Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients

Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. Results: We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82-0.76 in PVPs, 7.15-0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21-79.82) compared to the KP group (1.95%; 74.36-72.41). Conclusions: No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties.

Does the articularis cubiti muscle really exist? Anatomical, histological, and magnetic resonance imaging study with a narrative review of literature

Although the term articularis cubiti muscle is incorporated in the official anatomical nomenclature, only sparse data about its appearance are available. It is usually described as few fibres originating from the medial head of the triceps brachii muscle and inserting to the capsule of the elbow joint. However, the most recent observations regarding the morphological relations in the posterior elbow region point towards the absence of a well-defined muscle. Therefore, this study was designed to verify the existence of the articularis cubiti muscle in question and to compile more data on the topographical features of the subtricipital area near the posterior aspect of the elbow. To address these questions, 20 embalmed upper limbs were dissected, and seven samples were collected for histological analysis. The laboratory findings were then correlated with 20 magnetic resonance imaging (MRI) scans of the elbow. Consequently, a narrative review of literature was performed to gain more information on the discussed muscle in a historical context. Upon the anatomical dissection, muscular fibres running from the posterior aspect of the shaft of the humerus to the elbow joint capsule and olecranon were identified in 100% of cases. Histologically, the connection with the joint capsule was provided via winding bands of connective tissue. On MRIs, the muscular fibres resembled a well-demarcated thin muscle located underneath the medial head of the triceps brachii muscle. Combined with the review of literature, we concluded that the constant articularis cubiti muscle originates from the posterior shaft of the humerus and attaches indirectly to the posterior aspect of the elbow joint capsule and directly to the superior portion of the olecranon. The obtained results slightly differ from the modern description, but are in agreement with the original publication, which has become misinterpreted throughout time. Presumably, the misused description has led to questioning the existence of an independent muscle. Moreover, our findings attribute to the articularis cubiti muscle, a function in pulling on the posterior aspect of the elbow joint capsule to prevent its entrapment, and possibly also a minor role in extension of the forearm. The presented results should be taken into consideration when intervening with the posterior aspect of the elbow joint because the articularis cubiti muscle poses a consistently appearing landmark.

Procalcitonin kinetics following abdominal aortic surgery and its value for postoperative intestinal ischaemia detection

OBJECTIVE

The purpose of our study was to describe perioperative kinetics of procalcitonin (PCT) in patients undergoing aortic surgery, to compare the kinetics in the open abdominal aortic aneurysm (AAA) repair and aortobifemoral bypass for aortoiliac occlusive disease (AIOD), and to evaluate the ability of PCT to detect intestinal ischaemia.

METHODS

A prospective non-randomized observational cohort study in 80 patients (62 men and 18 women) undergoing elective aortic surgery was performed. Serum PCT was measured at baseline and defined intraoperative and postoperative timepoints up to postoperative day 7. MRI contrast-enhanced imaging was used to detect intestinal ischaemia.

RESULTS

The comparison of the AAA and AIOD cohort did not show any significant difference in PCT levels. Patients with intestinal ischaemia had higher serum PCT at multiple timepoints postoperatively. The most accurate timepoints for early diagnosis were postoperative day 3, followed by 24 h after declamping of the vascular reconstruction, and postoperative day 7. The sensitivity and negative predictive values were 100% in all mentioned timepoints. However, event at the best timepoint the specificity was 89% and the positive predictive value 43%.

CONCLUSIONS

Procalcitonin levels in the postoperative period at proper timepoints might help to detect postoperative intestinal ischaemia. The limitation of this marker is its low specificity for intestinal ischaemia and low positive predictive value. The highest value of this marker is that it can rule out this complication because normal PCT levels mean that intestinal ischaemia is very unlikely.

Treatment of knee cartilage by cultured stem cells and three dimensional scaffold: a phase I/IIa clinical trial

PURPOSE

Damage of the knee cartilage is a common condition manifesting itself mainly by pain and/or swelling that may substantially reduce the quality of life while ultimately leading to osteoarthritis in affected patients. Here, we aimed to evaluate the safety and efficacy of cultured autologous bone marrow mesenchymal stem cells (BM-MSCs) attached to the 3D Chondrotissue® scaffold by autologous blood plasma coagulation (BiCure® ortho MSCp) in the treatment of knee cartilage defects.

METHODS

The primary endpoint of this phase I/IIa clinical trial was to evaluate the safety of the treatment. The secondary objective was to determine the short-to-medium-term therapeutic outcomes by standardized scoring questionnaires including Lysholm Knee Scoring Scale (Lysholm score), Knee Injury and Osteoarthritis Outcome Score (KOOS), and pain Visual Analogue Scale (VAS) systems and imaging (X-ray and magnetic resonance imaging, MRI). A total of six patients were included and followed for 12 months after the surgery.

RESULTS

BiCure® ortho MSCp was well tolerated with no adverse events associated with the investigational medicinal product. Significant improvements were observed in Lysholm scores and KOOS while X-ray showed no deterioration of the arthritis and MRI revealed a persistent filling of the chondral defects by the implant.

CONCLUSION

Overall, our data demonstrate the safety of the tested investigational medicinal product. The function of the treated knee improved within one year after surgery in all enrolled patients.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

EudraCT No.: 2018-004,067-31; October 18 2018.

Chiral Light Emission from a Hybrid Magnetic Molecule-Monolayer Transition Metal Dichalcogenide Heterostructure

Hybrid layered materials assembled from atomically thin crystals and small molecules bring great promises in pushing the current information and quantum technologies beyond the frontiers. We demonstrate here a class of layered valley-spin hybrid (VSH) materials composed of a monolayer two-dimensional (2D) semiconductor and double-decker single molecule magnets (SMMs). We have materialized a VSH prototype by thermal evaporation of terbium bis-phthalocyanine onto a MoS₂ monolayer and revealed its composition and stability by both microscopic and spectroscopic probes. The interaction of the VSH components gives rise to the intersystem crossing of the photogenerated carriers and moderate p-doping of the MoS₂ monolayer, as corroborated by the density functional theory calculations. We further explored the valley contrast by helicity-resolved photoluminescence (PL) microspectroscopy carried out down to liquid helium temperatures and in the presence of the external magnetic field. The most striking feature of the VSH is the enhanced A exciton-related valley emission observed at the out-of-resonance condition at room temperature, which we elucidated by the proposed nonradiative energy drain transfer mechanism. Our study thus demonstrates the experimental feasibility and great promises of the ultrathin VSH materials with chiral light emission, operable by physical fields for emerging opto-spintronic, valleytronic, and quantum information concepts.

Kinetics of d-lactate and ischemia-modified albumin after abdominal aortic surgery and their ability to predict intestinal ischemia

OBJECTIVES

Acute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these markers for the early diagnosis of acute intestinal ischemia is assessed.

DESIGN & METHODS

This non-randomised, single-centre cohort study enrolled 50 patients with abdominal aortic aneurysm (AAA) and 30 patients with aortoiliac occlusive disease (AOID). Serum d-lactate and IMA were assessed pre-, intra-, and postoperatively at eight defined time points.

RESULTS

The highest serum d-lactate was at 6 h after complete declamping of the vascular graft. The highest predictive power of d-lactate was at 3 h after complete declamping (AUC 0.857). IMA was found to be higher in the AAA group in ischemic patients 10 min after complete declamping than in the AOID group. The highest predictive values of IMA were at 1 h after aortic cross-clamping (AUC 0.758) and 3 and 6 h after complete declamping (0.745 and 0.721, respectively). Moreover, the multivariate model with both markers at 3 h after complete declamping improved the detection of intestinal ischemia (AUC 0.894).

CONCLUSIONS

Serum levels of IMA and d-lactate seem to be influential predictive markers for postoperative intestinal ischemia, especially after 3 h from complete declamping of vascular reconstruction.

Current Approaches to Osteoid Osteoma and Minimally Invasive Surgery-A Minireview and a Case Report

Osteoid osteoma is a benign bone tumor typically affecting the long bones of the lower limbs in young male patients. The lesion can be asymptomatic but, in most cases, patients present with characteristic nocturnal pain that is very responsive to the administration of non-steroidal anti-inflammatory drugs. Although osteoid osteomas can regress spontaneously over time, surgical therapy is often indicated in cases of long-lasting resistant pain. Apart from a traditional open resection, the modalities of minimally invasive surgery, such as radiofrequency ablation or cryoablation, have gradually become the option of choice in most cases. The first part of this manuscript is a minireview of the contemporary literature on the pathogenesis, diagnosis, and current trends in the treatment of osteoid osteoma. The second part is a case report of our own experience with a conventional C-arm-guided radiofrequency ablation of an osteoid osteoma located in the femoral neck in an adolescent patient. The aim was to prove that, even when more sophisticated guiding devices (CT, O-arm, etc.) are not available, the safe and reliable ablation of the lesion using a C-arm is still possible even in hard-to-reach areas. The case was a success, with no perioperative or postoperative complications.

Reactive synovitis of the knee joint after COVID-19 vaccination: The first ultrastructural analysis of synovial fluid

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus 2019 disease (COVID-19) have spread all around the world since 2019 and have affected millions of people. The development of COVID-19 vaccines helped to decelerate the spread of the virus. However, as in the case of vaccines against other infectious diseases, adverse events can also present with COVID-19 vaccines.

CASE PRESENTATION

We report here a rare case of a 53-year-old man with knee-joint synovitis, after the first dose of messenger RNA vaccine, with no fever and a negative COVID-19 reverse transcription polymerase chain reaction test. During a clinical examination the suspicion of pyogenic arthritis was excluded by blood tests and by a complex joint effusion examination, including a microbiological and cytological-energy analysis of the synovial fluid. The treatment received by our patient consisted of 3 doses of dexamethasone administered intravenously over a period of 3 days. All the symptoms improved after this therapy, and in the 3-week follow-up period we recorded full recovery with no consequences.

CONCLUSION

Case reports on patients undergoing COVID-19 vaccination should be examined in order to detect rare and long-term side-effects. This is the first report to present the outcomes of an ultrastructural analysis of post-vaccination synovitis.

The possible role of hypoxia in the affected tissue of relapsed clubfoot

Our aim was to study the expression of hypoxia-related proteins as a possible regulatory pathway in the contracted side tissue of relapsed clubfoot. We compared the expression of hypoxia-related proteins in the tissue of the contracted (medial) side of relapsed clubfoot, and in the tissue of the non-contracted (lateral) side of relapsed clubfoot. Tissue samples from ten patients were analyzed by immunohistochemistry and image analysis, Real-time PCR and Mass Spectrometry to evaluate the differences in protein composition and gene expression. We found a significant increase in the levels of smooth muscle actin, transforming growth factor-beta, hypoxia-inducible factor 1 alpha, lysyl oxidase, lysyl oxidase-like 2, tenascin C, matrix metalloproteinase-2, matrix metalloproteinase-9, fibronectin, collagen types III and VI, hemoglobin subunit alpha and hemoglobin subunit beta, and an overexpression of ACTA2, FN1, TGFB1, HIF1A and MMP2 genes in the contracted medial side tissue of clubfoot. In the affected tissue, we have identified an increase in the level of hypoxia-related proteins, together with an overexpression of corresponding genes. Our results suggest that the hypoxia-associated pathway is potentially a factor contributing to the etiology of clubfoot relapses, as it stimulates both angioproliferation and fibroproliferation, which are considered to be key factors in the progression and development of relapses.

A Successful Case of TKA With Complex Deformity And Retained Hardware Using Computer Navigation

We present a case report of a 60-year-old Caucasian female patient, who had undergone a series of procedures for a periprosthetic (after total hip arthroplasty) Vancouver C type diaphyseal fracture of the right femur (reverse distal femoral locking compression plate [LCP] osteosynthesis, then a corrective osteotomy with another distal femoral LCP osteosynthesis). Subsequently, she developed high-grade osteoarthrosis of the right knee, indicated for a total knee arthroplasty. Considering the extent of previous procedures, which had significantly compromised the bone quality of the femur and therefore increased the risk of a refracture after an eventual hardware removal, we decided to retain the LCP plate. We concluded that the optimal solution would be the use of a computer-navigated total knee arthroplasty. This procedure obviated the need for intramedullary guiding, while ensuring optimal joint alignment. No postoperative complications emerged.

Toxocariasis as a Rare Parasitic Complication of a Transthoracic Spine Surgery Procedure

Human toxocariasis is a helminthozoonosis caused by the migration of Toxocara species larvae through an organism. The infection in humans is transmitted either by direct ingestion of the eggs of the parasite, or by consuming undercooked meat infested with Toxocara larvae. This parasitosis can be found worldwide, but there are significant differences in seroprevalence in different areas, depending mainly on hot climate conditions and on low social status. However, the literature estimates of seroprevalence are inconsistent. Infected patients commonly present a range of symptoms, e.g., abdominal pain, decreased appetite, restlessness, fever, and coughing. This manuscript presents a case report of a polytraumatic patient who underwent a two-phase spinal procedure for a thoracolumbar fracture. After the second procedure, which was a vertebral body replacement via thoracotomy, the patient developed a pathologic pleural effusion. A microscopic cytology examination of this effusion revealed the presence of Toxocara species larvae. Although the patient presented no specific clinical symptoms, and the serological exams (Enzyme–linked immunosorbent assay (ELISA), Western blot) were negative, the microscopic evaluation enabled a timely diagnosis. The patient was successfully treated with albendazole, with no permanent sequelae of the infection.

Minoxidil decreases collagen I deposition and tissue-like contraction in clubfoot-derived cells: a way to improve conservative treatment of relapsed clubfoot?

AIM

Clubfoot is a congenital deformity affecting the musculoskeletal system, resulting in contracted and stiff tissue in the medial part of the foot. Minoxidil (MXD) has an inhibitory effect on lysyl hydroxylase, which influences the quality of extracellular matrix crosslinking, and could therefore be used to reduce the stiffness and to improve the flexibility of the tissue. We assessed the in vitro antifibrotic effects of minoxidil on clubfoot-derived cells.

METHODS

Cell viability and proliferation were quantified by xCELLigence, MTS, and LIVE/DEAD assays. The amount of collagen I deposited into the extracellular matrix was quantified using immunofluorescence with subsequent image segmentation analysis, hydroxyproline assay, and Second Harmonic Generation imaging. Extracellular matrix contraction was studied in a 3D model of cell-populated collagen gel lattices.

RESULTS

MXD concentrations of 0.25, 0.5, and 0.75 mM inhibited the cell proliferation in a concentration-dependent manner without causing a cytotoxic effect. Exposure to ≥0.5 mM MXD resulted in a decrease in collagen type I accumulation after 8 and 21 days in culture. Changes in collagen fiber assembly were observed by immunofluorescence microscopy and nonlinear optical microscopy (second harmonic generation). MXD also inhibited the contraction of cell-populated collagen lattices (0.5 mM by 22%; 0.75 mM by 28%).

CONCLUSIONS

Minoxidil exerts an in vitro inhibitory effect on the cell proliferation, collagen accumulation, and extracellular matrix contraction processes that are associated with clubfoot fibrosis. This study provides important preliminary results demonstrating the potential relevance of MXD for adjuvant pharmacological therapy in standard treatment of relapsed clubfoot.

Rare Case of Traumatic Anterior Knee Dislocation of Total Knee Arthroplasty With a Serious Neurovascular Injury

Traumatic anterior dislocation of a total knee arthroplasty (TKA) is an extremely rare occurrence. There are only a few known cases of this type of dislocation which discuss the high risk of a neurovascular complication. This article describes a traumatic anterior dislocation of the TKA with a severe vascular lesion in a 75-year-old severely comorbid patient. Further complications led to the development of a compartment syndrome. Despite the repeated effort in performing a well-functioning anastomosis of the popliteal artery tear by the vascular surgeon, reperfusion of the lower extremity was not effective. Furthermore, multiorgan system failure due to the reperfusion syndrome evolved. This led to an above-knee amputation as a lifesaving procedure. Despite thorough intensive care therapy, the patient did not survive this complication. Presently there are no reported cases with such severe complications after the luxation of a previously well-functioning TKA leading to the death of the patient.

Clinical, genetic and functional analysis of R562S-Kv7.1 mutation associated with long QT syndrome type 1

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Education, Youth and Sports of the Czech Republic

Introduction

Loss-of-function variants of the KCNQ1 gene are associated with life-threatening arrhythmogenic long QT syndrome type 1 (LQT1). This gene encodes structure of the slow delayed rectifier potassium channel (IKs). Some functional characteristics of the C-terminal KCNQ1 variant c.1686G > C (p.R562S) have been recently described [1]. However, accumulation of the current under beta-adrenergic stimulation, essential for shortening the action potential duration during exercise, have not been tested.

Purpose

The aim of this study was to analyse clinical and genetic characteristics of the R562S variant in our patients and to investigate impact of the variant on IKs channel function with a special focus on reactivity of the channels on beta-adrenergic stimulation.

Methods

The clinical diagnosis was established according to ESC Guidelines including QTc analysis at rest and after exercise. The molecular genetics diagnostics followed according to current practices (the massive parallel sequencing since 2016). The biophysical analysis was performed on Chinese hamster ovary cells (CHO) by the whole cell patch clamp technique at 37 °C. CHO cells were transiently transfected with wild type (WT) and/or R562S human IKs channels (KCNQ1/KCNE1/Yotiao, 1:2:4). Cyclic adenosine monophosphate (cAMP, 200 µM) and okadaic acid (OA, 0.2 µM) in the pipette solution were used to simulate the beta-adrenergic stimulation. In the confocal microscopy experiments, expression of Yotiao was omitted and GFP-tagged KCNQ1 was used.

Results

The variant R562S-Kv7.1 has been identified in 7 heterozygous carriers from 3 putatively unrelated families in the Czech Republic. The genotype was associated with long QT syndrome phenotype (prolonged QTc, symptoms including syncopes and aborted cardiac arrest) in some of the carriers. The basic functional analysis proved that both homozygous and heterozygous R562S channels are expressed on the cell membrane (confocal microscopy) and carry IKs (whole cell patch clamp) which agrees with the recently published data on this variant. Importantly, reactivity on beta-adrenergic stimulation was absent in both homozygous and heterozygous R562S channels (n = 14 and 8, respectively), but present in the wild-type channels (increase by 51.4 ± 11.1 % at 120-s cAMP/OA diffusion; n = 12).

Conclusions

The R562S-Kv7.1 variant may be a founder LQT1 variant in our region which will be further investigated in the future. This variant impairs response of IKs channel to beta-adrenergic stimulation. Absence of this essential regulation may considerably aggravate the channel dysfunction and, thus, may result in life-threatening arrhythmias in R562S carriers during exercise.

In Comparison to Pathological Q Waves, Selvester Score is a Superior Diagnostic Indicator of Increased Long-Term Mortality Risk in ST Elevation Myocardial Infarction Patients Treated with Primary Coronary Intervention

The development of pathological Q waves has long been correlated with worsened outcome in patients with ST elevation myocardial infarction (STEMI). In this study, we investigated long-term mortality of STEMI patients treated by primary percutaneous coronary intervention (PPCI) and compared predictive values of Q waves and of Selvester score for infarct volume estimation. Data of 283 consecutive STEMI patients (103 females) treated by PPCI were analysed. The presence of pathological Q wave was evaluated in pre-discharge electrocardiograms (ECGs) recorded ≥72 h after the chest pain onset (72 h Q). The Selvester score was evaluated in acute ECGs (acute Selvester score) and in the pre-discharge ECGs (72 h Selvester score). The results were related to total mortality and to clinical and laboratory variables. A 72 h Q presence and 72 h Selvester score ≥6 was observed in 184 (65.02%) and 143 (50.53%) patients, respectively. During a follow-up of 5.69 ± 0.66 years, 36 (12.7%) patients died. Multivariably, 72 h Selvester score ≥6 was a strong independent predictor of death, while a predictive value of the 72 h Q wave was absent. In high-risk subpopulations defined by clinical and laboratory variables, the differences in total mortality were highly significant (p < 0.01 for all subgroups) when stratified by 72 h Selvester score ≥6. On the contrary, the additional risk-prediction by 72 h Q presence was either absent or only borderline. In contemporarily treated STEMI patients, Selvester score is a strong independent predictor of long-term all-cause mortality. On the contrary, the prognostic value of Q-wave presence appears limited in contemporarily treated STEMI patients.

Primary percutaneous coronary intervention is appropriate in transient ST-elevation myocardial infarction

INTRODUCTION

Reperfusion therapy by primary percutaneous coronary intervention (PPCI) is generally indicated in patients suffering from acute myocardial infarction (MI) with ST-segment elevation (STEMI). Prior to hospital admission, full ST-segment resolution (fSTR) may occur. Optimal management of such patients with transient STEMI (TSTEMI) is potentially challenging. Our aim was to evaluate the hypothesis that in TSTEMI patients, patency of infarct related artery (IRA) is achieved before PPCI, and to compare the outcome of TSTEMI and STEMI patients during a prolonged follow-up.

MATERIAL AND METHODS

Three hundred consecutive adult STEMI patients were referred to catheterization laboratory. In all patients, standard 12 lead ECGs were obtained both at the time of the first medical contact, and on catheterization laboratory admission.

RESULTS

TSTEMI occurred in 20 patients (6.7%). Despite fSTR (isoelectric ST segment), occluded IRA was found in 5 of these patients (25%). Pre-PPCI TIMI flow grade 2 was found in 6 TSTEMI patients (30%). Troponin T value at 24 h after symptom onset was lower in the TSTEMI group (1.8±2.5 mg/L vs. 3.6±3.5 mg/L, P=0.008). These patients also had a lower value of brain natriuretic peptide (156.3±119.5 ng/L vs. 438.5±429.0 ng/L, P<0.001) and higher left ventricular ejection fraction (59.9±6.3% vs. 51.6±10.2%, P<0.001). All patients were followed for a median of 5.6 years during which the overall survival did not differ between the TSTEMI and STEMI groups.

CONCLUSION

Primary PCI is strongly recommended in TSTEMI patients because of a relatively high incidence of occluded infarct related arteries. The rate of patients with TSTEMI is relatively low.

Differences in right-to-left vs left-to-right interventricular conduction times in patients indicated to cardiac resynchronization therapy

INTRODUCTION

Differences in conduction times from right ventricle to left ventricle and from left ventricle to right ventricle respectively were observed during biventricular devices implantation when changing pacing vector direction. In this article the phenomenon of interventricular conduction time differences is described and assessed in relationship to various clinical and electrophysiological parameters.

METHODS

In 62 consecutive patients (9 females) interventricular conduction times between right and left ventricle in both directions were measured during cardiac resynchronization therapy device implantation procedure. Complex pacing protocol was performed.

RESULTS

Investigated individuals was divided into 3 subgroups according to type of interventricular conduction pattern and statistically tested with various clinical data. Substantial differences in right-to-left vs left-to-right conduction times (> 5 ms, range 7-72 ms) were observed in 24 (39%) of all patients. They were more common in patients with dilated cardiomyopathy (20 of 38, 53%) compared to 4 (17%) of 24 patients with coronary artery disease (p = 0.011). The phenomenon occurred more often in hypertensive patients (p = 0.012). Other tested factors were nonsignificant.

CONCLUSIONS

There are almost no data on this topic. The occurrence of conduction difference phenomenon is quite common in dilated cardiomyopathy while it is rare in coronary artery disease. We assume the diffuse nature of the disease and the way of remodeling of myocardium play the main role. Knowledge of this phenomenon could be useful in personalized cardiac resynchronization therapy optimization.

Clinical value of different QRS-T angle expressions

Aims

Increased spatial angle between QRS complex and T wave loop orientations has repeatedly been shown to predict cardiac risk. However, there is no consensus on the methods for the calculation of the angle. This study compared the reproducibility and predictive power of three most common ways of QRS-T angle assessment.

Methods and results

Electrocardiograms of 352 healthy subjects, 941 survivors of acute myocardial infarction (MI), and 605 patients recorded prior to the implantation of automatic defibrillator [implantable cardioverter defibrillator (ICD)] were used to obtain QRS-T angle measurements by the maximum R to T (MRT), area R to T (ART), and total cosine R to T (TCRT) methods. The results were compared in terms of physiologic reproducibility and power to predict mortality in the cardiac patients during 5-year follow-up. Maximum R to T results were significantly less reproducible compared to the other two methods. Among both survivors of acute MI and ICD recipients, TCRT method was statistically significantly more powerful in predicting mortality during follow-up. Among the acute MI survivors, increased spatial QRS-T angle (TCRT assessment) was particularly powerful in predicting sudden cardiac death with the area under the receiver operator characteristic of 78% (90% confidence interval 63-90%). Among the ICD recipients, TCRT also predicted mortality significantly among patients with prolonged QRS complex duration when the spatial orientation of the QRS complex is poorly defined.

Conclusion

The TCRT method for the assessment of spatial QRS-T angle appears to offer important advantages in comparison to other methods of measurement. This approach should be included in future clinical studies of the QRS-T angle. The TCRT method might also be a reasonable candidate for the standardization of the QRS-T angle assessment.

Novel contribution to clubfoot pathogenesis: The possible role of extracellular matrix proteins

Idiopathic pes equinovarus (clubfoot) is a congenital deformity of the feet and lower legs. Clubfoot belongs to a group of fibro-proliferative disorders but its origin remains unknown. Our study aimed to achieve the first complex proteomic comparison of clubfoot contracted tissue of the foot (medial side; n = 16), with non-contracted tissue (lateral side; n = 13). We used label-free mass spectrometry quantification and immunohistochemistry. Seven proteins were observed to be significantly upregulated in the medial side (asporin, collagen type III, V, and VI, versican, tenascin-C, and transforming growth factor beta induced protein) and four in the lateral side (collagen types XII and XIV, fibromodulin, and cartilage intermediate layer protein 2) of the clubfoot. Comparison of control samples from cadavers brought only two different protein concentrations (collagen types I and VI). We also revealed pathological calcification and intracellular positivity of transforming growth factor beta only in the contracted tissue of clubfoot. Most of the 11 differently expressed proteins are strongly related to the extracellular matrix architecture and we assume that they may play specific roles in the pathogenesis of this deformity. These proteins seem to be promising targets for future investigations and treatment of this disease. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Expression of CD44, EGFR, p16, and their mutual combinations in patients with head and neck cancer: Impact on outcomes of intensity-modulated radiation therapy

BACKGROUND

Progress in radiation treatment of head and neck squamous cell carcinoma (HNSCC) deserves the studies focused on molecular predictors that would help to enhance individually tailored treatment.

METHODS

p16/epidermal growth factor receptor (EGFR)/cluster of differentiation-44 (CD44) was immunohistochemically analyzed in 165 HNSCC patients.

RESULTS

In the entire group and the p16 negative cohort, better 3-year overall survival and locoregional control correlated with p16 positivity, CD44, and EGFR negativity were observed. Combined analysis revealed the worst results in the CD44+/p16-, EGFR+/p16-, and EGFR+/CD44+ groups and in the EGFR+/CD44+ within p16 negative cohort. Multivariate analysis found tumor stage, Karnofsky index, p16, and CD44 as prognostic factors of overall survival and clinical stage, and p16 as a prognostic factor for locoregional control. Clinical stage and Karnofsky index affected overall survival and tumor stage. EGFR affected locoregional control in the p16 negative subgroup.

CONCLUSION

Our study confirmed the negative effect of CD44 and EGFR and the positive effect of p16 on radiotherapy results.

Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation

Aims

The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value.

Methods and results

The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years.

Conclusions

The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.

Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates

OBJECTIVE

The introduction of primary percutaneous coronary intervention (PPCI) has modified the profile of ST elevation myocardial infarction (STEMI) patients. Occurrence and prognostic significance of hypotension episodes are not known in PPCI treated STEMI patients. It is also not known whether and/or how the hypotension episodes correlate with the degree of myocardial damage and whether there are any sex differences.

METHODS

Data of 293 consecutive STEMI patients (189 males) treated by PPCI and without cardiogenic shock were analyzed. Blood pressure was measured noninvasively. A hypotensive episode was defined as a systolic blood pressure below 90 mmHg over a period of at least 30 minutes.

RESULTS

A hypotensive episode was observed in 92 patients (31.4%). Female sex was the strongest independent predictor of hypotension episodes (p < 0.0001), while there was no relationship to electrocardiographic STEMI localization. Hypotensive patients had significantly higher levels of troponin T and brain natriuretic peptide; hypotensive episodes were particularly frequent in women with increased troponin T. Treatment with angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) and betablockers was less frequent in hypotensive patients. After a mean 20-month follow-up, all-cause mortality did not differ between hypotensive patients and others. However, mortality in hypotensive patients who did not tolerate ACEI/ARB therapy was significantly higher compared to other hypotensive patients (p = 0.016).

CONCLUSION

Hypotension episodes are not uncommon in the sub-acute phase of contemporarily treated STEMI patients with a striking difference between sexes-female sex was the strongest independent predictor of hypotension episodes. Hypotensive episodes may lead to a delay in pharmacotherapy which influences prognosis. Higher incidence of hypotension in women could at least partially explain the sex-related differences in the use of cardiovascular pharmacotherapy which was repeatedly observed in various studies.

Pseudoaneurysm of the Dorsalis Pedis Artery: Case Report and Literature Review

Aneurysms and pseudoaneurysms of the dorsalis pedis artery are rare vascular entities usually caused by traumatic injury or iatrogenic intervention, producing a focal soft pulsatile tissue mass in the dorsal foot. Gradual expansion of the fibrous capsule can produce secondary physical signs through the pressure exerted on surrounding structures. We report the case of a 57-year-old male with an idiopathic pseudoaneurysm of the dorsalis pedis artery. A focused history found a low-grade blunt trauma to the dorsal foot that had occurred 2 years previously. The diagnosis of a pseudoaneurysm was confirmed by ultrasound examinations and computed tomography angiograms. The pseudoaneurysm was treated with resection, and a short reversed great saphenous vein interposition graft was placed. He recovered well after surgery and remained free of symptoms 18 months postoperatively. The literature review of this uncommon vascular pathologic entity and the diagnosis and management are discussed.

Association of the right ventricle impairment with electrocardiographic localization and related artery in patients with ST-elevation myocardial infarction

INTRODUCTION

The right ventricular myocardial infarction (RVMI) has traditionally been mainly related to inferior wall ST elevation myocardial infarction (STEMI). This study assessed the RVMI electrocardiographic (ECG-RVMI) signs in relationship to ECG-based STEMI localization and to the infarct related artery in patients treated with primary percutaneous coronary intervention (pPCI).

METHODS

Three hundred consecutive adult patients (107 females) were referred to catheterization laboratory with the acute STEMI diagnosis. In all patients, both the standard 12-lead ECGs and the right-sided precordial leads (V1R-V6R) were recorded. ECG-RVMI was diagnosed by ST segment elevation above 100μV in V4R.

RESULTS

ECG signs of RVMI were found in 35 and 31 (23.8% for both) patients with inferior and anterior wall STEMI, respectively. In 32 ECG-RVMI patients, the right coronary artery (RCA) was occluded while in 34 patients, the occlusions were in the left anterior descending (LAD) or the left circumflex artery. No statistically significant differences were found in ECG-RVMI patients when comparing clinical variables between those with anterior and inferior wall STEMI.

CONCLUSIONS

ECG signs of RVMI during acute STEMI are not uncommon. RCA was the infarction-related artery in only one half of these patients. Anterior wall STEMI and the LAD were associated with a significant proportion of ECG-RVMI cases.

Evaluation of three purely polypropylene meshes of different pore sizes in an onlay position in a New Zealand white rabbit model

BACKGROUND

The aim of the study was to evaluate the influence of the pore size of a polypropylene mesh on the shrinkage and elasticity of the mesh-tissue complex and the inflammatory reaction to the implant in an open onlay hernia repair.

MATERIALS AND METHODS

Twenty-one 10 × 10 cm samples of polypropylene meshes of a different pore size (3.0 × 2.8 mm-PP3, 1.0 × 0.8 mm-PP1 and 0.6 × 0.5 mm-PP.5) were implanted in an onlay position in 21 New Zealand white rabbits. After 90 days of implantation the shrinkage, elasticity and foreign body reaction (FBR) were assessed.

RESULTS

The shrinkage of PP3 was 30.6 ± 4.3 %, PP1 49.3 ± 2.9 % and PP.5 49.5 ± 2.6 %. The shrinkage of PP3 was significantly lower (PP3 × PP1 p = 0.007, PP3 × PP.5 p = 0.005), PP1 and PP.5 were similar. The elasticity was similar. The strength of FBR in mesh pores was similar. The width of foreign body granuloma layers at the mesh-tissue interface was significantly reduced with increasing pore size (inner: PP3 10.1 ± 1.2; PP1 12.5 ± 2.9; PP.5 17.4 ± 5.2 and outer: PP3 21.2 ± 2.5; PP1 30.6 ± 6.3; PP.5 60.4 ± 14.9). All differences between the widths of granuloma layers were statistically significant (p < 0.010). One animal (PP1) was excluded because of a mesh infection.

CONCLUSIONS

Implantation of polypropylene mesh of a pore size of 3 mm in an onlay position is associated with a significant reduction of shrinkage in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh. A pore size increase to 3 mm is not sufficient for an improvement of mesh-tissue complex elasticity in comparison to a 1 mm pore lightweight and 0.5 mm heavyweight mesh. Polypropylene mesh with enlarged pores to 3 mm is associated with a similar strength of FBR in mesh pores and a reduced foreign body granuloma in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh.

Towards clinical molecular diagnosis of inherited cardiac conditions: a comparison of bench-top genome DNA sequencers

BACKGROUND

Molecular genetic testing is recommended for diagnosis of inherited cardiac disease, to guide prognosis and treatment, but access is often limited by cost and availability. Recently introduced high-throughput bench-top DNA sequencing platforms have the potential to overcome these limitations.

METHODOLOGY/PRINCIPAL FINDINGS

We evaluated two next-generation sequencing (NGS) platforms for molecular diagnostics. The protein-coding regions of six genes associated with inherited arrhythmia syndromes were amplified from 15 human samples using parallelised multiplex PCR (Access Array, Fluidigm), and sequenced on the MiSeq (Illumina) and Ion Torrent PGM (Life Technologies). Overall, 97.9% of the target was sequenced adequately for variant calling on the MiSeq, and 96.8% on the Ion Torrent PGM. Regions missed tended to be of high GC-content, and most were problematic for both platforms. Variant calling was assessed using 107 variants detected using Sanger sequencing: within adequately sequenced regions, variant calling on both platforms was highly accurate (Sensitivity: MiSeq 100%, PGM 99.1%. Positive predictive value: MiSeq 95.9%, PGM 95.5%). At the time of the study the Ion Torrent PGM had a lower capital cost and individual runs were cheaper and faster. The MiSeq had a higher capacity (requiring fewer runs), with reduced hands-on time and simpler laboratory workflows. Both provide significant cost and time savings over conventional methods, even allowing for adjunct Sanger sequencing to validate findings and sequence exons missed by NGS.

CONCLUSIONS/SIGNIFICANCE

MiSeq and Ion Torrent PGM both provide accurate variant detection as part of a PCR-based molecular diagnostic workflow, and provide alternative platforms for molecular diagnosis of inherited cardiac conditions. Though there were performance differences at this throughput, platforms differed primarily in terms of cost, scalability, protocol stability and ease of use. Compared with current molecular genetic diagnostic tests for inherited cardiac arrhythmias, these NGS approaches are faster, less expensive, and yet more comprehensive.

Right ventricular myocardial infarction: From pathophysiology to prognosis

Right ventricle myocardial infarctions (RVMIs) accompany inferior wall ischemia in up to one-half of cases. The clinical sequelae of RVMIs vary from no hemodynamic compromise to severe hypotension and cardiogenic shock. Diagnosis is based on physical examination, electrocardiography, echocardiography and coronary angiography. Because the standard 12-lead electrocardiogram is insufficient for the assessment of RV involvement, right-sided precordial leads should always be included. Adequate fluid administration in combination with positive inotropic agents and early coronary reperfusion are crucial components of treatment, while diuretics and nitrates should be avoided. Intra-aortic balloon counterpulsation and right ventricle assist devices may be used with success in RVMIs associated with medically refractory heart failure. Right ventricular involvement appears to be an independent prognostic factor that dramatically increases in-hospital mortality, due, in part, to a significantly higher risk of hemodynamically compromising arrhythmias. Thus, using right-sided precordial leads and early RVMI identification to trigger an appropriately aggressive treatment protocol may improve patients' prognosis.

Effect of atorvastatin on dynamic parameters of myocardial repolarization in healthy subjects

BACKGROUND

Antiarrhythmic properties of statins were suggested as a part of their pleiotropic effects. The aim of the present study was to evaluate the effects of atorvastatin on myocardial repolarization as manifested on surface electrocardiograms (ECGs) in healthy subjects.

METHODS AND RESULTS

Forty young healthy volunteers (20 men, 20 women) underwent a single-dose double-blind 3-way crossover study of 20 and 80 mg of atorvastatin and placebo. Long-term 13-hour 12-lead ECGs were obtained in each subject and each study period starting 15 minutes before drug administration. Each study period contained 18 time-points of 5-minute durations when the subjects were in resting supine positions. Digital ECG recordings were analyzed automatically, and the results were completed blindly before statistical analyses. Dynamic parameters of myocardial repolarization and T-wave morphology descriptors were evaluated. Although some trends were observed, no significant drug-related changes in any of investigated ECG repolarization descriptors were found.

CONCLUSION

In comparison with placebo, single doses of atorvastatin had no effect on repolarization heterogeneity in healthy subjects. The observation confirms safe profile of the drug with limited proarrhythmic potential.

Mutation analysis ion channel genes ventricular fibrillation survivors with coronary artery disease

BACKGROUND

Observations from population-based studies demonstrated a strong genetic component of sudden cardiac death. The aim of this study was to test the hypothesis that ion channel genes mutations are more common in ventricular fibrillation (VF) survivors with coronary artery disease (CAD) compared to controls.

METHODS

The entire coding sequence of KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2 genes was analyzed in 45 (five females) CAD individuals-survivors of documented VF and in 90 matched healthy controls. In another control group of 141 matched patients with CAD without malignant arrhythmias, the exons containing rare coding variants found in the VF survivors were sequenced.

RESULTS

The carrier frequency of all the rare sequence variants was significantly higher in the VF survivors (8/45, 17.8%) than in CAD controls (3/141, 2.2%, P = 0.001). In VF survivors, four coding variants in eight individuals were found. Three in KCNH2 gene: R148W and GAG186del are novel; P347S was previously related to long QT syndrome. In SCN5A gene, P2006A variant was found in five unrelated males. This variant has been demonstrated previously to have small effect on sodium channel kinetics. No rare coding variants were found in the healthy controls. The P2006A variant was found in three CAD controls.

CONCLUSION

The prevalence of selected, rare coding variants in five long QT genes was significantly higher in cases versus controls, confirming a mechanistic role for these genes among a subgroup of patients with coronary disease and VF.

Universal oscillations in counting statistics

Noise is a result of stochastic processes that originate from quantum or classical sources. Higher-order cumulants of the probability distribution underlying the stochastic events are believed to contain details that characterize the correlations within a given noise source and its interaction with the environment, but they are often difficult to measure. Here we report measurements of the transient cumulants n(m) of the number n of passed charges to very high orders (up to m = 15) for electron transport through a quantum dot. For large m, the cumulants display striking oscillations as functions of measurement time with magnitudes that grow factorially with m. Using mathematical properties of high-order derivatives in the complex plane we show that the oscillations of the cumulants in fact constitute a universal phenomenon, appearing as functions of almost any parameter, including time in the transient regime. These ubiquitous oscillations and the factorial growth are system-independent and our theory provides a unified interpretation of previous theoretical studies of high-order cumulants as well as our new experimental data.

Subject-specific profiles of QT/RR hysteresis

The time lag of the QT interval adaptation to heart rate changes (QT/RR hysteresis) was studied in 40 healthy subjects (18 females; mean age, 30.4+/-8.1 yr) with 3 separate daytime (>13 h) 12-lead electrocardiograms (ECG) in each subject. In each recording, 330 individual 10-s ECG segments were measured, including 100 segments preceded by 2 min of heart rate varying greater than +/-2 beats/min. Other segments were preceded by a stable heart rate. In segments preceded by variable rate, QT/RR hysteresis was characterized by lambda parameters of the exponential decay models. The intrasubject SDs of lambda values were compared with the intersubject SD of the individual means. The lambda values were also correlated to individually optimized parameters of heart rate correction. Intrasubject SDs of lambda were substantially smaller than the population SD of individual means (0.390+/-0.197 vs. 0.711, P<0.0001). The lambda values were unrelated to the QT/RR correction parameters. When compared with the corrected QT (QTc) for averaged RR intervals in 10-s ECGs and with the averaged RR intervals in 2-min history, QTc for QT/RR hysteresis led to a substantially smaller SD of QTc values (11.4+/-2.00, 6.33+/-1.31, and 4.66+/-0.85 ms, respectively, P<0.0001). Thus the speed with which the QT interval adapts to heart rate changes is highly individual with intrasubject stability and intersubject variability. QT/RR hysteresis is independent of the static QT/RR relationship and should be considered as a separate physiological process. The combination of individual heart rate correction with individual hysteresis correction of the QT interval is likely to lead to substantial improvements of cardiac repolarization studies.

Pilot study of compliance with healthcare facility smoking laws in Georgia

In 2003 Georgian Parliament restricted smoking in all healthcare facilities to designated smoking areas. Observed compliance has been low. This quantitative study of airborne nicotine and particulate concentrations in nine healthcare facilities in Tbilisi and Region Kakheti in February, 2007 was a pilot to assess the degree of noncompliance with the law and to identify potential strategies for increasing compliance. Passive sampling of nicotine and active sampling of PM(2.5) in selected healthcare facilities. None of the facilities we monitored had designated smoking areas that met the legal requirements. Fifty of the 51 samplers registered concentrations of nicotine above the level of detection. Of these, 52% showed concentrations below 1 microg/m(3) nicotine, 27% showed concentrations between 1 and 5 microg/m(3) and 20% were above 5 microg/m(3). The highest nicotine levels were found in medical staff offices, and in undesignated "informal smoking areas". These data support qualitative observations that the law restricting smoking in Georgian healthcare facilities to designated areas is poorly enforced and does not protect patients and employees from secondhand smoke. These findings suggest that Georgian law should be changed to make all healthcare institutions smoke free environments and that there is a need for tobacco control programs targeted at medical professionals in Georgia.

Hepatocellular carcinoma--evaluation of a group of 74 patients treated at the surgical department

The authors present their experience with treatment of 74 patients operated on for hepatocellular carcinoma. Resection could be performed only in 44 patients. In 19 cases, a catheter for regional chemotherapy was implanted. Tumor destruction with alcohol was performed 4 times and radiofrequency thermal ablation 5 times either as a single intervention or in addition to the resection. Liver cirrhosis was verified by histology in 29 operated patients. Hospital mortality: 2 operated patients. Median survival after the liver resection: 42 months, mean survival: 72 months. The importance of preoperative indocyanine green elimination test for the exact determination of functional capacity of the liver and the priority of radical resection as compared to the other treatment modalities are emphasized (Tab. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

The impact of PET with 18FDG in radiotherapy treatment planning and in the prediction in patients with cervix carcinoma: results of pilot study

Positron emission tomography (PET) is used to distinguish between benign and malign tumors, to diagnose relapse or post-therapeutic changes. Lately, PET is used to predict the treatment response. and also a complementary method to determine target volumes in radiotherapy. Daily using of PET in the oncology praxis can change treatment strategy and improve its outcome. Results of this pilot study show the role of PET with 8-F-fluorodeoxyglucose ((18)FDG) for staging of cervical carcinoma and in the radiotherapeutic planning. Between March 2005 and May 2007, 51 patients with cervical carcinoma were treated with combination of external beam radiotherapy and HDR brachytherapy, with or without concomitant cisplatin. The lymphatic nodes treatment field size was determined by PET/CT fusion. Treatment results were evaluated by PET 3 and 9 months after treatment. The differences in the results of PET and CT were evaluated in this study. In 32 cases (62.75%) the results of PET and CT were identical, in 14 cases (27.45%) the nodal involvement was more extensive according to PET, in 5 cases (9.8%) the nodal involvement was more extensive according to CT. PET results 3 months after treatment were as follows: in 3 cases (5.88%) stable disease, in 35 cases (68.63 %) negative, in 4 cases (7.84%), progression of disease, in 3 cases (5.88 %) partial regression. There were no false positive results caused by inflammatory reaction persisting 3 months after radiotherapy, as was confirmed by repeating PET 9 months after treatment. The results of this study confirmed the important role of PET in diagnosis and treatment of cervical carcinoma and in determination of target volumes in radiotherapy. PET was found to be a standard staging examination of cervical carcinoma in Masaryk Memorial Cancer Institute. The predictive value of PET has not yet been validated.

Monitoring of QT interval in patients treated with psychotropic drugs

BACKGROUND

Psychotropic drugs have the potential for QT interval prolongation, the frequency is not known. The aim of this study was to monitor the occurrence of QT interval prolongation in a non-selected population of patients treated with psychotropic drugs with proarrhythmic potential.

METHODS

In consecutive patients hospitalized at psychotic wards at the Department of Psychiatry treated with antipsychotic and antidepressant drugs with known or unexplored proarrhythmic potential a 12-lead ECG was recorded (50 mm/s, 20 mm/mV) on therapy; the QT interval was measured manually, corrected according to Bazett and Fridericia. QTc intervals of 470 ms (females) and 450 ms (males) were considered borderline, longer QTc intervals were considered pathologic.

RESULTS

ECGs were recorded in 452 patients (187 females, 265 males, aged 43+/-16 years). Using Bazett's correction, abnormal QTc values were observed only in 2% of the whole group and in 1.8% of the patients treated with drugs associated with QT prolongation (the greatest QTc value is 490 ms in female and 480 ms in male). With Fridericia's correction, there was only 1 case of borderline QTc in the whole group (the greatest QTc value is 450 ms in both sex groups).

CONCLUSIONS

Our 2-year real-life experience shows that occurrence of QTc prolongation in present psychiatric patients is low. Values associated with high risk of arrhythmias (QTc>500 ms) were not observed. This might be related to the recent changes of spectrum of antipsychotic therapy used, the general trend to use lower doses, and increasing awareness about the drug-induced long QT syndrome.

The homozygous KCNQ1 gene mutation associated with recessive Romano-Ward syndrome

In a 7-year-old boy with normal hearing suffering from repeated syncope an extremely prolonged QTc interval (up to 700 ms) was found. The mother was completely asymptomatic and the father had an intermittently borderline QTc interval (maximum 470 ms) but no symptoms. In the proband a mutation analysis of KCNQ1 gene revealed a homozygous 1893insC mutation. The parents were heterozygous for this mutation. There was no consanguineous marriage in the family. The clinical relevance of these findings is that apparently normal individuals may have a latent reduction of repolarizing currents, a "reduced repolarization reserve," because they are carriers of latent ion channel genes mutations.

Longterm treatment results of childhood medulloblastoma by craniospinal irradiation in supine position

Medulloblastoma, a primitive neuroectodermal tumor growing in cerebellum, is one of the most sensitive to radiation therapy childhood brain tumors. The radiotherapy is an essential method of treatment for these tumours, but the surgery is the primary treatment of choice in medulloblastoma. I this study between January 1997 and March 2005 were post-operative irradiated a total number of 33 pediatric patients aged under 15 years (median age 8.7 years) with medulloblastoma. All tumors were histologically proved and were localizated infratentorially in the posterior fossa. All of the patients were irradiated with a dose of 24-36 Gy to the whole craniospinal axis and boost with conformal therapy restricted to the tumor bed to the total dose of 50-54 Gy (30-36 Gy "high risk", 24-30 Gy "standard risk" group). Chemotherapy received 26 patients (78%). Patients with craniospinal irradiation were placed in supine position and fixed by a vacuum-form body immobilizer and head mask. Irradiation was performed using standard fractionation (5 fractions per week) with a single dose of 1.5-1.8 Gy for craniospinal axis by photon beam (6 MV) of the linear accelerator. The median overall survival for the whole group was 55.3 months. The median of disease-free survival was 20.6 months, 8 patients (24%) died. In our study the statistical difference in survival rate between standard and high-risk patients with medulloblastoma was not shown. No relationship was found between survival and age, sex or tumor size. Endocrine deficits occurred in 45% (8 patients of the group were hypothyroid, 6 patients needed growth hormone replacement therapy, 1 patient had early puberty). This results (results of overall and disease-free survival) and side-effects of technique of craniospinal axis irradiation in supine position are comparable with results of technique in prone position. Further evaluation of the effectiveness of our therapy is not feasible due to the small number of patients.