Ex-vivo and early clinical results using a new pullback atherectomy catheter (PAC)

Digitalitzat per Artypla

Sequential electrodiagnostic abnormalities in acute inflammatory demyelinating polyradiculoneuropathy

We reviewed 180 electroneuromyographic (EMG) studies from patients with acute inflammatory demyelinating polyradiculoneuropathy. EMG criteria suggestive of demyelination were met during the first 5 weeks in 87% of patients; an additional 10% had indeterminate electrodiagnostic evaluations, and 3% demonstrated axonal degeneration only. Motor nerve conduction abnormalities initially predominated, with the nadir of abnormality occurring at week 3. Sensory nerve conduction abnormalities peaked during week 4 and were atypical for polyneuropathy, with 52% of patients having normal sural but abnormal median sensory studies, perhaps reflecting distal nerve involvement. Delayed sensory abnormalities may reflect, in part, secondary involvement related to increased intraneural edema accentuated by compression at sites of anatomic vulnerability. Fibrillation potentials and increased polyphasia appeared between weeks 2 and 5 in proximal and distal muscles simultaneously, which is consistent with either random axonal degeneration at any point along the axon or distal involvement. Resolution of conduction abnormalities began between weeks 6 and 10, with increased mean motor-evoked amplitude best reflecting functional clinical recovery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50137/1/880080609_ftp.pd

Influence of Pleistocene glacial deposits on the transport of agricultural nitrate in the river Wensum catchment, UK

Mitigating NO3− pollution requires an understanding of the hydrological processes controlling contaminant mobilisation and transport, particularly in agricultural catchments underlain by Pleistocene glacial deposits. Focusing on the Wensum catchment in East Anglia, UK, precipitation (n = 20), stream water (n = 50), field drainage (n = 22) and groundwater (n = 84) samples collected between February–March 2011 and April–September 2012 were variously analysed for water stable isotopes (δ2HH2O and δ18OH2O), the dual-isotopes of NO3− (δ15NNO3 and δ18ONO3), groundwater residence time indicators (CFCs and SF6) and hydrochemical parameters. The residence time indicators suggested a component of modern (post-1960) groundwater throughout the sequence of glacial deposits that corresponds with the penetration of agricultural NO3−. Denitrification and lower NO3− concentrations (<8 mg L−1) are observed in the glacial tills, compared with higher NO3− concentrations (<90 mg L−1) observed under more oxidising conditions in the glacial sands and gravels. Storm hydrograph separation for two storms in April and September 2012 using two- and three-component mixing models showed a faster response with field drainage (36–38 %) and baseflow (5–37 %) contributing to the total stream discharge in areas of clay loam soils over glacial tills. In these areas, the dual stable isotopes of NO3− (δ15NNO3 = +11.8 ‰ and δ18ONO3 = +7.1 ‰) indicated a denitrified source of nitrogen from field drainage and groundwater. In comparison, a dampened response and a higher percentage of baseflow (29–80 %) was observed in areas of sandy clay loam soils over glacial sands and gravels. In these areas, mean NO3− isotopic signatures (δ15NNO3 = +7.8 ‰ and δ18ONO3 = +5.0 ‰) indicated a source of nitrified NH4+. In conclusion, understanding hydrological processes in catchments underlain by variable glacial deposits can inform nutrient management plans and cultivation practices to reduce the risk of agricultural NO3− contamination

Acquired inflammatory demyelinating polyneuropathies: Clinical and electrodiagnostic features

The acquired demyelinating polyneuropathies include acute (AIDP, Guillain-BarrÉ syndrome, GBS) and chronic (CIDP, dysproteinemic) forms which differ primarily in their temporal profile. They are inflammatory-demyelinating diseases of the peripheral nervous system and likely have an immunologic pathogenesis. Although these neuropathies usually have a characteristic presentation, the electromyographer plays a central role in their recognition, since the demyelinating component of the neuropathy, which greatly reduces the differential diagnosis, is often first identified in the electromyography laboratory. In AIDP, the electromyographer, in addition to establishing the diagnosis, can sometimes predict the prognosis. Recognition of the chronic and dysproteinemic forms of acquired demyelinating polyneuropathy is important since they are treatable. The dysproteinemic forms also may be associated with occult systemic disorders that also may require treatment, independent of the neuropathy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50143/1/880120602_ftp.pd

Parsing the passive: comparing children with Specific Language Impairment to sequential bilingual children

25 monolingual (L1) children with Specific Language Impairment (SLI), 32 sequential bilingual (L2) children, and 29 L1 controls completed the Test of Active & Passive Sentences-Revised (van der Lely, 1996) and the self-paced listening task with picture verification for actives and passives (Marinis, 2007). These revealed important between-group differences in both tasks. The children with SLI showed difficulties in both actives and passives when they had to reanalyse thematic roles on-line. Their error pattern provided evidence for working memory limitations. The L2 children showed difficulties only in passives both on-line and off-line. We suggest that these relate to the complex syntactic algorithm in passives and reflect an earlier developmental stage due to reduced exposure to the L2. The results are discussed in relation to theories of SLI and can be best accommodated within accounts proposing that difficulties in the comprehension of passives stem from processing limitations

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D