Association Between Three-Dimensional Left Ventricular Outflow Tract Area and Gradients After Myectomy in Hypertrophic Obstructive Cardiomyopathy.

OBJECTIVE: Determine whether the intraoperative three-dimensional left ventricular outflow tract cross-sectional area may be inversely correlated with pressure gradients as a determinant of surgical success after septal myectomy in hypertrophic cardiomyopathy patients. DESIGN: Perioperative data were obtained by retrospective review. SETTING: Toronto General Hospital, University of Toronto, Toronto, Canada, a tertiary hospital. PARTICIPANTS: The study comprised 67 patients with hypertrophic obstructive cardiomyopathy. INTERVENTIONS: Transthoracic and intraoperative transesophageal echocardiographic assessment of pressure gradients. Transesophageal measurement of the three-dimensional left ventricular outflow tract cross-sectional area. MEASUREMENTS AND MAIN RESULTS: The smallest left ventricular outflow tract area increased on average 1.883 cm2 (98.3%) after septal myectomy. There was a significant correlation between the increase in the area and the transesophageal pressure gradients (r = -0.32; p = 0.01) after myectomy, but none with postoperative transthoracic gradients at rest (r = -0.10; p = 0.42). Postoperative transesophageal and transthoracic gradients were significantly correlated (r = 0.26; p = 0.04). The best risk factors to predict high residual gradients were preoperative transesophageal gradient >97 mmHg, postoperative transesophageal area <3.16 cm2, and moderate or more residual transesophageal mitral regurgitation (specificity 89%, 81%, and 78%, respectively). CONCLUSIONS: Three-dimensional left ventricular outflow tract area measurements with transesophageal echocardiography after myectomy correlated fairly well with postoperative transesophageal pressure gradients. Patients with residual transthoracic elevated gradients after surgery at follow-up had a smaller transesophageal area and higher transesophageal pressure gradients immediately after the procedure. However, transesophageal pressure gradients after myectomy correlated poorly with follow-up transthoracic gradients at rest.

[Qidong Chronic Hepatitis B Cohort: participants enrollment and comparison of baseline characteristics by gender stratification].

Objective: To establish a study cohort of chronic hepatitis B (CHB) in Qidong and evaluate its baseline characteristics. Methods: CHB outpatients of the Third People's Hospital of Qidong were invited to participate in baseline survey from January 1, 2016, including questionnaire survey, liver function detection, serum detection of HBV infection and upper abdomen ultrasound detection. Anticipated sample size was at least one thousand. Baseline data were inputted by EpiData 3.1 software and then cleaned and analyzed by SAS 9.3 software. Results: As of 18 July, 2016, a total of 1 006 participants had been enrolled into the current study, including 615 males with an average age of (44.26±9.97) years and 391 females with an average age of (46.66±11.17) years. The difference in family history of liver disease was not significant between males and females (P>0.05), while the differences in other key information, such as age, education level, tobacco consumption, alcohol drinking, tea consumption, and antiviral intervention, were significant between males and females (P<0.05). Among the key clinical parameters, such as ALT, HBeAg, HBsAg, HBV DNA, albumin, and width of splenic vein and portal vein, only the abnormal rates of ALT and total bilirubin levels were higher in males than in females, the difference was significant (P<0.05). Conclusion: Outpatient department-based CHB cohort was established successfully in Qidong, and sub-cohort could be divided according to the differences on baseline characteristics.

Perfusion Cardiac Magnetic Resonance Imaging as a Rule-Out Test for Cardiac Allograft Vasculopathy.

Cardiac allograft vasculopathy (CAV) is a leading cause of mortality after heart transplantation. Noninvasive imaging techniques used in CAV evaluation have important limitations. In a cross-sectional study, we investigated perfusion cardiac magnetic resonance (CMR) imaging to determine an optimal myocardial perfusion reserve index (MPR) cutoff for detecting CAV using receiver operating characteristic curve analysis. We evaluated CMR performance using sensitivity, specificity and likelihood ratio analysis. We included 29 patients (mean 5 ± 4 years after transplant) scheduled for coronary angiography with intravascular ultrasound (IVUS) who completed CMR. CAV was defined as maximal intimal thickness (MIT) >0.5 mm by IVUS of the left anterior descending artery. CAV was evident in 19 patients (70%) on IVUS (mean MIT 0.82 ± 0.42 mm). MPR was significantly lower in patients with MIT ≥0.50 mm (1.35 ± 0.23 vs. 1.71 ± 0.45, p = 0.013). There was moderate inverse correlation between MPR and MIT (r = -0.36, p = 0.075). The optimal MPR cutoff ≤1.68 for predicting CAV showed sensitivity of 100%, specificity of 63%, a negative predictive value of 100%, a positive predictive value of 86% and a positive likelihood ratio of 2.7. An MPR ≤1.68 has high negative predictive value, suggesting its potential as a test to rule out CAV.

Clinical impact of a pharmacist-physician co-managed programme on hyperlipidaemia management in Hong Kong.

OBJECTIVE: The study aimed to investigate the clinical impact of pharmacist-physician co-managed programme on the management of hyperlipidaemia. METHODS: The study was a prospective randomized controlled trial. Adult patients were selected if: (i) they were taking one or more lipid-lowering agents with a valid lipid panel before their next follow up; (ii) had a baseline lipid profile within the previous 6 months; (iii) their lipid panel did not reach the targeted low-density lipoprotein-cholesterol (LDL-C) goal based on the National Cholesterol Education Programme Adult Treatment Panel III. Pharmacists interviewed patients in the intervention group for 15-30 min to provide consultation on the drug regimen and lifestyle modifications. A telephone follow-up every 4 weeks and a follow-up interview on the date of the physician visit were scheduled. Patients in the control group received routine conventional care. The primary outcome measurement was the change in lipid panel between baseline and at the end of study. RESULTS: One hundred and eighteen patients were recruited to the study [58 patients in intervention group (mean age 63 +/- 10 years old) and 60 in control group (mean age 61 +/- 12 years old)]. Starting with similar baseline levels, the end of study LDL-C and total cholesterol levels for the intervention and control groups were LDL-C: 2.80 +/- 0.89 mmol/L and total cholesterol 4.75 +/- 1.08 mmol/L vs. LDL-C: 3.24 +/- 0.78 mmol/L and total cholesterol 5.18 +/- 0.93 mmol/L, respectively. The differences were statistically significant (P < 0.0015). CONCLUSION: The study showed that a pharmacist-physician co-managed programme for hyperlipidaemic patient was effective in getting more patients to reach their target lipid levels.

Evaluation of tuberculosis contact investigations in California.

OBJECTIVE: To estimate the burden of tuberculosis (TB) contact investigations in California, assess outcomes and effectiveness, and identify performance gaps. METHODS: Aggregate program management reports were used to examine contact investigations conducted for pulmonary TB cases reported between 1 July 1999 and 30 June 2000 in California. Findings were compared to national objectives, and performance gaps were identified. Costs were estimated, and effectiveness of TB case detection and prevention was assessed. RESULTS: A total of 2032 acid-fast bacilli sputum smear-positive and sputum smear-negative/culture-positive cases was reported; 17774 contacts were elicited, and 15582 (88%) contacts were evaluated. TB disease and latent tuberculosis infection (LTBI) were diagnosed in 111 (<1%) and 4609 (30%) contacts, respectively; 1958 (43%) contacts with LTBI completed treatment. Costs of contact investigations were estimated at dollars 4.8 million; 81% of expected TB cases were detected, but only 35% of cases expected to occur within 2 years following the investigation were prevented. CONCLUSIONS: California's performance did not meet national objectives for contact evaluation or treatment completion; improved effectiveness of contact investigations in California is needed. Although analysis of existing contact investigation surveillance data provided a macro-level view of performance gaps, expanded surveillance data are required to inform interventions.

Frequent c-myc and Int-2 overrepresentations in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is a commonly occurring tumor in southern China. Although several causative factors have now been recognized, the genetic basis underlying its tumorigenesis is still unclear. To identify potential chromosomal aberrations for further investigations, comparative genomic hybridization (CGH) analysis was applied to the study of genomic imbalances in 10 NPC biopsy specimens. Before CGH analysis, the tumor cell content within the biopsy specimens was enriched by tissue microdissection, and universal genome amplification was performed on the recovered DNA. Recurrent chromosomal gains were detected on 1q (6 of 10 cases), 2q (5 of 10 cases), 3q (7 of 10 cases), 6p (8 of 10 cases), 6q (5 of 10 cases), 7q11.2 (4 of 10 cases), 8q (6 of 10 cases), 11q13, 12, and 15q (8 of 10 cases each), 17q (6 of 10 cases), and 20q (5 of 10 cases). Common losses were identified on 3p (5 of 10 cases), 9p (5 of 10 cases), 11q14-qter (8 of 10 cases), and 14q (5 of 10 cases). Among these aberrations, 7, 8, and 11 gains were further investigated on a series of NPC tissue samples, by interphase fluorescent in situ hybridization (FISH), for the incidence of alpha-satellites: 7, 8, and 11 c-myc and Int-2. Low-level increases of alpha-satellite 7 (9 of 34 cases; 26.5%), alpha-satellite 8 (15 of 34 cases; 44%), and alpha-satellite 11 (8 of 32 cases; 25%) were detected, whereas high-level copy gains of c-myc (21 of 34 cases; 62%) and Int-2 (26 of 34 cases; 76.5%) were more frequently found. Our series is the first to identify genomic overrepresentations of c-myc and Int-2 in NPC. The high incidence of Int-2 amplifications strongly suggests a role of this proto-oncogene in the pathogenesis of NPC.

Serum concentrations of cartilage oligomeric matrix protein and bone sialoprotein in hip osteoarthritis: a one year prospective study.

OBJECTIVE: To evaluate serum concentrations of cartilage oligomeic matrix protein (COMP) and bone sialoprotein (BSP) as predictors of disease progression in hip osteoarthrtitis (OA). METHODS: Forty eight consecutive patients, referred to hospital for symptomatic hip OA, (ACR criteria) were monitored in a one year prospective trial with radiographs and serum samples. The radiographs were graded for joint space narrowing, osteophytes, and sclerosis and the joint space width was measured by a digitised image analyser. Serum COMP and BSP were quantified by immunoassays. RESULTS: The COMP concentrations at baseline correlated with the joint space width at entry and with its yearly mean narrowing (r = 0.38, p = 0.002) but not with joint space narrowing grade progression. The concentrations were higher in patients with bilateral hip OA (p = 0.03). The serum BSP concentrations at baseline were unrelated to OA progression but correlated inversely to the osteophyte grade (r = -0.36, p = 0.004) and sclerosis grade (r = -0.42, p = 0.0004). CONCLUSION: Serum COMP seems to be a surrogate marker of OA and may be of interest for the detection of patients at risk of rapidly progressing disease in hip OA. Serum BSP changes seem to reflect alterations in the subchondral bone turnover in hip OA. Measurement of joint space width using a digitised image analyser is a sensitive way of assessing OA progression that facilitates evaluation of tissue markers in relation to anatomical changes in the joint.

[A study on the quality of fruits of Citrus aurantium L. (zhishi and Zhiqiao) produced in Jiangxi].

Through a study on the quality of different commercial fruits of Citrus aurantium (Zhishi and Zhiqiao) produced in Jiangxi, it has been found that the quality of Eyan Zhishi is good and Jiang Zhishi and Jiang Zhiqiao are the best varieties.