Sex differences in 123I-mIBG scintigraphy imaging techniques in patients with heart failure

BACKGROUND

123I-mIBG-scintigraphy could be a useful stratifying tool for patients with heart failure (HF). The purpose of this retrospective study is to evaluate whether there are differences between men and women with HF in terms of the prediction of cardiac arrhythmic events (AE).

RESEARCH AND METHODS

A total of 306 patients, before implantable-cardioverter-defibrillator (ICD) implantation, were evaluated. They underwent 123I-mIBG-scintigraphy and an evaluation of the results was performed after 85 months of follow-up. Early and late planar and SPECT cardiac images were acquired. Heart-to-mediastinum ratio (HM) for planar images and the sum of the segmental scores (SS) for SPECT were calculated.

RESULTS

In the general population, age, early SS (ESS), late SS (LSS), and ejection fraction (EF) were statistically significant for the prediction of AE at Cox regression, while early and late HM (eHM,lHM) were not significative for the prediction of AE. Population was divided into females and males and univariate analysis was conducted separately for the two cohorts: no significant variables for prediction of AE were found in females. For males, ESS, LSS, EF, and late HM were statistically significant predictors of AE. The overall survival was similar in males and females, but the risk of AE is lower in males than in females.

CONCLUSIONS

123I-mIBG represents a more effective tool for the prediction of AE in male patients than in women.

Hemiplegic Migraine in Children and Adolescents

BACKGROUND

Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar characteristics of pediatric HM.

METHODS

This is a narrative review based on 14 studies on pediatric HM selected from 262 papers.

RESULTS

Different from HM in adults, pediatric HM affects both genders equally. Early transient neurological symptoms (prolonged aphasia during a febrile episode, isolated seizures, transient hemiparesis, and prolonged clumsiness after minor head trauma) can precede HM long before its onset. The prevalence of non-motor auras among children is lower than it is in adults. Pediatric sporadic HM patients have longer and more severe attacks compared to familial cases, especially during the initial years after disease onset, while familial HM cases tend to have the disease for longer. During follow-up, the frequency, intensity, and duration of HM attacks often decrease. The outcome is favorable in most patients; however, neurological conditions and comorbidities can be associated.

CONCLUSION

Further studies are needed to better define the clinical phenotype and the natural history of pediatric HM and to refine genotype-phenotype correlations in order to improve the knowledge on HM physiopathology, diagnosis, and outcome.

A prospective randomised controlled mixed-methods pilot study of home monitoring in adults with cystic fibrosis

BACKGROUND

Home monitoring (HM) is able to detect more pulmonary exacerbations (PEx) than routine care (RC) in individuals with cystic fibrosis (CF), but there is currently no evidence for benefits in health outcomes. Patient experiences of using HM and a health economics assessment have not been rigorously assessed to date. This study aimed to assess the effects of HM on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience.

METHODS

This randomised controlled mixed-methods pilot study recruited CF adults cared for in one large regional CF centre. Participants were randomly allocated 1:1 to the intervention cohort [twice-weekly HM of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and forced expiratory volume in one second (FEV₁)] or a control cohort (routine clinical care) for the 12-month study period. Measurements were recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, comorbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous) and PEx (defined by the modified Fuchs criteria) were recorded at each study visit. Health status, capability and cost-effectiveness were measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience of HM was assessed by semi-structured qualitative interviews at baseline and 12 months.

RESULTS

Eighty-eight participants were recruited, with 44 (50%) randomised to receive HM and 44 (50%) randomised to receive RC. Patient hospital inpatient bed days per annum and overall health-related quality of life were similar between the groups. Protocol-defined PEx requiring intravenous and oral antibiotics were detected more frequently in the HM group, with no other differences between the groups in the secondary outcomes. The total mean National Health Service (NHS) costs were approximately £1500 more per patient for the RC arm than the HM group. The qualitative analysis demonstrated that the patient experience of HM was generally positive and overall the intervention was well accepted.

CONCLUSION

The findings of this trial confirm that HM is effective in detecting PEx in adults with CF. There were no significant differences in hospital inpatient bed days and overall health-related quality of life between the groups. Despite the cost of the HM equipment and the salary of the research fellow to respond to the results, health economics analysis suggests the intervention was less expensive than RC. HM was generally well accepted, with most participants reporting that it resulted in them feeling more empowered and reassured.

TRIAL REGISTRATION

The study protocol was registered with Clinicaltrials.gov (NCT02994706) on 16 July 2014 and published in a peer reviewed journal.Data from this trial has been presented in abstract form at the ECFS Conference in Lyon in September 2020.

Hydatidiform molar pregnancy following assisted reproduction

INTRODUCTION

The use of assisted reproduction techniques (ART) is increasing; however, reports of molar pregnancy following ART remain scarce. Currently, the Human Fertility and Embryology Authority (HFEA) collates data on the molar pregnancies that have resulted through the use of ART. Recently, they have indicated that they will no longer collect these data.

AIM

This paper aimed to examine the incidence of molar pregnancy amongst patients undergoing assisted reproduction.

METHODS

We contacted HFEA and placed a request under the Freedom of Information Act (2000) for the number of molar pregnancies that resulted from fresh/frozen embryo transfer since HFEA started collecting data in 1991 to February 2018. We also asked how many patients who had suffered a molar pregnancy went on to have a normal pregnancy and how many had subsequent molar pregnancies, in subsequent treatment cycles.

RESULTS

Between 68 and 76 molar pregnancies occurred within this period using ART (n = 274,655). The incidence of molar pregnancy using fresh intracytoplasmic sperm injection (ICSI) (1/4302) and fresh in vitro fertilisation (IVF) (1/4333) was similar. The risk of recurrence of molar pregnancy following a previous molar was higher following ART compared to spontaneous conceptions.

CONCLUSION

The use of ICSI should be protective against triploidy; however, the retrospective data suggests that molar pregnancy is not eliminated with the use of ART. It is pertinent to continue to record this data, through the gestational trophoblastic disease centres, in order to ensure no further increase in incidence, appropriate follow-up, and transparency in communication.

Phosphoric acid purification sludge: Potential in heavy metals and rare earth elements

The present study was carried out to show the potential in heavy metals (HM) and the rare earth elements (REE) which presents the residues of phosphoric-acid(PA) purification. Three different cadmiferous solid residues (according to the nature of the purification process of the PA: BG, BC and BS) were collected from an industrial site located in the south of Tunisia. The mineralogical study showed the predominance of anhydrite, accompanied by quartz, malladrite; calcium sulfate hemihydrate and fluorapophyllite. The microanalysis showed (i) the association of cadmium and zinc, (ii) as well as the presence of associated REEs. The chemical analysis showed that (i) the calcium sulfate concentrations are majority in samples BS, BG and BC (44, 34 and 44%, respectively), (ii) significant concentrations of phosphoric acid (28, 18 and 21% P₂O₅, respectively), (iii) the HM: Cd, Zn, Cr, Ni, V, Cu, Pb, Co, Mo, Mn and U have proportion in the order of 0.1%. The concentrations of Cd, Zn and Cr are respectively in the order of: 230, 149 and 189 mg/kg for BS, 346, 243 and 153 mg/kg for BG and 183, 129 and 440 mg/kg for BC and (iv) the REEs: La, Ce, Nd, Eu, Y et Yb present considerable mass percentages able to reach 0.2%. A series of extraction tests was led on the cadmiferous sludges to evaluate the rates of HM (Cd, Zn) and REE dissolution, using two solvents (deionized water (DW) and aqueous sodium based alkaline metal solution). The results showed that the dissolution rates of Cd and Zn are respectively in the order of (12-29% and 41-45% for DW; 67-86% and 83-93% for Na₂SO₄ solution). The extractability of HM and REE is strongly influenced by pH, solvent nature and mineral load in the cadmiferous sludges. The water-soluble metals represent a significant mobile fraction, making the toxic elements more sensitive to mobilization processes, such as leaching and erosion. Whereas, the metals extractable by the Na₂SO₄ solution represent a very important exchangeable and "co-crystallization" fraction, which reflects the bioavailability of these metals.

Spatial characteristics of cadmium in topsoils in a typical e-waste recycling area in southeast China and its potential threat to shallow groundwater

Informal electrical and electronic waste (e-waste) recycling often creates secondary sources of cadmium (Cd) pollution. To characterize the total Cd concentration (Cdtotal) in topsoil and evaluate the threat of Cd in topsoils to shallow groundwater, 187 topsoil samples and 12 shallow groundwater samples were collected in a typical e-waste recycling area in southeast China. Soil organic matter content, soil pH and Cdtotal in topsoil, pH and dissolved Cd concentration in shallow groundwater were measured. Cdtotal in the topsoils showed an inverse distribution trend with soil pH in that high Cd concentrations (and low pH values) were found in the surrounding area of the metal recycling industrial park where there were many family-operated e-waste recycling facilities before the industrial park was established and with low concentrations (and high pH values) in other areas, and they had similar spatial correlation structures. Cd accumulation and acidification were synchronous in topsoils, and soil pH was significantly correlated with Cdtotal in topsoils with low to moderate negative correlation coefficient (r=-0.24), indicating that both of them maybe correlated with informal recycling. The shallow groundwater in the surrounding area of the metal recycling industrial park was seriously contaminated by Cd, and topsoil Cd accumulation and acidification in the surrounding area of e-waste recycling sites significantly increase the risk of shallow groundwater contaminated by Cd. Action is urgently required to control Cd accumulation and acidification by improving the recycling operations of e-wastes in order to reduce the risk of Cd leaching from topsoils and shallow groundwater contamination.

Trichoderma virens PDR-28: a heavy metal-tolerant and plant growth-promoting fungus for remediation and bioenergy crop production on mine tailing soil

A heavy metal-tolerant fungus, Trichoderma virens PDR-28, was isolated from rhizosphere soil and evaluated for use in remediating mine tailing soil and for plant biomass production. PDR-28 exhibited plant growth-promoting traits, including 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase, acid phosphatase and phytase activity, siderophore production, and P solubilization. HMs were more available in mine tailing soil inoculated soil with PDR-28 than in uninoculated soil; the order of HM bioleaching was Cd > As > Zn > Pb > Cu. PDR-28 effectively removed HMs in the order of Pb > Cd > As > Zn > Cu from liquid media containing 100 mg HM L(-1). Inoculating HM-contaminated mine tailing soil with the fungus significantly increased the dry biomass of maize roots (64%) and shoots (56%). Chlorophyll, total soluble sugars (reducible and nonreducible), starch, and protein contents increased by 46%, 28%, 30%, and 29%, respectively, compared to plants grown in uninoculated soil. Inoculation increased heavy metal concentrations in maize roots by 25% (Cu) to 62% (Cd) and in shoots by 35% (Cu) to 64% (Pb) compared to uninoculated plants. Results suggest that PDR-28 would be beneficial for phytostabilization and plant biomass production as a potential source of biofuel in the quest for renewable energy.

Effect of copper on pro- and antioxidative reactions in radish (Raphanus sativus L.) in vitro and in vivo

The generation of superoxide radicals, lipid peroxidation (as measured by malone dialdehyde formation) and the activity of selected antioxidant enzymes (superoxide dismutase, catalase, ascorbate peroxidase) were assessed in radish (Raphanus sativus L.), in response to elevated concentrations of copper ions in the culture medium in vitro and in vivo. Experiments were performed on 7-day-old seedlings and 5-week-old calluses grown on media supplemented with CuSO4 in concentrations of 10, 100 and 1000μМ. The exposure to elevated Cu concentrations in the medium significantly reduced both callogenesis and the proliferation of radish calluses in vitro. Cu treatment resulted in the increased generation of the superoxide radical (O2(-)) in radish seedlings and calluses indicating the occurrence of oxidative stress in radish cells, whereas the level of lipid peroxidation (LPO) remained unchanged. Both in calluses and in radish seedlings in vivo, the relative level of oxidative stress was maximal at micromolar Cu concentrations and became attenuated with increasing Cu concentrations. Stronger oxidative stress occurred in the radish seedlings in vivo, compared with radish calluses in vitro. The observed lower sensitivity of calluses to Cu-induced oxidative stress and their ability to proliferate upon exposure to Cu concentrations of up to 1000μМ demonstrate the potential of in vitro cell-selection to obtain metal-tolerant radish plant lines.

A sensitive UPLC-MS/MS method for simultaneous determination of eleven bioactive components of Tong-Xie-Yao-Fang decoction in rat biological matrices

There is a growing concern for the sensitive quantification of multiple components using advanced data acquisition method in herbal medicines (HMs). An improved and rugged UPLC-MS/MS method has been developed and validated for sensitive and rapid determination of multiply analytes from Tong-Xie-Yao-Fang (TXYF) decoction in three biological matrices (plasma/brain tissue/urine) using geniposide and formononetin as internal standards. After solid-phase extraction, chromatographic separation was performed on a C18 column using gradient elution. Quantifier and qualifier transitions were monitored using novel Triggered Dynamic multiple reaction monitoring (TdMRM) in the positive ionization mode. A significant peak symmetry and sensitivity improvement in the TdMRM mode was achieved as compared to conventional MRM. The reproducibility (RSD%) was ≤7.9% by applying TdMRM transition while the values were 6.8-20.6% for MRM. Excellent linear calibration curves were obtained under TdMRM transitions over the tested concentration ranges. Intra- and inter-day precisions (RSD%) were ≤14.2% and accuracies (RE%) ranged from -9.6% to 10.6%. The validation data of specificity, carryover, recovery, matrix effect and stability were within the required limits. The method was effectively applied to simultaneously detect and quantify 1 lactone, 2 monoterpene glucosides, 1 alkaloid, 5 flavonoids and 2 chromones in plasma, brain tissue and urine after oral administration of TXYF decoction. In conclusion, this new and reliable method is beneficial for quantification and confirmation assays of multiply components in complex biological samples.

Pharmacokinetic comparisons of two different combinations of Shaoyao-Gancao Decoction in rats: competing mechanisms between paeoniflorin and glycyrrhetinic acid

ETHNOPHARMACOLOGICAL RELEVANCE

Shaoyao-Gancao Decoction (SGD), a well-known traditional Chinese medicine prescription, is a combination of Radix Paeoniae Alba (Paeonia lactiflora Pall, root) and Glycyrrhizae uralensis (Glycyrrhiza uralensis Fisch., root and rhizome, honeyed) for spasmolysis and emergency pain relief. Paeoniflorin (PF) and glycyrrhetinic acid (GA) are two typical active components of SGD for pain relief.

AIM OF THE STUDY

To study comparative pharmacokinetics of ten bioactive compounds in SGDs with two different combinations of RP and GU, and therefore to investigate the herb-herb interaction mechanisms of Shaoyao-Gancao Decoction for better spasmolysis and emergency pain relief in rats.

MATERIALS AND METHODS

Herbal IR macro-fingerprinting was implemented to provide the full chemical fingerprints of RP, GU and SGD decoctions and to investigate the variation rule of the full chemical profile of SGDs with various combinations of RP and GU. A specifically developed HPLC-MS/MS assay coupled with protein precipitation method was employed to determine the plasma concentrations of the ten analytes. Male Wistar rats were orally administered with SGD1 (RP:GU, 1:1 (w/w)) and SGD2 ((RP:GU, 4:1 (w/w)) equivalent to 9.5 g/kg body weight of GU.

RESULTS

Full chemical fingerprints of RP, GU and SGDs with various combinations of RP and GU were provided in the form of IR macro-fingerprints. Except for liquiritin, there were statistically significant differences (p<0.05 or p<0.01) of these analytes between SGD1 and SGD2 in in vivo pharmacokinetic study. Compared with the results when oral administrated with SGD1, six glycosides (PF, albiflorin, oxypaeoniflorin, isoliquiritin, ononin, and glycyrrhizin) exhibited higher systematic exposure levels (AUC0-t) and slower elimination rates (CL) whereas two glycones (GA and isoliquiritigenin) were the reverse when administrated with SGD2.

CONCLUSIONS

Increasing the amount of RP attenuated the inhibitory effect of GA via competing being consumed by intestinal bacteria (or β-glucosidase) to reduce the conversion amount of glycyrrhizin to GA and subsequently to afford significantly higher bioavailability and longer efficacy of PF, glycyrrhizin, albiflorin, oxypaeoniflorin, isoliquiritin, and ononin, leading to better spasmolysis and emergency pain relief.

Stereospecific requirement of cholesterol in the function of the serotonin1A receptor

The serotonin1A receptor is an important member of the G protein-coupled receptor (GPCR) family. It is involved in the generation and modulation of a variety of cognitive and behavioral functions and serves as a drug target. Previous work from our laboratory has established the sensitivity of the function of the serotonin1A receptor to membrane cholesterol. Solubilization of the hippocampal serotonin1A receptor utilizing the zwitterionic detergent CHAPS is accompanied by loss of cholesterol and results in reduction in specific ligand binding. Replenishment of cholesterol to solubilized membranes restores specific ligand binding to the receptor. We utilized this strategy of sterol replenishment of solubilized membranes to explore the stereospecific stringency of cholesterol for receptor function. We used two stereoisomers of cholesterol, ent-cholesterol (enantiomer of cholesterol) and epi-cholesterol (a diastereomer of cholesterol), for this purpose. Importantly, we show here that while ent-cholesterol could replace cholesterol in supporting receptor function, epi-cholesterol could not. These results imply that the requirement of membrane cholesterol for the serotonin1A receptor function is diastereospecific, yet not enantiospecific. Our results extend and help define specificity of the interaction of membrane cholesterol with the serotonin1A receptor, and represent the first report utilizing ent-cholesterol to examine stereospecificity of GPCR-cholesterol interaction.

Motor skill depends on knowledge of facts

Those in 20th century philosophy, psychology, and neuroscience who have discussed the nature of skilled action have, for the most part, accepted the view that being skilled at an activity is independent of knowing facts about that activity, i.e., that skill is independent of knowledge of facts. In this paper we question this view of motor skill. We begin by situating the notion of skill in historical and philosophical context. We use the discussion to explain and motivate the view that motor skill depends upon knowledge of facts. This conclusion seemingly contradicts well-known results in cognitive science. It is natural, on the face of it, to take the case of H.M., the seminal case in cognitive neuroscience that led to the discovery of different memory systems, as providing powerful evidence for the independence of knowledge and skill acquisition. After all, H.M. seems to show that motor learning is retained even when previous knowledge about the activity has been lost. Improvements in skill generally require increased precision of selected actions, which we call motor acuity. Motor acuity may indeed not require propositional knowledge and has direct parallels with perceptual acuity. We argue, however, that reflection on the specifics of H.M.'s case, as well as other research on the nature of skill, indicates that learning to become skilled at a motor task, for example tennis, depends also on knowledge-based selection of the right actions. Thus skilled activity requires both acuity and knowledge, with both increasing with practice. The moral of our discussion ranges beyond debates about motor skill; we argue that it undermines any attempt to draw a distinction between practical and theoretical activities. While we will reject the independence of skill and knowledge, our discussion leaves open several different possible relations between knowledge and skill. Deciding between them is a task to be resolved by future research.

Genetic and non-genetic factors affecting the visual outcome of ocular Behcet's disease

OBJECTIVE

To examine the prognostic factors for visual outcome in Korean BD patients with uveitis.

METHODS

Seventy-seven Korean BD patients with uveitis were enrolled. HLA-B and HLA-A genotypes were determined by PCR-based method. Visual acuity was measured by Snellen chart. Vision loss was graded into visual impairment (VI) defined as VA<20/40 for more than 6 months, loss of useful vision (LUV) as VA < 20/200, and near total blindness (NTB) as VA of light perception or worse.

RESULTS

VI was associated with a longer duration of uveitis, posterior uveitis, and cataract, LUV with male gender, a longer duration of uveitis, posterior uveitis, and cataract, and NTB with a longer duration of uveitis, cataract, and glaucoma. HLA-B*51 and HLA-A*26:01 did not show any association with VI, LUV, or NTB. However, HLA-B*51 carriers had earlier onset of uveitis and HLA-A*26:01 was strongly associated with posterior uveitis. In patients with posterior uveitis, VI was associated with a longer duration of uveitis and cataract, LUV with a longer duration, and NTB with HLA-B*51.

CONCLUSION

Longer duration of uveitis, posterior uveitis, male gender, cataract, and glaucoma were found to be associated with poor visual outcome in BD-related uveitis. HLA-B*51 was associated with NTB in patients with posterior uveitis. HLA-A*26:01 showed no association with VI, LUV, or NTB, however, was strongly associated with posterior uveitis.

Heavy metals in agricultural soils and crops and their health risks in Swat District, northern Pakistan

This study assessed the concentrations of heavy metals such as cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni) and zinc (Zn) in agricultural soils and crops (fruits, grains and vegetable) and their possible human health risk in Swat District, northern Pakistan. Cd concentration was found higher than the limit (0.05 mg/kg) set by world health organization in 95% fruit and 100% vegetable samples. Moreover, the concentrations of Cr, Cu, Mn, Ni and Zn in the soils were shown significant correlations with those in the crops. The metal transfer factor (MTF) was found highest for Cd followed by Cr>Ni>Zn>Cu>Mn, while the health risk assessment revealed that there was no health risk for most of the heavy metals except Cd, which showed a high level of health risk index (HRI⩾10E-1) that would pose a potential health risk to the consumers.