Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism

BACKGROUND: Right-to-left shunt through a patent foramen ovale is frequently diagnosed by contrast echocardiography and can be particularly prominent in the presence of elevated pressures in the right side of the heart. Its prognostic significance in patients with pulmonary thromboembolism, however, is unknown. METHODS AND RESULTS: The present prospective study included 139 consecutive patients with major pulmonary embolism diagnosed on the basis of clinical, echocardiographic, and cardiac catheterization criteria. All patients underwent contrast echocardiography at presentation. The end points of the study were overall mortality and complicated clinical course during the hospital stay defined as death, cerebral or peripheral arterial thromboembolism, major bleeding, or need for endotracheal intubation or cardiopulmonary resuscitation. Patent foramen ovale was diagnosed in 48 patients (35%). These patients had a death rate of 33% as opposed to 14% in patients with a negative echo-contrast examination (P=.015). Logistic regression analysis demonstrated that the only independent predictors of mortality in the study population were a patent foramen ovale (odds ratio [OR], 11.4; P<.001) and arterial hypotension at presentation (OR, 26.3; P<.001). Patients with a patent foramen ovale also had a significantly higher incidence of ischemic stroke (13% versus 2.2%; P=.02) and peripheral arterial embolism (15 versus 0%; P<.001). Overall, the risk of a complicated in-hospital course was 5.2 times higher in this patient group (P<.001). CONCLUSIONS: In patients with major pulmonary embolism, echocardiographic detection of a patent foramen ovale signifies a particularly high risk of death and arterial thromboembolic complications.     

Lipoprotein(a): a link between thrombosis and atherosclerosis?

Lipoprotein(a) (Lp(a)) represents a class of plasma lipoproteins similar to low-density lipoprotein (LDL), but containing an unique apolipoprotein(a) with striking homology to plasminogen. Plasma Lp(a) is inherited as a quantitative genetic trait, with a continuous distribution in Caucasian populations (< 10-2000 mg/l), where high levels are associated with an increased risk of atherosclerotic disease. The physiological role of Lp(a) is unknown, and the metabolism is obscure. Plasma Lp(a) is apparently resistent to diets and drug therapy, and LDL-apheresis is currently the most effective way of reducing plasma Lp(a). However, clinical benefits of lowering plasma Lp(a) have not been demonstrated, and specific therapeutic goals cannot be recommended at present. The structural similarity between apo(a) and plasminogen has generated several experimental observations indicating a prothombogenic and proatherogenic role of Lp(a), but the exact pathophysiological mechanisms have not been determined.     

Blood flow rate: an important determinant of urea clearance and delivered Kt/V

PURPOSE: To compare the magnetic resonance (MR) imaging findings of primary hepatocellular carcinoma (HCC) in cirrhotic versus noncirrhotic livers. MATERIALS AND METHODS: MR images in 36 patients with HCC (30 men and she women aged 42-84 years [mean age, 65 years]) were retrospectively reviewed. The number and size of hepatic lesions were assessed. Lesion margins were categorized as well circumscribed or ill defined. The presence of a capsule, intratumoral high signal intensity on T1-weighted MR images, and a stellate scar were determined. RESULTS: Eleven (31%) patients had MR imaging evidence of cirrhosis, and 25 (69%) did not: Lesions in cirrhotic livers differed significantly from those in noncirrhotic livers in terms of size (22 cm2 vs 99 cm2, P < .05), frequency of a solitary lesion (27% vs 72%, P < .05), and frequency of a central scar (6% vs 50%, P < .05). There was no difference between the cirrhotic and noncirrhotic livers with regard to tumor margin, intratumoral high signal intensity on T1-weighted images, or tumor capsule. CONCLUSION: Differences exist in the MR imaging appearance of HCC between patients with and those without cirrhosis, although there is overlap of imaging findings.     

Clomethiazole (Zendra) in acute ischemic stroke: basic pharmacology and biochemistry and clinical efficacy

This review discusses the efficacy of clomethiazole (CMZ) in models of global and focal ischemia. The fact that neuroprotection is demonstrable by using histological, biochemical, and functional measures is emphasised. The importance of the neuroprotection observed when the drug is given after the ischemic insult and at doses that are safely tolerated by humans is discussed, with reference to requirements necessary for an experimental neuroprotective agent to be considered as a therapeutic drug for stroke. The biochemical pharmacology of CMZ is reviewed and also evaluated with reference to the possible mechanism(s) by which CMZ exerts its neuroprotective action. Finally, the clinical evidence that CMZ protects against the neurological consequences of a major stroke is outlined.     

Diversity is a compelling interest, and affirmative action is an important strategy for achieving it.

Responds to comments made by Pipes (see record 2007-01685-011) and Kuncel and Sackett (see record 2007-01685-012) on the current authors' original article (see record 2006-01690-003). The current authors respond to the various points raised in the commenting articles, and suggest that diversity is a compelling interest and affirmative action is one means of achieving it. They stand by their original challenge, with the caveat that they do recognize that some tests may predict certain educational outcomes with similar reliability across diverse populations. They suggest that an increase in diversity in psychology would promote a robust exchange of ideas and would be of value to all. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation between transient ischemic attack and ischemic stroke within the first six hours after onset of symptoms by using 99mTc-ECD-SPECT

The aim of this study was to define the accuracy of 99mTc-ethyl cysteinate dimer-single photon emission computed tomography (99mTc-ECD-SPECT) in distinguishing transient ischemic attack from completed ischemic stroke at early stages after the onset of symptoms. In a prospective study we examined 82 patients within 6 hours after the onset of symptoms (neurologic deficit caused by middle cerebral artery ischemia) using both 99mTc-ECD-SPECT and computed tomography (CT). The follow-up was based on Scandinavian Stroke Scale (SSS) 24 hours and 5-7 days, as well as on CT 7 days, after the event. SPECT evaluation was performed both visually and using semiquantitative region-of-interest (ROI) analysis. According to visual SPECT analysis, on admission 59 of 82 patients had activity deficits in the symptomatic hemisphere. After 7 days, all these patients had neurologic symptoms (SSS 28 +/- 12 points), caused by a cerebral infarction as evidenced with CT. Twenty-three of 82 patients displayed no early activity deficit despite clinical symptoms. None of these patients had neurologic symptoms after 7 days (indicating transient ischemic attack or prolonged reversible ischemic neurologic deficit). In the semiquantitative SPECT analysis, all patients had abnormal count densities in the respective ROI (activity < 90% compared with the contralateral side). All patients with transient ischemia (n = 23) had count rate densities more than 70% of the respective contralateral ROI, whereas all patients with subsequent infarction (n = 59) had values < 70%. Use of 99mTc-ECD-SPECT allows transient ischemia to be distinguished from ischemic infarction using relative regional activity thresholds within the first 6 hours after onset of symptoms.     

Cytomegalovirus infection, lipoprotein(a), and hypercoagulability: an atherogenic link?

A link between cytomegalovirus (CMV) infection and atherosclerosis has been suggested by experimental, clinical, and epidemiologic studies. We investigated the association between CMV antibody titers in serum collected in 1974 in 300 adult residents in Washington County, Md, and hemostatic parameters in plasma collected in 1987 through 1989, when these individuals participated in the baseline examination of the Atherosclerosis Risk in Communities Study. The cross-sectional association of CMV serum antibodies and hemostatic parameters was also explored in another set of Atherosclerosis Risk in Communities cases and controls. In the longitudinal analyses, CMV titers in 1974 were directly associated with 1987 through 1989 plasma levels of von Willebrand factor, factor VIII, and protein C and negatively associated with activated partial thromboplastin time. In the cross-sectional analyses, CMV titers were directly related to antithrombin III and fibrinogen levels. When the association between CMV antibodies and atherosclerosis was examined in stratified analyses, a significant association was restricted to individuals with high levels of lipoprotein(a) and fibrinogen. These results are compatible with previous evidence suggesting that CMV virus might have procoagulant properties. The possible synergism of CMV infection and resulting hypercoagulability with reduced fibrinolysis due to increased lipoprotein(a) levels deserves further investigation.     

The changes of lipids, lipoproteins and apolipoproteins in plasma in ischemic stroke

Contents of lipids (cholesterol CS, triglycerides) as well as levels of CS of lipoproteins of different density and of apolipoproteins A1 and B were measured in blood serum of 31 patients in different periods after of ischemic stroke. The majority of the indices studied were significantly decreased in men in acute periods of the stroke, especially in 8-21 days after the stroke development. Meanwhile, the levels of lipids, CS lipoproteins of both low and very low densities were increased later. Contents of CS of antiatherogenic lipoproteins of high density (HDLP) was low in different periods after the development of disorders of cerebral circulation. This confirms the concept that low level of HDLP is one of the risk factors of ischemic stroke. Decrease of the levels of both lipids and CS of lipoproteins of different density was more pronounced in patients with more severe atherosclerotic damages of the main cerebral arteries. Disorders of metabolism of lipoproteins in ischemic disorders of cerebral circulation are discussed with reference to literary data taking into consideration their heterogeneity. Genetically determined pathology of certain apolipoproteins plays a key role factor in the development of early atherosclerosis and in the elucidation of biochemical markers of the primary damages of cerebral vessels.     

Sequence context is an important determinant in the mutagenic potential of 1,N6-ethenodeoxyadenosine (epsilonA): formation of epsilonA basepairs and elongation in defined templates

Many laboratories have obtained data on mutagenicity of modified bases in naturally occurring DNA sequences. It has often been noted that mutation is favored in certain sequence contexts, sometimes termed 'hot spots'. This approach to the contribution of neighboring sequences does not permit a systematic study of both the qualitative and quantitative mutational frequencies. In the present experiments we have chosen to use the exocyclic adduct, 1,N6-etheno A (epsilonA), site-specifically placed in a defined 25-mer oligonucleotides in which epsilonA is flanked by differing 5' and 3' tandem bases. Mutation was assessed using an in vitro replication assay and five polymerases of varying fidelity. The relevant central sequences were 3' --> 5' -CC-epsilonA-CC-, -GG-epsilonA-GG-, -TT-epsilonA-TT-, -AA-epsilonA-AA-, -GG-epsilonA-TT-, -TT-epsilonA-AA-, -AT-epsilonA-TT- and -TA-epsilonA-TA-. Using the Klenow fragment (Kf) (exo+ or exo-) of E. coli Pol I, it was found the epsilonA is an ambiguous base and, with varying efficiencies, all four dNTPs could be inserted opposite epsilonA in all sequences. However, only 3' --> 5' -TT-epsilonA-TT-, -GG-epsilonA-TT- and -AT-epsilonA-TT- were fully extended to a significant extent. The only sequences essentially blocked at the position of epsilonA were -AA-epsilonA-AA- and -TT-epsilonA-AA-. The others were intermediate. When replication was performed with Sequenase, MMLV RT or HIV RT, different patterns were observed, in which replication terminated one base prior to epsilonA, at epsilonA, or one base after epsilonA without further extension. In favored sequences, using the Klenow fragment, an epsilonA x N pair could be extended to form normal basepairs. No extension could be demonstrated in sequences in which tandem adenines were 5' to epsilonA. Kinetic data showed that two of the epsilonA x N pairs, epsilonA x A and epsilonA x C, could form at 10 microM or less dNTP. Which bases were preferentially inserted opposite epsilonA was a function of the flanking bases. Under the kinetic conditions used, epsilonA x T did not form even at 1 mM dTTP. These results indicate that the chemical structure of an adduct is not the only determinant of mutagenic efficiency. It is likely that the effect of the adduct on replication is due to the changes in the structural environment conferred by the flanking bases.     

Acute phase proteins: alpha-1-acid glycoprotein (AGP) and alpha-1 antichymotrypsin (ACT) in serum of patients with cerebral ischemic stroke

BACKGROUND: Because of methods required for obtaining isolated left ventricular myocytes, evaluation of the contractile function of isolated left ventricular myocytes in normal human patients has been limited. Accordingly, the goal of the present study was to develop a means to isolate human left ventricular myocytes from small myocardial biopsy specimens collected from patients undergoing elective coronary artery bypass operations and to characterize indices of myocyte contractile performance. METHODS: Myocardial biopsy specimens were obtained from the anterior left ventricular free wall of 22 patients undergoing coronary artery bypass operations. Myocytes were isolated from these myocardial samples by means of a stepwise enzymatic digestion method and micro-trituration techniques. Isolated left ventricular myocyte contractile function was assessed by computer-assisted high-speed videomicroscopy under basal conditions and in response to beta-adrenergic receptor stimulation with isoproterenol. RESULTS: A total of 804 viable left ventricular myocytes were successfully examined from all of the myocardial biopsy specimens with an average of 37+/-4 myocytes per patient. All myocytes contracted homogeneously at a field stimulation of 1 Hz with an average percent shortening of 3.7%+/-0.1% and shortening velocity of 51.3+/-1.3 microm/s. After beta-adrenergic receptor stimulation with isoproterenol, percent shortening and shortening velocity increased 149% and 118% above baseline, respectively (P < .05). CONCLUSION: The unique results of the present study demonstrated that a high yield of myocytes could be obtained from human left ventricular biopsy specimens taken during cardiac operations. These myocytes exhibited stable contractile performance and maintained the capacity to respond to an inotropic stimulus. The methods described herein provide a basis by which future studies could investigate intrinsic and extrinsic influences on left ventricular myocyte contractility in human beings.     

Hyperlipemia. Post-operative fat embolism, with psychiatric signs, and persistent lipuria (author's transl)

The authors report an exceptional case of fat embolism with neuro-psychiatric signs, following a digestive by-pass operation for hypercholesterolemia. They emphasize the difficulty in diagnosis and attach value to the lipuria when it is massive. A short review of the literature recalls the various pathogenic theories of fat embolism.     

Renal perfusion pressure is an important determinant of sodium and calcium excretion in DOC-salt hypertension

This study tested the hypothesis that the increased renal perfusion pressure in DOC-salt hypertension is essential for the maintenance of sodium balance and is responsible for the hypercalciuria associated with this model. Twelve chronically instrumented dogs were placed on a high salt intake and mean arterial pressure (MAP) was measured 24 h/day. After a control period, a 17-day DOC infusion period was begun. In six dogs, however, renal perfusion pressure (RPP) to both kidneys was maintained at control levels for the first 12 days of the DOC infusion by the continuous, servo-controlled adjustment of a suprarenal silastic occluder on the abdominal aorta. The servo-controlled dogs had significantly more sodium retention and a greater increase in blood pressure than the six control DOC hypertensive dogs. Urinary calcium excretion in the control dogs began to increase from 24 +/- 6 mg/day on day 1 of DOC, and increased progressively to 100 +/- 14 and 175 +/- 30 mg/day by days 7 and 12, respectively. Plasma ionized calcium decreased, and parathyroid hormone (PTH) (1-84) increased, significantly by day 4. The hypercalciuria was not different in the servo-controlled dogs for the first 7 days of DOC, but was attenuated thereafter. Thus, increased RPP is important in restoring sodium balance and in maintaining the calciuresis in DOC-salt hypertension; however, other mechanisms also are important, particularly during the onset of hypertension.     

Prevalence of apolipoprotein E alleles in healthy subjects and survivors of ischemic stroke: an Italian Case-Control Study

OBJECTIVES: The purpose of this study was to investigate whether atrial and brain natriuretic peptides (ANP and BNP, respectively) represent autocrine/paracrine factors and are accumulated in pericardial fluid. BACKGROUND: ANP and BNP, systemic hormones produced by the heart, have elevated circulating levels in patients with heart failure. Recent evidence suggests that the heart itself is one of the target organs for these peptides. METHODS: With an immunoreactive radiometric assay, we measured the concentrations of these peptides in plasma and pericardial fluid simultaneously in 28 patients during coronary artery bypass graft surgery. RESULTS: The pericardial levels of BNP were markedly elevated in patients with impaired left ventricular function. We investigated the correlation of ANP and BNP levels in plasma or pericardial fluid with left ventricular hemodynamic variables. None of the hemodynamic variables correlated with ANP levels in plasma or pericardial fluid. Both plasma and pericardial fluid levels of BNP were significantly related to left ventricular end-diastolic and systolic volume indexes (LVEDVI and LVESVI, respectively). In addition, BNP pericardial fluid levels had closer relations with LVEDVI (r = 0.679, p < 0.0001) and LVESVI (r = 0.686, p < 0.0001) than did BNP plasma levels (LVEDVI: r = 0.567, p = 0.0017; LVESVI: r = 0.607, p = 0.0010). BNP levels in pericardial fluid but not in plasma correlated with left ventricular end-diastolic pressure (r = 0.495, p = 0.0074). CONCLUSIONS: BNP levels in pericardial fluid served as more sensitive and accurate indicators of left ventricular dysfunction than did BNP levels in plasma. Thus, BNP may be secreted from the heart into the pericardial space in response to left ventricular dysfunction, and it may have a pathophysiologic role in heart failure as an autocrine/paracrine factor.     

Identification of Microthoracius mazzai (Phthiraptera: Anoplura) as an economically important parasite of alpacas

The hematophagous sucking louse Microthoracius mazzai Werneck, 1932, is redescribed and identified as a parasite of alpacas, Lama pacos L. Specimens were collected on animals 10-14 mo old, located on a large community farm at 4,600 m above sea level in the Peruvian Andes. In total, 26 scanning electron microscope (SEM) figures are included that highlight salient and differential characteristics, especially the unique elongated spindle-shaped head, which is almost as long as its abdomen. Alpacas, 1 of the 4 species of South American camelids, are important for their production of high-quality wool in the Andes Mountain range countries, especially Peru and Bolivia; to a lesser degree Chile; and more recently Argentina, where breeding and disease control programs are receiving increased technical support. Information is given on the prevalence of lice infestations in the flock, clinical signs, and economic losses. We report the efficacy of moxidectin (SC, 200 mcg/kg, b.w.) in a repeated treatment program of 7-10 d, which is currently used for mange control in these ruminants.     

A mathematical evaluation of the multiple breath nitrogen washout (MBNW) technique and the multiple inert gas elimination technique (MIGET)

We consider two and 50 compartment lung models for use with two techniques used to investigate the efficiency of the lungs: the Multiple Breath Nitrogen Washout (MBNW) technique used for investigating the ventilation-volume distribution; and the Multiple Inert Gas Elimination Technique (MIGET) used for investigating the ventilation-perfusion distribution. In each of these techniques pulmonary respiratory gas exchange is described by conservation of mass equations which may be written in identical form, and in each the underlying distributions of ventilation to volume and ventilation to perfusion are assumed to be continuous functions (usually assumed to be a linear sum of log-normal distributions). The mathematical models used to describe the lung have predominantly used a collection of discrete compartments to approximate these continuous distributions. The most commonly used models have used one, two or 50 compartments. In this paper, we begin by showing that in the limit as the width of the peaks of the distribution tend to zero, the continuous distributions may be replaced by a single discrete compartment placed at each peak of the distribution. We investigate the various methods used previously for parameter recovery, and show that one commonly used method for the MBNW is not suitable and suggest a modification to this recovery technique. Using simulated error-free data, we show that both the two compartment model and the 50 compartment model contain information about the ventilation-volume (or ventilation-perfusion) distribution, and investigate the extent to which this information can be used to recover the parameters which define these distributions. We go on to use Monte-Carlo methods to investigate the stability of the recovery process.     

心理健康教育是增强高校思想政治工作有效性的重要途径

一2 1世纪是一个高科技飞速发展的社会 ,一个竞争激烈的社会。这些新的社会发展特点向大学生提出了更高的素质要求 ,也给高校思想政治工作提出了一系列新的课题。《中共中央、国务院关于深化教育改革 ,全面推进素质教育的决定》明确指出 :“各级各类学校必须更加重视德育工作—