The potential impact and diagnostic value of inflammatory markers on diabetic foot progression in type II diabetes mellitus: A case-control study.

BACKGROUND: The wound-healing process in diabetic foot is affected by pro and anti-inflammatory markers, and any disruption in the inflammatory reaction interferes with tissue homeostasis, leading to chronic non-wound healing. AIM: This study aimed to determine the diagnostic value and effect of CRP, IL-6, TNF, and HbA1c on initiation the and progression of diabetic foot ulcers. METHOD: ELISA was used to quantify IL-6, TNF, CRP, and HbA1c in 205 patients with diabetes, and 105 were diabetic foot free. The prevalence and progression of diabetic foot were also evaluated. The area under the curve (AUC) was calculated using the receiver operating characteristic (ROC) curve to analyze the predictive values. Forward stepwise logistic regression analysis was used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs). RESULTS: CRP, IL-6, and FBS were found to be significant predictors of diabetic foot (OR=1.717, 95% CI=1.250-2.358, P=0.001; OR=1.434, 95% CI=1.142-1.802, P=0.002; and OR=1.040, 95% CI=1.002-1.080, P=0.037), respectively. The AUCs for CRP, IL-6, and HbA1c in predicting diabetic foot were 0.839, 0.728, and 0.834, respectively, demonstrating a good predictive value for each diagnostic marker. CONCLUSION: The current study demonstrated that IL-6, CRP, and HbA1c may be useful biomarkers to indicate diabetic foot progression. Furthermore, our findings showed a substantial relationship between CRP and HbA1c in individuals with diabetic foot conditions.

Genotypic characterization of mecA gene and antibiogram profile of coagulase-negative staphylococci in subclinical mastitic cows.

Background and Aim: Coagulase-negative staphylococci (CNS) are becoming the major cause of clinical and subclinical bovine mastitis around the world. This study aims to estimate the prevalence, antibiogram, and frequency of the methicillin-resistant (MR) (mecA) gene in CNS collected from cows with subclinical mastitis. Materials and Methods: Thirty-four milk samples were collected from 20 cows. Fifteen subclinical mastitis samples (~44.12%) were identified as CNS isolates. The Vitek2 compact system method was employed for the identification of the species. Furthermore, antibiotic sensitivity tests were performed against 10 different antibiotics for CNS strains. The mecA gene from isolated CNS was detected by conventional polymerase chain reaction (PCR). Results: Staphylococcus haemolyticus was the most predominant isolated species with an incidence of 33.3% (5/15 isolates), followed by 26.7% for Staphylococcus sciuri and Staphylococcus vitamins (4/15 isolates), and 13.3% for Staphylococcus vitulinus (2/15 isolates), respectively. The highest resistance rates were determined to be 40% (6/15 isolates) against penicillin and oxacillin (OX), 33.3% (5/15 isolates) against clindamycin, 13% (2/15 isolates) against chloramphenicol, amoxicillin, and erythromycin, and 5% (1/15 isolates) against ciprofloxacin, respectively. The results revealed that the isolates were resistant to one or more antimicrobial agents, with five isolates displaying multiple antimicrobial resistance. Furthermore, the results exhibit that all CNS isolates had the mecA gene at 310 bp with a 100% frequency. Moreover, for detecting MR isolates, there are significant discrepancies between phenotypic and genotypic approaches, and only 6/15 CNS isolates phenotypically demonstrated OX resistance. Conclusion: The results emphasize the necessity of frequent monitoring of phenotypic and genotypic profiles of CNS isolates to ensure effective control measures and the prevention of multidrug resistance strain evolution.

Synthesis and electrochemical performance of α-Al2O3 and M-Al2O4 spinel nanocomposites in hybrid quantum dot-sensitized solar cells.

The aim of this study is to describe the performance of the aluminum oxide nanoparticle and metal aluminate spinel nanoparticle as photo-anodes in quantum dot photovoltaic. By using a sol-gel auto combustion method, Al2O3 NPs, CoAl2O4, CuAl2O4, NiAl2O4, and ZnAl2O4 were successfully synthesized. The formation of Al2O3 NPs and MAl2O4 (M=Co, Cu, Ni, Zn) nanocomposite was confirmed by using several characteristics such as XRD, UV-Vis, FTIR, FE-SEM, and EDX spectra. The XRD shows that the CoAl2O4 has a smaller crystallite size (12.37 nm) than CuAl2O4, NiAl2O4, and ZnAl2O4. The formation of a single-phase spinel structure of the calcined samples at 1100 °C was confirmed by FTIR. Our studies showed that the pure Al2O3 NPs have a lower energy gap (1.37 eV) than synthesized MAl2O4 under UV-Vis irradiation. Due to the well separation between the light-generated electrons and the formed holes, the cell containing ZnAl2O4 nanocomposite with CdS QDs has the highest efficiency of 8.22% and the current density of 22.86 mA cm-2, while the cell based on NiAl2O4 as a photoelectrode, six cycles of CdS/ZnS QDs, and P-rGO as a counter electrode achieved the best (PCE) power conversion efficiency of 15.14% and the current density of 28.22 mA cm-2. Electrochemical impedance spectroscopy shows that ZnAl2O4 and NiAl2O4 nanocomposites have the highest life times of the photogenerated electrons (τn) of 11*10-2 and 96*10-3 ms, respectively, and the lowest diffusion rates (Keff) of 9.09 and 10.42 ms-1, respectively.

Chemical characterization, antimicrobial, antioxidant, and cytotoxic potentials of Swietenia mahagoni.

Infectious diseases are the most important cause of death worldwide. Many of these diseases show great resistance to drugs and antibiotics with long-term use. Extracts of some medicinal plants have antimicrobial properties, which can treat and overcome these diseases. Meliaceae is a family of timber trees used extensively in treating many bacterial and fungal diseases, especially Swietenia mahagoni (L.) Jacq. In this study, phytochemical screening, gas chromatography/mass spectrometry (GC/MS) analysis, and antimicrobial, antioxidant, and antitumor activities of the methanolic extract of S. mahagoni (L.) leaves were performed. Phytochemical screening exhibited the presence of alkaloids, flavonoids, saponins, phenols, triterpenoids, glycosides, and tannins. GC/MS analysis exhibited 40 compounds, mainly 7-hexadecene, (Z)-, imidazole-4,5-d2, and 1-acetyl-4,4-bis[4-(3-bromopropoxy)-3,5-dimethoxyphenyl] piperidine. The antibacterial and antifungal potentials of the methanolic extract of S. mahagoni (L.) leaves was investigated using the agar well diffusion technique. Potent antibacterial activity against Staphylococcus aureus, Escherichia coli, Salmonella enterica, Enterobacter aerogenes, and Proteus vulgaris and antifungal activity against Aspergillus flavus, Aspergillus niger, and Candida albicans were found. The minimum inhibitory concentration and minimum bactericidal and fungicidal concentrations ranged from 12.5 to 25 mg/mL. Antioxidant activity was studied using the free radical scavenging assay, and the IC50 value of the leaf extract was 69.9 µg/mL. Cytotoxic activity was screened using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and the IC50 value was 44.2 µg/mL. These findings suggested the importance of this plant in treating some bacterial and fungal infections and cancer.

Development of multidrug-resistant Escherichia coli in some Egyptian veterinary farms.

Background and Aim: Food of animal origin is considered a major source of foodborne diseases. In this context, multidrug-resistant (MDR) Escherichia coli pose a serious hazard to public health due to the consumption of food contaminated with antibiotics that are used for the treatment of various bacterial infections in farm animals. Therefore, this study aimed to determine the effect of the excessive use of antibiotics on the development of MDR E. coli strains in Egyptian poultry, dairy, and meat farms. Materials and Methods: A total of 1225 samples were randomly collected from poultry, dairy, and meat products intended for human consumption in different governorates. E. coli were isolated from the collected samples and subjected to biochemical identification and antibiotic sensitivity tests with antibiotics commonly used in human and veterinary medicine. Then, amoxicillin (AML)- and oxytetracycline (OT)-resistant E. coli isolates were subjected to a polymerase chain reaction test to detect the bla TEM and tetA genes, respectively. Results: E. coli were isolated from 132 out of 350, 148 out of 350, 177 out of 350, and 35 out of 175 poultry, milk, meat, and human samples, respectively. Most of the isolates expressed multidrug resistance, and resistance genes (bla TEM and tetA) were detected in all the tested AML- and OT-resistant E. coli isolates. Conclusion: Foods of animal origin may represent a source of MDR E. coli, which can be a major threat to public health.

A comparison of the effects of selective and non-selective mineralocorticoid antagonism on glucose homeostasis of heart failure patients with glucose intolerance or type II diabetes: A randomized controlled double-blind trial.

Mineralocorticoid receptor antagonists (MRAs) decrease morbidity and mortality in patients with heart failure (HF). However, spironolactone, a non-selective MRA, has been shown to exert a harmful effect on glucose homeostasis. The objective of this multicenter, randomized, controlled, double-blind trial was to compare the effects of spironolactone to those of the selective MRA eplerenone on glucose homeostasis among 62 HF patients with glucose intolerance or type II diabetes. Trial registration number:NCT01586442.

Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation.

Previous studies have suggested good adaptation of cardiac transplant (CTx) recipients to exposure to a high altitude. No studies have investigated the cardiopulmonary and biomarker responses to acute hypoxic challenges following CTx. Thirty-six CTx recipients and 17 age-matched healthy controls (HC) were recruited. Sixteen (16) patients (42%) had cardiac allograft vasculopathy (CAV). Cardiopulmonary responses to maximal and submaximal exercise at 21% O2 , 20-minutes hypoxia (11.5% O2 ), and following a 10-minute exposure to 11.5% O2 using 30% of peak power output were completed. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), suppression of tumorigenicity 2 (ST2) were measured at baseline and at peak stress. Endothelial peripheral function was assessed using near-infrared spectroscopy. Compared with HC, CTx presented a lesser O2 desaturation both at rest (-19.4 ± 6.8 [CTx] vs -24.2 ± 6.0% O2 [HC], P < 0.05) and following exercise (-23.2 ± 4.9 [CTx] vs -26.2 ± 4.7% O2 [HC], P < 0.05). CTx patients exhibited a significant decrease in peak oxygen uptake. IL-6 and VEGF levels were significantly higher in CTx recipients in basal conditions but did not change in response to acute stress. CTx patients exhibit a favorable ventilatory and overall response to hypoxic stress. These data provide further insights on the good adaptability of CTx to exposure to high altitude.

A prospective study of the impact of AGTR1 A1166C on the effects of candesartan in patients with heart failure.

AIM: To evaluate the impact of AGTR1 A1166C (rs5186) on the response to candesartan in patients with heart failure. MATERIALS & METHODS: Prospective, multicentre, open-label study. We studied 299 symptomatic patients with heart failure presenting a left ventricular ejection fraction ≤40%. RESULTS: Reductions in the primary end points of natriuretic peptides were not significantly associated with AGTR1 A1166C. Nevertheless, carrying the 1166C allele was associated with a greater compensatory increase in renin activity (p = 0.037) after 16 weeks of treatment with candesartan and a more modest effect on aldosterone concentrations (p = 0.022). CONCLUSION: AGTR1 1166C carriers may experience a greater long-term compensatory renin-angiotensin-aldosterone system activation following treatment with candesartan. Whether these associations ultimately influence clinical outcomes requires investigation. Clinicaltrials.gov : NCT00400582.

Pregnancy after heart transplantation: a well-thought-out decision? The Quebec provincial experience - a multi-centre cohort study.

Despite reports of successful pregnancies in heart transplant (HTx) recipients, many centers recommend their patients against maternity. We reviewed our provincial experience of pregnancy in HTx recipients by performing charts review of all known gestations following HTx in the province of Quebec (Canada), stratified between planned and unplanned pregnancies. Long-term survival was compared to HTx recipient women of childbearing age who did not become pregnant. Eighteen pregnancies, 56% unplanned, occurred in eight patients, 10.1 (2.6-27.0) years after HTx. Immunosuppression was CNI-based, with a mean dose increase of 48.3% (tacrolimus) and 26.5% (cyclosporine), without rejection. Cardiometabolic complications were high compared to the general Canadian population, including preeclampsia (15.4% vs. 5.5%), hypertension (38.5% vs. 4.6%), and diabetes (15.4% vs. 5.6%). Mean gestational age was 35.1 (23.4-39.6) weeks (72.2% live births; 53.8% prematurity). Mean birthweight was 2418 (660-3612) g. Serum creatinine increased during pregnancy, becoming significant after delivery (P = 0.0239), and returning to preconception level in all but three patients within a year. After 4.6 (1.2-17.2) years of follow-up, two rejection episodes occurred in one patient. Long-term mortality was similar to overall HTx women (Kaplan-Meier; P = 0.8071). Pregnancy in HTx carries high cardiometabolic complications and decreased kidney function, but is feasible with acceptable outcomes and no impact on mother's survival.

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study.

PURPOSE: The primary objective of this study was to define the ultrasound-derived anatomy of the axillary/subclavian vessels. As a secondary objective, we evaluated the relationship between the vascular anatomy and demographic, anthropometric, and hemodynamic data of patients. METHODS: This observational anatomical study used bedside ultrasound with 150 cardiac surgical patients in the operating room. Bilateral axillary and subclavian anatomy was determined using a high-frequency ultrasound probe with fixed reference points. Images were recorded and analyzed, and correlation with demographic, anthropometric, and hemodynamic data was performed. RESULTS: The images were adequate to evaluate potential anatomical variations in 97.4% of patients with a body mass index as high as 46.4 kg·m-2. The mean (standard deviation) diameter of the axillary vein was 1.2 (0.3) cm on the right side and 1.1 (0.2) cm on the left side. The dimensions of the axillary vein were larger on the right side in 69% of patients. The vein was located directly over the artery in the mid-clavicular view in 67% of the patients and in lateral-clavicular view in only 7% of the patients. As we moved the probe laterally, the vein was lateralized in relation to the artery in 89% of patients. There was no significant correlation between the hemodynamic data and vessel size, although direct correlation was found between body mass index and the depth of the vessel (P < 0.001). The axillary vein area was smaller in females than in males (P < 0.002), and in 4% of patients, the axillary vein was in an aberrant position. CONCLUSIONS: In patients undergoing cardiac surgery, axillary vessel anatomy varied considerably, and the patients' hemodynamics could not predict the size of the axillary vessels. Only the patients' weight correlated moderately with the depth of the vein.

Detection of Staphylococcus aureus enterotoxigenic strains in bovine raw milk by reversed passive latex agglutination and multiplex polymerase chain reaction.

AIM: This review gives an outline of the assessment of enterotoxigenic Staphylococcus aureus tainting levels in raw milk from different sources in Egypt and characterization of enterotoxigenic strains utilizing a technique in light of PCR to identify genes coding for the production of staphylococcal enterotoxin (SE). The obtained data were compared with results from the application of the reversed passive latex. MATERIALS AND METHODS: Multiplex PCR and reversed passive latex agglutination (RPLA) were used. A total of 141 samples of raw milk (cow's milk=33, buffalo's milk=58, and bulk tank milk=50) were investigated for S. aureus contamination and tested for enterotoxin genes presence and toxin production. RESULTS: S. aureus was detected in 23 (16.3%) samples phenotypically and genotypically by amplification of nuc gene. The S. aureus isolates were investigated for SEs genes (sea to see) by multiplex PCR and the toxin production by these isolates was screened by RPLA. SEs genes were detected in six isolates (26.1%) molecularly; see was the most observed gene where detected in all isolates, two isolates harbored seb, and two isolates harbored sec. According to RPLA, three isolates produced SEB and SEC. CONCLUSION: The study revealed the widespread of S. aureus strains caring genes coding for toxins. The real significance of the presence of these strains or its toxins in raw milk and their possible impact a potential hazard for staphylococcal food poisoning by raw milk consumption. Therefore, detection of enterotoxigenic S. aureus strains in raw milk is necessary for consumer safety.

Molecular imaging of the human pulmonary vascular endothelium in pulmonary hypertension: a phase II safety and proof of principle trial.

PURPOSE: The adrenomedullin receptor is densely expressed in the pulmonary vascular endothelium. PulmoBind, an adrenomedullin receptor ligand, was developed for molecular diagnosis of pulmonary vascular disease. We evaluated the safety of PulmoBind SPECT imaging and its capacity to detect pulmonary vascular disease associated with pulmonary hypertension (PH) in a human phase II study. METHODS: Thirty patients with pulmonary arterial hypertension (PAH, n = 23) or chronic thromboembolic PH (CTEPH, n = 7) in WHO functional class II (n = 26) or III (n = 4) were compared to 15 healthy controls. Lung SPECT was performed after injection of 15 mCi 99mTc-PulmoBind in supine position. Qualitative and semi-quantitative analyses of lung uptake were performed. Reproducibility of repeated testing was evaluated in controls after 1 month. RESULTS: PulmoBind injection was well tolerated without any serious adverse event. Imaging was markedly abnormal in PH with ∼50% of subjects showing moderate to severe heterogeneity of moderate to severe extent. The abnormalities were unevenly distributed between the right and left lungs as well as within each lung. Segmental defects compatible with pulmonary embolism were present in 7/7 subjects with CTEPH and in 2/23 subjects with PAH. There were no segmental defects in controls. The PulmoBind activity distribution index, a parameter indicative of heterogeneity, was elevated in PH (65% ± 28%) vs. controls (41% ± 13%, p = 0.0003). In the only subject with vasodilator-responsive idiopathic PAH, PulmoBind lung SPECT was completely normal. Repeated testing 1 month later in healthy controls was well tolerated and showed no significant variability of PulmoBind distribution. CONCLUSIONS: In this phase II study, molecular SPECT imaging of the pulmonary vascular endothelium using 99mTc-PulmoBind was safe. PulmoBind showed potential to detect both pulmonary embolism and abnormalities indicative of pulmonary vascular disease in PAH. Phase III studies with this novel tracer and direct comparisons to lung perfusion agents such as labeled macro-aggregates of albumin are needed. CLINICAL TRIAL: ClinicalTrials.gov, NCT02216279.

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation.

Recent reports suggest that individuals who underwent heart transplantation in the last decade have improved post-transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time-dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25-year period (1983-2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m(2) ) and severe renal dysfunction (eGFR <30 ml/min/1.73 m(2) ). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m(2) ), improved at discharge (eGFR=72.3 ml/min/1.73 m(2) ; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m(2) ; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004-2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.

Clinical validation of semi-automated software for volumetric and dynamic contrast enhancement analysis of soft tissue venous malformations on magnetic resonance imaging examination.

OBJECTIVES: To evaluate venous malformation (VM) volume and contrast-enhancement analysis on magnetic resonance imaging (MRI) compared with diameter evaluation. METHODS: Baseline MRI was undertaken in 44 patients, 20 of whom were followed by MRI after sclerotherapy. All patients underwent short-tau inversion recovery (STIR) acquisitions and dynamic contrast assessment. VM diameters in three orthogonal directions were measured to obtain the largest and mean diameters. Volumetric reconstruction of VM was generated from two orthogonal STIR sequences and fused with acquisitions after contrast medium injection. Reproducibility (interclass correlation coefficients [ICCs]) of diameter and volume measurements was estimated. VM size variations in diameter and volume after sclerotherapy and contrast enhancement before sclerotherapy were compared in patients with clinical success or failure. RESULTS: Inter-observer ICCs were similar for diameter and volume measurements at baseline and follow-up (range 0.87-0.99). Higher percentages of size reduction after sclerotherapy were observed with volume (32.6 ± 30.7%) than with diameter measurements (14.4 ± 21.4%; P = 0.037). Contrast enhancement values were estimated at 65.3 ± 27.5% and 84 ± 13% in patients with clinical failure and success respectively (P = 0.056). CONCLUSIONS: Venous malformation volume was as reproducible as diameter measurement and more sensitive in detecting therapeutic responses. Patients with better clinical outcome tend to have stronger malformation enhancement. KEY POINTS: • Magnetic resonance imaging readily demonstrates diameters and volumes of venous malformations • MRI diameter calculations are reproducible in estimating the size of venous malformations • But volumetric models of malformations are more sensitive in detecting therapeutic response • Dynamic enhancement is also better assessed with automated volumetric software • Volumetric analysis of malformations offers promise to guide therapy and assess response.

Acute responses to intermittent and continuous exercise in heart failure patients.

BACKGROUND: The purpose of this study was to compare cardiopulmonary responses, exercise adherence, tolerance, and safety of optimized high-intensity interval exercise (HIIE) compared with moderate-intensity continuous exercise (MICE) in patients with heart failure and reduced ejection fraction (HFREF). METHODS: Twenty patients with HFREF (aged 61 ± 9.9 years) were randomly assigned to HIIE corresponding to 2 × 8 minutes of 30-second intervals at 100% of peak power output and 30-second passive recovery intervals and to a 22-minute MICE corresponding to 60% of peak power output. Gas exchange, electrocardiogram, and blood pressure were measured continuously. Cardiac troponin T (cTnT), C-reactive protein (CRP), and brain natriuretic peptide (BNP) were measured before, 20 minutes after, and 24 hours after HIIE and MICE. RESULTS: Cardiopulmonary responses did not differ between MICE and HIIE. Higher exercise adherence and efficiency were observed on HIIE with a similar perceived exertion and time spent above 90% of peak oxygen consumption compared with MICE. Neither HIIE nor MICE caused any significant arrhythmias or increased CRP, BNP, or cTnT. CONCLUSIONS: Compared with MICE, HIIE demonstrated a higher exercise adherence and was well tolerated in patients with HFREF, while still providing a high-level physiological stimulus and leaving indices of inflammation (CRP), myocardial dysfunction (BNP), and myocardial necrosis (cTnT) unaffected.

Prolonged QT interval and lipid alterations beyond ß-oxidation in very long-chain acyl-CoA dehydrogenase null mouse hearts.

Patients with very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency frequently present cardiomyopathy and heartbeat disorders. However, the underlying factors, which may be of cardiac or extra cardiac origins, remain to be elucidated. In this study, we tested for metabolic and functional alterations in the heart from 3- and 7-mo-old VLCAD null mice and their littermate counterparts, using validated experimental paradigms, namely, 1) ex vivo perfusion in working mode, with concomitant evaluation of myocardial contractility and metabolic fluxes using (13)C-labeled substrates under various conditions; as well as 2) in vivo targeted lipidomics, gene expression analysis as well as electrocardiogram monitoring by telemetry in mice fed various diets. Unexpectedly, when perfused ex vivo, working VLCAD null mouse hearts maintained values similar to those of the controls for functional parameters and for the contribution of exogenous palmitate to ß-oxidation (energy production), even at high palmitate concentration (1 mM) and increased energy demand (with 1 µM epinephrine) or after fasting. However, in vivo, these hearts displayed a prolonged rate-corrected QT (QTc) interval under all conditions examined, as well as the following lipid alterations: 1) age- and condition-dependent accumulation of triglycerides, and 2) 20% lower docosahexaenoic acid (an omega-3 polyunsaturated fatty acid) in membrane phospholipids. The latter was independent of liver but affected by feeding a diet enriched in saturated fat (exacerbated) or fish oil (attenuated). Our finding of a longer QTc interval in VLCAD null mice appears to be most relevant given that such condition increases the risk of sudden cardiac death.

Description and assessment of a common reference method for fluoroscopic and transesophageal echocardiographic localization and guidance of mitral periprosthetic transcatheter leak reduction.

OBJECTIVES: This study sought to describe and compare a novel fluoroscopic method and a 2-dimensional transesophageal echocardiographic (TEE) method to localize mitral periprosthetic leaks (PPLs) for transcatheter reduction. BACKGROUND: Transcatheter reduction of significant regurgitation represents a modern and attractive alternative to surgery for the treatment of mitral PPL in high-risk patients. Accurate localization and precise communication between the echocardiographer and the interventional cardiologist are essential for procedural success. METHODS: We analyzed TEE and fluoroscopic studies of patients with mitral PPL who underwent multiplane 2-dimensional TEE-guided transcatheter reduction in our institution. Periprosthetic leaks were routinely localized using the "surgeon's-view" time-clock method during periprocedural TEE assessments. The 2-dimensional TEE examinations were later retrospectively reviewed by an echocardiographer blinded to procedural TEE findings. A corresponding surgeon's-view time-clock method was plotted for fluoroscopic PPL localization. Using this fluoroscopic method, offline fluoroscopic images were reviewed by an independent interventional cardiologist blinded to TEE results. Agreement between methods was evaluated. RESULTS: Complete imaging data were available for analysis in 20 patients who, between 2002 and 2009, underwent transcatheter reduction in which the defect was successfully crossed. There was excellent agreement between procedural TEE and retrospective TEE review for PPL localization (100%; p < 0.0001) and between fluoroscopic and procedural TEE localization (90%; 95% confidence interval [CI]: 77% to 100%; p = 0.0003). In the 2 cases where there was disagreement, fluoroscopic PPL localization was adjacent to TEE localization. CONCLUSIONS: The surgeon's-view time-clock method of localizing PPL using 2-dimensional TEE is highly reproducible and allows fluoroscopic localization using the same reference system with very good agreement.

The Oort structural equation modeling approach detected a response shift after a COPD self-management program not detected by the Schmitt technique.

OBJECTIVE: If individuals experience a response shift, scores on measures before and after a self-management intervention may not be comparable. This study evaluated whether persons with chronic obstructive pulmonary disease (COPD) experience a response shift after participating in a self-management program. The second objective was to compare the Oort and Schmitt structural equation modeling (SEM) approaches. METHODS: Secondary analyses from a randomized controlled trial comparing a home- and hospital-based pulmonary rehabilitation program were used to assess response shift on a physical and mental health-measurement model measured using the Chronic Respiratory Questionnaire (CRQ) and the St. George's Respiratory Questionnaire (SGRQ) over a 1-year period. RESULTS: The Oort approach showed significant changes between the no response shift model and models removing invariance constraints for the residual of the CRQ dyspnea (chi(2)(SBdiff)=7, df=1) (uniform recalibration) and intercepts of the SGRQ activity (chi(2)(SBdiff)=14, df=1) and impact (chi(2)(SBdiff)=10, df=1) subscales (nonuniform recalibration). Change in factor means showed changes in the physical health factor, which was slightly lower in unadjusted (0.32) as compared with the response shift-adjusted model (0.40). The Schmitt procedure was not supportive of any response shift effect and showed a marginal change in random error over time. CONCLUSIONS: This study showed that COPD patients experienced a response shift after participating in a self-management program, which resulted in an underestimation of change in physical health. These results suggest that the Oort procedure is more sensitive in detecting a response shift, and that a measurement of response shift is needed before results can be interpreted. Future comparisons with other methods and a control group are needed.