bluuebunny/crossref_metadata_2025 huggingface dataset:
Basic investigation of heart failure
Authors: Gardner Roy S.
Published: April 2012

Although the clinical history and examination may suggest adiagnosis of heart failure (HF), objective evidence of cardiacdysfunction is also required. A number of diagnostic tests can bereliably employed to identify patients with left ventricular systolicdysfunction (LVSD). However, HF with preserved systolic functionis less reliably pinpointed, particularly as the syndrome isa mixed bag of conditions rather than a specific entity.As well as investigating patients to identify the presence andseverity of cardiac dysfunction and any relevant comorbidities, itis important to clarify the underlying aetiology. Some causes arepotentially correctable with possible improvement in the degreeof cardiac dysfunction. Appropriate investigations will also helpto risk-stratify patients, identifying those suitable for advancedtherapies such as device therapy (ICD, CRT, VAD) and cardiactransplantation.Although echocardiography is currently the principal diagnostictest for patients with HF, cardiac magnetic resonance imaging(CMR) is now considered to be the ‘gold standard’ method ofassessing cardiac function. The investigations that should be done,or at least considered, in the patient suspected of having HF are shown in Table 18.1. This chapter concentrates on the first-lineinvestigations.
Nuclear medicine in heart failure
Authors: Bharadwaj Pushan , Underwood S. Richard
Published: April 2012

Nuclear medicine, sometimes known as molecular imaging, involvesthe characterization and measurement of biological processes in vivousing small amounts of radiolabelled tracers. It is the most sensitiveimaging technique in routine use, providing images of nano- oreven picomolar concentrations of the tracer. In patients with heartfailure (HF), biological processes such as myocardial perfusion,metabolism (both fatty acid and glucose), injury (including necrosisand apoptosis), and innervation are relevant and can be imaged.The ideal tracer is a biological molecule labelled with an isotopeof one of its constituent elements (carbon, oxygen, nitrogen, etc.),since the tracer will have biological properties identical to those ofthe natural compound. Such isotopes are positron emitters and areimaged by positron emission tomography (PET), which relies ondetecting the synchronous 511-keV photons emitted in oppositedirections when the positron annihilates with an electron in thesurrounding tissue.More common tracers use foreign elements such as iodine ortechnetium bound to a pharmaceutical that provides useful biologicalproperties. Theseradiopharmaceuticals usually emit singlegamma photons that are imaged by a gamma camera, often usingsingle photon emission computed tomography (SPECT) to producetomograms or three-dimensional images.PET has some inherent advantages over SPECT, such as higherresolution and more reliable attenuation correction that simplifies quantification of the biological process being imaged. PET is howevermore expensive and, with the exception of fluorine-18, the veryshort-lived radionuclides have to be generated on site, requiring theadditional expense of a cyclotron.
Heart failure imaged by cardiac magnetic resonance imaging
Authors: Parsai C. , Prasad S.K.
Published: April 2012

Heart failure (HF) is a growing clinical condition resulting from a variety of primary or systemic disorders that impair the ability of the heart to meet systemic demands. Coronary artery disease(CAD), hypertension, and dilated cardiomyopathy (DCM) represent the most common aetiologies in the Western world, with a genetic background found in up to 30% of DCM. Although HF is largely a clinical diagnosis, imaging has become an essential part of patients’ work-up complementing more invasive testing (e.g. coronary angiography, endomyocardial biopsy) and genetic testing. It is key to characterize myocardial and valvular structure and function; identify an underlying treatable substrate; risk-stratify patients; and guide decision-making for medical, surgical, or device therapies such as internal cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT). In addition, it provides measurements for assessing the effect of treatment, including percutaneous or surgical procedures. As the prognosis of HF remains poor, particular emphasis has been placed on detection of early disease in patients at risk and in those with asymptomatic evidence of left ventricular damage as well as screening of relatives. Although echocardiography remains the first imaging step, cardiac magnetic resonance imaging (CMR) is now widely available and appears as an ideal complementary technique with the potential to address in a single 45–60 min scan an exhaustive evaluation of three-dimensional cardiac anatomy, function, tissue characterization, coronary and microvascular perfusion, valve disease, and coronary angiography. The diagnostic and prognostic strengths of CMR as an integral part of the clinical workup of a HF patient are reviewed in a stepwise approach.
CT imaging techniques
Authors: Schuijf Joanne D. , Tops Laurens F. , Bax Jeroen J.
Published: April 2012

In patients presenting with heart failure (HF), assessment of underlying aetiology is critical for optimal management. To differentiate between ischaemic and nonischaemic dilated cardiomyopathy, invasive coronary angiography is frequently performed. This technique is currently still considered the gold standard in the detection of coronary artery disease (CAD). In addition to accurate assessment of the presence, location, and severity of coronary artery lesions, the technique also provides the opportunity for direct intervention. On the other hand, the technique carries a small but not negligible risk of complications, while in many patients no clinically relevant abnormalities will be observed. Patients presenting with unexplained dilated cardiomyopathy and a low to intermediate likelihood of CAD may therefore benefit from a noninvasive imaging approach.

To this end, anatomical imaging with CT techniques has been proposed. With this technology, high-resolution images of the coronary arteries are obtained. In addition, detailed information on cardiac structures, and to some extent also function, can be derived. The aim of the current chapter is to provide an overview of the various applications of CT technology that may be relevant in the setting of HF.
Metabolic exercise testing in chronic heart failure
Authors: Witte Klaus K.
Published: April 2012

Chronic heart failure (HF) is characterized by exercise intoleranceusually due to breathlessness or fatigue in the presence of cardiac dysfunction.Hence when assessing a patient with such symptoms, inaddition to appropriate cardiac imaging, some form of standardizedexercise testing is important to measure objectively the degree andnature of the symptoms and confirm their aetiology. In addition,exercise capacity is a powerful predictor of mortality and is used as amarker of the need for cardiac transplantation. Although useful datacan be gained from a standard treadmill-based exercise test, or a corridorwalk test, additional and independent information is availablewhen the test is performed while measuring metabolic gas exchange.
Diastolic heart failure
Authors: Clark Andrew L.
Published: April 2012

The vast majority of clinical trials in patients with chronic heartfailure (CHF) have been conducted in patients with left ventricularsystolic dysfunction (LVSD). Although defining CHF can be difficult, its pragmatic definition requiring symptoms compatible withthe syndrome in the presence of cardiac dysfunction makes LVSDrelatively easy to identify. This is the appeal of the left ventricularejection fraction (LVEF) as a measurement — a normal range canbe established, and those people who are breathless on exertionand whose ejection fraction falls below the normal range arelabelled as having heart failure (HF).This pragmatic approach to identifying patients who should betreated leaves a large group of people who have undoubted symptomscompatible with a diagnosis of CHF, but who have normal(or at most mildly impaired) left ventricular systolic function.There are many reports suggesting that perhaps half of all patientswith HF fall into this category, and various labels are used.
Renal dysfunction
Authors: Green Darren , Kalra Philip A.
Published: April 2012

Up to 55% of patients with heart failure (HF) have evidence ofchronic kidney disease (CKD) stages 3–5 (estimated glomerular filtration rate (eGFR) of 15–59 mL/min), and mortalityrises in proportion to fall in GFR. 1 In such patients,advanced CKD is as prognostically important as left ventricularejection fraction (LVEF). 2 HF and its treatment may also play animportant role in the pathophysiology of acute kidney injury(AKI), with a further associated risk of adverse outcome.

Cardiovascular disease is the leading cause of death in patients withCKD, and structural cardiac abnormalities are highly prevalent indialysis patients.
Chronic lung disease
Authors: Greenstone Michael , Hart Simon P. , Hawkins Nathaniel M.
Published: April 2012

Chronic obstructive pulmonary disease (COPD) and heart failure(HF) commonly occur in the same patient and the presence of onewill affect the prognosis from the other. There is a growing body ofevidence linking COPD and vascular events. When the NationalHealth and Nutrition Examination Survey population was stratified by forced expiratory volume in 1 s (FEV1) and examined forcause of death, then the risk of death from cardiovascular disease was as much as fivefold greater in those with the lowest FEV1 compared to the highest. Studies in Malmo and Baltimore showed thatthose with the most rapidly declining FEV1 were most likely to dieof cardiovascular disease. Low baseline FEV1 also predicts strokemortality, all-cause cancer mortality, and death from nonrespiratory, noncardiac causes. Thus cardiac disease and respiratoryfunction are strongly correlated: although smoking is the obviouscommon risk factor, the relationship still stands in nonsmokers. Itis possible that FEV1 is a marker for an ill-defined environmentalfactor such as poor nutrition but it could also be a marker of asystemic process of chronic tissue damage and abnormal repair.
Pulmonary hypertension
Authors: Corte T.J. , Wort S.J.
Published: April 2012

Pulmonary hypertension (PH) is definedhaemodynamically as anincrease in mean pulmonary arterial pressure (mPAP) of at least25 mmHg at rest, as assessed by right heart catheterization (RHC).At the 2008 World Symposium on Pulmonary Hypertension inDana Point, mPAP of 20–25 mmHg was considered abnormal, andthe term ‘pre-PH’ was proposed to signify this. Previously, the definition of PH included exercise-induced PH (mPAP ≥ 30 mmHgon exercise). However, the data for exercise-induced PH is limited, and the recent reclassification of PH does not include exercise-inducedPH in its definition.
Diabetes mellitus
Authors: Jamieson AndrewJ
Published: April 2012

Heart failure (HF) and diabetes mellitus (DM) are both increasingin prevalence worldwide, and HF is a serious and increasingly commoncomorbid factor in the patient with DM. The patient with HFand DM may present particular problems in relation to a numberof management areas. As a consequence, it is increasingly importantthat practitioners dealing with patients with HF have someknowledge of the interplay between DM and HF and the potentialpitfalls encountered when treating the diabetic patient with HF,and vice versa.
Valvular heart disease
Authors: Ducroq Gregory , Iung Bernard , Vahanian Alec
Published: April 2012

Valvular heart disease (VHD), although not as common as coronarydisease or hypertension, is an important, and challenging, clinicalentity. The prevalence of VHD is still high, increasing with age, affecting 13.2% of people over the age of 75. There have beenimportant changes in the distribution of the aetiologies of VHDin Western countries over the last 50 years and the degenerativeaetiology is now the most frequent. Increased age is associated witha higher frequency of comorbidity, rendering decision-making forintervention more complex. The presence of VHD is of interest in patients with heart failure(HF) because the treatment of the causative VHD may cureHF, which stresses the importance of its detection and appropriatetreatment. However, decision-making for surgery may be difficult in patients with VHD and HF because of higher operativemortality and concerns over late results, which may be worsenedby progression of the underlying disease.

The present chapter will concentrate on adult patients eitherwith acquired VHD or with a valve prosthesis, focusing specificallyon the patient with HF.
Arrhythmias
Authors: Nisbet Ashley M. , Connelly Derek T.
Published: April 2012

Both atrial and ventricular arrhythmias are common in patientswith heart failure (HF), regardless of the underlying aetiology. Arrhythmias contribute significantly to symptoms, and lead to anincrease in morbidity and mortality. In particular, ventriculararrhythmias can cause sudden cardiac death (SCD). Therefore, thediagnosis and treatment of arrhythmias is an important element inthe clinical management of patients with HF.
Angiotensin converting enzyme inhibitors and vasodilators
Authors: Squire Iain , Clark Andrew L.
Published: April 2012

Heart failure (HF) is a complex syndrome, characterized byneurohumoral activation. That increased activation of the renin–angiotensin–aldosterone system (RAAS) plays a central role in thepathophysiology of chronic HF, has been recognized for many years. However, until the latter part of the 20th century, the pharmacologicalmanagement of chronic HF was limited to correction of fluid and electrolyte disturbances (diuretics) and augmentationof myocardial contractility (cardiac glycosides).The situation is very different now; physicians caring for patientswith HF have at their disposal an armamentarium of powerfulpharmacological therapies, encompassing angiotensin convertingenzyme (ACE) inhibitors, angiotensin receptor antagonists, aldosteronereceptor antagonists, and β‎ -receptor blockers, in addition toour old friends diuretics and digoxin. To a greater or lesser extent,the newer agents act to inhibit activity of the RAAS, emphasizingthe crucial role of this system in the HF syndrome. Among the agents with proven efficacy in the management of HF, ACE inhibitorshave the most extensive evidence base, and, in head-to headcomparisons with alternative RAAS inhibitors, remain unsurpassed in terms of clinical benefit. This chapter considers briefly the development and pharmacologyof ACE inhibitors, their physiological actions, and the evidencebase for their prescription to patients with HF. It also discusses the side effect profile of ACE inhibitors.
b-Adrenoreceptor antagonists and heart failure
Authors: Dargie Henry J. , Fitzgerald Desmond
Published: April 2012

Sir James Black’s quest for a substance that would block the potentiallyharmful effects of adrenaline on the ischaemic heart led tohis invention of the β‎ -adrenoceptor (AR) antagonistspronethaloland propranalol between 1959 and 1962. The ubiquitous natureof adrenaline ensured that these β‎ -AR antagonists, commonlyreferred to in clinical practice as β‎-blockers, found a role in multipleaspects of cardiovascular therapeutics. Sir James could nothave predicted the colossal impact his discovery of β‎ -blockers subsequentlywould have in improving the lives and preventing thedeaths of countless patients over the subsequent 50 years. Regardedby basic scientists as the father of analytical pharmacology, he wasalso a committed exponent of what we now regard as translationalmedical research. James Black’s achievement in discoveringβ‎ -blockers followed by histamine type 2 antagonists (H2 blockers), the first effective treatment for peptic ulcer, was recognized by theaward of the Nobel Prize in 1986.
Therapeutic control of fluid balance in chronic heart failure
Authors: Clark Andrew L. , Coletta Alison P. , Cleland John G.F.
Published: April 2012

One of the cardinal clinical features of chronic HF (CHF) is fluidretention. Ankle swelling is one of the commonest presentationsleading to the diagnosis of heart failure (HF), and oedema is thestate that leads to the diagnosis of ‘congestive’ HF. Until the arrivalof thiazide and loop diuretics, the management of fluid retentionin HF was very limited. Tourniquets could be used to reduce preload, and Southey’s tubes, introduced by direct skin incision, were used to drain fluid. Venesection was a further option, and HFis perhaps one of the few instances where venesection proved helpful, at least in the short term.Digoxin provided some diuretic effect, particularly in those patients with atrial fibrillation and a rapid ventricular response, but the first specific diuretics available for use were the mercurial when mercury treatment for syphilis was noted to have a diuretic effect. Thiazide diuretics became available in the late 1950s andthe loop diuretic furosemide in the 1960srevolutionizing themanagement of HF.
Antithrombotic agents
Authors: Cleland John G.F. , Torabi Azam , Zhang Jufen , Chelliah Raj K.
Published: April 2012

Heart failure (HF) and the causes of HF provide, theoretically, a powerful pathophysiological substrate for thrombosis but there is remarkably little evidence that the rate of thrombotic events can be reduced by antithrombotic therapy. HF is often associated with coronary artery disease and with atrial fibrillation two conditions for which long-term antithrombotic agents are traditionally given. Accordingly, many consider it unnecessary to investigate whether antithrombotic agents are effective in HF, since they consider the result a foregone conclusion. Some would even consider it unethical to withhold antithrombotic agents in patients with HF. Such an opinion reflects a general lack of rigour in the analysis and interpretation of long-term trials of antithrombotic agents for cardiovascular disease, undermining the scientific basis of medicine. It is widely perceived that patients with HF have high rates of vascular occlusive events, including myocardial infarction (MI) and stroke, but this may not be true. Reported rates of MI and stroke are certainly low compared to mortality in patients with HF. Moreover, treatment directed at reducing the risk of vascular events, including aspirin, statins, and coronary revascularization, has not yet been shown to reduce mortality in patients with HF, even though statins reduce the rate of nonfatal vascular events.

In summary, the contribution of vascular occlusive events to the morbidity and mortality of HF is uncertain. Too many opinions have been based on too few facts, resulting in recommendations about management that are only weakly supported by evidence. A lot of this stems from misinterpretation of the effects of aspirin in long-term trials of patients with atherosclerotic vascular disease.
Inotropes, pressors, and vasodilators
Authors: Price Susanna , Uddin Shahana
Published: April 2012

There has been a perceptible change in the approach to the managementof chronic heart failure (CHF) from focusing on inotropy,to a predominantly neurohormonal approach to therapeutic intervention.By contrast, in acute heart failure (AHF) the critical inabilityof the myocardium to maintain a cardiac output sufficient tomeet the demands of the peripheral circulation demands urgentintervention to restore adequate perfusion. Thus, haemodynamicconsiderations are pivotal, and the use of inotropes, pressors, andvasodilators remains widespread. This is despite concerns aboutthe potential of inotropic agents to increase mortality in somepatient populations. Current recommendations are thereforethat inotropes should be used only in selected patients, and withdrawnas soon as adequate organ perfusion is restored. The presentchapter reviews the pharmacology of positive inotropic drugs, theprinciples underlying the choice of vasoactive drugs in AHF, andpotential future developments in the field.
Implantable cardioverter-defibrillators in heart failure
Authors: Myles Rachel C. , Connelly Derek T.
Published: April 2012

The implantable cardioverter-defibrillator (ICD) is established asan effective therapy for ventricular arrhythmias and is now routinelyused for both primary and secondary prevention of suddencardiac death in at-risk populations. Patients with heart failure(HF) have an increased propensity to arrhythmic sudden deathand large randomized trials have demonstrated a clear mortalitybenefit following ICD implantation in selected HF patients. Despitethis, the optimal use of ICDs in patients with HF remains a particularlychallenging area of clinical practice. This is primarily becausepatients with HF are exposed to competing risks, which are both dynamic and difficult to quantify. As the cost and morbidity associatedwith ICD implantation are not insignificant, careful consideration of the risks and benefits associated with ICD implantationin each individual patient is required.
Heart transplantation
Authors: Banner Nicholas R. , Simon Andre R. , Burke Margaret M.
Published: April 2012

Clinical organ transplantation began in the mid-20th century, initially with renal transplants. Surgical techniques for heart transplantation began to be developed during the same period particularly byCass and Brock in the United Kingdom, and Lower and Shumway in the United States. The drugs then available for prophylaxis against rejection were limited to corticosteroids and azathioprine. The first human heart transplant was performed in 1967; the story of the pioneers in this field has been told elsewhere. The initial results of clinical heart transplantation were disappointing because of relatively ineffective pharmacological immunosuppression, lack of effective monitoring for acute rejection, and lack of therapeutic options for complications including infection and cardiac allograft vasculopathy. The results of organ transplantation improved dramatically following the introduction of ciclosporin as an immunosuppressive agent, first for kidney transplantation and subsequently for the heart and other organs.
Ventilatory strategies in acute heart failure
Authors: Mebazaa Mhamed , Mebazaa Alexandre
Published: April 2012

Ventilatory support and positive end-expiratory pressure (PEEP)are pivotal treatments of cardiogenic pulmonary oedema. Asrecently recommended, it should be introduced within minutes ofadmission at hospital for acute heart failure (HF) and ideally athome in case of prehospital management. Ventilatory support isone of the few tools that have been proven to change short-termoutcome in acute HF.
Multidisciplinary heart failure management programmes
Authors: Vazir Ali , Hardman Suzanna
Published: April 2012

In the early 21st century, heart failure (HF) guidelines and otherconsensus documents recommend a multidisciplinary approach tothe management of people with this diagnosis. This trendtowards, and aspiration to, the involvement of a range of healthcare professionals in the care of a particularly vulnerable patientgroup does not appear controversial. It seems intuitive that thiswould deliver best care, and is an approach welcomed by patientgroups. But how robust is the evidence for this approach, andwhich components of these multidisciplinary services confer benefit and in what health care contexts? To what extent are they thenapplicable to other populations and health care environments? Theliterature is extensive, diverse, and complex, which explains therepeated meta-analyses undertaken, and both published andplanned Cochrane reviews.In this chapter we explore the background to, and evidence for,different models of multidisciplinary working, and conclude byarguing for a more consistent implementation of care for thosewith HF.
End of life
Authors: Johnson Miriam
Published: April 2012

The clinical course of heart failure (HF) has been transformed bythe development of therapies (medication, devices, and surgery)targeted at the pathophysiological mechanisms underlying itsperpetuation and progression. Over the last decade, the prognosishas improved and it is likely that the 1-year survival figures often quoted are now less bleak. However, given that HF is a progressivedisease, patients who have not suffered a sudden cardiac deathfrom arrhythmia ultimately enter an end stage which may be prolonged, and carries a significant daily symptom burden, affectingboth themselves and their caregivers. With increasing use of implantable defibrillators, more patients may eventually live toexperience such endstage disease. In addition, comorbidities, oftensmoking related, are common. Comorbidities add to the symptomload, affect optimum cardiac management, and may be the finalcause of death.End-of-life care is not always delivered well, particularly in secondarycare settings where the emphasis may still be on life-prolonginginterventions. The dying phase may not be recognized oracknowledged. Despite Hinton’s observations 50 years ago thatpatients with HF and renal failure often died in distress, those withnonmalignant disease still have unequal access to services skilled inend-of-life care; more than 95% of patients seen by hospice servicesin the United Kingdom have cancer. In the United Kingdom, theDepartment of Health has declared end-of-life care to be a national priority. To this end, a national End of Life Strategy is to be implementedthroughout the National Health Service, and tools suchas the Liverpool Care of the Dying Pathway (LCP) and the GoldStandards Framework (GSF) have been recommended. Such acentral drive is welcome, but several challenges remain in the careof the patient dying from HF; the main one being the difficultiesclinicians, patients, and their carers may have in recognizing theend stage of the illness.
Simple Technique for Augmentation of the Facial Soft Tissue
Authors: Inchingolo Francesco , Tatullo Marco , Abenavoli Fabio M. , Marrelli Massimo , Inchingolo Alessio D. , Corelli Roberto , Mingrone Raffaella , Inchingolo Angelo M. , Dipalma Gianna
Published: April 2012

Due to the request of numerous patients to improve the aspect of the perioral area in combination with other types of cosmetic and reconstructive surgery, we started to use autologous fillers. In fact, there are numerous potential fillers that can be utilized during various operations executed in many bodily areas, such as the breast, abdomen, and face. The muscular fascia as well as the dense connective tissue which the surgeon encounters in various bodily areas during some stages of the operation, in fact, can be removed and replaced both by themselves or superimposed in order to increase their thickness. The insertion of the grafts is carried out by using a needle, but other methods can also be used with the same success. The consistency of the area treated, after a few days of edema, is very similar to the host area, and the volume obtained remains uniform in time (our followup is after 24 months). The time utilized for the removal and the insertion in the chosen area was only a few minutes. The result was extremely satisfactory in all the 30 patients treated, and there was no complication or side effects.
Antibiotic Synergy Interaction against Multidrug-ResistantPseudomonas aeruginosaIsolated from an Abattoir Effluent Environment
Authors: Igbinosa Etinosa O. , Odjadjare Emmanuel E. , Igbinosa Isoken H. , Orhue Phillips O. , Omoigberale May N. O. , Amhanre Napoleon I.
Published: April 2012

Pseudomonas aeruginosais an opportunistic pathogen in environmental waters with a high prevalence of multidrug resistance. In this study the synergistic efficacy of synergy antibiotic combinations in multidrug-resistantP. aeruginosastrains isolated from an abattoir effluent was investigated. Water samples were processed using membrane filtration;Pseudomonaswas isolated with Pseudomonas Isolation Agar and confirmed using polymerase chain reaction with specie-specific primer. Susceptibility studies andin vitrosynergy interaction testing were carried out, employing agar dilution and Etest procedure, respectively. Resistance was noted for clinically relevant antipseudomonal agents tested. Finding from antibiotic synergy interaction studies revealed that cefepime, imipenem, and meropenem combined with amikacin resulted in statistically significant (P<0.0001)in vitroantibiotics synergy interaction, indicating the possible use of this regimen in treatment of pseudomonal infections.
Major Extremity Injuries Associated with Farmyard Accidents
Authors: Copuroglu Cem , Heybeli Nurettin , Ozcan Mert , Yilmaz Baris , Ciftdemir Mert , Copuroglu Elif
Published: April 2012

Background. The aim of the study is to analyze the major agricultural injuries related to the extremities.Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period.Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60–360). Mean length of stay was 24 days (4–150), and mean number of operations during hospitalization was 2.4 (1–30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%).Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.
Changes in Serum Natriuretic Peptide Levels after Percutaneous Closure of Small to Moderate Ventricular Septal Defects
Authors: Kaya Yuksel , Akdemir Ramazan , Gunduz Huseyin , Murat Sani , Bulut Orhan , Kocayigit İbrahim , Vatan M. Bulent , Cakar M. Akif , Yeter Ekrem , Kilic Harun , Agac Mustafa Tarik , Acar Zeydin
Published: April 2012

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels.Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were ) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure.Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant ( versus , ).Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.
Effects of Aflatoxin on Some Haematological Parameters and Protective Effectiveness of Esterified Glucomannan in Merino Rams
Authors: Dönmez Nurcan , Dönmez H. H. , Keskin E. , Kısadere İ.
Published: April 2012

The objective of the present study was to evaluate the toxic effects of aflatoxin on some hematological parameters and to determine the preventive effectiveness of added glucomannan. In the study, 32 Merino rams were used, and the rams were separated equally to four groups as control (C), glucomannan (G), glucomannan + aflatoxin (AG), and aflatoxin (A). Erythrocyte, leukocyte count, hemoglobin, and hematocrit levels were decreased in A group compared with the other groups, and there was a reduction in similar parameters in AG group compared to control values. On the other hand, these parameters were tended to increase in AG group compared to A group values. Aflatoxicosis caused the lymphocytopenia and monocytopenia but increased percentage of neutrophil counts. In conclusion, the results determined in the study might be important to demonstrate the effects of aflatoxicosis and glucomannan on some haematological parameters before the clinical symptoms appear.
A Study of Epstein-Barr Virus BRLF1 Activity in aDrosophilaModel System
Authors: Adamson Amy , LaJeunesse Dennis
Published: April 2012

Epstein-Barr virus, a member of the herpesvirus family, infects a large majority of the human population and is associated with several diseases, including cancer. We have createdDrosophilamodel systems to study the interactions between host cellular proteins and the Epstein-Barr virus (EBV) immediate-early genes BRLF1 and BZLF1. BRLF1 and BZLF1 function as transcription factors for viral transcription and are also potent modifiers of host cell activity. Here we have used our model systems to identify host cell genes whose proteins modulate BRLF1 and BZLF1 functions. Via ourGMR-Rmodel system, we have found that BRLF1 expression results in overproliferation of fly tissue, unlike BZLF1, and does so through the interaction with known tumor suppressor genes. Through an additional genetic screen, we have identified severalDrosophilagenes, with human homologs, that may offer further insights into the pathways that BRLF1 interacts with in order to promote EBV replication.
Triacylglycerols Composition and Volatile Compounds of Virgin Olive Oil from Chemlali Cultivar: Comparison among Different Planting Densities
Authors: Guerfel Mokhtar , Ben Mansour Mohamed , Ouni Youssef , Guido Flamini , Boujnah Dalenda , Zarrouk Mokhtar
Published: April 2012

The present study focused on the comparison the chemical composition of virgin olive oil samples obtained from fruits of the main Tunisian olive cultivar (Chemlali) grown in four planting densities (156, 100, 69, and 51 trees ha−1). Despite the variability in the triacylglycerols and volatile compounds composition, the quality indices (free fatty acids, peroxide value, and spectrophotometric indices K232and K270) all of the virgin olive oils samples studied met the commercial standards. Decanal was the major constituent, accounting for about 30% of the whole volatiles. Moreover, the chemical composition of the volatile fraction of the oil from fruits of trees grown at the planting density of 156, 100, and 51 trees ha−1was also characterised by the preeminence of 1-hexanol, while oils from fruits of trees grown at the planting density of 69 trees ha−1had higher content of (E)-2-hexenal (20.3%). Our results confirm that planting density is a crucial parameter that may influence the quality of olive oils.
Back to Natural Fiber: Wool Color Influences Its Sensitivity to Enzymatic Treatment
Authors: Amara Amro A.
Published: April 2012

There are many missed biotechnological opportunities in the developmental countries. Wool quality improvement is one of them. This study is concerning with improving the wool quality using technical enzymes. White wool proves to be more susceptible to the enzymatic treatment than blackish brown wool. This proves that the enzymatic reaction is sensitive to the natural color differences between wool fibers. A simple enzymatic method has been used to improve the wool quality as well as to investigate the changes happened in the wool fibers.Geobacillus stearothermophilushas been used under mesophilic and static cultivation conditions using wool as the main carbon source. These conditions prove to be more suitable for maintaining the fiber structure, less expensive, and reliable as an in-house biotechnological process that can be adapted everywhere. The enzyme activity in case of white wool was 4 Units/ml and for blackish brown wool was 1.5 Units/ml. Electron microscope has been used to evaluate the end result. By following the process included in this paper using probable microbial strain(s), the wool quality improvement can be applied globally and can add another value to the economy of the developmental countries.
Uncovering cis-regulatory sequence requirements for context-specific transcription factor binding
Authors: Yáñez-Cuna J. Omar , Dinh Huy Q. , Kvon Evgeny Z. , Shlyueva Daria , Stark Alexander
Published: April 2012

The regulation of gene expression is mediated at the transcriptional level by enhancer regions that are bound by sequence-specific transcription factors (TFs). Recent studies have shown that the in vivo binding sites of single TFs differ between developmental or cellular contexts. How this context-specific binding is encoded in the cis-regulatory DNA sequence has, however, remained unclear. We computationally dissect context-specific TF binding sites in Drosophila, Caenorhabditis elegans, mouse, and human and find distinct combinations of sequence motifs for partner factors, which are predictive and reveal specific motif requirements of individual binding sites. We predict that TF binding in the early Drosophila embryo depends on motifs for the early zygotic TFs Vielfaltig (also known as Zelda) and Tramtrack. We validate experimentally that the activity of Twist-bound enhancers and Twist binding itself depend on Vielfaltig motifs, suggesting that Vielfaltig is more generally important for early transcription. Our finding that the motif content can predict context-specific binding and that the predictions work across different Drosophila species suggests that characteristic motif combinations are shared between sites, revealing context-specific motif codes (cis-regulatory signatures), which appear to be conserved during evolution. Taken together, this study establishes a novel approach to derive predictive cis-regulatory motif requirements for individual TF binding sites and enhancers. Importantly, the method is generally applicable across different cell types and organisms to elucidate cis-regulatory sequence determinants and the corresponding trans-acting factors from the increasing number of tissue- and cell-type-specific TF binding studies.
Plasma Membrane Calcium ATPases Are Important Components of Receptor-Mediated Signaling in Plant Immune Responses and Development
Authors: Frei dit Frey Nicolas , Mbengue Malick , Kwaaitaal Mark , Nitsch Lisette , Altenbach Denise , Häweker Heidrun , Lozano-Duran Rosa , Njo Maria Fransiska , Beeckman Tom , Huettel Bruno , Borst Jan Willem , Panstruga Ralph , Robatzek Silke
Published: April 2012

Plasma membrane-resident receptor kinases (RKs) initiate signaling pathways important for plant immunity and development. In Arabidopsis (Arabidopsis thaliana), the receptor for the elicitor-active peptide epitope of bacterial flagellin, flg22, is encoded by FLAGELLIN SENSING2 (FLS2), which promotes plant immunity. Despite its relevance, the molecular components regulating FLS2-mediated signaling remain largely unknown. We show that plasma membrane ARABIDOPSIS-AUTOINHIBITED Ca2+-ATPase (ACA8) forms a complex with FLS2 in planta. ACA8 and its closest homolog ACA10 are required for limiting the growth of virulent bacteria. One of the earliest flg22 responses is the transient increase of cytosolic Ca2+ ions, which is crucial for many of the well-described downstream responses (e.g. generation of reactive oxygen species and the transcriptional activation of defense-associated genes). Mutant aca8 aca10 plants show decreased flg22-induced Ca2+ and reactive oxygen species bursts and exhibit altered transcriptional reprogramming. In particular, mitogen-activated protein kinase-dependent flg22-induced gene expression is elevated, whereas calcium-dependent protein kinase-dependent flg22-induced gene expression is reduced. These results demonstrate that the fine regulation of Ca2+ fluxes across the plasma membrane is critical for the coordination of the downstream microbe-associated molecular pattern responses and suggest a mechanistic link between the FLS2 receptor complex and signaling kinases via the secondary messenger Ca2+. ACA8 also interacts with other RKs such as BRI1 and CLV1 known to regulate plant development, and both aca8 and aca10 mutants show morphological phenotypes, suggesting additional roles for ACA8 and ACA10 in developmental processes. Thus, Ca2+ ATPases appear to represent general regulatory components of RK-mediated signaling pathways.
DELLA Signaling Mediates Stress-Induced Cell Differentiation in Arabidopsis Leaves through Modulation of Anaphase-Promoting Complex/Cyclosome Activity
Authors: Claeys Hannes , Skirycz Aleksandra , Maleux Katrien , Inzé Dirk
Published: April 2012

Drought is responsible for considerable yield losses in agriculture due to its detrimental effects on growth. Drought responses have been extensively studied, but mostly on the level of complete plants or mature tissues. However, stress responses were shown to be highly tissue and developmental stage specific, and dividing tissues have developed unique mechanisms to respond to stress. Previously, we studied the effects of osmotic stress on dividing leaf cells in Arabidopsis (Arabidopsis thaliana) and found that stress causes early mitotic exit, in which cells end their mitotic division and start endoreduplication earlier. In this study, we analyzed this phenomenon in more detail. Osmotic stress induces changes in gibberellin metabolism, resulting in the stabilization of DELLAs, which are responsible for mitotic exit and earlier onset of endoreduplication. Consequently, this response is absent in mutants with altered gibberellin levels or DELLA activity. Mitotic exit and onset of endoreduplication do not correlate with an up-regulation of known cell cycle inhibitors but are the result of reduced levels of DP-E2F-LIKE1/E2Fe and UV-B-INSENSITIVE4, both inhibitors of the developmental transition from mitosis to endoreduplication by modulating anaphase-promoting complex/cyclosome activity, which are down-regulated rapidly after DELLA stabilization. This work fits into an emerging view of DELLAs as regulators of cell division by regulating the transition to endoreduplication and differentiation.
Redetermination of rifampicin pentahydrate revealing a zwitterionic form of the antibiotic
Authors: Wicher Barbara , Pyta Krystian , Przybylski Piotr , Tykarska Ewa , Gdaniec Maria
Published: April 2012

Rifampicin belongs to the family of naphthalenic ansamycin antibiotics. The first crystal structure of rifampicin in the form of the pentahydrate was reported in 1975 [Gadret, Goursolle, Leger & Colleter (1975).Acta Cryst.B31, 1454–1462] with the rifampicin molecule assumed to be neutral. Redetermination of this crystal structure now shows that one of the phenol –OH groups is deprotonated, with the proton transferred to a piperazine N atom, confirming earlier spectroscopic results that indicated a zwitterionic form for the molecule, namely (2S,12Z,14E,16S,17S,18R,19R,20R,21S,22R,23S,24E)-21-acetyloxy-6,9,17,19-tetrahydroxy-23-methoxy-2,4,12,16,18,20,22-heptamethyl-8-[(E)-N-(4-methylpiperazin-4-ium-1-yl)formimidoyl]-1,11-dioxo-1,2-dihydro-2,7-(epoxypentadeca[1,11,13]trienimino)naphtho[2,1-b]furan-5-olate pentahydrate, C43H58N4O12·5H2O. The molecular structure of this antibiotic is stabilized by a system of four intramolecular O—H...O and N—H...N hydrogen bonds. Four of the symmetry-independent water molecules are arrangedviahydrogen bonds into helical chains extending along [100], whereas the fifth water molecule forms only one hydrogen bond, to the amide group O atom. The rifampicin molecules interactviaO—H...O hydrogen bonds, generating chains along [001]. Rifampicin pentahydrate is isostructural with recently reported rifampicin trihydrate methanol disolvate.
Molecular phylogeny of the New World Dipsadidae (Serpentes: Colubroidea): a reappraisal
Authors: Grazziotin Felipe G. , Zaher Hussam , Murphy Robert W. , Scrocchi Gustavo , Benavides Marco A. , Zhang Ya‐Ping , Bonatto Sandro L.
Published: April 2012

We present a phylogenetic analysis of the New World dipsadids based on an expanded data matrix that includes 246 terminal taxa including 196 dipsadids. The species are sampled for eight genes (12S, 16S, cytb, nd2, nd4, bdnf, c‐mos, rag2). The data are explored using two distinct optimality procedures—maximum parsimony and maximum likelihood—and two alignment strategies—dynamic homology and static homology. Two previously unsampled dipsadid genera, Sordellina and Rhachidelus, are now included in the analysis. The definitions of the genera, Erythrolamprus, Clelia, Hypsirhynchus, Philodryas and Phimophis, and the tribes Alsophiini, Echinantherini and Conophiini, are revised. In order to maintain monophyly, the genus Umbrivaga is synonymized with Erythrolamprus, and two new genera are erected to accommodate Phimophis iglesiasi and Clelia rustica, as well as their closely related species. The West Indian genera Schwartzophis, Darlingtonia, Antillophis and Ocyophis are resurrected.

© The Willi Hennig Society 2012.
Magnetic resonance tumor targeting imaging using gadolinium labeled human telomerase reverse transcriptase antisense probes
Authors: Ren Bing Xiu , Yang Fan , Zhu Gao Hong , Huang Zi Xing , Ai Hua , Xia Rui , Liu Xi Jiao , Lu Man , Song Bin
Published: April 2012

To develop a molecular probe for MRI detection of human tumor telomerase reverse transcriptase (hTERT) mRNA expression. Uniformly phosphorothioate‐modified hTERT antisense oligonucleotide (ASON) homing hTERT mRNA was labeled with gadolinium (Gd) through the bifunctional chelator 1,4,7, 10‐tetraazacyclododecane‐N, N', N'', N'''‐tetraacetic acid (DOTA) stirred within 45 minutes at 60°C. The Gd labeled probes were characterized in vitro. The cellular uptake rate and biodistribution of 99mTc‐DOTA‐ASON was measured instead of that of Gd‐DOTA‐ASON. A549 lung adenocarcinoma model was established in BALB/c nude mice and Gd‐DOTA‐ASON was injected intraperitoneally and MR images were acquired using 7.0T Micro‐MRI (Bruker Biospec, Ettlingen, Germany) at different time points. Immunohistochemical analysis of telomerase activity of each xenograft was operated two days after in vivo imaging. The binding efficiency of Gd‐DOTA‐ASON reached as high as 71.7 ± 4.5% (n = 6). Gd‐DOTA‐ASON displayed perfect stability in fresh human serum at 37°C for 24 h. Compared with normal lung cells, A549 cells showed an obviously higher uptake of 99mTc‐DOTA‐ASON than that of lung cells (10.5 ± 2.7% vs. 4.8 ± 2.6%, P < 0.05). The signal intensity of A549 xenografts can be enhanced by Gd‐DOTA‐ASON and the signal to noise ratio (SNR) of tumor to muscle reached 2.37 and maintained a relatively high level within 6 h after injection. The activity of hTERT in A549 tumors can be suppressed by Gd‐DOTA‐ASON in pathological slices. The results of this study show that Gd‐DOTA‐ASON can be a promising intracellular MR contrast probe for targeting telomerase‐positive carcinomas. (Cancer Sci, doi: 10.1111/j.1349‐7006.2012.02316.x, 2012)