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Objective: We describe cases of invasive group A Streptococcus (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28 days of birth and investigation of clusters in maternity units. Design: Cross‐sectional retrospective study. Setting and population: Notified confirmed iGAS cases in either mothers or neonates with onset within 28 days of birth in London and the South East of England between 2010 and 2016 Method: Review of public health records of notified cases. Main outcome measures: Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6 months. Results: We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28 days postpartum was 109 (95% CI 90–127) compared with 1.3 in other females aged 15–44. For neonates the incidence was 1.5 (95% CI 9–23). The median onset time was 2 days postpartum [interquartile range (IQR) 0–5 days] for mothers and 12 days (IQR 7–15 days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued. Conclusions: iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved. Are public health guidelines being followed in the management of mothers and their newborns to reduce the risk of iGAS infection? Are public health guidelines being followed in the management of mothers and their newborns to reduce the risk of iGAS infection? [ABSTRACT FROM AUTHOR]

Abstract: Studies in the early 1990s suggested that a hormone identical to ouabain or an isomer of ouabain is secreted by the adrenal glands into the circulation and plays a role in the regulation of arterial pressure and cardiac and renal function. This hormone, known as endogenous ouabain (EO), was claimed to contribute to the pathophysiology of a number of disorders including heart failure, renal failure, pregnancy‐induced, and essential hypertension. However, some research groups have been unable to confirm the presence of EO in the human circulation and the issue remains in dispute. In that the implications are of considerable importance to clinicians who, like the authors, lack biochemical expertise, it would be useful if the dispute could be addressed by disinterested scientists with long‐standing and acknowledged expertise in analytical chemistry who could opine as to whether the evidence is, or is not, sufficient to state categorically that EO does (or does not) exist in the circulation in man. This brief review does not present new data but, rather, recommends that adjudication is needed regarding this important issue. © 2018 BioFactors, 44(3):219–221, 2018 [ABSTRACT FROM AUTHOR]

Aims: Previous analyses suggest that heart failure (HF) therapy guided by (N-terminal pro-)brain natriuretic peptide (NT-proBNP) might be dependent on left ventricular ejection fraction, age and co-morbidities, but the reasons remain unclear.Methods and Results: To determine interactions between (NT-pro)BNP-guided therapy and HF with reduced [ejection fraction (EF) ≤45%; HF with reduced EF (HFrEF), n = 1731] vs. preserved EF [EF > 45%; HF with preserved EF (HFpEF), n = 301] and co-morbidities (hypertension, renal failure, chronic obstructive pulmonary disease, diabetes, cerebrovascular insult, peripheral vascular disease) on outcome, individual patient data (n = 2137) from eight NT-proBNP guidance trials were analysed using Cox-regression with multiplicative interaction terms. Endpoints were mortality and admission because of HF. Whereas in HFrEF patients (NT-pro)BNP-guided compared with symptom-guided therapy resulted in lower mortality [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.62-0.97, P = 0.03] and fewer HF admissions (HR = 0.80, 95% CI 0.67-0.97, P = 0.02), no such effect was seen in HFpEF (mortality: HR = 1.22, 95% CI 0.76-1.96, P = 0.41; HF admissions HR = 1.01, 95% CI 0.67-1.53, P = 0.97; interactions P < 0.02). Age (74 ± 11 years) interacted with treatment strategy allocation independently of EF regarding mortality (P = 0.02), but not HF admission (P = 0.54). The interaction of age and mortality was explained by the interaction of treatment strategy allocation with co-morbidities. In HFpEF, renal failure provided strongest interaction (P < 0.01; increased risk of (NT-pro)BNP-guided therapy if renal failure present), whereas in HFrEF patients, the presence of at least two of the following co-morbidities provided strongest interaction (P < 0.01; (NT-pro)BNP-guided therapy beneficial only if none or one of chronic obstructive pulmonary disease, diabetes, cardiovascular insult, or peripheral vascular disease present). (NT-pro)BNP-guided therapy was harmful in HFpEF patients without hypertension (P = 0.02).Conclusion: The benefits of therapy guided by (NT-pro)BNP were present in HFrEF only. Co-morbidities seem to influence the response to (NT-pro)BNP-guided therapy and may explain the lower efficacy of this approach in elderly patients. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 988–994 (2010) Aims Autonomic nervous system dysfunction is observed in Type 2 diabetes. As gestational diabetes is a potent risk factor of later Type 2 diabetes, we set out to determine whether autonomic nervous system imbalance could already be observed in women with this condition. Because activity of the sympathetic nervous system tends to be relatively stable in the nocturnal hours, we performed the study at night. Research design and methods We studied 41 women with gestational diabetes, 22 healthy pregnant controls and 14 non-pregnant controls. We assayed plasma noradrenaline at 24.00, 04.00 and 07.00 h and performed an overnight Holter recording for heart rate variability analysis. In addition, we assayed plasma adrenomedullin, a cardiovascular protective hormone. Results Compared with non-pregnant controls, plasma noradrenaline levels were increased at 04.00 and 07.00 h in the gestational diabetic ( P = 0.003) and pregnant control ( P = 0.002) groups, with no difference between them. Heart rate variability, very-low-frequency and low-frequency power were lower in pregnant groups compared to the non-pregnant controls. Heart rate variability remained unchanged between specified sampling times in the gestational diabetic group, in contrast to fluctuation seen in the control groups. Conclusions Gestational diabetes, compared with normal pregnancy, seems not to be a state of overall sympathetic nervous system activation. At the heart level, however, an inhibitory effect on autonomic nervous system modulation was seen. Plasma noradrenaline and heart rate variability correlated well, supporting the use of this function in future studies of overall sympathetic activity during pregnancy. [ABSTRACT FROM AUTHOR]

Aims: Mechanisms for clearance of circulating amino-terminal pro-brain natriuretic peptide (NT-proBNP) remain poorly understood and are relevant to the clinical utility of NT-proBNP as a diagnostic and prognostic biomarker in cardiovascular disorders. We sought to determine site(s) of production and clearance of plasma NT-proBNP in the human circulation. [ABSTRACT FROM PUBLISHER]

Lung cancer is the most common form of cancer in the world, and 90% of patients die from their disease. The angiotensin converting enzyme (ACE) inhibitors are used widely as antihypertensive agents, and it has been suggested that they decrease the risk of some cancers, although available data are conflicting. Accordingly, we investigated the anticancer activity of the ACE inhibitor, captopril, in athymic mice injected with highly tumorigenic LNM35 human lung cells as xenografts. Using this model, we demonstrated that daily IP administration of captopril (2.8 mg/mouse) for 3 weeks resulted in a remarkable reduction of tumor growth (58%, P < 0.01) and lymph node metastasis (50%, P= 0.088). There were no undesirable effects of captopril treatment on animal behavior and body weight. In order to determine the mechanism by which captopril inhibited tumor growth, we investigated the impact of this drug on cell proliferation, apoptosis, and angiogenesis. Immunohistochemical analysis demonstrated that captopril treatment significantly reduced the number of proliferating cells ( Ki-67) in the tumor samples but was not associated with inhibition of tumor angiogenesis (CD31). Using cell viability and fluorescent activated cell sorting analysis tests, we demonstrated that captopril inhibited the viability of LNM35 cells by inducing apoptosis, providing insight about the mechanisms underlying its antitumorigenic activities. In view of these experimental findings, we conclude that captopril could be a promising option for the treatment of lung cancer. [ABSTRACT FROM AUTHOR]

Abstract: Background: How best to decide when to introduce drugs and what doses are optimal in individual patients with chronic heart failure (CHF), is unclear. Aims: We will determine whether titration of drug treatment according to plasma NTproBNP is superior regarding clinical outcomes to intensive standardised clinical assessment; whether either of the regimens noted above is superior to usual care; and whether age alters the relative efficacy of NTproBNP guided treatment. Methods: We will randomise 360 patients, stratified by age, to drug treatment directed by plasma NTproBNP, to intensive standardised clinical assessment, or to usual care. The primary outcome is total mortality, and secondary outcomes include death plus hospital admission for any cardiovascular event plus episodes of outpatient decompensated heart failure. Analyses will be conducted at the end of one and two years. Results: 308 patients have been recruited, the majority being in NYHA functional class II, 60.6% being >75 years. The entry plasma NTproBNP level is 238, 50–1250 pmol/l, median and range, approximately 400–11,000 pg/ml. Conclusion: We describe details of a study to test the potential utility of serial measurements of NTproBNP in adjusting the drug treatment of patients with CHF. Projected completion date is 2007. [Copyright &y& Elsevier]

The time course of cardiac sympathetic nerve activity (CSNA) following acute myocardial infarction (MI) is unknown. We therefore undertook serial direct recordings of CSNA, arterial blood pressure (MAP) and heart rate (HR) in 11 conscious sheep before and after MI, and compared them with 10 controls. Conscious CSNA recordings were taken daily from electrodes glued into the thoracic cardiac nerves. Infarction was induced under pethidine and diazepam analgesia by applying tension to a coronary suture. MI size was assessed by left ventricular planimetry (%) at postmortem, peak troponin T and brain natriuretic peptide levels (BNP). Baroreflex slopes were assessed daily using phenylephrine-nitroprusside ramps. The mean infarcted area was 14.4± 2.9%, troponin T 1.88± 0.39μg l−1 and BNP 8.4± 1.3 pmol l−1. There were no differences in haemodynamic parameters or CSNA between groups at baseline. MAP and HR remained constant following MI. CSNA burst frequency increased from baseline levels of 55.8± 7.1 bursts min−1 to levels of 77.5± 8.7 bursts min−1 at 2 h post-MI, and remained elevated for 2 days ( P< 0.001). CSNA burst area also increased and was sustained for 7 days following MI ( P= 0.016). Baroreflex slopes for pulse interval and CSNA did not change. CSNA increases within 1 h of the onset of MI and is sustained for at least 7 days. The duration of this response may be longer because the recording fields decrease with time. This result is consistent with a sustained cardiac excitatory sympathetic reflex. [ABSTRACT FROM AUTHOR]

Sample sub-populations, each of six plants, were chosen for high, mid and low tolerance of copper from each of two naturally-occurring copper tolerant populations and from tolerant individuals selected from a cultivar of Agrostis capillaris L. The naturally-occurring ecotypes came from a closed sward community at Drws y Coed, and from an open community at Parys Mountain, both copper mines in North Wales. Clonal replicates of all plants were introduced into swards of perennial ryegrass cvs. S23 or S24, growing on normal soil at the University of Liverpool Botanic Gardens. S23 plots were cut eight times between June 1977 and July 1978, whilst S24 plots were cut 3 times during the same period. Half the experimental plots received N, P, K, fertilizer; the rest received none. Plants selected from the cultivar (selected) produced most dry matter, and with infrequent defoliation flowered freely in competition with ryegrass. Those taken from Parys Mountain mine spoil produced least dry matter and no inflorescences. Drws y Coed plants were intermediate in dry matter and inflorescence production. These results may reflect differences in population density in the habitats from which the populations were sampled. Sub-populations chosen for high, mid or low copper tolerance within the selected and Drws y Coed populations did not differ significantly in dry matter yield. By contrast under certain circumstances Parys Mountain plants with low tolerance outyielded other more tolerant plants. These results are considered with respect to growth strategies adopted by plants growing on and off copper mine sites. [ABSTRACT FROM AUTHOR]

Heavy-metal tolerance was investigated in Agrostis capillaris L. (A. tenuis Sibth.) using a standard rooting test on plants originating from a copper-contaminated site (Parys Mountain) and a lead-contaminated site (Goginan). Six F1 families obtained by interpopulation hybridization and F2 and backcross generations derived from one of them were screened. Estimates of the genetic and environmental components of phenotypic correlation were obtained in terms of both root length and tolerance index. Results are discussed in relation to problems of interpretation of evidence for multiple- or co-tolerance based on tolerance indices and phenotypic correlations. [ABSTRACT FROM AUTHOR]

The rooting response of seven populations of Agrostis tenuis Sibth. to a range of copper concentrations in calcium nitrate solution is described. Variation in both index of tolerance and sensitivity of rooting to increased copper levels were found and shown to be phenotypically independent characters. It is suggested that rooting sensitivity to a range of copper concentrations provides a further measure of copper tolerance which is independent of the methods previously employed for assessing tolerance. [ABSTRACT FROM AUTHOR]

Hormonal, haemodynamic and subjective psychological responses to the intravenous infusion of clonidine were investigated in nine male alcoholics who had been abstinent for 5 weeks, and were compared with those of nine healthy controls. The growth hormone response to clonidine was significantly blunted in the abstinent alcoholics. Both baseline cortisol levels and the clonidine-induced cortisol decrease were significantly greater in the alcoholics than in controls. Blood pressure, pulse race and psychological responses to clonidine were similar in both groups. These results indicate chat some aspects of alpha-2-adrenocepwr sensitivity are persistently abnormal in alcoholics at least 5 weeks into abstinence. [ABSTRACT FROM AUTHOR]

Abstract: Vitamin D deficiency is common in Arab countries particularly among women. This is the result of a low dietary intake of the vitamin, limited exposure to sunlight (a paradox in view of the high sunshine figures), skin colour, obesity and high parity. Apart from its adverse effects on bone in women and their offspring, vitamin D deficiency has the potential to cause or exacerbate heart failure through a number of mechanisms including activation of the renin–angiotensin system and increased arterial pressure. Accordingly, we propose that ensuring adequate vitamin D levels in Arab women will have a much greater impact on health than just the prevention of bone disease. In particular, we suggest that prevention and correction of vitamin D deficiency will reduce the incidence of heart failure and, for Arab women with established heart failure and vitamin D deficiency, improve cardiac function. [Copyright &y& Elsevier]

Objective: We describe cases of invasive group A Streptococcus (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28 days of birth and investigation of clusters in maternity units.Design: Cross-sectional retrospective study.Setting and Population: Notified confirmed iGAS cases in either mothers or neonates with onset within 28 days of birth in London and the South East of England between 2010 and 2016 METHOD: Review of public health records of notified cases.Main Outcome Measures: Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6 months.Results: We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28 days postpartum was 109 (95% CI 90-127) compared with 1.3 in other females aged 15-44. For neonates the incidence was 1.5 (95% CI 9-23). The median onset time was 2 days postpartum [interquartile range (IQR) 0-5 days] for mothers and 12 days (IQR 7-15 days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued.Conclusions: iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved.Tweetable Abstract: Are public health guidelines being followed in the management of mothers and their newborns to reduce the risk of iGAS infection? [ABSTRACT FROM AUTHOR]

A letter to the editor which discusses the case of a 76-year-old man who is diagnosed with acute myeloid leukaemia is presented.