Findings on artery plaque

                                            

Tuesday 10 August 2010

Medical Research
Findings on artery plaque

Haim Shmilovich and his fellow researchers from Heart Institute, Cedars-Sinai Medical Centre, Los Angeles, California found that, besides the degree of blockage, the composition of the plaque causing the blockage has significant impact on blood flow through coronary artery, writes K S Parthasarathy

If a person is diagnosed as suffering from heart disease, the current medical practice is to carry out an invasive procedure such as angioplasty or stent-placement or open heart surgery as appropriate. A study presented at the 57th Annual Meeting of the Society of Nuclear Medicine in June at Salt Lake City, USA is challenging this practice.

People with similarly blocked arteries can experience vastly different symptoms. Nobody knows why.

Dr Haim Shmilovich and his fellow researchers from Heart Institute, Cedars-Sinai Medical Centre, Los Angeles, California found that, besides the degree of blockage, the composition of the plaque causing the blockage has significant impact on blood flow through coronary artery. May be this is why two people with similarly blocked arteries can experience vastly different symptoms.

According to Dr Mason W Freeman, Associate Professor, Harvard Medical School coronary artery disease (CAD) begins when plaques build up in the arteries.

Plaque deposit hardens later

He vividly described the process. Initially, the plaque deposit may be soft and mushy; later it hardens, narrowing the artery. Blood flow to the heart decreases; at the beginning, this reduction is not severe enough to compromise heart muscle function or to produce any symptom.

Later on, the plaque may enlarge further reducing the blood flow. After a critical point, the heart muscle no longer gets adequate oxygen delivery when it is working vigorously. A prolonged or complete interruption will kill myocardial cells and cause a heart attack.
The plaques are not homogenous. They contain fat and other substances including calcium. Plaques vary in size. Even very young persons may have early stage plaques. When plaques cause blockade of the arteries, symptoms develop .When the blockade is 70% or more physicians carry out invasive procedures to reduce symptoms and potentially to prevent heart attacks. How can we determine the composition of the tiny deposits of fat in the blood vessel of a few millimetres diameter deep inside a living person? Researchers use coronary CT angiography (CCTA) for this and to find the degree of blockage it causes.

Use of an intravenous dye

The coronary CT angiography uses an intravenous dye which contains iodine and CT scanning to image the coronary arteries. Physicians measure the relative blood flow to different regions of the heart by myocardial perfusion imaging (MPI). During myocardial perfusion imaging, the physician administers a radio-pharmaceutical intravenously to depict the distribution of blood flow nourishing the myocardium- the middle of the three layers forming the wall of the heart.

Perfusion imaging identifies areas of reduced myocardial blood flow associated with ischemia or scar. Physicians can assess the relative regional distribution of perfusion at rest, cardiovascular stress, or both. They also perform imaging during chest pain of unknown etiology, such as in the coronary care unit or emergency department.

They found that clinicians can more accurately determine a patient’s risk of reduced blood flow to the heart muscle by identifying three plaque characteristics: the presence of a fatty core, signs of spotty calcifications and enlargement of the arterial wall from “positive remodelling”, which means that the body has responded to arterial damage by altering the structure of the artery. Researchers noted that either individually or combined, the presence of these characteristics can predict reduced blood flow to the heart muscle, which could lead to symptoms including heart attack.

They imaged 34 patients without known coronary artery disease using CCTA and MPI to determine the presence of adverse plaque characteristic and blood flow. All patients had severe (70 to 89 per cent) blockage in the beginning or middle section of a major coronary artery on CCTA.

A third-party expert evaluated adverse plaque characteristics on CCTA; an automated computer -based analysis carried out the myocardial perfusion imaging.

When imaged with MPI, over 38 per cent had significantly limited blood flow to the heart muscle.

In the arteries with plaques with a fatty core, significant ischemia (condition in which blood flow and hence oxygen supply is reduced) of the heart muscle occurred at a much higher and statistically significant frequency (80 per cent) than those without fatty core (21per cent).

When specialists found multiple adverse plaque characteristics in a plaque, that was associated with higher degrees of significant ischemia.

Findings could redefine treatment

The researchers claimed that if they can determine certain characteristics of the coronary artery plaque, they can predict whether a patient’s symptoms are due to limitation of blood flow to the heart.

They believe that with more studies, their findings may change treatment planning for patients with severe but stable coronary artery disease by helping them determine which patients could be treated just as effectively with medications and life style changes, thereby avoiding unnecessary invasive angioplasty and bypass surgery. The study is promising. A major problem with all medical imaging modalities is that the technology advances with unbelievably astonishing speed; the clinical use lags disappointingly behind.

(The writer is Raja Ramanna Fellow, Department of Atomic Energy.)

Laser pointers may damage vision

THE TRIBUNE


SCIENCE & TECHNOLOGY
Friday, August 6, 2010, Chandigarh, India


Laser pointers may damage vision
K.S. Parthasarathy



AS Dr.Timothy B L Ho, Firmley Park Hospital NHS Foundation Trust, Surrey, UK entered his house one evening, his seven year old son flashed a laser pointer on his face. The eye injury, he suffered, was not apparent immediately.
Four days later, he developed an area of partial alteration of his field of vision His son found the device, a gift from a drug company, on his father’s desk. Laser pointers which are common place now can damage vision if handled carelessly.
“My vision took several months to recover and initially I was very worried”, Dr Ho wrote in The British Medical Journal, (BMJ, 29 June 2010), when Drs Ziahosseini, Doris and Turner published in the BMJ, a laser injury case suffered by a teenager.
He bought a green diode laser pointer over the internet and shone the laser beam into his eyes while playing with it. He had no previous medical or ophthalmic problems. Tests confirmed disturbance of his retinal pigment epithelium; it took two months to improve his clearness of vision.
In yet another instance, while on the school bus, a friend attempted to determine whether a laser pointer would cause pupillary constriction (Arch Ophthalmol, Nov 1999). She made an 11 year old girl to stare at an activated laser pointer for several multi-second exposures with the right eye. The victim immediately noted decreased vision. It took many months to recover her vision; long term effects of the injury are unknown.
Retinal injuries from lasers may be caused by ablative, thermal or photochemical mechanisms. These depend on power, wavelength, exposure time and size of the pupil (BMJ, 27 May 2010). Normally, the adverse impact may be transient; they may disturb the retina and the interconnecting layers and may induce clinical conditions causing loss of sight later.
Laser pointers costing a few dollars are available in curio shops, electronic stores or office supply shops. You may buy them directly or through mail order or by placing orders with internet outlets. Children may use them as toys.
Most laser pointers used while presenting lectures operate in the visible light region of wavelengths between 600 to 670 nanometre (one-thousandth of a millionth of a metre, nm). They are low powered, battery operated, hand-held devices and are cheaper than those operating at green light of wavelength 532 nm.
The response of the eye depends on wavelength with a peak at about 550nm. It decreases as either end of the spectrum is reached. If laser pointers are compared at the wave lengths of 670 nm, 635 nm and 532 nm at the same power level, the brightness as eye perceives it will be nearly in the ratios of 1:10:30.When the laser beam is closer to the eye’s peak response, it can produce adequate visual stimulus at lower power levels.
If you want to buy a laser pointer choose only one that is labelled Class II and operates with a wavelength between 630 nm and 680 nm. Maximum output should be less than 5 milliwatts.
Before you use a laser pointer, read the caution or danger sticker carefully. Never point the laser at another person. Do not point a laser pointer at mirror-like surfaces. A reflected beam can act like a direct beam on the eye. Never look directly at the laser beam. Never view a laser beam using a binoculars or a microscope.
Lastly, you must not gift a laser pointer to a child. You may regret later. Laser pointers are not toys.
The writer is Raja Ramanna Fellow, Department of Atomic Energy

No genetic effects in children of A-bomb survivors

THE HINDU

S & T
Published: August 5, 2010 03:48 IST | Updated: August 5, 2010 03:58 IST August 5, 2010
No genetic effects in children of A-bomb survivors
K. S. PARTHASARATHY






AP SEVERAL STUDIES: In the 1950 Japanese national census nearly 2,80,000 persons claimed that they were exposed to radiation. Several studies have been carried out on the survivors. Photo: AP
On August 6, 1945, the U.S. dropped an atom bomb on Hiroshima. Nagasaki was bombed three days later.
In the 1950 Japanese national census nearly 280,000 persons claimed that they were exposed to radiation. Initially, the Atomic Bomb Casualty Commission and from 1975, Radiation Effects Research Foundation (RERF), carried out several studies on the survivors.
Research programmes
The research programmes covered Life Span Study (LSS), Adult Health Study, study of the Children of Atomic-bomb Survivors (F{-1}) and the evaluation of the lifetime health experience of a specially exposed population, namely those in utero at the time of the bombings.
Other areas covered included immunology, radiation biology, molecular epidemiology, cytogenetics, statistics and A-bomb dosimetry.
RERF researchers and other scientists studied the interaction with radiation and smoking.
Radiation increased the risk of lung cancer among the survivors. Among 105,404 subjects of the LSS, researchers identified 1803 primary lung cancer cases for the period 1958-1999.
They used individual smoking history information and the latest radiation dose estimates to investigate the combined effects of radiation and smoking on lung cancer rates.
Lung cancer risks
Relative to never-smokers, lung cancer risks increased with the amount and duration of smoking and decreased with time since quitting smoking at any level of radiation exposure (Radiation Research, 174, 2010).
The excess risk increased rapidly with smoking intensity up to about 10 cigarettes per day, but additive or sub-additive for heavy smokers smoking a pack or more per day, with little indication of any radiation-associated excess risk
The authors concluded that the joint effect of smoking and radiation on lung cancer in the LSS is dependent on smoking intensity and is best described by the generalized interaction model rather than a simple additive or multiplicative models
Fatty liver predicts ischemic heart disease or heart disease due to reduced blood supply to the heart.
Fatty liver predictors
The researchers at RERF observed the incidence and predictors of fatty liver by examining 1635 survivors of Nagasaki A-bomb every two years through 2007 (mean follow up for 11.6 y) by abdominal ultrasonography.
The subjects were without fatty liver at base line (November 1990 through 1992). The researchers diagnosed 323 new fatty liver cases.
The average incidence was 19.9 cases in 1000 person years peaking in the sixth decade of life (Hypertension Research April 2010).
After controlling for age, sex, and smoking and drinking habits, obesity, hypertriglyceridemia (large levels of tryglicerides) and hypertension were predictive of fatty liver.
All variables included
When all variables are included, obesity, hypertriglyceridemia and hypertension remained predictive.
Scientists have not observed genetic effects in the children of A-bomb survivors.
To evaluate the genetic effects of A-bomb radiation, RERF researchers examined mutations at specific loci in the chromosomes of exposed families (father-mother-offspring, mostly uni-parental exposures) and control families. The mutation rates observed were not statistically significant.
That radiation exposure causes thyroid cancer is an established fact.
But we do not know the radiation effects on papillary micro carcinoma (PMC) of the thyroid, a common sub-clinical thyroid malignancy.
RERF researchers identified PMCs in a subset of 7659 subjects after reviewing their pathology and evaluating the histological features of the tumors.
Papillary thyroid cancer
From 1958 to 1995, they detected 458 PMCs among 313 study subjects; most of them exhibited pathologic features of papillary thyroid cancers.
A significant radiation-dose response was found for the prevalence of PMCs with the excess risk observed primarily among women.
Exposure to low-to-moderate doses of ionizing radiation appears to increase the risk of thyroid PMCs, even when exposure occurs during adulthood (Cancer, 2010).
Raja Ramanna Fellow with the Department of Atomic Energy
(ksparth@yahoo.co.uk)
Keywords: Hiroshima bombing, genetic effects
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