Hand-held echocardiography: added value in clinical cardiological assessment

In the present article we review the main published data on the application of Tissue Doppler Imaging (TDI) to stress echocardiography for the detection of myocardial ischemia. TDI has been applied to stress echocardiography in order to overcome the limitations of visual analysis for myocardial ischemia. The introduction of a new technology for clinical routine use should pass through the different phases of scientific assessment from feasibility studies to large multicenter studies, from efficacy to effectiveness studies. Nonetheless the pro-technology bias plays a major role in medicine and expensive and sophisticated techniques are accepted before their real usefulness and incremental value to the available ones is assessed. Apparently, TDI is not exempted by this approach : its applications are not substantiated by strong and sound results. Nonetheless, conventional stress echocardiography for myocardial ischemia detection is heavily criticized on the basis of its subjectivity. Stress echocardiography has a long lasting history and the evidence collected over 20 years positioned it as an established tool for the detection and prognostication of coronary artery disease. The quantitative assessment of myocardial ischemia remains a scientific challenge and a clinical goal but time has not come for these newer ultrasonographic techniques which should be restricted to research laboratories.     

Peptide YY and cancer: current findings and potential clinical applications

Peptide YY (PYY) is a naturally occurring gut hormone with mostly inhibitory actions on multiple tissue targets. PYY has been identified in several carcinoid tumors and a decreased expression of PYY may be relevant to the development and progression of colon adenocarcinoma. Treatment with PYY decreases growth in pancreatic and breast tumors, most likely through a reduction in intracellular cAMP. In cancer patients, PYY may also improve malnutrition that results from iatrogenic causes or cachexia associated with advanced disease. PYY plays a significant role in multiple aspects of cancer from regulation of cell growth to potential therapeutic applications.     

The clinical potential of stem cells

Stem cells are defined by their capacity for self-renewal and multilineage differentiation, making them uniquely situated to treat a broad spectrum of human diseases. For example, because hematopoietic stem cells can reconstitute the entire blood system, bone marrow transplantation has long been used in the clinic to treat various diseases. Similarly, the transplantation of other tissue-specific stem cells, such as stem cells isolated from epithelial and neural tissues, can treat mouse disease models and human patients in which epithelial and neural cells are damaged. An alternative to tissue-specific stem cell therapy takes advantage of embryonic stem cells, which are capable of differentiating into any tissue type. Furthermore, nuclear transfer, the transfer of a post-mitotic somatic cell nucleus into an enucleated oocyte, creates a limitless source of autologous cells that, when combined with gene therapy, can serve as a powerful therapeutic tool.     

Proteomic analysis of synovial fluid: current and potential uses to improve clinical outcomes

Introduction: Synovial fluid (SF) is in close proximity to tissues which are primarily altered during articular disease and has significant potential to better understand the underlying disease pathogeneses of articular pathologies and biomarker discovery. Although development of mass spectrometry-based methods has allowed faster and higher sensitivity techniques, interrogation of the SF proteome has been hindered by its large protein concentration dynamic range, impeding quantification of lower abundant proteins.

Areas covered: Recent advances have developed methodologies to reduce the large protein concentration dynamic range of SF and subsequently allow deeper exploration of the SF proteome. This review concentrates on methods to overcome biofluid complexity, mass spectrometry proteomics methodologies, extracellular vesicles proteomics and the application of advances within the field in clinical disease, including osteoarthritis, rheumatoid arthritis, spondyloarthritis and juvenile arthritis. A narrative review was conducted with articles searched using PubMed, 1991–2018.

Expert opinion: The SF proteomics field faces various challenges, including the requirement for rigorous and standardised methods of sample collection/storage, the sensitivity and specificity of proteomic assays, techniques to combat the large protein concentration dynamic range and comprehensive data analysis to reduce falsely identified markers. Additionally, there are challenges in developing multi ‘omic’ integration techniques, with computational integration enhancing analysis.     

The potential value of immunoperoxidase techniques in diagnostic cytology

A slightly modified immunoperoxidase method was developed in our laboratory and applied to a variety of aspiration and exfoliative cytologic material. Our aims were: (1) to explore the applicability of the immunoperoxidase procedure to diagnostic cytology, (2) to attempt to define the histogenesis of neoplastic cells when morphology alone proved insufficient, and (3) to investigate the possibility of differentiating reactive from neoplastic lymphoreticular disorders by studying their immunoglobulin patterns. Our findings indicate that the immunoperoxidase technique is applicable to cytologic material. The simplicity of the procedure, combined with its high sensitivity and excellent morphology, merits wider application of this technique to routine diagnostic cytology.     

The potential value of honey in palaeopalynology and archaeology

Over 70 pollen types were recovered from honey samples from eight localities in southern Nigeria. The identified honey pollen are those of important climatic and environmental indicator species, and clearly reflect the botanical and geographical origins of the honey samples. The implications of this in the study of past environments and archaeology are discussed.     

Unleashing the potential of peptides in agriculture and beyond

Peptides display a broad range of regulatory functions. Ormancey et al. recently identified an important new mechanism – complementary peptides (cPEPs) – that provide a versatile means to control cell functions. We draw a parallel between RNA and peptide biology, and discuss new routes of investigation and industrial applications opened by this work.     

骨性关节炎的超声诊断价值

骨性关节炎是目前发病率较高的一组以关节软骨为主要病理特征的临床综合症,目前主要影像学检查方式包括:X线、CT、MRI。近年来随着超声成像技术水平和精确性的不断提高,已能够更加快捷、方便、准确的对骨性关节炎作出较明确的诊断,具有重要的临床价值。     

The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol

Background

The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations.

Integrated-quadruple stress-echo

Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In “ABCD” protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo.

Conclusion

Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous “ABCD” protocol.

     

The appropriate response of Spanish Gitanos: short-run orientation beyond current socio-economic status

Humans differ greatly in their tendency to discount future events, but the reasons underlying such inter-individual differences remain poorly understood. Based on the evolutionary framework of Life History Theory, influential models predict that the extent to which individuals discount the future should be influenced by socio-ecological factors such as mortality risk, environmental predictability and resource scarcity. However, little empirical work has been conducted to compare the discounting behavior of human groups facing different socio-ecological conditions. In a lab-in-the-field economic experiment, we compared the delay discounting of a sample of Romani people from Southern Spain (Gitanos) with that of their non-Romani neighbors (i.e., the majority Spanish population). The Romani-Gitano population constitutes the main ethnic minority in all of Europe today and is characterized by lower socio-economic status (SES), lower life expectancy and poorer health than the majority, along with a historical experience of discrimination and persecution. According to those Life History Theory models, Gitanos will tend to adopt “faster” life history strategies (e.g., earlier marriage and reproduction) as an adaptation to such ecological conditions and, therefore, should discount the future more heavily than the majority. Our results support this prediction, even after controlling for the individuals' current SES (income and education). Moreover, group-level differences explain a large share of the individual-level differences. Our data suggest that human inter-group discrimination might shape group members' time preferences through its impact on the environmental harshness and unpredictability conditions they face.     

Gynecomastia: analysis of 159 patients and current recommendations for treatment

Gynecomastia has been treated surgically in 159 patients during the past 22 1/2 years. Prior to 1980, all patients had traditional excision, which was followed by a high incidence of complications and undesired sequelae, not the least of which was that the results of this aesthetic operation were often unaesthetic. Since 1980, when suction lipectomy became the cornerstone of treatment, the results have been much better. As a result, current recommendations for treatment are as follows: If the gynecomastia is entirely due to fat, suction lipectomy alone is sufficient treatment. However, since suction will not remove breast parenchyma, those patients whose gynecomastia is due to parenchymal hypertrophy also require local excision of the parenchyma. Skin excision is rarely, if ever, necessary.     

The potential value of silage in detoxifying aflatoxin B1

Serial concentrations of aflatoxin B₁ ranging from 200 to 1500 p.p.b. in 2% lactic acid solution (which is the aimed concentration of lactic acid in fresh silage) were assayed for detoxification. Thin-layer chromatography analysis, revealed a complete transformation of 1 000 p.p.b. of aflatoxin B₁ to a new fluorescing compount corresponding to aflatoxin B_2a which is referred to as hydroxydihydro-aflatoxin B₁ toxicity test on chickens confirmed Ciegler's findings (4). The results confirm that the chemical changes taken place in the silo can detoxify aflatoxin B₁ to aflatoxin B_2a.     

On marker-assisted prediction of genetic value: beyond the ridge

Marked-assisted genetic improvement of agricultural species exploits statistical dependencies in the joint distribution of marker genotypes and quantitative traits. An issue is how molecular (e.g., dense marker maps) and phenotypic information (e.g., some measure of yield in plants) is to be used for predicting the genetic value of candidates for selection. Multiple regression, selection index techniques, best linear unbiased prediction, and ridge regression of phenotypes on marker genotypes have been suggested, as well as more elaborate methods. Here, phenotype-marker associations are modeled hierarchically via multilevel models including chromosomal effects, a spatial covariance of marked effects within chromosomes, background genetic variability, and family heterogeneity. Lorenz curves and Gini coefficients are suggested for assessing the inequality of the contribution of different marked effects to genetic variability. Classical and Bayesian methods are presented. The Bayesian approach includes a Markov chain Monte Carlo implementation. The generality and flexibility of the Bayesian method is illustrated when a Lorenz curve is to be inferred.     

The Wildbad Kreuth initiative: European current practices and recommendations for optimal use of blood components

With the aging population in Europe it is anticipated that the growing demand for blood products will not be met by the estimated supply. Therefore up-to-date recommendations for optimal administration of blood products in hemotherapy are needed. Ten years after the first meeting on optimal use of blood products at Wildbad Kreuth, Germany, a second symposium was organized to convene leading experts from the clinical, regulatory and economic perspective. The aim was to re-evaluate the existing state of hemotherapy, identify areas where further studies are needed, and to provide up-dated recommendations. A preparatory survey by questionnaire concerning guidelines, quality management in clinical use of blood products, provision of products in the individual countries and re-evaluation of the 1999 Wildbad Kreuth recommendations was completed in advance. The second Kreuth Meeting in April 2009 was attended by 110 experts in transfusion medicine, regulators and regulatory authorities from 38 countries. By consensus, 20 new recommendations were adopted. Most of the 1999 recommendations were found to still be valid 10 years later. But their realization and implementation on the levels of clinical practice, regulatory authorities and health policy decision makers is still lagging behind leaving an important task to accomplish. The Kreuth initiative toward optimal use of blood products should continue.