A mobile application for STEMI care optimization: pilot implementation project report

Background

In an effort to improve outcomes of STEMI patients, we developed a secure mobile application (app) to streamline real-time communication and coordination between multiple teams taking care of STEMI patients in a large health care system. The app includes multi-level alarm and notification systems, instant EKG transmission for quick interpretation, activation of the cardiac catheterization laboratory (CCL) after expert case review, secure video chat among team members facilitating clinical discussion, continuous updates on patients' clinical status and ambulance location tracking.

Purpose

One of the major shortcomings in STEMI system of care has been long delays in transfer of patients from non-PCI capable hospitals to a receiving center for primary PCI. To address the challenges of interhospital transfer, we designed a pilot project employing the app for STEMI transfer from a first contact hospital to our CCL. This report assesses the effect of the app on door-to-device time by comparing the key metric for STEMI transfer before (historic) and after app launch.

Methods

The pilot project involved key leadership stakeholders from Emergency Medicine and Nursing Departments at the referring hospital, CCL and our transfer center. During pilot period (July 2021 to January 2022) the referring center activated STEMI alarms using app activation in parallel with the previously established STEMI activation process via traditional phone calls to the transfer center. The built-in workflow redundancy was introduced to ensure the rapid and efficient, and at the same time, safe and reliable response to STEMI alert. In preparation for the pilot, more than 250 people were provisioned accounts, trained on their user-specific roles and scheduled in the app according to their schedules.

Results

A total of 40 suspected STEMIs were activated through the app during the pilot study; among them 30 cases were accepted for transfer and 10 rejected. After excluding patients who expired during transfer, were intubated, or had normal coronaries, final study population included 13 STEMI cases activated through the app. These cases were compared with 43 STEMIs activated through the traditional pathway from January 2019 to July 2021 before app launch. After implementing the app, the mean door-to-device time for STEMI transfer decreased from 120.3±48.3 to 91.8±15.4 min (P=0.002) (Figure 1). The significant improvement, 29 min (24%), of the key metric for interhospital transfer resulted in all STEMI cases meeting AHA goal of door-to-device time ≤120 minutes after the app launch. The respective percent of STEMI cases meeting the goal before app was 71% (Figure 2).

Conclusions

Implementation of a mobile app into STEMI workflow of a large urban healthcare system had a significant impact on the quality of care for transfer of STEMI patients, which has also helped bring our clinical practice closer to the AHA guidelines pertaining to the first door-to-device time.

Funding Acknowledgement

Type of funding sources: None.

Histology of Chemically Induced Mesotheliomas in Mrc-wistar Rats

Two peritoneal mesotheliomas were induced in rats during a carcinogenicity study of 1-nitroso-5,6-dihydrouracil (NO-DHU) injected intraperitoneally. A review of literature concerning experimental induction of such tumors indicated that they seldom produced with organic compounds and rarely occur spontaneously. In the present study, several reports of chemically induced mesotheliomas of the testes are analyzed and the diagnoses critically reviewed along with other differential diagnoses.

Metal-organic and covalent organic frameworks as single-site catalysts

Heterogeneous single-site catalysts consist of isolated, well-defined, active sites that are spatially separated in a given solid and, ideally, structurally identical. In this review, the potential of metal-organic frameworks (MOFs) and covalent organic frameworks (COFs) as platforms for the development of heterogeneous single-site catalysts is reviewed thoroughly. In the first part of this article, synthetic strategies and progress in the implementation of such sites in these two classes of materials are discussed. Because these solids are excellent playgrounds to allow a better understanding of catalytic functions, we highlight the most important recent advances in the modelling and spectroscopic characterization of single-site catalysts based on these materials. Finally, we discuss the potential of MOFs as materials in which several single-site catalytic functions can be combined within one framework along with their potential as powerful enzyme-mimicking materials. The review is wrapped up with our personal vision on future research directions.

Abstract P5-22-04: Efficacy of thoracic paravertebral block for reducing acute post-mastectomy pain

Background: Mastectomy is associated with acute and chronic postoperative pain. This study investigated the efficacy of thoracic paravertebral block (TPB) compared to local anesthetic of surgical wound (LASW) in breast cancer patients undergoing mastectomy.

Methods: This phase 3, randomized controlled, single blind, parallel arms and superiority clinical trial aimed to evaluate the efficacy of TPB compared to LASW on acute pain at rest and motion at 24 hours post-mastectomy, measured by a visual analog scale (VAS). The study size of 60 patients is determined to have 90% power to detect a difference of 20% in acute pain in favor of TPB. In TPB group use of ultrasound was mandatory to guide puncture of intervertebral space T3 for infiltrating 0.5% bupivacaine at dose of 1.5 mg/kg. In LASW group was used bupivacaine 0.5% at dose of 1.5mg/kg on subcutaneous tissue of surgical area. VAS was used to measure surgical pain at rest and motion in 2,4,6,12 and 24 hours post-operatives for both groups. Trial Registry: ClinicalTrials.gov; Identifier:NCT02609321.

Findings: From 08-2015 to 09-2016, 60 breast cancer patients were enrolled; 3 dropped off consent. Mean age was 51 year; 78% had stage II and III; and 65% receive neoadjuvant chemotherapy.There were no significant differences in the VAS pain measurement for the groups of BWT compared to LASW in the 24 hour measurement, neither at rest (P=0.6525) nor in movement (P=0.7929). There were no significant differences in both groups for repeated pain measurements (5 measures mean), total dose of opioid administration, time to first dose of opioids or adverse events.

Conclusions: There were not statistical differences for post-mastectomy acute pain in first 24 hours between TPB and LASW patients. According our findings the use of TPB should not routinely recommended for breast cancer patients undergoing mastectomy.

Citation Format: Herazo-Maya F, Egurrola J, Restrepo CE, Torres L, Palacios L, Ossa CA, Borrero M, Angel GA, Marquez JJ, Valencia S, Perez A, Oyola JC, Lobo L, Gomez R, Garcia H. Efficacy of thoracic paravertebral block for reducing acute post-mastectomy pain [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-04.

Abstract P5-16-20: Impact of “immunohistochemistry-based molecular subtype” on chemo-sensitivity and survival in Hispanic breast cancer patients following neoadjuvant chemotherapy (NAC)

NAC it´s the standard procedure when handling non-surgical tumors and inflammatory breast carcinomas, increases the possibility of conservative surgery and must be considered an evaluative tool in designing a therapeutic strategy. NAC improves Disease-Free Survival (DFS) and Overall Survival (OS) in patients achieving pathological complete response (pCR). “Immunohistochemitry-Based Molecular Subtyping” (IMS) with ER, PR,HER2 and KI67 has shown good correlation with gene expression assays to identify Intrinsic Molecular Subtypes. The relationship between IMS, chemo sensitivity and survival is currently a matter of interest. Achieving pCR at the time of Surgery has been associated with a favorable prognosis.

Objectives:to investigate the pathological response to NAC and its correlation with IMS, as well as its correlation with DFS and OS in patients who have undergone NAC.

Methods: Women > 18 years old. treated with NAC and surgery at IDC (January 2009 to December 2013).Demographic, clinical en follow-up variables were obtained from de IDC patient´s registry. Patient´s vital status was traced trough phone calls.pCR was defined as ypT0 ypN0 (the absence of invasive cancer AND in situ cancer in the breast and axillary nodes). IDC´s IRB approved the research project.

Results: A total of 592 patients fulfilled the study's inclusion criteria. The distribution by subtypes were: “Luminal A”: 150 (25.3%), “Luminal B/HER2 -”: 189 (31.9%), “Luminal B/HER2+”: 114 (19.3%), “HER2-enriched”: 45 (7.6%) and “Triple negative”: 94 (15.9%). The median follow-up was 51 months (interquartile range: 37-68).Pathological response to NAC was: complete pathological response (pCR) in 59 (10%) patients, partial pathological response in 426 (72.0%); stable disease in 82 (13.8%), and progression in 25 (4.2%) patients.In Multivariable Cox Regression Models, pCR is associated with a significant improvement in the DFS (HR 6.89; 95% CI: 2.53 to 18.75. p=0.01) and OS (HR 6.82; 95% CI 2.13 to 21.78. p=0.01). By “Immunohistochemistry-based molecular subtype” the pCR is associated with a significantly better DFS for “Luminal B”, “Triple Negative” and “HER2-enriched”. For OS we found significantly association with pCR for “Triple negative” and “”Luminal B” “Immunohistochemistry-based molecular subtype”. The “HER2-enriched”shown a trend to better OS if obtain pCR (p=0.05).

Conclusions: pCR is associated with an improved overall survival and disease-free survival rates in this group of Hispanics patients. In advanced stages, histologial grade 3, Luminal B, Triple Negative and HER2+ enriched tumors the pCR is associated with a significantly better DFS .

Citation Format: Gomez-Wolff R, Garcia H, Ossa C. Impact of “immunohistochemistry-based molecular subtype” on chemo-sensitivity and survival in Hispanic breast cancer patients following neoadjuvant chemotherapy (NAC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-20.

Localized surface plasmon sensing based investigation of nanoscale metal oxidation kinetics

The localized surface plasmon resonance (LSPR) of nanoparticles can be a powerful and sensitive probe of chemical changes in nanoscale volumes. Here we have used the LSPR of silver (Ag) to study the oxidation kinetics of nanoscopic volumes of cobalt (Co) metal. Bimetal nanoparticles of the immiscible Co-Ag system prepared by pulsed laser dewetting were aged in ambient air and the resulting changes to the LSPR signal and bandwidth were used to probe the oxidation kinetics. Co was found to preferentially oxidize first. This resulted in a significant enhancement by a factor of 8 or more in the lifetime of stable Ag plasmons over that of pure Ag. Theoretical modeling based on optical mean field approximation was able to predict the oxidation lifetimes and could help design stable Ag-based plasmonic nanoparticles for sensing applications.

The detection and PCR-based characterization of the parasites causing trypanosomiasis in water-buffalo herds in Venezuela

The usefulness of PCR-based assays for detecting trypanosomiasis in water buffaloes and other livestock was explored, under field conditions, in Venezuela. The sensitivity and specificity of the assays, which were based on established primer pairs (21-mer/22-mer and ILO1264/ILO1265), were evaluated, partly by comparison with the results of parasitological tests (stained bloodsmears and microhaematocrit centrifugation) and immunological assays (IFAT) run in parallel. The optimised PCR-based assays showed a sensitivity of 10 pg DNA. The use of the 21-mer/22-mer primer pair gave a test that was specific for species in the subgenus Trypanozoon (including Trypanosoma evansi), whereas use of ILO1264/ILO1265 produced a test that was specific for T. vivax. The results of a hybridization assay using T. evansi-DNA and T. vivax-DNA probes indicated no cross-hybridization between the T. evansi and T. vivax PCR products.The results of the bloodsmear examinations, microhaematocrit centrifugations (MHC) and IFAT indicated that 23 (6.7%), 39 (11.4%) and 135 (39.5%) of the 342 blood samples investigated (including 316 from water buffaloes) contained trypanosomes, respectively. The results of the PCR-based assays indicated that 68 (19.9%) of the same blood samples contained T. vivax (or at least T. vivax DNA), and that none contained T. evansi or any other member of the subgenus Trypanozoon. For the detection of trypanosomes, the assay therefore appeared almost twice as sensitive as the MHC. These results are the first on the molecular characterization of the trypanosomes infecting water buffaloes in Venezuela. When the results of the MHC (which is the most practical, and frequently used, alternative detection method) were used as the gold standard, the PCR-based assay for T. vivax was found to have 100% sensitivity, 90.4% specificity, a positive predictive value of 0.57, a positive likelihood ratio of 10.45, and a negative likelihood ratio of 0.00. The assay therefore appears a reasonable choice for detecting T. vivax in the mammalian livestock of Venezuela and elsewhere.

Oxidation-resistant silver nanostructures for ultrastable plasmonic applications

Reduced degradation (oxidation) of silver nanoparticles (NPs) is achieved by contacting Ag with immiscible Co NPs. The relative decay of the plasmon peak (plot) shows that pure Ag NPs (blue dashed curve) decay by 25% in ca 20 days, whereas AgCo NPs last about 10 times longer, requiring nearly five months for a similar decay (red solid curve). The TEM images for both Ag and AgCo were taken after 50 days of storage under ambient conditions.

Pulmonary vascular complications in portal hypertension and liver disease: a concise review

Chronic liver disease and/or portal hypertension may be associated with one of the two pulmonary vascular complications: portopulmonary hypertension and hepatopulmonary syndrome. These pulmonary vascular disorders are notoriously underdiagnosed; however, they have a substantial negative impact on survival and require special attention in order to understand their diagnostic approach and to select the best therapeutic options. Portopulmonary hypertension results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. On the other hand, abnormal intrapulmonary vascular dilations, profound hypoxemia, and a wide alveolar-arterial gradient are the hallmarks of the hepatopulmonary syndrome, resulting in difficult-to-treat hypoxemia. The aim of this review is to summarize the latest pathophysiologic concepts, diagnostic approach, therapy, and prognosis of portopulmonary hypertension and hepatopulmonary syndrome, as well as to discuss the role of liver transplantation as a definitive therapy in selected patients with these conditions.

Left fallopian tube primitive serous adenocarcinoma presenting as a cardiac tamponade - a case report and review of literature

A 61-year-old woman presented to the emergency room complaining of anterior left thoracic pain and shortness of breath even after minor efforts. Her previous medical history was unremarkable. Pulmonary angiographic tomography showed a moderate bilateral pleural effusion that had collapsed inferior lung lobes, a large pericardial effusion, and several enlarged lymph nodes in the anterior mediastinum. Echocardiogram (ECG) showed a considerable pericardial effusion with some degree of heart function impairment. Pericardiocentesis and thoracocentesis revealed neoplastic cells in both pericardial and pleural fluids. Abdominal and pelvic ultrasound showed a complex cystic mass with a 13-cm diameter located at left adnexal region and another complex cystic tumor with five-cm diameter at right adnexal region, with small amount of peritoneal effusion. Surgical staging was performed. Pathologic diagnosis was primitive left fallopian tube serous adenocarcinoma with peritubal involvement and multiple peritoneal and lymphatic metastases (FIGO Stage IV; TNM pT3c M1). Chemotherapy was initiated. Death occurred 25 months after diagnosis, with secondary dissemination (breast and lung). No recurrence of pericardial effusion was registered after chemotherapy, suggesting a high susceptibility of pericardial metastasis.

Self-organized bimetallic Ag-Co nanoparticles with tunable localized surface plasmons showing high environmental stability and sensitivity

We demonstrate a promising synthesis route based on pulsed laser dewetting of bilayer films (Ag and Co) to make bimetallic nanoparticle arrays. By combining experiment and theory we establish a parameter space for the independent control of composition and diameter for the bimetallic nanoparticles. As a result, physical properties, such as the localized surface plasmon resonance (LSPR), that depend on particle size and composition can be readily tuned over a wavelength range one order of magnitude greater than for pure Ag nanoparticles. The LSPR detection sensitivity of the bimetallic nanoparticles with narrow size distribution was found to be high-comparable with pure Ag (∼60 nm/RIU). Moreover, they showed significantly higher long-term environmental stability over pure Ag.

Analysis of organic compounds in an urban wastewater treatment plant effluent

In the present work we fractioned the effluent water from an urban sewage treatment plant (USTP) of Ribarroja (Valencia, Spain) using the conventional protocol based on DAX8 and XAD4 resins. The fractions were analyzed by elemental analysis, FT-IR, 1H-NMR, COSY-NMR, HSQC-NMR, FAB+-MS and also by derivatization with bis(trimethylsilyl)trifluoroacetamide with 10% of trimethylchlorosilane. The four fractions obtained have common spectroscopic features and individual compounds indicating that the fractioning procedure is inefficient at separating different families of compounds. Gas chromatography/mass spectrometry (GC-MS) analysis of the derivatized fractions allowed identification of many individual compounds. The main classes of organic compounds present in the effluent are saccharides, amino acids, fatty acids, hydroxyacids, aromatic compounds and steroids. Also we were able to identify in the effluent the emerging pollutants paracetamol and ketoprofen - two best-selling antiinflammatory drugs used in humans.

Breakdown of Fourier's law in nanotube thermal conductors

We present experimental evidence that the room temperature thermal conductivity (kappa) of individual multiwalled carbon and boron-nitride nanotubes does not obey Fourier's empirical law of thermal conduction. Because of isotopic disorder, kappa's of carbon nanotubes and boron-nitride nanotubes show different length dependence behavior. Moreover, for these systems we find that Fourier's law is violated even when the phonon mean free path is much shorter than the sample length.

Spanish validation of the HIV dementia scale in women

HIV infection is increasing in minority groups, particularly in African American and Hispanic women. Although the incidence of HIV dementia has decreased since the advent of highly active antiretroviral treatment, prevalence of neurocognitive complications has increased as patients are now living longer. This study's purpose was to determine the psychometric properties of the Spanish-language HIV Dementia Scale (HDS) in a group of HIV-infected women. We recruited 96 women: 60 HIV-seropositive and 36 HIV-seronegative. Modification of the HDS into a Spanish-language version consisted of translating the instructions, substituting four words in Spanish (gato, media, azul, piña), increasing 1 second in the psychomotor speed because the Spanish alphabet has more letters than the English alphabet, and not offering clues for memory recall. Cognitive impairment (CI) was defined according to the modified American Academy of Neurology HIV-dementia criteria including an asymptomatic CI group. Statistical analysis consisted of analysis of variance to determine group differences and receiver operator characteristics (ROC) to determine the optimal cutoff point for the screening of CI. HDS-Spanish total score and subscores for psychomotor speed and memory recall showed significant differences between HIV-seronegative and women with HIV-dementia (p < 0.001) and between HIV-seropositive women with normal cognition and those with HIV-dementia (p < 0.001). The optimal cutoff point of 13 or less had performance characteristics of 87% sensitivity and 46% specificity for HIV-associated CI (50.0% positive predictive value, 85.0% negative predictive value). The HDS-Spanish translation offers a useful screening tool with value for the identification of Hispanic women at risk of developing HIV-associated symptomatic neurocognitive disturbances.

Nanotube radio

We have constructed a fully functional, fully integrated radio receiver from a single carbon nanotube. The nanotube serves simultaneously as all essential components of a radio: antenna, tunable band-pass filter, amplifier, and demodulator. A direct current voltage source, as supplied by a battery, powers the radio. Using carrier waves in the commercially relevant 40-400 MHz range and both frequency and amplitude modulation techniques, we demonstrate successful music and voice reception.

Probing nanoscale solids at thermal extremes

We report a novel nanoscale thermal platform compatible with extreme temperature operation and real-time high-resolution transmission electron microscopy. Applied to multiwall carbon nanotubes, we find atomic-scale stability to 3200 K, demonstrating that carbon nanotubes are more robust than graphite or diamond. Even at these thermal extremes, nanotubes maintain 10% of their peak thermal conductivity and support electrical current densities approximately 2 x 10{8} A/cm{2}. We also apply this platform to determine the diameter dependence of the melting temperature of gold nanocrystals down to three nanometers.

Nanotube phonon waveguide

We find that the high thermal conductivity of carbon nanotubes remains intact under severe structural deformations while the corresponding electrical resistance and thermoelectric power show compromised responses. Similar robust thermal transport against bending is found for boron nitride nanotubes. Surprisingly, for both systems the phonon mean free path exceeds the characteristic length of structural ripples induced by bending and approaches the theoretical limit set by the radius of curvature. The robustness of heat conduction in nanotubes refines the ultimate limit that is far beyond the reach of ordinary materials.

Isotope effect on the thermal conductivity of boron nitride nanotubes

We have measured the temperature-dependent thermal conductivity kappa(T) of individual multiwall boron nitride nanotubes using a microfabricated test fixture that allows direct transmission electron microscopy characterization of the tube being measured. kappa(T) is exceptionally sensitive to isotopic substitution, with a 50% enhancement in kappa(T) resulting for boron nitride nanotubes with 99.5% 11B. For isotopically pure boron nitride nanotubes, kappa rivals that of carbon nanotubes of similar diameter.

Augmentation mammoplasty and 'silicone-osis'

BACKGROUND

Claims have been made that breast augmentation induces a previously unrecognized disease ("silicone-osis").

AIMS

To confirm the existence of "silicone-osis", qualify and quantify its characteristics.

METHODS

In this population-based retrospective cohort study, the health status of 458 female Sydney residents who had augmentation mammoplasty for cosmetic reasons ("augmentation mammoplasty-exposed" or "exposed" cohort) between 1979 and 1983 was compared with the health status of 687 female Sydney residents who had non-silicone-associated plastic surgery ("augmentation mammoplasty-nonexposed" or "non-exposed" cohort). Both groups were matched for age (+/- 5 years), year of plastic surgery (+/- 2 years), plastic surgeon, anaesthetist and mode of anaesthesia. Outcome measures comprised dummy symptoms to assess reporting bias, as well as symptoms and symptom clusters from a comprehensive 78-symptom list.

RESULTS

Dummy variables were not over-reported by the exposed cohort. The following individual symptoms developed more commonly in the exposed cohort after index plastic surgery: "memory loss/confusion", "altered bowel habit", "chest pain made worse by deep breathing", "shortness of breath after walking up 10 steps", "breast pain", "sweating mainly at night" and "tunnel vision". Of eight identified symptom clusters, three were rejected as biologically unimportant: "joint swelling of the bunion joint", "haemorrhoids" and "breast lumps" (the latter two occurring more commonly in the non-exposed cohort). In contrast, five symptom clusters were thought to have potential biological importance and occurred more commonly in the exposed cohort. The symptom "night sweats" was common to all five clusters, and comprised the sole symptom in one instance. The other four multisymptom clusters were also characterized by "low energy" (lethargy) and "pins and needles", whereas "breast pain", "impaired memory", "muscle pain" and "reflux", occurred in three of the four clusters.

CONCLUSION

Cluster analysis suggested the existence of a multisystem disorder occurring more commonly in the exposed cohort and characterized by night sweats, lethargy, breast pain, impaired mentation, reflux, paraesthesiae, hand muscle weakness and myalgia. The argument against this being a new disease entity --"silicone-osis"-- however, was its presence, albeit at lower frequency, in the silicone-unexposed cohort. Thus this study did not confirm the existence of a new disease entity "silicone-osis" uniquely and causally associated with silicone exposure. The possible interpretations of these findings are discussed.

Single-trial event-related potentials with wavelet denoising

The application of a recently proposed denoising implementation for obtaining event-related potentials (ERPs) at the single-trial level is shown. We study its performance in simulated data as well as in visual and auditory ERPs. For the simulated data, the method gives a significantly better reconstruction of the single-trial event-related responses in comparison with the original data and also in comparison with a reconstruction based on conventional Wiener filtering. Moreover, with wavelet denoising we obtain a significantly better estimation of the amplitudes and latencies of the simulated ERPs. For the real data, the method clearly improves the visualization of both visual and auditory single-trial ERPs. This allows the calculation of better averages as well as the study of systematic or unsystematic variations between trials. Since the method is fast and parameter free, it could complement the conventional analysis of ERPs.

Frequency evolution during tonic-clonic seizures

By using the Short Time Fourier Transform, we analyzed the EEG frequency evolution during tonic-clonic seizures on 18 scalp recordings corresponding to 7 patients admitted for Video-EEG monitoring. This information was correlated with clinical findings observed in the video recordings. From the time-frequency plots, we recognized patterns related with brain activity even when embedded in a background of muscle artifacts. In 13/18 seizures we found a clear frequency dynamics characterized by an activity originally localized at about 8 Hz, later slowing down to about 1.5 Hz. In the remaining cases muscle artifacts hinder the disclosure of a clear frequency evolution. The clonic phases started when the main frequency slowed down to about 3 Hz. We conclude that the Short Time Fourier Transform is very useful for a quantitative analysis of epileptic seizures, especially when muscle artifacts contaminate the recordings. We further conclude that the clonic phase starts as a response to brain activity that can be only established when brain oscillations are slow enough to be followed by the muscles.

High blood pressure and decreased heart rate variability in the Cuban epidemic neuropathy

Autonomic cardiovascular reflexes were investigated in patients with an epidemic optic and peripheral neuropathy, which affected more than 50 000 people in Cuba between 1991 and 1994 and was probably caused by nutritional deficiency. Affected patients had significantly higher blood pressure than age matched controls, both while supine and standing, and significantly lower heart rate variability during paced breathing, suggesting reduced cardiac parasympathetic innervation.

Dynamics of nonstructural carbohydrates and biomass yield in a fodder legume tree at different harvest intensities

Tropical tree fodder is harvested by frequent prunings, and resprouting depends on nonstructural carbohydrate reserves in the remaining tree parts. We studied the effects of three pruning intensities (removal of all leaves and branches leaving 1 m of stem once a year (T-12), or every 6 months (T-6), and about 50% pruning every 2 months (P-2)) on regrowth and the dynamics of soluble sugars and starch in the legume tree Gliricidia sepium (Jacq.) Walp. growing under humid tropical conditions in Guadeloupe, Lesser Antilles. Carbohydrates were sampled in roots, stems and branches. Among pruned trees, trees in the T-6 harvest regime had the highest leaf fodder yield (0.73 kg tree(-1) year(-1)). High litter loss reduced leaf yield of T-12 trees, but compared with the other treatments, T-12 trees produced the most branch biomass (3.43 kg tree(-1)). Among treatments, P-2 trees had an intermediate leaf fodder yield and the lowest branch production. Sucrose, glucose and fructose were the most common sugars in all biomass compartments. Mannose, pinitol and an unidentified cyclitol were relatively abundant in branches. Root sugar and starch concentrations were unaffected by harvest regime. There was a significant interactive effect of harvest intensity and regrowth time on stem sugar concentration. Stem starch concentration was highest in T-12 trees. After a year of fodder harvesting, whole-tree reserves of nonstructural carbohydrates were highest in T-12 trees; however, a larger proportion of reserves were located in roots and stems of T-6 and P-2 trees. These reserves, which were not lost in pruning and contributed to regrowth of G. sepium after pruning, may explain the relatively small effects of harvesting regime on soluble sugar and starch concentrations.

Urea reduction ratio considering urea rebound

An American National Study shows that survival benefits from higher dialysis doses appear to be present up to a Kt/V level of 1.3 or a urea reduction ratio (URR) of 70%. The effect of increasing dialysis efficiency magnified urea rebound and the error in URR determinations. Several formulas have been developed to calculate URR considering the urea rebound (URRr). Smye and coworkers have proposed a method whereby the equilibrated blood urea nitrogen is predicted by additional intradialytic urea sample. Maduell and colleagues, based on analysis of postdialysis urea rebound, have proposed a method whereby the urea rebound is predicted. To compare measured URRr to estimated by Smye and Maduell formulas, 384 patients were studied, 211 males and 173 females, who received a dialysis session with their habitual parameters. Measurements of plasma urea concentration were obtained at the beginning, 90-100 min following the start of dialysis, at the end, and 45 min after dialysis. The postdialysis urea rebound was 22.4+/-9.7%. The urea kinetic model Kt/V was 1.365+/-0.26, and Kt/Vr was 1.14+/-0.23. URR was 68.7+/-6.6%, and when it was calculated with urea rebound, it decreased to 61.9+/-7.4%. The URRr correlated with calculations by Smye and Maduell formulas: 60.7+/-8.4 (r = 0.722, p < 0.001) and 61.8+/-6.6 (r = 0.933, p < 0.001), respectively. The precision of estimated limits of agreement and percentage of error by Bland and Altman analysis show that URRr estimated Maduell formula could be used in place of the URRr. Otherwise, the degree of agreement of the Smye method was not clinically acceptable. In conclusion, our results led us to suggest that in actual dialysis, the use of URR is not adequate for delivered hemodialysis dose, and URRr should be used. URRr estimated by Maduell formula could be a simple and accurate method for use in clinical practice. The recommended dialysis dose by the American National Study of URR of 70% could correspond, considering urea rebound, to Kt/Vr 1.18 or URRr of 64%.

Both dermal matrix and epidermis contribute to an inhibition of wound contraction

Contracture is a major detriment to functional recovery from large wounds. To determine the relative value of dermal replacement and epidermal coverage in inhibiting wound contraction, five full-thickness wounds (all 5 x 5 cm2) were placed on the back of 8 swine and treated in the following manner: (1) open wound, (2) porcine acellular dermis (analogous to AlloDerm for human use), (3) porcine acellular dermis with epidermal autograft placed 7 days postwounding, (4) porcine acellular dermis with immediate epidermal autograft, and (5) conventional-thickness autograft. Scar dimensions and punch biopsies were taken at days 14 and 30 postwounding. The planimetry results demonstrated that wound contraction was significantly greater with the open wounds (group 1) than all other wounds with a dermal substitute. Furthermore, wounds with initial epidermal coverage had significantly less contraction than unepithelialized wounds (14.8 +/- 1.1 cm2 at day 14 in wound group 2 vs. 20.4 +/- 0.6 cm2 in wound group 4; p < 0.05). Biopsy results revealed that wounds with initial epithelial coverage had the least amount of inflammation. These findings suggest that both dermal matrix and epidermal coverage contribute to an inhibition of wound contraction and that prompt epithelial coverage appears to impede contraction by reducing inflammation.

Evaluation of peri- and post-natal toxicity of Policosanol in rats

The effects of Policosanol, a newly developmented hypocholesterolemic drug administered during the perinatal and postnatal periods, were studied in Sprague-Dawley rats. This compound was administered orally to female rats at dose levels of 0 (control), 5, 50, and 500 mg/kg/day, from day 15 of pregnancy to day 21 after parturition. The animals were allowed to deliver and their offspring were examined for postnatal growth and development. No signs of toxic effects related to the test material were observed in the dams F0 during pregnancy and lactation. No adverse effects were observed on the postnatal growth, behaviours, or reproductive ability of pups F1. The physical and sensorial development of pups F2 was also normal. These results confirm that Policosanol does not affect the reproductive performance or fetal/neonatal development.

Primary cardiac lymphoma diagnosed by percutaneous intracardiac biopsy with combined fluoroscopic and transesophageal echocardiographic imaging

Primary cardiac tumors have very low prevalence with cardiac lymphoma, being one of the rarest forms. Several recent reports have shown transesophageal echocardiography to be an accurate technique for characterizing and localizing these neoplasms, with results comparable to CT and MRI scans. Transvenous intracardiac tumor biopsy has been employed as a minimally invasive technique to obtain tissue samples. The addition of transesophageal echocardiographic (TEE) guidance to this process has increased the accuracy of obtaining diagnostic specimens while improving patient safety. We review published cases of this relatively new technique using combined fluoroscopic and TEE guidance and present a case of primary cardiac lymphoma diagnosed by this method. The patient achieved complete tumor remission after treatment with standard chemotherapy and remains fully functional 32 months after initial diagnosis.

Meteorological factors affecting daily urticaceae pollen counts in southwest Spain

The influence of meteorological factors on daily Urticaceae pollen counts were studied in Córdoba (southwest Spain) in 1996 and 1997. The daily Urticaceae pollen concentrations were obtained by using a Hirst-type volumetric sampler, and meteorological data were obtained from the Córdoba airport, located near the sampling site. The highest correlation between pollen concentration and meteorological parameters was obtained during non-rainy seasons. Temperature was found to be the most important meteorological parameter influencing pollen counts in spring, as temperature is the main reason for the increase of pollen concentration in the atmosphere. In autumn, humidity was another important parameter influencing pollen counts. Rain, however, did not appear to be significant. The influence of the pollen concentration of the 2 previous days and the pollen concentration of the previous day has been studied. During periods with low precipitation, the pollen concentration of the previous day was a useful predictor of Urticaceae pollen concentrations for the following day.