Preoperative thromboxane A2/prostaglandin H2 receptor activity predicts early graft thrombosis

AbstractPurpose: This study was carried out to determine whether early failure of infrainguinal bypass grafts is associated with increased expression of platelet thromboxane A2/prostaglandin H2 (TXA2/PGH2) receptors. A prospective correlation of preoperative platelet TXA2/PGH2 receptor-mediated activity with lower extremity graft patency was sought. Methods: Twenty-five patients who underwent infrainguinal bypass surgery for limb salvage were studied at an inpatient academic tertiary referral center and Department of Veterans Affairs Medical Center. Outcome measures were primary graft patency rate at 3 months, platelet TXA2/PGH2 receptor activity by equilibrium binding with 125I-BOP, and aggregation to the TXA2-mimetic U46619. Results: Preoperative platelet TXA2/PGH2 receptor density was higher (Bmax, 3100 ± 1300 vs 1500 ± 1100 sites/platelet [mean ± SD]; p = 0.004) in the five patients who had graft thrombosis within 3 months. The EC50 for U46619 was lower (26 ± 6 nmol/L vs 57 ± 30 nmol/L; p < 0.05) in these patients as well, confirming the functional effect of the increased receptor density. Early graft thrombosis was more likely in patients with a platelet TXA2/PGH2 receptor density greater than 3000 sites/platelet (odds ratio, 76; 95% confidence interval, 3.9 to 1500) or an EC50 for U46619 less than 30 nmol/L (odds ratio, 16; 95% confidence interval, 1.4 to 180). Conclusions: Elevated platelet TXA2/PGH2 receptor levels and enhanced sensitivity of platelet aggregation to TXA2 predict early arterial graft thrombosis. Specific TXA2/PGH2 receptor antagonism may prevent one of the mechanisms that contributes to early graft occlusion. (J Vasc Surg 1998;27:317-28.

Bypass and embolization for a vertebral artery aneurysm in a patient with Marfan syndrome

Extracranial vertebral artery aneurysms represent an uncommon presentation of collagen vascular disease. We performed staged proximal embolization of large left vertebral artery aneurysm after distal common carotid-to-vertebral bypass at C2 in a young adult patient with Marfan syndrome and a hypoplastic contralateral vertebral artery. Dilation of the autogenous saphenous vein graft occurred at 1 year with proximal graft stenosis requiring operative revision. Subsequent dilation of the basilar artery led to symptoms of pontine compression at 18 months that have resolved at 31 months of follow-up

THE CONTRIBUTION OF ELBOW EXTENSION TO WRIST SPEED IN CRICKET FAST BOWLERS

The purpose of this modelling study was to assess the sensitivity of wrist joint speed to systematic manipulations of empirical elbow joint flexion-extension kinematic profiles. The joint kinematic profiles of 12 cricket fast bowlers were entered into a Forward Kinematic Model and the elbow joint kinematic profiles were subsequently amplified to elicit wrist speed changes. An amplification factor of zero decreased wrist speed by a mean of 8.6% (± 6.9%), whereas an amplification factor of two increased speed by a mean of 8.8% (± 7.1%). An opposite relationship was found for two participants who extended the elbow joint prior to release and it is proposed that an internally rotated humerus will displace the wrist joint posteriorly when the elbow joint is extending

Spatial and temporal variability in recruitment of intertidal mussels around the coast of southern Africa

Intensity of intertidal mussel recruitment was compared across a range of different spatial and temporal scales around the coast of southern Africa between June 1995 and October 1996. Comparison of the east and west coasts revealed significantly higher recruit densities on the west coast, corresponding to larger adult densities. This difference between the two coasts reflects biogeographic disparities in mussel species composition, growth rates and spawning intensities, oceanographic conditions and productivity. Significant spatial variations in recruitment were recorded between regions 100–1000 km apart and between localities 1–25 km apart. Results suggest that the influence of dispersal processes on recruitment patterns acts at a relatively small scale, and may affect the distribution and abundance of adults among shores only a few kilometres apart. The high variability in recruitment intensities at a scale of metres indicates that larva! supply to the shore may be locally patchy, or that settlement preferences of recruits may be sensitive to subtle small-scale differences in adult density within mussel clumps. Small-scale differences in post-settlement mortality (e.g. owing to patchy predation pressure) may also play a role. This small-scale variability in recruitment is likely to reinforce the mosaic distribution of mussels evident on many of the shores. Significant temporal variability in recruit density was recorded, both between 3-monthly sampling intervals and interannually. Seasonal differences were absent for the north-west regions, whereas asynchronous seasonal patterns were displayed in the other regions. Results suggest that temporal cycles of recruitment are irregular and episodic, which may have important consequences for the dynamics of adults. Significant positive correlations were obtained between maximal recruitment and adult abundance, measured by density, or total number of adults on the shore (stock). This could be explained by the density-dependent role of adult conspecifics in providing suitable settlement habitat, or supply-side recruit limitation. These results have important implications for the management of exploited populations of mussels around the coast of southern Africa. Exploitation may influence recruitment success via at least two processes: reduction of larval supply by depletion of adult stock, and alteration of habitat suitable for settlement. Thus, overexploitation will compromise recruitment, which is itself the only mechanism of recovery. The west-coast mussel populations are likely to be more resilient to exploitation as recruitment is more predictable over time, stocks are larger and recruitment intensities high. This brings into question the present regulations for mussel harvesting because, paradoxically, more lenient regulations are applied on the east coast, where stocks and recruitment are low, than on the west coast, where biomass, recruitment and potential for recovery are high

Shell model description of normal parity bands in odd-mass heavy deformed nuclei

The low-energy spectra and B(E2) electromagnetic transition strengths of 159Eu, 159Tb and 159Dy are described using the pseudo SU(3) model. Normal parity bands are built as linear combinations of SU(3) states, which are the direct product of SU(3) proton and neutron states with pseudo spin zero (for even number of nucleons) and pseudo spin 1/2 (for odd number of nucleons). Each of the many-particle states have a well-defined particle number and total angular momentum. The Hamiltonian includes spherical Nilsson single-particle energies, the quadrupole-quadrupole and pairing interactions, as well as three rotor terms which are diagonal in the SU(3) basis. The pseudo SU(3) model is shown to be a powerful tool to describe odd-mass heavy deformed nuclei.Comment: 11 pages, 2 figures, Accepted to be published in Phys. Rev.

The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland:longitudinal analysis

Funding This research was funded by the Chief Scientist Office (grant CZH/4/916). Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorate. AL is funded by the Medical Research Council (MC_UU_12017/13) and the Chief Scientist Office of the Scottish Government Health Directorate (SPHSU13)Peer reviewedPublisher PD

Defect-induced condensation and central peak at elastic phase transitions

Static and dynamical properties of elastic phase transitions under the influence of short--range defects, which locally increase the transition temperature, are investigated. Our approach is based on a Ginzburg--Landau theory for three--dimensional crystals with one--, two-- or three--dimensional soft sectors, respectively. Systems with a finite concentration $n_{\rm D}$ of quenched, randomly placed defects display a phase transition at a temperature $T_c(n_{\rm D})$, which can be considerably above the transition temperature $T_c^0$ of the pure system. The phonon correlation function is calculated in single--site approximation. For $T>T_c(n_{\rm D})$ a dynamical central peak appears; upon approaching $T_c(n_{\rm D})$, its height diverges and its width vanishes. Using an appropriate self--consistent method, we calculate the spatially inhomogeneous order parameter, the free energy and the specific heat, as well as the dynamical correlation function in the ordered phase. The dynamical central peak disappears again as the temperatur is lowered below $T_c(n_{\rm D})$. The inhomogeneous order parameter causes a static central peak in the scattering cross section, with a finite $k$ width depending on the orientation of the external wave vector ${\bf k}$ relative to the soft sector. The jump in the specific heat at the transition temperatur of the pure system is smeared out by the influence of the defects, leading to a distinct maximum instead. In addition, there emerges a tiny discontinuity of the specific heat at $T_c(n_{\rm D})$. We also discuss the range of validity of the mean--field approach, and provide a more realistic estimate for the transition temperature.Comment: 11 pages, 11 ps-figures, to appear in PR

STAT6 and Furin Are Successive Triggers for the Production of TGF-β by T Cells

Production of TGF-β by T cells is key to various aspects of immune homeostasis, with defects in this process causing or aggravating immune-mediated disorders. The molecular mechanisms that lead to TGF-β generation by T cells remain largely unknown. To address this issue, we take advantage of the fact that intestinal helminths stimulate Th2 cells besides triggering TGF-β generation by T lymphocytes and regulate immune-mediated disorders. We show that the Th2 cell-inducing transcription factor STAT6 is necessary and sufficient for the expression of TGF-β propeptide in T cells. STAT6 is also necessary for several helminth-triggered events in mice, such as TGF-β-dependent suppression of alloreactive inflammation in graft-versus-host disease. Besides STAT6, helminth-induced secretion of active TGF-β requires cleavage of propeptide by the endopeptidase furin. Thus, for the immune regulatory pathway necessary for TGF-β production by T cells, our results support a two-step model, composed of STAT6 and furin

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine

"The ACC/AHA Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease (CVD). Coronary artery disease (CAD) is the leading cause of death in the United States. Unstable angina (UA) and the closely related condition of non–ST-segment elevation myocardial infarction (NSTEMI) are very common manifestations of this disease. The committee members reviewed and compiled published reports through a series of computerized literature searches of the English-language literature since 2002 and a final manual search of selected articles. Details of the specific searches conducted for particular sections are provided when appropriate. Detailed evidence tables were developed whenever necessary with the specific criteria outlined in the individual sections. The recommendations made were based primarily on these published data. The weight of the evidence was ranked highest (A) to lowest (C). The final recommendations for indications for a diagnostic procedure, a particular therapy, or an intervention in patients with UA/NSTEMI summarize both clinical evidence and expert opinion.

Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART