Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

BACKGROUND AND AIMS

Metabolic dysfunction associated steatotic liver disease (MASLD) increases the risk of incident chronic kidney disease (CKD). However, the relative risk of CKD associated with increasing hepatic fibrosis, and consequent mortality risk, remains underexplored in real-world cohorts. In this study, we sought to establish whether hepatic fibrosis is associated with increased CKD risk and explore differences in mortality risk in a cohort of people living with MASLD, contingent on liver fibrosis and CKD status.

METHODS

This was an observational study of people who underwent routine liver function testing in Tayside, Scotland. MASLD was defined as: elevated ALT (>30 U/L) or GGT (>73 U/L); presence of diabetes, and/or hypertension, and/or obesity; weekly alcohol consumption <14 units (112g (+/-8g) alcohol); and negative screen for other aetiologies. Data was collected from digital health records. We used log-binomial models to quantify the risk of CKD among those with and without fibrosis, and Cox regression models to estimate differences in mortality risk dependent on fibrosis and CKD.

RESULTS

In our cohort (n = 2,046), 1,448 (70.8%) people had MASLD without fibrosis and 598 (29.2%) with fibrosis; 161 (11.1%) and 117 (19.6%) respectively also had CKD. After excluding individuals with structural, autoimmune, or malignant CKD (n = 22), liver fibrosis (n = 593; 18.9% with CKD) was associated with increased CKD risk (aRR = 1.31, 1.04-1.64, p = 0.021). Increased mortality risk was observed for those with liver fibrosis (aHR = 2.30, 1.49-3.56, p = <0.001) and was higher again among people with both fibrosis and CKD (aHR = 5.07, 3.07-8.39, p = <0.014).

CONCLUSIONS

Liver fibrosis was an independent risk factor for CKD in this cohort of people living with MASLD. Furthermore, those with MASLD with liver fibrosis had higher risk for mortality and this risk was further elevated among those with co-morbid CKD. Given the increased risk of CKD, and consequent mortality risk, among people living with MASLD fibrosis, renal function screening should be considered within liver health surveillance programmes and guidelines.

Genomic Estimated Breeding Value of Milk Performance and Fertility Traits in the Russian Black-and-White Cattle Population

A breakthrough in cattle breeding was achieved with the incorporation of animal genomic data into breeding programs. The introduction of genomic selection has a major impact on traditional genetic assessment systems and animal genetic improvement programs. Since 2010, genomic selection has been officially introduced in the evaluation of the breeding and genetic potential of cattle in Europe, the U.S., Canada, and many other developed countries. The purpose of this study is to develop a system for a genomic evaluation of the breeding value of the domestic livestock of Black-and-White and Russian Holstein cattle based on 3 milk performance traits: daily milk yield (kg), daily milk fat (%), and daily milk protein content (%) and 6 fertility traits: age at first calving (AFC), calving interval (CI), calving to first insemination interval (CFI), interval between first and last insemination (IFL), days open (DO), and number of services (NS). We built a unified database of breeding animals from 523 breeding farms in the Russian Federation. The database included pedigree information on 2,551,529 cows and 69,131 bulls of the Russian Holstein and Black-and-White cattle breeds, as well as information on the milk performance of 1,597,426 cows with 4,771,366 completed lactations. The date of birth of the animals included in the database was between 1975 and 2017. Genotyping was performed in 672 animals using a BovineSNP50 v3 DNA Analysis BeadChip microarray (Illumina, USA). The genomic estimated breeding value (GEBV) was evaluated only for 644 animals (427 bulls and 217 cows) using the single-step genomic best linear unbiased prediction – animal model (ssGBLUP-AM). The mean genetic potential was +0.88 and +1.03 kg for the daily milk yield, -0.002% for the milk fat content, and –0.003 and 0.001% for the milk protein content in the cows and bulls, respectively. There was negative genetic progress in the fertility traits in the studied population between 1975 and 2017. The reliability of the estimated breeding value (EBV) for genotyped bulls ranged from 89 to 93% for the milk performance traits and 85 to 90% for the fertility traits, whereas the reliability of the genomic estimated breeding value (GEBV) varied 54 to 64% for the milk traits and 23 to 60% for the fertility traits. This result shows that it is possible to use the genomic estimated breeding value with rather high reliability to evaluate the domestic livestock of Russian Holstein and Black-and-White cattle breeds for fertility and milk performance traits. This system of genomic evaluation may help bring domestic breeding in line with modern competitive practices and estimate the breeding value of cattle at birth based on information on the animal’s genome.

Clinical profiles of atrial fibrillation patients with or without malignancy: analysis from the Jordan Atrial Fibrillation study

Introduction

Atrial Fibrillation (AF) is the most prevalent arrhythmia and is associated with high morbidity and mortality. Malignancy can predispose to AF directly or through adverse effects of certain chemotherapeutic agents. Moreover, AF in the presence of malignancy is a special subgroup with high risk of both thromboembolism and bleeding.

Purpose

To study the clinical characteristics of AF in patients with malignancy compared to those without malignancy in a Middle Eastern population.

Methods

A total of 2015 Consecutive adult patients with previously or newly diagnosed AF in 19 hospitals and 30 out-patient cardiology clinics were enrolled in the Jordan AF study from May 2019 to October 2020. Clinical and epidemiological characteristics of patients with coexisting malignancy were compared to those without malignancy.

Results

Of the 2015 patients enrolled in the study, 136 (6.7%) had a coexisting malignancy; with breast cancer being the most common type of cancer (19.8%). Patients with malignancy were older than patients without malignancy (71±10 vs 67.5±13.3 years, p=0.005) with no gender difference between the two groups.

Patients with malignancy were less symptomatic compared to those without malignancy; fatigue (6.6% vs. 21.9%, p=0.ehab724.28492), dizziness (2.9% vs. 11.8%, p=0.0006) and shortness of breath (8.1% vs. 35.2%, p&lt;0.0001). Patients with AF and malignancy were more likely to have permanent AF at presentation compared to patients without malignancy (42.6% vs. 29.4%, P=0.0005).

While mean CHA2DS2-VASc in patients with malignancy was similar to those without malignancy (3.8±2.0 vs 3.5±2.0 p=0.269), the malignancy group had a higher proportion of patients with CHA2DS2-VASc score &gt;2.0 compared to those without malignancy (91.9% vs. 84.8%, p=0.023). On the contrary, patients without malignancy had higher proportions with HAS-BLED score &gt;3 compared to patients with malignancy (19.6% vs. 11.0%, p=0.014).

Left ventricular hypertrophy (LVH) and pulmonary hypertension (PAH) were diagnosed more frequently on echocardiography in patients with compared to those without malignancy (55.9% vs. 34.2%, p&lt;0.0001) and (43.4 vs. 26.2%, p&lt;0.ehab724.28498) respectively.

While patients with malignancy had a lower rate of direct oral anticoagulants (DOACs) utilization compared to patients without malignancy (34.6% vs. 48.1%, p=0.002), they had a higher rate of Low molecular weight heparin (LMWH) utilization (16.2% vs. 1.3%, p&lt;0.0001). There was no difference in the utilization of vitamin K antagonist between the two groups (29.4% vs. 31.8%. p=0.568).

Conclusion

Middle Eastern patients who have AF and coexisting malignancy were older, had less symptoms at presentation, and higher prevalence of permanent AF than patients without malignancy. These patients were more likely to be prescribed LMWH and less likely to receive DOACs compared to those without malignancy. Prospective long-term follow-up and outcomes is underway.

Funding Acknowledgement

Type of funding sources: None.

Antimicrobial stability of Cosmos caudatus extract at varies pH and temperature, and compounds identification for application as food sanitiser

The occurrence of foodborne diseases and food poisoning due to the consumption of contaminated foods is increasing nowadays, thus become a major threat to food industries in particular. In order to overcome this problem, prevention must be taken at the early stages of food preparation like sanitization. Typically, chemically based antimicrobial sanitisers were used in food industries to remove dirt and microbial population on food surfaces or food equipment. However, the emergence of microbial resistance and consumer awareness on the formation of carcinogenic compounds and safety issues in long term effects has led researchers to find an alternative. Therefore, a study was conducted to find a natural food sanitiser that was able to minimize the number of harmful bacteria without a change in the food quality and safety. In this study, the stability of Cosmos caudatus extract at different pH (pH 3, pH 7, pH 8 and pH 11) and temperatures (25°C, 30°C, 50°C, 80°C and 121°C) were determined for suitability as food sanitiser. The identification and quantification of this plant extract also were performed using HPLC and LC-MS/MS analysis to detect the major compounds which contributed to the biological activity of C. caudatus extract. Generally, results showed that the antimicrobial activity of C. caudatus extract was stable after exposure to various pH and temperatures, in fact, the extract increased its antimicrobial activity at lower acidity (pH 3) and higher temperature (50°C) against most pathogens. Furthermore, quercetin 3-O-rhamnoside was identified as a major compound in C. caudatus extract with the relative amounts of 29.66 mg/g. It can be concluded that C. caudatus extract is stable when exposed to various pH and temperatures. These useful findings have proved the antimicrobial stability of C. caudatus extract after exposure to several pH and temperatures thus can be further developed as a food sanitiser in food industries.

Erratum to: “The use of whole genome amplification for genomic evaluation of bovine embryos”

.

The use of whole genome amplification for genomic evaluation of bovine embryos

The integration of high technologies into livestock production has been actively occurring in the last decade in the countries with a developed animal breeding. First of all, we are talking about reproductive technologies (IVF) and genomic technologies (general genomic evaluation of animal and genomic evaluation of breeding value). Combining reproductive and genomic technologies is a promising approach that allows receiving highquality breeding cattle in the shortest possible time. The basis of the proposed technology for accelerated reproduction of high-value breeding cattle is to obtain information about the genome of the embryo for genomic evaluation. The amount of genetic material that can be obtained for research is extremely limited, as it is necessary to preserve the viability of the embryo. The stage of the whole genome amplification was introduced to obtain a high quality of genetic material in a sufficient quantity. The main purpose of this work is to assess the possibility of using embryo biopsy specimens (bsp) for embryo genotyping using microarray chips and predicting the carrier status of lethal haplotypes at the embryo stage. We obtained 100 cattle embryos, of which 78 biopsy specimens were taken to analysis. For the biopsies obtained we performed the whole genome amplification. The quality and quantity of DNA for all the 78 samples after the whole genome amplification were satisfactory for further genotyping. The quality of the performed genotyping was satisfactory and allowed the assessment of lethal haplotype carriers (determining the sex of the animal and identification of the carrier status for sevenHolsteinlethal haplotypes). We tested 78 embryos. From the genotyping analysis, there was detected one carrier status for three lethal haplotypes, HH0 (Brachyspina), HH5, and HCD. The carrier status of HH0 and HH5 was confirmed by testing the casual mutation using PCR analysis. The carrier status for HCD has not been confirmed by casual mutation analysis. The situation in which an animal is an HCD carrier, but not the carrier of a casual mutation, can be explained. The putative ancestor of the haplotype is the bull HOCAN000000334489 WILLOWHOLME MARK ANTHONY (year of birth is 1975), but a casual mutation associated with this disease has arisen only in his descendant HOCAN000005457798 MAUGHLIN STORM (year of birth is 1991). The results obtained confirm the importance of testing the casual mutation in the animals that are carriers of lethal haplotypes according to the genotyping data.

In vitro antioxidant and, α-glucosidase inhibitory activities and comprehensive metabolite profiling of methanol extract and its fractions from Clinacanthus nutans

BACKGROUND

This study was aimed to evaluate antioxidant and α-glucosidase inhibitory activity, with a subsequent analysis of total phenolic and total flavonoid content of methanol extract and its derived fractions from Clinacanthus nutans accompanied by comprehensive phytochemical profiling.

METHODS

Liquid-liquid partition chromatography was used to separate methanolic extract to get hexane, ethyl acetate, butanol and residual aqueous fractions. The total antioxidant activity was determined by 2,2-diphenyl-1-picrylhydrazy (DPPH) radical scavenging and ferric reducing antioxidant power assay (FRAP). The antidiabetic activity of methanol extract and its consequent fractions were examined by α-glucosidase inhibitory bioassay. The chemical profiling was carried out by gas chromatography coupled with quadrupole time-of-flight mass spectrometry (GC Q-TOF MS).

RESULTS

The total yield for methanol extraction was (12.63 ± 0.98) % (w/w) and highest fractionated value found for residual aqueous (52.25 ± 1.01) % (w/w) as compared to the other fractions. Significant DPPH free radical scavenging activity was found for methanolic extract (63.07 ± 0.11) % and (79.98 ± 0.31) % for ethyl acetate fraction among all the fractions evaluated. Methanol extract was the most prominent in case of FRAP (141.89 ± 0.87 μg AAE/g) whereas most effective reducing power observed in ethyl acetate fraction (133.6 ± 0.2987 μg AAE/g). The results also indicated a substantial α-glucosidase inhibitory activity for butanol fraction (72.16 ± 1.0) % and ethyl acetate fraction (70.76 ± 0.49) %. The statistical analysis revealed that total phenolic and total flavonoid content of the samples had the significant (p < 0.05) impact on DPPH free radical scavenging and α-glucosidase inhibitory activity.

CONCLUSION

Current results proposed the therapeutic potential of Clinacanthus nutans, especially ethyl acetate and butanol fraction as chemotherapeutic agent against oxidative related cellular damages and control the postprandial hyperglycemia. The phytochemical investigation showed the existence of active constituents in Clinacanthus nutans extract and fractions.

Metabolic alteration in obese diabetes rats upon treatment with Centella asiatica extract

ETHNOPHARMACOLOGICAL RELEVANCE

'Pegaga' is a traditional Malay remedy for a wide range of complaints. Among the 'pegaga', Centella asiatica has been used as a remedy for diabetes mellitus. Thus, we decided to validate this claim by evaluating the in vivo antidiabetic property of C. asiatica (CA) on T2DM rat model using the holistic (1)H NMR-based metabolomics approach.

METHOD

In this study, an obese diabetic (mimic of T2DM condition) animal model was developed using Sprague-Dawley rats fed with a high-fat diet and induced into diabetic condition by the treatment of a low dose of streptozotocin (STZ). The effect of C. asiatica extract on the experimental animals was followed based on the changes observed in the urinary and serum metabolites, measured by (1)H NMR of urine and blood samples collected over the test period.

RESULTS

A long-term treatment of obese diabetic rats with CA extract could reverse the glucose and lipid levels, as well as the tricarboxylic acid cycle and amino acid metabolic disorders, back towards normal states. Biochemical analysis also showed an increase of insulin production in diabetic rats upon treatment of CA extract.

CONCLUSION

This study has provided evidence that clearly supported the traditional use of CA as a remedy for diabetes. NMR-based metabolomics was successfully applied to show that CA produced both anti-hyperglycemic and anti-hyperlipidemic effects on a rat model. In addition to increasing the insulin secretion, the CA extract also ameliorates the metabolic pathways affected in the induced diabetic rats. This study further revealed the potential usage of CA extract in managing diabetes mellitus and the results of this work may contribute towards the further understanding of the underlying molecular mechanism of this herbal remedy.

Multivariate analysis of PRISMA optimized TLC image for predicting antioxidant activity and identification of contributing compounds from Pereskia bleo

Multivariate analysis of thin-layer chromatography (TLC) images was modeled to predict antioxidant activity of Pereskia bleo leaves and to identify the contributing compounds of the activity. TLC was developed in optimized mobile phase using the 'PRISMA' optimization method and the image was then converted to wavelet signals and imported for multivariate analysis. An orthogonal partial least square (OPLS) model was developed consisting of a wavelet-converted TLC image and 2,2-diphynyl-picrylhydrazyl free radical scavenging activity of 24 different preparations of P. bleo as the x- and y-variables, respectively. The quality of the constructed OPLS model (1 + 1 + 0) with one predictive and one orthogonal component was evaluated by internal and external validity tests. The validated model was then used to identify the contributing spot from the TLC plate that was then analyzed by GC-MS after trimethylsilyl derivatization. Glycerol and amine compounds were mainly found to contribute to the antioxidant activity of the sample. An alternative method to predict the antioxidant activity of a new sample of P. bleo leaves has been developed.

The influence of deep frying using various vegetable oils on acrylamide formation in sweet potato (Ipomoea batatas L. Lam) chips

The objective of this study was to evaluate the precursors of acrylamide formation in sweet potato (SP) (Ipomoea batatas L. Lam) chips and to determine the effect of different types of vegetable oils (VOs), that is, palm olein, coconut oil, canola oil, and soya bean oil, on acrylamide formation. The reducing sugars and amino acids in the SP slices were analyzed, and the acrylamide concentrations of SP chips were measured. SP chips that were fried in a lower degree of unsaturation oils contained a lower acrylamide concentration (1443 μg/kg), whereas those fried with higher degree of unsaturated oils contained a higher acrylamide concentration (2019 μg/kg). SP roots were found to contain acrylamide precursors, that is, 4.17 mg/g glucose and 5.05 mg/g fructose, and 1.63 mg/g free asparagine. The type of VO and condition used for frying, significantly influenced acrylamide formation. This study clearly indicates that the contribution of lipids in the formation of acrylamide should not be neglected.

Simultaneous detection of 12 mycotoxins in cereals using RP-HPLC-PDA-FLD with PHRED and a post-column derivatization system

A new method for the simultaneous quantification of 12 mycotoxins was developed and optimized using reverse phase high performance liquid chromatography (RP-HPLC) with a photodiode array (PDA) and fluorescence detector (FLD), a photochemical reactor for enhanced detection (PHRED) and post-column derivatization. The mycotoxins included aflatoxins (AFB(1), AFB(2), AFG(1), and AFG(2)), ochratoxin A (OTA), zearalenone (ZEA), deoxynivalenol (DON), fumonisins (FB(1), FB(2), and FB(3)), T-2 and HT-2 toxins. A double sample extraction with a phosphate-buffered saline solution (PBS) and methanol was used for co-extraction of mycotoxins, and a multifunctional immunoaffinity column was used for cleanup. Optimum conditions for separation of the mycotoxins were obtained to separate 12 mycotoxins in FLD and PDA chromatograms with a high resolution. The method gave recoveries in the range 72-111% when applied to spiked corn samples. The limits of detection (LOD) were 0.025 ng/g for AFB(1) and AFG(1), 0.012 ng/g for AFB(2) and AFG(2), 0.2 ng/g for OTA, 1.5 ng/g for ZEA, 6.2 ng/g for FB(1), FB(3) and HT-2 toxin, 9.4 ng/g for FB(2) and T-2 toxin, and 18.7 ng/g for DON. In addition, the limits of quantification (LOQ) ranged from 0.04 ng/g for AFB(2) and AFG(2) to 62 ng/g for DON. The method was successfully applied to the determination of these mycotoxins in 45 cereal samples obtained from the Malaysian market. The results indicated that the method can be applied for the multi-mycotoxin determination of cereals.

Endothelin-1 receptors on cultured rat articular chondrocytes: regulation by age, growth factors, and cytokines, and effect on cAMP production

The presence of endothelin-1 receptor proteins and the expression of their specific mRNAs were studied using 1st passage confluent monolayers of articular chondrocytes, isolated from 1-month and 18-month-old rats following 24-h incubation with several growth factors and cytokines. The ET-1- binding sites were predominantly of ETA subtype since BQ123, but not IRL1038 (ETB receptor subtype agonist), effectively blocked 125I-ET-1 binding. The 18-month-old rat cell monolayers bear approximately twice as many 125I-ET-1-binding sites as the 1-month-old rat cells. PDGF, EGF, and IGF-1 increased the number of binding sites in a concentration-dependent manner in both old and young rat cells with PDGF being the most active and EGF more active than IGF-1. IL-1beta, more potently than LPS, increased the number of binding sites in young rat cells only, whereas b-FGF, TGF-beta and GM-CSF had no effect or decreased slightly 125I-ET-1 binding in both types of cells. TNF-alpha strongly decreased the number of binding sites on both young and old rat cells, only. RT-PCR showed an increased expression of the specific ETA mRNA with the age of animals and in the presence of 50 ng/ml PDGF BB only. The incubation of the cells with ETs 1-3 for 10 min resulted in a 50% decrease of cellular cAMP but the blocking of the receptors with BQ123 prior to their exposure to ETs had no effect on cAMP production whereas IRL1038 counteracted this effect only marginally. This suggests a receptor-independent mechanism for ETs-induced inhibition of cAMP production. However, a 10-min co-incubation of cells with ET-1 and with one of the following agents: cholera toxin, pertussis toxin, indomethacin, L-NMA, U73122 and calphostin resulted in an almost complete (calphostin) or partial suppression of ET-1-induced inhibition of cAMP production. The significance of these findings is unclear but the increased density of ET-1 binding sites on old rat cells and its regulation by certain growth factors or cytokines suggest the involvement of ET-1 in aging and possibly in age-related diseases.

Mitochondrial DNA affinity of several Jewish communities

The mitochondrial DNA (mtDNA) of 332 individuals from Israel, including 270 Jews (originating from 7 communities) and 62 Arabs, was analyzed. Each mtDNA haplotype was determined by the fragment patterns of restriction enzymes HpaI, BamHI, HaeII, MspI (HpaII), and AvaII. The variability of the total sample and of each community was high. Of 40 different haplotypes, 20 were found more than once. Most haplotypes are typical of Caucasians, but African types were found among Ethiopian Jews and to a lesser extent among Arabs. The communities differed in their haplotypes: Chi-square tests among six communities showed significant differences for most pairwise comparisons and nonsignificant differences involving mainly the Moroccan Jews. In a genetic distance analysis only the Ethiopian Jews appeared to be distinguished from the other communities. According to a GST analysis, approximately 30% of the variation among the mtDNA restriction maps is attributable to differences between communities.

[Analysis using transcranial Doppler of hemodynamic consequences in 58 severe obstructions of the internal carotid artery. Preliminary results]

The authors have analyzed by transcranial pulsed Doppler 50 patients with one or two obstructions of the internal carotid artery, divided in three groups: 19 tight stenoses, 23 obstructions and 8 bilateral tight stenoses. The haemodynamic consequences of these carotid obstructions was evaluated from the results of velocity in the intracerebral arteries, the resistance index and the pulsatility compared to a reference artery (PTI). The PTI seems the most sensitive. Compared with the resistance index, it permits to better define the patients prone to be the victims of a haemodynamic cerebro-vascular accident, and seems indicated before carotid surgery is contemplated.

[Tissue concentrations of beta-methyl-digoxin in children]

Beta-methyl-digoxin concentrations in adipose, skeletal muscle and myocardial tissues, were studied in 8 patients undergoing by-pass surgery because of congenital heart disease. Correlation between doses/kg, plasmatic and tissue concentrations were analysed. We found statistically correlation between doses/kg and plasmatic concentrations; doses/kg and skeletal muscle concentrations (p less than 0.01); plasmatic and skeletal muscle concentrations (p less than 0.05). Concentrations was significantly greater in myocardial than adipose tissue before extracorporeal circulation (p less than 0.01); and significantly greater than adipose (p less than 0.01) and skeletal muscle (p less than 0.05) tissues after extracorporeal circulation. Extracorporeal circulation lessens adipose and skeletal muscle concentrations, but increases myocardial concentrations significantly (p less than 0.05). It is concluded, that the behaviour of beta-methyl-digoxin, in relation with tissue concentrations, is similar to digoxin.

[Continuous Holter electrocardiogram in children. Analysis of 100 traces]

Authors analyse the value of the Holter system for diagnosis and follow-up of cardiac dysrhythmias. They report their experience from 100 records performed to 87 patients, who were between one day and 14 years old. Among them, 58 were male and 42 female. The recorder and analyser were automatics holter II/Quickscan, and the program was 24 hours in all cases. For the study of results, patients were divided in five groups (34 dysrhythmias; 18 neurologic; 10 were normal control; 20 newborns between 1 and 7 days; and 17 in a miscellaneous group). They emphasized on the possibility of the system to be performed in pediatric patients, even in the youngest; on the worth of records from neurologic with normal clinical examinations; on diagnostic aspects of undetected dysrhythmias by ECG (30%), and to know the normal values from the control group. Tables and figures show rhythm types and quantitative values; finally they comment on artifacts and indications.

[Rheumatic carditis and its future (author's transl)]

Authors report results of the study of a series of rheumatic heart disease in 34 children between three and 14 years old, followed-up from one month to 14 years (mean six years and six months), and another one of 14 adults operated because of cardiac sequelae, in whom the average age was 48. The most significant results are: more common in autumn-winter (62%) and females (60%); family history of rheumatic fever (55%); low social level; mitral predominance with mitral regurgitation in children and stenosis in adults; during puberty age; without symptoms in the joints in 36%, and with better prognosis since 1974. Parameters with prognostic value in the prediction of sequelae were: family history of rheumatic fever; rural environment; increase in cardiac volume, PR prolongation in the ECG and inadequate treatment and prophylaxis. 36% of the mitral lesions and 20% of the aortic ones disappeared. The main conclusion is the need for intensive treatment during the acute period of the disease and continuous prevention during the rest of their lives of cardiac sequelae.

[Ventricular septal defect: Prognosis of spontaneous closure (author's transl)]

In a series of 150 cases of isolated ventricular septal defect (VSD), the authors have found 25 cases (16%) of spontaneous closure over an average period of observation of 20 months. The closure was observed in 32% of the cases before 6 months and in 60% before 12 months, with a range between 1 month and 8 years. The number of out patient with was 7 per case on average. A large group of parameters was taken into account in every case; from some of them, indicators of prognosis of closure were obtained, among them: early appearance of the murmur, descending shape, muscular character of the VSD, absence of symptoms and diastolic rumble, presence of ejection clic and normality in ECG and XRay.

[Functional evaluation of pancreas cystic fibrosis. Correlations and value of the echocardiogram versus other methods (author's transl)]

The results of a correlation of various parameters used in the functional evaluation of 12 cases of pancreas cystic fibrosis (PCF) are reported. Three clinical scores were measured by four separate observers and average score was taken. Electrocardiogram, phono, vectorcardiogram, pH, blood gases, radiology, spirometry, erythropoietin, blood counts and echocardiogram were also recorded. Each of these were correlated. In the echocardiogram (EC), right and left systolic time intervals, wall and cavity of the right ventricle and the left ventricular function were measured. Some correlations were found to have a statistical significance: the data attained from the EC, clinical score and the spirometry. However, blood count, blood gases, erythropoietin and pH were found to have no statistical significance. The EC was found to be the most accurate and sensitive method of recognising the initial stages of pulmonary hypertension in PCF; detecting its presence at as early an age as six years (on average). These results present a strong argument for the use of the EC as a vital part of each exam of PCF.