ACE-inhibition prevents postischemic coronary leukocyte adhesion and leukocyte-dependent reperfusion injury

Objective: Polymorphonuclear leukocytes (PMN), retained in the microvascular bed, can contribute to postischemic myocardial reperfusion injury. Since a beneficial effect of ACE-inhibition on reperfusion injury has been reported, we investigated the impact of cilazaprilat on PMN dependent reperfusion injury in isolated guinea pig hearts. Methods: Hearts (n=5 per group) were subjected to 15 min of ischemia. Immediately thereafter, a bolus of PMN was injected into the coronary system. External heart work (EHW) and total cardiac nitric oxide release were measured. For microscopic evaluation, hearts received rhodamine 6G labelled PMN after ischemia, were arrested 5 min later and further perfused with FITC dextran (0.1%). Localization of retained PMN was assessed by fluorescence microscopy. Leukocyte activation was studied by FACS analysis of the adhesion molecule CD11b before and after coronary passage of the PMN. The ACE-inhibitor cilazaprilat (Cila, 2 μM) and the NO-synthase inhibitor nitro-L-arginine (NOLAG, 10 μM) were used to modulate nitric oxide formation of the heart. Results: Postischemic EHW recovered to 67±5% (controls) and 64±6% (Cila) of the preischemic value. Addition of PMN severely depressed recovery of EHW (39±2%) and NO release (39±6% of the preischemic value). Simultaneously, ischemia led to a substantial increase in postcapillary PMN adhesion (from 21±5 to 172±27 PMN/mm² surface) and CD11b-expression of the recovered PMN (3-fold). Cila attenuated postischemic PMN adhesion (83±52 PMN/mm²) and activation of PMN, whereas it improved recovery of work performance (64±4%) and NO release (65±4%) in the presence of PMN. Conversely, NOLAG increased PMN adhesion (284±40 PMN/mm²) and myocardial injury. We conclude that ACE-inhibition prevents leukocyte dependent reperfusion injury mainly by inhibition of postcapillary leukocyte adhesion. The effect may be mediated by NO, given the proadhesive effect of NOLAG

Evaluation of the diagnostic accuracy of a point-of-care device to measure concentrations of nonesterified fatty acids in serum and whole blood

The objective of this study was to compare measurements of nonesterified fatty acids (NEFA) between the gold standard diagnostic laboratory method and a handheld NEFA meter (Qucare Pro meter, DFI Co. Ltd.). Three experiments were conducted to study the usability of the meter. In experiment 1 we compared results of the meter obtained from measurements in serum and whole blood with results of the gold standard method. Based on the results of experiment 1 we compared the results measured by the meter in whole blood with results obtained from the gold standard method on a larger scale, as we wanted to omit the step of centrifugation with the cow-side test. In experiment 3 we determined the influence of ambient temperature on measurements. Overall, blood samples of 231 cows were collected between 14 and 20 d in milk. The Spearman correlation coefficients (ρ) were calculated and Bland-Altman plots were created to compare the accuracy of the NEFA meter with the gold standard. In addition, in experiment 2 receiver operating characteristic (ROC) curve analyses were performed, to define thresholds for the NEFA meter to detect cows with a NEFA concentration above 0.3, 0.4, and 0.7 mEq/L. In experiment 1, there was a high correlation between NEFA concentrations in whole blood and serum determined by the NEFA meter and the gold standard (ρ = 0.90 for measurement in whole blood; ρ = 0.93 for measurement in serum). In experiment 2, the measurement in whole blood with the NEFA meter was compared with the gold standard. Despite a lower correlation (ρ = 0.79) the ROC curve analyses revealed a high specificity and a moderate sensitivity for lower cut-points (i.e., 0.3 and 0.4 mEq/L). The NEFA meter underestimated especially high concentration of >0.7 mEq/L. Considering thresholds of 0.3, 0.4, and 0.7 mEq/L measured by the gold standard test, sensitivity and specificity were 59.1% and 96.7%, 79.0% and 95.4%, and 86.4% and 95.6%, respectively, when using 0.3, 0.3, and 0.4 mEq/L as thresholds for the NEFA meter. Accuracy was 74.1%, 88.3%, and 93.8% for the 3 thresholds tested. Experiment 3 showed that measurements should be conducted at approximately 21°C (ρ = 0.73) as correlations were poor at 6.2°C and 15.1°C (ρ = 0.18 and 0.22, respectively)

Effect of helium pre- or postconditioning on signal transduction kinases in patients undergoing coronary artery bypass graft surgery

Background: The noble gas helium induces pre- and postconditioning in animals and humans. Volatile anesthetics induce cardioprotection in humans undergoing coronary artery bypass graft (CABG) surgery. We hypothesized that helium induces pre-and postconditioning in CABG-patients, affecting signaling molecules protein kinase C-epsilon (PKC-epsilon), p38 mitogen activated protein kinase (p38 MAPK), extracellular signal-regulated kinase 1/2 (ERK-1/2) and heat shock protein 27 (HSP-27) within cardiac tissue, and reducing postoperative troponin levels. Methods: After ethical approval and informed consent, 125 elective patients undergoing CABG surgery were randomised into this prospective, placebo controlled, investigator blinded, parallel arm single-centre study. Helium preconditioning (3 x 5 min of 70 % helium and 30 % oxygen) was applied before aortic cross clamping; postconditioning (15 min of helium) was applied before release of the aortic cross clamp. Signaling molecules were measured in right atrial appendix specimens. Troponin-T was measured at 4, 12, 24 and 48 h postoperatively. Results: Baseline characteristics of all groups were similar. Helium preconditioning did not significantly alter the primary outcome (molecular levels of kinases PKC-e and HSP-27, ratio of activated p38 MAPK or ERK 1/2). Postoperative troponin T was 11 arbitrary units [5, 31; area-under-the-curve (interquartile range)] for controls, and no statistically significant changes were observed after helium preconditioning [He-pre: 11 (6, 18)], helium postconditioning [He-post: 11 (8, 15)], helium pre-and postconditioning [He-PP: 14 (6, 20)] and after sevoflurane preconditioning [APC: 12 (8, 24), p = 0.13]. No adverse effects related to study treatment were observed in this study. Conclusions: No effect was observed of helium preconditioning, postconditioning or the combination thereof on activation of p38 MAPK, ERK 1/2 or levels of HSP27 and PKC-e in the human heart. Helium pre-and postconditioning did not affect postoperative troponin release in patients undergoing CABG surgery

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Objective. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes. Design. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods. Setting. Tertiary referral university hospital with 30,000 surgical procedures per year. Methods. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection. Results. During baseline time period A (3,836 procedures), RAP was administered 30-74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate. Conclusions. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standar

Autism spectrum disorder-specific changes in white matter connectome edge density based on functionally defined nodes

IntroductionAutism spectrum disorder (ASD) is associated with both functional and microstructural connectome disruptions. We deployed a novel methodology using functionally defined nodes to guide white matter (WM) tractography and identify ASD-related microstructural connectome changes across the lifespan.MethodsWe used diffusion tensor imaging and clinical data from four studies in the national database for autism research (NDAR) including 155 infants, 102 toddlers, 230 adolescents, and 96 young adults – of whom 264 (45%) were diagnosed with ASD. We applied cortical nodes from a prior fMRI study identifying regions related to symptom severity scores and used these seeds to construct WM fiber tracts as connectome Edge Density (ED) maps. Resulting ED maps were assessed for between-group differences using voxel-wise and tract-based analysis. We then examined the association of ASD diagnosis with ED driven from functional nodes generated from different sensitivity thresholds.ResultsIn ED derived from functionally guided tractography, we identified ASD-related changes in infants (pFDR ≤ 0.001–0.483). Overall, more wide-spread ASD-related differences were detectable in ED based on functional nodes with positive symptom correlation than negative correlation to ASD, and stricter thresholds for functional nodes resulted in stronger correlation with ASD among infants (z = −6.413 to 6.666, pFDR ≤ 0.001–0.968). Voxel-wise analysis revealed wide-spread ED reductions in central WM tracts of toddlers, adolescents, and adults.DiscussionWe detected early changes of aberrant WM development in infants developing ASD when generating microstructural connectome ED map with cortical nodes defined by functional imaging. These were not evident when applying structurally defined nodes, suggesting that functionally guided DTI-based tractography can help identify early ASD-related WM disruptions between cortical regions exhibiting abnormal connectivity patterns later in life. Furthermore, our results suggest a benefit of involving functionally informed nodes in diffusion imaging-based probabilistic tractography, and underline that different age cohorts can benefit from age- and brain development-adapted image processing protocols

Identification of novel Cyclooxygenase-2-dependent genes in Helicobacter pylori infection in vivo

<p>Abstract</p> <p>Background</p> <p><it>Helicobacter pylori </it>is a crucial determining factor in the pathogenesis of benign and neoplastic gastric diseases. Cyclooxygenase-2 (Cox-2) is the inducible key enzyme of arachidonic acid metabolism and is a central mediator in inflammation and cancer. Expression of the <it>Cox-2 </it>gene is up-regulated in the gastric mucosa during <it>H. pylori </it>infection but the pathobiological consequences of this enhanced Cox-2 expression are not yet characterized. The aim of this study was to identify novel genes down-stream of Cox-2 in an <it>in vivo </it>model, thereby identifying potential targets for the study of the role of Cox- 2 in <it>H. pylori </it>pathogenesis and the initiation of pre- cancerous changes.</p> <p>Results</p> <p>Gene expression profiles in the gastric mucosa of mice treated with a specific Cox-2 inhibitor (NS398) or vehicle were analysed at different time points (6, 13 and 19 wk) after <it>H. pylori </it>infection. <it>H. pylori </it>infection affected the expression of 385 genes over the experimental period, including regulators of gastric physiology, proliferation, apoptosis and mucosal defence. Under conditions of Cox-2 inhibition, 160 target genes were regulated as a result of <it>H. pylori </it>infection. The Cox-2 dependent subset included those influencing gastric physiology (<it>Gastrin, Galr1</it>), epithelial barrier function (<it>Tjp1, connexin45, Aqp5</it>), inflammation (<it>Icam1</it>), apoptosis (<it>Clu</it>) and proliferation (<it>Gdf3, Igf2</it>). Treatment with NS398 alone caused differential expression of 140 genes, 97 of which were unique, indicating that these genes are regulated under conditions of basal Cox-2 expression.</p> <p>Conclusion</p> <p>This study has identified a panel of novel Cox-2 dependent genes influenced under both normal and the inflammatory conditions induced by <it>H. pylori </it>infection. These data provide important new links between Cox-2 and inflammatory processes, epithelial repair and integrity.</p

Thermal Evolution of Neutron Stars in 2 Dimensions

There are many factors that contribute to the breaking of the spherical symmetry of a neutron star. Most notably is rotation, magnetic fields, and/or accretion of matter from companion stars. All these phenomena influence the macroscopic structures of neutron stars, but also impact their microscopic compositions. The purpose of this paper is to investigate the cooling of rotationally deformed, two-dimensional (2D) neutron stars in the framework of general relativity theory, with the ultimate goal of better understand the impact of 2D effects on the thermal evolution of such objects. The equations that govern the thermal evolution of rotating neutron stars are presented in this paper. The cooling of neutron stars with different frequencies is computed self-consistently by combining a fully general relativistic 2D rotation code with a general relativistic 2D cooling code. We show that rotation can significantly influence the thermal evolution of rotating neutron stars. Among the major new aspects are the appearances of hot spots on the poles, and an increase of the thermal coupling times between the core and the crust of rotating neutron stars. We show that this increase is independent of the microscopic properties of the stellar core, but depends only on the frequency of the star.Comment: 8 pages, 6 figures, revised versio

Economic Burden of Surgical Site Infections at a European University Hospital

Objective. To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital. Design. Matched case-control study nested in a prospective observational cohort study. Setting. Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year. Methods. All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care. Results. A total of 6,283 procedures were performed:187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492-SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (n = 76). Conclusions. Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare provider

Adding Student Video Projects to Physics Courses

Physics students have traditionally prepared many kinds of reports—laboratory, activity, project, and even book or article reports. Smartphones and YouTube videos are familiar cultural objects to current students, and our students use smartphone cameras to include photographs of apparatus, phenomena, hand-sketched figures, graphs, and mathematical equations in their physics reports. Here we present basic techniques for physics students to use smartphones and tablets to create short (\u3c 5 min) end-of-semester video projects. Our students mainly use Apple Computer’s iPad1 tablets, but also other tablets and various smartphones. Finally we discuss appropriate instructor expectations and grading. Similar non-physics student video reporting efforts were reported using video cameras by Kearney,2 and Hechter and Guy.

Integration of CT urography improves diagnostic confidence of 68Ga-PSMA-11 PET/CT in prostate cancer patients

Background: To prove the feasibility of integrating CT urography (CTU) into 68Ga-PSMA-11 PET/CT and to analyze the impact of CTU on assigning focal tracer accumulation in the ureteric space to either ureteric excretion or metastatic disease concerning topographic attribution and diagnostic confidence. Methods: Ten prostate cancer patients who underwent 68Ga-PSMA-11 PET/CT including CTU because of biochemical relapse or known metastatic disease were retrospectively analyzed. CTU consisted of an excretory phase 10 min after injection of 80 mL iodinated contrast material. Ureter opacification at CTU was evaluated using the following score: 0, 0% opacification; 1, &lt; 50%; 2, 50–99%; 3, 100%. Topographic attribution and confidence of topographic attribution of focal tracer accumulation in the ureteric space were separately assessed for 68Ga-PSMA-11 PET/CT without and with CTU. Diagnostic confidence was evaluated using the following score: 0, &lt; 25% confidence; 1, 26–50%; 2, 51–75%; 3, 76–100%. Results: At CTU, mean ureter opacification score was 2.6 ± 0.7. At 68Ga-PSMA-11 PET/CT without CTU, mean confidence of topographic attribution of focal tracer accumulation was 2.5 ± 0.7 in total and 2.6 ± 0.7 for metastatic disease. At 68Ga-PSMA-11 PET/CT with CTU, mean confidence of topographic attribution of focal areas of tracer accumulation was significantly higher with 2.9 ± 0.2 in total and 2.7 ± 0.9 for metastatic disease (p &lt; 0.001). In 4 of 34 findings (12%) attribution to either ureteric excretion or metastatic disease was discrepant between 68Ga-PSMA-11 PET/CT without and with CTU (n.s). Conclusions: Integration of CTU into 68Ga-PSMA-11 PET/CT is feasible and increases diagnostic confidence of assigning focal areas of tracer accumulation in the ureteric space to either metastatic disease or ureteric excretion