Crop productivity estimation by integrating multisensor satellite, in situ, and eddy covariance data into efficiency-based model

Accurate and quantitative regional estimates of the carbon budget require an integration of eddy covariance (EC) flux-tower observations and remote sensing in ecosystem models. In this study, a simple remote sensing driven light use efficiency (LUE) model was used to estimate the primary productivity for major cropping systems using multi-temporal satellite data over the Saharanpur district in India.The model is based on radiation absorption and its conversion into biomass. The LUE model was implemented for major crop rotations derived from the time-series of Sentinel-2 and Landsat 8 with monthly satellite-based spatially explicit fields of photosynthetically active radiation (PAR), fraction of absorbed PAR (fAPAR) and down-regulated light use efficiency. Incident PAR and fAPAR were estimated on monthly basis from the ground-calibrated empirical equation using INSAT-3D insolation product and remote sensing-based vegetation indices, respectively. Spatial LUE maps created by down-regulating maximum LUE (EC tower-based) with water and temperature stressors derived from land surface water index (LSWI) and EC-based cardinal temperature, respectively. LUE-based modeled GPP over the sugarcane-wheat system was found higher than the rice-wheat system in Saharanpur district. This is because C4 crop (sugarcane) has very high photosynthetic efficiency compared to C3 crops (rice and wheat). Modeled GPP over the sugarcane-wheat system was found in good agreement with observed EC tower-based GPP (Index of Agreement = 0.93). Further regionally calibrated remote sensing-based LUE model well captures gross photosynthesis rates (GPP) over cropland ecosystem compared to globally modeled MODIS GPP product.

Integrated use of regional weather forecasting and crop modeling for water stress assessment on rice yield

This study evaluated the effects of water stress on rice yield over Punjab and Haryana across North India by integrating Weather Research Forecasting (WRF) and Decision Support System for Agrotechnology Transfer (DSSAT) models. Indian Remote Sensing Satellite datasets were used to define land use/land cover in WRF. The accuracy of simulated rainfall and temperature over Punjab and Haryana was evaluated against Tropical Rainfall Measuring Mission and automated weather station data of Indian Space Research Organization, respectively. Data from WRF was used as weather input to DSSAT to simulate rice yield in Punjab and Haryana for 2009 and 2014. After simulated yield has been evaluated against district-level observed yield, the water balance components within the DSSAT model were used to analyze the impact of water stress on rice yield. The correlation (R²) between the crop water stress factor and the rice yield anomaly at the vegetative and reproductive stage was 0.64 and 0.52 for Haryana and 0.73 and 0.68 for Punjab, respectively. Severe water stress during the flowering to maturity stage inflicted devastating effects on yield. The study concludes that the regional climate simulations can be potentially used for early water stress prediction and its impact on rice yield.

Dynamics of CO2 fluxes and controlling environmental factors in sugarcane (C4)-wheat (C3) ecosystem of dry sub-humid region in India

In this study, CO₂ exchange over sugarcane and wheat growing season was quantified by continuous measurement of CO₂ fluxes using eddy covariance (EC) system from January 2014 to June 2015. We also elaborated on the response of CO₂ fluxes to environmental variables. The results show that the ecosystem has seasonal and diurnal dynamics of CO₂ with a distinctive U-shaped curve in both growing seasons with maximal CO₂ absorption reaching up to -8.94 g C m^-2 day^-1 and -6.08 g C m^-2 day^-1 over sugarcane and wheat crop, respectively. The ecosystem as a whole acted as a carbon sink during the active growing season while it exhibits a carbon source prior to sowing and post-harvesting of crops. The cumulative net ecosystem exchange (NEE), gross primary productivity (GPP), and ecosystem respiration (R_eco) were -923.04, 3316.65, and 2433.18 g C m^-2 over the sugarcane growing season while the values were -192.30, 621.47, and 488.34 g C m^-2 over the wheat growing season. The sesbania (green manure) appeared to be a carbon source once it is incorporated into soil. The response of day-time NEE to photosynthetically active radiation (PAR) under two vapor pressure deficit (VPD) sections (0-20 h Pa and 20-40 h Pa) seems more effective over sugarcane (R² = 0.41-0.61) as compared to the wheat crop (R² = 0.25-0.40). A decrease in net CO₂ uptake was observed under higher VPD conditions. Similarly, night-time NEE was exponentially related to temperature at different soil moisture conditions and showed higher response to optimum soil moisture conditions for sugarcane (R² = 0.87, 0.33 ≤ SWC < 0.42 m³ m^-3) and wheat (R² = 0.75, 0.31 ≤ SWC < 0.37 m³ m^-3) crop seasons. The response of daily averaged NEE to environmental variables through path analysis indicates that PAR was the dominant predictor with the direct path coefficient of -0.65 and -0.74 over sugarcane and wheat growing season, respectively. Satellite-based GPP products from Moderate Resolution Imaging Spectroradiometer (GPP_MOD) and Vegetation Photosynthetic model (GPP_VPM) were also compared with the GPP obtained from EC (GPP_EC) technique. The seasonal dynamics of GPP_EC and GPP_VPM agreed well with each other. This study covers the broad aspects ranging from micro-meteorology to remote sensing over C4-C3 cropping system.

Environmental Impact of Lockdown Amid COVID-19 Over Agricultural Sites in Himalayan Foothills

Human life has come to a standstill when the countrywide lockdown was imposed to curb the infection of the highly contagious COVID-19 pandemic. Mass transportation and industrial activities were prohibited, which has proven advantageous for the environmental quality. This study was conducted to investigate the impact of lockdown on the environmental parameters measured over agricultural ecosystems in the Himalayan foothills [Saharanpur Flux Site (SFS) and Palampur Flux Site (PFS)], India. The UV–Aerosol Index obtained from the Sentinel-5 Precursor satellite falls drastically after imposing lockdown particularly in both the agricultural regions. It reached up to −3.082 and −3.522 during the first lockdown in SFS and PFS, respectively. Furthermore, due to the lesser availability of aerosols into the atmosphere, the availability of direct radiant energy increased, thus led to warming the earth’s surface. Improvement in direct radiant energy and normalized difference vegetation index positively increases the gross primary productivity in SFS and PFS.

Synthesis and Thermal Stability of Unsaturated Polyamides

Unsaturated polyamides were prepared by condensing /3(4-ethoxyphenyl) glutaconic acid with various aromatic diamines. The polycondensates were characterized by IR spectroscopy, vapor phase osmometry, thermogravimetric analysis, differential scanning calorimetry and elemental analysis. All resins were found to decompose in the range '-210-600 °C. The kinetics of decomposition were studied. The results indicated that the resins possess reasonably good thermal stability.

Physiologic load-bearing characteristics of autografts, allografts, and polymer-based scaffolds in a critical sized segmental defect of long bone: an experimental study

Background

To address the challenge of treating critical sized intercalary defects, we hypothesized that under physiologic cyclic loading, autografts, allografts, and scaffolds loaded with and without human mesenchymal stem cells (hMSCs) would have different biomechanical characteristics.

Methods

Using a rat femoral defect model, 46 rats were assigned to four groups, ie, autograft (n = 12), allograft (n = 10), scaffold (n = 13), and scaffold with hMSCs (n = 11). The scaffold groups used a 5 mm segment of scaffold composed of 80% poly-ε-caprolactone and 20% hydroxyapatite. Rats were sacrificed 4 months postoperatively, and the repairs were assessed radiographically and biomechanically.

Results

Autograft and allograft groups exhibited the most bridging callus, while the scaffold/hMSCs group had more callus than the scaffold repairs. Although signs of radiographic healing did not accurately reflect restoration of mechanical properties, addition of hMSCs on the scaffold enhanced bone formation. The scaffold alone group had significantly lower elastic and viscous stiffness and higher phase angles than other repairs and the contralateral controls. Addition of hMSCs increased the elastic and viscous stiffness of the repair, while decreasing the phase angle.

Conclusion

Further comparative analysis is needed to optimize clinical use of scaffolds and hMSCs for critical sized defect repairs. However, our results suggest that addition of hMSCs to scaffolds enhances mechanical simulation of native host bone.

Analysis of agricultural drought using vegetation temperature condition index (VTCI) from Terra/MODIS satellite data

The most commonly used normalized difference vegetation index (NDVI) from remote sensing often fall short in real-time drought monitoring due to a lagged vegetation response to drought. Therefore, research recently emphasized on the use of combination of surface temperature and NDVI which provides vegetation and moisture conditions simultaneously. Since drought stress effects on agriculture are closely linked to actual evapotranspiration, we used a vegetation temperature condition index (VTCI) which is more closely related to crop water status and holds a key place in real-time drought monitoring and assessment. In this study, NDVI and land surface temperature (T (s)) from MODIS 8-day composite data during cloud-free period (September-October) were adopted to construct an NDVI-T (s) space, from which the VTCI was computed. The crop moisture index (based on estimates of potential evapotranspiration and soil moisture depletion) was calculated to represent soil moisture stress on weekly basis for 20 weather monitoring stations. Correlation and regression analysis were attempted to relate VTCI with crop moisture status and crop performance. VTCI was found to accurately access the degree and spatial extent of drought stress in all years (2000, 2002, and 2004). The temporal variation of VTCI also provides drought pattern changes over space and time. Results showed significant and positive relations between CMI (crop moisture index) and VTCI observed particularly during prominent drought periods which proved VTCI as an ideal index to monitor terminal drought at regional scale. VTCI had significant positive relationship with yield but weakly related to crop anomalies. Duration of terminal drought stress derived from VTCI has a significant negative relationship with yields of major grain and oilseeds crops, particularly, groundnut.

Development and validation of packed column supercritical fluid chromatographic technique for quantification of chlorzoxazone, paracetamol and aceclofenac in their individual and combined dosage forms

A reproducible, rapid and sensitive method has been developed for the assay of chlorzoxazone (CHL), paracetamol (PCM) and aceclofenac (ACE) in their combined solid dosage forms using packed-column supercritical fluid chromatography (SFC). The analytes were resolved by elution with supercritical carbon dioxide doped with 15% v/v methanol as the modifier on an ACE 5 Phenyl column (150 × 4.6 mm, 5 µm). The detection was carried out at 215 nm using a UV-Visible detector. The densities and polarities of the mobile phase were optimized from the effects of pressure, temperature and modifier concentration on chromatographic parameters like retention time, retention factor, resolution, asymmetry and theoretical plates. Modifier concentration proved to be the most effective means for changing both retention and selectivity. The developed method was validated as per International Conference on Harmonization guidelines. The developed SFC method was compared with a reported high-performance liquid chromatography method for the estimation of CHL, PCM and ACE using Student t-test. With respect to the speed and use of organic solvents, SFC was found to be superior and eco-friendly. The developed SFC method was successfully used for the assay of different marketed formulations containing CHL, PCM and ACE individually and in combination.

It's good to talk! Changes in coronary revascularisation practice in PCI centres without onsite surgical cover and the impact of an angiography video conferencing system

INTRODUCTION

Percutaneous coronary intervention (PCI) activity has increased more than 6 fold in the last 15 years. Increased demand has been met by PCI centres without on-site surgical facilities. To improve communication between cardiologists and surgeons at a remote centre, we have developed a video conferencing system using standard internet links. The effect of this video data link (VDL) on referral pattern and patient selection for revascularisation was assessed prospectively after introduction of a joint cardiology conference (JCC) using the system.

METHODS

Between 1st October 2005 and 31st March 2007, 1346 patients underwent diagnostic coronary angiography (CA). Of these, 114 patients were discussed at a cardiology conference (CC) attended by three consultant cardiologists (pre-VDL). In April 2007, the VDL system was introduced. Between 1st April 2007 and 30th September 2008, 1428 patients underwent diagnostic CA. Of these, 120 patients were discussed at a JCC attended by four consultant cardiologists and two consultant cardiothoracic surgeons (post-VDL). Following case-matching for patient demographics and coronary artery disease (CAD) severity and distribution, we assessed the effect upon management decisions arising from both the pre- and post-VDL JCC meetings.

RESULTS

When comparing decision-making outcomes of post-VDL JCC with pre-VDL CC, significantly fewer patients were recommended for PCI (36.8% vs. 17.2% respectively, p = 0.001) and significantly more patients were recommended for surgery (21.1% vs. 48.4% respectively, p < 0.001). There were no significant differences in waiting times for PCI following JCC discussion; however, waiting times for surgical revascularisation were significantly reduced (140.9 ± 71.8 days vs. 99.4 ± 56.6 days respectively, p = 0.045).

CONCLUSIONS

  The VDL system provides a highly practical method for PCI centres without onsite surgical cover to discuss complex patients requiring coronary revascularisation and significantly increases the number of patients referred for surgical revascularisation rather than PCI.

Estimation and analysis of terrestrial net primary productivity over India by remote-sensing-driven terrestrial biosphere model

In the present study, the Carnegie-Ames-Stanford Approach (CASA), a terrestrial biosphere model, has been used to investigate spatiotemporal pattern of net primary productivity (NPP) during 2003 over the Indian subcontinent. The model drivers at 2-min spatial resolution were derived from National Oceanic and Atmospheric Administration advanced very high resolution radiometer normalized difference vegetation index, weather inputs, and soil and land cover maps. The annual NPP was estimated to be 1.57 Pg C (at the rate of 544 g C m(-2)), of which 56% contributed by croplands (with 53% of geographic area of the country (GAC)), 18.5% by broadleaf deciduous forest (15% of GAC), 10% by broadleaf evergreen forest (5% of GAC), and 8% by mixed shrub and grassland (19% of GAC). There is very good agreement between the modeled NPP and ground-based cropland NPP estimates over the western India (R2=0.54; p=0.05). The comparison of CASA-based annual NPP estimates with the similar products from other operational algorithms such as C-fix and Moderate Resolution Imaging Spectroradiometer (MODIS) indicate that high agreement exists between the CASA and MODIS products over all land covers of the country, while agreement between CASA and C-Fix products is relatively low over the region dominated by agriculture and grassland, and the agreement is very low over the forest land. Sensitivity analysis suggest that the difference could be due to inclusion of variable light use efficiency (LUE) across different land cover types and environment stress scalars as downregulator of NPP in the present CASA model study. Sensitivity analysis further shows that the CASA model can overestimate the NPP by 50% of the national budget in absence of downregulators and underestimate the NPP by 27% of the national budget by the use of constant LUE (0.39 gC MJ(-1)) across different vegetation cover types.

First time and repeat cardioversion of atrial tachyarrhythmias - a comparison of outcomes

INTRODUCTION

Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006.

METHODS

A total of 770 patients of mean age (SD) 70.1(10.1) underwent 1013 DCCVs (first n = 665, repeat n = 348) for atrial tachyarrhythmias from 1996 to 2006. Time to persistent arrhythmia recurrence was compared between first and multiple DCCV, and the effect of age, gender, presence of heart disease, left atrial size, fractional shortening, arrhythmia duration, anti-arrhythmic drug therapy (AAD) and other concomitant cardiac medication was evaluated using the Kaplan-Meier method and Cox's Proportional-hazards model.

RESULTS

In all, 33% of first and 29% of repeat DCCVs were in sinus rhythm (SR) at 12 months (m). There was no difference in median time to arrhythmia recurrence (SE) between first and multiple procedures: 1.5 +/- 0.1 m (1.3-1.7) and 1.5 +/- 0.0 m (1.4-1.6) respectively, p = 0.45. AAD use was significantly higher, arrhythmia duration shorter and more diabetic patients underwent repeat procedures. Amiodarone, OR 0.56, p = 0.04, sotalol, OR 0.61, p = 0.02 and arrhythmia duration, < 6 m, OR 0.72, p = 0.03 were independent predictors of improved outcome in first procedures only. In patients undergoing first procedures on amiodarone or sotalol, median time to arrhythmia recurrence was longer and 12 m SR rates higher, 6.0 +/- 2.4 m (42%) than those who had a repeat procedure on the same medication, 1.5 +/- 0.1 m (33%), p = 0.06.

CONCLUSIONS

The efficacy of first and subsequent DCCV procedures is similar, achieving a similar proportion of SR maintenance at 1 year. However, the benefits of AAD therapy are the greatest following first time procedures. Concomitant AAD therapy should be considered for all first time procedures for persistent AF.

A randomised controlled trial comparing StarClose and AngioSeal vascular closure devices in a district general hospital--the SCOAST study

AIMS

AngioSeal and StarClose are vascular closure devices (VCDs) that can be used following cardiac catheterisation via the femoral artery to achieve haemostasis. Both devices have been demonstrated to be superior to conventional manual pressure, which reduce time to haemostasis and time to patient ambulation. We sought to compare these devices in a prospective, randomised trial.

METHODS

Patients undergoing elective coronary angiography were randomised to receive either AngioSeal VIP or StarClose VCD with immediate postprocedure mobilisation. Bruising was recorded at 30 min, 60 min and at 1 week postprocedure. Patient satisfaction surveys were taken at 1 h and 1 week postprocedure. Complications for both groups were compared.

RESULTS

Four hundred and one patients were included. Arteriotomy closure was achieved in 144 of 208 (69.2%) patients randomised to AngioSeal and 134 of 193 (69.3%) patients randomised to StarClose (p = ns). There was no significant bruising in either group at either 30 or 60 min postprocedure. However, at 1 week, there was significantly more bruising in the AngioSeal group than the StarClose group (63.1 vs. 38.5cm2, p = 0.02). Patient satisfaction and pain perception with the procedure at closure were not significantly different between the groups. Deployment success and instant mobilisation rates were significantly lower for junior, as compared with senior, operators.

CONCLUSION

Achievement of haemostasis is similar with both AngioSeal and StarClose. The StarClose vascular closure device results in significantly less bruising at 1 week postprocedure as compared with AngioSeal, with no significant differences in complication rates. Patients' pain perception and satisfaction are similar with both VCDs.

A randomised controlled trial comparing the routine use of an Angio-Seal STS device strategy with conventional femoral haemostasis methods in a district general hospital

Femoral artery closure devices reduce the time to haemostasis and ambulation. Most district general hospitals (DGHs) now perform day case angiography on site. The purpose of this study was to assess the Angio-Seal self-tightening suture (STS) device in comparison with manual compression in this environment. A prospective randomised controlled trial was undertaken comparing the Angio-Seal STS device with manual pressure recording complications, time from end of procedure and patient satisfaction in a DGH setting. Angiography lists of 206 patients undergoing day case diagnostic cardiac catheterisation with a five French sheath at a DGH were randomised by intention to treat to receive either manual compression or a six French Angio-Seal STS device. Time from sheath removal to mobilisation, complication rate and patient satisfaction were compared. There were no significant differences between the two groups in terms of demographics (manual compression: Angio-Seal; male (%) 58 vs. 57, age (years) 65.4 vs. 66.3, body mass index (kg/m(2)) 27.7 vs. 27.5). Despite randomisation, only 74 of 107 patients in the Angio-Seal group actually had a device deployed. Angio-Seal use was associated with significantly shorter times to mobilisation (87.6 vs. 144.1 min; p < 0.001), significantly less bruising (bruise size at 1 week (28.5 vs. 82.5 cm(3); p < 0.01) and no increase in vascular complications. In addition, patients were more satisfied with Angio-Seal devices in terms of length of immobility. The routine use of Angio-Seal closure devices result in earlier mobilisation, less bruising, increased patient satisfaction with no increase in other complications in comparison to manual pressure.

What is the optimal electrode configuration for atrial defibrillators in man?

AIMS

To compare the atrial defibrillation threshold (DFT) for two electrode configurations in patients with drug refractory persistent atrial fibrillation (AF).

METHODS AND RESULTS

11 patients, 73% male, mean age 60.9 (range 38 to 83), underwent implantation of a Medtronic Jewel AF dual chamber defibrillator (model 7250). A step-up atrial DFT was performed in a randomized sequence for two electrode configurations: (1) Right atrial to distal coronary sinus electrode (RA > CS) and (2) defibrillator can to right ventricular and right atrial electrodes (CAN > RV + RA). The RA > CS configuration restored SR in 10 patients (91%). The CAN > RA + RV configuration restored SR in four patients (36%). The mean atrial DFT was significantly lower for the RA > CS than CAN > RA + RV configuration (10 +/- 7 Joules vs 25 +/- 6 Joules), P < 0.01. At 3 months post implantation, AF was reinduced and the protocol was repeated for the optimal electrode configuration. There was no significant difference in the atrial DFT compared with that at implant.

CONCLUSION

The right atrium to coronary sinus electrode configuration significantly reduces the atrial DFT. The atrial DFT also remains stable at 3 months post-implantation. Patients with persistent AF undergoing insertion of an atrial defibrillator should have a coronary sinus electrode implanted.

Modified Norwood operation for hypoplastic left heart syndrome

BACKGROUND

We examined early results in infants with hypoplastic left heart syndrome undergoing the Norwood operation with perioperative use of inhaled nitric oxide and application of extracorporeal membrane oxygenation.

METHODS

Medical records were reviewed retrospectively.

RESULTS

Between April 1997 and March 2001, 50 infants underwent a modified Norwood operation for hypoplastic left heart syndrome. Mean age at operation was 7.5 +/- 5.7 days, and mean weight was 3.1 +/- 0.5 kg. Five infants had a delayed operation because of sepsis. The mean diameter of the ascending aorta by echocardiography was 3.6 +/- 1.8 mm. Ductal cannulation was used to establish cardiopulmonary bypass in all patients. Mean circulatory arrest time was 39.4 +/- 4.8 minutes. The size of the pulmonary-systemic shunt was 3.0 mm in 6 infants, 3.5 mm in 37, and 4.0 mm in 7. Infants with persistent hypoxia (partial pressure of oxygen < 30 mm Hg) received nitric oxide after they were weaned from cardiopulmonary bypass. Extracorporeal membrane oxygenation was initiated in 8 infants in the pediatric intensive care unit primarily for low cardiac output and in 8 in the operating room because of the inability to separate them from cardiopulmonary bypass. The 30-day mortality rate was 22% (11 of 50 patients), and the hospital mortality rate was 32% (16 of 50 patients). Mean follow-up was 17 months. Ten patients (20%) underwent stage-two repair, with one operative death. One survivor had a Fontan procedure, and 2 underwent heart transplantation, with one death.

CONCLUSIONS

Early application of extracorporeal membrane oxygenation for hemodynamic instability and selective use of nitric oxide for persistent hypoxia in the immediate postoperative period may improve survival of patients with hypoplastic left heart syndrome. Renal failure requiring hemofiltration during extracorporeal membrane oxygenation (p < 0.05) and cardiopulmonary arrest in the pediatric intensive care unit (p < 0.05) were predictors of hospital mortality.

Safety, effectiveness and cost efficacy of diagnostic electrophysiology and radiofrequency ablation in a district general hospital

Electrophysiological studies (EPS) are now being performed in district general hospitals (DGH) in the UK. In order to audit our results, a prospective database was established for all patients undergoing EPS and radiofrequency (RF) ablation at Eastbourne District General Hospital, East Sussex. Between 1 January 1997 and 1 July 2000, 300 EPS procedures were performed, resulting in 155 RF ablations. The average RF ablation procedure time was 119.3 minutes with an average fluoroscopy time of 19.1 minutes. Cost per RF ablation procedure was 1166.79 Pounds excluding use of facilities, pacemaker devices, medical nursing and radiography staffing costs. The overall success rate for RF ablation was 93.6% with a major complication rate of 0.6%, a total complication rate of 3.9% and no associated mortality. We have shown that RF ablation can be performed safely, effectively and economically in a DGH setting with a high rate of success and a low complication rate.

How many people with heart failure are appropriate for biventricular resynchronization?

AIMS

Increasing evidence exists suggesting that biventricular pacing improves outcome and symptoms in severe heart failure if various selection criteria are fulfilled. It is unsure how many people might benefit from this therapy. Our aim was to provide such data.

METHODS AND RESULTS

Over one calendar year all patients admitted to a large U.K. District General Hospital, that were classified with a diagnosis of heart failure, were audited. The selection criteria were; (1) severe heart failure (NYHA class III or IV), (2) heart failure due to a dilated cardiomyopathy, (3) QRS duration greater than 120 ms or (4) the presence of a bundle branch block pattern. Subjects were divided into those in sinus rhythm to determine those who would be suitable for atrially synchronized biventricular pacing and those with an abnormally long PR interval (>210 ms) who might additionally benefit from improved atrioventricular synchrony. 1042 patients were coded with heart failure. 721 fulfilled diagnostic criteria and were studied. 202 (28%) had severe heart failure, 178 (25%) had a QRS of at least 120 ms, 437 (61%) had an ischaemic cardiomyopathy, 176 (24%) an idiopathic cardiomyopathy and 433 (60%) were in sinus rhythm. Overall mortality at the time of census was 29%. 43 patients were suitable for biventricular pacing with a further 29 atrial patients fibrillation who might benefit from biventricular pacing alone.

CONCLUSION

Using our criteria, approximately 10% of an unselected group of heart failure admitted to a typical U.K. district general hospital over a calendar year would be appropriate for biventricular pacing. This represents a large number of patients who might derive benefit from this new therapy.

Does angina vary with the menstrual cycle in women with premenopausal coronary artery disease?

OBJECTIVE

To determine whether angina in women with established coronary heart disease varies with changes in hormone concentrations during the menstrual cycle.

DESIGN

Subjects were prospectively studied once a week for four weeks.

SETTING

Cardiology outpatient department of tertiary referral centre.

SUBJECTS

Nine premenopausal women, mean (SEM) age 38.89 (2.18) years, with established coronary heart disease, symptomatic angina, and a positive exercise test.

MAIN OUTCOME MEASURE

Myocardial ischaemia as determined by time to 1 mm ST depression during symptom limited exercise testing. Position in the menstrual cycle was established from hormone concentrations.

RESULTS

The early follicular phase, when oestradiol and progesterone concentrations were both low, was associated with the worst exercise performance in terms of time to onset of myocardial ischaemia, at 290 (79) seconds; the best performance (418 (71) seconds) was when oestrogen concentrations were highest in the mid-cycle (p < 0.05). Similar trends were observed in other measured variables. Progesterone concentrations did not influence exercise performance.

CONCLUSIONS

During the menstrual cycle myocardial ischaemia was more easily induced when oestrogen concentrations were low. This may be important for timing the assessment and evaluating treatment in women with coronary heart disease.

The pharmacologic mechanism by which inhaled epinephrine reduces airway obstruction in respiratory syncytial virus-associated bronchiolitis

Inhaled racemic epinephrine relieves airway obstruction in patients with respiratory syncytial virus bronchiolitis. The contribution of alpha- versus beta-adrenoreceptor stimulation toward this clinical effect is unknown. We describe an infant treated with propranolol for supraventricular tachycardia in whom respiratory syncytial virus bronchiolitis developed. Inhaled racemic epinephrine improved his respiratory symptoms, whereas nebulized albuterol did not.

Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis

OBJECTIVE

To evaluate the bronchodilator effect of inhaled nitric oxide (NO) in infants with respiratory failure caused by respiratory syncytial virus (RSV) bronchiolitis and to compare the effect with the one obtained by salbutamol.

DESIGN

Prospective study.

SETTING

Pediatric intensive care unit of a university children's hospital.

PATIENTS

Twelve acutely ill, intubated infants (mean age 4.5 months, mean weight 4.9 kg) with respiratory failure due to documented RSV bronchiolitis.

INTERVENTIONS

Total respiratory system resistance (Rrs) was measured by single breath occlusion at the baseline and after inhaling NO at 20, 40 and 60 ppm for 1 h, and after inhalation of a standard beta2-agonist, salbutamol. Arterial blood gas analysis was performed at each study level on 6 of the 12 patients.

RESULTS

The baseline mean Rrs (SE) was 0.29 (0.04) cm H2O/ml per s. At each dose of NO, the mean Rrs (SE) was 0.28 (0.04) cm H2O/ml per s. With salbutamol, the mean Rrs (SE) was 0.21 (0.03) cm H20/ml per s. These values were not significantly different from each other (by ANOVA). Inhaled NO produced a significant decrease in Rrs of greater than 4 times the coefficient of variation of the baseline measurement in 3 of 12 patients. Seven of 12 patients had no significant change while two patients had a significant increase in Rrs. Inhaled salbutamol produced a significant decrease in Rrs in 5 of 11 patients, while 6 showed no change in Rrs.

CONCLUSION

Inhaled NO has no apparent bronchodilator effect in the majority of acutely ill infants with RSV bronchiolitis and does not appear to provide any additional benefit over the use of salbutamol. The clinical benefit of inhaled NO as a bronchodilator is questionable under these conditions.

Acute effects of hormone replacement with tibolone on myocardial ischaemia in women with angina

This study was designed to evaluate whether hormone replacement therapy with tibolone demonstrated similar effects to those observed with oestrogen on myocardial ischaemia and angina. Ten postmenopausal women with documented coronary artery disease were evaluated by treadmill exercise electrocardiograms before and 24 hours after the oral administration of tibolone 2.5 mg. Onset of myocardial ischemia, as defined by ST segment depression, increased by a median 102 seconds (p = 0.022). Time to onset of angina increased by 31 seconds (p = 0.038), while total exercise time was not significantly affected (p = 0.24). Haemodynamic variables in the form of heart rate, systolic blood pressure and their product were unaffected by tibolone administration. We conclude that tibolone appears to show similar anti-ischaemic properties to oestrogen.

A newly developed PCR assay of H. pylori in gastric biopsy, saliva, and feces. Evidence of high prevalence of H. pylori in saliva supports oral transmission

We have recently developed a new PCR assay for the detection of H. pylori. In this study, the polymerase chain reaction (PCR) assay was used to detect H. pylori in 88 gastric biopsy, 85 saliva, and 71 fecal specimens from 88 patients. H. pylori infection was confirmed in 71 of 88 patients by culture and/or histological stain of gastric biopsies. Serum IgG antibody to H. pylori was also measured and resulted in 97% sensitivity and 94% specificity. H. pylori DNA was detected by the PCR assay in gastric biopsy specimens from all 71 patients (100% sensitivity) with proven gastric H. pylori infection but not from 17 noninfected patients (100% specificity). In saliva specimens, H. pylori DNA was identified in 57 of the 68 patients (84%) with proven gastric H. pylori infection and in three of the 17 patients without gastric H. pylori infection. However, the PCR assay was only able to detect H. pylori DNA in the feces from 15 of 61 patients (25%) with proven gastric H. pylori infection and one of the 10 patients without gastric H. pylori infection. The results show that the PCR assay is reliable for detecting the presence of H. pylori in gastric biopsy and saliva specimens. The data indicate that H. pylori exists in a higher prevalence in saliva than feces and that the fecal-oral route may be an important means of transmission of this infection in developing countries but not as significant as previously suspected in the developed countries. It is likely that the oral-oral route is more prominent.

Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: a 24-hour pH monitoring study

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al. in 1980 [1]. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost [2,3]. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months [4,5]. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.

Exact logistic regression: theory and examples

We provide an alternative to the maximum likelihood method for making inferences about the parameters of the logistic regression model. The method is based appropriate permutational distributions of sufficient statistics. It is useful for analysing small or unbalanced binary data with covariates. It also applies to small-sample clustered binary data. We illustrate the method by analysing several biomedical data sets.

Oral absorption of anti-AIDS nucleoside analogues. 1. Intestinal transport of didanosine in rat and rabbit preparations

The intestinal transport of didanosine (ddl), a nucleoside analog used in the treatment of human immunodeficiency virus (HIV) infection, was characterized using in situ and in vitro techniques. The zero-trans uptake of ddl in rat intestinal brush border membrane vesicles (BBMV) was linear over the range of 1 microM to 50 mM, ruling out a significant carrier-mediated absorption component. The lack of carrier-mediated transport was confirmed in a second species (rabbit). In order to quantitate the convective (Pconv) and diffusive (Pdiff) components of ddl intestinal permeability, the steady state wall permeability (P*w) was determined using an established perfusion technique in rats. Even though baseline P*w (pH 6.5, 290 mosm/kg, no modulator) and fluid absorption results were similar to those of furosemide, the ratios (ddl:furosemide) of Pdiff and phi, the sieving coefficient, were 0.31:1 and 1.70:1, respectively, demonstrating that ddl's Pdiff is low and Pconv is high relative to furosemide's, suggesting significant paracellular absorption of ddl. The apparent diffusive absorptive clearances (P'app) of ddl and furosemide were determined in BBMV, which lack functional tight junctions, and the ratios (ddl:furosemide) of P'app in rat and rabbit were 0.23:1 and 0.24:1, respectively. The BBMV results demonstrate that the majority of ddl intestinal transport does not occur by passive membrane diffusion, confirming the single pass intestinal perfusion (SPIP) findings. The results of these studies suggest that ddl is transported by nonfacilitated membrane and paracellular diffusion with paracellular transport being responsible for the majority of ddl absorption from the intestine.

High prevalence of Helicobacter pylori in saliva demonstrated by a novel PCR assay

AIMS

To investigate the prevalence of Helicobacter pylori in the saliva of patients infected with this bacterium.

METHODS

A novel polymerase chain reaction (PCR) assay was developed to detect H pylori in saliva and gastric biopsy specimens from patients undergoing endoscopy.

RESULTS

Our PCR assay amplified a 417 base pair fragment of DNA from all 21 DNAs derived from H pylori clinical isolates but did not amplify DNA from 23 non-H pylori strains. Sixty three frozen gastric biopsy and 56 saliva specimens were tested. H pylori specific DNA was detected by PCR in all 39 culture positive biopsy specimens and was also identified from another seven biopsy specimens which were negative by culture but positive by histology. H pylori specific DNA was identified by PCR in saliva specimens from 30 (75%) of 40 patients with H pylori infection demonstrated by culture or histological examination, or both, and in three patients without H pylori infection in the stomach.

CONCLUSION

The results indicate that the oral cavity harbours H pylori and may be the source of infection and transmission.

Gastrointestinal and biliary indwelling devices

Esophageal and biliary stents are indwelling devices used in the treatment of selected gastrointestinal and biliary disorders. Stenting is accepted as a standard procedure for palliation of malignant obstruction of the esophagus and biliary system. Review of the early and late complications associated with these devices is made with emphasis on the clinical and radiographic features. A suggested approach to diagnosis and treatment recommendations are made for each complication that the emergency department physician may encounter.