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Grapevine shoots and canes represent a significant amount of biomass, considered as a waste in viticulture. In cooler climates, grapevines are pruned in the autumn (October) and spring (March) due to harsh winter conditions (e.g., snow, low temperatures), and large amounts of biomass are produced at these different pruning times. This work was undertaken in order to investigate the potential of vineyard pruning waste for recovery of polyphenolic compounds for biomass valorization. Qualitative and quantitative analyses of grapevine shoot and cane polyphenols, including flavonoids and stilbenoids were performed using UHPLC MS/MS method. The results revealed the flavonols (quercetin) to be the most abundant compounds in shoots among all the three cultivars screened (Zilga, Hasansky Sladky, Rondo). Stilbenoids (ε-viniferin) dominated in the canes, while increased level of flavonols with lower contents of stilbenoids was detected in the endo-dormant canes, and higher amounts of flavanols and stilbenoids were recorded in eco-dormant canes. In conclusion, the content of polyphenols in grapevine shoots and canes differed among the cultivars and dormancy phases. The results generated from the present study contribute to the sustainable and environmentally friendly viticulture practice via valorization of vineyard pruning wastes.

Background: This research study aimed at assessing the electrocardiographic (ECG) changes caused by ageing in a cohort of healthy subjects with normal echocardiographic examinations., Methods: A total of 219 healthy individuals (119 males and 100 females) were evaluated for possible arrhythmias with a standard 12-lead resting ECG and 24-h Holter ECG. As the recordings were performed between 1998 and 2000, a 20-year follow-up study was carried out by assessing the local medical records to investigate whether the subjects had experienced any cardiovascular health complications or disease since the baseline assessment., Results: Eighty-three subjects (45 males and 38 females) presented with pathological ECG findings at baseline. The most common finding on analysis of Holter ECG recordings was premature atrial contractions, and the most severe pathological finding was episodes of ventricular tachycardia (eight subjects). Regarding the analysis of the standard 12-lead ECG, the most common finding was left ventricular hypertrophy, and the most severe pathological findings were ST-T changes and prolongation of the QT interval. Despite other cardiac examinations performed on these patients showing normal results, in combination with a strict inclusion criterion, this study showed that 28% of all subjects had pathological resting 12-lead ECGs at rest and 35% had pathological heart rhythms when assessed by 24-h Holter ECG. At follow-up, 21% of females and 43% of males had presented with ECG abnormalities, and 30% of females and 36% of males had cardiovascular disease. There was hypertension in 45% of females and in 58% of males. However, no association was found between the follow-up findings and ECG changes seen at baseline., Conclusion: Although most ECG changes found at baseline could be considered as a normal variation, they may progress to more severe heart complications as the subject ages. The results of this study also validate ECG findings of previous studies and underline that diagnostic criteria should be based on gender and age., Competing Interests: The authors declare no potential conflicts of interest., (© 2021 The Author(s). Published by Upsala Medical Society.)

Objectives: Patients with rheumatoid arthritis (RA) have an accelerated progression of atherosclerosis. The aims of this study were to study the associations between subsets of T-cells, subclinical atherosclerosis assessed by intima-media thickness (IMT) and serological status for CMV in patients with RA., Methods: Patients with new-onset RA (n=79), aged ≤60 years at diagnosis, were included in a prospective study of atherosclerosis. Controls matched for age and sex were also included (n=44). Ultrasound measurement of IMT in the common carotid artery was undertaken at inclusion (T0), after 1.5 years (T1.5) and after 11 years (T11). At T11, flow-cytometry analysis was undertaken to investigate subsets of T-cells. Serological analysis for CMV was undertaken from samples collected at T0., Results: At T0, 66% of the patients and controls were CMV immunoglobulin G-positive. CMV-IgG positive patients had a significantly more rapid increase in IMT at T1.5, compared with controls and CMV-IgG negative patients. CMV-IgG positive patients had a significantly higher percentage of T-cells lacking CD28 (both CD4+CD28null and CD8+CD28null T-cells) than CMV-IgG negative patients. Increased levels of CD4+CD28null and CD8+CD28null T-cells were significantly associated with IMT at T11, adjusted for systolic blood pressure. CX3CR1 was expressed in CD4+ and CD8+ CD28null T-cells, but CX3CR1 per se was not associated with increased IMT., Conclusions: Presence of CMV IgG-antibodies in patients with RA is associated with altered T-cell-populations and an increased burden of atherosclerosis. A possible protective effect of antiviral treatment in CMV-positive patients with new-onset RA should be considered.

This study aims to define the changes in the quality of bakery products depending on the β-glucan source and its contribution using bake-off technology. The examined bread was enriched with a 10% addition of oat flour, barley flour, oat fibre preparation, and barley fibre preparation. Bread was tested for rheological parameters, baking performance, hardness and springiness, water content, specific volume, porosity, crust and crumb colour, and β-glucan content. In the executed research, the adverse effect of this component on the formation of gluten network and hardness of the crumb was observed. In the double compression test, it was shown that the highest hardness on the day of baking was characterized by the bread with the addition of barley preparation. The fastest rate of staling was observed in the bread with additional barley flour that was affected by the highest amount of β-glucan. A significant decrease of the β-glucan level was also found during the technological bake-off process, which can be explained by the activity of enzymes.

Objectives: Patients with rheumatoid arthritis (RA) have an increased mortality and morbidity due to cardiovascular disease (CVD). In this prospective 5-year follow up of patients with RA, we analysed several biomarkers, known to be associated with atherosclerosis and/or inflammation in the general population. The aim of this study was to find out whether the RA-disease per se affect these biomarkers and if those could be associated with the progression of atherosclerosis, as measured by intima media thickness (IMT) among patients with early RA., Methods: Patients from northern Sweden diagnosed with early RA, are consecutively recruited into an ongoing prospective study on CVD comorbidity. A subgroup of patients, aged ≤60 years (n = 71) was included for ultrasound measurements of IMT at inclusion (T0) and after 5 years (T5) together with age-sex-matched controls (n = 40). The patients were clinically assessed. Blood was analysed for lipids, ESR and CRP and several biomarkers known to be associated with atherosclerosis in the general population., Results: At T0, the patients with RA had significantly lower levels of MIF and significantly higher levels of interleukin (IL)-18 and MIC-1 compared with controls. At T5, the patients with RA had significantly higher levels of pentraxin3, MIC-1, TNF-R2, ICAM-1, VCAM-1 and endostatin compared with controls. At T0 the levels of MPO correlated with DAS28, sCD40L with CRP and IL-18 with systolic blood pressure and Reynolds risk score. Using PLSR on a CVD-panel analysed with multiplex immunoassay, the patients with RA could be correctly classified into those who had a worsening in their IMT over the five years or not. Here, MMP3 was identified as influential., Conclusions: This study indicates that the RA disease itself could affect several of the biomarkers in this study, and possibly also the processes involved in the development of atherosclerosis., Competing Interests: The authors have declared that no competing interests exist.

Problem: Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented. The aim of this study was to systematically review findings from published randomized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants., Eligibility Criteria: Randomized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified. Articles accepted for inclusion met the following criteria: English language, original, peer refereed, randomized controlled clinical trials published within the past 5 years, study sample: preterm infants, setting: neonatal intensive care units, study intervention behavioral and environmental, outcome pain measurement score from valid and reliable pain scale., Sample: Fourteen randomized controlled trials from a literature search of PubMed and Medline databases were included in this review., Results: Across all age groups, facilitated tucking, oral sucrose, and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions., Conclusion: Among preterm infants, facilitated tucking, oral sucrose, and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures., Implications: Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants. This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Accurate age- and sex-related normal reference values of ventricular structure and function are important to determine the level of dysfunction in patients. The aim of this study therefore was to document normal age range sex-related measurements of LV structural and functional measurements to serve such purpose., Methods: We evaluated left ventricular structure and function in 293 healthy subjects between 20 and 90 years with equally distributed gender. Doppler echocardiography was used including measure of both systolic and diastolic functions., Results: Due to systolic LV function, only long axis function correlated with age (r = 0·55, P<0·01) and the correlation was stronger in females. Concerning diastolic function, there was a strong age correlation in all parameters used (r = 0·40-0·74, P<0·001). Due to LV structural changes over age, females showed a larger reduction in end-diastolic volumes, but no or trivial difference in wall thickness after the age of 60 years., Conclusion: Age is associated with significant normal changes in left ventricular structure and function, which should be considered when deciding on normality. These changes are related to systemic arterial changes as well as body stature, thus reflecting overall body ageing process. Furthermore, normal cardiac ageing in females might partly explain the higher prevalence of heart failure with preserved ejection in females., (© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

The intent of this commentary is to identify elements of fraction sense and note how the research studies provided in this special issue, in related but somewhat different ways, validate the importance of such understandings. Proficiency with fractions serves as a prerequisite for student success in higher level mathematics, as well as serving as a gateway to many occupations and varied contexts beyond the mathematics classroom. Fraction sense is developed through instructional opportunities involving fraction equivalence and magnitude, comparing and ordering fractions, using fraction benchmarks, and computational estimation. Such foundations are then extended to operations involving fractions and decimals and applications involving proportional reasoning. These components of fraction sense are all addressed in the studies provided in this issue, with particular consideration devoted to the significant importance of the use of the number line as a central representational tool for conceptually understanding fraction magnitude.

Objectives: To describe adverse events (AEs) and noteworthy clinical or ocular findings associated with retinopathy of prematurity (ROP) evaluation procedures., Study Design: Descriptive analysis of predefined AEs and noteworthy findings reported in a prospective observational cohort study of infants <1251 g birth weight who had ROP study visits consisting of both binocular indirect ophthalmoscopy (BIO) and digital retinal imaging. We compared infant characteristics during ROP visits with and without AEs. We compared respiratory support, nutrition, and number of apnea, bradycardia, or hypoxia events 12 hours before and after ROP visits., Results: A total of 1257 infants, mean birth weight 802 g, had 4263 BIO and 4048 imaging sessions (total 8311 procedures). No serious AEs were related to ROP visits. Sixty-five AEs were reported among 61 infants for an AE rate of 4.9% infants (61/1257) or 0.8% total procedures (65/8311 BIO + imaging). Most AEs were due to apnea, bradycardia, and/or hypoxia (68%), tachycardia (16%), or emesis (8%). At ROP visit, infants with AEs, compared with those without, were more likely to be on mechanical ventilation (26% vs 12%, P = .04) even after adjustment for weight and postmenstrual age. Noteworthy clinical findings were reported during 8% BIO and 15% imaging examinations. Respiratory and nutrition support were not significantly different before and after ROP evaluations., Conclusions: Retinal imaging by nonphysicians combined with BIO was safe. Noteworthy clinical findings occurred during both procedures. Ventilator support was a risk factor for AEs. Monitoring rates of AEs and noteworthy findings are important to the safe implementation of ROP imaging protocols., Trial Registration: Clinicaltrials.gov: NCT01264276., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls., Methods: Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included., Results: In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent., Conclusion: This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation, is associated with cardiovascular disease. This prospective study of an inception cohort aimed to investigate whether the level of Lp-PLA2 is associated with subclinical atherosclerosis in patients with rheumatoid arthritis (RA)., Methods: Patients from northern Sweden diagnosed with early RA were consecutively recruited into an ongoing prospective study. From these, all patients ≤60 years (n = 71) were included for measurements of subclinical atherosclerosis at inclusion (T0) and five years later (T5). Forty age- and sex-matched controls were included. The patients were clinically assessed, SCORE, Reynolds Risk Score, and Larsen score were calculated, and blood samples were drawn from all individuals at T0 and T5., Results: There was no significant difference in the level of Lp-PLA2 between patients with RA and controls (p > 0.05). In simple linear regression models among patients with RA, Lp-PLA2 at T0 was significantly associated with intima media thickness (IMT) at T0 and T5, flow mediated dilation (FMD) at T0 and T5, ever smoking, male sex, HDL-cholesterol (inversely), non-HDL-cholesterol, SCORE, Reynolds Risk Score, and Larsen score (p < 0.05). CONCLUSION. In this cohort of patients with early RA, the concentration of Lp-PLA2 was associated with both subclinical atherosclerosis and disease severity.

An infant of 36 weeks' postmenstrual age (PMA) and 25 weeks' gestation received bilateral intravitreal bevacizumab injections for type 1 retinopathy of prematurity. He underwent laser photocoagulation in both eyes 5 days later, confluent except for 1 clock hour obscured by hemorrhage in the left eye. Despite initial regression, neovascularization in both vascularized and lasered retina with plus disease recurred, requiring repeat laser bilaterally at 51 weeks' PMA and vitrectomy in the left eye at 54 weeks' PMA. Whereas late recurrence is thought to occur rarely after laser treatment, infants who have received both bevacizumab injections and laser may still require long-term surveillance for recurrence. In this case, fundus photography proved valuable for appreciating recurrent plus disease because the initial treatments had resulted in marked retinal vessel attenuation., (Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Aims: The aim was to determine the incidence of new ischaemic lesions on diffusion-weighted MR imaging (DWI) in a non-randomised cohort of patients after protected and unprotected carotid artery stent placement using the Parodi Anti-Emboli System (PAES)., Methods and Results: A retrospective review was conducted on 269 patients who received DWI prior to, and 24-72 hours after, stent placement. All patients were enrolled in one centre. Forty patients stented with the PAES device were matched with 229 patients stented without protection (control group). New diffusion restriction on DWI was detected in 25.8% (PAES) versus 32.3% (control group); p=0.64. On average there were 0.7 lesions (PAES) versus 0.8 lesions (control group) per patient. The area of lesions was 1.7 (PAES) versus 5.6 mm2. In a subanalysis of patients (32 PAES, 148 non-protected) with >80% stenosis, the area of restricted diffusion was less when proximal protection was used (p<0.05). The number and area of DWI lesions did not differ on the contralateral, non-stented side. When the PAES system was used, patients were more likely not to have any lesion at all (p=0.028)., Conclusions: In high-grade stenosis, the use of the Gore PAES device significantly reduced the area of new DWI lesions and patients were more likely not to have any new DWI lesion at all.

Background and Objectives: Events in the delivery room significantly impact the outcomes of preterm infants. We developed evidence-based guidelines to prevent heat loss, reduce exposure to supplemental oxygen, and increase use of noninvasive respiratory support to improve the care and outcomes of infants with birth weight ≤1250 g at our institution., Methods: The guidelines were implemented through multidisciplinary conferences, routine use of a checklist, appointment of a dedicated resuscitation nurse, and frequent feedback to clinicians. This cohort study compares a historical group (n = 80) to a prospective group (n = 80, after guidelines were implemented). Primary outcome was axillary temperature at admission to the intensive care nursery. Secondary outcomes measured adherence to the guidelines and changes in clinically relevant patient outcomes., Results: Baseline characteristics of the groups were similar. After introduction of the guidelines, average admission temperatures increased (36.4°C vs 36.7°C, P < .001) and the proportion of infants admitted with moderate/severe hypothermia fell (14% vs 1%, P = .003). Infants were exposed to less oxygen during the first 10 minutes (P < .001), with similar oxygen saturations. Although more patients were tried on continuous positive airway pressure (40% vs 61%, P = .007), the intubation rate was not significantly different (64% vs 54%, P = .20). Median durations of invasive ventilation and hospitalization decreased after the quality initiative (5 vs 1 days [P = .008] and 80 vs 60 days [P = .02], respectively)., Conclusions: We have demonstrated significantly improved quality of delivery room care for very preterm infants after introduction of evidence-based delivery room guidelines. Multidisciplinary involvement and continuous education and reinforcement of the guidelines permitted sustained change.

Despite recent advances, automatic blood vessel extraction from low quality retina images remains difficult. We propose an interactive approach that enables a user to efficiently obtain near perfect vessel segmentation with a few mouse clicks. Given two seed points, the approach seeks an optimal path between them by minimizing a cost function. In contrast to the Live-Vessel approach, the graph in our approach is based on the curve fragments generated with vessel tracing instead of individual pixels. This enables our approach to overcome the shortcut problem in extracting tortuous vessels and the problem of vessel interference in extracting neighboring vessels in minimal-cost path techniques, resulting in less user interaction for extracting thin and tortuous vessels from low contrast images. It also makes the approach much faster.

Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications., Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy., Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis--not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95%CI 4.2-20.8%) had carotid stenosis--significantly over the 5% pre-specified threshold (p = 0.014, Binomial test)., Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy., Trial Registration: The study was registered at http://www.clinicaltrials.gov; NCT00514644.

Objective: To develop an efficient clinical prediction model that includes postnatal weight gain to identify infants at risk of developing severe retinopathy of prematurity (ROP). Under current birth weight (BW) and gestational age (GA) screening criteria, <5% of infants examined in countries with advanced neonatal care require treatment., Patients and Methods: This study was a secondary analysis of prospective data from the Premature Infants in Need of Transfusion Study, which enrolled 451 infants with a BW < 1000 g at 10 centers. There were 367 infants who remained after excluding deaths (82) and missing weights (2). Multivariate logistic regression was used to predict severe ROP (stage 3 or treatment)., Results: Median BW was 800 g (445-995). There were 67 (18.3%) infants who had severe ROP. The model included GA, BW, and daily weight gain rate. Run weekly, an alarm that indicated need for eye examinations occurred when the predicted probability of severe ROP was >0.085. This identified 66 of 67 severe ROP infants (sensitivity of 99% [95% confidence interval: 94%-100%]), and all 33 infants requiring treatment. Median alarm-to-outcome time was 10.8 weeks (range: 1.9-17.6). There were 110 (30%) infants who had no alarm. Nomograms were developed to determine risk of severe ROP by BW, GA, and postnatal weight gain., Conclusion: In a high-risk cohort, a BW-GA-weight-gain model could have reduced the need for examinations by 30%, while still identifying all infants requiring laser surgery. Additional studies are required to determine whether including larger-BW, lower-risk infants would reduce examinations further and to validate the prediction model and nomograms before clinical use.

BACKGROUND: Platelets may act as vascular endothelial growth factor (VEGF) scavengers, possibly limiting neovascularization in retinopathy of prematurity (ROP). The purpose of this study was to investigate the association between thrombocytopenia (platelets <150,000/μL) and the development of type 1 ROP. METHODS: This was a retrospective 1:1 matched case-control study. Cases required laser; controls developed no or stage 1 ROP and were matched for birth weight within 100 g and gestational age within 1 week. Most recent platelet count prior to laser (case) and matched postmenstrual age (control) were abstracted. Conditional logistic regression was used. RESULTS: A total of 91 cases and 91 controls were reviewed. Of the cases, 25% had thrombocytopenia; of controls, 13% (P = 0.034; OR = 2.38; 95% CI, 1.04-5.43). Birth weight, gestational age, postmenstrual age, and culture-proven sepsis were not confounders in multivariate analysis. The association was significant for zone 1 (n = 16; OR = 9.00; 95% CI, 1.14-71.0) but not for zone 2 (OR = 1.43; 95% CI, 0.54-3.75) cases and controls. CONCLUSIONS: Thrombocytopenia was associated with type 1 ROP, primarily among infants with zone 1 ROP. This effect may result from disease location or disease timing, as posterior disease occurs at an earlier postmenstrual age. Longitudinal studies are required to further examine the roles of cumulative platelet deficits, thresholds, or critical time windows in the observed association.

Introduction: In this study we aimed to investigate whether there are indications of premature atherosclerosis, as measured by endothelial dependent flow-mediated dilation (ED-FMD) and intima media thickness (IMT), in patients with very early RA, and to analyze its relation to biomarkers of endothelial dysfunction, taking inflammation and traditional cardiovascular disease (CVD) risk factors into account., Methods: Patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study of CVD co-morbidity. Of these, all patients aged ≤60 years were consecutively included in this survey of CVD risk factors (n = 79). Forty-four age and sex matched controls were included. IMT of common carotid artery and ED-FMD of brachial artery were measured using ultrasonography. Blood was drawn for analysis of lipids, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA)-mass, VonWillebrand factor (VWF), soluble intercellular adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), sE-selectin, sL-selectin and monocyte chemotactic protein-1 (MCP-1). In a subgroup of 27 RA patients and their controls the ultrasound measurements were reanalysed after 18 months., Results: There were no significant differences between RA patients and controls in terms of IMT or ED-FMD at the first evaluation. However after 18 months there was a significant increase in the IMT among the patients with RA (P < 0.05). Patients with RA had higher levels of VWF, sICAM-1 (P < 0.05) and of MCP-1 (P = 0.001) compared with controls. In RA, IMT was related to some of the traditional CVD risk factors, tPA-mass, VWF (P < 0.01) and MCP-1 and inversely to sL-selectin (P < 0.05). In RA, ED-FMD related to sL-selectin (P < 0.01). DAS28 at baseline was related to PAI-1, tPA-mass and inversely to sVCAM-1 (P < 0.05) and sL-selectin (P = 0.001)., Conclusions: We found no signs of atherosclerosis in patients with newly diagnosed RA compared with controls. However, in patients with early RA, IMT and ED-FMD were, to a greater extent than in controls, related to biomarkers known to be associated with endothelial dysfunction and atherosclerosis. After 18 months, IMT had increased significantly in RA patients but not in controls.

The killer cell lectin-like receptor G1 (KLRG1) is expressed by NK cells and by T cells. In both humans and mice, KLRG1 identifies Ag-experienced T cells that are impaired in their proliferative capacity but are capable of performing effector functions. In this study, we identified E-cadherin as a ligand for murine KLRG1 by using fluorescently labeled, soluble tetrameric complexes of the extracellular domain of the murine KLRG1 molecule as staining reagents in expression cloning. Ectopic expression of E-cadherin in B16.BL6 target cells did not affect cell-mediated lysis by lymphokine-activated NK cells and by CD8 T cells but inhibited Ag-induced proliferation and induction of cytolytic activity of CD8 T cells. E-cadherin is expressed by normal epithelial cells, Langerhans cells, and keratinocytes and is usually down-regulated on metastatic cancer cells. KLRG1 ligation by E-cadherin in healthy tissue may thus exert an inhibitory effect on primed T cells.

Objective: To study changes in Finnish GPs' child-psychiatric networks over a one-year period., Design: Postal questionnaire., Setting: Health centres in the area of Tampere University Hospital with a catchment population of one million., Intervention: A one-off course in the field of child psychiatry was held 56 times in different health centres., Subjects: GPs (n = 761) working in the area received a questionnaire in 2000 and 2001. Those responding in both years were included in the analysis (n = 371)., Main Outcome Measures: A fill-in picture was used to identify professionals in the network of each GP. Three levels were analysed: (1) health centre, (2) municipality, and (3) secondary healthcare., Results: The number of collaborators increased significantly only in the training group at municipality level. No statistically significant differences were found in proportions of GPs naming cooperating persons., Conclusion: The impact of a one-off training programme on the scope of GPs' child-psychiatric networks was not very strong but was in accordance with the aims of the programme.

Airway irritants such as ozone are known to impair lung function and induce airway inflammation. Clara cell protein (CC16) is a small anti-inflammatory protein secreted by the nonciliated bronchiolar Clara cells. CC16 in serum has been proposed as a noninvasive and sensitive marker of lung epithelial injury. In this study, we used lung function and serum CC16 concentration to examine the pulmonary responses to ambient O3 exposure and swimming pool attendance. The measurements were made on 57 children 10-11 years of age before and after outdoor exercise for 2 hr. Individual O3 exposure was estimated as the total exposure dose between 0700 hr until the second blood sample was obtained (mean O3 concentration/m3 times symbol hours). The maximal 1-hr value was 118 microg/m3 (59 ppb), and the individual exposure dose ranged between 352 and 914 microg/m3hr. These O3 levels did not cause any significant changes in mean serum CC16 concentrations before or after outdoor exercise, nor was any decrease in lung function detected. However, children who regularly visited chlorinated indoor swimming pools had significantly lower CC16 levels in serum than did nonswimming children both before and after exercise (respectively, 57 +/- 2.4 and 53 +/- 1.7 microg/L vs. 8.2 +/- 2.8 and 8.0 +/- 2.6 microg/L; p < 0.002). These results indicate that repeated exposure to chlorination by-products in the air of indoor swimming pools has adverse effects on the Clara cell function in children. A possible relation between such damage to Clara cells and pulmonary morbidity (e.g., asthma) should be further investigated.

The potential for removing uranium from contaminated groundwater by stimulating the in situ activity of dissimilatory metal-reducing microorganisms was evaluated in a uranium-contaminated aquifer located in Rifle, Colo. Acetate (1 to 3 mM) was injected into the subsurface over a 3-month period via an injection gallery composed of 20 injection wells, which was installed upgradient from a series of 15 monitoring wells. U(VI) concentrations decreased in as little as 9 days after acetate injection was initiated, and within 50 days uranium had declined below the prescribed treatment level of 0.18 micro M in some of the monitoring wells. Analysis of 16S ribosomal DNA (rDNA) sequences and phospholipid fatty acid profiles demonstrated that the initial loss of uranium from the groundwater was associated with an enrichment of Geobacter species in the treatment zone. Fe(II) in the groundwater also increased during this period, suggesting that U(VI) reduction was coincident with Fe(III) reduction. As the acetate injection continued over 50 days there was a loss of sulfate from the groundwater and an accumulation of sulfide and the composition of the microbial community changed. Organisms with 16S rDNA sequences most closely related to those of sulfate reducers became predominant, and Geobacter species became a minor component of the community. This apparent switch from Fe(III) reduction to sulfate reduction as the terminal electron accepting process for the oxidation of the injected acetate was associated with an increase in uranium concentration in the groundwater. These results demonstrate that in situ bioremediation of uranium-contaminated groundwater is feasible but suggest that the strategy should be optimized to better maintain long-term activity of Geobacter species.

Application of clinical phytology in treatment of oncology diseases was limited by intensive development of chemical pharmaceuticals and surgery. The authors had set the task to develop the computer database for phytotherapy application. The database included full information on patient's clinical status (identified diseases, symptoms, syndromes) and applied phytotherapy treatment. Special attention was paid to the application of phyto preparations containing chitosan. The computer database contains information on 2335 patients. It supports reliable data on efficiency of phytotherapy in general and allows to evaluate the efficiency of some particular medicinal herbs and to develop efficient complex phyto preparations for treatment of specific diseases. The application of phytotherapy in treatment of oncology patients confirmed the positive effect on patient's quality of life. In conclusion it should be emphasized that the present situation of practical application of phytotherapy could be considered as unacceptable because of absence of necessary knowledge and practical experience in using phytotherapy in outpatient clinics, hospitals and medicinal centers.

Background: Transthyretin amyloidosis is today an accepted indication for orthotopic liver transplantation (OLT). For several mutations progression of the cardiomyopathy has been observed after OLT. The aim of this study was to assess the course of cardiac involvement in Swedish familial amyloidotic polyneuropathy (FAP), Portuguese type, after OLT. By comparison of the echocardiographic findings before OLT with those obtained after, the course of the heart involvement was followed., Methods: Twenty-three patients, who had undergone OLT and were examined with echocardiography 1-12 months before OLT, were available for the study. Twenty-one patients were examined 12-27 months after OLT, and 12 were re-examined 52-71 months after OLT. Two-dimensional and M-mode echocardiography were performed in accordance with the standards of the American Society of Echocardiography., Results: A significantly increased septal and left ventricular posterior wall thickness and a significantly increased left atrial dimension was observed at the post-OLT examinations, indicating a progression of the amyloid heart disease. This increase of the cardiac involvement was neither correlated to waiting time for OLT or to pre-operative signs of cardiomyopathy., Conclusions: Even though the production of the amyloidogenic-mutated transthyretin is stopped by OLT, the cardiomyopathy may progress after the operation even for the Portuguese type of FAP. The increase of the septal and left ventricular posterior wall thickness after OLT is not restricted to patients with signs of left ventricular hypertrophy before the transplantation. The findings have important implications for the follow-up of FAP patients after OLT.

Objective: To compare the myocardium at risk (MAR) as estimated by computerized vectorcardiography (cVCG) with MAR determined by Tc-99m-sestamibi-SPECT using coronary angioplasty as the model for transient transmural ischemia in humans., Methods and Results: In 37 patients with stable angina pectoris, cVCG was recorded continuously during coronary angioplasty. The scintigraphic defect was quantified using an automated software program (CEqual). The ST vector magnitude (ST-VM) and the ST change vector magnitude (STC-VM) correlated well with MAR estimated by scintigraphy, ST-VM (r = 0.71, p < 0.001) and STC-VM (r = 0.84, p < 0.001). All patients with STC-VM <50 microV during occlusion had defects of less than 10% of the left ventricle., Conclusion: 1) ST-VM and STC-VM give a reasonable useful estimate of MAR size during transient coronary occlusion. 2) STC-VM <50 microV is a reliable limit to identify patients with MAR size less than 10%. 3) ST-VM does not add information to STC-VM with respect to detection of ischemia. 4) The existence of collateral vessels has great impact on both ST-vector changes and scintigraphic imaging of myocardial ischemia.

T cell and natural killer (NK) cell functions are regulated by triggering of activating and inhibitory cell surface receptors. Here, we have studied the expression profile and predicted inhibitory function of mouse "killer cell lectin-like receptor G1" (KLRG1) on CD8 T cells. KLRG1 was present on 1 - 3 % of adult splenic CD8 cells that expressed CD8alpha beta heterodimers as well as a polyclonal TCR Vbeta repertoire indicative of conventional CD8 cells. The majority of KLRG1(+) CD8 cells belonged to the memory pool as determined by extensive phenotypic marker analysis. Spontaneous IFN-gamma production by approximately 20 % of KLRG1(+) CD8 cells identified them as pro-inflammatory effector cells. In contrast to NK cells, Ly49 and KLRG1 expression on CD8cells was found to be mutually exclusive. Therefore, distinct programs regulate KLRG1 expression in CD8 and NK cells. Finally, we provide evidence that KLRG1 triggering interferes with TCRalpha beta-mediated Ca(++) mobilization and cytotoxicity, raising the possibility that KLRG1 functionally participates in down-regulation of CD8 T cell responses.

Objective: To measure the extent of atherosclerosis in patients with rheumatoid arthritis (RA) with a disease duration of considerable length, and in age and sex matched individuals., Methods: Thirty-nine patients with RA (30 women, 9 men) with disease onset occurring between 1974 and 1978, and less than 65 years of age at the time of investigation, were enrolled together with 39 sex and age matched controls. Quantitative measurement of intima-media thickness (IMT) and semiquantitative assessment of the presence of plaque were undertaken by B-mode ultrasound of the common carotid artery (CCA-IMT) and the common femoral artery on the right-hand side. Echo Doppler cardiography was performed with an Accuson Aspen. The results were related to disease activity variables and accumulated disease activity, to lipid levels [i.e., cholesterol, high density lipoproteins, low density lipoproteins, triglycerides (TG)], to hemostatic factors [tissue plasminogen activator antigen (tPAag), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF)], and to soluble adhesion molecules (sICAM-1 and sE-selectin)., Results: Patients with RA had higher maximal and mean IMT values compared with controls. The difference concerning mean CCA-IMT reached statistical significance in patients with RA and correlated significantly with lipids (cholesterol, LDL, LDL/HDL ratio, TG) and tPAag. The prevalence of plaques, as well as of aortic cusp sclerosis, was higher in RA but only the difference in aortic cusp sclerosis was statistically significant. Patients with plaques had significantly higher levels of lipids (cholesterol, LDL, LDL/HDL ratio) than patients without plaques, while patients with cusp sclerosis had significantly higher cholesterol and TG levels. sICAM-1 was significantly higher both in patients with plaques and in those with aortic cusp sclerosis compared to patients without., Conclusion: Our results suggest an accelerated atherosclerosis in patients with RA that is related mainly to lipid levels.

Background and Objectives: To evaluate the complication and visual outcomes of residents performing temporal clear cornea (TCC) compared to superior scleral tunnel (SST) phacoemulsification., Patients and Methods: We conducted a retrospective analysis of complications and visual outcomes for 534 phacoemulsification procedures done by third-year residents over a five-year period (June 1992-July 1997) at the department of ophthalmology, University of Chicago. All cases were completed using a TCC or SST incision., Results: There was vitreous loss in 6.0% of 348 eyes with TCC incisions and in 11.8% of 186 eyes with SST incisions (P < 0.02). Posterior capsule breaks occurred in 1 1.5% of the TCC group versus 17.7% in the SST group (P < 0.0453). Best corrected visual acuity of 20/40 or better was achieved in 82.5% of all eyes with TCC incisions and in 75.3% of all eyes with SST incisions (P < 0.05). When 151 patients with previous ophthalmic conditions were excluded, the difference in BCVA between the two groups was not statistically significant., Conclusions: Most institutions train residents with the SST technique prior to advancing to TCC. This study demonstrates that with proper teaching, residents can achieve excellent outcomes using TCC incisions, and can therefore be trained in this technique concurrently with SST incisions.

Purpose: To report a patient who developed photic maculopathy after pterygium removal., Methods: A 27-year-old woman underwent pterygium removal with a conjunctival autograft after administration of retrobulbar anesthesia. A coaxial operating microscope was used, with an estimated retinal exposure of approximately 40 minutes., Results: On the first postoperative day, the patient noted a paracentral scotoma. A fluorescein angiogram on the fourth postoperative day documented a phototoxic lesion in the macula., Conclusions: Phototoxic injury to the macula may occur after pterygium removal. Ophthalmologists should take precautions to minimize prolonged intense coaxial illumination of the retina while performing any ocular microsurgery.

Purpose: To determine the antiproliferative effect of minoxidil on human corneal epithelium (hCE) proliferation in vitro and to assess whether topical minoxidil can significantly alter corneal topography after radial keratotomy (RK) by inhibiting myofibroblast activity in the keratotomy wound., Setting: Corneal Research Laboratory, University of Chicago, Illinois, USA., Methods: In the in vitro evaluation, proliferating hCE was exposed to minoxidil (0.1 to 2.0 mM) for 96 hours to determine the minimum inhibitory dose. Human corneal epithelium cell proliferation was assessed by the incorporation of bromodeoxyuridine (BRDU) into DNA. In the in vivo analysis, eight New Zealand albino rabbits had an eight-incision bidirectional RK on one eye and were divided into two groups. The control eyes (n = 3) received tobramycin and dexamethasone (TobraDex), ciprofloxacin hydrochloride (Ciloxan), and balanced salt solution (BSS) drops four times a day for 3 weeks, while the treatment eyes (n = 5) received TobraDex, Ciloxan, and minoxidil 1.0 mM drops four times daily for 3 weeks. The net change in corneal curvature at 3 weeks was analyzed with corneal topography. Myofibroblast activity in the keratotomy wound was assessed using alpha smooth muscle actin staining techniques., Results: At concentrations of 1.0 mM and above, minoxidil caused a statistically significant, dose-dependent reduction in hCE cellular proliferation ranging from 29 to 44% (P < .05). Minoxidil (1.0 mM) caused a statistically significant central corneal flattening effect of 4.66 diopters (D) after RK in the treatment eyes compared with 1.11 D in the control eyes (P = .05). Histologically, minoxidil-treated keratotomy wounds lacked cells with contractile elements consistent with myofibroblast differentiation. Corneal epithelial wound healing was similar in both groups., Conclusion: At the appropriate dose, topical minoxidil may be a useful adjunctive treatment that can reduce the number of undercorrections after mini-RK without apparent toxicity to the corneal epithelium.

The objective of the study was evaluation of the pulmonary venous blood flow (PVF) pattern and the influence of ventricular function and atrioventricular valve regurgitation on this flow in patients with univentricular hearts post total cavo-pulmonary connection (TCPC). Transthoracic or transoesophageal echocardiographic studies were performed in 24 children with normal hearts (group A) and in 24 patients with univentricular hearts (group B). Ventricular function and atrioventricular valve regurgitation was semiquantitatively assessed. Systolic/diastolic maximal velocities and velocity time integrals (VTI) were measured from PVF tracings. Ejection fraction was measured by radionuclide angiography in 11 patients. Twelve patients underwent heart catheterization and angiography. In group B the PVF showed a biphasic flow velocity curve. The systolic integrals were smaller and the diastolic integrals were larger than in group A (6.4 vs. 13.0 cm, P = 0.0001, and 13.9 vs. 10.0 cm, P = 0.005). The pulmonary venous systolic flow fraction in 13 patients with an open fenestration and/or atrioventricular valve regurgitation grade 2-3 was significantly lower than in those 11 patients without fenestration and none/small regurgitation (0.19 vs. 0.40, P = 0.05). In conclusion, the PVF pattern in children with univentricular hearts pallitated with TCPC is similar to the PVF pattern found in individuals with biventricular hearts showing a biphasic flow velocity curve despite the absence of pulsatile pulmonary artery flow. The PVF in patients with TCPC-palliated univentricular hearts is influenced by atrioventricular valve regurgitation and fenestration flow.

Perioperative cardiac morbidity is a recognized complication of anesthesia and surgery. Morbidity includes myocardial infarction, new onset of unstable angina, congestive heart failure, and arrhythmias. Almost one third of all patients undergoing noncardiac surgery may be at increased risk of cardiac complications by virtue of age, coronary artery disease (CAD), or presence of two or more risk factors for CAD. Although postoperative ischemia has been identified as a significant risk factor for morbidity, automated ST segment analysis systems available with the new generation bedside monitors have not been used to identify ischemic episodes in patients recovering from anesthesia. Twenty-eight patients, age 41 to 80 years, were monitored in the postanesthesia care unit for ST segment changes (mean monitoring period, 97 minutes). Four patients had ischemic episodes from 7 to 44 minutes, and two of these patients had subsequent postoperative morbidity. All episodes were clinically silent. Automated ST segment analysis is an easily used technology that shows promise as a means of early detection of clinically silent perioperative myocardial ischemia.

Background and Aims of the Study: In patients with mitral regurgitation, left ventricular angiography is usually performed to grade the regurgitation. This is a semi-quantitative method which gives some information related to the regurgitant volume at a certain time. The aim of our study was to evaluate the benefits of invasive hemodynamic examinations during stress. Patients with mitral regurgitation according to Doppler color flow mapping, and regurgitation of no more than grade 2+ according to left ventricular angiography, were of special interest., Methods: One hundred and four consecutive patients were examined with transesophageal echocardiography (TEE), left ventricular angiography and cardiac catheterization during rest and during hemodynamic stress., Results: All patients had mitral regurgitation according to Doppler color flow mapping. Thirty eight patients had a mitral regurgitation of grade 0, 1+ or 2+ according to left ventricular angiography. Of these, seven had a resting v-wave < or = 25 mmHg, and a v wave > or = 50 mmHg during stress. When these seven patients were compared with those with severe grade 3+ and 4+ regurgitation, there was a significant difference between the v-wave at rest (p = 0.02) but no significant difference during stress (p = 0.42)., Conclusions: Mitral regurgitation is a dynamic lesion, the complete assessment of which cannot be obtained from a single measure during one hemodynamic situation. Additional information from v-wave recordings during hemodynamic stress identified a subgroup of patients who had near-normal pressures at rest, but whose v-wave measurements during stress did not differ significantly from those of patients with severe angiographically assessed regurgitation (grades 3+ and 4+). In patients with only minor mitral regurgitation which is suspected to contribute to their clinical symptoms, the monitoring of invasive hemodynamic parameters during stress is important.

It has been argued that the aortic valve area (AVA) in patients with aortic stenosis increases with flow. Others, however, have attributed the apparent increase to flow dependence of the empiric constant in the Gorlin formula. We examined the changes in AVA during changes in transvalvular flow induced by dipyridamole infusion in 34 patients with aortic stenosis. Two-dimensional and Doppler echocardiography was used and AVA was calculated according to the continuity equation, which does not include empiric constants. Flow increased in 29, decreased in four, and was unchanged in one patient. There was a linear correlation between percent change in flow and percent change in AVA: delta AVA% = 1.1 + delta flow%. 0.56 (r = 0.72; p < 0.001) In conclusion, AVA was found to be flow dependent. The magnitude of change in AVA observed by noninvasive recordings agrees with previous invasive studies according to the Gorlin formula.

Purpose: To determine whether filtering blebs resulting from adjunctive use of mitomycin C (MMC) leads to an increased risk of endophthalmitis., Methods: The authors retrospectively reviewed the records of 232 consecutive trabeculectomies performed at the W. K. Kellogg Eye Center with adjunctive use of MMC from May 1990 through June 1993. Data obtained from the records included patient age, sex, race, type of glaucoma, site of filtration surgery, concentration and duration of exposure to MMC, presence of early or late bleb leakage, and the occurrence of endophthalmitis., Results: Three patients were lost to follow-up less than 1 month after surgery. A total of 229 eyes of 192 patients (11 women and 82 men) were included in the study. Mean follow-up of patients remaining free of infection was 18.5 +/- 10.8 months (range, 1-44 months). The overall incidence of bleb-related endophthalmitis was 2.6%. Endophthalmitis developed in 8% of patients (4 or 50) in whom an inferior approach was used and in 1.1% (2 or 179) in whom a superior approach was used (P = 0.02, Fisher's exact test). The estimated odds ratio for the development of endophthalmitis after trabeculectomy with adjunctive MMC for inferior versus superior filtration sites was 7.7., Conclusion: Short-term follow-up of trabeculectomies performed with adjunctive use of MMC demonstrates an overall incidence of endophthalmitis comparable to filtrationprocedures performed with 5-fluorouracil or without antifibrotic agents. However, inferior trabeculectomy performed with adjunctive MMC carries a significantly increased risk of bleb-related endophthalmitis compared with filters performed superiorly.

Dipyridamole single-photon emission tomography (SPET) is used for the detection of coronary artery disease (CAD) and the method has also been applied in patients with aortic stenosis. This study was undertaken to establish the gender-specific normal limits of thallium-201 distribution in patients with aortic stenosis and to apply these normal limits in a larger group of patients with aortic stenosis to obtain the sensitivity and specificity for coexisting CAD. A low-dose dipyridamole protocol was used (0.56 mg/kg during 4 min). Thallium was injected 2 min later and tomographic imaging was performed. Following image reconstruction a basal, a midventricular and an apical short-axis slice were selected. The highest activity in each 6 degree segment was normalised to the maximal activity of each slice. The normal uptake for patients with aortic stenosis was obtained from ten men and ten women with aortic stenosis and a normal coronary angiography. Eighty-nine patients were prospectively evaluated. An area reduction of at least 75% in a coronary artery was considered to be a significant coronary lesion and was found in 57 (64%) patients. With gender-specific curves (-2.5 SD) sensitivity for detecting CAD was 100% and specificity was 75% in men, while sensitivity was 61% and specificity 64% in women. It is concluded that the gender-specific normal distribution of 201Tl uptake in patients with aortic stenosis, using dipyridamole SPET, yields a high sensitivity and specificity for coronary artery lesions in men but a lower sensitivity and specificity in women with aortic stenosis.

Background: Limited data exist concerning left ventricular thrombi during and after hospitalization in patients treated according to modern principles. The purpose of the present study was to examine the formation and resolution of left ventricular thrombi during the first month in patients with acute anterior myocardial infarction treated with streptokinase and aspirin., Methods: Seventy-seven consecutive patients were studied prospectively during the hospital stay and 1-month follow-up study. Aspirin was used routinely, whereas anticoagulants were only used after a decision by the attending physician. Echocardiography was performed within 3 days of admission, before hospital discharge and after 1 month of follow-up., Results: At the first examination, 17 of 77 patients (22%) had a thrombus. At discharge, 73 patients remained in the study. In five (31%) of the 16 patients with early thrombus, the thrombus persisted; in 18 (32%) of the 57 patients without early thrombus, a new thrombus was diagnosed. One month later, 65 patients remained eligible for follow-up study. In three of 20 patients (15%) the thrombus from the second examination persisted and in four of 45 patients (9%) a new thrombus was diagnosed. The disappearance rate between the second and third examination was high irrespective of whether patients were treated with anticoagulants (eight of nine, 89%) or not (nine of 11, 82%). Extensive left ventricular segmental dysfunction and signs of congestive heart failure were associated with the appearance of a left ventricular thrombus. No embolic events were recorded., Conclusion: In patients with anterior myocardial infarction treated with streptokinase and aspirin the development and disappearance of left ventricular thrombi is a highly dynamic process. A large proportion of thrombi resolve without additional anticoagulant therapy.

Dipyridamole is a potent vasodilator used in pharmacologic stress testing. Patients with severe aortic stenosis are not suitable for exercise, and are usually not subjected to testing with vasodilator substances. The aim of the present study was to investigate hemodynamic changes during dipyridamole stress test in patients with aortic stenosis and to see if these changes where reversible by theophylline, an aminophylline derivative. Ten patients with aortic stenosis underwent right and left heart catheterization. Simultaneous recordings of cardiac output, left ventricular and aortic pressures were performed at baseline, after intravenous dipyridamole infusion (0.56 mg/kg dissolved in 250 ml of saline given over four minutes), and after intravenous theophylline injection (115 mg). There was an increase in heart rate, stroke volume and flow, and a decrease in systolic and diastolic blood pressure and in systemic vascular resistance after dipyridamole infusion. Left ventricular stroke work index and pressure time per minute increased after dipyridamole infusion suggesting an increase in myocardial oxygen demand, but there was no significant change compared to baseline after theophylline administration. Less than one third of left ventricular work was due to the resistance of the aortic valve. The aortic valve area changed with changes in flow. It is concluded that cardiac output, left ventricular work and myocardial oxygen demand after dipyridamole infusion increased in patients with aortic stenosis. The systemic vascular resistance seems to be more important determinant of cardiac output than the aortic valve obstruction. The calculated valve area appears to be flow-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: To determine the current level of formal training in ocular anesthesia provided to nonophthalmologist physicians, the rationale for this training or lack thereof, and the perceived need for this training by anesthesia residency training programs., Methods: A two-page survey questionnaire was forwarded to all residency directors of ophthalmology and anesthesia training programs listed with the American Medical Association. A second mailing followed 2 months after the initial mailing if no response was received from a particular program., Results: An overwhelming response of 92% of ophthalmology programs and 76% of anesthesiology programs was achieved. In 93% of ophthalmology programs and 77% of anesthesiology programs, no formal training was provided to nonophthalmologist physicians in retrobulbar or peribulbar anesthesia. In addition, 78% of ophthalmology and 65% of anesthesiology programs denied having any plans to provide this training even though 40% of the anesthesia departments wanted to initiate and coordinate such training., Conclusions: Currently, few ophthalmology programs offer formal training to anesthesiology residents in ocular anesthesia. Following are the predominant factors involved in this decision: (1) the operating surgeon is ultimately responsible for any complications; (2) there is a lack of knowledge of orbital anatomy and axial eye length by anesthesia personnel; and, most importantly, (3) there is a brief episodic nature in which anesthesia residents encounter ophthalmologic procedures resulting in minimal opportunities for training and experience from which the residency training program could ensure quality outcome and proper credentialling.

Unlabelled: Dipyridamole SPECT detects significant coronary artery disease (CAD) in patients without aortic stenosis. This study was done to establish normal 201Tl distribution limits in patients with aortic stenosis and to apply these normal limits to patients with aortic stenosis and angiographically significant CAD (> or = 75% area reduction)., Methods: Fifty-two patients (mean age 68 yr; mean valve area 0.67 cm2) were examined with 201Tl SPECT after dipyridamole infusion (0.56 mg/kg during 4 min). After tomographic reconstruction, basal, mid-ventricular and apical short-axis slices were selected. The highest activity in each six-degree segment was normalized to the maximal activity of each slice., Results: Significant CAD was found in 24 patients. Five patients without CAD, but with localized hypokinesia or left bundle-branch block, were excluded from the reference group which finally consisted of 16 patients. Sensitivity for CAD was 88% when the lowest relative activity in each segment was used as the lower limit of normal. With -2 s.d. and -2.5 s.d. curves the sensitivity was 83% and 75%, respectively. Gender-specific limits were not used. Nonsignificant CAD was found in seven patients (< 75% stenoses)., Conclusions: This study presents the normal distribution of 201Tl uptake for patients with aortic stenosis, using dipyridamole SPECT. The range method had the highest sensitivity for detection of significant CAD.

Renal function was investigated in 17 patients with simple renal cysts. Single kidney glomerular filtration rate was estimated by gamma camera renography with 99mTc-DTPA before, 5 days and 6 months after percutaneous puncture and evacuation of the cysts. Prior to the puncture and evacuation, the only negative effects on renal function noted were signs of moderate obstruction of the renal outflow in 2 patients. Percutaneous puncture with evacuation of the cystic fluid did not change the renal function significantly. It was concluded that simple renal cysts do not have any functional consequences nor does percutaneous puncture and evacuation of the cysts.

Women undergoing ambulatory laparoscopy are known to experience a variety of minor postoperative morbidity which prolongs recovery time and delays discharge. The purpose of this study was to investigate general anesthetic recovery of ambulatory laparoscopy patients receiving two rapid-acting, but disparate, anesthetic techniques. Thirty-one ASA I and II patients between 19 and 44 years of age were randomly divided into two groups. Group I received an isoflurane-based anesthetic, and Group II received an alfentanil continuous infusion. Through analysis of covariance (ANCOVA), Group II recovery scores were found to be significantly higher at T0 (p less than .0001), (p less than .0001), T15 (p less than .001), T30 (p less than .01) and T45 (p less than .02). There was no difference between groups at T60, at which time all patients received the maximum score of 10. No other factor besides anesthetic technique significantly affected recovery scores. Group II patients spent an average of 166 minutes (+/- 59 standard deviation) in the recovery room in comparison with 192 minutes (+/- 32 standard deviation) for Group I patients. Despite this finding, an ANCOVA determined that only presence of postoperative vomiting significantly affected recovery room time (p less than .03). Further research is indicated in the endeavor to reduce postoperative morbidity of this patient population.

Surfactant protein-A (SP-A) was measured in bronchoalveolar lavage (BAL) samples from ventilated neonates in order to study the concentration of SP-A with regard to: 1) high-frequency oscillatory ventilation (HFOV) vs. conventional mechanical ventilation (CMV); 2) the postnatal course and ontogeny of SP-A; and 3) the correlation with measurements of pulmonary function. Patients on HFOV had markedly lower BAL SP-A concentrations on days 1 and 2 compared to those on CMV, which may indicate influence of mode of ventilation on surfactant metabolism. The SP-A concentrations increased postnatally concurrent with resolution of acute respiratory distress syndrome. Finally, there were only weak correlations between BAL SP-A concentration and dynamic lung compliance and oxygen requirement.

A patient with familial amyloid polyneuropathy and congestive heart failure underwent myocardial imaging using technetium-99m pyrophosphate. Planar scintigraphy showed an intense, diffuse biventricular uptake of the radiotracer. Single-photon emission computed tomography demonstrated an unevenly distributed uptake of the isotope. The greatest activity corresponded to regions with marked echocardiographic changes. Emission tomography may aid in assessing the degree and distribution of the infiltrative lesions in cardiac amyloidosis.

The study population comprises 28 patients with sarcoidosis who all had repolarization disturbances in their exercise ECGs. None of the patients had hypertension or known cardiovascular disease, and all but two were non-smokers. The mean age was 45 years. Exercise test with beta-adrenergic blockade was performed within one month of the first examination. Persisting abnormal ST-T changes in exercise ECGs after beta-blockade were seen in 12 (43%) patients. No significant relationship was found between persisting ST-T changes and age, sex, chest X-ray stage, lung function or working capacity. In an earlier study, we found ST-T abnormalities in exercise ECG in 56 of 127 individuals (44%) in a consecutive 5-year study of patients with newly detected sarcoidosis. From this and the present report we postulate that, in our region, as much as 20% of the patients with newly detected sarcoidosis might have organic myocardial disease, possibly of sarcoid origin, as shown by repolarization disturbances in exercise ECG. If ECG abnormalities in the ST-T region are present in patients with sarcoidosis, exercise ECG with beta-blockade is a simple way of establishing suspicion of organic myocardial lesions. If exercise ECG abnormalities in the ST-T region persist after beta-blockade, careful clinical follow-up is recommended, and, in some patients early steroid therapy should be considered.

To assess the severity of outlfow obstruction in patients with aortic valve disease, the aortic valvar area was noninvasively determined in 22 patients with isolated aortic stenosis or combined stenosis and regurgitation. The ejection time (ET), maximal velocity (Vmax), and systolic velocity integral (SVI) of the aortic flow was obtained by continuous wave Doppler ultrasound. Left ventricular stroke volume (SV) was determined by radionuclide angiography, using a counts-based nongeometric technique with individual attenuation correction. Aortic valve area (AVA) was calculated using a modified Gorlin formula; AVA = SV/(71.2 X ET X Vmax), and also by dividing the stroke volume by the systolic velocity integral; AVA = SV/SVI. The two noninvasive determinations correlated closely with the valve areas obtained by invasive measurements; r = 0.95, SEE = +/- 0.13 cm2 by the modified Gorlin formula, and r = 0.94, SEE = +/- 0.14 cm2 by the integration method. The two noninvasive calculations showed almost uniform results; r = 0.98, SEE = +/- 0.09 cm2. In conclusion, aortic valve area can be determined with reasonable accuracy by combining Doppler echocardiography and radionuclide angiography. This noninvasive approach may reduce the need for invasive measurements in patients with suspected aortic valve disease. In addition, radionuclide angiography provides important information about left ventricular function.

Non-invasive estimation of the mean pulmonary capillary wedge pressure was accomplished by simultaneous electrocardiographic, phonocardiographic and continuous wave Doppler echocardiographic recordings. The interval from the onset of the QRS complex to the Doppler determined mitral valve closure (Q-MC) and the interval from the phonocardiographic aortic component of the second heart sound to the Doppler determined mitral valve opening (A2-MO) were measured. The non-invasive registrations were carried out simultaneously with direct measurements of the wedge pressure. In an initial group of 22 patients, a significant correlation was observed between the intervals alone and the wedge pressure, r = 0.60, SEE = +/- 6.9 mmHg, p less than 0.01, for the Q-MC interval and r = -0.70, SEE = 6.2 mmHg, p less than 0.001 for the A2-MO interval. A closer correlation was observed between the ratio Q-MC/A2-MO and the measured wedge pressure, r = 0.93, SEE = +/- 3.1 mmHg, p less than 0.001. The linear regression equation, PCW = 19.5 (Q-MC/A2-MO) + 3.0 (mmHg), was applied prospectively to a second group of 23 patients. Again the relationship between estimated and measured wedge pressure was highly significant, r = 0.90, SEE = +/- 3.1 mmHg, p less than 0.001. Twenty-two patients were also studied during an exercise test, and acceptable non-invasive recordings were obtained in 19 of them. The change in estimated wedge pressure during activity related closely to the change in actual wedge pressure, r = 0.80, SEE = +/- 5.7 mmHg, p less than 0.001. A simplified equation suitable for routine clinical practice, PCW = 24 (Q-MC/A2-MO) (mmHg), yielded almost equally accurate estimates of the wedge pressure over a wide range of pressures. The simplicity and reasonable accuracy of Doppler-assisted estimation of the wedge pressure makes it useful in the evaluation and follow-up of patients with suspected cardiac disorders. The method may assist in evaluating the effects of diagnostic or therapeutic procedures, since it is sufficiently sensitive to detect acute directional changes in wedge pressure.