Fatal heart block from intentional yew tree (Taxus baccata) ingestion: a case report

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Background Taxus baccata, also known as English yew, is a poison that causes cardiac arrhythmias and can result in death from cardiogenic shock.Case summary A 49-year-old gentleman was admitted following yew ingestion with suicidal intent. He was bradycardic at 30 b.p.m. and hypotensive on arrival. Electrocardiography revealed complete heart block with broad complex ventricular escape rate of 30 b.p.m. Bedside echocardiography revealed severe global impairment of right and left ventricular systolic function. Urgent temporary transvenous pacing was instituted, and the patient was considered for veno-arterial extracorporeal membrane oxygenation. Unfortunately, he deteriorated rapidly and cardiorespiratory arrest ensued, and despite prolonged in-hospital resuscitation, the patient died. Post-mortem examination revealed small needle-shaped plant leaves together with seeds found in the stomach. Ante mortem serum sample analysis sent to the Royal Botanical Gardens and revealed the presence of taxine Type B alkaloids in the patient’s blood.Discussion Yew poisoning is a rare occurrence, and there is currently no effective antidote. Treatment involves supportive management, comprising prolonged effective cardiopulmonary resuscitation, pacing, and mechanical cardiac support. This case illustrates the importance of prompt recognition of yew poisoning, alongside early consideration of pacing and mechanical cardiac support. Due to the rarity of this cause of heart block, and since patients may not always volunteer a history of yew ingestion, yew poisoning is something that physicians should be aware of and this should be considered in the differential diagnosis in patients with unexpected heart block. Serum analysis for taxine alkaloids can be used to confirm the diagnosis.Peer reviewe

Improved Materials for High-Temperature Black Liquor Gasification

The laboratory immersion test system built and operated at ORNL was found to successfully screen samples from numerous refractory suppliers, including both commercially available and experimental materials. This system was found to provide an accurate prediction of how these materials would perform in the actual gasifier environment. Test materials included mullites, alumino-silicate bricks, fusion-cast aluminas, alumina-based and chrome-containing mortars, phosphate-bonded mortars, coated samples provided under an MPLUS-funded project, bonded spinels, different fusion-cast magnesia-alumina spinels with magnesia content ranging from 2.5% to about 60%, high-MgO castable and brick materials, spinel castables, and alkali-aluminate materials. This testing identified several candidate material systems that perform well in the New Bern gasifier. Fusion-cast aluminas were found to survive for nearly one year, and magnesia-alumina spinels have operated successfully for 18 months and are expected to survive for two years. Alkali-aluminates and high-MgO-content materials have also been identified for backup lining applications. No other material with a similar structure and chemical composition to that of the fusion-cast magnesium-aluminum spinel brick currently being used for the hot-face lining is commercially available. Other materials used for this application have been found to have inferior service lives, as previously discussed. Further, over 100 laboratory immersion tests have been performed on other materials (both commercial and experimental), but none to date has performed as well as the material currently being used for the hot-face lining. Operating experience accumulated with the high-temperature gasifier at New Bern, North Carolina, has confirmed that the molten alkali salts degrade many types of refractories. Fusion-cast alumina materials were shown to provide a great improvement in lifetime over materials used previously. Further improvement was realized with fusion-cast magnesia-alumina spinel refractory, which appears to be the most resistant to degradation found to date, exhibiting over a year of service life and expected to be capable of over two years of service life. Regarding the use of refractory mortar, it was found that expansion of the current chrome-alumina mortar when subjected to black liquor smelt is likely contributing to the strains seen on the vessel shell. Additionally, the candidate high-alumina mortar that was originally proposed as a replacement for the current chrome-alumina mortar also showed a large amount of expansion when subjected to molten smelt. A UMR experimental mortar, composed of a phosphate bonded system specifically designed for use with fusion-cast magnesium-aluminum spinel, was found to perform well in the molten smelt environment. Strain gauges installed on the gasifier vessel shell provided valuable information about the expansion of the refractory, and a new set of strain gauges and thermocouples has been installed in order to monitor the loading caused by the currently installed spinel refractory. These results provide information for a direct comparison of the expansion of the two refractories. Measurements to date suggest that the fusion-cast magnesia-alumina spinel is expanding less than the fusion-cast {alpha}/{beta}-alumina used previously. A modified liquor nozzle was designed and constructed to test a number of materials that should be more resistant to erosion and corrosion than the material currently used. Inserts made of three erosion-resistant metallic materials were fabricated, along with inserts made of three ceramic materials. The assembled system was sent to the New Bern mill for installation in the gasifer in 2005. Following operation of the gasifier using the modified nozzle, inserts should be removed and analyzed for wear by erosion/corrosion. Although no materials have been directly identified for sensor/thermocouple protection tubes, several of the refractory material systems identified for lining material applications may be applicable for use in this capacity. Results of the modeling studies suggest that the temperature distribution is higher at the bottom of the gasifier than previously thought. Therefore, it may be possible to reduce the refractory temperature in the gasifier by changing the liquor spray. Also, modeling showed that because of the strong swirl, a separation zone could be formed at the corner of the conical wall where it meets the vertical barrel wall, and some the liquor droplets could be suspended in this zone. The accumulation of droplets in this area could cause instabilities in the performance and also in corrosion of the refractory

Potentiation of thrombus instability: a contributory mechanism to the effectiveness of antithrombotic medications

© The Author(s) 2018The stability of an arterial thrombus, determined by its structure and ability to resist endogenous fibrinolysis, is a major determinant of the extent of infarction that results from coronary or cerebrovascular thrombosis. There is ample evidence from both laboratory and clinical studies to suggest that in addition to inhibiting platelet aggregation, antithrombotic medications have shear-dependent effects, potentiating thrombus fragility and/or enhancing endogenous fibrinolysis. Such shear-dependent effects, potentiating the fragility of the growing thrombus and/or enhancing endogenous thrombolytic activity, likely contribute to the clinical effectiveness of such medications. It is not clear how much these effects relate to the measured inhibition of platelet aggregation in response to specific agonists. These effects are observable only with techniques that subject the growing thrombus to arterial flow and shear conditions. The effects of antithrombotic medications on thrombus stability and ways of assessing this are reviewed herein, and it is proposed that thrombus stability could become a new target for pharmacological intervention.Peer reviewedFinal Published versio

THE VALUE TO THE SURGEON OF PARATHYROID HORMONE ASSAYS IN PRIMARY HYPERPARATHYROIDISM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72424/1/j.1445-2197.1988.tb01084.x.pd

Assessment of endogenous fibrinolysis in clinical using novel tests - Ready for clinical roll-out?

© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The occurrence of thrombotic complications, which can result in excess mortality and morbidity, represent an imbalance between the pro-thrombotic and fibrinolytic equilibrium.The mainstay treatment of these complications involves the use of antithrombotic agents but despite advances in pharmacotherapy, there remains a significant proportion of patients who continue to remain at risk.Endogenous fibrinolysis is a physiological counter-measure against lasting thrombosis and may be measured using several techniques to identify higher risk patients who may benefit from more aggressive pharmacotherapy. However, the assessment of the fibrinolytic systemis not yet accepted into routine clinical practice.In this review, we will revisit the different methods of assessing endogenous fibrinolysis (factorial assays, turbidimetric lysis assays, viscoelastic and the global thrombosis tests), including the strengths, limitations, correlation to clinical outcomes of each method and howwe might integrate the assessment of endogenous fibrinolysis into clinical practice in the future.Peer reviewedFinal Published versio

Developmental Trajectories of Body Mass Index Among Japanese Children and Impact of Maternal Factors during Pregnancy

Background The aims of this study were to 1) determine the distinct patterns of body mass index (BMI) trajectories in Japanese children, and 2) elucidate the maternal factors during pregnancy, which contribute to the determination of those patterns. Methodology/Principal Findings All of the children (1,644 individuals) born in Koshu City, Japan, between 1991 and 1998 were followed in a longitudinal study exploring the subjects’ BMI. The BMI was calculated 11 times for each child between birth and 12 years of age. Exploratory latent class growth analyses were conducted to identify trajectory patterns of the BMI z-scores. The distribution of BMI trajectories were best characterized by a five-group model for boys and a six-group model for girls. The groups were named “stable thin,” “stable average,” “stable high average,” “progressive overweight,” and “progressive obesity” in both sexes; girls were allocated to an additional group called “progressive average.” Multinomial logistic regression found that maternal weight, smoking, and skipping breakfast during pregnancy were associated with children included in the progressive obesity pattern rather than the stable average pattern. These associations were stronger for boys than for girls. Conclusions/Significance Multiple developmental patterns in Japanese boys and girls were identified, some of which have not been identified in Western countries. Maternal BMI and some unfavorable behaviors during early pregnancy may impact a child’s pattern of body mass development. Further studies to explain the gender and regional differences that were identified are warranted, as these may be important for early life prevention of weight-associated health problems

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

info:eu-repo/semantics/publishe

Early life factors and being overweight at 4 years of age among children in Malmö, Sweden

<p>Abstract</p> <p>Background</p> <p>Rising rates of obesity and overweight is an increasing public health problem all over the world. Recent research has shown the importance of early life factors in the development of child overweight. However, to the best of our knowledge there are no studies investigating the potential synergistic effect of early life factors and presence of parental overweight on the development of child overweight.</p> <p>Methods</p> <p>The study was population-based and cross-sectional. The study population consisted of children who visited the Child Health Care (CHC) centers in Malmö for their 4-year health check during 2003-2008 and whose parents answered a self-administered questionnaire (n = 9009 children).</p> <p>Results</p> <p>The results showed that having overweight/obese parents was strongly associated with the child being overweight or obese. Furthermore, there was an association between unfavorable early life factors (i.e., mother smoking during pregnancy, presence of secondhand tobacco smoke early in life, high birth weight) and the development of child overweight/obesity at four years of age, while breastfeeding seemed to have a protective role. For example, maternal smoking during pregnancy was associated with an odds ratio (OR) of 1.47 (95% CI: 1.22, 1.76) for overweight and 2.31 (95% CI: 1.68, 3.17) for obesity. The results further showed synergistic effects between parental overweight and exposure to unfavourable early life factors in the development of child overweight.</p> <p>Conclusions</p> <p>The present study shows the importance of early life factors in the development of child overweight and obesity, and thus puts focus on the importance of early targeted interventions.</p

NADPH oxidases in cardiovascular disease: insights from in vivo models and clinical studies

NADPH oxidase family enzymes (or NOXs) are the major sources of reactive oxygen species (ROS) that are implicated in the pathophysiology of many cardiovascular diseases. These enzymes appear to be especially important in the modulation of redox-sensitive signalling pathways that underlie key cellular functions such as growth, differentiation, migration and proliferation. Seven distinct members of the family have been identified of which four (namely NOX1, 2, 4 and 5) may have cardiovascular functions. In this article, we review our current understanding of the roles of NOX enzymes in several common cardiovascular disease states, with a focus on data from genetic studies and clinical data where available