Left ventricular geometric patterns and cardiac function in patients with chronic renal failure undergoing hemodialysis

The aim of this study was to estimate the impact and prevalence of left ventricular geometric alterations and systolic and diastolic dysfunction in hemodialysis patients, as well as the relationship with cardiac troponin as a marker of myocardial damage. Methods: 31 patients (pts), 19 males and 12 females, age 58.1±16.4 (26 on hemodialysis, 5 on peritoneal dialysis) and 31 healthy normal controls were enrolled. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations. Left ventricular mass was calculated, according to the Devereux formula and indexed to height and weight 2.7. Doppler echocardiography was performed to study diastolic function by measurements of isovolumetric relaxation period (IVRT), E wave deceleretion time (DTE) and E/A ratio. Cardiac troponin was measured by a third generation electrochemiluminescence immunoassay. Statistical analysis was performed using the t-test for between-group comparisons and the Pearson and Spearman’s tests to investigate correlations; p values of <0.05 were considered statistically significant. Results: Eccentric hypertrophy was the most frequent pattern (n=17; 55%), followed by normal cardiac geometry (n=7; 23%), and concentric hypertrophy (n=5; 16%). Only 6% of pts (n=2) showed concentric remodelling. Systolic dysfunction was present in terms of endocardial parameters in 3 pts (9%) (fractional shartening <25%, EF<50%), but in terms of midwall myocardial shortening in 51% (n=16). Diastolic dysfunction was present in 87% (n=27) with a pattern of impaired relaxation (in 5 without left ventricular hypertrophy). E/A was negatively correlated with age (r=-0.41, p=0.02); DTE was positively correlated with posterior wall thickness (r=0.36, p=0.05) and interventricular septum thickness (r=0.45, p=0.01); cardiac troponin was positively correlated with age (r=0.50, p=0.00), left ventricular mass (r=0.41, p=0.02), posterior wall thickness (r=0.41; p=0.02) and interventricular septum thickness (r=0.39, p=0.03) but not with diastolic dysfunction parameters. No significant difference was found in terms of duration of dialysis between patients with normal left ventricular geometry and those with left ventricular hypertrophy, but a significant difference in age was found (p=0.03). Pts with diastolic dysfunction had more frequent hypotensive episodes during dialysis (p <0.01). Conclusion: Impaired geometry and cardiac function is frequently observed in pts undergoing hemodialysis. Diastolic dysfuction is associated to a geometric pattern of left ventricular hypetrophy, although it can be an isolated initial manifestation of myocardial damage. Depressed midwall myocardial shortening can discriminate left ventricular dysfunction better than traditional endocardial systolic indexes

Isolated congenital coronary fistula in adult population: discussion a clinical case and review of current literature

We describe a case of a 56 year-old man with a history of chest pain. No evidence of myocardial ischemia or arrhytmias was observed. Echocardiographic examination in Emergency Department evidenced aortic root dilatation. Angio CT excluded aortic dissection. Trans esophageous Echocardiography (TEE) correctly identified an arterial fistula between the right coronary artery and superior vena cava, confirmed by angio CT 3-D reconstruction and coronarography. The definitive diagnosis was made after integrated approach (using TTE, TEE, CT, coronarography). The anatomic features of the fistula and the aortic root were examinated. Actually the patient is being followed with serial clinical and echocardiography examination for monitoring hemodynamic overload by fistula and size of aortic root for potential surgical correction. Current literature for incidence, diagnosis and the treatment of coronary fistulas is discussed

The Neural Basis of Decision-Making and Reward Processing in Adults with Euthymic Bipolar Disorder or Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) share DSM-IV criteria in adults and cause problems in decision-making. Nevertheless, no previous report has assessed a decision-making task that includes the examination of the neural correlates of reward and gambling in adults with ADHD and those with BD

Differential cognitive and affective theory of mind abilities at mild and moderate stages of behavioral variant frontotemporal dementia

To study the affective and cognitive components of theory of mind (ToM) performance in patients with behavioral variant frontotemporal dementia (bvFTD), focusing on differential impairment at mild and moderate disease stages.ToM, a central capacity for appropriate social behavior, is critically impaired in patients with bvFTD, even early in the disease. No previous study has explored how the cognitive and affective components of ToM may relate differentially to disease severity.We assessed 40 patients with an established diagnosis of bvFTD and 18 healthy controls, using a complete neuropsychological battery that featured executive function and ToM tasks. We used patients' Clinical Dementia Rating scores to classify them as having either mild or moderate bvFTD.Both groups of patients showed deficits in the affective and cognitive components of ToM relative to the controls. The patients with mild bvFTD outperformed the group with moderate bvFTD in cognitive ToM capacities; however, affective ToM was equally impaired in both bvFTD groups. The cognitive, but not the affective, component of ToM correlated with performance on the executive function tests.Our results suggest that affective ToM is markedly diminished even during the initial stages of bvFTD; as the disease progresses, deficits in cognitive ToM become more prominent. These findings may relate to the pattern of cortical atrophy described for bvFTD. We also found significant correlations between the cognitive component of ToM and executive functions.8 page(s

The Relationship of Clinical, Cognitive and Social Measures in Schizophrenia: A Preliminary Finding Combining Measures in Probands and Relatives

This study examines performance of schizophrenia patients, unaffected relatives and controls in social cognition, cognitive and psychiatric scales looking for possible markers of vulnerability in schizophrenia. Performance of schizophrenia patients from multiplex families, first-degree relatives, and matched controls was compared and, subsequently, discriminant analysis method was used for identifying the best predictors for group membership. By using Multigroup Discriminant Analyses on the three groups, the best predictors were PANSS, Premorbid Adjustment Scale, Faux Pas test, and a face/emotion categorizing task. This model obtained 82% correct global classification, suggesting that the combination of psychiatric scales and neuropsychological/social cognition tesks are the best approach for characterizing this disease. Although preliminary, our results suggest that social cognition tasks are robust markers of schizophrenia family impairments, and that combining clinical, social and neuropsychological measures is the best approach to asses patients and relatives vulnerability

Endoscopic ultrasound-guided fine-needle biopsy with or without macroscopic on-site evaluation: a randomized controlled noninferiority trial

BACKGROUND : The advantage of using the macroscopic on-site evaluation (MOSE) technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) performed with 22G Franseen needles has not been investigated. We aimed to compare EUS-FNB with MOSE vs. EUS-FNB performed with three needle passes. METHODS : This randomized trial involved 10 Italian referral centers. Consecutive patients referred for EUS-FNB of pancreatic or nonpancreatic solid lesions were included in the study and randomized to the two groups. MOSE was performed by gross visualization of the collected material by the endoscopists and considered adequate when a white/yellowish aggregate core longer than 10 mm was retrieved. The primary outcome was diagnostic accuracy. Secondary outcomes were specimen adequacy, number of needle passes, and safety. RESULTS : 370 patients with 234 pancreatic lesions (63.2 %) and 136 nonpancreatic lesions (36.8 %) were randomized (190 EUS-FNB with MOSE and 180 with standard EUS-FNB). No statistically significant differences were found between EUS-FNB with MOSE and conventional EUS-FNB in terms of diagnostic accuracy (90.0 % [95 %CI 84.8 %-93.9 %] vs. 87.8 % [95 %CI 82.1 %-92.2 %]; P = 0.49), sample adequacy (93.1 % [95 %CI 88.6 %-96.3 %] vs. 95.5 % [95 %CI 91.4 %-98 %]; P = 0.31), and rate of adverse events (2.6 % vs. 1.1 %; P = 0.28). The median number of passes was significantly lower in the EUS-FNB with MOSE group (1 vs. 3; P &lt; 0.001). CONCLUSIONS : The accuracy of EUS-FNB with MOSE is noninferior to that of EUS-FNB with three needle passes. MOSE reliably assesses sample adequacy and reduces the number of needle passes required to obtain the diagnosis with a 22G Franseen needle

ERP descriptive statistics.

<p>Mean amplitude values of valence and magnitude for patients with BD, those with ADHD and controls.</p

Decision-making task results (IGT, RDMUR and RDGT).

<p>A) IGT net score of Blocks 1 to 5; B) The number of cards selected in the RDMUR task; c) Total reaction time in the RDMUR task; D) Valence effects in the RDGT task; ERP mean amplitudes at the fERN timeframe; and E) Magnitude effects in the RDGT task; ERP mean amplitudes at the P3 timeframe. Boxes indicate SDs in b, c, d and e.</p

fERN and P3 modulation of valence and reward magnitude.

<p>A) FERN Valence modulation (wins vs. losses) in controls, patients with ADHD and those with BD.Voltage maps show the scalp modulations (losses minus wins) at the fERN timeframe. B) Magnitude modulation (large vs. small rewards) in controls, patients with ADHD and those with BD. The P3s of controls discriminated reward magnitudes whereas this effect was absent in patients with ADHD but enhanced in patients with BD. Voltage maps show the scalp modulations (large minus small) at the P3 timeframe.</p

Cortical current density mapping of valence and reward magnitude.

<p>A. The source estimation of distributed valence dipoles (fERN, left) and magnitude effects (P3, right) for controls, patients with ADHD and those with BD. Color-map values represent the t-values of comparisons between signal and noise. B. A time-series of the absolute power activation evoked by valence and reward magnitudes at the anterior, medial and posterior cingulate cortex (aCC, mCC, pCC). C. The average values of absolute power at aCC, mCC and PCC for the valence and magnitude effects for all groups. We obtained the ROIs at aCC, mCC and pCC using a Tzourio-Mazoyer partition.</p