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.     

Current concepts: spinal injuries and rehabilitation

Spinal cord injuries and their catastrophic effects require a treatment infrastructure able to provide an integrated process of management, including rehabilitation from injury and on an ongoing basis. This is particularly important because the incidence of spinal cord injuries is small. Better outcomes and cost efficiency with such an infrastructure have been established, but further knowledge is required to solve the remaining controversies in some aspects of management.     

Pulmonary vein stenosis after catheter ablation of atrial fibrillation

BACKGROUND: This report describes the complication of pulmonary vein stenosis with resultant severe pulmonary hypertension that developed in 2 patients after successful catheter ablation of chronic atrial fibrillation. METHODS AND RESULTS: Three months after successful catheter ablation of atrial fibrillation, both patients developed progressive dyspnea and pulmonary hypertension. Both were found to have severe stenosis of all 4 pulmonary veins near the junction with the left atrium. Balloon dilation of the stenotic pulmonary veins was performed in these patients, with improvement in dyspnea and pulmonary hypertension. CONCLUSIONS: The complication of pulmonary vein stenosis is potentially life-threatening, and the application of radiofrequency current within the pulmonary veins with standard catheter technology should be avoided. This complication can be treated with balloon dilation, although the long-term course is unknown.     

Application of high-performance liquid chromatograph-electrospray ionization mass spectrometry and matrix-assisted laser-desorption ionization time-of-flight mass spectrometry in combination with selective enzymatic modifications in the characterization of glycosylation patterns in single-chain plasminogen activator

The application of high-performance liquid chromatography (HPLC), electrospray ionization mass spectrometry (ESI-MS) and matrix-assisted laser-desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and selective enzymatic deglycosylation treatments is demonstrated in the analysis of glycosylation patterns in recombinant Desmodus salivary plasminogen activator, a heterogeneous glycoprotein. The sample was initially digested with a proteolytic enzyme (endoproteinase Lys-C) and then further treated with either PNGase F to remove N-linked carbohydrates or a combination of neuraminidase and O-glycosidase to remove sialic acid and O-linked carbohydrates. By comparison of the LC-ESI-MS peptide maps for the fully glycosylated and deglycosylated samples, it was possible to unambiguously identify the sites of N-linked glycosylation as well a number of N-linked glycopeptides. The O-link glycopeptides, which are present at low level ( < 1%), were not detected prior to the deglycosylation, nor could changes in peptide elution in the map following deglycosylation be correlated with potential O-linked glycosylation sites.     

Nonlinear optical susceptibility of HgGa2S4

The second harmonic coefficient d36of HgGa2S4has been measured to be 5 times larger than d36(LiNbO3). The birefringence is usefully large.     

The cardiovascular effects of diazepam and of diazepam and pancuronium during fentanyl and oxygen anaesthesia

A study of the physiological behaviour of the synthetic compound Orthonil (alpha-chloro-beta-(3-chloro-o-tolyl)-propionitrile revealed a strong auxin activity in higher plants. Otherwise, Orthonil appeared not to be a herbicide-auxin. It is metabolized intensively in plant tissues. Among the identified metabolites, two compounds were detected which also exert a high auxin activity. It is concluded that at least a part of the apparent auxin activity of Orthonil may be due to alpha-(3-chloro-o-tolyl) acetic acid, one metabolite of Orthonil. Although Orthonil strongly stimulates elongation growth, this growth is not accompanied by a stimulated ethylene evolution as is the case with other auxins. A possible metabolic pathway of Orthonil is discussed.     

The citric acid fermentation by Aspergillus niger: regulation by zinc of growth and acidogenesis

The citric acid fermentation by Aspergillus niger is divided into two consecutive phases, a growth phase when the cells proliferate but do not accumulate citrate, followed by an accumulating phase when they produce citrate but do not proliferate, or else do so at a much reduced rate. When studied in a low sucrose (0.4-0.8%) mpinimal salts medium the growth-accumulation alternative was controlled by the concentration of zinc: high zinc (about 1-2 muM) maintained growth phase, while at low zinc (below 1 muM) growth became limited by zinc deficiency and the cultures passed into accumulating phase. Addition of zinc to accumulating cultures resulted in their reversion to growth phase. Iron, manganese, calcium at concentrations as high as 5-10 muM had no influence on either growth or citrate accumulation. These results suggest that zinc plays a role in the regulation of growth and citric acid accumulation.     

Discovery of insect anti-juvenile hormones in plants.?2U

Two simple chromenes with anti-JH activity have been isolated and identified from the bedding plant Ageratum houstoianum. By contact and fumigation these compounds induce precocious metamorphosis and sterilization in several hemipteran species of insects. Certain holometabolous species are sterilized, forced into diapause, or both. Each of these biological actions is equivalent to removal of the corpora allata, which produce the JH's, and is reversible by treatment with exogenous JH. Thus, the action of these compounds is to stop the production or depress the titer of the JH's. To our knowledge, this is the first discovery of anti-JH, and we hope it will guide the way to the emergence of a fourth generation of safe and insect-specific pesticides.