Electroanatomical voltage mapping with contact force sensing for diagnosis of arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: Three-dimensional electroanatomical mapping (EAM) can be helpful to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC). Yet, previous studies utilizing EAM have not systematically used contact-force sensing catheters (CFSC) to characterize the substrate in ARVC, which is the current gold standard to assure adequate tissue contact. OBJECTIVE: To investigate reference values for endocardial right ventricular (RV) EAM as well as substrate characterization in patients with ARVC by using CFSC. METHODS: Endocardial RV EAM during sinus rhythm was performed with CFSC in 12 patients with definite ARVC and 5 matched controls without structural heart disease. A subanalysis for the RV outflow tract (RVOT), septum, free-wall, subtricuspid region, and apex was performed. Endocardial bipolar and unipolar voltage amplitudes (BVA, UVA), signal characteristics and duration as well as the impact of catheter orientation on endocardial signals were also investigated. RESULTS: ARVC patients showed lower BVA vs. controls (p = 0.018), particularly in the subtricuspid region (1.4, IQR:0.5-3.1 vs. 3.8, IQR:2.5-5 mV, p = 0.037) and RV apex (2.5, IQR:1.5-4 vs. 4.3,IQR:2.9-6.1 mV, p = 0.019). BVA in all RV regions yielded a high sensitivity and specificity for ARVC diagnosis (AUC 59-78%, p < 0.05 for all), with the highest performance for the subtricuspid region (AUC 78%, 95% CI:0.75-0.81, p < 0.001, negative predictive value 100%). A positive correlation between BVA and an orthogonal catheter orientation (46°-90°:r = 0.106, p < 0.001), and a negative correlation between BVA and EGM duration (r = -0.370, p < 0.001) was found. CONCLUSIONS: EAM using CFSC validates previous bipolar cut-off values for normal endocardial RV voltage amplitudes. RV voltages are generally lower in ARVC as compared to controls, with the subtricuspid area being commonly affected and having the highest discriminatory power to differentiate between ARVC and healthy controls. Therefore, EAM using CFSC constitutes a promising tool for diagnosis of ARVC.

Multiple clinical profiles of families with the short QT syndrome.

Aims: Short QT syndrome (SQTS) is a rare cardiac channelopathy characterized by a shortened corrected QT (QTc)-interval that can lead to ventricular arrhythmias and sudden cardiac death. The aim of this study was to investigate the clinical phenotypes and long-term outcomes of three families harbouring genetic mutations associated with the SQTS. Methods and results: Clinical data included medical history, physical examination, 12-lead ECG, 24-h Holter-ECG, and transthoracic echocardiography from three index patients and their first-degree relatives. Next generation clinical exome sequencing and genetic cascade screening were performed in index patients and their relatives, respectively. Two index patients experienced malignant ventricular arrhythmias and one patient suffered from arrhythmogenic syncope during a median follow-up period of 8 years. They all had genetic mutations associated with the SQTS. Two mutations were found in the KCNH2 gene, and one in the CACNA2D gene. One patient had an additional SCN10A variant. Alive and mutation-positive family members had short QTc-intervals, but no further phenotypic manifestations. None of the mutation-negative family members had an abnormal ECG or any symptoms. In all patients with shortened QTc-intervals, the QTc-interval had a low long-term variability and QTc shortening always remained detectable by 12-lead ECG. Conclusion: This study shows the variety of phenotypic manifestations in different families with SQTS. It further emphasizes the importance of a 12-lead ECG for early diagnosis, and the utility of next generation sequencing for the identification of mutations associated with the SQTS.

Role of Se+Zn in regeneration (Ki-67) following Pb toxicity (p53andcad) in the germinal epithelium of adult Wistar rats.

The germinal epithelium is the delicate epithelial lining of the seminiferous tubule lying on the blood-testes barrier; formed by the sustenacular cells of Sertoli and the adjoining basement epithelium this study addresses the effect of lead (Pb) toxicity on the epithelium and the proliferative effect of Zinc (Zn) and Selenium (Se) administered in trace concentration. Sixty F1 generation adult male Wistar rats were divided into four groups of 15 animals each. Group 1 received normal saline, group 2: 100 mg kg(-1) of lead acetate, group 3: 100 mg kg(-1) of lead acetate then 2.25 mg kg(-1) each of Zinc (Chelated zinc) and Selenium (Sodium Selenium) and group 4: 2.25 mg kg(-1) of zinc and selenium (Se+Zn). The duration of treatment was 56 days following which the animals were sacrificed on the 57th day and the testes harvested and fixed in Bouin's fluid. Pb induced toxicity can follow a mitochondria pathway involving Cathepsin D (CAD) or a cytoplasmic pathway involving p53 (protein 53; a 53 KDa nucleolase), the most predominant form of cell death is apoptosis which can result from both pathways. Se+Zn treatment improves proliferation and counters Pb toxicity by substitution, activation of enzymes (radical scavengers and vitamins), growth factors, activation of endothelial factors and activation of oxygen radical scavengers.

The effect of unilateral vasectomy on testosterone and testicular parameters in the adult male African giant rat (Cricetomys gambianus).

BACKGROUND: The effects of vasectomy on spermatogenesis and reproductive parameters are recognized to be specie-dependent with marked differences in levels of perturbations observed. OBJECTIVES: To assess the impact of unilateral vasectomy on testosterone level and other testicular parameters in the male African giant rat (AGR) (Cricetomys gambianus). METHODS: Sixteen adult male AGRs weighing 500-1300 g were recruited for the experiment. Animals were randomly divided into three experimental groups (1-3) and one control (sham operated) group with four rats per group. Experimental vasectomy was done by carefully ligating the vas deferens of the right testis of all the experimental groups (1, 2, and 3) and animals were allowed either 8, 6 and 2 weeks respectively before sacrifice. Sham-operated animals served as the control. Blood samples were collected and assayed for testosterone while testicular tissue was further processed for seminal fluid and histo-pathological analyses. RESULTS: Spermatogenic parameters indicate a pattern of decline in sperm count and motility between the experimental groups and the control and azoospermia in the eight-week group. Histological alterations were marked by atrophy of seminiferous tubules which was proportional to the duration of vasectomy. Serum testosterone levels were significantly reduced at eight weeks. There was no statistically significant difference between sperm counts of right and left testes except for group 3. Results suggest that unilateral vasectomy of the AGR may have negative impact on the contralateral testis in the male African giant rat. CONCLUSION: These preliminary results reveal that unilateral vasectomy in the AGR may result in perturbations of the histo-architecture of the testes with possible decline in function.

X-ray pelvimetry and labour outcome in term pregnancy in a rural Nigerian population.

BACKGROUND: X-ray pelvimetry is a radiological investigation that involves the measurement of different anthropometric dimensions of the pelvis. The pelvic inlet and outlet play important role in labour outcome. The query as to whether x-ray pelvimetry has a useful predictive value regarding labour outcome prompted this study. OBJECTIVES: To determine whether the use of X-ray pelvimetry is still relevant in term pregnancy, and its reliability in predicting labour outcome. METHOD: This was a retrospective study of pregnant patients who had X-ray pelvimetry at term and successfully delivered at a rural community based mission maternity hospital between 2005-2008. Each x- ray pelvimetry report was matched with the mode of delivery of the patient. 150 patients who were found suitable had data such as age, mode of delivery, etc, extracted. RESULTS: In a review of 150 X -ray pelvimetry films, 119 (79.33%) were categorised as adequate pelvis, 10(6.67%) borderline pelvis and 21 (14%) inadequate pelvis respectively based on the conclusions of the radiologist. Out of the 21 patients with inadequate pelvis, 14 (67%) had normal delivery and 7 (33%) had caesarean section. For the 10 patients with borderline pelvis, 7 (67%) had normal delivery and 3 (33%) had caesarean section. CONCLUSION: This study has demonstrated that X-ray pelvimetry may not be accurate but has fair predictive value on mode of delivery in term pregnancy.

Experimental Testicular Torsion in a Rat Model: Effects of Treatment with Pausinystalia macroceras on Testis Functions.

BACKGROUND: Testicular torsion is a medical emergency with catastrophic sequelae that deserves the same treatment considerations and concerted efforts in research as any other complicated medical condition. The aim of this study was to investigate the effect of Pausinystalia macroceras (PM) bark extract on sperm quality and serum testosterone levels in testicular torsion in a rat model. METHODS: Sixty-five (65) mature male Wistar rats apportioned randomly into four experimental groups of A to C; were further divided into four subgroups according to duration of torsion. Group D were the normal regular rats. Each group/subgroup comprised five rats. Testis maintained in the torted position (T) for 1, 2, 3 and 4 hr in Group A (subgroups: AT1+PM, AT2+PM, AT3+PM, and AT4+PM). Group B (sub- groups: B1+PM, B2+PM, B3+PM, B4+PM) were sham-operated animals, which did not undergo torsion and served as the sham control group. Group C subgroups: CT1, CT2, CT3 and CT4 were torted as in A. All animals (except groups C and D) were treated by PM extract (0.1 g/kg b.w. per day) for 56 days. Group D rats were fed distilled water. Serum testosterone concentrations and sperm quality (motility and count) were measured. Analyses of variance with Scheffe's post-hoc test were carried out on the data. RESULTS: PM extract had a positive effect (significant; p < 0.5) on the sperm count and motility in rats with testicular torsion compared to those not receiving the extract. There was also an increase in serum testosterone levels in the former groups. CONCLUSION: Treatment of rats following testicular torsion result to the enhancement of sperm production in comparison with untreated rats.

The protective role of ascorbic acid in burn-induced testicular damage in rats.

OBJECTIVE: To investigate the ability of ascorbic acid to protect the testes from damage in severe burns. DESIGN: Experimental study. SETTING: University of Lagos Medical School, Department of Anatomy. ANIMALS: 28 adult male Wistar rats (250-300 g). INTERVENTION: Third degree burn was induced on 40% body surface area of rats and they were given ascorbic acid at 4 mg/kg over 8 weeks. MAIN OUTCOME MEASURED: Weight of reproductive organs and epididymal sperm parameters were measured. Oxidative status was assayed and a semi-quantitative assessment of histologic changes was also carried out. RESULTS: Burn caused severe seminiferous tubular damage, especially germ cell loss (p<0.05). This was matched by significant reduction in sperm density and morphology (p<0.05). Burn also increased oxidative stress, with elevated malondialdehyde (MDA) levels (p<0.01) and changes in catalase and superoxide dismutase enzyme levels. Ascorbic acid prevented the changes in all sperm parameters. It normalized MDA levels (p<0.01) and attenuated changes in the levels of catalase and superoxide dismutase. Ascorbic acid treatment also significantly reduced histologic damage to seminiferous tubules. CONCLUSION: This study shows that severe thermal injury causes significant testicular damage and impairs spermatogenesis. It also shows that ascorbic acid protects the testis from such damage and therefore has the potential to be a useful adjunct therapy during treatment of young males with severe burns.

Palliative effect of Pausinystallia macroceras on testicular ischemic reperfusion injury in Wistar rats: a histological study / Efecto paliativo de Pausinystallia macroceras sobre la lesión testicular por isquemia-reperfusión en ratas Wistar: un estudio histológico

Testicular torsion is a disorder involving the scrotum that results in a compromise of its blood supply. The aim was to investigate the effect of Pausinystallia macroceras (PM) on testicular histology following torsion-detortion at different time intervals ranging from 1 to 4 hours 65 mature male Wister rats allotted randomly into seven groups (A to G; E& F further divided into 4-subgroups). Each group/subgroup comprised 5 rats. Testis maintained in the torted position (T) for 1, 2, 3 and 4 hours in Groups A (AT1+PM), B (BT2+PM), C (CT3+PM) and D (DT4+PM). Group E subgroups (E1+PM, E2+PM, E3+PM, E4+PM -) were sham operated, without torsion served as the sham control. Group F subgroups (F1T1, F2T2, F3T3 and F4T4) were torted as in A. All animals (except groups F & G) treated with PM extract (0.1 g/kg.b.w/day) for 56 days. Group G rats (normal control). Testes processed for histological studies. In AT1+PM showed preserved seminiferous tubules. BT2+PM, revealed varying number of necrosed and apoptotic seminiferous tubules. Group CT3+PM rats were similar to BT2+PM although with a slightly higher proportion of seminiferous tubules had undergone necrosis. In DT4+PM, sections showed few viable spermatozoa within the seminiferous tubules. When compared to the torted group F; showed extensive areas of seminiferous tubular necrosis (F3T3) as well as damage to the interstitium; while in F4T4 there were no viable testicular tissues seen. In conclusion, PM significantly prevented the cellular changes and cell death observed especially in group AT1+PM and BT2+PM.

La torsión testicular es un trastorno que involucra el escroto resultando en un compromiso del suministro sanguíneo. El objetivo fue investigar el efecto de Pausinystallia macroceras (PM) en la histología testicular tras torsión-detorsión a intervalos de tiempo diferentes que van desde 1 a 4 horas en 65 ratas macho Wistar maduras, asignando aleatoriamente en siete grupos (desde A a G, mientras que E y F se dividieron en 4 subgrupos). Cada grupo/subgrupo estuvo compuesto por 5 ratas. Los testículos se mantuvieron en posición torsionada (T) durante 1, 2, 3 y 4 horas en los grupos A (AT1 + PM), B (BT2 + PM), C (CT3 + PM) y D (DT4 + PM). El grupo E, subgrupos (E1 + PM, E2 + PM + PM E3, E4 + PM) fueron operados por modelo sham sin torsión, que sirvió de control. El grupo F, subgrupos (F1T1, F2T2, F3T3 y F4T4) fueron torsionados como en A. Todos los animales (excepto los grupos F y G) fueron tratados con extracto de AM (0,1 g/kg peso corporal/día) durante 56 días. El grupo G fueron ratas control (control normal). Los testículos fueron procesados para el estudio histológico. En AT1 + PM se observó preservación de los túbulos seminíferos. BT2 + PM, reveló un número variable de túbulos seminíferos con necrosis y apoptosis. El grupo de ratas CT3 + PM fue similar a BT2 + PM, aunque un porcentaje ligeramente superior de los túbulos seminíferos mostraron necrosis. En DT4 + PM, los cortes mostraron pocos espermatozoides viables dentro de los túbulos seminíferos. En comparación con el grupo F torsionado mostró extensas áreas de necrosis tubular (F3T3), así como daños en el intersticio; mientras que en F4T4 no hubo tejido testicular viable. En conclusión, PM previno significativamente cambios celulares y la muerte celular observada, especialmente en el grupo AT1 + PM y BT2 + PM.

Bromelain in the early phase of healing in acute crush Achilles tendon injury.

UNLABELLED: Bromelain, an enzyme extracted from the stem of the pineapple plant has been proposed as a treatment for reducing pain and swelling following acute muscle injuries but studies are yet to be done on its effect on tendon healing. This study therefore investigated the effects of bromelain on tenocyte proliferation and the tendon malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats. Twenty four male rats were divided randomly into three groups; groups 2 and 3 had induced crush injury to the left Achilles tendon. Group 1; nil injury and nil treatment, Group 2; nil treatment, Group 3; oral bromelain treatment. Bromelain was given at a dosage of 7 mg/kg body weight daily over the first 14 days post-injury. On day 15 post injury, the animals were killed and the tendons excised and processed for histological study and MDA assay. The results showed a significant increase in the tenocyte population in the bromelain group; p < 0.05. There was, however, no significant difference in the MDA level. CONCLUSION: Based on this study, 600 GDU bromelain given once daily in acute tendon injury at a dosage of 7 mg/kg promoted healing by stimulating tenocyte proliferation.

The role of aqueous extract of pineapple fruit parts on the healing of acute crush tendon injury.

BACKGROUND: The Pineapple plant contains the enzyme bromelain which has been acclaimed to reduce pain and swellings following acute muscle injuries as well as carotenoids and polyphenols which are powerful antioxidants. It is yet to be determined if these constituents are distributed throughout the plant and what effect they have on the healing of acute tendon injuries. OBJECTIVE: This study therefore investigated the effects of the aqueous extract of different parts of the pineapple plant on tenoblast proliferation and the tendon Malondialdehyde (MDA) level in the early stage of healing in a crush injury to the achilles tendon of Sprague-Dawley rats. METHODS: Forty male rats were divided randomly into five groups; all had induced crush injury to the left Achilles tendon. Group 1; injury and nil treatment, Group 2; leaves extract, Group 3; fruit flesh extract, Group 4; bark extract, Group 5; core extract. The extract was given at a dosage of 30 mg/kg body weight daily over the first 14 days post-injury. On the 15th day post injury, the animals were sacrificed and the tendons excised and processed for histological study and MDA assay. RESULTS: The flesh and bark extract induced a proliferation of tenoblasts which however was not significantly different from that of the untreated tendon while the leaves and core extracts reduced the population of the tenocytes. The flesh extract significantly (p < 0.05) reduced the MDA level while the leaves and core extract significantly (p < 0.001) increased it. The bark extract had no significant impact on the MDA level compared with the untreated tendon. CONCLUSION: This study suggests that the anti-oxidant constituents of the pineapple plant are concentrated in the flesh while the bark and flesh extracts have the potential to promote healing by stimulating tenoblast proliferation.

[Hypertrophic cardiomyopathy and sudden cardiac death--ICD indications in the margin of uncertainty]. / Hypertrophe Kardiomyopathie und plötzlicher Herztod - ICD-Indikationen in der Grauzone.

Hypertrophic cardiomyopathy (HCM) represents the most common genetic cardiovascular disease with sudden cardiac death being it's most feared and devastating complication. Due to the availability of an effective prevention method from sudden cardiac death since the development of the implantable cardioverter defibrillator (ICD), identification of high-risk patients has become a prominent objective. For a subgroup of patients clear evidence is lacking and the indication for an ICD is bound to a considerable uncertainty, due to the absence of randomized, prospective trials. In trying to guide and facilitate the decision making process, the following article provides an overview of the current available evidence.

Sperm quality changes in survivors of severe burns.

Severe thermal injury occurs frequently, especially in the low-income countries of the world, where they account for a substantial mortality and a wide range of devastating morbidity. Almost all systems of the body are affected, including the cardiovascular, immune, and reproductive systems. A number of studies have shown that people with severe burns may develop impaired spermatogenesis and testicular damage. However, if we consider the many systems that are negatively affected by burns, the effects on the reproductive system are among the least investigated and are therefore poorly understood. We delineated sperm quality changes in 20 men recovering from severe burn injury. They submitted semen at monthly intervals for analysis over a fourmonth period. Our results show that these subjects had significantly lower total sperm counts than normal for their age range. Sperm counts were 20 million/ml or less in half of the study population with a mean of 26.58 ± 7.52 m/ml. Progressive motility was even more severely affected; the score was less than 20% in more than half of the patients, with a mean of 27.74 ± 7.64. Though abnormal sperm rates were within the normal range, in many of the patients 80% of abnormal cells had swollen, oblong and round heads. Cells with tail anomalies made up the rest. Our findings suggest that severe burns cause significant reduction of sperm density and motility. They also cause specific head abnormalities in the cells produced. Such sperm is now known to have very poor fertilization potential.

Brief ischaemia reduces testicular lipid peroxidation following subsequent ischaemia: an evidence for ischaemic preconditioning.

BACKGROUND: Brief periods of ischaemia followed by reperfusion protect tissues like the brain and heart from subsequent ischaemic episodes. Similar effects in the testis has not been adequately studied despite the fact that the testis is subject to ischaemia-reperfusion phenomena of clinical importance during testicular torsion. OBJECTIVE: The present study was designed to investigate whether the testis exhibits ischaemic pre-conditioning. MATERIALS AND METHODS: In the first part of the experiment, 85 adult male Sprague-Dawley rats were divided into five groups. In the first group, testicular malondialdehyde levels was determined as the control. In four groups, right sided testicular torsion was induced by twisting the testes and spermatic cord in a counter-clockwise direction through 720 degrees for 15, 30, 45 and 60 minutes. Five of the animals in each group had testes removed for determination of MDA levels, while the remaining had torted testes de-torted and orchidopexied. After 2, 4 and 6 weeks, five animals in each group had the right testes again twisted through 7200 for 15, 30, 45 and 60 minutes and de-torted. Animals were then sacrificed and testes collected for estimation of MDA. In the second part of the experiment, the above procedure was repeated except that intra-peritoneal melatonin 1 mg/kg was administered before de-torsion. RESULTS: Following retorsion after two weeks, MDA levels were significantly reduced from the control after 30, 45 and 60 minutes of torsion but not after 15 minutes of torsion. There was no significant difference between testicular MDA levels at initial torsion and subsequent levels following re-torsion if melatonin was administered at initial torsion. CONCLUSION: The testis exhibits ischaemic preconditioning which is abolished by melatonin.

Anabolic effect of Hibiscus rosasinensis Linn. leaf extracts in immature albino male rats.

UNLABELLED: Many plants remedies have been employed in solving man's health needs especially the nutritive value which enhances health living. Aphrodisiac plants are plants with anabolic properties i.e. they help in protein synthesis and enhances sexual abilities in males. They are also known as androgenic plants because their properties are similar to that of androgen a male hormone. Cold aqueous extract of Hibiscus rosasinensis leaves is reported by local traditional practioners in Western Nigeria to be aphrodisiac. OBJECTIVE: To investigate the anabolic properties of Hibiscus rosasinensis. MATERIALS AND METHOD: Three groups (8/group) of immature male rats of known weights were administered equal doses of aqueous (cold and hot) and alcoholic extracts of Hibiscus rosasinensis leaves for 8 weeks. The gain in body and isolated sexual organs (testis, epididymis, seminal vesicle and prostate) weights were determined after treatment and compared to the value obtained from a fourth untreated group which served as the control. Section through the testes of both the treated and untreated rats were also examined microscopically and displayed as a photomicrograph for comparism. All data were statistically analysed and displaced in graphic form. RESULTS: Over the 8 weeks of treatment, the control, the cold aqueous extract dosed, hot aqueous extract dosed and alcoholic extract dosed rats gained 8%, 15%, 18% and 22% in body weights respectively. The increase in the weight of testis, epididymis, seminal vesicle and prostate of the alcoholic extract dosed rats was 19%, 30%, 31% and 40% respectively. CONCLUSION: The anabolic effect of the leaf extracts of H. rosasinensis is hereby established. More work needs to be done on these leaf extracts to know their effect on the gonadotrophin hormones which regulate the activity of the androgens in relation to spermatogenesis.

N-terminal pro-brain natriuretic peptide used for the prediction of coronary artery stenosis.

BACKGROUND: The level of the inactive N-terminal fragment of pro-brain (B-type) natriuretic peptide (NT-proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non-invasive diagnosis of coronary artery disease. MATERIALS AND METHODS: The NT-proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT-proBNP was assessed for predicting CAD at angiography. RESULTS: Elevated NT-proBNP levels were associated with the extent of CAD and with the female sex (P < 0.001). The ability of NT-proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut-off point of 85 pg mL(-1), positive likelihood ratio 2.2 (95% CI, 1.7-3.0), negative likelihood ratio 0.53 (95% CI 0.45-0.63) and area under the receiver-operating-characteristic (ROC) curve 0.72: for women, it was assessed using a cut-off point of 165 pg mL(-1), positive likelihood ratio 2.4 (95% CI, 1.7-3.4), negative likelihood ratio 0.55 (95% CI, 0.44-0.70) and area under ROC curve 0.71. In multiple logistic-regression analysis, NT-proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2.76, 95% CI, 1.76-4.32, P < 0.001). CONCLUSIONS: The NT-proBNP is a marker of non-obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT-proBNP with the use of sex-specific reference ranges may improve the non-invasive prediction of CAD.

Effects of torsion, detorsion and melatonin on testicular malondialdehyde level.

BACKGROUND: Unilateral testicular torsion is a cause of bilateral testicular damage, which has ischaemic and reperfusion components. The damage may involve lipid peroxidation leading to production of lipid peroxides in the testes, including malondialdehyde (MDA). OBJECTIVE: To investigate the MDA variations in the ipsilateral and contralateral testes following ischaemia-reperfusion and the effect of melatonin. METHODS: Mature adult male Sprague-Dawley rats were divided into 13 groups of 10 each. One control group underwent sham operation. Three groups were subjected to right sided testicular torsion by twisting the testes 720 degrees counterclockwise for one, three and five hours; three groups were subjected to de-torsion following torsion lasting one, three and five hours; three groups were treated with intra-peritoneal melatonin (1 mg/kg) before torsion lasting one, three and five hours, and three groups were treated with intra-peritoneal melatonin before de-torsion following torsion lasting one, three and five hours. At the end of the experiment all animals were sacrificed by decapitation and testes were collected for MDA level estimation. RESULTS: The MDA level was significantly higher in ipsilateral torted testis than the control testis in all groups (P < 0.05), with the levels increasing with the duration of torsion. Detorsion significantly increased the MDA level only if the initial torsion was for less than three hours. Melatonin did not significantly affect the MDA level in the ipsilateral testis if administered before torsion, but significantly reduced the level if administered before detorsion. CONCLUSION: Malondialdehyde levels are altered in the both testes following unilateral testicular torsion-detorsion injuries. The reperfusion component of the injury is significant and may be reduced by melatonin.

Simple criteria for differentiation of Fabry disease from amyloid heart disease and other causes of left ventricular hypertrophy.

AIMS: Fabry disease may be difficult to differentiate from other causes of left ventricular hypertrophy such as other myocardial storage diseases (including amyloidosis), hypertrophic cardiomyopathy (HCM), or hypertensive heart disease (HHD). We sought to determine simple criteria to best differentiate the above mentioned cardiac diseases. METHODS AND RESULTS: All patients in a six-year time period with left ventricular hypertrophy due to Fabry disease (13 patients), biopsy proven cardiac amyloidosis (16 patients), non-obstructive HCM (17 patients), and 22 randomly selected patients with advanced HHD were compared. Retrospective analysis of clinical characteristics, findings of electrocardiogram (ECG) and echocardiography by blind review was performed. RESULTS: No single clinical characteristic or findings of ECG or echocardiography could reliably differentiate between the various diseases. Increased echogenicity/granular sparkling, valvular abnormalities, abnormal renal function, and diastolic function were not helpful discriminators. In a univariate analysis, four criteria (acroparesthesia, anhydrosis, absence of hypertension and presence of Sokolow criteria for left ventricular hypertrophy in the ECG) were significant for Fabry disease. By logistic regression analysis, the following most suitable discriminative parameters were identified: hypertension in HHD (specificity 82%), orthostasis and/or pericardial effusion for amyloidosis (specificity 93%), papillary muscle anomaly in non-obstructive HCM (specificity 92%), and Fabry disease if neither hypertension orthostatis, pericardial effusion nor a papillary muscle anomaly was present (specificity 87%). CONCLUSION: A combination of symptoms, echocardiographic findings and ECG in unexplained left ventricular hypertrophy may help to differentiate amyloidosis, non-obstructive HCM and hypertensive heart disease from Fabry disease. The results of this preliminary study will have to be confirmed in a prospective study.

Radar soundings of the ionosphere of Mars.

We report the first radar soundings of the ionosphere of Mars with the MARSIS (Mars Advanced Radar for Subsurface and Ionosphere Sounding) instrument on board the orbiting Mars Express spacecraft. Several types of ionospheric echoes are observed, ranging from vertical echoes caused by specular reflection from the horizontally stratified ionosphere to a wide variety of oblique and diffuse echoes. The oblique echoes are believed to arise mainly from ionospheric structures associated with the complex crustal magnetic fields of Mars. Echoes at the electron plasma frequency and the cyclotron period also provide measurements of the local electron density and magnetic field strength.

Predictors of adverse outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: long term experience of a tertiary care centre.

OBJECTIVE: To investigate the predictors for adverse clinical outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) during long term follow up. METHODS: 61 patients with ARVD/C were studied to assess the impact of family history, clinical findings, surface ECG parameters, echocardiographic findings, and electrophysiological findings on clinical outcome. The prevalence of these risk factors were compared in two patient groups: group A (patients with adverse clinical outcome: sudden cardiac death, death from heart failure, or heart transplant) and group B (survivors excluding patients who received a heart transplant). RESULTS: Mean age at first diagnosis was 44 (14) years. The mean follow up duration was 55 (47) months. Ten patients (16%) died during follow up. The cause of death of eight of these patients was probably arrhythmic. Two patients died of advanced heart failure. Five patients underwent heart transplantation because of terminal heart failure. Risk factors significantly associated with adverse outcome were history of congestive heart failure (p < 0.001), the presence of left ventricular involvement on echocardiography (p < 0.001), left atrial dilatation (p < 0.05), prolonged PR duration (p < 0.01), prolonged QRS in V1 (p < 0.05), and bundle branch block (p < 0.05). In multivariate analysis, history of congestive heart failure and presence of left ventricular involvement were identified as independent risk predictors for an adverse outcome. CONCLUSIONS: Congestive heart failure and left ventricular involvement are independently associated with adverse outcome in patients with ARVD/C during long term follow up.