A Pilot Study on Dietary Approaches in Multiethnicity: Two Methods Compared

Background. Medical nutritional therapy is the most important method for normalizing glucose levels in pregnancy. In this setting, there is a new problem to consider relating to migrants, their personal food preferences, and ethnic, cultural, and religious aspects of their diet. We compared maternal and fetal outcomes between two multiethnic groups of pregnant women, one adopting a food plan that included dishes typical of the foreign women's original countries (the “ethnic meal plan” group), while the other group adopted a standard meal plan. Findings. To develop the meal plan, each dish chosen by the women was broken down into its principal ingredients. The quantity of each food was given in tablespoons, teaspoons, slices, and cups, and there were photographs of the complete dish. The group treated with the ethnic meal plan achieved a better metabolic control at the end of the pregnancy and a lower weight gain (though the difference was not statistically significant). As for fetal outcome, the group on the ethnic meal plan had babies with a lower birth weight and there were no cases of macrosomia or LGA babies. Conclusions. This preliminary study indicates the positive effect of an ethnic approach to diet on the outcome of pregnancy

Plasma phospholipid fatty acid composition and desaturase activity in women with gestational diabetes mellitus before and after delivery

AIMS: Analyze plasma phospholipid fatty acids (PPFA) composition and desaturase activity in women with gestational diabetes (GDM) and in women with a normal glucose tolerance (NGT) before and after delivery, and to evaluate the possible relationship between desaturase activity and inflammatory parameters. METHODS: PPFA composition was analyzed by gas chromatography in 21 women with GDM and from 21 with NGT, during the third trimester of pregnancy and 6 months after delivery. We used fatty acid product-to-precursor ratios to estimate desaturase activity, and we also measured in all women interleukins six and ten, tumor necrosis factor alpha and C-reactive protein. RESULTS: No significant differences were observed between NGT and GDM women in terms of PPFA composition, both in pregnancy and after pregnancy. Estimated desaturase \u3949-18 activity was significantly higher, and estimated desaturase \u3945 activity was significantly lower during pregnancy in all women. We observed no correlations between inflammatory markers and desaturases activity, during or after pregnancy, in both groups. CONCLUSIONS: Our data suggest that GDM does not influence PPFA composition and desaturase activity during pregnancy. In addition, late pregnancy characterized by hyperinsulinemia appears to upregulate desaturase \u3949-18 activity in NGT and GDM women

Non-compact myocardium assessment by cardiac magnetic resonance: dependence on image analysis method.

none8To compare image analysis methods for the assessment of left ventricle non-compaction from cardiac magnetic resonance (CMR) imaging. CMR images were analyzed in 20 patients and 10 normal subjects. A reference model of the MR signal was introduced and validated based on image data. Non-compact (NC) myocardium size and distribution were assessed by tracing a single, continuous contour delimiting trabeculated region (Jacquier) or by one-by-one selection of trabeculae (Grothoff). The global non-compact/compact (NC/C) ratio, the NC mass, and the segmental NC/C ratio were assessed. Results were compared with the reference model. A significant difference between Grothoff and Jacquier approaches in the estimation of NC/C ratio (32.08 ± 6.63 vs. 19.81 ± 5.72, p < 0.0001) and NC mass (26.59 ± 8.36 vs. 14.15 ± 5.73 g/m2, p < 0.0001) was found. The Grothoff approach better matches the expected signal distribution. Inter-observer reproducibility of both Grothoff and Jacquier methods was adequate (9.71 and 8.22%, respectively) with no significant difference between observers. Jacquier and Grothoff approaches are not interchangeable so that specific diagnostic thresholds should be used for different image analysis methods. Grothoff method seems to better capture the true extension of trabeculated tissue.mixedPositano V; Meloni A; Macaione F; Santarelli MF; Pistoia L; Barison A; Novo S; Pepe APositano, V; Meloni, A; Macaione, F; Santarelli, Mf; Pistoia, L; Barison, A; Novo, S; Pepe,

Myocardial T1 Values at 1.5 T: Normal Values for General Electric Scanners and Sex-Related Differences

Background No data are available about normal ranges for native T1 in human myocardium using General Electric (GE) scanners.Purpose To establish normal ranges for myocardial T1 values and evaluate regional variability and the influence of physiological factors.Study type Prospective.Subjects One hundred healthy volunteers with normal electrocardiogram, no cardiovascular/systemic diseases, or risk factors (age range: 20-70 years; 50 females).Field Strength/Sequence 1.5 T/Steady-state free precession cine and a modified Look-Locker inversion recovery sequence in diastole (also in systole for 61 volunteers).Assessment Image analysis was performed by operators with &gt;10 years experience in cardiac MR using commercially available software. T1 values were calculated for 16 myocardial segments, and the global value was the mean. Segments were grouped according to circumferential region (anterior, septal, inferior, and lateral) and to level (basal, medial, apical). Twenty images were analyzed twice by the same operator and by a different operator to assess reproducibility.Statistical Tests Independent-samples t-test or Mann-Whitney test; paired sample t-test or Wilcoxon signed-rank test; one-way repeated measures ANOVA or Friedman tests; Pearson's or Spearman's correlation. Reproducibility evaluated using coefficient of variability (CoV).Results Due to artifacts and/or partial-volume effects, 45/1600 (2.8%) segments were excluded. A good intra- and inter-operator reproducibility was detected (CoV &lt; 5%). There were significant differences in segmental T1 values (P &lt; 0.05). A significant circumferential variability was present (P &lt; 0.05): the mean native T1 value over the lateral region was significantly lower than in the other three regions. An increasing gradient from basal to apical slices was detected (P &lt; 0.05). Segmental and global T1 values were not associated with age (range P = 0.052-0.911) but were significantly lower in males than in females (global: 993 +/- 32 vs. 1037 +/- 27 ms; P &lt; 0.05) and significantly correlated with heart rate (range R for segmental values = 0.247-0.920; P &lt; 0.05). Almost all segmental T1 values were inversely correlated with wall thickness (R from -0.233 to -0.514; P &lt; 0.05). Systolic T1 values were significantly lower than diastolic values in basal anteroseptal segment, in all medial segments except the inferior one, and in all apical segments (P &lt; 0.05).Data Conclusion Myocardial T1 values differ among myocardial regions, are influenced by sex, heart rate, and wall thickness and vary according to the cardiac cycle in healthy adults.Level of Evidence 2Technical Efficacy Stage

Myocardial T2 values at 1.5 T by a segmental approach with healthy aging and gender

Objectives Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables. Methods One hundred healthy volunteers aged 20-70 years (50% females) underwent cardiovascular magnetic resonance. Basal, mid-ventricular, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. The T2 value was assessed in all 16 myocardial segments and the global value was the mean. Results The global T2 value averaged across all subjects was 52.2 +/- 2.5 ms (range: 47.0-59.9 ms). Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation &lt; 5%). 3.6% of the segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (p &lt; 0.0001), with the lowest value in the basal anterolateral segment (50.0 +/- 3.5 ms) and the highest in the apical lateral segment (54.9 +/- 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both mid-ventricular and apical slices and in the mid-ventricular slice than in the apical slice. Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate. A significant inverse correlation was detected between global T2 values and mean wall thickness. Conclusions The optimized MEFSE sequence allows for robust and reproducible quantification of segmental T2 values. Gender- and age-specific segmental reference values must be defined for distinguishing healthy and diseased myocardium

Liver T1 and T2 mapping in a large cohort of healthy subjects: normal ranges and correlation with age and sex

Objective: We established normal ranges for native T1 and T2 values in the human liver using a 1.5&nbsp;T whole-body imager (General Electric) and we evaluated their variation across hepatic segments and their association with age and sex. Materials and methods: One-hundred healthy volunteers aged 20-70&nbsp;years (50% females) underwent MRI. Modified Look-Locker inversion recovery and multi-echo fast-spin-echo sequences were used to measure hepatic native global and segmental T1 and T2 values, respectively. Results: T1 and T2 values exhibited good intra- and inter-observer reproducibility (coefficient of variation &lt; 5%). T1 value over segment 4 was significantly lower than the T1 values over segments 2 and 3 (p &lt; 0.0001). No significant regional T2 variability was detected. Segmental and global T1 values were not associated with age or sex. Global T2 values were independent from age but were significantly lower in males than in females. The lower and upper limits of normal for global T1 values were, respectively, 442&nbsp;ms and 705&nbsp;ms. The normal range for global T2 values was 35&nbsp;ms-54&nbsp;ms in males and 39&nbsp;ms-54&nbsp;ms in females. Discussion: Liver T1 and T2 mapping is feasible and reproducible and the provided normal ranges may help to establish diagnosis and progression of various liver diseases

The additive prognostic value of end-systolic pressure-volume relation by stress CMR in patients with known or suspected coronary artery disease

Purpose: The difference between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an afterload-independent index of left ventricular (LV) contractility. We assessed the independent prognostic value of ΔESPVR index by dipyridamole stress-cardiovascular magnetic resonance (CMR) in patients with known/suspected coronary artery disease (CAD). Methods: We considered 196 consecutive patients (62.74 ± 10.66 years, 49 females). Wall motion and perfusion abnormalities at rest and peak stress were analysed. Replacement myocardial fibrosis was detected by late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. Results: A reduced ΔESPVR index (≤ 0.02 mmHg/mL/m2) was found in 88 (44.9%) patients and it was associated with a lower LV ejection fraction (EF) and with a higher frequency of abnormal stress CMR and myocardial fibrosis. During a mean follow-up of 53.17 ± 28.21 months, 50 (25.5%) cardiac events were recorded: 5 cardiac deaths, 17 revascularizations, one myocardial infarction, 23 hospitalisations for heart failure or unstable angina, and 4 ventricular arrhythmias. According to Cox regression analysis, diabetes, family history, LVEF, abnormal stress CMR, myocardial fibrosis, and reduced ΔESPVR were significant univariate prognosticators. In the multivariate analysis the independent predictors were ΔESPVR index ≤ 0.02 mmHg/mL/m2 (hazard ratio-HR = 2.58, P = 0.007), myocardial fibrosis (HR = 2.13, P = 0.036), and diabetes (HR = 2.33, P = 0.012). Conclusion: ΔESPVR index by stress-CMR was independently associated with cardiac outcomes in patients with known/suspected CAD, in addition to replacement myocardial fibrosis and diabetes. Thus, the assessment of ΔESPVR index may be included into the standard stress-CMR exam to further stratify the patients

Biventricular Tissue Tracking with Cardiovascular Magnetic Resonance: Reference Values of Left- and Right-Ventricular Strain

We derived reference values of left-ventricular (LV) and right-ventricular (RV) strain parameters in a cohort of 100 healthy subjects by feature tracking cardiac magnetic resonance (FT-CMR). Global and regional strain values were calculated for the LV; circumferential and radialSAX strain parameters were derived from the short-axis (SAX) stack, while longitudinal and radialLAX strain parameters were assessed in three long-axis (LAX) views. Only global longitudinal strain (GLS) was calculated for the RV. Peak global LV circumferential strain was −16.7% ± 2.1%, LV radialSAX strain was 26.4% ± 5.1%, LV radialLAX strain was 31.1% ± 5.2%, LV GLS was −17.7% ± 1.9%, and RV GLS was −23.9% ± 4.1%. Women presented higher global LV and RV strain values than men; all strain values presented a weak relationship with body surface area, while there was no association with age or heart rate. A significant association was detected between all LV global strain measures and LV ejection fraction, while RV GLS was correlated to RV end-diastolic volume. The intra- and inter-operator reproducibility was good for all global strain measures. In the regional analysis, circumferential and radial strain values resulted higher at the apical level, while longitudinal strain values were higher at the basal level. The assessment of cardiac deformation by FT-CMR is feasible and reproducible and gender-specific reference values should be used