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Brachial plexus neuropathy is an unfortunate complication that sometimes follows radiotherapy to the axillary and supraclavicular regions. A patient is described who, 30 years after radiotherapy for Hodgkin's disease and more than 10 years after the development of radiation-induced bilateral brachial plexus neuropathy, presented with bilateral diaphragmatic weakness secondary to bilateral phrenic nerve weakness. Previous radiotherapy was the most probable cause of the condition. [ABSTRACT FROM AUTHOR]

Dental erosion and factors affecting the risk of its occurrence were investigated with a case-control approach. One hundred and six cases with erosion and 100 randomly selected controls from the same source population were involved in the study. All cases and controls were evaluated by the recording of structured medical and dietary histories and by examination of the teeth and saliva. Erosion was classified according to pre-determined criteria. The relative importance of associations between factors and erosion was analyzed by a logistic multivariable model. Adjusted odds ratios (AOR) were estimated. There was considerable risk of erosion when citrus fruits were eaten more than twice a day (AOR 37), soft drinks were drunk daily (AOR 4), apple vinegar was ingested weekly (AOR 10), or sport drinks were drunk weekly (AOR 4). The risk of erosion was also high in individuals who vomited (AOR 31) or exhibited gastric symptoms (AOR 10), and in those with a low unstimulated salivary flow rate (AOR 5). [ABSTRACT FROM AUTHOR]

Competing Interests: Conflict of interest: None declared.

Background: Left ventricle (LV) optimized views are routinely used for left atrial (LA) volume and strain measurements on 2D echocardiography. This might be a source of the error because of the variation of the angle between the left atrial and left ventricle long axes (LA-LV angle), leading to foreshortening of the LA., Methods: We investigated two novel parameters: the angle between the left atrial and left ventricle long axes (LA-LV angle) and its deviation from the 4-chamber plane. To accurately measure the angles in 3D space, these measurements were performed using 3D echocardiography. We developed a method for the measurement based on marking anatomic points of reference in the 3D echocardiogram and measuring the angles between these points. We used three types of phantoms made of wood and agar-agar to investigate the repeatability and reproducibility of these measurements and performed measurements on human subjects., Results: The ultrasound measurements were in excellent agreement with the true angles of the phantoms: LA-LV angle bias was .5 degrees (95% CI -1.8 to +2.7) in the wooden phantoms and 1.2 degrees (-.7 to +3.1) in the agar-agar phantoms, while the angle deviation from the 4-chamber plane was -.9 degrees (-4.3 to +4.1) in the wooden phantoms and .0 degrees (-3.3 to +3.3) in the agar-agar phantoms. The measurements demonstrated good repeatability and reproducibility (Pearson correlation coefficients ranging from .91 to .99). The measurements from human hearts showed good repeatability (Pearson correlation was .81 for repeated LA-LV angle measurements and .97 for repeated measurements of the deviation from the 4-chamber plane)., Conclusion: The measurement of the LA-LV angle is a feasible tool to investigate one eventual error of 2D echocardiography., (© 2023 The Authors. Echocardiography published by Wiley Periodicals LLC.)

Introduction and Methods: There is limited knowledge of cumulative effect of repetitive cold-water diving on cardiac function. Single cold dives cause some known cardiological risks, such as malign arrhythmia, due to a concurrent activation of the sympathetic and parasympathetic autonomic nervous system. A previous study from warmer water dives has shown that successive dives cause a decrease in vagal tone and a less responsive cardiovascular system. The aim of this study was to evaluate changes in cardiac function with 2D echocardiography during 4 days of diving in near-freezing water., Results: Left ventricle systolic function measures did not show any uniform changes. E/A ratio seemed to decrease successively with the number of dives. The diastolic tissue velocity of relaxing basal septum (e') showed a decreasing trend as well. Diastolic blood pressure seemed to increase from predive (mean: 83 RR mmHg) to postdive values (mean: 87 RR mmHg) (p=NS). Heart rate decreased significantly from predive (mean: 71 bpm, range: 56-103) to postdive values (mean: 60 bpm, range: 37-88) (p < 0.03)., Discussion and Conclusions: The study was conducted in very cold condition and with limited number of divers. Results of this preliminary study suggested a decreasing trend in left ventricular diastolic function in successive cold dives. Cumulative changes in cardiac function may cause health risks that need to be considered during cold water diving operations., (© 2023 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

To elucidate underlying disease mechanisms, we compared transition of gadolinium-based contrast agent bolus in cardiac chambers in magnetic resonance imaging between young patents with cryptogenic ischemic stroke and stroke-free controls. We included 30 patients aged 18-50 years with cryptogenic ischemic stroke from the prospective Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers and Outcome (NCT01934725) study and 30 age- and gender-matched stroke-free controls. Dynamic contrast-enhanced T1-weighted first-pass perfusion images were acquired at 1.5 T and analyzed for transit time variables, area under curves, relative blood flow, and maximum and minimum enhancement rates in left atrial appendage, left atrium, and left ventricle. These data were compared with previously published left ventricular non-compaction data of the same study population. Arrival time of contrast agent bolus in superior vena cava was similar in patients and controls (6.7[2.0] vs. 7.1[2.5] cardiac cycles, P = 0.626). Arrival and peak times showed comparable characteristics in patients and controls (P > 0.535). The minimum enhancement rate of the left ventricle was lower in patients than in controls (- 28 ± 11 vs. - 36 ± 13 1/(cardiac cycle), P = 0.012). Area under curves, relative blood flow, and other enhancement rates showed no significant differences between patients and controls (P > 0.107). Relative blood flow of cardiac chambers correlated with non-compacted left ventricular volume ratio (P < 0.011). Our results indicate slower washout of contrast agent and blood flow stagnation in the left ventricle of young patients with cryptogenic ischemic stroke. The washout was associated with left ventricular non-compaction, suggesting conditions favoring formation of intraventricular thrombosis., (© 2022. The Author(s).)

Purpose: There is growing evidence that paradoxical embolism through patent foramen ovale (PFO) is a cause for cryptogenic stroke. However, it is still unclear why the foramen ovale fails to close after birth. We studied whether the 3D relations between the atrial septum (AS) and the inferior vena cava (IVC) are associated with PFO., Methods: We recruited 30 patients (18-49 years) with a first-ever cryptogenic stroke and 30 age- and sex-matched stroke-free controls. Using cardiac magnetic resonance, an approach to evaluate the 3D relations between the AS and the IVC was developed. The presence of interatrial right-to-left shunt was evaluated with transesophageal echocardiography (TEE) in patients and transcranial Doppler in controls., Results: Of 30 patients, 29 underwent successful TEE, of which 12 (41%) had a shunt. Patients with a shunt had a greater mean 3D angle (γ) between the atrial septal plane and the vector from the orifice of the IVC to the middle of the AS compared with patients without a shunt (45 ± 9° vs. 36 ± 8°, p = 0.017). Of 30 controls, 12 (40%) had a shunt and a greater mean γ compared with controls without a shunt (47 ± 8° vs. 37 ± 10°, p = 0.007). In a pooled analysis, 24 (41%) of 59 subjects with a shunt had a mean γ of 46 ± 9° compared with subjects without a shunt of 37 ± 9° (p < 0.001)., Conclusions: More perpendicular orientation of the atrial septal plane to the orifice of the IVC is associated with PFO, possibly by directing the IVC flow to PFO., (© 2022 S. Karger AG, Basel.)

Background: Accurate measurement of left atrial (LA) volumes is needed in cardiac diagnostics and the follow up of heart and valvular diseases. Geometrical assumptions with 2D methods for LA volume estimation contribute to volume misestimation. In this study, we test agreement of 3D and 2D methods of LA volume detection and explore contribution of 3D LA axis orientation and LA shape in introducing error in 2D methods by cardiovascular magnetic resonance imaging., Methods: 30 patients with prior first-ever ischemic stroke and no known heart disease, and 30 healthy controls were enrolled (age 18-49) in a substudy of a prospective case-control study. All study subjects underwent cardiac magnetic resonance imaging and were pooled for this methodological study. LA volumes were calculated by biplane area-length method from both conventional long axis (LAV AL-LV ) and LA long axis-oriented images (LAV AL-LA ) and were compared to 3D segmented LA volume (LAV SAX ) to assess accuracy of volume detection. 3D orientation of LA long axis to left ventricular (LV) long axis and to four-chamber plane were determined, and LA 3D sphericity indices were calculated to assess sources of error in LA volume calculation. Shapiro-Wilk test, Bland-Altman analysis, intraclass and Pearson correlation, and Spearman's rho were used for statistical analysis., Results: Biases were - 9.9 mL (- 12.5 to - 7.2) for LAV AL-LV and 13.4 (10.0-16.9) for LAV AL-LA [mean difference to LAV SAX (95% confidence interval)]. End-diastolic LA long axis 3D deviation angle to LV long axis was 28.3 ± 6.2° [mean ± SD] and LA long axis 3D rotation angle to four-chamber plane 20.5 ± 18.0°. 3D orientation of LA axis or 3D sphericity were not correlated to error in LA volume calculation., Conclusions: Calculated LA volume accuracy did not improve by using LA long axis-oriented images for volume calculation in comparison to conventional method. We present novel data on LA axis orientation and a novel metric of LA sphericity and conclude that these measures cannot be utilized to assess error in LA volume calculation., Trial Registration: Main study Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) has been registered previously., (© 2021. The Author(s).)

Background: Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients., Methods: Thirty patients (aged 18-49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume - minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant., Results: We found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%-121.7%) vs 229.1% (151.8%-337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027)., Conclusions: This study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke., Trial Registration Number: NCT01934725., Competing Interests: Competing interests: JPi reports personal fees from General Electric Healthcare, outside the submitted work. JPu reports personal fees from Boehringer Ingelheim, Bayer, Portola and Terve Media, research grants and personal fees from BMS-Pfizer and Abbott/St Jude Medical, research grants from Business Finland and Amgen, research collaboration with Nokia Technologies, Bittium and BcB Medical, research collaboration and stock ownership with Vital Signum, outside the submitted work; and he has participated in the European Stroke Organisation’s guideline working groups on (1) Post-stroke hyperglycaemia and (2) Secondary prevention in patients with atrial fibrillation, and in the Finnish Duodecim Society’s guideline working group on ischaemic stroke and transient ischaemic attack. Other authors have nothing to disclose., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Ischemic stroke in young patients often remains cryptogenic, that is, no underlying reason can be found. Some of these strokes may originate in the heart. Left ventricular (LV) dynamic volumetry and strain analysis are relatively new and promising methods for evaluating LV function., Methods: In this pilot study, we recruited 30 young (18-50 years) patients with cryptogenic ischemic stroke and 30 age- and sex-matched controls from the SECRETO study (NCT01934725). The LV systolic function was assessed by LV volumetry (ejection fraction, peak emptying rate, and time to peak emptying rate). The longitudinal systolic function was assessed by speckle tracking strain and strain rate imaging, and by tissue velocity imaging derived MAD (mitral annular displacement) and septal S'., Results: Stroke patients had less vigorous global longitudinal strain (median -18.9, interquartile range 3.3), compared to healthy controls (median -20.0, interquartile range 2.8), P = .010. There was no statistically significant differences in septal S', MAD, global longitudinal strain rate, or dynamic volumetry-derived parameters between the two groups., Conclusions: Young cryptogenic stroke patients have subtly altered systolic function compared to healthy controls, found merely with longitudinal strain analysis. This infers that the heart may play a role in the pathogenesis of cryptogenic ischemic stroke., (© 2021 The Authors. Echocardiography published by Wiley Periodicals LLC.)

Background: Ischaemic stroke in young individuals often remains cryptogenic. In this pilot study, we investigated, whether advanced echocardiography methods could find differences in the diastolic function between young cryptogenic stroke patients and stroke-free controls., Methods: We recruited 30 cryptogenic ischaemic stroke patients aged 18-49 and 30 age- and sex-matched stroke-free controls among participants of the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study (NCT01934725). We measured diastolic function parameters derived from speckle tracking strain rate, Doppler techniques and 4D volumetry. We also performed statistical analyses comparing only the highest and lowest tertile of cases and controls for each parameter., Results: None of our patients or controls had diastolic dysfunction according to ASE/EACVI criteria. However, compared to stroke-free controls, the stroke patient group had lower E/A ratio of mitral inflow, lower lateral and mean e', lower A/a' ratio, lower strain rate in early diastole and lower speckle tracking-derived e/a ratio. When comparing the lowest tertiles, patients also had a lower peak filling rate by 4D volumetry, a lower peak early filling fraction (fraction of left ventricular filling during early diastole), and lower velocities in a series of the tissue Doppler-derived diastolic parameters and blood flow/tissue velocity ratios., Conclusion: Our study displayed subtle differences in diastolic function between patients and stroke-free controls, which may play a role in early-onset cryptogenic stroke. The differences were clearer when the lowest tertiles were compared, suggesting that there is a subgroup of young cryptogenic stroke patients with subclinical heart disease., (© 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian.)

Background: Up to 50% of ischemic strokes in the young after thorough diagnostic work-up remain cryptogenic or associated with low-risk sources of cardioembolism such as patent foramen ovale (PFO). We studied with cardiac magnetic resonance (CMR) imaging, whether left ventricular (LV) non-compaction-a possible source for embolic stroke due to sluggish blood flow in deep intertrabecular recesses-is associated with cryptogenic strokes in the young., Methods: Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is an international prospective multicenter case-control study of young adults (aged 18-49 years) presenting with an imaging-positive first-ever ischemic stroke of undetermined etiology. In this pilot substudy, 30 cases and 30 age- and sex-matched stroke-free controls were examined with CMR. Transcranial Doppler (TCD) bubble test was performed to evaluate the presence and magnitude of right-to-left shunt (RLS)., Results: There were no significant differences in LV volumes, masses or systolic function between cases and controls; none of the participants had non-compaction cardiomyopathy. Semi-automated assessment of LV non-compaction was highly reproducible. Non-compacted LV mass (median 14.0 [interquartile range 12.6-16.0] g/m2 vs. 12.7 [10.4-16.6] g/m2, p = 0.045), the ratio of non-compacted to compacted LV mass (mean 25.6 ± 4.2% vs. 22.8 ± 6.0%, p = 0.015) and the percentage of non-compacted LV volume (mean 17.6 ± 2.9% vs. 15.7 ± 3.8%, p = 0.004) were higher in cases compared to controls. In a multivariate conditional logistic regression model including non-compacted LV volume, RLS and body mass index, the percentage of non-compacted LV volume (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.10-2.18, p = 0.011) and the presence of RLS (OR 11.94, 95% CI 1.14-124.94, p = 0.038) were independently associated with cryptogenic ischemic stroke., Conclusions: LV non-compaction is associated with a heightened risk of cryptogenic ischemic stroke in young adults, independent of concomitant RLS and in the absence of cardiomyopathy., Clinical Trial Registration: SECRETO; NCT01934725. Registered 4th September 2013. https://clinicaltrials.gov/ct2/show/NCT01934725., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: J.Pi. reports personal fees from General Electric Healthcare, outside the submitted work. J.Pu. reports personal fees from Boehringer-Ingelheim, Bayer, Portola and Terve Media, research grants and personal fees from BMS-Pfizer and Abbott/St. Jude Medical, research grants from Business Finland and Amgen, research collaboration with Nokia Technologies, Bittium and BcB Medical, research collaboration and stock ownership with Vital Signum, outside the submitted work; and he has participated in the European Stroke Organisation's guideline working groups on (1) Post-stroke hyperglycemia and (2) Secondary prevention in patients with AF, and in the Finnish Duodecim Society's guideline working group on Ischemic stroke and TIA. Other authors have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background Ischemic stroke in young individuals often remains cryptogenic. Some of these strokes likely originate from the heart, and atrial fibrosis might be one of the etiological mechanisms. In this pilot study, we investigated whether advanced echocardiography findings of the left atrium (LA) of young cryptogenic stroke patients differ from those of stroke-free controls. Methods and Results We recruited 30 cryptogenic ischemic stroke patients aged 18 to 49 years and 30 age- and sex-matched stroke-free controls among participants of the SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study (NCT01934725). We measured basic left ventricular parameters and detailed measures of the LA, including 4-dimensional volumetry, speckle tracking epsilon, strain rate, and LA appendix orifice variation. Data were compared as continuous parameters and by tertiles. Compared with controls, stroke patients had smaller LA reservoir volumes (10.2 [interquartile range, 5.4] versus 13.2 [5.4] mL; P =0.030) and smaller positive epsilon values (17.8 [8.5] versus 20.8 [10.1]; P =0.023). In the tertile analysis, stroke patients had significantly lower left atrial appendage orifice variation (3.88 [0.75] versus 4.35 [0.90] mm; P =0.043), lower LA cyclic volume change (9.2 [2.8] versus 12.8 [3.5] mL; P =0.023), and lower LA contraction peak strain rate (-1.8 [0.6] versus -2.3 [0.6]; P =0.021). We found no statistically significant differences in left ventricular measures. Conclusions This preliminary comparison suggests altered LA dynamics in young patients with cryptogenic ischemic stroke, and thus that LA wall pathology might contribute to these strokes. Our results await confirmation in a larger sample.

Objective: We aimed to validate the accuracy of imaging of left atrial and ventricular volumes using cardiac cadaveric silicone casts., Methods: Left atrial (n = 14) and ventricular (n = 15) casts were imaged using 64-slice computed tomography (CT). Water displacement (WD) of cardiac casts was used as the gold standard for volume measurements., Results: Compared with WD, CT resulted in slightly higher left atrial and ventricular volumes (54 ± 25 vs 56 ± 26 mL [P = 0.003] and 57 ± 47 vs 66 ± 47 mL [P = 0.0001]). Variability between left atrial and ventricular volumes by CT and WD was low (coefficients of variation [CVs], 4% [intraclass correlation coefficient {ICC}, 0.99] and 12% [ICC, 0.97]). Intraobserver variability of CT was low for both the left atrium and the left ventricle (CVs, 1% [ICC, 1.00] and 4% [ICC, 1.00])., Conclusions: Cardiac CT is both accurate and reproducible in assessment of left ventricular and atrial chamber volumes.

Background: Previous data suggest that mitral valve leaflets are elongated in hypertrophic cardiomyopathy (HCM), and mitral valve leaflet elongation may constitute a primary phenotypic expression of HCM. Our objective was to measure the length of mitral valve leaflets by cardiovascular magnetic resonance (CMR) in subjects with HCM caused by a Finnish founder mutation in the myosin-binding protein C gene (MYBPC3-Q1061X), carriers of the same mutation without left ventricular hypertrophy, as well as in unselected consecutive patients with HCM, and respective controls., Methods: Anterior mitral valve leaflet (AML) and posterior mitral valve leaflet (PML) lengths were measured by CMR in 47 subjects with the Q1061X mutation in the gene encoding MYBPC3 and in 20 healthy relatives without the mutation. In addition, mitral valve leaflet lengths were measured by CMR in 80 consecutive non-genotyped patients with HCM in CMR and 71 age- and gender-matched healthy subjects., Results: Of the subjects with the MYBPC-Q1016X mutation, 32 had left ventricular hypertrophy (LVH, LV maximal wall thickness ≥ 13 mm in CMR) and 15 had no hypertrophy. PML was longer in patients with the MYBPC3-Q1061X mutation and LVH than in controls of the MYBPC group (12.8 ± 2.8 vs 10.6 ± 1.9 mm, P = 0.013), but the difference between the groups was not statistically significant when PML was indexed for BSA (P = 0.066), or when PML length was adjusted for BSA, age, gender, LV mass and ejection fraction (P = 0.195). There was no significant difference in the PML length in mutation carriers without LVH and controls (11.1 ± 3.4 vs 10.6 ± 1.9, P = 0.52). We found no difference in AML lengths between the MYBPC mutation carriers with or without hypertrophy and controls. In 80 consecutive non-genotyped patients with HCM, there was no difference either in AML or PML lengths in subjects with HCM compared to respective control subjects., Conclusions: In subjects with HCM caused by the Q1061X mutation in the MYBPC3 gene, the posterior mitral valve leaflets may be elongated, but mitral valve elongation does not constitute primary phenotypic expression of the disease. Instead, elongated mitral valve leaflets seem to be associated with body size and left ventricular remodeling.

The production of recombinant integral membrane proteins for structural and functional studies remains technically challenging due to their relatively low levels of expression. To address this problem, screening strategies have been developed to identify the optimal membrane sequence and expression host for protein production. A common approach is to genetically fuse the membrane protein to a fluorescent reporter, typically Green Fluorescent Protein (GFP) enabling expression levels, localization and detergent solubilisation to be assessed. Initially developed for screening the heterologous expression of bacterial membrane proteins in Escherichia coli, the method has been extended to eukaryotic hosts, including insect and mammalian cells. Overall, GFP-based expression screening has made a major impact on the number of membrane protein structures that have been determined in the last few years.

Background/aim: The left atrium (LA) is frequently imaged in cardiac computed tomographic (cCT) examinations. The LA volume can be accurately measured with three-dimensional (3D) volumetry but this method is time consuming and thus not routinely used in clinical practice. Accordingly, increased LA size may be overlooked although volume enlargement is associated with adverse cardiovascular events. We evaluated the accuracy of LA diameter measurement in cCT and in transthoracic echocardiography (TTE) in the diagnosis of LA enlargement using 3D cCT as the reference standard., Patients and Methods: Altogether, 146 patients with suspected cardiogenic stroke underwent cCT and TTE. LA volume by cCT was determined for all patients. LA diameter was measured in both modalities. Furthermore, 40 healthy controls were analyzed in order to assess the cut-off values for normal LA volume. Diagnostic performance of cCT and conventional TTE diametrical measurements for detecting enlarged LA volume were analyzed and compared using Cohen's kappa (κ)., Results: In controls, the mean LA volume was 59.8±15.3 ml and the mean LA diameter was 30.4±5.0 mm by cCT. The mean value plus twice the standard deviation, which was considered the upper limit, for normal LA volume and diameter were 90.4 ml and 40.4 mm, respectively. Age- and gender-matched patients with stroke had statistically significantly (p<0.001) larger LA volumes (85.5±21.1 vs. 59.8±15.3 ml) and diameters (37.6±5.7 vs. 30.4±5.0 mm) than controls. LA diameter measurement by cCT was more reliable in detecting an LA volume enlargement than the corresponding measurement with TTE (κ=0.489 vs. 0.234; p=0.002)., Conclusion: An enlarged LA diameter measured by cCT was more reliable than TTE at detecting enlarged LA volume., (Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Cardiac magnetic resonance imaging (CMR) is a promising method for detecting coronary artery disease (CAD). The first reports of new diagnostic techniques indicated generally unrealistic diagnostic performance relying on retrospectively observed cut-off values of quantitative parameters. Although visual analysis of CMR is the most applicable method for clinical work, its diagnostic performance is not fully elucidated for study components such as wall motion, perfusion and late enhancement in patients with different severity of CAD., Methods: A total of 30 subjects including 20 patients with CAD and 10 healthy volunteers were selected for the study. Of the patients, ten had stable CAD, five confirmed myocardial infarction (MI) without Q-waves in electrocardiogram (ECG) and five confirmed MI with Q-waves in ECG. All patients underwent coronary angiography and CMR for evaluating resting wall motion, rest and stress perfusion and late enhancement., Results: Combining the data from the three CMR techniques, 12 out of 20 patients were correctly identified as having CAD, and all controls were found to be healthy. Sensitivity, specificity, accuracy, positive and negative predictive values were 60.0%, 100.0%, 73.0%, 100.0% and 55.6%, respectively. Of the CMR components, resting wall motion and late enhancement gave the most diagnostic yield., Conclusions: We conclude that evaluation of CAD is feasible in patients with different severity of CAD using visually analysed CMR, especially when available CMR methodologies are combined together.

Cardiac magnetic resonance imaging (CMR) has rapidly gained acceptance as an accurate, reproducible and non-invasive imaging method for assessment of a wide range of cardiovascular diseases. However, CMR has not been used widely for diagnostic purposes in valvular heart disease (VHD). Unlike echocardiography it has no body habitus-related limitations and can thus be used to complement echocardiography. It is an especially good alternative for clinical follow-up in patients with VHD, as it allows accurate measurement of valvular dysfunction and related ventricular burden. Additionally, CMR is an ideal method for evaluating complex congenital heart disease and determining the significance of its components. It can also be used to study the physiological course of valvular dysfunction and response to therapeutic interventions. In this review, we present a basic introduction to CMR methodology, including its advantages and potential problems, and the physiology and quantification in VHD. We also discuss clinical applications of CMR in VHD. Furthermore, we describe how a CMR study statement should be structured in order to increase clinical use of this valuable methodology in cardiology.

Purpose: Our goal was to assess the utility of different imaging directions in volumetric studies of the heart with MRI, in particular to identify the optimal imaging plane for studies of the right ventricle., Method: We examined 12 sets of human four-chamber cadaveric cardiac casts. Gradient echo MRI was performed in four imaging planes: (a) perpendicular to the right ventricular inflow tract; (b) perpendicular to the right ventricular outflow tract; (c) in the left ventricular short axis view; and (d) in the axial view. The volumes of the right ventricle and other cardiac cavities were determined with the method of discs. The true cast volumes were measured with the water displacement technique. The agreement between true and measured volumes and the repeatability of image analysis were determined using the Bland-Altman method., Results: There were no statistically significant differences between the measured and true right ventricular volumes irrespective of the imaging plane. The axial plane gave the smallest mean absolute difference from the true right ventricular volume (3.2 +/-2.2 ml) and also the best repeatability of volume analysis (0.2+/-1.6 ml). However, the other imaging planes performed nearly as well, and the differences across the planes were not statistically significant (p > 0.05). Also, in studies of the left ventricle and left and right atrium, the axial view appeared to give the best results, but differences across the imaging planes remained small., Conclusion: The present studies of human cardiac casts suggest that gradient echo MRI is well applicable to right ventricular volume measurements. Imaging the right ventricle in axial planes covering the entire heart gives good agreement with true right ventricular volumes and excellent analysis reproducibility. However, other imaging directions perform nearly as well, and thus selection of the imaging plane may not be of major importance to the accuracy of cardiac volume measurements with MR.

Eating disorders are often associated with regurgitation of gastric contents into the mouth and dental erosion. In this study the dental status was evaluated in bulimic patients. Thirty-five bulimics, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level were examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly commoner among bulimics than controls. Bulimics commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was commoner among bulimics than controls, and bulimics had an increased tooth sensitivity to cold and touch. More should be done to protect teeth from dental erosion among bulimics, because loss of tooth tissue remains even if the eating disorder disappears.

Background: The purpose of this study was to determine the volumes and cyclic volume changes of the cardiac atria after heart transplantation in physically healthy recipients., Methods: Ten heart transplant recipients (New York Heart Association grade I) entered the protocol. All operations had been made with classic biatrial anastomoses. Eight healthy volunteers were studied as controls. To measure the volumes of both atria and left ventricular cavity, we used a gradient-echo cine sequence. The 10 mm slices covered both atria over the total cardiac cycle. Images were planimetered, and simultaneous volumes were totalled to give the cavity volume at each time phase., Results: The heart rate of the heart transplant recipients was faster than in controls, which resulted in higher cardiac output. The atrial minimum volumes were significantly larger, and fractional emptying was smaller in transplanted hearts when compared with controls. Reservoir and stroke volumes were smaller and conduit volumes were larger in transplanted hearts than in controls. The atrial filling and emptying rates were lower in heart transplant recipients than in controls., Conclusions: The classic surgical technique used in heart transplantation results in large atria with decreased volume changes and filling rates even in physically healthy transplant recipients. Magnetic resonance imaging is a reliable tool in assessment of atrial volumes and cyclic function after heart transplantation.

This work aimed at developing a rapid and clinically applicable method for the assessment of left atrial size and function using magnetic resonance imaging (MRI). We studied 17 healthy subjects and 26 cardiac patients. Left atrial cine MRI with 50 ms phases was made in 6-12 contiguous long-axis sections encompassing the entire atrial cavity. A volume-time curve was reconstructed to measure the minimum and maximum volumes as well as the fractional volume change, reservoir function, ejection fraction, and mean filling and emptying rates of the left atrium. The image section with the largest left atrial area was then selected and a comparable area-time curve was reconstructed. The atrial phasic areas and functional indices were determined analogously to the volume-based assessment. The contours of atrial area-time and volume-time curves agreed closely in individual subjects. All area-based left atrial measurements distinguished cardiac patients as a group from healthy persons. The combined specificity of the area-based analyses was 92% and the sensitivity, 65%, in identifying abnormal results in individual patients. The accuracy of the area-based data was best for the atrial minimum size, fractional change, reservoir function, and mean filling rate. The estimated time savings with the simplified method were 5 to 6 h per patient. Left atrial size and function can be studied by reconstructing a phasic atrial area-time curve with cine MRI. Atrial enlargement and abnormalities of filling and reservoir function can be reliably identified, but if data on conduit or stroke function are crucial the three-dimensional MRI technique is still recommended.

The spatial distribution of instantaneous diastolic flow velocities across the mitral annulus was studied with cardiac gated cine magnetic resonance imaging in 10 healthy persons aged 26-46 yr. Velocity encoding used two interleaved gradient echo pulse sequences with velocity sensitivity in the direction of flow perpendicular to the annular imaging plane. Velocity maps were reconstructed at 30- to 43-ms intervals throughout diastole. Velocity-time curves and mean flow rates were determined in five regions of the mitral annulus using a 0.6-cm2 measurement area. The spatial velocity minimum was consistently in the anterolateral commissural area, whereas the maximum was in the anterior annulus in early diastole shifting posteromedially in late diastole. The mean flow rate (+/- SD) averaged 18.4 +/- 8.1 ml.s-1.cm-2 of annular area centrally, 18.3 +/- 7.2 ml.s-1.cm-2 anteriorly, 16.9 +/- 7.4 ml.s-1.cm-2 posteriorly, 13.0 +/- 7.7 ml.s-1.cm-2 in the anterolateral commissural area, and 23.0 +/- 7.3 ml.s-1.cm-2 in the posteromedial commissural area (P < 0.001). We conclude that mitral transannular flow shows marked spatial inhomogeneity in normal humans. The skewness of flow profiles compromises the use of local velocity measurements as indexes of left ventricular filling.

In the sugar industry the quality of a syrup is judged by taste. The aim of this study was to investigate whether tasting affected the taster's teeth. Seven technicians who had tasted syrups for at least 2 years and 21 age-matched controls working in the same factory were investigated. Dental, medical, and dietary histories were obtained, and salivary and intra-oral examinations were undertaken. The tasters had similar DMFS indices to but more decayed surfaces than the controls (3.4 versus 1.0; p < 0.05), especially on proximal surfaces (2.0 versus 0.7; p < 0.05). The tasters had also higher visible plaque index and gingival bleeding index than the controls (23% versus 11% and 23% versus 10%; p < 0.05). We conclude that frequent exposure to syrup may increase caries activity, despite the various preventive measures commonly adopted. It is concluded that those selected for tasting should be carefully examined for general health and oral status and that preventive dental measures be emphasized.

The effects of new experimental sports drinks on dental enamel were studied in vitro using bovine tooth specimens. Profilometric analysis was used to measure the loss of tooth material after immersion of the specimens in the drinks. Thereafter the specimens' surface hardness was measured and scanning electron microphotographs were taken. In addition, 13 commercial sports drinks and experimental drinks containing either citric acid or malic acid were tested for their capacity to dissolve hydroxyapatite in vitro. The erosive effect increased markedly with decreasing pH. The citric acid containing drinks were more erosive than malic acid containing drinks. No erosion was observed with the malic acid containing drink (pH 5.90) but the drink of similar composition containing citric acid caused an erosion 1.3 +/- 1.1 microns deep and a commercial citric acid containing drink caused a lesion 12.3 +/- 4.5 microns deep after 120 min immersion. Softening of enamel was greater in specimens immersed in citric acid than in those immersed in malic acid containing drink. The in vitro hydroxyapatite dissolving effect of the commercial sports drink samples studied (all having a pH under 4.22) was markedly greater (0.48-4.38 mmol/l) than that of the malic acid containing experimental drink (pH 5.50, Ca++ concentration in the supernatant 0.19 mmol/l) and of the similar citric acid containing drink (0.35 mmol/l). The hydroxyapatite dissolving effect of both drinks started to be marked at a pH level of about 5.0 but increased thereafter exponentially with decreasing pH. At pH levels above 4.0 the hydroxyapatite dissolving effect of citric acid containing drinks was greater than that of malic acid containing drinks.

The purpose of the present study was to establish whether the number of intact teeth in Helsinki schoolchildren aged 7-13 years was rationally correlated with the wartime reduction in sugar consumption and, later, with dental health education programs in Finland. The period covered is 44 years. The results show that dental health education is effective in caries prevention and that enforced programs can lead to an improvement similar to that seen during the war.

Ten voluntary dental students were examined by 12 teachers at the same dental clinic. Eleven items of data were subjected to a two-way analysis of variance: missing teeth, filled teeth, filled teeth surfaces, DMF and DMFS index scores, decayed surfaces (first (C 1) and second (C 2) degree caries), decayed surfaces (C 2 only), decayed approximal surfaces (C 2), decayed occlusal surfaces (C 2), decayed smooth surfaces (C 2), and teeth considered to require treatment. Significant differences were found between the subjects for all 11 items assessed. The differences between the examiners were not significant for missing teeth, filled teeth, filled surfaces, and decayed smooth surfaces, but for the other items the between-examiner variation was significant at the level P less than 0.01. In particular, great variation was found in the plans for reparative care. It is suggested that teachers should undergo a special training program in order to make more consistent clinical judgments and hence to reduce the between-dentist variation in postgraduate clinical practice. This would probably be beneficial to the patients.

The lead content of deciduous molar enamel was measured with an accurate physical technique based on proton-induced X-ray emission. The absolute values were calibrated according to the animal bone standard of the International Atomic Energy Agency. The results obtained from five different communities indicated little difference between communities in the lead content of the deciduous molar enamel of children born in 1960-1975. The overall mean for all samples analyzed was 3.2 (SD 1.6) micrograms/g (N = 120); the highest individual value measured was 10.0 micrograms/g. Judging from the lead content of the teeth, the general population in Finland does not yet seem to be exposed to detectably higher amounts of artificially occurring environmental lead, neither in urban nor in rural areas. It would seem that naturally occurring environmental lead still plays a decisive role in the integrated long-term exposure in Finland.