The symptoms asymmetry of drug-induced parkinsonism is not related to nigrostriatal cell degeneration: a SPECT-DaTSCAN study.

AIM: Drug-induced parkinsonism (DIP) is the most common form of parkinsonism after Parkinson's disease (PD) itself. It has been widely believed that DIP is characterised by symmetry of symptoms. Studies of patients with DIP in whom PD had been ruled out by SPECT-DaTSCAN have shown that symptom asymmetry is a common element of DIP clinical presentation. The aim of our study was to determine whether the asymmetry of symptoms in DIP is related to any abnormality within the presynaptic part of the nigrostriatal dopaminergic system. MATERIALS AND METHODS: Eleven patients with the diagnosis of DIP and asymmetric symptoms were studied. Their individual SPECT-DaTSCANs were normal. Indices calculated for the whole group of radiotracer uptake in the whole striatum, putamen and caudate contralateral to more severe DIP symptoms were compared to values obtained in the opposite hemisphere. RESULTS: We did not find significant differences in radiotracer uptake in structures contralateral to more severe clinical symptoms when compared to the homolateral hemisphere. CONCLUSIONS: Our results have not confirmed the presence of a presynaptic nigrostriatal deficit which could be related to asymmetry of DIP. The factors responsible for the asymmetry of DIP symptoms should be sought in the postsynaptic part of the nigrostriatal dopaminergic system.

Should non-movement specialists refer patients for SPECT-DaTSCAN?

BACKGROUND: SPECT with radioligand DaTSCAN (SPECT-DaTSCAN) is a sensitive tool used for assessing the functional integrity of the presynaptic part of the nigrostriatal dopaminergic system. The procedure is useful whenever there is a need to distinguish between neurodegenerative parkinsonism and other parkinsonian syndromes in subjects with equivocal signs and symptoms. It can be assumed that the neurologist's decision to perform SPECT-DaTSCAN depends on his or her experience and skill in the diagnosis of parkinsonian and tremor syndromes. AIMS: To assess the accuracy of referrals to SPECT-DATSCAN made by non-movement disorders specialists. MATERIAL AND METHODS: Sixty seven patients referred for SPECT-DaTSCAN by a general neurologist were studied. In all subjects, a movement disorder specialist performed the neurological examination, collected medical history, and analysed previous treatments and the results of diagnostic tests. RESULTS: Evaluation carried out by a movement disorder specialist did not confirm an indication for SPECT-DaTSCAN in 31 patients (46.3%). General neurologists needed support for clinical diagnosis with SPECT-DaTSCAN most frequently in subjects with parkinsonism even though they were presenting a full-blown disease manifestation and even though the patients met the diagnostic criteria for Parkinson's disease or one of the atypical parkinsonian syndromes. CONCLUSIONS: Our presented results probably reflect the limited experience of general neurologists in the evaluation of parkinsonian syndromes and tremor. The use of SPECT-DaTSCAN by non-movement disorders specialists is associated with a significant risk of overuse of this tool. To minimise this risk, the skills of general neurologists in diagnosing parkinsonian and tremor syndromes should be improved. Moreover, patients should be provided with access to movement disorders specialists.

Is nigrostriatal dopaminergic deficit necessary for Holmes tremor to develop? The DaTSCAN and IBZM SPECT study.

Holmes's tremor (HT) is assumed to be the result of coexistence of nigrostriatal dopaminergic system impairment and the lesion of cerebello-thalamic pathways. It was suggested that dopaminergic deficiency is responsible for rest tremor, and lack of compensatory cerebellar function leads to spill of tremor into voluntary movements. Cases of HT with and without abnormalities of the presynaptic part of dopaminergic nigrostriatal were published and these findings raised the question of possibility of the postsynaptic lesion. Three patients with HT diagnosed according to criteria of Consensus Statement on Tremor were studied. In all of them SPECT imaging with ligands of presynaptic (I 123-FP CIT-DaTSCAN) and postsynaptic (I 123-iodobenzamide-IBZM) nigrostriatal dopaminergic neurons was performed. Indices of uptake in caudate and putamen normalized to nonspecific uptake in occipital cortex and indices of asymmetry for each whole striatum as well as for putamen and caudate separately were calculated. SPECT studies did not reveal asymmetry of DaTSCAN and IBZM binding in striatum in all studied subjects. The current clinical diagnostic criteria of HT are presumably insufficiently specific and when using them we identify patients both with and without the involvement of dopaminergic system. These two groups may represent tremor disorders of similar phenomenology but of different pathomechanism.

The study of t-PA, u-PA and PAI-1 genes polymorphisms in patients with abdominal aortic aneurysm.

The most important feature of abdominal aortic aneurysm (AAA) pathogenesis is an enzymatic degradation of elastic lamellae and extracellular matrix proteins particularly with participation of matrix metalloproteinases. Plasmin, which is responsible for the dissolution of fibrin in blood vessels, plays also a key role in the cascade for activation of the metalloproteinases. The purpose of this study was to evaluate the influence of selected polymorphisms in genes coding for tissue plasminogen activator (-7351 C/T polymorphism), urokinase-type plasminogen activator (1788 C/T polymorphism) and plasminogen activator inhibitor 1 (-675 4G/5G and -844 G/A polymorphism) on the susceptibility to AAA. We performed a case-control study of 153 polish patients hospitalized due to AAA and compared them with matched healthy control subjects. The polymorphisms were ascertained through genotyping by polymerase chain reaction and restriction digestion of amplified fragments or through high-resolution melting analysis. In this study we have found lower frequency of wild-type GG genotype of the -844G/A PAI-1 polymorphism in cases than in controls, what may suggest the protective effect of this genotype for the risk of AAA development. None of the remaining polymorphisms tested were associated with AAA occurrence.

Single nucleotide polymorphisms of NR3C1 gene and recurrent depressive disorder in population of Poland.

Depressive disorder is a disease characterized by disturbances in the hypothalamo-pituitary-adrenal axis. Abnormalities include the increased level of glucocorticoids (GC) and changes in sensitivity to these hormones. The changes are related to glucocorticoid receptors gene (NR3C1) variants. The NR3C1 gene is suggested to be a candidate gene affecting depressive disorder risk and management. The aim of this study was to investigate polymorphisms within the NR3C1 gene and their role in the susceptibility to recurrent depressive disorder (rDD). 181 depressive patients and 149 healthy ethnically matched controls were included in the study. Single nucleotide polymorphisms were assessed using polymerase chain reaction/restriction fragment length polymorphism method. Statistical significance between rDD patients and controls was observed for the allele and genotype frequencies at three loci: BclI, N363S, and ER22/23EK. The presence of C allele, CC, and GC genotype of BclI polymorphism, G allele and GA genotype for N363S and ER22/23EK variants respectively were associated with increased rDD risk. Two haplotypes indicated higher susceptibility for rDD, while haplotype GAG played a protective role with OR(dis) 0.29 [95 % confidence interval (CI) = 0.13-0.64]. Data generated from this study support the earlier results that genetic variants of the NR3C1 gene are associated with rDD and suggest further consideration on the possible involvement of these variants in etiology of the disease.

[Evaluation of exposure to ionizing radiation among gamma camera operators]. / Ocena narazenia na promieniowanie jonizujice techników obslugujacych gammakamery.

BACKGROUND: Protection of nuclear medicine unit employees from hazards of the ionizing radiation is a crucial issue of radiation protection services. We aimed to assess the severity of the occupational radiation exposure of technicians performing scintigraphic examinations at the Nuclear Medicine Department, Central Teaching Hospital of Medical University in Lódz, where thousands of different diagnostic procedures are performed yearly. MATERIALS AND METHODS: In 2013 the studied diagnostic unit has employed 10 technicians, whose exposure is permanently monitored by individual dosimetry. We analyzed retrospective data of quarterly doses in terms of Hp(10) dose equivalents over the years 2001-2010. Also annual and five-year doses were determined to relate the results to current regulations. Moreover, for a selected period of one year, we collected data on the total activity of radiopharmaceuticals used for diagnostics, to analyze potential relationship with doses recorded in technicians performing the examinations. RESULTS: In a 10-year period under study, the highest annual dose recorded in a technician was 2 mSv, which represented 10% of the annual dose limit of 20 mSv. The highest total dose for a 5-year period was 7.1 mSv, less than 10% of a 5-year dose limit for occupational exposure. Positive linear correlation was observed between total activity of radiopharmaceuticals used for diagnostics in the period of three months and respective quarterly doses received by technicians performing examinations. CONCLUSIONS: Doses received by nuclear medicine technicians performing diagnostic procedures in compliance with principles of radiation protection are low, which is confirmed by recognizing the technicians of this unit as B category employees.

Myocardial perfusion GSPECT imaging in patients with myocardial bridging.

BACKGROUND: The aim of this study was to investigate the incidence, reversibility, and severity of LV perfusion abnormalities in patients with isolated myocardial bridges using a gated myocardial perfusion SPECT study (GSPECT). METHODS: A retrospective study involved 42 patients without history of myocardial infarction, with isolated myocardial bridges detected in coronary angiography and no substantial evidence of atherosclerotic changes in coronary arteries. In all patients a gated SPECT study was performed at both rest and stress, after intravenous administration of (99m)Tc MIBI. Reconstructed slices were analyzed using a 20-segment model of the left ventricle. RESULTS: Incidence and severity of stress-induced ischemia were related to degree of artery constriction (P = .002 and .00014, respectively). Perfusion abnormalities were detected only in patients with critical narrowing (≥ 50%) of artery (in 12 out of 28, i.e., 43% of patients). Summed stress scores (SSS) ranged from 4 to 11 (mean 7), indicating slight or moderate defect intensity. Only 1 patient presented with a SSS value of 31 (severe defect). Perfusion defects were stress induced in 70 out of 72 (97%) segments with abnormal perfusion. CONCLUSION: Perfusion abnormalities were observed in ab. 40% of patients with critical (≥ 50%) narrowing of artery affected by bridging and were mild, stress induced.

Single nucleotide polymorphisms and mRNA expression for melatonin MT(2) receptor in depression.

Polymorphisms (rs 4753426 and rs 794837) and expression of the melatonin MT(2) receptor gene were evaluated in 181 patients with recurrent depressive disorder (rDD) and 149 healthy subjects of Polish origin. We found an increased risk for rDD in patients with the C allele and a decreased risk in patients with the T allele (rs4753426). Patients with the AT heterozygote (rs794837) had an increased mRNA level. The significance of the MT(2) receptor gene and the risk of rDD are suggested.

Women with oligo-/amenorrhoea and polycystic ovaries have identical responses to GnRH stimulation regardless of their androgen status: comparison of the Rotterdam and Androgen Excess Society diagnostic criteria.

OBJECTIVE: As increased frequency of gonadotrophin-releasing hormone (GnRH) pulses is characteristic for polycystic ovary syndrome (PCOS), we assessed gonadotrophin response to GnRH in women with PCOS with normal and raised androgens and in regularly menstruating controls. DESIGN, PATIENTS AND METHODS: The study involved 155 subjects: PCOS, n=121, age (mean±SD) 24.8±5.4 yrs, BMI 24.5±6.0 kg/m2, all with oligo-/amenorrhoea and PCO morphology, and 34 controls. Gonadotrophins were measured in early follicular phase after GnRH stimulation (0, 30 and 60 minutes). RESULTS: Fifty four (41.9%) women with PCOS had androgens (testosterone, androstendione, dihydroepiandrosterone sulphate) within the reference range, and would fulfil the "Rotterdam", but not the Androgen Excess Society PCOS criteria. Baseline and stimulated LH concentrations were higher in PCOS (9.09±5.56 vs 4.83±1.71 IU/l, 35.48±31.4 vs 16.30±6.68 IU/l, 33.86±31.8 vs 13.45±5.2 IU/l, at 0, 30 and 60 min post GnRH, respectively, p<0.0001). An LH/FSH ratio in PCOS increased further after GnRH stimulation. ROC analysis revealed that LH30min/FSH30min >2.11 or LH60min/FSH60min >1.72 had 78.3% and 87.5% sensitivity and 81.7% and 81.3% specificity for diagnosis of PCOS. Both baseline and GnRH-stimulated LH and FSH concentrations were similar in women with PCOS and raised androgens and with androgens within the reference range (p=0.71 and p=0.20 for LH and FSH, respectively). CONCLUSIONS: Regardless of their androgen status, women with PCO morphology and oligo-/amenorrhoea have higher baseline and GnRH-stimulated LH concentrations and higher GnRH-stimulated LH/FSH ratio than controls, suggestive of similar underlying mechanism accounting for menstrual irregularities. These observations support validity of PCOS diagnostic criteria based on the Rotterdam consensus.

Single-nucleotide polymorphisms and mRNA expression for melatonin synthesis rate-limiting enzyme in recurrent depressive disorder.

Depressive disorder (DD) is characterised by disturbances in blood melatonin concentration. It is well known that melatonin is involved in the control of circadian rhythms, sleep included. The use of melatonin and its analogues has been found to be effective in depression therapy. Melatonin synthesis is a multistage process, where the last stage is catalysed by acetylserotonin methyltransferase (ASMT), the reported rate-limiting melatonin synthesis enzyme. Taking into account the significance of genetic factors in depression development, the gene for ASMT may become an interesting focus for studies in patients with recurrent DD. The goal of the study was to evaluate two single-nucleotide polymorphisms (SNPs) (rs4446909; rs5989681) of the ASMT gene, as well as mRNA expression for ASMT in recurrent DD-affected patients. We genotyped two polymorphisms in a group of 181 recurrent DD patients and in 149 control subjects. The study was performed using the polymerase chain reaction/restriction fragment length polymorphism method. The distribution of genotypes in both studied SNPs in the ASMT gene differed significantly between DD and healthy subjects. The presence of AA genotype of rs4446909 polymorphism and of GG genotype of rs5989681 polymorphism was associated with lower risk for having recurrent DD. In turn, patients with depression were characterised by reduced mRNA expression for ASMT. In addition, ASMT transcript level in both recurrent DD patients and in healthy subjects depended significantly on genotype distributions in both polymorphisms. In conclusion, our results suggest the ASMT gene as a susceptibility gene for recurrent DD.

Functional polymorphism of cyclooxygenase-2 gene (G-765C) in depressive patients.

BACKGROUND: Depressive disorder (DD) is characterized by an inflammatory process and oxidative stress. Cyclooxygenase-2 (COX-2), the expression of which increases in depression, is an enzyme involved in inflammation and free radical processes. The aim of our study was to assess the correlation between single nucleotide polymorphism G-765C of the COX-2 gene and recurrent DD. METHODS: The study was carried out in a group of 181 patients treated for recurrent DD, and in 149 healthy subjects of the control group (CG). Polymerase chain reaction/restriction fragment length polymorphism was used for genotyping. RESULTS: A statistically significant difference in genotype distribution was observed as a result of the comparison between the CG and the patients with DD. We demonstrated that the presence of the -765G allele in the COX-2 gene increased 2.1-fold the risk of DD development, whereas the presence of a homozygote (G-765G) in the analyzed gene increased the risk of DD development 2.5-fold. CONCLUSION: According to the obtained results, it may be proposed with some caution that the presence of both the -765G allele and the G-765G genotype in the COX-2 gene may confer a susceptibility to an increased risk of recurrent DD in the Polish population.

Serum levels of matrix metalloproteinases MMP-2 and MMP-9 and their inhibitors in women with glucose intolerance in pregnancy and normal controls.

AIM: Matrix metalloprotenases (MMPs) are proteolytic enzymes active in inflammatory states. We have examined MMP-9, MMP-2, and their respective tissue inhibitors: TIMP-1 and TIMP-2 in sera of women with gestational diabetes mellitus (GDM) and various degrees of insulin resistance (IR) in the third trimester of pregnancy. METHODS: Fasting serum levels of MMP-9, MMP-2, TIMP-1 and TIMP-2 were measured in 26th-28th week of gestation in 51 women divided according to their response to a 50-g glucose challenge test (GCT) and a 75-g OGTT: controls (n = 20): both tests normal; the GDM group (n = 16) both tests abnormal; the intermediate group (IG; n = 15) abnormal GCT and normal OGTT. MMPs and TIMPs were correlated with the parameters of IR: homeostasis model assessment (HOMA) and insulin resistance index (IRI). RESULTS: MMP-9, MMP-2, TIMP-1 and MMP-9/TIMP-1 ratio were not different among the groups. TIMP-2 levels were significantly higher in the GDM and IG groups than in controls (p < 0.01). MMP-2/TIMP-2 ratio was lower in the GDM group than in the other groups (p < 0.01) and was correlated to HOMA and IRI (r = -0.465 and r = -0.43 respectively, p < 0.01). CONCLUSIONS: Serum MMP levels do not reflect inflammation in GDM. Elevated TIMP-2 and consequently lower MMP-2/TIMP-2 levels in GDM need to be clarified, but are unlikely to be a consequence of inflammation.

Single nucleotide polymorphism of the KIBRA gene in recurrent depressive disorders.

OBJECTIVE: Depression is a disease of multifactor background. Episodic memory dysfunction is one of depression characterising disturbances, which may lead to its onset and development. Memory processes are controlled by a number of extra- and intracellular mechanisms. KIBRA, a newly discovered protein, belonging to signal transduction proteins, participates in the control of episodic memory. The presented study was designed to assess correlation between single nucleotide polymorphism (SNP) T/C (rs17070145) of the KIBRA gene and the risk of recurrent depressive disorder (DD). METHODS: The study was carried out in a group of 181 patients with recurrent DD and 149 healthy control subjects. Genotyping was conducted by polymerase chain reaction (PCR)/restriction fragment length polymorphism (RLFP) method. RESULTS: TThe obtained results have revealed no significant correlation between the studied polymorphism and recurrent DD. Obtained value of the disease odds ratio (ORdis) suggests that presence of T/T homozygote decreases risk of development of recurrent DD, but the result was not statistically significant. CONCLUSIONS: Following the results, it may be concluded that the studied polymorphism does not influence either the onset mechanism or the course of recurrent DD. Even if T/C polymorphism of the KIBRA gene induces memory disturbances, they may be unspecific and unselective for recurrent DD. Further studies on the genes, which control characteristic processes of DD and influence their course, are demanded and mostly justified.

Assessment of clinical usefulness of parametric clearance images in diagnosis of kidney cicatrisation in children with chronic infections of the urinary tract.

BACKGROUND: Cicatrisation of the renal cortex is closely related to chronic infections of the urinary system. Static renal scintigraphy is used as the method enabling detection of local defects of radiopharmaceutical uptake, and is treated as the "gold standard" in the diagnosis of renal scars. The aim of the reported investigation was a comparison of the diagnostic efficacy of parametric clearance images and the conventional summation images - obtained from dynamic scintigraphy - in the detection of local defects of renal function. As the "gold standard" for the above comparison, the static scintigraphy of kidneys was accepted. MATERIAL AND METHODS: Forty-one patients (age 4-19 years), 28 girls and 13 boys, participated in the study. Altogether, 73 kidneys were analyzed (in 9 patients, only one kidney). In each patient dynamic renal scintigraphy was performed after IV administration of 99mTc EC (ethylenedicysteine) and static planar renal scintigraphy using 99mTc-DMSA (dimercaptosuccinic acid) as a reference method. From the dynamic study, summation and parametric clearance images were generated. Each kidney was divided into 3 segments (upper, middle, lower); altogether 219 segments were evaluated by modified Howard's scale. Planar and oblique projection images were compared with corresponding summation and parametric clearance images. RESULTS AND CONCLUSIONS: Parametric clearance imaging has a higher sensitivity and accuracy for detection of regional post-inflammatory changes in the kidneys than conventional summation images (p < 0.05) and shows parenchymal changes similarly to static scintigraphy (high Cohen's kappa index).

Positive correlation between serum omentin and thrombospondin-1 in gestational diabetes despite lack of correlation with insulin resistance indices.

UNLABELLED: Gestational Diabetes (GDM) is characterized by insulin resistance and a pro-inflammatory state, both factors possible related to adipokine expression. SUBJECTS AND METHODS: The study included 20 women with GDM, diagnosed according to the WHO criteria, and 23 matched for age and BMI women with normal glucose tolerance. Omentin and TSP-1 were measured by ELISA assays. Insulin resistance was assessed by HOMA and Insulin Resistance Index (IRI). RESULTS: There were no significant differences in omentin and TSP-1 levels between subjects with GDM and controls (48.0 +/- 12.0 ng/ml versus 50.2 +/- 7.9 ng/ml and 2150 +/- 1661 ng/ml versus 1569 +/- 1160 ng/ml, p = 0.64 and p = 0.29, for omentin and TSP-1 in GDM and control subjects, respectively). There was no significant correlation between either omentin or TSP-1 with HOMA or IRI, however there was a significant positive correlation between thrombospondin-1 and omentin (r = 0.49, p = 0.010). There was also a positive correlation between serum omentin and glucose levels at 60 and 90 minutes of OGTT, however, in the control group only (p < 0.05). CONCLUSIONS: Concentrations of omentin and thrombospondin-1 seem to be inter-related in pregnancy however there are no differences in serum levels between women with normal glucose tolerance and those with glucose intolerance. These observations suggest that regulation of concentrations of these adipokines in pregnancy might be mediated though different mechanisms than in non-pregnant subjects.

Oxidative stress parameters after combined fluoxetine and acetylsalicylic acid therapy in depressive patients.

OBJECTIVE: There are numerous reports indicating disturbed equilibrium between oxidative processes and antioxidative defense in patients with depression. Moreover, depressive patients are characterized by the presence of elements of an inflammatory process, which is one of the sources of reactive oxygen species (ROS). In view of the above, it was decided to study both the effect of fluoxetine monotherapy and that of fluoxetine co-administered with acetylsalicylic acid on lipid peroxidation and antioxidative defense in patients with the first depressive episode in their life. METHOD: Seventy seven patients with major depressive disorder (MDD), divided into two groups were included in the study. The first group, consisting of 52 patients, received fluoxetine 20 mg, and the second one, in addition to fluoxetine 20 mg, received 150 mg of acetylsalicylic acid. The activity of antioxidative enzymes, copper-zinc superoxide dismutase (CuZnSOD, SOD1), catalase (CAT), glutathione peroxidase (GPSH-x) and the concentration of malonyldialdehyde (MDA) was determined in erythrocytes, whereas the total antioxidant status (TAS) was determined in the plasma. All parameters were measured before and after three month therapy. RESULTS: The obtained results indicate a significant decrease in the activity of SOD1, CAT and GSHP-x, as well as in MDA concentration after the combined therapy. Also a significant TAS increase was observed after the combined therapy. The study demonstrated that combined therapy with fluoxetine and ASA is characterized by the same efficacy and clinical safety as fluoxetine monotherapy, resulting additionally in improvement of oxidative stress parameters in the patients treated for depression.

Lipid peroxidation and antioxidant protection in patients during acute depressive episodes and in remission after fluoxetine treatment.

Increasing numbers of studies indicate that free radicals and their derivatives play a role in some neuropsychiatric disorders, such as depression. The aim of this study was to investigate the activities of antioxidant enzymes, lipid peroxidation and total antioxidant status (TAS) in patients suffering from major depressive disorder (MDD) as compared to healthy controls. Specifically, we wanted to estimate how fluoxetine influences antioxidant defense and lipid peroxidation. Fifty MDD patients and thirty healthy controls participated in the study. Antioxidant enzyme activities and lipid peroxidation levels were measured in erythrocytes, while TAS was measured in plasma. All measurements were taken during an acute depressive episode and then again during depression remission after a three-month fluoxetine treatment. During acute depressive episodes, patients had significantly higher activity levels of antioxidant enzymes, such as copper-zinc superoxide dismutase (SOD1) and catalase (CAT), as compared to healthy controls. Concentrations of malondialdehyde (MDA) were also significantly higher during depressive episodes. Activity levels of glutathione peroxidase (GPx) did not differ significantly between depressed patients and healthy control subjects. Moreover, the plasma total antioxidant status of the depressed patients was decreased in comparison to control subjects. After three months of fluoxetine treatment, the above parameters did not change significantly. Major depressive disorder is accompanied by disturbances in the balance between pro- and anti-oxidative processes; however, these disturbances do not improve in patients in remission after three months of fluoxetine therapy.

Application of stress-only myocardial perfusion imaging.

BACKGROUND: Single-photon emission computed tomography myocardial perfusion study is usually a sequence of stress and rest part. In case of a normal stress study rest part can be given up. The objective of this study was to examine factors affecting concordance of results of stress-only (SO) and stress-rest (SR) studies. MATERIAL AND METHODS: SO and SR studies without and with attenuation correction (AC) of 212 selected patients (without cardiomyopathy, history of myocardial infarction or coronary artery bypass grafting) were analyzed visually. Influence of percutaneous coronary intervention (PCI) in the past, type of stress (physical/pharmacological) and application of AC (in form of combined method of non-corrected and corrected images - CM), patient body mass index (BMI) and gender on concordance rates of SO and SR studies were examined. RESULTS: Neither a history of PCI, nor a type of stress affected concordance rate. AC (in form of CM) improved concordance rate significantly, from 60% to 68% (p = 0.018). Patient BMI affected concordance rates - 72% in non-obese and 59% in obese patients (p = 0.05). In the whole group, risk of overlooking patients with abnormal perfusion in SO study was small (< 2%), but it grew significantly with patient BMI. Rest study was necessary in about 20% of non-obese and in about 50% of obese patients. CONCLUSION: MPS can be limited to stress part in appropriately selected, especially non-obese, patients provided that AC is applied, due to a low risk of overlooking patients with abnormal perfusion. In case of obese patients, careful analysis of exercise images for their normality is particularly important.

Elevated concentrations of retinol-binding protein-4 (RBP-4) in gestational diabetes mellitus: negative correlation with soluble vascular cell adhesion molecule-1 (sVCAM-1).

BACKGROUND: Retinol-binding protein-4 (RBP-4) may increase insulin resistance (IR) in animals, with elevated levels reported in humans with obesity and type 2 diabetes. There are, however, few data on concentrations of RBP-4 in gestational diabetes mellitus (GDM). METHODS: We measured fasting serum levels of RBP-4, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in 50 women at 28 weeks of gestation, divided according to the results of a 50 g glucose challenge test (GCT) and a 75 g oral glucose tolerance test (OGTT): (1) controls (n = 20), normal responses to both GCT and OGTT; (2) intermediate group (IG) (n = 15): false positive GCT, but normal OGTT; and (3) GDM group (n = 15), both GCT and OGTT abnormal. IR was assessed by homeostasis model assessment (HOMA-IR) and by insulin resistance index (IRI) based on glycemia and insulinemia during OGTT. RESULTS: All groups were matched for age and body mass index (BMI). RBP-4 levels (microg/ml, mean+/-standard deviation) were higher in women with GDM vs. controls (53.9 +/- 17.9 vs. 29.7 +/- 13.9, p < or = 0.001), with a trend towards higher RBP-4 in GDM compared with IG (38.0 +/- 19.3, p = 0.07). There was no significant correlation between RBP-4 and age, BMI, insulin, IRI or HOMA-IR, but there was a moderate, significant negative correlation between RBP-4 and sVCAM-1 (r(2) = 0.20, p = 0.001). CONCLUSIONS: RBP-4 levels are elevated in women with GDM, but do not correlate with IR indices and correlate negatively with sVCAM-1. The physiological significance of RBP-4 rise in women with GDM remains to be elucidated.

Effect of attenuation correction on normal (99)mTc-MIBI myocardial perfusion scintigrams acquired with a hybrid SPECT/CT camera.

The aim of this study was to evaluate the effect of the CT-derived attenuation correction on (99m)Tc-MIBI normal myocardial perfusion scintigrams. Rest perfusion scintigrams of patients in whom coronary artery disease was suspected, without a history or any signs in ECG of a myocardial infarction, were analysed. Patients were included in the material if their rest perfusion scintigrams were normal. This criterion was fulfilled by 61 patients (29 men and 32 women) aged between 40 and 74 (mean value 57) years, with body mass between 50 and 120 (mean value 70) kg. Tomographic reconstruction of a radionuclide study was performed with an iterative OSEM method (10 subsets, 2 iterations) sequentially without and with attenuation and scatter corrections on a dedicated Xeleris workstation, applying an ACQC tool to enable manual realignment of SPECT and CT images. SPECT studies were evaluated visually and semiquantitatively. Visual analysis of tomograms was performed with the aim of finding sites of significantly lower counts in comparison with the maximal level (in the lateral wall). Semiquantitative analysis was based on counts in 20 segments of a polar map. Attenuation correction caused a complete (in 32 of 40 - 80% of patients) or partial (in 8 of 40 - 20% of patients) filling out of all areas of lower counts in the inferior wall. However, although in the anterior wall attenuation correction caused a complete (in 11 of 35 - 31% of cases) or partial (10 of 35 - 29% of cases) filling of areas of lower counts, in 14 cases (40%) those areas remained unchanged or increased, and in 8 cases (13% of all patients) new areas of decreased counts appeared. The same was true for the apical region, in which areas of decreased counts were detected in 14 of 61 (23%) cases without attenuation correction, but after application of the correction number of apical defects, this figure grew to 22 (36%) patients. Altogether, attenuation correction reduced the total number of lower count areas from 104 to 66. Semi-quantitative analysis revealed that attenuation correction reduced nonuniformity in counts in the whole myocardium - the mean difference between segment with maximum counts and values in all segments was reduced from 17.5 +/- +/- 12% to 11.0 +/- 10.3% (p < 0.0001) in male patients, and in female patients, from 11.5 +/- 9% to 10.5 +/- 8.6%, thus equalling non-uniformities in myocardial scintigrams of both sexes. Misalignment of CT and SPECT studies was observed in 17 (28%) patients but only in 2 (3% of all patients) patients did CT realignment evidently change the attenuation corrected scintigrams. Although attenuation correction can cause artefacts, its use is justified by the reduction of the total number of areas of lower counts and the improvement of uniformity of images of normally perfused myocardium.