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16112939 | Hybrid coronary artery revascularization: logistics and program development. | Planning hybrid coronary artery bination of cardiac surgery with percutaneous procedures--requires, at first sight, a plex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascularization approaches and the intent bine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascularization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures. |
16112938 | Combined minimally invasive pulmonary vein isolation, left atrial appendage excision and cardiac resynchronization therapy for heart failure: case report. | A 76-year-old male with ischemic cardiomyopathy presented with heart failure symptoms in the absence of angina. Several hospitalizations were required due to heart failure exacerbation and paroxysmal atrial fibrillation. Electrocardiography and tissue synchronization imaging confirmed ventricular dyssynchrony, requiring biventricular pacing. After a failed attempt of percutaneous placement of the left ventricular lead, a novel minimally invasive approach was indicated. It consisted of left ventricular epicardial lead placement, microwave pulmonary vein isolation, and left atrial appendage excision through bilateral minithoracotomies. The postoperative recovery was unremarkable, with reestablishment of the ventricular synchrony and regular rhythm. |
16112940 | Total endoscopic CABG using robotics on beating heart. | The implementation of a total endoscopic coronary surgery on the beating heart with the aid of the Da Vinci surgical system (Intuitive, Sunnyvale, CA) requires a stepwise learning process. After cadaveric training and clinical start of the program in November 2002, we gained experience with arrested heart procedures starting in May 2003. In November 2003, we moved to beating heart surgery. |
16112942 | Operative mortality after valvular reoperations. | To determine the incidence and risk factors of mortality and morbidity in valvular reoperations. |
16112943 | Treatment of double vessel coronary artery disease by totally endoscopic bypass surgery and drug-eluting stent placement in one simultaneous hybrid session. | Hybrid coronary artery revascularization is bination of minimally invasive coronary artery surgery and catheter-based coronary intervention. Hybrid procedures enable adequate revascularization of patients with multivessel coronary artery disease plete opening of the chest and with the advantage of the most durable option, a left internal mammary artery (LIMA) graft is placed to the left anterior descending (LAD) artery. The hybrid concept is gaining renewed interest because totally endoscopic LIMA to LAD placement has e feasible and because drug-eluting stents in non-LAD targets may petitive even for arterial bypass grafts. Simultaneous hybrid procedures would be desirable. We report on a case in which robotic totally endoscopic LIMA to LAD grafting using the da Vinci telemanipulation system bined with placement of a rapamycin coated stent to the right coronary artery in one single procedure. |
16112944 | Ongoing procedure development in robotically assisted totally endoscopic coronary artery bypass grafting (TECAB). | Totally endoscopic coronary artery bypass grafting (TECAB) using robotics requires stepwise introduction into a heart surgery program. It is the aim of this study to evaluate the state of procedure development after continued application of telemanipulation techniques in the clinical setting. We also sought to assess perioperative and intermediate term clinical results after robotically assisted CABG. |
16112945 | Subxiphoid multi-arterial OPCAB: surgical technique and initial case report. | The surgical technique of transsternal coronary artery bypass grafting (CABG) has remained relatively stagnant for the past three decades. Unlike general and orthopedic surgery, cardiac surgery has made very little progress in converting our mon procedure into a minimally invasive alternative. Minithoracotomy techniques introduced in 1995 enjoyed a brief period of popularity but were inherently single vessel (LIMA-LAD) procedures and thus not an answer to the need for a less invasive multivessel operation. Totally endoscopic CABG has been performed in a small number of cases but the learning curve is very steep and the rate of conversion to open surgery remains high with only a few successful multivessel cases. There remains a great need for a less invasive approach that has the potential to graft all coronary targets without disturbing the chest wall and which can be performed by all current and future surgeons with acceptable hospital costs. A small subxiphoid incision has been used for single vessel grafting to anterior or inferior targets, but until now lateral wall grafting has not been considered possible. Development of a successful multivessel subxiphoid technique on the beating heart, including lateral wall grafting, is now reported in this article. |
16112947 | Pharmacology of estrogens and progestogens: influence of different routes of administration. | This prises the pharmacokinetics and pharmacodynamics of natural and synthetic estrogens and progestogens used in contraception and therapy, with special consideration of hormone replacement therapy. The paper describes the mechanisms of action, the relation between structure and hormonal activity, differences in hormonal pattern and potency, peculiarities in the properties of certain steroids, tissue-specific effects, and the metabolism of the available estrogens and progestogens. The influence of the route of administration on pharmacokinetics, hormonal activity and metabolism is presented, and the effects of oral and transdermal treatment with estrogens on tissues, clinical and serum parameters pared. The effects of oral, transdermal (patch and gel), intranasal, sublingual, buccal, vaginal, subcutaneous and intramuscular administration of estrogens, as well as of oral, vaginal, transdermal, intranasal, buccal, intramuscular and intrauterine application of progestogens are discussed. The various types of progestogens, their receptor interaction, hormonal pattern and the hormonal activity of certain metabolites are described in detail. The structural formulae, serum concentrations, binding affinities to steroid receptors and serum binding globulins, and the relative potencies of the available estrogens and progestins are presented. Differences in the tissue-specific effects of the pounds and regimens and their potential implications with the risks and benefits of hormone replacement therapy are discussed. |
16112948 | The role of mammographic density in evaluating changes in breast cancer risk. | The Women's Health Initiative (WHI) study showed that postmenopausal bined estrogen-progestogen therapy (EPT) significantly increases the risk of breast cancer, thus confirming the results from large epidemiological studies. These results were predicted approximately 15 years previously based on the epidemiology of breast cancer and the relationship of ovarian hormone levels to breast cell proliferation. However, the prediction had little effect on prescribing habits due to its theoretical nature. Many questions remain regarding menopausal therapy and breast cancer risk, especially the effects of other schedules and regimens. Epidemiological case-control studies and randomized clinical trials with breast cancer as the e cannot answer these questions in an appropriate timeframe. Some intermediate marker of breast cancer risk must therefore be used as a basis of rational prescribing. There is considerable evidence in support of using changes in mammographic densities as such a marker. For example, measurement of changes in mammographic density in the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial showed that EPT was likely to be associated with a notably greater risk than estrogen therapy alone, that sequential EPT regimens are likely to increase the risk as much as continuous regimens (if the total progestin dose is similar), and that replacing medroxyprogesterone acetate with progesterone is unlikely to significantly alter the additional risk. |
16112949 | Mammographic breast density and cancer risk: the radiological view. | Breast density refers to the presence of fibroglandular tissue in the breast. Several investigators have demonstrated that extensive mammographic density is strongly associated with increased risk of breast cancer. Density can be assessed either subjectively or quantitatively. Subjective measurements include Wolfe patterns, the Breast Imaging Reporting and Data System and the 6-category scale. However, quantitative density measurements, such as interactive thresholding, planimetry and volumetric density imaging, provide stronger estimates of risk than those which are simply qualitative. Breast density is of particular interest in assessing the etiology of breast cancer, but it may also have potential as a surrogate marker of risk in interventions designed to reduce the risk of breast cancer. However, a surrogate marker is only acceptable if it shows biological feasibility and statistical correlation. To date, we can say that there is undoubtedly an association between breast density and breast cancer, but it will not be until an intervention study using risk as an endpoint has firmly established the connection between change in density and change in risk that density will be absolutely acceptable as a surrogate for breast cancer risk. |
16112950 | Menopausal hormone therapies: their effect on mammographic density and breast cancer risk. | Postmenopausal hormone therapy (HT) increases breast density, an effect that is rapidly reversed upon treatment discontinuation. Increased breast density is recognised to be a powerful risk factor for breast cancer. It is therefore important to know whether HT-induced changes in mammographic breast density can provide information about an individual's future risk of breast cancer; or whether an absence of any change in breast density following HT should be viewed as reassuring. Mammographic breast density therefore needs to be examined in further detail in order to better assess the risks of breast cancer in postmenopausal women and further individualize prescribing practices. |
16112952 | The need for tissue selective menopausal agents. | For decades, hormone therapy (HT) has been the mainstay for managing menopausal symptoms. However, fear of breast cancer, as well as side-effects such as breast pain and return of vaginal bleeding, have made many women stop HT or refuse to take it. There is therefore a clear need for alternative treatments. Recent years have seen the development of hormonal agents with selective effects, such as tibolone. Tibolone has a unique mode of action and is described as a STEAR (Selective Tissue Estrogenic Activity Regulator). The main action of tibolone is mediated through two 3-hydroxy metabolites; small amounts of a third metabolite are also found in the circulation. In the brain, the effect is estrogenic and perhaps androgenic and, as such, tibolone relieves hot flushes and improves energy and sexual well-being. The uterus converts tibolone and its hydroxy metabolites into a Delta4 metabolite that has a progestogenic effect. In the breast, the metabolites of tibolone inhibit key enzymes that result in estrogen depletion within the breast itself. Clinically, tibolone does not stimulate the breast and it does not increase mammographic density. There are several key large, placebo-controlled international trials of tibolone currently underway, one of which (LIBERATE) aims to test the safety of tibolone (vs placebo) in women with a history of breast cancer who are suffering from climacteric symptoms. |
16112951 | Is mammographic density, as currently measured, a robust surrogate marker for breast cancer? | In order to determine current beliefs concerning the relevance of breast mammographic percent density (MPD) as a surrogate marker for breast cancer, the panel and the pleted a questionnaire. There was general agreement between the panel and delegates on most aspects, although the delegates were unsure whether high breast MPD is a contraindication for hormone therapy and tended to err on the side of caution in suggesting that estrogen and estrogen/progestogen therapy should be stopped before screening mammography. The overall consensus of the panel and the delegates was that breast MPD should e an important clinical tool, and that carefully designed studies are needed to determine exactly how it can be best used to guide clinical decision-making. |
16112955 | Prevalence of obesity and dyslipidaemia in hypertensives seen in Abuja, Nigeria. | This is a report of observations on a hospital-based study over the prevalence of obesity and dyslipidaemia seen in hypertensives attending our hypertension clinic. 409 patients were screened and 315 (77%) found hypertensive (BP>140/70 mmHg): 71.6% of 109 women screened (mean systolic 165 mmHg) were obese (BMI>30) as against 50.5% of 184 men (mean systolic 161 mmHg). Total cholesterol (TC) concentration was higher in women (mean, 5.28 mmol/L) [4.9-5.8 mmol/L] than in men (mean, 5.1 mmol/L) [5,0-5.4 mmol/L] but the mean atherogenic index (TC/HDL-cholesterol) was higher in men (4.8) than in women (4.1) (normal <4.5). The aim of this study is to sensitise our relevant clinicians to look for obesity and dyslipidaemia coexisting with hypertension, treat such cases aggressively to avoid coronary event and progressive renal disease. This study is to be extended to other geopolitical zones in Nigeria through the coordination of Nigerian Association of Clinical Chemists (NACC). |
16112954 | The metabolic syndrome. | The metabolic syndrome is a multifaceted clinical entity resulting from the interaction of genetic, hormonal, and lifestyle factors. Over the past two decades, the number of people diagnosed with the syndrome has steadily increased and is associated with the global epidemic of obesity and diabetes. The metabolic syndrome is characterized by the clustering of disorders which includes high blood pressure, high (pro)insulin concentrations, excess body weight with central obesity, and an altered lipid profile (dyslipidaemia) that increase the likelihood to develop micro- and plications, including coronary heart disease or stroke. Each of these disorders is by itself a risk factor for other diseases including diabetes mellitus. bination, morbidity and mortality are dramatically increased. Because the defining thresholds for establishing the diagnosis of the metabolic syndrome are controversial, the NCEP: ATP III and the WHO have made specific suggestions. The current definitions of the metabolic syndrome can be used as predictors of plications. Risk assessment and subsequent selection of probands for intervention, such as weight reduction and increased physical activity are mended for the clinical management of the metabolic syndrome. |
16112956 | Clinical and laboratory diagnostics of cardiovascular disease: focus on natriuretic peptides and cardiac ischemia. | Chest pain is the mon clinical presentation of acute ischemic heart disease, but only one third of these patients are ultimately found to have an acute coronary syndrome. Initial assessment of the patient presenting with chest pain includes a careful history, physical examination, an initial electrocardiogram (ECG) and measurement of biochemical markers of myocardial injury. The natriuretic peptide system is activated in a broad spectrum of cardiovascular diseases, including acute coronary syndromes and stable coronary disease. A strong relation between plasma levels of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) obtained in the subacute phase, and long-term, all-cause mortality, as well as the rate of re-admissions for heart failure after myocardial infarction, has been documented. Persistently elevated NT-proBNP levels during the first 72 hours following admission for an acute coronary syndrome have recently been associated with the presence of refractory ischemia and high risk of short-term recurrent ischemic events. Patients with signs of exercise-induced ischemia by dobutamine stress echocardiography have been reported to have higher baseline BNP values. Moreover, BNP and NT-proBNP levels are increased acutely in proportion to the magnitude of the inducible perfusion defect observed during stress testing, suggesting that BNP and NT-proBNP are markers of acute ischemia. Recently, a relationship between circulating levels of BNP and NT-proBNP and long-term all cause mortality in patients with stable coronary artery disease has been documented. |
16112958 | Insulin resistance and inflammation in the early phase of type 2 diabetes: potential for therapeutic intervention. | Prospective studies of prediabetic subjects have shown that obesity and its duration are major risk factors for type 2 diabetes. Longitudinal studies are consistent with an etiologic role of subclinical inflammation in the pathogenesis of type 2 diabetes, primarily as a mediator of obesity-induced insulin resistance. Inflammation is closely associated with endothelial dysfunction and is recognized as one of the cardiovascular risk factors clustering in the Insulin Resistance Syndrome or Metabolic Syndrome. The adipose tissue has been recognized as an important source of metabolically active secretory products (adipocytokines), free fatty acids, leptin, TNF-alpha, Iinterleucin-6, plasminogen activator inhibitor-1, adiponectin and resistin. Prevention of insulin resistance by weight loss, diet and exercise is very effective in reducing the progression from glucose intolerance to type 2 diabetes in obese subjects. Since insulin resistance is a key disturbance in early type 2 diabetes additional drug treatment with insulin-sensitizing drugs might be helpful to reduce the progression to both beta-cell failure and macrovascular plications. The PROACTIVE study will determine if the effects of improving insulin sensitivity and reducing inflammation will translate into clinical benefits and reduce the cardiovascular morbidity and mortality associated with insulin resistance and Type 2 diabetes. |
16112959 | Quality of guidelines for the laboratory management of diabetes mellitus. | There is increasing concern about the quality and reliability of practice guidelines, especially in the field of laboratory medicine, as most mendations are developed by clinical specialty societies, often without involving laboratory professionals. Little information is available on the methodological quality of guidelines for the use of laboratory investigations in the care of specific diseases. We describe a pilot assessment of the most well-known guidelines for the diagnosis and monitoring of diabetes mellitus (DM). |
16112960 | Consequences of bias and imprecision in measurements of glucose and hba1c for the diagnosis and prognosis of diabetes mellitus. | To investigate the effect posite analytical bias and imprecision in the measurements of fasting plasma-glucose (fPG) for diagnosis of diabetes mellitus and estimation of risk of development and progression of retinopathy using measurements of Haemoglobin A1C (HbA1C%). |
16112961 | Standardization of HbA1c and Optimal Range of Monitoring. | The IFCC has established a working group on HbA1c standardization, which developed a reference system to act as basis for global standardization of all glycohemoglobin/HbA1c assays. The reference system is based on HbA1c, defined as beta-N-1-deoxy fructosyl haemoglobin ponent. Two reference methods specifically measure the glycated N-terminal residue of the beta chain of haemoglobin. The assay principle is peptide mapping after proteolytic cleavage of the molecule followed by measurement of the ratio of the glycated and non-glycated ss-N-terminal hexapeptides by HPLC/MS or HPLC/CE. An international network of 12 reference laboratories is in place. An overall CV below 2% is achieved parison studies, which guarantees a reliable value assignment to secondary reference materials. For implementation of the system, the relationship between IFCC and the existing Designated Comparison Methods in the US (NGSP), Sweden (MonoS) and Japan was calculated in seven parisons. In all cases, the correlation was exactly the same, making recalculation of the various systems to one IFCC reference system possible. IFCC values will be a reference range of 3-4% HbA1c with a target value of optimal treatment of 5% and change of therapy proposed at values >6%. The last item of the IFCC WG on HbA1c standardization is the adjustment of all mercial methods to this new reference system. Three parison studies with all the major manufacturer methods were performed. This allowed us to first anchor mercial methods to the IFCC reference system and thereafter recalculate the results to the new IFCC system. Secondary reference materials and a transfer protocol are provided to enable manufacturers to adjust their routine tests to the new reference system. The IFCC reference system for HbA1c will make it possible to improve the performance of routine HbA1c assays. The goal of this improved analytical performance is a within and between run CV of 2%. If this can be achieved, then the HbA1c results can be incorporated into the diagnostic strategies for detecting diabetes mellitus. |
16112962 | Elevated placental growth factor (PlGF) predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy. | Placental growth factor (PlGF) is up-regulated in early and advanced atherosclerotic lesions, acts as a primary inflammatory instigator of atherosclerotic plaque instability, and may be an independent biomarker of adverse e in patients with acute coronary syndromes. In diabetic nephropathy the relative cardiovascular mortality and morbidity is increased and therefore, this study investigated the prognostic value of PlGF in a large cohort of type 1 diabetic patients with and without diabetic nephropathy. |
16112963 | Quality control of SMBG in clinical practice. | We present results of quality control of self-monitored blood glucose (SMBG) performed in diabetes outpatient clinic. The tests included: inspection of glucose meter, blood glucose self-measurement by a patient, glucose measurement by point-of-care analyzer used in a clinic and with the laboratory method. In the study 158 glucose meters were controlled pared with HemoCue glucose analyzer used in the clinic as the reference. 122 glucose meters readings were pared with the reference laboratory method. Tested glucose meters included: Accutrend {18}, Glucotrend {59}, Precision QiD {39}, One Touch {26} and Glucocard II {16}. Reference glucose assays were performed using glucose oxidase method on Hitachi 911 analyzer. Glucose concentrations measured by the controlled glucose meters ranged from 36 to 425 mg/dL. The analytical bias of the glucose meters amounted from 2.48% to 8.27%. Correlation coefficient between results obtained by the tested glucose meters and HemoCue analyzer ranged from 0.957 to 0.980 and between glucose meters and laboratory method from 0.955 to 0.985. Passing-Bablok agreement test and Deming regression analysis indicated good concordance of results between all the tested glucose meters and HemoCue analyzer, whereas good agreement with the laboratory method was found for Accutrend, Glucotrend, Precision QiD and One Touch glucose meters. In conclusion, good analytical performance of the employed glucose meters and a bias less than 10% from the reference values were found. Results of this study show the possibility for routine, convenient for the patient quality control of SMBG in an outpatient clinic. |
16112964 | Biomarkers in angina. | Angina represents the earliest stage of symptomatic atherothrombotic disease and is part of the continuum that ultimately results in myocardial infarction. Development of plaque is related to conventional risk factors. The progression to active disease occurs as a result of plaque destabilisation and rupture. This is a continuous process with clinically apparent disease occurring when there are multiple episodes of plaque rupture. Elevation of inflammatory markers including C reactive protein is predictive of the risk of development of cardiac events. However, it appears that B type natriuretic peptide is single most powerful predictor of cardiovascular mortality. This probably reflects its role as the integrator of the cardiac neuroendocrine system and marker of global cardiac performance. Progression of disease to occlusion will initially produce myocardial ischaemia, which may then progress to infarction. Ischaemia modified albumin is currently the most promising of the markers for early detection of ischaemia at first presentation. |
16112965 | Diagnosis and management of patients with suspected acute myocardial infarction. | Patients admitted with suspected acute myocardial infarction (MI) constitute a diagnostic, prognostic and therapeutic challenge for the treating physician. Elevation of a marker of myocardial necrosis together with ischemic symptoms and/or ischemic ECG changes are mandatory for the diagnosis of acute MI. Troponin T or I is the preferred marker of myocardial necrosis. The diagnostic process should start as soon as possible. The introduction of prehospital ECG recordings and prehospital administration of thrombolytic treatment in case of ST-segment elevation MI, have been shown to decrease the time from onset of symptoms till treatment considerably, which also translates into saved lives. In contrast, data of the value of prehospital analyses of biochemical markers are still limited. In patients without ST-segment elevation on admission the diagnosis is dependent on repeated measurements of markers of myocardial damage, which together with other biochemical markers (e.g. CRP and BNP/NT-proBNP) also are useful for risk assessment. Patients identified to be at low risk of future cardiac events might be discharged early and, on the contrary, a more intense treatment might be started in patients identified to be at high risk. An elevated troponin concentration is shown to identify patients who benefit from antithrombotic therapy and invasive procedures. Several different risk scoring models based on bination of clinical variables, ECG-changes and biochemical markers, have been shown to further improve risk assessment and selection of treatment. |
16112966 | Monitoring of patients with heart failure. | The recent guidelines of the European Society of Cardiology, mends laboratory testing as an essential part of the evaluation of the patient presenting with acute or chronic heart failure. The decrease in BNP has been included as a treatment goal for the management of acute heart failure. As for other properties it is important to define what difference can be considered as a real change of the marker in serial measurements. Therefore, knowledge of pathophysiological influences and pre-analytical issues as well as the intraindividual variability of BNP and N-terminal proBNP (NT-proBNP) due to analytical imprecision and biological variation is crucial. Erroneous test results with BNP or NT-proBNP assays are rare but may occasionally occur analytical interferences and should be suspected if the results do not suit the clinical picture or the serial kinetics. Although BNP assays correlate closely, due to lack of standardization no two BNP assays are analytically equivalent, and the same assay must be used for serial measurement. The in-vitro stabilities of BNP and NT-proBNP are sufficient for routine use, and blood sampling for BNP or NT-proBNP directly after arrival without a standardized period of rest is feasible, however, heavy physical exercise should be avoided before blood sampling. To be on the safe side a period of 10 minutes rest before blood sampling is mended. BNP and NT-proBNP are suitable for heart failure monitoring, and BNP and NT-proBNP changes >50% from baseline correlated well with clinical course and a reduction of mortality in heart failure patients. |
16112968 | Markers for early detection of cardiac diseases. | The existing markers for myocardial necrosis, such as cardiac troponin, creatine kinase-MB, and myoglobin are thought to be released into blood following irreversible myocardial necrosis. Thus results of these tests are usually negative for patients with acute coronary syndromes (ACS) who present to the emergency department (ED) within the first 3 hours after the onset of chest pain. Given the need to make early therapeutic and triage decisions, biomarkers that can be used to diagnose and/or risk stratify ACS patients during their initial ED presentation will be important. Active research in this area has identified several classes of biomarkers that show promise for early detection of disease. These include tests for the presence of acute inflammation and infiltration (e.g., high sensitivity-C-reactive protein, myeloperoxidase), plaque instability (e.g., pregnancy-associated plasma protein-A, placental growth factor), platelet activation (e.g., whole blood choline, platelet density, CD40 ligand), and myocardial ischemia (e.g., ischemia modified albumin, free fatty acids, serum choline, and B-type natriuretic peptide). Each of these tests has demonstrated some utility for early diagnosis. However, as most lack specificity for myocardial disease, routine use may require a multi-marker approach. |
16112967 | Standardization of cardiac markers. | Developing primary reference materials to standard cardiac biomarker assays, specifically cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), as well as develop quality specifications for immunoassays to optimize clinical use, whether for diagnostics or risk assessment, have been primary goals of the IFCC Committee on Standardization of Markers of Cardiac Damage (C-SMCD). The purpose of this paper is to review the current status of standardization issues for myoglobin, creatine kinase MB, cardiac troponin I and natriuretic peptides (BNP and NT-proBNP) and quality specifications for analytical immunoassays for the worldwide, consistent clinical utilization of these and future cardiac biomarkers. |
16112969 | Prevalence of the metabolic syndrome in southwest Germany. | The metabolic syndrome is a highly prevalent multifaceted clinical entity. Obesity, which is part of the metabolic syndrome, is the fastest growing health-related problem worldwide. Since currently prevalence data of the metabolic syndrome are lacking from Germany, we have applied ATP III-criteria in two urban and rural cohorts. Our population-based studies provide evidence that the prevalence of the metabolic syndrome increases with age. It was found to be more prevalent in a rural population and in this group it clustered in males. As a consequence of our population-based studies evidence that especially the rural population is at high risk for future plications is substantiated. The urgent need for preventive measures aimed at reducing the significantly increased health risk is underscored. |
16112970 | Health gains by using natriuretic peptides in diagnosis, prognosis and treatment. | The cardiac natriuretic peptides, and in particular plasma levels of the B-type natriuretic peptides, are acknowledged biomarkers of cardiac function and prognosis in cardiovascular disease. A growing body of evidence confirms plasma BNP and/or NT-proBNP are independent predictors of mortality and/or heart failure events in acute heart failure, established chronic heart failure, acute coronary syndromes and even in asymptomatic but at risk populations. Alongside this large body of associative observational data, there is a growing evidence base from controlled trials which indicates that knowledge of plasma B-type natriuretic peptide levels can be translated into improved clinical es. Measurements of NT-proBNP improve diagnostic accuracy in patients presenting with heart failure in munity. Provision of plasma BNP data improves speed of diagnosis and reduces rates of hospital admission in patients with heart failure presenting with breathlessness (all whilst reducing overall costs). A randomised pilot study demonstrates serial measurements of NT-proBNP can assist in more effective optimisation of heart failure pharmacotherapy with a itant improvement in e. This finding has been corroborated by a recently reported multicentre study. Screening for left ventricular systolic dysfunction in the general population or in asymptomatic subjects at high risk of cardiovascular events appears to be cost-effective. This developing evidence base from controlled trials encourages further implementation of plasma BNP and/or NT-proBNP in diagnosis, risk stratification and management, not only of acute and chronic heart failure but also in those with coronary disease and asymptomatic subjects with cardiovascular risk factors. |
16112971 | Biochemical cardiac risk markers in the general population, hypertension and coronary artery disease. | Recently there has been a growing interest in risk assessment of individuals, using biochemical markers of cardiac risk, with an increasing focus on a multi-marker strategy. Natriuretic peptides (BNP and NT-proBNP) are well-established markers of increased risk in the general population and in high-risk groups with hypertension, and coronary heart disease. However, there is at present no indication for routine measurements of natriuretic peptides in the risk assessment of individuals or patients, as there is no evidence for subsequent therapeutic initiatives. Natriuretic peptides are useful when screening for heart failure in symptomatic individuals. However, the use of NT-proBNP screening for risk or left ventricular systolic dysfunction in the general population is still a matter of debate. |
16112972 | The HOPE (Heart Outcomes Prevention Evaluation) Study and its consequences. | The HOPE study was a 19 country, prospective randomized trial in which the ACE-inhibitor Ramipril but not Vitamin E significantly reduced the risk of future cardiovascular events in a high-risk population of men and women, including many with diabetes. The benefits were present in all sub-groups, independent of the presence or absence of diabetes, hypertension, evidence of cardiovascular disease, microalbuminuria, blood pressure lowering, the use of aspirin, lipid-lowering or antihypertensive medication. It provided clear evidence that Ramipril should safely and cost-effectively be used in individuals not known to have low ventricular ejection fraction or heart failure but at high-risk of cardiovascular events. It was also beneficial in patients with renal insufficiency, reducing progression of proteinuria and development of new microalbuminuria. It provided micro- and macrovascular benefits in people with diabetes, reduced the development of new cases of diabetes and showed a positive and graded association between the waist-to-hip ratio and the risk of developing diabetes. pleted and on-going into the predictive role of natriuretic peptides, infectious and inflammatory markers, provide insight into possible mechanisms of action of Ramipril. |
16112973 | Interrogation of patient data delivered to the operating theatre during hepato-pancreatic surgery using high-performance computing. | The Op3D visualization system allows, for the first time, a surgeon in the operating theatre to interrogate patient-specific medical data sets rendered in three dimensions using puting. The hypothesis of this research is that the success rate of hepato-pancreatic surgical resections can be improved by replacing the light box with an interactive 3D representation of the medical data in the operating theatre. |
16112974 | The effect of visual and haptic feedback on computer-assisted needle insertion. | We present a study evaluating the effects of visual and haptic feedback on human performance in a needle insertion task. |
16112975 | The use of a head-mounted display for visualization in neuroendoscopy. | To evaluate the clinical use of a head-mounted display (HMD) for visualization in all neuroendoscopic procedures. |
16112976 | Safe femoral pin placement in knee navigation surgery: a cadaver study. | A number of navigation systems used for total knee replacement surgery currently require the insertion of a distal femoral reference sensor pin, which is placed anterior to posterior just superior to the level of the knee joint. There is potential for the posterior neurovascular bundle to be damaged during the insertion of this sensor device. The aim of this cadaveric study was to identify the structures at risk during insertion of the distal femoral sensor, and determine whether a safe zone for insertion could be identified. Sixteen cadaveric lower limbs (8 pairs) were studied. In each knee Steinman pins were passed from anterior to posterior, 5 cm proximal to the level of the femoral articular cartilage, directly AP and angled at 30 degrees passing medially or laterally. All pins that were passed directly from anterior to posterior and from lateral to medial passed within 5 mm of a major neurovascular structure, while 62.5% of pins passing from medial to lateral passed within 5 mm of a major neurovascular structure. The popliteal vessels and the sciatic nerve are at risk of injury from a navigation pin or drill placed in the distal femur during knee navigation. Caution should be exercised in passing these pins and alternate methods of fixing femoral sensors should be considered. |
16112977 | An "optimal" k-needle placement strategy and its application to guiding transbronchial needle aspirations. | This article addresses the problem of finding an "optimal" strategy for placing k biopsy needles, given a large number of possible initial needle positions. We consider two variations of the problem: (1) Calculate the smallest set of needles necessary to guarantee a successful biopsy; and (2) Given a number k, calculate k needles such that the probability of a successful biopsy is maximized. Note that "needle" is used as shorthand for the parameter vector that specifies the needle placement. Both problems are formulated in terms of two general, NP-hard optimization problems. Our k-needle placement strategy can be considered as "optimal" in the sense that we are able to formulate it as a known NP-hard problem for which it is believed (NP not equal P conjecture) that no efficient algorithm exists putes the optimal solution. In other words, our strategy is "optimal" with respect to the best approximative algorithm known for the respective NP-hard problem. For the second variation we have implemented an approximative algorithm that is guaranteed to be within a factor of approximately 0.63 of the exact solution. Given a number k, the algorithm calculates k sets of parameters, each set specifying the placement of a needle and the corresponding probability of success. The resulting probabilities show that our approach can provide valuable decision support for the physician in choosing how many needles to place and how to place them.A typical example of a biopsy where the initial needle position is known approximately is a transbronchial needle aspiration (TBNA). We demonstrate how our "optimal" needle placement strategy can be used to achieve sensor-less guidance of TBNA. The basic idea is to use a patient-specific model of the tracheobronchial tree (from CT/MR) and our model for flexible endoscopes to preoperatively estimate the unknown position of the bronchoscope. The result is a set of candidate shapes for the unknown shape of the bronchoscope before needle placement or, in other words, a (large) number of possible initial needle positions. By parameterizing the handling of the bronchoscope, including the insertion of the biopsy needle, we are able to apply our "optimal" strategy. The result is a TBNA protocol that, if executed during the procedure, prescribes how to handle the bronchoscope to maneuver the needle into the target. With the aforementioned endoscope model, we present a new way of modeling long, flexible instruments. The algorithm requires no initialization or preprocessing and calculates the workspace of an instrument based on its insertion depth and a set of internal and external constraints. |
16112979 | Reading and reviewing the orthopaedic literature: a systematic, evidence-based medicine approach. | The principles of evidence-based medicine are rapidly gaining acceptance in the field of orthopaedic surgery. This approach to patient care requires a careful, systematic review of the literature to appropriately value the merit of studies. Systematic review assists the orthopaedic surgeon in interpreting study results and in understanding the relative validity of these results in the hierarchy of evidence. Sufficiently valid evidence-based information ultimately will help in making decisions regarding patient care. |
16112980 | Gene therapy for the treatment of musculoskeletal diseases. | Research into the orthopaedic applications of gene therapy has resulted in progress toward managing chronic and acute genetic and nongenetic disorders. Gene therapy for arthritis, the original focus of research, has progressed to the initiation of several phase I clinical trials. Preliminary findings support the application of gene therapy in the treatment of additional chronic conditions, including osteoporosis and aseptic loosening, as well as musculoskeletal tumors. The most rapid progress is likely to be in tissue repair because it requires neither long-term transgene expression nor closely regulated levels of transgene expression. Moreover, healing probably can be achieved with existing technology. In preclinical studies, genetically modulated stimulation of bone healing has shown impressive results in repairing segmental defects in the long bones and cranium and in improving the success of spinal fusions. An increasing amount of evidence indicates that gene transfer can aid the repair of articular cartilage, menisci, intervertebral disks, ligaments, and tendons. These developments have the potential to transform many areas of musculoskeletal care, leading to treatments that are less invasive, more effective, and less expensive than existing modalities. |
16112985 | Rapid and sensitive identification of major histocompatibility complex class I-associated tumor peptides by Nano-LC MALDI MS/MS. | Identification of major plex (MHC)-associated peptides recognized by T-lymphocytes is a crucial prerequisite for the detection and manipulation of specific immune responses in cancer, viral infections, and autoimmune diseases. Unfortunately immunogenic peptides are less abundant species present in plex mixtures of MHC-extracted material. Most peptide identification strategies use microcapillary LC coupled to nano-ESI MS/MS in a challenging on-line approach. Alternatively MALDI PSD analysis has been applied for this purpose. We report here on the first bination of nanoscale (nano) LC and MALDI TOF/TOF MS/MS for the identification of naturally processed MHC peptide ligands. These peptides were acid-eluted from human leukocyte antigen (HLA)-A2, HLA-A3, and plexes separately isolated from a renal cell carcinoma cell lysate using HLA allele-specific antibodies. After reversed-phase HPLC, peptides were further fractionated via nano-LC. This additional separation step provided a substantial increase in the number of detectable candidate species within plex peptide pools. MALDI MS/MS analysis on nano-LC-separated material was then sufficiently sensitive to rapidly identify more than 30 novel HLA-presented peptide ligands. Peptide sequences contained perfect anchor amino acid residues described previously for HLA-A2, HLA-A3, and HLA-B7. The most promising candidate for a T-cell epitope is an HLA-B7-binding nonamer peptide derived from the tumor-associated gene NY-BR-16. To demonstrate the sensitivity of our approach we characterized peptides binding to HLA-C molecules that are usually expressed at the cell surface at approximately only 10% the levels of HLA-A or HLA-B. In fact, multiple renal cell carcinoma peptides were identified that contained anchor amino acid residues of HLA-Cw5 and HLA-Cw7. We conclude that the nano-LC MALDI MS/MS approach is a sensitive tool for the rapid and automated identification of MHC-associated tumor peptides. |
16112986 | Proteomic analysis of Schistosoma mansoni cercarial secretions. | Schistosomiasis is a global health problem caused by several species of schistosome blood flukes. The initial stage of infection is invasion of human skin by a multicellular larva, the cercaria. We identified proteins released by cercariae when they are experimentally induced to exhibit invasive behavior. Comparison of the proteome obtained from skin lipid-induced cercariae (the natural activator), a cleaner mechanical induction procedure, and an uninduced proteomic control allowed identification of protein groups contained in cercarial acetabular gland secretion versus other sources. These included a group of proteins involved in calcium binding, calcium regulation, and calcium-activated functions; two proteins (paramyosin and SPO-1) implicated in immune evasion; and protease isoforms implicated in degradation of host skin barriers. Several other protein families, traditionally found as cytosolic proteins, appeared concentrated in secretory cells. These included proteins with chaperone activity such as HSP70, -86, and -60. Comparison of the three experimental proteomes also allowed identification of protein contaminants from the environment that were identified because of the high sensitivity of the MS/MS system used. These included proteins from the intermediate host snail in which cercariae develop, the investigator, and the laboratory environment. Identification of proteins secreted by invasive larvae provides important new information for validation of models of skin invasion and immune evasion and aids in rational development of an anti-schistosome vaccine. |
16112981 | Management of extremity trauma and related infections occurring in the aquatic environment. | Wounds sustained in oceans, lakes, and streams are exposed to a milieu of bacteria rarely encountered in typical land-based injuries. These include Vibrio species, Aeromonas hydrophila, Pseudomonas and Plesiomonas species, Erysipelothrix rhusiopathiae, Mycobacterium marinum, and other microbes. Failure to recognize and treat these mon pathogens in a timely manner may result in significant morbidity or death. Initial antibiotic therapy should mon gram-positive and gram-negative aquatic bacteria, depending on the environment. Trauma occurring in brackish or salt water should be treated with doxycycline and ceftazidime, or a fluoroquinolone (eg, ciprofloxacin or levofloxacin). Freshwater wounds should be managed with ciprofloxacin, levofloxacin, or a third- or fourth-generation cephalosporin (eg, ceftazidime). Injuries sustained in a marine or freshwater environment may result from bites or venomous stings of aquatic organisms as well as from accidental trauma. Musculoskeletal trauma caused by venomous underwater species (eg, stingrays, stinging fish, sea urchins, and coral) requires immediate neutralization of the heat-labile toxin with immersion in nonscalding water for 30 to 90 minutes. Appropriate management of aquatic wounds requires recognition of the mechanism of injury, neutralization of venom, antibiotic administration, radiographic assessment, surgical débridement with irrigation, wound cultures, and structural repair or amputation as indicated by the severity of the injury. |
16112983 | Orthopaedic management of ankylosing spondylitis. | Ankylosing spondylitis is an inflammatory disease of unknown etiology that affects an estimated 350,000 persons in the United States and 600,000 in Europe, primarily Caucasian males in the second through fourth decades of life. Worldwide, the prevalence is 0.9%. Genetic linkage to HLA-B27 has been established. Ankylosing spondylitis primarily affects the axial skeleton and is characterized by inflammation and fusion of the sacroiliac joints, spine, and hips. The resultant deformity leads to severe functional impairment in approximately 30% of patients. Orthopaedic management primarily involves correction of hip deformity through total hip arthroplasty and, less frequently, correction of spinal deformity with spine osteotomy. Closing wedge osteotomies have the lowest incidence plications. Whether patients with ankylosing spondylitis are at increased risk for heterotopic ossification remains controversial, parison with age- and sex-matched counterparts suggests no dramatically higher risk. Because of the high rate of missed fractures plications after minor trauma in patients with ankylosing spondylitis, plain radiographs are usually not sufficient for evaluation. Thorough patient assessment should include prehensive history, physical examination, and laboratory studies. |
16112982 | Management of the upper extremity in juvenile rheumatoid arthritis. | Juvenile rheumatoid arthritis is a multifaceted disease. Average age of onset is 6 years, with peaks between 1 and 4 and between 9 and 14 years. Girls are affected more frequently than boys. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of antirheumatic drugs may be used early for progressive disease. Intra-articular corticosteroid injections should be considered to preserve joint mobility and muscle strength when medical treatment fails to control synovitis or when marked functional impairment exists. Historically, surgery has been a last resort, but in appropriate patients, it should be considered soon after failure of conservative management. However, when possible, reconstructive surgery should be delayed pletion of skeletal growth. |
16112984 | High tibial osteotomy. | High tibial osteotomy is effective for managing a variety of knee conditions, including gonarthrosis with varus or valgus malalignment, osteochondritis dissecans, osteonecrosis, posterolateral instability, and chondral resurfacing. The fundamental goals of the procedure are to unload diseased articular surfaces and to correct angular deformity at the tibiofemoral articulation. Although the clinical success of total knee arthroplasty has resulted in fewer high tibial osteotomies being done during the past decade, the procedure remains useful in appropriately selected patients with partmental knee disease. Renewed interest in high tibial osteotomy has occurred for a number of reasons. These include the prevalence of physiologically young active patients presenting with partment osteoarthritis; the advent of new techniques for performing the procedure (ie, improved instrumentation and fixation plates for medial opening wedge osteotomy, dynamic external fixation for medial opening wedge osteotomy, and improved instrumentation for lateral closing wedge osteotomy); and the need to itantly correct malalignment when performing chondral resurfacing procedures (ie, autologous chondrocyte transplantation, mosaicplasty, and microfracture). |
16112988 | Comparative study of the L-hydro process and glutaraldehyde preservation. | Commercial bioprosthetic heart valves monly preserved in glutaraldehyde and are cytotoxic to host cells, preventing spontaneous endothelialization. The aim of this study was to demonstrate the potential for in vivo endothelialization of bioprostheses treated by the L-Hydro process which consists of mild extraction of antigenic substances and incorporation of antiinflammatory and antithrombotic agents. Seven stented porcine heart valves treated by the L-Hydro process and 3 glutaraldehyde-fixed porcine heart valves were implanted in the mitral position in juvenile sheep. The valves were evaluated by echocardiography, angiography, histology, and histochemistry. No hemodynamic differences were observed, but scanning and transmission electron microscopy showed plete coverage by endothelial cells of all leaflets in the L-Hydro-treated valves after 5 months of implantation. The endothelial cells were in direct contact with the underlying collagen and expressed von Willebrand-related antigens. The surfaces of the glutaraldehyde-treated valves were covered by fibrin, macrophages, calcium, and thrombotic material; only sparse endothelial cells were observed and contact with the underlying tissue was plete. These data indicate that L-Hydro-treated porcine valves are capable of inducing spontaneous endothelialization. |
16112989 | Early results of anatomic repair in a subgroup of corrected transposition. | The atrial switch operation with the Rastelli procedure is ing popular for treatment of the subgroup of corrected transposition of the great arteries with ventricular septal defect and pulmonary obstruction. This technique eliminates the problem of short- and long-term right ventricular failure, and decreases the incidence of iatrogenic atrioventricular heart block. Between April 2001 and November 2002, this technique was used in 3 patients aged 5 to 7 years. Two had a Senning operation and one had a Mustard operation. There was no operative death. The first patient needed re-operation to close the sternum. The last patient was re-explored for bleeding. All patients were in New York Heart Association functional class I at their last follow-up. The atrial switch plus Rastelli procedure is feasible in this subgroup of corrected transposition, but longer follow-up is necessary to determine whether this approach is indeed warranted. |
16112990 | Omentoplasty in treatment of early bronchopleural fistulas after pneumonectomy. | This study was undertaken to assess the efficacy of omentoplasty in 12 cases of bronchopleural fistula after pneumonectomy. All fistulas formed within 16 days after the primary operation (median, 7 days). In 10 cases, omentoplasty was performed within 10 hours of diagnosis; the other 2 cases were treated at 28 and 31 hours. The greater omentum was mobilized through a laparotomy and secured tightly around the bronchial stump using original principles of fixation. After omentoplasty, dehiscence of the bronchial stump was observed in 5 (42%) patients, but owing to reinforcement with greater omentum, recurrence of the fistula was observed in only one case. In 3 patients, recurrence of pleural empyema did not lead to the return of the bronchopleural fistula. Hospital mortality was 8.3% (one patient). In patients without bronchopleural fistula recurrence, the median postoperative hospital stay was 31 days. Early omentoplasty for bronchopleural fistula after pneumonectomy is an effective procedure that eliminates purulent pletely within the shortest possible period of time. |
16112992 | Conservative management of postsurgical chylothorax with octreotide. | Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax. |
16112991 | Repair of anomalous pulmonary artery with interposition graft: midterm results. | Anomalous pulmonary artery arising from the aorta is a rare congenital anomaly. The midterm results of repair of this malformation by Gore-Tex graft interposition were examined in 5 patients: 3 with anomalous right pulmonary artery and 2 with anomalous left pulmonary artery from the ascending aorta. Echocardiography was adequate in 4 cases for diagnosis, planning the operation, and follow-up. Angiography was needed for diagnosis in one case where the echocardiographic findings were unclear. The mean follow-up period was 4 years. One patient with tracheoesophageal fistula and cardiac malformation died 2 months after the operation due to multi-organ failure. Three patients needed re-operation because of graft narrowing, and one was without problems 5.2 years postoperatively. In anomalous pulmonary artery from the ascending aorta, repair should be performed as early as possible to prevent pulmonary hypertensive changes. When the anomalous pulmonary artery cannot be anastomosed directly to the main pulmonary artery, an interposition graft can be placed safely without cardiopulmonary bypass. With appropriate follow-up, this can be a satisfactory solution, although it carries the risk of re-operation due to graft narrowing. |
16112993 | Total cavopulmonary connection with off-pump technique. | The aim of this study was to evaluate an off-pump technique for total cavopulmonary connection. Between May 2000 and June 2004, 16 patients underwent total cavopulmonary connection without cardiopulmonary bypass. There were 8 males and 8 females, with a mean age of 9.8 +/- 6.2 years and a mean weight of 27.7 +/- 14.9 kg. Preoperative percutaneous oxygen saturation was 75% +/- 6%, and pulmonary arterial pressure was 12.6 +/- 2.7 mm Hg. Postoperative es were pared with a group of 17 patients who underwent total cavopulmonary connection with an extracardiac conduit under cardiopulmonary bypass. Two patients died early postoperatively. Chylothorax occurred in 2 patients and 3 underwent reoperation for fenestration between the extracardiac conduit and the right atrium in the early postoperative period. All survivors were acyanotic. On discharge from hospital, the percutaneous oxygen saturation breathing air was 95% +/- 3%. Patients in the off-pump group demonstrated significantly shorter extubation time and intensive care unit stay. This connection technique is easy to perform and helpful in the early management of patients with a functional univentricular heart. However, much remains to be learned about this unique physiologic system. |
16112994 | Concomitant aortoaxillary bypass and coronary artery bypass grafting. | The optimal revascularization strategy for patients with subclavian and coronary artery disease has not been established. This study assessed the mid-term clinical e of itant aortoaxillary bypass and coronary artery bypass grafting in 5 patients. A ring-reinforced polytetrafluoroethylene graft was attached to the ascending aorta and led to the proximal segment of the axillary artery via the pleural cavity. Patients were followed up for 2-10 years (mean, 5.4 +/- 3.4 years). Postoperative aortography and angiography demonstrated patent aortoaxillary and coronary bypass grafts in the short-term follow-up of all patients. Two patients with Takayasu aortitis needed re-operations for recurrent angina and annuloaortic dilatation. Another patient required removal of the aortoaxillary bypass graft because of infection, and subsequently underwent a left femoroaxillary bypass one year after the original procedure. Subclavian steal phenomenon did not occur. Aortoaxillary bypass with coronary artery bypass may be an effective option for patients with co-existing subclavian and coronary artery disease. |
16112995 | Effect of chordal preservation on left ventricular function. | Chordopapillary apparatus preservation pared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been pletely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p=0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that parable to those of patients with total chordal preservation. |
16112996 | Correction of traumatic tricuspid insufficiency using the double orifice technique. | Traumatic tricuspid insufficiency is an mon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique bination with ring annuloplasty. There was no repeat operation, no plications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid petence. Satisfactory clinical es can be produced in carefully selected patients. |
16112997 | Clinical and electrophysiologic profile of Brugada syndrome in Iranian patients. | Clinical and electrophysiologic characteristics of 20 patients (15 males; mean age, 42 +/- 9 years) with Brugada syndrome were studied. Electrocardiographic abnormalities (spontaneous in 6 and provoked in 14) were recognized in 5 symptomatic and 15 asymptomatic patients. Mean PR (188 +/- 18 vs. 184 +/- 24 ms) and QT (362 +/- 34 vs. 382 +/- 28 ms) intervals and ST-segment elevation (2.28 +/- 0.42 vs. 2.70 +/- 0.77 mm) were similar in both groups. The PR interval was slightly longer in males than females (191 +/- 21 vs.168 +/- 18 ms, p = 0.042), but ST-segment elevation (2.70 +/- 0.78 vs. 2.24 +/- 0.26 mm) was similar. The HV interval was longer in males than females (57 +/- 4 vs. 50 +/- 4 ms, p = 0.047). Ventricular arrhythmias were induced in 40% of asymptomatic patients. There was no significant difference in age, sex, PR interval, ST-segment elevation, or HV interval between inducible and non-inducible patients. A defibrillator was implanted in 8 patients. During 16 +/- 2 months of follow-up, one symptomatic patient had appropriate device therapy. None of the asymptomatic and non-inducible patients experienced a cardiac event. Electrophysiologic data have no role in predicting inducibility in programmed stimulation. |
16112998 | Ablation of atrial fibrillation using microwave energy--early experience. | Between Dec 12, 2002 and Aug 22, 2004, 84 operative patients with chronic atrial fibrillation (AF) were subjected to AF ablation with microwave energy. Of these, 49 patients were female; their ages ranged between 20 and 72 years (mean, 43.1 years). Most patients suffered from mitral disease, panied in over one third of cases with tricuspid insufficiency. Thirteen patients had aortic valve disease, mostly with mitral involvement. Three patients had coronary artery disease, three had atrial septal defect and one had a left atrial (LA) myxoma. Seventy-two patients underwent endocardial ablation and 12 patients underwent epicardial ablation. Operative mortality was 4 (4.8%), and there were no major untoward postoperative events. Fifty seven patients (71.3%) had their AF converted to sinus rhythm immediately after surgery. Amiodarone or sotalol was used in all postoperative patients for 6 months, except in 8 who had bradycardia. Electrical defibrillation was utilized in cases of atrial flutter or persistent AF. Seventy patients were followed for at least 6 months. In total, 52 of them (74.3%) are still in sinus rhythm. We believe microwave ablation is a satisfactory and safe method of AF ablation, and because it is brief, it can be added to surgical procedures without undue risk to the patient. |
16112999 | Bicaval anastomosis reduces tricuspid regurgitation after heart transplantation. | The standard surgical technique utilizing two atrial cuff anastomoses has been used in the majority of transplant centers until recently when bicaval anastomoses was introduced. The purpose of this study was pare the prevalence of tricuspid regurgitation after the bicaval and standard techniques of anastomosis. Heart transplantation was performed in 43 patients at our institution from April 1994 to December 2003: 15 by the standard technique (group A) and 28 by the bicaval technique (group B). No differences in pre-transplant diagnosis, donor age, immunosuppression, rejection treatment, or graft ischemic time were evident between the two groups. The prevalence of tricuspid regurgitation (> or = moderate) was higher after the standard technique (36.4% vs. 10.5%; p < 0.05). Survival rates at 1 and 3 years in group A were 87% and 55%, and 86% and 78% in group B, with a significant difference in the 3-year mortality. The bicaval anastomosis technique was found to be associated with a lower incidence of tricuspid regurgitation during the late postoperative period, and should be preferred for heart transplantation. |
16113000 | Mixed venous-arterial CO2 tension gradient after cardiopulmonary bypass. | Significant venous hypercarbia has been reported in septic shock and circulatory failure. Cardiopulmonary bypass also impairs systemic and pulmonary blood perfusion. The objective of this study was to determine the clinical significance of the increased venous-arterial CO2 tension gradient resulting from venous hypercarbia after cardiopulmonary bypass. On arrival in the intensive care unit, venous and arterial CO2 tensions were measured in the radial and pulmonary arteries in 140 consecutive patients who had undergone coronary (n = 79), valve (n = 34), aortic (n = 20), and other (n = 7) surgery under cardiopulmonary bypass. The mean venous-arterial CO2 tension gradient was 5.0 +/- 3.3 mm Hg (range, 7.7 to 15.7 mm Hg). By linear regression analysis, the factors that significantly correlated with venous-arterial CO2 tension gradient were bypass duration, aortic crossclamp time, initial arterial lactate level, transpulmonary arteriovenous lactate difference, arterial bicarbonate level, base excess, cardiac index, mixed venous O2 saturation, O2 delivery, O2 consumption, and the peak value of creatine kinase. The venous-arterial CO2 tension gradient may reflect impaired perfusion and anaerobic metabolism induced by cardiopulmonary bypass and could be a simple and useful indicator for patient management after surgery under cardiopulmonary bypass. |
16113001 | Analysis of recurrent mitral regurgitation after mitral valve repair. | Mitral valve repair was performed in 437 patients with mitral regurgitation from January 1994 to January 2002. The causes of mitral regurgitation were degenerative in 238 (54%), rheumatic in 134 (31%), and others in 65 (15%). The most frequently employed surgical techniques were ring annuloplasty in 417 (95%) cases, new chordae formation in 216 (50%), and quadrangular resection in 117 (27%). The mean follow-up was 29.04 +/- 22.81 months. There were 5 (1.2%) early and 5 (1.2%) late deaths. The reoperation rate was 1.6% with 41 (9%) cases of recurrent mitral regurgitation. Of these 22 were procedure-related: plete repair in 13, discordant new chordal length in 7, suture dehiscence and leaflet perforation in 1 case each. There were 19 cases of valve related failures: progression of rheumatic disease in 18 and subacute infective endocarditis in 1. Valve-related failure strongly correlated with progression of rheumatic disease. As initial operative success was the prime determinant of repair durability, intraoperative repair assessment with transesophageal echocardiography was essential. |
16113002 | Mitral valve repair for ischemic mitral regurgitation in dilated cardiomyopathy. | Ischemic mitral regurgitation contributes to poor survival in patients with heart failure. The intermediate-term e of mitral reconstruction in 15 patients who had ischemic dilated cardiomyopathy with mitral regurgitation requiring surgical intervention was studied. They underwent mitral valve repair along with coronary artery bypass surgery. The mitral valve coaptation depth was considered an important parameter in deciding on repair. Ages ranged from 43 to 72 years. Left ventricular ejection fractions were 15-38% (mean, 26.5% +/- 4.3%). The operative technique in all 15 patients was posterior annuloplasty using Dacron felt. At a mean follow-up of 4.6 +/- 1.2 months (1-8 months), postoperative transesophageal echocardiography revealed mild mitral regurgitation in 2 patients and none in 13. There was a significant improvement in New York Heart Association functional class from 3.9 +/- 1.1 to 1.9 +/- 0.3. Mitral valve repair by posterior felt annuloplasty provides favorable results in the intermediate-term in selected patients with ischemic cardiomyopathy and severe left ventricular dysfunction. |
16113003 | A very rare entity: catamenial pneumothorax. | Catamenial pneumothorax, a variant of spontaneous pneumothorax occurs exclusively in women of menstrual age. Catamenial pneumothorax is associated with a high rate of recurrence. The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically. Surgical treatment should be plished during menstruation for optimal visualization of pleurodiaphragmatic endometriosis. |
16113004 | Stent implantation to maintain patency of a stenosed Blalock Taussig shunt. | A 14-year-old female plex congenital heart disease underwent a left-sided classical Blalock Taussig (BT) shunt 15 days after birth. Ten years after the operation her oxygen saturation had decreased significantly. An angiography revealed a severely stenosed BT shunt. Balloon dilation including implantation of a 6 x 13 mm stent was performed successfully. Immediately after intervention, oxygen saturation rose from 55% to 80 84% in room air. Follow-up at a year and a half later showed the classical BT shunt was still patent. |
16113005 | Aortic coarctation repair with patch graft aortoplasty and severe hemoptysis. | This report describes the successful treatment of a confirmed case of hemoptysis from a false aneurysm at the site of a previous coarctation repair. Professionals involved in the clinical care of patients that have undergone previous coarctation repair with patch graft aortoplasty, should be aware of the late risk of false aneurysm occurrence. Periodically screening patients with magnetic resonance imaging to prevent potentially plications is mended. |
16113006 | A new surgical technique for adenoid cystic carcinoma involving tracheal carina. | Reported is the successful treatment of a 24-year-old male with adenocystic carcinoma involving the tracheal carina, in which the tumor extended along the right main bronchus across the orifice of the right upper lobe. The patient underwent a carinal resection plus right upper lobectomy and reconstruction of the carina, resulting in neither plication nor recurrence of disease during 28 months of follow-up. |
16113007 | Unruptured sinus of Valsalva aneurysms manifesting as complete heart block. | We present a patient with bilateral unruptured sinus of Valsalva aneurysms involving both the left and right coronary sinuses. The large left sinus aneurysm protruded into the left atrium and the right sinus aneurysm extended into the interventricular septum, producing a plete heart block. |
16113008 | Cellular cardiomyoplasty for myocardial regeneration. | The evolving challenge of managing patients with congestive heart failure is the need to develop new therapeutic strategies. The cellular, molecular, and genetic approaches investigated aim to reinforce the weak, failing heart muscle while restoring its functional potential. This approach is principally cellular therapy (i.e. cellular cardiomyoplasty), the preferred therapeutic choice because of its clinical applicability and regenerative capacity. Different stem cells: bone marrow cells, skeletal and smooth muscle cells, vascular endothelial cells, mesothelial cells, adipose tissue stroma cells, dental stem cells, and embryonic and fetal cells, have been proposed for regenerative medicine and biology. Stem cell mobilization with G-CSF cytokine was also proposed as a single therapy for myocardial infarction. We investigated the association of cell therapy with electrostimulation (dynamic cellular cardiomyoplasty), the use of autologous human serum for cell cultures, and a new catheter for simultaneous infarct detection and cell delivery. Our team conducted cell-based myogenic and angiogenic clinical trials for chronic ischemic heart disease. Cellular cardiomyoplasty constitutes a new approach for myocardial regeneration; the ultimate goal is to avoid the progression of ventricular remodeling and heart failure for patients presenting with ischemic and non-ischemic cardiomyopathies. |
16113014 | Exclusive versus predominant breastfeeding in Italian maternity wards and feeding practices through the first year of life. | Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization's (WHO's) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother's overweight (OR = 1.74), and pliance with the WHO's steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to pliant with the WHO's steps, and Baby-Friendly Hospital Initiatives should be promoted. |
16113013 | Clinical lactation practice: 20 years of evidence. | Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health es; factors associated with breastfeeding initiation, exclusivity, and duration; lactation mon breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding es worldwide will continue. |
16113015 | Factors affecting the duration of exclusive breastfeeding among HIV-infected and -uninfected women in Lusaka, Zambia. | Exclusive breastfeeding (EBF) is optimal for infant health and is associated with decreased risk of mother-to-child HIV pared with mixed feeding of breast milk and other foods. To investigate why many women stop EBF before the mended 6 months, maternal and infant health and infant-feeding data were collected from 177 HIV-infected and 177-uninfected Zambian women regularly from 34 weeks gestation to 16 weeks postpartum. Despite strong support for good breastfeeding practice, only 37% of women were still EBF at week 16. Factors significantly associated with shorter duration of EBF were primiparity, maternal systemic illness, and infant length at 6 weeks. The results suggest that the association of EBF with lower rates of mother-to-child HIV transmission may not be causal but may be secondary to the reduced duration of EBF associated with poor maternal or infant health. Programs supporting EBF should include support for maternal health. |
16113016 | Exclusive breastfeeding in 3 rural localities in Mexico. | The purpose of this study was to assess the factors associated with exclusive breastfeeding (EBF) during the first 6 months of life. A prospective, cohort study was conducted in 291 newborn children in 3 semirural localities in Mexico. Data were collected on infant-feeding practices, anthropometry, morbidity, and maternal and household characteristics. Two-stage multivariate regression models were used for statistical analysis. Prevalence of EBF was 50% at day 5. Average duration of EBF was 2.18 months. According to the 2-stage model, maternal age, maternal work, and better socioeconomic conditions were associated with EBF at day 5. Infant nutritional status, prevalence of diarrhea, giving colostrum to the newborn, and maternal experience in breastfeeding were associated with duration of EBF. The prevalence of EBF and its duration were much shorter than mended internationally. EBF during the early days of life and EBF duration are 2 different processes that are determined by different factors. |
16113017 | Regional variation in public opinion about breastfeeding in the United States. | Because social and cultural norms are associated with women's breastfeeding behaviors, it is important to understand public opinions toward breastfeeding in the United States. Using data from the Healthstyles survey, the authors examined regional variations in (1) public knowledge about health benefits of breastfeeding, (2) public attitudes toward breastfeeding in public, (3) public support for workplace breastfeeding policies, and (4) public perceptions about breastfeeding duration. Pacific, West South Central, West North Central, and Mountain respondents were the most knowledgeable about the health benefits of breastfeeding. Mountain, New England, and Pacific respondents exhibited the most positive attitudes about breastfeeding in public. Mountain and Pacific respondents showed the strongest support for workplace breastfeeding policies. Pacific, Mountain, and East North Central respondents displayed the most positive perceptions about breastfeeding duration. This study emphasizes the need to learn from the best regions and apply subsequent findings to those regions having less positive public opinions and low breastfeeding rates. |
16113018 | Explanation for cessation of breastfeeding in mothers of twins. | This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother's role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants' behaviors, challenges presented by growth and development, and mitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise. |
16113019 | Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. | This prospective cohort study examined the association between epidural analgesia during labor and delivery, infant neurobehavioral status, and the initiation and continuation of effective breastfeeding. Healthy, term infants delivered vaginally by mothers who received epidural analgesia (n = 52) or no analgesia (n = 63) during labor and delivery were assessed at 8 to 12 hours postpartum, followed by a telephone interview with the mothers at 4 weeks postpartum. There was no significant difference between the epidural analgesia and no-analgesia groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours or in the proportion of mothers continuing to breastfeed at 4 weeks. Therefore, epidural analgesia did not appear to inhibit effective breastfeeding. There was a positive correlation between infant neurobehavioral status and breastfeeding effectiveness (Spearman rho = 0.48, P = .01), suggesting that neurobehavioral assessment may prove beneficial in identifying infants at greater risk for breastfeeding difficulties. |
16113020 | Country of origin and race/ethnicity: impact on breastfeeding intentions. | This article reports on breastfeeding intentions of Hispanic and black women by country of origin (continental US born or foreign born) in a e population that has experienced demographic shifts. Data were derived from prenatal interviews with 382 women from munity clinics. Primary e measures were intentions to formula feed, breastfeed, or formula and breastfeed. Foreign-born women were significantly more likely to intend to only breastfeed (42% vs 24% for continental US born, P < .05). In multivariate analyses, country of origin and having breastfed a previous child were the only significant predictors of breastfeeding intention. In contrast to previous work, black (non-Hispanic) and Hispanic women's breastfeeding plans were similar. This finding coincides with dramatic increases in the numbers of blacks from West Indian countries-where breastfeeding is the norm-in the study locale. |
16113021 | Factors influencing the initiation and duration of breastfeeding among low-income women followed by the Canada prenatal nutrition program in 4 regions of quebec. | The factors that influence the actual initiation and duration of breastfeeding were studied among e women followed by the Canada Prenatal Nutrition Program (CPNP). A group of 196 pregnant women were selected at random from a sample of 6223 pregnant women who registered with the CPNP. Two 24-hour recalls and information regarding lifestyle habits, peer support, and infant-feeding practices were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth. Women who received a university education (completed or pleted) versus women with < or = high school education (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.02-69.50), women born outside Canada (OR,8.81; 95% CI, 3.34-23.19), and women of low birth weight infants (OR, 0.39; 95% CI, 0.16-0.96) were more likely to initiate breastfeeding. Late introduction of solid foods (P = .004), nonsmoking (P = .005), multiparity (P = .012), and a higher level of education (P = .049) were positively associated with the duration of breastfeeding among initiators. Understanding factors associated with initiation and duration of breastfeeding among e women is critical to better target breastfeeding promotion. |
16113022 | National prevalence of breastfeeding in Taiwan. | The objectives of this study were to describe the national prevalence of breastfeeding during hospitalization and at 1 and 3 months after delivery in Taiwan. A stratified proportional probability sampling method was used, with a total of 2079 mothers participating in the postal questionnaire. The prevalence of exclusive and partial breastfeeding (to any degree) was 17.9% and 47.0% during hospitalization, 22.3% and 48.4% at 1 month, and 16.7% and 17.4% at 3 months, respectively. There were significant regional variations in the rate of breastfeeding, with the highest rates demonstrated for Taipei City. Prevalence of breastfeeding in this study was generally higher than previously reported; however, a decline of more than 50% was noted between 1 and 3 months. In addition, the rates of exclusive breastfeeding were low. The results suggest the need to increase breastfeeding duration and encourage exclusive breastfeeding in Taiwan. Regional variations in prevalence of breastfeeding merit further study. |
16113023 | Improving breastfeeding practices on a broad scale at the community level: success stories from Africa and Latin America. | munity-level behavior change programs designed to improve breastfeeding practices were implemented in Bolivia, Ghana, and Madagascar. These programs reached sizable populations: Bolivia, 1 million; Ghana, 3.5 million; and Madagascar, 6 million. Over 3 to 4 years, timely initiation of breastfeeding (within 1 hour of birth) increased from 56% to 74% (P < .001) in Bolivia, 32% to 40% (P < .05) in Ghana, and 34% to 78% (P < .001) in Madagascar. Marked increases in exclusive breastfeeding of infants 0 to 6 months of age were also documented: from 54% to 65% (P < .001) in Bolivia, 68% to 79% (P < .001) in Ghana, and 46% to 68% (P < .001) in Madagascar. In Ghana and Madagascar, significant results were seen within 1 year munity interventions. The authors conclude that large-scale programs designed to improve breastfeeding practices are feasible and should be a ponent of any child survival strategy. |
16113028 | Challenges to complementary and alternative medical research: focal issues influencing integration into a cancer care model. | Complementary and alternative therapies are increasingly used by cancer patients for palliative and postcancer preventive and/or wellness care. It is critical that evidence-based models be employed to both provide information for patients' use and informed consent and for physicians to advise patients and assess relative risk:benefit ratios of using plementary and alternative medicine (CAM) approaches within the cancer care paradigm. Research models for biomedicine have been somewhat limited when applied to broader, more holistic conceptualizations of mon to many forms of CAM. Thus, while numerous challenges to studying CAM exist, a fundamental question is not just what CAM practices should be studied but how CAM should be studied. The authors propose a model that emphasizes methodologic rigor yet approaches CAM research according to relative levels of evidence, meaning, and context, ranging from experimental, quantitative studies of mechanism to qualitative, observational studies of noetic/salutogenic variables. Responsibility for training researchers prepared to meet such challenges rests on both CAM and mainstream academic institutions, and care must be taken to avoid philosophical and practical pitfalls that might befall a myopic perspective of integration. |
16113029 | Chinese herbal medicine and chemotherapy in the treatment of hepatocellular carcinoma: a meta-analysis of randomized controlled trials. | Hepatocellular carcinoma (HCC), one of the mon malignancies worldwide, is highly resistant to standard therapy. It is unclear whether chemotherapy, arterial embolization, or arterial chemoembolization improve survival advantage enough to justify their high toxicity. Treatment with Chinese herbal medicine has been bining herbs that stimulate host immune response with those that have cytotoxic activity against HCC cells. The authors sought to evaluate the effectiveness of Chinese herbal bined with chemotherapy. The hypothesis was that Chinese herbal medicine added to chemotherapy for the treatment of HCC would improve survival and tumor response, pared to treatment with chemotherapy alone. |
16113031 | Toward an understanding of decision making on complementary and alternative medicine use in poorer countries: the case of cancer care in Pakistan. | During the past 2 decades, the study plementary and alternative medicine (CAM) in general, and the sociological study of CAM in particular, have developed apace in richer countries. In addition to data on use levels and the nature of provision, there is now increasing research on issues such as motivation for use, decision-making processes, and so on. The integration of nonorthodox therapies into cancer care has been an important focus for such work. However, this interest has yet to be matched by work in poorer countries. While the nature of traditional medicine (TM) has long been of interest to anthropologists, the new context (marked by the globalized nature of CAMs existing alongside TM and allopathic treatment) has yet to be examined in any depth. In this article, the authors discuss the structural and cultural context of the first sociological research to be conducted into the role ofCAMandTMin cancer care in Pakistan. They identify some potentially important processes (ie, those identified in the limited existing literature and in mentary), which are being tested by the new empirical study. The specific foci of the work are outlined. It is argued that research in poorer countries is essential both to ensure that an existing academic imbalance is addressed and to underpin more informed policy making plex medically pluralistic (poorer) countries. |
16113030 | Can a cancer program-sponsored spiritual event meet with acceptance from patients and other attendees? | While many cancer patients derive strength from spiritual or religious faith, concern often remains regarding how different patient subgroups and munity members might react to faith-based services when sponsored by a secular health care organization. |
16113032 | Patient assessment of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicines, and allopathic medicines for cancer in Pakistan. | Virtually no research has been conducted on patient assessments of traditional medicines and allopathic medicines for cancer care in poorer countries marked by pluralistic medical environments. Pakistan represents an excellent case for such a study because of the coexistence of culturally and historically specific indigenous traditional medicine, the strong presence of allopathic medicine, and, to a lesser extent, the availability of some plementary and alternative medicines. |
16113035 | Soft tissue facial profile changes following functional appliance therapy. | The aim of this study was to evaluate changes in the facial profile resulting from the use of a twin block (TB) functional appliance. The prised 38 patients (24 males and 14 females) with a Class II division 1 malocclusion. Nineteen subjects were treated with a functional appliance while the remaining 19, who did not undergo any intervention, served as the control. The mean age of the treated group was 9.5 years (SD 10 months) and of the control group 9.9 years (SD 13 months). Lateral cephalograms were obtained for all subjects at the initial consultation and again after one year. The changes in facial profile, resulting from treatment with the TB, were analysed after the influence of growth had been taken into account. The results showed a significant improvement in the facial profile, which closely followed the underlying dentoskeletal changes. Thus, the most significant effects were a total facial profile improvement, retraction of the upper lip and anterior movement of soft tissue pogonion (P < 0.05). Subjects treated with a TB appliance achieved improved facial harmony, but such changes were not observed in the control group. |
16113036 | Prediction of post-treatment outcome after combined treatment with maxillary protraction and chincap appliances. | The aims of this study were to identify differences in the initial skeletal morphology between successful and unsuccessful groups and to establish a novel method for predicting the final e of treatment with a maxillary protraction appliance (MPA) and chincap. The cephalograms used in this study were taken from 32 Japanese girls (mean age 10.2 years) with a Class III malocclusion at the beginning of treatment with an MPA and chincap (T1), at removal of the appliance (T2), and during the final post-treatment period (T3). The subjects were divided into two groups according to the treatment e at T3. Lower face height (ANS-Me), total face height (N-Me), ratio of face height (ANS-Me/N-ANS), maxillary position, mandibular plane and gonial angle at T1 were all significantly larger in the unsuccessful pared with the successful group. Discriminant analysis indicated that lower face height and gonial angle were significant determinants for distinguishing between the two groups at T1. From T1 to T2, while the anterior displacement of the maxilla was almost the same in the two groups, SNB decreased by 1.6 degrees in the successful group and 0.4 degrees in the unsuccessful group. After orthopaedic treatment, a second phase of treatment with a multibracket system was performed (T2 to T3). From T2 to T3, SNA increased by 0.4 degrees in the successful group and decreased by 0.7 degrees in the unsuccessful group. These results indicate that the vertical dimensions of the craniofacial skeleton are important for predicting the prognosis of skeletal Class III patients treated with a MPA and chincap and that the discriminant formula established in this study is effective in predicting the final treatment e. |
16113038 | Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour. | Remifentanil has been suggested as an ideal opioid for patient-controlled analgesia (PCA) in labour, but the safety profile has not been established. The aims of this preliminary prospective observational study were to investigate the maternal side-effects and early neonatal effects, and to assess the placental transfer of remifentanil PCA during labour. |
16113037 | Low dose of S+-ketamine prevents long-term potentiation in pain pathways under strong opioid analgesia in the rat spinal cord in vivo. | micro-Opioid receptor (MOR) agonists are strong antinociceptive drugs. Low, but not high doses of the MOR agonist fentanyl prevent synaptic long-term potentiation (LTP) in pain pathways. Block of spinal N-methyl-D-aspartate (NMDA) receptors prevent central sensitization. Here we tested whether the NMDA receptor antagonist S(+)-ketamine reduces C-fibre-evoked potentials and prevents induction of LTP despite high doses of fentanyl. |
16113039 | Halothane enhances dopamine metabolism at presynaptic sites in a calcium-independent manner in rat striatum. | We have previously reported that halothane anaesthesia increases the extracellular concentration of dopamine (DA) metabolites in the rat striatum with no change in DA. Although the metabolism of catecholamines is a source of oxidative stress, there is little information about DA metabolism and anaesthesia. We assessed the mechanism(s) of enhanced DA metabolism induced by halothane. |
16113040 | Recent advances in contraceptive vaccine development: a mini-review. | Contraceptive vaccines (CV) may provide viable and valuable alternatives to the presently available methods of contraception. The molecules that are being explored for CV development either target gamete production [luteinizing hormone-releasing hormone (LHRH)/GnRH, FSH], gamete function [sperm antigens and oocyte zona pellucida (ZP)], and gamete e (HCG). CV targeting gamete production have shown varied degrees of efficacy; however, they either affect sex steroids causing impotency and/or show only a partial rather than plete effect in inhibiting gametogenesis. However, vaccines based on LHRH/GnRH are being developed by several panies as substitutes for castration of domestic pets, farm and wild animals, and for therapeutic anticancer purposes such as in prostatic hypertrophy and carcinoma. These vaccines may also find applications in clinical situations that require the inhibition of increased secretions of sex steroids, such as in uterine fibroids, polycystic ovary syndrome, endometriosis and precocious puberty. CV targeting molecules involved in gamete function such as sperm antigens and ZP proteins are exciting choices. Sperm constitute the most promising and exciting target for CV. Several sperm-specific antigens have been delineated in several laboratories and are being actively explored for CV development. Studies are focused on delineating appropriate sperm-specific epitopes, and increasing the immunogenicity (specifically in the local genital tract) and efficacy on the vaccines. Anti-sperm antibody (ASA)-mediated immunoinfertility provides a naturally occurring model to indicate how a vaccine might work in humans. Vaccines based on ZP proteins are quite efficacious in producing contraceptive effects, but may induce oophoritis, affecting sex steroids. They are being successfully tested to control feral populations of dogs, deer, horses and elephants, and populations of several species of zoo animals. The current research for human applicability is focused on delineating infertility-related epitopes (B-cell epitopes) from oophoritis-inducing epitopes (T-cell epitopes). Vaccines targeting gamete e primarily focus on the HCG molecule. The HCG vaccine is the first vaccine to undergo Phase I and II clinical trials in humans. Both efficacy and lack of immunopathology have been reasonably well demonstrated for this vaccine. At the present time, studies are focused on increasing the immunogenicity and efficacy of the birth control vaccine, and examining its clinical applications in various HCG-producing cancers. The present article will focus on the current status of the anti-sperm, anti-ZP, anti-LHRH/GnRH and anti-HCG vaccines. |
16113041 | Intervertebral disc height in treated and untreated overweight post-menopausal women. | The effect of the menopause and HRT on the intervertebral discs has not been investigated. |
16113042 | Follow-up of ovarian function post-chemotherapy following ovarian cryopreservation and transplantation. | The purpose of this study was to assess the ovarian function after treatment of a malignant disease in women who previously had cortical tissue from an entire ovary cryopreserved prior to chemotherapy, and to assess ovarian function after autotransplantation of cryopreserved ovarian tissue. All were treated with chemotherapeutic drugs with an estimated high risk of inducing ovarian failure. |
16113043 | Phosphatidylserine externalization in human sperm induced by calcium ionophore A23187: relationship with apoptosis, membrane scrambling and the acrosome reaction. | Translocation of phosphatidylserine (PS) from the inner to the outer leaflet of the plasma membrane is a modification of the lipid architecture occurring in sperm. This is one of the earliest signs of apoptosis that can be monitored by the calcium-dependent binding of annexin V. |
16113044 | Dynamic assays of inhibin B, anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome. | We evaluated basal and dynamic hormonal markers [(FSH, inhibin B, estradiol and anti-Mullerian hormone (AMH)] during the follicular phase and luteal phase of the menstrual cycle and ultrasonic ovarian morphology as predictors of IVF e. |
16113047 | Prostaglandin E2 protects lower airways against bronchoconstriction. | Prostaglandin E2 (PGE2), similar to beta-adrenergic receptor agonists, can protect airways from bronchoconstriction and resulting increase in airway resistance induced by a number of agents, including cholinergic receptor agonists and antigen. We examined the impact of sustained alterations in PGE2 pathways on changes in airway resistance. Genetic methods were utilized to alter PGE2 metabolism and signal transduction in the murine lung. PGE2 levels were elevated by generating mice lacking 15-hydroxyprostaglandin (Hpgd-/-), the major catabolic enzyme of PGE2, and by generating a transgenic line in which mouse PGE2 synthase (Ptges) expression is driven by a human lung-specific promoter, hSP-C. Conversely, to determine the impact of loss of PGE2 on airway reactivity, we examined mice lacking this synthase (Ptges-/-) and receptors that mediate the actions of PGE2, particularly the PGE2 EP2 receptor (Ptger2). Diminished capacity to produce and respond to PGE2 did not alter the response of mice to cholinergic stimuli. In contrast, the responsiveness to cholinergic stimulation was dramatically altered in animals with elevated PGE2 levels. The Hpgd-/- and hSP-C-Ptges transgenic lines both showed attenuated airway responsiveness to methacholine as measured by lung resistance. Thus, promise of the Ptges/PGE2/Ptger2 pathway does not alter airway responsiveness, genetic modulation that elevates PGE2 levels in the lung attenuates airway responsiveness. |
16113046 | Growth and density-dependent regulation of NO synthase by the actin cytoskeleton in pulmonary artery endothelial cells. | We previously reported association of eNOS with actin increases eNOS activity. In the present study, regulation of activity of eNOS by actin cytoskeleton during endothelial growth was studied. We found eNOS activity in PAEC increased when cells grew from preconfluence to confluence. eNOS activity was much greater in PAEC in higher density than those in lower density, suggesting increase in eNOS activity during cell growth is caused by increase in cell density. Although eNOS protein contents were also increased when endothelial cells grew from preconfluence to confluence, magnitude of increase in eNOS activity was much higher than increase in eNOS protein content, suggesting posttranslational mechanisms played an important role in regulation of eNOS activity during endothelial growth. Confocal fluorescence microscopy revealed eNOS was colocalized with G-actin in preconfluent cells in perinuclear region, with both G-actin in perinuclear area and cortical F-actin in plasma membrane in confluent cells. There was more beta-actin coimmunoprecipitated with eNOS in Triton X-100-soluble fraction in confluent cells in later growth phase and in high density. Decrease in eNOS association with beta-actin by silencing beta-actin expression using beta-actin siRNA causes inhibition of eNOS activity, NO production, and endothelial monolayer wound repair in PAEC. Moreover, PAEC incubation with cytochalasin D and jasplakinolide resulted in increases in eNOS/actin association and in eNOS activity without changes in eNOS protein content. Yeast two-hybrid experiments suggested strong association between eNOS oxygenase domain and beta-actin. These results indicate increase in eNOS association with actin is responsible for greater eNOS activity in confluent PAEC. |
16113048 | NO responsiveness in pulmonary artery and airway smooth muscle: the role of cGMP regulation. | The purpose of this study was to assess intrinsic smooth muscle mechanisms contributing to greater nitric oxide (NO) responsiveness in pulmonary vascular vs. airway smooth muscle. Canine pulmonary artery smooth muscle (PASM) and tracheal smooth muscle (TSM) strips were used to perform concentration response studies to an NO donor, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA-NO). PASM exhibited a greater NO responsiveness whether PASM and TSM were contracted with receptor agonists, phenylephrine and acetylcholine, respectively, or with KCl. The >10-fold difference in NO sensitivity in PASM was observed with both submaximal and maximal contractions. This difference in NO responsiveness was not due to differences in endothelial or epithelial barriers, since these were removed, nor was it due to the presence of cGMP-independent NO-mediated relaxation in either tissue. At equal concentrations of NO, the intracellular cGMP concentration ([cGMP]i) was also greater in PASM than in TSM. Phosphodiesterase (PDE) inhibition using isobutylmethylxanthine indicated that the greater [cGMP]i in PASM was not due to greater PDE activity in TSM. Expression of soluble guanylate cyclase (sGC) subunit mRNA (2 +/- 0.2 and 1.3 +/- 0.2 attomol/microg total RNA, respectively) and protein (47.4 +/- 2 and 27.8 +/- 3.9 ng/mg soluble homogenate protein, respectively) was greater in PASM than in TSM. sGCalpha1 and sGCbeta1 mRNA expression was equal in PASM but was significantly different in TSM, suggesting independent regulation of their expression. An intrinsic smooth muscle mechanism accounting for greater NO responsiveness in PASM vs. TSM is greater sGC activity. |
16113049 | Hypoxia-induced skeletal muscle fiber dysfunction: role for reactive nitrogen species. | Hypoxia impairs skeletal muscle function, but the precise mechanisms are pletely understood. In hypoxic rat diaphragm muscle, generation of peroxynitrite is elevated. Peroxynitrite and other reactive nitrogen species have been shown to impair contractility of skinned muscle fibers, reflecting contractile protein dysfunction. We hypothesized that hypoxia induces contractile protein dysfunction and that reactive nitrogen species are involved. In addition, we hypothesized that muscle reoxygenation reverses contractile protein dysfunction. In vitro contractility of rat soleus muscle bundles was studied after 30 min of hyperoxia (Po2 approximately 90 kPa), hypoxia (Po2 approximately 5 kPa), hypoxia + 30 microM N(G)-monomethyl-L-arginine (L-NMMA, a nitric oxide synthase inhibitor), hyperoxia + 30 microM L-NMMA, and hypoxia (30 min) + reoxygenation (15 min). One part of the muscle bundle was used for single fiber contractile measurements and the other part for nitrotyrosine detection. In skinned single fibers, maximal Ca2+-activated specific force (Fmax), fraction of strongly attached cross bridges (alphafs), rate constant of force redevelopment (ktr), and myofibrillar Ca2+ sensitivity were determined. Thirty minutes of hypoxia reduced muscle bundle contractility. In the hypoxic group, single fiber Fmax, alphafs, and ktr were significantly pared with hyperoxic, L-NMMA, and reoxygenation groups. Myofibrillar Ca2+ sensitivity was not different between groups. Nitrotyrosine levels were increased in pared with all other groups. We concluded that acute hypoxia induces dysfunction of skinned muscle fibers, reflecting contractile protein dysfunction. In addition, our data indicate that reactive nitrogen species play a role in hypoxia-induced contractile protein dysfunction. Reoxygenation of the muscle bundle partially restores bundle contractility pletely reverses contractile protein dysfunction. |
16113050 | Pulmonary vascular iNOS induction participates in the onset of chronic hypoxic pulmonary hypertension. | Pathogenesis of hypoxic pulmonary hypertension is initiated by oxidative injury to the pulmonary vascular wall. Because nitric oxide (NO) can contribute to oxidative stress and because the inducible isoform of NO synthase (iNOS) is often upregulated in association with tissue injury, we hypothesized that iNOS-derived NO participates in the pulmonary vascular wall injury at the onset of hypoxic pulmonary hypertension. An effective and selective dose of an iNOS inhibitor, L-N6-(1-iminoethyl)lysine (L-NIL), for chronic peroral treatment was first determined (8 mg/l in drinking water) by measuring exhaled NO concentration and systemic arterial pressure after LPS injection under ketamine+xylazine anesthesia. A separate batch of rats was then exposed to hypoxia (10% O2) and given L-NIL or a nonselective inhibitor of all NO synthases, N(G)-nitro-L-arginine methyl ester (L-NAME, 500 mg/l), in drinking water. Both inhibitors, applied just before and during 1-wk hypoxia, equally reduced pulmonary arterial pressure (PAP) measured under ketamine+xylazine anesthesia. If hypoxia continued for 2 more wk after L-NIL treatment was discontinued, PAP was still lower than in untreated hypoxic controls. Immunostaining of lung vessels showed negligible iNOS presence in control rats, striking iNOS expression after 4 days of hypoxia, and return of iNOS immunostaining toward normally low levels after 20 days of hypoxia. Lung NO production, measured as NO concentration in exhaled air, was markedly elevated as early as on the first day of hypoxia. We conclude that transient iNOS induction in the pulmonary vascular wall at the beginning of chronic hypoxia participates in the pathogenesis of pulmonary hypertension. |
16113051 | Potentiation of tumor formation by topical administration of 15-deoxy-delta12,14-prostaglandin J2 in a model of skin carcinogenesis. | The effect of prostaglandins on the development of papillomas has been investigated in mice receiving prostaglandins E2 (PGE2) or the cyclopentenone 15-deoxy-delta(12,14)-PGJ2 (15dPGJ2) topically, using the 7,12-dimethylbenz[a]anthracene (DMBA)-induced tetradecanoylphorbol acetate (TPA)-promoted model of skin carcinogenesis. The presence of 15dPGJ2 during DMBA and TPA treatment inhibited apoptosis and increased the rate, number, size and vascularization of the papillomas, some of them progressing into carcinomas. Moreover, skin sections from mice treated for one week with DMBA and 15dPGJ2 showed a much reduced rate of apoptotic cells, and an enhanced expression of vascular epithelial growth factor pared with animals receiving DMBA, with or without PGE2. The analysis of molecular events in the MCA3D keratinocyte cell line showed that 15dPGJ2 activated Ras and improved cell viability by inhibiting DMBA-dependent apoptosis. In addition to this, cell adhesion was impaired in MCA3D keratinocytes co-treated with 15dPGJ2 and DMBA, at the same time when the expression of cyclooxygenase-2 (COX-2) was observed under these conditions. These effects mediated by 15dPGJ2 might contribute to understand the role of COX-2 metabolites in carcinogenesis, leading to an increase of cell viability after mutagenic injury and therefore in the progression of tumors. |
16113052 | Accurate genotyping from paraffin-embedded normal tissue adjacent to breast cancer. | Genetic polymorphism analysis for disease risk is widely used in epidemiology studies; blood or oral cavity cells are the most widely used source of DNA. However, these types of samples are not always available, particularly for studies that were conducted years ago. An alternative potential source of patient DNA exists in the form of paraffin-embedded normal tissue adjacent to tumor samples, which are collected and stored routinely for clinical use. The use of such samples can be conceptually problematic, however, due to the presence of field cancerization in the surrounding normal tissue, with the possible presence of chromosomal loss. Specifically, loss of heterozygosity (LOH) might bias the genotyping results and cause genotype misclassification. However, field cancerization and LOH might not be an issue because LOH is not easily found unless there is careful microdissection of only tumor cells (leaving stromal, inflammatory and fat cells), for example, laser-capture microdissection. In this study, we set out to determine the degree of genotype misclassification from normal tissues adjacent to tumors, if any, paring these results with blood genotyping. We examined samples from 106 subjects with breast cancer, analyzing five different genotypes selected from monly known to have LOH in breast cancer. These genotypes were methylenetetrahydrofolate reductase (MTHFR), oxoguanosine glycosylase 1 (hOGG1), dopamine beta-hydroxylase (DBH), dopamine receptor D2 (DRD2) and NAD(P)H dehydrogenase quinone 1 (NQO1), conducted by using real-time PCR and TaqMan genotyping analyses. We found that among these five genotypes and parisons, there was a 100% concordance for genotyping from normal tissue adjacent to tumor and from blood. Our findings indicate that the use of adjacent normal tissues provides accurate genotyping results with high specificity. Although this study only used breast tumor samples, and may be applicable only to breast cancer studies, we expect the results to be applicable to other types of cancers also. |
16113053 | Inhibition of Akt signaling and enhanced ERK1/2 activity are involved in induction of macroautophagy by triterpenoid B-group soyasaponins in colon cancer cells. | Triterpenoid B-group soyasaponins have been found to induce macroautophagy in human colon cancer cells at concentrations obtainable through consumption of legume foodstuffs. In the present studies the mechanism(s) for this autophagy-inducing action of soyasaponins was evaluated by measuring changes in signal transduction pathways associated with autophagy. Specifically, inhibition of the Akt signaling pathway and enhanced activity of ERK1/2 have previously been implicated in controlling induction of macroautophagy in mammalian cancer cells. Here we show that these pathways are also involved in B-group soyasaponin-induced macroautophagy, as changes in enzyme activities preceded significant increases in autophagic activity. The autophagic capacity of HCT-15 cells was significantly increased by 6 h post-saponin exposure, which led us to measure alterations in signaling events that preceded this time point. We determined that exposure to B-group soyasaponins suppressed Akt activity maximally by 50%, which was associated with a reduction in the activating phosphorylation of the Akt-serine473 residue. In addition, ERK1/2 activity was significantly increased by 60%, and was determined to be necessary for B-group soyasaponin-induced autophagy. The raf-1 kinase has been identified as a potential point of cross-talk between the Akt and ERK1/2 signaling cascades. Following B-group soyasaponin treatment activity of raf-1 was significantly increased by a maximal 200%, suggesting that this enzyme in part modulates the enhanced ERK1/2 activity. These results provide new insights into the signaling events that control induction of autophagy by B-group soyasaponins in human colon cancer cells and suggest that soyasaponins warrant further study as potential colon cancer chemopreventive agents. |
16113054 | Meat and meat-mutagen intake and risk of non-Hodgkin lymphoma: results from a NCI-SEER case-control study. | Non-Hodgkin Lymphoma (NHL) incidence has risen dramatically over past decades, but the reasons for most of this increase are not known. Meat cooked well-done using high-temperature cooking techniques produces heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) such as benzo[a]pyrene (B[a]P). This study was conducted as a population-based case-control study in Iowa, Detroit, Seattle and Los Angeles and was designed to determine whether meat, meat-cooking methods, HCAs or PAHs from meat were associated with NHL risk. This study consisted of 458 NHL cases, diagnosed between 1998 and 2000, and 383 controls. pleted a 117-item food frequency questionnaire (FFQ), with graphical aids to assess the meat-cooking method and doneness level, which was linked to a HCA and B[a]P database. Logistic paring the fourth to the first quartile, found no association between red meat or processed meat intake and risk for NHL [odds ratio (OR) and 95% confidence interval (CI): 1.10 (0.67-1.81) and 1.18 (0.74-1.89), respectively]. A marginally significant elevated risk for NHL was associated with broiled meat [OR and 95% CI: 1.32 (0.99-1.77); P trend = paring those who consumed broiled meat with those who did not. The degree to which meat was cooked was not associated with the risk for NHL, although one of the HCAs, DiMeIQx (2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline), was associated with an inverse risk. Fat intake was associated with a significantly elevated risk for NHL [OR and 95% CI: 1.60 (1.05-2.45); P trend = 0.12]; in contrast, animal protein was inversely associated with risk for NHL [OR and 95% CI: 0.39 (0.22-0.70); P trend = 0.004]. Overall, our study suggests that consumption of meat, whether or not it is well-done, does not increase the risk of NHL. Furthermore, neither HCAs nor B[a]P from meat increase the risk of NHL. |
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