CT Coronary Angiogram With FFR CT - A Revolution In The Diagnostic Flow Of Coronary Artery Disease.

Within the last few years, advances in CT coronary imaging has revolutionised the diagnostic flow of suspected coronary artery disease. CT coronary angiogram has a high diagnostic accuracy and negative predictive value for diagnosis of coronary disease. Its non-invasive nature makes it a lower risk and lower cost procedure compared to conventional invasive coronary angiogram. However, there is restricted value in anatomical evaluation without input regarding the functional significance of each lesion identified with cross-sectional imaging. The gold standard to assess whether a lesion is haemodynamically significant has been the assessment of FFR (fractional flow reserve). Fractional flow reserve is the ratio between maximum coronary flow in the presence of stenosis and in the hypothetical absence of stenosis. This is measured invasively by introducing a pressure wire across the lesion involving intracoronary nitro-glycerine as well as intravenous infusion of adenosine. However, the introduction of FFR CT provides information on functional significance of a lesion only using the CT data set of CT CA. Through complex non-linear equations and supercomputing, it produces a three-dimensional model of the coronary artery giving FFR values at multiple point along every major coronary vessel. It is non-invasive, involves no extra dose or contrast and does not require adenosine stress. A lesion that may appear moderate to severe on CT CA with FFR values above 0.80 can be managed by optimal medical management alone. Together FFR Ct and CTCA provide a comprehensive assessment for CAD leading to a reduction in downstream testing and unnecessary revascularisation procedures.

The effect of non-steroidal anti-inflammatory drugs on matrix metalloproteinases levels in patients with osteoarthritis.

OBJECTIVE: The objective of this study is to determine and comparatively evaluate the effects of three different non-steroidal anti-inflammatory drugs on the levels of metalloproteinases MMP-1, MMP-3 and MMP-8, as well as on their tissue inhibitor TIMP-1, in patients suffering from idiopathic osteoarthritis. The effect of these drugs on the articular cartilage and the probable use of MMPs and TIMP-1 as markers of disease and treatment was also investigated. METHODS: Thirty-six patients with OA were selected and allocated to three groups on the basis of their disease location. All patients received anti-inflammatory treatment with special selective COX-2 inhibitors, i.e. celecoxib, meloxicam, aceclofenac. Each drug was given to every patient for three months following a randomized order of administration. Serum levels of MMP-1, MMP-3, MMP-8 and TIMP-1, and ratios MMP-1/TIMP-1, MMP-3/TIMP-1, MMP-8/TIMP-1 were measured before and after treatment. RESULTS: The use of aceclofenac resulted in no significant variation in either MMPs concentration and MMPs/TIMP-1 ratio. This outcome concerns the three groups and the 36 patients that form them. After all patients had received all three NSAIDs, MMPs and TIMP-1, these parameters were compared to their initial and final median values. A significant reduction in MMP-3 was found so in all OA patients as in the group of knee OA patients. CONCLUSIONS: 1. Of the MMPs studied, MMP-3 levels were found to be significantly reduced after NSAIDs treatment. Therefore, serum MMP-3 levels in OA patients could be proven to be a useful evaluating marker of treatment on the cartilage level. 2. No significant differences were observed among NSAIDs administered with regards to their effect on MMPs and TIMP-1 concentration.

Somatostatin Analogue Treatment of a TSH-Secreting Adenoma Presenting With Accelerated Bone Metabolism and a Pericardial Effusion: A Case Report.

Increased bone turnover and other less frequent comorbidities of hyperthyroidism, such as heart failure, have only rarely been reported in association with central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma (TSHoma). Treatment is highly empirical and relies on eliminating the tumor and the hyperthyroid state.We report here an unusual case of a 39-year-old man who was initially admitted for management of pleuritic chest pain and fever of unknown origin. Diagnostic work up confirmed pericarditis and pleural effusion both refractory to treatment. The patient had a previous history of persistently elevated levels of alkaline phosphatase (ALP), indicative of increased bone turnover. He had also initially been treated with thyroxine supplementation due to elevated TSH levels. During the diagnostic process a TSHoma was revealed. Thyroxine was discontinued, and resection of the pituitary tumor followed by treatment with a somatostatin analog led to complete recession of the effusions, normalization of ALP, and shrinkage of pituitary tumor.Accelerated bone metabolism and pericardial and pleural effusions attributed to a TSHoma may resolve after successful treatment of the tumor. The unexpected clinical course of this case highlights the need for careful long-term surveillance in patients with these rare pituitary adenomas.

Uranium levels in Cypriot groundwater samples determined by ICP-MS and α-spectroscopy.

The uranium concentration and the isotopic ratio (238)U/(234)U have been determined in Cypriot groundwater samples by ICP-MS after ultrafiltration and acidification of the samples and α-spectroscopy after pre-concentration and separation of uranium by cation-exchange (Chelex 100 resin) and electro-deposition on stainless steel discs. The uranium concentration in the groundwater samples varies strongly between 0.1 and 40 µg l(-1). The highest uranium concentrations are found in groundwater samples associated with sedimentary rock formations and the obtained isotopic ratio (238)U/(234)U varies between 0.95 and 1.2 indicating basically the presence of natural uranium in the studied samples. The pH of the groundwater samples is neutral to weak alkaline (7 < pH < 8) and this is attributed to the carbonaceous content of the sedimentary rocks and the ophiolitic origin of the igneous rocks, which form the background geology in Cyprus. Generally, in groundwaters uranium concentration in solution increases with decreasing pH (7 < pH < 8) and this is attributed to the fact that at lower pH dissolution of soil minerals occurs, and uranium, which is adsorbed or forms solid solution with the geological matrix enters the aqueous phase. This is also corroborated by the strong correlation between the uranium concentration and the electrical conductivity (e.g. dissolved solids) measured in the groundwaters under investigation.

On the limits of the air pollution predictability: the case of the surface ozone at Athens, Greece.

PURPOSE: The aim of this study is to investigate the potential effects of increased urbanization in the Athens city, Greece on the intrinsic features of the temporal fluctuations of the surface ozone concentration (SOC). METHODS: The detrended fluctuation analysis was applied to the mean monthly values of SOC derived from ground-based observations collected at the centre of Athens basin during 1901-1940 and 1987-2007. RESULTS: Despite the present-day SOC doubling in respect to SOC historic levels, its fluctuations exhibit long-range power-law persistence, with similar features in both time periods. This contributes to an improved understanding of our predictive powers and enables better environmental management and more efficient decision-making processes. CONCLUSIONS: The extensive photochemistry enhancement observed in the Athens basin from the beginning of the twentieth century until the beginning of the twenty-first century seems not to have affected the long memory of SOC correlations. The strength of this memory stems from its temporal evolution and provides the limits of the air pollution predictability at various time scales.

Long-term variation in surface ozone and its precursors in Athens, Greece: a forecasting tool.

INTENTION, GOAL, SCOPE, BACKGROUND: Photochemical pollution is a very complex process involving meteorological, topographic, emission and chemical parameters. The most important chemical mechanisms involved in the atmospheric process have already been identified and studied. However, many unknown parameters still exist because of the large number of participating chemical reactions. OBJECTIVE: The present study investigates the processes involved in the photochemical pollution effect of an urban station located in the greater area of the Athens basin and gives a plausible explanation for the different seasonal ozone development between that station and another rural one. Furthermore, the distribution of the mean monthly surface ozone observed at the urban station during 1987-2001 is examined in order to create a relevant forecasting tool. METHODS: Averaged hourly data of O3 and NOx observations monitored at the above mentioned stations, during 1987-2001, have been used in order to derive the daytime (7:00-15:00) values. Trajectories calculated by using a 2D-trajectory code and meteorological data, during the period 1988-1996, have also been used. RESULTS AND DISCUSSION: At the urban station, the percentage negative trend of NO and NOx data in winter and summer is higher than that in spring and autumn, while the percentage ozone trend is maximum in the summer. On the contrary, the negative surface ozone trend at the rural station exhibits a minimum in summer and a maximum in autumn and winter. The mean seasonal wind-rose for the selected months shows that the northward wind flow dominates during June, the month of the lowest negative ozone trend in the rural station. Finally, the development of the forecasting tool shows that the mean monthly surface ozone data during the period (1987-2001) demonstrates a semi-log distribution. CONCLUSIONS: Air transport effect on the air pollution of the rural station (not blocked by mountains) is deduced as a possible reason for the different seasonal ozone development observed between the rural and the urban station. Finally, the discrepancies between the theoretical probabilities deduced by the model and the empirical ones appear to be very small, and the corresponding correlation coefficient is 0.99. RECOMMENDATION AND OUTLOOK: However, to interpret the aforementioned statistical results about the negative trends in ozone and its precursors, additional parameters can be taken into account. Changes in NOx concentrations, for instance, can result not only from changes in emissions or meteorological conditions. There might also be a contribution through changes in the atmospheric composition. A study of the contribution of changes in atmospheric composition to trends of observed NOx concentrations requires that a series of steps be taken (removal of meteorological influence in the time series, calculation of trends in OH concentrations, etc.).

On the plausible association between environmental conditions and human eye damage.

The increase in solar ultraviolet radiation can have various direct and indirect effects on human health, like the incidence of ocular damage. Data of eye damage in residents of three suburban regions in Greece and in two groups of monks/nuns and fishermen are examined here. The statistics performed on these data provides new information about the plausible association between increased levels of solar ultraviolet radiation, air-pollution at ground level, and the development of ocular defects.