Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

White blood cell count and clustered components of metabolic syndrome: A study in western Iran

Background

White blood cell count (WBC) is one of the objective parameters of systemic inflammation. The aim of present study was to evaluate the relationship between WBC count and metabolic syndrome.

Methods

In this study on Lor population in Borujerd province (West of Iran), from 2011 to 2013, 800 persons were enrolled. MetS was defined based on ATP III criteria. Differences among the quartiles of WBC were examined by one-way analysis of variance.

Results

Only 14.7% did not have any of the five components and 43% of all subjects had metabolic syndrome. The means of WBC count in MetS group were significantly higher than the control group (p<0.0001). In subjects without any MetS components, the means of WBC was 5.321 /µL, and it was 5.664, 5.714, 5.961, 6.302, and 6.572 /µL in subjects with 1, 2, 3, 4, and 5 components, respectively. These differences show a significant increasing trend (p<0.0001).

Conclusion

WBC count was associated with clustered components of metabolic syndrome. It seems that WBC counts could be considered as a predictive factor for metabolic syndrome in preventive medicine.

Fault Detection of continuous time linear switched systems using combination of Bond Graph method and switching observer

In this paper, a new Fault Detection (FD) scheme based on combination of switching observer and Bond Graph (BG) method for linear continuous time switched systems with Average Dwell Time (ADT) approach is proposed. The proposed scheme is a BG-based two-stage FD system in which the compact state space representation and Global Analytical Redundancy Relations (GARRs) are derived based on the BG model. In the first stage, a switched observer is designed considering disturbance attenuation level, fault sensitivity and rapid fault detection criteria by solving a weighted Linear Matrix Inequality (LMI) optimization problem. Next, a new form of GARRs which is based on output estimation error of the observer and is called Error-based Global Analytical Redundancy Relations (EGARRs) is developed to combine the observer and BG method. The output estimation errors from the observer, which are adequately sensitive to faults and simultaneously the effects of disturbances are attenuated therein, are given to the EGARRs to generate the residuals of the FD system. The proposed method may be used for fault detection of switched linear systems with ADT based on the BG model of the system. Finally, two case studies including a two-tank system and a buck converter-driven DC motor are considered to show the efficiency and real-time implementation of the proposed method.

Prevalence of Coronary Artery Disease and the Associated Risk Factors in the Adult Population of Borujerd City, Iran

Background: Cardiovascular events are the leading cause of mortality and are highly associated with lifestyle. We aimed to evaluate the prevalence of coronary artery disease (CAD) and its major risk factors in the western Iranian city of Borujerd. Methods: This cross-sectional study was conducted on 801 subjects older than 35 years of age, recruited via cluster sampling in Borujerd. The diagnosis of CAD was based on the positive results of Rose Angina Questionnaire, Minnesota coding, or prior history of CAD. Then, the risk factors were measured by biochemistry and relevant laboratory examinations, or data extraction from the subjects’ history. Results: The study sample consisted of 412 men and 389 women at a mean age of 54.82±12.11 years. The prevalence of risk factors including hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity was 38.2%, 17.4%, 64%, 23.2%, and 22.8%, respectively. Based on the criteria, 19.1% and 31.7% of the CAD cases were definite and probable, respectively. Furthermore, 12.5% had definite signs and symptoms of CAD, and 5.4% had positive Rose Angina Questionnaire outcomes. Conclusion: The current study demonstrated the distribution of CAD in the Iranian city of Borujerd and it was demonstrated that obesity and smoking are the most common risk factors, respectively.

Blunted Overnight Blood Pressure Dipping in Second Trimester; A Strong Predictor of Gestational Hypertension and Preeclampsia

Background:

Preeclampsia is a global burden with 10 million incidences annually and 210 daily deaths worldwide. Diagnosis is mainly based on the features following full presentation.

Objective:

This study explored whether early pregnancy circadian changes of ambulatory blood pressure monitoring (ABPM) could predict preeclampsia and hypertension.

Methods:

In a prospective study, 294 pregnant women who were referred to Sarem Women’s Hospital, Iran were recruited. Systolic, diastolic and mean arterial pressures (MAP) were recorded (diurnally and nocturnally) in each trimester. Dipping was defined as a minimum 10% decrease in blood pressure.

Results:

Of the 251 women who completed the study, 25 percent (n=63) experienced blunted MAP dipping during sleep phases in the second trimester. Eighty-nine percent (n=56) experienced hypertensive disorder in the third trimester, one-third of which experienced preeclampsia. Of the women with normal MAP dipping (n=188), 5 percent (n=10) had gestational hypertension and 1 percent (n=2) became preeclamptic. (P<0.0001).

Conclusion:

This study clearly demonstrated blunted blood pressure dipping overnight during the second trimester which is a strong predictor of forthcoming pregnancy-induced hypertension and preeclampsia. A scoring system was developed to predict hypertensive disorder and it was significantly correlated with preeclampsia occurrence.

Early Improvement in Mitral Regurgitation after Cardiac Resynchronization Therapy in Cardiomyopathy Patients

BACKGROUND

The study aim was to investigate factors affecting the improvement of mitral regurgitation (MR) severity within 48 hours after cardiac resynchronization therapy (CRT) in patients with cardiomyopathy.

METHODS

Sixty-nine cardiomyopathy patients (48 males, 21 females; mean age 59.12 ± 9.66 years) in NYHA functional class ≥III, with left ventricular ejection fraction (LVEF) ≤35%, and QRS duration >120 ms, with MR ≥moderate, were included in the study. Conventional echocardiography was performed before and within 48 h after CRT, and all patients underwent tissue Doppler imaging prior to CRT. Improved MR was defined as a reduction of at least one grade in MR severity.

RESULTS

After CRT, 49 patients (71%) showed MR improvement but 20 (29%) had no MR improvement. The mean MR severity grade was reduced significantly, from 2.70 ± 0.77 before CRT to 1.90 ± 0.94 after CRT (p<0.001). The group with improved MR had a significantly higher rate of left bundle branch block (75.5% versus 45%; p = 0.015), a higher QRS duration (172.00 ± 31.98 versus 147.25 ± 28.75 ms; p = 0.001), a higher median septal lateral delay (70 versus 35 ms, p = 0.035), and a higher median anteroseptal to posterior-wall delay by M mode (200 versus 130 ms, p = 0.041). Older age, longer QRS duration, and septallateral delay remained significant independent predictors of MR improvement. A greater proportion of patients with improved MR showed ≥5% increase in LVEF (55.1% versus 30.0%, p = 0.058).

CONCLUSIONS

CRT acutely reduced the severity of functional MR in the majority of cardiomyopathy patients. Those patients with improved MR showed a higher frequency of ≥5% increase in LVEF after CRT. Older age, longer QRS duration, and septallateral delay were independent predictors of MR improvement after CRT.

Interleukin-1 receptor antagonist mediates toll-like receptor 3-induced inhibition of trophoblast adhesion to endometrial cells in vitro

STUDY QUESTION

Is interleukin-1 receptor antagonist (IL-1RA) involved in the toll-like receptor 3 (TLR 3)-induced inhibition of trophoblast cells' adhesion to endometrial cells in vitro?

SUMMARY ANSWER

IL-1RA mediates the TLR 3-induced inhibition of trophoblast cells' adhesion to endometrial cells in vitro.

WHAT IS KNOWN ALREADY

It is well documented that endometrial TLR 3 activation leads to impairment of trophoblast binding to endometrial cells in vitro. IL-1RA is known as an anti-implantation factor, as its injection significantly reduced implantation rates in mice by an effect on endometrial receptivity.

STUDY DESIGN, SIZE, DURATION

Poly I:C was used as a TLR3 specific ligand and endometrial cells were either treated or not with Poly I:C (treated versus control) in vitro. IL-1RA was applied to block IL-1 signal transduction. IL-1RA was knocked down by Accell Human IL1RN siRNA. Flagellin was used to stimulate TLR 5. SP600125 (JNK) was applied to inhibit the mitogen-activated protein kinases (MAPK) pathway. BAY11 -7082 was used to inhibit the nuclear factor-κB (NF-κB) pathway. The experiments were performed in three replicates on three separate days.

PARTICIPANTS/MATERIALS, SETTING, METHODS

An in vitro assay was developed using RL95-2 (an endometrial cell line) and JAr (a trophoblast cell line) cells. Initially, the production of IL-1RA in RL95-2 cells in response to TLR 3 activation was measured. To determine whether the TLR 3-induced inhibition of trophoblast binding was mediated through IL-1RA: (i) we evaluated the effect of IL-1RA on the attachment of trophoblast cells to endometrial cells; (ii) we knocked down TLR3-induced IL-1RA gene expression by IL-1RA Small interfering RNA (siRNA) and evaluated trophoblast attachment to endometrial cells. Finally, to clarify through which pathway TLR 3-induced inhibition of trophoblast binding occurs: (i) activation of NF-κB and MAPK was detected by transfecting the cells with secreted placental alkaline phosphatase reporter plasmids bearing promoter sequences for each transcription factor; (ii) the inhibitors for NF-κB and MAPK were used to block signaling; (iii) it was then investigated whether addition of these inhibitors could restore the TLR 3-induced impairment of trophoblast attachment to the endometrial cells.

MAIN RESULTS AND THE ROLE OF CHANCE

Our results showed that addition of polyinosinic:polycytidylic acid (Poly I:C) to RL95-2 cells significantly increased the production of IL-1RA (P < 0.05). Addition of human recombinant IL-1RA to RL95-2 cells remarkably decreased the adhesion rate of trophoblast cells to endometrial cells (P < 0.05). In addition, suppression of TLR3-induced IL-1RA gene expression in RL95-2 cells significantly restored trophoblast cells attachment to endometrial cells in the presence of Poly I:C (P < 0.05). Only TLR3 and not TLR5 induced MAPK activation (P < 0.05). TLR3 ligation did not affect NF-κB activation. Of NF-kB and MAPK inhibitors, only MAPK's inhibitor could achieve restoration of spheroid adhesion to endometrial cells (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

This study has been only done in vitro. Future in vivo studies will confirm our data.

WIDER IMPLICATIONS OF THE FINDINGS

The findings of this study have a potential clinical application in introducing IL-1RA as one of the diagnostic infertility markers in the endometrium, which can affect the process of embryo adhesion at the time of implantation. Moreover, based on the novel data obtained in the current study, blocking and regulating the MAPK pathway by its inhibitors can be used as a new strategy to prevent and treat virus-induced infertility cases in ART techniques.

STUDY FUNDING/COMPETING INTEREST

This study was partially funded by a Marie Curie IIF-253948 grant to I.C. and was partially funded by the author's institutions. The authors have no conflict of interest to declare.

Aspirin Resistance in Different Doses by Bleeding Time and Urinary 11-dehydro-thromboxane B2

The aim of the present study was the evaluation bleeding time (BT) in comparison to Urinary 11-dehydro thromboxane B2 (TXB2) regarding different ASA frequent dosages used in Borujerd city. This is a double blind randomized clinical trial on 370 subjects aged 35 years and older, referred to clinical offices in Borujerd. All ischemic heart disease’s patients were randomly assigned to 4 ASA dose groups (80 mg, 81 mg, 100 mg and 325 mg) and one group-matched control group without any IHD. BT was measured by Ivy method; TXB2 was measured in a urine sample, both at least 5 days after ASA consumption. Probale AR was indicated if TXB2 was normal or higher than normal higher limit values, or BT was normal or lower than normal higher values. (IRCT201202026958N3) Probale AR was present in 37.6% and 64% resistance by BT and TXB2, respectively. All 4 treated groups had higher TXB2 levels than the control group/normal values (p>0.05). Also, urinary TXB2 level correlated positively with BT. Given the simplicity and low costs of its performance it might be of some potential use in developing countries. However, due to IVY method limitations it cannot be perceived as a tool to assess such specific aspects of platlat function or aspirin resistance.

Metabolic syndrome and its components associated with chronic kidney disease

Background:

There is limited information on the relationship between metabolic syndrome (MetS) and chronic kidney disease (CKD) in the Iranian population, a group that has a high prevalence of CKD and obesity. The aim of present study was to determine the relationship between MetS and CKD in West of Iran.

Materials and Methods:

A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study. MetS was defined based on the Adult Treatment Panel III criteria, and CKD was defined from the Kidney Disease Outcomes Quality Initiative practice guidelines. Waist circumference and body mass index were calculated, as well, blood samples were taken and lipid profile, plasma glucose levels, and serum creatinine were measured. Data were analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA).

Results:

CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS. MetS was associated with an increased odds ratio (OR) for a glomerular filtration rate <60 ml/min/1.73 m² (OR: 1.91; 95% confidence interval [CI]: 1.22-2.99; P = 0.004). Individuals with 2, 3, 4, and 5 components of the MetS had an increased OR for CKD: 2.19 (95% CI: 0.95-3.62), 2.65 (95% CI: 1.03-4.71), 2.86 (95% CI: 1.08-5.53), and 5.03 (95% CI: 1.80-8.57), respectively, compared with individuals with none of the components.

Conclusion:

We found a high prevalence of CKD in patients with MetS compared with the subject without MetS. Our observations raised major clinical and public health concerns in Iran, where both the MetS and kidney diseases are becoming common.

The Association Between Primary Open Angle Glaucoma and Clustered Components of Metabolic Syndrome

Purpose :

There is conflicting evidence whether components of metabolic syndrome (MetS) increase or decrease the risk of primary open-angle glaucoma (POAG). The aim of the present study was to determine the association between metabolic syndrome and primary open-angle glaucoma.

Methods :

A total of 200 participants comprising 100 controls and 100 patients with POAG documented by clinical tests and examined by an experienced ophthalmologist using standard ophthalmologic equipment were included in the study. MetS was defined and based on ATP III criteria and POAG was defined by the criteria of the International Society of Geographic and Epidemiological Ophthalmology (ISGEO). The data were entered into the SPSS software and analyzed.

Results :

The prevalence of MetS in the glaucoma group was 53% in comparison to 38% in the control group (p=0.037). MetS was associated with an increased odds ratio for an IOP higher than 21 mmHg (OR: 1.72; 95% CI 1.03-2.79; p=0.034). The mean IOP was 24.91±4.29 mmHg in the patients without MetS, and 27.23±4.81 mmHg in those with MetS (p=0.027). The mean values of CCT were 603.64±63.16 µm in MetS patients and 579.27±72.87 µm in controls (p=0.018).

Conclusion :

Data showed an increased prevalence of components of metabolic syndrome in patients with glaucoma. The mechanisms underlying these associations need to be established in future studies. Our results support the recommendation that patients with metabolic syndrome undergo regular ophthalmological exams to monitor for the onset or progression of glaucoma.

Activation of Toll-like receptor 3 reduces actin polymerization and adhesion molecule expression in endometrial cells, a potential mechanism for viral-induced implantation failure

STUDY QUESTION

Does activation of endometrial Toll-like receptor 3 (TLR 3) affect cell receptivity to trophoblast adhesion?

SUMMARY ANSWER

TLR 3 activation in vitro reduces the attachment of trophoblast cells to endometrial cells by altering the cell cytoskeleton and reducing the expression of adhesion molecules in human endometrial cells.

WHAT IS KNOWN ALREADY

It is well documented that the presence of an infection at the time of implantation can lead to implantation failure. The female reproductive tract recognizes invading micro-organisms through the innate pathogen recognition receptors such as the TLRs.

STUDY DESIGN, SIZE, DURATION

Poly I:C was used as a TLR 3-specific ligand and endometrial cells were either treated or not with Poly I:C (treated versus control) in vitro. The experiments were performed in three replicates on three separate days.

PARTICIPANTS/MATERIALS, SETTING, METHODS

An in vitro assay was developed using RL95-2 (a human endometrial cell line) and JAr (a human trophoblast cell line) cells. Initially, the percentage of attached JAr spheroids to RL95-2 was measured in response to TLR 3 activation. Next, actin polymerization in RL95-2 cells was assessed in response to TLR 2/6, 3 and 5 activation. Phalloidin was used to assess the mean fluorescence intensity of F-actin by flow cytometry or confocal microscopy. Secondly, the influence of TLR 2/6, 3 and 5 activation on the expression of cluster of differentiation 98 (CD98) and β3 integrin was determined. To further understand through which pathways the TLR 3-induced alterations occur, inhibitors were applied for Toll/interleukin-1 receptor domain-containing adaptor inducing interferon-beta (TRIF), myeloid differentiation primary response 88 (MYD88), mitogen-activated protein kinases (MAPK) and nuclear factor pathways.

MAIN RESULTS AND THE ROLE OF CHANCE

We observed that stimulation of TLR 3 in endometrial cells with different concentrations of Poly I:C led to a reduction in the percentage of trophoblasts attached to the endometrial cells in a dose-dependent manner (P < 0.05). This decrease was consistent in the Poly I:C treated group regardless of the co-incubation time (P < 0.05). In addition, our results demonstrated that actin polymerization and CD98 expression significantly decreased only in response to TLR 3 activation (P < 0.05). Activation of endometrial cells with TLR 2/6, 3 and 5 significantly reduced β3 integrin expression (P < 0.05). These alterations were shown to work via MYD88-MAPK pathways (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

This study has been performed in vitro. Future in vivo studies will be required in order to confirm our data.

WIDER IMPLICATIONS OF THE FINDINGS

This is a novel discovery which extends our current knowledge concerning diagnosis and treatment of viral-induced infertility cases.

STUDY FUNDING/COMPETING INTERESTS

This research was supported by the COST Action FA1201 (GEMINI) by granting a Short Term Scientific Mission and the Instituto de Salud Carlos III by granting Grant PI11/01645. The authors have no conflict of interest to declare.

Metabolic syndrome and inflammatory biomarkers in adults: a population-based survey in Western region of iran

BACKGROUND

There is evidence that inflammation may be involved in pathogenesis of MetS. Inflammatory biomarkers are moving to the forefront as the potent predictors of MetS.

OBJECTIVES

The present study aimed to evaluate the association between MetS and some inflammatory biomarkers.

PATIENTS AND METHODS

This community-based cross-sectional study was conducted on 800 subjects aged above 35 years selected through random sampling in Borujerd (west of Iran) from 2011 to 2013. MetS was defined based on ATP III criteria and the subjects were divided into two groups (MetS and non-MetS groups). Waist circumference and Body Mass Index (BMI) were calculated. In addition, blood samples were taken and C-Reactive Protein (CRP), lipid profile, Fasting Blood Sugar (FBS), and Bleeding Time (BT) were measured. Then, the correlations between MetS and the above-mentioned variables were estimated. After all, the data were entered into the SPSS statistical software (v. 17) and analyzed using T-test, chi-square, median test, and spearman's rank correlation.

RESULTS

In this study, 344 subjects (43%) met the ATP III criteria. The results showed a significant difference between MetS and non-MetS groups regarding BMI, white blood cell, total cholesterol, LDL, platelet, and high-sensitivity CPR (hs-CRP) (P < 0.0001, P = 0.040, P < 0.0001, P < 0.0001, and P = 0.045, respectively). Besides, waist circumference, Triglyceride (TG), FBS, and systolic and diastolic blood pressure were significantly higher, while HDL was significantly lower in the MetS group (P < 0.0001).

CONCLUSIONS

The incidence rate of MetS in our survey was higher compared to the previous reports. In addition, this incidence rate was higher in females in comparison to males. The results also showed a significant correlation between inflammatory biomarkers and MetS and that the higher levels of hs-CRP were associated with higher rate of MetS.

Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran

BACKGROUND

Bleeding time (BT) is the oldest and simplest test for assessing the platelets (Plts) function. BT can affect by several factors such as race and diet, which has a wide reference range. The aim of this project is to determine the normal range of BT in Borujerd, Iran. Determining the normal range of BT can help us to modify the definition of bleeding disorder and aspirin resistance.

METHODS

This was cross-sectional study carried out in 2011-2012. Subjects with a history of coagulation disorders or a positive family history of coagulation disorders, consumption of anti-Plts, anti-histamines, and phenothiazine in the previous month and subject with Plt less than 150,000 were excluded. The samples were 505 volunteers who were referred from 16 urban and 9 rural clusters to research center. BT of the samples was determined according to Ivy simplate method considering national standard protocol in the selected persons. Normal range was calculated as mean ± 2 standard deviation.

RESULTS

Of 505 volunteers, 50.4% were female. The range of BT was 2.8-2.95 min with mean of 2.79 ± 0.78 min. Range and mean of BT in women was 2.83-3.06 min and 2.88 ± 0.87 min, and range and mean of BT in men was 2.7-2.9 min and 2.69 ± 0.67 min; this difference was significant (P = 0.012). BT in urban and rural participants was 2.78 ± 0.79 and 2.77 ± 0.73 min. There was no significant difference between BT in urban and rural participants.

CONCLUSION

The normal range of BT in Boroujerd was in the lower limit of the normal universal range. In this study, BT was significantly different in both genders, but its correlation with age, blood group, and place of residency was not significant.

Large Left Atrial Myxoma Causing Mitral Valve Obstruction: A Rare Cause of Syncope

Cardiac myxoma is the most frequent benign tumors of heart. A 37-year-old woman dropped during the second prostration in prayer and decreased his mental state, with no prior history of syncope. On cardiac examination, there was an early diastolic sound that was compatible with a tumor plop. A transthoracic echocardiogram was performed which showed the presence of a pediculated mass in the left atrium, with an appearance suggestive of atrial myxoma. Atrial Myxoma can appear with non-specific symptoms. The best diagnostic method for myxoma is echocardiography that has a high sensitivity

The impact of alendronate on bone mineral density of osteoporotic patients

The present study assessed the real life therapeutic effects of weekly doses of alendronate in treating a group of osteoporotic patients in Iran. The present historical cohort was conducted on patients who had undergone two or more bone mineral densitometry within an interval of 1.5-2 years in Shariati Hospital bone mineral density department between 2002 and 2010.patients were asked by phone about consumption of alendronate. The mean increase in the BMD values at different sites was calculated. There was a significant increase in the body mass index (BMI) values of both the individuals taking alendronate and the control group (P<0.001). Taking the weekly dosage of the drug was associated with a 7.67% increase in the BMD values at the femoral neck, 8.68% at the total hip, and 3.17% at the lumbar spine. Moreover, our results showed a significant difference between the height decline in the two groups (alendronate taking: 0.7±2.4 vs. control: -0.7±2.6, P<0.001). Comparing the results of the present study with that of previous ones revealed the drug is beneficial in improving bone mineral density in Iranians; as well alendronate is more effective in Iranian postmenopausal women when compared with the Americans.

The effect of inhaled corticosteroids on hypothalamic-pituitary-adrenal axis

Objectives:

The aim of this study was to compare systemic effects of high-dose fluticasone propionate (FP) and beclomethasone dipropionate (BDP) via pressurized metered dose inhaler on adrenal and pulmonary function tests.

Materials and Methods:

A total of 66 patients with newly diagnosed moderate persistent asthma without previous use of asthma medications participated in this single blind, randomized, parallel design study. FP or BDP increased to 1 500 μg/d in 62 patients who had not received oral or IV corticosteroids in the previous six months. Possible effects of BDP and FP on adrenal function were evaluated by free cortisol level at baseline and after Synacthen test (250 μg). Fasting plasma glucose and pulmonary function tests were also assessed. Similar tests were repeated 3 weeks after increasing dose of inhaled corticosteroids to 1 500 μg/d.

Results:

No statistically significant suppression was found in geometric means of cortisol level post treatment in both groups. After treatment in FP group, mean forced expiratory volume in one second (FEV1) and mean forced vital capacity (FVC) values improved by 0.17 l (5.66% ± 13.91, P=0.031) and 0.18 l (5.09% ± 10.29, P=0.010), respectively. Although FEV1 and FVC improved in BDP group but was not statistically significant. Oral candidiasis and hoarseness were observed in 6.5% patients receiving BDP, but hoarseness was found in 3.2% patients in FP group (P=0.288).

Conclusions:

The results indicate that safety profiles of high doses of BDP and FP with respect to adrenal function are similar, but FP is more efficacious than that of BDP in improving pulmonary function test.

Assessment of Left Ventricular Dyssynchrony in Heart Failure Patients Regarding Underlying Etiology and QRS Duration

BACKGROUND

Left ventricular (LV) dyssynchrony is a prevalent feature in heart failure (HF) patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology.

METHODS

The available data on the tissue Doppler imaging (TDI) of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and ≥ 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM). The time-to-peak myocardial sustained systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay ≥ 40 ms and tissue Doppler velocity all segments delay ≥ 105 ms; standard deviation (SD) of all segments ≥ 34.4 ms; basal segments delay ≥ 78 ms; SD of basal segments ≥ 34.5 ms; and opposing wall delay ≥ 65 ms.

RESULTS

After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration ≥ 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration ≥ 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group.

CONCLUSION

The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices.

The effect of V/III ratio and catalyst particle size on the crystal structure and optical properties of InP nanowires

InP nanowires were grown on 111B InP substrates by metal-organic chemical vapour deposition in the presence of colloidal gold particles as catalysts. Transmission electron microscopy and photoluminescence measurements were carried out to investigate the effects of V/III ratio and nanowire diameter on structural and optical properties. Results show that InP nanowires grow preferably in the wurtzite crystal structure than the zinc blende crystal structure with increasing V/III ratio or decreasing diameter. Additionally, time-resolved photoluminescence (TRPL) studies have revealed that wurtzite nanowires show longer recombination lifetimes of approximately 2500 ps with notably higher quantum efficiencies.

MRP1 polymorphisms (T2684C, C2007T, C2012T, and C2665T) are not associated with multidrug resistance in leukemic patients

One of the main problems in treating cancer patients is that cancer cells can develop drug resistance. Resistance to multiple anticancer drugs, so called multidrug resistance (MDR), most likely involves a nonspecific mode of resistance, through drug-efflux transporters. One of the most extensively studied genes involved in MDR is multidrug resistance protein 1 (MRP1). We investigated a possible association between the expression level of MRP1 and the occurrence of MDR in leukemic patients, and we tested the hypothesis that MRP1 polymorphisms are predictive of MDR in patients with acute leukemia. The mRNA level of MRP1 was determined in 111 patients with acute leukemia (including 52 patients with acute myeloid leukemia and 59 patients with acute lymphoblastic leukemia), by quantitative real-time PCR, to determine how it affected the response to chemotherapy. We typed T2684C, C2007T, C2012T, and C2665T MRP1 polymorphisms in 111 patients classified as either drug-resistant or drug-responsive. We found that high expression of MRP1 was associated with the MDR phenotype in both acute myeloid leukemia and acute lymphoblastic leukemia patients. There was no effect of a particular genotype on the expression level of the MRP1 gene. We found no significant differences in chemosensitivity among any of these genotypes.

Impact of a clinical pharmacist in a multidisciplinary intensive care unit

OBJECTIVES

To describe the activities of a clinical intensive care unit (ICU) pharmacist and to determine whether pharmacist-initiated consultations lead to changes in drug costs.

DESIGN

Prospective, 3-month study.

SETTING

A 15-bed, university-affiliated, tertiary care medical-surgical ICU.

INTERVENTIONS

The following ICU pharmacist activities were recorded: providing drug information for physician inquiries; providing drug information for nurse inquiries; clarification of drug orders; drug accessibility information; pharmacokinetic consultation; detection and reporting of adverse drug reactions; and pharmacist-initiated therapeutic consultation leading to changes in drug therapy. When changes in drug therapy occurred, drug costs before and after the change were determined.

MEASUREMENTS AND MAIN RESULTS

During 54 weekdays, 575 pharmacist interventions occurred (10.7 +/- 5.0 interventions/day). The most common interventions were pharmacist-initiated therapeutic consultations (44.7%, 257/575 of the total), and response to physician requests for drug information (39.0%, 224/575). The most resource-intensive activities were provision of physician drug information and therapeutic consultations (49.6 mins and 35.9 mins per day, respectively). On average, 1.70 hrs (102 mins) per day were spent on all interventions. Therapeutic consultations decreased (47.1%), did not change (42.0%), or increased (10.9%) drug costs for a net savings of $10,010.60 (Canadian) over 3 months, or a projected annual savings of $67,664.24, if clinical pharmacy services were extended to 7 days/wk.

CONCLUSIONS

Dedicated ICU pharmacists are crucial healthcare team members in a multidisciplinary ICU. In addition to substantially reducing drug costs, they provide continuity in individualized pharmacotherapeutic care, and serve an important educational function.

Factors affecting spore formation in a Candida albicans strain

Growth and spore formation of Candida albicans Y-45 was enhanced by low oxygen tension. Mycelium and chlamydospores were abundantly found on rice infusion-Tween 80 agar within 48 to 96 h, and abundant chlamdospore production occurred most rapidly under reduced oxygen tension and incubation at 30 degrees C. Zn, Mg, Mn, anf Fe were tested for their ability to promote filamentation in C. albicans Y-45. Filamentation under conditions of low Mg and high Mn suggested that morphogenesis is possibly correlated with the presence of salts of these heavy metals.