Supernormal diastolic function and role of left atrial myocardial deformation analysis by 2D speckle tracking echocardiography in elite soccer players

Purpose: Top‐level training is associated with morphological and functional changes in the heart. Left atrial (LA) enlargement can be regarded as a physiologic adaptation to exercise conditioning. Athletes show an improvement in myocardial diastolic properties and supernormal left ventricular (LV) diastolic function. The aims of the study were to assess diastolic function by pulsed Doppler tissue imaging (DTI) and to analyze the role of LA in athletes by speckle tracking echocardiography (STE). Methods: Twenty‐three male elite soccer players underwent a complete echocardiographic analysis. Twenty‐six age‐matched healthy sedentary men were used as controls. Measured variables included LA indexed volumes, DTI of the LV, peak atrial longitudinal strain, and peak atrial contraction strain (PACS). Results: LA areas and indexed volumes were significantly higher in athletes (P < 0.001). Athletes had a higher peak E velocity (P < 0.001), a lower A peak (P < 0.01), and a higher peak E/A ratio (P < 0.0001); a higher Em peak (P < 0.001), a lower Am peak (P < 0.01), and a higher Em/Am ratio (P < 0.0001). Global PACS was lower in athletes compared with controls (P < 0.0001) and strongly correlated with mitral Am (r = 0.55; P < 0.0001), mitral Em (r =?0.41; P < 0.001), heart rate (r =?0.38; P < 0.01), and LA area (r = 0.18; P < 0.05). Conclusions: Athletes showed a shift in the pattern of ventricular filling period toward early diastole as seen through DTI analysis of the diastolic properties of LV and STE analysis of LA function. DTI is a useful tool to analyze the improved myocardial diastolic properties of athletes and STE may elucidate the role of LA in the context of athlete's heart remodeling. (Echocardiography 2011;28:320‐326)     

Cholecystectomy increases hepatic triglyceride content and very‐low‐density lipoproteins production in mice

Background & aims: Bile acid (BA) pool size remains unchanged after cholecystectomy (XGB) but it circulates faster, exposing the enterohepatic system to an increased flux of BA. Triglyceride (TG) and BA metabolisms are functionally inter‐related. We investigated whether ablation of the gallbladder (GB) modifies hepatic TG metabolism. Methods: Male mice were subjected to XGB and fed a normal diet. In some experiments, mice received a 1% nicotinic acid diet to block lipolysis. Parameters of BA and TG metabolism, and microsomal triglyceride transfer protein (MTTP) activity were measured 1–2 months after XGB. Serum parameters, hepatic lipids and mRNA expression of genes of lipid metabolism were determined. Results: BA pool size and synthesis were normal, but biliary BA secretion doubled during the diurnal light phase in XGB mice. Serum and hepatic TG concentrations increased 25% (P<0.02), and hepatic very‐low‐density lipoproteins (VLDL)–TG and apoB‐48 productions increased 15% (P<0.03) and 50% (P<0.01), respectively, after XGB. Feeding a 1% nicotinic acid did normalize VLDL production. MTTP activity increased 15% (P<0.005) after XGB. Hepatic free fatty acid (FFA) synthesis and content, and mRNA levels of lipid metabolism‐related genes remained normal in XGD mice. Conclusions: XGB increased serum and hepatic TG levels, and VLDL production, which were restored to normal by nicotinic acid. The results suggest that FFA flux from adipose tissue to the liver is increased in XGB mice. They support the hypothesis that the GB has a role in the regulation of hepatic TG metabolism and that XGB may favour the accumulation of fat in the liver.     

An uncommon cause of seizures in children living in developed countries: neurocysticercosis -a case report

Background

It is well known that certain non-thyroidal critical illness may lead to euthyroid sick syndrome(ESS). There are little reports about the change of thyroid hormone in the children's central nervous system (CNS) infections.

Results

The results of serum TT3, TT4 and TSH in these children were compared with those in 20 cases of healthy adults and 20 cases of adults with primary hypothyroidism. Serum T3 and T4 were decreased in 34/78 children with CNS infections, T3 and T4 were much lower than those of healthy adult (p < 0.05), but still higher than that of the primary hypothyroidism (p < 0.05), and TSH levels were not significant differences among children with CNS infections and children with non-CNS infections (p > 0.05). Low T3 and T4 levels in serum and cerebrospinal fluid(CSF)were predominant in children with serious infections of CNS, 31/34 (percent 91.17) cases of serious CNS infection had low serum TT3 and/or TT4. The low T3 with low T4 was seen in 14/34 children of severe CNS infections, 3 of them died. The levels of CSF T3 (X ± SD = 0.39 ± 0.47 ng/ml) and T4 (x ± SD = 1.02 ± 1.27 ug/dl) in the serious CNS infections were lower than that of non-CNS infections T3 (x ± SD = 0.93 ± 1.23 ng/ml), and T4 (x ± SD = 2.42 ± 1.70 ug/dl), 7 died children were all in the subjects of low T3 and/or low T4. In 22 children with non-CNS infections, serum T3 and T4 levels were lower than that of healthy adult, but have not significant difference(p > 0.05).

Conclusions

These results suggest that detection of TT3, TT4 and TSH in serum and/or CSF simultaneous or alone in analyses would be valuable in correctly judging thyroid function and evaluating the prognosis of the children with infections of CNS. Measuring a little amount of blood (1 ml)or CSF required for this method is a simple, convenient and accurate method.     

Seizures can precede cognitive symptoms in late-onset Alzheimer's disease

This study describes late-onset Alzheimer's disease (LOAD) in the mild cognitive impairment (MCI) stage, debuting with seizures in a 72 year-old woman. Prodromal AD was consistently diagnosed with four among amyloidosis and neurodegeneration biomarkers about 1 year after onset of seizures. Genetic assessment demonstrated apolipoprotein E ε2/ε3 genotype and three intronic single nucleotide substitutions, two in presenilin 1 and one in amyloid-β protein precursor genes. This case of seizures at onset of LOAD with severe signs of brain amyloidosis and neurodegeneration but with just MCI leads to a re-appraisal of the intriguing relationship between AD pathology and neuron excitability in humans.     

The use of veritas collagen matrix to reconstruct the posterior chest wall after costovertebrectomy

Among the new materials introduced for chest wall reconstruction, the use of collagen matrix is gaining increasing favor for its biomechanical properties. We describe the reconstruction of the chest wall with Veritas (Synovis, St Paul, MN) collagen matrix of a posterior chest wall defect after costovertebrectomy for Ewing's sarcoma. En bloc resection was performed, including partial D7 through D9 vertebrectomy along with the posterolateral segments of corresponding ribs. The collagen matrix patch was sutured to the spine stabilizer and the surrounding rib segments and was covered by previously raised latissimus dorsi and trapezius muscle flaps. Excellent stabilization was obtained.