ECHO parameters of diastolic dysfunction

Most patients with cardiac disease have diastolic dysfunction which is characterized by impaired diastolic filling and/or abnormal diastolic relaxation. The trans-esophageal echocardiography (TEE) used routinely during open-heart surgical procedures has exceptional resolution that may permit the identification and grading of diastolic dysfunction. The goal of this study was to determine which echocardiography (ECHO) parameters can best describe diastolic dysfunction due to myocardial remodeling and fibrosis. Baseline transthoracic ECHO was performed on 3-month-old C57BL/6J female mice followed by administration of isoproterenol (2 microg/g/d) for 6 days. On day 7, transthoracic ECHO was performed to determine the change of left ventricular (LV) inflow parameters due to isoproterenol-mediated cardiac remodeling. The mid-LV region was stained with picrosirius red to quantify myocardial fibrosis and demonstrated a 5-fold increase in cardiac fibrosis (p = 0.002). LV mass was increased by 36% (p = 0.0016). Mitral valve flow Doppler peak velocities E and A were measured from a 4-chamber view. The E/A ratio did not change, but the E deceleration time, velocity time integral of the E-A complex (E-A VTI), E/E-A VTI ratio, isovolumic relaxation time (IVRT), and diastolic time all significantly increased. The corresponding tissue Doppler parameter, Ea/Aa ratio, decreased by 25% (p = 0.035). The left atrial dimension and the ECHO index of left atrial pressure (E/Ea) significantly increased (p < 0.02). These data suggest that, with a long-axis and a 4-chamber view, the clinician can adequately determine diastolic function in the open-heart surgical patient.

[Continuous glucose monitoring using the glucose sensor CGMS in metabolically normal pregnant women during betamethasone therapy for fetal respiratory distress syndrome]

PURPOSE

The object of this study was to evaluate the effect of betamethasone therapy on maternal glucose levels, to observe the incidence of ketoacidosis and gestational diabetes as well as to judge fetal outcome.

METHODS

26 patients underwent measurement with the CGMS for at least 72-hour. Morning urine was examined for ketones and glucose, venous blood was drawn from a hand vein for blood gas measurements. At a minimum of seven days after the last betamethasone treatment, an oral glucose tolerance test was performed to exclude gestational diabetes. For fetal outcome weight, body length, head circumference, APGAR and pH of umbilical cord blood were determined.

RESULTS

All patients showed transient hyperglycaemia from day 1 to day 2 with normoglycaemia on day 3 (mean +/- SD: 129.6 +/- 20 mg/dL on day 1, 127.1 +/- 17.7 mg/dL on day 2, 96.7 +/- 12.9 mg/dL on day 3, and 91.3 +/- 17.8 mg/dL on day 4). There was a significant fall (p < 0.01) of the mean glucose levels between day 1/3, day 1/4, day 2/3, day 2/4. Neither acidosis (pH < 7.35) nor clinically relevant BE/lactate shifts were seen. Ketonuria was detected in 30 % of the patients before betamethasone, rose to 50 % (on day 1), fell to 24 % (on day 2), and 6 % (on day 3). One week later one patient (4 %) was diagnosed as having gestational diabetes, while four (17 %) showed impaired glucose tolerance. Fetal outcome showed no significant difference compared to the average of the Virchow Klinikum.

CONCLUSION AND DISCUSSION

Pregnant patients have high glucose measurements for two days during betamethasone therapy. No maternal acidosis and no diabetic delayed metabolic effects were seen, and fetal outcome showed good results. A prophylactic use of insulin is not generally needed in healthy women.

Epigenetics of Complex Diseases: From General Theory to Laboratory Experiments

Despite significant effort, understanding the causes and mechanisms of complex non-Mendelian diseases remains a key challenge. Although numerous molecular genetic linkage and association studies have been conducted in order to explain the heritable predisposition to complex diseases, the resulting data are quite often inconsistent and even controversial. In a similar way, identification of environmental factors causal to a disease is difficult. In this article, a new interpretation of the paradigm of "genes plus environment" is presented in which the emphasis is shifted to epigenetic misregulation as a major etiopathogenic factor. Epigenetic mechanisms are consistent with various non-Mendelian irregularities of complex diseases, such as the existence of clinically indistinguishable sporadic and familial cases, sexual dimorphism, relatively late age of onset and peaks of susceptibility to some diseases, discordance of monozygotic twins and major fluctuations on the course of disease severity. It is also suggested that a substantial portion of phenotypic variance that traditionally has been attributed to environmental effects may result from stochastic epigenetic events in the cell. It is argued that epigenetic strategies, when applied in parallel with the traditional genetic ones, may significantly advance the discovery of etiopathogenic mechanisms of complex diseases. The second part of this chapter is dedicated to a review of laboratory methods for DNA methylation analysis, which may be useful in the study of complex diseases. In this context, epigenetic microarray technologies are emphasized, as it is evident that such technologies will significantly advance epigenetic analyses in complex diseases.

P-selectin glycoprotein ligand-1 (PSGL-1) is up-regulated on leucocytes from patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by a dysregulated recruitment of circulating leucocytes into the lung which is associated with the onset and progress of the disease. P-selectin glycoprotein ligand-1 (PSGL-1) is expressed on leucocytes and plays an essential role in primary leucocyte-endothelial cell adhesive contacts. The present study investigated if PSGL-1 is up-regulated on leucocytes of COPD patients. Peripheral blood samples were collected from COPD patients as well as controls (smoking, nonsmoking volunteers) and subjected to analysis of PSGL-1 expression on leucocytes, i.e. neutrophils, eosinophils, monocytes and lymphocytes by flow cytometry. No significant difference was observed between healthy nonsmoking and healthy smoking control subjects. In contrast, PSGL-1 expression was found to be significantly increased on the surface of all four leucocyte populations in COPD patients compared to both control groups. The finding that PSGL-1 surface expression is up-regulated on leucocytes of COPD patients as compared to leucocytes of controls suggests PSGL-1 as a potential target for anti-inflammatory treatment.

Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey

OBJECTIVE

To gain insight into patient experience of the disease course and health related quality of life during and after pregnancy in women with rheumatoid arthritis and ankylosing spondylitis.

METHODS

10 patients with rheumatoid arthritis, 10 patients with ankylosing spondylitis, and 29 age matched healthy pregnant controls were evaluated by the medical outcomes study short form 36 (SF-36) health survey once at each trimester and at 6, 12, and 24 weeks postpartum. A group of non-pregnant age matched female patients (40 rheumatoid arthritis, 16 ankylosing spondylitis) was studied for comparison.

RESULTS

Impaired physical dimensions as well as increased bodily pain was observed in healthy women in late pregnancy. Patients with rheumatoid arthritis showed improved physical functioning scores in the second trimester and reduced pain in the third trimester. Among pregnant patients, those with ankylosing spondylitis suffered the greatest impairment of health related quality of life during pregnancy. In all patient groups the physical impairment in the third trimester was less pronounced than in healthy controls. Mental health scores remained stable even with persisting active disease during pregnancy, or with a postpartum flare.

CONCLUSIONS

Pregnancy reduced physical functioning in healthy women and patients, but had no impact on mental and emotional health, even at times of disease aggravation. The pregnancy experience documented in our patients may be helpful when counselling patients contemplating pregnancy.

Chlamydia LPS and MOMP seropositivity are associated with different cytokine profiles in patients with coronary heart disease

BACKGROUND

Persistent Chlamydia pneumoniae infection within atherosclerotic plaques are possible stimulators of inflammation in atherosclerosis. Why the microbe develops persistency in some individuals is unknown, but experimental studies in cell cultures and animals have demonstrated the levels of gamma interferon (IFNgamma) and interleukin 10 (IL-10) to be of crucial importance.

DESIGN

We wanted to evaluate whether Chlamydia seropositivity in patients with coronary heart disease (CHD) (n = 193) was associated with elevated IFNgamma and IL-10. Two methods for detection of Chlamydia antibodies were included as well as analysis of tumour necrosis factor alpha (TNFalpha), soluble vascular cell adhesion molecule 1 (sVCAM-1) and soluble E-selectin for the evaluation of vascular inflammation.

RESULTS

We found that patients with IgA antibodies towards Chlamydia lipopolysaccharide (LPS) had elevated levels of IFNgamma (P = 0.048), IL-10 (P = 0.029), TNFalpha (P = 0.009) and sE-selectin (P = 0.045), while Chlamydia LPS IgG seropositivity predicted elevated levels of IL-10 (P = 0.013). Patients with IgA antibodies towards C. pneumoniae major outer membrane protein (MOMP) without simultaneous LPS IgA seropositivity had lower levels of IFNgamma and sVCAM-1 when compared to patients with Chlamydia LPS IgA alone (P = 0.005 for IFNgamma, P = 0.016 for VCAM-1) and patients with combined Chlamydia MOMP and LPS IgA seropositivity (P = 0.046 and P = 0.013, respectively).

CONCLUSIONS

In summary, we demonstrated an association between Chlamydia LPS IgA seropositivity and elevated levels of IFNgamma, IL-10, TNFalpha, sVCAM-1 and sE-selectin in CHD patients that might indicate persistent Chlamydia infection and a proinflammatory state. On the other hand, C. pneumoniae MOMP antibodies were not associated with elevated inflammatory markers and might merely be indicative of past infection, possibly with successful microbe clearance.