Coronary artery fistulas morphology in coronary computed tomography angiography.

BACKGROUND: The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. MATERIALS AND METHODS: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. RESULTS: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. CONCLUSIONS: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Effects of renin-angiotensin system inhibitors on fibrosis in patients with alcoholic chronic pancreatitis.

Chronic pancreatitis (CP) results in impairment of exocrine as well as endocrine functions and progressive fibrosis. Previous studies, have demonstrated the presence of renin-angiotensin system receptors within different pancreatic cells. The aim of the present study was to assess the effects of renin-angiotensin system (RAS) inhibitors on serum levels of fibrosis biomarkers (matrix metalloproteinase 2 and 9 (MMP-2, MMP-9), tissue inhibitor of MMP (TIMP- 1, TIMP-2), hyaluronic acid (HA)) and fasting glucose levels in patients with alcoholic CP. Seventy seven outpatients (mean age 43 years, 62 males) with diagnosed alcoholic CP were randomly enrolled into 5 study groups depending on the RAS inhibitors administered and their doses (2.5 or 5 mg and 12.5 or 25 mg for ramipril or losartan, respectively). Venous blood was sampled monthly for a period of one year to monitor serum drug levels. MMP-2, -9, TIMP-1, TIMP-2 and HA were measured with ELISA method on the onset and at the end of the study. Only forty five patients regularly participated in follow-up visits and completed the study. The fluctuations in serum HA levels observed among patients from the remaining groups also did not reach statistical significance. Serum MMP-2 levels (P = 0.06) and MMP-2/TIMP-1 ratio (P = 0.06) showed increasing tendency in the losartan 25 mg group. High doses of ramipril and losartan statistically significantly reduced fasting glucose levels. High doses of losartan can increase the MMP-2 activity in serum of alcoholic CP patients, which potentially is likely to affect turnover of extracellular matrix proteins within the pancreas. Moreover, high doses of both RAS inhibitors decrease the fasting glucose level.

Persistent trigeminal artery as a rare cause of ischaemic lesion and migraine-like headache.

The persistent trigeminal artery (PTA) is a rare remnant of the embryonic intracranial circulatory system that forms a carotid-vertebrobasilar anastomosis. In most cases PTA does not have clear clinical implications. However, some authors report the association of PTA occurrence with vertigo, dizziness and nerve palsy, resulting in diplopia, strabismus or trigeminal neuralgia in patients. In rare cases it may also be related to posterior cerebral circulation strokes. This work reports the case of a female patient who presented with migraine-like headache and an ischaemic lesion in the left temporal lobe in association with PTA.

CT volume/density ratio as the marker of ischaemic brain injury.

OBJECTIVES: We believe that the CT volume/density ratio (VDR) of infarcted area reflects the degree of brain tissue damage during ischaemic stroke (IS). PATIENTS AND METHODS: Forty six patients with IS were prospectively enrolled into the study. CT scan was performed on days 1 and 10 of hospitalization. S100BB serum level, gelatinase activities (MMP-2 and MMP-9) and neurological examination (NIHSS) were performed on days 1, 5 and 10 of IS. After 3 months, 42 patients were examined by functional disability scales: Barthel index (BI) and modified Rankin scale (mRS). RESULTS: The VDR of ischaemic focus correlated well with the average S100BB serum level, MMP-9 serum activity and NIHSS score. The weak but statistically significant relationships were noticed between the VDR vs BI and mRS estimated 3 months after stroke. CONCLUSION: VDR reflects well the damage ratio of brain tissue during IS. In addition, the study underlines the relationship between VDR vs patients' neurological status and disability after IS.

The effects of hypo- and hyperthyroidism on nuclear, cytosolic, endoplasmic and mitochondrial fractions of sialoglycoproteins in rabbit hepatocytes.

Enhanced sialylation of glycoproteins occurs during hypo- and hyperthyroidism. The role of sialic acid (SA) in cell membranes is well-standing, but its role in intracellular structures is still under analysis. We wanted to evaluate the influence of thyroid hormones on the sialylation ratio of intracellular proteins presented in cytosolic, mitochondrial, endoplasmic and nuclear fractions of rabbit hepatocytes. Twenty-one New Zealand male rabbits were divided into three groups. Hypothyroidism (N = 7) or hyperthyroidism (N = 7) was induced by adding propylthiouracyl (2 mg/l) or L-thyroxine (12 mg/l), respectively, to the drinking water for four weeks. Results were compared with healthy (euthyroid) control animals (N = 7). After isolation of intracellular fractions, standard SDS-PAGE electrophoresis and transfer onto nitrocellulose membrane were performed. Identification of SA residue was carried out with digoxigenin- labelled lectins: Sambucus nigra agglutinin (SNA) and Maackia amurensis agglutinin (MAA). We noticed significantly higher level of SNA than MAA linkage sialoglycoproteins in all evaluated fractions. The sialylation ratio was significantly lower (P < 0.05) in the nuclear fraction in case of hyperthyroidism (detected with both agglutinins). In contrast to the nuclear fraction the content of SNA-detected sialoglycoproteins was significantly reduced in mitochondrial fraction of hyperthyroid hepatocytes (P < 0.05). Non-significant augmentation of MAA-detected sialoglycoproteins was observed in the mitochondrial fractions in both hypo- and hyperthyroidism. The fluctuations of sialoglycoproteins in endoplasmic fraction were not significant. Our work showed that the subcellular structures are rich in SA residues. Differing effects of thyroid hormones on sialylation ratio suggest an important role for hypo- and hyperthyroidism in sialoglycoprotein metabolism.

The effect of interferon beta-1a on MMP-2 and MMP-9 proteolytic activity.

MMP-2 and MMP-9 play a significant role in the development of numerous diseases mainly with the inflammatory pathogenesis. One of the drugs exerting an effect on metalloproteinases is IFN-beta. Previous studies showed that IFN beta-1b can decrease MMP synthesis and moreover inhibit their proteolytic activity. The aim of our study was to analyse the influence of recombinant IFN beta-1a (identical with natural IFN-beta) on MMP-2 and MMP-9 activities. The gelatinolytic activity was evaluated with zymography in sera obtained from 10 healthy donors. After electrophoresis gels were incubated with or without IFN beta-1a (2000 U/ml) for 18 h. We noticed a significant decrease of MMP-2/72 kDa (P = 0.0283) and the augmentation of MMP-9/92 kDa (P = 0.0042) activities after incubation with interferon. The elevation of MMP-9/92 kDa activity suggests that IFN beta-1a can exhibit proinflammatory features besides well-known anti-inflammatory properties.

Astrocytic activation in relation to inflammatory markers during clinical exacerbation of relapsing-remitting multiple sclerosis.

The study aimed to assay the cerebrospinal fluid (CSF) levels of protein S100B, a biomarker of astrocyte activation in relation to kynurenic acid (KYNA) and nitric oxide (NO) metabolites, nitrate/nitrite (NOx) concentrations in acute relapse multiple sclerosis (MS) patients. Twenty relapsing-remitting MS (RR-MS) patients and 10 controls were enrolled. RR-MS patients were assessed on the expanded disability status scale (EDSS) and underwent lumbar puncture. The CSF KYNA, NOx and S100B levels were significantly higher in RR-MS group compared to controls (p = 0.01, 0.001, 0.04, respectively). There was a significant correlation between CSF S100B and KYNA (p = 0.01) but not NOx (p > 0.05) in RR-MS. CSF KYNA, NOx or S100B concentrations did not correlate with disease characteristics of MS patients. Our study suggests the activation of the kynurenine pathway leading to the increase of neuroprotective KYNA in the CSF of MS patients during acute relapse what contrasts with chronic phases of the disease.

Simvastatin could prevent increase of the serum MMP-9/TIMP-1 ratio in acute ischaemic stroke.

MMP-9 plays an important role in the pathogenesis of AIS and predicts haemorrhagic transformation of the ischaemic focus. The aim of our study was to analyse both serum MMP-9 and its most specific endogenous inhibitor (TIMP-1) levels in AIS and to check whether HMG-CoA reductase inhibitor (simvastatin) affects the MMP-9/TIMP-1 ratio value. Fifty patients with AIS were randomly divided into two groups: Group I (N = 25) treated with 40 mg/day with simvastatin within 24 hours after the onset of stroke and Group II (N = 25) non-treated with statin. To evaluate MMP-9 and TIMP-1 serum levels, the ELISA method was used. The serum MMP-9 level was significantly elevated on the 7th day of stroke in both groups (from 668 to 862 ng/ml and 670 to 855 ng/ml, respectively, in Group I and II). The serum TIMP-1 level was also elevated on the 7th day of stroke in both groups but the results were not significant. The MMP-9/TIMP-1 ratio was elevated on the 7th day of stroke in both groups, but the result was significant only in the Group II (P < 0.01). These findings indicate that simvastatin given during 24 hours after the onset of stroke could have an influence on the MMP-9/TIMP-1 ratio during AIS.