Carotid intimal-media thickness and endothelial function in young patients with history of myocardial infarction

AIM

The aim of the study was to evaluate the prevalence of carotid atherosclerosis and endothelial dysfunction in 45 young patients (38 mens and 7 females) with myocardial infarction (MI), age 29-45, mean age 42+/-3 years, to verify its possible role as a marker of coronary atherosclerosis.

METHODS

Vascular echography was performed to verify the presence of carotid atherosclerosis and/or endothelial dysfunction in 45 young patients with MI and in 45 healthy control subjects well matched for age and sex.

RESULTS

We observed a normal intima media thickness (IMT) only in 30% of patients with juvenile myocardial infarction (JMI) compared with 66% in the control group (P<0.0001) and 34% of patients showed an increased IMT compared with 24% of healthy subjects (P<0.0001). Compared with control subjects, patients with JMI had lower flow-mediated reactivity of the brachial arteries (P<0.05). There was a negative linear relationship between flow-mediated dilation and IMT (P<0.001). The severity of coronary artery disease (CAD) was correlated with increased IMT and with a lower flow-mediated dilation. Finally, multiple regression analysis, demonstrated that both brachial-artery reactivity and carotid IMT were significantly and independently correlated with severity of CAD.

CONCLUSIONS

Structural (carotid atherosclerosis) and functional changes (endothelial dysfunction) were present at an early age in the arteries of persons with history of JMI.

Short term prognostic role of NT-proBNP in patients after myocardial infarction

AIM

The clinical and prognostic role of cardiac natriuretic peptides (CNP) in patients with heart failure is well known; recently, several studies have evaluated the possibility of using CNP to evaluate their potential prognostic role in patients with acute coronary syndromes (ACS). The aim of this study was to evaluate the short term prognostic value of NT-proBNP in 70 patients admitted for ACS.

METHODS

The authors studied 70 patients with ACS, evaluating, at admission, clinical-anamnestic, instrumental and laboratory characteristics including NT-proBNP plasma levels. Patients were monitored in a 6-month-follow-up to record adverse fatal events and their possible correlation with baseline characteristics.

RESULTS

The incidence of adverse events during the follow-up period was 28% (10 patients). In patients with adverse events, the authors observed lower left ventricle ejection fraction (P=0.01), higher prevalence of ST elevation myocardial infarction (P=0.03) and higher NT-proBNP levels (P=0.03), compared to those without adverse events. Moreover, the logistic regression analysis underlined how ST elevation myocardial infarction (P=0.05) and higher NT-proBNP levels (P=0.05) were the only predictive variables for adverse events during the follow up period.

CONCLUSIONS

This study demonstrates the short term prognostic role of NT-pro BNP in patients admitted for ACS.

Prognostic role of endothelial dysfunction and carotid intima-media thickness in patients undergoing coronary stent implantation

AIM

Impaired endothelial function and increased carotid intima-media thickness are key events in the atherosclerotic process and predict future cardiovascular events in subjects with and without coronary artery disease. The purpose of this study was to investigate whether the vasodilator response to increased flow in the brachial artery and the presence of carotid lesions may have a prognostic significance for in-stent restenosis in patients undergoing coronary angioplasty.

METHODS

The study population included 58 patients undergoing percutaneous coronary intervention (PCI) with stenting and at least 10 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI. Flow mediated dilatation (FMD) was investigated after 5 minutes of occlusion of the artery and nitroglycerin mediated dilation (NMD) was investigated after administration of sublingual nitrates. Vascular echography was performed to measure intima media thickness (IMT) of carotid arteries. At baseline we evaluated all the established traditional cardiovascular risk factors. We also subdivided our study cohort according to values of FMD in patients with FMD above and patients below the median value.

RESULTS

Patients with FMD above the median value showed higher prevalence of hypertension (P=0.002), diabetes (P=0.02) and carotid IMT (P=0.006) than those below the median. Brachial FMD was inversely correlated (P=0.001) to carotid IMT. At the end of follow-up clinical events occurred in nine patients. In a multivariate analysis, including all the variables evaluated at baseline, carotid IMT (P=0.02), level of glycemia (P=0.001), a lower FMD (P=0.005) and presence of carotid plaque remained the only variables predictive of restenosis.

CONCLUSIONS

Evaluation of FMD and carotid IMT may provide important prognostic information in patients undergoing PCI.

Clinical significance of macrophage colony stimulating factor levels in acute coronary syndrome

AIM

The aim of this paper was to ascertain whether macrophage colony stimulating factor (MCSF) serum levels, measured during the acute phase of coronary syndromes (ACS), are useful to predict short term outcomes.

METHODS

Seventy-four consecutive patients (mean age: 66+/-12), admitted to the Intensive Coronary Care Unit of Palermo University Hospital (Italy) affected by ACS were observed; 39 patients showed a non ST elevation (NSTEMI) and 35 showed a ST elevation myocardial infarction (STEMI). During the hospital stay, all patients underwent echocardiography and 84% of patients received coronary angiography. Peripheral venous blood samples were collected for the determination of serum levels of MCSF, C-reactive protein (CRP), fibrinogen, I troponin and complete lipid pattern.

RESULTS

There was no significant difference in MCSF concentrations for STEMI versus NSTEMI patients (326.65+/-143.87 vs 297.15+/-110.43 pg/mL, P=NS). Higher levels of MCSF (363.00+/-147.61 vs 251.00+/-186.69, P=0.03) and CRP (1.04+/-0.40 vs 0.97+/-0.50 mg/L, P=0.03) were found in patients with a worst in hospital stay (recurrence of angina, re-infarction, death) and with a more severe coronary artery disease (330.03+/-241.51 vs 223.61+/-128.29 pg/mL, P=0.04 and 1.14+/-0.50 vs 0.60+/-0.22 mg/L, P=0.05).

CONCLUSIONS

MCSF levels are useful in the prediction of short term prognosis in ACS patients.

The G67E mutation in hMLH1 is associated with an unusual presentation of Lynch syndrome

Germline mutations in the mismatch repair (MMR) genes are associated with Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Here, we characterise a variant of hMLH1 that confers a loss-of-function MMR phenotype. The mutation changes the highly conserved Gly67 residue to a glutamate (G67E) and is reminiscent of the hMLH1-p.Gly67Arg mutation, which is present in several Lynch syndrome cohorts. hMLH1-Gly67Arg has previously been shown to confer loss-of-function (Shimodaira et al, 1998), and two functional assays suggest that the hMLH1-Gly67Glu protein fails to sustain normal MMR functions. In the first assay, hMLH1-Gly67Glu abolishes the protein's ability to interfere with MMR in yeast. In the second assay, mutation of the analogous residue in yMLH1 (yMLH1-Gly64Glu) causes a loss-of-function mutator phenotype similar to yMLH1-Gly64Arg. Despite these molecular similarities, an unusual spectrum of tumours is associated with hMLH1-Gly67Glu, which is not typical of those associated with Lynch syndrome and differs from those found in families carrying the hMLH1-Gly67Arg allele. This suggests that hMLH1 may have different functions in certain tissues and/or that additional factors may modify the influence of hMLH1 mutations in causing Lynch syndrome.

Failed efficacy of soluble human CD83-Ig in allogeneic mixed lymphocyte reactions and experimental autoimmune encephalomyelitis: implications for a lack of therapeutic potential

Soluble forms of CD83, a dendritic cell-specific surface glycoprotein, have been strongly proposed to be of therapeutic utility in inflammatory conditions such as multiple sclerosis and transplantation. We demonstrate here, however, that eukaryotically expressed, recombinant soluble human CD83-Ig molecules fail to achieve efficacy in model systems for those conditions: mouse experimental autoimmune encephalomyelitis models in vivo or in mixed lymphocyte reactions in vitro. These results raise concern as to the viability of a eukaryotically expressed soluble CD83 strategy for clinical therapeutic use.

The role of the N-terminal caspase cleavage site in the nucleoprotein of influenza A virus in vitro and in vivo

The N-terminal caspase cleavage in the nucleoprotein (NP) of influenza A virus is correlated with the host origin of the virus, thus could be a molecular determinant for host range. We studied how mutations targeting the NP cleavage motif of human and avian influenza viruses affect virus replication in vitro and in vivo. The "avian-like" D16-->G substitution in the NP, which makes this protein resistant to cleavage, did not significantly affect the human A/Puerto Rico/8/34 (H1N1) virus replication in vitro but decreased the lethality of this virus in mice by 68-fold. Gene incompatibility contributed to the attenuated phenotype of the reassortant A/Puerto Rico/8/34 virus with avian NP derived from A/Teal/Hong Kong/w312/97 (H6N1) virus in vitro and in vivo. Insertion of the "human-like" G16-->D mutation into avian NP, which resulted in susceptibility to caspase cleavage, did not rescue virulence, but made the reassortant virus even more attenuated. Introducing the human-like G16-->D substitution into the NP of highly pathogenic A/Vietnam/1203/04 (H5N1) virus decreased lethality in mice. We confirmed that position 16, which associated with the N-terminal caspase cleavage of the NP, is important for optimal virus fitness in vitro and in vivo. An avian-like mutation at position 16 in the NP of human virus as well as a human-like substitution at this residue in avian NP both resulted in virus attenuation.

Extracoronary atherosclerosis in patients with chronic ischemic heart disease: relationship with risk factors and the severity of coronary artery disease

AIM

The aim of the present study was to investigate the prevalence of carotid and/or peripheral atherosclerotic lesions in patients with chronic ischemic heart disease (previous acute myocardial infarction [AMI] or stable angina).

METHODS

We studied 248 patients (168 male and 80 female), mean age 63+/-10 years, which were investigated for traditional risk factors. Systolic blood pressure, body mass index, lipid profile, fasting glucose and plasma fibrinogen were also measured. We assessed the prevalence of atherosclerotic lesions in carotid and lower limb arteries, by ultrasound duplex scanning (UDS).

RESULTS

Angina was present in 33% of the patients, a previous AMI in 67%, a previous transient ischemic attack in 4% and a previous ischemic stroke in 6% of patients. A total of 195 patients underwent coronary angiography: 1 vessel was involved in 48% of patients, 2 vessels in 33%, and 3 vessels in 19%. Detecting peripheral atherosclerotic lesions by UDS, increased intima-media thickness (IMT) or plaques in carotid arteries were found in 232 patients (94%) and carotid stenosis >70% in 13 patients (5%). In lower limb arteries, IMT or plaques were present in 202 patients (82%) and a stenosis >70% in 18 patients (7%). Severity of coronary artery disease (CAD) was correlated to extracoronary atherosclerosis: carotid and lower limb arterial atherosclerosis was detected in 73% of patients with 1 vessel, in 83% of patients with 2 vessel, in 87% of those with 3 vessel CAD.

CONCLUSION

Our study suggests that in patients with CAD, it is useful to screen the peripheral circulation by non-invasive tests, such as UDS. Patients with the diagnosis of ischemic heart disease and combined extracoronary atherosclerosis need a careful follow-up and a more aggressive therapy for secondary prevention.

WITHDRAWN: Failed efficacy of soluble human CD83-Ig in allogeneic mixed lymphocyte reactions and experimental autoimmune encephalomyelitis: implications for a lack of therapeutic potential?

This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.

Lungenembolie

In the population the annual incidence of pulmonary embolism amounts to 1.3-2.8 per 1000 at the age of 65-89 years. Mortality reaches about 17% within the first 3 months. Acute pulmonary embolism is characterized by an increase in pulmonary arterial pressure and an impairment of the pulmonary gas exchange. Elevation of the right cardiac pressure up to right heart decompensation may follow. In addition, hypoxemia, hyperventilation, dead space ventilation, right to left shunting, bronchoconstriction, and vasoconstriction may occur. Clinical examination, ECG, laboratory findings such as elevated D-dimer, blood gas analysis, ultrasound examination of the veins of the lower extremities, and transthoracic echocardiography are acutely available diagnostic methods of an emergency department. In addition, extensive diagnostic procedures like pulmonary scintigraphy and pulmonary angiography may be required. The aim is to get a definite diagnosis as quickly as possible to direct therapy. In acute pulmonary embolism with cardiac shock, monitoring and stabilization of the circulatory function as well as an appropriate anticoagulant therapy are essential. In some cases surgery or a local fibrinolytic intervention is indicated.

Molecular changes in the polymerase genes (PA and PB1) associated with high pathogenicity of H5N1 influenza virus in mallard ducks

The highly pathogenic (HP) influenza viruses H5 and H7 are usually nonpathogenic in mallard ducks. However, the currently circulating HP H5N1 viruses acquired a different phenotype and are able to cause mortality in mallards. To establish the molecular basis of this phenotype, we cloned the human A/Vietnam/1203/04 (H5N1) influenza virus isolate that is highly pathogenic in ferrets, mice, and mallards and found it to be a heterogeneous mixture. Large-plaque isolates were highly pathogenic to ducks, mice, and ferrets, whereas small-plaque isolates were nonpathogenic in these species. Sequence analysis of the entire genome revealed that the small-plaque and the large-plaque isolates differed in the coding of five amino acids. There were two differences in the hemagglutinin (HA) gene (K52T and A544V), one in the PA gene (T515A), and two in the PB1 gene (K207R and Y436H). We inserted the amino acid changes into the wild-type reverse genetic virus construct to assess their effects on pathogenicity in vivo. The HA gene mutations and the PB1 gene K207R mutation did not alter the HP phenotype of the large-plaque virus, whereas constructs with the PA (T515A) and PB1 (Y436H) gene mutations were nonpathogenic in orally inoculated ducks. The PB1 (Y436H) construct was not efficiently transmitted in ducks, whereas the PA (T515A) construct replicated as well as the wild-type virus did and was transmitted efficiently. These results show that the PA and PB1 genes of HP H5N1 influenza viruses are associated with lethality in ducks. The mechanisms of lethality and the perpetuation of this lethal phenotype in ducks in nature remain to be determined.

[Radial optic neurotomy (RON) for central retinal vein occlusion]

BACKGROUND

Compression in the lamina cribrosa is discussed as a reason for central retinal vein occlusion. Radial optic neurotomy should release the pressure and increase venous blood outflow.

PATIENTS AND METHODS

In a clinical trial 27 eyes with central retinal vein occlusion (22 eyes with clinical ischaemia, 5 eyes with continuous disc oedema and visual acuity below 4/10) underwent surgical decompression by vitrectomy and radial optic neurotomy. During surgery the intravenous pressure in the central vein was tested by infusion dynamometry before and right next to the incision. Follow up-time minimally was 1.5 years.

RESULTS

Infusion dynamometry demonstrated a decrease of the central vein pressure right next to the incision in all eyes. In 17/22 eyes with ischaemic type of occlusion 6 weeks after surgery the relative afferent pupillary defect was lowered significantly and no growth of neovascularisations occurred. 5 eyes with persistence of the afferent pupillary defect received laser/cryocoagulation because of neovascularisations. After surgery visual acuity improved in 20/27 eyes and remained unchanged in 4/27 eyes. As complications we saw small subretinal haemorrhages at the neurotomy site (5/27), vitreous haemorrhages (7/27), hypotonia and choroidal detachment (1/27) and segmental visual field loss (14/27).

CONCLUSIONS

The results of infusion dynamometry strongly support the hypothesis of a postulated compression of the central retinal vein in the lamina cribrosa. Functional results of radial optic neurotomy are superior to those of the natural course of ischaemic retinal vein occlusion in the literature, but visual field defects in association with the neurotomy site seem to be a serious side-effect of this therapeutic approach.

Conditional Responding is Impaired in Chronic Alcoholics

Bechara (2003) describes a model for disturbances in executive functions related to addiction. This model involves deficits in decision-making and in suppressing pre-potent representations or response patterns. We tested this model in 29 individuals with long-term heavy alcohol dependency and compared their performance with that of 20 control subjects. Only individuals without memory impairment, with normal intelligence and normal visual response times were included. We examined word fluency, object alternation, spatial stimulus-response incompatibility, extra-dimensional shift learning and decision-making using the Gambling task. We subtracted the performance in a control condition from that of the executive condition, in order to focus specifically on the executive component of each task. Only the object alternation and incompatibility tasks revealed significant differences between the group of alcoholics and the control group. Moreover, response times in the object alternation task correlated with duration of alcohol dependency. The results do not argue in favor of a specific deficit in decision-making or in shifting between relevant representations. We conclude that long-term alcohol abuse leads to an impairment in conditional responding, provided the response depends on former reactions or the inhibition of pre-potent response patterns.

Performance of very small wastewater treatment plants with pronounced load variations

The operation of very small biological wastewater systems is strongly influenced by the patterns of wastewater generation. The absence of people in the connected building(s) during holidays or off-season leads to a system underload, other circumstances however may lead to an overload. Experiments have been carried out to display the effects of no-feed conditions on activated sludge biomass and its microbial activity during a 24 hour period after re-feeding. The decrease of the biomass during idle periods can be modelled by a first order equation. The initial specific oxygen uptake rate (OUR) of the remaining biomass decreased with the duration of the preceding no-feed sequence. Four different laboratory-scale treatment plants were operated to demonstrate the system performance when re-started after a break period of 24 and 52 days respectively. The effluent concentration after a break of 52 days had not been sufficient as compared to the discharge requirements given by German laws. In addition a full scale trickling filter was monitored, while the connected building accommodated a maximum of 40 guests interrupted by times with no guest at all. Conclusions are drawn from the experimental results and from literature, giving some hints on how to manage the impacts of varying loads at very small wastewater treatment plants.

Study of rotating biological contactor performance in wastewater treatment using multi-culture biofilm model

The rotating biological contactor (RBC) process offers the specific advantages of a biofilm system in treatment of wastewater for removal of soluble organic substances and stabilisation of nitrogen compounds. Being a unique adaptation of the moving-medium biofilm system, it facilitates easy and effective oxygen transfer. However, process optimisation and adaptability under different conditions remain challenging tasks for the efficient use of this technology. Although modelling helps to study system performance under various external conditions, satisfactory mathematical representation is lacking due to the dynamic nature of the RBC system. In this work, it has been attempted to frame a mathematical model for a three-stage RBC process in simple and realistic ways. The model is based on the well-known principles of one-dimensional mass transfer and transport of substances. The biochemical conversion process is adopted from the Activated Sludge Model No. 3 which represents a mixed-culture biomass environment. Owing to the dynamic nature of oxygen transfer, which is the typical limiting substrate in municipal wastewaters, the boundary layer is assumed to be completely mixed and concentrations averaged over the entire volume. A part of the boundary layer is assumed to be exposed to air and the rest submerged in bulk liquid at all times. The model results are compared with laboratory-scale experimental data available at 25 'C. Sensitivity analysis is performed with the model to study the significance of variation of different system parameters or the surrounding environment. In essence, the model helps to explore the flexibilities within a RBC system and optimise the process design accordingly.

Carotid and peripheral atherosclerosis in patients who underwent primary percutaneous coronary intervention and outcome associated with multifocal atherosclerosis

AIM

The aim of our study was to determine if patients with multifocal atherosclerosis have a worse prognosis than patients with atherosclerosis only in the coronary bed.

METHODS

We studied 45 subjects admitted to intensive coronary care unit of the Division of Cardiology with the diagnosis of acute myocardial infarction (AMI). Traditional cardiovascular risk factors were investigated and laboratory analysis included measurement of plasma lipids, glycemia, fibrinogen and high-sensitivity-C-reactive protein (hs-CRP). Each patient underwent coronary-angiography as well as carotid and peripheral arterial ultrasound examination. A follow-up of 13+/-2 months was performed.

RESULTS

We found that the severity of coronary atherosclerosis is significantly associated with the presence of carotid (P<0.05) and peripheral atherosclerosis (P<0.005). Markers of inflammation, hs-CRP (P<0.005) and fibrinogen (P<0.05), were significantly associated with multifocal atherosclerosis. We have shown that an increased number of coronary vessels with atherosclerotic stenosis is associated with a higher value of carotid (P<0.0001) and peripheral intima media thickness (P<0.0001). During 13 months of follow-up the incidence of fatal or non fatal events was 18%. The multivariate analysis showed that the variables independently associated with fatal and non fatal events were: male sex (P<0.001), family history of cardiovascular disease (P<0.005), hypertension (P<0.01), diabetes mellitus (P<0.05), higher levels of total cholesterol (P<0.05), smoking habit (P<0.05), and multifocal atherosclerosis (P<0.05).

CONCLUSIONS

The ultrasound examination of carotid and peripheral atherosclerotic lesions may be useful in placing patients with AMI in a category of higher risk of cerebrovascular and cardiovascular events. Moreover, the precocious identification of patients at risk can suggest a more aggressive pharmacological treatment and a more accurate follow-up in order to avoid future events.

„Das iatrogene akute Koronarsyndrom” - 59-jähriger Patient mit Adenokarzinom des Colon ascendens und Stenokardien unter adjuvanter Chemotherapie mit 5-Fluorouracil

Fluorouracil-associated cardiotoxic adverse events represent a relevant but underestimated problem in 5-fluorouracil treatment. After right hemicolectomy for adenocarcinoma of the rightsided colonic flexure a 59-year old patient was referred to our hospital for adjuvant chemotherapy according to MOSAIC-protocol with oxaliplatin and 5-fluorouracil. The patient's history was unremarkable for any cardiopulmonary disease and for any cardiovascular risk factors. 24 hours after completing the first cycle the patient was readmitted to our emergency department because of thoracic pain combined with significantly elevated cardiac enzymes and ischaemic changes in ECG. Coronary angiography was performed revealing no coronary artheriosclerosis. Clinical symptoms and pathological ischaemic serum parameters returned to normal range within 12 hours. Diagnosis of 5-FU-induced acute coronary syndrome could be made. Because of the high rate of recurring cardiotoxicity the patient's chemotherapy was modified to an alternative regimen containing raltitrexed instead of 5-fluorouracil. Immediate diagnosis of 5-FU-induced cardiotoxicity and differentiation from preexisting coronary heart disease is still a major problem in daily oncological practice.

[Sagittal balance of the spine and degenerative spondylolisthesis]

PURPOSE OF THE STUDY

Several reports have examined the pathophysiology of degenerative spondylolisthesis. Very little work has however been devoted to the influence of spinal balance in the sagittal plane in its pathogenesis. The purpose of this work was to present a descriptive analysis of pelvic and spinal sagittal balance in a cohort of seventy patients treated for degenerative spondylolisthesis and to compare findings with those established in a population of 250 volunteers. The goal was to deduct pathophysiological hypotheses and identify therapeutic implications.

MATERIAL AND METHODS

Seventy patients were included in this study. The following variables were noted: pelvic incidence and version, sacral slope, lumbar lordosis, thoracic kyphosis, T9 sagittal tilt and S1-S2 angle. These variables were measured on digitalized lateral views of the spine using a dedicated software (SpineView). Univariate analysis of the values obtained was performed to identify the variable distributions. Multivariate analysis was applied to study the relationships between these variables and to better define perturbations of spinal balance in the anteroposterior plane. The findings were compared with those obtained in a control population.

RESULTS

One of the essential characteristics of the cohort of patients with degenerative spondylolisthesis was the presence of an exaggerated pelvic incidence (62.6 degrees versus 54.7 degrees in the control population). The most significant determinants of T9 sagittal tilt (which reflects sagittal balance) were: pelvic version, pelvic incidence, lumbar lordosis, and L4-S1 local lordosis. One-third of our patients presented posterior tilt due to exaggerated thoracic kyphosis. The high pelvic incidence, via hyperlordosis and increased pelvic version, could be one of the factors favoring degenerative disease of the spinal unit.

CONCLUSIONS

This work enabled us to better describe sagittal balance in patients with degenerative spondylolisthesis and to propose hypotheses concerning the underlying mechanism of progressive degeneration. We emphasize the diversity of spinal balance in these patients and the different therapeutic implications.

[Drug treatment of atrial fibrillation]

Before initiating specific treatment of atrial fibrillation treatable causes must first be reliably ruled out. Furthermore, the chances of maintaining a sinus rhythm must be individually weighed against the potential complications and risks of an anti-arrhythmic therapy, and also alternative strategies considered. Today, rate control is recommended in the case of asymptomatic patients, in particular in the elderly, while rhythm control is the strategy of choice in younger, symptomatic patients. For recurrence prevention, beta blockers are the first-choice drugs. In patients with no structural heart disease, class IC antiarrhythmic agents, in those with structural heart disease only amiodarone, may be considered. Promising new additive therapeutic approaches are ACE-inhibitors and AT-II receptor antagonists. In the future, combinations of pharmacotherapy and non-drug treatments will help to improve the treatment of atrial fibrillation.

Interleukin-6 gene polymorphism is an age-dependent risk factor for myocardial infarction in men

Several studies show that inflammatory components may contribute to atherosclerosis and increase the risk for myocardial infarction (MI). Interleukin-6 (IL-6) is a key pro-inflammatory and immune-modulatory cytokine of relevance for cardiovascular diseases. In this case-control study, 200 patients with MI and 257 healthy controls were genotyped for the polymorphism present in -174 promoter region of the IL-6 gene. Plasma concentrations of IL-6 and C-reactive protein (CRP) in a group of patients and controls were measured. The -174 C allele was associated with an increased risk of developing MI (OR = 2.886, c.i. = 1.801-4.624, P = 0.0001) in older patients, while no association was found in younger ones. The IL-6 plasma levels were higher in patients with MI carrying the CC genotype than in GG patients (CC carriers, IL-6 = 2.97 pg mL(-1) vs. GG carriers = 1.81 pg mL(-1), P = 0.016). A positive correlation of IL-6 levels with those of CRP in serum from patients with MI was also found. Data from this study suggest that the C allele of the promoter polymorphism in the IL-6 gene is a risk factor for MI in the elderly, and the production of the IL-6 is differentially affected by different genotypes of the IL-6 -174 promoter polymorphism.

Scanning laser polarimetry and retinal thickness analysis before and after laser in situ keratomileusis

PURPOSE

To evaluate changes in retinal nerve fiber layer (RNFL) thickness after laser in situ keratomileusis (LASIK) using a scanning laser polarimeter with fixed corneal compensation (GDx) and the retinal thickness analyzer (RTA).

METHODS

Thirty-eight eyes of 19 healthy subjects (10 female and 9 male; mean age 37.0-/+8.8 years) underwent GDx and RTA measurements before and after LASIK. All subjects revealed mild to high myopia (mean spherical refraction: -4.0-/+2.75 D). Measurements using GDx were followed by RTA measurements after pupil dilation. All measurements were performed the day before LASIK and 1 week postoperatively.

RESULTS

GDx revealed a decrease in nerve fiber layer thickness measurements after LASIK, but did not reach statistical significance (p>0.05). Using RTA, mean RNFL thickness (MRNFL) and RNFL cross sectional area decreased significantly after LASIK (p=0.03 and p=0.02, respectively).

CONCLUSIONS

Scanning laser polarimetry revealed a slight decrease in RNFL thickness measurements after LASIK. MRNFL and RNFL cross section were significantly lower after LASIK using RTA. The changes might be artifacts in a small group of myopic subjects.

[Evaluation of typical psychopathic traits with juvenile offenders]

The concept of psychopathy has received many definitions for the first days of psychiatry. Recently, the Hare's Psychopathy Check List Revised has been created. This scale has the advantage to investigate the classically characteristic traits of the syndrome (need of stimulation, lack of culpability, superficial activity, lack of empathy, impassivity) and to point out the early development of behavior disturbances. In the American classification (DSM IV), oppositional and aggressive behavior in child and adolescent is grouped under the Conduct Disorder diagnostic criteria. This trouble appears to be a strong predictive factor of psychopathy in adult. Identifying the high risk factors of evolution to psychopathic personality would allow an earlier intervention and prevention by multisystemic interventions for example. The present study aims to evaluate in what measure characteristic traits of psychopathy in adults are present in severe juvenile offenders and to point out, in a second time, the differences between adolescents meeting the DSM IV criteria for Conduct Disorder and a control population by a dimensional personality inventory.

METHOD

The sample consists in 47 severe juvenile offenders referred for at least 3 months by a Youth Court to a Public Institution for Youth Protection (Belgium, Wauthier-Braine, 1999-2001), who have given an oral contentment and completely fulfilled the Temperament and Character Inventory-TCI. We have collected data about: schooling year by year, number of fails, changes of school; antecedents of oppositional defiant disorder with provocation (ODD, DSM IV criteria); antecedent of Conduct Disorder (CD, DSM IV criteria); penal antecedents (Youth Judge, works of general interest, placements); medico-psychological antecedents (consultation to a psychologist or a psychiatrist, hospitalization, illness, surgical intervention); psychoactive drug use or abuse. We used the TCI--Temperament and Character Inventory. This is a dimensional personality inventory. Based on biological, genetic and clinical hypothesis, it describes 2 types of variables defining personality: Variables of temperament (genetically transmitted and biologically controlled), and Variables of character (learned part of the personality reflecting the degree of adaptation and maturity, varying with environment through development). We have chosen this tool because of its dimensional aspect. Adolescence being a time of psychological and personality changes, such a tool is more useful than a categorical one. We also used this tool to verify the existence of the specific triad described by Cloninger and Svrakic. According to these authors, psychopathic personality in adult is characterized by a specific triad in which novelty seeking is high while harm avoidance and reward dependence are low. These observations are highly correlated to Hare's definition of psychopathy. We give the principal scores for the 7 personality dimensions expressed in global scores (total of the items for each dimension) and pondered ones (global scores divided by the number of items of the dimension x 100).

RESULTS

Statistical analysis was performed with the Stateview 5.0 t-test program for data analysis. Statistical results show the absence of a statistically significant difference between the 2 groups for TCI 1, 4.5 and 7 but a statistically significant difference for TCI 2, 3 and 6 (p <.0001).

DISCUSSION

The first limitation of our study is linked to the sample composed of young adolescents placed in an Institution for Youth Protection who doesn't reflect the whole population of offenders. A second limitation is correlated to the randomization system: randomization for age but not for sex, ethnical and cultural origin and socioeconomic status. Our results with adolescent offenders don't completely meet the Cloninger's psychopathy triad in adults. Moreover, in literature data, aggressive behavior is correlated to high novelty seeking and associated with low harm avoidance, reward dependence and persistence in children, these items are predictive of antisocial behavior in teenage and young adulthood. In our sample where antisocial behaviors are severe, we should be expecting a high novelty seeking but that is not the case. Our results should be explained by the fact that adolescence in itself is a more powerful factor of high novelty seeking than psychopathic trait. Harm avoidance and reward dependence seem to be a real problem in offending population and reflect aggressive behaviors in adolescents (lack of harm perception, sensitivity and empathy). Another interesting element is the cooperation factor that is significantly lower in the study group. This seems to comfort the hypothesis of a lower social maturity in institutionalized adolescents.

CONCLUSION

Regarding to a control group subjects from 15 to 25 years old, adolescent offenders observed in an Institution for Youth Protection show a significantly different profile in the TCI for Harm Avoidance, Reward Dependence and Cooperation. Regarding to adult psychopaths, adolescent offenders partially meet the classical diagnostic triad of psychopathy, what should be indicating that such adolescents already show emotional perturbations: lower harm avoidance, reward dependence and cooperation than control population. This third factor is not characteristic of psychopathy but reflects relational difficulties, which are important in adolescent offenders. So, our study point out the complex psychopathology of adolescent offenders and the coexistence in such adolescents of attachment disorder and the difficulty to treat them because of their multiple lacks (cognitive, psychopathological, familial and scholar). We think important to discuss the necessity of approaches based on the development of personal creative abilities and involving all the professionals concerned in the young's universe. Future researches should compare adolescent offenders and controls randomized for age, sex, socioeconomic, ethnical and cultural status. They also should test specifically the diagnostic triad of psychopathology developed by Cloninger, especially the novelty seeking dimension. Moreover, it would be interesting to integrate these results in a wider protocol and to compare them with clinical, forensic and neurocognitive data, individually and within the familial context.

Effects of asbestos on initiation of DNA damage, induction of DNA-strand breaks, P53-expression and apoptosis in primary, SV40-transformed and malignant human mesothelial cells

Human mesothelial cells (HMC), the progenitor cells of asbestos-induced mesothelioma, are particularly sensitive to the genotoxic effects of asbestos, although the molecular mechanisms by which asbestos induces injury in HMC are not well known. The high susceptibility of HMC to simian virus 40 (SV40)-mediated transformation is assumed to play a causative role in the pathogenesis of mesothelioma. The aim of this study was to investigate the asbestos-induced DNA damage in cultured HMC and SV40-transformed HMC (MeT-5A) compared with their malignant counterparts, i.e. human mesothelioma cells (MSTO). The time-dependent initiation of DNA-strand breaks as well as the induction of oxidative DNA base modifications were key factors for investigation. HMC, MeT-5A and MSTO cells were exposed to chrysotile and crocidolite asbestos (3 microg/cm2) during different time periods (1-72 h). DNA damage was investigated by use of the Comet assay and alkaline unwinding, the latter in combination with the Fpg protein. The P53 level was analyzed by immunofluorescence, and measurement of apoptosis was conducted by flow cytometry. We found a significant induction of DNA damage in asbestos-treated HMC already after an exposure time of 1.5 h. This effect could not be observed in treated MeT-5A and MSTO cells. Also, a time-dependent significant increase in DNA-strand breaks was observed by alkaline unwinding in asbestos-treated HMC, but not in treated MeT-5A and MSTO cells. In none of the three cell lines we could detect oxidative DNA damage recognized by the Fpg protein (e.g. 8-oxo-guanine), up to 24 h after exposure to asbestos. In contrast to what was found in HMC, P53 was over-expressed in untreated MeT-5A and MSTO. The induction of apoptosis by asbestos fibers was suppressed in MeT-5A and MSTO cells. Crocidolite fibers induced the higher genotoxic effects and chrysotile the more pronounced apoptotic effects. We conclude that asbestos induces DNA damage in HMC already after a very short exposure time in the absence of 8-oxo-guanine formation. The presence of SV40-Tag in MeT-5A and MSTO cells results in an increased expression of P53, but not in additive genotoxic effects after exposure to asbestos. The deregulation of the apoptotic pathway may lead to proliferation of genomically damaged cells and finally to the development of mesothelioma.

Association between platelet endothelial cellular adhesion molecule 1 (PECAM-1/CD31) polymorphisms and acute myocardial infarction: a study in patients from Sicily

Adhesion of circulating cells to the arterial surface is among the first detectable events in atherogenesis. Cellular adhesion molecules, expressed by the vascular endothelium and by circulating leucocytes, mediate cell recruitment and their transendothelial migration. Platelet endothelial cellular adhesion molecule 1 (PECAM-1/CD31), involved in this migration, has been associated with the developmental course of atherosclerosis. A few studies have investigated an association between coronary heart disease and single nucleotide polymorphisms (SNPs) located in functionally important domains of the PECAM-1/CD31 gene. In particular, Ser563Asn and Gly670Arg SNPs have been described as susceptibility factors involved in acute myocardial infarction (AMI) in the Japanese male population. To confirm these observations, we studied 96 male patients (mean age 40 years; age range 20-46) affected by AMI and 118 healthy male controls (mean age 38 years, age range: 20-55), and analysed for the following PECAM-1/CD31 SNPs: Val125Leu, Asn563Ser and Gly670Arg. The frequency of the Gly670Arg polymorphism was significantly higher in patients with AMI (58.9% vs. 48.3%; P = 0.019), whereas the frequencies of the other two SNPs (Leu125Val and Ser563Asn) were not significantly different between patients and controls. By comparing the observed number of 670Arg/Arg genotypes in the patients with the expected number, calculated from the allele frequency in a healthy population, a significance of P = 0.02 (odds ratio, 2.04; 95% CI: 1.1-3.7) was obtained, supporting a recessive model of inheritance. Hence, the differences between patients and controls are significant, but relatively small. However, as AMI is a multifactorial disease, any single mutation will only provide a small or modest contribution to the risk, which also depends on environmental interaction. All in all, we believe that the results of the present study would add support to the role of pro/anti-inflammatory genotypes in determining susceptibility or resistance to immune-inflammatory diseases, including atherosclerosis.

Genetic risk factors in myocardial infarction at young age

The role of genetic susceptibility to coronary artery disease (CAD) seems to be quite important in young patients. In the last years the attention has been focused on polymorphisms influencing some biological functions (coagulation and fibrinolysis, platelets, vascular function, lipid metabolism, inflammation). The study of prothrombotic polymorphisms has kindled a deep interest. The role of atherosclerosis and thrombosis is different in the different ages. In all the studies we examined, the polymorphism G20210A in the prothrombin gene was associated with an increased risk of acute myocardial infarction (AMI) in young people, especially when other risk factors were present. Contradictory results have been found in the studies on Factor V Leiden: according to many authors the activated protein C resistance (APCR) is associated with an increased risk of AMI only in smokers, above all if women. On the other hand, some polymorphisms of the Factor VII gene seem to be protective. Young AMI could be also caused by a reduction of the fibrinolytic activity, as it was found when the allele 4G in the promoter of plasminogen activator inhibitor (PAI) gene is present. The attention has also been focused on the effects of variations in genes that influence platelet functions. According to a metanalysis of studies published up to 1999, there is no association between the polymorphism PlA1/A2 of the GP IIIa gene and young AMI, whereas there is doubt about the role of the polymorphism in the GP IIb e GP Ib genes. Moreover, it seems to be present an association with the polymorphisms in the thrombopoietin gene (C4830A and A5713G). Also the role of some genes coding for proteins influencing the vascular functions has been valued. Few studies were performed on genetics of the renin-angiotensin-aldosterone system and the results are insufficient and contradictory, such as those about the association between the polymorphism G894T in the eNOS gene or the polymorphism C677T in the MTHFR gene and young AMI. Genes coding for proteins involved in the lipid metabolism have been closely examined. Many polymorphisms were discovered in the Apo B gene: the variant C-516T was found to be associated with increased LDL levels, whereas the results about the association between this and other polymorphisms in the same gene (I/D of LAL sequence, PvuII, MspI, Asp4311Ser) and young AMI are discordant. On the other hand, the variant e4 of the ApoE gene was associated with an increased risk of AMI at young age in many works. In the last years, a particular interest has kindled the study of the relationship between inflammation, atherosclerosis and CAD. Even if the studies performed are few, it was found an association between young AMI and polymorphism C-260T in the CD14 gene, between coronarics atherosclerosis and polymorphism A516C in the E Selectin gene or polymorphisms Leu125Val and Ser563Asn in the PECAM1 gene.

Posterior cervicothoracic instrumentation in spine tumors

STUDY DESIGN

We retrospectively review 32 patients who underwent posterior fixation for cervicothoracic junctional tumors. All patients possessed unstable or potential after surgery unstable spines as a result of either their tumors or the surgery performed. We examined cervicothoracic spine stability, maintenance of alignment, and associated complications.

OBJECTIVES

To review our experience with 3 different posterior osteosynthesis systems applied to the cervico-thoracic junction for spinal tumors. Our review includes surgical outcomes and complications. The evolution through 3 different systems between 1994 and 1997 reflects our attempts to improve accuracy in light of variable facet and pedicle interspaces. Our goal is not to compare the efficacy of the systems but to assess the efficiency of cervicothoracic facet and transpedicular screw and plate or rod fixation. However, we will comment on why the evolution occurred. The 3 different systems share a similar characteristic. Each system employs posterior cervical facet screw fixation and thoracic trans-pedicular screw fixation.

SUMMARY OF BACKGROUND DATA

Spinal disorders involving the cervicothoracic junction and specific instrumentation to this region have been sparsely described in the literature.

METHODS

Between June 1994 and June 2000, 32 patients underwent surgery for spinal tumors involving the cervicothoracic junction at our institution. There were 27 males and 5 females. The ages ranged from 17 to 72 years with a mean age of 52 years. A total of 32 cervicothoracic instrumentations were performed. We used the R. Roy-Camille thoracolumbar plate in 20 patients, the cervico-thoracic plate in 8, and the Agora rod system in 4. In all, 96 lateral mass screws were implanted from C4 to C6, 54 into C7, and 180 pedicle screws from T1 to T8. Nineteen patients had lung cancer with vertebral body invasion (Pancoast tumors), 11 had metastasis to the cervicothoracic junction, 1 had a chondrosarcoma, and 1 had myeloma. In a first group consisting of 19 patients, a combination of anterior and extended posterior surgical approaches allowed complete en bloc resection of the tumors, including all invaded vertebrae. Four total vertebrectomies and 15 partial vertebrectomies were performed. A second group of 13 patients had only posterior palliative stabilizing procedures with laminectomy and cervicothoracic fixation.

RESULTS

The follow-up period varied from 3 to 54 months, average 15 months. The average duration of survival for patients who underwent partial or total vertebrectomy was 16 months (range 3-54 months). The average duration of survival for patients who underwent palliative decompression and stabilization was 11 months (range 5-19 months). No changes in the sagittal alignment occurred during the immediate postoperative period for 30 patients. However, 2 mechanical failures occurred. Two patients experienced a clinically significant early increase in thoracic kyphosis and required revision of the posterior instrumentation. A 21-month minimum follow-up was available for 6 patients, in whom all implants were stable. We noted no screw, plate, or rod breakage in this series. No neurologic complications, including root impingement or spinal cord injury, or vertebral artery injury occurred related to screw insertion into either the thoracic pedicles (180 screws) or the cervical lateral masses (96 screws in C4-C5-C6 and 54 screws in C7).

CONCLUSIONS

Posterior plate or rod and screw fixation is a good method of treatment for cervicothoracic instability in spine tumors. Facet screw fixation in the cervical spine with Roy-Camille drilling technique and transpedicular screw fixation in the thoracic spine provides an efficacious means by which to stabilize the cervicothoracic junction. This stabilization technique was effective even in cases of high postoperative instability, such as with partial or total vertebrectomy. This screw-type stabilization is clinically effective and well documented. The evolution through 3 different systems reflects our attempts to improve accuracy in light of variable facet and pedicle interspaces. Importantly, posterior instrumentation will not interfere with subsequent laminectomy or more extreme surgical procedures.

P2 receptor-mediated effects on the open field behaviour of rats in comparison with behavioural responses induced by the stimulation of dopamine D2-like and by the blockade of ionotrophic glutamate receptors

The effects of the P2 receptor ligands 2-methylthio ATP (2-MeSATP; 10 pmol)--as a non-specific agonist--and pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS; 10 pmol)--as a non-selective antagonist--after bilateral intra-accumbens injection on the locomotor response were investigated in an open field situation. The P2 receptor-mediated effects on the pattern of locomotor activity were compared with the effects caused by the dopamine D2-like receptor agonist quinpirole (10 pmol) and by the combination of the N-methyl-D-aspartate (NMDA) receptor antagonist (+/-)-3-(2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP; 10 pmol) with the alpha-amino-3-hydro-5-methyl-4-isoxazolpropionic acid (AMPA) and kainate receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX; 30 pmol). The intra-accumbens injection of all tested compounds elicited an increase in the locomotor activity over a test period of 20 min when compared with the controls. No statistically significant differences could be evaluated between the different drug-treated groups. However, a more detailed analysis--using further behavioural parameters such as the number of movement direction changes, the effective running time and the running speed--revealed two basically different patterns of locomotor activity. The locomotor response induced by the injection of 2-MeSATP or quinpirole was characterised by a continuous and consistent locomotion, whereas the enhanced locomotor activity elicited by PPADS or CPP/CNQX was determined by an increased running speed accompanied by more disruptions and more changes of movement direction. The coadministration of 2-MeSATP and quinpirole led to an enhancement of locomotor activity in a limited post-treatment interval. The effects of both compounds could be abolished by the pre-treatment with the D2/D3 receptor antagonist sulpiride (100 pmol). Coadministration of PPADS and CPP/CNQX caused additive effects suggesting that the pathway mediated by P2 and ionotrophic glutamate receptors is different. The stimulation of P2 receptors in the nucleus accumbens (NAc) modulates the locomotion in the direction to be to be longer lasting, more consistent and more goal directed.

Modulation of feeding behaviour by blocking purinergic receptors in the rat nucleus accumbens: a combined microdialysis, electroencephalographic and behavioural study

The nonspecific P2 receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS), the nonspecific P1 receptor antagonist 8-(p-sulphophenyl)-theophylline (8-SPT) and the combination of both were applied by retrograde microdialysis into the nucleus accumbens (NAc) before and during feeding of 18-h food-deprived rats. In addition to the registration of behavioural parameters, such as the amount and duration of food intake, the feeding-induced changes in dopamine (DA) concentration and the concomitant changes of neuronal activity in the NAc and the ventral tegmental area (VTA) were simultaneously determined. The perfusion with PPADS (20 microm) diminished the amount of food intake and the duration of feeding. Furthermore, the P2 receptor antagonist blocked the feeding-induced DA release and prevented the feeding-elicited changes of the electroencephalography (EEG) power distribution which was characterised by an increase in the power of the 8.0-13.0-Hz frequency band in the NAc and the VTA. The effects of PPADS could be completely prevented by the concomitantly perfused adenosine receptor antagonist 8-SPT (100 microm). When given alone, 8-SPT increased the amount of food ingested, the duration of feeding and the EEG power of the higher frequency range, particularly between 19.0 and 30.0 Hz, in both the NAc and the VTA. The feeding-elicited DA release was supplemented to the enhanced DA level caused by the perfusion with 8-SPT in an additive manner. The P2 and P1 receptor antagonists interact antagonistically in the modulation of feeding behaviour and the feeding-induced changes of EEG activity suggesting that both endogenous extracellular ATP and adenosine are involved in the regulation of the feeding-associated mesolimbic neuronal activity in a functionally antagonistic manner.

Polymorphonuclear leukocyte membrane fluidity and cytosolic Ca(2+) content in young adults with acute myocardial infarction. Evaluation at the initial stage and after 12 months

Our aim was to examine two aspects of polymorphonuclear leukocyte (PMN) rheology (membrane fluidity and cytosolic Ca2+ content), at baseline and after in vitro activation, in a group of young adults with acute myocardial infarction (AMI) at the initial stage and after 12 months. We enrolled 21 AMI subjects aged < or = 45 years (mean age 41.1 +/- 3.5 years) and evaluated PMN membrane fluidity, labelling intact PMN cells with the fluorescent probe 1,4-(trimethylamino)-phenyl-4-phenylhexatriene and the PMN cytosolic Ca2+ content marking PMN cells with the fluorescent probe Fura 2-AM, at baseline and after in vitro activation with 4-phorbol 12-myristate 13-acetate (PMA) and N-formyl-methionyl-leucyl-phenylalanine (fMLP). During the initial stage PMN membrane fluidity and cytosolic Ca2+ content did not distinguish AMI patients from control subjects; after 12 months, when compared with the initial stage, PMN cytosolic Ca2+ content was significantly increased. In vitro PMN activation with PMA and fMLP caused no variation of the two PMN parameters in control subjects, while in AMI patients membrane fluidity decreased and cytosolic Ca2+ content increased; the same behaviour pattern was observed after 12 months. The constant functional alteration of PMN cells in young AMI patients highlights the role of activated leukocytes as a component of the inflammatory reaction that follows ischemia.