Evaluation of substance P as a biomarker for pain in equine colic

Equine colic is an important condition associated with acute abdominal pain and one of the leading causes of death in horses. As such, objectively evaluating pain is of interest for attending veterinarians. Pain scales for assessment are present, but no single pain-specific biomarker has been reported. The aim of this study was to determine if substance P (SP) could be a reliable biomarker to reflect pain and serve as a parameter to predict outcome in equine colic. The hypothesis was that horses displaying severe colic signs present with higher values of SP in contrast to those with mild colic signs. Thirty warmblood horses, aged between 3 and 20 years were recruited; evenly distributed (10 horses each) in three colic groups (mild, moderate, severe). To classify the colic signs, the horses were graded by the Equine Acute Abdominal Pain Scale (EAAPS). Clinical examination and EAAPS were performed at arrival in the hospital. Blood samples were collected four times in hourly intervals commencing from arrival. For comparison, already established parameters for prognosticating equine colic (heart rate, serum cortisol, and blood lactate concentration) were also measured. The assumption of increasing SP concentrations along with pain could not be confirmed. SP did not show any association with heart rate, cortisol, lactate, or EAAPS. Whereas the established parameters increased according to the EAAPS, SP remained stable in individual horses regardless of clinical signs, treatment, and disease progression. Consequently, SP was not a reliable parameter to reflect painful conditions or to predict outcome in equine colic.

Individuals at risk for severe COVID-19 in whom ritonavir-containing therapies are contraindicated or may lead to interactions with concomitant medications: a retrospective analysis of German health insurance claims data

Background

Nirmatrelvir/ritonavir is authorized for the treatment of COVID-19 but has several contraindications and potential drug-drug interactions (pDDIs) due to ritonavir-induced irreversible inhibition of cytochrome P450 3A4. We aimed to assess the prevalence of individuals with one or more risk factors for severe COVID-19 along with contraindications and pDDIs due to ritonavir-containing COVID-19 therapy.

Methods

Retrospective observational study of individuals with one or more risk factors according to Robert Koch Institute criteria for severe COVID-19 according to German statutory health insurance (SHI) claims data from the pre-pandemic years 2018-2019 based on the German Analysis Database for Evaluation and Health Services Research. Prevalence was extrapolated to the entire SHI population using age-adjusted and sex-adjusted multiplication factors.

Results

Nearly 2.5 million fully insured adults, representing 61 million people in the German SHI population, were included in the analysis. In 2019, prevalence of individuals that would have been at risk of severe COVID-19 was 56.4%. Amongst them, the prevalence of contraindications for treatment with ritonavir-containing COVID-19 therapy was approximately 2% according to presence of somatic comorbidities (severe liver or kidney disease). Prevalence of intake of medicines contraindicated for their potential interactions with ritonavir-containing COVID-19 therapy was 16.5% according to Summary of Product Characteristics and 31.8% according to previously published data. The prevalence of individuals at risk of pDDIs during ritonavir-containing COVID-19 therapy without adjustment of their concomitant therapy was 56.0% and 44.3%, respectively. Prevalence data for 2018 were similar.

Conclusion

Administering ritonavir-containing COVID-19 therapy can be challenging as thorough medical record review and close monitoring are required. In some cases, ritonavir-containing treatment may not be appropriate due to contraindications, risk of pDDIs, or both. For those individuals, an alternative ritonavir-free treatment should be considered.

Climate-driven variability of the Southern Ocean CO2 sink

The Southern Ocean is a major sink of atmospheric CO2, but the nature and magnitude of its variability remains uncertain and debated. Estimates based on observations suggest substantial variability that is not reproduced by process-based ocean models, with increasingly divergent estimates over the past decade. We examine potential constraints on the nature and magnitude of climate-driven variability of the Southern Ocean CO2 sink from observation-based air-sea O2 fluxes. On interannual time scales, the variability in the air-sea fluxes of CO2 and O2 estimated from observations is consistent across the two species and positively correlated with the variability simulated by ocean models. Our analysis suggests that variations in ocean ventilation related to the Southern Annular Mode are responsible for this interannual variability. On decadal time scales, the existence of significant variability in the air-sea CO2 flux estimated from observations also tends to be supported by observation-based estimates of O2 flux variability. However, the large decadal variability in air-sea CO2 flux is absent from ocean models. Our analysis suggests that issues in representing the balance between the thermal and non-thermal components of the CO2 sink and/or insufficient variability in mode water formation might contribute to the lack of decadal variability in the current generation of ocean models. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

Southern ocean carbon and heat impact on climate

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea-ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

Mental imagery of whole-body motion along the sagittal-anteroposterior axis

Whole-body motor imagery is conceptualised as a mental symbolisation directly and indirectly associated with neural oscillations similar to whole-body motor execution. Motor and somatosensory activity, including vestibular activity, is a typical corticocortical substrate of body motion. Yet, it is not clear how this neural substrate is organised when participants are instructed to imagine moving their body forward or backward along the sagittal-anteroposterior axis. It is the aim of the current study to identify the fingerprint of the neural substrate by recording the cortical activity of 39 participants via a 32 electroencephalography (EEG) device. The participants were instructed to imagine moving their body forward or backward from a first-person perspective. Principal Component Analysis (i.e. PCA) applied to the neural activity of whole-body motor imagery revealed neural interconnections mirroring between forward and backward conditions: beta pre-motor and motor oscillations in the left and right hemisphere overshadowed beta parietal oscillations in forward condition, and beta parietal oscillations in the left and right hemisphere overshadowed beta pre-motor and motor oscillations in backward condition. Although functional significance needs to be discerned, beta pre-motor, motor and somatosensory oscillations might represent specific settings within the corticocortical network and provide meaningful information regarding the neural dynamics of continuous whole-body motion. It was concluded that the evoked multimodal fronto-parietal neural activity would correspond to the neural activity that could be expected if the participants were physically enacting movement of the whole-body in sagittal-anteroposterior plane as they would in their everyday environment.

Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case

Background

The analysis of statutory health insurance (SHI) data is a little-used approach for understanding treatment and care as well as resource use of lung cancer (LC) patients in Germany. The aims of this observational, retrospective, longitudinal analysis of structured data were to analyze the healthcare situation of LC patients in Germany based on routine data from SHI funds, to develop an algorithm that sheds light on LC types (non-small cell / NSCLC vs. small cell / SCLC), and to gain new knowledge to improve needs-based care.

Methods

Anonymized billing data of approximately four million people with SHI were analyzed regarding ICD-10 (German modification), documented medical interventions based on the outpatient SHI Uniform Assessment Standard Tariff (EBM) or the inpatient Operations and Procedure Code (OPS), and the dispensing of prescription drugs to outpatients (ATC classification). The study included patients who were members of 64 SHI funds between Jan-1st, 2015 and Dec-31st, 2016 and who received the initial diagnosis of LC in 2015 and 2016.

Results

The analysis shows that neither the cancer type nor the cancer stage can be unambiguously described by the ICD-10 coding. Furthermore, an assignment based on the prescribed medication provides only limited information: many of the drugs are either approved for both LC types or are used off-label, making it difficult to assign them to a specific LC type. Overall, 25% of the LC patients were unambiguously identifiable as NSCLC vs SCLC based on the ICD-10 code, the drug therapy, and the billing data.

Conclusions

The current coding system appears to be of limited suitability for drawing conclusions about LC and therefore the SHI patient population. This makes it difficult to analyze the healthcare data with the aim of gathering new knowledge to improve needs-based care. The approach chosen for this study did not allow for development of a LC differentiation algorithm based on the available healthcare data. However, a better overview of patient specific needs could make it possible to modify the range of services provided by the SHI funds. From this perspective, it makes sense, in a first step, to refine the ICD-10 system to facilitate NSCLC vs. SCLC classification.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07982-8.

P–449 Evaluation of ovarian reserve in female children and adolescents with non-iatrogenic primary ovarian insufficiency to establish criteria for ovarian tissue cryopreservation

Study question

What is the predictive value of ovarian reserve evaluation in patients with non-iatrogenic primary ovarian insufficiency (NIPOI) for follicle detection in ovarian tissue harvested for cryopreservation?

Summary answer

Ovarian tissue cryopreservation (OTCP) should be considered if patients present at least one of the following parameters: detectable AMH, FSH≤20mIU/ml, detection of ≥ 1 antral follicle.

What is known already

In pre-pubertal girls suffering from NIPOI, which majorly has a genetic etiology, fertility preservation using OTCP is commonly practiced. When OTCP was performed in an unselected group of children and adolescents with NIPOI, only 26% of them had follicles in ovarian tissue while 74% did not benefit from the surgery. The role of preoperative evaluation of anti-müllerian hormone (AMH) serum level, follicular stimulating hormone (FSH) serum level, and trans-abdominal ultrasound for the antral follicle count to predict the detection of primordial follicles in the harvested ovarian tissue is unclear.

Study design, size, duration

We conducted a retrospective analysis of all patients ≤ 18 years old who were referred for fertility preservation counseling due to NIPOI at a single tertiary hospital between 2010 and 2020. If initial evaluation suggested a diminished ovarian reserve and at least one positive parameter indicating a follicular activity (AMH > 0.16ng/ml, FSH ≤ 20mIU/ml, detection of ≥ 1 antral follicle by transabdominal sonography), OTCP was offered. Patients with 46XY gonadal dysgenesis were excluded.

Participants/materials, setting, methods

OTCP was performed laparoscopically in all cases. A fresh sample of cortical tissue was fixed in buffered formaldehyde for histological analysis. The rest of the ovarian tissue was cut into small cuboidal slices 1–2 mm in thickness and cryopreserved. After the serial sections, the histological slides were evaluated for the presence of follicles by a certified pathologist. Follicles were counted and categorized as primordial, primary, and secondary.

Main results and the role of chance

During the study period, 39 patients with suspected NIPOI were referred to the fertility preservation center. Thirty-seven patients included in the study were diagnosed with Turner’s syndrome (n = 28), Galactosemia (n = 3), Blepharophimosis-Ptosis-Epicanthus Inversus syndrome (n = 1), and idiopathic NIPOI (n = 6). Of 28 patients with Turner’s syndrome, 6 had 45X monosomy, 15 had mosaicism and 7 had structural anomalies in X-chromosome. One patient with gonadal dysgenesis and one with the presence of Y-chromosome in 20% of somatic cells were excluded from the study. OTCP was conducted in 14 patients with at least one positive parameter suggesting ovarian function. No complications of the surgical procedure or the anesthesia were observed. Primordial follicles were found in all patients with two or three positive parameters (100%) and in three of six cases with one positive parameter (50%). In total, of the 14 patients who underwent OTCP with at least one positive parameter, 11 (79%) had primordial follicles at biopsy (mean 23.9, range 2–47). This study demonstrates a positive predictive value of 79% for the detection of primordial follicles in patients who had at least one positive parameter of ovarian reserve evaluation. If two or three parameters were positive, the positive predictive value increased to 100%.

Limitations, reasons for caution

This study did not examine the negative predictive value of our protocol as OTCP was not recommended in the absence of positive parameters. The future fertility potential of cryopreserved tissue in the population with NIPOI is unclear and should be discovered in further studies.

Wider implications of the findings: We suggest the evaluation of ovarian reserve by antral follicles count, AMH, and FSH serum levels prior to OTCP in patients with NIPOI. By recommendation of OTCP only if ≥ 1 parameter suggesting the ovarian function is positive, unnecessary procedures can be avoided.

Trial registration number

Not applicable

Mesoscale atmosphere ocean coupling enhances the transfer of wind energy into the ocean

Although it is well established that the large-scale wind drives much of the world's ocean circulation, the contribution of the wind energy input at mesoscales (10–200 km) remains poorly known. Here we use regional simulations with a coupled high-resolution atmosphere–ocean model of the South Atlantic, to show that mesoscale ocean features and, in particular, eddies can be energized by their thermodynamic interactions with the atmosphere. Owing to their sea-surface temperature anomalies affecting the wind field above them, the oceanic eddies in the presence of a large-scale wind gradient provide a mesoscale conduit for the transfer of energy into the ocean. Our simulations show that this pathway is responsible for up to 10% of the kinetic energy of the oceanic mesoscale eddy field in the South Atlantic. The conditions for this pathway to inject energy directly into the mesoscale prevail over much of the Southern Ocean north of the Polar Front.

The precise mechanism for wind energy input into the ocean at mesoscales remains uncertain. Here, using a high-resolution atmosphere-ocean model of the South Atlantic, the authors show that a mesoscale conduit associated with oceanic eddies is responsible for up to 10% of kinetic energy transfer.

Changes in Ocean Heat, Carbon Content, and Ventilation: A Review of the First Decade of GO-SHIP Global Repeat Hydrography

Global ship-based programs, with highly accurate, full water column physical and biogeochemical observations repeated decadally since the 1970s, provide a crucial resource for documenting ocean change. The ocean, a central component of Earth's climate system, is taking up most of Earth's excess anthropogenic heat, with about 19% of this excess in the abyssal ocean beneath 2,000 m, dominated by Southern Ocean warming. The ocean also has taken up about 27% of anthropogenic carbon, resulting in acidification of the upper ocean. Increased stratification has resulted in a decline in oxygen and increase in nutrients in the Northern Hemisphere thermocline and an expansion of tropical oxygen minimum zones. Southern Hemisphere thermocline oxygen increased in the 2000s owing to stronger wind forcing and ventilation. The most recent decade of global hydrography has mapped dissolved organic carbon, a large, bioactive reservoir, for the first time and quantified its contribution to export production (∼20%) and deep-ocean oxygen utilization. Ship-based measurements also show that vertical diffusivity increases from a minimum in the thermocline to a maximum within the bottom 1,500 m, shifting our physical paradigm of the ocean's overturning circulation.

Development and evaluation of a new instrument to measure visual exploration behavior

Effective visual exploration is required for many activities of daily living and instruments to assess visual exploration are important for the evaluation of the visual and the oculomotor system. In this article, the development of a new instrument to measure central and peripheral target recognition is described. The measurement setup consists of a hemispherical projection which allows presenting images over a large area of ± 90° horizontal and vertical angle. In a feasibility study with 14 younger (21-49 years) and 12 older (50-78 years) test persons, 132 targets and 24 distractors were presented within naturalistic color photographs of everyday scenes at 10°, 30°, and 50° eccentricity. After the experiment, both younger and older participants reported in a questionnaire that the task is easy to understand, fun and that it measures a competence that is relevant for activities of daily living. A main result of the pilot study was that younger participants recognized more targets with smaller reaction times than older participants. The group differences were most pronounced for peripheral target detection. This test is feasible and appropriate to assess the functional field of view in younger and older adults.

High-latitude controls of thermocline nutrients and low latitude biological productivity

The ocean's biological pump strips nutrients out of the surface waters and exports them into the thermocline and deep waters. If there were no return path of nutrients from deep waters, the biological pump would eventually deplete the surface waters and thermocline of nutrients; surface biological productivity would plummet. Here we make use of the combined distributions of silicic acid and nitrate to trace the main nutrient return path from deep waters by upwelling in the Southern Ocean and subsequent entrainment into subantarctic mode water. We show that the subantarctic mode water, which spreads throughout the entire Southern Hemisphere and North Atlantic Ocean, is the main source of nutrients for the thermocline. We also find that an additional return path exists in the northwest corner of the Pacific Ocean, where enhanced vertical mixing, perhaps driven by tides, brings abyssal nutrients to the surface and supplies them to the thermocline of the North Pacific. Our analysis has important implications for our understanding of large-scale controls on the nature and magnitude of low-latitude biological productivity and its sensitivity to climate change.

[Evolution of inflammatory parameters after fibroid embolization]

PURPOSE

To describe the rise of classical laboratory tests for inflammation following transarterial uterine fibroid embolization (UFE) in order to monitor the normal course following UFE.

MATERIALS AND METHODS

In 20 females, white blood cell (WBC) count and C-reactive protein (CRP) were determined before and up to 5 days after UFE. With the exception of one noninflammatory complication, the post-procedure course was uneventful in all patients. The measured values were correlated with both the total uterine volume and the amount of instilled embolizing agent.

RESULTS

Following UFE, an increase in the WBC count to an average maximum of 10.8 +/- 3.5/wL (range 5.9 - 18.6/wL) was found. In 13 of 20 patients, the WBC count was above normal on at least one day following UFE. The increase reached the maximum on the third post-interventional day and subsided within 5 days after the UFE. The CRP values increased significantly to an average maximum of 41.9 +/- 28.8 mg/l. The maximum was found on the 2nd post-interventional day in 8 patients, on the 3rd day in 11 patients and on the 4th day in one patient. No correlation to the total uterine volume or to the amount of the instilled embolizing agents was detected.

CONCLUSION

Following uncomplicated UFE, a steep increase in CRP occurs with no or only a mild increase in the WBC count, which does not indicate an infected fibroid. The maximum is reached on the 3rd or 4th post-interventional day, followed by a decline in CRP and normalization of the WBC count.

Fetal behavioural state changes following maternal fluoxetine infusion in sheep

Clinical depression is diagnosed in 5-15% of women during pregnancy, increasing the risk of negative outcomes. Fluoxetine (FX), a selective serotonin reuptake inhibitor, is prescribed during pregnancy. In adults, FX alters sleep patterns with single doses decreasing total sleep time and rapid eye movement sleep. The effects of FX on sleep in the fetus are unknown. However, 5-hydroxytryptophan, the precursor of serotonin, has been reported to prolong high-voltage (HV) electrocortical (ECoG) activity and increase the incidence of fetal breathing movements (FBM) in the sheep fetus. We hypothesize that FX exposure will decrease the incidence of LV ECoG in the fetus. Twenty-one pregnant sheep were surgically prepared for chronic study of blood gases, ECoG activity, eye movements and FBM. After 3 days of recovery, ewes received a 70-mg bolus i.v. infusion of FX or sterile water followed by continuous infusion at a rate of 0.036 mg/min for 8 days. The incidence of low-voltage (LV) ECoG decreased from 54+/-4% on the preinfusion day to 45+/-5% on infusion day 1 in the FX group and remained decreased throughout the infusion period. In addition, the incidence of both eye movements and FBM was decreased on infusion day 1 compared to preinfusion day in the FX group. HV ECoG increased from 39+/-3% on preinfusion day to 68+/-14% on FX infusion day 1 and remained elevated throughout the infusion period. These data show that maternal FX administration alters fetal behavioural state.

The global carbon cycle: a test of our knowledge of earth as a system

Motivated by the rapid increase in atmospheric CO2 due to human activities since the Industrial Revolution, several international scientific research programs have analyzed the role of individual components of the Earth system in the global carbon cycle. Our knowledge of the carbon cycle within the oceans, terrestrial ecosystems, and the atmosphere is sufficiently extensive to permit us to conclude that although natural processes can potentially slow the rate of increase in atmospheric CO2, there is no natural "savior" waiting to assimilate all the anthropogenically produced CO2 in the coming century. Our knowledge is insufficient to describe the interactions between the components of the Earth system and the relationship between the carbon cycle and other biogeochemical and climatological processes. Overcoming this limitation requires a systems approach.

Drug treatment of Alzheimer's disease. Effects on caregiver burden and patient quality of life

Alzheimer's disease is a devastating illness that will become more common as the population ages. Although clinical diagnosis of the illness is not certain without histological examination of the brain, and misdiagnosis may occur, broad working criteria to help diagnose the likely presence of Alzheimer's disease are available. Thoughtful clinical evaluation improves diagnostic accuracy, and appropriately diagnosed patients are critical for involvement in research into new antidementia agents. Essential to the discovery of new drugs is careful measurement of illness response. A variety of scales--some aimed at patients, others at their caregivers, and yet others for clinicians--assess Alzheimer's disease severity, progression, symptom response, and quality of life. Of note, patient response is not the only measurement of treatment benefit today. Growing interest is also being placed on tracking the possible amelioration of caregiver 'burden'. This burden refers to the psychological, physical, and material costs of providing care for an Alzheimer's patient over long periods of time. A number of scales and questionnaires have been developed and are occasionally used. Many drugs have been tried in Alzheimer's disease, but very few have produced any benefit, and this is often modest. Ergoloid mesylates, initially thought to be effective, are now considered of little value. The cholinomimetic drugs, especially the acetylcholinesterase inhibitor tacrine, have provided a very modest benefit, slowing the progression of the illness for a number of months. No cognitive improvement has been noted with the various nootropic agents such as piracetam. Early studies with levacecarnine (acetyl-L-carnitine), a substance that facilitates the use of fatty acids, memantidine, the dimethyl derivative of amantidine, and the calcium channel blocker nimodipine, have shown some promise, but require larger, more rigorous studies. As mentioned above, documenting effects in individual patients is crucial; examining for potential benefit to caregivers is a growing part of research design. Current treatment efforts will become more sophisticated as a deeper understanding of the neurobiology of Alzheimer's disease develops. For the immediate future, the goal is not cure but slowing of the disease process. Achieving this limited goal would have a substantial impact on the financial and human costs of the illness.

Production of spectrally narrow soft-x-ray radiation through the use of broadband laser-produced plasma sources and multilayer-coated reflecting optics

We describe a special filter design that produces spectrally narrow soft-x-ray radiation by using a broadband laser-produced plasma source and multilayer-coated reflecting optics. Calculations for the design were carried out at several laser-produced plasma-source temperatures and various multilayermirror combinations with and without a soft-x-ray filter. We determined that the best arrangement for a laser-produced plasma source consists of two multilayer mirrors and one soft-x-ray filter for each temperature investigated.

[Comparative evaluation of dipyridamole and dobutamine 2-dimensional echocardiography in ischemic heart disease]

Dipyridamole and dobutamine stress were performed in the same 41 angiographically controlled patients. Both tests were followed by 2 dimensional-echocardiography. The dose of dipyridamole was 0.56 mg/kg/4 min. or 0.84 mg/kg over 10 min., while the dose of dobutamine was 10-20-30-40 and 40 micrograms/kg/min. over 3 min. each step. In addition, to reach the submaximal heart rate 0.25 mg/min Atropine was also injected for 4 minutes in 13 cases. One vessel disease was found in 15 cases, and 2 vessel disease was in 2 cases. The number of coronarography negative cases was 24. The sensitivity, specificity, positive and negative predictive values for both tests were 70%, 91%, 85% and 81%, respectively. False positive results were observed in 2 cases and false negative ones were found in 5 cases, mainly at left anterior descendent stenosis. There was a good agreement between the wall motion abnormality and the anatomic localization of stenoses. Both non-invasive tests are suitable for the diagnosis of ischaemic heart disease.

Prospective evaluation of thallium-201 reinjection in single-vessel coronary patients undergoing coronary bypass surgery

Twenty-two patients with single-vessel left anterior descending coronary artery disease were investigated by means of dipyridamole stress thallium-201 myocardial perfusion scintigraphy, using single photon emission tomography (SPET), 1 week before and 2-5 weeks after coronary bypass surgery. The dose of dipyridamole was 0.56 mg/kg, and the injected activity of 201Tl was 74 MBq. Before surgery, and after completion of the redistribution study, a further 37 MBq of 201Tl was injected. Ten minutes and 1 h later, repeated SPET imaging were performed. SPET images were evaluated both subjectively and semiquantitatively, using a five-grade segmental defect score system, with higher scores for more severe perfusion defects. Before surgery, the 3-h redistribution images revealed complete or partial persistence of the perfusion defects in all patients. On the images taken 10 min after reinjection, these defects were completely filled in four cases, and partially filled in ten cases. Further positive changes were observed on the 1-h post-reinjection images in four cases. Three of the 1-h post-reinjection images exhibited a paradox redistribution. The stress images after surgery corresponded well to the 201Tl distribution on the preoperative 1-h post-reinjection images in 11 cases. The average of the segmental defect severity scores was 17.0 after stress, 10.1 at rest, 7.1 10 min after reinjection and 6.4 1 h after reinjection. After surgery, the average of both the post-stress and the 3-h redistribution scores was 3.1.(ABSTRACT TRUNCATED AT 250 WORDS)

[False positive results of exercise tests with thallium myocardial scintigraphy]

The authors have examined supposed causes of positive Th-201 stress scintigraphy. Patients were divided into two groups according to the presence of exercise-induced transitory hypoperfusion or in absence of it. In both groups negative coronarograms were verified. Results of two groups were compared according to parameters of the left ventricle function, pulmonary pressure, to the presence of disorder of system stimulus-conduction (LBBB, RBBB), mitral prolapsus, foramen ovale apertum, anomalous coronary anatomy, level of load during exercise, body weight, heart volume-index. Significant difference was found in disorder of left ventricle motion, ejection fraction and in comprehensive value of left ventricle function (F1).

[Ergometric stress test using Tl-201 myocardial perfusion. Tomographic or planar imaging?]

The clinical performance of the planar vs. tomographic ergometric stress 201-Tl myocard perfusion scintigraphy was compared. The results of the investigations of 80 patients were analysed retrospectively. In 59 patients planar, in 21 tomographic imaging was performed. As a consequence of clinical decision making cardiac catheterization was made in all of the patients, within 3 months after the perfusion scintigraphy. The sensitivity of the planar method was 23/27 (85%), the specificity 18/32 (56%), the accuracy 41/59 (69%). The respective values of the SPECT technique were: Sensitivity: 12/12 (100%), specificity 6/9 (66%), accuracy 18/21 (86%). It is concluded, that in comparison to the planar imaging the SPECT technique is superior in the detection of the perfusion abnormalities of the myocard due to significant coronary narrowings.

[The significance of the dipyramidole echocardiography test in ischemic heart disease]

The diagnostic value of the dipyridamole echocardiography test was investigated in 46 patients who underwent coronary angiography due to suspected ischaemic heart disease. Twenty-two of 46 patients were found to have a narrowing of at least 70% one vessel. Twenty-four hour ECG monitoring was also performed on 19 patients on the day of the dipyridamole test. The sensitivity and specificity of the two-dimensional echocardiography test (new wall motion abnormality) were 72.7% and 62.5%. The ECG (V2-5-9) had a low sensitivity during the test (43.8%). Good agreement was found between the localization of the wall motion abnormalities and the site of anatomic narrowing in the ischaemic group. No significant ventricular arrhythmias were detected, and the sensitivity and specificity of ST-T changes were found to be 62.5% and 54.6% by means of Holter monitoring. The dipyridamole echocardiography test proved to be a suitable noninvasive method for the diagnosis of ischaemic heart disease and for the selection of patients for coronary angiography.

[Cardiolite (99m-Tc-isonitrile) SPECT studies in patients prior to coronary bypass surgery]

The authors studied with 99m-Tc Cardiolite (methoxy-isobutyl-isonitrile) SPECT examination the effect of coronary bypass operation on the myocardial perfusion. One week before and 3 weeks after the operation examinations were performed first with dipyridamol loading and 24 hours later in rest. The regional perfusion of the myocardium was studied on the basis of transversal section-pictures of corrected axis position. In the examinations preceding the operation the global sensitivity of the method was found to be 100%. In the demonstration of the structures of the ramus descendens 95%, of the ramus circumflexus and of the right coronary artery 100% sensitivity was reached. In postoperative examinations following the bridging of the ramus descendens anterior the improvement of the perfusion of the corresponding ventricular segment was found in 15/20 during the loading and in 7/8 cases following the bridging of the ramus circumflexus and right coronary artery. Improving perfusion was demonstrated in 17/20 and in 6/8 cases in rest. On the basis of the results the authors consider their method suitable for the study of the regional blood perfusion and for the examination of the changes taking place upon coronary bypass operations.

The heart in acromegaly: an echocardiographic study

We used echocardiography to study anatomic and functional changes of the heart in 25 patients with acromegaly. Asymmetric septal hypertrophy was found in 10 patients, in the range of 12 to 30 mm, with an average of 16 mm. The degree of septum-thickness was severe in 1 case, marked in 5 cases and mild in 4 cases. Concentric left ventricular hypertrophy was present in 1 patient. In 8 patients the left ventricle was normal and left ventricular dilatation of more than 60 mm was present in 6 cases. Except in one patient, the ejection fraction was decreased in the dilated group, indicating diminished myocardial contractility. The growth hormone level was higher in patients with left ventricular hypertrophy as compared to those patients with normal or dilated left ventricles. In acromegaly primary myocardial hypertrophy may be related to the growth hormone level.

Real-time ultrasound observation of breathing and movements in the fetal lamb

In seven pregnant ewes with catheters chronically implanted in the fetus, real-time ultrasound observations of fetal breathing and body movements were correlated with direct measurements of fetal arterial and tracheal pressures, heart rate, and intrauterine pressure. There was excellent correlation between the ultrasound record of fetal breathing and recordings of intratracheal pressure changes even when breath amplitude was low or frequently was high. Fetal body movements (stretches, rolls, kicks) were observed during both breathing and nonbreathing periods; vigorous movements were accompanied by rapid deflections of the amniotic and tracheal pressure traces. Movement was frequently accompanied by transient increases or decreases in heart rate. The results indicate that real-time ultrasound is an accurate method of observation of fetal movement in pregnant sheep and is particularly valuable when combined with direct measurements of fetal physiologic parameters.