bluuebunny/crossref_metadata_2025 huggingface dataset:
MODELING THE GROUP MOBILITY PATTERN IN WIRELESS BODY SENSOR NETWORKS
Authors: REN HONGLIANG , MENG MAX Q.-H.
Published: June 2007

Wireless network of wearable biomedical sensors by human body shows great potential to enhance the biometrics performance significantly. Meanwhile, it poses prominent characteristics and challenges to physicians and engineers for its particular medical application as compared to other application of wireless sensor networks (WSN). Mobility pattern plays an important role in designing the wireless body sensor networks (WBSN) and will also affect the accuracy of modeling WBSN in health care application. Much of the mobility scenarios generated in current work of wireless body sensor networks has used fairly simple models to generate the mobile topological graph, which bear little resemblance to the actual mobility patterns. This paper is the first attempt to investigate the mobility model in WBSN based on the existing mobility models in wireless data networks and ad hoc networks. We first briefly review the existing mobility models in related research areas such as wireless ad hoc network and cellular networks. Further on, we propose a dedicated and more realistic mobility model named BAMM (Body Area Mobility Model) for wireless body sensor networks by concentrating on the unique characteristics of WBSN and finally study the effects of mobility on the performance of WBSN by simulation experiments.
Misfolded BRICHOS SP-C mutant proteins induce apoptosis via caspase-4- and cytochrome c-related mechanisms
Authors: Mulugeta Surafel , Maguire Jean Ann , Newitt Jennifer L. , Russo Scott J. , Kotorashvili Adam , Beers Michael F.
Published: June 2007

Several mutations within the BRICHOS domain of surfactant protein C (SP-C) have been linked to interstitial lung disease. Recent studies have suggested that these mutations cause misfolding of the proprotein (proSP-C), which initiates the unfolded protein response to resolve improper folding or promote protein degradation. We have reported that in vitro expression of one of these proteins, the exon 4 deletion mutant (hSP-CΔexon4), causes endoplasmic reticulum (ER) stress, inhibits proteasome function, and activates caspase-3-mediated apoptosis. To further elucidate mechanisms and common pathways for cellular dysfunction, various assays were performed by transiently expressing two SP-C BRICHOS domain mutant (BRISPC) proteins (hSP-CΔexon4, hSP-CL188Q) and control proteins in lung epithelium-derived A549 and kidney epithelium-derived (HEK-293) GFPu-1 cell lines. Compared with controls, cells expressing either BRICHOS mutant protein consistently exhibited increased formation of insoluble aggregates, enhanced promotion of inositol-requiring enzyme 1-dependent splicing of X-box binding protein-1 (XBP-1), significant inhibition of proteasome activity, enhanced induction of mitochondrial cytochrome c release, and increased activations of caspase-4 and caspase-3, leading to apoptosis. These results suggest common cellular responses, including initiation of cell-death signaling pathways, to these lung disease-associated BRISPC proteins.
Exercise intensity influences cardiac baroreflex function at the onset of isometric exercise in humans
Authors: Fisher James P. , Ogoh Shigehiko , Young Colin N. , Keller David M. , Fadel Paul J.
Published: June 2007

We sought to examine the influence of exercise intensity on carotid baroreflex (CBR) control of heart rate (HR) and mean arterial pressure (MAP) at the onset of exercise in humans. To accomplish this, eight subjects performed multiple 1-min bouts of isometric handgrip (HG) exercise at 15, 30, 45 and 60% maximal voluntary contraction (MVC), while breathing to a metronome set at eupneic frequency. Neck suction (NS) of −60 Torr was applied for 5 s at end expiration to stimulate the CBR at rest, at the onset of HG (<1 s), and after ∼40 s of HG. Beat-to-beat measurements of HR and MAP were recorded throughout. Cardiac responses to NS at onset of 15% (−12 ± 2 beats/min) and 30% (−10 ± 2 beats/min) MVC HG were similar to rest (−10 ± 1 beats/min). However, HR responses to NS were reduced at the onset of 45% and 60% MVC HG (−6 ± 2 and −4 ± 1 beats/min, respectively; P < 0.001). In contrast to HR, MAP responses to NS were not different from rest at exercise onset. Furthermore, both HR and MAP responses to NS applied at ∼40s of HG were similar to rest. In summary, CBR control of HR was transiently blunted at the immediate onset of high-intensity HG, whereas MAP responses were preserved demonstrating differential baroreflex control of HR and blood pressure at exercise onset. Collectively, these results suggest that carotid-cardiac baroreflex control is dynamically modulated throughout isometric exercise in humans, whereas carotid baroreflex regulation of blood pressure is well-maintained.
Two Proton Translocation Pathways in a Secondary Active Multidrug Transporter
Authors: Bapna Akanksha , Federici Luca , Venter Henrietta , Velamakanni Saroj , Luisi Ben , Fan Tai-Ping , van Veen Hendrik W.
Published: June 2007

LmrP is a secondary active multidrug transporter from Lactococcus lactis. The protein belongs to the major facilitator superfamily and utilizes the electrochemical proton gradient (inside negative and alkaline) to extrude a wide range of lipophilic cations from the cell. Previous work has indicated that ethidium, a monovalent cationic substrate, is exported by LmrP by electrogenic antiport with two (or more) protons. This observation raised the question whether these protons are translocated sequentially along the same pathway, or through different routes. To address this question, we constructed a 3-D homology model of LmrP based on the high-resolution structure of the glycerol-3P/Pi antiporter GlpT from Escherichia coli, and we tested by mutagenesis the possible proton conduction points suggested by this model. Similar to the template, LmrP is predicted to contain an internal cavity formed at the interface between the two halves of the transporter. On the surface of this cavity lie two clusters of polar, aromatic and carboxylate residues with potentially important function in proton shuttling. Cluster 1 in the C-terminal half contains D235 and E327 in immediate proximity of each other, and is located near the apex of the cavity. Cluster 2 in the N-terminal half contains D142. Analyses of LmrP mutants containing charge-conservative or carboxyl-to-amide replacements at positions 142, 235 and 327 suggest that D142 is part of a dedicated proton translocation pathway in the ethidium translocation reaction. In contrast, D235 and E327 are part of an independent pathway, in which D235 interacts with protons. E327 appears to modulate the pKa of D235 and plays a role in the interaction with ethidium. These results are consistent with the proposal that major facilitator superfamily proteins consist of two membrane domains, one of which is involved in substrate binding and the other in ion coupling, and they indicate that there are two proton conduction pathways at play in the transport mechanism.
Studies of the Bacteriorhodopsin Photocycle without the Use of Light: Clues to Proton Transfer Coupled Reactions
Authors: Lanyi Janos K.
Published: June 2007

In the photochemical cycle of bacteriorhodopsin, the light-driven proton pump of halobacteria, only the first step, the isomerization of the all-trans retinal to 13-cis, is dependent on illumination. Because the steps that accomplish the translocation of a proton during the ensuing reaction sequence of intermediate states are thermal reactions, they have direct analogies with such steps in other ion pumps. In a surprisingly large number of cases, the reactions of the photocycle could be studied without using light. This review recounts experiments of this kind, and what they contribute to understanding the transport mechanism of this pump, and perhaps indirectly other ion pumps as well.
Diagnostic Problems in Follow-Up Bone Marrow Biopsies of Patients Treated for Acute and Chronic Leukaemias and MDS
Authors: Dirnhofer Stephan , Went Philip , Tichelli André
Published: June 2007

Bone marrow biopsy evaluation after therapy for hematolymphoid disorders is complex. The difficulties encountered by the pathologist are due to the fact that a variety of heterogenous diseases for which different treatments can be applied have to be considered. Moreover, usually different clinical questions have to be addressed for which different analyses are performed, typically in different laboratories by different investigators. In the present paper, we suggest a systematic, integrative and interdisciplinary approach that includes knowledge of the original diagnosis and of the type of prior therapy, considers treatment effects and a use of standardized response criteria for AML and MDS. Finally, we discuss how to deal with discrepancies between morphological findings in a bone marrow biopsy and the corresponding aspirate.
Neues zur Pathophysiologie der Endometriose
Authors: Neukomm Corinne , Mueller Michael D.
Published: June 2007

Die Endometriose ist eine faszinierende und komplexe Erkrankung, welche vor allem durch eine Dysregulation zwischen, durch retrograde Menstruation ins Abdomen gelangte, Endometriumzellen und der peritonealen Flüssigkeit entsteht. Erhöhte Konzentrationen von aktivierten peritonealen Makrophagen, Lymphozyten, spezifischen Zytokinen und Wachstumshormonen in der peritonealen Flüssigkeit unterstützen diese Hypothese. Die genaue Rolle dieser verschiedenen Faktoren ist noch nicht bekannt, sicher ist aber, dass das Wachstum der Endometrioseherde durch ein komplexes Zusammenspiel dieser verschiedenen Faktoren bestimmt wird. Vor allem die Angiogenese (= Gefässneubildung) spielt in diesem Prozess eine wichtige Rolle. In den letzten Jahren konnte eine Vielzahl an Wachstumsfaktoren und Zytokinen identifiziert werden, die chemotaktische, modulatorische oder inhibierende Eigenschaften mit Wirkung auf Endothelien, glatte Muskelzellen und Perizyten besitzen. Die Aussprossung von neuen Blutgefässen aus bestehenden tritt nur dann auf, wenn die lokal angiostimulatorischen Faktoren gegenüber den angioregressorischen Einflüssen überwiegen. Diese Veränderung des streng kontrollierten Prozesses scheint eine entscheidende Prämisse für die adäquate Blutversorgung und das Überleben der ektopen Endometriumzellen zu sein. Im Folgenden werden einige der wichtigsten Faktoren zusammengefasst, welche in der Entwicklung, im Wachstum und in der Progression der Endometriose eine Schlüsselrolle einnehmen.
Tacrolimus-Induced Intestinal Angioedema: Diagnosis by Capsule Endoscopy
Authors: Zvidi I. , Gal E. , Rachamimov R. , Niv Y.
Published: June 2007

Small intestinal angioedema has been reported with angiotensin converting enzyme inhibitors therapy, but not in implanted patients treated with tacrolimus. We present a kidney transplanted patient, hospitalized with severe diarrhea, diagnosed with tacrolimus-induced intestinal angioedema with abdominal computerized tomography and capsule endoscopy. To the best of our knowledge this is the first described case of tacrolimus-induced small bowel angioedema diagnosed with capsule endoscopy.
Myocardial
Smad4
Is Essential for Cardiogenesis in Mouse Embryos
Authors: Song Lanying , Yan Wensheng , Chen Xinbin , Deng Chu-xia , Wang Qin , Jiao Kai
Published: June 2007

Congenital heart diseases are the most commonly observed human birth defects and are the leading cause of infant morbidity and mortality. Accumulating evidence indicates that transforming growth factor-β/bone morphogenetic protein signaling pathways play critical roles during cardiogenesis.
Smad4
encodes the only common Smad protein in mammals, which is a critical nuclear mediator of transforming growth factor-β/bone morphogenetic protein signaling. The aim of this work was to investigate the roles of
Smad4
during heart development. To overcome the early embryonic lethality of
Smad4
−/−
mice, we specifically disrupted
Smad4
in the myocardium using a Cre/loxP system. We show that myocardial-specific inactivation of
Smad4
caused heart failure and embryonic lethality at midgestation. Histological analysis revealed that mutant mice displayed a hypocellular myocardial wall defect, which is likely the primary cause for heart failure. Both decreased cell proliferation and increased apoptosis contributed to the myocardial wall defect in mutant mice. Data presented in this article contradict a previous report showing that
Smad4
is dispensable for heart development. Our further molecular characterization showed that expression of
Nmyc
and its downstream targets, including cyclin D1, cyclin D2, and Id2, were downregulated in mutant embryos. Reporter analysis indicated that the transcriptional activity of the 351-bp
Nmyc
promoter can be positively regulated by bone morphogenetic protein stimulation and negatively regulated by transforming growth factor-β stimulation. Chromatin immunoprecipitation analysis revealed that the
Nmyc
promoter can form a complex with Smad4, suggesting that
Nmyc
is a direct downstream target of Smad4. In conclusion, this study provides the first mouse model showing that
Smad4
plays essential roles during cardiogenesis.
Coronary Catheterisation Does Not Lead to Retinal Artery Emboli in Short-Term Follow-Up of Cardiac Patients
Authors: Thyer Isaac , Kovoor Pramesh , Wang Jie Jin , Taylor Bronwen , Kifley Annette , Lindley Richard , Mitchell Paul , Thiagalingam Aravinda
Published: June 2007

Background and Purpose—

There is emerging evidence that coronary catheterization can cause cerebrovascular embolization. We aimed to assess the proportion of cardiac patients with retinal emboli before coronary catheterization and the proportion with newly developed retinal embolism shortly after coronary catheterization.

Methods—

Ninety-seven patients attending Westmead Hospital for coronary catheterization between December 2005 and February 2006 were recruited. Medical history, physical examination, and pre- and postcatheterization photography of 5 retinal fields was performed. The proportion of patients with new retinal emboli was assessed by comparing post- and precatheterization retinal photographs.

Results—

Before catheterization, retinal emboli were observed in 5 patients (5.2%) and were significantly associated with higher body mass index (
P
=0.007). The presence of angiographic coronary artery disease was not significantly associated with preexisting retinal emboli. In 97 patients, we found no new emboli within the 16-hour (median: range 4 to 45 hours) postcoronary catheterization period.

Conclusions—

Asymptomatic retinal emboli are relatively common in patients being assessed for coronary artery disease. We found no evidence suggesting coronary catheterization contributes to retinal embolism shortly after the procedure.
A Plaster Combining Diclofenac and Heparin: Microcirculatory Evaluation in 2 Models of High-Perfusion Microangiopathy
Authors: Belcaro G. , Cesarone M. R. , Vinciguerra G. , Ledda A. , Dugall M. , Di Renzo A. , Stuard S. , Ricci A. , Cacchio M. , Ippolito E. , Hosoi M. F. , Fano P. , Spignoli G.
Published: June 2007

A medicated plaster containing diclofenac epolamine (DHEP) and heparin has been recently proposed for the treatment of local trauma (ie, ankle sprains) accompanied by a clinically significant edema and/or hematoma formation, based on the combined antiinflammatory, hemorheologic, and antiedema properties of diclofenac and heparin. The aim of this study was therefore to compare the effects of a combined DHEP/heparin and DHEP alone in 2 clinical experimental models of microangiopathy, in order to provide a pharmacologic rationale for association of diclofenac and heparin. The microcirculation was evaluated by measuring cutaneous blood flow (laser Doppler) and transcutaneous oxygen and carbon dioxide pressures (TcPO2 and TcPCO2) in 10 healthy volunteers before and after producing 2 microcirculatory models of microangiopathy: the models were based on reactive hyperemia (RH) and on local histamine injection, which both produce a significant increase in skin flux and alterations of TcPO2 and TcPCO2. The area of the study was the distal medial leg, treated with placebo, DHEP alone (Flector Tissugel), and DHEP/heparin (Flector Tissugel Heparin). The plasters were applied before producing the microcirculatory models to evaluate the efficacy of DHEP and DHEP/heparin in controlling and limiting vasodilatation and development of microangiopathy. A significant increase in cutaneous flux was obtained with both models. The application of DHEP partially limited the increase in flux and in TcPCO2, as well as the decrease in TcPO2 (which were considered signs of microangiopathy), but the combination DHEP/heparin was significantly more effective than DHEP alone. The inclusion of heparin in the plaster thus improved the control of the microcirculation achieved with diclofenac alone, when an experimental model of venous/arterial hyperemia and microangiopathy was used. In conclusion, DHEP in association with heparin modulates microcirculatory changes better than DHEP alone. It should be interesting to investigate the product in comparable clinical conditions in which it may be useful to act pharmacologically both on inflammation and microcirculatory disturbances that delay the recovery of patients.
N-Terminal Pro-Brain Natriuretic Peptide Levels Are Elevated in Patients with Acute Ischemic Stroke
Authors: Giannakoulas George , Hatzitolios Apostolos , Karvounis Haralambos , Koliakos George , Charitandi Aphrodite , Dimitroulas Theodoros , Savopoulos Christos , Tsirogianni Efrosini , Louridas George
Published: June 2007

Brain natriuretic peptide (BNP) is a counterregulatory hormone released by the ventricles of the heart. Its main actions are natriuresis and vasodilation. The authors studied N-terminal pro-brain natriuretic peptide (NT-proBNP) levels soon after an acute ischemic stroke. They compared plasma NT-proBNP concentrations in 30 patients with an acute ischemic stroke with those of 30 controls. The 2 groups were adjusted for age and gender, and there were no significant differences in vascular risk factors and left ventricular systolic and diastolic function. Venous samples were collected within the first 11.8 ±1.2 hours after the onset of symptoms and again on day 6. Brain computed tomography/magnetic resonance imaging (CT/MRI) was performed on the same days (day 0 and day 6) in order to assess the site (carotid or vertebrobasilar), cause (atherothrombotic, cardioembolic, or lacunar), and size (large, medium, or small) of the brain infarct. NT-proBNP levels were elevated in patients with acute stroke (129.9 ±9.9 fmol/mL) compared with the controls (90.8 ±6.3 fmol/mL, p<0.05). These levels remained elevated at day 6 (113.5 ±13.0 fmol/mL). NT-proBNP at admission was significantly higher in cardioembolic compared with atherothrombotic infarctions. There was no correlation between circulating NT-proBNP and stroke topography, infarct size, or severity as assessed by the National Institutes of Health Stroke Scale (NIHSS) at any of the 2 time points (admission and day 6). NT-proBNP levels were raised in patients with acute ischemic stroke; this effect persisted until day 6. The authors suggest that neurohumoral activation occurs in patients with acute ischemic stroke, either reflecting a counterbalancing vasodilating response to the cerebral ischemia or direct myocardial dysfunction.
Chronic Venous Disease and the Leukocyte-Endothelium Interaction: From Symptoms to Ulceration
Authors: Nicolaides A. N.
Published: June 2007

The mechanisms regulating varicose vein development and the subsequent skin sequelae seen in chronic venous disease (CVD) have been investigated recently. Despite the diversity of signs and symptoms associated with the disease, it seems likely that they are related to venous hypertension. Valvular incompetence is the most important cause of venous hypertension. Recent findings suggest that inflammatory processes are involved in the structural remodeling in venous valves and in the vein wall, leading to valvular incompetence and the development of varicose veins. This has been shown by Ono and colleagues, who found infiltration of valve leaflets and the venous wall by leukocytes (monocytes and tissue macrophages) in all valve specimens from patients with CVD and in none from controls. Further work by Takase and colleagues confirmed this hypothesis. Vein wall remodeling is likely to involve the complex interplay of a range of factors, including an altered ratio between metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), and elevated levels of cytokines and growth factors favor an alteration of the extracellular matrix. Neutrophils and mast cells and their interaction with the venous endothelium are believed to play an important role in the initiation of the inflammatory response in CVD. The transmission of high venous pressures to the dermal microcirculation results in the stimulation of an inflammatory process in which cytokine and growth factor release leads to leukocyte migration into the interstitium and the initiation of further inflammatory events. This process is associated with the intense dermal fibrosis and tissue remodeling seen in chronic venous insufficiency. The many manifestations of the disease are frequently associated with symptoms usually ascribed to CVD. The proportion of patients with symptoms increases with increasing CEAP clinical classes, but the mechanisms underlying symptom appearance have not been elucidated. It has been postulated that it is related to the inflammatory cascade of events seen at all stages of CVD and in which the leukocyte and its interaction with the endothelium play a key role. It is increasingly believed that the emerging twin themes of disturbed venous flow patterns and chronic inflammation underlie and link all the manifestations of the disease. Among the many pathophysiologic mechanisms at work, the leukocyte-endothelium interactions seem to be important in many aspects of the disease and have been identified as a possible target for pharmacologic intervention. Pharmacologic agents that could attenuate various elements of the inflammatory cascade and inhibit the inflammatory process might offer a greater opportunity to prevent future morbidity. It seems reasonable to speculate that such treatment could reduce the risk of CVD progression if applied as soon as the first symptoms appear.
Daflon 500 mg: Symptoms and Edema
Authors: Ramelet Albert-Adrien
Published: June 2007

Patients suffering from any class of the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of chronic venous disease (CVD) may be symptomatic (C0s-C6s). Leg heaviness, discomfort, itching, cramps, pain, paresthesia, and edema (C3) are the most frequent manifestations of CVD and a major reason for medical consultation. Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) is an effective treatment for symptoms and edema in CVD as demonstrated in several randomized controlled studies. A 2-month, double-blind study in 40 patients established the superiority of Daflon 500 mg over placebo with regard to symptoms and objective signs. This was confirmed in another double-blind, placebo-controlled trial (2 months’ treatment, 160 patients), and in the Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids (RELIEF) study. The latter included 5,052 patients in 23 countries, using a visual analog scale for evaluating pain, leg heaviness, cramps, and a sensation of swelling. All symptoms showed significant and progressive improvement. The quality-of-life results (scores on the ChronIc Venous Insufficiency quality of life Questionnaire [CIVIQ]) paralleled those of symptoms. The decrease in the ankle and calf circumferences was significantly greater (p<0.001) in the group of patients treated with Daflon 500 mg in two studies, and correlated well with the improvement in the sensation of swelling (p<0.001). This was confirmed with more sophisticated measurement techniques as in the RELIEF study or in a trial assessing edema with an optoelectronic volumeter in 20 patients. A further double-blind, randomized, controlled study established a statistically significant difference in favor of Daflon 500 mg in comparison with diosmin, both on symptoms and edema. The therapeutic efficacy of Daflon 500 mg on CVD symptoms and edema has been demonstrated in double-blind, randomized, controlled studies. Further studies using a new approach may define the most precise and validated methodology for application in future research in phlebology.
Evaluation of Enalapril+Losartan Treatment with Cardiopulmonary Exercise Test in Patients with Left Ventricular Dysfunction
Authors: Akbulut Tamer , Akgöz Haldun , Dayi Şennur Ünal , Çelik Seden Erten , Gürkan Ufuk , Tayyareci Gülşah
Published: June 2007

The aim of this study was to evaluate the effects of the combination of enalapril and losartan in patients with left ventricular systolic dysfunction by means of cardiopulmonary exercise test (CPET). Patients with left-ventricular systolic dysfunction and ejection fractions of 40% or less were included to the study. All patients were under the treatment of enalapril 20 mg once daily. The study group consisted of 20 patients (18 men, 2 women; mean age ± standard deviation: 62.4 ±6.5 years) and the comparison group consisted of 10 (8 men, 2 women; mean age 59.3 ±11.9 years). The dose of 50 mg of losartan once daily was given additionally to the study patients. Breath-by-breath CPET was performed before administration of losartan and then 6-8 weeks later in the study group and 2 times with an interval of 6-8 weeks in the control group without any change in the treatment protocol. In the study group the average exercise times were 361 ±192 and 454 ±205 seconds (p=0.001) before and after the study. Peak oxygen consumption (V̇O2) values were 1,209 ±366 and 1,284 ±398 mL/minute before and after the study (p=0.01). Anaerobic threshold V̇O2 values were 785 ±187 and 855 ±217 mL/minute before and after the study, respectively (p=0.01). Peak heart rates (HR) were 141 ±28 and 143 ±22/minute (p=0.35); peak V̇O2/HR values were 9.02 ±3.1 and 9.3 ±3 mL/minute (p=0.4) before and after the study, respectively. On the other hand, in the control group, average exercise times were 556 ±250 and 528 ±251 seconds (p=0.8); peak V̇O2 values were 1,502 ±537 and 1,450 ±501 mL/minute (p=0.2); and anaerobic threshold V̇O2 values were 1,005 ±338 and 975 ±319 mL/min (p=0.7), before and after the study respectively. At the highest comparable exercise stage for both tests in the study group the expired volume/oxygen consumption (V̇E/V̇O2) ratio declined from 35.1 ±6.2 to 32.4 ±5.6 (p=0.007). V V̇E values declined from 37.5 ±10.9 to 33.9 ±10.1 L (p=0.02); heart rate declined from 140 ±27 to 132 ±21/minute (p=0.02). No significant change was observed in the mentioned values for the control group. Addition of losartan to the standard therapy in patients with left ventricular systolic dysfunction improved exercise capacity and caused lower heart rate and ventilation requirements for the same exercise level.
Superior Vena Cava Rupture Caused During Balloon Dilation for Treatment of SVC Syndrome Due to Repetitive Catheter Ablation
Authors: Oshima Kiyohiro , Takahashi Toru , Ishikawa Susumu , Nagashima Toshiteru , Hirai Keitaro , Morishita Yasuo
Published: June 2007

A 29-year-old woman with an implanted AAI mode permanent pacemaker, who had undergone catheter ablation for inappropriate sinus tachycardia 4 times, experienced complications of superior vena cava (SVC) syndrome. Severe stenosis of the SVC wall was observed in computed tomograms. During balloon dilation for the treatment of SVC syndrome, the SVC was ruptured, resulting in cardiac tamponade. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). A longitudinal tear 1 cm in length was identified at the junction of the right atrium and the SVC, requiring a patch plasty using an autologous pericardium 2.5 cm x 3 cm in size.

SVC rupture is a complication to be completely avoided when we perform balloon dilation for the treatment of SVC syndrome. Therefore, the indication of balloon dilation for the treatment of SVC syndrome requires critical examination and attention.
Microalbuminuria Is Determined by Systolic and Pulse Pressure Over a 12-Year Period and Related to Peripheral Artery Disease in Normotensive and Hypertensive Subjects: The Three Areas Study in Greece (TAS-GR)
Authors: Tsakiris Alexandros , Doumas Michael , Lagatouras Dimitrios , Vyssoulis Grigorios , Karpanou Evangelia , Nearchou Nearchos , Kouremenou Chrysoula , Skoufas Panagiotis
Published: June 2007

Microalbuminuria and peripheral artery disease represent 2 different forms of target organ damage due to raised blood pressure. The aim of this study was to investigate the association between blood pressure with microalbuminuria and the appearance of peripheral artery disease after more than a decade, and moreover, to address whether any relationship exists between microalbuminuria and peripheral disease in a Greek Caucasian population. In 1990, 635 normal subjects were examined and their blood pressure was recorded. Nine and 12 years later, subjects were reexamined and 361 of them (57%) were available at last visit for the determination of microalbuminuria and ankle-arm index. Microalbuminuria was detected in 35/361 (9.7%) and peripheral artery disease in 89/361 (24.7%). Both conditions were statistically correlated with pulse and systolic blood pressure at all time points during the 12-year follow-up period, while the relationship with diastolic and mean arterial pressure existed only for baseline values and was then abolished. Microalbuminuria was statistically correlated to peripheral artery disease ( r =-0.460, p=0.0001). Blood pressure levels seemed to predict the appearance of microalbuminuria and peripheral disease after 12 years. Microvasculature and macro-vasculature abnormalities (microalbuminuria and peripheral disease, respectively) showed a significant relationship, suggesting a common pathogenetic mechanism.
Acute Myocardial Infarction After a European Hornet Sting
Authors: Korantzopoulos Panagiotis , Kountouris Evaggelos , Voukelatou Maria , Charaktsis Ioannis , Dimitroula Vasiliki , Siogas Konstantinos
Published: June 2007

The authors briefly describe an 87-year-old man who experienced an acute ST-elevation myocardial infarction in the context of an anaphylactic reaction caused by a European hornet (Vespa cabro linnaeus) envenomation. This unusual case highlights the potential cardiovascular complications associated with common insect stings such as those caused by hymenoptera. Thus, a thorough cardiovascular evaluation is essential in such cases since the vasoactive, inflammatory, and thrombogenic mediators of anaphylactic reactions may provoke myocardial ischemia.
The Relationship Between β-Receptor Sensitivity and Nocturnal Blood Pressure and Heart Rate Recovery in Normotensive People
Authors: Akgöz Haldun , Gürkan Ufuk , Dayi Şennur Ünal , Terzi Sait , Akbulut Tamer , Torun Arzu , Tayyareci Gülşah
Published: June 2007

This study examined the relationship between nocturnal blood pressure (BP) dipping and chronotropic dose25 (CD25) as an indicator of β-adrenergic receptor functioning in normotensive people. In addition, the authors evaluated the influence of β-receptor functioning on heart rate recovery after exercise. The sample consisted of 41 participants (18 men, 23 women). Ambulatory BP monitoring took place in each patient's home. On a separate occasion, β-adrenergic receptor sensitivity was determined by response to isoproterenol infusion. Heart rate (HR) recovery was defined as the change from peak HR to that measured after 1 and 2 minutes of recovery. Relationships between dipping and CD25 were found such that participants with higher CD25 values had less nocturnal decline in systolic BP, diastolic BP, and mean arterial pressure ( r =–0.445, –0.533, –0.510, respectively; p<0.004, 0.001, 0.001, respectively). Heart rate recovery at 1 and 2 minutes after exercise was 28.8 ±5 and 49.9 ±6 beats/minute, respectively. Participants with higher CD25 values had more heart rate decline during the first 2 minutes of recovery ( r =0.407, p<0.008). In addition, heart rate recovery was inversely related to systolic, diastolic, and mean nocturnal blood pressure dipping ( r =–0.348, –0.432, –0.408, respectively, p<0.028, 0.005, 0.009, respectively). Normotensive people with an abnormal circadian pattern of blood pressure may have desensitized β-adrenergic receptors. This desensitization may contribute to blunted nocturnal blood pressure and increased heart rate recovery as measured at 2 minutes following exercise testing.
Unusual Retrograde Aortic Arch Dissection During Percutaneous Coronary Intervention
Authors: Patel Tejas M. , Shah Sanjay C. , Ranjan Alok
Published: June 2007

Coronary dissection is one of the most frequently occurring complications during coronary interventional procedures. However, extensive coronary dissection retrograde to the coronary sinus of Valsalva and to the arch of aorta is very rarely observed. The authors report a case of retrograde coronary dissection extending into the arch of aorta. Management and coronary angiography at 6-month follow-up are discussed.
Antibodies Against Various Forms of Mildly Oxidized Low-Density Lipoprotein Are Not Associated With Carotid Intima-Media Thickness in Patients With Primary Hyperlipidemia
Authors: Tsouli Sofia G. , Kiortsis Dimitrios N. , Xydis Vasilios , Argyropoulou Maria I. , Elisaf Moses , Tselepis Alexandros D.
Published: June 2007

The carotid intima-media thickness (IMT) can reflect early atherosclerosis. Oxidative modification of low-density lipoprotein (LDL) leads to the formation of several immunogenic epitopes and different forms of antibodies against oxidized LDL (oxLDL). We investigated the possible relationship between autoantibody titers against various forms of mildly oxLDL and carotid IMT in patients (n=100) with primary hyperlipidemia. Three different types of mildly oxidized LDL—oxLDLL, oxLDLP, and oxLDLD—were prepared at the end of lag, propagation, and decomposition phases of oxidation, respectively. Similar types of oxLDL were also prepared from the same LDL preparations after inactivation of the LDL-associated platelet-activating factor acetylhydrolase (PAF-AH). These types were denoted as oxLDL(-)L, oxLDL(-)P, and oxLDL(-)D. OxLDL types are primarily enriched in lysophosphatidylcholine (lyso-PC) due to hydrolysis of oxidized phospholipids (oxPL) by PAF-AH. OxLDL(-) types are mainly enriched in intact oxPL due to the inactivation of the LDL-associated PAF-AH before oxidation. IgG autoantibodies against all types of oxLDL were determined and IMT was evaluated ultrasonographically. IMT values were significantly associated with age, systolic blood pressure and serum triglyceride levels, whereas no correlation was found between IMT values and antibody titers against all types of either oxLDL or oxLDL(-). We suggest that autoantibodies against various types of mildly oxidized LDL enriched either in lyso-PC or in oxPL are not associated with the extent of carotid atherosclerosis. This supports the concept that extensively oxidized LDL enriched in aldehydes rather than mildly oxidized LDL may play a prominent role in the early stage of atherosclerosis.
Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report
Authors: Weissman Gaby , Kwon Christopher C. , Shaw Richard K. , Setaro John F.
Published: June 2007

Free wall rupture of the myocardium is an important complication and major cause of death following acute transmural (ST segment elevation) myocardial infarction. Pathologic changes on a cellular level may combine with mechanical stressors to weaken the myocardium postinfarction. Risk factors for myocardial rupture include advanced age, female gender, prior hyper-tension, first myocardial infarction, late presentation, lack of collateral blood flow, and persisting chest pain and ST segment elevations. Thrombolytic therapy does not increase risk of rupture when given early in myocardial infarction, but late thrombolytic therapy may heighten risk. Primary percutaneous coronary intervention for acute myocardial infarction has reduced the incidence of myocardial rupture compared to thrombolytic therapy. This advantage likely can be ascribed to higher rates of immediate reperfusion with catheter techniques, as well as to the avoidance of thrombolytic-mediated hemorrhagic transformation of the infarction zone. Careful regulation of blood pressure and pulse using nitrates and beta-adrenergic blockers may mitigate the tendency toward myocardial rupture. Early and accurate diagnosis based on clinical and echocardiographic evidence can lead to successful surgical treatment.
Acute Myocardial Infarction and Status Asthmaticus: A Case Report
Authors: RuDusky Basil M.
Published: June 2007

A patient with a painless, extensive anterolateral myocardial infarct, which occurred during a prolonged bout of refractory asthma, is presented. Cardiac catheterization revealed a large akinetic area involving the septum and anterolateral walls and completely normal coronary arteries. The etiology of the infarct was believed to be intense coronary vasospasm occurring during the lengthy period of status asthmaticus.
Left Atrial Anatomy and Function After Conversion From Atrial Fibrillation in Hypertrophic Hearts
Authors: Mattioli Anna Vittoria , Bonatti Silvia , Mattioli Giorgio
Published: June 2007

The aim of the study was to evaluate the influence of left ventricular (LV) hypertrophy on left atrial (LA) electrical and mechanical function after cardioversion atrial fibrillation (A-Fib) of brief duration. Study group A included 100 patients with a first diagnosis of hypertension who had a moderate LV hypertrophy. The patient population included 64 men and 36 women with a mean age of 55 ±7 years who were hospitalized because of A-Fib and were cardioverted with external DC shock. Control group B included 100 patients without cardiac hypertrophy cardioverted because of lone A-Fib. Atrial function and size were assessed by Doppler echocardiography and the following parameters were measured: transmitral peak A velocity, atrial filling fraction, atrial ejection force, peak E velocity, deceleration time, and isovolumic relaxation time, LA maximal and minimal volume, and LV cardiac mass index. Baseline echocardiography showed that LA diameters and volumes were enlarged in all patients during A-Fib. After the restoration of sinus rhythm LA diameters and volumes decreased and the reduction was more evident in group B compared to group A. LA function as a continuous variable was negatively related to LV mass index ( r = -0.77), LA diameter ( r = -0.66 and r = -0.69 for the superoinferior diameter), LA maximal volume ( r = -0.61) and LA minimal volume ( r = -0.55) (all p<0.01). Atrial ejection force as a continuous variable was positively related to age ( r =0.78), peak A wave velocity ( r =0.71), systolic blood pressure ( r =0.51), and IVRT ( r =0.41) (all p<0.01). Hypertrophy influenced the recovery of atrial function after cardioversion of A-Fib. Atrial function was reduced in patients with LV hypertrophy even after A-Fib of brief duration.
Swallow Syncope in a Patient With Esophageal Stenosis Caused by an Ascending Aorta Aneurysm: Differential Diagnosis From Postprandial Hypotension
Authors: Patsilinakos S. P. , Antonatos D. G. , Spanodimos S. , Nikolaou N. I. , Sotirellos K. , Korkonikitas P. I. , Tsingas D.
Published: June 2007

Swallow syncope is usually caused by organic or functional disorders of the esophagus due to abnormal vasovagal reflex. In elderly patients this situation could be confused with postpran-dial hypotension. We present a case of an elderly patient who presented with swallow syncope that was caused by a waist in the midportion of esophagus induced by an ascending aorta aneurysm.
Child Abuse and Domestic Violence in Families of Children Seen for Suspected Sexual Abuse
Authors: Bowen Kathryn
Published: June 2007

We surveyed families of children seen in a sexual abuse evaluation clinic regarding domestic violence in the child's home and physical and sexual abuse during childhood among the mothers. Domestic violence occurred in 54% (216/402) of the children's homes; 28% (111/392) of mothers reported childhood physical abuse, and 42% (167/395) reported sexual abuse. There were no differences in the rates of domestic violence (X2=0.42, 2df, p=0.8), maternal physical abuse (X2=2.40, 2df, p=0.3), or maternal sexual abuse (X2=2.11, 2df, p=0.3) based on whether our current patient was at high, medium, or low risk for having actually experienced sexual abuse. Neither domestic violence in the child's home nor the mother's childhood experience of abuse was increased if the child's perpetrator was a relative or lived in the home. Domestic violence in the child's home was more frequent if the mother had experienced physical abuse during childhood (65%, 70/107) than if she had not (48%, 130/271; X2=8.69, p<0.01). Child sexual abuse is part of a global pattern of victimization, and clinicians must address other forms of family violence when evaluating a child for allegations of sexual abuse.
Acetaminophen Intoxication During Treatment: What You Don't Know Can Hurt You
Authors: Kearns Gregory L. , Leeder J. Steven , Wasserman Gary S.
Published: June 2007

For over two decades, pediatricians have been made aware of the potential risk associated with the acute ingestion of large single and/or multiple doses of acetaminophen (APAP). Clearly, APAP-induced hepatotoxicity remains as a recognized medical emergency which, when treated promptly with appropriate gastrointestinal decontamination and when indicated, with the antidote N-acetylcysteine, has a uniformly good clinical outcome. Recently, the hepatotoxic potential associated with “therapeutic” APAP administration has been brought to the attention of the pediatric community. This review explores the issue of APAP toxicity with therapeutic intent by examining both the clinical literature and also, relevant information concerning the basic pharmacology and toxicology of this old and widely used nonprescription drug. A “risk profile” is developed with regard to factors that may predispose infants and children to this iatrogenic form of toxicity so that the awareness of physicians and other caregivers (including parents) can be heightened and preventative education administered. As is true for most all potentially beneficial medicines used in pediatrics, awareness of the actual amount of drug received from all sources and caution to not exceed the age-appropriate dosing guidelines (i.e., both amount and duration) contained in the approved labeling for all products containing APAP will insure safe and effective therapy.
Neurodevelopmental Outcome in ECMO Vs Near-Miss ECMO Patients at 5 Years of Age
Authors: Rais-Bahrami K. , Wagner Ann E. , Coffman Cara , Glass Penny , Short Billie L.
Published: June 2007

The objective of this study was to compare the outcome of children at 5 years of age who were treated with extracorporeal membrane oxygenation (ECMO) and those who were critically ill but did not meet ECMO criteria, identified as near-miss ECMO. In one of the longest studies of its kind, we compared the neurodevelopmental outcome of 76 5-year-old ECMO-treated children with 20 5-year-old near-miss ECMO patients with similar primary diagnoses. The two groups were compared for demographic data, level of ventilatory support, and degree of hyperventilation. The comprehensive assessment protocol included an assessment of intelligence (IQ), attainment of preacademic and early academic skills, and parents' report of adaptive behavior. Both groups had similar demographic data and primary diagnosis. The near-miss ECMO patients required increased ventilatory support but not significantly more than the ECMO patients. The cognitive outcome was similar in both groups with mean estimated Full-Scale IQ in the normal range for near-miss and ECMO groups (89 and 97, respectively). Rates of severe mental handicap (FSIQ <70) (near-miss = 11%, ECMO = 12%) and risk for school failure (near-miss = 38%, ECMO = 37%) were also similar. More parents of near-miss ECMO patients reported immature adaptive skills than did parents of ECMO patients, although the numbers were small in each group. Rates of parent-reported child behavior problems were similar in both groups. ECMO and near-miss ECMO patients have similar cognitive and adaptive outcomes at 5 years of age. A significant number in each group are at risk of school failure and should be closely followed up.
Detection of Enteroviruses in the Cerebrospinal Fluid by Polymerase Chain Reaction: Prospective Study of Impact on the Management of Hospitalized Children
Authors: Spicher Virginie Masserey , Berclaz Pierre-Yves , Cheseaux Jean-Jacques , Morandi Pierre-Alain , Suter Susanne , Wunderli Werner , Siegrist Claire-Anne
Published: June 2007

A polymerase chain reaction kit (AMPLICOR EV®) for the detection of enteroviruses (EV-PCR) in the cerebrospinal fluid (CSF) was evaluated in clinical conditions in a prospective blinded-intention study. Forty-three children (mean age 2.7 years) hospitalized for suspected meningitis or fever of unclear etiology were enrolled. EV-PCR was performed on a daily basis. Results were available in less than 2 days in 72% of cases. EV-PCR was positive in nine (21%) children, including three infants without CSF pleocytosis. Knowing their EV-PCR result would have allowed a saving of 18 hospital days and 12 days of antibiotic therapy. The EV-PCR in the CSF can thus be practically useful for children hospitalized for meningitis or fever if available on-site on a daily basis.
Recurrent Abdominal Pain in Children-A Retrospective Study of Outcome in a Group Referred to a Pediatric Gastroenterology Practice
Authors: Croffie Joseph M. , Fitzgerald Joseph F. , Chong Sonny K. F.
Published: June 2007

Recurrent abdominal pain (RAP) affects a significant number of children each year. We reviewed our experience over a 2-year period to determine the outcome of patients who were referred for pediatric gastroenterology consultation. We identified 356 patients, 149 (42%) male and 207 (58%) female. All patients underwent a thorough interview and complete physical examination. Patients suspected of having irritable bowel syndrome (IBS) were treated as such without further initial evaluation. Others underwent an initial blood and urine evaluation. When these initial screening studies were negative, additional studies were performed including abdominal ultrasonography, radiography, and/or endoscopy of the upper gastrointestinal (GI) tract if the history suggested a possible diagnosis that could be excluded or confirmed by such tests. There was no identifiable diagnosis in 43.5% of the patients studied. IBS was diagnosed in 25.8% of all patients. Constipation was diagnosed in 3.7%. Miscellaneous causes, including GI mucosal lesions, and renal and pancreatic disorders were found in an additional 27% of patients. In a follow-up survey, more than 70% of the treated respondents were improved (i.e., their RAP had resolved or was markedly improved). We conclude that most children with RAP have a functional disorder. Patients with an organic cause for pain can be identified and treated in a cost-effective manner with carefully planned evaluation.