Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis.

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

The Association of the Oral Microbiota with the Effects of Acid Stress Induced by an Increase of Brain Lactate in Schizophrenia Patients.

The altered cerebral energy metabolism central to schizophrenia can be linked to lactate accumulation. Lactic acid is produced by gastrointestinal bacteria, among others, and readily crosses the blood-brain barrier, leading to the brain acidity. This study aimed to examine the association of the oral microbiota with the effects of acid stress induced by an increase of brain lactate in schizophrenia patients. The study included patients with a diagnosis of acute polyphasic psychotic disorder meeting criteria for schizophrenia at 3-month follow-up. Results: Individuals with a significantly higher total score on the Positive and Negative Syndrome Scale had statistically significantly lower lactate concentrations compared to those with a lower total score and higher brain lactate. We observed a positive correlation between Actinomyces and lactate levels in the anterior cingulate cap and a negative correlation between bacteria associated with lactate metabolism and some clinical assessment scales. Conclusions: Shifts in the oral microbiota in favour of lactate-utilising bacterial genera may represent a compensatory mechanism in response to increased lactate production in the brain. Assessment of neuronal function mediated by ALA-LAC-dependent NMDA regulatory mechanisms may, thus, support new therapies for schizophrenia, for which acidosis has become a differentiating feature of individuals with schizophrenia endophenotypes.

Altered Functional Connectivity Differences in Salience Network as a Neuromarker of Suicide Risk in Euthymic Bipolar Disorder Patients.

OBJECTIVE: The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. METHOD: 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. RESULTS: A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. CONCLUSION: Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration.

Oxidative-Antioxidant Imbalance and Impaired Glucose Metabolism in Schizophrenia.

Schizophrenia is a neurodevelopmental disorder featuring chronic, complex neuropsychiatric features. The etiology and pathogenesis of schizophrenia are not fully understood. Oxidative-antioxidant imbalance is a potential determinant of schizophrenia. Oxidative, nitrosative, or sulfuric damage to enzymes of glycolysis and tricarboxylic acid cycle, as well as calcium transport and ATP biosynthesis might cause impaired bioenergetics function in the brain. This could explain the initial symptoms, such as the first psychotic episode and mild cognitive impairment. Another concept of the etiopathogenesis of schizophrenia is associated with impaired glucose metabolism and insulin resistance with the activation of the mTOR mitochondrial pathway, which may contribute to impaired neuronal development. Consequently, cognitive processes requiring ATP are compromised and dysfunctions in synaptic transmission lead to neuronal death, preceding changes in key brain areas. This review summarizes the role and mutual interactions of oxidative damage and impaired glucose metabolism as key factors affecting metabolic complications in schizophrenia. These observations may be a premise for novel potential therapeutic targets that will delay not only the onset of first symptoms but also the progression of schizophrenia and its complications.

Changes in the Selected Antioxidant Defense Parameters in the Blood of Patients after High Resolution Computed Tomography.

Ionizing radiation generated during high resolution computed tomography (HRCT) scanning may have an indirect effect on the mechanisms regulating the oxidative-antioxidant balance in the human body, which is one of the necessary factors ensuring the maintenance of its homeostasis. The aim of the study was to analyze the response of antioxidant systems through the determination of the antioxidant markers in the blood of patients exposed to oxidative stress resulting from the routine HRCT examination of the chest. Blood of 35 people aged 60.77 ± 10.81 taken before and at four time points after the examination constituted the test material. The determination of the total antioxidant capacity expressed as ferric reducing ability of plasma (FRAP) and ferric reducing antioxidant activity and ascorbic acid concentration (FRASC) were performed together with an examination of catalase activity and the concentration of the reduced glutathione. The organism's response to ionizing radiation was associated with a significant decrease in the antioxidant markers' levels at all time-points and showed a significant negative correlation depending on the radiation dose. Visible down-regulation of these markers is a response to increased oxidative stress. In light of the obtained results, the measurement of the selected markers of antioxidant defense may be a useful parameter of oxidative stress caused by ionizing radiation.

[Fibrous dysplasia of the scull discovered accidently on CT from different indication]. / Dysplazja wlóknista kosci czaszki wykryta przypadkowo badaniem TK z róznych wskazan.

UNLABELLED: Fibrous dysplasia (dysplasia fibrosa -DF) is a local disorder of spongy bone structure caused by local pathological metabolism. Transformation of trabecular bony structure into connective tissue takes place. Inside the transformed bone scattered connective tissue elements, cartilaginous elements and pathological density are found. The disease proliferates either in the medullary bone or in subperiosteal region, and the development of fibrous tissue causes bone expansion with thinning of overlying cortex. The radiological appearance depends on the stage of the disease. The margins of the lesions are usually obscured and gradually turn into pathological tissue of trabeculated appearance. AIM OF THE STUDY: The aim of the study is to demonstrate fibrous dysplasia that is accidentally found during radiological diagnostics of facial skeleton and stomatological disease, and to describe radiological appearance of the pathological lesions. MATERIAL AND METHOD: The material included 23 patients (9 males, 14 females), of 24 to 64 years of age, that were directed for the diagnostics of facial skeleton and stomatological disease with the use of multislice computer tomography, because of clinically diagnosed pathologies in the nasal sinuses, temporomandibular joints, pathologies of the mandible and maxillary, and before treatment with prosthetic implants. All the presented fibrous dysplasia cases were diagnosed during the performance of the above examinations. The examinations were performed by the use of spiral CT (Siemens Somatom Sensation 10) with standard parameters. The range of the examination included the nasal sinuses, facial skeleton or the whole scull-configuration of the detectors 10 x 0.75 mm, slice thickness 1 mm, reconstruction gap 0.7 mm, kernel H60s for osseous structure evaluation, and slice thickness 1, 4 do 4 mm, reconstruction gap 4 mm, kernel H31s for soft tissue evaluation. The obtained results were presented sented in the form of figures. RESULTS: In the analyzed material 23 cases of scull fibrous dysplasia were found. The disease involved 9 males (39.14%) and 14 females (60.86%) from 24 to 64 years of age. Mean age for the whole group was 46.6 years, for males was 50,5 years and for females was 44.4 years. Females with fibrous dysplasia were more numerous (60.86%) than males (39.14%). Monoostotic dysplasia was found in 18 cases (78,89%), polyostotic dysplasia was found in 4 cases (13.05%), the skull-face dysplasia was found in 9 cases (14.07%). The radiological appearance is characterized by lesions that unclearly and gradually turn into pathological tissue with different densities, trabeculated appearance, and sclerotic, lytic or mixed structure. Early lesions usually have lower density than the normal surrounding bone, giving the appearance of translucency. CONCLUSIONS: Fibrous dysplasia of the facial skeleton is most commonly incidentally found on CT examinations of the head, mandible and nasal sinuses. Diagnosis of fibrous dysplasia is important because of unfavorable influence of the disease on stomatognathic system, laryngological disease, ophthalmic and neurological disease.