Cancer thyroïdien de souche folliculaire avec persistance d’anticorps antithyroglobuline : signification pronostique et apport de la TEP/TDM au F-FDG

Aim

To investigate the rate of persistence or/and recurrence of follicular cell-derived thyroid cancer with elevated serum antithyroglobulin antibody (TgAb) one year after ablative therapy. We also evaluated the predictive factors of persistence or/and recurrence and the clinical impact of PET/CT with FDG.

Methods

This retrospective study involved 154 TgAb+ patients. PET/CT was performed in 22 patients with a pejorative anatomo-clinical type. The results of the PET/CT were compared with histology and clinical follow-up.

Results

In 23 cases, thyroglobulin (Tg) was positive (14% of TgAb+ Tg+) while in other 131 cases, stimulated Tg was negative (86% of TgAb+ Tg−). Twenty-nine patients (18%) were finally diagnosed with persistent or recurrent disease during follow-up. Independent predictive factors were: age higher than 60 years, Tg+, increase of TgAb concentration in the first year following surgery, and T3/T4/N1 status. PET/CT showed sensitivity of 66% and specificity of 90%. Positivity of PET/CT was significantly associated with a poor prognosis.

Discussion and conclusion

There is no significant association between persistence of TgAb and persistent/recurrent disease when stimulated Tg is negative. An increase of TgAb concentration in the first year of follow-up is an important prognostic indicator. PET/CT with FDG seems to be very useful in the therapeutic management of differentiated thyroid cancer, especially for the patients with pejorative anatomo-clinical types.     

Évaluation de la TEP au 18F-FDG dans la tuberculose extrapulmonaire : premiers résultats d’une étude pilote observationnelle

Aim

Extrapulmonary tuberculosis treatment is difficult to assess and there is a need for new tools. The aim of this observational pilot study is to evaluate the potential role of 18F-FDG PET/CT in the initial staging and treatment evaluation of extrapulmonary tuberculosis.

Methods

Twenty-eight patients were included between January 2009 and 2010. Twenty-three had a 18F-FDG PET/CT before treatment and/or during and/or after treatment. All patients will be followed for 18 months after the end of treatment. A control group of five patients with previous history of tuberculosis was also included and PET/CT was performed.

Results

Three cases of differential diagnosis were excluded of the study. The initial PET for staging showed additional lesions in 8/10 patients compared to conventional imaging. At the end of treatment, 6/11 patients had a negative PET, and 5/11 patients had a positive PET. PET had a significant clinical impact for 3/10 patients at initial staging (guiding biopsy or increase of planned treatment duration), and for 3/16 during follow up (extend or early interruption of the treatment). All PET scans in the control group were negative.

Conclusion

18F-FDG PET has an excellent sensitivity for the detection of extrapulmonary tuberculosis lesion and excellent negative predictive values. The impact of initial PET staging seems significant. The interest of 18F-FDG PET for the evaluation of response to treatment remains to be assessed and will be correlated with patients’ follow up in a second phase of this study.     

Imagerie hybride dans l’embolie pulmonaire aiguë : apport de la TDM couplée à la tomoscintigraphie de ventilation et de perfusion

Purpose

V/P-SPECT lung scan can be combined with computerized tomography (CT) from hybrid camera. We investigated if CT data could be use only with perfusion scans for the diagnosis of acute pulmonary embolism (PE).

Patients and methods

In a retrospective study, 75 consecutives patients, referred for suspicion of PE, underwent SPECT ventilation and perfusion scans coupled with a CT on Symbia T2. The perfusion images (P-SPECT) were classified as normal or abnormal with systematized (segmental and sub-segmental) or not systematized perfusion abnormalities. The ventilation images (V-SPECT) were considered as normal or abnormal in light of perfusion defects. The same was done for CT images. Correlations between V-SPECT and CT were studied.

Results

Hence, 28 patients had a normal P-SPECT and did not have PE. Patients (47) had an abnormal P-SPECT (among them, 16 turned out to have PE and 31 did not). There were 192 perfusion abnormalities of which 81 were segmental and 81 sub-segmental. Corresponding to these abnormalities, V-SPECT and CT were concordant in 83 % of the cases. When not-concordant, V-SPECT abnormalities with normal CT were found in 14 % of the cases and CT abnormalities with normal V-SPECT were found in 3 % of the cases. According to the EANM guidelines for PE diagnosis, sensitivity was 88 % and specificity 93 % with V/P-SPECT and 100 % and 83 % respectively with CT/P-SPECT (p = NS).

Conclusion

V/P-SPECT remains slightly more specific for the diagnosis of PE. However, this study demonstrates that CT/P-SPECT obtained with hybrid camera could be used for PE diagnosis with performances similar to V/P-SPECT. If these results would be confirmed on larger populations, this could lead to a significant reduction of scanning time which would improve patient comfort and reduce the camera load.     

Factores asociados a la polifarmacia en población anciana no institucionalizada. Análisis de la submuestra de la Encuesta Nacional de Salud 2006 para personas mayores de Castilla y León

Background

The increase in chronic and degenerative diseases in the elderly leads to increased and multiple drug usage, which in turn leads to problems associated with adverse reactions and drug interactions.

Material and methods

We analysed the subsample of the National Health Survey 2006, for adults over 65 living in Castile-León (n = 458). Using a logistic regression model and correlation analysis the variables having more influence on polypharmacy were evaluated.

Results

A total of 86% of those interviewed claimed to be taking drugs and 93.9% had a chronic illness. The most common health problems included arthrosis, arthritis or rheumatism (53.5%) and hypertension (48.3%), and most frequently used drugs were hypotensives (45%), pain medications (37.1%) and those for rheumatism (21.4%). Both the mean number of illnesses suffered and the drugs consumed are significantly higher in those who claimed to have, “or or fair health, used the health services, had impaired eyesight and hearing, dependent for personal care and domestic tasks, and mobility (P < .05). The variables associated with polypharmacy are three or more chronic diseases (OR = 18.3), regular-poor self perceived health (OR = 3.4) and females (OR = 1.9).

Conclusions

Given the magnitude of the problem it would be appropriate to include a review of the medications in health examinations of the elderly, particularly in women older than 75 years, with regular or self-perceived poor health and who have 3 or more diseases.     

Caméras hybrides TEMP-TDM et semi-quantification du I-FPCIT : évaluation de l’apport de la TDM

Objectives

Tomoscintigraphy of dopamine transporters with ¹²³I-FP-CIT is nowadays essential to visualise impairment of nigro-striatal system for the diagnosis of parkinsonism and for the differential diagnosis of dementia. With the development of hybrid cameras (SPECT-CT), the CT contribution in nuclear neurology needs to be assessed in diagnostic and semi-quantification performances. The main purpose of our study is to compare attenuation correction using CT to attenuation correction using the linear algorithm of Chang. SPECT-CT with parallel collimation results were also weighed against fan beam collimation and the contribution of partial volume effect correction was studied in secondary objective.

Materials and methods

We used a trilinear phantom to define spatial resolution and an anthropomorphic striatal phantom to quantify the activity in striatal cavities. We compared the impact of attenuation and scatter correction on spatial resolution and semi-quantification in striatum. We performed the partial volume effect correction on reconstructed images according to the method of Rousset.

Results

Attenuation correction by CT did not improve significantly spatial resolution compared to the algorithm of Chang. The semi-quantification of ¹²³I-FPCIT in striata was not significantly different according to the various CA, but was significantly improved with CT attenuation and scatter correction. Partial volume effect correction improved the quantification from 40 to 60% in the striatal structures, when the activity was superior in at least twice the background noise.

Conclusion

SPECT-CT hybrid cameras increase spatial resolution and improve semi-quantification of ¹²³I-FPCIT because of CT attenuation and scatter correction. Another use of CT is the possibility of calibrating anatomic segmentation of striata for partial volume effect correction. Partial volume effect correction improves quantification and is essential for early diagnosis of nigro-striatal disease.     

La TEP-TDM à la F-Dopa aurait-elle un rôle dans le suivi postopératoire des patients atteints de carcinome médullaire de la thyroïde ? Résultats préliminaires de l’expérience strasbourgeoise et revue de la littérature

Aim

Retrospective study to assess the value of fluorine-18 dihydroxyphenylalanine (¹⁸F-Dopa) positron emission tomography (PET)/computed tomography (CT) in the post-surgical follow-up of patients with history of medullary thyroid carcinoma (MTC) and biological suspicion of disease relapse. A review of the literature was also performed.

Patients and methods

Ten patients (23-71 years) with MTC previously treated by surgery were examined by at least one ¹⁸F-Dopa PET/CT. All patients presented with elevated serum calcitonin (130-9076 ng/l) and/or CEA (1.2-518 ng/ml) levels. 3D whole body PET/CT was performed 45 and 120 minutes after intravenous injection of 4 MBq/kg of ¹⁸F-Dopa. Scintigraphic images were visually interpreted. For quantitative analysis, maximum standardized uptake value (SUV_max) per focus was employed. PET results were compared with histological findings and/or with the results of all other imaging procedures.

Results

Seven patients (70%) had a positive ¹⁸F-Dopa PET/CT. Twenty-five focal tracer accumulations were described. Histopathological confirmation of metastatic disease was obtained in four of the seven patients with pathologic ¹⁸F-Dopa PET/CT. No scintigraphic abnormalities were evidenced in the three other patients, whose conventional morphological imaging procedures were also negatives. Delayed PET/CT examinations didn’t increase sensitivity. No correlation between ¹⁸F-Dopa PET/CT results and both serum calcitonin and CEA levels was achieved.

Conclusion

Our results are in accordance with the existing literature, showing the potential role of ¹⁸F-Dopa PET/CT in the clinical management of patients with history of MTC and biological suspicion of relapse during post-surgical follow-up. Prospective studies including larger patient series are necessary to confirm the future place of ¹⁸F-Dopa PET/CT in follow-up of MTC.     

Images de soustraction TEMP, en double isotope, Tc-sestamibi/I fusionnées au scanner : intérêt chez des patients présentant une hyperparathyroïdie

Purpose

To assess dual-tracer imaging of hybrid SPECT/CT (S/CT) compared to planar scintigraphy (S/PL) and ultrasounds (US), in preoperative localization hyperparathyroidism.

Methods

Dual tracer S/CT, S/PL and US for preoperative localization were performed in 99 patients with hyperparathyroidism. Patients with single-gland and multiple gland disease (MGD) were evaluated. For S/PL and S/CT, 15 MBq of ¹²³I were given and 2 hours later, 555 MBq/kg of ^99mTc-MIBI was injected. Images were acquired simultaneously using appropriate windows in S/PL and S/CT, then compared to US. Thus, the predicted positions were compared to the intraoperative findings and abnormal parathyroid glands were measured.

Results

Seventy-five patients underwent invasive surgery, which served as standard. Sixty-seven adenomas and 17 MGD were found on 70 patients. Sensitivity for US, S/PL and S/CT was respectively 69, 82 and 83%; and specificity was 96, 91 and 93% with an overall kappa-coefficient of 0.64, 0.73 and 0.76. US, S/PL and S/CT were correlated with the size of abnormal glands even if US remains the most accurate measuring technique. S/CT was able to predict the true position of the abnormal gland in 80% of cases.

Conclusion

Dual-isotope planar imaging and S/CT were statistically significantly superior to US imaging in sensitivity. The addition of CT to SPECT further improves parathyroid adenoma localization and predicts the size, which can help for mini-invasive surgery.     

Évaluation de méthodes automatiques de segmentation des volumes tumoraux en tomographie par émission de positons par comparaison avec des contours manuels réalisés par un groupe d’experts

Objective

Set up a framework for evaluating automatic segmentation methods of tumour volumes on PET images.

Patient and methods

This study was performed with PET images of 18 patients with non-Hodgkin's lymphoma. One target lesion per patient was pointed out. Each lesion was then three times manually delineated by five experts. Four automatic methods (the application of a threshold of 42% of the maximum SUV, the MIP-based method, the Daisne et al. method and the Nestle et al. method) were evaluated by comparison with the set of manual delineations.

Results

From the manual delineations, we have concluded to a moderate intra-operator variability and to a reduced interoperator reproducibility. From statistical tests performed on various quantitative criteria, there was no significant difference between the MIP-based method, the Daisne et al. method and the Nestle et al. one. The application of a threshold of 42% of the maximum SUV appears to be less efficient.

Conclusion

This work proposes a comparison and an evaluation protocol for segmentation methods. The generated data set will be distributed online for the community to simplify the evaluation of any new method of segmentation.     

Resultados de la endarterectomía carotídea en pacientes ancianos

Introduction

Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones.

Material and method

Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75 years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis.

Results

Data were collected on 147 EA in 134 patients of 75 years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1 years, with a survival of 86% at one year and 54% at 5 years and with the main cause of death being heart disease.

Conclusions

Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation.     

Apport de deux techniques d’analyse automatisées des examens [F] FDG TEP dans la discrimination des patients déments frontotemporaux et malades d’Alzheimer

Introduction

In younger patients, the in vivo clinical diagnosis of Alzheimer's disease (AD) and of the frontotemporal type (FTD) may be cumbersome. The gold standard diagnostic proof is currently still based upon pathology examination. It is crucial to find reliable techniques to make an accurate in vivo diagnosis and to differentiate the etiology of the dementia.

Patients and method

Twenty-four patients bearing clinically diagnosed AD (n = 16) and FTD (n = 8) underwent [¹⁸F] FDG-PET/CT brain scan. Four nuclear medicine physicians with varying expertise in neuroimaging read each scan according to: visual analysis; automated analysis computed by BRASS^® Hermes^® software; automated analysis computed by Cortex ID^® General Electric^® software. Interpretation aimed at assessing the global scan aspect, the cerebral metabolism per hemisphere (in five relevant regions) and the diagnostic degree of confidence. Diagnostic interpretations derived from visual and automated analyses were compared to clinical diagnosis. Inter-observer agreement and Kappa scores were calculated.

Results

Kappa analyses showed a gain in diagnostic accuracy for a nonexpert physician, a gain in diagnostic confidence with Cortex ID^® and a gain in interobserver diagnostic agreement with BRASS^®.

Conclusion

Using automated software such as Cortex ID^® or BRASS^® helps standardizing the interpretation of [¹⁸F] FDG distribution pattern in AD or FTD.     

Evaluación breve del estado cognitivo de la demencia en estadios avanzados: resultados preliminares de la validación española del Severe Mini-Mental State Examination

Introduction

The cognitive assessment of patients with advanced dementia needs proper screening instruments that allow obtain information about the cognitive state and resources that these individuals still have. The present work conducts a Spanish validation study of the Severe Mini Mental State Examination (SMMSE).

Material and methods

Forty-seven patients with advanced dementia (Mini-Cognitive Examination [MEC]<11) were evaluated with the Reisberg's Global Deterioration Scale, MEC, SMMSE and Severe Cognitive Impairment Profile scales.

Results

All test items were discriminative. The test showed high internal ( α = 0.88), test-retest (0.64 to 1.00, P < .01) and between observers reliabilities (0.69-1.00, p < 0.01), both for scores total and for each item separately. Construct validity was tested through correlations between the instrument and MEC scores (r = 0.59, P < 0.01). Further information on the construct validity was obtained by dividing the sample into groups that scored above or below 5 points in the MEC and recalculating their correlations with SMMSE. The correlation between the scores in the SMMSE and MEC was significant in the MEC 0-5 group (r = 0.55, P < .05), but not in the MEC>5 group. Additionally, differences in scores were found in the SMMSE, but not in the MEC, between the three GDS groups (5, 6 and 7) (H = 11.1, P < .05).

Conclusions

The SMMSE is an instrument for the assessment of advanced cognitive impairment which prevents the floor effect through an extension of lower measurement range relative to that of the MEC.From our results, this rapid screening tool and easy to administer, can be considered valid and reliable.     

Relación entre el rendimiento en la prueba de estación unipodal y la velocidad del centro de presión en adultos mayores

Introduction

Frequent falls are one of the most important health problems in the elderly population. The unipedal stance test (UPST), asses postural stability and is used in fall risk measures. Despite this, there is little information about its relationship with posturographic parameters (PP) that characterizes postural stability. Center of pressure velocity (CoPV) is one of the best PP that describes postural stability. The aim of this study was to analyze the relation between UST score and CoPV in elderly population.

Materials and methods

A sample of 38 healthy elderly subjects where divided in two groups according to their UPST score, low performance (LP, n = 11) and high performance (HP, n = 27). The correlation between UPST score and COP mean velocity (CoPmV), recorded from a posturographic test, was analyzed between both groups.

Results

An inverse correlation between UPST score and CoPmV was found in both groups. However, this was higher in the LP group (r = −0.69, P = .02) compared to the HP (r = −0.39, P = .04).

Conclusions

Based on the results of this investigation, it may be concluded that the achievement on UPST has an inverse relationship with CoPmV, especially in subjects with low performance in the UPST.     

Síntomas depresivos en adultos mayores participantes de una universidad abierta a la tercera edad

Introduction

Although depressive disorders prevalence among older adults usually is less than in the younger population, the presence of significant symptoms of depression is common in elderly people. Studies show that taking part in social, educational and pleasure activities is associated with a reduction in depressive symptoms in this population. The purpose of this study was to examine the prevalence of depressive symptoms above the elderly participants of a Third Age Open University, taking the time taking part as a reference.

Material and methods

A cross-sectional design was implemented, with a participation of 95.2% (n = 140) of the total enrolled in the first trimester of 2009 in the activities of the Third Age Open University of the Schools of Arts, Sciences and Humanities of the University of São Paulo. They all answered a socio-demographic questionnaire and the Geriatric Depression Scale (GDS-15).

Results

The prevalence of depressive symptoms found was 3.57%. The statistical analysis showed a relationship between participation formore than one semester in the Third Age Open University and a lower index of depressive symptoms (p < .05).

Conclusions

Participating for longer than one academic semester is associated with less depressive symptoms, possibly being a protector factor against depression.     

Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes

Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture.

Methods

Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months.

Results

A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P = .04), focusing more on independence in eating (76% vs 91.9%, P < .05), grooming (72% vs 91,9%, P < .01), faecal continence (60% vs 78.7%, p < .05) and walking indoors (80% vs 93.3%, P < .05).

Conclusions

The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable.     

Apport de l’imagerie hybride TEMP/TDM dans la détection des ganglions sentinelles : à propos de 32 cas

Objectives

Retrospective evaluation of the SPECT/CT role in the Sentinel Lymph Node identification.

Patients and methods

Thirty-two patients underwent a lymphoscintigraphy with SPECT/CT imaging. Those patients presented several cancer types (16 melanoma, one squamous cell carcinoma, three breast cancers, eight vulvar cancers, three cervical cancers).

Results

The scintigraphic detection rate was 81% with planar imaging while this rate was 89% with SPECT/CT. The SPECT/CT provided an additional quantitative information in 66% cases. Moreover, the quality of the interpretation was better in two different conditions (planar interpretation followed by routine and blinded SPECT/CT interpretation) with SPECT/CT. In our study, the false negative rate is 4.5%.

Conclusions

SPECT/CT provides quantitative and qualitative informations in the sentinel lymph node detection. Therefore, it can be a valuable tool for the surgeon to find and harvest the sentinel lymph node especially where the lymphatic drainage pattern can be unusual or hard to predict (cervical or trunk localisation). It's a new tool for preoperative detection and it can decrease the false negative rate.     

El Instrumento de Fragilidad para Atención Primaria de la Encuesta de Salud, Envejecimiento y Jubilación en Europa (SHARE-FI): resultados de la muestra española

Background

Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample.

Methods

In the wave 1 of SHARE (2004), the Spanish sample was composed of 1,279 women and 933 men, all living in the community (mean age: 65.6 years). For each sex, a latent class analysis was used to summarise the five (adapted) frailty criteria into three incremental frailty classes. We tested the association of the frailty classes against a biopsychosocial range of wave 1 variables; the predictive validity of the frailty classes was tested using mortality data from the second wave of SHARE (2006-2007), which were available for 846 women and 660 men.

Results

The frailty classes had the expected cross-sectional associations. The age-adjusted Odds ratio for mortality (with 95% confidence interval) associated with the frail class was 3.2 (1.0-10.2) for women and 8.3 (3.1-22.1) for men.

Discussion

SHARE-FI is a valid and freely accessible instrument, which is intended to facilitate the adoption of the frailty paradigm in primary care.     

Calidad de vida percibida por las personas mayores. Consecuencias de un programa de estimulación cognitiva a través de la motricidad «Memoria en movimiento»

Introduction

This article presents the results of evaluation of health related quality of life in a group of elderly people who were engaged in the program of cognitive stimulation «Memory in movement».

Materials and methods

A content analysis was conducted to determine the type of experience that the subjects stated in the context of an interview. The statements were classified into categories created ad hoc. The sample consisted of 32 participants with a mean age of 69.92 ± 4.98 years. The software QSR NVivo-8 was used for data processing.

Results

The results show that the 48% of the elderly perceive some improvements in their memorisation abilities, 47% in attention and concentration, and 10% in the satisfaction with life after being in the program. They are especially worried about the loss of memory -stated by the 65.62%- and they came to the cognitive stimulation program with the aim of improving this capacity. The feelings that participants reported having experienced during the program have to do with fun, vitality and energy.

Conclusions

Programs on cognitive stimulation that incorporate some physical activities, together with a clear playful and social component, improve the psychic and social capacities and they open an important line of intervention due to their good acceptance by the elderly.     

Asociación entre la realización de ejercicio e indicadores de funcionamiento físico y cognitivo. Comparativa de resultados en función de la edad

Background

Gerontology research shows the importance of physical exercise for active aging. This study demonstrates the relationship between the practice of aerobic exercise, and physical fitness (muscle strength, respiratory capacity and motor speed) and cognitive performance (memory and visual-perceptual speed) and analyzes whether age is a modulating factor of this relationship.

Material and methods

The sample included 690 subjects with an age range of 30-85 years. The level of physical exercise was assessed using self-report form. Two sub-scales were used for the evaluation of cognitive performance: Digit Span Backwards and Digit Symbol (both are sub-scales of the Wechsler Adult Intelligence Scale - WAIS). The physical fitness was assessed using bio-behavioral measurements (strength, lung capacity, speed). To test the combined effect of exercise and age on the two variables (physical fitness and cognitive performance) two separate factorial analysis of variance were performed (procedure - general linear model: Univariate).

Result

The most significant result showed that scores on cognitive performance is a function of the intensity of the physical activity (F=4.8; P<0.002). With regard to physical fitness, its relationship with physical exercise is also significant (F=4.10; P<0.007) as well as the interaction between exercise and age (F=2.2; P<0.001).

Conclusions

The intensity in achieving aerobic exercise is associated with physical fitness and cognitive performance. Age has a specific weight in the association between exercise and physical fitness, this effect is higher in the older age groups (65-74 and 75-85 years for 30-49 and 50-64 years). These data suggest the compensatory effect of exercise on decline in old age.     

RANTES gene mRNA expression and its -403 G/A promoter polymorphism in coronary artery disease

Objective

Increased RANTES expression has been described to have a role in atherosclerosis plaque formation. Functional polymorphisms within RANTES promoter region have shown association with increased risk of coronary atherosclerosis (CAD). The aim of this study was to examine the RANTES mRNA expression in patients with CAD compared to patients without CAD and its association with RANTES − 403 G/A polymorphism in an Iranian population.

Methods

The study was performed on 319 patients who underwent coronary artery angiography and patients with > 50% stenosis in vessels considered as case groups (CAD+) N = 191 and normal vessels group as control (CAD−) N = 128. In each group 20 patients were examined for RANTES mRNA expression.RANTES mRNA expression was examined using quantitative real-time PCR. Genotyping of − 403 polymorphism was performed using PCR-RFLP technique.

Results

We found that RANTES mRNA expression was increased to 1.37 fold in CAD patients compared to the controls but the difference was not statistically significant. Also comparing the RANTES mRNA expression in patients with different RANTES − 403 G/A polymorphism showed that in patients carrying AA genotype RANTES mRNA expression was increased to 1.74 fold compared to patients carrying GG genotype and to 1.51 fold compared to patients carrying GA genotype. No significant difference for allele and genotype frequencies of RANTES − 403 polymorphism was found between cases and controls.

Conclusion

More studies on larger number of samples are required to further evaluate role of RANTES in pathogenesis of CAD.