Validation of putative biomarkers of furan exposure through quantitative analysis of furan metabolites in urine of F344 rats exposed to stable isotope labeled furan

Humans are chronically exposed to furan, a potent liver toxicant and carcinogen that occurs in a variety of heat-processed foods. Assessment of human exposure based on the furan content in foods is, however, subject to some uncertainty due to the high volatility of furan. Biomarker monitoring is thus considered an alternative or complementary approach to furan exposure assessment. Previous work suggested that urinary furan metabolites derived from the reaction of cis-2-butene-1,4-dial (BDA), the reactive intermediate of furan, with glutathione (GSH) or amino acids may serve as potential biomarkers of furan exposure. However, some metabolites were also reported to occur in urine of untreated animals, indicating either background contamination via animal feed or endogenous sources, which may limit their suitability as biomarkers of exposure. The overall aim of the present study was to accurately establish the correlation between external dose and concentration of furan metabolites in urine over time and to discriminate against endogenous formation and furan intake via feed. To this end, the furan metabolites GSH-BDA (N-[4-carboxy-4-(3-mercapto-1H-pyrrol-1-yl)-1-oxobutyl]-L-cysteinylglycine), NAcLys-BDA (R-2-(acetylamino)-6-(2,5-dihydro-2-oxo-1H-pyrrol-1-yl)-1-hexanoic acid), NAcCys-BDA-NAcLys (N-acetyl-S-[1-[5-(acetylamino)-5-carboxypentyl]-1H-pyrrol-3-yl]-L-cysteine) and NAcCys-BDA-NAcLys sulfoxide (N-acetyl-S-[1-[5-(acetylamino)-5-carboxypentyl]-1H-pyrrol-3-yl]-L-cysteine sulfoxide) were simultaneously analyzed by stable isotope dilution ESI-LC-MS/MS as unlabeled and [13C4]-furan dependent metabolites following oral administration of a single oral dose of isotopically labelled [13C4]-furan (0.1, 1, 10, 100 and 1000 µg/kg bw) to male and female F344/DuCrl rats. Although a linear correlation between urinary excretion of [13C4]-furan-dependent metabolites was observed, analysis of unlabeled NAcLys-BDA, NAcCys-BDA-NAcLys and NAcCys-BDA-NAcLys sulfoxide revealed substantial, fairly constant urinary background levels throughout the course of the study. Analysis of furan in animal feed excluded feed as a source for these background levels. GSH-BDA was identified as the only furan metabolite without background occurrence, suggesting that it may present a specific biomarker to monitor external furan exposure. Studies in humans are now needed to establish if analysis of urinary GSH-BDA may provide reliable exposure estimates.

A Lewis acid β-diiminato-zinc-complex as all-rounder for co- and terpolymerisation of various epoxides with carbon dioxide

A β-diiminato-zinc-N(SiMe3)2 complex (1) was synthesised and fully characterised, including an X-ray diffraction study. The activity of catalyst 1 towards the coupling reaction of CO2 and various epoxides, including propylene oxide (PO), cyclohexene oxide (CHO), styrene oxide (SO), limonene oxide (LO), octene oxide (OO) and epichlorohydrin (ECH), was investigated. Terpolymerisation of CO2, PO and LO, as well as CO2, CHO and PO, was successfully realised, resulting in polymers with adjustable glass transition temperatures and transparencies. Reaction conditions such as temperature, pressure and catalyst concentration were varied to find the optimal reaction values, especially regarding LO/CO2. In situ IR experiments hinted that at 60 °C and a critical LO concentration, polymerisation and depolymerisation are in an equilibrium (ceiling effect). Pressurising catalyst 1 with carbon dioxide resulted in a dimeric catalyst (2) with a OSiMe3 group as a new initiator. Homopolymerisation of different epoxides was carried out in order to explain the reactivity concerning copolymerisation reaction of CO2 and epoxides.

Dinuclear zinc catalysts with unprecedented activities for the copolymerization of cyclohexene oxide and CO2

New dinuclear zinc catalysts reveal by far the highest polymerization rates for the copolymerization of cyclohexene oxide and CO₂.

Googling caesarean section: a survey on the quality of the information available on the Internet

OBJECTIVE

To examine the quality and completeness of information on caesarean section in web pages used by laypersons in Brazil, a country with very high rates of caesarean delivery.

DESIGN

Cross-sectional study.

SETTING

Brazil.

SAMPLE

A total of 176 Internet websites.

METHODS

The term 'caesarean delivery' and 25 synonyms were entered into the most popular search engines in Brazil. The first three pages of hits were downloaded and assessed by two independent investigators using the DISCERN instrument and a content checklist.

MAIN OUTCOME MEASURES

Quality and completeness of information on caesarean section.

RESULTS

A total of 3900 web pages were retrieved and 176 fulfilled the selection criteria. The overall average DISCERN score was 43.6 (±8.9 SD), of a maximum score of 75; 30% of the pages were of poor or very poor quality and 47% were of moderate quality. Most pages scored low, especially in questions related to reliability of the information. The most frequently covered topics were: indications for caesarean section (80% of websites), which did not reflect clinical practice; short-term maternal risks (80%); and potential benefits of caesarean section (56%), including maternal and doctor convenience. Less than half of the websites mentioned perinatal risks and less than one-third mentioned long-term maternal risks associated with caesarean section, such as uterine rupture (17%) or placenta praevia/accreta (12%) in future pregnancies.

CONCLUSIONS

The quality and completeness of web-based resources in Portuguese about caesarean section were poor to moderate. Pending improvement of these resources, obstetricians should warn pregnant women about these facts and encourage them to discuss what they have read on the Internet about caesarean section.

TWEETABLE ABSTRACT

The quality and completeness of information about caesareans is poor in 176 websites used by Brazilians.

[The supraclavicular flap for reconstruction of the head and neck]

The complex anatomy of the head and neck region requires the ability to raise a wide spectrum of pedicled and free flaps, to ensure optimal reconstruction of various defects by the reconstructive surgeon. The supraclavicular (island) flap, which has almost been buried in oblivion, provides excellent potential to reconstruct even bigger defects of the head and neck region, while causing minimal donor site morbidity at the same time. Its benefits lie in the reliable skin island and its wide arc of rotation, resulting in excellent cosmetic and functional outcomes.

Intracelluläre Wirkung von Hydroxyalkenalen auf tierische Tumoren / Intracellular Effect of Hydroxyalkenals on Animal Tumors

When incubated for 30 min in vitro, 4-hydroxyalkenals in a 5 x 1 0 ~ 3 m solution react with SH-groups of soluble cytoplasmic and nuclear proteins (ProtL-SH) of Morris hepatomas 9618 A and 5123 tc, and of Ehrlich ascites tumor (EAT) cells. The extent of the reaction strongly increases with decreasing doubling time of the respective tumors. Former experiments with EAT cells have shown that the reaction with cytoplasmic ProtL-SH causes inhibition of respiration, glycolysis, and probably of other SH-controlled processes associated with cell division. The intranuclear reaction leads to an inhibition of DNA-and RNA-synthesis. In a 2 x 10-4 M solution of hydroxyalkenals, however, the reaction with cytoplasmic ProtL-SH diminishes almost completely so that no mea­ surable inhibition of respiration and only 3% inhibition of glycolysis are observed, while 20 to 30 percent of the nuclear ProtL-SH are still blocked. This corresponds well with a previous obser­ vation that a 2 x 10-4 m solution of hydroxypentenal inhibits DNA-synthesis by 90 percent.

[Tract sealing techniques in percutaneous nephrolitholapaxy]

Since the introduction of the percutanous nephrolitholapaxy (PNL), the instruments as well as the technique have experienced a tremendous modification. The miniaturisation of the instruments has led to a decreased hospital stay, reduced analgetic use as well as an extension of the indication for PNL. A nephrostomy tube was normally inserted to prevent urinoma and to provoke renal haemostasis. In 1997, the necessity for the regular use of a nephrostomy tube was first questioned. In a prospective study, the nephrostomy tube was successfully omitted in 50 selected patients. Since then, increasingly, the nephrostomy tube is omitted. Alternatively, different haemostatic substances are used for renal tract closure. The necessity for the use of these agents is still unclear.

[Prevention of postprostatectomy incontinence: etiology and risk factors]

The prevention of postprostatectomy incontinence has always been a challenge for urologists. Improved understanding of male continence and changes in pelvic anatomy after radical prostatectomy and the implementation of new surgical techniques raised hope of reduced incontinence rates. Despite using the full potential of continence-sparing techniques and atraumatic robot-assisted surgery, postprostatectomy incontinence still occurs in 5-20 % of cases. Recently published data showed a trend of improved early return to continence using anterior suspension or posterior reconstruction in robot-assisted prostatectomy. Postprostatectomy incontinence has a negative impact on quality of life and causes high costs of treatment. Therefore, further research in the amelioration of postoperative continence is mandatory.

Diabetes and thrombolysis for acute stroke: a clear benefit for diabetics

BACKGROUND AND PURPOSE

Diabetes is a predictor for poor outcome after thrombolysis in stroke patients, and early post-stroke glycaemia is associated with higher rates of post-thrombolytic symptomatic intracerebral haemorrhages (SICHs). Diabetic stroke patients may nevertheless profit from thrombolysis. Here, we compared outcome data of matched thrombolysed and non-thrombolysed diabetic and non-diabetic stroke patients from a national database.

METHODS

The outcomes of 1079 matched quadruples, each consisting of a thrombolysed diabetic, a non-thrombolysed diabetic, a thrombolysed non-diabetic and a non-thrombolysed non-diabetic case (a total of 4316 cases), enrolled in the Austrian Stroke Unit Registry (2004-2013), were compared. Patients were matched according to sex, age, stroke severity, pre-stroke disability and prior stroke.

RESULTS

A regression model with improvement as depending variable found no effect of diabetes (P = 0.158) or the interaction diabetes × thrombolysis (P = 0.507), whereas the effect of thrombolysis itself was highly significant (P < 0.001). Functional outcome (modified Rankin Scale) was significantly better in thrombolysed than in non-thrombolysed diabetic patients at discharge from the stroke-unit (P < 0.001) and 3 months later (P = 0.006). No significant differences were found in the number of SICHs after thrombolytic treatment between diabetic (4.9%) and non-diabetic strokes (3.5%). Both groups had a higher risk of SICH compared with the non-thrombolysed groups (diabetics 2.6%, non-diabetics 2.5%). Due to lack of documentation, the effect of admission blood glucose on SICH was not investigated.

CONCLUSIONS

Data from this nationwide survey show that diabetic stroke patients receive a substantial benefit from thrombolysis, and therefore diabetic strokes should not be excluded from thrombolytic treatment.

Sensitive cardiac troponin in the diagnosis and risk stratification of acute heart failure

BACKGROUND

The aim of our study was to investigate the diagnostic and prognostic value of a sensitive cardiac troponin I (s-cTnI) assay in patients with acute heart failure (AHF).

METHODS

Sensitive cardiac troponin I was measured in 667 consecutive patients at presentation to the emergency department with acute dyspnoea. Three s-cTnI strata were predefined: below the limit of detection (<0.01 μg L(-1) , undetectable), detectable but still within the normal range (0.01-0.027 μg L(-1) ) and increased (≥0.028 μg L(-1) , ≥99th percentile). The final diagnosis was adjudicated by two independent cardiologists blinded to the s-cTnI levels. Median follow-up in patients with AHF was 371 days.

RESULTS

Levels of s-cTnI were higher in patients with AHF (n = 377, 57%) compared to patients with noncardiac causes of acute dyspnoea (median 0.02 vs. <0.01 μg L(-1) , P < 0.001). In patients with AHF, in-hospital mortality increased with increasing s-cTnI in the three strata (2%, 5% and 14%, P < 0.001). One-year mortality also increased with increasing s-cTnI (21%, 33% and 47%, P < 0.001). s-cTnI remained an independent predictor of 1-year mortality [adjusted odds ratio 1.03 for each increase of 0.1 μg L(-1) , 95% confidence interval (CI) 1.02-1.05, P < 0.001] after adjustment for other risk factors including B-type natriuretic peptide. The net reclassification improvement was 68% (P < 0.001), and absolute integrated discrimination improvement was 0.18 (P < 0.001). The diagnostic accuracy of s-cTnI for the diagnosis of AHF as quantified by the area under the receiver operating characteristic curve was 0.78 (95% CI, 0.75-0.82).

CONCLUSIONS

Sensitive cardiac troponin I is a strong predictor of short- and long-term prognosis in AHF that helps to reclassify patients in terms of mortality risk. Detectable levels of s-cTnI, even within the normal range, are independently associated with mortality.

[A leak in the lung: endobronchial one-way valve placement as treatment for a persistent bronchopleural fistula]

Patients with bronchopleural fistula are at an increased risk of morbidity and mortality. Treatment of the air leak includes intrathoracic drainage, antibiotic therapy and closure of the fistula, which conventionally has been performed via surgical means. In patients with limited respiratory capacity, less-invasive alternatives are required. Here we report on a 62-year-old patient with underlying severe COPD, who was admitted with a lung abscess and consecutively developed a persistent bronchopleural fistula. Treatment involved antibiotic therapy and endobronchial one-way valve placement, which resulted in termination of the air leak and full recovery.

The expanding Lyme Borrelia complex--clinical significance of genomic species?

Ten years after the discovery of spirochaetes as agents of Lyme disease in 1982 in the USA, three genomic species had diverged from the phenotypically heterogeneous strains of Borrelia burgdorferi isolated in North America and Europe: Borrelia afzelii, B. burgdorferi sensu stricto (further B. burgdorferi), and Borrelia garinii. Whereas B. burgdorferi remained the only human pathogen in North America, all three species are aetiological agents of Lyme borreliosis in Europe. Another seven genospecies were described in the 1990s, including species from Asia (Borrelia japonica, Borrelia turdi, and B. tanukii), North America (Borrelia andersonii), Europe (Borrelia lusitaniae and Borrelia valaisiana), and from Europe and Asia (Borrelia bissettii). Another eight species were delineated in the years up to 2010: Borrelia sinica (Asia), Borrelia spielmanii (Europe), Borrelia yangtze (Asia), Borrelia californiensis, Borrelia americana, Borrelia carolinensis (North America), Borrelia bavariensis (Europe), and Borrelia kurtenbachii (North America). Of these 18 genomic species B. afzelii, B. burgdorferi and B. garinii are the confirmed agents of localized, disseminated and chronic manifestations of Lyme borreliosis, whereas B. spielmanii has been detected in early skin disease, and B. bissettii and B. valaisiana have been detected in specimens from single cases of Lyme borreliosis. The clinical role of B. lusitaniae remains to be substantiated.

Quantification noise in single cell experiments

In quantitative single-cell studies, the critical part is the low amount of nucleic acids present and the resulting experimental variations. In addition biological data obtained from heterogeneous tissue are not reflecting the expression behaviour of every single-cell. These variations can be derived from natural biological variance or can be introduced externally. Both have negative effects on the quantification result. The aim of this study is to make quantitative single-cell studies more transparent and reliable in order to fulfil the MIQE guidelines at the single-cell level. The technical variability introduced by RT, pre-amplification, evaporation, biological material and qPCR itself was evaluated by using RNA or DNA standards. Secondly, the biological expression variances of GAPDH, TNFα, IL-1β, TLR4 were measured by mRNA profiling experiment in single lymphocytes. The used quantification setup was sensitive enough to detect single standard copies and transcripts out of one solitary cell. Most variability was introduced by RT, followed by evaporation, and pre-amplification. The qPCR analysis and the biological matrix introduced only minor variability. Both conducted studies impressively demonstrate the heterogeneity of expression patterns in individual cells and showed clearly today's limitation in quantitative single-cell expression analysis.

Influence of anabolic combinations of an androgen plus an estrogen on biochemical pathways in bovine uterine endometrium and ovary

The application of anabolic steroids in food producing animals is forbidden in the EU since 1988, but the abuse of such drugs is a potential problem. The existing test systems are based on known compounds and can be eluded by newly emerging substances. The examination of physiological effects of anabolic hormones on different tissues to indirectly detect misuse might overcome this problem. Two studies were conducted with post-pubertal 24-months old Nguni heifers and pre-pubertal female 2-4 weeks old Holstein Friesian calves, respectively. The animals of the accordant treatment groups were administered combinations of estrogenic and androgenic compounds. The measurement of the gene expression pattern was undertaken with RT-qPCR. Target genes of different functional groups (receptors, angiogenesis, steroid synthesis, proliferation, apoptosis, nutrient metabolism and others) have been quantified. Several biochemical pathways were shown to be influenced by anabolic treatment. Both studies identified significant regulations in steroid and growth factor receptors (AR, ERβ, LHR, FSHR, Flt-1, PR, IGF-1R, Alk-6), angiogenic and tissue remodeling factors (VEGFs, FGFs, BMPs, ANGPT-2, MMPs, TIMP-2, CTSB), steroid synthesis (S5A1, HSD17, CYP19A1), proliferation (TNFα, IGF-1, IGFBPs, p53, c-fos; CEBPD, c-kit), apoptosis (CASP3, FasL, p53) and others (C7, INHA, STAR). Several genes were regulated to opposite directions in post-pubertal compared to pre-pubertal animals. PCA for Nguni heifers demonstrated a distinct separation between the control and the treatment group. In conclusion, anabolics modify hormone sensitivity and steroid synthesis, and they induce proliferative effects in the whole reproductive tract (uterus and ovary) as well as anti-angiogenic effects in the ovary. However, the extent will depend on the developmental stage of the animals.

Hsa-mir-145 is the top EWS-FLI1-repressed microRNA involved in a positive feedback loop in Ewing's sarcoma

EWS-FLI1 is a chromosome translocation-derived chimeric transcription factor that has a central and rate-limiting role in the pathogenesis of Ewing's sarcoma. Although the EWS-FLI1 transcriptomic signature has been extensively characterized on the mRNA level, information on its impact on non-coding RNA expression is lacking. We have performed a genome-wide analysis of microRNAs affected by RNAi-mediated silencing of EWS-FLI1 in Ewing's sarcoma cell lines, and differentially expressed between primary Ewing's sarcoma and mesenchymal progenitor cells. Here, we report on the identification of hsa-mir-145 as the top EWS-FLI1-repressed microRNA. Upon knockdown of EWS-FLI1, hsa-mir-145 expression dramatically increases in all Ewing's sarcoma cell lines tested. Vice versa, ectopic expression of the microRNA in Ewing's sarcoma cell lines strongly reduced EWS-FLI1 protein, whereas transfection of an anti-mir to hsa-mir-145 increased the EWS-FLI1 levels. Reporter gene assays revealed that this modulation of EWS-FLI1 protein was mediated by the microRNA targeting the FLI1 3'-untranslated region. Mutual regulations of EWS-FLI1 and hsa-mir-145 were mirrored by an inverse correlation between their expression levels in four of the Ewing's sarcoma cell lines tested. Consistent with the role of EWS-FLI1 in Ewing's sarcoma growth regulation, forced hsa-mir-145 expression halted Ewing's sarcoma cell line growth. These results identify feedback regulation between EWS-FLI1 and hsa-mir-145 as an important component of the EWS-FLI1-mediated Ewing's sarcomagenesis that may open a new avenue to future microRNA-mediated therapy of this devastating malignant disease.

Interleukin family member ST2 and mortality in acute dyspnoea

OBJECTIVES

The study objective was to investigate the prognostic utility and patient-specific characteristics of ST2 (suppression of tumorigenicity 2), assessed with a novel sensitive assay.

BACKGROUND

Suppression of tumorigenicity 2 signalling has been shown to be associated with death in cardiac and pulmonary diseases.

DESIGN/SUBJECTS

In an international multicentre cohort design, we prospectively enrolled 1091 patients presenting with acute dyspnoea to the emergency department (ED). ST2 was measured in a blinded fashion using a novel assay and compared to B-type natriuretic peptide (BNP) and NT-proBNP. The primary end-point was mortality within 30 days and 1 year. The prognostic value of ST2 was evaluated in comparison and in addition to BNP and NT-proBNP.

RESULTS

Suppression of tumorigenicity 2 concentrations was higher amongst decedents than among survivors (median 85 vs. 43 U mL⁻¹, P < 0.001) and also higher in patients with impaired left ventricular ejection fraction (LVEF) when compared with preserved LVEF (P < 0.001). In receiver operator characteristics analysis, the area under the curve (AUC) for ST2, BNP and NT-proBNP to predict 30-day and 1-year mortality were 0.76, 0.63 and 0.71, and 0.72, 0.71 and 0.73, respectively. The combinations of ST2 with BNP or NT-proBNP improved prediction of mortality provided by BNP or NT-proBNP alone. After multivariable adjustment, ST2 values above the median (50 U mL⁻¹) significantly predicted 1-year mortality (HR 2.3, P < 0.001).

CONCLUSION

In patients presenting to the ED with acute dyspnoea, ST2 is a strong and independent predictor of 30-day and 1-year mortality and might improve risk stratification already provided by BNP or NT-proBNP.

Gene expression in hair follicle dermal papilla cells after treatment with stanozolol

Doping with anabolic agents is a topic in sports where strength is crucial, e.g. sprinting, weight lifting and many more. Testosterone and its functional analogs are the drugs of choice taken as pills, creams, tape or injections to increase muscle mass and body performance, and to reduce body fat. Stanozolol (17β-hydroxy-17α-methyl-5α-androst-2-eno[3,2c]pyrazol) is a testosterone analogue with the same anabolic effect like testosterone but its ring structure makes it possible to take it orally. Therefore, stanozolol is one of the most frequently used anabolic steroids.

Common verification methods for anabolic drugs exist, identifying the chemicals in tissues, like hair or blood samples. The idea of this feasibility study was to search for specific gene expression regulations induced by stanozolol to identify the possible influence of the synthetically hormone on different metabolic pathways. Finding biomarkers for anabolic drugs could be supportive of the existing methods and an additional proof for illegal drug abuse.

In two separate cell cultures, human HFDPC (hair follicle dermal papilla cells) from a female and a male donor were treated with stanozolol. In the female cell culture treatment concentrations of 0 nM (control), 1 nM, 10 nM and 100 nM were chosen. Cells were taken 0 h, 6 h, 24 h and 48 h after stimulation and totalRNA was extracted. Learning from the results of the pilot experiment, the male cell culture was treated in 10 nM and 100 nM concentrations and taken after 0 h, 6 h, 24 h and 72 h. Using quantitative real-time RT-PCR expression of characteristics of different target genes were analysed.

Totally 13 genes were selected according to their functionality by screening the actual literature and composed to functional groups: factors of apoptosis regulation were Fas Ligand (FasL), its receptor (FasR), Caspase 8 and Bcl-2. Androgen receptor (AR) and both estrogen receptors (ERα, ERβ) were summarized in the steroid receptor group. The growth factor group included the insulin like growth factor receptor (IGF1R) and growth hormone receptor (GHR). Fibroblast growth factor 2 (FGF2) and keratinocyte growth factor (FGF7) were summarized in the hair cycle factor group. 5α-Steroidreductases (SRD5A1, SRD5A2) represented the enzyme group. Three reference genes were taken for relative quantification: ubiquitin (UBQ), glycerinaldehyde-3-phsophate-dehydrogenase (GAPDH), and β-actin (ACTB).

In cell culture 1 AR, FasR, FGF2 showed significant regulations within one treatment time, significant gene expressions over time were analysed for Caspase 8. In cell culture 2 AR, FasR and SRD5A2 were significantly regulated within one treatment time.

In this feasibility study first biomarker for a screening pattern of anabolic agents could be identified providing the rationality to investigate modified, metabolic pathways in the whole hair follicle.

Response inhibition in borderline personality disorder: event-related potentials in a Go/Nogo task

Borderline personality disorder (BPD) has been related to a dysfunction of anterior cingulate cortex, amygdala, and prefrontal cortex and has been associated clinically with impulsivity, affective instability, and significant interpersonal distress. We examined 17 patients with BPD and 17 age-, sex-, and education matched control participants with no history of Axis I or II psychopathology using event-related potentials (ERPs). Participants performed a hybrid flanker-Go/Nogo task while multichannel EEG was recorded. Our study focused on two ERP components: the Nogo-N2 and the Nogo-P3, which have been discussed in the context of response inhibition and response conflict. ERPs were computed on correct Go trials (button press) and correct Nogo trials (no button press), separately. Groups did not differ with regard to the Nogo-N2. However, BPD patients showed reduced Nogo-P3 amplitudes. For the entire group (n = 34) we found a negative correlation with the Barratt Impulsiveness Scale (BIS-10) and Becks's depression inventory (BDI). The present study is the first to examine Nogo-N2 and Nogo-P3 in BPD and provides further evidence for impaired response inhibition in BPD patients.

Plaque imaging of the internal carotid artery - correlation of B-flow imaging with histopathology

BACKGROUND AND PURPOSE

The noninvasive identification of plaque types prone to cause symptomatic disease is of great interest to improve the effectiveness of surgical or interventional management. The purpose of the present prospective pilot study was to evaluate the association between the results of imaging-the novel sonography technique B-flow imaging (BFI), B-mode, and color Doppler imaging (CDI)-and histopathologic examination in the characterization of internal carotid artery (ICA) plaques.

METHODS

Twenty-eight consecutive patients with high-grade internal carotid artery stenosis scheduled for carotid endarterectomy were included. BFI, B-mode, and CDI images were used to classify the plaques applying the standardized scores of Beletsky et al and the American Heart Association (AHA), to calculate the gray-scale median (GSM) and to detect potential ulcerations; histopathologic examination results of explanted plaques served as the "gold standard."

RESULTS

Based on the classification of Beletsky et al, BFI and histopathologic examination results agreed in 21 (75%, kappa = 0.61, P < .001) patients, and the corresponding results for B-mode were 19 (68%, kappa = 0.52, P < .001) patients, respectively. Corresponding results for the AHA classification revealed inferior agreements for BFI (19 patients/68%, kappa = 0.38, P = .003) and B-mode (17 patients/61%, kappa = 0.25, P = .045). The median GSM for BFI and B-mode correlated significantly (r = 0.95, P < .001). The sensitivity of BFI for the detection of ulcerated plaques was 100% and the specificity was 95.8%; corresponding values for CDI were 100% and 92.7%, respectively.

CONCLUSION

BFI and the combination of B-mode and CDI exhibit comparable results in the assessment of ICA plaque components and plaque ulceration as well as in the determination of GSM levels.

Skin cholesterol: test performance, evaluation of potential determinants and correlation analysis with cardiovascular risk factors and circulating markers of inflammation

BACKGROUND

Skin cholesterol (SkC) has been suggested to be an additional risk predictor, so we evaluated the test performance, potential determinants of this marker as well as a potential correlation of SkC with markers of inflammation and the history of cardiovascular events.

PATIENTS AND METHODS

SkC, determined by the non-invasive PREVU POC Skin Sterol test, as well as serum lipids, the body fat status, high-sensitive CRP (hs-CRP) and serum amyloid A (SAA) were evaluated in consecutive patients with and without documented atherosclerotic disease.

RESULTS

SkC was assessed in 201 patients. The within-day precision (CV) was 3.8%, the day-to-day CV of the right hand was 8.6% and 4.3% for the left hand, respectively. Neither univariate analysis nor multiple regressions identified a significant influence of age, sex, serum lipids, body fat status, smoking or diabetes mellitus on SkC, corresponding results were observed in a further analysis including 174 of these patients concerning hs-CRP and SAA (all p > 0.05). T-test analyses detected no significant differences between patients with and without a history of coronary, peripheral vascular and cerebrovascular events (all p > 0.05).

CONCLUSIONS

The PREVU POC Skin Sterol test for the assessment of SkC proved an acceptable test performance. SkC is independent from serum lipids, traditional cardiovascular risk factors, two sensitive markers of systemic inflammation as well as the history of cardiovascular events indicating that the perception of this parameter as an established marker of vascular disease is premature.

Evaluation of Inspiratory Muscle Function in a Healthy Austrian Population – Practical Aspects

BACKGROUND

There is no clear evidence whether inspiratory muscle strength (Pi(max)) is closely linked to inspiratory muscle endurance (T(lim)). Moreover, normal values of T(lim), measured by flow-resistive loads, have not been established.

OBJECTIVES

We tried to find answers to the following questions: Is it possible to establish normative values of T(lim) when using flow-dependent, resistive loads? Are Pi(max) and Borg scale values predictors of T(lim)? Are anthropometric and spirometric data closely related to T(lim)? Is it really necessary to measure T(lim) in addition to Pi(max) when evaluating inspiratory muscle function?

METHODS

Sixty-eight healthy Austrian volunteers between 17 and 75 years of age and with a sedentary lifestyle participated in our study. Pi(max) was defined as the maximal inspiratory mouth pressure, measured with a differential pressure transducer. T(lim) was determined as the time span until exhaustion, while breathing against a resistive loading device.

RESULTS

Pi(max) values showed a low intra- and high interindividual variability for both sexes and were significantly age, weight and height dependent. For male subjects, Pi(max) was also significantly related to spirometric parameters. T(lim) values showed a very high interindividual variability, but a low intraindividual variability. Interestingly, no correlation was found between T(lim) and Pi(max), nor lung function parameters and age.

CONCLUSIONS

The results indicate that both Pi(max) and T(lim) have to be determined when inspiratory muscle function is measured. Normal values for T(lim), evaluated by flow-resistive loads, cannot be satisfactorily established due to the high interindividual variability.

Influence of HMG-CoA-reductase inhibitors on the body fat status

BACKGROUND

While the literature has conclusively shown a significant decrease of plasma lipids after intake of HMG-CoA reductase inhibitors, there is no detailed information provided about their effects on the body fat status.

PATIENTS AND METHODS

We performed a retrospective analysis of a prospective randomized controlled trial including consecutive patients with suspected arterial occlusive disease. Normolipidemic patients served as the control group and hyperlipidemic patients were randomized to either 20 mg atorvastatin or to 40 mg simvastatin. At baseline, after 6 weeks and after 6 months we assessed the relative body fat, the waist circumference and the body mass index (BMI) as well as plasma total cholesterol (chol), low-densitiy lipoprotein cholesterol (LDL) and triglycerides (TG).

RESULTS

In total we included 129 patients in our analysis. The body fat status remained unchanged in the control group as well as in the atorvastatin group (all p > 0.05) for the whole study period, while simvastatin treatment led to a slight, but significant increase of the relative body fat (+ 4.2%) between the 6 weeks and 6 months assessment (p = 0.013).

CONCLUSIONS

Long-term intake of statins seems to have no positive influence on parameters of the body fat status and therefore misses one important goal in the cardiovascular risk prevention.

[Three-dimensional digital rotation angiography for embolization therapy of uterine leiomyomas: first results]

PURPOSE

To evaluate three-dimensional rotational digital subtraction angiography (3D-RDSA) in the embolization of the uterine artery in the treatment of symptomatic uterine leiomyomas (fibroids).

MATERIALS AND METHODS

Eight women with complex pelvic vessel anatomy caused by large fibroids were embolized using 3D-RDSA. The raw data were sent to an external workstation, and video files with a resolution of one image/3 degrees and a scan range of 180 degrees in a surface-shaded display mode were produced. The primary goal was to assess an image intensifier angulation for the optimal visualization of the origin of the uterine artery. In addition, the intervention parameters were compared with those of 48 patients with standard angiography.

RESULTS

The analysis revealed no single angulation that can be recommended for standard angiography. No statistical differences were found between both groups concerning fluoroscopy time, dosage area product and amount of administered contrast medium (p > 0.05).

CONCLUSION

It can be stated that 3D-RDSA is a feasible method that facilitates the catheterization of the uterine artery even in patients with complex pelvic vessel anatomy, with the potential to reduce the radiation exposure and the amount of administered contrast medium in future embolization therapy of symptomatic uterine fibroids.

[Extended field-of-view sonography in Achilles tendon disease: a comparison with MR imaging]

PURPOSE

To evaluate the role of real-time extended field-of-view sonography (EFOVS) in symptomatic Achilles tendon disease in comparison with MR imaging (MRI).

MATERIALS AND METHODS

Twenty-three symptomatic tendons were examined by conventional grayscale sonography, EFOVS and MRI, which served as the gold standard.

RESULTS

The median tendon thickness in MRI was 7.8 mm (IQR 3.1) and correlated significantly to the results of EFOVS (7.0 mm, IQR 2; r = 0.74, P < 0.01). In total, MRI detected 24 lesions in 18 tendons and EFOVS 21 hypoechoic lesions in 15 tendons, corresponding to a sensitivity of 87.5 % and specificity of 100 %. The additional usage of conventional grayscale sonography improved sensitivity to 95.8 %. The median distance of the largest lesion to the calcaneal tuberosity was 10.4 mm (IQR 3.4) in MRI and 8.5 mm (IQR 5.1) in EFOVS (r = 0.64; P < 0.05). The sensitivity and specificity of EFOVS for the detection of a peritendinitis were 63.6 % and 66.7 %, respectively. Corresponding values for the detection of a bursitis were 68.8 % and 28.6 %. The additional usage of conventional grayscale sonography improved the specificity to 85.7 %.

CONCLUSION

The combination of EFOVS and grayscale sonography has the potential to challenge MRI as the preferred imaging method in diagnosing symptomatic Achilles tendon disease, especially with respect to saving time and cost and the absence of any contraindications.

Colour and Power Doppler Sonography in Symptomatic Achilles Tendon Disease

The present trial focused on the exact role of colour and power Doppler sonography in Achilles tendinopathy and correlated these techniques with the clinical severity of the disease and with findings on grey-scale sonography. Twenty patients with in total 28 symptomatic Achilles tendons were included in this prospective trial. Additionally included were the asymptomatic tendons (n = 12) of patients and both tendons (n = 30) of fifteen controls. The pain score of Robinson - which ranges from 0 (strong severe pain) to 100 (asymptomatic) - was used to assess clinical severity of the disease. Both tendons of patients and controls were examined by a GE LOGIQ 9 trade mark scanner with a small-parts 14 MHz transducer. Grey-scale sonography detected in total 31 focal hypoechoic areas in 19 (68 %) of the 28 symptomatic tendons. Colour as well as power Doppler sonography detected blood flow in 14 (74 %) of the 19 tendons with focal hypoechoic areas. No blood flow was detected in the remaining symptomatic tendons (n = 14) and in the asymptomatic tendons of patients or in both tendons of controls. Colour and power Doppler sonography resulted in a specificity of 100 % and a sensitivity of 50 % for symptomatic Achilles tendinopathy. Patients with blood flow within the tendon had a significantly lower score according to Robinson than symptomatic patients without flow (P = 0.009). It is concluded that colour and/or power Doppler sonography are useful as an adjunct to grey-scale sonography in the examination of Achilles tendinosis, especially because the presence of blood flow is associated with stronger pain, discomfort and physical restriction.