Longitudinal change in left ventricular 4D flow kinetic energy after myocardial infarction

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation HRUK

Background. Four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) imaging provides quantification of intra-cavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. Myocardial infarction (MI) is known to cause acute alterations in intra-cardiac blood flow but assessments of longitudinal changes are lacking.

Purpose. Assess longitudinal changes in LV flow post ST-elevation myocardial infarction (STEMI).

Method. Twenty acutely reperfused STEMI patients (13 men, 7 women, mean age 54 ± 9 years) underwent 3T CMR acutely (within 5-7 days) and 3 months post-MI.  CMR protocol included functional imaging, late gadolinium enhancement and 4D flow. Using Q-MASS, LV KE parameters were derived and indexed to LV end-diastolic volume (LVKEiEDV). Based on acute ejection fraction (EF), patients were grouped as follows: preserved (pEF) EF >50%, reduced (rEF) EF <50% including mild (rEF= 40-49%), moderate to severe (EF <40%) impairment. 

Results. Out of 20 patients, 13 had rEF acutely (7 mild rEF, 6 moderate to severe rEF). Acute LVKEiEDV parameters varied significantly between pEF and rEF (Table). At 3 months, pEF and mild rEF patients showed a significant (P < 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P < 0.05) reduction in minimal and peak-E wave LVKEiEDV. However in patients with moderate to severe rEF in the acute scan, there were no significant change by 3 months (Figure).

Conclusion. Following MI, 4D flow LVKE derived biomarkers significantly decreased over time in pEF and mild rEF groups but not in moderate to severe rEF group. 4D flow assessment might provide incremental prognostic value beyond EF assessment alone.

Table pEF (n = 7) rEF (n = 13) V1 V2 P-value V1 V2 P-value EF(%) 56 ± 5 55 ± 4 0.40 41 ± 7 47 ± 9 0.01 Infarct Size(%) 31 ± 20 15 ± 9 0.04 18 ± 13† 16 ± 11 0.41 LV KEiEDV parameters Average(µJ/ml) 9 ± 2 7 ± 2 0.02 10 ± 3† 8 ± 3 0.01 Minimal(µJ/ml) 1 ± 0.6 1 ± 0.5 0.46 1.3 ± 0.5 1 ± 0.6 0.03 Systolic(µJ/ml) 10 ± 4 7 ± 2 <0.01 12 ± 4† 7 ± 3 <0.01 Diastolic(µJ/ml) 8 ± 3 7 ± 2 0.13 9 ± 3 8 ± 3 0.09 Peak-E wave(µJ/ml) 22 ± 9 23 ± 8 0.44 20 ± 7 18 ± 10 0.23 Peak-A wave(µJ/ml) 18 ± 10 11 ± 4 0.04 17 ± 9 14 ± 7 0.02 †P < 0.05 V1 comparison between pEF and rEF Abstract Figure

Effects of pollution on marine organisms

This review covers selected 2018 articles on the biological effects of pollutants, including human physical disturbances, on marine and estuarine plants, animals, ecosystems, and habitats. The review, based largely on journal articles, covers field and laboratory measurement activities (bioaccumulation of contaminants, field assessment surveys, toxicity testing, and biomarkers) as well as pollution issues of current interest including endocrine disrupters, emerging contaminants, wastewater discharges, marine debris, dredging, and disposal. Special emphasis is placed on effects of oil spills and marine debris due largely to the 2010 Deepwater Horizon oil blowout in the Gulf of Mexico and proliferation of data on the assimilation and effects of marine debris. Several topical areas reviewed in the past (e.g., mass mortalities ocean acidification) were dropped this year. The focus of this review is on effects, not on pollutant sources, chemistry, fate, or transport. There is considerable overlap across subject areas (e.g., some bioaccumulation data may be appear in other topical categories such as effects of wastewater discharges, or biomarker studies appearing in oil toxicity literature). Therefore, we strongly urge readers to use keyword searching of the text and references to locate related but distributed information. Although nearly 400 papers are cited, these now represent a fraction of the literature on these subjects. Use this review mainly as a starting point. And please consult the original papers before citing them.

Spot urine protein/creatinine ratios are unreliable estimates of 24 h proteinuria in most systemic lupus erythematosus nephritis flares

The diagnosis of glomerulonephritis flares in systemic lupus erythematosus (SLE) is usually based on whether the magnitude of proteinuria has changed. Our study tests two methods to assess proteinuric change: protein/creatinine (P/C) ratios of intended 24-h urine collections or that of spot urine samples. Sixty-four patients with glomerulonephritis due to SLE followed in the Ohio SLE Study provided bimonthly paired spot and intended 24-h urine collections. Completeness of each collection was estimated as the ratio of the measured creatinine to the expected creatinine based upon Cockroft-Gault. Intended 24-h urine collections with measured/expected creatinine ratios between 0.5 and 0.9 (237 samples overall) showed ratios that were not significantly different from ratios of complete 24-h urine collections with ratios of 0.9-1.1 (159 samples). To compare spot and 24 h P/C ratios, we randomly selected pairs of samples with measured/expected ratios above 0.75. Consistent with previous studies, spot and 24-h urine P/C ratios showed good correlation over the range of values as well as reasonably strong concordance. Over the range of most SLE glomerulonephritis flares, however, correlation was present but concordance was poor. Our work suggests that the use of spot urine P/C ratios will yield more false-positive and -negative diagnoses of glomerulonephritis flares in patients with SLE than the ratio in 24-h urines.

A rapid test for the diagnosis of thrombotic thrombocytopenic purpura using surface enhanced laser desorption/ionization time-of-flight (SELDI-TOF)-mass spectrometry

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP), a life-threatening thrombotic microangiopathy, requires immediate diagnosis and plasma exchange therapy. Development of TTP is related to functional deficiency of ADAMTS-13 protease that leads to the accumulation of ultra large von Willebrand factor (VWF) and subsequent platelet thrombosis. Currently no clinical test is available for the rapid detection of ADAMTS-13 activity.

OBJECTIVES

The goal is to devise a novel method to rapidly detect functional activity of ADAMTS-13 and improve clinical outcome.

METHODS AND RESULTS

A recombinant VWF substrate containing the ADAMTS-13 cleavage site and a 6X Histidine tag was cleaved by ADAMTS-13 in a dose-dependent manner, generating approximately 7739 Da peptide containing a 6X Histidine tag. This cleaved peptide, bound to an IMAC/Nickel ProteinChip, was quantified using Surface Enhanced Laser Desorption/Ionization Time-of-flight Mass Spectrometry (SELDI-TOF-MS). The assay is capable of quantifying ADAMTS-13 activity as low as 2.5% in plasma within 4 h. When the cleaved peptide was quantified as a ratio of an internal control peptide, the test displayed good reproducibility, with an average inter-assay coefficient of variation (CV) of < 33%. Further validation revealed a mean ADAMTS-13 activity of 92.5% +/- 16.6% in 39 healthy donors. Sixteen patients with idiopathic TTP displayed mean ADAMTS-13 activity of 1.73% +/- 3.62%. Further utility of this novel method includes determining the inhibitory titer of ADAMTS-13 antibody in cases of acquired TTP.

CONCLUSIONS

We have devised a novel SELDI-TOF-MS assay that offers a rapid, cost-effective, and functionally relevant test for timely diagnosis and management of TTP.

Point-of-care testing at the millennium

Point-of-care testing (POCT) is a major force in the future evolution of hospital care, with prospects for even greater expansion of accessibility, speed, and also, hopefully, accuracy of results. New developments in POCT technology will predictably occur in three areas: connectivity, test menu expansion, and noninvasiveness. Connectivity for POCT devices has evolved from point-of-service workstations to standardized POCT data transmission protocols to remote roaming wireless connectivity with automatic data capture. POCT test menus will continue to expand, with more coagulation testing, chemistries, and infectious screening, but also on-site drug screening, intraoperative hormone levels, and microchip DNA diagnostics. Noninvasive POCT will expand beyond the GlucoWatch glucose monitor and the Bilichek noninvasive bilirubin monitor to noninvasive CBCs and Pap smears.

The challenges and opportunities of laboratory regionalization

These are some of the major historical trends and rationale for the sea change in laboratory medicine today. The creation of cooperative regional networks and consolidated regional laboratories potentially can: 1) Pool the technologic strengths of individual laboratories across a region; 2) Create economies of scale by combining capacities for certain procedures; 3) Lower unit costs by increasing volumes of business from nonpatients; 4) Span all of the traditional testing venues along the new expanding continuum of care. The authors in this monograph will take the saga forward in time, outlining critical organizational, technologic, and strategic aspects of the newly evolving laboratory of the 21st century.

Genetic diversity from a limited repertoire of mutations on different common allelic backgrounds: alpha 1-antitrypsin deficiency variant Pduarte

alpha 1-Antitrypsin (alpha 1AT) is one of the most polymorphic gene loci in the human genome. alpha 1AT variants are typically identified by their migration position in an isoelectric focusing gel at pH 4-5. Heterogeneity of the isoelectric point of alpha 1AT variants, hence variant migration, most often results from amino acid substitutions which alter the net charge of the molecule. We identified an individual heterozygous for an alpha 1AT variant migrating in the "P" variant region which differs from other known "P" variants. Using isoelectric focusing on an immobilized pH gradient at pH 4.50-4.85 the novel P allele, Pduarte, migrates between Pst. albans and Plowell. Densitometric analysis of normal "M" type alpha 1AT and the deficiency variant Plowell major bands separated by isoelectric focusing demonstrates that Pduarte contributes approximately 41% as much alpha 1AT to the total serum alpha 1AT concentration as the normal "M" alpha 1AT, similar to Plowell. Direct DNA sequencing of the proband's genomic DNA demonstrates that the Pduarte allele differs from the normal M1 (V213) allele by two amino acid substitutions, R101 (CGT)-->H(CAT) and D256 (GAT)-->V(GTT). Individually, these amino acid substitutions characterize the normal M4 allele (R101-->H) and the deficient Plowell allele (D256-->V). Thus the Pduarte allele differs from the Plowell allele only by the normal allelic background in which the V256 mutation occurs. Comparison of amino acid sequences among several alpha 1AT variants demonstrates that Pduarte is an example of a more general observation regarding diversity within the PI (protease inhibitor) system.(ABSTRACT TRUNCATED AT 250 WORDS)

Solubility in binary solvent systems: 8. Estimation of binary alkane plus p-dioxane solvent nonideality from measured anthracene solubilities

Experimental solubilities are reported for anthracene in binary solvent mixtures containing p-dioxane with n-hexane, cyclohexane, n-heptane, methylcyclohexane, n-octane, cyclooctane, and isooctane at 25 degrees C. Results of these measurements, used in conjunction with the nearly ideal binary solvent (NIBS) model, enabled excess Gibbs free energies, delta GBCfh, of the seven binary solvent mixtures to be estimated. Estimated values for p-dioxane plus cyclohexane, p-dioxane plus n-heptane, and p-dioxane plus methylcyclohexane mixtures are in reasonable agreement with published values based on vapor pressure measurements.

Expression of integrated Rous sarcoma viruses: DNA rearrangements 5′ to the provirus are common in transformed rat cells but not seen in infected but untransformed cells

The study of Rous sarcoma virus (RSV)-infected rat cell clones offers a novel approach to unravelling the mechanisms controlling eukaryotic gene expression. RSV-transformed rat cell clones frequently contain duplicated proviral sequences immediately upstream of an intact provirus. This category of proviral rearrangement is not seen in cells that remain untransformed after RSV infection nor in subsequently segregating transformants. These results suggest that such rearrangements occur during or soon after proviral integration, and that they may favour early proviral expression.

Environmental influences on serotonin and cyclic nucleotides in rat cerebral cortex

The response to different environmental conditions and negative air ions was investigated on cerebral cortical serotonin and cyclic nucleotides. The results indicated that negative air ions alter the weight of the cerebral cortex and that concentrations of serotonin and cyclic nucleotides can be altered both by different environments and by negative air ions. The data stress the importance of the role of the environment when studying the structure and chemistry of the cerebral cortex.

Pulmonary alveolar proteinosis and cytomegalovirus infection

We report a case of pulmonary alveolar proteinosis (PAP) and cytomegalovirus (CMV) infection occurring in a 5-year-old boy with acute lymphoblastic leukemia. The association of PAP and CMV infection is rare, but the possible etiologic role of CMV in the production of PAP is raised. Pulmonary alveolar proteinosis is being reported with increasing frequency in immunocompromised patients, and this disease may be difficult to distinguish from other causes of diffuse lung disease both clinically and radiologically. Pulmonary alveolar proteinosis, either alone or in combination with CMV infection, should therefore be considered in the differential diagnosis of diffuse lung disease in these cases.