Scanning electron microscopy for blood micro-crystals in aortic stenosis patients.

BACKGROUND: Micro-crystals of calcium phosphate have been detected on the aortic valve of patients with aortic stenosis using scanning electron microscopy. It is not known whether crystalisation is specific to heart valve tissue or a general blood-derived process. METHODS: To this end we modified the method to determine whether calcium phosphate micro-crystals were present in the blood of patients with aortic stenosis. The method was first validated by adding synthetic calcium phosphate hydroxyapatite micro-crystals to healthy volunteer blood samples and determining the lower limit of detection. Then the method was used to examine the blood of 63 patients with echocardiographically confirmed aortic stenosis and 69 unaffected controls undergoing echocardiography for other reasons. Serum calcium and phosphate were measured and the calcium phosphate product compared in cases and controls. RESULTS: In the validation study, synthetic hydroxyapatite micro-crystals were identified down to a lower concentration limit of 0.008mg/mL. In the experimental study no particles were identified in any patient, with or without aortic stenosis, even though serum calcium phosphate was higher in cases compared with controls 2.6mmol/L (2.58-2.77) versus 2.47mmol/L (2.36-2.57), p = 0.005 for the difference. CONCLUSION: The results of our study confirm a positive association between serum calcium phosphate and aortic stenosis, but indicate that the calcium phosphate particles found in valve tissue do not precipitate freely in the blood

Current management of children and young people with heterozygous familial hypercholesterolaemia - HEART UK statement of care

This consensus statement on the management of children and young people with heterozygous familial hypercholesterolaemia (FH) addresses management of paediatric FH in the UK, identified by cascade testing when a parent is diagnosed with FH and for those diagnosed following incidental lipid tests. Lifestyle and dietary advice appropriate for children with FH; suggested low density lipoprotein cholesterol (LDL-C) targets and the most appropriate lipid-lowering therapies to achieve these are discussed in this statement of care. Based on the population prevalence of FH as ~1/250 and the UK paediatric population, there are approximately 50,000 FH children under 18 years. Currently only about 550 of these children and young people have been identified and are under paediatric care

Randomised Trial of Text Messaging on Adherence to Cardiovascular Preventive Treatment (INTERACT Trial)

BACKGROUND: About one third of patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed. We conducted a randomized trial to evaluate text messaging as a means of improving adherence to cardiovascular disease preventive treatment. METHODS: 303 patients taking blood pressure and/or lipid-lowering medications were randomly assigned to being sent text messages (Text group, 151) or not being sent them (No text group, 152). Texts were sent daily for 2 weeks, alternate days for 2 weeks and weekly thereafter for 22 weeks (6 months overall), using an automated computer programme. Patients were asked to respond on whether they had taken their medication, whether the text reminded them to do so if they had forgotten, and if they had not taken their medication to determine if there was a reason for not doing so. At 6 months, use of medication was assessed. RESULTS: Two patients were lost to follow-up, providing data on 301 for analysis. In the No text group 38/151 (25%) took less than 80% of the prescribed regimen (ie. stopped medication completely or took it on fewer than 22 of the last 28 days of follow-up) compared to 14/150 patients (9%) in the Text group - an improvement in adherence affecting 16 per 100 patients (95% CI 7 to 24), p<0.001. The texts reminded 98/151 patients (65%) to take medication on at least one occasion and lead to 20/151 (13%) who stopped taking medication because of concern over efficacy or side-effects, resuming treatment. CONCLUSIONS: In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease, text messaging improved medication adherence compared with no text messaging. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN74757601

BPS black holes, the Hesse potential, and the topological string

The Hesse potential is constructed for a class of four-dimensional N=2 supersymmetric effective actions with S- and T-duality by performing the relevant Legendre transform by iteration. It is a function of fields that transform under duality according to an arithmetic subgroup of the classical dualities reflecting the monodromies of the underlying string compactification. These transformations are not subject to corrections, unlike the transformations of the fields that appear in the effective action which are affected by the presence of higher-derivative couplings. The class of actions that are considered includes those of the FHSV and the STU model. We also consider heterotic N=4 supersymmetric compactifications. The Hesse potential, which is equal to the free energy function for BPS black holes, is manifestly duality invariant. Generically it can be expanded in terms of powers of the modulus that represents the inverse topological string coupling constant, $g_s$, and its complex conjugate. The terms depending holomorphically on $g_s$ are expected to correspond to the topological string partition function and this expectation is explicitly verified in two cases. Terms proportional to mixed powers of $g_s$ and $\bar g_s$ are in principle present.Comment: 28 pages, LaTeX, added comment

Spin 3 cubic vertices in a frame-like formalism

Till now most of the results on interaction vertices for massless higher spin fields were obtained in a metric-like formalism using completely symmetric (spin-)tensors. In this, the Lagrangians turn out to be very complicated and the main reason is that the higher the spin one want to consider the more derivatives one has to introduce. In this paper we show that such investigations can be greatly simplified if one works in a frame-like formalism. As an illustration we consider massless spin 3 particle and reconstruct a number of vertices describing its interactions with lower spin 2, 1 and 0 ones. In all cases considered we give explicit expressions for the Lagrangians and gauge transformations and check that the algebra of gauge transformations is indeed closed.Comment: 17 pades, no figure