bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Cisapride on Ventricular Depolarization-Repolarization and Arrhythmia Markers in Infants
Authors: Zamora Samuel A. , Belli Dominique C. , Ferrazzini Giovana , Friedli Beat
Published: April 2003

To study prospectively the effects of cisapride on ventricular repolarization, depolarization, and arrhythmia markers in neonates, we determined before and three days after starting cisapride (1 mg/kg/day): corrected QT interval (QTc) and QT dispersion (QTd) on standard ECGs, and duration of filtered QRS (fQRS) and of low amplitude (<40 µV) terminal signals (LAS40, ms) and root mean square of the last 40 ms (RMS40, µV) using high-gain signal-averaged ECG (SAECG). Twenty-four term and 11 preterm infants (gestational age 23–35 weeks) were studied at a median chronological age of 32 days. QTc and QTd were not different between term and preterm infants. Cisapride lengthened QTc (mean ± SD; ms: 396.6 ± 24.8 before vs. 417.0 ± 35.2 after, p < 0.001). Three term and two preterm infants (5/35 = 14%; 95% CI: 5–30%) had a QTc >450 ms after cisapride. QTd after cisapride increased significantly in all infants with prolonged QTc. Filtered QRS, LAS40, and RMS40 before and after cisapride were within our normal values. We conclude that cisapride prolongs ventricular repolarization in neonates and infants without altering depolarization. Although no clinical arrhythmias were observed the dose of 0.8 mg/kg/day should not be exceeded.
Estimation of Mean Nuclear Volume of Neocortical Neurons in Sudden Infant Death Syndrome Cases Using the Nucleator Estimator Technique
Authors: Ansari T. , Sibbons P.D. , Howard C.V.
Published: April 2003

At present, no information is available with regards to either neocortical neuronal mean nuclear volume or maturation (functional or morphological) in abnormal paediatric brains. Using the nucleator estimator technique, the mean neocortical nuclear volume was estimated in sudden infant death syndrome (SIDS) cases [10 normal birth weight (NBW) and 10 low birth weight (LBW) cases classified by birth weight for gestational age] and compared to 10 NBW control cases. Both the control and SIDS LBW cases showed an increase in mean nuclear volume with age; the SIDS NBW cases showed no increase. At 8 months, the SIDS NBW cases showed a reduced mean nuclear volume (p = 0.02) when compared to controls. The SIDS LBW cases showed no statistically significant difference (p = 0.10) when compared with controls. A deficiency in mean neuronal nuclear volume may represent a deficiency in neuronal function.
Cord Blood Levels of Interleukin-6 and Interleukin-8 for the Immediate Diagnosis of Early-Onset Infection in Premature Infants
Authors: Krueger Marcus , Nauck Markus S. , Sang Sibylle , Hentschel Roland , Wieland Heinrich , Berner Reinhard
Published: April 2003

Background: Cytokine plasma levels are suggested to be sensitive indicators of neonatal sepsis, but conventional assays are time consuming. This study aimed at evaluating the significance of cord blood levels of interleukin (IL)-6 and IL-8 determined by a fully automated random access assay within 90 min of admission to predict systemic bacterial infection. Patients and Methods: Cord blood levels of IL-6 and IL-8 were determined in 71 mature and 100 premature infants by a chemiluminescence assay (Immulite®). Patients were divided into four groups according to a clinical and laboratory scoring system. Group A: documented early-onset infection; group B: infection possible; group C: infection unlikely, and group D: healthy newborns. Results: Median IL-6 levels in the subgroup of premature newborns were as follows: group A, 1,920 pg/ml (5–95% confidence interval 308–4,660 pg/ml); group B, 50 (15–102) pg/ml; group C, 21 (12–71) pg/ml, and group D, 8 (6–11) pg/ml. For IL-8, median levels for groups A–D were 289 (226–514) pg/ml, 87 (40–107) pg/ml, 44 (33–98) pg/ml and 21 (16–25) pg/ml, respectively. The difference between group A and the other groups was highly significant (IL-6 p < 0.0001, IL-8 p < 0.001). At a cut-off of 80 pg/ml, the sensitivity of IL-6 for the diagnosis of sepsis was 96% (specificity 95%). For IL-8 (cut-off 90 pg/ml), the sensitivity was 87% (specificity 94%). Conclusion: In premature infants, the diagnosis of an early-onset infection can be established or ruled out with a high level of confidence by measuring IL-6 or IL-8 levels from cord blood using a random access chemiluminescence assay.
The Activity of Collagen-Degrading Enzymes of Wharton’s Jelly in EPH Gestosis (Pre-Eclampsia)
Authors: Sobolewski Krzysztof , Galewska Zofia , Wolańska Małgorzata , Jaworski Stefan
Published: April 2003

Oedema/proteinuria/hypertension (EPH) gestosis is one of the more common complications observed during pregnancy. Our previous studies demonstrated some qualitative and quantitative changes in the extracellular matrix of Wharton’s jelly in newborns delivered by mothers with EPH gestosis. For this reason it was decided to evaluate the effect of EPH gestosis on the activity of gelatinolytic and proteolytic enzymes which may be involved in collagen degradation in Wharton’s jelly. Zymographic analysis of control and EPH gestosis samples of Wharton’s jelly demonstrates different electrophoretic patterns of gelatinolytic enzymes. The control Wharton’s jelly contains two latent forms of gelatinolytic enzymes: gelatinase A [metalloproteinase (MMP)-2, 72 kD] and gelatinase B (MMP-9, 92 kD). In contrast to control tissue, the main gelatinolytic enzyme of EPH gestosis Wharton’s jelly is gelatinase A (MMP-2). It was found that the proteolytic activity in EPH gestosis Wharton’s jelly differs from control. The decrease in gelatinase activity may be one of the factors which promote the accumulation of collagen in this tissue.
Liver Lipid Accumulation in Duck Embryos and Hatchlings Change with Parental Age1
Authors: Braun Christie M. , Burgess John R. , Latour Mickey A.
Published: April 2003

The purpose of this study was to investigate the effects of duck breeder age on liver lipid accumulation and yolk absorption and utilization in duck embryos (day 25 of incubation) and newly hatched ducklings. One breeder flock was monitored at 24 (young breeders), 31 (mature breeders and near peak egg production) and 47 (post peak egg production) weeks of age. Electron microscopy images of duck embryo liver slices revealed a significant change in hepatic lipid accumulation as a function of breeder age. More specifically, as breeder age increased both the relative number of liver lipid droplets as well as the size of the lipid droplets increased in duck embryos (day 25 of incubation). At hatch, however, newly hatched ducklings from 31-week-old breeders exhibited the lowest number as well as the smallest sized lipid droplets when compared to ducklings from 24 or 47-week-old breeders. The trend in yolk absorption at day 25 as a function of breeder age paralleled that in liver lipid accumulation. That is, day 25 maintained a higher percentage of unabsorbed yolk when compared to embryos from 31- or 47-week-old breeders. In contrast to breeder age, time of incubation (day 25 vs. day 28 or hatch) had little effect on yolk fatty acid profiles when compared to breeder age. Although there were no clear trends in yolk fatty acid usage among the various ages of breeders, newly hatched ducklings from 31-week-old breeders did have a significantly higher proportion of 18:2 n6 compared to those from breeders at 24 or 47 weeks of age. These data would suggest that breeder age subsequently affects the relative number and size of liver lipid droplets in embryos and newly hatched ducklings.
Regional Brazilian Diet-Induced Low Birth Weight Is Correlated with Changes in Renal Hemodynamics and Glomerular Morphometry in Adult Age
Authors: Paixão Ana D.O. , Maciel Cristiana R. , Teles Maria Beatriz B. , Figueiredo-Silva José
Published: April 2003

Number of nephrons, renal hemodynamics, and glomerular morphometry were assessed in rats submitted to a multideficient diet which was developed from a basic regional diet consumed in a Brazilian region of sugarcane cultivation. We evaluated three groups of male Wistar rat offspring: (1) from dams fed a standard diet throughout mating, pregnancy and lactation (control group) and (2) from dams fed the multideficient diet during mating and pregnancy (MalN1 group) or (3) throughout mating, pregnancy, and lactation (MalN2 group). At adult age, the animals were anesthetized to measure mean arterial blood pressure and renal hemodynamics. The MalN1 group, as compared with the control group, showed unaltered body and kidney weights, nephron deficiency, a high mean arterial blood pressure, glomerular hypertrophy, and renal vasoconstriction. The MalN2 group showed the same nephron deficiency and mean arterial blood pressure levels as the MalN1 group. These animals exhibited lower body and kidney weights and no glomerular hypertrophy. In conclusion, the alterations induced by intrauterine malnutrition are compatible with the development of chronic renal failure.
Temperature and Heater Responses during Transition between Radiant and Incubator Thermal Environment in Newborn Preterm Lambs
Authors: Touch Suzanne M. , Greenspan Jay S. , Cullen Aaron B. , Wolfson Marla R. , Shaffer Thomas H.
Published: April 2003

Objective: Although both incubators and radiant warmer beds can provide thermal support to infants in the neonatal intensive care unit, the transition between devices can be a stressful event. The goal of this study was to evaluate a new device that combines these methods of warming and converts between them without requiring physical movement of the infant. Study Design: Twin preterm lambs received thermal support from a radiant warmer bed and an incubator (control), or from the VersaletTM 7700 Care Center (treatment) in the warmer and incubator configurations. Temperature of each lamb, as well as device heater power, were monitored every 2 min before, during, and after the transition. Physiological parameters were monitored every 15 min. Results: There was a significant difference in response time between closed-open and open-closed conditions for both groups. More adverse events occurred in the control group during transfers. There were no differences in temperatures or physiological variables during transitions in either group. Conclusions: These data suggest the Versalet provides similar thermal stability to traditional devices, with fewer adverse events associated with the lack of physical movement between warming configurations. The impact of this device on the care of the preterm neonate will be evaluated in a clinical trial.
Sepsis-Induced Alteration in T-Cell Ca2+ Signaling in Neonatal Rats
Authors: Alattar Mohammad H. , Ravindranath Thyyar M. , Choudhry Mashkoor A. , Muraskas Jonathan K. , Namak Shahla Y. , Dallal Ousama , Sayeed Mohammed M.
Published: April 2003

Sepsis-induced suppression in T-cell proliferation follows deranged Ca2+ signaling in adult rats. In preliminary studies, we observed suppression in T-cell proliferation in septic neonatal rats as well. In this study, we assessed splenic T-cell cytosolic Ca2+ concentration, [Ca2+]i, as its elevation plays an important role in T-cell proliferation. Also, we investigated the role of PGE2 in sepsis-related changes in T-cell [Ca2+]i in animals pretreated with cyclooxygenase-1 (COX-1) inhibitor (resveratrol) and cyclooxygenase-2 (COX-2) inhibitor (NS-398). Sepsis was induced in 15-day-old rat pups by intraperitoneal implantation of fecal pellets containing Escherichia coli and Bacteroides fragilis. The sham group consisted of pups implanted with sterile fecal pellets. Septic and sham pups were sacrificed 24 h after implantation and their spleens were removed. The spleens from sham and septic pups, along with spleens from unoperated control pups, were processed for single cell suspensions, and T cells were isolated using nylon wool columns. Fura-2 fluorophotometry was employed for the measurement of [Ca2+]i (in nM units) in T cells stimulated with concanavalin A (ConA). Our results show that ConA-mediated T-cell [Ca2+]i response is significantly suppressed in septic neonatal rats. Pretreatment of pups with COX-2, but not COX-1 inhibitor, prevented the decrease in the [Ca2+]i response. These findings suggest that PGE2 might induce the attenuation in T-cell Ca2+ signaling during sepsis in neonatal rats.
Neonatal Hair Analysis for Benzoylecgonine: A Sensitive and Semiquantitative Biological Marker for Chronic Gestational Cocaine Exposure
Authors: Katikaneni Lakshmi D. , Salle Floyd R. , Hulsey Thomas C.
Published: April 2003

Hair analysis for the major metabolite of cocaine, benzoylecgonine (BZE) was performed in a cohort of 251 predominantly African-American newborns utilizing a modified radioimmunoassay (RIA) (Abuscreen Roche Laboratories, Nutley, N.J., USA). Maternal drug intake was confirmed by positive urine drug screen for cocaine metabolites at the time of delivery. The BZE concentrations reported here are the composites of both the parent compound cocaine (hydrolyzed to BZE) and the native BZE metabolized by the patient and deposited in the hair follicle. Hair analysis as an indicator for gestational cocaine exposure had a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 85%. The range of BZE was 99–23,300 ng/g of hair, with 79% having hair BZE levels <5,000 ng/g of hair. The BZE RIA was confirmed by gas chromatography and mass spectrometry (GC/MS). Of the 18 mother/infant pairs tested, the hair BZE ratio (maternal to neonatal) varied from 0.5 to 8.9 in 13 pairs. In spite of maternal high hair BZE levels, 5 newborns had no evidence of hair BZE, stressing the importance of the placental role for the cocaine transfer to the fetus. After controlling for gestational age, higher BZE levels significantly correlated with smaller head circumference (p < 0.03) and birth weight (p < 0.01).
The Development of a Circadian Pattern of Salivary Cortisol Secretion in the Neonatal Piglet
Authors: Gallagher Nerida L. , Giles L. Roger , Wynn Peter C.
Published: April 2003

Saliva was collected from neonatal piglets in order to assess the secretory dynamics of cortisol in the newborn piglet. Saliva was collected from two litters of piglets (n = 16) from multiparous sows at 07.00, 11.00, 15.00 and 19.00 h on days 0, 1, 2, 4, 6, 10, 14, 18, 22, 26 and 30 post partum. Salivary cortisol concentration was determined by radioimmunoassay. Salivary cortisol concentration was high perinatally and declined with age. The frequency of escape attempts and vocalisation intensity during collection, as well as the similarity in salivary cortisol concentration on day 22 in control piglets and piglets that had provided samples repeatedly from day 0 suggested that this was not an adaptive response. A circadian pattern was evident in female pigs from day 6, whereas males displayed a similar pattern from day 10. The collection of saliva in the piglet provides a viable alternative to blood sampling for the assessment of a glucocorticoid circadian rhythm.
Cortical Layer VII and Persistent Subplate Cells in Mammalian Brains
Authors: Reep Roger L.
Published: April 2003

Layer VII is the deepest cortical layer in rats, and consists of a thin layer of persistent subplate cells overlain by a cell-sparse, myelin-rich stratum through which many corticocortical axons travel. Layer VII neurons participate in local and long-distance corticocortical connections. The present study was undertaken to determine whether layer VII is a typical feature in rodent brains, and to determine which other mammalian taxa exhibit a layer VII. The adult brains of 144 species from 22 orders were examined. Of these, 43 species in 6 orders exhibit a layer VII. These include the sciurognath Rodentia, Insectivora, Paucituberculata, Paramelemorphia, some Xenarthra, and some Chiroptera. In all taxa interstitial cells were observed scattered throughout the white matter. The observed distribution of layer VII in this sample of mammalian taxa suggests that layer VII is a typical feature in some orders, but is not present in most orders. The heterogeneous distribution of layer VII in the Rodentia and Chiroptera suggests that species-level developmental dynamics are involved. It is hypothesized that the timing of subplate apoptosis in relation to the establishment of corticocortical connections is the major factor that determines whether layer VII is present in the adult stage.
Brain Areas in Abyssal Demersal Fishes
Authors: Wagner H.-J.
Published: April 2003

Four areas of the brain which receive primary projections from chemical senses ([1] olfactory bulb, [2] gustatory area including facial and vagal lobes), the eye ([3] optic tectum), and mechanosensory, and-hair-cell based systems i.e. the lateral line, vestibular and auditory systems ([4] trigeminal and octavolateral regions) have been studied and relative size differences used to make deductions on the sensory preferences of 35 fish species living on or near the bottom of the deep sea. Furthermore the relative volumes of the telencephalon and the corpus cerebelli were determined. Two evaluation modes were applied: (1) the relative mean of each system was calculated and species with above-average areas identified; (2) a cluster analysis established multivariate correlations among the sensory systems. The diversity of sensory brain areas in this population of fish suggests that the benthic and epibenthic environment of the abyss presents a rich sensory environment. Vision seems to be the single most important sense suggesting the presence of relevant bioluminescent stimuli. However, in combination the chemical senses, smell and taste, surpass the visual system; most prominent among them is olfaction. The trigeminal/octavolateral area indicating the role of lateral line input and possibly audition is also well represented, but only in association with other sensory modalities. A large volume telencephalon was often observed in combination with a prominent olfactory system, whereas cerebella of unusually large sizes occurred in species with above-average visual, hair-cell based, but also olfactory systems, confirming their role as multimodal sensorimotor coordination centers. In several species the predictions derived from the volumetric brain analyses were confirmed by earlier observations of stomach content and data obtained by baited cameras.
Role of T Channels in Cardiovascular Function
Authors: Hermsmeyer Kent
Published: April 2003

Although two types of Ca2+ channels are found to occur in the cardiovascular system, very little is known about one of them, primarily because a pharmacological blocking agent has been lacking. The enigmatic transient (T)-type Ca2+ channel has finally been recognized by a selective Ca2+ antagonist. The novel tetralol Ca2+ antagonist, mibefradil, is a selective T-type Ca2+ channel blocker that produces effective vasodilatation with additional inhibitory actions on blood vessel wall and left ventricular thickening. The availability of a blocking agent has begun to reveal the significance of T-type Ca2+ channel signals. Selective T-type Ca2+ channel blockade characteristics include vascular selectivity, freedom from negative cardiac inotropism, consistent and predictable reduction in heart rate, reduction in subendothelial proliferation, and increased survival of severely hypertensive and heart failure animal models. Mibefradil increases coronary blood flow without increasing myocardial oxygen consumption, and by decreasing heart rate and thus time spent in diastole, improves subendocardial perfusion. Improved perfusion of the myocardial wall and lowered heart rate appear to normalize the underlying pathophysiological factors, improve heart failure, and provide long-term protection. Thus, T-type Ca2+ channel blockade offers significant new cardiovascular protective benefits, even in the presence of critical pathophysiological elements (i.e. increased heart rate and neurohumors in the presence of decreased ejection fraction and contractility) found in heart failure.
Randomized, Double-Blind, Placebo-Controlled, Multicenter Study of Sibutramine in Obese Hypertensive Patients
Authors: Hazenberg Bouke P.
Published: April 2003

Objectives: To compare weight loss efficacy, safety and tolerability of sibutramine and placebo in mildly to moderately obese hypertensive subjects; to assess the effect of weight loss on blood pressure. Design: Randomized, double-blind, parallel-group; 3-week placebo run-in and 12-week treatment phase. Setting: Nine hospital outpatient clinics and general practices in the Netherlands. Participants: 127 men and women, 18–65 years old, with body mass indices (BMI) ranging from 27 to 40 kg/m2 and stabilized hypertension – mean resting diastolic blood pressure of 90–120 mm Hg – with or without antihypertensive medication. Interventions: Sibutramine 10 mg once daily; placebo. Main outcome measures: Body weight, blood pressure, routine laboratory and clinical safety monitoring. Results: Of 113 evaluable patients, 54 received sibutramine and 59 placebo. Weight reduction was significantly greater with sibutramine from week 2 onwards (last observation carried forward): mean, 4.4 kg with sibutramine and 2.2 kg with placebo (p = 0.002); mean percentage weight reduction, 4.7 and 2.3%, respectively (p < 0.001); mean BMI reduction, 1.6 and 0.8 kg/m2, respectively (p < 0.01). Reduction in excessive body weight was associated with a reduction in blood pressure in both groups, although the mean reduction in supine diastolic blood pressure was numerically, but not statistically significantly, greater in the placebo group (5.7 mm Hg) compared with the sibutramine group (4.0 mm Hg; p = 0.21). Similar reductions were seen in supine systolic blood pressure. Both treatments were well tolerated. Conclusions: Sibutramine 10 mg once daily is a useful, effective therapy for obesity in the presence of stable hypertension.
Changes in Myocardial Perfusion after Transmyocardial Laser Revascularization in Patients with End-Stage Angina pectoris
Authors: Kostkiewicz Magdalena , Rudziński Paweł , Tracz Wiesława , Dziatkowiak Antoni
Published: April 2003

The purpose of the present study was to analyze the effects of transmyocardial laser revascularization (TMLR) on myocardial perfusion. The value of 99mTc-MIBI scintigraphy in the detection of changes in perfusion of the lased and nonlased segments was assessed as well. In 15 patients before TMLR and then 3 and 6 months afterwards, MIBI scintigraphy and a stress test were carried out. At the beginning of the study, all patients were classified as having angina pectoris class III or IV (according to the criteria of the Canadian Cardiac Society); their ejection fraction was >30%. The parameters of the stress test increased significantly in 70% of the patients. Cardiac scintigraphy revealed improved perfusion of 33.7% of the transient defects within 3 months after TMLR which persisted at 6 months with a clear trend towards further improvement in the lased segments. TMLR has been found to be particularly beneficial in patients in whom other invasive methods of treatment cannot be applied.
HMG-CoA Reductase Inhibitors: Is the Endothelium the Main Target?
Authors: Puddu Paolo , Puddu Giovanni M. , Muscari Antonio
Published: April 2003

Endothelial dysfunction is an early event in atherosclerosis and could be considered a response to the injury induced by major risk factors. There is evidence that endothelial dysfunction is intimately involved in the onset and the progression of cardiovascular disease through abnormalities in the production, release or degradation of endothelium-derived factors, mainly nitric oxide and endothelin 1. Several reports have shown that drugs of the statin class could have multiple beneficial effects related to endothelium-mediated vasoactive, antithrombotic, antiproliferative and anti-inflammatory actions. Thus, the question arises of whether endothelial cells are the main target of statin therapy, in the setting of both hypercholesterolemia and normocholesterolemia. Experimental and clinical studies are reported that could support this hypothesis.
Insulin Resistance Is Increased by Transdermal Estrogen Therapy in Postmenopausal Women with Cardiac Syndrome X
Authors: Assali A.R. , Jabara Z. , Shafer Z. , Solodky A. , Herz I. , Sclarovsky E. , Strasberg B. , Sclarovsky S. , Fainaru M.
Published: April 2003

Estrogen has been reported to have both short- and long-term effects on the cardiovascular system. However, it remains to be examined how short-term transdermal estrogen therapy (TET) affects insulin sensitivity (SI) in patients with cardiac syndrome X (CSX), who are characterized by elevated insulin resistance. SI was assessed in a randomized, double-blind, placebo-controlled crossover study by minimal model analysis in seven postmenopausal women with CSX treated by TET. SI decreased by 32 ± 8.3%, from 5.94 ± 1.14 at baseline to 3.61 ± 0.40 [(10–4 × min–1)/(µU/ml)] during TET (p = 0.03). Time to the onset of symptoms increased from 414.2 ± 51.0 s at baseline to 450.0 ± 53.2 s (p = 0.04). We conclude that TET increases SI in postmenopausal women with CSX. This effect is unrelated to the beneficial anti-ischemic effects on exercise duration.
The Influence of Fetal and Postnatal Growth on Heart Rate Variability in Young Infants
Authors: Massin Martial M. , Withofs Nadia , Maeyns Kristel , Ravet Françoise
Published: April 2003

Heart rate variability (HRV), a measure of cardiac autonomic control, was analyzed in infants to assess the hypothesis that early undernutrition may induce autonomic dysfunction that could play a role in the programming of later cardiovascular disease. HRV data were collected during a night session in 546 healthy infants at 5–12 weeks of adjusted age, and statistical associations with fetal and postnatal growth indices were established. A significant positive correlation between birth weight, the ratio of neonatal weight to head circumference and postnatal weight gain, and HRV indices mostly influenced by sympathetic activity was demonstrated in 11- and 12-week-old infants. A slight correlation (p > 0.05) was also found in younger infants. These data suggest the influence of fetal and postnatal growth on the programming of the autonomic nervous system beyond the neonatal period. This influence may be one of the important mechanisms that link impaired growth in fetal and infant life to high blood pressure and other cardiovascular disease during childhood and adulthood (the Barker hypothesis).
The Peripheral Vascular Response to Exercise Is Impaired in Patients with Risk Factors for Coronary Artery Disease
Authors: Chenzbraun Adrian , Levin Galina , Scheffy Jakob , Keren Andre , Stern Shlomo , Goor Daniel
Published: April 2003

Background: Abnormal coronary and brachial artery responses have been described in individuals with risk factors for coronary artery disease (CAD). Peripheral arterial tonometry (PAT), a newly developed digital plethysmographic technique was used to assess peripheral vascular response to exercise in healthy controls and individuals with risk factors. Methods and Results: Continuous finger PAT during Bruce protocol exercise test was performed in 30 subjects with risk factors for CAD and 30 healthy individuals. Compared with baseline, the PAT wave amplitude at peak exercise decreased in the subjects but increased in the controls: 83 ± 28% vs. 114 ± 40% respectively, p < 0.01. Conclusions: A different pattern of systemic vascular response to exercise was found in individuals with risk factors for atherosclerosis. Since the vascular behavior in these patients is probably related to endothelial dysfunction, it may be that peripheral arterial tonometry can be used as a simple, readily available technique to assess endothelial function.
Isolated Acute Anterolateral Papillary Muscle Rupture Presenting as a Sole Manifestation of Acute Myocardial Infarction and Mimicking Mitral Valve Vegetation
Authors: Moustapha Ali , Lyngholm Karen , Barasch Eddy
Published: April 2003

We present here a case of an acute myocardial infarction presenting solely as rupture of the head of anterolateral papillary muscle of the mitral valve with an echocardiographic appearance of a mitral valve vegetation. A 61-year-old male patient presented to the hospital with cardiogenic shock. Transesophageal echocardiography revealed normal left ventricular global and regional systolic function with the echocardiographic appearance of a large vegetation attached to the anterior mitral valve leaflet and severe mitral regurgitation. Intraoperatively, an infracted and ruptured head of the anterolateral papillary muscle was found with no evidence of vegetations. Papillary muscle rupture is a rare complication of acute myocardial infarction, is usually associated with inferior myocardial infarction and rarely seen as the only clinical and echocardiographic finding. Transesophageal echocardiography is more sensitive than transthoracic echocardiography but misdiagnosis can still occur.
Outcome and Cost-Effectiveness of Cardiopulmonary Resuscitation after In-Hospital Cardiac Arrest in Octogenarians
Authors: Paniagua David , Lopez-Jimenez Francisco , Londoño Juan C. , Mangione Carol M. , Fleischmann Kirsten , Lamas Gervasio A.
Published: April 2003

Context: Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population. Objective: We sought to investigate the clinical benefit and cost-effectiveness of CPR after in-hospital cardiac arrest in octogenarians. Main Outcome Measure: Years of life saved. Design: Effectiveness data were obtained from a review of 91,372 hospital discharges from January 1st, 1993 until June 30th, 1996. Cardiac arrest was reported in 956 patients. The study group consisted of 474 patients ≧80 years old. CPR costs included equipment and training, physician and nursing time and medications. Post-CPR expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. Life expectancy of the patients who were still alive at the end of the study was estimated from census data. A utility of 0.8 was used to calculate quality-adjusted-life years saved (QALYS). We used a societal perspective for analysis. Results: The study population was 86 ± 4.8 years old (range 80–103), and 42% were male. Fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. Assuming that a cardiac arrest without CPR has 100% mortality, 12 octogenarians required treatment with CPR in order to save one life to hospital discharge. Similarly, 29 octogenarian patients with cardiac arrest have to be treated with CPR to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). The cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was USD 50,412 per year of life saved, and USD 63,015 per QALYS. However, a utility of 0.5 yielded a cost of USD 100,825 per QALYS. Conclusion: In comparison with other life-saving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients’ preference for quality rather than quantity of life, as expressed by the utility assumptions.
Caries Detection Methods: Can They Aid Decision Making for Invasive Sealant Treatment?
Authors: Pereira A.C. , Verdonschot E.H. , Huysmans M.C.D.N.J.M.
Published: April 2003

The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut–offs for traditional dentine caries detection and at reduced cut–offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut–offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut–offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut–offs may aid the indication of invasive sealant treatment. The visual detection of dentinal caries is substantially increased, but not perfect after fissure opening.
Effectiveness of Three Minimal Intervention Approaches for Managing Dental Caries: Survival of Restorations after 2 Years
Authors: Mandari G.J. , Truin G.J. , van’t Hof M.A. , Frencken J.E.
Published: April 2003

The present study was aimed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces. The approaches tested comprised a conventional and a modified–conventional treatment and a modified Atraumatic Restorative Treatment (ART). The conventional approach was performed in a university dental clinic whilst the modified–conventional, employing portable equipment, and the modified ART, using hand instruments and a caries removal solution (Caridex®), were carried out in the field. Using the split–mouth design, 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass–ionomers in permanent molars of 152 school children by one dental therapist. The restorations were assessed using a modified USPHS–Ryge criteria. After 2 years, the cumulative survival percentages for occlusal amalgam and glass–ionomer restorations were 92 and 96%, respectively. The survival of all restorations in the conventional, modified–conventional and the modified ART group was 96, 96 and 91%, respectively. The survival of occlusal amalgam and glass–ionomer restorations per treatment group was as follows: 94 and 99%, respectively (conventional group); 95 and 97%, respectively (modified–conventional group), and 89 and 93%, respectively (modified ART group). The differences in survival percentage between restorations with amalgam and glass–ionomer, and between the three restorative treatment approaches were not statistically significant. In countries facing scarcity in resources for dental care, ART seems a promising restorative approach to occlusal caries in posterior teeth. However, a longer clinical observation period is required to substantiate this initial conclusion.
Protective Properties of Salivary Pellicles from Two Different Intraoral Sites on Enamel Erosion
Authors: Hannig M. , Balz M.
Published: April 2003

The purpose of this study was to investigate the protective effect and ultrastructure of salivary pellicles formed in vivo near the orifices of the ducts of parotid and submandibular/sublingual salivary glands. Pellicles were formed by exposing bovine enamel slabs to the oral environment at the buccal aspect of the upper first molars and at the lingual aspect of the lower incisors in 3 subjects over periods of 24 h. Enamel specimens with and without 24–hour pellicles were immersed in citric acid (0.1 and 1%) for periods ranging from 30 s to 5 min, and processed for measurement of surface microhardness (SMH) and transmission electron microscopy (TEM). In comparison to uncovered enamel specimen significantly less decrease in SMH due to acid exposure was observed in pellicle–coated enamel specimens. Pellicles formed at the buccal aspect of the upper molars were less effective in protecting the enamel against acid–induced softening as compared to pellicles formed at the lingual aspect of the lower incisors only after 5 min exposure in 1% citric acid. TEM analysis showed that pellicle layers were dissolved continously due to acid exposure. However, even after 5 min exposure to 1% citric acid, a residual pellicle layer could be detected on the enamel surface. In conclusion, site–dependent differences of buccally and lingually in vivo formed 24–hour pellicles have minor importance concerning the pellicle–induced protection of the enamel surface against erosive changes.
The Association between Asthma and Dental Caries in Children and Adolescents: A Population–Based Case–Control Study
Authors: Shulman J.D. , Taylor S.E. , Nunn M.E.
Published: April 2003

This study explored the potential association between childhood asthma and caries using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988–1994 (NHANES III). We fitted GEE Poisson regression models with adjustment for parents’ income, gender, race, exposure to potentially xerostomic drugs, and the presence of pit and fissure sealants. There was no association between the use of drugs commonly used by asthmatics (antihistamines, corticosteroids, and antiasthmatic inhalers) and df/DMF scores. Asthmatic children 4–10 years of age at all severity levels had similar dfs scores to the controls, however, severely asthmatic children 4–10 years of age had significantly lower DMFS (p = 0.010) and DMFT (0.049) scores than controls. Similarly, severely asthmatic children 11–16 years of age had significantly lower DMFT scores than controls (p = 0.024) and DMFS scores approaching statistical significance (p = 0.053). While our analysis adjusted for covariates, potential confounders such as fluoride intake from water, diet, use of topical fluorides, and dose of antiasthmatic medication could not be addressed. Our results indicate that any association between asthma and dental caries may occur primarily in younger children with no evidence of an association between asthma and dental caries as children mature.
Clinical Investigation of Two Glass–Ionomer Restoratives Used with the Atraumatic Restorative Treatment Approach in China: Two–Years Results
Authors: Lo E.C.M. , Luo Y. , Fan M.W. , Wei S.H.Y.
Published: April 2003

Objective: To compare the clinical performance of two glass–ionomer cements, ChemFlex (Dentsply DeTrey) and Fuji IX GP (GC), when used with the atraumatic restorative treatment (ART) approach in China. Methods: Eighty–nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included. A split–mouth design was used in which the two materials were randomly placed on contralateral sides. The performance of the restorations was assessed directly and also indirectly from die–stone replicas at baseline and after 6, 12, and 24 months. Results: The 24–month cumulative survival rates of ART restorations in the primary teeth were 93 and 90% for the ChemFlex and Fuji IX GP class I restorations, respectively, while 40 and 46% of class II restorations placed with the respective materials were satisfactory. In the permanent dentition, only class I restorations were involved and the cumulative survival rates were 95 and 96% for ChemFlex and Fuji IX GP. For the primary teeth after 24 months, net mean occlusal wear was 87 µm for ChemFlex and 85 µm for Fuji IX GP. The occlusal wear in the permanent teeth was 75 µm for ChemFlex and 79 µm for Fuji IX GP. Conclusion: The clinical performance of both materials over a 24–month period was similar and the survival rates of class I ART restorations in both primary and permanent teeth were high.
Absence of Circulating Microemboli in Patients with Atrial Fibrillation Undergoing Electric Cardioversion
Authors: Nabavi Darius G. , Allroggen Achim , Reinecke Holger , Kemény Vendel , Droste Dirk W. , Breithardt Günter , Ringelstein E. Bernd
Published: April 2003

Electrical cardioversion (CV) of atrial fibrillation (AF) is associated with an increased risk of stroke, and its appropriate prevention is still a matter of debate. It is known that, besides dislodgement of pre-existing intra-atrial thrombi, the ‘stunned’ atrium after CV is an important cause of thrombus formation and subsequent embolism. We investigated whether CV of AF is associated with occurrence of circulating microemboli (ME) representing a sensitive marker of the actual thromboembolic activity. Twenty-nine patients (22 men) aged 54 ± 13 years suffering from valvular (n = 5) or nonvalvular (n = 24) AF were studied. All but 1 patient (with recent-onset AF) had been put on oral anticoagulation (INR >2.0) for at least 3 weeks before and 4 weeks after successful CV. In all patients, exclusion of internal carotid artery stenosis and atrial thrombus was performed prior to CV. Five unilateral 1-hour transcranial Doppler ME monitorings over the middle cerebral artery were performed (1) before CV, and (2) immediately, (3) 4–6 h, (4) 24 h, and (5) 2–4 weeks after CV. Total absence of circulating ME was found before CV as well as during a cumulative monitoring time of 115 h after successful CV. Electrical CV of AF after at least 3 weeks of effective anticoagulation is not associated with occurrence of cerebral circulating ME. This finding requires further investigation including high-risk patients with AF undergoing CV based on different treatment protocols.
Nerve Growth Factor and Transforming Growth Factor-β Serum Levels in Acute Stroke Patients
Authors: Stanzani L. , Zoia C. , Sala G. , Appollonio I. , Frattola L. , De Simoni M.G. , Ferrarese C.
Published: April 2003

Background and Purpose: Experimental evidence indicates cytokine and neurotrophin production in brain tissue after stroke. Since neurotrophins may also be released from blood cells, we measured nerve growth factor (NGF) and transforming growth factor (TGF)-β serum levels in 40 patients at various times after stroke and compared them to those in 20 healthy controls. Methods: Venous blood was obtained 1, 4, 10, 30 and 90 days after stroke and NGF and TGF-β serum levels were measured by commercial ELISA. Values at each time were correlated with stroke severity, assessed using the National Institute of Health Stroke Scale, and with lesion volume, calculated using Cavalieri’s direct estimator on a computerized tomography scan performed 5 days after stroke. Results and Conclusions: Although no significant differences between the two groups were demonstrated, in stroke patients, serum neurotrophins were significantly associated with clinical and neuroradiological parameters of brain injury and positively correlated with each other in the acute phases of stroke, suggesting that stroke may modulate peripheral neurotrophin levels.
Internuclear Ophthalmoplegia and Cerebellar Ataxia: Report of One Case
Authors: Krespi Yakup , Aykutlu Ebru , Çoban Oğuzhan , Tunçay Rezzan , Bahar Sara
Published: April 2003

Deep hemispheric or brainstem small infarcts can lead to atypical lacunar syndromes. Unilateral internuclear ophthalmoplegia (INO) and cerebellar ataxia has not been reported previously. A 57-year-old hypertensive female presented with bilateral appendicular and left truncal cerebellar ataxia and right INO. Cranial MRI showed a right paramedian infarct of lacunar size located in the tegmentum of caudal mesencephalon. At this level the involvement of medial longitudinal fascicle (MLF) led to right INO and the lesion of brachium conjunctivum caused the bilateral cerebellar ataxia. Ipsilateral involvement of both cerebellofugal fibers, before and after decussation, was responsible for bilateral cerebellar ataxia.
Carotid Angioplasty with Cerebral Protection and Stenting: Report of 164 Patients (194 Carotid Percutaneous Transluminal Angioplasties)
Authors: Guimaraens Leopoldo , Sola María Teresa , Matalí Arantxa , Arbeláez Andrés , Delgado Mercedes , Soler Luis , Balaguer Ernesto , Castellanos Carmen , Ibáñez Jordi , Miquel Luis , Theron Jacques
Published: April 2003

Background: The introduction of cerebral protection devices with systematic stent placement has changed the nature of carotid artery stenosis treatment, reducing the immediate periprocedural complications and delayed restenosis. Methods: We treated 164 patients with 194 carotid artery stenosis procedures; 92% of them were symptomatic patients. Results: The morbidity rate of our series was 1.03% and the mortality was 1.9%. Conclusions: In the future, carotid stenosis treatment should perhaps be performed as a preventative measure and not used as a cure for full-blown symptoms. This could be effective in reducing the morbidity and mortality rates of this pathology.
Blood Pressure in Acute Stroke
Authors: Jørgensen H.S. , Nakayama H. , Christensen H.R. , Raaschou H.O. , Kampmann J.P. , Olsen T.S.
Published: April 2003

This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. BP declined with increasing time from stroke onset with a total of 8/4 mm Hg. Independent factors related to diastolic BP were ischemic heart disease (–3.9 mm Hg), male gender (2.2 mm Hg), known hypertension prior to stroke (8.6 mm Hg), and primary hemorrhage (9.7 mm Hg). Independent factors related to systolic BP were age (3.6 mm Hg/10-year increase), atrial fibrillation (–7.2 mm Hg), ischemic heart disease (–6.0 mm Hg), intracerebral hemorrhage (13.3 mm Hg), and known hypertension prior to stroke (16.3 mm Hg). No independent relations were seen between BP and diabetes, claudication, previous stroke, smoking, daily alcohol consumption, initial stroke severity and lesion size. The increase in BP in the acute phase of stroke is a uniform response to the ischemic event per se. BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.
Stroke following Chiropractic Manipulation
Authors: Jeret Joseph S. , Bluth Mark
Published: April 2003

We present 3 cases of stroke due to arterial dissection following chiropractic manipulation: (1) a 31-year-old woman with left vertebral dissection developed a large cerebellar infarct, (2) a 64-year-old man developed a left parietal infarct due to left carotid dissection and (3) a 51-year-old man developed right Horner’s syndrome, fluctuating dysarthria, left facial droop, and left arm weakness due to right carotid dissection. Imaging studies and the literature are reviewed.