Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction / 老年心脏病学杂志（英文版）

Background Previous data from a recently conducted prospective, single blind randomized clinical trial among community dwelling older patients with heart failure with a preserved ejection fraction (HFPEF) and anemia randomized to treatment with epoetin alfa (erythro-poiesis-stimulating agents, ESA) vs. placebo did not demonstrate significant benefits of therapy regarding left ventricular (LV) structure, functional capacity, or quality of life (QOL). However, several patients randomized to the treatment arm were non-responders with a subop-timal increase in hemoglobin. All patients in the trial also received oral ferrous gluconate, which could have contributed to increases in he-moglobin observed in those receiving placebo. Accordingly, we performed an analysis separating patients into responders vs. non-responders in order to determine if measured improvement in anemia would have any effect on clinical endpoints. Methods A total of 56 patients (age 77 ± 11 years, 68%female) were recruited who had anemia defined as a hemoglobin of≤12 g/dL (average, 10.4 ± 1 g/dL) with HFPEF defined as having NHANES-CHF (National Health And Nutrition Examination Survey:Congestive Heart Failure) criteria score of≥3 and an ejection fraction of>40%(average EF=63%±15%). Patients were randomly allocated to receive either ESA and ferrous gluconate or ferrous gluconate only. In this analysis, a responder was defined as a patient with an increase of 1 g/dL in the first 4 weeks of the trial. Re-sults Nineteen subjects were classified as responders compared to 33 non-responders. While the average hemoglobin increased signifi-cantly at the end of 6 months for responders (1.8 ± 0.3 vs. 0.8 ± 0.2 g/dL, P = 0.004), 50% of the subjects assigned to ESA were non-responders. Left ventricular function including ejection fraction (P=0.32) and end diastolic volume (P=0.59) was unchanged in res-ponders compared to non-responders. Responders also showed no significant improvements in New York Heart Association (NYHA) class, Six Minute Walk Test (6 MWT) and peak VO2. Though QOL improved significantly within each group, there was no difference between the two. Conclusions A significant hemoglobin response to anemia treatment with ESA and oral iron does not lead to differences in LV re-modeling, functional status, or QOL. Additionally, a significant percent of older adults with HFPEF and anemia do not respond to ESA ther-apy. Given the results of this small trial, it appears as though using objective improvements in anemia as a marker in older adult subjects with HFPEF does not have significant clinical utility.

Cross-cultural standardization of the South Texas Assessment of Neurocognition in India.

Background & objectives: Despite the central role of cognition for mental disorders most studies have been conducted in western countries. Similar research from other parts of the world, particularly India, is very limited. As a first step in closing this gap this cross-cultural comparability study of the South Texas Assessment of Neurocognition (STAN) battery was conducted between USA and India. Methods: One hundred healthy adults from Kerala, India, were administered six language independent subtests of the Java Neuropsychological Test (JANET) version of the STAN, assessing aspects of general intellectual ability (Matrix Reasoning), attention (Identical Pairs Continuous Performance, 3 Symbol Version Test; IPCPTS), working memory (Spatial Capacity Delayed Response Test; SCAP), response inhibition (Stop Signal Reaction Time; SSRT), Emotional Recognition and Risk taking (Balloon Analogue Risk Task; BART). Test results were compared to a demographically matched US sample. Results: Overall test performance in the Kerala sample was comparable to that of the US sample and commensurate to that generally described in studies from western countries. Interpretation & conclusions: Our results support the metric equivalence of currently available cognitive test batteries developed in western countries for use in India. However, the sample was restricted to individuals who were literate and had completed basic primary and secondary education.

Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.

Dentinogenesis imperfecta: A case report.

Dentinogenesis imperfecta is an autosomal dominant disorder of tooth development characterized by the presence of opalescent dentin, resulting in a dusky blue to brownish discoloration of the teeth. This condition is genetically and clinically heterogeneous; it may affect only the teeth or it may be associated with the osteogenesis imperfecta. Dentinogenesis imperfecta has been subdivided into three types: type I is associated with osteogenesis imperfecta; in type II there is no associated osteogenesis imperfecta; and when the condition is associated with the Brandywine triracial isolate and large pulp chambers it is classified as type III. This report describes a 16-year-old female patient who showed the characteristic dental features of dentinogenesis imperfecta type II. The etiology and prevalence of the disorder, and a comprehensive treatment plan, will be briefly reviewed.

Use of vancomycin in the culture of Mycobacterium tuberculosis from gastric lavage.

BACKGROUND & OBJECTIVES: Earlier studies from the Tuberculosis Research Centre, Chennai, on culture of Mycobacterium tuberculosis from gastric lavage (GL) specimens in selective Kirchner's medium (SK) resulted in a loss of 60 per cent culture results due to contamination with aerobic spore bearers (ASB). Addition of vancomycin to SK (SKV) effectively reduced the contamination rate to 20 per cent. The objective of the present study was to further reduce the contamination by collecting the specimens in bottles containing vancomycin, thus providing continuous exposure of the sample to the drug, which is bactericidal to ASB. METHODS: One thousand GL specimens collected from children in vancomycin containing bottles were decontaminated and cultured in SK medium, with and without vancomycin, subcultured on Lowenstein Jensen (LJ) medium and the culture results compared. RESULTS: The contamination of cultures in SK and SKV was 15 and 4 per cent respectively when the specimens were collected in bottles containing vancomycin compared to 60 and 20 per cent contamination reported in the earlier studies. INTERPRETATION & CONCLUSION: The reduced contamination in SK and SKV is most likely due to the collection of samples in vancomycin containing bottles. Although a concurrent comparison of samples processed in vancomycin free conditions would have been ideal, it could not be done due to practical difficulties. The study thus confirms the value of vancomycin as a major deterrent for contamination due to aerobic spores and better results can be obtained if vancomycin is used in sample collection bottles, transport media and liquid culture media used in mycobacteriology laboratories particularly in humid and tropical environment.

Predicting the composition of gallstones by infrared spectroscopy.

AIM: To determine the composition of gallstones in South India by comparing visual assessment with graphic interpretation of infrared spectra. METHODS: Infrared spectroscopy (IRS) was used in qualitative analysis of 168 gallstones from Tamilnadu, Kerala and Karnataka and compared with visual interpretation. The spectrum of cholesterol, calcium bilirubinate and calcium carbonate for each stone was correlated with visual inspection. RESULTS: Fifty four percent of gallstones were of pigment variety, 43% were of mixed and the remaining 3% were cholesterol gallstones as categorised by visual interpretation. Based on infrared spectrocopic interpretation the percentages were 58%, 39% and 2% respectively. There was a good agreement between the visual inspection and IRS in classification of gallstones (Kappa value 85%; 95% CI 77-93%). CONCLUSION: Visual inspection of gallstones can predict the composition of gallstone with good accuracy and was comparable to infrared spectroscopic interpretation.

Conn's syndrome: a simple diagnostic approach.

BACKGROUND: Primary aldosteronism is usually diagnosed after a battery of biochemical tests and adrenal imaging. If an adrenal tumour (Conn's syndrome) is identified, patients need surgery. However, bilateral adrenal hyperplasia is treated medically. Till 1994, we diagnosed Conn's syndrome using simple biochemical tests and a CT scan of the adrenal glands. Aldosterone and plasma renin activity assay became available in our institution in 1994 and were used subsequently in the work up of patients suspected to have Conn's syndrome. We analysed our data to determine whether simple tests such as serum and urinary potassium values combined with CT imaging of the adrenal glands are adequate to arrive at a diagnosis in these patients. METHODS: All consecutive patients (n = 17) diagnosed to have Conn's syndrome, managed by the Departments of Endocrinology and Surgical Endocrinology of this institution during a nine-year period from 1990 to 1998, were studied retrospectively. RESULTS: Until 1994, Conn's syndrome was diagnosed after documenting hypertension, hypokalaemia, inappropriate kaliuresis, metabolic alkalosis and CT scanning to localize the tumour. Serum aldosterone and plasma renin activity (PRA) were used in addition since 1994. All patients underwent adrenalectomy after adequate preoperative preparation. There was no operative mortality. Postoperatively, normokalaemia was established in all patients. Persistent postoperative hypertension was present in 43.8% of patients. CONCLUSIONS: In our experience, Conn's syndrome could be diagnosed accurately with simple investigations and CT imaging of the adrenal glands. Extensive biochemical testing, including aldosterone and PRA assay, is helpful when the diagnosis is uncertain. While hypokalaemia is curable after surgery, residual hypertension persists in about 45% of patients.

Early results from indirect drug susceptibility test for tubercle bacilli.

The indirect susceptibility test results on L-J medium for tubercle bacilli against streptomycin, isoniazid and rifampicin were read at the end of 2 wk and compared with the results at 4 wk. It was found that drug resistance could be correctly predicted in over 70 per cent of cultures including multi-drug resistant tuberculosis (MDR TB) strains at the end of 2 wk. The susceptibility to para-nitrobenzoic acid (PNB) read at 2 wk was able to distinguish non-tuberculous mycobacteria from Mycobacterium tuberculosis cultures. The early detection of resistance by this procedure requires only minimum inputs, and can benefit the majority of patients harbouring drug resistant tubercle bacilli.

Surgical presentation of melioidosis in India.

BACKGROUND: Melioidosis, the disease caused by Burkholderia pseudomallei, is common in Southeast Asia. It has also been reported from India, where some investigators feel it is under-diagnosed and under-reported. We report our experience with melioidosis presenting as abscesses at unusual sites. METHODS: All consecutive patients with culture proven B. pseudomallei, who presented to a single surgical unit between 1995 and 1998, were evaluated. RESULTS: Three patients presented with splenic abscesses and one with a soft tissue abscess in the neck. One patient developed septicaemia. All patients responded favourably to ceftazidime and/or co-trimoxazole which was started as soon as the diagnosis was confirmed. CONCLUSION: Melioidosis is under-diagnosed in India, probably due to a low index of suspicion of this disease among clinicians. It should be considered as a possibility when abscesses are encountered at unusual sites. The pus must then be cultured to identify the causative agent.

Composition of gallstones in Coimbatore District of Tamil Nadu State.

BACKGROUND: Gallstones in northern India are predominantly of the cholesterol type; such information on gallstones in southern India is scant. AIM: To analyze the composition of gallstones from patients residing in Coimbatore District in Tamil Nadu State. METHODS: The stones were classified using the Bernhoft criteria and was correlated with the morphological characteristics. RESULTS: Of the 105 gallstones analyzed, 67 (63.8%) were of the pigment variety and 36 (34.8%) of the intermediate/mixed type. There were only two cholesterol stones. The mean proportions of cholesterol, bilirubin and calcium in the pigment and intermediate stones were 7.1%, 26.1% and 7.8% and 30.2%, 18.4% and 6.3%, respectively. The mean proportion of bilirubin in the pigment stones was higher than in the intermediate type. Morphologically, pigment stones were black in 55% and amorphous in 63%; the intermediate stones were hard in 50% and of variegated color ranging from yellow to ivory white in 61%; both cholesterol stones were multiple, hard and brown. CONCLUSIONS: There is a predominance of pigment and intermediate gallstones (98%) in this district. These stones have reduced cholesterol and an increase in bilirubin and calcium proportions.

Modulation of biochemical activity of hepatocytes in culture by matrix substratum.

The influence of extra cellular matrix on the biochemical activity of hepatocytes was studied by maintaining rat hepatocytes in primary culture in a serum free medium on different matrix protein substrata or biomatrices prepared from liver, aorta or mammary gland. There was significant difference in the individual protein synthesis and distribution by cells maintained on different substrata. Comparison of the kinetics of synthesis and secretion of albumin by cells maintained on different tissue biomatrix showed that those maintained on hepatic biomatrix synthesized more albumin and retained more of albumin synthetic capacity, when compared to those maintained on aortic and mammary gland biomatrix. Similarly, hepatocytes maintained on hepatic biomatrix synthesized significantly more apo B, the major apo protein of VLDL, than those maintained on heterologous tissue matrix. Induction of tyrosine aminotransferase by dexamethasone and the uptake of [14C]-amino isobutyric acid were found to be maximum in cells maintained on liver biomatrix than the heterologous biomatrix. But cells maintained on hepatic biomatrix incorporated less amounts of radioactivity into total cytoskeletal proteins as well as the individual proteins such as actin and the cytokeratins C8 and C18 while that by cells maintained on aortic biomatrix was significantly high. Quantitative analysis of the relative incorporation of radioactivity into individual cytoskeletal proteins and albumin in pulse labelling studies with cells maintained in culture on different matrix for different lengths of time revealed a reciprocal relationship between these two activities. These results indicate that the substrata with which the cells are in contact influence on a selective basis, the biochemical activity of hepatocytes in primary culture.

Atelectasis in children.

BACKGROUND: In children with lower respiratory tract symptoms, the elicited signs are not enough to distinguish common diagnosis like pneumonic consolidation, foreign body aspiration and atelectasis. Radiology and bronchoscopy would identify the true nature of the etiology. DESIGN: Prospective study. SUBJECTS: Thirty five children with both acute and chronic lower respiratory tract symptomatology, were analyzed for clinical and radiological signs of atelectasis. RESULTS: There were 23 cases in the acute group and 12 in chronic group. Acute group included cases of pneumonia, foreign body aspiration and mucus plug syndrome. Chronic group included cases of congenital heart disease, endobronchial tuberculosis and bronchial stenosis. Clinical recognition of atelectasis on the basis of localized loss of breath sounds and mediastinal shift was seen only in a minority of cases (8/35). The presence of atelectasis in children with pneumonia, missed clinically were diagnosed by the presence of tracheal shift, elevated hemidiaphragm and silhouette sign. In 21 cases, silhouette sign was positive making it an important radiological sign. Twenty one children underwent either diagnostic or/and therapeutic bronchoscopy. Findings included foreign bodies (n = 5), mucus plugs (n = 4), narrowing of main bronchus (n = 4) and inflammatory mucoid secretions and narrowing of lumen (n = 8). There were no major complications. CONCLUSION: The diagnosis of atelectasis in children may pose difficulties and there is a need to have a high index of suspicion to exclude atelectasis in children with either acute or chronic respiratory tract symptomatology.

Alterations in total and differential counts of WBC during ochratoxicosis in rabbits.

Consumption of ochratoxin-contaminated feed (10 mg/kg) by young rabbits for 90 days altered total and differential counts of WBC. Time dependent decline in WBC count indicates occurrence of cumulative toxicity.

Role of pinaverium bromide in south Indian patients with irritable bowel syndrome.

The effect of pinaverium bromide in controlling gastrointestinal symptoms in 61 patients with irritable bowel syndrome was studied, as an open trial. Individually, there was significant relief in abdominal discomfort/pain as well as in bowel symptoms in most of the patients. Abdominal pain was reduced in 49%, stool consistency improved in 74%, straining and urgency decreased in 71% and mucus decreased in 64%. Tolerance to the drug administered was good and side-effects reported were few.

Is vegetarianism a precipitating factor for gallstones in cirrhotics?

AIM: To study the association of factors such as alcohol, smoking and vegetarianism with presence of gallstones amongst cirrhotics. PATIENTS AND METHODS: Data on alcoholism, smoking and vegetarianism was collected from the case records of 669 cirrhotics with (76) or without gallstones (593) retrospectively. Relative risk for the factors was computed individually and in combination controlling for the effects of alcoholism and smoking on vegetarianism. RESULTS: Alcoholism and smoking were of low relative risk [R.R-1.27 (95% CI 0.82 to 1.96), and 1.02 (95% CI 0.65 to 1.61) respectively] while vegetarianism was associated with high risk for gallstone formation in cirrhotics [R.R 2.74 (95% CI 1.65-4.53)]. Vegetarian men had a relative risk of 3.02 (95% CI 1.75-5.22) irrespective of their alcoholic status. If women were alcoholic the relative risk increased to 7.03 (95% CI 3.26-15.12). Controlling for effects of gender and alcoholism, vegetarian cirrhotics had a 3 times greater risk for gallstone formation [Mantel Haenszel Relative Risk 3.18 (95% CI MHRR 1.82-5.56)]. CONCLUSIONS: Cirrhotic, vegetarian women in South India have a much higher risk for gallstones, if they are alcoholic. Alcoholic men who are vegetarians are at a greater risk for gallstone disease.

Mediastinal enterogenic cyst presenting as paraplegia--a case report.

A rare case of a mediastinal enterogenic cyst with an intraspinal extension through a anterior vertebral defect presenting with paraplegia in a 10 year boy is presented. Laminectomy and the trans-thoracic excision of the cyst resulted in the complete recovery of the neural deficit.

Ochratoxin induced hemolysis in rabbits.

A saline suspension of RBC when incubated with an increasing concentration (1 to 10 micrograms/ml) of crude ochratoxin at 37 degrees C for 16 hr showed a marked alteration in morphological characters followed by hemolysis. The effect was more pronounced with higher concentration of toxin. The result suggests extreme cytotoxic effect of ochratoxin on RBC leading to its lysis.

Selection for high and low number of sternopleural bristles in Drosophila ananassae: correlated response in the frequency of chromosome inversions

Directional selection for high and low number of sternopleural bristles in Drosophila ananassae was applied for 13 generations. The selection produced a rapid divergence in the mean number of sternopleural bristles in the replicates high and low lines: i-high (H1 -25.75, H2 -25.69); ii-low (L1 -14.16 L2 -13.55); iii-control (17.21) lines in G13. Regression coefficients for the high and low lines were significantly different from zero. The realized heritability over thirteen generations was 21-23 for the high lines and 14-18 for the low lines. The results suggest that the number of sternopleural bristles in D. ananassae is under polygenic control, with a substantial amount of additive genetic variation. Flies of the base population had three chromosome inversions: AL (2L), ZE (2R) and DE (3L). The comparisons of chromosome arrangement between high and low lines (the G13 generation of selection) indicates significant changes in the inversion frequency during the course of selection, providing evidence for correlation between the bristle number and particular chromosome arrangements

Vancomycin for controlling contamination of selective Kirchner's liquid medium in the culture of gastric lavage for tubercle bacilli.

Gastric lavage (GL) was collected for culture of tubercle bacilli from children too young to expectorate sputum. The selective Kirchner's liquid medium (SKLM), routinely used as one of the media for culture of all extrapulmonary specimens, was found to often get contaminated when cultured with GL. We have shown that vancomycin at a concentration of 10 mg/l successfully reduced the contamination from about 60 to 20 per cent, and enhanced the isolation rate of tubercle bacilli from 3 to 6 per cent. Decontamination of the liquid culture before subculture on solid medium also helped to reduce the contamination rate. Vancomycin was found to be an effective selective drug for use in the Kirchner's liquid medium for culture of tubercle bacilli.