early on the day of implantation of the primary CIED, or to a control group (n = 147), consisting of those discharged and followed up with the HM system according to usual medical practices.

RESULTS

The mean duration of hospitalization was 73.2% shorter in the active group than in the control group, corresponding to 20.5 ± 13 fewer hours (95% confidence interval [CI]: 6.3-29.5; P < 0.01) spent in the hospital (7.5 ± 1.5 vs 28 ± 4.5 h). This shorter mean hospital stay was attributable to a 78.8% shorter postoperative period in the active group. The proportion of patients with treatment-related adverse events was 11% (n = 23) in the active group and 17% (n = 25) in the control group (95% CI: 5.5-8.3; P = 0.061). This 6% absolute risk reduction (95% CI: 3.3-9.1; P = 0.789) confirmed the noninferiority of the ambulatory implanted CIED when compared with standard management of these patients.

CONCLUSIONS

Early discharge with the HM system after ambulatory CIED implantation was safe and not inferior to the classic medical procedure. Thus, together with lower costs, HM and its modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs.

Time-resolved spectroscopy at 19,000 lines per second using a CMOS SPAD line array enables advanced biophotonics applications

A SPAD-based line sensor fabricated in 130 nm CMOS technology capable of acquiring time-resolved fluorescence spectra (TRFS) in 8.3 milliseconds is presented. To the best of our knowledge, this is the fastest time correlated single photon counting (TCSPC) TRFS acquisition reported to date. The line sensor is an upgrade to our prior work and incorporates: i) parallelized interface from sensor to surrounding circuitry enabling high line rate to the PC (19,000 lines/s) and ii) novel time-gating architecture where detected photons in the OFF region are rejected digitally after the output stage of the SPAD. The time-gating architecture was chosen to avoid electrical transients on the SPAD high voltage supplies when gating is achieved by excess bias modulation. The time-gate has an adjustable location and time window width allowing the user to focus on time-events of interest. On-chip integrated center-of-mass (CMM) calculations provide efficient acquisition of photon arrivals and direct lifetime estimation of fluorescence decays. Furthermore, any of the SPC, TCSPC and on-chip CMM modes can be used in conjunction with the time-gating. The higher readout rate and versatile architecture greatly empower the user and will allow widespread applications across many techniques and disciplines. Here we focused on 3 examples of TRFS and time-gated Raman spectroscopy: i) kinetics of chlorophyll A fluorescence from an intact leaf; ii) kinetics of a thrombin biosensor FRET probe from quenched to fluorescence states; iii) ex vivo mouse lung tissue autofluorescence TRFS; iv) time-gated Raman spectroscopy of toluene at 3056 cm^-1 peak. To the best of our knowledge, we detect spectrally for the first time the fast rise in fluorescence lifetime of chlorophyll A in a measurement over single fluorescent transient.

Vitamin C suppresses lipopolysaccharide-induced procoagulant response of human monocyte-derived macrophages

OBJECTIVE

Although vitamin C is a strong antioxidant, the epidemiologic evidence to support its role in lowering risk of cardiovascular disease is inconsistent. In order to define the role of vitamin C in vascular pathophysiology, we have investigated the effect of vitamin C on the tissue factor (TF) and Factor VII Activating Protease (FSAP) expression induced by lipopolysaccharide (LPS) in human monocyte-derived macrophages.

MATERIALS AND METHODS

Vitamin C at clinically relevant doses was tested to its ability to influence the LPS- and reactive oxygen species (ROS) - generating system of xanthine/xanthine oxidase (X/XO) NF-kB activity in human monocyte-derived macrophages.

RESULTS

Vitamin C-treatment prevents LPS- and ROS-induced DNA-binding activity of NF-kB in a concentration-dependent fashion. Vitamin C also inhibited the phosphorylation and proteolytic degradation of the inhibitor protein IkBa. In parallel to regulate NF-kB activity, vitamin C reduced the expression of TF and FSAP, genes known to be induced by bacterial LPS and triggered the extrinsic coagulation cascade and linked thrombosis with inflammation.

CONCLUSIONS

Vitamin C alters pro-inflammatory and pro-coagulatory processes via inhibition of NF-kB activation and exerts beneficial antiatherogenic effects on human monocyte-derived macrophages in addition to its anti-oxidant properties.

Failure of Femoral Access to Electrophysiological Evaluation Due to Aplasia of the Inferior Vena Cava

We report an interesting case of a man with a persistent left superior vena cava (PLSVC) with left azygos vein who underwent electrophysiological evaluation. Further evaluation revealed congenital dilated azygos vein, while a segment connecting the inferior vena cava (IVC) to the hepatic vein and right atrium was missing. The azygos vein drained into the superior vena cava, and the hepatic veins drained directly into the right atrium. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature.

Surface modification of CdSeS nanocrystals for polymer hybrid solar cells

We report synthesis of Fluorene–Carbazole derivatives as caping agent for CdSeS nanocrystals to improve the performance of polymer nanocrystal hybrid solar cells.

Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test

BACKGROUND

The diagnosis of small intestinal bacterial overgrowth (SIBO) remains challenging. Our aim was to examine the diagnostic yield of duodenal aspiration/culture and glucose breath test (GBT), and effects of gender, race and demographics on prevalence of SIBO.

METHODS

Patients with unexplained gas, bloating and diarrhea and negative endoscopy, imaging and blood tests were prospectively enrolled in two centers in USA. Randomly, within 1 week each patient underwent both duodenal aspiration/culture and GBT. The diagnostic yield of each test and relationship of symptoms, and effects of ethnicity, age, and gender on prevalence of SIBO were assessed and compared.

KEY RESULTS

Duodenal culture was positive in 62/139 (44.6%) subjects and GBT was positive in 38/139 (27.3%) subjects with an overall diagnostic agreement of 65.5%. The sensitivity, specificity, positive and negative predictive value of GBT was 42%, 84%, 68%, and 64%, respectively. Ethnicity or gender did not influence SIBO, but SIBO positive patients were older (p = 0.0018). Symptom patterns were similar except bloating was more prevalent in GBT positive and gas in culture positive subjects.

CONCLUSIONS & INFERENCES

Duodenal aspiration/culture identifies 45% of patients with suspected SIBO. GBT has lower sensitivity but good specificity for detection of SIBO. There were no ethnic or gender differences in the prevalence of SIBO, but patients with SIBO were older. Because GBT is non-invasive, it should be considered first in patients with suspected SIBO.

An evaluation of the lower extremity muscle strength of patients with chronic venous insufficiency

Objective

In this study, the aim was to evaluate the lower extremity muscle strength in patients with chronic venous insufficiency using an isokinetic dynamometer.

Methods

The study comprised a group of 36 lower extremities of 23 patients diagnosed with chronic venous insufficiency and a control group of 40 lower extremities of 20 patients who did not have chronic venous insufficiency. In the diagnosis and evaluation of chronic venous insufficiency, photoplethysmography was used to evaluate the venous return circulation time. Visual Analog Scale scoring was applied to define the level of pain of the patients. Muscle strength measurements were made in all the lower extremities by using an isokinetic dynamometer.

Results

A statistically significant difference was detected between the groups in terms of the muscle strength parameters in the ankle plantar flexion, and knee flexor and extensor muscles. However, no statistically significant difference was found between the groups in the ankle dorsiflexion muscle strength parameters. A significant difference was determined in the ratio of ankle dorsiflexion/plantar flexion muscle strength between the mild, moderate and severe venous insufficiency groups. A statistically considerable negative correlation was found between the Visual Analog Scale scores and the photoplethysmography results. According to the Visual Analog Scale results, as the degree of venous insufficiency increased, so did the level of pain.

Conclusion

Impaired lower extremity muscle strength was observed in chronic venous insufficiency patients. Although the current study was consistent with literature in respect of impaired calf muscle strength, this finding was also seen in the thigh muscles. Furthermore, we concluded that if venous insufficiency becomes more severe, impaired calf muscle strength becomes more evident.

Association of circulating factor seven activating protease (FSAP) and of oral Omega-3 fatty acids supplements with clinical outcome in patients with atrial fibrillation: the OMEGA-AF study

Factor VII Activating Protease (FSAP) activates factor VII (FVII) as well as pro-urokinase (uPA). Our goal was to evaluate the relation between plasma levels of FSAP and clinical instability in atrial fibrillation (AF) and possible effects of oral omega-3 fatty acids (FA) supplements. 101 patients with persistent AF were analyzed in the OMEGA-AF Study. Plasma FSAP levels were measured at baseline and after 12 weeks of treatment with omega-3 FA. The median FSAP antigen concentration, in contrast to FSAP activity, was higher in patients with persistent AF. The maintenance of SR after successful cardioversion (CV) did not lead to a normalization of FSAP concentration. Supplementation with omega-3 FA but not placebo significantly reduced elevated FSAP concentration. Furthermore, elevated FSAP levels did not indicate a significantly increased risk of recurrence of AF after electrical CV or cardiovascular clinical events during 1 year of follow-up. Plasma FSAP concentration was increased in patients with AF and may be involved in the pathogenesis of this condition. The possible effects of omega-3 FA on clinical AF potential could be linked with modulation of circulating FSAP levels.

Monocyte CD40 expression in young healthy female smokers and/or oral contraceptives users without additional risk factors for atherosclerosis

OBJECTIVE

Atherosclerosis, as an inflammatory disease, is characterized by pathologically altered levels of cytokines. We investigated whether smoking and/or oral contraceptives (OCs) affect the CD40/CD40L plasma levels and expression in young females without other risk factors for atherosclerosis.

PATIENTS AND METHODS

A case-control single-center design was used. Expression levels of CD40/CD40L were analyzed in healthy non-pregnant, pre-menopausal, non-smoking women who did not take OCs (n=49), women who currently smoke and take OCs (n=40), and women who are only smokers (n=40) or currently take OCs (n=42).

RESULTS

In OC users, there was a significant increase in CD40 mRNA expression in circulating monocytes as compared with smokers and control group. However, there were no significant differences in CD40 mRNA expression in monocytes between smokers and non-smokers. Interestingly, CD40 mRNA expression in women taking OCs and currently smoking was significantly decreased compared to only OC users (p<0.001). With regard to plasma CD40 levels there were significant differences between OC-users and control group. However, contrary to our expectations, there were no significant differences in expression levels of CD40L between four groups. In vitro experiments demonstrated enhanced CD40 mRNA and surface expression in human monocyte-derived macrophages stimulated with estrogens. Furthermore, nicotine pretreatment led to a suppression of estrogens stimulated CD40 induction.

CONCLUSIONS

In young healthy females without additional risk factors for atherosclerosis, OCs, but not smoking, are associated with dramatic changes in CD40 gene and plasma levels. These findings may be providing an important link between OCs and enhancement of pro-inflammatory and atherothrombotic conditions in healthy women.

Effects of parathyroid hormone-related peptide on the large conductance calcium-activated potassium channel and calcium homeostasis in vascular smooth muscle cells

AIM

To demonstrate the impact of the parathyroid hormone-related peptide (PTHrP) on the large conductance calcium-activated potassium (BKCa) channels in vascular smooth muscle cells (VSMC) and hyperpolarization of the cell membrane and its dependence on calcium.

MATERIALS AND METHODS

VSMC were isolated from rat aorta and further subcultured. Four experiments were conducted in calcium-release measurements and each of them consisted of a control group, PTHrP, chemical substance, and PTHrP + chemical substance. Chemical substances used were: iberiotoxin, xestospongin C, xestospongin D, and thapsigargin, respectively. Fura-2 imaging was used to determine changes in calcium release of VSMC. In membrane-potential experiments, groups were designed similarly to the Fura-2 imaging experiments: iberiotoxin, BAPTA, and xestospongin D were added, in respective order. Changes in the membrane potential were examined using the fluorescence dye (DiBAC).

RESULTS

Given in a dose between 0.01 and 1.0 μmol/L, PTHrP caused a concentration-dependent decrease in fluorescence intensity, with a maximum effect at 0.5 μmol/L. The decrease, therefore, demonstrated a PTHrP-induced hyperpolarization of the VSMC. The effect was blocked by use of iberiotoxin (100 nmol/L), a highly selective inhibitor of BKCa. Furthermore, when the calcium chelator BAPTA (10 μmol/L) was added, there was a significant reduction in PTHrP-induced hyperpolarization. Use of PTHrP (0.5 μmol/L) also decreased the fluorescence intensity of the indicator for intracellular calcium, Fura-2AM (a membrane-permeable derivative of Fura 2). This effect was re-blocked by use of iberiotoxin. Xestospongin C (3 μmol/L) and xestospongin D (6 μmol/L), both inhibitors of the inositol 1,4,5 trisphosphate-triggered calcium release, inhibited the effects of PTHrP. Additionally, thapsigargin (1 μmol/L), a sarcoplasmic/endoplasmic reticulum Ca2+-ATPase inhibitor, inhibited the effect of PTHrP.

CONCLUSION

The results of our study show that PTHrP induces hyperpolarization and activates BKCa in VSMC. The activation of BKCa channels is calcium dependent; activation is linked to the inositol 1,4,5 trisphosphate-triggered calcium release and is also dependent on the endo/sarcoplasmic reticulum calcium pump.

The impact of statins on FGF-2-stimulated human umbilical vein endothelial cells

AIM

To determine the effects of different types of statins on proliferative and migrative behaviors of basic fibroblastic growth factor (FGF)-2-stimulated endothelial cells.

MATERIALS AND METHODS

Human umbilical vein endothelial cells (HUVECs) were isolated and cultured. Groups were arranged in order to observe the impact of each individual substance alone, or under stimulation with statin on FGF-2-stimulated endothelial cells. Endothelial cells were stimulated with human growth factor (HGF), statins, methyl-β-cyclodextrin (β-MCD), and either farnesyl pyrophosphate (FPP) ammonium salt, or geranylgeranyl-pyrophosphate (GGPP), respectively. Cell proliferation analyses were performed 48 hours after stimulation and gaps between migration borders were used in migration analyses.

RESULTS

The statins showed significant antiproliferative and anti-migrative effects and inhibited the proliferative behavior of FGF-2. However, endothelial cell proliferation and migration were significantly increased after mevalonate co-incubation. Experiments with β-MCD indicated that the destruction of lipid rafts had a negative impact on the action of FGF-2. Stimulation of statin-incubated cells with FPP had no additional effect on proliferation or migration. Notably, although FGF-2 exerted a pro-migrative effect, the effect was not shown in the FPP + FGF-2 group. The anti-migrative actions of statins along with disruption of membrane integrity were reversed by the addition of GGPP.

CONCLUSION

The angiogenic effect of FGF-2 is suppressed through inhibition of the intracellular cholesterol biosynthesis via statins. Inhibitory effects of statins on FGF-2-stimulated HUVECs were observed to result from both the inhibition of isoprenylation and the destruction of lipid rafts on the cell membrane.

Importance of large conductance calcium-activated potassium channels (BKCa) in interleukin-1b-induced adhesion of monocytes to endothelial cells

OBJECTIVE

The present study investigated the role of the large conductance calcium-activated potassium channels (BKCa) in interleukin-1b (IL-1b) induced inflammation.

MATERIALS AND METHODS

Human umbilical vein endothelial cells (HUVECs) were isolated and cultured. Endothelial cell membrane potential measurements were accomplished using the fluorescent dye DiBAC4(3). The role of BKCa was assessed using iberiotoxin, a highly selective BKCa inhibitor. Changes in the calcium intracellular calcium were investigated using Fura-2-AM imaging. Fluorescent dyes DCF-AM and DAF-AM were further used in order to measure the formation of reactive oxygen species (ROS) and nitric oxide (NO) synthesis, respectively. Endothelial cell adhesion tests were conducted with BCECF-AM adhesion assay and tritium thymidine uptake using human monocytic cells (U937). Expression of cellular adhesion molecules (ICAM-1, VCAM-1) was determined by flow cytometer.

RESULTS

Interleukin-1b induced a BKCa dependent hyperpolarization of HUVECs. This was followed by an increase in the intracellular calcium concentration. Furthermore, IL-1b significantly increased the synthesis of NO and ROS. The increase of intracellular calcium, radicals and NO resulted in a BKCa dependent adhesion of monocytes to HUVECs. Endothelial cells treated with IL-1b expressed both ICAM-1 and VCAM-1 in significantly higher amounts as when compared to controls. It was further shown that the cellular adhesion molecules ICAM-1 and VCAM-1 were responsible for the BKCa-dependent increase in cellular adhesion. Additionally, inhibition of the NADPH oxidase with DPI led to a significant downregulation of IL-1b-induced expression of ICAM and VCAM, as well as inhibition of eNOS by L-NMMA, and intracellular calcium by BAPTA.

CONCLUSIONS

Activation of the endothelial BKCa plays an important role in the IL-1b-induced monocyte adhesion to endothelial cells.

Effect of bauhinia bauhinioides kallikrein inhibitor on endothelial proliferation and intracellular calcium concentration

OBJECTIVES

Proteinase inhibitors act as a defensive system against predators e.g. insects, in plants. Bauhinia bauhinioides kallikrein inhibitor (BbKI) is a serine proteinase inhibitor, isolated from seeds of Bauhinia bauhinioides and is structurally similar to plant Kunitz-type inhibitors but lacks disulfide bridges. In this study we evaluated the antiproliferative effect of BbKI on endothelial cells and its impact on changes in membrane potential and intracellular calcium.

MATERIALS AND METHODS

HUVEC proliferation was significantly reduced by incubation with BbKI 50 and 100 µM 12% and 13%. Furthermore, BbKI (100 µM) exposure caused a significant increase in intracellular Ca2+ concentration by 35% as compared to untreated control.

RESULTS

The intracellular rise in calcium was not affected by the absence of extracellular calcium. BBKI also caused a significant change in the cell membrane potential but the antiproliferative effect was independent of changes in membrane potential.

CONCLUSIONS

BBKI has an antiproliferative effect on HUVEC, which is independent of the changes in membrane potential, and it causes an increase in intracellular Ca2+.

Acute left main coronary artery occlusion

The treatment of an acute left main coronary artery occlusion still poses a challenge. In this case report we present a 50-year-old patient with an acute occlusion of the left main artery. After a successful angioplasty without "stenting" due to the complexity of the stenosis the patient underwent a successful bypass surgery. We discuss the therapeutic options of acute left main occlusion regarding medical, interventional and surgical options.

Deep vein thrombosis and novel oral anticoagulants: a clinical review

Deep vein thrombosis (DVT) is a common disease associated with high rates of mortality and significant morbidity. The diagnostic approach of DVT has evolved over the years. Algorithmical use of pretest probability, D-Dimer testing and ultrasonography allow safe and accurate investigation of DVT. The anticoagulation therapy, used to treat DVT, includes vitamin K antagonists (VKAs) and low-molecular-weight heparin (LMWH) or unfractionated heparin (UF). The duration of anticoagulation therapy depends on the cause of DVT and patient's clinical profile. Although these conventional therapies are effective, narrow therapeutic index, need for frequent monitoring and various food-drug interactions cause difficulties for patients. In recent decades, new oral anticoagulants have been developed. These drugs focus directly on inhibiting either Factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran). In contrast to warfarin, these new agents have shorter half-life, fewer drug or food interactions, no necessity for a close monitoring and ease of administration. This review summarizes current knowledge about deep vein thrombosis and new treatment aspects with novel oral anticoagulants.

The effects of different types of statins on proliferation and migration of HGF-induced Human Umbilical Vein Endothelial Cells (HUVECs)

BACKGROUND AND AIM

Statins are HMG-CoA reductase inhibitors within the framework of cholesterol biosynthesis and used to lower the low-density lipoprotein (LDL). There are other aspects of statins can deploy a protective effect, even without the LDL's lowering. The aim of this study is to investigate the effects of different type of statins on proliferative and migrative behaviors of Hepatocyte Growth Factor (HGF) induced human umbilical vein endothelial cells (HUVECs).

MATERIALS AND METHODS

Human umbilical vein endothelial cells were isolated and cultured. Groups were designed in order to observe the effects of every individual substance. HUVECs were stimulated with HGF, statins and farnesylpyrophosphat ammonium salt (FPP) or geranylgeranyl-pyrophosphate (GGPP), respectively. Cell proliferations were counted 48 hours after initial stimuli and distances between migration fronts were used in migration analyses.

RESULTS

All types of statins showed significant anti-migrative and anti-proliferative characters. Simvastatin and fluvastatin but not cerivastatin, were able to inhibit the HGF-depending migration and showed a significant effect on the inhibition of the isoprenylation (GGPP). Only simvastatin influenced the HGF-depending migration via inhibiting the isoprenylation process through GGPP. Cerivastatin significantly decreased the proliferation and Fluvastatin significantly enhanced the migration behaviors of HUVECs when they were co-incubated with methyl-8-cyclodextrin (MCD).

CONCLUSIONS

Statins countermand the proproliferative and as well as the promigrative effect of HGF on HUVECs. The mechanisms which provoke this effect are dependent on the type of statin. Direct interactions of statins with lipid rafts play a significant role in the endothelial cell mechanisms.

Discovery of asymptomatic Krukenberg tumors diagnosed during caesarean section: therapy with hyperthermic intraperitoneal chemotherapy

We report a case of the discovery of asymptomatic Krukenberg tumors in a 37-year-old woman in the 37th week of pregnancy during caesarean section. Subsequent gastroscopy revealed an adenocarcinoma of the stomach as the primary tumor site. The patient was treated with hyperthermic intraperitoneal chemotherapy (HIPEC). Tumor surgery (Partial parietal peritonectomy and partial gastrectomy) and HIPEC treatment were successful, with no complications found during follow-up. Use of HIPEC seems to be a promising option after radical surgery, including its use in patients with gastric tumors that are in advanced stages, and use in patients who have tumors with poor prognoses, such as Krukenberg tumors.

Giant aneurysm of the right coronary artery with fistula to right atrium

Coronary artery aneurysms are rare entities with a prevalence of 0.15%-4.9%. Giant coronary artery aneurysms are known as more than 2 to 5 cm in size. We present a case of 74 year-old female who was admitted to our clinic with chest pain and dyspnea. Coronary angiography demonstrated a giant right coronary artery (RCA) aneurysm with a significant left-to-right shunt. The patient underwent an open heart surgery. During the exploration, an aneurysm of 40 mm in diameter of the RCA was seen. The aneurysmatic RCA was excluded and continuously closed with the support of intra-aortic balloon pump (IABP). The patient was discharged on the 13th postoperative day without any complication.

Regulation of monocyte/macrophage function by factor VII activating protease (FSAP)

OBJECTIVE

Factor VII activating protease (FSAP) is a novel regulator of vascular inflammation and hemostasis. However, the molecular mechanism by which circulating FSAP influences inflammatory events and progression of atherosclerosis is not yet entirely understood. Here we have investigated the influence of FSAP on monocyte/macrophage functions.

METHODS

We stimulated human monocyte-derived macrophages with FSAP and analyzed their cellular responses.

RESULTS

FSAP induced IκB-dependent NF-κB activation in a time- and concentration-dependent fashion. FSAP also activated the phosphorylation and proteolytic degradation of the inhibitor protein IκBα. The phosphorylation of the p65 subunit of NF-κB was induced by FSAP, which is known to contribute to the enhancement of DNA-binding activity of NF-κB. Concomitantly, FSAP up-regulated the expression of pro-inflammatory cytokines, matrix metalloproteinases, cell adhesion molecules and tissue factor. In the presence of FSAP there was increased monocytes adhesion and transendothelial migration in a beta2 integrin dependent manner.

CONCLUSIONS

Our findings suggest that FSAP activates the NF-κB pathway and the associated downstream pro-inflammatory factors in monocytic cells. This adds to a spectrum of FSAP effects on the vascular system that may explain its association with cardiovascular diseases.

Effects of caffeic acid phenethyl ester (CAPE) on membrane potential and intracellular calcium in human endothelial cells

BACKGROUNG AND OBJECTIVES: Caffeic acid phenethyl ester (CAPE) is an active component of the resin propolis obtained from beehives. Propolis has a long history of medicinal use and a number of studies have already reported on some of its pharmaceutical properties. This study aimed to explore the effects of CAPE on the cytosolic Ca2+ concentration, cell proliferation, membrane potential and NO levels in human endothelial cells.

MATERIALS AND METHODS

Isolated human umbilical vein endothelial cells (HUVEC) were incubated with CAPE (1-100 µM) at 37°C for 48 hours. Cell proliferation was estimated by counting cell numbers with use of a Neubauer chamber. The effect of CAPE (1-100 µM) on the membrane potential was measured with the fluorescence dye DIBAC4(3) whereas its effect on the cytosolic Ca2+ concentration was measured by use of the fluorescence probe Fluo-3 AM (Invitrogen, Leiden, Netherlands). NO production was assayed using the flourophore DAF~AM (Invitrogen, Leiden, Netherlands). Changes in fluorescence intensity was determined with the GENios plate reader (Genios, Tecan, Austria).

RESULTS

A dose-dependent hyperpolarization of the endothelial cell membrane was observed with CAPE stimulation. The initial increase in the intracellular Ca2+ concentration showed a subsequent decrease over time. CAPE stimulation also resulted in an increase in NO production; however, at higher doses a decrease in NO levels was observed. HUVEC proliferation was inhibited by CAPE.

CONCLUSIONS

Here we report on the effect of CAPE stimulation on the cytosolic Ca2+ concentration, cell proliferation, membrane potential and NO production in HUVEC in a dose-dependent manner. These findings provide important insights into some potential key roles that both calcium and the membrane potential play in the CAPE activation of endothelial cells in a concentration-dependent manner.

The antiproliferative effect of pinostrobin on human umbilical vein endothelial cells (HUVEC)

BACKGROUND

Atherosclerosis and stent re-stenosis are problems that are accompanied with high morbidity and mortality. Endothelial cell proliferation plays a role in both diseases, so the quest for potent inhibitors is still ongoing.

AIM

The flavonoid pinostrobin previously showed cytotoxic effects on different cell lines. In this investigation, we tested the antiproliferative effect of pinostrobin on human umbilical vein endothelial cells (HUVEC).

MATERIALS AND METHODS

The effect of pinostrobin on human umbilical vein endothelial cells after 1 hour and after 48 hours of treatment was tested. A dose- and time-dependent antiproliferative effect of pinostrobin was observed.

RESULTS

After 1 hour of treatment, no significant differences between the control group and the cells treated with pinostrobin could be detected. After 48 h of pinostrobin treatment, the number of cells decreased significantly. Higher doses had stronger inhibitory effects on the proliferation. Furthermore, we tested the change of membrane potential on cells that were treated with different concentrations of pinostrobin. We could show that the change of membrane potential was also time- as well as dose-dependent.

CONCLUSIONS

Our hypothesis is that pinostrobin leads to depolarisation of the cell potential of endothelial cells. Since the membrane potential remains less negative, this could lead to instability of the membrane, resulting in cell death.

Ultrasonography and magnetic resonance imaging findings of abdominal complications of cystic fibrosis

In this study, our aim is to discuss the imaging findings of the abdominal complications seen in Cystic Fibrosis (CF), with ultrasonography (US) and magnetic resonance imaging (MRI). Our first case, a 22 year-old female showed changes characterized by severe biliary involvement such as cholelithiasis and cholangitis. Our second case was a 36 year-old male with severe hepatic manifestations. In this case signs of severe cirrhosis, portal hypertension and marked splenomegaly were seen. Micro-gallbladder, cholecystolithiasis and diffuse fatty infiltration of the pancreas were seen in both cases.

IN CONCLUSION

US and MRI are effective and noninvasive imaging techniques to evaluate the abdominal complications of cystic fibrosis.

Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. "Routine Practice" data from the SEARCH MI registry

BACKGROUND

A multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients' outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI) and prophylactic cardioverter defibrillator (ICD) implant on device activations.

METHODS

643 patients with left ventricular dysfunction (mean LVEF 26 ± 5%) and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years.

RESULTS

The cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock) were higher in patients implanted longer time from last MI (Gray's Test p=0.002 and p=0.013 respectively). No significant differences were seen in all cause mortality (Gray's Test p=0.618) or sudden cardiac death across the MI stratification groups (Gray's Test p=0.663).

CONCLUSIONS

Patients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

Circulating factor VII activating protease (FSAP) is associated with clinical outcome in acute coronary syndrome

BACKGROUND

Factor VII activating protease (FSAP) is a circulating serine protease strongly expressed in unstable plaques and may serve as a marker of plaque destabilization. The aim of this study was to examine the relation between plasma concentrations of FSAP and clinical instability and outcome in coronary artery disease (CAD).

METHODS AND RESULTS

Circulating FSAP concentration and activity, as well as FSAP mRNA expression in monocytes, were measured in 231 sequential patients who underwent coronary angiography because of stable angina pectoris (n=50), unstable angina pectoris (n=43), or acute myocardial infarction (n=87). FSAP activity, but not FSAP antigen concentration, was elevated in patients with CAD compared with a control group. Elevated FSAP activity (≥1.035 plasma equivalent units [PEU]/ml) indicated a significantly increased risk of death or non-fatal myocardial infarction during 1 year of follow-up as compared with patients with low activity of FSAP (odds ratio 1.895 [95% confidence interval 1.093-3.283]; P=0.023). Furthermore, there were no significant changes in the FSAP expression in monocytes from CAD and control subjects in the basal state but there were differences after stimulation with proinflammatory factors.

CONCLUSIONS

Plasma FSAP activity was significantly increased in patients with acute coronary syndrome and may be involved in the pathogenesis of these conditions. High levels of FSAP activity were predictive of adverse events during follow-up, suggesting its potential role in risk stratification and clinical management of CAD patients.

Interplay between Ca2+ cycling and mitochondrial permeability transition pores promotes reperfusion-induced injury of cardiac myocytes

Uncontrolled release of Ca²⁺ from the sarcoplasmic reticulum (SR) contributes to the reperfusion-induced cardiomyocyte injury, e.g. hypercontracture and necrosis. To find out the underlying cellular mechanisms of this phenomenon, we investigated whether the opening of mitochondrial permeability transition pores (MPTP), resulting in ATP depletion and reactive oxygen species (ROS) formation, may be involved. For this purpose, isolated cardiac myocytes from adult rats were subjected to simulated ischemia and reperfusion. MPTP opening was detected by calcein release and by monitoring the ΔΨ_m. Fura-2 was used to monitor cytosolic [Ca²⁺]_i or mitochondrial calcium [Ca²⁺]_m, after quenching the cytosolic compartment with MnCl₂. Mitochondrial ROS [ROS]_m production was detected with MitoSOX Red and mag-fura-2 was used to monitor Mg²⁺ concentration, which reflects changes in cellular ATP. Necrosis was determined by propidium iodide staining. Reperfusion led to a calcein release from mitochondria, ΔΨ_m collapse and disturbance of ATP recovery. Simultaneously, Ca²⁺ oscillations occurred, [Ca²⁺]_m and [ROS]_m increased, cells developed hypercontracture and underwent necrosis. Inhibition of the SR-driven Ca²⁺ cycling with thapsigargine or ryanodine prevented mitochondrial dysfunction, ROS formation and MPTP opening. Suppression of the mitochondrial Ca²⁺ uptake (Ru360) or MPTP (cyclosporine A) significantly attenuated Ca²⁺ cycling, hypercontracture and necrosis. ROS scavengers (2-mercaptopropionyl glycine or N-acetylcysteine) had no effect on these parameters, but reduced [ROS]_m. In conclusion, MPTP opening occurs early during reperfusion and is due to the Ca²⁺ oscillations originating primarily from the SR and supported by MPTP. The interplay between Ca²⁺ cycling and MPTP promotes the reperfusion-induced cardiomyocyte hypercontracture and necrosis. Mitochondrial ROS formation is a result rather than a cause of MPTP opening.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in the evaluation of the biliary obstruction

Purpose. In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. Materials and Methods. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18–86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. Results. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. Conclusion. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.

Asymmetrically increased uptake in upper extremities on (99m)Tc-MDP bone scintigraphy caused by intra-arterial injection: different uptake patterns in three cases

Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc-(99m) methylene diphosphonate ((99m)Tc-MDP) on the antecubital region and discuss the findings and differential diagnosis.

Tako-tsubo cardiomyopathy in a 92-year old woman

Tako-Tsubo cardiomyopathy (TTC) is an acute reversible cause of segmental myocardial dysfunction that is poorly understood and cannot be explained by the occlusion of a single coronary vessel. Its clinical presentation is similar to that of acute coronary syndrome and is often precipitated by a severe psychological or physical stress.