The Periodontal-Cardiovascular alliance: Evaluation of miRNA-146a in subgingival plaque samples of chronic periodontitis patients with and without coronary heart disease.

AIM: To quantify the levels of miRNA-146a in subgingival plaque samples, and correlate with periodontal and cardiac parameters, in chronic periodontitis patients with and without coronary heart disease. METHODS: The study involved 90 subjects; 30 patients with chronic periodontitis and coronary heart disease (CP + CHD) as part of Group I; group II comprising 30 with chronic periodontitis alone (CP); and group III comprising 30 systemically healthy controls. Demographic variables, periodontal parameters such as plaque index, bleeding on probing, probing pocket depth and clinical attachment levels, cardiac parameters such as total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride levels, and systolic and diastolic blood pressure were recorded from the patients. miRNA-146a level was analyzed in subgingival plaque samples by real-time polymerase chain reaction assay and correlated with periodontal and cardiac parameters. RESULTS: miRNA-146a showed the highest levels in the CP + CHD group and also showed a positive correlation with body mass index, and periodontal and cardiac parameters. CONCLUSION: miRNA-146a is involved in the pathogenesis of both periodontitis and coronary heart disease.

An unusual combination of coronary arterial and systemic venous anomalies-clinical implications.

A 57-year-old male underwent coronary angiography for exertional angina which showed two left anterior descending coronary arteries (LAD)--a short LAD from the left coronary sinus terminating in the proximal Anterior Inter-Ventricular Sulcus (AIVS), a long LAD from the proximal right coronary artery entering the distal AIVS and an anomalous left circumflex artery from the right coronary sinus. In addition, he also had absent right superior vena cava and a persistent left superior vena cava entering the coronary sinus.

16S rRNA-based detection of oral pathogens in coronary atherosclerotic plaque.

BACKGROUND: Atherosclerosis develops as a response of the vessel wall to injury. Chronic bacterial infections have been associated with an increased risk for atherosclerosis and coronary artery disease. The ability of oral pathogens to colonize in coronary atheromatous plaque is well known. AIM: The aim of this study was to detect the presence of Treponema denticola, Porphyromonas gingivalis and Campylobacter rectus in the subgingival and atherosclerotic plaques of patients with coronary artery disease. MATERIALS AND METHODS: Fifty-one patients in the age group of 40-80 years with coronary artery disease were selected for the study. DNA was extracted from the plaque samples. The specific primers for T. denticola, C. rectus and P. gingivalis were used to amplify a part of the 16S rRNA gene by polymerase chain reaction. STATISTICAL ANALYSIS USED: Chi-square analysis, correlation coefficient and prevalence percentage of the microorganisms were carried out for the analysis. RESULTS: Of the 51 patients, T. denticola, C. rectus and P. gingivalis were detected in 49.01%, 21.51% and 45.10% of the atherosclerotic plaque samples. CONCLUSIONS: Our study revealed the presence of bacterial DNA of the oral pathogenic microorganisms in coronary atherosclerotic plaques. The presence of the bacterial DNA in the coronary atherosclerotic plaques in significant proportion may suggest the possible relationship between periodontal bacterial infection and genesis of coronary atherosclerosis.

Prevalence of periodontal pathogens in coronary atherosclerotic plaque of patients undergoing coronary artery bypass graft surgery.

BACKGROUND: Chronic bacterial infections have been associated with an increased risk for atherosclerosis and coronary artery disease. The ability of oral pathogens to colonize in coronary atheromatous plaque is well known. The aim of our study was to detect the presence of four common periodontal pathogens in coronary plaques. We detected the presence of 16S rRNA of Treponema denticola, Eikenella Corrodens, Porphyromonas gingivalis and Campylobacter rectus in subgingival and atherosclerotic plaques of CABG surgery by using Polymerase Chain Reaction. METHODS: 51 patients in the age group of 40 to 80 years with chronic periodontitis were recruited for the study. These patients were suffering from Coronary Artery Disease (CAD) and underwent Coronary Artery Bypass Grafting (CABG). DNA was extracted from the subgingival plaque and coronary atheromatous plaque samples. Universal Primer for the general detection of bacterial DNA and the primers for T.denticola, E. Corrodens, C.rectus and P.gingivalis were used to amplify part of 16SrRNA gene by Polymerase Chain Reaction. RESULTS: T.denticola, E.corrodens, C.rectus and P.gingivalis were detected in 49.01 %, 27.45 %, 21.51% and 45.10% of atherosclerotic plaque samples. In both subgingival and coronary plaque samples, T. denticola was detected in 39.21% of the cases, E.corrodens in 19.60%, C.rectus in 11.76% and P.gingivalis in 39.22% of the cases respectively. CONCLUSION: Our study revealed the presence of significant bacterial DNA of oral pathogens in coronary plaques. This suggests possible relationship between periodontal infection and atherosclerosis and can help devise preventive treatment strategies.

Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy.

OBJECTIVE: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. METHODS: We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair (anterior mitral leaflet plication); 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall's procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge. RESULTS: One patient died of post-operative heart failure. The mean follow-up time was 4.3 years. There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association (NYHA) Classes I-II due to associated valvular lesions. CONCLUSION: Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion (SAM) of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.

Mitral valve reoperation through the left atrial appendage in a patient with mesocardia.

We report the case of a patient with mesocardia, mitral restenosis, and mitral regurgitation. He had undergone an open mitral valvotomy 4 years earlier and, therefore, presented us with a problematic approach to the mitral valve. In such cases, access to the mitral valve is almost impossible due to the position of the valve, which is more posterior and to the left of a normal valve, and due to adhesions from the previous surgery We approached the mitral valve through the left atrial appendage and replaced the mitral valve with a mechanical prosthesis.

Heart-lung transplantation in India: initial experience.

Heart-lung transplantation is a well accepted and standard form of therapy for the surgical management of patients with end-stage cardiopulmonary disorders. The first heart-lung transplant in India was performed at our institution on May 3, 1999 and, subsequently, 2 more patients have undergone this procedure. The initial experience is encouraging and heralds a new era of thoracic organ transplantation in India.

Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task.

Cocaine abusers demonstrate faulty decision-making as manifested by their inability to discontinue self-destructive drug-seeking behaviors. The orbitofrontal cortex (OFC) plays an important role in decision-making. In this preliminary study we tested whether 25-day-abstinent cocaine abusers show alterations in normalized cerebral blood flow (rCBF) in the OFC using PET with (15)O during the Iowa Gambling Task (a decision-making task). This task measures the ability to weigh short-term rewards against long-term losses. A control task matched the sensorimotor aspects of the task but did not require decision-making. Cocaine abusers (N = 13) showed greater activation during performance of the Iowa Gambling Task in the right OFC and less activation in the right dorsolateral prefrontal cortex (DLPFC) and left medial prefrontal cortex (MPFC) compared to a control group (N = 13). Better Iowa Gambling Task performance was associated with greater activation in the right OFC in both groups. Also, the amount of cocaine used (grams/week) prior to the 25 days of enforced abstinence was negatively correlated with activation in the left OFC. Greater activation in the OFC in cocaine abusers compared to a control group may reflect differences in the anticipation of reward while less activation in the DLPFC and MPFC may reflect differences in planning and working memory. These findings suggest that cocaine abusers show persistent functional abnormalities in prefrontal neural networks involved in decision-making and these effects are related to cocaine abuse. Compromised decision-making could contribute to the development of addiction and undermine attempts at abstinence.

Hydatid cyst of the left ventricle of the heart.

Hydatid disease of the heart is rare. We report a case of hydatid cyst of left ventricle in a forty year old lady where the diagnosis was made intra-operatively. The transthoracic and transesophageal echocardiography showed a mixed echogenic mass arising from the left ventricle. The diagnosis of hydatid cyst was confirmed by the demonstration of scolex and hooklets in the cyst fluid. Hydatid cyst should be a differential diagnosis for a mixed echogenic mass on echocardiography.

Nocardia asteroides mediastinitis complicating coronary artery bypass surgery.

A 63 years diabetic male was admitted with mediatinitis and sternal dehiscence. Nocardia asteroides sensu stricto Type VI was isolated from the mediastinal tissue and fluid during debridement. Prompt surgical intervention and treatment with ofloxacin both intravenously and later orally led to the cure.

Decision-making in a risk-taking task: a PET study.

As decision-making is central to motivated behavior, understanding its neural substrates can help elucidate the deficits that characterize various maladaptive behaviors. Twenty healthy adults performed a risk-taking task during positron emission tomography with (15)O-labeled water. The task, a computerized card game, tests the ability to weigh short-term rewards against long-term losses. A control task matched all components of the risk-taking task except for decision-making and the difference between responses to contingent and non-contingent reward and punishment. Decision-making (2 runs of the active task minus 2 runs of the control task) activated orbital and dorsolateral prefrontal cortex, anterior cingulate, insula, inferior parietal cortex and thalamus predominantly on the right side, and cerebellum predominantly on the left side. In an exploratory analysis, guessing (run 1 minus run 2 of the active task) accompanied activation of sensory-motor associative areas, and amygdala on the left side, whereas informed decision-making (run 2 minus run 1) activated areas that subserve memory (hippocampus, posterior cingulate) and motor control (striatum, cerebellum). The findings provide a framework for future investigations of decision-making in maladaptive behaviors.

Invasive pulmonary aspergillosis with intraspinal extension in a non-immunocompromised host. A case report.

A case of invasive pulmonary aspergillosis in a 33-year-old, non-immunocompromised male presenting with lower limb paraplegia is reported. The clinical manifestations, diagnosis, and combined medical and surgical management of this rare condition are described.

Absent pulmonary valve syndrome with aortic regurgitation in a 50-year-old man.

A 50-year-old man was diagnosed as having absent pulmonary valve syndrome with aneurysmal dilatation of the pulmonary arteries. He also had a large subaortic ventricular septal defect and severe aortic regurgitation. He underwent successful intracardiac repair and aortic valve replacement. This case is presented in view of its rarity and controversies in the surgical management.

6-[18F]fluoro-A-85380, a novel radioligand for in vivo imaging of central nicotinic acetylcholine receptors.

A novel positron emission tomography (PET) radiotracer, 6-[18F]fluoro-3-(2(S)-azetidinylmethoxy)pyridine (6-[18F]fluoro-A-85380, 6-[18F]FA) was synthesized by a no-carrier-added fluorination. In vitro 6-[18F]FA bound to nicotinic acetylcholine receptors (nAChRs), with very high affinity (Kd 28 pM). In PET studies, 6-[18F]FA specifically labeled central nAChRs in the brain of the Rhesus monkey and demonstrated highest levels of accumulation of radioactivity in brain regions enriched with the alpha4beta2 subtype of nAChR. 6-[18F]FA exhibited a target-to-non-target ratio (estimated as radioactivity in the thalamus to that in the cerebellum) of binding in primate brain similar to that previously determined for a labeled analog of epibatidine, [18F]FPH. In contrast to [18F]FPH, the novel tracer is expected to exhibit substantially less toxicity. Thus, the novel radioligand, 6-[18F]FA, appears to be a suitable candidate for imaging nAChRs in human brain.

2-[18F]F-A-85380: a PET radioligand for alpha4beta2 nicotinic acetylcholine receptors.

2-[18F]fluoro-3-(2(S)-azetidinylmethoxy)pyridine (2-[18F]F-A-85380), a ligand for nicotinic acetylcholine receptors (nAChRs) was evaluated in an in vitro binding assay with membranes of rat brain and in vivo by PET in Rhesus monkey brain. The ligand has high affinity for alpha4beta2 nAChRs (K(D)=50 pM), crosses the blood-brain barrier, and distributes in the monkey brain in a pattern consistent with that of alpha4beta2 nAChRs. The specific/non-specific binding ratio increased steadily, reaching a value of 3.3 in the thalamus at 4 h. The specific binding of 2-[18F]F-A-85380 was reversed by cytisine. These results, in combination with the data demonstrating low toxicity of 2-[18F]F-A-85380, indicate that this ligand shows promise for use with PET in human subjects.

Transmyocardial laser revascularization: early results and 1-year follow-up.

BACKGROUND: Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. METHODS: From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years and 92.15% were men. Mean preoperative angina class and ejection fraction were 2.6 +/- 0.7 and 44.7% +/- 10.5%, respectively. Diabetes was present in 49.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 +/- 8 channels were created in each patient using an 800-W CO2 laser. RESULTS: The early mortality was 14.7% and univariate predictors of mortality were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressure greater than 21 mm Hg. At 1-year follow-up there was significant improvement in angina class and effort tolerance but no significant change in left ventricular ejection fraction. CONCLUSIONS: We conclude that transmyocardial revascularization provides symptomatic benefit and improves exercise tolerance in a group of patients suffering from disabling angina not amenable to other modes of treatment. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects is uncertain and patency of laser channels is controversial, but laser-induced neoangiogenesis is being looked on as a possible explanation.

Clinical course after mitral valve replacement.

Two hundred and fifty patients underwent mitral valve replacement for rheumatic valvular disease during a 9-year period from January 1979 to December 1987. A maximum period of follow-up of 10 years and minimum of 1 year was achieved with a mean duration of 4.4 years. The follow-up covered 921 out of a possible 1006 patient-years and was 91.5 per cent complete. Of the patients, 58 (23.2%) were in class II, 145 (58%) were in class III and 47 (18.8%) belonged to class IV. The early mortality for patients in Class II, III and IV was 8.6 per cent, 15.8 per cent and 31.9 per cent respectively and the 3, 5 and 10 years actuarial survival rates for the entire group were 93 per cent, 87 per cent and 70 per cent. The event-free survival rates at the same intervals were 77 per cent, 63 per cent and 57 per cent respectively. Late deaths occurred in 18 (9.5%) of the patients. Twelve of these (66.6%) could be directly ascribed to a valve-related cause.