Management of coronary artery fistulae Patient selection and results of transcatheter closure

AbstractObjectivesWe report short-term findings in 33 patients after transcatheter closure (TCC) of coronary artery fistulae (CAF) and compare our results with those reported in the recent transcatheter and surgical literature.BackgroundTranscatheter closure of CAF has been advocated as a minimally invasive alternative to surgery.MethodsWe reviewed all patients presenting with significant CAF between January 1988 and August 2000. Those with additional complex cardiac disease requiring surgical management were excluded.ResultsOf 39 patients considered for TCC, occlusion devices were placed in 33 patients (85%) at 35 procedures and included coils in 28, umbrella devices in 6 and a Grifka vascular occlusion device in 1. Post-deployment angiograms demonstrated complete occlusion in 19, trace in 11, or small residual flow in 5. Follow-up echocardiograms (median, 2.8 years) in 27 patients showed no flow in 22 or small residual flow in 5. Of the 6 patients without follow-up imaging, immediate post-deployment angiograms showed complete occlusion in 5 or small residual flow in 1. Thus, complete occlusion was accomplished in 27 patients (82%). Early complications included transient ST-T wave changes in 5, transient arrhythmias in 4 and single instances of distal coronary artery spasm, fistula dissection and unretrieved coil embolization. There were no deaths or long-term morbidity. Device placement was not attempted in 6 patients (15%), because of multiple fistula drainage sites in 4, extreme vessel tortuosity in 1 and an intracardiac hemangioma in 1.ConclusionsA comparison of our results with those in the recent transcatheter and surgical literature shows similar early effectiveness, morbidity and mortality. From data available, TCC of CAF is an acceptable alternative to surgery in most patients

Electron attachment to valence-excited CO

The possibility of electron attachment to the valence $^{3}\Pi$ state of CO is examined using an {\it ab initio} bound-state multireference configuration interaction approach. The resulting resonance has $^{4}\Sigma^{-}$ symmetry; the higher vibrational levels of this resonance state coincide with, or are nearly coincident with, levels of the parent $a^{3}\Pi$ state. Collisional relaxation to the lowest vibrational levels in hot plasma situations might yield the possibility of a long-lived CO$^-$ state.Comment: Revtex file + postscript file for one figur

BCL-2 family protein expression and platinum drug resistance in ovarian carcinoma

The expression of the BCL-2 family proteins, BCL-2, BAX, BCLXLand BAK have been determined in a panel of 12 human ovarian carcinoma cell lines encompassing a wide range in sensitivity to cisplatin. Whereas BAX, BCLXLand BAK levels did not correlate with sensitivity, there was a statistically significant inverse correlation (r = –0.81;P = 0.002) between growth inhibition by cisplatin and BCL-2 levels. In sublines possessing acquired resistance to various platinum-based drugs or across a panel of human ovarian carcinoma xenografts, there was no consistent pattern of BCL-2 expression. Two relatively sensitive lines (A2780 and CH1) have been stably transfected with bcl-2 and bclXLrespectively and two relatively resistant lines (A2780cisR and SKOV-3) stably transfected with bax. Overexpression of BCL-2 in A2780 cells led to resistance to cisplatin compared to the vector control when assayed at 48 h post-drug incubation but a significant increase in sensitivity at 96 h. Relative rates of apoptosis at 48- and 96-h post-cisplatin exposure mirrored the growth inhibition. There was no significant difference in sensitivity of the pair of lines by clonogenic assay. No significant changes in chemosensitivity to a variety of DNA-damaging or tubulin-interactive agents were observed in the remaining transfected lines. Taken together, these results suggest that, in human ovarian carcinoma cells, high BCL-2 levels (either naturally occurring or through gene transfection) confers a trend towards sensitivity not resistance to platinum drugs. © 2000 Cancer Research Campaig

On isovector meson exchange currents in the Bethe-Salpeter approach

We investigate the nonrelativistic reduction of the Bethe-Salpeter amplitude for the deuteron electrodisintegration near threshold energies. To this end, two assumptions have been used in the calculations: 1) the static approximation and 2) the one iteration approximation. Within these assumptions it is possible to recover the nonrelativistic result including a systematic extension to relativistic corrections. We find that the so-called pair current term can be constructed from the $P$-wave contribution of the deuteron Bethe-Salpeter amplitude. The form factor that enters into the calculation of the pair current is constrained by the manifestly gauge independent matrix elements.Comment: 15 pages, incl. 3 figures, to be published Phys. Rev.

Review: ‘Gimme five’: future challenges in multiple sclerosis. ECTRIMS Lecture 2009

This article is based on the ECTRIMS lecture given at the 25th ECTRIMS meeting which was held in Düsseldorf, Germany, from 9 to 12 September 2009. Five challenges have been identified: (1) safeguarding the principles of medical ethics; (2) optimizing the risk/benefit ratio; (3) bridging the gap between multiple sclerosis and experimental autoimmune encephalitis; (4) promoting neuroprotection and repair; and (5) tailoring multiple sclerosis therapy to the individual patient. Each of these challenges will be discussed and placed in the context of current research into the pathogenesis and treatment of multiple sclerosis

Nesting properties and anisotropy of the Fermi surface of LuNi2_{2}B2_{2}C

The rare earth nickel borocarbides, with the generic formula $R$Ni$_{2}$B$_{2}$C, have recently been shown to display a rich variety of phenomena. Most striking has been the competition between, and even coexistence of, antiferromagnetism and superconductivity. We have measured the Fermi surface (FS) of LuNi$_{2}$B$_{2}$C, and shown that it possesses nesting features capable of explaining some of the phenomena experimentally observed. In particular, it had previously been conjectured that a particular sheet of FS is responsible for the modulated magnetic structures manifest in some of the series. We report the first direct experimental observation of this sheet.Comment: 4 pages, 4 PS figure

Dietary micronutrient composition affects fillet texture and muscle cell size in Atlantic salmon (Salmo salar)

During the past 20 years, plant ingredients have taken over as the main constituents in feed for Atlantic salmon. This has changed the nutrient composition of the feeds, the bioavailability of nutrients and perhaps nutrient metabolism. Plant‐based diets also contain more anti‐nutrients. The EU‐funded project ARRAINA re‐evaluated recommendations for micronutrient supplementation to Atlantic salmon feeds, and the present study compared a diet supplemented with micronutrients according to NRC (2011) (control diet, 100% NP (nutrient package)) with a diet supplemented according to the new recommendations (New NP). Tissue concentrations of pyridoxine, pantothenic acid, niacin, vitamin C, Zn and Se were significantly higher; and Cu was lower in Atlantic salmon fed the diet with the New NP compared to the control fish. The New NP also gave a near significant effect on growth, decreased muscle firmness and increased muscle cell size, and it affected metabolism of nitrogen‐containing metabolites in the muscle. While we cannot be certain which micronutrient(s) gave these effects, the B vitamins are probable candidates, since they are mediators of intermediary metabolism and have been shown to influence some of the affected metabolites

Developing an intervention to facilitate family communication about inherited genetic conditions, and training genetic counsellors in its delivery.

Many families experience difficulty in talking about an inherited genetic condition that affects one or more of them. There have now been a number of studies identifying the issues in detail, however few have developed interventions to assist families. The SPRinG collaborative have used the UK Medical Research Council's guidance on Developing and Evaluating Complex Interventions, to work with families and genetic counsellors (GCs) to co-design a psycho-educational intervention to facilitate family communication and promote better coping and adaptation to living with an inherited genetic condition for parents and their children (<18 years). The intervention is modelled on multi-family discussion groups (MFDGs) used in psychiatric settings. The MFDG was developed and tested over three phases. First focus groups with parents, young people, children and health professionals discussed whether MFDG was acceptable and proposed a suitable design. Using evidence and focus group data, the intervention and a training manual were developed and three GCs were trained in its delivery. Finally, a prototype MFDG was led by a family therapist and co-facilitated by the three GCs. Data analysis showed that families attending the focus groups and intervention thought MFDG highly beneficial, and the pilot sessions had a significant impact on their family' functioning. We also demonstrated that it is possible to train GCs to deliver the MFDG intervention. Further studies are now required to test the feasibility of undertaking a definitive randomised controlled trial to evaluate its effectiveness in improving family outcomes before implementing into genetic counselling practice.The National Institute of Health Research funded the study but any views expressed do not necessarily reflect those of the Authority. Funded by NIHR reference number: RP-DG-1211-10015

Patterning the geographies of organ transplantation: corporeality, generosity and justice

publication-status: PublishedThis is the author's post-print version of an article published in Transactions of the Institute of British Geographers, 2006, Vol. 31, Issue 3 pp. 257 – 271 Copyright © 2006 Institute of British Geographers / Royal Geographical Society. The definitive version is available at www3.interscience.wiley.comOrgan transplantation is now an established treatment for patients with end-stage organ failure, yet there are spatial inequalities in access to this procedure. This paper explores the uneven geographies of kidney transplantation in London, arguing that inequalities in access to organ transplantation are created through interlocking spatialities of corporeal difference, enacted through global movements of populations, national organ transplantation protocols and the internal immunological spaces of the body. The combination of these processes, operating at different scales, has produced a distinctive configuration in the embodiment of risk in relation to kidney transplants, particularly born by London's Black and Asian communities. Two ethical dimensions to this geography of organ transplantation are explored here: the ethical responsiveness to others shaping the generous practices of organ donation, and the medical practices categorizing difference through techniques of blood typing, tissue matching and the spatial organization of organ transplantation. In concluding, I argue both are critical to understanding the links between ethics and justice in the geographies of organ exchange in London. Further, I suggest geography is central to political debate about the exchange of biological material elsewhere, for it is only through tracing the intersection of ethical, corporeal and technological practices in situ that we can fully reflect on questions of justice within the developing bioeconomy