bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and nonclinical correlates of racial and ethnic differences in recommendation patterns for coronary revascularization
Authors: Barnhart J. Marie , Wassertheil‐Smoller Sylvia , Monrad E. Scott
Published: February 2009

Background: We sought to determine whether gender or racial differences exist in recommendations for coronary revascularization in a multiracial patient population undergoing their first coronary angiography at an academic institution from 1990–1993 for the evaluation of coronary artery disease (CAD).

Hypothesis: For patients with clinically significant CAD, no racial differences exist in the recommendation to revascularization following coronary angiography.

Methods: The main outcome measure was a recommendation for coronary revascularization such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) for patients with clinically significant CAD (n = 590). The primary multiple logistic regression analysis focused on only those patients with angiographically severe disease, defined as triple‐vessel or left main CAD (n = 180). Race was trichotomized into Hispanic, black, and white to ascertain whether any differential effects of race/ethnicity existed while controlling for age, gender, ejection fraction, angina, diabetes, hypertension, and peripheral vascular disease. A medical record review for all patients with severe CAD, who were given a recommendation for medical therapy, was conducted to ascertain whether previously unmeasured clinical factors or nonclinical factors may have precluded a PTCA/CABG recommendation.

Results: Hispanics with severe disease were significantly less likely than whites to be given a recommendation for PTCA/CABG following angiography [odds ratio (OR) = 0.39; 95% confidence interval (CI) (0.17,0.92)]. Blacks were 67% as likely as whites to be given such a recommendation [OR=0.67; 95% CI (0.17,2.71)]. Medical records, reviewed for 35 of 40 of these patients given a recommendation for medical therapy, revealed that 6 patients eventually had PTCA/CABG within 6 months due to precipitating ischemic events; 9 had such severe or diffuse disease that revascularization did not appear to be an alternative, and 2 patients opted for medical therapy.

Conclusions: Racial differences were manifested in the recommendations made following angiography and may be explained by previously unmeasured clinical as well as nonclinical factors.
Increased platelet activation and endothelial dysfunction in patients with atrial fibrillation immediately following percutaneous balloon mitral valvuloplasty
Authors: Goldsmith Ira R.A. , Li‐Saw‐Hee Foo Leong , Blann Andrew D. , Lip Gregory Y.H.
Published: February 2009

Background: Immediately following percutaneous balloon mitral valvuloplasty (PBMVP), patients have a 3% risk of systemic thromboembolism.

Hypothesis: We hypothesized that this may in part be due to an increase in hypercoagulability (as indicated by abnormal coagulation, platelet activation, and endothelial dysfunction) in such patients.

Methods: We measured indices of platelet activation [soluble P‐selectin (sPsel), ELISA], endothelial dysfunction [von Willebrand factor (vWf), ELISA], and coagulation (fibrinogen, modified Clauss) in 16 patients (15 women, mean age 59 ± 10 years) with chronic atrial fibrillation admitted for PBMVP, and 16 healthy age‐ and gender‐matched controls. Blood samples were obtained as follows: (1) peripheral venous samples prior to PBMVP, immediately following PBMVP, and 24 h after PBMVP; and (2) arterial samples prior to and immediately following PBMVP.

Results: Patients with mitral stenosis and chronic atrial fibrillation demonstrated significantly higher mean levels of vWf [148 (SD24) vs. 102 (SD 37); t‐test, p<0.001] and plasma fibrinogen [4.2 (SD 0.8) vs. 3.3 (SD 0.8); p = 0.003] at baseline than matched healthy controls. There was a nonsignificant trend toward lower median sP‐sel levels in patients with mitral stenosis [64 (inter quartile range 47–91) vs. 109 (46–128); Mann‐Whitney test, p = 0.08]. Following PBMVP, there was a significant increase in venous sP‐sel levels immediately post procedure (paired Wilcoxon test, p = 0.03) and at 24 h afterward (p = 0.01). Arterial s‐Psel levels correspondingly increased immediately post procedure (p = 0.008). There was a significant increase in mean venous (at 24 h) but not arterial vWf levels post PBMVP. There were no significant changes in mean venous or arterial plasma fibrinogen levels following PBMVP.

Conclusion: Patients with mitral stenosis and chronic atrial fibrillation have increased plasma levels of vWf and fibrinogen levels compared with healthy controls, suggesting increased endothelial dysfunction and coagulation at baseline in these patients. The increased levels of sP‐sel immediately post procedure and at 24 h, in association with increased vWf levels at 24 h after PBMVP, are in keeping with an increase in platelet activation and endothelial dysfunction following PBMVP. These changes may contribute to the increased risk of thromboembolism following PBMVP and suggest the need for adequate antithrombotic therapy following PBMVP.
Immediate and late clinical and angiographic outcomes after GFX coronary stenting: Is high‐pressure balloon dilatation necessary?
Authors: Park Seong‐Wook , Hong Myeong‐Ki , Lee Cheol Whan , Kim Jae‐Joong , Park Hoon‐Ki , Cho Goo‐Yeong , Kang Duk‐Hyun , Song Jae‐Kwan , Park Seung‐Jung
Published: February 2009

Background: The GFX stent is a balloon‐expandable stent made of sinusoidal element of stainless steel. The adjunct high‐pressure balloon dilatations were usually recommended in routine stenting procedure.

Hypothesis: The aim of this study was to evaluate the immediate and long‐term clinical and angiographic outcomes and to investigate the necessity of high‐pressure balloon dilatation during GFX stenting.

Methods: In all, 172 consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: (1) stent size of a final stent‐to‐artery ratio of 1:1 (inflation pressure > 10 atm, high‐pressure group), and (2) stent size of 0.5 mm bigger than reference vessel (inflation pressure ≤ 10 atm, low‐pressure group). The adjunct high‐pressure balloon dilatations were performed only in cases of suboptimal results.

Results: The adjunct high‐pressure balloon dilatation was required in 11 of 83 lesions (13%) in the high‐pressure group and in 7 of 105 lesions (7%) in the low‐pressure group (p = 0.203). Procedural success rate was 100%. There were no significant differences of in‐hospital and long‐term clinical events between the two groups. The overall angiographic restenosis rate was 17.7%; 18.4% in the high‐pressure group and 17.1% in the low‐pressure group (p = 0.991).

Conclusions: The GFX stent is a safe and effective device with a high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantation.
Changes of the t‐wave amplitude and angle: An early marker of altered ventricular repolarization in hypertension
Authors: Dilaveris Polychronis , Gialafos Elias , Poloniecki Jan , Hnatkova Katerina , Richter Dimitris , Andrikopoulos George , Lazaki Elena , Gialafos John , Malik Marek
Published: February 2009

Background: The heterogeneity of ventricular repolarization is an important proarrhythmic factor. QT dispersion has been proposed to reflect the inhomogeneity of ventricular repolarization, but a poor reproducibility limits its clinical applicability. Reliable noninvasive methods to quantify abnormalities in ventricular repolarization are still lacking. The T‐loop morphology analysis is a novel method aimed at quantifying ventricular repolarization.

Hypothesis: To test the ability of the T‐loop morphology analysis to discriminate between hypertensive patients and healthy subjects, 105 hypertensive patients (mean age 63.6 ± 12.3 years) and 110 healthy controls (mean age 49.7 ± 14.3 years) were evaluated.

Methods: The maximum QT interval (QT maximum), the minimum QT interval (QT minimum), and their difference (QT dispersion) were calculated from a digitally recorded 12‐lead electrocardiogram (ECG) in both study groups. X, Y, and Z leads were reconstructed from the 12‐lead ECG, and the amplitude of the maximum T vector (T amplitude) and the angle between the maximum T vector and X axis (T angle) were calculated from the projection of the T loop in the frontal plane.

Results: T amplitude (p < 0.001), T angle (p=0.05), and QT dispersion (p = 0.04) were significandy different between hypertensive patients and controls, while QT maximum (p = 0.14) and QT minimum (p = 0.35) did not differ between the groups. T amplitude was the only marker which differed between hypertensive patients without ECG criteria for left ventricular hypertrophy and controls (p = 0.002).

Conclusions: T‐loop features and particularly T amplitude are significantly different between hypertensive patients and healthy controls and may serve as early markers of repolarization abnormalities in a hypertensive population.
Influence of angiotensin‐converting enzyme gene polymorphism on development of athlete's heart
Authors: Nagashima Junzo , Musha Haruki , Takada Hideomi , Awaya Toru , Oba Haruo , Mori Narumi , Ohmiya Kazuto , Nobuoka Sachihiko , Murayama Masahiro
Published: February 2009

Background and hypothesis: Genetic influence on development of athlete's heart is uncertain. This study investigated whether angiotensin‐converting enzyme (ACE) gene polymorphism influenced development of athlete's heart.

Methods: Forty‐three participants in a 100‐km ultramarathon were classified on the basis of ACE gene polymorphism into a deletion group (n = 26) and an insertion group (n = 17). Echocardiograms were recorded to determine left ventricular end‐diastolic and end‐systolic diameters, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass, and ejection fraction.

Results: Left ventricular end‐diastolic diameter (65.5 ± 4.0 mm) and left ventricular mass (369.5 ± 73.9 g) were significantly larger in the subjects with deletion than in those with insertion (57.4 ± 4.2 mm, 306.5 ± 93.7 g). However, no significant differences in the other parameters were noted.

Conclusions: In long‐distance runners, ACE gene polymorphism of the D/D and D/I genotypes has a stronger influence on left ventricular hypertrophy than polymorphism of the I/I genotype.
DDD and single‐lead VDD pacing: Evaluation of atrial signal dynamic changes
Authors: Boriani Giuseppe , Biffi Mauro , Branzi Angelo , Bandini Alberto , Moracchini Pier Vittorio , Capucci Alessandro , Sigliano Riccardo , Mininno Antonio
Published: February 2009

Background: Single‐lead VDD pacing systems are an alternative to conventional DDD pacemakers in patients with atrioventricular (AV) block and normal sinus function.

Hypothesis: The aim of this study was to assess changes of P‐wave amplitude occurring in dynamic conditions in two groups of patients with a single‐lead VDD and with a DDD pacing system, respectively.

Methods: Twenty‐eight patients with second‐ or third‐degree AV block and normal sinus function were enrolled prospectively into the study. Seventeen patients were implanted with a single‐lead VDD pacing system and 11 with a DDD pacemaker. Patients were evaluated at 3 months (all patients) and at 6 months (26 patients) at supine and in dynamic conditions (postural changes, hyperventilation, and during exercise).

Results: Mean P‐wave values at supine were 1.92 ± 1.10 mV at 3 months and 1.76 ± 1.01 mV at 6 months for VDD systems, and 4.63 ± 2.18 mV at 3 months and 4.58 ± 2.80 mV at 6 months for DDD pacemakers. In dynamic conditions, P‐wave amplitude changes compared with supine condition ranged between —74 and +226% in VDD, and between —53 and +138% in DDD; however P‐wave amplitudes showed no significant changes compared with baseline. Moreover, changes in atrial signal amplitudes did not occur randomly, and in both systems P‐wave amplitudes remained significantly correlated with supine values.

Conclusions: A wide range of P‐wave amplitude variations occurs in different postural conditions or during exercise, both with single‐lead VDD and DDD pacing systems. However, with appropriate programming of atrial sensitivity based on supine values, constant atrial tracking can be maintained.
Effect of cibenzoline on regional left ventricular function in hypertrophic obstructive cardiomyopathy
Authors: Kondo Isao , Mlzusfflge Katsufumi , Nozaki Shiro , Hirao Kenichi , Iwado Yasuyoshi , Ohmori Koji , Matsuo Hirohide
Published: February 2009

Background: Cibenzoline, a class la antiarrhythmic drug, can be used to relieve left ventricular (LV) outflow obstruction in hypertrophic obstructive cardiomyopathy (HOCM). However, the mechanism of this agent in HOCM has been controversial.

Hypothesis: This study was designed to investigate the effect of cibenzoline on regional LV function and the acoustic properties in HOCM using ultrasonic integrated backscatter.

Methods: Ten patients with HOCM and 16 healthy volunteers were examined. In patients with HOCM, wall thickening (%WT) and the magnitude of cyclic variation of integrated backscatter (mag‐CVIBS) in the interventricular septum (IVS) and LV posterior wall were measured before and after oral administration of cibenzoline. To assess asynchrony of contractile elements, the phase difference between CVIBS and%WT were measured from the LV posterior wall. Pressure gradients at the LV outflow tract were estimated using continuous‐wave Doppler echocardiography.

Results: Although%WT decreased significantly in the LV posterior wall, %WT and mag‐CVIBS remained unchanged in the IVS. The phase difference in the LV posterior wall was significantly greater in patients with HOCM than in healthy volunteers (HOCM:healthy volunteers, 1.57 ± 0.23:1.00 ± 0.03, p < 0.001) at baseline. After administration of cibenzoline, the phase difference shifted to normal value (from 1.57 ± 0.23 to 1.28 ± 0.27, p = 0.0382), and pressure gradients at the LV outflow tract decreased (from 109 ± 55 to 58 ± 48 mmHg, p = 0.0063). Changes in pressure gradients at the LV outflow tract and the phase difference were closely related.

Conclusions: Regional function and the acoustic properties of myocardium in HOCM were altered by cibenzoline in the LV posterior wall but remained unchanged in the IVS. The normalization of the phase difference in the LV posterior wall was closely related to the decrease in pressure gradients at the LV outflow tract. These findings suggest that negative inotropic action and the improvement of asynchrony in the LV posterior wall rather than in the IVS may contribute to the reduction of pressure gradients at the LV outflow tract in HOCM.
Fast platelet suppression by lysine acetylsalicylate in chronic stable coronary patients. Potential clinical impact over regular aspirin for coronary syndromes
Authors: Gurfinkel Enrique P. , Altman Raul , Scazziota Alejandra , Heguilen Ricardo , Mautner Branco
Published: February 2009

Background: The rapid utilization of fibrinolytics following Q‐wave myocardial infarction has clearly modified the evolution of this disease. However, it is still not known whether the immediate inhibition of platelet aggregation (PA) during the coronary event improves outcomes.

Hypothesis: The present study was designed to test, in patients with known coronary artery disease (chronic stable angina), whether the particular kinetic pattern of lysine acetyl‐salicylate (LA) compared with aspirin may affect the time to onset of inhibition of platelet aggregation.

Methods: Ten patients suffering from chronic stable angina participated in this study to compare the efficacy and speed of the inhibition of PA with 320 mg of LA versus 320 mg of aspirin. All patients discontinued the use of aspirin and any other anti‐inflammatory agents for 15 days prior to the beginning of the study. They were randomly assigned to LA or aspirin. Blood specimens were obtained to measure the PA at admission, and 5,10,20,30, and 60 min after ingestion. Patients continued to take the assigned drug once a day for the following 4 days. On Day 5, a new blood sample was taken. After this, patients underwent a 15‐day wash‐out period, and then crossed over to the opposite drug. The samples were analyzed immediately using platelet‐rich plasma stimulated with adenosine diphosphate (ADP) 2 μmol/l, collagen 1 μg/ml, epinephrine 20 μmol/l, and sodium arachidonate acid 0.75 mm/l.

Results: The same level of PA inhibition after 30 and 60 min of aspirin administration can be obtained with LA 5 min following ingestion (sodium arachidonate acid: LA: 16.3 ± 25.9 vs. aspirin 57.6 ± 8.2; p = 0.00014; collagen: LA 18.9 ± 20.1 vs. aspirin 47.2 ± 10.5; p = 0.00092; ADP: LA 27.3 ± 18.4 vs. aspirin 39.7 ± 21.8, p = 0.18; epinephrine: LA 22.0 ± 9.9 vs. aspirin 55.4 ± 10.9, p = 0.00002.

Conclusions: Platelet aggregation inhibition immediately following LA may have significant clinical implications for the treatment of coronary syndromes.
Relationship between mean right atrial pressure and doppler parameters in patients with right ventricular infarction
Authors: Mattioli Anna Vittoria , Castelli Annadele , Mattioli Giorgio
Published: February 2009

Background: The incidence of an inferior left ventricular infarction involving the right ventricle is very high, ranging from 14 to 84%. Isolated right ventricular infarction accounts for < 3% of all cases of infarction.

Hypothesis: The aim of the present study was to assess the relationship between Doppler parameters of hepatic vein and tricuspid inflow, as well as mean right atrial (RA) pressure in patients with right ventricular infarction.

Methods: In all, 59 consecutive patients with inferior left ventricular infarction involving the right ventricle were selected for the study. All patients underwent Doppler echocardiographic evaluation of tricuspid and hepatic vein parameters and catheterization of the right side of the heart. Patients were divided into two groups according to the presence or absence of severe tricuspid regurgitation.

Results: In patients with severe tricuspid regurgitation, a significant correlation (r = 0.64; p < 0.001) between RA maximal volume and mean right atrial pressure (RAP) was found, and the sensitivity of RA maximal volume in identifying mean RAP > 7 mmHg was 64% with a specificity of 78%. In patients without severe tricuspid regurgitation, the most significant relationship was observed between mean RAP and inferior vena cava collapse index. Significant correlations between maximal and minimal diameters of the inferior vena cava were also observed.

Conclusions: Echocardiography and Doppler parameters may be useful for evaluating mean RAP in patients with right ventricular infarction. In patients with severe tricuspid regurgitation, the more important parameters are maximal and minimal RA volumes. In patients without severe tricuspid regurgitation together with right atrial volume, the important parameters are acceleration and deceleration time of the tricuspid inflow peak E velocity and hepatic systolic and diastolic venous flow.
Increased arterial wave reflection may predispose syncopal attacks
Authors: Chen Chen‐Huan , Hu Han‐Hwa , Lin Yao‐Ping , Chern Chang‐Ming , Hsu Tsei‐Lieh , Ding Philip Yu‐An
Published: February 2009

Background: The incidence of syncope increases with age, while aging is also associated with increased arterial wave reflection.

Hypothesis: The study was undertaken to determine whether increased arterial wave reflection is a predisposing factor of syncope.

Methods: We recruited 38 patients (28 men and 10 women, mean age 57.2 ± 20.3 years, range 17–87 years) with a history of syncope within 6 months of entry. The etiology of syncope was documented for each patient by a complete assessment of vasomotor function and cerebral flow. All patients received a comprehensive echocardiographic evaluation of cardiac structure and function. Carotid augmentation index (AI) was estimated noninvasively with the tonometry technique. The results were compared with those from 54 age‐and gender‐matched controls.

Results: The most frequent diagnoses of syncope were postural hypotension (13 patients) and cerebrovascular dy sauto‐regulation (10 patients), and the cause could not be determined in 9 patients. Compared with the control group, the syncope group had a greater AI (20 ± 21 vs. 10 ± 15%, p = 0.013). Subgroup analysis of 20 patients aged > 50 years and with the aforementioned diagnoses showed even more striking results: AI, 29 ± 10 vs. 11 ± 15%, p < 0.001. The enhanced augmentation in the patients remained when age, systolic blood pressure, height, and heart rate were accounted for. Analysis of the carotid pulse wave suggested that both the timing and intensity of wave reflection were enhanced in patients with a history of syncope compared with controls.

Conclusions: Our results support the hypothesis that enhanced arterial wave reflection is associated with the occurrence of syncope, especially in the elderly.
Predictors of ventricular tachycardia recurrence in 100 patients receiving tiered therapy defibrillators
Authors: Costeas Xenophon F. , Link Mark S. , Foote Caroline B. , Homoud Müunther K. , Wang Paul J. , Estes III N. A. Mark
Published: February 2009

Background and hypothesis: Programmed electrical stimulation (PES) is a time‐honored diagnostic tool in patients with ventricular tachyarrhythmias. The response to PES can be used to assess efficacy of pharmacologic or electrical therapy, as well as to obtain prognostic information. Reproducible induction of ventricular tachycardia with invasive electrophysiologic testing, or stimulation through defibrillator lead systems, can help optimize antiarrhythmic drug therapy and device programming during clinical follow‐up.

Methods: We present our experience with 100 patients who had inducible sustained monomorphic ventricular tachycardia (SMVT) during invasive PES at baseline, and received a third‐generation implantable cardioverter‐defibrillator (ICD) alone, or in combination with antiarrhythmic drug therapy. Noninvasive programmed stimulation (NIPS) was performed prior to hospital discharge in 61 patients.

Results: The inducibility of SMVT was concordant between the invasive study and NIPS in a subgroup of 40 (82%) patients who had invasive PES on the same drug regimen. During a mean follow‐up of 16 months, there were 12 nonar‐rhythmic deaths and recurrence of spontaneous SMVT in 36 (40%) of the surviving patients. Using a Cox proportional hazards model, the following variables were associated with early arrhythmia recurrence: persistent inducibility of SMVT during the MPS session (relative risk 11, range 2.6–47); induction of SMVT with a cycle length > 280 ms during invasive baseline PES (2.5, 1.2–5) and presence of prior inferior myocardial infarction (2.1, 1–4.2). Timing to initial recurrence of spontaneous tachycardia was unaffected by other clinical variables or concomitant antiarrhythmic drug use.

Conclusion: Programmed electrical stimulation techniques offer insight into the patterns of spontaneous ventricular tachycardia recurrence and have significant practical utility in the management of patients receiving third‐generation ICDs.
Effect of Heart Failure Program on Cardiovascular Drug Utilization and Dosage in Patients with Chronic Heart Failure
Authors: Ramahi Tarik M. , Longo Marcella D. , Rohlfs Kate , Sheynberg Natalie
Published: February 2009

Background: Utilization and dosage of angiotensin‐converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF) remain low. Recent data suggest that care of patients with CHF in specialized heart failure programs is associated with improved clinical outcomes.

Hypothesis: Specialized heart failure care is associated with better utilization and higher dose of cardiovascular drugs.

Methods: Data from 133 patients with CHF referred to a heart failure program were analyzed. Mean functional class 3.1 ± 0.5, left ventricular ejection fraction 19 ± 8. Utilization and doses of cardiovascular drugs were examined at initial evaluation and at last visit, after an average period of 17 ± 14 months. Hospitalization and survival data were determined.

Results: Utilization of ACE inhibitors and angiotensin‐receptor blockers increased from 87 to 100% (p< 0.001). Average daily dose increased by 60%, from the equivalent of captopril 105 ± 78 mg to 167 ± 86 mg (p < 0.001). Utilization of the following drugs increased significantly: beta blockers (16–37%, p< 0.001), metolazone (10–23%, p = 0.007), spironolactone (l‐36%, p<0.001), amiodarone (7–15%, p=0.05), hydralazine (1–9%, p = 0.004), and nitrates (20–33%, p = 0.03). One‐year survival was 90%. The 3‐ and 6‐month hospitalization rates for heart failure were 4 and 7%, and for all cardiovascular causes they were 6 and 11%, respectively.

Conclusions: Care of patients with CHF in a specialized heart failure program was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was also associated with excellent clinical outcomes.
Clinical Significance of Brain Natriuretic Peptide in Patients with Postmyocardial Infarction
Authors: Bettencourt Paulo , Ferreira António , Pereira Margarida , Pardal‐Oliveira Nuno , Queir ós ConceiçãO , Ara újo Vitor , Cerqueira‐Gomes MÁRio , Maciel Maria JÚLia
Published: February 2009

Background: Risk stratification after acute myocardial infarction (AMI) includes the evaluation of left ventricular (LV) function. Natriuretic peptides, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI.

Hypothesis: Brain natriuretic peptide levels are related to ventricular function, either systolic or isolated diastolic, and can give prognostic information in patients surviving AMI.

Methods: In all, 101 patients were enrolled. An echocardiographic (M‐mode, two‐dimensional, and pulsed Doppler) evaluation was performed and blood samples for BNP measurement were obtained. Clinical events were recorded during 12 months of follow‐up.

Results: A negative correlation between BNP and LV ejection fraction was observed (r= ‐0.38; p<0.001). The BNP levels were higher among patients with LV systolic dysfunction than in patients with isolated diastolic dysfunction (339.1 ± 249.9 vs. 168.0 ± 110.5 pg/ml, p = 0.001). The latter had higher levels of BNP than those with normal LV function (68.3 ± 72.6 pg/ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was good (area under the ROC curve [AUC] = 0.83) and increased when isolated diastolic dysfunction was also considered (AUC = 0.87). Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the development of heart failure (AUC = 0.90).

Conclusion: These results extend previous evidence relating BNP to systolic function after AMI. Furthermore, a relationship between BNP levels and diastolic function was found. Brain natriuretic peptide had a very good performance in detecting the occurrence of an adverse event. We conclude that BNP can detect high‐risk patients and help select patients for more aggressive approaches.
A history of iron deficiency anemia during infancy alters brain monoamine activity later in juvenile monkeys
Authors: Coe Christopher L. , Lubach Gabriele R. , Bianco Laura , Beard John L.
Published: February 2009

Both during and after a period of iron deficiency (ID), iron‐dependent neural processes are affected, which raises the potential concern that the anemia commonly experienced by many growing infants could have a protracted effect on the developing brain. To further investigate the effects of ID on the immature brain, 49 infant rhesus monkeys were evaluated across the first year of life. The mothers, and subsequently the infants after weaning, were maintained on a standardized diet containing 180 mg/kg of iron and were not provided other iron‐rich foods as treats or supplements. As the infants grew, they were all screened with hematological tests, which documented that 16 (33.3%) became markedly ID between 4 and 8 months of age. During this anemic period and subsequently at 1 year of age, cerebrospinal fluid (CSF) specimens were collected to compare monoamine activity in the ID and iron‐sufficient infants. Monoamine neurotransmitters and metabolite levels were normal at 4 and 8 months of age, but by 1 year the formerly anemic monkeys had significantly lower dopamine and significantly higher norepinephrine levels. These findings indicate that ID can affect the developmental trajectory of these two important neurotransmitter systems, which are associated with emotionality and behavioral performance, and further that the impact in the young monkey was most evident during the period of recovery. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 301–309, 2009
Enantiospecific Assembly of a Homochiral, Hexanuclear Palladium Complex
Authors: Colquhoun Howard M. , Powell C. Timothy , Zhu Zhixue , Cardin Christine J. , Gan Yu , Tootell Paula , Tsang Josephine S. W. , Boag Neil M.
Published: February 2009

The linking of orthopalladated ferrocenylene units by parabanato(2–) ligands results in enantiospecific assembly of a hexanuclear complex in which (i) the steric bulk of the ferrocenylene moiety, (ii) the folded configuration dictated by the imidato(2–) bridging ligand, and (iii) the strong preference for a trans arrangement of the carbonyl oxygen and ferrocenyl carbon atoms, combine to ensure that only ferrocenylene‐palladium units with the same chirality can be located at adjacent positions in the assembled complex. The resulting tris‐parabanato(2–)‐bridged, hexapalladium complex is thus homochiral (R,R,R,R,R,R or S,S,S,S,S,S), as demonstrated by 1H NMR spectroscopy and by X‐ray analysis of a racemic crystal which shows the complex to possess a tapering, twisted, trigonal‐prismatic skeleton of palladium atoms with threefold crystallographic symmetry.(© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009)
Structure of the Core Region from the Lipopolysaccharide of Plesiomonas shigelloides Strain 302‐73 (Serotype O1)
Authors: Pieretti Giuseppina , Corsaro M. Michela , Lanzetta Rosa , Parrilli Michelangelo , Vilches Silvia , Merino Susana , Tomás Juan M.
Published: February 2009

Plesiomonas shigelloides is a Gram‐negative pathogenic bacterium belonging to the Enterobacteriaceae family. To date, only few lipopolysaccharide (LPS) structures from P. shigelloides strains are known. In particular, three core oligosaccharides have been found. Recently, we elucidated the structure of the O‐antigen of P. shigelloides 302‐73 (serotype O1) and in this paper we present the characterization of the core structure from the LPS of the same strain. The LPS was hydrolyzed under both alkaline and mildly acidic conditions. In both cases, a mixture of oligosaccharides was obtained, which was purified by gel filtration and HPAEC. The oligosaccharides were characterized by chemical analysis, 2D NMR spectroscopy and MALDI‐TOF mass spectrometry. A new core structure was found for P. shigelloides. In particular, from the analysis of the acid hydrolysed product it was possible to reveal the presence of a of D‐glycero‐D‐talo‐2‐octulopyranosonic acid (Ko) residue, which substitutes in part the terminal 3‐deoxy‐D‐manno‐oct‐2‐ulosonic acid (Kdo) unit. The Ko residue is not frequently found in core structures.(© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009)
Damage identification of a 3D full scale steel–concrete composite structure with partial‐strength joints at different pseudo‐dynamic load levels
Authors: Molinari M. , Savadkoohi A. T. , Bursi O. S. , Friswell M. I. , Zonta D.
Published: February 2009

Partial‐strength composite steel–concrete moment‐resisting (MR) frame structures represent an open research field in seismic design from both a theoretical and an experimental standpoint. Among experimental techniques, vibration testing is a well‐known and powerful technique for damage detection, localization and quantification, where actual modal parameters of a structure at different states can be determined from test data by using system identification methods. However, the identification of semi‐rigid connections in framed structures is limited, and hence this paper focuses on a series of vibration experiments that were carried out on a realistic MR frame structure, following the application of pseudo‐dynamic and quasi‐static cyclic loadings at the European laboratory for structural assessment of the Joint Research Centre at Ispra, Italy, with the scope of understanding the structural behaviour and identifying changes in the dynamic response. From the forced vibration response, natural frequencies, damping ratios, modal displacements and rotations were extracted using the circle fitting technique. These modal parameters were used for local and global damage identification by updating a 3D finite element model of the intact structure. The identified results were then correlated with observations performed on the structure to understand further the underlying damage mechanisms. Finally, the latin hypercube sampling technique, a variant of the Monte Carlo method, was employed in order to study the sensitivity of the updated parameters of the 3D model to noise on the modal inputs. Copyright © 2009 John Wiley & Sons, Ltd.
Enhancing objective evaluation of speech quality algorithm: current efforts, limitations and future directions
Authors: Lee Wonsuck , Lee Minkyu , McGowan Jim
Published: February 2009

We discuss a performance improvement over the current state‐of‐the‐art objective speech quality assessment algorithm by means of a parameter study. The state‐of‐the‐art algorithm computes a certain measure of disturbances surface, and applies a cognitive model to map the computed value to the scale used mean opinion score (MOS). We note that many parameters, including the used metric of Lp space, do not appear to be robust enough in terms of the performance of the algorithm. First, we search for optimum Lp‐norms over the frequency‐‐time domain disturbance surface. The optimum Lp‐norms yield the most desirable correspondence between symmetric/asymmetric disturbance terms and subjective scores. New features are added to the cognitive processing algorithm. Improvements are substantial, but still only incrementally improve the performance. Limitations and bottlenecks of the current standardised approaches, as well as emerging new ideas, are reviewed. Finally, we call for more innovative, rather than renovative, research efforts in objective speech quality measurement for fundamental enhancement of the algorithm. Copyright © 2009 John Wiley & Sons, Ltd.
Hepatitis B virus X protein enhances the transcriptional activity of the androgen receptor through c-Src and glycogen synthase kinase-3β kinase pathways #
Authors: Yang Wan-Jen , Chang Ching-Ju , Yeh Shiou-Hwei , Lin Wei-Hsiang , Wang Sheng-Han , Tsai Ting-Fen , Chen Ding-Shinn , Chen Pei-Jer
Published: February 2009

Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) occurs predominantly in men. By enhancing the transcriptional activity of the androgen receptor (AR) gene in a ligand-dependent manner, the HBV X protein (HBx) might contribute to this disparity between sexes. To dissect the mechanisms underlying HBx-enhanced AR transactivation, we investigated the effect of HBx on two critical steps in the regulation of ligand-stimulated AR activities. One step is the dimerization of AR (through the interaction of its N-termini and C-termini), and the other step is the activation of the AR N-terminal transactivation domain (NTD). HBx increased the NTD activation of the AR through c-Src kinase. HBx also enhanced AR dimerization by inhibiting glycogen synthase kinase-3β (GSK-3β) activity, which acts as a negative regulator of the interaction between AR and the N-termini and C-termini. The HBx-enhanced AR transactivation was abolished by blocking c-Src and activating GSK-3β kinases simultaneously, suggesting that these two kinases act as major switches in the activation process. The regulatory function of both kinases has been further verified in primary hepatocytes isolated from the livers of HBx transgenic male mice. Conclusion: Our study thus identified two key kinases through which HBx enhances the AR transcriptional activity. These kinases might be potential candidates for future prevention or therapy for HBV-related HCC in men. (Hepatology 2009.)
The cyclophilin inhibitor Debio 025 combined with PEG IFNα2a significantly reduces viral load in treatment-naïve hepatitis C patients #
Authors: Flisiak Robert , Feinman Saya V. , Jablkowski Maciej , Horban Andrzej , Kryczka Wieslaw , Pawlowska Małgorzata , Heathcote Jenny E. , Mazzella Giuseppe , Vandelli Carmen , Nicolas-Métral Valérie , Grosgurin Pierre , Liz Jorge S. , Scalfaro Pietro , Porchet Hervé , Crabbé Raf
Published: February 2009

The anti–hepatitis C virus (HCV) effect and safety of three different oral doses of the cyclophilin inhibitor Debio 025 in combination with pegylated interferon-α2a (PEG IFN-α2a) were investigated in a multicenter, randomized, double-blind, placebo-controlled escalating dose-ranging phase II study in treatment-naïve patients with chronic hepatitis C. Doses of 200, 600, and 1,000 mg/day Debio 025 in combination with PEG IFN-α2a 180 μg/week for 4 weeks were compared with monotherapy with either 1,000 mg/day Debio 025 or 180 μg/week PEG IFN-α2a. In patients with genotypes 1 and 4, the 600- and 1,000-mg combination treatments induced a continuous decay in viral load that reached −4.61 ± 1.88 and −4.75 ± 2.19 log10 IU/mL at week 4, respectively. In patients with genotypes 2 and 3, HCV RNA levels at week 4 were reduced by −5.91 ± 1.11 and −5.89 ± 0.43 log10 IU/mL, respectively, with the same treatment regimens. Adverse events were comparable between treatment groups apart from a higher incidence of neutropenia associated with PEG IFN-α2a and an increased incidence of isolated hyperbilirubinemia at the highest dose of Debio 025 (1,000 mg/day). Conclusion: These results confirm that Debio 025 has a potent activity and an additive effect on HCV RNA reduction in genotype 1 and 4 patients at 600 and 1,000 mg/day when combined with PEG IFN-α2a. (Hepatology 2009.)
Rho-kinase 2 is frequently overexpressed in hepatocellular carcinoma and involved in tumor invasion #
Authors: Wong Carmen Chak-Lui , Wong Chun-Ming , Tung Edmund Kwok-Kwan , Man Kwan , Ng Irene Oi-Lin
Published: February 2009

Deregulation of Rho family small guanosine triphosphatases has been implicated in human carcinogenesis. Rho-kinases are downstream effectors of Rho guanosine triphosphatases in the regulation of cytoskeletal reorganization and cell motility. However, their functions in human cancers remain elusive. In this study, we aimed to investigate the role of Rho-kinases in hepatocellular carcinoma (HCC) tumor progression and invasion. We first examined the expression of the two Rho-kinases (ROCK1 and ROCK2) in human HCC, and found that ROCK2 was frequently overexpressed in primary HCCs (22/41 [53.66%]). Clinico-pathological analysis revealed that overexpression of ROCK2 was significantly associated with the presence of tumor microsatellite formation (P = 0.005), suggesting that deregulation of ROCK2 may contribute to the intrahepatic metastasis of HCC. Consistently, we demonstrated that stable overexpression of ROCK2 significantly enhanced cell motility and invasiveness in HCC cells. Conversely, stable knockdown of ROCK2 by short hairpin RNA approach remarkably reduced HCC cell migration and invasion. Moreover, orthotopic liver xenograft models provided further support that stable knockdown of ROCK2 suppressed HCC invasion in vivo. Stable knockdown of ROCK2 in HCC cells significantly inhibited Golgi reorientation, myosin phosphatase phosphorylation, and formations of stress fibers, filopodia, and lamellipodia; these molecular and cellular events are crucial for cell motility and cancer invasion. Conclusion: Our results indicate that ROCK2 was overexpressed in human HCCs, and this overexpression was associated with a more aggressive biological behavior. Our findings also demonstrate that ROCK2 played a significant role in regulating cytoskeletal events and contributed to the invasion of HCC. (Hepatology 2009.)
Occurrence of phthalate esters in the Seine River estuary (France)
Authors: Dargnat C. , Blanchard M. , Chevreuil M. , Teil M. J.
Published: February 2009

The rigin and fate of six phthalate esters (dimethyl phthalate (DMP), diethyl phthalate (DEP), di‐n‐butyl phthalate (DnBP), butyl benzyl phthalate (BBP), di (2‐ethylhexyl) phthalate (DEHP) and di‐n‐octyl phthalate (DnOP)), were investigated during 2005 and 2006 in the densely populated Seine river estuary. Four compounds, DMP, DEP, DnBP and DEHP were detected at all the stations with DEHP (160–314 ng L−1), followed by DEP (71–181 ng L−1) and next DnBP (67–319 ng L−1), except at la Bouille, where DnBP was the second most important compound. BBP and DnOP concentrations remained low and were not found at all the stations. Considering all six phthalates, Caudebec‐en‐Caux (beginning of the salinity gradient) was the least polluted station (464 ng L−1), whereas Honfleur (771 ng L−1) and La Bouille (716 ng L−1) displayed the highest contamination levels, probably related to important industrial plants. From Caudebec‐en‐Caux to Honfleur (maximum turbidity), variation of DEHP concentration was related to that of suspended matter. In addition, the salinity rise in that area might have facilitated DEHP sorption upon particles. A significant correlation between flow magnitude and DEHP concentration was found (P < 0·01, n = 12), supporting the influence of the hydrological cycle upon contamination. Runoff contribution (56·9 kg d−1) to river contamination was confirmed by the annual evolution of phthalate concentrations in the Seine river at Poses. Concentrations of DEHP in the tributaries were in the same range as those of the Seine River (100–350 ng L−1), except for two in densely populated and industrialized areas: Robec (800 ng L−1) and Cailly (970 ng L−1). The treatment plant discharge fluxes were in the same range as those of tributaries (30·4–250 g d−1). During high flow periods, the influence of tributaries and of treatment plants seemed to play a minor part in the contamination level of the Seine river estuary. Copyright © 2009 John Wiley & Sons, Ltd.
Simulating hydrologic and hydraulic processes throughout the Amazon River Basin
Authors: Beighley R. E. , Eggert K. G. , Dunne T. , He Y. , Gummadi V. , Verdin K. L.
Published: February 2009

Presented here is a model framework based on a land surface topography that can be represented with various degrees of resolution and capable of providing representative channel/floodplain hydraulic characteristics on a daily to hourly scale. The framework integrates two models: (1) a water balance model (WBM) for the vertical fluxes and stores of water in and through the canopy and soil layers based on the conservation of mass and energy, and (2) a routing model for the horizontal routing of surface and subsurface runoff and channel and floodplain waters based on kinematic and diffusion wave methodologies. The WBM is driven by satellite‐derived precipitation (TRMM_3B42) and air temperature (MOD08_M3). The model's use of an irregular computational grid is intended to facilitate parallel processing for applications to continental and global scales. Results are presented for the Amazon Basin over the period Jan 2001 through Dec 2005. The model is shown to capture annual runoff totals, annual peaks, seasonal patterns, and daily fluctuations over a range of spatial scales (>1, 000 to < 4·7M km2). For the period of study, results suggest basin‐wide total water storage changes in the Amazon vary by approximately + /− 5 to 10 cm, and the fractional components accounting for these changes are: root zone soil moisture (20%), subsurface water being routed laterally to channels (40%) and channel/floodplain discharge (40%). Annual variability in monthly water storage changes by + /− 2·5 cm is likely due to 0·5 to 1 month variability in the arrival of significant rainfall periods throughout the basin. Copyright © 2009 John Wiley & Sons, Ltd.
Integration of remote sensing and GIS for modelling flash floods in Wadi Hudain catchment, Egypt
Authors: El Bastawesy Mohammed , White Kevin , Nasr Ayman
Published: February 2009

This paper presents a new approach to modelling flash floods in dryland catchments by integrating remote sensing and digital elevation model (DEM) data in a geographical information system (GIS). The spectral reflectance of channels affected by recent flash floods exhibit a marked increase, due to the deposition of fine sediments in these channels as the flood recedes. This allows the parts of a catchment that have been affected by a recent flood event to be discriminated from unaffected parts, using a time series of Landsat images. Using images of the Wadi Hudain catchment in southern Egypt, the hillslope areas contributing flow were inferred for different flood events. The SRTM3 DEM was used to derive flow direction, flow length, active channel cross‐sectional areas and slope. The Manning Equation was used to estimate the channel flow velocities, and hence the time‐area zones of the catchment. A channel reach that was active during a 1985 runoff event, that does not receive any tributary flow, was used to estimate a transmission loss rate of 7·5 mm h−1, given the maximum peak discharge estimate. Runoff patterns resulting from different flood events are quite variable; however the southern part of the catchment appears to have experienced more floods during the period of study (1984–2000), perhaps because the bedrock hillslopes in this area are more effective at runoff production than other parts of the catchment which are underlain by unconsolidated Quaternary sands and gravels. Due to high transmission loss, runoff generated within the upper reaches is rarely delivered to the alluvial fan and Shalateen city situated at the catchment outlet. The synthetic GIS‐based time area zones, on their own, cannot be relied on to model the hydrographs reliably; physical parameters, such as rainfall intensity, distribution, and transmission loss, must also be considered. Copyright © 2009 John Wiley & Sons, Ltd.
Surface engineering: A low wearing solution for metal‐on‐metal hip surface replacements
Authors: Leslie Ian J. , Williams Sophie , Brown Chris , Anderson James , Isaac Graham , Hatto Peter , Ingham Eileen , Fisher John
Published: February 2009

Increased patient blood and serum levels of Co and Cr and dissemination of metal wear particles throughout organs and tissues are the primary concerns with metal‐on‐metal surface replacements. Surface engineering, providing a ceramic bearing surface on a metal substrate, could provide a solution. This study investigated thick (>10 μm) arc evaporation plasma vapor deposition chromium nitride (CrN) coated surface replacements in terms of wear, ion levels, and wear particles in a 10 million cycle hip simulator study, compared to a contemporary metal‐on‐metal surface replacement. The ion levels were measured by inductively coupled plasma mass spectroscopy. The wear particles were imaged by field emission gun scanning electron microscopy. The CrN‐coated bearings had 80% lower wear than the MoM controls. The Cr and Co ion levels in the lubricant of the CrN bearings were 73 and 98% lower than in the MoM controls. The wear particles produced were in the nanometer size range and round to oval in morphology. The CrN coating could provide a reduction in the wear and ion release of MoM surface replacements, thereby reducing the perceived risks to the patient associated with these prostheses. © 2009 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2009