Second Trimester Fetal and Maternal Epicardial Fat Thickness in Gestational Diabetic Pregnancies.

Our aim was to evaluate the association between gestational diabetes mellitus and sonographically measured fetal epicardial fat thickness between 24-28 weeks' gestation. This was a cross-sectional study that included 40 pregnancies with gestational diabetes mellitus, matched with 40 normal pregnancies with similar maternal age, body-mass index, gestational age, fetal gender, and fetal abdominal circumference on ultrasound. Fetal epicardial fat thickness was measured and recorded during ultrasonography at 24-28 weeks of gestation. Maternal evaluation included measurement of maternal epicardial fat thickness, using echocardiography. Fetal and maternal epicardial fat thickness values were compared across the groups. Ultrasound views of fetal epicardial fat thickness were evaluated independently by 3 perinatology fellows to determine inter- and intra-observer variability. Partial and intraclass correlation analyses were used. Fetal and maternal epicardial fat thickness measurements were moderately correlated (r=0.63). Mean fetal and maternal epicardial fat thickness values were higher in gestational diabetes mellitus pregnancies (p=0.004 and p<0.0001, respectively) compared to controls. Fetal epicardial fat thickness was positively correlated (r=0.43) with postchallenge 2-h glucose values. Inter- and intra-observer agreement was high, demonstrated by strong correlations (r=0.99 and r=0.99, respectively) across fetal epicardial fat thickness measurements of the examiners. Fetuses from gestational diabetes mellitus pregnancies have significantly higher fetal and maternal epicardial fat thickness values compared to nongestational diabetes mellitus pregnancies. Fetal epicardial fat thickness obtained during second trimester fetal anatomy ultrasound may potentially be a reliable indicator for gestational diabetes mellitus. However, clinical validation studies are needed.

Multiple gene polymorphisms predisposing to the prothrombotic state in an adolescent with acute myocardial infarction.

Acute myocardial infarction with ST-segment elevation (STEMI) is rare in adolescents and its pathogenesis is unclear. Growing evidence shows an association between the prothrombotic state and acute STEMI. Prothrombotic genetic factors may be involved in the pathogenesis of STEMI. We present a case of an adolescent with acute STEMI who had multiple prothrombotic gene polymorphisms: in the beta fibrinogen, methylenetetrahydrofolate reductase and cholesteryl ester transfer protein genes, as well as genotypes in plasminogen activator inhibitor-1 and human platelet antigen type-1. He had normal coronary arteries with catheterinduced spasm and was treated with a calcium antagonist and aspirin.

The effect of conversion type on P wave dispersion in patients with atrial fibrillation.

AIM: The aim of this study was to investigate whether conversion type of atrial fibrillation (AF) to sinus rhythm affects the P wave dispersion (PD) in patients with AF. METHODS: Based on conversion type, 95 consecutive patients with AF<3 months were divided into 3 groups: spontaneous cardioversion (SC) (N.=33, mean age: 60.6+/-11.6 years), pharmacologic cardioversion (PC) (N.=32, mean age: 59.2+/-9.6 years) and electrical cardioversion (EC) (N.= 30, mean age: 65.3+/-10.6 years). P wave duration (maximum and minimum) were measured in 12-lead ECG, and PD was calculated. RESULTS: Left atrial diameter and AF duration were significantly higher in EC (43.6+/-4.8 mm and 794.1+/-815.1 h) than SC (38.5+/-3.9 mm and 13.8+/-18.3 h) and PC (40.9+/-4.5 mm and 65.3+/-148.5 h) groups (P<0.01). P maximum was much longer in EC group compared with SC and PC group (121.6+/-9.7, 108.4+/-6.4 and 115.8+/-8.6 ms, P=0.01, respectively). There was a significant difference in PD among SC, PC and EC groups (44.4+/-9.2, 49.5+/-8.7 and 53.5+/-8.8 ms; P=0.005, respectively). PD correlated with AF duration (r=0.36, P=0.03), left atrial diameter (r=0.45, P=0.002) and conversion type (r=0.29, P=0.03). However, there was no significant association between PD and conversion type in multivariate analysis. The prolonged PD resulted from AF duration (P=0.01) and the left atrial size P=0.001). CONCLUSION: This study suggests that conversion type of AF to sinus rhythm has no effect on P wave duration and independent of AF duration and the left atrial diameter.

Analysis and modelling of land-based nutrient pollution by watershed models coupled with GIS: a case study from Turkey.

Diffuse pollution is usually temporally and spatially uncertain, and thus hard to analyze. In many cases, discretizing a diffuse source of pollution into individual point sources can ease diffuse pollution modelling and analysis, and therefore reduce high uncertainty especially in the spatial distribution of pollution loads. This is however a difficult task, since quite a number of sub-drainage areas, with complex structures and land-use properties, has to be delineated. Watershed models can be used to delineate the sub-drainage areas in a watershed with high accuracy and locate the related outlets which connect the sub-drainage areas to the main waterbody in a watershed. In this study, such an approach has been used on a case study to model the diffuse nutrient loads carried to streams that reach to a medium-sized lake in Turkey. The annual nutrient loads, which were calculated by using mathematical models, were then converted to a load-map with the help of a geographical information system.

Complications associated with percutaneous placement of intra-aortic balloon counterpulsation: can unsheathed insertion reduce limb ischaemia?

Complications related to percutaneous placement of intra-aortic balloon pump counterpulsation are still high despite major refinements in catheter design and techniques. One hundred and forty-eight patients in whom intra-aortic balloon pumping was inserted were classified into two groups on the basis of the insertion technique. Group I included 103 patients in whom the conventional percutaneous insertion was used. A sheathless insertion technique was used in group II (n = 45). The overall complication rate was 16.6% (25 of 150), in which lower limb ischaemia was the most common complication. The limb ischaemia was noted in 12 patients (11.5%) in group I and 4 patients (8.9%) in group II (statistically not significant). Peripheral vascular disease, diabetes mellitus and female gender were found to be significant predictors of limb ischaemia (p = 0.01, p = 0.02 and p = 0.03, respectively). In conclusion, sheathless insertion of intra-aortic balloon pump catheters does not reduce the incidence of limb ischaemia.

Circulating cytokines and complements in chronic heart failure.

Elevated levels of cytokines and complements have been reported in patients with advanced heart failure, but the exact clinical significance remains unclear. Therefore, assessments correlated with hemodynamic and clinical variables may provide important insight into the actions of cytokines and complements in chronic heart failure. The authors evaluated the clinical significance of cytokines and complements. The study included 60 subjects (50 men, 10 women); 34 had idiopathic dilated cardiomyopathy (DCM) and 26 had ischemic heart disease (IHD). Tumor necrosis factor alpha and interleukin-2 receptor concentrations in chronic heart failure were greater than in control subjects (20.0 +/- 0.4 vs 18.0 +/- 0.5 pg/mL, p<0.05 and 817.23 +/- 63.50 vs 642.75 +/- 27.31 pg/mL, p<0.05, respectively). There was no significant difference between DCM and IHD patients in circulating levels of the cytokines and the components complements (p=NS). Additionally, although functional classes III and IV heart failure patients showed a tendency to increase the levels of the cytokines and the component complements, these differences were not statistically significant (p=NS). Similarly, correlation analysis showed that the levels of the circulating cytokines and the component complements had independent value for mortality. These results suggest that humoral and cellular immunity abnormalities may play an important role in the pathogenesis of heart failure and dilated cardiomyopathy.

Plasma leukocyte elastase concentration and coronary artery disease.

It has previously been shown that leukocyte elastase is involved in the pathogenesis of atherosclerosis. Few studies have addressed the relation between leukocyte elastase concentrations and coronary artery disease (CAD). The authors investigated (1) the clinical significance of leukocyte elastase determination in the diagnosis of CAD and (2) the relation between plasma leukocyte elastase concentration and lesion morphology. The study included 185 subjects (140 men, 45 women) who underwent coronary angiography during investigation of chest pain; 135 had coronary stenosis (Group I) and 50 had nonstenotic coronaries (Group II). Among Group I patients, those with simple atheromatous plaques were distinguished from those with complex plaques. Elastase concentrations in Group I were greater than in Group II (57.1 +/- 1.16 micrograms I[-1] vs 27.6 +/- 1.0 microgram, I[-1], P<0.001), and greater in complex plaque patients than in those with simple plaques (64.5 +/- 1.24 micrograms I[-1] vs 45.9 +/- 1.01 micrograms I[-1], P<0.001). Logistic regression analysis showed (1) that elastase concentration, age, and sex had independent value for prediction of CAD and (2) that among Group I patients, the risk of complex plaques was greatest for those with high elastase concentration. These results suggest that plasma leukocyte elastase concentration is a sensitive diagnostic marker of CAD and that high values of elastase may indicate the presence of complex atheromatous plaques.