Myocardial fibrosis in stroke survivors

Stroke survivors are most likely to die of cardiac death, yet few undergo comprehensive cardiac assessment to look for reversible causes. Myocardial fibrosis (MF) is not only the hallmark of cardiomyopathy, but also a substrate for sudden cardiac death, ventricular tachyarrhythmia and heart failure. Procollagen carboxyl-terminal telopeptide (PICP) was found to be a marker of MF. The relationship between PICP and cardiac abnormalities in stroke survivors is unknown. We recently showed that MF in stroke survivors can be treated by spironolactone and amiloride in a randomised placebo-controlled cross-over study with reduction in PICP levels and QTc [1]

Pretreatment with beta-blockers and the frequency of hypokalemia in patients with acute chest pain

Plasma potassium concentration was measured at admission in 1234 patients who presented with acute chest pain. One hundred and ninety five patients were on P blockers before admission. The potassium concentrations of patients admitted early (within four hours of onsetof symptoms) were compared with those admitted later (4-18 hours after onset of symptoms). There was a transient fall in plasma potassium concentrations in patients not pre-treated with , B blockers. This was not seen in patients who had been on P blockers before admission. Nonselective, B blockers were more effective than cardioselective agents in maintaining concentrationsof plasma potassium. These findings suggest a mechanism for the beneficial effects of ,B blockers on morbidity and mortality in acute myocardial infarction

QT peak prolongation predicts cardiac death following stroke

Cardiac death has been linked in many populations to prolongation of the QT interval (QTe). However, basic science research suggested that the best estimate of the time point when repolarisation begins is near the T-wave peak. We found QT peak (QTp) was longer in hypertensive subjects with LVH. A prolonged “depolarisation” phase, rather than “repolarisation” (T peak to T end) might therefore account for the higher incidence of cardiac death linked to long QT. Hypothesis: We have tested the hypothesis that QT peak (QTp) prolongation predicts cardiac death in stroke survivors. Methods and Results: ECGs were recorded from 296 stroke survivors (152 male), mean age 67.2 (SD 11.6) approximately 1 year after the event. Their mean blood pressure was 152/88 mmHg (SD 29/15mmHg). These ECGs were digitised by one observer who was blinded to patient outcome. The patients were followed up for a median of 3.3 years. The primary endpoint was cardiac death. A prolonged heart rate corrected QT peak (QTpc) of lead I carried the highest relative risk of death from all cause as well as cardiac death, when compared with the other more conventional QT indices. In multivariate analyses, when adjusted for conventional risk factors of atherosclerosis, a prolonged QTpc of lead I was still associated with a 3-fold increased risk of cardiac death. (adjusted relative risk 3.0 [95% CI 1.1 - 8.5], p=0.037). Conclusion: QT peak prolongation in lead I predicts cardiac death after strok

Examining the relationship between different naturally-occurring maxillary beak shapes and their ability to cause damage in commercial laying hens

1. Using chicken models to avoid unnecessary harm, this study examined the relationship between naturally-occurring maxillary (top) beak shapes and their ability to cause pecking damage.2. A selection of 24 Lohmann Brown laying hens from a total population of 100 were sorted into two groups based on their maxillary beak shape, where 12 were classified as having sharp beaks (SB) and 12 as having blunt beaks (BB).3. All hens were recorded six times in a test pen which contained a chicken model (foam block covered with feathered chicken skin) and a video camera. During each test session, the number of feathers removed from the model, the change in skin and block weight (proxies for tissue damage) and the percentage of successful pecks (resulting in feather and/or tissue removal) were recorded.4. SB hens removed more feathers from the model and had a greater change in skin weight than BB hens. The mean number of pecks made at the model did not differ between the beak shape groups; however, SB hens had a greater percentage of successful pecks, resulting in feather and/or tissue removal, compared to BB hens.5. In conclusion, SB hens were more capable of removing feathers and causing damage. Birds performed more successful pecks resulting in feather and/or tissue removal as they gained experience pecking at the model.</p

Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Additive Intensity Regression Models in Corporate Default Analysis

We consider additive intensity (Aalen) models as an alternative to the multiplicative intensity (Cox) models for analyzing the default risk of a sample of rated, nonfinancial U.S. firms. The setting allows for estimating and testing the significance of time-varying effects. We use a variety of model checking techniques to identify misspecifications. In our final model, we find evidence of time-variation in the effects of distance-to-default and short-to-long term debt. Also we identify interactions between distance-to-default and other covariates, and the quick ratio covariate is significant. None of our macroeconomic covariates are significant

The impact of infrared beak treatment on turkey tom and hen beak length and performance to 12 weeks of age

Controlling injurious pecking in commercial turkeys remains a significant challenge to producers and the industry. Infrared beak treatment is an effective method of controlling injurious pecking in chickens; however, the effects of infrared beak treatment on turkey performance are still largely unknown. Two experiments were conducted to determine the impact of infrared beak treatment on the beak length and performance of turkeys raised to 12 wk of age. Experiment 1 tested both toms (n = 236) and hens (n = 324), while Experiment 2 focused on hens (n = 608). Poults for each experiment were assigned to 1 of 2 beak treatments: infrared beak treated (IR) on the day of hatch at a commercial hatchery or sham untreated control (C). Data collected included beak length, body weight, feed intake, feed efficiency, and mortality. Data were analyzed using a 1 or 2-way ANOVA, followed by Tukey's range test for mean separation when interactions were found. Results showed that beak length (Experiment 1 only) was significantly shorter in IR poults from 2 to 12 wk of age. In the same experiment, IR toms had lighter body weight than C toms, but IR hens were heavier than C hens from 2 to 4 wk of age. By 12 wk, IR poults were heavier than C poults, regardless of gender. In experiment 2, IR hens had lighter body weight from 2 to 4 wk of age. In conclusion, infrared beak treatment had minimal effects on feed intake, feed efficiency, or mortality over the 12-wk periods of both experiments