Partitioning of the genetic trends of French dairy sheep in Mendelian samplings and long-term contributions.

The genetic trend of milk yield for 4 French dairy sheep breeds (Lacaune, Basco-Béarnaise, Manech Tête Noire, and Manech Tête Rousse) was partitioned in Mendelian sampling trends by categories of animals defined by sex and by selection pathways. Five categories were defined, as follows: (1) artificial insemination (AI) males (after progeny testing), (2) males discarded after progeny testing, (3) natural mating males, (4) dams of males, and (5) dams of females. Dams of males and AI males were the most important sources of genetic progress, as observed in the decomposition in Mendelian sampling trends. The yearly contributions were more erratic for AI males than for dams of males, as AI males are averaged across a smaller number of individuals. Natural mating males and discarded males did not contribute to the trend in terms of Mendelian sampling, as their estimated Mendelian sampling term is either null (natural mating males) or negative (discarded males). Overall, in terms of Mendelian sampling, females contributed more than males to the total genetic gain, and we interpret that this is because females constitute a larger pool of genetic diversity. In addition, we computed long-term contributions from each individual to the following pseudo-generations (one pseudo-generation spanning 4 years). With this information, we studied the selection decisions (selected or not selected) for females, and the contributions to the following generations. Mendelian sampling was more important than parent average to determine the selection of individuals and their long-term contributions. Long-term contributions were greater for AI males (with larger progeny sizes than females) and in Basco-Béarnaise than in Lacaune (with the latter being a larger population).

Genomic and pedigree estimation of inbreeding depression for semen traits in the Basco-Béarnaise dairy sheep breed.

Inbreeding depression is associated with a decrease in performance and fitness of the animals. The goal of this study was to evaluate pedigree-based and genomic methods to estimate the level of inbreeding and inbreeding depression for 3 semen traits (volume, concentration, and motility score) in the Basco-Béarnaise sheep breed. Data comprised 16,196 (or 15,071) phenotypic records from 620 rams (of which 533 rams had genotypes of 36,464 SNPs). The pedigree included 8,266 animals, composed of the 620 rams and their ancestors. The number of equivalent complete generations for the 620 rams was 7.04. Inbreeding coefficients were estimated using genomic and pedigree-based information. Genomic inbreeding coefficients were estimated from individual SNP and using segments of homozygous SNP (runs of homozygosity, ROH). Short ROH are of old origin, whereas long ROH are due to recent inbreeding. Considering that the equivalent number of generations in Basco-Béarnaise was 6, inbreeding coefficients for ROH with a length >4 Mb refer to all (recent + old) inbreeding, those with a length >17 Mb correspond to recent inbreeding, and the difference between them indicates old inbreeding. Pedigree-based inbreeding coefficients were also estimated classically, or accounting for nonzero relationships for unknown parents, or including metafounder relationships (estimated using markers) to account for missing pedigree information. Finally, inbreeding coefficients combining genotyped and nongenotyped animal information were computed from matrix H of the single-step approach, also including metafounders. Inbreeding depression was estimated differently depending on the approach used to compute inbreeding coefficients. These 8 estimators of inbreeding coefficients were included as covariates in different animal models. No inbreeding depression was detected for sperm volume or sperm concentration. Inbreeding depression was significant for the motility of spermatozoa. The effect of old and recent inbreeding on motility was null and negative, respectively, demonstrating the existence of purging by selection of deleterious recessive alleles affecting motility. A 10% increase in inbreeding would result in a reduction in mean motility ranging between 0.09 and 0.22 points in the score (from 0 to 5). Motility is unfavorably affected by increasing recent inbreeding but the impact is very small. Runs of homozygosity and metafounders allow us to accurately estimate inbreeding depression and detect recent inbreeding.

Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer / 한국유방암학회지

Purpose@#The management of older adults with breast cancer (BC) remains controversial.The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival. @*Methods@#Consecutive patients with BC aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, and GFI) and two functional status scales (Karnofsky performance score and Eastern Cooperative Oncology Group Performance Status) were applied. Disease characteristics, treatment options, and causes of mortality were recorded during a 5-year follow-up. In addition, we defined undertreatment and correlated its survival impact with frailty. @*Results@#A total of 92 patients were included in the study. The median age was 77 (range 70– 94) years. The prevalence of frailty was discordant (G8, 41.9%; fTRST, 74.2%; GFI, 32.3%).Only 47.8% of the patients had a local disease, probably due to a late diagnosis (73.9% based on self-examination). Thirty-three patients (35.6%) died, of which 15 were from BC.We found a considerably high proportion (53.3%) of undertreatment, which had a frailtyindependent negative impact on the 5-year survival (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.1–12.5). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR, 3.9; 95% CI, 1.9–7.9). @*Conclusion@#BC treatment in older adults should be individualized. More importantly, assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. Undertreatment in daily practice is frequent and might have a negative impact on survival, as we report.

Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial.

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design, Setting, and Participants: In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece. Intervention: Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks. Main Outcomes and Measures: Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. Results: A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003). Conclusions and Relevance: In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution. Trial Registration: ClinicalTrials.gov Identifier: NCT04326790.

Prevalence of Parasitic Infections in Surgically Removed Appendices: Parasitological and Histopathological Studies.

Intestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.

Synthesis and cytotoxic activity of new artemisinin hybrid molecules against human leukemia cells.

A series of new artemisinin-derived hybrids which incorporate cholic acid moieties have been synthesized and evaluated for their antileukemic activity against sensitive CCRF-CEM and multidrug-resistant CEM/ADR5000 cells. The new hybrids 20-28 showed IC50 values in the range of 0.019µM-0.192µM against CCRF-CEM cells and between 0.345µM and 7.159µM against CEM/ADR5000 cells. Amide hybrid 25 proved the most active compound against both CCRF-CEM and CEM/ADR5000 cells with IC50 value of 0.019±0.001µM and 0.345±0.031µM, respectively. A relatively low cross resistance to hybrids 20-28 in the range of 5.7-fold to 46.1-fold was measured. CEM/ADR5000 cells showed higher resistance than CCRF-CEM to all the tested compounds. Interestingly, the lowest cross resistance to 23 was observed (5.7-fold), whereas hybrid 25 showed 18.2-fold cross-resistant to CEM/ADR5000 cells. Hybrid 25 which proved even more potent than clinically used doxorubicin against CEM/ADR5000 cells may serve as a promising antileukemic agent against both sensitive and multidrug-resistant cells.

Evaluation of the effect of acupuncture on hand pain, functional deficits and health-related quality of life in patients with rheumatoid arthritis--A study protocol for a multicenter, double-blind, randomized clinical trial / 中西医结合学报

<p><b>BACKGROUND</b>Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine (TCM) diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.</p><p><b>METHODS/DESIGN</b>We are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.</p><p><b>DISCUSSION</b>The findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.</p><p><b>TRIAL REGISTRATION NUMBER</b>ClinicalTrials.gov Identifier NCT02553005.</p>

Current management and quality of life of patients with acute coronary syndrome undergoing percutaneous coronary intervention in Greece: 12-Month results from antiplatelet therapy observational study II (APTOR II).

INTRODUCTION: We describe the current management of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) over 12 months in Greece. METHODS: This was a prospective observational study in ACS patients undergoing PCI from September 2008 to April 2009, capturing practices over 12 months at 22 sites that enrolled 558 eligible patients. RESULTS: A total of 351 patients suffered from unstable angina or non-ST elevation myocardial infarction (UA/ NSTEMI), while 207 patients suffered from ST-elevation myocardial infarction (STEMI). For the UA/NSTEMI group, the median age was 64 years (interquartile range: 55-73), while for the STEMI group the median age was 56 years (interquartile range: 49-66). Stents were placed in 96.4% of patients: bare-metal stents alone were placed in 19% of patients, drug-eluting stents alone in 77.5% of patients, and both types of stent in 3.5% of patients. 74% of UA/NSTEMI patients and 87% of STEMI patients received the first antiplatelet loading dose within 1 day of the episode. 76% of UA/NSTEMI patients underwent PCI within 3 days following the initial ACS symptoms, while 67% of STEMI patients underwent PCI within 1 day of the ACS symptoms. Follow-up data were available for 540 (96.8%) patients. The percentages of patients on antiplatelet therapy and on other medications at the time of hospital discharge and at 12 months post-PCI were as follows: aspirin 98%, 97%; clopidogrel 99%, 96%; statins 81%, 79%; beta-blockers 73%, 72%; calcium blockers 11%, 11%; angiotensin II receptor blockers/angiotensin-converting enzyme inhibitors 64%, 62%; proton-pump inhibitors 39%, 35%. CONCLUSIONS: In ACS patients treated with PCI in Greece, dual antiplatelet treatment is maintained in a very high percentage through 1 year post-procedure, and drug-eluting stent use is also high.

Serum levels of ischemia modified albumin in overweight/obese postmenopausal women: a potential biomarker of atherosclerotic burden associated with oxidative stress.

OBJECTIVE: Menopause is associated with weight gain and an increase of cardiovascular risk. The aim of the present study was to estimate serum ischemia-modified albumin (IMA) levels in postmenopausal women and evaluate their association with body mass index (BMI) and coronary artery disease (CAD). METHODS: The study included 130 non-smoker postmenopausal women aged 43-80: 40 with BMI 26-32 kg/m(2) (Group A), 60 with BMI 21-25 kg/m(2) (Group B), and 30 with documented CAD and BMI 23-29 kg/m(2) (Group C). Serum IMA, albumin, hsCRP and NT-proBNP, glucose and insulin were measured. Homeostasis assessment model score (HOMA) and Quantitative insulin sensitivity index (QUICKI) were co-estimated. RESULTS: Serum IMA and IMA to albumin ratio were significantly elevated in Group A as compared to Group B (p<0.001) and similar to those of Group C. hsCRP and NT-proBNP did not differ between Groups A and B while they were lower in comparison to Group C (p<0.001). Glucose, insulin and HOMA were elevated in Group A compared to Group B (p<0.001) while QUICKI was lower (p<0.001). In Group A, IMA was positively correlated with BMI, hsCRP, insulin, HOMA and negatively with QUICKI. In postmenopausal women, multivariable regression analysis revealed that obesity was the strongest significant determinant of circulating IMA levels (p<0.001) contributing, therefore, to the elevated serum IMA concentration. CONCLUSIONS: Postmenopausal obesity is associated with elevated serum IMA possibly due to obesity associated oxidative stress. IMA measurement could provide an assessment of atherosclerotic burden in postmenopausal women. Further clinical evaluation is under investigation.

Relation of ventricular tachycardia/fibrillation to beta-blocker dose maximization guided by pacing mode analysis in nonpacemaker-dependent patients with implantable cardioverter-defibrillator.

We hypothesized that uptitration of ß blockade and adjustment of pacing parameters to achieve a prevalence of single chamber atrial inhibited rate-responsive (AAIR) pacing in patients with dual-chamber implantable cardioverter--defibrillators (ICDs) would result in maximization of ß-blocker dosage and thus decrease appropriate ICD therapies. We included patients with ischemic or dilated cardiomyopathy and implanted ICDs without contraindications to ß blockers and atrioventricular conduction disturbances. Two 6-month periods were compared: clinically guided phase (pacing function set at back-up dual-chamber rate-responsive pacing mode at a lower rate of about 40 beats/min) and pacing-guided phase, during which ß-blocker dosage was titrated with a target of achieving >90% AAIR pacing (lower rate 60 beats/min). Sixty-one patients (64.2 ± 8.3 years old) were included. During the pacing-guided phase the target of ≥90% AAIR pacing was achieved in 80.3% of patients. Mean metoprolol dose during the clinically guided phase was 96.7 ± 29.4 versus 127.0 ± 39.6 mg/day in the pacing-guided phase (p <0.001). Appropriate ICD therapies were recorded in 35 patients (57.4%) during the clinically guided phase versus 20 (32.8%) during the pacing-guided phase (p <0.001; 1.15 and 0.48 appropriate ICD therapies per patient, respectively, p <0.001). In multivariate analysis, AAIR pacing and ß-blocker dose were inversely related to appropriate ICD therapies. In conclusion, a pacing-guided approach for maximizing ß-blocker doses guided by maximizing AAIR pacing in patients with ICDs may be beneficial compared to the conventional strategy. This pacing-guided approach led to higher daily ß-blocker doses, which were correlated to fewer appropriate ICD therapies.

Circulating concentrations of α- and ß-chemokines in neonatal sepsis.

BACKGROUND: Despite advances in neonatal care, sepsis remains a threat, in particular for premature neonates, due to immature immunologic defense. Deficient chemotaxis, an essential process in the host response to pathogens, may contribute to this vulnerability. In this study we investigated chemokine expression in septic premature and term neonates. METHODS: Seventy-one neonates with signs and symptoms suggestive of systemic infection, requiring full sepsis evaluation and treatment, formed the study group; 58 neonates without sepsis served as the control group. Serum concentrations of two α-chemokines (GRO-α and ENA-78) and two ß-chemokines (RANTES and MIP-1α) were measured at day 0 and day 3-5 of infection in the study group, and on the day of inclusion in the study in the control group. RESULTS: During infection, serum levels of GRO-α in the study group were higher and serum levels of RANTES were lower as compared to those of the control group (p<0.001 and p<0.001, respectively). Furthermore, levels of GRO-α were higher and levels of RANTES were lower on day 0 as compared to levels on day 3-5 (p<0.001 and p<0.001, respectively). Chemokine serum concentrations on day 3-5 in the study group did not differ significantly as compared to those of the control group. Term and preterm infants seemed to respond similarly regarding chemokine expression. No significant differences were found in serum levels of MIP-1α and ENA-78. CONCLUSIONS: Our findings suggest up-regulation of GRO-α and down-regulation of RANTES at the onset of a septic episode, similar to the response pattern observed in septic adults. Both term and preterm neonates appear to have the potential to elicit a chemotactic response to infection.

Ischemia modified albumin, high-sensitivity c-reactive protein and natriuretic peptide in patients with coronary atherosclerosis.

BACKGROUND: Ischemia modified albumin (IMA), is a new biomarker of oxidative processes involved with coronary artery disease (CAD). We determined serum IMA, high-sensitivity C-reactive protein (hsCRP), and natriuretic peptide (NT-proBNP), and evaluated their correlation with severity of coronary atherosclerosis in patients undergoing coronary angiography (CA). Cardiac troponin T (cTnT), CK-MB mass, albumin and Total Antioxidant Status (TAS) were also evaluated. METHODS: The study included 114 patients (88 men and 30 women) aged 43-80 years with documented CAD without evidence of acute coronary syndrome undergoing CA and 163 controls (131 men and 32 women) similarly aged. RESULTS: IMA, hsCRP and NT-proBNP were higher (p<0.001 and p=0.008 for NT-proBNP) while TAS was lower (p<0.001) in patients than in controls. IMA and TAS were negatively correlated in all subjects (p<0.01). Among patients, there was no correlation between IMA and the number of diseased vessels. For CAD diagnosis the best cut-off point for IMA was 101.5 KU/L with a sensitivity and a specificity of 87.7% and a negative predictive value of 83.3%. IMA was associated with an increased risk for CAD (OR=1.23, 95% CI: 1.16-1.31; p<0.001). CONCLUSIONS: IMA determination may provide earlier information of CAD presence before hsCRP or NT-proBNP elevation, contributing to early assessment of overall patient risk.

Intracardiac echocardiography-facilitated ablation of a left-lateral bypass tract in a patient with atrial septal aneurysm.

Intracardiac echocardiography (ICE) has been used as an adjunctive tool during electrophysiological procedures, mainly to increase the safety of transseptal puncture. We present the case of a young patient with a left-lateral bypass tract and atrial septal aneurysm, in whom ICE delineated the underlying anatomy, excluded the presence of thrombus and facilitated access to the left atrium through a small atrial septal defect, avoiding the risk of needle puncture for interatrial septal crossing.

Epidemiological characteristics, management and early outcome of acute myocardial infarction in Greece: the HELlenic Infarction Observation Study.

INTRODUCTION: Taking into consideration the need for an updated survey on acute myocardial infarction (AMI) in Greece, we conducted the HELIOS study (HELlenic Infarction Observation Study), aiming to recruit a cohort of AMI patients that would be representative of the total AMI population. METHODS: The HELIOS study is a countrywide registry of AMI, conducted during 2005-2006 by the Prevention Working Group of the Hellenic Cardiological Society. We enrolled 1840 AMI pts from 31 hospitals (mean age 68 +/- 13 years, 75% men, 1096 ST-elevation myocardial infarction [STEMI] patients), with a proportional representation of all types of hospitals and of all geographical areas. The study recruited 10% of the total number of AMI cases that occur per year on a countrywide basis, taking into consideration the seasonal variations of the population in each geographical area. RESULTS: Despite demographic changes, there is still a male predominance among AMI patients and an increasing prevalence of cardiometabolic risk factors, (obesity, diabetes, hypertension) compared to previous AMI studies in the Greek population. Almost 60% of STEMI patients received reperfusion therapy, but the median value of the pain-to-door time was 180 minutes. The rates of administration of evidence-based medications during hospitalisation or upon discharge and the short-term mortality rates were in accordance with those observed in other international AMI registries. CONCLUSIONS: The HELIOS study provided valuable insights into the epidemiology, clinical characteristics, management and outcome of patients with AMI in the Greek population. Although there are notable advances compared to previous reports, there is still considerable room for improvement and we should particularly focus on minimising the time delay between arrival at the emergency department and performance of reperfusion, by either pharmacological or catheter-based approaches.

[Sensitization of tilt-table testing for syncope of unknown etiology: which drug to use?]. / Quel agent pharmacologique utiliser pour la sensibilisation du test d'inclinaison dans l'evaluation des syncopes d'origine indéterminée?

OBJECTIVE: The sensitivity of tilt-table testing in the diagnosis of vasovagal syncope is between 30% and 50% only. The most common method currently used to improve the sensitivity of the test is the administration of isoproterenol i.v. However, this method is difficult to perform and time consuming. The objective of our study was to compare sublingual trinitrin administration to i.v. isoproterenol during tilt-table testing. METHODS: We analyzed the results of 257 consecutive patients referred for tilt testing. Patients who had a negative test received either a ten minutes infusion of i.v. isoproterenol at the dose of 4 mcg/kg/min, or 0.4 mg of trinitrin given sublingually. RESULTS: Two hundred (and) fifty-seven patients underwent tilt-table testing. In the first group (isoproterenol group), 42 patients (39%) had a spontaneous positive tilt test, compared to 45 patients (31%) in the trinitrin group (P = NS). After sensitization, 24 additional patients (22%) had a positive test in the isoproterenol group vs 55 patients (37%) in the trinitrin group (P = NS). The total number of positive tests was 66 (61%) in the isoproterenol group compared to 100 (68%) in the trinitrin group (P = NS). CONCLUSION: Sublingual trinitrin is at least as good as IV isoproterenol during tilt-table testing. Because trinitrin is simpler to use and because its administration is much faster than isoproterenol, it should be recommended as the drug of choice to improve the sensitivity of tilt-table testing.

[Chaotic atrial tachycardia-induced cardiomyopathy: report of an isolated case]. / La tachycardie atriale chaotique compliquée de cardiomyopathie: à propos d'un cas insolite.

Chaotic atrial tachycardia is a rare arrhythmia that has no known etiology and that usually inflicts upon newborn infants. The diagnosis is established using the surface electrocardiogram (ECG) which shows a spectacular polymorphism and irregularity of the atrial electrical activity. Clinical tolerability is variable depending on the ventricular rhythm. Cases that are not well tolerated and cases who do not recover spontaneously require medical treatment which relies mainly on amiodarone and other class IC anti-arrhythmic drugs. There is usually complete recovery during the first few months of life. The authors present the case of a female patient who was diagnosed with chaotic atrial tachycardia with induced cardiomyopathy following birth. She was successfully treated with amiodarone but had several relapses of the arrhythmia upon discontinuation of the drug. Although this observation is classic in its presentation, we consider that it is useful to remember this rare and frequently forgotten syndrome and to report the unique and particular aspects of our case and its evolution.

Periocular corticosteroids in diabetic papillopathy.

PURPOSE: To ascertain the therapeutic effect of periocular corticosteroids in diabetic papillopathy. METHODS: Prospectively, five consecutive adult-onset diabetic patients with symptomatic diabetic papillopathy underwent visual fields and fluorescein angiography before and after superonasal subtenon injection of corticosteroids. RESULTS: The median duration of papillopathy was 2.5 weeks by ophthalmoscopy and 3 weeks by fluorescein angiography. The median recovery time of best-spectacle-corrected visual acuity was 2 weeks. Two patients developed sequential diabetic papillopathy, and both reported faster visual recovery and better subjective vision in treated eyes. In these two patients, the final best-spectacle-corrected visual acuity and visual evoked responses were comparable between the two eyes, while automated visual fields were less constricted in treated eyes. Complications included ocular hypertension, mild progression of cataract, and mild ptosis in one patient each. CONCLUSIONS: Periocular corticosteroids shortened the duration of diabetic papillopathy from a reported median of 5 months to 3 weeks in the present uncontrolled observational study, partly by their angiostatic and antioedema effects at the level of the anterior optic nerve. Intraocular pressure needs to be monitored in eyes receiving periocular corticosteroids.

Morphometric and histochemical study of the adrenal cortex in experimental schistosomiasis mansoni.

In this study, 45 mice were used, 30 mice of them were injected subcutaneously with 80-100 schistosoma mansoni cercariae and 15 mice remained uninfected and served as a control group. Infected mice were killed at 8 and 12 weeks post-infection while control mice were killed at one time. Paraffin sections were made from adrenal cortex and liver. The thickness and cellularity of zonae glomerulosa and fasciculata as well as the serum cortisol level were determined. In the infected group of mice, the zona glomerulosa and fasciculata increased in the thickness and cellularity and the serum cortisol level increased with the progression of infection as compared with the control uninfected group. Bilharzial liver granulomas were profound in the infected group at 12 weeks post-infection which coincided with the time of suprarenal hyperactivity.

Hypothalamic origin of reproductive failure in chronic experimental toxoplasmosis.

Laboratory bred female mice were used to study the effect of chronic toxoplasmosis on reproductive performance. The animals were infected with small dose (3 x 10(3)) tachyzoites of Toxoplasma parasites. The female mice were mixed with normal males for one week, then separated to monitor their reproductive performance one and two months post infection (p.i). Mice bred one month p.i. showed reproductive failure with one of twenty females delivered two sick newborns. The others did not complete pregnancy and faetal wastage occurred. Mice bred two months p.i. were infertile. Histopathological examination of the ovaries revealed impaired folliculogenesis and atropic degeneration. Coronal sections of cerebrum showed widespread vasculitis, focal disruption of the ependymal cells lining both the lateral and third ventricles. The supraoptic and paraventricular hypothalamic nuclei were deformed and showed pyknotic neurons. Immunoperoxidase staining was used to detect IgG and IgM deposits in brain tissue. IgG deposits were found on the vicinity of Toxoplasma cysts and focally in the paraventricular zone. So, the reproductive failure of infected mice was due to hypogonadotrophic hypogonadism secondary to hypothalamic dysfunction as a result of chronic toxoplasmosis.