Role of Carotid Ultrasonography Combined with Monocyte/HDL Ratio in Internal Carotid Artery Stenosis

BACKGROUND

Carotid duplex ultrasonography (DUS) is the primary screening tool for carotid artery stenosis, but has low reliability. MHR, which is the ratio of monocytes to high-density lipoprotein cholesterol (HDL-C), can be a marker for the degree and distribution of extracranial and intracranial atherosclerotic stenosis.

OBJECTIVE

We determined the diagnostic value of DUS+MHR for internal carotid artery (ICA) stenosis.

METHODS

We divided 273 hospitalized patients into non-stenosis (<50%) and ICA stenosis (≥50%) groups based on Digital Subtraction Angiography (DSA). We determined the peak systolic velocity (PSV) in the ICA on DUS, calculated the MHR, and investigated their relationship with ICA stenosis.

RESULTS

On DSA, 34.1% (93/273) patients had moderate-to-severe ICA stenosis. DUS and DSA showed low concordance for detecting ICA stenosis (kappa = 0.390). With increasing age, the incidence of moderate-to-severe ICA stenosis increased. PSV, monocyte count, and MHR were significantly greater in the stenosis group than in the non-stenosis group (P < 0.001), while the HDL-C level was significantly lower (P = 0.001). PSV (OR: 1.020, 95% CI: 1.011-1.029, P < 0.001) and MHR (OR: 5.662, 95% CI: 1.945-16.482, P = 0.002) were independent risk factors for ICA stenosis. The area under the receiver operating characteristic curve of PSV+MHR (0.819) was significantly higher than that of PSV or MHR alone (77.42% sensitivity, P = 0.0207; 73.89% specificity, P = 0.0032).

CONCLUSION

The combination of ICA PSV on DUS and MHR is better than PSV alone at identifying ICA stenosis and is well-suited to screen high-risk patients.

Rapid detection of porcine sapelovirus by reverse transcription recombinase polymerase amplification assay

BACKGROUND

Porcine Sapelovirus (PSV) infection has been confirmed in pigs worldwide, mostly asymptomatic, but in some cases, it can lead to significant issues in the gastrointestinal, respiratory, neurological, or reproductive systems. PSV is considered an emerging pathogen of porcine species. Recombinase polymerase amplification (RPA) is a simple and fast isothermal technique that uses three enzymes for amplification without the use of any sophisticated equipment.

METHODS AND RESULTS

The reverse transcription recombinase polymerase amplification (RT-RPA) assay was developed and optimized for field based detection of PSV. The assay was developed by targeting 5´UTR region of PSV genome and optimized for reaction time, temperature, primer and MgOAc concentration. The analytical sensitivity and specificity of assay was determined. The assay was evaluated on 85 porcine faecal samples collected from field. In addition to conventional format, this assay was also optimized for visual dye-based detection format and lateral flow strips based detection (in combination with probe). The developed assay works at constant temperature of 35 °C for 20 min with forward primer concentration 20pm, reverse primer concentration 10pm and MgOAc concentration of 14mM. This assay is highly sensitive and detects up to 28 copies of viral nucleic acid both in the conventional as well as in fluorescent dye based detection format. Using the newly developed assay 21 samples out of 85 samples were found positive, showing positivity rate of 24.7%. The positivity rate of RT-RPA assay corroborated with the gold standard RT-PCR test.

CONCLUSIONS

This study presented the development of an RT-RPA isothermal assay for rapid and accurate detection of PSV. The assay is highly sensitive, specific, works at a low and constant temperature, does not require any high-end instrument and can be a potential diagnostics tool for pen-side testing of PSV in the field conditions. The newly developed RT-RPA assay could successfully detect PSV circulating in swine population of Haryana, India. This is a first report of this kind from the region.

Thyroid ultrasound pattern in primary hypothyroidism is similar to Graves' disease: a report of three cases

Ultrasound can identify important characteristics in primary hypothyroidism and diffuse hyperthyroidism (Graves' disease). Therefore, sonologists are actively investigating ultrasound criteria to differentiate between these two conditions. Nevertheless, practice shows the absence of such ultrasonic landmarks. For the first time in the literature, three cases of primary hypothyroidism have demonstrated an ultrasound pattern identical to that of Graves' disease. This pattern includes the presence of goiter, marked total hypoechogenicity of the parenchyma, significantly or moderately increased blood flow intensity ('thyroid inferno'), and elevated peak systolic velocity of the superior thyroid arteries. These signs are less common in hypothyroidism compared to hyperthyroidism. Diagnostic data suggest that the pathogeneses of primary hypothyroidism and Graves' disease share the same mechanisms, leading to similar thyroid ultrasound patterns. One of these shared mechanisms is presumably thyroid overstimulation by the autonomic nervous system, which is adequate to the body's hormonal requirements in hypothyroidism but excessive in hyperthyroidism.

Novel markers of Doppler ultrasonography in the placenta accreta spectrum to predict complications

Objective

Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers.

Material and Methods

This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology.

Results

Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively.

Conclusion

Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers.

Novel markers of doppler ultrasonography in the placenta accreta spectrum to predict complications

Objective

Ultrasonography is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women; however, the lack of a strong criteria protocol in diagnosis and predicting the severity of the consequences facing pregnant women requires novel markers investigation.

Material and Methods

This prospective cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Therefore, 51 pregnant women were involved in the study. Their characteristic information, medical and surgical history, blood loss severity(severe:>=2500 ml), following hysterectomy, and the histopathology after the surgery were collected. Also, the Doppler of right and left uterine arteries, including the pulsatility index(PI), resistance Index(RI), peak systolic velocity(PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler ultrasonography. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS(bleeding, hysterectomy, pathology).

Results

The mean age of the pregnant women was 35.4±4.11 (median:35.00) years. 17(33.3%) of pregnant women had severe Bleeding. The median of bladder PSV, cervix PSV, and left uterine artery for women with severe bleeding were 57.00(34,90), 26.00(0,63), and 89.00(81,135), while there were 33.00(20,64), 18.00(0.76), and 68.00(61,113) for women without severe bleeding (p-value: <0.001, 0.037, 0.045). 34 (66.66%) pregnant women had hysterectomy. Bladder PSV, cervix PSV, and left uterine PSV for women with hysterectomy were 46.00(20,90), 20.00(0,76), and 68.00(61,135) compared to 39.50(33,46), 20.00(14,26), and 82.00(63,101) for women without (p-value=0.005, 0.013, 0.003).

Conclusion

Bladder PSV, cervix PSV, and uterine PSV are significantly higher in pregnant women with PSV, and they can be appropriate markers in diagnosing PAS and predicting its severity. So that healthcare providers could use them to make better clinical decisions.

Composite free gastroepiploic artery graft for off-pump coronary artery bypass grafting with celiac artery or superior mesenteric artery stenosis: A report of two cases

INTRODUCTION

We report two cases of off-pump coronary artery bypass grafting (CABG) with celiac artery (CA) or superior mesenteric artery (SMA) stenosis using skeletonized gastroepiploic artery (GEA) grafts.

PRESENTATION OF CASE

A 77-year-old man (case 1) and a 49-year-old man (case 2) underwent off-pump CABG for unstable angina. Preoperative ultrasonography revealed CA or SMA stenosis; therefore, we chose a free GEA composite with an internal thoracic artery (ITA) graft instead of an in-situ GEA graft. The patients were ultimately discharged uneventfully.

DISCUSSION

GEA graft are remarkably reliable; however, their frequency of use seems to have decreased. In some cases, before GEA harvesting, echocardiogram shows accelerated peak systolic velocity (PSV) in the CA or SMA suggesting vascular stenosis, which prompts relinquishing GEA use. Therefore, free GEA grafts and composite of ITA graft were chosen recently.

CONCLUSION

Free GEA grafts are especially advantageous for patients with peripheral artery disease who are unsuitable for saphenous vein harvesting. Free GEA grafting could be an alternative modality to avoid aortic clamping in patients with severe atherosclerotic lesions. The routine use of echocardiogram to evaluate blood flow in the CA and SMA should be advocated, as it often shows accelerated PSV (greater than 150 cm/s), which suggests vascular stenosis.

Clinical outcomes in patients undergoing invasive mechanical ventilation using NAVA and other ventilation modes - A systematic review and meta-analysis

PURPOSE

Neurally adjusted ventilatory assist mode (NAVA) benefit in mechanical ventilation (MV) patients with regard to clinically outcomes is still uncertain. Recent randomized clinical trials (RCTs) have addressed this issue, making it important to assess the real impact of NAVA in relation to these outcomes.

MATERIALS AND METHODS

We performed a systematic review and meta-analysis of RCTs comparing NAVA ventilation mode versus the standard ventilation mode in critically ill adult patients admitted to the ICU with invasive MV. The main outcome was 28-days ventilatory free-days (VFD). Secondary outcomes were weaning failure, mortality, ICU and hospital length of stay and need for tracheostomy.

RESULTS

We included 5 RCTs (643 patients). The patients in the NAVA group had increased VFDs compared to the control group: mean difference (MD) 3.42 (95% CI 1.21 to 5.62, I² = 0%). NAVA and control groups did not differ in ICU mortality [OR 0.58 (95% CI 0.33 to 1.03), I2 = 41%]. NAVA mode was associated with a reduced incidence of weaning failure [OR 0.51 (95% CI 0.29 to 0.88), I² = 0%]. NAVA and control groups did not differ in the number of MV days: MD -1.9 days (95% CI -4.2 to 0.3, I² = 0%).

CONCLUSIONS

NAVA mode has a modest impact on MV-free days and weaning success, with no association with improvements in other relevant clinical outcomes.

Development and application of a low-priced duplex quantitative PCR assay based on SYBR Green I for the simultaneous detection of porcine deltacoronavirus and porcine sapelovirus

Porcine deltacoronavirus (PDCoV) and porcine sapelovirus (PSV) are two viruses that can cause diarrhoea in pigs and bring great economic loss to the pig industry. In this research, a duplex real-time quantitative polymerase chain reaction (qPCR) assay based on SYBR Green I was developed to simultaneously detect PDCoV and PSV. No specific melting peaks were found in other porcine diarrhoea-associated viruses, indicating that the method developed in this study had good specificity. The detection limits of PDCoV and PSV were 1.0 × 101 copies μl-1 and 1.0 × 102 copies μl-1, respectively. The duplex real-time qPCR assay tested two hundred and three (203) intestinal and faecal samples collected from diarrhoeal and asymptomatic pigs. The positive rates of PDCoV and PSV were 20.2% and 23.2%, respectively. The co-infection rate of PDCoV and PSV was 13.8%. To evaluate the accuracy of the developed method, conventional PCR and singular TaqMan real-time qPCR assays for PDCoV/PSV were also used to detect the samples. The results showed that the duplex real-time qPCR assay was consistent with the singular assays, but its sensitivity was higher than conventional PCR methods. This duplex real-time qPCR assay provides a rapid, sensitive and reliable method in a clinic to simultaneously detect PDCoV and PSV.

Doppler ultrasound peak systolic velocity versus end tidal carbon dioxide during pulse checks in cardiac arrest

BACKGROUND

An accurate, non-invasive measure of return of spontaneous circulation (ROSC) is needed to improve management of cardiac arrest patients.

OBJECTIVES

During a pulse check in Emergency Department (ED) cardiac arrest patients, we compared the correlation between 1) end tidal carbon dioxide (ETCO₂) and systolic blood pressure (SBP), and 2) Doppler ultrasound peak systolic velocity (PSV) and SBP. Additionally, we assessed the accuracy of PSV ≥ 20 cm/sec in comparison to previously suggested ETCO₂ ≥ 20 or ≥ 25 mmHg thresholds to predict ROSC with SBP ≥ 60 mmHg.

METHODS

This was a secondary analysis of a previously published prospective observational study of ED cardiac arrest patients with an advanced airway and femoral arterial line in place. During each pulse check, highest SBP, highest PSV, and ETCO₂ at the end of the pulse check were recorded. Spearman correlation coefficients were calculated and compared using a Fisher Z-transformation. Accuracy of previously determined PSV and ETCO₂ thresholds for detecting ROSC with SBP ≥ 60 mmHg were compared using McNemar's tests.

RESULTS

Based on data from 35 patients with 111 pulse checks, we found a higher correlation between PSV and SBP than ETCO₂ and SBP (0.71 vs 0.31; p < 0.001). Diagnostic accuracy of PSV ≥ 20 cm/sec for detecting ROSC with SBP ≥ 60 mmHg was 89% (95% CI: 82%-94%) versus 59% (95% CI: 49%-68%) and 58% (95% CI: 48%-67%) for ETCO₂ ≥ 20 and ≥ 25 mmHg, respectively.

CONCLUSIONS

During a pulse check, Doppler ultrasound PSV outperformed ETCO₂ for correlation with SBP and accuracy in detecting ROSC with SBP ≥ 60 mmHg.

A randomized controlled trial comparing non-invasive ventilation delivered using neurally adjusted ventilator assist (NAVA) or adaptive support ventilation (ASV) in patients with acute exacerbation of chronic obstructive pulmonary disease

PURPOSE

No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

MATERIALS AND METHODS

In this randomized controlled trial, we compared NAVA-NIV with ASV-NIV for delivering NIV in consecutive subjects with AECOPD. The primary outcome was NIV failure rate (invasive mechanical ventilation). The key secondary outcomes were number of NIV manipulations, asynchrony index, and 90-day mortality.

RESULTS

We enrolled 76 subjects (NAVA-NIV, n = 36, ASV-NIV, n = 40; 74% males) with a mean ± SD age of 61.4 ± 8.2 years. We found no difference in NIV failure rates between the two arms (NAVA-NIV vs. ASV-NIV; 8/36 [22.2%] vs. 8/40 [20%]; p = 0.83). The median physician manipulations for NIV were significantly less in the ASV-NIV arm than in the NAVA-NIV arm (2 [0.8-4] vs. 3 [2-5]; p= 0.014) during the initial 24-h. We found no difference in median asynchrony index (NAVA-NIV vs. ASV-NIV, 16.6% vs. 16.4%, p = 0.5) and 90-day mortality (22.2% vs. 17.5%, p = 0.67).

CONCLUSION

The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality.

TRIAL REGISTRY

www.

CLINICALTRIALS

gov (NCT04414891).

Isolation and characterization of mammalian orthoreoviruses using a cell line resistant to sapelovirus infection

Porcine sapelovirus (PSV) is a causative agent of acute diarrhoea, pneumonia and reproductive disorders in swine. Since PSV infection interrupts the growth of other viruses due to its high replication capability in cell culture, the prevention of PSV replication is a keystone to the isolation of non-PSV agents from PSV-contaminated samples. In the present study, we established the PSV infection-resistant cell line N1380 and isolated three mammalian orthoreoviruses (MRV) strains, sR1521, sR1677 and sR1590, from swine in Taiwan. These Taiwanese isolates induced an extensive cytopathic effect in N1380 cells upon infection. The complete and empty virus particles were purified from the cell culture supernatants. Next-generation sequencing analyses revealed that the complete virus particles contained 10 segments, including 3 large (L1, L2 and L3), 3 medium (M1, M2 and M3) and 4 small (S1, S2, S3 and S4) segments. In contrast, the empty virus particles without genome were non-infectious. Phylogenetic analyses revealed that the Taiwanese strains belong to serotype 2 MRV (MRV2). We established an ELISA for the detection of IgG antibody against MRV2 by using the empty virus particles as the antigen. A total of 540 swine and 95 wild boar serum samples were collected in Japan, and the positive rates were 100% and 52.6%, respectively. These results demonstrated that MRV infection occurred frequently in both swine and wild boar in Japan. We established a cell line that is efficient for the isolation of MRV, and the ELISA based on the naturally occurring empty particles would be of great value for the surveillance of MRV-related diseases.

Detection and Characterization of Porcine Sapelovirus in Italian Pig Farms

Simple Summary

Sapelovirus (PSV) is known to infect pigs asymptomatically but, sporadically, can cause reproductive failure and severe neurologic, enteric, or respiratory signs. Sapelovirus infections have been reported worldwide in pigs. However, information about PSV circulation in Italy is unavailable and rarely investigated across Europe. In this study, we reported the circulation of PSV in three Italian pig farms and added novel information about evolutionary heterogeneity of PSV strains showing a low genetic correlation with the other strains detected worldwide. The present study gives information about PSV circulation in intensive pig farms and highlights the need for further investigation.

Abstract

Porcine sapelovirus (PSV) belongs to the genus Sapelovirus of the family Picornaviridae. PSV infects pigs asymptomatically, but it can also cause severe neurologic, enteric, and respiratory symptoms or reproductive failure. Sapelovirus infections have been reported worldwide in pigs. The objective of this study was to investigate the presence and the prevalence of PSV in Italian swine farms in animals of different ages to clarify the occurrence of the infection and the genetic characteristics of circulating strains. In the present study, 92 pools of fecal samples, collected from pigs across three farms, were analyzed by Reverse Transcriptase-polymerase Chain Reaction-PCR (RT-PCR). Fecal pools from young growers (63/64) were found positive for Sapelovirus in all farms while detection in sows (4/28) was observed in only one farm. Phylogenetic analyses of the 19 partial capsid protein nucleotide sequences (VP1) (6–7 each farm) enable the classification of the virus sequences into three distinct clades and highlighted the high heterogeneity within one farm. The whole genome sequence obtained from one strain showed the highest correlation with the Italian strain detected in 2015. The study adds novel information about the circulation and heterogeneity of PSV strains in Italy and considering the movement of pigs across Europe would also be informative for other countries.

Development of a Taqman-based real-time PCR assay for detection of porcine sapelovirus infection in pigs

The objective of the present study was to develop a rapid, simple, specific and sensitive Taqman-based real-time PCR assay for porcine sapelovirus (PSV) detection. Specific primers and probe were designed from the five untranslated regions (UTRs) of the viral genome. The detection limit of the real-time PCR was 10² copies. The specificity of the Taqman real-time PCR assay was evaluated using other animal viruses and nuclease free water as a negative control. Strong fluorescent signals were obtained only in the detection of PSV real-time PCR and conventional RT-PCR were preformed simultaneously on 90 faecal samples. Based on conventional RT-PCR study 17.7% (16/90) of the faecal samples were positive for PSV. Whereas 21 of 90 samples (23.3%) were positive by real-time RT-PCR. The results showed that real-time PCR was more sensitive than the conventional RT-PCR assay. In conclusion, the Taqman real-time PCR assay for detection of PSV developed, herein, is sensitive, specific, and reliable. This assay will be useful for clinical diagnosis, epidemiological, and pathogenesis studies.

Fetal middle cerebral artery Doppler to time intrauterine transfusion in red-cell alloimmunization: a randomized trial

OBJECTIVES

To evaluate whether Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) for timing subsequent intrauterine transfusions (IUTs) in fetuses that had undergone one IUT for anemia secondary to red-cell alloimmunization is non-inferior to timing based on expected decrease in fetal hematocrit (Hct) or fetal hemoglobin level, without compromising infant hemoglobin at birth.

METHODS

This was an international, pragmatic multicenter randomized controlled trial. Women with a pregnancy complicated by fetal anemia secondary to red-cell alloimmunization (due to any antibody alone or in combination), as indicated by the need to undergo a single IUT, were eligible for inclusion. Women were randomized to the determination of timing of further transfusion(s) by Doppler measurement of MCA-PSV (MCA-PSV Group), with a serial upward trend of values >1.5 multiples of the median considered indicative of the need for another IUT, or timing of transfusion by a decrease in fetal Hct (fetal Hct Group), with subsequent IUTs timed according to an estimated fall in fetal Hct of 1% per day or fetal hemoglobin of 0.3 g/dL per day, to maintain fetal hemoglobin level between 7 and 10 g/dL. The primary outcome was infant hemoglobin level measured at birth.

RESULTS

A total of 71 women were randomized, 36 to the MCA-PSV Group and 35 to the fetal Hct Group. Median gestational age at randomization was 30.3 weeks, the majority of women were Caucasian and non-smokers, 9.9% of women had Kell alloimmunization, and 14% of fetuses were hydropic at their first IUT. No statistically significant differences between the two treatment groups were observed with regard to mean hemoglobin levels at birth (MCA-PSV Group, 10.36 ± 3.82 g/dL vs fetal Hct Group, 12.03 ± 3.14 g/dL; adjusted mean difference -1.56 g/dL (95% CI, -3.24 to 0.13 g/dL); P = 0.070), or the number of IUTs performed after randomization (MCA-PSV Group, 1.75 ± 1.79 vs fetal Hct Group 1.80 ± 1.32; adjusted relative risk 0.88 (95% CI, 0.61-1.26); P = 0.474). There was no statistically significant difference between the two groups with respect to the risk of adverse infant outcomes related to alloimmunization or procedure-related complications.

CONCLUSION

Both Doppler measurement of MCA-PSV and estimation of the decrease in fetal Hct or hemoglobin can be used to determine the timing of second and subsequent IUTs in fetuses with red-cell alloimmunization. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist

We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg^-1·min^-1) during both PSV and NAVA. We measured the patient's (Ti/Ttot_neu) and ventilator (Ti/Ttot_mec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delay_trinsp) and expiratory (Delay_trexp) trigger delays and the Asynchrony Index (AI). Increasing doses of remifentanil did not modify EAdi, regardless the ventilatory mode. In comparison to baseline, remifentanil infusion >0.05μg/Kg^-1/min^-1 produced a significant reduction of Ti/Ttot_neu and Ti/Ttot_mec, by prolonging the expiratory time. Delay_trinsp and Delay_trexp were significantly shorter in NAVA, respect to PSV. AI was not influenced by the different doses of remifentanil, but it was significantly lower during NAVA, compared to PSV. In conclusion remifentanil did not affect the respiratory drive, but only respiratory timing, without differences between modes.

Effects of programmed kinesiologic stimulus to hemodynamics at peripheral artery disease of lower limbs

Goal:

The goal of the article is to examine level of hemodynamic improvement in the peripheral artery diseases of lower limbs among patients on medication therapy and patients included in programmed physical activities simultaneously with the medication therapy.

Material and methods:

Prospective-retrospective study includes 100 patients of the Clinic for Vascular Disease, Clinical Center of Sarjevo University (CCUS). It has been found out that the majority of patients in both groups were males. Average age of patients in control group was 48.60±3.82. Average value of claudication distance for patients in control group was 277 m, while the value for patients in test group was 270 m.

Results:

At the end of research the analysis of average PSV values proved significant difference in relation to examined groups (p<0.05). Average PSV value statistically significantly decreased in both groups after the treatment. According to the obtained results it was determined that the claudication distance of control group was statistically considerably smaller in comparison to the average claudication distance in the test group.

Conclusion:

It was established that the chance for the patients to have claudication distance within reference values is 2.57 times higher in the test group in comparison with the patients in the control group after the treatment.

Live Cell Imaging During Germination Reveals Dynamic Tubular Structures Derived from Protein Storage Vacuoles of Barley Aleurone Cells

The germination of cereal seeds is a rapid developmental process in which the endomembrane system undergoes a series of dynamic morphological changes to mobilize storage compounds. The changing ultrastructure of protein storage vacuoles (PSVs) in the cells of the aleurone layer has been investigated in the past, but generally this involved inferences drawn from static pictures representing different developmental stages. We used live cell imaging in transgenic barley plants expressing a TIP3-GFP fusion protein as a fluorescent PSV marker to follow in real time the spatially and temporally regulated remodeling and reshaping of PSVs during germination. During late-stage germination, we observed thin, tubular structures extending from PSVs in an actin-dependent manner. No extensions were detected following the disruption of actin microfilaments, while microtubules did not appear to be involved in the process. The previously-undetected tubular PSV structures were characterized by complex movements, fusion events and a dynamic morphology. Their function during germination remains unknown, but might be related to the transport of solutes and metabolites.

A pilot study on peak systolic velocity monitoring of fetal anemia after administration of chemotherapy during pregnancy

OBJECTIVES

To monitor fetal anemia during administration of chemotherapy to the fetus's mother.

STUDY DESIGN

Between 2007 and 2012 six patients with malignancy diagnosed during pregnancy were included in our prospective study. For evaluation of fetal anemia, peak systolic velocimetry (PSV) of the middle cerebral artery is considered the best method. The patients were repeatedly examined one day before and on the third day after the administration of chemotherapy. At least three measurements were performed and the highest value was used as appropriate. Multiples of the median (MoM) were calculated using the website http://www.perinatology.com/calculators/MCA.htm. When the MoM reached 1.29, moderate anemia was diagnosed.

RESULTS

The women's average age was 30 years. The average gestational age at diagnosis was 20.7 weeks of pregnancy. Borderline fetal anemia was detected in only in one patient. After delivery newborns were examined by standard pediatric evaluation and blood count was provided. There was no evidence of any newborn anemia.

CONCLUSIONS

Chemotherapy administered during pregnancy is becoming more frequent due to increasing knowledge and data on such cases. Close monitoring of the fetus should be performed in specialized centers. For detection of chemotherapy-induced anemia, PSV measurement should be employed.

OsVPS9A functions cooperatively with OsRAB5A to regulate post-Golgi dense vesicle-mediated storage protein trafficking to the protein storage vacuole in rice endosperm cells

In the rice endosperm cells, glutelins are synthesized on rough endoplasmic reticulum as proglutelins and are sorted to the protein storage vacuoles (PSVs) called protein body IIs (PBIIs), where they are converted to the mature forms. Dense vesicle (DV)-mediated trafficking of proglutelins in rice seeds has been proposed, but the post-Golgi control of this process is largely unknown. Whether DV can fuse directly with PSV is another matter of debate. In this study, we propose a regulatory mechanism underlying DV-mediated, post-Golgi proglutelin trafficking to PBII (PSV). gpa2, a loss-of-function mutant of OsVPS9A, which encodes a GEF of OsRAB5A, accumulated uncleaved proglutelins. Proglutelins were mis-targeted to the paramural bodies and to the apoplast along the cell wall in the form of DVs, which led to a concomitant reduction in PBII size. Previously reported gpa1, mutated in OsRab5a, has a similar phenotype, while gpa1gpa2 double mutant exacerbated the conditions. In addition, OsVPS9A interacted with OsRAB5A in vitro and in vivo. We concluded that OsVPS9A and OsRAB5A may work together and play a regulatory role in DV-mediated post-Golgi proglutelin trafficking to PBII (PSV). The evidence that DVs might fuse directly to PBII (PSV) to deliver cargos is also presented.

An evaluation of thyrotoxic autoimmune thyroiditis patients with triplex Doppler ultrasonography

OBJECTIVE

This study aimed to investigate the usefulness of blood flow parameters obtained from STA and CCA with Triplex Doppler ultrasonography (TDU) on patients with thyrotoxicosis.

MATERIALS AND METHODS

This cross-sectional study included consecutive 24 patients with thyrotoxicosis and 18 healthy controls. The thyroid gland blood flow parameters were evaluated with TDU.

RESULTS

The thyroid volumes and FT3, TRAb, 4-h and 24-h radioactive iodine uptake (RAIU) levels of Group 1 were significantly high compared to those of Group 2. The thyroid volumes and FT3, FT4 and TSH levels of both Group 1 and Group 2 showed a statistically significant difference compared to Group 3. STA-PSV values for Group 1, Group 2 and Group 3 were 138 cm/s, 54 cm/s and 37 cm/s, respectively. STA-EDV values for these groups were 60 cm/s, 25 cm/s and 15 cm/s, respectively. PSVR values for these groups were 1.01, 0.45, 0.34 cm/s, respectively. EDVR values for these groups were 1.29, 0.70 and 0.49 cm/s, respectively. In Group 1, STA-PSV, STA-EDV, PSVR and EDVR values were significantly high compared to those of Group 2. RAIU levels showed a significant positive correlation with the STA-PSV, STA-EDV and PSVR.

CONCLUSION

The thyroid gland blood flow parameters may be used in clinical diagnosis of patients with thyrotoxicosis.

Expression of the calcium binding proteins Necab-1,-2 and -3 in the adult mouse hippocampus and dentate gyrus

The family of EF-hand calcium binding proteins is composed of more than 250 members. In search for other neuronal markers, we studied the expression pattern of Necab-1, -2 and -3 in the Ammons horn of adult mice at the gene- and protein levels using in-situ hybridization and immunohistochemistry. The genes for the three Necab's were expressed in specific, non-overlapping areas of the hippocampus. A minority of the Necab-positive interneurons were GABA-ergic, and they virtually never coexpressed one of the classical calcium binding proteins (calretinin, calbindin D-28k and parvalbumin). Necab's are promising new neuronal markers in the brain.

How can plant virus satellite RNAs alter the effects of plant virus infection? A study of the changes in the Nicotiana benthamiana proteome after infection by peanut stunt virus in the presence or absence of its satellite RNA

Peanut stunt virus (PSV), which belongs to the Cucumovirus genus, is a pathogen of legumes. Certain PSV strains associated with a satellite RNA (satRNA) modify the symptoms of infected plants and interfere with plant metabolism. We used PSV-P genomic transcripts (GTs) with and without PSV-P satRNA and a comparative proteomic 2D-DIGE/MS study to assess their effects on Nicotiana benthamiana infection. When the proteomes of the PSV-P genomic transcripts-infected (no satRNA present) and mock-inoculated plants were compared 29 differentially regulated proteins were found. When comparisons were made for plants infected with PSV-P-GT in the presence or absence of satRNA, and for mock-infected plants and those infected with the satRNA-associated PSV-P-GT, 40 and 60 such proteins, respectively, were found. The presence of satRNA mostly decreased the amounts of the affected host proteins. Proteins involved in photosynthesis and carbohydrate metabolism, for example ferredoxin-NADP-reductase and malate dehydrogenase, are among the identified affected proteins in all comparisons. Proteins involved in protein synthesis and degradation were also affected. Such proteins include chaperonin 60β--whose abundance of the proteins changed for all comparisons--and aminopeptidase that is a satRNA- or PSV-P-GT/satRNA-responsive protein. Additionally, the levels of the stress-related proteins superoxide dismutase and acidic endochitinase Q increased in the PSV-P-GT- and PSV-P-GT/satRNA-infected plants. This study appears to be the first report on plant proteome changes in response to a satRNA presence during viral infection and, as such, may provide a reference for future studies concerning the influence of satRNAs during viral infections.

Parotid perfusion in nasopharyngeal carcinoma patients in early-to-intermediate stage after low-dose intensity-modulated radiotherapy: evaluated by fat-saturated dynamic contrast-enhanced magnetic resonance imaging

PURPOSE

To investigate parotid perfusion in early-to-intermediate stage after parotid-sparing radiation dose using fat-saturated DCE-MRI, and to verify whether the perfusion alteration was related to radiation dose and the PSV.

METHODS AND MATERIALS

Thirty-two parotid glands from 16 consecutive patients with pathologically proven nasopharyngeal carcinoma treated by IMRT were examined. The parotid glands received a radiation dose of 28.9±3.9Gy with a PSV of 43.1%±13.9%. Perfusion parameters were calculated using time-shifted Brix model from fat-saturated DCE-MRI data before (pre-RT) and in early-to-intermediate stage after (post-RT) IMRT. Paired t-test was used to evaluate perfusion changes, while Pearson's correlation test was used to examine perfusion dependency on radiation dose and PSV. For multiple comparisons Bonferroni correction was applied.

RESULTS

Successful fat saturation was achieved in 29 of 32 parotid glands. Compared with pre-RT, the post-RT parotid glands showed significantly higher A, peak enhancement, and wash-in slope, plus a lower Kel, suggesting a mixed effect of increased vascular permeability and acinar loss. Linear regression showed that peak enhancement was positively associated with radiation dose in post-RT parotid glands. Kel and slope were negatively associated with PSV, while time-to-peak was positively associated with PSV significantly.

CONCLUSIONS

Our results suggest that time-shifted Brix model is feasible for quantifying parotid perfusion using DCE-MRI. The perfusion alterations in early-to-intermediate stage after IMRT might be related to a mixed effect of increased vascular permeability and acinar loss with dose and PSV dependencies.

Increasing the production yield of recombinant protein in transgenic seeds by expanding the deposition space within the intracellular compartment

Seeds must maintain a constant level of nitrogen in order to germinate. When recombinant proteins are produced while endogenous seed protein expression is suppressed, the production levels of the foreign proteins increase to compensate for the decreased synthesis of endogenous proteins. Thus, exchanging the production of endogenous seed proteins for that of foreign proteins is a promising approach to increase the yield of foreign recombinant proteins. Providing a space for the deposition of recombinant protein in the intracellular compartment is critical, at this would lessen any competition in this region between the endogenous seed proteins and the introduced foreign protein. The production yields of several recombinant proteins have been greatly increased by this strategy.