bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertensive Heart Failure in Nigerian Africans: Insights from the Abeokuta Heart Failure Registry
Authors: Ogah Okechukwu S. , Sliwa Karen , Akinyemi Joshua O. , Falase Ayodele O. , Stewart Simon
Published: February 2015

Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short‐ and medium‐term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5–21) while intra‐hospital mortality was 3.4%. The 30‐day, 90‐day, and 180‐day mortality rates were 0.9% (95% confidence interval, −0.2 to 3.5), 3.5% (95% confidence interval, −1.7 to 7.3), and 11.7% (95% confidence interval, −7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, −1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in‐hospital mortality.
Targeting lung cancer stem‐like cells with TRAIL gene armed oncolytic adenovirus
Authors: Yang Yu , Xu Haineng , Huang Weidan , Ding Miao , Xiao Jing , Yang Dongmei , Li Huaguang , Liu Xin‐Yuan , Chu Liang
Published: February 2015

Lung cancer stem cell (LCSC) is critical in cancer initiation, progression, drug resistance and relapse. Disadvantages showed in conventional lung cancer therapy probably because of its existence. In this study, lung cancer cell line A549 cells propagated as spheroid bodies (named as A549 sphere cells) in growth factors‐defined serum‐free medium. A549 sphere cells displayed CSC properties, including chemo‐resistance, increased proportion of G0/G1 cells, slower proliferation rate, ability of differentiation and enhanced tumour formation ability in vivo. Oncolytic adenovirus ZD55 carrying EGFP gene, ZD55‐EGFP, infected A549 sphere cells and inhibited cell growth. Tumour necrosis factor‐related apoptosis‐inducing ligand (TRAIL) armed oncolytic adenovirus, ZD55‐TRAIL, exhibited enhanced cytotoxicity and induced A549 sphere cells apoptosis through mitochondrial pathway. Moreover, small molecules embelin, LY294002 and resveratrol improved the cytotoxicity of ZD55‐TRAIL. In the A549 sphere cells xenograft models, ZD55‐TRAIL significantly inhibited tumour growth and improved survival status of mice. These results suggested that gene armed oncolytic adenovirus is a potential approach for lung cancer therapy through targeting LCSCs.
Protective effect of heme oxygenase induction in ethinylestradiol‐induced cholestasis
Authors: Muchova Lucie , Vanova Katerina , Suk Jakub , Micuda Stanislav , Dolezelova Eva , Fuksa Leos , Cerny Dalibor , Farghali Hassan , Zelenkova Miroslava , Lenicek Martin , Wong Ronald J. , Vreman Hendrik J. , Vitek Libor
Published: February 2015

Estrogen‐induced cholestasis is characterized by impaired hepatic uptake and biliary bile acids secretion because of changes in hepatocyte transporter expression. The induction of heme oxygenase‐1 (HMOX1), the inducible isozyme in heme catabolism, is mediated via the Bach1/Nrf2 pathway, and protects livers from toxic, oxidative and inflammatory insults. However, its role in cholestasis remains unknown. Here, we investigated the effects of HMOX1 induction by heme on ethinylestradiol‐induced cholestasis and possible underlying mechanisms. Wistar rats were given ethinylestradiol (5 mg/kg s.c.) for 5 days. HMOX1 was induced by heme (15 μmol/kg i.p.) 24 hrs prior to ethinylestradiol. Serum cholestatic markers, hepatocyte and renal membrane transporter expression, and biliary and urinary bile acids excretion were quantified. Ethinylestradiol significantly increased cholestatic markers (P ≤ 0.01), decreased biliary bile acid excretion (39%, P = 0.01), down‐regulated hepatocyte transporters (Ntcp/Oatp1b2/Oatp1a4/Mrp2, P ≤ 0.05), and up‐regulated Mrp3 (348%, P ≤ 0.05). Heme pre‐treatment normalized cholestatic markers, increased biliary bile acid excretion (167%, P ≤ 0.05) and up‐regulated hepatocyte transporter expression. Moreover, heme induced Mrp3 expression in control (319%, P ≤ 0.05) and ethinylestradiol‐treated rats (512%, P ≤ 0.05). In primary rat hepatocytes, Nrf2 silencing completely abolished heme‐induced Mrp3 expression. Additionally, heme significantly increased urinary bile acid clearance via up‐regulation (Mrp2/Mrp4) or down‐regulation (Mrp3) of renal transporters (P ≤ 0.05). We conclude that HMOX1 induction by heme increases hepatocyte transporter expression, subsequently stimulating bile flow in cholestasis. Also, heme stimulates hepatic Mrp3 expression via a Nrf2‐dependent mechanism. Bile acids transported by Mrp3 to the plasma are highly cleared into the urine, resulting in normal plasma bile acid levels. Thus, HMOX1 induction may be a potential therapeutic strategy for the treatment of ethinylestradiol‐induced cholestasis.
Autophagy modulates the effects of bis‐anthracycline WP631 on p53‐deficient prostate cancer cells
Authors: Mansilla Sylvia , Vizcaíno Carolina , Rodríguez‐Sánchez Maria A. , Priebe Waldemar , Portugal José
Published: February 2015

Treatment of p53‐deficient PC‐3 human prostate carcinoma cells with nanomolar concentrations of bis‐anthracycline WP631 induced changes in gene expression, which resulted in G2/M cell cycle arrest, autophagy and cell death. The presence of 2‐deoxy‐D‐glucose (2‐DG), which induces metabolic stress and autophagy, enhanced the antiproliferative effects of WP631. Changes induced by WP631, 2‐DG, or co‐treatments with both compounds, in the expression of a variety of genes involved in autophagy and apoptosis were quantified by real‐time PCR. They were consistent with a raise in autophagy followed by cell death. Some cells dying from G2/M phase showed features of necrosis like early changes in membrane permeability, while others were dying by apoptosis that occurred in presence of little caspase‐3 activity. Our results indicate that WP631 is not only an antiproliferative agent acting on gene transcription, but it can also induce autophagy regardless of the presence of other pro‐autophagy stimuli. The development of autophagy seemed to improve the cytotoxicity of WP631 in PC‐3 cells. Our results indicate that autophagy would enhance the activity of DNA‐binding drugs like WP631 that are potent inhibitors of gene transcription.
β‐PIX controls intracellular viscoelasticity to regulate lung cancer cell migration
Authors: Yu Helen Wenshin , Chen Yin‐Quan , Huang Chi‐Ming , Liu Ching‐Yi , Chiou Arthur , Wang Yang‐Kao , Tang Ming‐Jer , Kuo Jean‐Cheng
Published: February 2015

Cancer metastasis occurs via a progress involving abnormal cell migration. Cell migration, a dynamic physical process, is controlled by the cytoskeletal system, which includes the dynamics of actin organization and cellular adhesive organelles, focal adhesions (FAs). However, it is not known whether the organization of actin cytoskeletal system has a regulatory role in the physiologically relevant aspects of cancer metastasis. In the present studies, it was found that lung adenocarcinoma cells isolated from the secondary lung cancer of the lymph nodes, H1299 cells, show specific dynamics in terms of the actin cytoskeleton and FAs. This results in a higher level of mobility and this is regulated by an immature FA component, β‐PIX (PAK‐interacting exchange factor‐β). In H1299 cells, β‐PIX's activity was found not to be down‐regulated by sequestration onto stress fibres, as the cells did not bundle actin filaments into stress fibres. Thus, β‐PIX mainly remained localized at FAs, which allowed maturation of nascent adhesions into focal complexes; this resulted in actin polymerization, increased actin network integrity, changes in the intracellular microrheology at the peripheral of the cell, and cell polarity, which in turn regulated cell migration. Perturbation of β‐PIX caused an inhibition of cell migration, including migration velocity, accumulated distance and directional persistence. Our results demonstrate the importance of β‐PIX to the regulation of high mobility of lung adenocarcinoma cell line H1299 and that this occurs via regulation of FA dynamics, changes in actin cytoskeleton organization and cell polarity.
Protease‐activated receptor (PAR)‐2 is required for PAR‐1 signalling in pulmonary fibrosis
Authors: Lin Cong , von der Thüsen Jan , Daalhuisen Joost , ten Brink Marieke , Crestani Bruno , van der Poll Tom , Borensztajn Keren , Spek C. Arnold
Published: February 2015

Idiopathic pulmonary fibrosis is the most devastating diffuse fibrosing lung disease of unknown aetiology. Compelling evidence suggests that both protease‐activated receptor (PAR)‐1 and PAR‐2 participate in the development of pulmonary fibrosis. Previous studies have shown that bleomycin‐induced lung fibrosis is diminished in both PAR‐1 and PAR‐2 deficient mice. We thus have been suggested that combined inactivation of PAR‐1 and PAR‐2 would be more effective in blocking pulmonary fibrosis. Human and murine fibroblasts were stimulated with PAR‐1 and PAR‐2 agonists in the absence or presence of specific PAR‐1 or PAR‐2 antagonists after which fibrotic markers like collagen and smooth muscle actin were analysed by Western blot. Pulmonary fibrosis was induced by intranasal instillation of bleomycin into wild‐type and PAR‐2 deficient mice with or without a specific PAR‐1 antagonist (P1pal‐12). Fibrosis was assessed by hydroxyproline quantification and (immuno)histochemical analysis. We show that specific PAR‐1 and/or PAR‐2 activating proteases induce fibroblast migration, differentiation and extracellular matrix production. Interestingly, however, combined activation of PAR‐1 and PAR‐2 did not show any additive effects on these pro‐fibrotic responses. Strikingly, PAR‐2 deficiency as well as pharmacological PAR‐1 inhibition reduced bleomycin‐induced pulmonary fibrosis to a similar extent. PAR‐1 inhibition in PAR‐2 deficient mice did not further diminish bleomycin‐induced pulmonary fibrosis. Finally, we show that the PAR‐1‐dependent pro‐fibrotic responses are inhibited by the PAR‐2 specific antagonist. Targeting PAR‐1 and PAR‐2 simultaneously is not superior to targeting either receptor alone in bleomycin‐induced pulmonary fibrosis. We postulate that the pro‐fibrotic effects of PAR‐1 require the presence of PAR‐2.
Thermal stress in Arctic charrSalvelinus alpinusbroodstock: a 28 year case study
Authors: Jeuthe H. , Brännäs E. , Nilsson J
Published: February 2015

Temperature and egg viability data from an Arctic charrSalvelinus alpinushatchery covering a period of 28 years were analysed. During the study period, there was a significant increase in the mean water temperature in May, July, August and September ofc.2° C. Independent of year, the egg viability showed a negative correlation with the mean monthly temperatures in July, August and September as well as with the temperature difference between October and November. The negative effect of high summer temperatures was further supported by a comparison of egg viability from replicate broodstock reared at two sites differing mainly in summer water temperature. The eggs from the colder site were, on average, significantly larger (4·4 mm compared with 4·0 mm) and had higher hatching rates (57% compared with 37%). These results suggest that unfavourable temperature conditions during the summer and autumn can explain much of the excessive egg mortality experienced at the main facility used for the SwedishS. alpinusbreeding programme. The main effect was supra‐optimal temperatures during the period July to September, but there also appears to have been an effect from the temperature regime before and during spawning (October to November) that was unrelated to the summer temperatures. These findings emphasize the importance of site selection and sustainable management of aquaculture hatcheries in the light of the ongoing climate change.
Reaction Kinetics of Ozone Gas in Paddy Grains
Authors: Pandiselvam Ravi , Thirupathi Venkatachalam , Anandakumar S.
Published: February 2015

The present study was carried out to evaluate the effect of ozone on paddy grains in an airtight acrylic bin with the following three aspects: saturation time, decomposition kinetics and half‐life of ozone. Experiments were performed in different bed thickness (5 and 10 cm) and moisture content (11.2 and 14.3% w.b.) at atmospheric condition. The lowest saturation time of ozone was 71 min with concentration of 773 ppm for paddy grains ozonated at 5 cm bed thickness with 11.2% (w.b.) moisture content. The decomposition kinetics obtained was first‐order model. As regard the half‐life of ozone, the lowest value obtained was 6.32 min for paddy grains ozonated at 10 cm bed thickness with moisture content of 14.3% (w.b.). In the process, half‐life of ozone in paddy grains, bed thickness (P ≤ 0.01) and moisture content (P ≤ 0.01) were found to be the key factors.

Practical Applications

Ozone is a highly reactive and strong oxidizing agent with insecticidal activity. For large volumes of stored grains, studies of ozone gas application are mostly experimental so they cannot be universal and applied to different storage systems. Reaction kinetics of ozone gas can be used to understand the effect of ozone on stored grains, optimize the design of ozone fumigation systems and find out the total fumigation time of farm‐level storage bin. An application method needs to be developed to minimize loss and distribute the fumigant evenly and quickly throughout the chamber. The effectiveness of ozone also depends on the moisture content and depth of the grains. Hence to verify the adaptability of ozone fumigation system to a large‐scale study on reaction kinetics is highly essential.
Biological Characteristics and Safety Examination of Five Enterococcal Strains from Probiotic Products
Authors: Lei Ming , Dai Xianjun , Liu Mingqi
Published: February 2015

Five enterococcal strains (Enterococcus faecalis LS15, PF03, BF10 and SL13 and Enterococcus faecium MM08) were isolated and identified from 130 probiotic products marketed in China. The determined biological characteristics were acid tolerance, bile tolerance, pepsin tolerance, trypsin tolerance, organic acid production and antimicrobial activity. Safety examination of potential virulence factors and antibiotic resistance were also performed. The five isolated strains showed good tolerance to biological barriers in vitro, and lactic acid was the most abundant organic acid (10–11 mg/mL) produced by these strains. The isolates exhibited antilisterial activities. Safety examinations revealed that certain potential virulence factors (ace, gelE and efaA) were harbored in strains LS15, PF03, BF10 and SL13, and all of the isolates exhibited complete or intermediate resistance to gentamicin, ciprofloxacin, erythrocin and tetracycline. Compared with the other isolates, the E. faecium MM08 played the leading role as a probiotic strain. These antilisterial probiotic enterococcal strains had good tolerance to biological barriers, mainly produced lactic acid, exhibited antibiotic resistance traits and could harbor certain virulence factors.

Practical Applications

This study aimed to examine the biological characteristics and safety aspects of probiotic enterococcal strains isolated from probiotic products. Five isolates showed good probiotic characteristics, but its safety aspects need to be studied in the future.
Strategies Used by Foreign‐Born Family Therapists to Connect Across Cultural Differences: A Thematic Analysis
Authors: Niño Alba , Kissil Karni , Davey Maureen P.
Published: February 2015

With the growing diversity in the United States among both clinicians and clients, many therapeutic encounters are cross‐cultural, requiring providers to connect across cultural differences. Foreign‐born therapists have many areas of differences to work through. Thus, exploring how foreign‐born family therapists in the United States connect to their clients can uncover helpful strategies that all therapists can use to establish stronger cross‐cultural therapeutic connections. A thematic analysis was conducted to understand strategies 13 foreign‐born therapists used during therapeutic encounters. Four themes were identified: making therapy a human‐to‐human connection, dealing with stereotypes, what really matters, and flexibility. Findings suggest that developing a deep therapeutic connection using emotional attunement and human‐to‐human engagement is crucial for successful cross‐cultural therapy. Clinical and training implications are provided.

Video Abstract
Seasonal electrocution fatalities in free‐range rhesus macaques (Macaca mulatta) of Shivalik hills area in northern India
Authors: Kumar Vijay , Kumar Vipin
Published: February 2015

Background

The arboreal nature of rhesus macaques makes them vulnerable to electrocution from high‐voltage industrial supply as well as low‐tension domestic wires. The data on pattern of electrocution injuries and electrocution mortalities in free‐ranging rhesus macaques are rarely reported.

Methods

From January 2011 to 2013, the cases of accidental electrocution injuries were recorded in difference to sex, age group, season, body region distribution, contact details, and extent of injuries in free‐ranging rhesus macaques (Macaca mulatta) of Shivalik hill areas.

Results

electrocution injuries were highest in juveniles (52.05%), followed by adults (30.13%) and old (10.95%) rhesus macaques. Of the 73 cases recorded, 23 (31.50%) succumbed to death following severe electrocution and associated injuries. The intensity and body region distribution of electrocution injuries was recorded.

Conclusion

High‐voltage current is the most common factor for fatal injuries. Strategies to avoid such electrocutions include burying all lines and transformers, shielding and insulating all high‐tension lines, installing bridges that monkeys, and other arboreal species can use to move around.
Programming the Brain and Behaviour by Early‐Life Stress: A Focus on Neuroactive Steroids
Authors: Brunton P. J.
Published: February 2015

Animal studies have amply demonstrated that stress exposure during pregnancy or in early postnatal life can adversely influence brain development and have long‐term ‘programming’ effects on future brain function and behaviour. Furthermore, a growing body of evidence from human studies supports the hypothesis that some psychiatric disorders may have developmental origins. Here, the focus is on three adverse consequences of early‐life stress: dysregulation of the hypothalamic‐pituitary‐adrenal (HPA) axis, heightened anxiety behaviour and cognitive impairments, with review of what is known about the underlying central mechanisms. Neuroactive steroids modulate neuronal activity and play a key role in neurodevelopment. Moreover they can negatively modulate activity of the HPA axis, exert anxiolytic actions and influence cognitive performance. Thus, neuroactive steroids may provide a link between early‐life stress and the resultant adverse effects on the brain and behaviour. Here, a role for neuroactive steroids, in particular the 5α‐reduced/3α‐hydroxylated metabolites of progesterone, testosterone and deoxycorticosterone, is discussed in the context of early‐life stress. Furthermore, the impact of early‐life stress on the brain's capacity to generate neurosteroids is considered and the evidence for an ability of neuroactive steroids to over‐write the negative effects of early‐life stress on the brain and behaviour is examined. An enhanced understanding of the influence of early‐life stress on brain neurosteroid systems could aid the identification of new targets for developing treatments for stress‐related conditions in humans.
Patients with 3‐Vessel Coronary Artery Disease and Impaired Ventricular Function Undergoing PCI with Impella 2.5 Hemodynamic Support Have Improved 90‐Day Outcomes Compared to Intra‐Aortic Balloon Pump: A Sub‐Study of The PROTECT II Trial
Authors: KOVACIC JASON C. , KINI ANNAPOORNA , BANERJEE SUBHASH , DANGAS GEORGE , MASSARO JOSEPH , MEHRAN ROXANA , POPMA JEFFREY , O'NEILL WILLIAM W. , SHARMA SAMIN K.
Published: February 2015

Objectives

To evaluate the efficacy of hemodynamic support using Impella 2.5 (IR2.5) vs intra‐aortic balloon pump (IABP) in patients with 3‐vessel coronary artery disease (3VD).

Background

PROTECT II demonstrated favorable 90‐day outcomes in patients with impaired LVEF and left main or 3VD undergoing PCI with hemodynamic support with IR2.5 compared to IABP. It is unclear if this was due to a specific benefit in a patient sub‐population and if certain patients may derive particular benefit from PCI with IR2.5 support.

Methods

Patients in PROTECT II were stratified upon enrollment into the left main/last patent vessel or 3VD subgroups and randomized to IR2.5 or IABP within those groups. Patients in the 3VD substratum were required to have LVEF ≤30%.

Results

Among the 3VD subgroup (n = 325 patients; IR2.5 167, IABP 158) patients were well matched, except for prior heart failure or CABG, which were more common in the IR2.5 group (both P ≤ 0.01). Mean number of lesions treated was 3.0 ± 1.5 vs. 2.9 ± 1.4 (P = 0.61). At 30 days after PCI, patients that received IR2.5 compared to IABP support trended toward a reduction in incidence of major adverse events (MAE): 32.9% vs. 42.4% (P = 0.078). At 90 days after PCI, there was a significant difference favoring IR2.5 for incidence of MAE: 39.5% vs. 51.0% (P = 0.039), with this effect being consistent across multiple clinical subgroups. Use of IR2.5 was an independent predictor of improved 90‐day outcomes.

Conclusions

Patients with 3VD and reduced LVEF show improved outcomes when PCI is performed with IR2.5 hemodynamic support. (J Interven Cardiol 2015;28:32–40)
Preventive versus Culprit‐Only Percutaneous Coronary Intervention in ST‐Elevation Myocardial Infarction Patients with Multivessel Disease: A Meta‐Analysis
Authors: SONG YEO‐JEONG , SHIN HO‐CHEOL , YANG JOO‐II , LEE HO‐YOUNG , JIN HAN‐YOUNG , SEO JEONG‐SOOK , YANG TAE‐HYUN , KIM DAE‐KYEONG , KIM DONG‐SOO , JANG JAE‐SIK
Published: February 2015

Background

Although previous studies have suggested clinical benefits of complete revascularization in patients with multivessel coronary artery disease, it is still controversial whether preventive percutaneous coronary intervention (PCI) leads to better clinical outcomes in the clinical setting of ST‐segment elevation myocardial infarction (STEMI).

Methods

Relevant studies through September 2014 were searched and identified in the electronic databases. Primary endpoint was all‐cause mortality at the longest follow‐up. Secondary endpoints included myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE).

Results

From 836 initial citations, 7 randomized trials, and 23 observational studies with 44,256 patients (8,087 preventive and 36,169 culprit‐only) were included in this study. Preventive PCI was associated with a significant reduction in repeat revascularization (odds ratios [OR]: 0.71; 95% CI: 0.51–0.99) with no differences in all‐cause mortality (OR: 0.99; 95% CI: 0.76–1.29) or MI (OR: 1.08; 95% CI: 0.62–1.87) as compared with culprit‐only PCI. Comparison of preventive PCI to the culprit‐only PCI group revealed OR for MACE of 0.80 (95% CI: 0.57–1.12). Stratified analysis according to revascularization strategy demonstrated a significant survival benefit of culprit‐only PCI over multivessel PCI during the index procedure and a significantly lower incidence of all‐cause mortality with staged PCI as compared with culprit‐only or multivessel PCI during the index procedure.

Conclusions

Preventive PCI strategy appears to be effective in reducing the risk of repeat revascularization without significant benefits for mortality or MI when compared with culprit‐only revascularization in STEMI patients with multivessel disease. (J Interven Cardiol 2015;28:1–13)
(Meta)‐Analysis of Safety and Efficacy Following Edge‐to‐Edge Mitral Valve Repair Using the MitraClip System
Authors: BAIL DOROTHEE H.L.
Published: February 2015

Objectives

The authors investigated safety and efficacy of the MitraClip‐System (MCS) using a systematic analysis.

Background

The safety and efficacy of the MCS continues to be debated, and randomized trials are still lacking.

Method

A systematic literature search was conducted using common medical and scientific databases. The following kinds of data were obtained: at baseline, 30 days, 6 and 12 month post‐procedure. For safety and efficacy mortality‐rate (survival), mitral regurgitation <2+ (MR), adverse event rate (AE), NYHA class and reoperation‐rate were documented. A meta‐analysis with quantitative summary was performed.

Results

Twenty‐six studies including 3821 patient's who were treated with MCS, were analyzed. Weighted mean age was 73.9 ± 2.3 years and LogEuroScore was 25.2 ± 6.0%. Post‐procedural MR<2+ was achieved in 86.4% and 66.3% of the patients were in NYHA class I/II within 30 days, AE‐rate was 18.3%, mortality‐rate was 2.8% and reoperation‐rate was 3.5%. Freedom from MR>3 + −4 was 80.2% (80.1%), from NYHA III/IV was 78.6% (66.1%) and freedom from death was 82.6% (87.8%) and from reoperation 95.6% (88.6%) at 6 and 12 month.

Conclusion

Based on the analysis of the current literature treatment with MCS is associated with good short‐term success and low mortality. MCS is safe and effective for patients with limited surgical options. The results are comparable with open mitral valve repair (oMVR) but patients are markedly older and have a higer risk profile than patients who undergo oMVR. Prospective randomized controlled trials are warranted to determine potential AEs, device durability and long‐term follow‐up. (J Interven Cardiol 2015;28:69–75)
Outcomes by Day and Night for Patients Bypassing the Emergency Department Presenting with ST‐Segment Elevation Myocardial Infarction Identified with a Pre‐Hospital Electrocardiogram
Authors: COCKBURN JAMES , KARIMI KEYVAN , HOO SOO , RASMUSSEN HELGE , HANSEN PETER , NELSON GREGORY , WARD MICHAEL , BHINDI RAVINAY , FIGTREE GEMMA
Published: February 2015

Background

Pre‐hospital ECG and emergency department (ED) bypass direct to the catheter laboratory may optimize reperfusion times for patients with ST‐segment elevation myocardial infarction. Questions remain over feasibility and safety during off hours.

Aims

To determine if presenting time of day is associated with differences in in‐hospital and 30‐day mortality and key reperfusion times.

Methods/Results

Seven hundred and twenty consecutive patients with STEMI triaged directly from the field to the catheter laboratory between June 2004–May 2013. Vital status was reported as of August 2013. The mean age was 65 ± 14 years, and 75.1% were male. Overall mortality (in‐hospital/30 days) did not significantly differ for patients (3.4% in hours and 3.1% off hours; P = N/S). Symptom onset‐to‐arrival to the heart attack was non‐significantly lower (100 minutes off hours (IQR 78–174) versus 110 minutes in hours (IQR 75–199), P = N/S). Call‐to‐balloon time was not significantly affected by the time of presentation: 150 min in hours (IQR 111–239) versus 154 minutes during off hours (IQR 115–225) P = N/S. Overall door‐to‐balloon time was 36 minutes (IQR 25–51), 34 minutes in hours (IQR 24–49) versus 40 minutes off hours (IQR 29–55) P = N/S. The overall false positive activation rate was only 13.1%, (in hours 12.2% vs. off hours 14.6%, respectively, P = N/S).

Conclusions

In a unit with an established field triage system facilitating ED bypass, reperfusion times and mortality are not significantly influenced by whether the patient presents during standard working hours or outside of these hours. (J Interven Cardiol 2015;28:24–31)
Tissue Properties of the Fossa Ovalis as They Relate to Transseptal Punctures: A Translational Approach
Authors: HOWARD STEPHEN A. , QUALLICH STEPHEN G. , BENSCOTER MARK A. , HOLMGREN BRYCE C. , ROLFES CHRISTOPHER D. , IAIZZO PAUL A.
Published: February 2015

Objectives

This study focused on how catheter size affects transseptal puncture, what transseptal indication means, and whether the swine model is predictive for humans.

Background

Transseptal puncture is a common procedure that gains access to the left atrium, allowing percutaneous mitral valve repair, left atrial appendage closure, and left‐sided ablations. The basic approach has not changed in many years; however, the frequency of transseptal punctures and the size of devices are increasing with emerging treatments.

Methods

A broad range of devices (4 F to 18  F) were advanced through atrial septa of swine hearts; some devices were inserted in both swine and human hearts using 10 F catheters.

Results

Greater forces were required to puncture through the septa of human hearts compared to those of swine. Larger catheters used in swine hearts required greater force to advance them through the septa, causing greater dilation of tissue and sometimes tearing the floor of the fossa ovalis; analyses indicated an exponential increase in the size of the iatrogenic atrial septal defect. Specific tissue property testing of the septum primum showed that this tissue sheared at a lower exerted force in a superior to inferior direction.

Conclusions

Results may provide physicians with important knowledge about what to expect when treating a possible iatrogenic atrial septal defect or help them understand the consequences of transseptal punctures. Comparative data between swine and human atrial septal tissue properties provide critical insights between the species and offer clinicians and device designers important information relative to differences in tissue behaviors. (J Interven Cardiol 2015;28:98–108)
First‐in‐Man Study of Dedicated Bifurcation Sirolimus‐eluting Stent: 12‐month Results of BiOSS LIM® Registry
Authors: GIL ROBERT J. , BIL JACEK , VASSILIEV DOBRIN , IÑIGO GARCIA LUIS A.
Published: February 2015

Objectives

The aim was to assess the effectiveness and safety profile of a new dedicated bifurcation stent ‐ sirolimus‐eluting BiOSS LIM® (Balton, Poland) in 12‐month Registry.

Background

The optimal approach to coronary bifurcations treatment by percutaneous coronary intervention (PCI) has been still a subject of debate. Dedicated bifurcation stents are one of the proposed solutions.

Methods

This was the international, 3‐center registry, which enrolled patients with non‐ST‐elevation acute coronary syndrome (NSTE‐ACS) and stable angina. Provisional T‐stenting was the obligatory strategy of the treatment. Angiographic control was planned at 12 months. The primary endpoint was cumulative rate of death, myocardial infarction (MI) and target lesion revascularization (TLR) at 12 months.

Results

A total of 60 patients with coronary bifurcations were enrolled (mean age 66.4 ± 11 years, 28.3% of female). There were 21.7% of patients with NSTE‐ACS, 78.3% with hypertension, 38.3% with diabetes, 28.3% had previous MI, and 46.7% and 10% underwent prior revascularization, respectively, PCI and coronary artery bypass graft. The device success rate was 100%. Side branch was treated with an additional classical drug‐eluting stent implantation in 23.3% of cases. At 12 months, the cumulative major adverse cardiovascular events rate was 11.7%. During follow‐up (11 ± 1 months) there was 1 non‐cardiac death (1.7%), 1 non‐ST‐elevated myocardial infarction (1.7%) due to restenosis and no case of stroke or in‐stent thrombosis. Overall TLR was 8.3% (clinically driven TLR – 1.7%, angiographically driven – 6.6%). Mean late lumen loss was as follows: In main vessel – 0.35 ± 0.33 mm, in main branch – 0.34 ± 0.27 mm and in side branch – 0.18 ± 0.38 mm.

Conclusion

Dedicated bifurcation stent BiOSS® LIM proved to be feasible device, with promising safety and long‐term clinical effectiveness in the treatment of coronary bifurcation lesions, including distal left main stem stenosis. (J Interven Cardiol 2015;28:51–60)
Relative FLAIR Signal Intensities over Time in Acute Ischemic Stroke: Comparison of Two Methods
Authors: Ostwaldt Ann‐Christin , Galinovic Ivana , Hotter Benjamin , Grittner Ulrike , Nolte Christian H. , Audebert Heinrich J. , Villringer Kersten , Fiebach Jochen B.
Published: February 2015

BACKGROUND AND PURPOSE

Visibility of lesions on fluid attenuated inversion recovery (FLAIR) images appears indicative of the time window in acute ischemic stroke. We compared two published methods for calculation of relative FLAIR signal intensities (rSI) regarding their association with time from symptom onset in a longitudinal fashion.

METHODS

We prospectively included patients receiving serial MRI examinations between 4.5 and 35 hours from symptom onset. FLAIR rSI was determined using two methods: a whole regions‐of‐interest (ROI) method and a hotspot method, selecting only a single area of visually highest signal. Signal intensity (rSI) was calculated relative to the contralateral side for each time point.

RESULTS

We included 21 patients with 3‐6 MRI examinations on the first 2 days after stroke onset. FLAIR rSI determined with both methods shows a linear association with time from onset, although the hotspot results showed higher variability. Both methods with their previously published thresholds are reliable for identifying patients outside the 4.5 hours time window.

CONCLUSION

Both methods show a similar performance, and might be a suitable help for the visual assessment of FLAIR lesion visibility.
T1 Hyperintense Prepontine Mass with Restricted Diffusion—A White Epidermoid or a Neuroenteric Cyst?
Authors: Medhi Gorky , Saini Jitender , Pandey Paritosh , Mahadevan Anita , Prasad Chandrajit
Published: February 2015

Neuroenteric cysts (NC) are benign, congenital malformation which are of endodermal origin commonly located in the central nervous system. We report a case of intracranial NC with squamous metaplasia and xanthogranulomatous response masquerading as a white epidermoid on conventional MRI sequences. Lesion showed two components on T2W‐images. We observed differential diffusion characteristics including fractional anisotropy, radial diffusivity and axial diffusivity within the two components of the lesion.
Differential Colonization Patterns of Bananas (Musa spp.) by Physiological Race 1 and Race 4 Isolates of Fusarium oxysporum f.sp. cubense
Authors: Guo Lijia , Yang Laying , Liang Changcong , Wang Guofen , Dai Qingdon , Huang Junsheng
Published: February 2015

Fusarium oxysporum f.sp. cubense (Foc) is the causative agent of Fusarium wilt of bananas (Musa spp.). To clarify the colonization patterns of Foc in bananas, two green fluorescent protein‐tagged isolates, NT320 (race 1) and B2‐gfp (race 4), were used to follow infection of the banana varieties Pisang Awak and Brazil. Penetration and colonization of both isolates in roots of these two banana varieties were observed within 6 days, but sporulation in xylem vessels was not observed until day 30 postinoculation. Interestingly, B2‐gfp penetrated into xylem vessels of Pisang Awak banana roots more quickly than NT320, implying that the race 4 isolate is more virulent than the race 1 isolate. This result was further confirmed by comparing the disease severity of plants inoculated with NT320 with that of plants inoculated with B2‐gfp. Quantitative real‐time PCR revealed that some pathogenicity‐associated genes, including Fga1, Fhk1, Fow2 and Ste12, were upregulated by B2‐gfp during exposure to Brazil bananas, while they were either downregulated by NT320 or not significantly changed. These data might partly explain why the race 4 isolate was more virulent than the race 1 isolate.
The impact of perinatal depression on exclusive breastfeeding: a cohort study
Authors: Rahman Atif , Hafeez Assad , Bilal Rakshanda , Sikander Siham , Malik Abid , Minhas Fareed , Tomenson Barbara , Creed Francis
Published: February 2015

Perinatal depression is associated with infant undernutrition. We hypothesised that perinatal depression was associated with early cessation of exclusive breastfeeding and reduced quantity of breast milk in rural Pakistan. We used a prospective cohort design to study a population‐based sample of 132 depressed and 147 non‐depressed women from the third trimester of pregnancy to 6 months post‐natal. Current major depressive episode was measured in the third trimester and 6 months post‐natal using the Structured Clinical Interview for DSM‐IV Diagnosis. In a convenience sample of 24 depressed and 31 non‐depressed exclusively breastfeeding mothers, breast milk quantity was assessed (mL kg−1 infant weight per 24 h) at 4 months using the dose‐to‐mother deuterium dilution method. We administered also the Perception of Insufficient Milk questionnaire at 6 months post‐natal. Depression was associated with fewer days of exclusive breastfeeding (91.8 (SD = 47.1) vs. 108.7 days (SD = 54.3) (95% CI: 3.4 to 30.3 P = 0.014). Women with persistent depression ceased exclusive breastfeed earliest. There was no difference in the quantity of breast milk produced by depressed and non‐depressed mothers: 89.3 (SD = 38.1) vs. 83.9 (29.0) ml/kg infant wt/24 hours, P = 0.57. Depressed mothers were significantly more likely to report insufficient milk: PIM scores were 34.4 (SD = 14.3) for depressed and 39.7 (SD = 10.4) for non‐depressed women (P = 0.004). In Cox regression PIM score mediated the association between depression and early cessation of breastfeeding. In this area of rural Pakistan, perinatal depression is associated with early cessation of exclusive breastfeeding and this is associated with mothers' perceptions of insufficiency of breast milk but not reduced milk production.
Variation in promiscuity and sexual selection drives avian rate of Faster‐Z evolution
Authors: Wright Alison E. , Harrison Peter W. , Zimmer Fabian , Montgomery Stephen H. , Pointer Marie A. , Mank Judith E.
Published: February 2015

Higher rates of coding sequence evolution have been observed on the Z chromosome relative to the autosomes across a wide range of species. However, despite a considerable body of theory, we lack empirical evidence explaining variation in the strength of the Faster‐Z Effect. To assess the magnitude and drivers of Faster‐Z Evolution, we assembled six de novo transcriptomes, spanning 90 million years of avian evolution. Our analysis combines expression, sequence and polymorphism data with measures of sperm competition and promiscuity. In doing so, we present the first empirical evidence demonstrating the positive relationship between Faster‐Z Effect and measures of promiscuity, and therefore variance in male mating success. Our results from multiple lines of evidence indicate that selection is less effective on the Z chromosome, particularly in promiscuous species, and that Faster‐Z Evolution in birds is due primarily to genetic drift. Our results reveal the power of mating system and sexual selection in shaping broad patterns in genome evolution.
Host preferences of ornithophilic biting midges of the genus Culicoides in the Eastern Balkans
Authors: BOBEVA A. , ZEHTINDJIEV P. , ILIEVA M. , DIMITROV D. , MATHIS A. , BENSCH S.
Published: February 2015

Many biting midges of the genus Culicoides Latreille, 1809 (Diptera: Ceratopogonidae) are competent vectors of a diverse number of pathogens. The identification of their feeding behaviour and of vector–host associations is essential for understanding their transmission capacity. By applying two different nested polymerase chain reaction (PCR) assays, of which one targeted the avian cyt b gene and the other targeted the COI gene of a wide range of vertebrates, we identified the blood hosts of six biting midge species including Culicoides circumscriptus, Culicoides festivipennis, Culicoides punctatus, Culicoides pictipennis, Culicoides alazanicus and Culicoides cf. griseidorsum, the latter two of which are reported in Bulgaria for the first time. Bird DNA was found in 50.6% of 95 investigated bloodmeals, whereas mammalian DNA was identified in 13.7%. Two Culicoides species were found to feed on both birds and mammals. There was remarkable diversity in the range of avian hosts: 23 species from four orders were identified in the abdomens of four Culicoides species. The most common bird species identified was the magpie, Pica pica (n = 7), which was registered in all four ornithophilic biting midge species. Six bloodmeals from the great tit, Parus major, were recorded only in C. alazanicus. None of the studied species of Culicoides appeared to be restricted to a single avian host.
What is an apex predator?
Authors: Wallach Arian D. , Izhaki Ido , Toms Judith D. , Ripple William J. , Shanas Uri
Published: February 2015

Large ‘apex’ predators influence ecosystems in profound ways, by limiting the density of their prey and controlling smaller ‘mesopredators’. The loss of apex predators from much of their range has lead to a global outbreak of mesopredators, a process known as ‘mesopredator release’ that increases predation pressure and diminishes biodiversity. While the classifications apex‐ and meso‐predator are fundamental to current ecological thinking, their definition has remained ambiguous. Trophic cascades theory has shown the importance of predation as a limit to population size for a variety of taxa (top–down control). The largest of predators however are unlikely to be limited in this fashion, and their densities are commonly assumed to be determined by the availability of their prey (bottom–up control). However, bottom–up regulation of apex predators is contradicted by many studies, particularly of non‐hunted populations. We offer an alternative view that apex predators are distinguishable by a capacity to limit their own population densities (self‐regulation). We tested this idea using a set of life‐history traits that could contribute to self‐regulation in the Carnivora, and found that an upper limit body mass of 34 kg (corresponding with an average mass of 13–16 kg) marks a transition between extrinsically‐ and self‐regulated carnivores. Small carnivores share fast reproductive rates and development and higher densities. Large carnivores share slow reproductive rates and development, extended parental care, sparsely populated territories, and a propensity towards infanticide, reproductive suppression, alloparental care and cooperative hunting. We discuss how the expression of traits that contribute to self‐regulation (e.g. reproductive suppression) depends on social stability, and highlight the importance of studying predator–prey dynamics in the absence of predator persecution. Self‐regulation in large carnivores may ensure that the largest and the fiercest do not overexploit their resources.
Growth–defense tradeoffs for two major anti‐herbivore traits of the common milkweed Asclepias syriaca
Authors: Züst Tobias , Rasmann Sergio , Agrawal Anurag A.
Published: February 2015

Costs of plant defense are a key assumption in evolutionary ecology, yet their detection has remained challenging. Here we introduce a novel method for quantifying plant growth using the common milkweed Asclepias syriaca and repeated non‐destructive size measurements to experimentally test for costs of defensive traits. We estimated mechanistic components of plant growth (relative growth rate, net assimilation rate, specific leaf area and leaf‐mass ratio) at two levels of fertilization (high and low), and related them to production of toxic cardenolides and exudation of sticky latex. We found negative genetic correlations between cardenolides and growth (most strongly with net assimilation rate) at both nutrient levels. Additionally, plants varied in their cardenolide response to low nutrients, and genetic families maintaining higher cardenolide production at low nutrient availability suffered proportionally larger reductions in growth. In contrast, the amount of latex was positively correlated with plant growth. Because latex is instantly deployed from a plant‐wide system of pressurized laticifers, larger plants may simply exude proportionally more latex when damaged and thus plant size is likely to mask potential costs of latex synthesis. Unbiased quantification of mechanistic growth processes, coupled with the manipulation of nutrient or stress levels, is thus an effective approach to demonstrate allocation to defense and tradeoffs with growth, especially in long‐lived plant species.
Development of a guideline for the management of the unanticipated difficult airway in pediatric practice
Authors: Black Ann E. , Flynn Paul E.R. , Smith Helen L. , Thomas Mark L. , Wilkinson Kathy A.
Published: February 2015

Background

Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching.

Objective

Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children. We aimed to develop guidelines for the management of the unanticipated difficult pediatric airway for use by anesthetists working in the nonspecialist pediatric setting.

Method

We reviewed available guidelines used in individual hospitals. We also reviewed research into airway management in children and graded papers for the level of evidence according to agreed criteria. A Delphi panel comprising 27 independent consultant anesthetists considered the steps of the acute airway management guidelines to reach consensus on the best interventions to use and the order in which to use them. If following the literature review and Delphi feedback, there was insufficient evidence or lack of consensus, regarding inclusion of a particular point; this was reviewed by a Second Specialist Group comprising 10 pediatric anesthetists.

Results

Using the Delphi group's deliberations and feedback from the Second Specialist Group, we developed three guidelines for the acute airway management of children aged 1–8 years.

Conclusions

This paper provides the background, available evidence base, and justification for each step in the resultant guidelines and gives a rationale for their use.