Dynamics and Power Balance of Near Unity Target Gain Inertial Confinement Fusion Implosions

The change in the power balance, temporal dynamics, emission weighted size, temperature, mass, and areal density of inertially confined fusion plasmas have been quantified for experiments that reach target gains up to 0.72. It is observed that as the target gain rises, increased rates of self-heating initially overcome expansion power losses. This leads to reacting plasmas that reach peak fusion production at later times with increased size, temperature, mass and with lower emission weighted areal densities. Analytic models are consistent with the observations and inferences for how these quantities evolve as the rate of fusion self-heating, fusion yield, and target gain increase. At peak fusion production, it is found that as temperatures and target gains rise, the expansion power loss increases to a near constant ratio of the fusion self-heating power. This is consistent with models that indicate that the expansion losses dominate the dynamics in this regime.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Natural history of subaortic stenosis in 166 dogs (1999-2011)

INTRODUCTION

Subaortic stenosis (SAS) is one of the most common congenital cardiac diseases in dogs. The objective of this study was to provide survival times on a large population of dogs with SAS and to propose a redefined pressure gradient (PG) scale to include a mild, moderate, severe and very severe disease group.

ANIMALS, MATERIALS AND METHODS

Dogs were divided into four groups based on the Doppler-derived PG across the stenosis. Disease severity was defined as follows: mild = PG < 50 mmHg; moderate = PG range 50-80 mmHg; severe = PG range 80-130 mmHg; and very severe = PG > 130 mmHg. Over the study period (1999-2011), 166 client-owned dogs were diagnosed with SAS of which 129 had follow-up information available.

RESULTS

Unadjusted median survival time for severity groups were as follows: mild 10.6 years; moderate 9.9 years; severe 7.3 years; and very severe 3.0 years. Univariable analysis examining the effect of the PG, age at diagnosis and sex found only the PG and age at diagnosis had a significant effect on survival. Adjusted survival curves showed that the survival time in the very severe group was decreased compared with all other groups.

CONCLUSION

Based on the results of this study, a revised SAS classification system with four PG groups is appropriate. Dogs with a PG > 130 mmHg were identified as those with the lowest median survival time.

The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study

OBJECTIVES

To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD).

ANIMALS

One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio ≥1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter ≥1.7 were included.

METHODS

Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated.

RESULTS

Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9-5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3-11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3-6.7), and NT-proBNP > 1500 ρmol/L (HR: 5.7; 95% CI: 3.3-9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak.

CONCLUSIONS

Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.

Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017)

OBJECTIVES

To describe a group of dogs with benign ureteral obstruction(s) treated by subcutaneous ureteral bypass and report the intra-operative, peri-operative, short- and long-term outcomes.

MATERIALS AND METHODS

Review of medical records of dogs that underwent subcutaneous ureteral bypass.

RESULTS

Nine dogs (12 renal units) were included. Causes of obstruction included: ureterolithiasis (n=9) extraluminal compression (n=2), and stricture (n=1). Eleven of 12 ureters had a previously placed stent and required subcutaneous ureteral bypass for: recurrent stricture (n=4), diffuse ureteritis (n=4) or stent migration (n=3). Placement was successful in all renal units and there were no peri-operative or procedure-related deaths. Median hospitalisation time was 3 days. The median creatinine values pre-operatively and 3 month post-operatively were 186 and 106 μmol/L, respectively. No dog had worsening azotaemia in the short-term. The most common long-term complication was mineralisation of six devices, of which four required exchange. All dogs that were infected post-operatively (n=5) had a history of at least one urinary tract infection pre-operatively. One of the nine dogs had a chronic post-operative urinary tract infection and had been chronically infected before placing the bypass. The median survival time was >774 days, with five of nine dogs alive at the time of publication.

CLINICAL SIGNIFICANCE

Placement of a subcutaneous ureteral bypass was an effective short-term treatment option for benign ureteral obstructions in dogs but there was a high rate of device mineralisation.

DELay of Appearance of sYmptoms of Canine Degenerative Mitral Valve Disease Treated with Spironolactone and Benazepril: the DELAY Study

INTRODUCTION

Efficacy of renin-angiotensin-aldosterone system (RAAS) blockade using angiotensin-converting enzyme inhibitors (ACEi) in dogs with preclinical myxomatous mitral valve disease (MMVD) is controversial.

HYPOTHESIS

Administration of spironolactone (2-4 mg q 24 h) and benazepril (0.25-0.5 mg q 24 h) in dogs with preclinical MMVD, not receiving any other cardiac medications, delays the onset of heart failure (HF) and cardiac-related death. Moreover, it reduces the progression of the disease as indicated by echocardiographic parameters and level of cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI).

ANIMALS

184 dogs with pre-clinical MMVD and left atrium-to-aortic root ratio (LA:Ao) ≥1.6 and normalized left ventricular end-diastolic diameter (LVEDDn) ≥1.7.

METHODS

This is a prospective, randomized, multicenter, single-blinded, placebo-controlled study. Primary outcome variable was time-to-onset of first occurrence of HF or cardiac death. Secondary end points included effect of treatment on progression of the disease based on echocardiographic and radiographic parameters, as well as variations of NT-proBNP and cTnI concentrations.

RESULTS

The median time to primary end point was 902 days (95% confidence interval (CI) 682-not available) for the treatment group and 1139 days (95% CI 732-NA) for the control group (p = 0.45). Vertebral heart score (p = 0.05), LA:Ao (p < 0.001), LVEDDn (p < 0.001), trans-mitral E peak velocity (p = 0.011), and NT-proBNP (p = 0.037) were lower at the end of study in the treatment group.

CONCLUSIONS

This study failed in demonstrating that combined administration of spironolactone and benazepril delays onset of HF in dogs with preclinical MMVD. However, such treatment induces beneficial effects on cardiac remodeling and these results could be of clinical relevance.

Pilot feasibility randomized clinical trial of negative-pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention

Background

Surgical wounds healing by secondary intention (SWHSI) are increasingly being treated with negative-pressure wound therapy (NPWT) despite a lack of high-quality research evidence regarding its clinical and cost-effectiveness. This pilot feasibility RCT aimed to assess the methods for and feasibility of conducting a future definitive RCT of NPWT for the treatment of SWHSI.

Methods

Eligible consenting adult patients receiving care at the study sites (2 acute and 1 community) and with a SWHSI appropriate for NPWT or wound dressing treatment were randomized 1 : 1 centrally to receive NPWT or usual care (no NPWT). Participants were followed up every 1-2 weeks for 3 months. Feasibility (recruitment rate, time to intervention delivery) and clinical (time to wound healing) outcomes were assessed.

Results

A total of 248 participants were screened for eligibility; 40 (16·1 per cent) were randomized, 19 to NPWT and 21 to usual care. Twenty-four of the 40 wounds were located on the foot. Participants received NPWT for a median of 18 (range 0-72) days. Two participants in the NPWT group never received the intervention and 14 received NPWT within 48 h of randomization. Five participants in the usual care group received NPWT during the study. Ten of the 40 wounds were deemed to have healed during the study.

Conclusion

A full-scale RCT to investigate the clinical and cost-effectiveness of NPWT for SWHSI is feasible. This study identified crucial information on recruitment rates and data collection methods to consider during the design of a definitive RCT. Registration number: ISRCTN12761776 (http://www.iscrtn.com).

Investigation of iron status and markers of inflammation in anaemic and non-anaemic hospitalised cats

OBJECTIVES

To measure iron parameters and markers of inflammation in anaemic cats presented for intensive care unit hospitalisation, and to compare these to cohorts of non-anaemic hospitalised cats and cats that develop hospital-acquired anaemia.

METHODS

Blood samples were collected for measurement of iron panel and serum amyloid A in addition to routine investigation in cats admitted to the intensive care unit. Medical records were reviewed to determine how many of the Systemic Inflammatory Response Syndrome criteria were met and to assign Acute Patient Physiologic and Laboratory Evaluation scores as a measure of illness severity.

RESULTS

Seventy-eight cats were enrolled. Anaemia was documented in 34·6% of cats on presentation and another 10·3% developed anaemia during hospitalisation. Compared with non-anaemic cats, animals that were anaemic on presentation had higher neutrophil and white blood cell counts, and longer hospitalisation. Iron status was consistent with anaemia of inflammation in most anaemic patients. Iron status, serum amyloid A concentration, and prevalence of systemic inflammatory response syndrome did not differ between anaemic and non-anaemic cohorts. All cause mortality was higher in anaemic cats.

CLINICAL SIGNIFICANCE

Anaemia is common in cats hospitalised in the intensive care unit. Systemic inflammation is also common in these cats. Iron status in anaemic cats suggests that anaemia of inflammatory disease may be a significant contributor to anaemia in this patient population.

Prevalence and prognostic importance of pulmonary hypertension in dogs with myxomatous mitral valve disease

Background

Pulmonary hypertension (PH) is common in dogs with myxomatous mitral valve disease (MMVD) but its effect on clinical outcome has not been investigated.

Hypothesis/objectives

The presence of PH worsens the outcome in dogs with MMVD. To compare survival times of dogs with MMVD and PH to those without PH.

Animals

Two hundred and twelve client‐owned dogs.

Methods

Case review study. Medical records of dogs diagnosed with ACVIM stage B2 and C MMVD between January 2010 and December 2011 were retrospectively reviewed. Long‐term outcome was determined by telephone interview or from the medical record. End of the observation period was March 2013. PH was identified if tricuspid regurgitation peak velocity was >3 m/s.

Results

Two hundred and twelve were identified. Eighty‐three dogs (39%) had PH. PH was more commonly identified in stage C compared to B2 (P < .0001). One hundred and five (49.5%) dogs died during the observation period. Median survival time for the entire study population was 567 days (95% CI 512–743). Stage C (P = .003), the presence of PH (P = .009), left atrial to aortic root ratio (LA/Ao) >1.7 (P = .0002), normalized left‐ventricular end‐diastolic diameter (LVEDn) >1.73 (P = .048), and tricuspid regurgitation pressure gradient (TRPG) >55 mmHg (P = .009) were associated with worse outcomes in the univariate analyses. The presence of TRPG >55 mmHg (HR 1.8 95% CI 1–2.9; P = .05) and LA/Ao > 1.7 (HR 2 95% CI 1.2–3.4; P = .01) remained significant predictors of worse outcome in the multivariate analysis.

Conclusions and Clinical Importance

In dogs with MMVD, moderate to severe PH worsens outcome.

Relationship of plasma N-terminal pro-brain natriuretic peptide concentrations to heart failure classification and cause of respiratory distress in dogs using a 2nd generation ELISA assay

Background

Cardiac biomarkers provide objective data that augments clinical assessment of heart disease (HD).

Hypothesis/Objectives

Determine the utility of plasma N‐terminal pro‐brain natriuretic peptide concentration [NT‐proBNP] measured by a 2nd generation canine ELISA assay to discriminate cardiac from noncardiac respiratory distress and evaluate HD severity.

Animals

Client‐owned dogs (n = 291).

Methods

Multicenter, cross‐sectional, prospective investigation. Medical history, physical examination, echocardiography, and thoracic radiography classified 113 asymptomatic dogs (group 1, n = 39 without HD; group 2, n = 74 with HD), and 178 with respiratory distress (group 3, n = 104 respiratory disease, either with or without concurrent HD; group 4, n = 74 with congestive heart failure [CHF]). HD severity was graded using International Small Animal Cardiac Health Council (ISACHC) and ACVIM Consensus (ACVIM‐HD) schemes without knowledge of [NT‐proBNP] results. Receiver‐operating characteristic curve analysis assessed the capacity of [NT‐proBNP] to discriminate between dogs with cardiac and noncardiac respiratory distress. Multivariate general linear models containing key clinical variables tested associations between [NT‐proBNP] and HD severity.

Results

Plasma [NT‐proBNP] (median; IQR) was higher in CHF dogs (5,110; 2,769–8,466 pmol/L) compared to those with noncardiac respiratory distress (1,287; 672–2,704 pmol/L; P < .0001). A cut‐off >2,447 pmol/L discriminated CHF from noncardiac respiratory distress (81.1% sensitivity; 73.1% specificity; area under curve, 0.84). A multivariate model comprising left atrial to aortic ratio, heart rate, left ventricular diameter, end‐systole, and ACVIM‐HD scheme most accurately associated average plasma [NT‐proBNP] with HD severity.

Conclusions and Clinical Importance

Plasma [NT‐proBNP] was useful for discriminating CHF from noncardiac respiratory distress. Average plasma [NT‐BNP] increased significantly as a function of HD severity using the ACVIM‐HD classification scheme.

Influence of beta blockers on survival in dogs with severe subaortic stenosis

Background

Subaortic stenosis (SAS) is one of the most common congenital cardiac defects in dogs. Severe SAS frequently is treated with a beta adrenergic receptor blocker (beta blocker), but this approach largely is empirical.

Objective

To determine the influence of beta blocker treatment on survival time in dogs with severe SAS.

Methods

Retrospective review of medical records of dogs diagnosed with severe, uncomplicated SAS (pressure gradient [PG] ≥80 mmHg) between 1999 and 2011.

Results

Fifty dogs met the inclusion criteria. Twenty‐seven dogs were treated with a beta blocker and 23 received no treatment. Median age at diagnosis was significantly greater in the untreated group (1.2 versus 0.6 years, respectively; P = .03). Median PG at diagnosis did not differ between the treated and untreated groups (127 versus 121 mmHg, respectively; P = .2). Cox proportional hazards regression was used to identify the influence of PG at diagnosis, age at diagnosis, and beta blocker treatment on survival. In the all‐cause multivariate mortality analysis, only age at diagnosis (P = .02) and PG at diagnosis (P = .03) affected survival time. In the cardiac mortality analysis, only PG influenced survival time (P = .03). Treatment with a beta blocker did not influence survival time in either the all‐cause (P = .93) or cardiac‐cause (P = .97) mortality analyses.

Conclusions

Beta blocker treatment did not influence survival in dogs with severe SAS in our study, and a higher PG at diagnosis was associated with increased risk of death.

Kidney, pancreas and liver allocation and distribution in the United States

Kidney transplant and liver transplant are the treatments of choice for patients with end-stage renal disease and end-stage liver disease, respectively. Pancreas transplant is most commonly performed along with kidney transplant in diabetic end-stage renal disease patients. Despite a steady increase in the numbers of kidney and liver transplants performed each year in the United States, a significant shortage of kidneys and livers available for transplant remains. Organ allocation is the process the Organ Procurement and Transplantation Network (OPTN) uses to determine which candidates are offered which deceased donor organs. OPTN is charged with ensuring the effectiveness, efficiency and equity of organ sharing in the national system of organ allocation. The policy has changed incrementally over time in efforts to optimize allocation to meet these often competing goals. This review describes the history, current status and future direction of policies regarding the allocation of abdominal organs for transplant, namely the kidney, liver and pancreas, in the United States.

Successful management of bleeding complications in patients supported with extracorporeal membrane oxygenation with primary respiratory failure

Background:

Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure in patients with severe respiratory insufficiency failing conventional support. Bleeding complications are common due to the necessity for anticoagulation and circuit-related factors.

Methods:

A retrospective review was conducted in patients requiring ECMO for respiratory failure from 7/2010 to 6/2011 to identify episodes of major bleeding, bleeding management and outcomes.

Results:

Twenty-one patients were supported with ECMO during the study although five experienced massive bleeding related to chest tube insertion, jejunal arterio-venous malformations, distal perfusion cannula dislodgement and ventricular rupture. Patients required aggressive resuscitation or endoscopic or operative intervention, totaling 28 procedures. There were no instances of dehiscence, infection or sepsis related to interventions. Anticoagulation was stopped six hours before and restarted 24 hours after major interventions, with no thrombotic or neurologic complications. All patients weaned off ECMO were discharged.

Conclusions:

ECMO bleeding complications can be managed successfully via surgical and endoscopic approaches in this high-risk population.

Acute azotemia as a predictor of mortality in dogs and cats

BACKGROUND

Acute kidney injury (AKI) has been shown to be a predictor of mortality in human medicine. Published studies in the veterinary literature evaluating relative changes in serum creatinine concentration as a prognostic factor are limited.

OBJECTIVE

To evaluate an AKI grading system based on serum creatinine concentration to determine if it correlates with outcome prediction in dogs and cats.

ANIMALS

Six hundred forty-five dogs and 209 cats that had at least 2 serum creatinine concentration measurements measured within 7 days.

METHODS

Retrospective study. Dogs and cats with an initial serum creatinine concentrations of ≤ 1.6 mg/dL and that had more than 1 concentration measured within 2, 3, and 7 days were placed into levels (0-2) based on absolute changes. Mortality then was determined at 30 and 90 days.

RESULTS

Based on odds ratios calculated with a 95% confidence interval, dogs placed in level 1 within 2 days were approximately 3 times more likely to die within 90 days. Dogs placed in level 2 within 2, 3, or 7 days were approximately 3 times more likely to die within 30 or 90 days. Cats placed in level 2 within 3 or 7 days were approximately 3 times more likely to die at 30 days and 4 times more likely to die if placed in this level within 7 days. If placed in level 2 within 2 or 3 days, cats were approximately 3 times more likely to die within 90 days.

CONCLUSIONS AND CLINICAL IMPORTANCE

Detecting increasing severity of azotemia helps predict mortality in dogs and cats.

Survival characteristics and prognostic variables of dogs with preclinical chronic degenerative mitral valve disease attributable to myxomatous degeneration

BACKGROUND

Preclinical myxomatous mitral valve degeneration (MMVD) includes a heterogeneous group of dogs. Therefore, identifying risk factors for progression of the disease is of clinical importance.

OBJECTIVES

To investigate survival time and risk factors for clinical and echocardiographic variables taken at initial examination for clinical progression in preclinical MMVD dogs.

ANIMALS

A total of 256 dogs with stage B1 or B2 MMVD.

MATERIALS AND METHODS

Medical records of 256 dogs with preclinical MMVD were reviewed retrospectively. Long-term outcome was assessed by telephone interview. Dogs alive at the time of phone interview were asked to return to the hospital for re-evaluation of their cardiac status.

RESULTS

Seventy of 256 (27.3%) dogs died during the observation period. The median survival time, regardless of cause of death, was 588 (range 75-1,668) days. The presence of a murmur was associated with an increased risk of death (AHR 2.14; 95% CI 1.12, 4.11; P = 0.022). Thirty (12%) deaths were considered cardiac related. LA/Ao > 1.4 was the only negative predictor (AHR 2.64; 1.13, 6.13; P = 0.024) for cardiac-related deaths. Eighty-three dogs were re-examined, of which 34 progressed to a more advanced stage of MMVD. The presence of Emax > 1.2 (AHR 2.75; 95% CI 1.01, 7.48; P = 0.047) and cough (AHR 7.89; 95% CI 3.18, 20.07; P < 0.001) were significant in the multivariate analysis.

CONCLUSIONS AND CLINICAL IMPORTANCE

Preclinical MMVD represents a relatively benign condition in dogs. Clinicians might find stratification of this dog population according to risk factors based on clinical and echocardiographic findings helpful in determining treatment.

Association of increased telomere lengths in limited scleroderma, with a lack of age-related telomere erosion

OBJECTIVES

Telomere erosion, a feature of biological ageing, is implicated in a wide range of diseases. Its impact on autoimmune diseases remains unclear although autoantibodies against many telomere nucleoprotein components are prevalent in these diseases. We aimed to assess if telomere biology was abnormal in a cohort of patients with limited cutaneous systemic sclerosis (lcSSc).

METHODS

Telomere lengths in peripheral blood leucocytes (PBL) were determined using Southern blotting methods in a cohort of lcSSc subjects (n=43; age range 37-80 years) and a control population (n=107; age range 21-65 years).

RESULTS

Telomere lengths in lcSSc subjects were longer than controls (p<0.001), did not show age-related telomere erosion and differed significantly from age-matched controls only after 50 years of age (p<0.001).

CONCLUSIONS

This is the first report of maintenance of telomere lengths in an autoimmune disease state. These data indicate aberrant telomere biology and irregular biological ageing from the fifth decade of life. These findings provide insight into compromised DNA damage repair in lcSSc. Whether these observations indicate a causal or consequential relationship requires further investigation. This in turn, may provide potential novel targets for therapeutic intervention.

Telomere attrition is associated with inflammation, low fetuin-A levels and high mortality in prevalent haemodialysis patients

INTRODUCTION

Chronic kidney disease (CKD) predisposes to a 10- to 20-fold increased cardiovascular risk. Patients undergo accelerated atherogenesis and vascular ageing. We investigated whether telomere attrition, a marker of cell senescence, contributes to this increased mortality risk.

METHODS

This is a cross-sectional study in prevalent haemodialysis patients [n = 175; 98 Males; median (range) age: 66 (23-86) years]. Biochemical markers of oxidative stress and inflammatory status were measured in relation to the patient's leucocyte telomere length. Overall mortality was assessed after a median of 31 (range 2-42) months.

RESULTS

Telomere length was shorter in CKD men, despite women being older (average +/- SD 6.41 +/- 1.23 vs. 6.96 +/- 1.48 kb, P = 0.002). Telomere length was associated with age (rho = -0.18, P = 0.01), fetuin-A (rho = 0.26, P = 0.0004), high-sensitivity C-reactive protein (rho = -0.21, P = 0.005) and IL-6 (rho = -0.17, P = 0.02). In a multivariate logistic regression (pseudo r(2) = 0.14), telomere length was associated with age >65 years (odds ratio: 2.11; 95% CI: 1.10, 4.06), sex (2.01; 1.05, 3.86), fetuin-A (1.85; 0.97, 3.50) and white blood cell count (2.04; 1.02, 4.09). Receiver operating characteristic curves identified a telomere length < 6.28 kb as a fair predictor of mortality. Finally, reduced telomere length was associated with increased mortality, independently of age, gender and inflammation (likelihood ratio 41.6, P < 0.0001), but dependently on fetuin-A levels.

CONCLUSION

Age and male gender seem to be important contributors to reduced telomere length in CKD patients, possibly via persistent inflammation. Reduced telomere length also contributes to the mortality risk of these patients through pathways that could involve circulating levels of fetuin-A.

Luminal stimuli acutely sensitize visceromotor responses to distension of the rat stomach

Inflammation can enhance responses to different stimuli consistent with the development of hypersensitivity. To determine whether sequentially applied stimuli interact, we determined visceromotor responses (VMR) to gastric distension, measured at baseline and 60 min after instillation of saline, glycocholic acid (GCA) or ethanol through a gastrostomy in controls and rats with gastric ulcers. In another series of experiments, chemicals were administered before and 60 min after repeated distension of the stomach. Ethanol, but not saline or GCA, increased VMR in controls with a more significant rise in rats with gastric ulcerations. GCA increased responses to gastric distension in controls, whereas GCA and ethanol enhanced responses to gastric distensions in rats with gastric ulcers. Responses to saline, GCA, or ethanol were not affected by repeated noxious distension of the stomach. Luminal stimuli can trigger visceromotor responses and sensitize gastric afferents to mechanical stimulation, thus potentially contributing to dyspeptic symptoms.

The use of telomere biology to identify and develop superior nitrone based anti-oxidants

We have employed a biological chemistry approach to dissect the mechanisms underpinning cellular responses to oxidant stress and to develop biologically relevant anti-oxidants. We have used telomere biology to define cellular stress responses and have observed telomere independent, p21- and p16-dependent stasis following oxidative insult in human fibroblasts. This was accompanied by a [corrected] reduction in XRCC5 expression and a reduction in [corrected] SIRT 1 expression. Using these markers in conjunction with senescence-associated beta-galactosidase expression, we have developed and screened novel nitrone based anti-oxidant compounds. We have identified functional compounds that are unsuitable for use in primary human cells. This has allowed subsequent identification of suitably structured compounds that act as superior biological anti-oxidants, which have potential for use in clinical interventions.

Experimentally induced ulcers and gastric sensory-motor function in rats

Prior studies have demonstrated that inflammation can sensitize visceral afferent neurons, contributing to the development of hyperalgesia. We hypothesized that both afferent and efferent pathways are affected, resulting in changes in motor and sensory function. Kissing ulcers (KU) were induced in the distal stomach by injecting 60% acetic acid for 45 s into a clamped area of the stomach. In controls, saline was injected into the stomach. A balloon catheter was surgically placed into the stomach, and electromyographic responses to gastric distension were recorded from the acromiotrapezius muscle at various times after ulcer induction. The accommodation reflex was assessed by slowly infusing saline into the distally occluded stomach. Gastric pressure changes in response to vagal stimulation were measured in anesthetized rats. Contractile function of circular muscle strips was examined in vitro using force-displacement transducers. KU caused gastric hypersensitivity that persisted for at least 14 days. Fluid distension of the stomach led to a rapid pressure increase in KU but not in control animals, consistent with an impaired accommodation reflex. Gastric ulcers enhanced the contractile response to vagal stimulation, whereas the effect of cholinergic stimulation on smooth muscle in vitro was not changed. These data suggest that inflammation directly alters gastric sensory and motor function. Increased activation of afferents will trigger vagovagal reflexes, thereby further changing motility and indirectly activating sensory neurons. Thus afferent and efferent pathways both contribute to the development of dyspeptic symptoms.

Gastric ulcers evoke hyperexcitability and enhance P2X receptor function in rat gastric sensory neurons

Tissue inflammation contributes to the development of hyperalgesia, which is at least in part due to altered properties of primary afferent neurons. We hypothesized that gastric ulcers enhance the excitability of gastric sensory neurons and increase their response to purinergic agonists. The rat stomach was surgically exposed, and a retrograde tracer [1.1'-dioctadecyl-3,3,3,'3-tetramethylindocarbocyanine methanesulfonate (DiI)] was injected into the wall of the distal stomach. Kissing ulcers (KUs) were produced by a single injection of acetic acid (0.1 ml for 45 s; 60%) into the clamped gastric lumen. Saline injection served as control. Gastric nodose ganglion (NG) or dorsal root ganglion (DRG) cells were harvested 7 days later and acutely dissociated for whole cell recordings. Based on whole cell capacitance, gastric DRG neurons exhibited larger cell size than NG neurons. Significantly more control gastric DRG neurons compared with NG counterparts had TTX-resistant action potentials. Almost all control NG neurons (90%) compared with significantly less DRG neurons (< or =38%) responded to ATP or alpha,beta-metATP. Whereas none of the control cells exhibited spontaneous activity, about 20% of the neurons from KU animals generated spontaneous action potentials. KUs enhanced excitability as shown by a decrease in threshold for action potential generation, which was in part due to an increased input resistance. This was associated with an increase in the fraction of neurons with TTX-resistant action potentials and cells responding to capsaicin and purinergic agonists. KU doubled the current density evoked by the P2X receptor agonist alpha,beta-metATP and slowed decay of the slowly desensitizing component of the current without affecting the concentration dependence of the response. These data show that KU sensitizes vagal and spinal gastric afferents by affecting both voltage- and ligand-gated channels, thereby potentially contributing to the development of dyspeptic symptoms.

Increased nerve growth factor expression triggers bladder overactivity

Prior studies have demonstrated an association between visceral inflammation, an increase in nerve growth factor (NGF) expression, and development of hyperalgesia. Because multiple mediators are released during inflammatory processes, we examined the effect of NGF alone using viral gene transfer in vivo. Replication-deficient adenoviral vectors encoding for NGF or beta-galactosidase were injected into the bladder wall. NGF levels were determined with an enzyme-linked immunoabsorbance assay. Cystometrograms were obtained 3 and 5 days after gene transfer by using a surgically implanted bladder catheter in awake male rats. Although the treatment with a control virus did not change NGF levels compared with those of naive animals, the vector encoding for NGF increased NGF protein levels in the bladder 4-fold. Histologically, no evidence of inflammation was noted. Expression of NGF led to bladder overactivity, whereas beta-galactosidase expression was without effect. These data demonstrate that a transient increase in NGF expression without associated inflammation sensitizes visceral reflex pathways, leading to bladder overactivity. Treatment strategies targeting NGF signaling might be useful in disorders involving sensitization of peripheral nerves.

PERSPECTIVE

Growth factors have been implicated in the pathogenesis of inflammatory pain. This study uses gene transfer to demonstrate that NGF sensitizes afferent pathways in the absence of inflammation, making it a potentially relevant treatment target.

Nerve growth factor and gastric hyperalgesia in the rat

We recently demonstrated an association between the development of hyperalgesia and an increase in nerve growth factor (NGF) during gastric inflammation. We hypothesized that block of NGF signalling will blunt injury-induced hyperalgesia. Male Sprague-Dawley rats (300-400 g) were anaesthetized, the stomach was exposed and placed in a circular clamp. Acetic acid (60%) or saline (control) was injected into this area and aspirated 45 s later, resulting in kissing ulcers. A balloon was surgically placed into the stomach and electromyographic responses to gastric distension (GD) were recorded from the acromiotrapezius muscle. Animals received a daily injection of neutralizing NGF antibody or control serum for 5 days. NGF in the stomach wall was measured with an ELISA. The severity of gastric injury was assessed macroscopically and by determination of myeloperoxidase (MPO) activity. Gastric injury enhanced the visceromotor response to GD and increased NGF content. Anti-NGF significantly blunted the development of hyperalgesia and led to a decrease in gastric wall thickness and MPO activity. Increases in NGF contribute to the development of hyperalgesia after gastric injury. This may be partly mediated by direct effects on afferent nerves and indirectly by modulatory effects on the inflammatory response.

The Sustainable Grazing Systems Program: new solutions for livestock producers

The Sustainable Grazing Systems (SGS) Program was established in 1996 to address the issues of declining pasture productivity and sustainability in the high rainfall zone (>600 mm/year) of southern Australia. The program goal was that 'by June 2001, at least 2000 producers in the high rainfall zone will have adopted changes to their grazing systems that can be shown to be at least 10% more profitable, and more sustainable, than those used prior to participating in SGS. A further 5000 producers will have trialed at least part of the recommended changes'. There were 4 interacting activities within SGS, collectively focused on delivering this goal. These were: (i)�a National Experiment to develop the principles and quantify the relationships; (ii) a regional producer network to determine and deliver on local producer priorities; (iii) training and skills development courses; and (iv) integration and management to ensure the goal was met in an efficient and effective manner. Producer input and ownership were considered essential and were built in at all levels of program activity and management. Independent surveys confirmed that SGS assisted large numbers of producers to make substantial change in farm practices. SGS met its goal by developing and delivering knowledge about more profitable and sustainable grazing systems to a network of almost 10 000 livestock producers across southern Australia. Critical elements of SGS included research, skills training and support for producer groups, on-farm trials and demonstrations, and farm-walks for producers to share information and experiences. A 'triple bottom line' approach was adopted to assess and report on the impacts of the program on the financial, social and environmental capital of the grazing industries in the high rainfall zone. In keeping with the triple bottom line approach, this special edition contains papers that report on biophysical, economic, environmental and social aspects of the program.

Thoracic disk herniation: a case report

OBJECTIVE

Thoracic disk herniations are relatively rare events that often mimic other, more serious disorders. This article discusses the case of a patient with thoracic disk herniation who required unusual treatment to aid resolution of her condition.

CLINICAL FEATURES

The patient, who had a complicated history of prior lumbar disk surgery, sustained a fall onto her buttocks and developed low back and bilateral leg pain. Initial suspicion was of reinjury of the L5 disk.

INTERVENTION AND OUTCOME

Light force spinal manipulation, physical therapies, and eventual cosmetic surgery were able to resolve the condition successfully.

CONCLUSIONS

A clinical situation often may require thinking "outside the box" in order for the patient's condition to be resolved. The failure of symptoms to correspond to the suspected condition should increase the suspicion that another problem may be present.

Viability and functional activity of cryopreserved mononuclear cells

Factors that influence viability and function of cryopreserved peripheral blood mononuclear cells (PBMC) were identified on 54 samples from 27 AIDS Clinical Trial Units. PBMC viability ranged from 1 to 96% with a median of 70%, was higher in laboratories with experienced staff, and was not significantly associated with CD4 cell number. Function of cryopreserved PBMC, measured by lymphocyte proliferation, was associated with viability. Preparations with viability greater than or equal to 70% had consistent proliferative responses and were suitable for functional analyses.

A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care

PURPOSE

The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children.

METHOD

Records of more than 600 patients sedated at Columbus Children's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber, dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics.

RESULTS

The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F = 20.3, P < 0.001; 16.2, P < 0.001; and 48.7, P < 0.001, respectively). ANOVA indicated a significant difference among drug regimens for percent of quiet, sleeping, and struggling behaviors. Quiet behavior accounted for 26%, 41%, and 67% of all behaviors for CH-H, CH-D-H, and M, respectively. Sleep accounted for 50%, 43%, 0.4% and struggling 11%, 8%, and 19% for CH-H, CH-D-H, and M, respectively. Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors (R = 0.32, P < 0.001). Significant differences among drug regimens were found for heart rate (HR) and mean arterial blood pressure (MAP) during certain procedures (e.g., CH-H produced lower MAP compared to the other drug regimens); however, all physiological variables were within normal limits for the children.

CONCLUSION

Significant differences were found for behavioral and physiological variables among the drug regimens (e.g., CH-D-H produced significantly more quiet and sleeping behaviors than M). Prospective studies are needed to confirm these findings.

Prevalence and patterns of physical restraint use in the acute care setting

Nurse executives usually have the principal responsibility to respond to the national movement to reduce physical restraint use in hospitals. The results of this three-site, interdisciplinary, prospective incidence study (based on more than 49,000 observations collected on 18 randomly selected days) reveal new patterns in the rationale and types of restraints used. The authors discuss how the results can be used in measuring success and allocating resources for restraint reduction programs.

Binding of transcription factors to widely-separated cis-regulatory elements of the murine FGF-4 gene

Embryonal carcinoma (EC) cells and their embryo-derived counterparts, embryonic stem (ES) cells, have been used extensively to study the transcriptional regulation of the fibroblast growth factor-4 (FGF-4) gene. The FGF-4 gene is expressed in EC cells and ES cells, but it is repressed in their retinoic acid (RA)-induced differentiated counterparts. Previous studies have shown that the transcription of the FGF-4 gene is controlled by cis-regulatory elements located in the 5' flanking region of the gene, and by a powerful enhancer located approximately 3 kb downstream from the transcription start site. In the current study, gel mobility shift analysis was used to examine the binding of nuclear proteins to cis-regulatory elements involved in the transcription of the FGF-4 gene. We demonstrate that the transcription factors Sp1 and Sp3 in nuclear extracts prepared from EC cells bind to three Sp1 motifs, one located in the downstream enhancer, and two located in the 5' flanking region of the gene. We also show that Sp1 and Sp3 bind to each of the Sp1 motifs when nuclear extracts prepared from EC-derived differentiated cells are used. In contrast, differentiation of EC cells and ES cells drastically reduces the ability of nuclear factors to bind to an octamer motif and an adjacent High Mobility Group (HMG) motif, which have been shown previously to play essential roles in the functioning of the FGF-4 enhancer. Together, these findings provide a mechanistic explanation of how the distant FGF-4 enhancer promotes transcription of this gene in EC cells and ES cells, and how differentiation of these cells represses transcription of the FGF-4 gene.

Effects of oxidation and reduction on the binding of transcription factors to cis-regulatory elements located in the FGF-4 gene

Previous studies have shown that the addition of reducing agents to the culture medium of embryonic cell lines stimulates their growth. Moreover, recent studies have shown that the redox state of several transcription factors affects their binding to DNA. In light of these findings, we employed gel mobility shift analysis to examine the effects of oxidation and reduction on the ability of transcription factors to bind cis-regulatory elements located in the FGF-4 gene, which is expressed during early mammalian development. In this study, we demonstrate that both the oxidizing agent diamide and the alkylating agent N-ethylmaleimide inhibit the ability of Oct-1, Oct-3, Sp1, and several Sp1-related nuclear proteins to bind important cis-regulatory elements located in the FGF-4 gene. We also demonstrate that not all transcription factors are affected by oxidation. Specifically, we show that the binding of the transcription factor NF-YA, which binds to a critical CCAAT box, and the binding of a high mobility group (HMG) protein(s), which binds to a critical HMG motif, are not affected by diamide or N-ethylmaleimide. Taken together, our findings and those of others support the hypothesis that the redox state of the cell can regulate gene transcription and, thus, can influence important physiological processes.

Blanket use of intranasal mupirocin for outbreak control and long-term prophylaxis of endemic methicillin-resistant Staphylococcus aureus in an open ward

In December 1992, a thoracic ward in a Melbourne teaching hospital experienced an increase in patients infected with methicillin-resistant Staphylococcus aureus (MRSA). It was decided to attempt to control the outbreak by cohorting positive patients (infected and colonized), as well as nurse cohorting, emphasis on handwashing, and use of intranasal mupirocin initially three times a day for three days, then thrice weekly, for all patients in the ward (with or without MRSA). The campaign comprised for phases of 53, 45, 92 and 365 days, respectively. Patient and nurse cohorting stopped at the end of phase I. In phases I and II, surveillance nose swabs were taken on admission, then twice weekly; in phase III, on admission and weekly and in phase IV, on admission until the end of 1993. In phases I and II (98 days), only one patient acquired MRSA. When the frequency of mupirocin prophylaxis was decreased to once weekly (phase III), two patients acquired MRSA in 92 days (no significant difference): thrice weekly administration resumed (phase IV), during which there were three acquisitions in 365 days. The rates of nose colonization of admissions were 6.4%, 6.3%, 9.7% and 3.1% in phase I-IV, respectively. Only three patients were treated with vancomycin between July 1993 and June 1994 (significantly lower than historical rates, P = 0.0086). No mupirocin resistance was seen in MRSA isolates from this ward during phases I, II and III. In areas of low-level endemic MRSA, the blanket use of thrice-weekly intranasal mupirocin may be effective in decreasing serious infections with MRSA, and does not necessarily elicit mupirocin resistance.

Appearance of nuclear protease activity after embryonal carcinoma cells undergo differentiation

Proteolytic systems are involved via multiple mechanisms in the regulation of gene expression, including tightly controlled metabolism of transcription factors. In this study, we demonstrate that differentiation of mouse embryonal carcinoma cells to parietal endoderm-like cells is accompanied by the appearance of nuclear protease activity. Interestingly, this nuclear-associated protease activity is not observed in the visceral endoderm-like cell line, PSA-5E, or in the differentiated cells derived from both mouse embryonic stem cells and the human embryonal carcinoma cell line NT2/D1. We also determined that this differentiation-associated nuclear protease activity causes proteolysis of a wide range of different transcription factors, including ATF-1, Sp1, NF-YA and B, and octamer-binding proteins Oct-1 and Oct-3. Based on the effects of specific inhibitors, the nuclear protease(s) can be classified as a cysteine protease; however, lack of inhibition by calpastatin and EGTA distinguishes this protease activity from the calpain family of proteases. Given the properties of the differentiation-associated nuclear protease(s), we discuss the possibility that this protease(s) plays a role in the metabolism of transcription factors during the differentiation of specific embryonic cells.

Cryptic promoter activity within the backbone of a plasmid commonly used to prepare promoter/reporter gene constructs

This report demonstrates that the plasmids, pBLCAT2 and pBLCAT3, which are used widely for the preparation of promoter reporter gene constructs, exhibit cryptic promoter activity when expressed in embryonal carcinoma (EC) cells and their differentiated cells. The promoterless plasmid pBLCAT3 is used widely because it has two multiple cloning sites. We demonstrate that the activity of the cryptic promoter present in pBLCAT3 is increased dramatically by an enhancerlike region of the murine k-FGF gene. However, the basal cryptic promoter activity and the enhanced cryptic promoter activity can be silenced effectively by the insertion of three tandemly arranged polyadenylation sequences. To characterize the influence of the cryptic promoter in pBLCAT3, we tested its effects on two promoters. Our findings suggest that the cryptic promoter increases by several fold the expression of the reporter gene in pBLCAT2, which contains the thymidine kinase promoter. In contrast, the cryptic promoter present in pBLCAT3 does not seem to influence the expression of the k-FGF promoter. Last, we observed cryptic promoter activity when pBLCAT3 was expressed transiently in EC-differentiated cells. Together, our findings argue that transcription silencing sequences should be used when examining weak promoters in these plasmids, especially in combination with enhancers.

Nearly quantum-limited timing jitter in a self-mode-locked Ti:sapphire laser

The experimentally measured timing jitter of a self-mode-locked Ti:sapphire laser is compared with the theoretically predicted quantum limit. Timing jitter figures of 150 fs (100-500 Hz) and 80 fs (500-5000 Hz), which approach the quantum limit, have been achieved by use of an improved cavity phase-locking technique.

The laryngeal mask airway for intraocular surgery: effects on intraocular pressure and stress responses

Tracheal intubation, performed routinely during general anaesthesia in patients undergoing intraocular surgery, may have adverse effects on cardiovascular function and intraocular pressure. This study assessed the suitability of the laryngeal mask airway (LMA) as a substitute for tracheal intubation. Intraocular and systemic pressor effects, heart rate changes and catecholamine concentrations were measured in two groups of 10 patients receiving standardized anaesthesia with either a tracheal tube (TT) or a LMA. There were significantly smaller changes in the pressor responses to insertion and in concentrations of catecholamines at critical times in the anaesthetic sequence in the LMA group. Mean (SEM) rate-pressure product was significantly smaller in the LMA group compared with the TT group after both insertion (8276 (730) vs 13307 (1348), P < 0.01) and removal (10152 (595) vs 14137 (1044), P < 0.01) of the airway device. The change in intraocular pressure was significantly less in the LMA group at all time points after airway instrumentation than that in the TT group, with the greatest difference after extubation (-2.3 (2.4) mm Hg vs 14.5 (3.4) mm Hg, P < 0.01).

The association of atopic diseases with endometriosis

Comparisons of the incidence of health-related problems were conducted between women with demonstrable endometriosis (N = 88) and a control group (N = 88). Increased incidence of respondents' reports of allergic manifestations (p less than .005) were found. Directions for further research are suggested.

Endometriosis: a comparison of associated disease histories

We examined a subgroup of 43 women with endometriosis who reported family members affected by the disease. A matched group of female friend-controls (n = 43) was used for comparison, and reports of selected autoimmune diseases, infectious diseases, and allergic manifestations were compared. For this subset of women, there appeared to be a strong familial tendency to allergic manifestations. Vaginal yeast infections, a history of mononucleosis, eczema, hayfever, and food sensitivities were reported to occur much more frequently for these women. All statistical tests on these conditions were significant at the .05 level of probability or less.

Family trait analysis: a case-control study of 43 women with endometriosis and their best friends

Analyses of lineage patterns show that for 43 women with endometriosis who reported that other family members have the disease, the vast majority of these familial cases involve the maternal lineage (79% to 93%). Of these women 34.9% of their mothers and 21.2% of their sisters were affected. With use of these rates, expected rates for first-degree relatives in a general population of women with endometriosis were determined. These rates were 6.2% and 3.8%, respectively; in combination, these rates yield an overall risk of 4.9% for first-degree relatives. Prior studies estimated this overall risk to be 6.9%; however, z scores determined that these rates do not differ statistically. Rates for second-degree maternal relatives are reported for grandmothers and aunts (0.4% compared to 3.1%, respectively), thus expanding results of former studies. In combination, an overall risk of 1.9% is estimated for second-degree relatives, as measured.