Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex

ObjectivesTo investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS.Methods143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB).ResultsFrequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments.Conclusions3DE confirmed significant dyssynchrony in  > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.     

Predictors of inhospital mortality in patients with infective endocarditis

Despite advances in therapy, infective endocarditis (IE) remains a serious disease with high mortality. We evaluated 155 Egyptian patients with Duke definite/possible IE to determine incidence, causes and predictors of inhospital mortality. The mean time from symptoms onset to diagnosis was 66.4 ± 97 days. The causes of mortality (38.7%) included congestive heart failure (CHF), sepsis, surgery related, stroke, cerebral hemorrhage, pulmonary embolism, sudden cardiac death, and hyperkalemia. Predictors of mortality on univariate analysis were duration of symptoms before hospital admission (p = 0.017), health care associated endocarditis (p = 0.039), CHF (p < 0.001), fulminant sepsis (p < 0.001), embolization (p = 0.011), need for dialysis (p = 0.003), need for cardiac surgery (p = 0.027), unperformed indicated cardiac surgery (p = 0.002) and higher C-reactive protein level (p = 0.05). In multivariate analysis, only CHF remained an independent predictor of mortality (p = 0.033). IE mortality was high in this cohort probably due to delayed diagnosis. Patients having these mortality predictors especially CHF deserve more aggressive treatment.     

Safety and efficacy of adaptive servo-ventilation in patients with severe systolic heart failure

Background and purposeIt is unclear whether adaptive servo-ventilation (ASV) is safe and effective in patients with severe systolic heart failure (HF). Our aim in this study was to estimate the safety and efficacy of ASV therapy for patients with severe systolic HF.Methods and subjectsSeventy-six HF patients (age: 69 ± 12 years; 53 men), categorized as New York Heart Association (NYHA) Class II–IV, with left ventricular ejection fraction (LVEF) of <50%, received ASV therapy after optimal medical therapy to determine the safety and efficacy of ASV. Patients were divided into 2 groups based on their LVEF: group L (LVEF < 30%; n = 42) and group H (LVEF ≥ 30%; n = 34). After 6 months of ASV therapy, we compared the changes in LVEF, brain natriuretic peptide (BNP), and incidence of fatal cardiovascular events between the groups.ResultsThe groups differed significantly with respect to beta-blocker treatment before ASV therapy (p < 0.0001). After 6 months of ASV therapy, LVEF and BNP levels had improved in both groups. In group L, LVEF had improved from 24.1 ± 5.6% to 35.2 ± 10.6% (p < 0.0001) and BNP from 591 (273–993) pg/ml to 142 (39–325) pg/ml (p = 0.002). Moreover, 1-year follow-up data showed a tendency toward improvement of NYHA classification in group L (group L: 50%; group H: 29%; p = 0.07), and showed no significant difference with regard to fatal cardiovascular events between the 2 groups (group L: 11.9%; group H: 5.9%; p = 0.36).ConclusionsOur study demonstrated that ASV therapy is safe and effective for use in very severe systolic HF patients as well as in relatively mild systolic HF patients.     

Low-frequency blood flow oscillations in congestive heart failure and after β1-blockade treatment

Laser Doppler flowmetry (LDF) of forearm skin blood flow, combined with iontophoretically-administered acetylcholine and sodium nitroprusside and wavelet spectral analysis, was used for noninvasive evaluation of endothelial function in 17 patients newly diagnosed with New York Heart Association class II–III congestive heart failure (CHF). After 20 ± 10 weeks' treatment with a β₁-blocker (Bisoprolol), the measurements were repeated. Measurements were also made on an age- and sex-matched group of healthy controls (HC). In each case data were recorded for 30 min. In HC, the difference in absolute spectral amplitude of LDF oscillations between the two vasodilators manifests in the frequency interval 0.005–0.0095 Hz (p < 0.01); this difference is initially absent in patients with CHF, but appears following the β₁-blocker treatment (p < 0.01). For HC, the difference between the two vasodilators also manifests in normalised spectral amplitude in 0.0095–0.021 Hz (p < 0.05). This latter difference is absent in CHF patients and is unchanged by treatment with β₁-blockers. It is concluded that there are two oscillatory skin blood flow components associated with endothelial function. Both are reduced in CHF. Activity in the lower frequency interval is restored by β₁-blocker treatment, confirming the association between CHF and endothelial dysfunction but suggesting the involvement of two distinct mechanisms.     

Does Sericin,as a Novel Pleurodesis Agent,Have Higher Effectiveness Compared to Talcum Powder,Doxycycline, and Silver Nitrate Pleurodesis?

IntroductionThe usefulness of sericin as pleurodesis agent has previously been described. Present study aims to compare sericin pleurodesis regarding success, effectiveness, tolerability, and side-effects.MethodsAdult, 12-week-old Wistar-albino rats (n = 60), divided to five groups as sericin, talcum-powder, doxycycline, silver-nitrate and control. Agents were administrated through left thoracotomy, rats sacrificed twelve-days after.ResultsHighest ratio of collagen fibers was observed in sericin group, and the intensity was higher than talcum-powder group (p < 0.05). Compared to silver nitrate, sericin group displayed better mesothelial reaction, and multi-layer mesothelium was also better (p < 0.05). Foreign body reaction and emphysema were less frequent in sericin group (p < 0.05). The presence of biological tissue in parenchyma was less prominent in sericin group (p < 0.05). Foreign body reaction on thoracic wall was less common in sericin group (p < 0.05). Presence of biological tissue glue in thoracic wall was less prominent in sericin group (p < 0.05).Glomerular degeneration was lower in sericin group compared to the silver nitrate group (p < 0.05), and tubular degeneration was less common in sericin group than talcum group (p < 0.05). Pericarditis was less common in sericin group compared to the other groups (p < 0.05).ConclusionAs an intrinsic, natural glue protein, sericin protects the lung parenchyma and tissues, and its glue-like characteristics enable pleurodesis. The success of sericin in pleurodesis was demonstrated in the present study based on investigations of the pleurae. Being cost-effective and better tolerated agent associated with a low potential of side effects, sericin is more effective, less expensive and provides more lung parenchyma protection.     

Anti-Allergic Effects of Vernonia amygdalina Leaf Extracts in Hapten-Induced Atopic Dermatitis-Like Disease in Mice

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic and ec- zematous skin lesions. In this study, AD-like disease was induced in NC/Nga mice so as to evaluate the antiallergic effects of Vernonia amygdalina leaf extracts (VAM).Methods: Forty NC/Nga mice were purchased for each of the two protocols (prophylactic and curative) of the study. Mice were randomly divided in groups of five or six after sensitization with 5% trinitrochlorobenzene (TNCB): aqueous extracts (VAM1), methanolic extracts (VAM2), hydrocortisone (HCT), buffer for the control (TNCB) and the normal mice (NORM) groups.Results: As for HCT, VAM1 and VAM2-pretreated mice showed significantly lower number of scratching behavior episodes (p < 0.01; vs. TNCB) following TNCB challenge. In addition, VAM1, VAM2 exerted a significant inhibitory effect on the development of AD skin symptoms (vs. TNCB group; p < 0.001), the production of IgE, TNF-alpha (p < 0.05), IL-5 and IFN-gamma (p < 0.01) (vs. TNCB group) and on the increase in ear thickness (p < 0.05) in prophylactic protocol.In the AD curative protocol, topical VAM1, VAM2 markedly improved skin lesions such as erythema/hemorrhage (p < 0.05), scaling/dryness, erosion/excoriation (p < 0.01) (vs. TNCB mice). Furthermore, a significant decrease in ear thickness was noted in VAM1, VAM2, HCT groups (vs. TNCB group; p < 0.05) as well as the serum total IgE, MCP-1 (p < 0.01) and eotaxin (p < 0.05). VAM2 also improved chronic eczema dermatitis skin symptoms in a patient.Conclusions: Results from this report suggest that VAM extracts, known as ERK pathway inhibitor, prevent and improve atopic/eczema dermatitis syndrome.     

The correlation between parental education and their knowledge of asthma

ObjectiveTo evaluate the impact of parental education on the success of Asthma Educational Intervention (AEI).MethodsAEI took place after the children's hospitalisation. Parental asthma knowledge was assessed at three time points: before AEI, immediately after, and 12 months later. The Intervention (I) group of parents (N = 231) received complete AEI. The Control (C) group of parents (N = 71) received instructions for proper use of asthma medications and the handbook.ResultsAsthma knowledge in I group increased immediately after the AEI (p < 0.01), and had not changed (p > 0.05) 12 months later. There were four subgroups in group I divided based on education level: elementary school, high school, college, and university degrees. Taking into account the parental education level, there were no differences in the baseline and final knowledge of asthma between subgroups (p > 0.05). The number of asthma exacerbations decreased after AEI (5.96:2.50, p < 0.01), regardless of the parental degree. Knowledge of asthma in group C did not improve during the study (p = 0.17). Final asthma knowledge was higher in group I compared to group C (p < 0.01).ConclusionThe parental education level did not influence the level of asthma knowledge after the AEI. The motivation and the type of asthma education had the greatest input on the final results.Practice implicationsAll parents should be educated about asthma regardless of their general education.     

Study of main arteries stiffness in patients with coronary heart disease depending on prevalence of atherosclerosis

ObjectiveTo study the vascular wall stiffness in patients with coronary artery disease based on the prevalence of atherosclerotic lesion.Materials and methodsThe study involved 90 patients diagnosed with unstable angina class II B, the control group consisted of 27 healthy individuals. By using the SphygmoCor (AtCor Medical, Australia) apparatus, stiffness indicators, like pulse wave velocity (PWV) and augmentation index (AIx) were studied by means of the applanation tonometry method. Coronary angiography was performed on the Allura CV-20 (Philips, The Netherlands) unit, the state of the carotid arteries was studied by duplex ultrasonography, involvement of femoral arteries was evaluated based on ankle-brachial index <0.9. In case of doubt, the patients underwent ultrasound duplex scanning. In the main group, patients were divided into 3 subgroups: subgroup A covered patients with isolated coronary lesion; subgroup B covered patients with bifocal atherosclerosis (combined lesion of coronary and carotid arteries or coronary and femoral arteries); subgroup C was represented by multifocal atherosclerosis patients who had atherosclerosis lesion in three vascular basins: carotid, coronary and femoral arteries.ResultsValues of PWV (11.2 ± 1.5 m/s) and AIx (19.8 ± 5.0%) in patients with coronary heart disease were 1.5 (p < 0.001) and 2.4 (p < 0.001) times higher than in those in healthy individuals. During the analysis carried out within the groups, the PWV in all three subgroups was accelerated with maximal values in the subgroup C (13.3 ± 1.5 m/s), which with sufficient level of confidence exceeds the value of this index in the subgroups A (10.1 ± 0.6, p < 0.01) and B (11.0 ± 0.9, p < 0.05). The value of augmentation index AIx was also highest in the subgroup C (26.8 ± 6.4%), relative to the subgroups A (13.7 ± 2.9%, p < 0.001) and B (18.9 ± 4.3%, p < 0.01).ConclusionPatients with coronary heart disease, have demonstrated growing vascular wall stiffness, which is manifested in higher pulse wave velocity (p < 0.001) and augmentation index (p < 0.001) compared with healthy individuals. Whereas in the multifocal atherosclerosis (coronary, carotid and peripheral arteries) were higher AA (p < 0.05), AIx (p < 0.001), PWV (p < 0.01) and the age of patients (p < 0.01). That allows to consider the studied parameters of vascular stiffness as surrogate markers to assess prevalence and progression of atherosclerosis, as well as the effectiveness of pharmacological interventions.     

Impact of pre-excitation syndrome on left ventricular systolic function and cardiac synchronization assessed by tissue Doppler imaging and speckle tracking techniques

BackgroundThe pathogenic mechanism for the development of left ventricular (LV) dysfunction in patients with asymptomatic pre-excitation syndrome has not yet been fully elucidated. We sought to assess the impact of pre-excitation on LV systolic function and whether the use of tissue Doppler imaging (TDI) and speckle tracking is more helpful in detection of the LV dyssynchrony than conventional echo parameters in these patients.MethodsThis observational case control study was carried out on adults with manifest pre-excitation syndromes. A detailed echocardiographic assessment was performed including TDI and speckle tracking examination.ResultsOur study patients were divided into two groups, group 1: with lateral accessory pathways (AP) (23 patients aged 31.65 ± 6.5 years), group 2: with septal AP (25 patients, 34.84 ± 10.8 years). Echocardiography showed a lower ejection fraction (EF) in group 2 than in group 1 (0.60 ± 0.07% in group 1 vs. 0.50 ± 0.08% in group 2, p = 0.000). The radial strain dyssynchrony index was higher in group 2 than in group 1 (58.78 ± 33.47 vs. 139.52 ± 21.14 ms; p < 0.0001) with a significant negative correlation with EF (r = −0.8, p = 0.000). Dyssynchrony detection was higher using speckle tracking technique than M mode/Doppler methods (p = 0.006).ConclusionPatients with pre-excitation syndrome may have depressed LV function unrelated to tachyarrhythmia, especially if the AP has a septal location. This dysfunction may be associated with the LV dyssynchronus contraction caused by pre-excitation. The use of TDI and speckle tracking echocardiographic techniques may be associated with an increase in the identification of manifest pre-excitation patients with significant LV dyssynchrony.     

Utility of QRS width and echocardiography parameters in an integrative algorithm for selecting heart failure patients with cardiac dyssynchrony

BackgroundCardiac resynchronization therapy (CRT) is an effective treatment in dilated cardiomyopathy (DCM). However, it has been demonstrated that mechanical dyssynchrony is not related to electrical dyssynchrony. We hypothesized that a new QRS width cutoff could be easier to use as a first step in the selection of patients with inter- and intraventricular dyssynchrony.MethodsWe included 58 patients with DCM. Electrocardiographic (PR interval and QRS width) and echocardiographic (left ventricular dimensions, systolic and diastolic function, dyssynchrony parameters) data were evaluated in all patients.ResultsAccording to QRS width, we divided the study population in two groups: Group 1, 25 patients having a narrow QRS (≤ 120 ms), and Group 2, 33 patients having a wide QRS (> 120 ms). Patients in Group 2 had larger left ventricles, with similar systolic function and more severe diastolic dysfunction than patients with narrow QRS. Interventricular dyssynchrony was more frequent in group 2 (54.5% vs 20%, p = 0.01), while intraventricular dyssynchrony was highly prevalent in both groups (82.1% vs 72%, p = 0.48). A QRS > 140 ms best predicted the presence of interventricular dyssynchrony (sensitivity 78.2% and specificity 63.6%), while a QRS > 150 ms best predicts intraventricular dyssynchrony (sensitivity 48.6% and specificity 80%).ConclusionsIntraventricular dyssynchrony has a high prevalence in patients with DCM, irrespective of the QRS width. Using a higher QRS width cutoff (150 ms) might help in patient selection for CRT. Electrocardiography and echocardiography can be combined into a selection algorithm for patients receiving resynchronization therapy.     

Portal hypertensive colopathy and haematochezia in cirrhotic patients: An endoscopic study

Background and study aimsIn patients with liver cirrhosis, portal hypertensive colopathy (PHC) and anorectal varices (ARVs) are thought to cause lower gastrointestinal (GI) bleeding. In the present work, we studied the diagnostic yield of colonoscopy in cirrhotic patients and haematochezia.Patients and methodsThe current study was conducted on 77 consecutive cirrhotic patients who underwent colonoscopy at Mansoura Emergency Hospital, Egypt, between May 2007 and May 2011. Following rapid evaluation and adequate resuscitation, a thorough history was obtained with complete physical examination including digital rectal examination and routine laboratory investigations. Colonoscopic evaluation was performed for the included patients by recording endoscopic abnormalities and obtaining biopsies from lesions.ResultsThere was no significant difference between the PHC-positive group when compared with the PHC-negative group regarding patients’ age, sex, severity of haematochezia, positive family history and the history of intake of non-steroidal anti-inflammatory drugs (NSAIDs). Significant difference was noted regarding the Child–Pugh class (p < 0.05), history of splenectomy (p < 0.05), prior history of endoscopic sclerotherapy (EST) or endoscopic variceal ligation (EVL) (p < 0.05), prior history of upper gut bleeding (p < 0.05), the presence of gastric varices (GVs) (p < 0.05), presence of portal hypertensive gastropathy (PHG) (p < 0.05), presence of haemorrhoids (p < 0.05) and rectal varices (<0.05) and therapy with β-blockers (p < 0.05). Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p < 0.05). All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation.Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p < 0.05).All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation.ConclusionOur data revealed that it is not only PHC which is involved in haematochezia in cirrhotic patients despite the significant association. Instead, a high prevalence of inflammatory lesions came on the top of the list. Complete colonoscopy is highly advocated to detect probable proximal neoplastic lesions.     

High prevalence of vitamin D deficiency and its association with left ventricular dilation: An echocardiography study in elderly patients with chronic heart failure

Background and aimsVitamin D deficiency has been associated with chronic heart failure (CHF). We evaluated vitamin D levels in relationship with New York Heart Association (NYHA) classes, N-terminal pro-brain natriuretic peptide (NT-proBNP) values and left ventricular (LV) measures in ≥60 year old patients with stable CHF. Differently from previous investigations, LV function was assessed by transthoracic echocardiography, to provide easily reproducible results.Methods and resultsThe study was performed at geographic latitude 44° N, from March to May and from September to November 2008. Acute HF and diseases or drugs altering vitamin D status were exclusion criteria. NYHA scores and 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D and NT-proBNP concentrations were assessed in 90 (45 F, 45 M) Caucasian patients with CHF secondary to hypertension and/or coronary artery disease. Vitamin D levels were also measured in 31 subjects without heart disease (controls). LV echocardiography was performed in 52 (26 F, 26 M) representative patients. Vitamin D concentrations were significantly lower in CHF cases than in controls. Among subject with CHF, 97.8% presented vitamin D deficiency (25(OH)D < 75 nmol/L), being severe (<25 nmol/L) in 66.7%. LV end-diastolic and end-systolic diameters were significantly longer, LV end-diastolic and end-systolic volumes bigger and fractional shortening lower in CHF patients with 25(OH)D < 25 nmol/L than with 25(OH)D ≥ 25 nmol/L (p < 0.05). Log-values of 25(OH)D were negatively correlated with LV end-systolic diameter and volume (r = ?0.28; p < 0.05). On subgroup analysis, these results persisted only in male patients.ConclusionsIn elderly CHF patients, vitamin D deficiency was highly prevalent and often severe. This first addressed echocardiography study showed a sex-specific association between vitamin D deficiency and LV dilation. Since further echocardiography data are easily obtainable, larger investigations are demanded.     

Orexin A associates with inflammation by interacting with OX1R/OX2R receptor and activating prepro-Orexin in cancer tissues of gastric cancer patients

ObjectiveGastric cancer (GC) has been become the second leading cause for cancer-associated death. This study aimed to investigate Orexin A levels and associated receptors in tumor tissues of GC patients.Patients and methodsForty-six consecutive gastric cancer patients (GC, n = 46) and 13 chronic atrophic gastritis patients (CAG, n = 13) were recruited. Meanwhile, 18 health individuals visiting Medical Examination Department were involved as control (N group, n = 18). ELISA was used to examine Orexin A concentration. Immunohistochemistry assay was used to examine OX1R and OX2R. HE staining was applied to evaluate inflammation. qRT-PCR was employed to detect OX1R, OX2R, prepro-Orexin mRNAs. Serum Helicobacter pylori (H. pylori) infection was measured.ResultsOrexin A expression in GC patients was significantly up-regulated compared to N group and CAG group (p < 0.05). Orexin A expression was increased in CAG group compared to N group (p < 0.05). Gastric cancer tissues exhibited significantly obvious inflammation compared to N group and CAG group (p < 0.05). OX1R and OX2R expressions were significantly down-regulated in GC group compared to N group and CAG group (p < 0.05). OX1R and OX2R were lower significantly in GC group compared to CAG group (p < 0.05). Prepro-Orexin was significantly depleted in tumor tissues of GC group compared to N group and CAG group (p < 0.05). Orexin A expression was un-associated with gender, age and differential grades (p > 0.05). CAG and GC patients demonstrated higher H. pylori infection rates.ConclusionOrexin A was associated with inflammation by interacting with OX1R/OX2R receptor and activating prepro-Orexin in tumor tissues of gastric cancer patients.     

A comparative study of insulin resistance for Saudi and Caucasian subjects across a range of glycaemic categories

AimSaudi and Caucasian subjects, matched for adiposity, and of differing glycaemic status were compared using several insulin sensitivity indices and to also to assess insulin, glucose and insulin-like growth factor binding protein-1 (IGFBP-1) responses to intravenous glucose.MethodsSubjects with normal glucose tolerance (NGT; n = 24), impaired fasting glucose (IFG; n = 12), impaired glucose tolerance (IGT; n = 12), and type 2 diabetes (DM; n = 13) were recruited from Saudi (n = 33) and Caucasian (n = 28) populations. All had specimens taken in the context of a standard oral glucose tolerance test at their first visit and had the insulin sensitivity parameter (Si) determined by frequently-sampled intravenous glucose tolerance test (FSIVGTT) at a second visit.ResultsSaudis in the NGT and pooled glucose intolerance categories had significantly higher diastolic blood pressure (p < 0.001, p < 0.05 respectively) and HbA1c (p < 0.01, p < 0.05 respectively) compared to Caucasians. Caucasians in the NGT category had significantly higher Si, fasting and 2 h IGFBP-1 (p < 0.01, p < 0.05 and p < 0.01 respectively) compared to Saudis. Two hours following oral or intravenous glucose serum IGFBP-1 decreased to 44% (p < 0.001) and 50% (p < 0.05) of baseline levels respectively.ConclusionsOur data suggest that adult Saudis with normal glucose tolerance appear to be more insulin resistant than Caucasians matched for adiposity. In normal individuals at 2 h the IGFBP-1 level will be about half the baseline level regardless of the route of glucose administration.     

Serum resistin in acute myocardial infarction patients with and without diabetes mellitus

AimHuman resistin is an adipokine, which has been suggested to be an inflammatory marker, with possible links to atherosclerosis and coronary heart disease. Meanwhile, the relationship between serum resistin, insulin resistance, and type 2 diabetes mellitus (T2DM) is still controversial. Therefore, this study aimed to assess serum resistin in patients with acute ST-segment elevation myocardial infarction (STEMI), with and without T2DM.Patients and methodsA total of 55 subjects included in this study, were categorized into three groups: 20 non-diabetic patients with acute STEMI (group I), 20 diabetic patients with acute STEMI (group II), and 15 healthy age and gender-matched controls (group III). Levels of serum lipids, fasting blood glucose (FBG), insulin, troponin I, creatine kinase (CK), lactate dehydrogenase (LDH), and resistin, were estimated.ResultsSerum total cholesterol, low density lipoprotein cholesterol (LDLc), FBG, troponin I, CK (total and MB), LDH, and resistin, were significantly higher in group II, than in group I and group III (p < 0.05). In group II, serum resistin was positively correlated with serum troponin I and TG (r = 0.59, p < 0.05 and r = 0.47, p < 0.05, respectively), but was negatively correlated with high density lipoprotein cholesterol (HDLc) (r = −0.46, p > 0.05). However, in this patients’ group, serum resistin was not correlated with age, gender, body mass index (BMI), total cholesterol, FBG, insulin, CK, LDH, and the calculated homeostasis model for insulin resistance (HOMA-IR) (p > 0.05). As regards group I, serum resistin was not correlated to any of these studied parameters (p > 0.05).ConclusionSerum resistin levels are elevated in patients with acute STEMI. This increase is more evident in patients with T2DM than those without T2DM, denoting higher degrees of inflammation. However, serum resistin is not correlated with age, gender, BMI, and insulin resistance. These data denote that serum resistin concentration might be used as a diagnostic biomarker for acute STEMI. In addition, optimization of the treatment of T2DM could improve cardioprotection.     

Changes in derived measures from six-minute walk distance following home-based exercise training in congestive heart failure: A preliminary report

The response of derived parameters from six-minute walk distance (6MWD), like 6MW work (6MWW), to exercise training and its correlation with quality of life (QoL) in congestive heart failure (CHF) is not known. A secondary analysis from a randomized controlled trial on 30 patients (23 males; mean age 57.7 ± 10.4 years; mean ejection fraction 31 ± 10%) with CHF in NYHA class I–IV who completed an eight-week home-based exercise training program found a significant improvement in 6MWW (p < 0.05), with similar correlations between 6MWD and 6MWW with QoL. 6MWW does not appear to provide additional benefit to 6MWD in cardiac rehabilitation for CHF.     

Effects of l-arginine supplementation associated with continuous or interval aerobic training on chronic heart failure rats

ObjectiveChronic heart failure (CHF) is related with exercise intolerance and impaired nitric oxide (NO) production, which can lead to several functional capacity alterations. Considering the possible superiority of aerobic interval training compared to continuous training and the capacity of l-arginine to restore the NO pathway, the aim of the present study was to investigate whether these treatments are beneficial to exercise capacity, muscle mass preservation and hemodynamic, inflammatory and oxidative stress parameters in CHF rats.MethodsThirty-eight male Wistar rats post 6 weeks of myocardial infarction (MI) surgery were randomly assigned into 6 CHF groups: sedentary (SED, n = 6); SED + Arg (n = 7); ACT (n = 8); ACT + Arg (n = 5); AIT (n = 7); AIT + Arg (n = 5). Exercise test capacity (ETC) was performed pre and post 8 weeks of intervention. Supplemented rats received Arg (1 g/kg) by oral gavage (7 ×/week). Exercise training was performed on a rat treadmill (5 ×/week). Hemodynamic variables, tissue collection, congestion, inflammatory cytokines, and oxidative parameters were evaluated at the end of protocols.ResultsAll trained groups showed a superior exercise capacity compared to SED groups on the post-intervention test (p < 0.0001). Pulmonary congestion was attenuated in AIT and AIT + Arg compared with the SED group (p < 0.05). Left ventricular end-diastolic pressure (LVEDP) was lower in ACT + Arg, AIT, and AIT + Arg groups than SED group (p < 0.05). Association of AIT with Arg supplementation was able to improve hemodynamic responses (left ventricular systolic pressure (LVSP), systolic blood pressure (SBP), + dP/dt_max, and − dP/dt_max (p < 0.05), likewise, decrease muscular and renal lipid peroxidation and tumor necrosis factor (TNF)-α, and increase interleukin (IL)-10/TNF-α plasmatic levels (p < 0.01). Groups that associated aerobic exercise with Arg supplementation (ACT + Arg and AIT + Arg) revealed higher gastrocnemius mass compared to the SED group (p < 0.01).ConclusionsBoth aerobic training protocols were capable to improve aerobic capacity, and the association with Arg supplementation was important to attenuate muscle loss. Moreover, interval training associated with Arg supplementation elicits greater improvements in hemodynamic parameters, contributing to reduction in pulmonary congestion, and demonstrated particular responses in the inflammatory profile and in the antioxidant status.     

Tei index: The earliest detectable cardiac structural and functional abnormality detectable in Hb Bart's foetal edema

ObjectivePremature death and still births are common in Hb Bart's foetal edema which carries significant risk to mothers. We aimed to identify early changes in cardiac structure and function in a cohort of HB Bart's foetuses, using Doppler echocardiography.MethodsWe studied 97 HB Bart's foetuses in different gestation groups; I (20–24 weeks),…, V (37–42 weeks) and compared them with age matched controls. We measured right and left atrial diameters as well as right and left ventricular diameters. From the Doppler filling and ejection velocities of the right and left ventricles we measured Tei index in 30 foetuses and compared them with age matched normal controls.ResultsThe four cardiac chamber dimensions were not significantly different from the respective controls (p = NS for all). The right atrial diameter was enlarged in groups II, III, IV and V (p < 0.05 vs normal controls). The right ventricle was significantly dilated in group III, IV and V (p < 0.05–0.01) compared with normals. The left atrium and left ventricle were enlarged in groups III and IV, respectively (p < 0.05 vs normals). Transmitral and transtricuspid E/A ratio was significantly less than normal in groups III (p < 0.01), IV (p < 0.05) and IV (p < 0.05). LV and RV fractional shortening and stroke distance of group IV and V were significantly less than the respective normals (p < 0.05 for all). LV and RV Tei index increased progressively from 20-week gestation (p < 0.05) with respect to controls.ConclusionsIn HB Bart's foetuses left and right ventricular asynchrony develop earlier than overt cavity dilatation and impairment of systolic function. The use of such markers of ventricular asynchronous function may play an important role in optimum management of these pregnancies.     

The relation of innate and adaptive immunity with viral-induced acute asthma attacks: Focusing on IP-10 and cathelicidin

BackgroundDespite growing evidence suggesting potential association between innate and adaptive immunity in viral-induced acute asthma, there is paucity of data in this area.ObjectiveThis study aimed to investigate the association of innate and adaptive immunity with acute asthma attacks by analysing the role of IFN-γ-inducible protein 10 (IP-10), TLR2, cathelicidin, vitamin D and cytokines.Material and methodsThis prospective study included 33 patients with viral-induced acute asthma and 30 children with controlled asthma. Nasopharyngeal swab samples were collected for virus identification and asthma attack scores assessed in acute asthma group. Blood sampling for IP-10, TLR2, cathelicidin, vitamin D levels, and spirometric indices were employed.ResultsSerum IP-10 and cathelicidin levels of acute asthma group were significantly higher and vitamin D levels were lower than controlled asthma group (IP-10; p = 0.006, cathelicidin; p = 0.002, vitamin D; p < 0.001). Serum IP-10 levels showed a significant negative correlation with age (p = 0.009), TLR2 (p = 0.05) and spirometric indices (p = 0.002) in all asthmatics and a significant positive correlation with parameters of asthma attack severity (p = 0.03) in acute asthma group. Higher cathelicidin values showed significant positive relation to IP-10 (beta coefficient: 33, p = 0.02). Serum IP-10 levels higher than 38.9 pg/ml (sensitivity: 85%, specificity: 47%, p = 0.002) were predictive of virus-induced asthma. Serum IP-10 and vitamin D levels were found to be significantly related to viral-asthma attacks (IP-10; aOR: 8.93, p = 0.03 and vitamin D; aOR: 0.82, p = 0.001).ConclusionsInnate immunity biomarkers such as serum IP-10 and cathelicidin can be used to predict viral-induced acute asthma. These biomarkers may provide potential new treatment targets for acute asthma.     

Gender and ethnic differences in the prevalence of type 2 diabetes among Asian subgroups in California

AimsTo investigate gender and ethnic type 2 diabetes (DM) prevalences among California Asian subgroups versus other ethnic groups and if risk factors explain these differences.MethodsWe identified the prevalence of DM and associated risk factors, stratified by gender, among Chinese, Filipino, South Asian, Japanese, Korean, Vietnamese, Mexican, Other Hispanic, African-American, Caucasian, and Native American adults in a large survey conducted in 2009 (n = 46,091, projected n = 26.6 million).ResultsThe highest age-adjusted DM prevalence was seen in Native Americans (32.4%), Filipinos (15.8%), and Japanese (11.8%) among men and in Native Americans (16.0%) and African-Americans (13.3%) among women. Caucasian and Mexican men had higher DM prevalences than women. Age and risk factor-adjusted logistic regression showed DM more likely (relative to Caucasians) among women in Koreans (OR = 4.6, p < 0.01), Native Americans (OR = 3.0, p < 0.01), and Other Hispanics (OR 2.9, p < 0.01) and among men in Filipinos (OR = 7.0, p < 0.01), South Asians (OR = 4.7, p < 0.01), and Native Americans (OR = 4.7, p < 0.01). No specific risk factors accounted for the gender differences.ConclusionsEthnic and gender differences in DM prevalence persist, even after adjusting for lifestyle and other risk factors; prevalence is high among certain Asian American subgroups. Different diabetes prevention approaches may be needed across ethnic/gender groups.