Noninvasive clinical model for the diagnosis of nonalcoholic steatohepatitis in overweight and morbidly obese patients undergoing bariatric surgery.

BACKGROUND: Liver biopsy, an invasive method, is the gold standard for differentiate nonalcoholic steatohepatitis (NASH) from other stages of fatty liver disease. A noninvasive test to diagnose NASH and disease severity before surgery and also for monitoring disease status after bariatric surgery (BS) will be an important medical challenge. AIM: To create a noninvasive biomarkers model for the diagnosis of NASH in overweight, obese and morbidly obese patients (MOP). PATIENTS AND METHODS: Sixty patients (mean BMI= 47.81kg/m2) were admitted after exclusion of other causes of liver disease. Liver biopsies were obtained at the time of the bariatric surgery or by percutaneous liver biopsy and graded using Kleiner score. Continuous variables were compared using Wilcoxon rank sum test and for prediction of NASH we used logistic regression. RESULTS: Logistic regression analysis showed that BMI, ALT, AST, alkaline phosphatase (ALP), HOMA-R, hs-CRP, M30, M65, leptine and adiponectine levels remained independent predictors for NASH (p less than 0.02). Using AUC analysis, we established the following cutoff levels being indicative of NASH: BMI e 47 kg/m2, ALT e 32 IU/mL, AST e 25 IU/mL, ALP e 85 IU/mL, HOMA-IR e 4, M65 e 389 U/L. Adiponectine less than 13.5 mg/L. A NASH-score, calculated as the sum of these 7 parameters, at a cutoff level of 4 points, can accurately predict NASH (sensitivity of 90%, specificity of 93.94% and AUC of 0.9576). CONCLUSIONS: We propose a noninvasive model for NASH diagnosis in MOP that should be validated prospectively. Using this noninvasive score, NASH would be predicted without the risks of liver biopsy.

Association of common genetic variants with colorectal cancer risk in a Romanian sample.

Recently, several genome-wide association studies identified and validated loci at which common genetic variants influence the risk of colorectal cancer. We aimed to test the association between eight SNPs and colorectal cancer in a Romanian case-control sample. We genotyped rs10795668, rs16892766, rs3802842, rs4444235, rs4779584, rs4939827, rs6983267, and rs9929218 and we statistically tested the association with the disease. Five SNPs (rs6983267, rs4939827, rs3802842, rs4444235, rs10795668) showed an association with colon and rectal cancer. Three of them proved to be statistically significant: rs6983267 and rs4939827 risk alleles were significantly associated with rectal cancers (p = 0.031 and p = 0.004 for homozygous, p = 0.002 and p = 0.005 for heterozygous). For rs3802842 we found a greater risk for colon than rectal cancer with an OR of 2.26 (CI = 1.04-5.88, p = 0.040) for the dominant model. The rs4444235 confirmed the risk for both homozygous and heterozygous carriers, with the greatest ORs of 1.49 (CI = 0.61-3.61) for heterozygote. For rs10795668 we found an increased risk for rectum cancer vs. controls with an OR of 1.46 (CI = 0.66-3.21), and for rectum cancer vs. colon cancer (OR = 2.19; CI = 0.87-5.55). This is the first Romanian study that confirms previously-identified associations with colorectal cancer risk for five out of eight SNPs investigated and underlines the necessity of extensive replication using larger samples.

[Dynamics of intestinal parasitic diseases in children admitted to the TB Preventorium in Gornesti, Mures county]. / Dinamica parazitozelor intestinale la copiii internati in Preventoriul TBC din Gornesti, judetul Mures.

This study follows the evolution of the intestinal parasitic infections during a 5 year period between 2000-2004, detected at the inhabitants of the TBC Preventorium Gornesti from Mures county. The 127 children included in the study are aged between 3 and 16 year, they attend a special kindergarten and a special school. The most important species of parasites found were Giardia lamblia, Ascaris lumbricoides, Hymenolepis nana and Trichuris trichiura. Most of the infected children had mono-parasitosis, only a few showed poly-parasitic infections with 2 parasites. In spite of the adequate treatment, the infections did not disappear, but neither did their number increase.

Cortical control of sinus arrhythmia in man studied by spectral analysis.

Eighteen healthy male volunteers, 21-26 years old, participated in a study intended to detect cortical control of beat-to-beat heart rate variability independent of the effects on breathing and mean heart rate. They were tested while seated and standing relaxed (baseline), and while performing tasks requiring concentrated attention while sitting. The mental concentration elicited a typical cardiorespiratory response manifested by moderate acceleration and shallowing of respiration with a small increase of mean heart rate (HR), a pattern already widely acknowledged as typically associated with concentration. With the aid of a variable tone delivered to the ear as a guide, the subjects were trained to breathe at the same rate without concentrating in order to test the influence of respiration on the concentration pattern. ECG, thermistor pneumogram and ear-lobe photo-plethysmogram were recorded and data reduction was performed on 3 minute or 1 minute data sequences selected for the best steady-state. Statistical treatment was limited to a subgroup of 10 subjects in whom there was no overlapping of the spectra of respiratory and Traube-Hering-Mayer sinus arrhythmia (RSA and THM-SA, respectively). Mental concentration elicited significant depression of both RSA and THM-SA even if the respiratory parameters were kept constant.

The weight of the cortical inflow against medullary reflexes as enlightened by spectral analysis of HR and SP waves.

Components of the autonomic drive to the heart were studied in 5 young normals subjected to: 1. sustained lung inflation (SLI) in various postures; 2. mental loading by concentration of attention; 3. face immersion (FI) in cold water under SLI or snorkel breathing, when sitting; 4. superpositions of 1-3 experimental interventions. Recorded were: cardiotachogram (CTG as RR interval) and T-wave amplitude from ECG, ear-lobe photo-plethysmogram, digital impedance rheogram, thermistor pneumogram (PNG). Heart rate (HR) and systolic pressure (SP) data were treated using the Fourier analysis on a M118B microcomputer. Preliminary data-exploration, reported in a previous paper, has verified the capability of the Fourier spectrum to spot in short quasistationary data-series known marks of single interventions and has pointed to the amphotrop nature of SLI and FI maneuvers. Present work approaches the same data from the point of view of the competition between various regulatory menus under combined interventions. The "cortico-cardiac reflex"--HR stabilizing under mental loading versus rest based upon balanced reduction in both respiratory and vasomotor sinus arrhythmia (RSA and VSA, respectively)--appeared now as a middle size actor upon medullary areas; it is overridden, yet not put to silence by the powerful orthostatic reflex; it is comparable (SLI) or major (FI) vis-a-vis of synergic vagal reflexes whose more easily approachable mechanisms could offer it meaningful models. Capacitating this "reflex" in the containment of intricated arrhythmias with extrinsic involvement or in "educating" the benefic vagal prevalence upon the heart should observe these precisions.

Model of respiratory sinus arrhythmia in man.

The first section of the model delineates the parasympathetic signal as a function of the interaction between the respiratory and the vagal neurones of the common brainstem network. The second section is a version of Chess and Calaresu's description of the vagus/heart period system in the sympathetically blocked cat. The sympathetic influence is introduced in the third section, taking into account the autonomic effects on the transmembrane potential of the sinoatrial pacemaker as found in the rabbit. The model was implemented on a dedicated analogue computer with an accuracy of 1 per cent. The concordance between the analogue and the breathing/respiratory sinus arrhythmia (RSA) system in humans was studied using simulated respiratory signals. The results confirm the central origin of the RSA as a meaningful modelling premise and indicate the dependence of the RSA amplitude on the operating point of the vagus.

Autonomic control of the heart in some vagal maneuvers and normal sleep.

Components of the autonomic control of the heart were studied in 5 young normals subjected to: 1) sustained lung inflation (SLI) in various postures; (2) mental loading by concentration of attention, 3) face immersion in cold water under SLI or snorkel breathing, when sitting; 4) superposition of above experimental interventions. We recorded cardiotachogram (RR interval) and T-amplitude from ECG, ear lobe photoplethysmogram, digital impedance rheogram, thermistor respiration. Cardiac data were explored by means of Fourier spectral analysis on a M 118 B microcomputer. Results caution that allegedly unilateral stimulation by some "vagal" maneuvers triggers in fact amphotropic heart rate control menus involving sympathetic nonreciprocal response. Subsequent bradycardia should be interpreted as an absolute indicator of the parasympathetic function only when a separate measure of the sympathetic counterpart is available. In vigil young adult at physical rest the medullary cardiovascular centers appear as subjected to "sliding capture" by their prominent input signal--as determined by various receptor stimulation or cortical status, the latter preserving a higher priority at competing task demands. In a coupled study 9 normals were polygraphically monitored (EEG, EOG, ear duct temperature and the above variables as well) during 2 nonconsecutive nights and cardiac data were spectrally examined along various sleep stages. Results suggest an increased dual autonomic tone during REM that could be related to reported stage-specific arrhythmias. Reciprocal dynamics of the respiratory versus lower frequency variability of RR interval from NREM to REM sleep points to a useful discriminant for computer sleep stage scoring.

Vagal involvement in sinus arrhythmia attenuation under mental load.

Experimental data document the slight increase of heart rate found during mildly stressing mental load as not being sufficient to explain concomitant sinus arrhythmia attenuation by pure sympathetic reaction. A general outlook on autonomic regulation and more specific direct and indirect arguments show heart rate response to mental load as underlain by a higher level balance of sympathetic and vagal drives. Their competition results mostly in slight increase yet sometimes in preservation or decrease of mean HR, while the consistency of sinus arrhythmia attenuation remains to reflect vagal increase specifically connected to cortex activation.

Conduction velocity in slower motor fibres.

Measuring conduction velocity in slower fibres (CVSF), through a partial antidromic block (Hopf-Seppäläinen method), allows estimating the dispersal of conduction velocity in motor fibres by the difference between the maximal motor conduction velocity (MCV) and CVSF. Investigations performed in workers exposed to medium concentrations of carbon disulphide show difference between MCV and CVSF as providing a more sensitive indicator for early diagnosis of peripheral neuropathies than MCV.