Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertension

AbstractPulmonary hypertension in chronic mitral valve disease has been related most commonly to left ventricular dysfunction or mitral stenosis; its association with chronic, isolated mitral regurgitation and preserved left ventricular systolic function is unclear. In 41 catheterized patients with chronic mitral regurgitation (known history of mitral regurgitation for >18 months) and preserved left ventricular systolic function (ejection fraction >0.55), historic, electrocardiographic, echocardiographic and hemodynamic variables were analyzed. Ten patients (Group 1) had normal pulmonary artery systolic pressure (>30 mm Hg), whereas 31 patients had pulmonary hypertension. Pulmonary artery systolic pressure was mildly increased (30 to 49 mm Hg) in 13 patients (Group II) and was >50 mm Hg in 18 patients (Group III).Univariate analysis showed the more frequent occurrence of male gender and ruptured chordae tendineae in the groups with pulmonary hypertension. Mean pulmonary capillary wedge pressure, size of the V wave in pulmonary capillary wedge pressure and pulmonary arteriole resistance were higher, whereas cardiac index was lower in the hypertension groups. Multivariate stepwise analysis revealed higher mean pulmonary capillary wedge pressure and pulmonary arteriole resistance as the only variables independently differing among groups.In conclusion, pulmonary hypertension occurs frequently (76% of cases) in patients with chronic, isolated mitral regurgitation with preserved left ventricular systolic function. In these patients, a severe increase in pulmonary capillary wedge pressure is associated with elevation in pulmonary artery resistance, a finding similar to that in mitral stenosis

Doctoral competencies and graduate research education: focus and fit with the knowledge economy?

The paper considers the evidence on the types of skills and abilities that are needed by doctoral students. In particular, it examines whether doctoral competencies can be differentiated from general undergraduate/postgraduate-level competencies and whether employers value the skills and abilities that doctoral graduates bring to work organisations. Surprisingly, given the cost of fourth level education, there is a dearth of existing work regarding graduate and doctoral students’ experiences (Cryer, 1997). In addition, where lists of doctoral competencies are proposed, there is little evidence of a theoretical or empirical basis for the choice of these competencies, and the lists appear to have emerged through a process of speculation, or the prior experience of students and faculty, rather than through any coherent analysis. Many commentators (Allen, 2002; Park, 2005; Mitchell, 2007) consider that PhD and other doctoral programmes must adapt and become more flexible, as students’ requirements and preferences change and that the personal skills and attributes that a doctoral student possesses are as important as any specialist knowledge or skills. The paper suggests that current conceptualisations of doctoral competencies are inadequate and puts forward a model to reframe the way in which these competencies are understood and labelled. The paper has implications for the education and training of doctoral students and for the graduate research education programmes (GREPS) that are emerging as part of the reconceptualisation of graduate education

Radiofrequency Ablation of Life-Threatening Supraventricular Tachycardia Due to a Posteroseptal Accessory Pathway in an Infant

Supraventricular tachycardia (SVT) in infants may be resistant to multiple medications and cause life-threatening symptoms. Despite the known risks, catheter ablation may be necessary in rare cases. We present a 4-month-old 4.5 kg infant who presented with SVT that was resistant to all antiarrhythmic medications, including a combination of propafenone, amiodarone and propranolol at maximal doses. The infant underwent successful radiofrequency ablation of a posteroseptal accessory pathway. Despite later recurrence, medical therapy with propafenone and propranolol at standard doses resulted in complete control of the tachycardia until one year of age, when all medications were stopped without further recurrences

Hazard identification of the Mediterranean Temporary Mountain Pond ecosystems in Central Greece: Α Geo-environmental approach

Mediterranean Temporary Ponds (MTPs) are shallow water bodies which are characterized from a short wet period and their small size. MTPs of Europe have are under an effective protection status, as a result of their identification as a priority habitat (Annex I code 3170*) in the EU Directive 92/43/EEC (Habitats' Directive). These ponds are very delicate ecosystems regarding their hydrological and geochemical characteristics. Due to their small size, they are open to random destruction or other unpredictable dangers. Although small in size, MTPs are complex ecosystems where topography, soil, water and hydrological conditions and microorganisms are closely connected. The conservation and restoration of such ecosystems is very difficult because of their unique characteristics. The most common threats for MTPs include destruction of the hosting area through human and animal pressures, hydrological disturbance, fire and generally changes in ecological conditions resulting in an increase of competitive plants, nutrition influx, toxic contaminants and wastes, sedimentary deposit filling, exotic-invasive fauna and flora and negative effects from domesticated or hunted fauna. The study was carried out in the MTPs area of the National Forest Park of Mt. Oiti (GR2440004) and Mt. Kallidromo (GR2440006). Overall, the survey has included seven small and independent MTPs of high altitude in the areas of Mt. Oiti (Louka, Livadies, Greveno and Alikaina) and Mt. Kallidromo (Nevropolis, Mourouzos and Souvala). This study aims to present a dataset of the geo-environmental parameters in order to assess the potential hazards for these priority habitats. Furthermore, it is also worth mentioning that MTPs are unevenly studied, regarding their geological, hydrological, hydrochemical, geochemical and mineralogical characteristics and this work provides a first report on an integrated evaluation of these parameters regarding the qualitative and quantitative risk identification of the MTPs in Central Greece

Angiographic progression of coronary artery disease and the development of myocardial infarction

AbstractThere are few data on angiographic coronary artery anatomy in patients whose coronary artery disease progresses to myocardial infarction. In this retrospective analysis, progression of coronary artery disease between two cardiac catheterization procedures is described in 38 patients: 23 patients (Group I) who had a myocardial infarction between the two studies and 15 patients (Group II) who presented with one or more new total occlusions at the second study without sustaining an intervening infarction.In Group I the median percent stenosis on the initial angiogram of the artery related to the infarct at restudy was significantly less than the median percent stenosis of lesions that subsequently were the site of a new total occlusion in Group II (48 versus 73.5%, p < 0.05). In the infarctrelated artery in Group I, only 5 (22%) of 23 lesions were initially >70%, whereas in Group II, 11 (61%) of 18 lesions that progressed to total occlusion were initially >70% (p < 0.01). In Group I, patients who developed a Q wave infarction had less severe narrowing at initial angiography in the subsequent infarct-related artery (34%) than did patients who developed a non-Q wave infarction (80%) (p < 0.05). Univariate and multivariate analysis of angiographic and clinical characteristics present at initial angiography in Group I revealed proximal lesion location as the only significant predictor of evolution of lesions ≥ 50% to infarction.This irrespective study suggests that myocardial infarction frequently develops from previously nonsevere lesions. In addition, it is often difficult to predict the location of a subsequent infarct from analysis of the first coronary angiogram. Non-Q wave infarction is usually preceded by a more severe pre-existing stenosis than is a Q wave infarction, perhaps indicating some degree of prior myocardial protection. A prospective evaluation will be necessary to confirm these findings

Etiology of Anemia in Patients With Advanced Heart Failure

ObjectivesWe prospectively investigated the causes of anemia in patients with advanced congestive heart failure (CHF).BackgroundAnemia is common in patients with advanced CHF, and its etiology is generally considered to be multifactorial. However, despite its importance, precise information is lacking regarding the prevalence of putative etiologic factors.MethodsPatients who were hospitalized for decompensated advanced CHF and who were stabilized after their initial treatment underwent evaluation of “clinically significant” anemia, defined as a hemoglobin content <12 g/dl for men and <11.5 g/dl for women. Patients with a serum creatinine concentration >3 mg/dl or patients with concurrent diseases that are known to cause anemia were not included. The initial evaluation included measurements of vitamin B12, folic acid, thyroid-stimulating hormone, erythropoietin, lactate dehydrogenase, Coombs test, multiple fecal occult tests, and bone marrow aspiration. Patients without diagnosis by these methods underwent red cell mass measurement with 51Cr assay.ResultsThe mean age of the 37 patients was 57.9 ± 10.9 years and mean left ventricular ejection fraction 22.5 ± 5.9%. Iron deficiency anemia was confirmed by bone marrow aspiration in 27 patients (73%), 2 patients (5.4%) had dilutional anemia, and 1 patient (2.7%) had drug-induced anemia. No specific cause was identified in 7 patients (18.9%) who were considered to have “anemia of chronic disease.” Serum ferritin for the iron-deficient patients was not a reliable marker of iron deficiency in this population.ConclusionsIn this group of patients, iron deficiency was the most common cause of anemia. The iron status of patients with end-stage chronic CHF should be thoroughly evaluated and corrected before considering other therapeutic interventions

Brain charts for the human lifespan

Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight1. Here we assemble an interactive open resource to benchmark brain morphology derived from any current or future sample of MRI data (http://www.brainchart.io/). With the goal of basing these reference charts on the largest and most inclusive dataset available, acknowledging limitations due to known biases of MRI studies relative to the diversity of the global population, we aggregated 123,984 MRI scans, across more than 100 primary studies, from 101,457 human participants between 115 days post-conception to 100 years of age. MRI metrics were quantified by centile scores, relative to non-linear trajectories2 of brain structural changes, and rates of change, over the lifespan. Brain charts identified previously unreported neurodevelopmental milestones3, showed high stability of individuals across longitudinal assessments, and demonstrated robustness to technical and methodological differences between primary studies. Centile scores showed increased heritability compared with non-centiled MRI phenotypes, and provided a standardized measure of atypical brain structure that revealed patterns of neuroanatomical variation across neurological and psychiatric disorders. In summary, brain charts are an essential step towards robust quantification of individual variation benchmarked to normative trajectories in multiple, commonly used neuroimaging phenotypes

Cardiopulmonary Resuscitation Update

BACKGROUND AND OBJECTIVES: Every 5 years experts, after reviewing literature and scientific evidence, update the guidelines on Cardiopulmonary resuscitation (CPR). The objective of this report is to review the main changes in resuscitation that occurred over the last 5 year period. CONTENTS: High-quality chest compressions with adequate rate and depth allowing full recoil of the chest with minimal interruptions is the mainstay of the recommended changes. The 30:2 compression ventilation ratio is maintained, but the former order is modified chest compressions first, followed by airway and breathing (C-A-B instead of A-B-C). Avoiding of excessive ventilation is also recommended. Chest compressions-only CPR in primary cardiac arrest victims, is an option for rescuers who are unable or unwilling to perform mouth to mouth ventilation. Advanced life support algorithm is simplified (regarding drugs, routes of administration, endotracheal intubation). Acute coronary syndromes (ACS) treatment has also been updated. Better practices for teaching and learning resuscitation skills are addressed. CONCLUSIONS: Updating CPR guidelines is important, and continuous education is recommended. This will improve the quality of resuscitation and survival of patients in cardiac arrest

A geophysical insight of the lithostratigraphic subsurface of Rodafnidia area (Lesbos Isl., Greece)

The study area of Rodafnidia on the island of Lesbos (Greece) is considered of archaeological interest, as Paleolithic stone tools have been recovered through excavation and collected from the ground surface in recent years. Geologically, the area is mostly covered by Quaternary post-alpine deposits and volcanic rocks. This paper presents the application of a local geophysical survey to determine the volume of the upper Quaternary deposits in which the Paleolithic artefacts can be found and the identification of their ignimbrite substrates. For this reason, the geoelectrical method was selected as the most appropriate for determining the lithostratigraphic subsurface layers. More specifically, a grid of twenty-one (21) Vertical Electrical Soundings (VES) along with an Electrical Resistivity Tomography (ERT) was carried out. The interpretation of the results of these surveys, in conjunction with the results of older excavation trenches, revealed that the Quaternary deposits have been investigated at depths ranging from 0.5 up to 28.5 meters. Furthermore, the lithological boundary of these post-alpine deposits and their underlying pyroclastic ignimbrite flow (with resistivity 24.0–58.0 Ohm.m) seem to dip to the north. The volume of the Quaternary layer is proposed as the maximum depth for archaeological investigation with high chances to recover more Paleolithic material

A crowd-sourcing approach for the construction of species-specific cell signaling networks

Motivation: Animal models are important tools in drug discovery and for understanding human biology in general. However, many drugs that initially show promising results in rodents fail in later stages of clinical trials. Understanding the commonalities and differences between human and rat cell signaling networks can lead to better experimental designs, improved allocation of resources and ultimately better drugs. Results: The sbv IMPROVER Species-Specific Network Inference challenge was designed to use the power of the crowds to build two species-specific cell signaling networks given phosphoproteomics, transcriptomics and cytokine data generated from NHBE and NRBE cells exposed to various stimuli. A common literature-inspired reference network with 220 nodes and 501 edges was also provided as prior knowledge from which challenge participants could add or remove edges but not nodes. Such a large network inference challenge not based on synthetic simulations but on real data presented unique difficulties in scoring and interpreting the results. Because any prior knowledge about the networks was already provided to the participants for reference, novel ways for scoring and aggregating the results were developed. Two human and rat consensus networks were obtained by combining all the inferred networks. Further analysis showed that major signaling pathways were conserved between the two species with only isolated components diverging, as in the case of ribosomal S6 kinase RPS6KA1. Overall, the consensus between inferred edges was relatively high with the exception of the downstream targets of transcription factors, which seemed more difficult to predict. Contact: [email protected] or [email protected]. Supplementary information: Supplementary data are available at Bioinformatics onlin