814-1 Variations of Segmental Endothelium Dependent and Endothelium Independent Vasomotor Tone in the Long Term Follow Up After Cardiac Transplantation (Qualitative Changes in Endothelial Function)

To assess segmental vasoconstrictor and dilator responses in patients after cardiac transplantation (CT) without obvious angiographic disease we infused the endothelium dependent vasodilator acetylcholine (ACH) and the endothelium independent vasodilator SIN-1 sequentially into the left coronary artery. ACH infusions always preceded SIN-1 infusions. Responses of 156 nonstenotic coronary segments (LAD and CX) were investigated in 26 patients (P). Group 1: l0 P 11.3±3 months after CT. Group 2: 16 P 52±11 months after CT. Five different responses to ACH followed by SIN-1 were observed: A) dilation followed by no change (fully preserved endothelium dependent function). B) dilation followed by further dilation. C) no change followed by dilation. D) constriction followed by dilation (defective endogenous NO-release and intact vascular smooth muscle function). EI constriction followed by constriction (defective endogenous NO-release and defective vascular smooth muscle function).ResultsDifferent segmental reaction types in both groups.proximal LADdistal LADGroup 1:20% A, 20% B. 30% C. 30% D50% C. 50% DGroup 2:19% C. 69% 0.12% E12% C. 81% D.7% EConclusion(1) In only 20% of patients 1 year after CT the endothelium dependent vasodilation is completely preserved. In 40% of the patients 1 year after CT the endothelium shows segmental heterogeneity in response to ACH [absence of endothelium dependent vasodilation (type A and B) in the distal segment]. (2) In the long term course after CT more than 80% of P have defective endothelial function in proximal and distal segments [absence of endothelium dependent vasodilation (type A and B) in the proximal and distal segment]. Moreover approximately 10% have defective vascular smooth muscle function. Functional assessment of endothelial integrity in P after CT shows time dependent qualitative differences between proXimal and distal coronary segment

Spatiotemporal variation in risk of Shigella infection in childhood : a global risk mapping and prediction model using individual participant data

BACKGROUND: Diarrhoeal disease is a leading cause of childhood illness and death globally, and Shigella is a major aetiological contributor for which a vaccine might soon be available. The primary objective of this study was to model the spatiotemporal variation in paediatric Shigella infection and map its predicted prevalence across low-income and middle-income countries (LMICs). METHODS: Individual participant data for Shigella positivity in stool samples were sourced from multiple LMIC-based studies of children aged 59 months or younger. Covariates included household-level and participant-level factors ascertained by study investigators and environmental and hydrometeorological variables extracted from various data products at georeferenced child locations. Multivariate models were fitted and prevalence predictions obtained by syndrome and age stratum. FINDINGS: 20 studies from 23 countries (including locations in Central America and South America, sub-Saharan Africa, and south and southeast Asia) contributed 66 563 sample results. Age, symptom status, and study design contributed most to model performance followed by temperature, wind speed, relative humidity, and soil moisture. Probability of Shigella infection exceeded 20% when both precipitation and soil moisture were above average and had a 43% peak in uncomplicated diarrhoea cases at 33°C temperatures, above which it decreased. Compared with unimproved sanitation, improved sanitation decreased the odds of Shigella infection by 19% (odds ratio [OR]=0·81 [95% CI 0·76-0·86]) and open defecation decreased them by 18% (OR=0·82 [0·76-0·88]). INTERPRETATION: The distribution of Shigella is more sensitive to climatological factors, such as temperature, than previously recognised. Conditions in much of sub-Saharan Africa are particularly propitious for Shigella transmission, although hotspots also occur in South America and Central America, the Ganges-Brahmaputra Delta, and the island of New Guinea. These findings can inform prioritisation of populations for future vaccine trials and campaigns. FUNDING: NASA, National Institutes of Health-The National Institute of Allergy and Infectious Diseases, and Bill & Melinda Gates Foundation.publishedVersionPeer reviewe

New Surgical Treatment for Severe Limb Ischemia

Revascularization after prolonged complete limb ischemia may result in severe damage to skeletal muscle and systemic alterations (postischemic syndrome)

Controlled limb reperfusion as a new surgical technique to reduce postischemic syndrome

In cardiac surgical practice, acute limb ischemia may occur as a result of the insertion of an intraaortic balloon pump, emboli, dissections, and other complications

Surgical revascularization in patients with acute myocardial infarction

This retrospective study was done to access the results of emergency revascularization in patients with acute myocardial infarction

Changing patterns of patients undergoing emergency surgical revascularization for acute coronary occlusion

Between 1977 and 1992 a total of 163 consecutive patients underwent emergency coronary artery bypass grafting after acute coronary occlusion