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Background OA is the most common joint condition, the fourth leading cause of disability globally and the fastest increasing major health condition. In older adults, OA frequently coexists with other morbidities, but the temporal nature is unclear. There is abundant evidence that markers of low SES are associated with poor outcomes among people with musculoskeletal conditions, however the mechanism linking comorbidity may vary with SES. Objectives To examine if OA predicted the onset of comorbidities that are the reason for frequent consultation to primary care, and if this association was moderated by SES. Methods Cohort study combining questionnaire data at two time points (2005, 2008) in the North Staffordshire Osteoarthritis Project, and medical record data from 2000 to 2005 (n=3910). OA was defined by consultation to primary care for OA between 2000 and 2005, and the indication of moderate to extreme pain interference in the questionnaire (2005). Logistic regression examined the association between OA and the onset of seven comorbidities (anxiety, depression, widespread pain (WP), insomnia, cognitive impairment, neurosis, stress between 2005 and 2008) and restricted social participation, first unadjusted and then adjusting for putative confounders (comorbidity, socio-demographic and lifestyle factors). Moderation of the association between OA and new onset comorbidity by change in income, education and area-level deprivation was examined by including interaction terms in regression and stratified analyses. Results were reported as odds ratios with a 95% Confidence Interval (OR; 95% CI). Results Mean age was 63, 55% were female, and 942 (24%) had OA. In the unadjusted analysis, OA was significantly associated with new onset of seven comorbidities (p Conclusions Consulters for OA were more likely to develop new physical and psychological comorbidities that lead to more frequent consultation to primary care than those without OA. Whilst confounders explained some of these associations, OA consulters may benefit from more proactive strategies to prevent further morbidity. Despite no significant multiplicative interactions, there were differences in the prevalence of new onset of morbidity in those with OA when stratified by SES. Onset of cognitive impairment was associated with inadequate income but WP was associated with those with higher education suggesting a “worried well” population seen both in other health surveys and in screening. OA and baseline morbidities were higher with lower SES and further exploration across the life- course will help to establish the role of SES on the natural history OA. Disclosure of Interest None declared

Objectives We sought to evaluate our experience with total arterial revascularization and compare it with the traditional approach of a single internal thoracic artery supplemented by saphenous veins. Methods From 1995 to 2010, 6059 patients with triple-vessel coronary artery disease underwent primary isolated coronary artery bypass grafting at 8 centers. A study cohort of 3774 patients was formed, with 2988 (79%) undergoing total arterial revascularization and 786 (21%) receiving only saphenous veins to supplement a single in situ internal thoracic artery. In the total arterial revascularization group, bilateral internal thoracic arteries were used in 1079 patients (36%) and at least 1 radial artery was used in 2916 patients (97%). Propensity score matching was used for risk adjustment. Results Patients undergoing total arterial revascularization were younger (65.0 ± 10.4 years vs 71.3 ± 7.9 years, P P P P = .0004). Conclusions This large multicenter study suggests that a strategy of total arterial revascularization is associated with improved long-term survival compared with the use of only a single arterial and saphenous vein grafts. Total arterial revascularization should be encouraged in patients with a reasonable life expectancy.

ObjectivesCoronary artery disease has been viewed as a relentless, progressive disease. We sought to describe the prevalence and distribution of regression of native vessel disease in coronary artery bypass patients and characterize its relationship with bypass grafting.MethodsAmong 619 patients who underwent bypass surgery in a radial artery trial, 405 had follow-up angiography available a mean of 6.2 ± 3.1 years (range, 0-14) after surgery. The percentage of diameter stenosis of each major native coronary vessel was reported by 3 cardiac specialists and classified into grades of nonflow limiting (0%-39%), moderate (40%-69%), flow limiting (70%-80%), severely stenosed (81%-99%), and occluded (100%). Native vessel disease regression was defined as decrease in 1 or more grades of stenosis between the pre- and postoperative angiograms.ResultsA total of 1742 native coronary arteries had preoperative stenosis of at least 40% and were included in the present analysis, receiving 753 arterial grafts and 391 saphenous vein grafts. Overall, the prevalence of disease regression was 19.7%, and 45% of patients demonstrated regression in 1 or more vessels. The presence of an arterial graft increased the likelihood of disease regression (21.3% compared with 16% for venous bypassed vessels, P = .012) as did the location in the left circulation (22.6% compared with 13.9% for the right circulation, P

Hypereosinophilic syndrome (HES) is a rare systemic condition, defined as a persistently elevated eosinophil count associated with end organ damage and the absence of a primary cause. Cardiac involvement occurs in about 50% of patients with HES. Myocardial infiltration results in endomyocardial fibrosis, valve dysfunction and mural thrombus. The atrioventricular valves are almost always involved, resulting in regurgitation due to leaflet restriction, most commonly affecting the posterior mitral valve leaflet. Surgical management remains challenging in patients with HES with limited data on the choice of valve surgery. We describe the case of a 17-year-old woman with HES complicated by congestive cardiac failure secondary to severe mitral and tricuspid regurgitation. Because of refractory heart failure despite medical therapy, surgical mitral and tricuspid valve repair was performed, and an excellent 24-month outcome was achieved. We believe this is the first report of double valve repair in this rare condition.

Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia Department of Cardiothoracic Surgery, Royal Melbourne Hospital; Department of Surgery, University of Melbourne Victorian Heart Centre, Epworth Hospital; Department of Cardiac Surgery, Austin Hospital; University of Melbourne, Melbourne, Australia Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (Monash Medical Centre), Monash University, Clayton, Victoria, Australia Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia

The genomic sequence of the novel HLA-B*44:220 allele identified in a British Caucasoid male.

Context: Cardiac surgery.Objective: To compare plasma and urinary neutrophil gelatinase-associated lipocalin (P-/U-NGAL) in on-pump (n = 43) versus off-pump (n = 40) surgery.Materials and methods: We obtained perioperative P-/U-NGAL and outcome data.Results: P-/U-NGAL increased after surgery. P-NGAL was higher post-surgery in on pump patients (139 versus 67 µg L−1; p

OBJECTIVES: We evaluated the influence of lipid exposure upon conduit patency in long-term follow-up after primary CABG. METHODS: From a prospectively compiled database, we identified 1207 grafts (436 SV and 771 mixed arterial grafts) among 413 CABG patients with 9.4 ± 2.4 years of follow-up (range 3–13). Surveillance angiography was performed as part of a randomized trial. All available lipid assays were collected from pathology laboratories, and from these, mean annualized lipid exposure was calculated for total cholesterol, HDL, LDL and triglycerides. Angiographical and clinical data were analysed against lipid exposure. Graft failure was defined as occlusion, string sign or >80% stenosis. RESULTS: Six thousand and seventy-seven lipid measurements were obtained, and there were 154 failed grafts. Three hundred and eleven patients received at least one vein graft, and all 413 patients received at least one arterial graft. Overall, only HDL levels were inversely correlated with graft failure, with total cholesterol and LDL showing no associations in a mixed pool of arterial and venous grafts. To assess whether total/LDL cholesterol had no effect or were exerting competing effects in arteries and veins, separate multivariate analyses were performed. Venous graft failure was associated with increased total cholesterol/HDL (P= 0.006) and LDL/HDL (P= 0.032). By contrast, elevated total cholesterol was correlated with a reduced risk of arterial graft failure (OR for graft failure 0.705, P= 0.023) with increasing LDL cholesterol following a similar trend (OR for graft failure 0.729, P= 0.051). CONCLUSION: Sub-fractions of dyslipidaemia known to be risk factors for native vessel disease appear to similarly influence vein grafts. Arterial conduits are at least more resistant to the effects of high lipid exposure, and appear to be protective. These results favour the use of arterial grafts in patients with poorly controlled dyslipidaemia.

ObjectiveThe radial artery (RA) has gained popularity as a conduit for coronary artery bypass surgery despite a paucity of patient-centered analysis of long-term quality of life after its removal. We sought to characterize forearm function and symptoms after RA harvest and compare these with those associated with saphenous vein (SV) removal.MethodsA total of 408 patients from an RA trial completed a questionnaire up to 14 years after primary coronary artery bypass surgery. The survey included 7 statements concerning hand and forearm symptoms or limitations in daily life and 4 questions on concerns associated with arm or leg scars. A total of 230 patients had received an RA graft (RA group). Responses were graded in order of severity from 0 to 7, with greater than 3 (mild concern) being regarded as a significant symptom. Mean response to each question and total scores were compared with the non-RA harvest group. Comparisons were also made with responses to the same questionnaire completed preoperatively and 3 months postoperatively. In patients who had both RA and SV removal, we compared the impact of a forearm scar on quality of life with that of a leg scar.ResultsThe mean duration of follow-up was 9.3 years (range, 4–14 years), and the response rate was 83%. In the RA group, 92% to 99% reported no significant symptoms, with the most frequent concerns relating to pain and numbness (8% each), but this was not significantly higher than in those who had not had an RA harvested. In the RA group, the mean scores for scar appearance and discomfort were 0.95 and 0.93, respectively (where 1 = no concern), suggesting satisfactory cosmesis and no impact on function. Symptom severity was significantly worse in 6 of 7 questions when compared with preoperative responses and in 4 of 7 items compared with 3-month follow-up, indicating a general deterioration in function over long-term follow-up. In those who had both the RA and SV harvested, patients reported more scar discomfort associated with SV harvest at 3 months (1.69 vs 1.34, P

Objective Whether to graft a moderately stenosed coronary vessel remains debatable. We investigated whether grafting such vessels is warranted based on angiographic evidence of disease progression. Methods Of 619 patients who underwent on-pump coronary artery bypass grafting in an ongoing, randomized radial artery trial, 405 have at least 1 follow-up angiogram at a mean of 6.2 ± 3.1 years (range, 0-14 years) after surgery. Percent diameter stenosis in each major native vessel was reported by 3 cardiac specialists and classified as either moderate (40%-69%) or severe (≥70%) stenosis. Progression of native vessel disease and graft patency were determined by comparison of pre- and postoperative angiography. Results A total of 3816 native vessels and 1242 bypass grafts were analyzed, of which 386 moderate preoperative lesions were identified, 323 of which were grafted. In all territories, grafted vessels had greater risk of disease progression than ungrafted equivalents (43.4% vs 10.5%, P 001). Moderate lesions were more likely than severe lesions to remain unchanged on follow-up angiography (52.6% vs 31.1%, P 001). Only 1 in 7 moderate lesions in the right coronary artery exhibited significant progression during follow-up if left ungrafted, whereas the likelihood of progression in left-sided counterparts approached 50%. Arterial and vein grafts to left-sided moderately stenosed vessels had excellent patency (83% and 77% at 8 years, respectively), which was not matched by right-sided grafts ( P = .051). Placement of a graft for a moderate lesion was associated with significantly greater incidence of disease progression, most marked in the right coronary territory. Conclusions The greater risk of progression of left-sided moderate lesions, and high graft patency rates when bypassed, suggests that the balance of clinical judgment lies in favor of grafting moderate left-sided lesions. In the right coronary system, however, a lesion is likely to remain moderate if left ungrafted and, with a low risk of progression, it may be reasonable to leave these vessels undisturbed.

Short-term mortality prediction models have an important role in current cardiac surgical practice. There has been much less attention paid to prediction of long-term outcomes which are probably an equal marker both of surgeon performance and appropriateness of surgical treatment. The aim of this study was to assess the performance of the New York State Cardiac Surgery Reporting System (NYSCSRS) risk model and the Northern New England Cardiovascular Disease Study Group (NNECDSG) risk model on the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) patient database.The NYSCSRS and the NNECDSG risk models were applied to all patients undergoing isolated coronary artery bypass graft (CABG) surgery that had complete data, were over the age of 18 and had a body mass index between 12 and 78 kg/m2. Predicted mortality was calculated using the published risk model formulae and compared with observed mortality, obtained via linkage with the National Death Index, at four time-points (one, three, five and seven years following surgery). Model discrimination and model calibration were tested at all four time points by determining the C-statistics for receiver operator characteristic (ROC) curves, and studying the Hosmer-Lemeshow chi-square tests, respectively.The NYSCSRS and NNECDSG risk models were applied to 34,961 and 34,998 patients, respectively. The NYSCSRS risk model over-predicted mortality by between 130% and 216% at all four time-points while the NNECDSG risk model under-predicted mortality at one year by 4.3% but over-predicted mortality at three, five and seven years by between 42.5% and 145.7%. The C-statistics obtained fell between 0.779 and 0.741 for the NYSCSRS risk model and between 0.785 and 0.752 for the NNECDSG risk model at all four time-points. Hosmer-Lemeshow chi-square tests returned p-values0.001 at all four time-points for both risk models.The NYSCSRS and NNECDSG risk models do not accurately predict long-term mortality following isolated CABG surgery in the ANZSCTS patient population. The use of either of these risk models is not appropriate in Australia.

Background The Salmonella enterica serovar Derby is frequently isolated from pigs and turkeys whereas serovar Mbandaka is frequently isolated from cattle, chickens and animal feed in the UK. Through comparative genomics, phenomics and mutant construction we previously suggested possible mechanistic reasons why these serovars demonstrate apparently distinct host ranges. Here, we investigate the genetic and phenotypic diversity of these two serovars in the UK. We produce a phylogenetic reconstruction and perform several biochemical assays on isolates of S. Derby and S. Mbandaka acquired from sites across the UK between the years 2000 and 2010. Results We show that UK isolates of S. Mbandaka comprise of one clonal lineage which is adapted to proficient utilisation of metabolites found in soya beans under ambient conditions. We also show that this clonal lineage forms a biofilm at 25 °C, suggesting that this serovar maybe well adapted to survival ex vivo, growing in animal feed. Conversely, we show that S. Derby is made of two distinct lineages, L1 and L2. These lineages differ genotypically and phenotypically, being divided by the presence and absence of SPI-23 and the ability to more proficiently invade porcine jejunum derived cell line IPEC-J2. Conclusion The results of this study lend support to the hypothesis that the differences in host ranges of S. Derby and S. Mbandaka are adaptations to pathogenesis, environmental persistence, as well as utilisation of metabolites abundant in their respective host environments. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0628-4) contains supplementary material, which is available to authorized users.

Objective: Coronary artery bypass grafting using arterial conduits may improve survival and minimise harvest site complications. However, in diabetes, the outcomes of coronary artery bypass grafting performed exclusively using arterial conduits are uncertain. We reviewed our experience with this approach. Methods: From 1996 to 2008, 400 patients with diabetes (managed with oral hypoglycaemics, insulin or both) underwent primary isolated coronary artery bypass grafting for triple vessel coronary disease. In 246 (61.5%), total arterial revascularisation was achieved using single or bilateral internal thoracic arteries supplemented by one or more radial arteries (arterial group), while in the remaining 154 (38.5%), at least one venous conduit was used (mixed conduits group: mean 1.5 veins per patient). Propensity-score matching was used to adjust for bias. Results: Total arterial revascularisation patients were more likely to be younger (arterial: 63 10 years vs mixed: 67 10 years, P 0.99) and major morbidities, except the arterial group who experienced less stroke (0.4% vs 3.2% vs P = 0.04) and harvest site infections (0.4% vs 4%, P = 0.016). Mean follow was 7.8 3.7 years. Estimated survival at 12-year survival in the arterial group was 80% 3.2% vs 54% 5.5% (P 0.99) and major morbidities were similar, as was an estimated 12-year survival (69% 6.1% vs 59% 6.5%, P > 0.99). Conclusions: The use of veins to supplement arterial conduits did not deleteriously affect survival. However, the significant number of patients receiving arterial grafts in both groups may have masked any potential difference. Greater numbers and longer follow-up will reveal the potential of this approach.

The possible involvement of salicylic acid (SA) in a typical growth response of plants to shade light was investigated using the model system Stellaria longipes L. Goldie. The prairie (shade) ecotype of S. longipes is from foothills grassland habitat where it grows under shrubs or among taller grasses. The plants of this ecotype responded, as expected, with increased growth under lower red to far- red (R/FR) ratio and reduced photosynthetically active radiation (PAR). By contrast, the alpine (sun) ecotype is from an open sunny habitat, where canopy shade is a non- factor. The plants of this ecotype failed to respond with increased growth under a lower R/FR ratio, but had increased growth under a reduced PAR level. To examine the possible role of SA in shade light-mediated growth, the two main components of shade light, R/FR ratio and PAR, were uncoupled, and a series of experiments were per- formed by measuring the endogenous SA content and the plant response to exogenous SA concentrations. Contrary to the alpine plants, the prairie plants had increased endogenous SA content and higher shoot biomass accu- mulation under a low R/FR ratio treatment compared with normal or high R/FR ratios. Both alpine and prairie plants responded to a low PAR treatment with a decrease in endogenous SA content and an increase in shoot biomass accumulation, but the magnitude of this response was higher in prairie plants. Based on the results of this study, we conclude that shoot SA content is differentially regu- lated by both R/FR ratio and PAR signals, and SA may contribute, in ecotype specific manner, to growth changes in plants subjected to changing light environments.

Here, multiple functions of jasmonic acid (JA) in maize (Zea mays) are revealed by comprehensive analyses of JA-deficient mutants of the two oxo-phytodienoate reductase genes, OPR7 and OPR8. Single mutants produce wild-type levels of JA in most tissues, but the double mutant opr7 opr8 has dramatically reduced JA in all organs tested. opr7 opr8 displayed strong developmental defects, including formation of a feminized tassel, initiation of female reproductive buds at each node, and extreme elongation of ear shanks; these defects were rescued by exogenous JA. These data provide evidence that JA is required for male sex determination and suppression of female reproductive organ biogenesis. Moreover, opr7 opr8 exhibited delayed leaf senescence accompanied by reduced ethylene and abscisic acid levels and lack of anthocyanin pigmentation of brace roots. Remarkably, opr7 opr8 is nonviable in nonsterile soil and under field conditions due to extreme susceptibility to a root-rotting oomycete (Pythium spp), demonstrating that these genes are necessary for maize survival in nature. Supporting the importance of JA in insect defense, opr7 opr8 is susceptible to beet armyworm. Overall, this study provides strong genetic evidence for the global roles of JA in maize development and immunity to pathogens and insects.

R50 (sym16) is a pea nodulation mutant that accumulates cytokinin (CK) in its vegetative organs. Total CK content increases as the plant ages because of the low activity of the enzyme cytokinin oxidase/dehydrogenase (CKX) responsible for CK degradation. R50 exhibits a large seed with high relative water content, and its seedling establishes itself slowly. Whether these two traits are linked to abnormal CK levels was considered here. R50 was found to have a similar germination rate but a much slower epicotyl emergence than Sparkle, its wild-type (WT). At the onset of emergence, the starch grains in R50 cotyledons were larger than those of WT; furthermore, they did not degrade as fast as in WT because of low amylase activity. No differences between the pea lines were observed in the CK forms identified during seed embryogenesis. However, while CK content compared to that of WT was reduced early in R50 embryogenesis, it was elevated later on in its dry seeds where CKX activity was low, although CKX transcript abundance remained high. Transcripts of the two known PsCKX isoforms exhibited tissue- and development-specific profiles with no detectable PsCKX2 expression in cotyledons. There were more of both transcripts in R50 roots than in WT roots, but less of PsCKX2 than PsCKX1 in R50 shoots compared to WT shoots. Thus, although there is a definite CKX post-transcriptional defect in R50 dry seeds, an abnormal CK homeostasis is not the basis of the delay in R50 seedling establishment, which we linked to abnormal amylase activity early in development.

Prosthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA). It is uncertain whether PPM after mitral valve replacement impacts upon clinical outcome. This was examined in an Australian population.From 2001 to 2009, 1006 mechanical and bioprosthetic mitral valves were implanted across 10 institutions. Effective orifice areas (EOA) were obtained from a literature review of in vivo echocardiographic data. Absent, moderate and severe PPM was defined as an indexed EOA (EOA/BSA) of1.20 cm(2)/m(2),0.90 to ≤1.20 cm(2)/m(2) and ≤0.9 cm(2)/m(2), respectively. Early outcomes and 7-year survival were compared between these three groups.PPM was absent in 34%, moderate in 53% and severe in 13% of patients. Patients with PPM were more likely to be male (42% vs 52% vs 62%, p0.0001) and obese (14% vs 20% vs 56%, p0.0001). Postoperatively there was similar 30-day mortality (5% vs 5% vs 6%, p=0.83) and early any mortality/morbidity (24% vs 27% vs 29%, p=0.40). Seven-year survival was similar between groups (72±4.1% vs 76±3.2% vs 69±10.3%, p=0.76). PPM did not predict adverse events after logistic and Cox regressions with and without propensity score adjustment. Subgroup analyses of those with isolated mitral valve surgery, patients with preoperative congestive heart failure and non-obese patients failed to show an association between PPM and mid-term mortality.Overall, PPM was not associated with poorer early outcomes or mid-term survival. Oversizing valves may be technically hazardous and do not yield superior outcomes. Easier implantation by appropriate sizing appears justified.

In order to identify phytohormones involved in the initiation and maintenance of galls on the hackberry tree, Celtis occidentalis (Ulmaceae), in the presence of the insect Pachypsylla celtidis (Psyllidae); endogenous levels of cytokinins (CKs) and abscisic acid (ABA) were measured in the tissues of leaves, galls, and larval insects using liquid-chromatography-tandem-mass-spectrometry. The CKs isopentenyl adenine, isopentenyl adenosine, trans-zeatin and cis-zeatin, were extremely concentrated in insect larvae compared to surrounding tissue of leaves and galls. ABA concentrations in the insects were also relatively high at about 3268 pmol•g-1 fresh mass – approximately 25 times higher than in leaves, and 17 times higher than in galls. This represents a novel case of high concentrations of ABA being found in a larval insect. These findings indicate that manipulation of CK and ABA are involved in the initiation and maintenance of hackberry galls in the presence of larval P. celtidis.

IN 1948, FLINT, MICHIGAN, was more than the backdrop for a Michael Moore movie.1 While it may be difficult to imagine today, Flint was then a prosperous industrial center. The American automobile industry, with its associated auto dealers, commanded an important position in the nation’s economy. With that position came wealth and political influence, but also, in the immediate post-war period, industry concern about the degree to which the government would control the peacetime economy. A few key individuals operated at the intersection of the auto dealers and politics, one of the most prominent being Flint’s own Arthur Summerfield, an active partisan Republican, leader in the auto dealers’ trade group, and the owner of the nation’s largest Chevrolet dealership. If Summerfield were active today, federal laws and regulations would classify and regulate many of his activities. He was a key fundraiser for his party—a “bundler” or a “conduit” of campaign funds in modern parlance. His extensive contacts in Washington might also have qualified him as a lobbyist. Even in the 1940s, Summerfield and his colleagues’ activities were subject to a degree of regulation. Beginning in 1907 with the Tillman Act, Congress had enacted a series of laws limiting what individuals and corporations could do in federal elections. Those criminal provisions were rarely enforced, and guidance on their scope and application was elusive.2 In 1948, the United States Department of Justice chose to prosecute Summerfield’s auto dealers for making illegal corporate contributions to Michigan Republican party accounts, allegedly to influence federal elections. This article explores the events leading to that choice and the results of the prosecutions. Although there is relatively little published research on campaign finance regulation prior to the 1974 amendments to the Federal Election Campaign Act, the few scholars who have studied that earlier period have offered a number of theories to explain the general lack of federal enforcement that then prevailed, especially against corporations.3 One explanation might be that corporations were unpopular targets for prosecution. Or prosecutors might have doubted the constitutionality of the law and therefore been reluctant to risk unfavorable precedent. Prosecutors were oftentimes political figures themselves, so perhaps political pressure explained the lack of prosecutions. A final possibility is that few corporations violated the law.

Background Renal impairment is a major risk factor for cardiovascular disease. This study addressed clinical predictors of outcome following cardiac surgery, focusing on pre-operative renal dysfunction. Methods All patients undergoing cardiac surgery at Austin Health from June 1, 2001 to June 30, 2006, were included in the analysis. Logistic regression models were used to evaluate clinical factors predicting “operative mortality” and common post-operative complications. Results The operative mortality was 1.36% for coronary artery bypass grafting (CABG) alone (n = 1027), 5.07% for valve surgery alone (n = 217), 4.43% for combined CABG and valve surgery (n = 158) and 11.11% for other cardiac surgical procedures (n = 270). Amongst CABG alone patients, pre-operative renal impairment was a strong predictor of operative mortality, with a 35–43% increased risk of death (p = 0.005) for every 10 ml/min/1.73 m2 that the glomerular filtration rate was lower. Peripheral vascular disease, recent myocardial infarction and congestive cardiac failure also predicted operative mortality. Pre-operative renal impairment also increased the rate of various post-operative complications, as well as duration of admission. Conclusion Renal dysfunction is significantly associated with increased mortality and morbidity following cardiac surgery and necessitates careful consideration in risk benefit analysis when considering cardiac surgery.

Varicella-zoster virus (VZV)–specific cell-mediated immunity responses are essential for recovery from primary (varicella) or reactivation (herpes zoster) infection with VZV [1-4]. Patients who lack adequate VZV-specific cell-mediated immunity often have severe and prolonged infections with VZV, some of which are fatal [3-5]. Thus, VZV-specific cell-mediated immunity is a marker for protection against primary VZV infection, and the presence and magnitude of this response correlates with recovery from varicella and with the incidence and severity of reactivation as manifested by herpes zoster. VZV-specific cell-mediated immunity is also a component of primary responses to varicella vaccine administered to susceptible children and adults and has been used to evaluate candidate vaccines to prevent herpes zoster in immunocompromised and elderly individuals [6-9]. In this report, we present a regression model of VZV-specific memory CD4 responses as a function of age, from early childhood to advanced adulthood among healthy individuals with prior VZV wild-type infectionas a reference against which responses of other select groups of individuals are compared. Comparisons are made to elderly recipients of a zoster vaccine and to human immunodeficiency virus (HIV)–infected children and adults. We demonstrate that VZV-specific cell-mediated immunity is determined by the nature of primary immunization (natural infection vs VZV vaccination) and the age and immune status of the subject tested.

To evaluate the effectiveness of Opalescence PF 10% just after treatment, at 6-month follow-up and at a 14-month follow-up period.Opalescence PF 10% was applied nightly for 14 days. The color of teeth 11 and 21 of 17 subjects were measured with a spectrophotometer (L*; a*; b*) before treatment, just after treatment (14 days), after 6 months and after 14 months. Subjects were instructed to take note of any tooth sensitivity.For all three components (L*, a* and b*) statistical significant differences (p0.05) in the values between base-line, after treatment (14 days later), after 6 months and after 14 months were found (Wilcoxon Signed Rank Sum Test). The decrease in L* was about 20% after 6 months and about 50% after 14 months. The a* value decreased approximately 14% after 6 months but was worse after 14 months than at the beginning. The b* value decreased the least with about 9% after 6 months and about 8% after 14 months. The decrease in DeltaE(ab)(*) was approximately 20% after 14 months. Less than 20% of the subjects experienced mild tooth sensitivity just after treatment.Significantly whiter teeth were found after treatment as well as after a 6-month follow-up period. The whiteness/brightness (L*) decreased with approximately 50% after 14 months and the a* value with approximately 50% after 7 months, while the yellowness (b* value) remained even after 14 months.The product is an effective tooth whitener resulting in only low tooth sensitivity. Re-bleaching could be done at about 14 months.

Objective To investigate the optimum conduit for coronary targets other than the left anterior descending artery, we evaluated long-term patencies and clinical outcomes of the radial artery, right internal thoracic artery, and saphenous vein through the Radial Artery Patency and Clinical Outcomes trial. Methods As part of a 10-year prospective, randomized, single-center trial, patients undergoing primary coronary surgery were allocated to the radial artery (n = 198) or free right internal thoracic artery (n = 196) if aged less than 70 years (group 1), or radial artery (n = 113) or saphenous vein (n = 112) if aged at least 70 years (group 2). All patients received a left internal thoracic artery to the left anterior descending, and the randomized conduit was used to graft the second largest target. Protocol-directed angiography has been performed at randomly assigned intervals, weighted toward the end of the study period. Grafts are defined as failed if there was occlusion, string sign, or greater than 80% stenosis, independently reported by 3 assessors. Analysis is by intention to treat. Results At mean follow up of 5.5 years, protocol angiography has been performed in groups 1 and 2 in 237 and 113 patients, respectively. There are no significant differences within each group in preoperative comorbidity, age, or urgency. Patencies were similar for either of the 2 conduits in each group (log rank analysis, P = .06 and P = .54, respectively). The differences in estimated 5-year patencies were 6.6% (radial minus right internal thoracic artery) in group 1 and 2.9% (radial minus saphenous vein graft) in group 2. Conclusion At mean 5-year angiography in largely asymptomatic patients, the selection of arterial or venous conduit for the second graft has not significantly affected patency. This finding offers surgeons, for now, enhanced flexibility in planning revascularization.

Abraham P. Bos and Rein Ferwerda, Aristotle, On the Life-Bearing Spirit (De Spiritu). A Discussion with Plato and his Predecessors on Pneuma as the Instrumental Body of the Soul (G. Groenewoud) Linda Trinkaus Zagzebski, The Philosophy of Religion: An Historical Introduction (A. Vroom) Jonathan L. Kvanvig (ed.), Oxford Studies in Philosophy of Religion (J. de Ridder) Lambert Zuidervaart, Social Philosophy after Adorno (R. Hayward)

Phytochelatins are short, cysteine-containing, detoxification peptides produced by plants, algae, and fungi in response to heavy metal exposure. These peptides auto-oxidize easily. Current extraction protocols do not adequately address losses of phytochelatins because of their oxidation and the use of indirect methods for quantification. Method enhancements include the use of an argon environment during extraction to reduce auto-oxidation, the use of glycine-(13)C2-labeled glutathione as an internal standard, and an electrospray ionization source with a triple quadrupole mass spectrometer as a detector. The method-detection limits were 0.081 microM for glutathione, 0.440 microM for phytochelatin 2, and 0.120 microM for phytochelatin 3. These detection limits were comparable to similar studies and were not compromised incorporating these adjustments. The use of a labeled internal standard and an inert gaseous environment during sample preparation greatly improved calibration linearity and sensitivity. Furthermore, phytochelatin degradation was significantly reduced and more accurately tracked. Previous studies involving phytochelatin analyses have likely been subject to higher variability caused by this propensity for phytochelatins to degrade rapidly in air. The method adjustments were simple and cost-effective and allowed phytochelatin analyses to be performed for hours at a time with minimal auto-oxidation.

In almost 30 years of operation, the Very Large Array (VLA) has proved to be a remarkably flexible and productive radio telescope. However, the basic capabilities of the VLA have changed little since it was designed. A major expansion utilizing modern technology is currently underway to improve the capabilities of the VLA by at least an order of magnitude in both sensitivity and in frequency coverage. The primary elements of the Expanded Very Large Array (EVLA) project include new or upgraded receivers for continuous frequency coverage from 1 to 50 GHz, new local oscillator, intermediate frequency, and wide bandwidth data transmission systems to carry signals with 16 GHz total bandwidth from each antenna, and a new digital correlator with the capability to process this bandwidth with an unprecedented number of frequency channels for an imaging array. Also included are a new monitor and control system and new software that will provide telescope ease of use. Scheduled for completion in 2012, the EVLA will provide the world research community with a flexible, powerful, general-purpose telescope to address current and future astronomical issues., Added journal reference: published in Proceedings of the IEEE, Special Issue on Advances in Radio Astronomy, August 2009, vol. 97, No. 8, 1448-1462 Six figures, one table

Objectives: In order to determine the best conduit for coronary targets other than the left anterior descending (LAD) artery, long-term clinical outcomes following revascularisation with a radial artery or saphenous vein graft were evaluated as part of the radial artery patency and clinical outcomes (RAPCO) study. Methods: As part of the RAPCO protocol for this prospective, randomised, single-centre trial, patients aged over 70 years undergoing primary CABG were randomly assigned to use of a radial artery (n = 113) or saphenous vein (n = 112) to revascularise the best non-LAD coronary vessel. Follow-up was annual. Primary clinical end-points were death, myocardial infarction or need for revascularisation. Data were analysed by intention to treat. Results: The preoperative demographics (age, gender, presence of hypertension or diabetes mellitus) and urgency of surgery did not differ significantly between the two groups. The allocated arterial or venous conduit was utilised as intended in 104/ 113 and 110/112 patients, respectively. Mean number of grafts was 3.2 ±0.9 and 3.3 ± 0.7 in the two groups. During follow-up of mean duration 6.2 years (maximum 10.8 years) there were 16 deaths in each group and 9 vs 13 other events in the radial artery and saphenous vein groups, respectively. These clinical outcomes did not differ significantly (log rank p = 0.98 for survival and p = 0.52 for event-free survival). Conclusions: Use of a radial artery or saphenous vein for the second graft during primary CABG does not significantly influence clinical outcome at 6 years. Mean 5-year angiographic patency data are awaited, but from the patient's perspective the likelihood of a satisfactory long-term result is equivalent, whichever conduit is used.

Herpes zoster (HZ) is an often painful neurocutaneous syndrome resulting from reactivation of varicella-zoster virus (VZV) that has remained latent in sensory ganglia after primary VZV infection (varicella) [1–3]. The frequency and severity of HZ and its most common debilitating complication, postherpetic neuralgia (PHN), increase with age [4–9]. This age-related increase in disease correlates closely with the decline in VZV-specific T cell mediated immunity (VZV-CMI) that accompanies aging [10–14]. It is very unlikely that antibodies to VZV play a role in this relationship, because they do not decline with aging [13, 14]. Furthermore, HZ frequently occurs in circumstances when VZV-CMI is depressed while levels of VZV antibody are maintained by intravenous γ-globulin, such as those following hematopoietic stem cell transplantation [15–17] On the basis of these observations, it was hypothesized that HZ might be prevented or attenuated (i.e., less pain and PHN) in elderly individuals if their waning VZV-CMI could be boosted with a VZV vaccine [18–20]. Pilot studies indicated that VZV-CMI could be boosted in subjects ⩾60 years old with live attenuated Oka strain VZV vaccines [13, 14, 21, 22]. Subsequent trials demonstrated the safety and immunogenicity of a high-potency Oka/Merck VZV vaccine in elderly subjects, including persons with diabetes and chronic lung disease, and established the optimal vaccine formulation and potency (M.J. Levin et al., unpublished data) A double-blind, placebo-controlled trial (Veterans Affairs Cooperative Study 403: “The Shingles Prevention Study”) that involved 38,546 subjects ⩾60 years of age demonstrated that a high potency live attenuated Oka/Merck VZV vaccine (hereafter, “zoster vaccine”) significantly reduced the burden of illness due to HZ, understood in terms of a severity-by-duration measure of HZ pain and discomfort (i.e., the vaccine decreased the incidence of HZ and decreased the average severity of HZ in vaccinees who developed HZ), and substantially reduced the incidence of PHN in vaccine recipients [9]. The trial included an immunology substudy in which a subset of subjects had immunologic assessments performed before and after vaccination. We describe here the magnitude and kinetics of VZV-specific immune responses to zoster vaccine measured during the immunology substudy and their possible association with the occurrence of HZ

Background To investigate the optimum revascularization conduit for coronary territories other than that of the left anterior descending artery, long-term clinical outcomes after use of a radial artery or right internal thoracic artery were evaluated as part of the Radial Artery Patency and Clinical Outcomes (RAPCO) study. Methods As part of a 10-year prospective randomized single-center trial, patients aged less than 70 years undergoing primary coronary surgery were randomly allocated to the use of the radial artery (n = 198) or free right internal thoracic artery (n = 196) for grafting the largest target other than the left anterior descending artery. Annual follow-up documented death, myocardial infarction, or revascularization as primary endpoints. Analysis was on an intention-to-treat basis. Results There were no significant differences in the preoperative status of the two groups including age, sex, diabetes mellitus, hypertension, and urgency of surgery. One hundred eighty-six of 198 patients in the radial artery group and 179 of 196 patients in the right internal thoracic artery group received the intended conduit. Mean number of grafts was 3.1 ± 0.8 and 3.2 ± 0.9 in the radial artery and the right internal thoracic artery groups, respectively. During surveillance of as long as 10.4 years (mean, 6.0), absolute survival and event-free survival were equivalent between groups, with 13 versus 18 deaths and 24 versus 37 events (death, myocardial infarction, or revascularization) in the radial artery and the right internal thoracic artery groups, respectively (log rank: p = 0.36 for survival, p = 0.08 for event-free survival). Conclusions These two arterial conduits may yield equivalent clinical outcomes at 5 or more years. That finding will be compared with mean 5-year angiographic patency when available. For now, equivalent clinical results offer surgeons flexibility in planning revascularization.

Known since Kepler's observation that a comet's tail is oriented away from the sun, radiation pressure stimulated remarkable discoveries in electromagnetism, quantum physics and relativity [1,2]. This phenomenon plays a crucial role in a variety of systems, from atomic [3-5] to astronomical [6] scales. The pressure of light is associated with the momentum of photons, and it is usually assumed that both the optical momentum and the radiation-pressure force are naturally aligned with the propagation of light, i.e., its wavevector. Here we report the direct observation of an extraordinary optical momentum and force directed perpendicular to the wavevector, and proportional to the optical spin (i.e., degree of circular polarization). Such optical force was recently predicted for evanescent waves [7] and other structured fields [8]. It can be associated with the enigmatic "spin-momentum" part of the Poynting vector, which was introduced by Belinfante in field theory 75 years ago [9-11]. We measure this unusual transverse momentum using a nano-cantilever capable of femto-Newton resolution, which is immersed in an evanescent optical field above the total-internal-reflecting glass surface. Furthermore, the transverse force we measure exhibits another polarization-dependent contribution determined by the imaginary part of the complex Poynting vector. By revealing new types of optical forces in structured fields, our experimental findings revisit fundamental momentum properties of light and bring a new twist to optomechanics., 9 pages, 3 figures, Supplementary Information

The genomic sequence of the novel HLA-B*44:220 allele identified in a British Caucasoid male.

Total arterial revascularization (TAR) with internal thoracic arteries (ITAs) and radial arteries (RA) is associated with greater long-term survival compared with the use of a single internal thoracic artery supplemented by veins. The optimal conduit choice and configuration in achieving TAR remains controversial, with uncertainty regarding the individual prognostic impact of ITAs and RAs. As such, among patients solely undergoing TAR, we compared long-term survival between patients receiving single thoracic arteries and those receiving bilateral ITAs.From 1995 to 2010, 2821 patients with 3-vessel coronary artery disease at 8 centers underwent primary isolated coronary artery bypass with TAR using ITAs and RAs. Bilateral ITAs were used in 912 patients. In 380 cases, bilateral in situ ITAs were grafted to the left coronary system. RAs were used in 848 patients (93%) receiving bilateral ITAs and 1906 patients (99.8%) receiving single ITAs. Survival data were obtained using the National Death Index. Separate 1:1 propensity score-matched analyses were performed for (1) bilateral ITA versus single ITA and (2) bilateral ITA incorporating a free right ITA versus single ITA and RAs. Among the 912 patients with bilateral ITAs, those receiving an in situ right ITA to the left coronary system were compared with those receiving a free right ITA.In the propensity score-matched analysis comparing bilateral versus single ITAs (591 matched pairs), there were similar rates of 30-day mortality and deep sternal wound infection. Bilateral ITA use was associated with greater 15-year survival (79% ± 3.9% vs 67% ± 4.7%, P.001). In the analysis between bilateral ITA incorporating a free right ITA versus single ITA + RAs (380 matched pairs), bilateral ITA use demonstrated comparable survival at 15 years (79% ± 4.7% vs 67% ± 5.7%, P = .09). Among patients receiving bilateral ITAs, comparison between in situ right ITA versus free right ITA recipients (206 matched pairs) revealed comparable 15-year survival (84% ± 6.1% vs 79% ± 6.7%, P = .13). Multivariable Cox regression found bilateral ITA use to be protective from mortality (hazard ratio, 0.73; 95% confidence interval, 0.59-0.90, P = .004).The use of bilateral ITAs as an in situ or free conduit is associated with greater survival and seems to offer a prognostic advantage over the use of only a single ITA supplemented by RAs. Therefore, all configurations of TAR are not equivalent.

Salmonella enterica is a zoonotic pathogen of clinical and veterinary significance, with over 2500 serovars. In previous work we compared two serovars displaying host associations inferred from isolation statistics. Here, to validate genome sequence data and to expand on the role of environmental metabolite constitution in host range determination we use a phenotypic microarray approach to assess the ability of these serovars to metabolise ~500 substrates at 25°C with oxygen (aerobic conditions) to represent the ex vivo environment and at 37°C with and without oxygen (aerobic/anaerobic conditions) to represent the in vivo environment. A total of 26 substrates elicited a significant difference in the rate of metabolism of which only one, D-galactonic acid-g-lactone, could be explained by the presence (S. Mbandaka) or the absence (S. Derby) of metabolic genes. We find that S. Mbandaka respires more efficiently at ambient temperatures and under aerobic conditions on 18 substrates including: glucosominic acid, saccharic acid, trehalose, fumaric acid, maltotriose, N-acetyl-D-glucosamine, N-acetyl-beta-D-mannosamine, fucose, L-serine and dihydroxy-acetone; whereas S. Derby is more metabolically competent anaerobically at 37°C for dipeptides, glutamine-glutamine, alanine-lysine, asparagine-glutamine and nitrogen sources glycine and nitrite. We conclude that the specific phenotype cannot be reliably predicted from the presence of metabolic genes directly relating to the metabolic pathways under study.

Editors Note : This invited editorial is in response to articles recently published in The Journal of Thoracic and Cardiovascular Surgery . For more in depth information on this subject, please refer to the manuscript: Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival . J Thorac Cardiovasc Surg 2014; 148:1238–44.

Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) DNA on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV DNA. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. Pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV DNA in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV DNA in MNCs likely represents partial degradation of viral DNA in MNCs that trafficked through ganglia during productive infection.

Lymphatic research has infrastructure needs ranging from the nursing support provided by General Clinical Research Centers to training grants for future clinician investigators. Both have high priority in the activities currently funded by the Division of Clinical Research at NCRR. Further into the future, the therapeutic development networks and embryonic stem cells resources that are currently being developed should seem equally to have been essential resources.

Aims To evaluate the relationship between patterns of rosiglitazone use and cardiovascular (CV) outcomes in the Veterans Affairs Diabetes Trial (VADT). Methods Time-dependent survival analyses, case–control and 1 : 1 propensity matching approaches were used to examine the relationship between patterns of rosiglitazone use and CV outcomes in the VADT, a randomized controlled study that assessed the effect of intensive glycaemic control on CV outcomes in 1791 patients with type 2 diabetes (T2D) whose mean age was 60.4 ± 9 years. Participants were recruited between 1 December 2000 and 31 May 2003, and were followed for 5–7.5 years (median 5.6) with a final visit by 31 May 2008. Rosiglitazone (4 mg and 8 mg daily) was initiated per protocol in both the intensive-therapy and standard-therapy groups. Main outcomes included a composite CV outcome, CV death and myocardial infarction (MI). Results Both daily doses of rosiglitazone were associated with lower risk for the primary composite CV outcome [4 mg: hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.49–0.81 and 8 mg: HR 0.60, 95% CI 0.49–0.75] after adjusting for demographic and clinical covariates. A reduction in CV death was also observed (HR 0.25, p

We report a case of an infusion of intra-aortic propofol after the missed inadvertent placement of a centra venous catheter into the right common carotid artery. Radiological imaging revealed bilateral ischaemic infarct in the posterior fossa and right cerebral artery territories consistent with an embolic source. The potential cause of the neurological injuries sustained in this case are explored. Discussion focuses on the sequelae, managemen and prevention of an iatrogenic carotid artery injury from a central venous catheter insertion. Finally, we propose an algorithm for management of iatrogenic carotid artery cannulation.

This study examined individual and combined effects of the cancer treatments goserelin acetate (GA) and doxorubicin (DOX) on bone and determined if treadmill running (TM) provides osteoprotection.Ten-week-old female Sprague-Dawley rats were randomly assigned to sedentary (SED) or TM groups. SED received GA, DOX, combined GA and DOX (GA+DOX), or placebo and maintained normal cage activity. TM received GA, DOX, GA+DOX, or placebo and participated in a progressive motorized treadmill protocol. After 8 weeks, tibiae were evaluated using micro computed tomography.Negative drug effects were observed in cancellous bone (bone volume/tissue volume, trabecular number, trabecular thickness, trabecular spacing; P0.05). An additive bone volume/tissue volume and trabecular spacing effect was observed in SED GA+DOX (vs. SED+GA and SED+DOX, P0.05) but not in TM GA+DOX (vs. TM+GA and TM+DOX, P0.05). Negative drug effects were observed in cortical bone (cross-sectional volume, cortical volume, marrow volume; P0.05), but combined GA+DOX did not exacerbate these effects. Additionally, there were no protective cortical bone effects observed in TM.Combined GA+DOX exacerbates cancellous osteopenia in the tibia, and treadmill running provided only minor protection.

Background We examined whether socioeconomic status and rurality influenced outcomes after coronary surgery. Methods We identified 14,150 patients undergoing isolated coronary surgery. Socioeconomic and rurality data was obtained from the Australian Bureau of Statistics and linked to patients’ postcodes. Outcomes were compared between categories of socioeconomic disadvantage (highest versus lowest quintiles, n= 3150 vs. 2469) and rurality (major cities vs. remote, n=9598 vs. 839). Results Patients from socioeconomically-disadvantaged areas experienced a greater burden of cardiovascular risk factors including diabetes, obesity and current smoking. Thirty-day mortality (disadvantaged 1.6% vs. advantaged 1.6%, p>0.99) was similar between groups as was late survival (7 years: 83±0.9% vs. 84±1.0%, p=0.79). Those from major cities were less likely to undergo urgent surgery. There was similar 30-day mortality (major cities: 1.6% vs. remote: 1.5%, p=0.89). Patients from major cities experienced improved survival at seven years (84±0.5% vs. 79±2.0%, p=0.010). Propensity-analysis did not show socioeconomic status or rurality to be associated with late outcomes. Conclusion Patients presenting for coronary artery surgery from different socioeconomic and geographic backgrounds exhibit differences in their clinical profile. Patients from more rural and remote areas appear to experience poorer long-term survival, though this may be partially driven by the population's clinical profile.

Colonization trays containing three sediment types (formulated, Florissant, and pond) were field deployed in a pond and a stream to assess the influence of sediment type, colonization time, and habitat type on benthic macroinvertebrate colonization. Benthos colonizing the trays was compared to ambient fauna to determine similarity. The pond was chosen as the optimal habitat type. By week 12, organisms colonizing trays in each of the three sediment types placed in the pond were not statistically different from Ekman grab samples in regard to both total abundance and abundance of each dominant taxa. The Florissant-filled colonization trays were the most similar to Ekman grab samples. Percent composition of dominant taxa was most similar (89% based on an affinity index) to Ekman grab samples and had the least variation in composition from the Ekman grab samples. The majority of invertebrates in the stream colonized a superficial layer of debris rather than in the sediments originally placed in the t...