Evaluation of Changes in the Cardiac Function before and after Transcatheter Edge-to-Edge Mitral Valve Repair in Healthy Dogs: Conventional and Novel Echocardiography

Mitral valve regurgitation is a common canine heart disease. Transcatheter Edge-to-Edge Repair (TEER) is a transcatheter, edge-to-edge mitral repair device that uses a hybrid approach. No detailed information has been published on the hemodynamic effect of TEER on cardiac function. The aim of this report is to provide a longitudinal observation of the cardiac functional changes observed after TEER implantation in normal dogs using traditional, two-dimensional speckle tracking, and color M-mode echocardiographic methods. In the current report, TEER was implanted into two healthy dogs under general anesthesia. An echocardiographic examination was performed at baseline and weekly postoperative follow-ups were conducted until the fourth week. Successful TEER implantation was achieved with a short operation time (98 and 63 min) in the two dogs. Functional mitral valve regurgitation, elevated E/e’ ratio, elevated radial strain, and stable intraventricular pressure gradients (IVPG) were observed after the operation in the dogs. Mild non progressive mitral valve stenosis was observed in both dogs. TEER is a minimally invasive method for mitral valve surgery that necessitates more clinical trials. With longitudinal observation of heart function using novel approaches, better outcomes will be expected.

Early-pregnancy prediction of risk for pre-eclampsia using maternal blood leptin/ceramide ratio: discovery and confirmation

ObjectiveThis study aimed to develop a blood test for the prediction of pre-eclampsia (PE) early in gestation. We hypothesised that the longitudinal measurements of circulating adipokines and sphingolipids in maternal serum over the course of pregnancy could identify novel prognostic biomarkers that are predictive of impending event of PE early in gestation.Study designRetrospective discovery and longitudinal confirmation.SettingMaternity units from two US hospitals.ParticipantsSix previously published studies of placental tissue (78 PE and 95 non-PE) were compiled for genomic discovery, maternal sera from 15 women (7 non-PE and 8 PE) enrolled at ProMedDx were used for sphingolipidomic discovery, and maternal sera from 40 women (20 non-PE and 20 PE) enrolled at Stanford University were used for longitudinal observation.Outcome measuresBiomarker candidates from discovery were longitudinally confirmed and compared in parallel to the ratio of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt-1) using the same cohort. The datasets were generated by enzyme-linked immunosorbent and liquid chromatography-tandem mass spectrometric assays.ResultsOur discovery integrating genomic and sphingolipidomic analysis identified leptin (Lep) and ceramide (Cer) (d18:1/25:0) as novel biomarkers for early gestational assessment of PE. Our longitudinal observation revealed a marked elevation of Lep/Cer (d18:1/25:0) ratio in maternal serum at a median of 23 weeks’ gestation among women with impending PE as compared with women with uncomplicated pregnancy. The Lep/Cer (d18:1/25:0) ratio significantly outperformed the established sFlt-1/PlGF ratio in predicting impending event of PE with superior sensitivity (85% vs 20%) and area under curve (0.92 vs 0.52) from 5 to 25 weeks of gestation.ConclusionsOur study demonstrated the longitudinal measurement of maternal Lep/Cer (d18:1/25:0) ratio allows the non-invasive assessment of PE to identify pregnancy at high risk in early gestation, outperforming the established sFlt-1/PlGF ratio test.

ON THE ORIGIN AND DISABILITY PREVENTION

There is an asymmetry in the disability research. Much more research is devoted to the problems of living conditions of people with disabilities and the instruments of their support and activation. Prevention of accidents, injuries and chronic diseases leading to disability is less researched. The article indicates that research on disability prevention should be multidisciplinary and based on the life course and settings (place of living) approach, preferably with the use of longitudinal observation. Correspondingly to this proposal, examples of studies meeting the author's suggestions are noted, as well as the guidelines of WHO and other specialized organizations on the use of developed definitions, creating national databases and mobilizing stakeholders for participation in adequate data collection process at international level.

Psychotic Features Among Patients in the Prodromal Stage of Dementia with Lewy Bodies During Longitudinal Observation

Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusional-hallucinatory, and seven were manic and/or depressive. Seven of the 21 cases exhibited delirium during longitudinal observation. A psychotic state repeatedly appeared without any trigger in 20 of the 21 patients. All subjects developed cognitive impairment at 9.1±4.6 (mean±SD) years after the initial appearance of psychotic symptoms, and subsequently diagnosed with DLB at 71.3±6.1 (mean±SD) years. Conclusion: Elderly patients with psychotic symptoms, such as catatonia, delusion-hallucination, manic and/or depressive features, and delirium without dementia, could indicate symptomatic psychosis or a prodromal stage of any neurocognitive disorder such as DLB. Therefore, further extensive workout (e.g., radioisotope neuroimaging) is required to avoid misdiagnosis.

Sensitivity to change and responsiveness of lowering to the ground and rising from the ground evaluation in Duchenne muscular dystrophy: one-year longitudinal observation

BACKGROUND: The progressive weakness of Duchenne muscular dystrophy (DMD) interferes with performance. This study investigated the sensitivity to change and the responsiveness of sitting and standing from the ground in patients with DMD. AIM: The aim was to assess the sensitivity to change and the responsiveness of lowering to/ rising from the ground, in three, six, nine, and twelve month-evaluation intervals and to define the most suitable reevaluation intervals for ambulatory patients with DMD. METHOD: This is an observational, longitudinal study. Recordings of 28 patients performing lowering to/ rising from the ground were analyzed. Sensitivity to change was assessed using effect sizes and standardized response means. Responsiveness was assessed using minimal detectable changes (MDC) and minimal clinically important differences (MCID). RESULTS: In the lowering to the ground, significant sensitivity to change was found in higher than 6 months reassessment intervals. In the rising from the ground, significant sensitivity to change was observed in higher than 9 reassessment intervals. MDC and MCID varied from 1.0 to 1.6 points and from 0.5 to 2.5 seconds when lowering to the ground and from 1.3 to 2.6 points and from 5.0 to 28.0 seconds when rising from the ground. CONCLUSION: Patients should be reassessed after nine months from the lowering to and rising from the ground. Increments of 2.0 points and/or 2.5 seconds (or higher) in the score of lowering to the ground assessment denote clinically relevant changes. Increments of 3 points (or higher) in rising from the ground assessment are clinically relevant.