Progressive Changes in Brain Regional Homogeneity Induced by Electroconvulsive Therapy Among Patients With Schizophrenia.

OBJECTIVES: Electroconvulsive therapy (ECT) has significant effects on improving psychotic symptoms in schizophrenia (SZ), but the changes of brain function induced by it are unclear. The purpose of the study was to explore progressive ECT-induced changes in regional homogeneity (ReHo) at multiple time points before, during, and after a course of ECT. METHODS: The 27 in-patients with SZ (SZ group) who met the recruitment criteria accepted clinical evaluations and resting-state functional magnetic resonance imaging scans before the first ECT (pre-ECT), after the first ECT (ECT1), and after the eighth ECT (ECT8), all conducted within 10 to 12 hours. Forty-three healthy controls (HCs; HC group) who matched well with the patients for age, sex, and years of education were recruited. For Positive and Negative Syndrome Scale (PANSS) and ReHo, progressive changes were examined. RESULTS: Pair-wise comparisons of patient pre-ECT, ECT1, and ECT8 ReHo values with HC ReHo values revealed that ECT normalized the ReHo values in bilateral superior occipital gyrus (SOG), right lingual gyrus (LG), left medial prefrontal cortex. Furthermore, improved ReHo in bilateral SOG and right LG appeared after the first ECT application. The ReHo values in right middle occipital gyrus, right middle temporal gyrus, and right inferior parietal lobule were not significantly altered by ECT. The total PANSS score was lower even after the first ECT application (mean ΔPANSSECT1, 11.7%; range, 2%-32.8%) and markedly reduced after the eighth application (mean ΔPANSSECT8, 86.3%; range, 72.5%-97.9%). CONCLUSIONS: The antipsychotic effects of ECT may be achieved through regulating synchronization of some regions such as bilateral SOG, right LG, and left medial prefrontal cortex. Furthermore, the enhanced synchronizations also take place in other regions.

Factors influencing fire accidents in urban complexes: a combined DEMATEL and ISM study.

Fire outbreaks in urban complexes are a major safety concern worldwide. Therefore, this study aims to examine the critical factors that influence fire accidents and their interaction mechanisms in urban settings. A (software factors, hardware factors, environmental factors, parties and other factors, SHEL) model is developed to identify 15 risk factors in four categories affecting fire incidents in urban complexes. The Decision-making Trial and Evaluation Laboratory method (DEMATEL) and Interpretive Structural Modeling (ISM) are employed to identify the key factors and their interrelationships, using the evaluation metrics of degree of influence, affected degree, centrality, and hierarchical structure. The results show that lack of safety management rules and regulations (S13), poor security awareness (S1), and uncorrected hidden dangers (S11) are the top three critical factors. Based on the hierarchical structure and centrality values, eight critical paths with the highest impact on fires are identified; for instance, Path 39 (comprising, lack of safety management rules and regulations (S13) → lack of fire training and drills (S12) → insufficient security knowledge (S2) → poor security awareness (S1) → poor sense of security responsibility (S3) → uncorrected hidden danger (S11) → inadequate maintenance of fire-fighting facilities (S14) → Accident), which, among all disaster impact paths, has the highest centrality value of 21.8796 (out of a total of 15 factors and total centrality value of 42.9226; Path 39 involves seven factors, but its centrality value accounts for 50.97% of the total). Finally, based on the factor analysis results, suggestions for fire control measures are provided to prevent fire accidents and ensure the safety of people and property.

Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African Americans with HIV infection.

BACKGROUND: Growing evidence suggests that vitamin D deficiency Is associated with clinical coronary artery disease (CAD). The relationship between vitamin D deficiency and subclinical CAD in HIV-infected individuals is not well-characterized. METHODS: Computed tomographic (CT) coronary angiography was performed using contrast-enhanced 64-slice multidetector CT imaging, and vitamin D levels and the presence of traditional and novel risk factor for CAD were obtained in 674 HIV-infected African American (AA) participants aged 25-54 years in Baltimore, MD, without symptoms/clinical evidence of CAD. RESULTS: The prevalence of vitamin D deficiency (25-hydroxy vitamin D <10 ng/mL) was 20.0% (95% confidence interval [CI], 16.9-23.1). Significant (≥50%) coronary stenosis was present in 64 (9.5%) of 674 participants. Multiple logistic regression analysis revealed that male gender (adjusted odds ratio [OR], 2.19; 95% CI, 1.17-4.10), diastolic BP ≥85 mmHg (adjusted OR: 1.94, 95% CI: 1.02 -3.68), low-density lipoprotein cholesterol ≥100 mg/dL (adjusted OR, 1.95; 95% CI, 1.13-3.36), cocaine use for ≥15 years (adjusted OR, 1.77; 95% CI, 1.01-3.10), use of antiretroviral therapies for ≥6 months (adjusted OR, 2.26; 95% CI, 1.17-4.36), year of enrollment after 2005 (adjusted ORs for 2006-2007, 2008-2009, and 2010 were 0.32 [95% CI, 0.13-0.76], 0.26 [95% CI, 0.12-0.56], and 0.32 (95% CI, 0.15-0.65], respectively), and vitamin D deficiency (adjusted OR, 2.28; 95% CI, 1.23-4.21) were independently associated with significant coronary stenosis. CONCLUSIONS: Both vitamin D deficiency and silent CAD are prevalent in HIV-infected AAs. In addition to management of traditional CAD risk factors and substance abuse, vitamin D deficiency should be evaluated in HIV-infected AAs. These data support the conduct of a prospective trial of vitamin D in this high-risk patient population.

Evaluating the Environmental Impact of Construction within the Industrialized Building Process: A Monetization and Building Information Modelling Approach.

Industrialization has been widely regarded as a sustainable construction method in terms of its environmental friendliness. However, existing studies mainly consider the single impact of greenhouse gas emissions or material consumption in the construction process of industrialized buildings, and pay less attention to ecological pollution and community interest, which leads to an insufficient understanding. There is an urgent need to systematically carry out accurate assessment of comprehensive construction environmental impact within industrialized building processes. Various methods, including face-to-face interviews, field research and building information modeling (BIM), were used for data collection. Four categories selected for the study included resource consumption, material loss, ecological pollution, and community interest. A life cycle assessment (LCA) model, namely input-process-output model (IPO), is proposed to analyze the construction environmental impact of the standard layer of industrialized buildings from four life cycle stages, namely, transportation, stacking, assembly and cast-in-place. The monetization approach of willingness to pay (WTP) was applied to make a quantitative comparison. Results reveal that the assembly stage has the largest impact on the environment at 66.13% among the four life cycle stages, followed by transportation at 16.39%, stacking at 10.29%, and cast-in-place at 7.19%. The key factors include power consumption, noise pollution, material loss, fuel consumption and component loss, which altogether account for more than 85% of the total impact. Relevant stakeholders can conduct their project using the same approach to determine the construction environmental performance and hence introduce appropriate measures to mitigate the environmental burden.

Long-term cocaine use and antiretroviral therapy are associated with silent coronary artery disease in African Americans with HIV infection who have no cardiovascular symptoms.

BACKGROUND: Long-term use of cocaine (⩾15 years) and antiretroviral therapy (ART) have been implicated in cardiovascular complications. Nevertheless, the individual and combined effects of ART and cocaine use on silent coronary artery disease have not been fully investigated.Methods: Computed tomography coronary angiography was performed for 165 human immunodeficiency virus (HIV)­ infected African American study participants aged 25­54 years in Baltimore, Maryland, with contrast-enhanced 64-slice multidetector computed tomography imaging.Result: Significant (⩾50%) coronary stenosis was detected in 24 (15%) of 165 participants. The prevalence of significant stenosis among those who had used cocaine for ⩾15 years and had received ART for ⩾6 months was 42%. Exact logistic regression analysis revealed that long-term cocaine use(adjusted odds ratio, 7.75; 95% confidence interval, 2.26­31.2) and exposure to ART for ⩾6 months(adjusted odds ratio, 4.35; 95% confidence interval, 1.30­16.4) were independently associated with the presence of significant coronary stenosis. In addition, after controlling for confounding factors,both stavudine use for ⩾6 months or combivir use for ⩾6 months were independently associated with the presence of significant coronary stenosis.Conclusions: Long-term exposure to ART may be associated with silent coronary artery disease;however, the magnitude of increased risk associated with ART was much lower than the risk associated with cocaine use or traditional risk factors. Cardiovascular monitoring and aggressive modification of cardiovascular risk factors are essential for reducing the risk of coronary artery disease in HIV-infected individuals. Extensive efforts should also be made to develop effective cocaine use cessation programs for HIV-infected cocaine users.

Effect of long-term cocaine use on regional left ventricular function as determined by magnetic resonance imaging.

This study examined left ventricular (LV) regional midwall circumferential strain by cardiac tagged magnetic resonance imaging in 32 long-term cocaine users and 14 nonusers. Most of the LV segmentations in the cocaine users had less average circumferential strain in the systolic and diastolic phases. The average diastolic strain in 5 ventricular segmentations was significantly less in the cocaine users (p<0.05). In conclusion, long-term cocaine use may be associated with regional LV dysfunction, especially diastolic dysfunction.

Human immunodeficiency virus 1 infection, cocaine, and coronary calcification.

BACKGROUND: Although cocaine use and human immunodeficiency virus (HIV) infection have been linked with clinical cardiovascular disease, the effects of cocaine use and HIV infection, especially the combination of the 2, on subclinical disease have rarely been reported. The objective of this study was to evaluate whether cocaine use alone, HIV infection alone, or a combination of the 2 is associated with coronary calcification, a marker of subclinical atherosclerosis. METHODS: Between May 20, 2000, and March 31, 2003, 224 black study participants from Baltimore were enrolled in an observational study of subclinical atherosclerosis as related to HIV and cocaine use. Interviews about sociodemographic characteristics and drug use behaviors, clinical examinations, echocardiographic examinations, lipid profiles, high-sensitivity C-reactive protein tests, and computed tomographic scans for coronary calcium were performed. Although the overall investigation is a cohort study, the data presented herein are cross sectional only. RESULTS: The highest proportion (37.6%) of presence of coronary calcification was in the HIV-positive and cocaine-positive group, followed by 29.8% in the HIV-negative and cocaine-positive group, 28.6% in the HIV-positive and cocaine-negative group, and 18.8% in the HIV-negative and cocaine-negative group. Univariate analysis showed that HIV, cocaine use, and both were associated with a higher number of lesions, calcified area, volume, and calcium score. In multiple regression analysis with adjustment for age, body mass index, low-density lipoprotein cholesterol level, triglyceride level, mean corpuscular volume, and systolic blood pressure, HIV, cocaine use, and both were independently associated with coronary calcification. CONCLUSION: These results suggest that HIV infection alone, cocaine use alone, or the 2 combined may contribute to early subclinical atherosclerotic cardiovascular disease.

Age, gender and metabolic syndrome-related coronary heart disease in U.S. adults.

BACKGROUND: Metabolic syndrome (MetS), a clustering of several prominent risk factors for atherosclerosis, is common among U.S. populations. The contribution of MetS to the prevalence of coronary heart disease (CHD) in different age-gender groups is currently unknown. METHODS: MetS was defined according to the definition of the National Cholesterol Education Program Adult Treatment Panel III. CHD was defined as having had a diagnosed heart attack in self-reported medical history. Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used to evaluate the MetS-associated CHD prevalences in different age-gender subpopulations, which include 35- to 54-year-old women, 55- to 74-year-old women, 35- to 54-year-old men, and 55- to 74-year-old men. RESULTS: The prevalences of MetS in these 4 age-gender subpopulations are 21%, 24%, 39%, and 38%, respectively. The odds ratios (and the 95% confidence intervals) of MetS to increased CHD in each subpopulations are 1.05 (0.40-2.79), 1.95 (1.19-3.20), 2.22 (1.03-4.81), and 1.96 (1.41-2.70), respectively. CONCLUSIONS: MetS-associated CHD prevalence in women aged 35-54 years is almost the same as in the control, whereas in women aged 55-74 and in men aged 35-54 or 55-74, this prevalence is about 2-fold that of the control. Endogenous estrogen may play a role in suppressing the pro-atherosclerotic effects of MetS-related risk factors, but further studies are needed for a more certain conclusion.

Coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in black injection drug users infected with human immunodeficiency virus-1 treated with protease inhibitors.

BACKGROUND: Protease inhibitors (PIs) may be associated with accelerated atherosclerosis in individuals infected with human immunodeficiency virus (HIV). We assessed the effects of HIV PIs on subclinical atherosclerosis. METHODS: The lipid profiles, C-reactive protein (CRP) levels, coronary artery calcification (CAC) scores, and blood cell morphologic changes were quantified in 98 black adult participants, aged 25 to 45 years, with HIV-1 infection in Baltimore, Md. Fifty-five participants (56.1%) were taking PIs; 43 participants (43.9%) were not. The Student t and chi(2) tests were used as a means of detecting the between-group differences. RESULTS: Participants in both the PI and non-PI groups were similar in age, sex, body mass index, blood pressure, heart rate, and red and white blood cell counts. Compared with the non-PI group, the PI group had significantly higher serum total cholesterol (4.8 +/- 1.0 vs 3.8 +/- 0.7 mmol/L, P <.001) and LDL cholesterol (2.9 +/- 0.8 vs 2.1 +/- 0.7 mmol/L, P <.001) levels and red blood cell mean corpuscular volume (92.2 +/- 9.3 vs 86.8 +/- 7.2 microm3, P =.048). The CAC scores in the PI group were also higher than those in the non-PI group (11.0 +/- 28.6 [n = 43] vs 1.7 +/- 5.8, P =.043). CAC scores were marginally associated with log-transformed duration of the PI therapy (P =.055). Serum CRP levels remained unchanged (5.5 +/- 13.6 mg/L [n = 45] vs 3.9 +/- 5.5 mg/L, P =.467). Serum total cholesterol level, LDL cholesterol level, red blood cell mean corpuscular volume, and CAC scores were indicated by means of regression analyses to be associated with log-transformed duration of the PI therapy. CONCLUSIONS: The use of PIs is associated with coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in individuals infected with HIV-1.

Relation of coronary artery calcium to left ventricular mass in African-Americans.

Both coronary artery calcium (CAC) deposits and increased left ventricular (LV) mass are important risk factors for coronary heart disease, but the relation between these 2 factors has rarely been studied. We examined the correlation of CAC and LV mass in 159 young to middle-aged African-Americans, and found that the average LV mass indexes were bigger in the CAC-positive groups than in CAC-negative groups in both genders (p = 0.0004 in men; p = 0.08 in women).

Echocardiographic and pathological characteristics of cardiac metastasis in patients with lymphoma.

The purposes of this study were to investigate the patterns of lymphoma involvement in the heart and to correlate pathologic findings in the heart at autopsy with echocardiographic presentation prior to death in patients with malignant lymphoma. Lymphoma patients with complete echocardiographic records prior to death and conformed cardiac metastasis at autopsy were included in the study. Echocardiographic records were reviewed retrospectively. Pathological diagnoses were compared with echocardiographic findings using Fisher's exact test. Twenty-nine patients aged 19-71 (mean +/- SD, 51.5+/-12.7) years were included in the study. Among them 17 (58.6%) were male. There were 6 cases (20.7%) with Hodgkin's disease and 23 (79.3%) cases with non-Hodgkin's lymphoma. Twenty-two (75.9%) cases were diagnosed with cardiac metastases at autopsy by gross appearance of their hearts. The most common (41.4%) site of metastatic involvement was the pericardium. The frequency of tumor on the valves was significantly lower than in the chambers and on other parts of the heart (6.9% versus 93.1%). Metastatic masses in right heart were found in 8 (8/23, 34.8%) non-Hodgkin's lymphoma cases, which was higher than that in Hodgkin's lymphoma cases (0/6, 0%; p=0.15). The frequency of high-grade non-Hodgkin's disease metastasizing to the right ventricle was significantly higher than that for the other kinds of lymphoma (3/7, 42.9% versus 0/22, 0%; p=0.01). Sensitivity of echocardiographic examination to detect cardiac metastasis was 75.9%. Echocardiography has been shown to be a sensitive method for the diagnosis of cardiac involvement in the patients with lymphoma. Patterns of cardiac involvement vary by the types of lymphoma, suggesting that different pathologic types of lymphoma may have different mechanisms of metastasis to the heart.

Long-term cocaine use is related to cardiac diastolic dysfunction in an African-American population in Baltimore, Maryland.

BACKGROUND: Only limited studies have been done on the effects of long-term cocaine use on the human heart, and the results remain controversial. In this study, we examined and compared the diastolic function of non-cocaine users and chronic cocaine users to reveal the impact of long-term cocaine use on the human heart. METHODS: Two-dimensional echocardiogram and pulsed Doppler transmitral blood flow pattern were obtained from 138 recruited study participants with different cocaine histories. The indices of cardiac structure and function were measured from the echocardiogram of each participant. Student's t-test was used to compare the average echocardiographic measurements of the non-cocaine user group and the cocaine user group. Multivariate regression analysis was deployed to eliminate the effects of age, gender, blood pressure, and HIV infection on the functional measurements of the two groups. RESULTS: The cocaine user group had a significantly longer average deceleration time than did the non-cocaine user group (208.1 +/- 38.2 vs. 167.5 +/- 39.1 ms, P<0.001). A linear association existed between the deceleration time and the log-transformed duration of cocaine use (beta=0.00351, S.E.=0.00104, P=0.001). Cocaine users in this study were approximately five times more likely to have an elongated deceleration time (>200 ms) than were non-users (OR, 4.799; 95% CI, 1.000-23.044; P=0.05). No significant differences were observed in the other measured diastolic functional parameters, such as isovolumic ventricular relaxation time, E wave, A wave, and E/A ratio. CONCLUSIONS: Long-term cocaine use is linked to decline in diastolic function.

Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases.

To investigate the characteristics and pathological features of primary cardiac tumors and to evaluate the diagnostic sensitivity of echocardiography in primary cardiac tumors, all pathologic and echocardiographic records at the Chinese PLA general hospital and its satellite hospitals between January 1st, 1990 and January 1st, 2000 were reviewed to identify patients with a confirmed diagnosis of primary cardiac tumors. A total of 149 patients who had complete echocardiographic records and who were diagnosed with primary cardiac tumors were included in the study. Pathologic and echocardiographic records were reviewed retrospectively to evaluate the presence, location and histologic type of the tumors. The majority (n=118, 79.2%) of cases had been diagnosed with benign tumors. Myxoma was the most common histologic type accounting for 50.0% of total cardiac tumors. Lipoma was the second most common type of benign tumor. Among cases with malignant tumors (n=31, 20.8%), unclassified sarcoma (n=7), angiosarcoma (n=6) and rhabdomyosarcoma (n=6) were the common histologic types of primary malignant tumor. Non-myxomatous benign tumors were more likely to have occurred in the ventricle than myxomas (17/43, 39.5% vs. 7/75, 9.3%; P=0.00). The proportion of pericardium involvement in the malignant tumors (8/31, 25.8%) was significantly higher than that in the myxomas (0/75, 0%; P=0.00) and non-myxomas (2/43, 4.7%; P=0.01). The diagnostic sensitivity of transthoracic and transesophageal echocardiography was 93.3% (139/149) and 96.8% (30/31), respectively. The study, using a relatively large sample, confirms that myxoma was the most common primary cardiac tumor. The locations of tumor involvement varied by types of tumor. Echocardiography may be a useful tool for early diagnosis of primary cardiac tumors.

Vitamin D deficiency is associated with coronary artery calcification in cardiovascularly asymptomatic African Americans with HIV infection.

OBJECTIVE: Patients with HIV infection are at increased risk for coronary artery disease (CAD), and growing evidence suggests a possible link between vitamin D deficiency and clinical/subclinical CAD. However, the relationship between vitamin D deficiency and coronary artery calcification (CAC), a sensitive marker for subclinical CAD, in those with HIV infection is not well investigated. METHODS: CAC was quantified using a Siemens Cardiac 64 scanner, and vitamin D levels and the presence of traditional and novel risk factors for CAD were obtained in 846 HIV-infected African American (AA) participants aged 25 years or older in Baltimore, MD, USA without symptoms or clinical evidence of CAD. RESULTS: The prevalence of vitamin D deficiency (25-hydroxy vitamin D <10 ng/mL) was 18.7%. CAC was present in 238 (28.1%) of the 846 participants. Logistic regression analysis revealed that the following factors were independently associated with CAC: age (adjusted odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.08-1.14); male sex (adjusted OR: 1.71; 95% CI: 1.18-2.49); family history of CAD (adjusted OR: 1.53; 95% CI: 1.05-2.23); total cholesterol (adjusted OR: 1.006; 95% CI: 1.002-1.010); high-density lipoprotein cholesterol (adjusted OR: 0.989; 95% CI: 0.979-0.999); years of cocaine use (adjusted OR: 1.02; 95% CI: 1.001-1.04); duration of exposure to protease inhibitors (adjusted OR: 1.004; 95% CI: 1.001-1.007); and vitamin D deficiency (adjusted OR: 1.98; 95% CI: 1.31-3.00). CONCLUSION: Both vitamin D deficiency and CAC are prevalent in AAs with HIV infection. In order to reduce the risk for CAD in HIV-infected AAs, vitamin D levels should be closely monitored. These data also suggest that clinical trials should be conducted to examine whether vitamin D supplementations reduce the risk of CAD in this AA population.

Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users.

BACKGROUND: Chronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported. METHODS: Between August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54 years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (≥ 50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed. RESULTS: Significant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle-high risk Framingham score, respectively. In those with low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D< 10 ng/mL (p=0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR=2.18, 95% CI: 1.07-4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors. CONCLUSIONS: The study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.

Vitamin D deficiency is associated with the development of subclinical coronary artery disease in African Americans with HIV infection: a preliminary study.

BACKGROUND: Premature coronary artery disease (CAD) is a major concern in human immunodeficiency virus (HIV)-infected African Americans. The objectives of the study were to estimate the incidence of subclinical CAD, defined by the presence of coronary plaque and/or calcification on cardiac computed tomography (CT), and to identify the associated risk factors in this vulnerable population. SUBJECTS AND METHODS: Between August 2003 and September 2010, 188 HIV-infected African Americans without known, or symptoms of, CAD underwent cardiac CT. The subset without demonstrable disease underwent a second cardiac CT approximately 2 years later. The incidence of disease over that period and the effects of antiretroviral treatment and other known and hypothesized risk factors were investigated. RESULTS: Sixty-nine of these 188 African Americans had evidence of subclinical disease on the initial cardiac CT, confirming prior high prevalence reports. A second cardiac CT was performed on 119 African Americans without disease approximately 2 years later. The total person-years of follow-up was 284.4. Subclinical CAD was detected in 14 of these, yielding an overall incidence of 4.92/100 person-years (95% confidence interval, 2.69-8.26). Among the factors investigated, only male sex and vitamin D deficiency were independently associated with the development of subclinical CAD. The study did not find significant associations between CD4 count, HIV viral load, antiretroviral treatment use, or cocaine use and the incidence of subclinical CAD. CONCLUSIONS: The incidence of subclinical CAD in African Americans with HIV infection is provocatively high. Larger studies are warranted to confirm the role of vitamin D deficiency in the development of CAD in HIV-infected African Americans.

HIV infection and abnormal regional ventricular function.

To examine the effect of HIV infection on regional left ventricular dysfunction in cardiovascularly asymptomatic individuals. Nineteen HIV-negative and 27 HIV-positive cardiovascularly asymptomatic study participants in Baltimore, Maryland were selected and underwent tagged cardiac magnetic resonance imaging. Regional left ventricular myocardial mid-wall peak systolic circumferential strain (Ecc) and early diastolic strain rate (SRE) of the left ventricle were assessed with the use of the harmonic phase analysis. The average Ecc and SRE measurements were compared between HIV-negative and HIV-positive individuals. Compared with the HIV-negatives, the HIV-positives had lower average Ecc and SRE measurements in 90% of the 16 standard left ventricular segments. Of the 14 segments with decreased Ecc strain, 3 were statistically significant and of 14 with decreased strain rate (SRE), 6 were statistically significant. HIV infection may be associated with subclinical regional left ventricular systolic and diastolic dysfunction in individuals free of overt cardiovascular disease.

Long-term combination antiretroviral therapy is associated with the risk of coronary plaques in African Americans with HIV infection.

The aim of the study was to assess whether long-term antiretroviral therapy (ART) is associated with the risk of coronary plaques in HIV-infected cardiovascularly asymptomatic African Americans. Between August 2003 and December 2007, 176 HIV-infected cardiovascularly asymptomatic African Americans were consecutively enrolled in an observational study investigating the effects of ART on subclinical atherosclerosis in Baltimore, Maryland. Computed tomography coronary angiography was performed to detect coronary plaques. The overall prevalence rate of coronary plaques was 30%. After adjusting for gender, total cholesterol, and cocaine use, logistic regression analysis revealed that exposure to ART for more than 18 months (adjusted odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.01, 4.79) was independently associated with the presence of coronary plaques. A higher HIV viral load was univariately associated with the presence of noncalcified plaques. Use of ART (>18 months) was independently associated with the presence of noncalcified plaques (adjusted OR: 7.61, 95% CI: 1.67, 34.7), whereas cocaine use (>15 years) was independently associated with the presence of calcified plaques (adjusted OR: 2.51, 95% CI: 1.11, 5.67). This study suggests that long-term exposure to ART may be associated with coronary plaques. Because long-term use of ART and HIV replication may be associated with the presence of noncalcified plaques, some of which may be more vulnerable to rupture, an intensive lifestyle intervention to reduce traditional risk factors for coronary artery disease (CAD) is ultimately vital to those who are on ART. This study also suggests that cocaine cessation is the single most effective strategy to prevent CAD in HIV-infected cocaine users.

Liposome-mediated transfer of vascular endothelial growth factor cDNA augments survival of random-pattern skin flaps in the rat.

Tissue engineering is an application for gene therapy that is in its infancy. We show that simple liposomal-mediated gene transfer could result in a potentially useful biological effect in the field of wound healing. cDNA encoding the 165 amino acid form of vascular endothelial growth factor complexed to commercially available liposomes was injected into rat skin 1 week before raising a random pattern 3 x 10 cm flap. The flap survival was enhanced by 14 percent, and was accomplished without accessing the arterial inflow of the territory. These results were statistically significant (p<0.002) and reproducible. No adverse effects were seen. Histological analysis of the angiogenesis localized much of the new vessel formation to the area around the hair follicles. Polymerase chain reaction amplification of extracted flap tissue confirmed the presence of the transgene.