Structural abnormalities of the coronary arterial wall - in addition to luminal narrowing - Affect myocardial blood flow reserve

Multislice CT provides information on coronary luminal narrowing and on the structural abnormalities of the coronary arterial wall using densitometric analysis. We sought to investigate the effects of coronary luminal narrowing, structural abnormalities of the coronary arterial wall, and cardiovascular risk factors on regional and global myocardial blood flow (MBF) reserve. Methods: We studied 68 patients (mean age ± SD, 61 ± 10 y; 41 men, 27 women) with an intermediate probability of coronary artery disease. We measured the severity of coronary stenoses and the fibroadipose, fibromuscular, and calcium components of the coronary arterial wall by 64-row multislice CT coronary angiography. We also measured regional and global MBF reserve by PET using 13N-ammonia as a flow tracer at rest and after dipyridamole. Results: One or more significant coronary stenoses (≥50% luminal narrowing) was present in 32 patients (47%), and nonsignificant stenoses were present in 15 patients (22%). Regional MBF reserve was significantly different in the territories perfused by normal coronary arteries, nonsignificant coronary stenoses, and significant coronary stenoses (P < 0.001). Calcium content was higher in the coronary arteries with significant or nonsignificant stenoses (0.95% ± 1.08% and 0.73% ± 0.93%, respectively) than in those without stenoses (0.11% ± 0.38%, P < 0.001). Significant coronary stenosis (P = 0.047) and calcium content (P = 0.017) were the only independent determinants of impaired regional MBF reserve using multivariate analysis. At multiple logistic regression analysis, the Framingham risk score, an index of global cardiovascular risk burden, was the only significant determinant of global MBF reserve (P = 0.028). Conclusion: Coronary stenoses and coronary calcium content independently affect regional MBF reserve. Framingham risk score is the only significant determinant of global MBF reserve. Copyright © 2011 by the Society of Nuclear Medicine, Inc

By-catch of cetaceans and other species of conservation concern during pair trawl fishing operations in the Adriatic Sea (Italy)

By-catch is one of the main sources of anthropogenic mortality in marine species of conservation concern worldwide. Between 2006 and 2008, the Consorzio Nazionale Interuniversitario per le Scienze del Mare (CoNISMa) coordinated a monitoring programme of cetacean by-catch in Italian pelagic trawlers, funded in compliance with European Regulation 812/2004. Sixteen independent observers monitored a total of 3141 hauls. The observation coverage ranged between 0.9 and 6.3% of the regional fishing effort. Almost all by-catch events were recorded in the northern Adriatic Sea. By-catch rates of bottlenose dolphins (Tursiops truncatus) and loggerhead turtles (Caretta caretta) were 0.0006 and 0.0255 individuals per haul, respectively. Given the low number of observed deaths, reliable estimates of total mortality for these two species were not obtained. The annual number of by-caught turtles was 863 (CV=0.15), with 99% released alive. A ‘hotspot’ for turtle captures was found off Goro (south Venice). The existence of lethal interactions makes it important to understand whether the scale of this mortality is sufficient to pose a threat at population level. Finally, annual by-catch estimates for rays and sharks were 5436 (CV=0.08) and 5414 (CV=0.15), respectively. Thintail threshers (Alopias vulpinus), piked dogfish (Squalus acanthias) and smooth-hounds (Mustelus mustelus), which are both commercial and vulnerable to overfishing, were taken in large numbers

Abnormal glucose and lipid control in non-ischemic left ventricular dysfunction

Background: Cardiovascular risk factors are classically associated with coronary atherosclerosis. We sought to investigate whether risk factors are also associated with left ventricular (LV) dilatation, contractile impairment and reduced myocardial blood flow (MBF) in patients with non-ischemic LV dysfunction. Methods: We studied 81 patients (59 males, age 60 ± 9 years) with mild-to-severe LV dysfunction (mean ejection fraction 37%, range 19%-50%), no history of diabetes and normal coronary arteries. Absolute MBF was measured by positron emission tomography and 13N-ammonia at rest and after dipyridamole (0.56 mg/kg I.V. over 4 min). Results: Overt LV dysfunction (LV end-diastolic diameter >60 mm associated with LV ejection fraction <45%) was present in 42 patients (52%); severely depressed hyperemic MBF (<1.09 mL·min-1·g-1) was present in 41 patients (51%). Using multivariate logistic regression analysis, low high-density lipoprotein cholesterol (HDL-C, P <.036), newly diagnosed non-insulin-dependent diabetes or insulin-resistance (NIDD/IR, P <.019) and the use of diuretics (P =.001) were independently associated with overt LV dysfunction. Low HDL-C (P =.015) and NIDD/IR (P =.048) were also independently associated with severely depressed hyperemic MBF. Conclusions: Low HDL-C and NIDD/IR are associated with more severe LV impairment and reduced hyperemic MBF in non-ischemic LV dysfunction. © 2012 American Society of Nuclear Cardiology

Levodopa-responsive breathing discomfort in Parkinson\u2019s disease patients

In Parkinson\u2019s disease (PD), respiratory disturbances have been reported and the effect of levodopa on respiratory function remains controversial. The objective of this study was to evaluate pulmonary function utilizing spirometric and subjective evaluations in mild to moderated PD. Thirty-four consecutive sporadic PD patients (Hoehn and Yahr scale: 1\u20133) were prospectively evaluated using clinimetric scales, spirometry and modified Borg scale, all in off- and on-conditions. To check the respiratory function, a follow-up was performed at 4 years in a subgroup of these patients. Spirometric results were normal for all patients in both the on- and off-conditions at baseline. After levodopa administration, in addition to a significant improvement in subjective state of breathing discomfort, the mean forced expiratory volume in 1 s (FEV1), vital capacity (VC), forced vital capacity (FVC) values and their mean percentages predicted values (FEV1%, VC%, FVC%) were significantly increased (p < 0.05). Moreover, residual volume, total lung capacity, and the FEV1/FVC ratio were not significantly different for the ON and OFF conditions. At 4-year follow-up no resulting variations in the baseline values for FEV1%, FVC% or VC% were revealed. The results from this prospective study suggest that PD patients report frequently pulmonary discomfort. Levodopa improves respiratory symptoms. Pulmonary restrictive and obstructive dysfunctions, when not present at baseline, might not be present at 4-year follow-up

Impulse Control Disorders and Levodopa-Induced Dyskinesias in Parkinson's Disease: Pulsatile versus Continuous Dopaminergic Stimulation

Background: Dopaminergic medications in Parkinson's disease (PD) are usually associated with the development of both levodopa-induced dyskinesias (LID) and impulse control and repetitive behavior disorders (ICRB). Objective: To assess the prevalence and the severity of ICRB in a cohort of moderate and advanced PD patients and to investigate the potential interplay between ICRB, LID and dopaminergic therapies. Methods: 117 PD patients were consecutively recruited. LID were assessed by using the Rush Dyskinesia Rating Scale (RDRS). ICRB were tested by means of Questionnaire for Impulsive Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS). Results: 55 patients were affected by LID. Among them, 37 were treated only by oral therapy, OT (LID/OT), while 18 were on treatment with jejunal levodopa infusion, JLI (LID/JLI). 62 patients were not affected by LID (NLID) and all of them were on therapy only with oral drugs. The overall prevalence of clinically significant ICRB was 34% (95% CI=26% to 43%) and the mean value (\ub1SD) of QUIP-RS total score was 5.4\ub18.5. Prevalence of clinically significant ICRB, as well as severity of ICRB, was higher in patients with LID compared to NLID patients (p=0.016 and p<0.001, respectively). When considering LID/JLI, LID/OT and NLID groups, QUIP-RS total score was significantly higher in LID/OT patients compared to LID/JLI (10.4\ub111.8 vs. 4.9\ub16.0, p=0.019) and NLID (10.4\ub111.8 vs. 2.5\ub14.8, p<0.001) groups. Conclusion: PD patients with LID show ICRB more frequently and more severely than patients without LID. Among LID patients, those treated by JLI showed a lower severity of ICRB than those on OT, suggesting a potential protective effect of JLI on ICRB