Correlation between clinical course and quantitative analysis of the ischemia related artery in patients with unstable angina pectoris, refractory to medical treatment. Results of two randomized trials. The European Cooperative Study Group

Patients with unstable angina, refractory to intensive medical therapy, are at high risk for developing thrombotic complications, such as recurrent ischemia, myocardial infarction and coronary occlusion during coronary angioplasty. As both platelet aggregation and/or thrombus formation play an important role in this ongoing ischemic process, a monoclonal platelet GPIIb/IIIa receptor antibody (c7E3) or thrombolytic therapy (alteplase) might be able to modify the clinical course and underlying coronary lesion morphology. To evaluate whether alteplase or c7E3 could influence the incidence of complications, we randomized 36 and 60 patients, respectively to alteplase or placebo, or c7E3 or placebo. All patients exhibited dynamic ECG changes and recurrent pain attacks, despite maximal tolerated medical therapy. Patients were randomized in both studies after initial angiography had demonstrated a culprit lesion amenable for angioplasty. After study drug infusion quantitative angiography was repeated and angioplasty performed. Recurrent ischemia during study drug infusion occurred in 5, 6, 9 and 16 patients from the alteplase, placebo, c7E3 and placebo group, respectively. Major events defined as death, myocardial infarction or urgent intervention occurred in 7, 3, 1 and 7 patients, respectively. Two patients died: one in the alteplase group and one in the placebo group from the c7E3 study. The first patient due to retroperitoneal hemorrhage, the second as a result of recurrent infarction. Qualitative angiography showed resolution of clots in the c7E3 group only, while the same group of patients showed in 20% an improvement in TIMI flow grade, without deterioration in any patient from this group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Agreement between a frequency-weighted filter for continuous biomechanical measurements of repetitive wrist flexion against a load and published psychophysical data

A previous pilot study demonstrated that a force and frequency-weighted filter network could be developed for processing continuous biomechanical measures of repetitive wrist motions and exertions. The current study achieves the objective by modelling subjective discomfort for repetitive wrist flexion using controlled posture, pace and force. A three-level fractional factorial experiment was conducted involving repetitive wrist flexion (2 s/motion, 6 s/motion, 10 s/motion) from a neutral posture to a given angle (10 degrees, 28 degrees, 45 degrees) against a controlled resistance (5 N, 25 N, 50 N) using a Box Behnken design. Ten subjects participated. Discomfort was reported on a 10 cm visual analogue scale. Results of response surface regression analysis revealed that main effects of force, wrist flexion angle, and repetition were all significant (p < 0.05) and that no second-order effects were observed. Linear regression analysis on these factors established a discomfort model on which the filter characteristics were based. The pure error test model revealed no significant lack of fit (p > 0.05). The continuous model was compared and agreed with discrete psychophysical data from other published studies. The model was used for generating parameters for a force and frequency-weighted digital filter that weighs continuous wrist postural signals with corresponding force in proportion to the equal discomfort function as a function of frequency of repetition. These filters will enable integration of large quantities of biomechanical data in field studies.     

Usefulness and limitations of thyrotropin measurements as a first-line test for follow-up of Graves'' patients

Although the good appearance and biocompatibility of dental porcelains, failures are still of considerable concern because of the limited properties to all ceramic system. Physical properties that might be considered ideal include high strength, resistance to abrasion, and resistance to the hostile oral environment. Porcelain has been considered by many of its physical characteristic are similar to those of enamel. In 1983 a new modality of treatment, the etched porcelain restoration was introduced by Simonsen and Calamia. Numerous investigations have shown the strength of the etched porcelain bonded to composite resin and also the clinical success of this porcelain to be used as laminated veneers and etched inlays and onlays.     

Superior activity of a thromboxane receptor antagonist as compared with aspirin in rat models of arterial and venous thrombosis

We determined the effects of aspirin and a novel thromboxane A2/prostaglandin endoperoxide (TP)-receptor antagonist, BMS-180291, on thrombosis and bleeding times in skin and mesenteric arteries. In anesthetized rats, occlusive thrombosis was induced in the carotid artery by topical application of ferrous chloride and in the vena cava by blood flow stasis combined with either infusion of thromboplastin or hypotonic saline. Aspirin (1, 10, and 50 mg/kg) did not reduce arterial or venous thrombus weight significantly. BMS 180,291 (150 micrograms/kg/min) decreased arterial thrombus weight and hypotonic saline-induced caval thrombus weight by 58 and 57%, respectively. BMS-180291 lacked antithrombotic activity at a lower dose (50 micrograms/kg/min) and failed to inhibit thromboplastin-induced caval thrombosis. BMS-180291 (150 micrograms/kg/min) significantly reduced arterial thrombus weight by 40% when plasma epinephrine concentration was increased to 5 ng/ml. BMS-180291 and aspirin produced increases of only < or = 30% in bleeding times. These results demonstrate that BMS-180291 has antithrombotic activity in experimental aspirin-resistant arterial and venous thrombosis. Both aspirin and BMS-180291 have only modest effects on small artery hemostasis in rats.     

Site of digestion and milk production by cows fed fats differing in saturation, esterification, and chain length

Four cannulated cows in a 4 x 4 Latin square design were used to study the effects of supplemental dietary fatty acids from roasted soybeans combined with tallow or partially hydrogenated fats, varying in esterification and fatty acid chain length, on nutrient digestion and lactation performance. Diets were formulated to contain (DM basis) 48% forage in addition to 1.5% fatty acids from roasted soybeans and 2.5% fatty acids from tallow, partially hydrogenated tallow triglycerides, partially hydrogenated tallow fatty acids, or a blend of 30% tallow and 70% hydrogenated fatty acids that were rich in palmitic acid. Apparent total tract digestibilities of OM, N, and NDF were similar among diets. Supplemental fat as fatty acids, compared with triglycerides, increased digestibilities of total fatty acids and C18:1 in the small intestine, perhaps indicating that lipolysis was rate-limiting. Fatty acids also increased milk fat percentage and efficiency of 4% FCM production. Although intake of C16 fatty acids was higher for cows fed the fat rich in palmitic acid than for those fed the tallow fatty acids, total duodenal flows of C16 fatty acids were similar, and digestibility in the small intestine was unaffected. Dry matter intake, 4% FCM production, and milk protein percentage were similar among treatments.     

Accuracy assessment of methods for determining hip movement in seated cycling

The goal of this research was to examine the accuracy of three methods used to indicate the hip joint center (HJC) in seated steady-state cycling. Two of the methods have been used in previous studies of cycling biomechanics and included tracking a marker placed over the superior aspect of the greater trochanter, a location that estimates the center of rotation of the hip joint, and assuming that the hip is fixed. The third method was new and utilized an anthropometric relationship to determine the hip joint location from a marker placed over the anterior-superior iliac spine. To perform a comparative analysis of errors inherent in the three methods, a standard method which located the true hip joint center was developed. The standard method involved establishing a pelvis-fixed coordinate system using a triad of video markers attached to an intracortical pin. Three-dimensional motion analysis quantified the true hip joint center position coordinates. To provide data for the comparative analysis, the intracortical pin was anchored to a single subject who pedaled at nine cadence-workrate combinations while data for all four methods were simultaneously recorded. At all cadence-workrate combinations the new method was more accurate than the trochanter method with movement errors lower by a factor of 2 in the vertical direction and a factor of 3 in the horizontal direction. Relative to the errors introduced by the fixed hip assumption, the new method was also generally more accurate by at least a factor of 2 in the horizontal direction and had comparable accuracy in the vertical direction. For computed kinetic quantities, the new method most accurately indicated hip joint force power but the fixed hip method most accurately indicated the work produced by the hip joint force over the crank cycle.     

Treatment of urinary tract infections

Urinary tract infections (UTIs) are common conditions in clinical practice. For uncomplicated UTIs, the causative organisms and their antimicrobial susceptibility profiles are generally predictable, and empiric short course (3 day) antibiotic therapy after an abbreviated laboratory workup is advocated. Acute pyelonephritis requires a 2 week antibiotic course, often with initial parenteral therapy. Women with frequent recurrences of UTIs may require intermittent self-treatment or continuous or postcoital antibiotic prophylaxis. Catheter-associated UTIs generally only require treatment if the patient shows signs of systemic infection. Treatment of asymptomatic bacteriuria is only recommended in certain circumstances. Careful consideration of the clinical circumstances, the patient's known or predicted urinary tract anatomy, and the antibiotic susceptibility of the bacterial pathogen(s) are critical factors in the choice of appropriate therapy for urinary tract infections.