Early rapid local impedance drop is associated with acute lesion efficacy during pulmonary vein isolation using a novel contact force sensing catheter

Introduction

The predictive role of adequate local impedance drop in lesion formation using a novel contact force sensing ablation catheter for pulmonary vein isolation was recently described. The purpose of our study was to assess the temporal characteristics of local impedance drop during ablation and its correlation with acute lesion efficacy.

Methods

Point-by-point radiofrequency pulmonary vein isolation was performed in power-controlled mode with 50 W energy setup. The efficacy of applications was determined by pacing along the circular ablation line. The successful lesions were estimated if loss of capture was achieved. Local impedance, contact force and catheter position data of the applications with 5 msec resolution was analysed. The local impedance of successful and unsuccessful applications was compared at baseline and 2, 4, 6, 8, 10 and 12 sec time points, respectively. We characterized the local impedance for each time point with the mean of the 5 impedance value closest in time. The sum of the range of catheter position in x, y and z dimensions was also compared to assess stability during the application.

Results

643 applications were analysed, 559 were successful and 84 were unsuccessful. Mean contact force was lower (p=0.04), while the sum of catheter position range was higher (p<0.001) in unsuccessful applications during ablation, suggesting worse catheter stability. The successful applications were characterized by a higher baseline local impedance (p<0.001), and a larger local impedance drop at the 2, 4, 6, 8 and 10 sec time points (p<0.001, for all). In case of unsuccessful applications, after a moderate but significant drop from baseline to the 2 sec time point (baseline: 153 Ohm vs 2 sec: 145 Ohm, p<0.001) local impedance did not change further over time (2 sec: 145 Ohm vs 12 sec: 143 Ohm; p=0.99). While on the other hand, in case of successful applications, the local impedance further decreased significantly up to the 10 sec timepoint, respectively (baseline: 161 Ohm vs 2 sec: 150 Ohm vs 10 sec: 141 Ohm, p<0.001 for all). The optimal cut-point for the local impedance drop indicating unsuccessful application was <9 Ohms at the 4 second time point [AUC=0.73 (0.67–0.76), p<0.001]. Failing to reach at least 9 Ohm impedance drop at the 4 second time point predicted unsuccessful applications [(p<0.001; OR: 3.82 (2.34–6.25)].

Conclusion

Rapid and enduring drop of the local impedance may predict effective lesion formation, while slightly changing or unchanged local impedance is associated with unsuccessful applications. In case of a moderate local impedance drop during the first 4 seconds of radiofrequency application, it might be reasonable to stop the application and start a new one after catheter repositioning.

Funding Acknowledgement

Type of funding sources: None.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Diagnostic and prognostic value of 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT in a single-center cohort of neuroendocrine tumors

Introduction

The aim was to assess the diagnostic value of 99mTc-Tektrotyd scintigraphy (TCT) and positron emission tomography/computed tomography using F-18 fluorodeoxyglucose (18F-FDG PET/CT) in the detection and follow-up of neuroendocrine tumors (NETs), and their predictive value for disease progression.

Material and methods

In this retrospective cohort, TCT and 18F-FDG PET/CT were performed in 90 patients (37 men, 53 women, mean age 52.7 ±15.1), with NET. Correlation of Ki67 and tumor grade versus Krenning score and SUVmax was assessed, Kaplan-Meier analysis was used for progression-free survival (PFS), and Cox regression analysis was performed to identify the association between progression-related factors and PFS.

Results

Out of 90, true positive TCT was detected in 56 (62.2%) patients, true negative in 19 (21.1%), false positive in 4 (4.4%), false negative in 11 (12.2%), while 18F-FDG PET/CT was true positive in 69 (76.7%) patients, true negative in 10 (11.1%), false positive in 5 (5.5%), false negative in 6 (6.7%). Mean 18F-FDG PET/CT SUVmax was 6.8 ±6.2. Diagnostic sensitivity of TCT was 83.6%, specificity 82.6%, accuracy 83.3% vs. 18F-FDG PET/CT sensitivity was 92.0%, specificity 66.7%, accuracy 87.8%. A significant correlation between Ki67 and SUVmax was found in positive 18F-FDG PET/CT findings, unlike the correlation between Ki67 and Krenning score. Median PFS was 25 months (95% CI: 18.2-31.8), in 18F-FDG PET/CT positive patients 23 months (95% CI: 16.3-29.7) and 18F-FDG PET/CT negative 26 months (p = 0.279). Progression-free survival predictors were SUVmax and Krenning score.

Conclusions

In our study, TCT and 18F-FDG PET/CT have high diagnostic accuracy in detection of NET. Higher Krenning score on TCT and SUVmax in positive 18F-FDG PET/CT findings are predictors of disease progression. 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT can be useful complementary tools in management of patients with NETs and in predicting patients' outcome.

The Relationship Between 99mTc-Pertechnetate Hand Perfusion Scintigraphy and Nailfold Capillaroscopy in Systemic Sclerosis Patients: A Pilot Study

Objectives

This study aims to assess the possible relationship between ^99mTc-pertechnetate hand perfusion scintigraphy (HPS) and nailfold capillaroscopy (NC) in systemic sclerosis (SSc) patients.

Patients and methods

The study group consisted of 25 SSc patients (6 males; 19 females; mean age 54.2±9.7 years; range, 32 to 67 years), 18 female patients with primary Raynaud's phenomenon (PRP) (mean age 47.1±9.5 years; range, 34 to 65 years) and 10 healthy individuals (3 males, 7 females; mean age 52.7±12.6 years; range, 37 to 73 years). NC and ^99mTc-pertechnetate HPS were performed in all examinees. The capillaroscopic findings were classified as normal or scleroderma pattern ("early", "active", or "late"). The fingers-to-palm ratios were calculated for both blood flow (BF) and blood pool (BP) phases of the ^99mTc-pertechnetate HPS.

Results

Systemic sclerosis patients showed a significantly lower BP ratio than PRP patients and healthy subjects (p=0.004). No statistically significant difference was observed between the SSc and PRP patients in respect to BF ratio. A gradual decrease of BF and BP with the severity of NC microangiopathy pattern ("early", "active" or "late") was found in SSc patients, while the differences were not statistically significant. Patients with diffuse SSc showed lower BF and higher BP than those with limited SSc, while these differences were without statistical significance. There was no significant correlation between BF or BP values and type of SSc (limited or diffuse) (p=0.77 versus p=0.54, respectively) as well as three microangiopathy patterns (p=0.22 versus p=0.54, respectively).

Conclusion

^99mTc-pertechnetate HPS improves the evaluation of vascular damage in SSc patients. There is no direct relationship between NC and ^99mTc-pertechnetate HPS; however, the two methods complement each other in the assessment of microcirculation in SSc.

Hybrid Imaging in Evaluation of Abdominal Sarcoidosis

OBJECTIVE

To determine the prevalence of abdominal involvement, distribution pattern and evaluate role of hybrid molecular imaging in patients with abdominal sarcoidosis.

METHODS

Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for the presence of abdominal sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. Follow up FDG PET/CT examination was done 12.3±5.4 months after the baseline.

RESULTS

Abdominal sarcoidosis was present in 31/82 patients with active sarcoidosis. FDG uptake was present in: retroperitoneal lymph nodes (77%), liver (26%), spleen (23%), adrenal gland (3%). Majority of patients had more than two locations of disease. Usually thoracic disease was spread into the extrathoracic localizations, while isolated abdominal sarcoidosis was present in 10% of patients. After first FDG PET/CT examination therapy was changed in all patients. Eleven patients came to the follow up examination where SUVmax significantly decreased in the majority of them. Three patients had total remission, three had absence of abdominal disease but discrete findings in thorax and others had less spread disease. ACE levels did not correlate with SUVmax level.

CONCLUSION

FDG PET/CT can be a useful tool for detection of abdominal sarcoidosis and in the evaluation of therapy response in these patients. Awareness of the presence of intra-abdominal sarcoidosis is important in order to prevent long-standing unrecognized disease.

17β-estradiol inhibits hepatic iNOS via the activation of the estrogen receptor ER-α and inhibition of erk1/2-mir-221 axis

17β-Estradiol (E2) is known to negatively regulate inducible nitric oxide (NO) synthase (iNOS) expression via estrogen receptor alpha (ER-α) activation in aortic vascular smooth muscle cells.Therefore, we sought to determine whether E2 can inhibit iNOS in vivo in hepatic tissue via the activation of ER-α and whether extracellular signal-regulated kinases 1/2 (ERK1/2)-miR-221 axis is involved in this process. Male Wistar rats were treated with a bolus injection of E2 intraperitoneally (40 μg/kg), and 24 hours after treatment the animals were sacrificed and the livers excised. The protein levels of iNOS, p50 and p65 subunits of nuclear factor κB (NFκB), ERα, ERK1/2 and protein kinase B (Akt), as well as the association of ERα/Src in liver lysates were assessed by Western blot. The expression of hepatic miR-221 was analyzed by qRT-PCR. Results show that E2 reduced hepatic iNOS protein expression (p less than 0.01), the protein level of ERα (p less than 0.05), ERK1/2 (p less than 0.05), Akt phosphorylation (p less than 0.001) and miR-221 expression (p less than 0.05). In contrast, hepatic ERα/Src kinase association level (p less than 0.05) increased after E2 treatment. Our results indicate that E2 inhibits hepatic iNOS via molecular mechanisms involving the activation of the ER-α and inhibition of ERK1/2-miR-221 axis.

Mitochondria-targeted dodecyltriphenylphosphonium (C12TPP) combats high-fat-diet-induced obesity in mice

Background:

A membrane-penetrating cation, dodecyltriphenylphosphonium (C₁₂TPP), facilitates the recycling of fatty acids in the artificial lipid membrane and mitochondria. C₁₂TPP can dissipate mitochondrial membrane potential and may affect total energy expenditure and body weight in animals and humans.

Methods:

We investigated the metabolic effects of C₁₂TPP in isolated brown-fat mitochondria, brown adipocyte cultures and mice in vivo. Experimental approaches included the measurement of oxygen consumption, carbon dioxide production, western blotting, magnetic resonance imaging and bomb calorimetry.

Results:

In mice, C₁₂TPP (50 μmol per (day•kg body weight)) in the drinking water significantly reduced body weight (12%, P<0.001) and body fat mass (24%, P<0.001) during the first 7 days of treatment. C₁₂TPP did not affect water palatability and intake or the energy and lipid content in feces. The addition of C₁₂TPP to isolated brown-fat mitochondria resulted in increased oxygen consumption. Three hours of pretreatment with C₁₂TPP also increased oligomycin-insensitive oxygen consumption in brown adipocyte cultures (P<0.01). The effects of C₁₂TPP on mitochondria, cells and mice were independent of uncoupling protein 1 (UCP1). However, C₁₂TPP treatment increased the mitochondrial protein levels in the brown adipose tissue of both wild-type and UCP1-knockout mice. Pair-feeding revealed that one-third of the body weight loss in C₁₂TPP-treated mice was due to reduced food intake. C₁₂TPP treatment elevated the resting metabolic rate (RMR) by up to 18% (P<0.05) compared with pair-fed animals. C₁₂TPP reduced the respiratory exchange ratio, indicating enhanced fatty acid oxidation in mice.

Conclusions:

C₁₂TPP combats diet-induced obesity by reducing food intake, increasing the RMR and enhancing fatty acid oxidation.

Patterns and Universals of Adult Romantic Attachment Across 62 Cultural Regions

As part of the International Sexuality Description Project, a total of 17,804 participants from 62 cultural regions completedthe RelationshipQuestionnaire(RQ), a self-reportmeasure of adult romanticattachment. Correlational analyses within each culture suggested that the Model of Self and the Model of Other scales of the RQ were psychometrically valid within most cultures. Contrary to expectations, the Model of Self and Model of Other dimensions of the RQ did not underlie the four-category model of attachment in the same way across all cultures. Analyses of specific attachment styles revealed that secure romantic attachment was normative in 79% of cultures and that preoccupied romantic attachment was particularly prevalent in East Asian cultures. Finally, the romantic attachment profiles of individual nations were correlated with sociocultural indicators in ways that supported evolutionary theories of romantic attachment and basic human mating strategies.

The diagnostic performance and added value of (18)F-FDG PET/CT in the detection of liver metastases in recurrent colorectal carcinoma patients

OBJECTIVE

The aim of this study was to assess the value of (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT in detection of liver metastases in patients with suspected recurrent colorectal carcinoma, as well as to compare diagnostic performance of (18)F-FDG PET/CT with conventional imaging methods (MDCT).

SUBJECTS AND METHODS

This study included 73 patients with resected primary colorectal adenocarcinoma referred for (18)F-FDG PET/CT to the National PET Center, at the Clinical Center of Serbia, Belgrade, from January 2010 to May 2013, with suspicion of recurrence. The patients underwent (18)F-FDG PET/CT examination on a 64-slice hybrid PET/CT scanner (Biograph, TruePoint64, Siemens Medical Solutions, Inc. USA). Prior to (18)F-FDG PET/CT all patients underwent contrast-enhanced MDCT. Findings of (18)F-FDG PET/CT and MDCT were compared to findings of subsequent histopathological examinations or with results of clinical and imaging follow-up over at least six months. Final diagnosis of liver metastases of colorectal cancer was made either by histopathological examination of specimen after biopsy or surgery, or based on clinical, laboratory and imaging evaluation during first six months after PET/CT scan.

RESULTS

In detection of liver metastases (18)F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 83.3%, 95.3%, 92.6%, 89.1% and 90.4%, respectively. In addition, MDCT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detection of liver metastases of 60%, 88.4%, 78.3%, 76% and 76.7%, respectively. There was significant difference in sensitivity (83.3% vs 60%; P=0.045) between these two methods. In addition, significant difference was observed in accuracy between PET/CT and MDCT (90.4% vs 76.7%; P=0.016). The higher specificity in visualization of liver metastases was also achieved by (18)F-FDG PET/CT compared to MDCT (95.3% vs 88.4%), but this difference was not significant (P=0.37).

CONCLUSION

(18)F-FDG PET/CT was highly sensitive, specific and accurate method in detection of liver metastases in patients with suspected recurrent colorectal carcinoma in our study. This hybrid imaging showed superior diagnostic performance in evaluation of suspected colorectal cancer liver metastases compared to conventional imaging.

Comparison of 18F-FDG PET/CT and MDCT for staging/restaging of non-small cell lung cancer

Multi-detector computed tomography (MDCT) is most commonly used for staging of non-small cell lung cancer (NSCLC). In recent years, 18F- fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) has also been used for the same purpose. Since studies comparing these two methods are scarce, our aim was to determine how the TNM classification and thereby staging of NSCLC compare between 18F-FDG PET/CT and MDCT. 18F-FDG PET/CT and MDCT were collected in 83 patients with NSCLC 3 to 30 days apart (median 17 days). The investigators interpreting 18F-FDG PET/CT were unaware of MDCT results. The Cohen's kappa (κ) was calculated to determine the rate of agreement. The hypothesis was that the strength of agreement between the two methods will be at least moderate (κ>0.40) based on the adopted criteria (κ<0.20 poor; 0.21-0.40 fair; 0.41-0.60 moderate; 0.61-0.80 good; 0.81-1.00 very good agreement). The agreement was moderate for determining the T class (κ=0.45, overall agreement 58%), poor for the N class (κ=0.13, 42%) and fair for the M class (κ=0.22, 58%). The agreement for overall staging of NSCLC was poor (κ=0.20, 45%). The major source of disagreement was that metastases were present more frequently and/or in larger number on 18F-FDG PET/CT than MDCT in the contralateral mediastinal, supraclavicular, and distant lymph nodes, as well as in the bones and suprarenal glands. Since 18F-FDG PET/CT detected more regional and distant metastases than MDCT, we conclude that FDG PET/CT is useful for staging/restaging and planning treatment of patients with NSCLC.

KEYWORDS

Non-small cell lung cancer, positron emission tomography, multidetector computed tomography, metastases detection.

Can (18)F-FDG PET/CT scan change treatment planning and be prognostic in recurrent colorectal carcinoma? A prospective and follow-up study

OBJECTIVE

To prospectively study whether in patients with resected primary colorectal cancer fluorine- 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) examination could diagnose the stage, specify treatment procedure and be prognostic.

SUBJECTS AND METHODS

This prospective study included 75 patients with resected primary colorectal adenocarcinoma referred for (18)F-FDG PET/CT to the National PET Center, at the Clinical Center of Serbia, Belgrade, from January 2010 to May 2013. Findings of (18)F-FDG PET/CT were compared to findings of subsequent histopathological examinations or with results of clinical and imaging follow-up. Patients were followed after PET/CT examination for a mean follow-up time of 16.7±5.9 months.

RESULTS

In the detection of recurrent disease (18)F-FDG PET/CT showed overall sensitivity, specificity, PPV, NPV and accuracy of 96.6%, 82.4%, 94.9%, 87.5% and 93.3%, respectively. In the detection of stages I and II sensitivity, specificity and accuracy of (18)F-FDG PET/CT were: 88%, 96.6% and 94.7%, respectively, and in the detection of stages III and IV sensitivity, specificity and accuracy were 94.9%, 87.5% and 93.3%, respectively. These findings prevented or changed intended surgical treatment in 12/32 cases. Univariate and multivariate Cox proportional regression analyses revealed that metastatic recurrence (stages III and IV) was the only and independent prognostic factor of disease progression during follow-up (P=0.012 and P=0.023, respectively). Although, survival seemed better in patients with local recurrence compared to metastatic recurrent disease, this difference did not reach significance (Log-rank test; P=0.324). In addition, progression-free survival time was significantly longer in patients in whom (18)F-FDG PET/CT scan led to treatment changes (Log-rank test; P=0.037).

CONCLUSION

(18)F-FDG PET/CT was sensitive and accurate for the detection and staging of local and metastatic recurrent colorectal carcinoma, with higher specificity in the detection of local recurrences. The (18)F-FDG PET/CT scan induced treatment changes in 30/75 patients, including 12/32 patients in which surgical treatment was previously planned, and progression free survival time was significantly longer in these patients.

Attitudes Toward Arab Ascendance

Arab nations are decades behind many other previously colonized nations in developing stronger economies, more democratic institutions, and more autonomy and self-government, in part as a result of external interference. The year 2011 brought the potential for greater Arab autonomy through popular uprisings against autocratic governments in Tunisia, Egypt, and Yemen, and through the Palestinian request for state recognition by the United Nations. We examined the psychology of support for Arab ascendancy among adults in 14 nations in the Balkans, the Middle East, Asia, Oceania, Europe, and North America. We predicted and found that people low on social dominance orientation endorsed forming an independent Palestinian state and desired that the Arab uprisings succeed. Rejection of ideologies that legitimize outside interference with Arabs mediated this support. Measures and model results were robust across world regions. We discuss theoretical implications regarding the advent of new ideologies and extending social dominance theory to address international relations.

Social Dominance in Context and in Individuals

We tested the internal reliability and predictive validity of a new 4-item Short Social Dominance Orientation (SSDO) scale among adults in 20 countries, using 15 languages ( N = 2,130). Low scores indicate preferring group inclusion and equality to dominance. As expected, cross-nationally, the lower people were on SSDO, the more they endorsed more women in leadership positions, protecting minorities, and aid to the poor. Multilevel moderation models showed that each effect was stronger in nations where a relevant kind of group power differentiation was more salient. Distributions of SSDO were positively skewed, despite use of an extended response scale; results show rejecting group hierarchy is normative. The short scale is effective. Challenges regarding translations, use of short scales, and intersections between individual and collective levels in social dominance theory are discussed.

The clinical value of scintigraphy of neuroendocrine tumors using (99m)Tc-HYNIC-TOC

PURPOSE

To assess the value of whole body scintigraphy using (99m)Tc-HYNIC-TOC (Tektrotyd) and with single photon emission computerized tomography (SPECT) in the detection of primary and metastatic neuroendocrine tumors (NETs).

METHODS

Thirty patients with different neuroendocrine tumors, mainly gastroenteropancreatic (GEP), were investigated. Whole body scintigraphy was performed 2 h (if necessary 10 min and 24h) after i.v. administration of 740 Mbq (99m)Tc-Tektrotyd, Polatom. In cases of unclear findings obtained by whole body scintigraphy, investigation was followed by SPECT.

RESULTS

From 12 patients with NETs of unknown origin, there were 10 true positive (TP), and 2 false negative (FN) findings. Diagnosis was made with SPECT in 6 patients. From 8 patients with gut carcinoids, there were 4 TP, 2 true negative (TN), one FN, and one false positive (FP) finding. Diagnosis was made with SPECT in 2 patients. From 7 patients with neuroendocrine pancreatic carcinomas there were 4 TP and 3 TN findings. Diagnosis was made with SPECT in 2 patients. From 3 patients with gastrinomas there were 2 TP findings and one TN findings. Diagnosis was made with SPECT findings in 2 patients. Sensitivity of (99m)Tc-HYNIC-TOC was 87%, specificity 86%, positive predictive value 95%, negative predictive value 67% and accuracy 87%.

CONCLUSION

We concluded that scintigraphy with (99m)Tc-Tektrotyd is an useful method for diagnosis, staging and follow up of the patients with NETs.

The utility of two somatostatin analog radiopharmaceuticals in assessment of radiologically indeterminate pulmonary lesions

PURPOSE

The aim of our study was to assess diagnostic accuracy of Tc-99m depreotide and Tc-99m-EDDA/HYNIC-TOC scintigraphy for evaluation of pulmonary lesions that appeared ambiguous on computed tomography (CT).

MATERIAL AND METHODS

Forty-nine consecutive patients (37 men and 12 women; mean age, 60 ± 11 years) with 60 pulmonary lesions on chest radiography and CT were referred for nuclear imaging. They were prospectively allocated to undergo whole-body scintigraphy (WBS) and single photon emission computed tomography (SPECT) using either Tc-99m depreotide (26 patients, group 1) or Tc-99m-EDDA/HYNIC-TOC imaging (23 patients, group 2). Histologic findings after tissue biopsy served as a gold standard for determining diagnostic accuracy of the 2 somatostatin analogs. Visual assessment was complemented by semiquantitative analysis based on target to background ratio.

RESULTS

Among the 32 pulmonary lesions scanned with Tc-99m depreotide, focal uptake was increased in 22 of 25 malignancies, whereas no uptake was found in 6 of 7 benign lesions (88% sensitivity, 85% specificity, and 88% accuracy) on both WBS and SPECT. Imaging of 28 pulmonary lesions with Tc-99m-EDDA/HYNIC-TOC had a similar diagnostic yield (sensitivity 87%, specificity 84%, and accuracy 86%). Overall, target to background ratios were higher on SPECT than WBS but not significantly different between groups 1 and 2 (SPECT 2.72 ± 0.70 vs. 2.71 ± 0.50, WBS 1.61 ± 0.32 vs. 1.62 ± 0.28, respectively).

CONCLUSION

This study demonstrates that Tc-99m depreotide and Tc-99m-EDDA/HYNIC-TOC have similar diagnostic value for characterizing pulmonary lesions that appear ambiguous on CT.

Fear and anger as predictors of motivation for intergroup aggression: Evidence from Serbia and Republika Srpska

We investigated the relationship between emotions of fear and anger and people’s motivation for intergroup aggression within the context of Serbian—Albanian relations in Serbia (Study 1) and Serbian—Bosniak intergroup relations in Bosnia (Study 2). Serbian students in Belgrade and Banja Luka completed a survey that assessed their attitudes towards Albanians or Bosniaks. We found that fear of the outgroup was related to increased motivation for aggression in the context of the ongoing conflict in Serbia, whereas fear was negatively related to aggression in Bosnia, where the conflict had been resolved. The relationships between fear and aggression were significant even after controlling for anger. Furthermore, ingroup affiliation mediated the relationship between fear and aggression in Serbia and between anger and aggression in Bosnia. These findings have implications for conflict resolution efforts in ongoing or intractable conflicts.

Adipose tissue pathways involved in weight loss of cancer cachexia

Background:

The regulatory gene pathways that accompany loss of adipose tissue in cancer cachexia are unknown and were explored using pangenomic transcriptome profiling.

Methods:

Global gene expression profiles of abdominal subcutaneous adipose tissue were studied in gastrointestinal cancer patients with (n=13) or without (n=14) cachexia.

Results:

Cachexia was accompanied by preferential loss of adipose tissue and decreased fat cell volume, but not number. Adipose tissue pathways regulating energy turnover were upregulated, whereas genes in pathways related to cell and tissue structure (cellular adhesion, extracellular matrix and actin cytoskeleton) were downregulated in cachectic patients. Transcriptional response elements for hepatic nuclear factor-4 (HNF4) were overrepresented in the promoters of extracellular matrix and adhesion molecule genes, and adipose HNF4 mRNA was downregulated in cachexia.

Conclusions:

Cancer cachexia is characterised by preferential loss of adipose tissue; muscle mass is less affected. Loss of adipose tissue is secondary to a decrease in adipocyte lipid content and associates with changes in the expression of genes that regulate energy turnover, cytoskeleton and extracellular matrix, which suggest high tissue remodelling. Changes in gene expression in cachexia are reciprocal to those observed in obesity, suggesting that regulation of fat mass at least partly corresponds to two sides of the same coin.

Plasma phospholipase A2 activity in patients with asthma: association with body mass index and cholesterol concentration

BACKGROUND

Secretory phospholipases A2 (sPLA2) have functions relevant to asthmatic inflammation, including eicosanoid synthesis and effects on dendritic cells and T cells. The aim of this study was to measure sPLA2 activity in patients with stable and acute asthma and to assess potential associations with body mass index (BMI), and plasma cholesterol and vitamin C concentrations.

METHODS

Plasma sPLA2 activity and concentrations of cholesterol and vitamin C were measured in 23 control subjects and 61 subjects with stable asthma (42 mild to moderate, 19 severe). In addition, sPLA2 activity was measured in 36 patients experiencing acute asthma and in 22 of these patients after recovery from the acute attack.

RESULTS

sPLA2 activity was not significantly greater in severe (499.9 U; 95% confidence interval (CI) 439.4 to 560.4) compared with mild to moderate asthmatic subjects (464.8; 95% CI 425.3 to 504.3) or control subjects (445.7; 95% CI 392.1 to 499.4), although it was higher in patients with acute asthma (581.6; 95% CI 541.2 to 622.0; p<0.001). Male gender, high plasma cholesterol, increased BMI and atopy were associated with increased sPLA2 activity, while plasma vitamin C was inversely correlated with sPLA2 activity in patients with stable asthma and in control subjects. There were significant interactions between gender and plasma cholesterol and between gender and vitamin C in relation to sPLA2 activity.

CONCLUSIONS

Plasma sPLA2 may provide a biological link between asthma, inflammation, increased BMI, lipid metabolism and antioxidants. Interactions among these factors may be pertinent to the pathophysiology and increasing prevalence of both asthma and obesity.

Topological quantum computing with only one mobile quasiparticle

In a topological quantum computer, universal quantum computation is performed by dragging quasiparticle excitations of certain two dimensional systems around each other to form braids of their world lines in 2 + 1 dimensional space-time. In this Letter we show that any such quantum computation that can be done by braiding n identical quasiparticles can also be done by moving a single quasiparticle around n - 1 other identical quasiparticles whose positions remain fixed.

The Activities of Antioxidant Enzymes and Monoamine Oxidase and Uncoupling Protein 1 Content in Brown Fat of Hypo- and Hyperthyroid Rats

We have studied the activities of antioxidant enzymes (AOE), namely, copper-zinc superoxide dismutase (CuZnSOD), manganese superoxide dismutase (MnSOD), and catalase (CAT), and the activity of catecholamine-degrading enzyme monoamine oxidase (MAO) and uncoupling protein 1 (UCP1) content in brown fat (BF) of hypo- and hyperthyroid rats. We found that hypothyroidism decreased BF UCP1 content and increased MAO, MnSOD, and CAT activities. T3 increased UCP1 content and MnSOD activity and decreased CuZnSOD, MAO, and CAT activities, while T4 significantly altered (decreased) only CAT activity. This study shows that UCP1 content and MAO and AOE activities in rat BF are notably affected by changed thyroid status.

Radioimmunoscintigraphy of colorectal carcinomas with three different radiopharmaceuticals

The aim of the study was evaluation of the clinical reliability of the immunoscintigraphy for the detection of metastases and recurrences of colorectal carcinomas using three different radiopharmaceutical substances. With IMACIS 1, the number of true negative findings (TN) was 4/7 and true positive (TP) 3/7, while in one patient, the results of immunoscintigraphy significantly influenced the therapeutical management. With INDIMACIS 19-9, there were 2/8 TN and 6/8 TP. In three patients, immunoscintigraphy results influenced patient further management. With ONCOSCINT in 2 patients findings were TN, in one FN and in one FP. In 3 patients, immunoscintigraphy influenced the management of the patient. Other imaging methods (CT, US, MRI) have advantage in detection of liver metastases, while immunoscintigraphy is more specific for the assessment of reccurences of the abdominal tumors. Thus immunoscintigraphy should be applied in patients with suggested recurrences and inconclusive outcome of routine diagnostic workup.

Rupestris stem pitting associated virus isolates are composed by mixtures of genomic variants which share a highly conserved coat protein

Broad spectrum primers were used to amplify a fragment comprising the CP gene and putative ORF6 by RT-PCR from ds-RNA templates originating from 46 Portuguese varieties, totalling 190 samples, including some wild Vitis ssp sylvestris vines, and 2 vines from Slovenia. SSCP analysis was used as a preliminary screen to avoid cloning and sequencing very similar variants. Four groups of variants were recognized. In pair wise comparisons between nucleotide sequences the minimal homology found was 81%. In case of the cultivated varieties, no relationship could be seen between the phylogenetic groups and geographic origin or grape variety. Several isolates were found harbouring mixed infections with genomic variants from different groups, but the mixing did not lead to an extensive recombination between them. The deduced amino-acid sequences revealed a conserved CP subjected to strong purifying selection pressure. Analysis of the selection pressure operating on the putative ORF6 suggests that this ORF does not exist. Previously produced polyclonal antiserum raised against the recombinant CP of RSPaV expressed in Escherichia coli was shown to be able to detect all four groups of variants of RSPaV included in this study, which might enable the diagnosis of the virus on a serological basis.

Patterns and universals of mate poaching across 53 nations: the effects of sex, culture, and personality on romantically attracting another person's partner

As part of the International Sexuality Description Project, 16,954 participants from 53 nations were administered an anonymous survey about experiences with romantic attraction. Mate poaching--romantically attracting someone who is already in a relationship--was most common in Southern Europe, South America, Western Europe, and Eastern Europe and was relatively infrequent in Africa, South/Southeast Asia, and East Asia. Evolutionary and social-role hypotheses received empirical support. Men were more likely than women to report having made and succumbed to short-term poaching across all regions, but differences between men and women were often smaller in more gender-egalitarian regions. People who try to steal another's mate possess similar personality traits across all regions, as do those who frequently receive and succumb to the poaching attempts by others. The authors conclude that human mate-poaching experiences are universally linked to sex, culture, and the robust influence of personal dispositions.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

Radioimmunodetection of colorectal carcinoma

BACKGROUND/AIMS

The aim of the study is detection of the recurrences and metastases of colorectal carcinomas using 111In-labeled antibodies B72.3.

METHODOLOGY

Fourteen patients underwent planar immunoscintigraphy and/or tomoscintigraphy.

RESULTS

With tomography in comparison to planar scintigraphy, we can access better distinction of tumor and estimation of its size. Other imaging methods (computed tomography, ultrasonography) have an advantage in detection of liver metastases, while immunoscintigraphy is more specific for the assessment of malignant abdominal tumors and extrahepatic metastases.

CONCLUSIONS

The first results point out that Oncoscint CR-103 can be useful in diagnosis of recurrences and metastases of colorectal carcinoma, viability assessment after radiotherapy and in the choice of the adequate surgical treatment in dependence of the spread of the disease.

Universal sex differences in the desire for sexual variety: tests from 52 nations, 6 continents, and 13 islands

Evolutionary psychologists have hypothesized that men and women possess both long-term and short-term mating strategies, with men's short-term strategy differentially rooted in the desire for sexual variety. In this article, findings from a cross-cultural survey of 16,288 people across 10 major world regions (including North America, South America, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, South/Southeast Asia, and East Asia) demonstrate that sex differences in the desire for sexual variety are culturally universal throughout these world regions. Sex differences were evident regardless of whether mean, median, distributional, or categorical indexes of sexual differentiation were evaluated. Sex differences were evident regardless of the measures used to evaluate them. Among contemporary theories of human mating, pluralistic approaches that hypothesize sex differences in the evolved design of short-term mating provide the most compelling account of these robust empirical findings.

Critical roles of a cyclic AMP responsive element and an E-box in regulation of mouse renin gene expression

Mouse As4.1 cells, obtained after transgene-targeted oncogenesis to induce neoplasia in renal renin expressing cells, express high levels of renin mRNA from their endogenous Ren-1(c) gene. We have previously identified a 242-base pair enhancer (coordinates -2866 to -2625 relative to the CAP site) upstream of the mouse Ren-1(c) gene. This enhancer, in combination with the proximal promoter (-117 to +6), activates transcription nearly 2 orders of magnitude in an orientation independent fashion. To further delimit sequences necessary for transcriptional activation, renin promoter-luciferase reporter gene constructs containing selected regions of the Ren-1(c) enhancer were analyzed after transfection into As4.1 cells. These results demonstrate that several regions are required for full enhancer activity. Sequences from -2699 to -2672, which are critical for the enhancer activity, contain a cyclic AMP responsive element (CRE) and an E-box. Electrophoretic mobility shift assays demonstrated that transcription factors CREB/CREM and USF1/USF2 in As4.1 cell nuclear extracts bind to oligonucleotides containing the Ren-1(c) CRE and E-box, respectively. These two elements are capable of synergistically activating transcription from the Ren-1(c) promoter. Moreover, mutation of either the CRE or E-box results in almost complete loss of enhancer activity, suggesting the critical roles these two elements play in regulating mouse Ren-1(c) gene expression. Although the Ren-1(c) gene contains a CRE, its expression is not induced by cAMP in As4.1 cells. This appears to reflect constitutive activation of protein kinase A in As4.1 cells since treatment with the protein kinase A inhibitor, H-89, caused a significant reduction in Ren-1(c) gene expression and this reduction is mediated through the CRE at -2699 to -2688.

A simple assay for a human serum phospholipase A2 that is associated with high-density lipoproteins

Phospholipase A2 (PLA2) activity is usually assayed with expensive radioactive or chromogenic substrates unsuitable for performing large numbers of assays. We have designed a simple microplate assay for human serum PLA2 using the chromogenic substrate 4-nitro-3-octanoyloxy-benzoic acid. Using this substrate, serum PLA2 activity was similar to that measured with the previously characterized chromogenic phospholipid substrate 1,2-bis-heptanoylthio-glycerophosphocholine. However, the assay described here appears to be more sensitive. The mean PLA2 activity in serum from healthy volunteers (n = 30) measured by this assay was 10.4 +/- 1.6 micromol x h(-1) x ml(-1). The assay is reproducible and is suitable for the analysis of large numbers of samples in a clinical setting. We have also demonstrated that 94% of the PLA2 activity in normal human serum is associated with high-density lipoproteins and that serum PLA2 activity is positively correlated with the lipoprotein parameters total triglyceride (P < 0.0001), total cholesterol (P < 0.0001), and atherogenic index (P = 0.008). The serum PLA2 activity was calcium dependent and was inhibited by the serine protease inhibitor 3,4-dichloroisocoumarin (EC(50) = 0.4 mM). The PLA2 activity characterized here is unlikely to be due to plasma platelet-activating factor acetylhydrolase or low molecular weight His-Asp sPLA2, and may represent a new sPLA2 type.

Downregulation of renin gene expression by interleukin-1

The As4.1 cell line was established from a mouse kidney tumor by transgene-targeted tumorogenesis. These cells express high levels of renin mRNA from their endogenous renin gene and release approximately eightfold-more prorenin than active renin in culture. Levels of renin mRNA in As4.1 cells are decreased in a dose-dependent manner by the addition of physiological concentrations of cytokine interleukin-1 to the media. Stability of renin mRNA and initial rates of release of active renin and prorenin were not significantly altered by interleukin-1. In contrast, transcription initiated from a construct that consisted of 4.1 kilobases of renin 5' flanking sequence fused to a reporter gene (chloramphenicol acetyltransferase) was markedly inhibited by interleukin-1. On the basis of our findings, we conclude that downregulation of renin synthesis caused by interleukin-1 occurs primarily at the level of transcription and that DNA sequence or sequences mediating that effect are positioned within 4.1 kilobases upstream of the renin gene. The physiological relevance of this regulation is related to the events that occur during septic shock, characterized by hypotension, cardiovascular collapse, multiple organ failure, and high mortality. Unexpectedly, hypotension associated with septic shock does not lead to activation of the renin-angiotensin system. The hypotension in septicemia is believed to be mediated by the combined action of many modulators including cytokines, and data presented here suggest direct involvement of interleukin-1 in this process.

Biosynthesis of renin in mouse kidney tumor As4.1 cells

As4.1, a renin-expressing cell line isolated from a mouse renal tumor, was characterized for synthesis, processing, storage and secretion of renin polypeptides. Metabolic labeling, immunoprecipitation and SDS/PAGE analysis revealed that renin was secreted into the culture supernatant predominantly in the form of prorenin which migrated as products of 42-47 kDa. The predominant intracellular renin was processed into two chains, of 33-34 and 5 kDa. N-glycanase treatment removed N-linked oligosaccharides and yielded products of 41 kDa for prorenin and 31-32 kDa for the heavier chain of two-chain renin. The N-terminus of the constitutively secreted prorenin was determined by automated Edman degradation to be Leu22 while the N-terminus of the heavy chain was Ser72. Renin polypeptides constituted 3.1 +/- 1.4% (mean percentage of total precipitable radioactivity +/- SD) of de-novo-synthesized protein secreted into the medium and 0.2 +/- 0.17% retained intracellularly. Extrapolation of renin activity assays suggest that a single cell stores approximately 680 fg of active renin. A slow incremental release into the medium of processed renin heavy chain was detected by immunoprecipitation and SDS/PAGE. Renin activity assays confirmed the release of approximately 4 fg prorenin and 0.32 fg active renin cell(-1) h(-1). Indirect immunofluorescence demonstrated intracellular renin to be distributed in a punctate pattern. Renin was found to be colocalized with the lysosomal marker, beta-glucuronidase, by double-fluorescent labeling. These cells have enabled characterization of glycosylated mouse renin-1 and may prove a valuable tool for studying intracellular trafficing of renin and associated processing enzymes.

Identification of an apo-superoxide dismutase (Cu,Zn) pool in human lymphoblasts

Copper incorporation (64Cu(II)) into Cu,Zn-superoxide dismutase (SOD) was studied in human lymphoblasts. Rapid incorporation of copper with a proportionate increase in SOD activity was detected. No copper incorporation or SOD activation was detected when 64Cu(II) was added to cell cytosols rather than to intact cells. Thus, incorporation of 64Cu was not due to isotopic exchange. Cycloheximide had no significant effect on copper incorporation and activation of SOD when the data were corrected for total cell copper. Thus, the data were consistent with copper incorporation into a preexisting apoSOD pool rather than newly synthesized SOD, and no new SOD synthesis was detected over a 15-h incubation period. The size of the apoSOD pool was estimated to be approximately 35% of the total SOD in lymphoblasts. When cells were preincubated for 15 h with excess copper (15 microM Cu(II)), the size of the apo pool markedly decreased but was not eliminated, suggesting that the apoSOD was not due to copper deficiency. These experiments also indicated that newly arrived copper was preferentially incorporated into the apoSOD pool, while the function(s) of an apoSOD pool remains unknown. Copper binding to apoSOD may provide a rapid protective response against copper toxicity.

Copper incorporation into superoxide dismutase in Menkes lymphoblasts

The incorporation of copper into Cu,Zn-superoxide dismutase (SOD) was examined in Menkes lymphoblasts that express a genetic defect of copper metabolism. SOD activity was approximately 40% higher in Menkes than normal lymphoblasts. Since Menkes lymphoblasts contain elevated copper levels, the higher SOD activity is most likely due to near copper saturation of an apoSOD pool that is in normal lymphoblasts. Cycloheximide markedly inhibited 64Cu(II) incorporation into SOD in Menkes lymphoblasts under conditions in which no significant, de novo synthesis of SOD protein was detected with normal lymphoblasts. The maximal amount of 64Cu incorporation into newly synthesized SOD in Menkes lymphoblasts was approximately equal to the maximal amount of 64Cu that could be incorporated into the apoSOD pool in normal lymphoblasts. The increased synthesis of SOD in Menkes lymphoblasts may play a protective role against copper toxicity in Menkes lymphoblasts. The protonophore, CCCP markedly inhibited 64Cu incorporation into SOD in both normal and Menkes lymphoblasts, which is consistent with 64Cu incorporation into SOD within a membrane-bounded compartment in both cell types. When 64Cu-incorporation into SOD was blocked with CCCP, copper accumulated in a Superose column fraction that contains S-adenosylhomocysteine hydrolase (SAHH), which has a high affinity for copper. SAHH may play a role in delivering copper to SOD.

Role of proximal promoter elements in regulation of renin gene transcription

Mouse As4.1 cells, obtained after transgene-targeted oncogenesis to induce neoplasia in renal renin-expressing cells, express high levels of renin mRNA from the endogenous Ren-1(c) gene. We have used these cells to characterize the role of the Ren-1(c) proximal promoter (+6 to -117) in the regulation of renin gene transcription. It was found that 4.1 kilobases (kb) of Ren-1(c) 5'-flanking sequence, in combination with the proximal promoter, are required for strong activation (approximately 2 orders of magnitude over the basal level of the promoter alone) of the chloramphenicol acetyltransferase reporter in transfection assays. Within the 4.1-kb fragment, a 241-base pair region was identified that retains full activity in an orientation-independent manner in combination with the promoter. The resulting transcripts initiate at the normal renin start site. Electrophoretic mobility shift assays identified a sequence at approximately position -60 in the promoter region that binds nuclear proteins specific for renin-expressing As4.1 cells. Mutations in this sequence, which disrupt binding of nuclear protein(s), completely abolish activation of transcription by the 4. 1-kb fragment. Activation of transcription by the 241-base pair enhancer was still observed, although it was diminished in magnitude (60-fold over the mutated promoter alone). We present a model derived from the current data that suggests that regulation of renin expression is achieved through cooperation of transcription factors binding at the proximal promoter element and a distal enhancer element to abrogate or override the effects of an intervening negative regulatory region.

Identification of a major hepatic copper binding protein as S-adenosylhomocysteine hydrolase

The properties of a mouse liver copper binding protein (CuBP) and human placental S-adenosylhomocysteine hydrolase (SAHH) were compared to test the hypothesis that CuBP is SAHH. CuBP and SAHH migrated identically on SDS-polyacrylamide gel electrophoresis gels, and their 48-kDa monomers both self-associate to tetramers. Human placental SAHH cross-reacted with polyclonal antibodies to mouse liver CuBP, and CuBP from mouse liver cross-reacted with two monoclonal antibodies to human placental SAHH. A third monoclonal antibody to human placenta SAHH reacted weakly with the mouse liver protein but well with CuBP from human lymphoblasts. NAD(+)-activated CuBP has high SAHH enzymatic activity. Moreover, human placental SAHH, like mouse liver CuBP, has a single high affinity copper binding site per 48-kDa subunit. Thus, the data confirm that CuBP is SAHH, and SAHH is proposed to be a bifunctional protein with roles in sulfur-amino acid metabolism and copper metabolism. The copper binding activity of SAHH is proposed to play a significant role in the intracellular distribution of copper, and SAHH enzymatic activity may influence copper metabolism through its role in cysteine biosynthesis from methionine.

[Treatment using Motilium of gastro-esophageal reflux associated with respiratory manifestations in children]

Eighteen children aged 1 month to 12 years 8 months (mean age, 4.9 years) with pH-metry proven gastroesophageal reflux (GOR)-associated chronic respiratory disorders were treated with Motilium, 2 mg/kg/d in four divided doses, for three months. The incidence of each of the respiratory manifestations decreased, and their cumulative score improved significantly at the end of the treatment period. Patient daily self-assessment scores also fell, but not significantly. Twenty-one hour pH recordings showed a significant reduction in the duration of nocturnal episodes below 4 (2.8 +/- 0.9% versus 8.2 +/- 2.6%, p less than 0.05). No side effects were recorded. Domperidone provides satisfactory control of nocturnal GOR and therefore emerges as a valuable agent for the treatment of chronic GOR-associated respiratory disorders in childhood.