Natural history of myocardial fibrosis in dilated cardiomyopathy

Background

It is commonly accepted that myocardial fibrosis (MF) is implicated in the pathology of dilated cardiomyopathy (DCM). However, MF is not a “fixed” abnormality but evolves over time. It is unknown what the natural history of MF is in optimally treated DCM patients.

Methods

This is a prospective, single-center, observational study. Between May 2019 and September 2020, 90 DCM (81 male, mean age 47.2±9.8 years, mean EF 34.5±12.2%) patients underwent cardiac magnetic resonance (CMR). All patients were optimally treated with heart failure approved medications (beta-blockers in 100%, ACE-I/ARNI/ARB – 98%, MRA – 95%). Both, replacement via late gadolinium enhancement (LGE) and interstitial via T1 mapping MF were assessed. Replacement MF was expressed as LGE mass and LGE extent, whereas interstitial MF as extracellular volume (ECV). Left ventricular (LV) matrix and cell volumes were calculated based on LV mass and ECV as: LV matrix volume = (LV mass/1.05 g/mL) × ECV and LV cell volume = (LV mass/1.05 g/mL) × (1 − ECV). After 12 months CMR studies with MF assessment were repeated.

Results

Overall, index LV end-diastolic and end-systolic volumes (LVEDvol, LVESvol) and LV mass significantly decreased, whereas EF increased during follow-up (Table 1). Both, LGE mass (8.7±8.1 vs. 8.6±7.7 g; p=0.6) and LGE extent (4.6±4.2 vs. 4.97±4.6%; p=0.14) were similar between two measurements. There was a trend towards ECV decrease between baseline and follow-up studies but it did not reach statistical significance (28.5±4.9 vs. 27.7±4.1%; p=0.09). LV matrix volume significantly decreased during follow-up (49.1±17.8 vs. 46.1±15.7 ml; p<0.05); however LV cell volume remained unchanged (123.1±35.6 vs. 119.7±39.6 ml; p=0.2).

Conclusions

Beneficial regression of LV volumes and improvement of systolic function is common in DCM over mid-term period (one year). Replacement fibrosis seems to be a “fixed” pathology without much room for improvement. On the other hand, interstitial fibrosis seems to be a subject for substantial change. Left ventricular cells compartment does not change over time. Two types of MF – replacement and interstitial behaved differently during follow-up. Interstitial MF is amenable for treatment, whereas replacement MF does not respond to currently available therapy.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was founded through the National Science Centre, Poland (grant number 2018/29/B/NZ5/02588) and the Department of Scientific Research and Structural Funds of Medical College, Jagiellonian University (grant number K/ZDS/007192)

Can atopy have a protective effect against cancer?

BACKGROUND

An increased prevalence of allergies and an increased incidence of breast cancer have been observed. The hypothesis that atopy may have a protective effect against the risk of different types of breast cancer was evaluated.

METHODS

In this study, 11,101 patients (11,101 women with a mean age of 55.2±14.7 years) with different types of breast cancer were tested for allergies. Allergies were confirmed based on the retrospective analysis of allergy diagnostic procedures in patients who had been previously diagnosed with breast cancer. The retrospective prevalence rates of active allergic diseases, including allergic rhinitis, bronchial asthma and atopic dermatitis, were assessed. All patients were also analyzed for bronchial asthma and allergic rhinitis according to the relevant guidelines. A group of healthy control patients was used for the comparisons.

RESULTS

The women with breast cancer had a significantly lower incidence of IgE-mediated allergic diseases than the controls. The odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.61 (95% CI: 0.57-0.73), 0.17 (95% CI: 0.11-0.44), and 0.73 (95% CI: 0.65-0.83), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of women with breast cancer than in the patients of the control group (39.2 ± 26.2 kU/L vs. 108.5 ± 38.5 kU/L; p = 0.002).

CONCLUSION

Our results suggest that the overall incidence of allergies, especially allergic rhinitis, is lower in patients with certain types of cancer than in individuals who did not have cancer. Further studies are needed to confirm our findings.

The sensitivity and specificity of the forced oscillation technique in the diagnosis of bronchoconstriction in children

OBJECTIVE

The forced oscillation technique (FOT) is a useful diagnostic respiratory system for children. However, the final value of the FOT in the diagnosis of bronchoconstriction is still open. The aim of the study was to evaluate the sensitivity and specificity of the FOT vs. body plethysmography tests in the measure of bronchoconstriction in asthmatic children.

MATERIALS AND METHODS

A total of 102 children aged 2 to 6 years diagnosed with early-onset asthma and 52 healthy controls were included in this prospective, randomized study. All asthmatic patients and healthy controls underwent a basic FOT as one measurement, according to the recommendation of the Resmon Pro FOT. Then, the reversibility test was performed 20 min after the administration of 200 mg salbutamol using the FOT and body plethysmography in all patients.

RESULTS

The mean basic Rrs, Xrs and sRaw in asthmatic patients were, respectively, 11.13 ± 1.28 kPa sL^-1, -4.6 ± 1.18 kPa sL^-1 and 1.72 ± 0.58 kPa s. Similar parameters were significantly better in the control group (p < 0.05). A total of 73 (71.6%) asthmatic patients had a positive test using the FOT according to Calogero. In 4 (7.7%) patients in the control group, a positive test was obtained. In body plethysmography, similar results were reached, with a positive test in 76 (74.5%) study patients and 5 (9.6%) control patients.

CONCLUSIONS

A bronchial reversibility test with the use of the FOT is useful for the diagnosis of bronchial asthma, especially with the use of an Rrs parameter, such as the body plethysmography test.

ACE Insertion/Deletion Polymorphism (rs4646994) Is Associated With the Increased Risk of Multiple Myeloma

Introduction: The insertion (I allele) deletion (D allele) polymorphism of ACE gene (rs4646994) may influence the etiopathogenesis of multiple myeloma (MM). ACE gene is expressed in bone marrow cells and encodes angiotensin converting enzyme (ACE). It converts angiotensin I to active peptide angiotensin II, which stimulates proliferation of hematopoietic stem cells. This suggests possible association of ACE I/D gene polymorphism with MM. The aim of our study was to check possible impact of this polymorphism on risk of development and outcome of MM, as well as, sensitivity to bortezomib in cell cultures derived from MM patients.

Objects and Methods: Genomic DNA from 98 newly diagnosed MM patients and 100 healthy blood donors were analyzed by PCR method. Chromosomal aberrations were detected by use of cIg-FISH. In a subgroup of 40 MM patients nucleated bone marrow cells were treated with bortezomib in vitro.

Results: The Hardy-Weinberg equilibrium test showed that genotypic frequencies diverged significantly from the equilibrium. The differences between I and D allele frequencies in control and study population were significant (p = 0.046). We observed the association between DD genotype and more than 2-fold risk of MM - OR = 2.69; p < 0.0001. We did not detect any significant differences among studied genotypes regarding clinical and laboratory parameters. Moreover, we did not observe the association between survival of MM patients and I/D genotypes. Bortezomib increased number of apoptotic and necrotic cells, but the only statistically significant differences were observed in the number of viable cells at 1 nM between ID and DD genotypes (p = 0.026).

Conclusion: Presented results confirmed the significant relationship between ACE (I/D) polymorphism and risk of MM development. We did not observe the association of ACE I/D polymorphism with disease outcome and bortezomib in vitro sensitivity.

Male gender and age range 20-29 years are the most important non-modifiable risk factors for recurrence after primary post-traumatic shoulder dislocation

PURPOSE

The aim of the study was to identify and analyze non-modifiable risk factors for recurrence after a first-time post-traumatic dislocation of the shoulder in the entire Polish population.

METHODS

The entire Polish population was included in a cohort study. Patients diagnosed with primary post-traumatic dislocation of the shoulder between January 1st, 2010 and December 31st, 2011 were identified and followed up from January 1st, 2010 to December 31st, 2014. Incidence and recurrence rates and odds ratios (OR) were calculated. Demographic data were obtained from Poland's Central Statistical Office. Data on the number of patients with primary post-traumatic shoulder dislocation were drawn from the National Health Fund database.

RESULTS

A total of 21,739 patients (14,466 males and 7273 females) with a primary shoulder dislocation in Poland were identified in 2010 and 2011. There were 3341 (15.4%) recurrences. Increased risk of recurrence was associated with male gender (OR = 1.92, 95% CI 1.76-2.09, p < 10^-10) in the age range of 20-29 years (OR = 2.59, 95% CI 2.38-2.83, p < 10^-10). The highest risk of first-time shoulder dislocation was revealed among females in the age group ≥ 80 years (OR = 24.1, 95% CI 22.6-25.7, p < 10^-10). The risk of recurrence in the same group was significantly decreased (OR = 0.41, 95% CI 0.32-0.51, p < 10^-10).

CONCLUSION

Male gender and age range 20-29 years are highest population risk factors for recurrence after primary shoulder dislocation. Female gender and age ≥ 80 years are highest risk factors for the first-time post-traumatic dislocation of the shoulder joint and protective factors for recurrences after the first-time shoulder dislocation.

LEVEL OF EVIDENCE

III.

The PD-1/PD-L1 Inhibitory Pathway is Altered in Primary Glomerulonephritides

The pathogenesis of primary proliferative and non-proliferative glomerulonephritides (PGN and NPGN) is still not fully understood, however, current evidence suggests that most cases of PGN and NPGN are the results of immunologic response to different etiologic agents that activates various biological processes leading to glomerular inflammation and injury. Programmed cell death protein 1 (PD-1) is the major inhibitory receptor regulating T cell exhaustion. The aim of this study was to evaluate the frequencies of PD-1-positive and PD-ligand 1 (PD-L1)-positive T and B lymphocytes in patients with NPGN and PGN in relation to clinical parameters for the first time. The study included peripheral blood (PB) samples from 20 newly diagnosed PGN and NPGN patients. The control group comprised of 20 healthy age- and sex-matched subjects. The viable PB lymphocytes underwent labelling with fluorochrome-conjugated monoclonal antibodies anti-PD-1 and anti-PD-L1, and were analyzed using a flow cytometer. The frequencies of CD4+/PD1+ T lymphocytes, CD8+/PD1+ T lymphocytes, and CD19+/PD-1+ B lymphocytes in the PGN group exceeded values obtained both in the NPGN group, and the control group. Alteration of PD-1/PD-L1 pathway may be involved in poorer prognosis, as patients with PGN are characterized by higher frequencies of PD-1-positive and PD-L1-positive T and B lymphocytes than patients with NPGN. Our results suggest that deregulation of PD-1/PD-L1 axis may contribute to the PGN and NPGN pathogenesis. High percentages of lymphocytes with PD-1 and PD-L1 expression may be related to the continuous T-cell activation and development of glomerular inflammation and injury.

Five-year prevalence of recurrent shoulder dislocation in the entire Polish population

PURPOSE

The aim of this study was to evaluate five-year prevalence of recurrent shoulder dislocation in the entire Polish population.

METHODS

The study involved the entire Polish population between 01 January 2010 and 31 December 2014. Demographic data were retrieved from the Central Statistical Office of Poland. Data on the number of shoulder joint dislocations were retrieved from the database of the National Health Fund.

RESULTS

We identified 32,253 Polish residents with shoulder instability. About 0.1% of Polish residents suffered from recurrent shoulder dislocation. Males suffered almost two times more often than females (66% and 34%, respectively), and male gender was recognized as a risk factor of instability (OR = 2.07, p <10^-10). Females in their eighth decade of life had the highest risk of recurrent shoulder dislocation (OR = 3.33, p <10^-10). In males the highest risk of recurrences was noted for the third decade of life (OR = 1.78, p <10^-10).

CONCLUSION

The period prevalence rate of recurrent shoulder dislocation in Poland is 83.7 per 100,000 persons per five years. The rate of recurrent shoulder dislocation for the general Polish population is 0.1%. Males suffered from recurrent shoulder dislocation almost twice as frequently as females (OR = 2.07).

Visualization and measurements of flows in micro silicon Y-channels

Velocities and accelerations are measured and visualized in silicon microchannels using particle tracking velocimetry (PTV). Both pulsatile and stationary flows are generated in channels with different geometry. Distinct differences between flow regimes and geometries are shown. Flow separation occurred at Re = 84 for the channel with an expanded bifurcation shown by streamlines from long exposed images. Moving least squares are used to find the ensemble-averaged positions of the measured velocities from tracking. This is needed to find the local and convective accelerations.

[Closed intramedullary stabilization of femoral shaft fractures with Eder's nails]

Forty-one femoral shaft fractures were treated with flexible Ender nails which were introduced through the great trochanter without reaming of the medullary canal. There was one case of intraoperative femoral neck fracture. No wound infection or osteomyelitis occurred. Axial and rotational malalignment was always due to technical errors. All fractures united at an average of 12 weeks. Transverse fractures, short oblique and those with "unicortical" comminution proved to be stable after Ender nailing, while cases with "bicortical" comminution had tendency for bone shortening and often required additional procedures.