Therapeutic effectiveness of a Calendula officinalis extract in venous leg ulcer healing

OBJECTIVE

Non-healing venous leg ulcers (VLUs) have a significant effect on patients' quality of life and substantially increase expenditures in health-care systems. The aim of this study was to evaluate the clinical efficacy of the Calendula officinalis extract, Plenusdermax, in the treatment of VLUs.

METHOD

Patients treated with Calendula officinalis extract (n=38) and control patients (n=19) were evaluated every two weeks for 30 weeks or until their ulcers healed. Assessments included determination of the wound area by planimetry, infection control, and evaluation of the clinical aspects of the wounds. The percentage of healing velocity per week (%HVw), taking the initial area at baseline into account, was also determined.

RESULTS

The proportion of the treatment patients achieving complete epithelialisation was 72 % and 32 % in the treatment and control groups, respectively. The average healing time was approximately 12 weeks in the treatment group and 25 % in control patients. Patients with ulcers treated with Calendula officinalis extract had a significant 4-fold increase in percentage healing velocity per week, 7.4 %, compared with 1.7 % in the control group. No adverse events were observed during the Calendula officinalis extract treatment.

CONCLUSION

Our findings indicate that Calendula officinalis extract is an effective treatment for VLUs.

DECLARATION OF INTEREST

The authors have no conflict of interest.

Localization of the gene for X-linked calvarial hyperostosis to chromosome Xq27.3-Xqter

X-linked calvarial hyperostosis is a rare disorder characterized by isolated calvarial thickening. Symptoms are prominent frontoparietal bones, a flat nasal root and a short upturned nose, a high forehead with ridging of the metopic and sagittal sutures, and lateral frontal prominences. The mandible is normal, as are the clavicles, pelvis and long bones. The thickened bone in the skull appears to be softer than normal bone. Despite calvarial hyperostosis, increased intracranial pressure and cranial nerve entrapment do not occur. The major disability seems to be cosmetic. The disease segregates with an X-linked recessive mode of inheritance. Female carriers do not show any clinical symptoms. To date, only one family has been described with X-linked calvarial hyperostosis including three affected individuals. In order to localize the disease causing gene, 31 polymorphic microsatellite markers that spread across the X-chromosome were analyzed. Genotypes were combined in haplotypes to delineate the region. A chromosomal region spanning from Xq27.3 to Xqter cosegregates with the disorder. This region encompasses 23.53cM or 8.2Mb according to the deCODE map and contains 165 genes. CNV-analysis did not show small duplications or deletions in this region. Exome sequencing was performed on a male patient in this family. However, this did not reveal any putative mutation. These results indicate that a non-coding regulatory sequence might be involved in the pathogenesis of this disorder.

No conclusive evidence for association of polymorphisms in the adiponectin receptor 1 gene, AdipoR1, with common obesity

AdipoR1 is one of the adiponectin receptors which are important for adiponectin signaling. Because adiponectin is a candidate gene for common obesity, it is also hypothesized that variations in AdipoR1 may be involved in the development of complex obesity. Therefore, we designed an association study for the AdipoR1 gene. We performed a case-control association study including 1,021 obese subjects (mean age 42 ± 12 years; mean BMI 38.2 ± 6.2 kg/m²) and 226 lean, healthy individuals (mean age 36 ± 7 years; mean BMI 22.1 ± 1.7 kg/m²). Nine tagSNPs were selected to cover the entire AdipoR1 gene and surrounding 7 kb region (based on HapMap data). TagSNPs were genotyped using AcycloPrime-Fluorescence Polarization (FP) SNP Detection kits and TaqMan Pre-Designed SNP Genotyping assays according to manufacturer's protocols. We found that the rs1075399 non-reference allele decreases obesity risk by 45 % in men only [odds ratio (OR) = 0.55, 95 % CI 0.35-0.87, nominal P = 0.010]. However, after Bonferroni correction for multiple testing, this association is lost. None of the other tagSNPs were associated with obesity when studying the entire population, nor when looking at men and women separately. Quantitative analysis of the effect of each SNP on height, weight, and BMI revealed that none of the tagSNPs are associated with weight or BMI. We report here that we found no decisive evidence for association between AdipoR1 tagSNPs and complex obesity in our Belgian Caucasian population.

Identification and molecular characterization of a novel splice-site mutation (G1205C) in the SQSTM1 gene causing Paget's disease of bone in an extended American family

Paget's disease of bone (PDB) is a common late-onset bone disorder characterized by focal areas of abnormal bone remodeling. Positional cloning efforts resulted in the identification of seven genetic loci (PDB1-7) with putative involvement in the pathogenesis of PDB. Meanwhile, the PDB-causing gene from the PDB3 region on chromosome 5q35 has been identified as the SQSTM1 gene. All mutations identified in this gene so far are located in or close to the ubiquitin-associated (UBA) domain of the protein. In 2001, we reported genotyping results of genetic markers located in the PDB3 region in an extended American family, indicating the involvement of the PDB3 locus. Here, we report the identification of a novel mutation (G1205C) in the SQSTM1 gene in this family. The G1205C mutation is located in the splice donor site of intron 7 and reverse-transcription polymerase chain reaction experiments showed that the presence of the C allele results in the production of two abnormal mRNA transcripts. Translation of the first transcript would result in a protein that lacks amino acids 351-388, including 26 amino acids of the second PEST domain in addition to two amino acids of the UBA domain. The second mutant mRNA transcript could result in a truncated protein (390X) that lacks almost the complete UBA domain. PDB mutations that disrupt the function of the PEST domain of SQSTM1 have not been reported before, so probably the pathogenic effect of both transcripts resides in the disruption of the ubiquitin-binding properties of the protein.

An intermediate form of juvenile Paget's disease caused by a truncating TNFRSF11B mutation

Juvenile Paget's disease (JPD) is a rare condition with an autosomal recessive mode of inheritance. Typically presenting in infancy or early childhood, the disorder is characterized by a generalized widening of the long bones and thickening of the skull combined with sustained elevation of serum alkaline phosphatase levels. The extremely rapid bone turnover results in osteopenia, fractures, and progressive skeletal deformity. In 2002, mutations in TNFRSF11B, the gene encoding osteoprotegerin, were described as underlying JPD. We evaluated a patient with JPD at the clinical, biochemical, radiological, and molecular level. Mutation analysis of TNFRSF11B revealed a homozygous insertion/deletion in exon 5, predicted to result in truncation of the protein at amino acid 325. The residual activity of the mutated protein product was investigated by Western blotting and ELISA upon transient overexpression. Absence of the C-terminal domain abolished homodimerization and was shown to lead to a decreased capacity of the mutant protein to bind its ligand RANKL. We conclude that truncation of the C-terminal part of osteoprotegerin negatively affects functional activity. As a consequence, osteoclast formation and function are up-regulated, causing the increased bone turnover seen in this patient.

Inotropic stimulation induces cardiac dysfunction in transgenic mice expressing a troponin T (I79N) mutation linked to familial hypertrophic cardiomyopathy

The cardiac troponin T (TnT) I79N mutation has been linked to familial hypertrophic cardiomyopathy and a high incidence of sudden death, despite causing little or no cardiac hypertrophy. In skinned fibers, I79N increased myofilamental calcium sensitivity (Miller, T., Szczesna, D., Housmans, P. R., Zhao, J., deFreitas, F., Gomes, A. V., Culbreath, L., McCue, J., Wang, Y., Xu, Y., Kerrick, W. G., and Potter, J. D. (2001) J. Biol. Chem. 276, 3743-3755). To further study the functional consequences of this mutation, we compared the cardiac performance of transgenic mice expressing either human TnT-I79N or human wild-type TnT. In isolated hearts, cardiac function was different depending on the Ca(2+) concentration of the perfusate; systolic function was significantly increased in Tg-I79N hearts at 0.5 and 1 mmol/liter. At higher Ca(2+) concentrations, systolic function was not different, but diastolic dysfunction became manifest as increased end-diastolic pressure and time to 90% relaxation. In vivo measurements by echocardiography and Doppler confirmed that base-line systolic function was significantly higher in Tg-I79N mice without evidence for diastolic dysfunction. Inotropic stimulation with isoproterenol resulted only in a modest contractile response but caused significant mortality in Tg-I79N mice. Doppler studies ruled out aortic outflow obstruction and were consistent with increased chamber stiffness. We conclude that in vivo, the increased myofilament Ca(2+) sensitivity due to the I79N mutation enhances base-line contractility but leads to cardiac dysfunction during inotropic stimulation.

Abnormal contractile function in transgenic mice expressing a familial hypertrophic cardiomyopathy-linked troponin T (I79N) mutation

This study characterizes a transgenic animal model for the troponin T (TnT) mutation (I79N) associated with familial hypertrophic cardiomyopathy. To study the functional consequences of this mutation, we examined a wild type and two I79N-transgenic mouse lines of human cardiac TnT driven by a murine alpha-myosin heavy chain promoter. Extensive characterization of the transgenic I79N lines compared with wild type and/or nontransgenic mice demonstrated: 1) normal survival and no cardiac hypertrophy even with chronic exercise; 2) large increases in Ca(2+) sensitivity of ATPase activity and force in skinned fibers; 3) a substantial increase in the rate of force activation and an increase in the rate of force relaxation; 4) lower maximal force/cross-sectional area and ATPase activity; 5) loss of sensitivity to pH-induced shifts in the Ca(2+) dependence of force; and 6) computer simulations that reproduced experimental observations and suggested that the I79N mutation decreases the apparent off rate of Ca(2+) from troponin C and increases cross-bridge detachment rate g. Simulations for intact living fibers predict a higher basal contractility, a faster rate of force development, slower relaxation, and increased resting tension in transgenic I79N myocardium compared with transgenic wild type. These mechanisms may contribute to mortality in humans, especially in stimulated contractile states.

Identification of the Gbeta5-RGS7 protein complex in the retina

The G protein beta subunit G beta 5 deviates significantly from the four other members of the G beta family in amino acid sequence, unique expression pattern (only in the CNS), and cytosolic localization. To identify the members of the G beta 5-mediated signaling pathway, we purified the native protein complex containing G beta 5 from the cytosolic fraction of bovine retina. Analysis of the isolated complex revealed that G beta 5 is tightly associated with RGS7, a member of the superfamily of negative regulators of G protein signaling. This finding, for the first time, demonstrates an interaction between a G beta subunit and an RGS protein. G beta 5 was not detected in the outer segments of photoreceptor cells, suggesting that the cytosolic G beta 5-RGS7 complex is not directly involved in phototransduction.

Prevalence of high blood pressure in children and adolescents. Influence of obesity

Obesity is associated with high blood pressure BP, mainly in adults. It has been suggested that body fat patterning plays a role in the etiology of hypertension. This relationship also exists in children, however it is less well known. The aim of this study was to evaluate the prevalence of high blood pressure (HBP) in children and adolescents, and the influence of obesity on this population, as well as the presence of familial aggregation for these factors. Eight hundred and eighty-nine children (389 boys and 500 girls aged 5-18 years) and their parents, from the North of Portugal were studied. Systolic blood pressure, diastolic blood pressure, weight, height, triceps skinfold, body mass index and sexual maturation were measured. The criterion of high blood pressure was defined as the BP being higher than the 90th percentile. All variables were converted to age and sex in specific "Z-scores". A SPSS package was used. We found 47 (5.2%) people of both sexes to have high blood pressure. The children of this group were compared with the normotensive group. These children were heavier (p < 0.005) and more obese (p < 0.0001) than the others. No difference was found for sexual maturation or height. The parents of the group with high blood pressure were heavier (p < 0.001) and more obese (p < 0.01) than the parents of the normotensive group. In conclusion, obesity is an important factor in children with higher values. Children with HBP are more likely to come from families with history of obesity. The identification of these risk factors in children is an important contribution to the prevention of cardiovascular disease in adulthood.

[Arterial hypertension in a patient with cardiac tamponade]

An elevated arterial pressure in cardiac tamponade, although not unusual might postpone the diagnosis of pericardial disease. We reported a case of cardiac tamponade, due to neoplastic infiltration of the pericardium, in which the diagnosis was first suspected by the presence of pulsus paradoxus. The patient presented cardiac tamponade and arterial hypertension simultaneously.

[Refractory heart failure in a 26-year-old woman with idiopathic hemochromatosis]

Idiopathic hemochromatosis, the most frequent inherited disease in Caucasians, is frequently undiagnosed. In this disorder, characterized by a continued inappropriated absorption of dietary iron, the clinical manifestations result from damage to those organ systems in which iron has been pathologically deposited, namely, the heart and the liver. Typically, hemochromatosis becomes clinically manifest in later life and in men more frequently than in women. This has been attributed to the extra loss of iron in women through menstruation and pregnancies. Removal of the excess iron by phlebotomy will prevent all of the complications of hemochromatosis of when begun early. In this paper, we report a case of a young woman with a eight years evolution of amenorrhea, cardiac failure, diabetes mellitus and increased pigmentation of the skin, associated with biochemical markers of iron overload. It is emphasized that hemochromatosis most be excluded in all patients with a unexplained cardiac failure.

Heart rate variability in 24-hour Holter recordings. Comparative study between short- and long-term time- and frequency-domain analyses

Mean hourly parameters obtained from all beats (long series) were compared with those obtained from a sample of 512 beats extracted each hour (short series) in nine presumably normal subjects. For both the short and long series, the spectral components, very low frequency, (VLF), low frequency (LF), and high frequency (HF), and time-domain indices (such as the Ewing statistic [PNN50] and RR standard deviation [SD-RR]), have been estimated. The spectral components LF and HF, estimated from the short and long series, were not significantly different, whereas significant differences were found between VLF, SD--RR, and PNN50. In both the short and long series, a strong correlation was found between LF and SD-RR and between HF and PNN50. The results suggest that, over a period of 24 hours, hourly LF and HF spectral components can be obtained using a single series of 512 beats every hour, with a great advantage over the evaluation of the mean hourly parameters. This method would be particularly useful in the study of circadian heart rate spectral analysis in Holter recordings with multiple artifacts or ectopic beats, and in general, when analysis of the entire 24-hour series is not feasible.

[Evaluation of the aerobic capacity of blind people, by direct VO2 maximal measurement]

Physical activity is the basic factor to the human being in order to assume his place in society. Blind persons are often sedentary, which compromises its physical capacity. The present work evaluates the blind person's physical capacity, analysing possible differences related to sex, age and life time blindness. The sample was constituted by 27 blind (congenital and noncongenital), 18 male and 9 female, aged between 17 and 37 years old. To evaluate previous physical activity, a questionnaire, was answered which showed a dominant sedentary population. The maximum oxygen uptake was determined in a treadmill test using standard procedures (Bruce protocol). Medium results for boys were 45.85 +/- 8 ml/kg/min and for girls were 34.46 +/- 3.8 ml/kg/min. The difference between congenital and acquired blindness on the VO2max values was 2.9 ml/kg/min, not statistically significant (p = 0.468). Those findings lead us to consider that aerobic capacity mostly depends on type and intensity of physical exercise which may be temporary related to the onset of blindness and visual impairment degree.

[High resolution electrocardiogram and late potential monitoring]

The signal-averaged ECG became an important noninvasive method for identifying life-threatening ventricular arrhythmias. It is most accurate in patients with coronary artery disease and can be helpful in predicting whether a patient with an unexplained syncope or nonsustained VT is at risk of developing sustained ventricular tachycardia or not. A patient with an entirely normal signal-averaged ECG is at very low risk of sustained VT. In contrast, an abnormal signal-averaged ECG should raise suspicion about VT, and prompt further studies, including electrophysiological testing. Signal-averaged ECG can also be used repeatedly with acceptable reproducibility. Technological advances and improvements in the frequency analysis of the averaged signal may increase the predictive accuracy of the technique and consequently enhance its clinical applications.

[Spectrum analysis of the variability of heart rate in athletes]

OBJECTIVES

Characterize power spectrum pattern of the heart rate variability and assessment of the relative contributions of sympathetic and parasympathetic cardiac nervous system control in athletes.

STUDY DESIGN

Prospective study of athletes and sedentary healthy control group sex and age matched.

SUBJECT AND METHODS

8 athletes, 3 female and 5 male, swimming (4), canoeing (2) and cycling (2), aged 17.4 +/- 3.6 years, and 8 sedentary healthy controls. ECG signals were recorded after a period of 15 minutes in supine rest with controlled breathing at 15 cycles/min. Signal acquisition was done at 300 samples/sec. From 512 consecutive heart beats, we calculated the average, the standard deviation, the maximum and the minimum values and the rate between the longest and the shortest R-R interval (E/I). We also calculated, after computing the fast Fourier transform, the total spectrum power, the low frequency component (LF, from 0.01 to 0.15 Hz) and the high frequency component (HF, greater than 0.15 Hz) and its ratio (LF/HF).

RESULTS

The average R-R interval was 921 +/- 154.2 msecs and 673.2 +/- 98 msecs, the standard deviation was 72.5 and 29.4 msecs and the ratio E/I 1.63 +/- 0.14 and 1.28 +/- 0.08, respectively for athletes and control group. Differences between groups were significant (p less than 0.01) for all parameters, with higher variability in the athletes. Both spectral bands (LF and HF) and higher power in athletes (LF = 0.54 +/- 0.23 and HF = 0.76 +/- 0.14) than in the control group (LF = 0.14 +/- 0.10 and HF = 0.18 +/- 0.15) (p less than 0.001). There were no significant differences for LF/HF ratio, or normalized LF (LF%) or normalized HF (HF%) between groups.

CONCLUSIONS

The present results indicates higher power of both spectral bands (LF and HF) and higher amplitude of the respective peaks in athletes when compared with healthy sedentary, with a clear predominance of the HF band in the total spectral power density, which suggest that the higher heart rate variability observed in athletes reveals the predominance of parasympathetic activity, without reduction of the sympathetic tone.