Coronary Microcirculatory vasoconstriction during ischemia in patients with unstable angina

OBJECTIVE To verify the behavior of coronary microvascular tone during spontaneous ischemia in patients with unstable angina (UA). BACKGROUND In UA, the pathogenetic role of vasoconstriction is classically confined at the stenotic coronary segment. However, microcirculatory vasoconstriction has been also suggested by previous experimental and clinical studies. METHODS The study included 10 patients with UA (recent worsening of anginal threshold and appearance of angina at rest) and single-vessel CAD. Blood flow velocity was monitored by a Doppler catheter in the diseased artery. Transstenotic pressure gradient was monitored by aortic and distal coronary pressure monitoring. Stenosis resistance was calculated as the ratio between pressure gradient and blood flow, microvascular resistance as the ratio between distal pressure and blood flow. Measurements were obtained at baseline, following intracoronary adenosine (2 mg) and during transient ischemia. Aortic and distal coronary pressures were also measured during balloon coronary occlusion. RESULTS Adenosine did not affect stenosis resistance, while it decreased (p , 0.05) microvascular resistance to 52 6 22% of baseline. Angina and ischemic ST segment shift were associated with transient angiographic coronary occlusion in 7 of 10 patients; however, in no case was ischemia associated with interruption of flow. Despite markedly different flow values, distal coronary pressure was similar during adenosine and during spontaneous ischemia (48 6 15 vs. 46 6 20 mm Hg, respectively, NS). During ischemia, a marked increase in the resistance of both coronary stenosis and coronary microcirculation was observed (to 1,233% 6 1,298% and 671% 6 652% of baseline, respectively, p , 0.05). Distal coronary pressure was markedly reduced during balloon coronary occlusion (14 6 7 mm Hg, p , 0.05 vs. both adenosine and ischemia), suggesting the absence of significant collateral circulation. CONCLUSIONS In patients with UA, transient myocardial ischemia is associated with vasoconstriction of both stenotic arterial segment and downstream microcirculation

Metallation of Isatin (2,3-Indolinedione). X-Ray Structure and Solution Behavior of Bis(Isatinato)Mercury(II)

The first X-ray structure of an isatin (2,3-indolinedione, isaH) metal complex, bis(isatinato)memury(II) (C16H8N2O4Hg) (1), was determined. (1) was obtained from the reaction of isaH with mercury(II) acetate in methanol. Analogously, treatment of sodium saccharinate and mercury(II) acetate in methanol yielded Hg(saccharinato)2•0.5CH3OH (3). (1) crystallizes in the monoclinic system, space group P21/ a with a = 7.299(1) Å, b = 8.192(1) Å, c = 11.601(1) Å , β = 105.82(1)°, V = 667.4 Å3, Z = 2, Dcalc = 2.452 g cm−3, MoKα radiation(λ = 0.71073 Å), μ = 115.5 cm-1, F(000) = 460, 21(1) °C. The structure was refined on the basis of 2023 observed reflections to R= 0.044. The two deprotonated, non coplanar isa ligands are trans to each other in a head to tail orientation and bound to the Hg through the nitrogen in a linear N-Hg-N arrangement. The Hg atom is at the center of symmetry of the complex and displaced by 0.62 Å from the two planes of the isa ligands (τ Hg-N1-C2-O2= -16°). The Hg-N bond length is 2.015 Å. Noπ-aryl-memury(ll)-π-aryl stacking interaction was observed either in the solid state or in the solution state. The IR, electronic, and 1H and 13CNMR spectral data of (1) and (3) suggest binding of the memury to the heterocyclic nitrogen, in agreement with the crystal structure determination of (1)

Geometric description for the anatomy of the mitral valve: A review

The mitral valve is a complex anatomical structure whose physiological functioning relies on the biomechanical properties and structural integrity of its components. Their compromise can lead to mitral valve dysfunction, associated with morbidity and mortality. Therefore, a review on the morphometry of the mitral valve is crucial, more specifically on the importance of valve dimensions and shape for its function. This review initially provides a brief background on the anatomy and physiology of the mitral valve, followed by an analysis of the morphological information available. A characterisation of mathematical descriptions of several parts of the valve is performed and the impact of different dimensions and shape changes in disease is then outlined. Finally, a section regarding future directions and recommendations for the use of morphometric information in clinical analysis of the mitral valve is presented

Acute primary repair of the anterior cruciate ligament with anterolateral ligament augmentation

Acute injuries of the anterior cruciate ligament are often associated with concurrent injuries to the structures of the anterolateral complex, specifically the anterolateral ligament. Some injury patterns of the anterior cruciate ligament involve tearing of the majority of the ligament from the femoral origin, leaving a large, viable ligament remnant. In these patients, a repair of the anterior cruciate ligament back to the femoral origin can be undertaken. Subsequently, percutaneous repair of the anterolateral ligament can be performed through anatomical, percutaneous suture tape augmentation. The combined technique of anterior cruciate ligament repair with anterolateral ligament reinforcement is presented

The MISSION-VET Consumer Workbook

Summary: Supplemental workbook for the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) treatment approach, which was adapted specifically for Veterans (MISSION-VET). MISSION-VET, a flexible, integrated, time-limited, yet assertive service delivery platform was designed specifically to provide direct treatment, ongoing support, and care coordination to homeless Veterans suffering from co-occurring disorders and transitioning and/or adjusting to independent living in the community. The Consumer Workbook is a supplemental workbook to engage homeless Veterans by providing exercises and resources to aid in their recovery from a co-occurring disorder and homelessness. Peer Support Specialists and Case Managers should work with the Veteran to complete the items in the workbook that correspond with specific Dual-Recovery Therapy sessions and use the workbook as a talking point in helping clients with co-occurring mental illness and substance abuse, homelessness and related issues that arise in the various stages of their recovery

Quick recovery and no arthrofibrosis in acute anterior cruciate ligament reconstruction. A prospective trial of early versus delayed reconstruction

Background. Anterior cruciate ligaments tears is one of the most frequent orthopae- dics and sports medicine injuries in the athletically active population and timing of reconstruction represents a debated topic. The aim of the study is to compare range of motion (ROM) recovery and clinical outcomes between patients operated for acute reconstruction (maximum 2 weeks injury-surgery interval) and delayed reconstruction (minimum 3 weeks injury-surgery interval). Methods. A total of 52 patients were prospectively involved in the study. 26 patients underwent acute reconstruction and 26 delayed reconstruction. A standard physical examination with Lachman and Pivot shift test and a passive ROM measurement with a goniometer were performed at each follow-up (2, 4, 8, 12 and 24 weeks postoper- atively). Clinical outcomes were measured at final follow-up using Knee Injury and Osteoarthritis outcome score (KOOS), Tegner Lysholm Score and International Knee Documentation Committe (IKDC 2000) and KT-1000 evaluation. Single-leg hop test and thigh circumference measurement were performed at final follow-up. Results. Both groups showed no statistically significant differences regarding the ROM. Full ROM was achieved 12 weeks after surgery in both groups. The mean IKDC was 98.7 and 95.2; the mean Tegner Lysholm was 100 and 93.8 and the mean KOOS was 99 and 95.5 in the acute group and delayed ACLR group respectively. Conclusions. There were no differences between acute and delayed anterior cruci- ate ligament reconstruction regarding the risk of arthrofibrosis and clinical outcomes. Acute reconstruction can be performed safely with no increased risk of arthrofibrosis

The Life of a Professor: Stress and Coping

The life of a professor is a balancing act, both professionally and personally. Professors must weigh the demands of research, publishing, teaching, and service with the requirements of their personal responsibilities. The purpose of this mixed-methods study was to explore the role of stress on the work-life balance of a professor. This study was conducted by an interdisciplinary research team and included participants from a wide-range of academic fields. A mixed-methods approach, utilizing an electronic survey composed of demographic questions, Likert-scale responses, and open-ended questions, yielded data related to the benefits and challenges of being a professor from 31 states in the United States as well as from other countries. Structured interviews were then conducted to reveal the coping methods of the participants. In addition, this article incorporated embedded media in the form of audio sound bites and animated video, which provided the ‘voice’ of the faculty. The triangulated data revealed that lack of supports, both social and institutional, significantly increased the stress experienced by professors. Mechanisms for coping with stress that could be utilized by individual professors as well as institutional stress management strategies were discussed

Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study.

The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm(2)/m(2); p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings

Team formation and performance: evidence from healthcare referral networks

We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals — for instance, sending their cardiology patients to fewer distinct cardiologists — this encourages repeat interactions between PCPs and specialists. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with 1 standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims, and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.P01 AG005842 - NIA NIH HHSPublished versio