Inhibitory effect of miR‑182‑5p on retinal neovascularization by targeting angiogenin and BDNF

Retinal neovascularization (RNV) is a type of serious vision-threating disease, commonly induced by hypoxia of ischemic retinopathy, which happens in various ocular diseases including diabetic retinopathy and retinopathy of prematurity. In clinical work, anti-VEGF therapy is the preferred strategy for treating RNV. However, not all cases are sensitive to anti-VEGF injection. It is urgent and necessary to develop novel targets for inhibiting neovascularization in ocular diseases. Angiogenin (ANG) and brain-derived neurotrophic factor (BDNF) are implicated in angiogenesis, although their regulation and effects in RNV remain to be elucidated. microRNA (miRNA) is a type of small non-coding RNA, which can modulate targets by degrading transcripts or inhibiting protein translation. In the present study, miRNA-mediated modulation of ANG and BDNF was explored in an oxygen-induced retinopathy mouse model and human retinal microvascular endothelial cells (HRECs) under hypoxia. The results showed that downregulation of miR-182-5p and upregulation of ANG and BDNF were found in vivo and in vitro. Overexpression of miR-182-5p suppressed the expression of ANG and BDNF significantly in HRECs under hypoxia. In addition, knockdown of ANG and BDNF by miR-182-5p transfection significantly improved hypoxia-induced HRECs dysfunctions, including enhancing cell viability, reducing cell migration and improved tube integrity. In conclusion, miRNA-dependent regulation on ANG and BDNF indicates a critical role in hypoxia-induced retinal microvascular response. miR-182-5p-based therapy can influence the expression of ANG and BDNF, which demonstrates the potential for treating RNV diseases.

Comparative Study of a Modified Sub-Tenon's Capsule Injection of Triamcinolone Acetonide and the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Retinitis Pigmentosa Combined With Macular Edema

Retinitis pigmentosa (RP) is a hereditary retinal degenerative disease leading to eventual blindness. When RP is combined with macular edema (ME), the visual impairment further worsens. We compared a modified sub-Tenon’s capsule injection of triamcinolone acetonide (TA) and the intravenous infusion of umbilical cord mesenchymal stem cells (UCMSCs) in the treatment of RP combined with ME (RP-ME) to assess their safety and efficacy in eliminating ME and restoring visual function. A phase I/II clinical trial enrolled 20 patients was conducted. All patients were followed up for 6 months. There were no severe adverse effects in both groups. In retinal morphological tests, the central macular thickness (CMT) in TA group significantly decreased at first week, first and second month after injection (p < 0.05). The CMT in UCMSCs group significantly decreased at first month after infusion. The rate of reduction of CMT in TA group was significantly greater than that in UCMSCs group at second month (p < 0.05). Reversely, the rate of reduction of CMT in UCMSCs group was significantly greater than that in TA group at sixth month (p < 0.05). In visual functional test, although there were no significant differences in visual acuity or visual fields within each group or between groups, but the amplitude of P2 wave of flash visual evoked potential (FVEP) showed significant increasing in TA group at second month in UCMSCs group at sixth month (p < 0.05). At 6th month, the rate of growth in the amplitude of P2 wave in USMCSs group was significantly greater than that in TA group (p < 0.05). This study suggests both modified sub-Tenon’s capsule injection of TA and intravenous infusion of UCMSCs are safe for RP-ME patients. TA injection is more effective at alleviating ME while improving visual function in a short term. UCMSC intravenous infusion shows slow but persistent action in alleviating ME, and can improve the visual function for a longer time. These approaches can be applied separately or jointly depending on the disease condition for patients to benefit maximumly.

Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR-ONC-16008839

Long-term follow-up of a Chinese patient with KCNV2-retinopathy

Purpose: To characterize and monitor the clinical and electrophysiological features of a Chinese patient with KCNV2 retinopathy.Methods: A 17-year-old Chinese male with the diagnosis of cone dystrophy with supernormal rod response (CDSRR) was followed-up for 5 years, with full ophthalmological examinations, including decimal best corrected visual acuity (BCVA), fundus photography, fundus autofluorescence (FAF) imaging, spectral-domain optical coherence tomography (SD-OCT), and full-field electroretinogram (ERG). Genetic screening was performed to detect the sequence variations in the retinal dystrophy associated genes in the patient and his parents.Results: The patient demonstrated the characteristic full-field electroretinography (ERG) features of CDSRR, namely a profound enlargement of the dark-adapted ERG b-wave amplitude with increasing flash strength and a broadened a-wave trough; this case also had undetectable light-adapted ERGs. A BCVA of 0.15 was maintained over 5 years in both eyes; while progressive macular atrophy was identified. Molecular genetic analyses revealed two novel disease-causing KCNV2 variants in compound heterozygous state: c.1408 G > C (p.Gly470Arg) and c.1500 C > G (p.Tyr500Ter).Conclusions: This is the first long-term case study of an East Asian patient with molecularly confirmed CDSRR. The progressive atrophy with maintained VA demonstrated in this case will be valuable for increasing the understanding of the natural course of KCNV2 retinopathy and it will help in counselling patients with this disease.

CT-Diskography, Diskomanometry and MR Imaging as Predictors of the Outcome of Lumbar Percutaneous Automated Nucleotomy

Purpose:

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy.

Material and Methods:

Ninety-one patients, 44 females and 47 males aged 18–68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system.

Results:

Sixty-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior bulges.

Conclusion:

The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain.

ECG aberrations, latent coronary heart disease and cardiopulmonary fitness in various age groups of Norwegian cross-country skiers

To assess the prevalence of possible, latent coronary heart disease (CHD) among physically active men, 149 elite cross-country skiers in three age groups (26-33, 43-50 and 58-64 years) were invited for an examination which included clinical examination, Vitalogram, resting ECG, and a near maximal bicycle test. Of the invited men, 122 participated, i.e. 81.8%. The following findings were made: Normal clinical findings in all except 2, low resting heart rate, lung function parameters of about normal mean; voltage signs of left ventricular hypertrophy in resting ECG in 61/122, incomplete right bundle branch block in 14/122, codable Q waves (Minnesota Code, MC) in 5/87 from the highest age groups, ischaemic exercise ECG changes of MC 4.1 or 4.2 types in 11/87 vs. 1/35 in the two oldest vs. the youngest age group. Physical performance was very high in all age groups, but regular training did not seem to inhibit the normal age-dependent decline in physical performance. The resting and exercise ECG data in the two oldest age groups did not differ favourably from similar data obtained in sedentary men of the same age from approximately the same geophraphic area. Thus, it is possible that regular strenuous exercise and training may not protect against the development of CHD. The implications of such a view are briefly discussed.

Five-year follow-up of ECG aberrations, latent coronary heart disease and cardiopulmonary fitness in various age groups of Norwegian cross-country skiers

A cross-sectional sample of 122 middle-aged and elderly long-time active, well-trained male cross-country skiers were studied in 1976 to assess the prevalence of possible latent coronary heart disease (CHD). One hundred and seventeen skiers were reexamined five years later to assess the prognostic significance of a number of ECG aberrations encountered in 1976, and to assess the CHD incidence among athletes. One had died and four did not participate in the restudy, but none of these five men had had cardiac disease. The findings at the time of the two surveys were remarkably similar. All had excellent physical performance and a stable life habit pattern. Only three had given up regular training in the observation period. There was a very high prevalence of sinus bradycardia, first degree AV blocks, left ventricular hypertrophy (LVH) and incomplete right bundle branch block. Pathologic exercise ECGs were found on both occasions. Of 23 men with "pathologic" exercise ECG, 21 had LVH. Five had codable Q waves according to the Minnesota code, but none had symptoms of CHD. Two developed angina pectoris during the follow-up and none had had myocardial infarction. It is concluded that the large number of ECG aberrations found in middle-aged and elderly athletes are mainly related to physiological adaptation to training and that training seems to protect against CHD.

Micromixer based on viscoelastic flow instability at low Reynolds number

We exploited the viscoelasticity of biocompatible dilute polymeric solutions, namely, dilute poly(ethylene oxide) solutions, to significantly enhance mixing in microfluidic devices at a very small Reynolds number, i.e., Re approximately 0.023, but large Peclet and elasticity numbers. With an abrupt contraction microgeometry (8:1 contraction ratio), two different dilute poly(ethylene oxide) solutions were successfully mixed with a short flow length at a relatively fast mixing time of <10 mus. Microparticle image velocimetry was employed in our investigations to characterize the flow fields. The increase in velocity fluctuation with an increase in flow rate and Deborah number indicates the increase in viscoelastic flow instability. Mixing efficiency was characterized by fluorescent concentration measurements. Our results showed that enhanced mixing can be achieved through viscoelastic flow instability under situations where molecular-diffusion and inertia effects are negligible. This approach bypasses the laminar flow limitation, usually associated with a low Reynolds number, which is not conducive to mixing.

Cost-effectiveness of percutaneous automated lumbar nucleotomy. Comparison with traditional macro-procedure discectomy

SUMMARY

This study was conducted in order to evaluate the cost-effectiveness of percutaneous automated lumbar nucleotomy in comparison with traditional macro-procedure discectomy in the treatment of herniated discs. Sixty-eight patients undergoing surgical procedures and 90 treated with nucleotomy were consecutively included. Both cohorts were assessed pre-operatively and at regular intervals for one year or more after treatment by independent observers, using a clinical overall scoring system (COS) with 0 being the best attainable result and 1000 the poorest conceivable status of the patients. There were better clinical results after surgery with 78% successes after one year compared to 62% after nucleotomy. By including subsequent operations and re-operations after failure to respond to the primary treatment, the success rates rose to 79% and 77%, respectively. The cost of surgical treatment was calculated to USD 6.119 per patient and the cost of a nucleotomy procedure was USD 1.252. Owing to an almost five times higher price of surgery than nucleotomy, the latter turned out to be 2.7 to 3.9 times more cost-effective, depending on whether secondary treatment was included or not. Due to the minimal difference in final outcome between the groups, however, the marginal cost per extra success in patients primarily treated with surgery was as high as USD 205.850. The study concludes that nucleotomy, as a mini-invasive procedure with low complication rates and the potential of a quick recovery, is more cost-effective than traditional surgical treatment for lumbar disc herniation.

[Clinical management of low back pain in primary health care]

Diagnostic differentiation seems crucial in the treatment of patients with low back pain. We must try to distinguish between pain originating from the moving segments or the soft tissue in the columna, and differentiate between radicular pain and referred pain to the leg. Principles of treatment for the acute and recurrent low back pain attacks are dealt with, as well as the treatment of patients with acute chronic sciatica and spinal stenosis. The special problems concerning treatment of degenerative disc disease and patients with back pain caused by psychosocial problems are further discussed.

[Mobilizing or stabilizing exercise in degenerative disk disease in the lumbar region?]

Degenerative disc disease may affect younger and middle-aged people with a kind of premature disc degeneration. The majority of these low back pain patients are not candidates for a spinal fusion and are in need of a structured conservative treatment. In a controlled clinical trial, 27 low back pain patients (mean age 40 years, range 25-48) with a mean duration of symptoms of 7.4 years, were randomized to mobilizing (n = 12) or stabilizing (n = 15) daily half hour exercise for an eight weeks period. A clinical overall score (COS) based on pain intensity (VAS), physical signs, functional status (Oswestry) and analgetics was used as outcome criterion. The treatment results were best for the group undergoing stabilizing treatment. They achieved a 17% reduction in COS, compared to a 10% increase in the group undergoing mobilizing treatment (p = 0.02). These types of exercises are discussed in relation to the instability theory in disc degeneration.

Enhanced HIV-1 envelope-tumor protection by a recombinant vaccinia virus expressing anchored HIV-1 gp120 lacking gp41

A recombinant vaccinia virus (rvv) expressing, human immunodeficiency virus type 1 (HIV-1) external envelope glycoprotein, gp120, fused to a non-cleavable transmembrane protein, vvE13, elicited protection against a tumor cell line expressing HIV-1 full length envelope glycoprotein, gp160, in mice. Mice vaccinated with vvE13 exhibited a decreased incidence of tumor development and significantly smaller tumors in comparison to mice vaccinated with rvv gp160, vvE1, or a thymidine kinase minus (TK-) rvv, vSC11, or phosphate-buffered saline (PBS) injected controls. vvE13 and vvE1 also delayed tumor development, compared to vSC11 and PBS-injected controls; however, a statistical correlation could not be demonstrated due to the development of tumors in so few animals. Specificity toward HIV-1 envelope glycoprotein, was shown, since HIV-1 envelope-tumor prevention (incidence for vvE13 and size for vvE1 and vvE13 and delay for vvE1 and vvE13) was statistically superior with HIV-1 envelope expressing tumors compared to parenteral tumors. The vvE13 recombinant vaccinia virus expressing the HIV-1 envelope glycoprotein gp120 fused to a non-cleavable transmembrane protein elicits superior protection against tumors expressing the gp160 envelope glycoprotein, as compared to vvE1 expressing gp160.

Clinical overall score: outcome evaluation after lumbar disc surgery, assessments of reliability and validity

In previous studies assessing prognostic factors for the outcome of lumbar disc surgery, a Clinical Overall Score (COS) based on four subsets-pain intensity (VAS), physical signs, functional status (Oswestry) and analgesics--was used as the main outcome criterion. Both the patient's and the examiner's opinions of outcome and return to work were registered. In this paper, assessments are made of reliability and validity regarding the COS. The COS was found sensitive to changes, and internal consistency, assessed using Cronbach's alpha, Pearson's correlation analyses and factor analysis, was good. An interrater reliability study of the assessments of the physical signs, using weighted Kappa statistics, demonstrated fair to good levels of agreement for most of the signs. The concurrent validity of the COS was satisfactory; COS compared favourably with the patient's and with the examiner's opinion of outcome and return to work.

Background variables (medical history, anthropometric and biological factors) in relation to the outcome of lumbar disc surgery

In a prospective cohort study 122 patients with herniated intervertebral lumbar disc and no previous low back surgery preoperatively were assessed regarding medical history, anthropometric and biological background variables. The outcome of surgery (traditional methods) was evaluated one year postoperatively, mainly using a composite Clinical Overall Score (COS), including pain intensity, physical signs, functional capacity and analgesics. Return to work was also assessed. In regression analyses, low body height, high values of weight and body mass index, as well as long duration of sickness absence were shown to be significantly related to a poor outcome, as evaluated by the COS. However, after controlling for modifying effects of previously determined predictive fibrinolytic and psychological variables, the background variables lost their significance. Female sex, low stature, long duration of sickness absence and physically strenuous work activities were statistically significantly related to lower frequencies of return to work.

Is the outcome of traditional lumbar disc surgery related to the size of the exposure?

The purpose of this study was to evaluate whether wide surgical exposures result in poorer outcome of lumbar disc surgery compared to smaller traditional exposures. The aim was also to assess if a dural tear has any impact on the postoperative clinical outcome. One hundred and twenty-two patients (56 women and 66 men, mean age 40.8 years) with herniated intervertebral lumbar disc and no previous back surgery, were included. Postoperatively they were grouped according to surgery as follows: surgery on one vs. two herniated discs (106 vs. 16 patients), partial vs. full laminectomy (93 vs. 29 patients), and the occurrence or not of a dural rent (8 vs. 114 patients). The outcome of surgery was evaluated one years postoperatively mainly by a composite clinical overall score (COS) and by its separate elements, which were: pain intensity in the lower-back or leg (VAS), neurological and clinical examination, functional capacity (Oswestry), and the need for analgesics. The results of the statistical regression analyses did not reveal significant differences in the postoperative outcome scores in the various groups of patients. The groups were comparable; no significant differences were seen in the pre-operative clinical overall scores.

CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy

PURPOSE

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy.

MATERIAL AND METHODS

Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotomy R system.

RESULTS

Sixty-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior bulges.

CONCLUSION

The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain.

Clinical results after percutaneous automated lumbar nucleotomy. A follow-up study

This study was carried out in order to assess the clinical results after percutaneous automated nucleotomy with regard to predictive factors for the outcome. Selection criteria included patients with predominance of low-back pain, diffuse posterior disk bulges and concomitant spinal stenosis who are not normally accepted for nucleotomy. In all, 142 patients were treated. The overall success rate after an average observation time of 21 months was 56%. The results were not influenced by whether a diffuse posterior bulge or a focal hernia had been treated or not (p = 0.449). Spinal stenosis (p = 0.043) and disk space narrowing exceeding 25% of the expected width (p = 0.017) were associated with a poor outcome. By excluding these categories and patients with symptoms from more than one disk level, the success rate rose to 70%. With this selection, the results were equally good in patients with predominantly low-back pain compared to those with predominantly sciatica (p = 0.490).

Can psychological traits predict the outcome of lumbar disc surgery when anamnestic and physiological risk factors are controlled for? Results of a prospective cohort study

In a prospective study 122 patients with herniated lumbar disc pre-operatively completed psychological questionnaires. Surgical outcome was evaluated 12 months post-operatively mainly by a composite clinical overall score (COS), and by its separate elements. Anxiety (HAD-A scale) and psychosomatic symptoms (MSPQ) had predictive value: fewer symptoms favoured a satisfactory overall outcome, and vice versa. The HAD-A Scale had a predictive power of poor (ppp) and satisfactory (pps) outcome of 28 and 81%, respectively. Correspondingly, for the MSPQ, the ppp and pps were 42 and 85%. Anamnestic and biological variables (including fibrinolytic variables: ECLT and PAI-1) predicted 20% of the outcome. By adding all psychological variables the prediction increased only to 24%, but the HAD-A Scale and the MSPQ were still significant. The results suggest that in order to further improve prediction of outcome, future studies should combine biological variables sensitive to the mental state of the patient, with psychometric assessments.

[Percutaneous automated lumbar nucleotomy. Patient selection, practical performance and clinical results]

Percutaneous nucleotomy is designed to treat small and medium-sized contained disk hernias. It is offered to patients who have not responded to conservative treatment for three months or more. The nucleotomy procedure is well tolerated by a majority of patients and the rate of complications is low. The patients can be treated as out-patients. Among a total material of 130 patients, a primary good response to the treatment was observed in 81 (62%). However, owing to recurrencies the success rate had fallen to 52% at 12-39 months (mean 22 months) after nucleotomy. In selected patients with symptoms from one disk level only, and with no evidence of spinal stenosis, or of osteophyte formation or a narrowing of the disk space by more than 25%, the results were better. Here the success rate was 61% (70% in males and 50% in females).

Fibrinolytic activity as a predictor of the outcome of prolapsed intervertebral lumbar disc surgery with reference to background variables: results of a prospective cohort study

In a prospective study 122 patients with a slipped lumbar disc and no previous surgery were preoperatively examined for fibrinolytic activity. Surgical results for these patients were evaluated 12 months postoperatively by clinical overall assessment. In a multiple linear regression analysis fibrinolytic variables, euglobulin clot lysis time and plasminogen activator inhibitor 1, were shown to have predictive value regarding outcome of surgery; that is, normal fibrinolytic activity favors a satisfactory outcome and vice versa. Background variables and lipid profile were also recorded preoperatively. Body mass index, gamma-glutamyl transpeptidase, triglycerides and smoking were of statistical significance in relation to euglobulin clot lysis time and plasminogen activator inhibitor 1. Postoperative fibrinolytic re-examination of 20 patients seem to confirm that patients at risk of surgical failure have a prolonged depression of fibrinolytic activity.

Concomitant occurrence of mucopolysaccharidosis IIIB and Glanzmann's thrombasthenia. Further evidence of a hyperactive alpha-N-acetylglucosaminidase-producing allele

A daughter of first cousins had two extremely rare, recessive disorders: thrombasthenia (Glanzmann's disease, glycoprotein IIb/IIIa deficiency) and mucopolysaccharidosis IIIB, (Sanfilippo B syndrome, alpha-N-acetylglucosaminidase (NAG) deficiency). Normal alpha-N-acetylglucosaminidase activity was observed in two obligate heterozygotes (the proband's father and her maternal grandmother), suggesting that in addition to the normal and defective alleles, a third, hyperactive allele is also present in this family. Such a hyperactive allele seems to be quite prevalent in our area, and makes the biochemical identification of heterozygotes impossible if no extensive family surveys provide additional clues. There was no linkage between the two diseases, nor between any of them and several blood-groups and HLA-antigens tested for.

[Discography]

Discography means imaging of the intervertebral discs by intradiscal contrast injections. Discography with a combined CT/discography allows a more detailed classification of annular disruption and degeneration. Combined with a pain response registration, discography can be of value in the diagnosis of chronic low back pain with signs of sciatica in cases where other x-ray modalities have failed to explain the source of pain. Among 20 discography examinations there was a correlation between radicular symptoms and annular disruption with contrast leakage to the epidural space, and disc protrusion on CT scanning.

[Therapeutic principles in chronic back pain]

Treatment of patients with chronic back pain may become a most difficult task. This article discusses the principles and indications for surgical treatment. Conservative treatment should emphasize information and exercises to increase function. Soft tissue treatment, manipulation, and poor pain treatment should be used as supplements, and not as alternatives to this treatment. Contra-indications to physiotherapy are discussed to the extent that ordination of treatment that is not well-founded may have unfortunate therapeutic consequences. The general practitioner should act as coordinator when a more extensive somatic and psycho-social rehabilitation programme is required.

[Etiology and diagnosis of chronic back pain]

Chronic low back pain is lumbar-sciatic pain of more than 3 months duration. It is necessary to classify back conditions into conditions with and without nerve root affection. In addition to herniated discs, spinal stenosis and intra- or extramedullary tumours, transdiscal ruptures may cause radicular symptoms and signs from a local inflammatory effect caused by the nucleus material affecting the epidural tissue. Low back pain without radicular affection accounts for 95% of all cases of chronic low back disability. Symptoms and signs, x-ray investigations, and laboratory data are dealt with in the structural and focal etiology of the pain. The relationship between psycho-social factors and low back pain is discussed.

[Low back pain malingering]

As in the case of other painful conditions, patients with low back pain may exhibit symptoms of malingering and of decreased function. This may occur at a conscious or a subconscious level. Certain signs in the case history and the clinical examination are typical of malingerers. Local treatment of symptoms may cause an exaggeration of the patients decreased function. Treatment should focus on possible underlying psycho-social problems. Sick leave should be avoided if possible during the treatment period.

Significance of a positive exercise ECG in middle-aged and old athletes as judged by echocardiographic, radionuclide and follow-up findings

To study the pathologic and prognostic significance of--and possible underlying mechanisms for--a pathological exercise ECG in athletes, two age-matched groups were selected from a total population of 117 middle-aged and old endurance athletes: Group A: 21 with a pathological exercise-ECG, and group B: 21 with normal exercise-ECGs. Data from 201-thallium perfusion scintigraphy, 99 m-technetium multiple gated acquisition ventriculography (MUGA), resting echocardiography and 3 years follow-up are as follows: None had thallium findings indicating reversible myocardial ischaemia, but one from group A had a probable old myocardial infarction. All had normal resting MUGA, but group A men slightly more often presented a subnormal increase in ejection fraction according to exercise MUGA than group B men (9/20 vs 4/21). The former also more often had ventricular hypertrophy (LVH) (19/21 vs 14/21). However, apart from slightly longer ventricular filling time among group A men the echocardiograms revealed no group differences e.g. in cardiac dimensions or in indices of systolic or diastolic function. Regardless of exercise-ECG response, 18/42 athletes had one or more value of left ventricular dimensions or diameter exceeding the 95th percentile of the normal range. Since one patient from group A had asymmetric septal hypertrophy, one developed cardiomyopathy during the 3 years follow-up and one had a previous myocardial infarction, only 3/21 had cardiac disease which might explain the pathological exercise-ECG. Thus, pathological exercise-ECG rarely signifies heart disease in athletes, and very rarely coronary heart disease. Rather, the pathological exercise-ECG may be related to LVH and various subtle alterations in cardiac physiology following long-term endurance training.

Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men

Physical fitness was assessed in relation to a near maximal bicycle exercise test in two populations; population 1: 122 middle aged and elderly cross-country skiers with a documented very high physical performance, and population 2: 2014 apparently healthy men 40-59 years of age. All were without known or suspected heart disease at the baseline study. A number of so-called coronary risk factors were studied simultaneously. The total incidence of coronary heart disease (CHD) events were noted as was the total 7 year incidence of death from CHD among men from population 2. By subdividing the latter in quartiles of physical fitness within each 5 year age group--and studying levels of coronary risk factors and CHD deaths within these 16 subgroups--the following findings were made: All coronary risk factors were favourably and strongly associated with high physical fitness and vice versa in a consistent way. Death from myocardial infarction and sudden, unexpected death followed the same pattern in an inverse way. The skiers as a group closely followed the most fit men from population 2 in all respects. Thus we have noted a strong, graded, positive association between physical fitness and a number of coronary risk factors, and an inverse relationship between high physical fitness and the risk of dying from CHD. These findings hold true for a period of 7 years among middle aged men free from known or suspected heart disease.

Thrombocytopenic purpura in baby pigs. Clinical studies

A report is given about spontaneous as well as experimental cases of thrombocytopenia in baby pigs. A total of 14 litters from 6 sows were studied.

The piglets were normal at birth, but got thrombocytopenia after sucking. After 2—3 days with low platelet counts which was sometimes accompanied by purpura the platelet number usually increased during the next few days and might reach a normal level at about 1 week of age. During the following week there was usually a second decrease which might result in purpura and death within a few days, but also might pass without clinical symptoms. Gases were observed where the piglets had thrombocytopenia, even with purpura the first day of life, but then had normal platelet counts all along after the first week.

In 1 experimental case, the piglets had a severe thrombocytopenia and purpura that lasted all during the first 3 weeks.

Differences were seen between litters of the same sow when this was sired by different boars.

In some cases of thrombocytopenia, a leucopenia was observed.