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Contemporary model driven development tools only partially support the abstractions occurring in complex embedded systems development. This article presents an interpretive case study in which architectural concerns important to seven engineers in a large product developing organization were compared to the views actually provided by the organization's models. The paper's main finding is an empirically grounded catalogue of architectural concerns for a large, complex embedded systems project, and an assessment of the degree to which the studied organization has managed to realize support for these concerns within economical and organizational constraints. In the studied case, 114 different architectural concerns were found to be important to the interviewed engineers. Of this sample, 75% were documented in models, structured text, or informal documentation, whereas 47% of all documented concerns were modeled. The paper's conclusion is that current modeling languages and methods inadequately address the full set of concerns that are important to engineers in base station development.

Patients with a systemic right ventricle are prone to develop heart failure. Beneficial effects of ACE-inhibition, angiotensin- or betareceptor blockade (advanced heart failure treatment, AHFT) are well established for patients with heart failure due to systemic left ventricular dysfunction, however

Cardiac conduction disturbances are frequent in amyloidosis with cardiac involvement, but the pathogenesis of these electrocardiographic abnormalities is not clear. In the present study, the conduction systems in six patients with the Swedish variety of familial amyloidosis with polyneuropathy (FAP), have been analyzed. The results suggest that in FAP, direct amyloid infiltration of the atrioventricular conduction system accounts for the majority of the electrocardiographic disturbances.

Background Ethanol-induced dopamine (DA) release in the mesolimbic system may reinforce excessive alcohol intake and the progression of alcohol dependence. Within this reward system, the DA transporter (DAT1) plays a key role in the regulation of dopaminergic neurotransmission through presynaptic DA reuptake. Objective This study investigated whether DAT1 genetic variation was associated with either alcohol consumption behavior or alcohol dependence in a Finnish cohort. Methods Eight single nucleotide polymorphisms and a frequently studied 3'-untranslated region 40-bp variable number tandem repeat were genotyped in unrelated male Finnish participants selected from alcoholism clinical treatment facilities (n=104), or through the Finnish Population Register (n=201). All participants completed the Alcohol Use Disorder Identification Test. Main results We found significant evidence that the synonymous exon 2 rs6350 variant was positively associated with both alcohol consumption behavior (P=0.0004) and problem drinking (G allele, odds ratio: 3.63, 95% confidence interval: 1.22-10.78). A second single nucleotide polymorphism, rs463379 (intron 4), was negatively associated with alcohol dependence (A allele, odds ratio: 0.61, 95% confidence interval: 0.39-0.94). However, two-locus haplotypic analysis of rs6350-rs463379 did not further increase the strength of association with the quantitative Alcohol Use Disorder Identification Test score trait (P=0.0024). Conclusion The present findings suggest that DAT1 genetic variation influences drinking behavior in our Finnish population, where the rs6350 A and rs463379 G alleles provide a protective role against high alcohol consumption and alcohol dependence, respectively. A systematic search for DAT1 variants that affect gene function or expression in the Finnish and other populations is warranted.

Patent foramen ovale (PFO) is a remnant of the foetal circulation, found in about a quarter of the population. PFO is an asymptomatic condition and the high prevalence infers that it is in most cases of no or only limited clinical significance. However, recent research has found an increased prevalence of PFO in cryptogenic stroke, decompression illness and migraine. The presence of a PFO has also been associated with oxygen desaturation in conditions such as obstructive pulmonary disease and obstructive sleep apnoea. The rapid evolution and widespread availability of catheter-based closing techniques have further stimulated interest. The seemingly growing significance of PFO will be discussed in this review.

The clinical and echocardiographic features of cardiac amyloidosis may closely resemble those of hypertrophic cardiomyopathy, and the disorders may thus be mixed up. The present study was undertaken in an attempt to identify features separating the two conditions by analysis of electro- and echocardiographic findings in patients with familial amyloid polyneuropathy and hypertrophic cardiomyopathy. Twenty-nine patients with familial amyloidosis and 22 with hypertrophic cardiomyopathy were studied. Particular attention was given to the sum of the S wave in V1 and R wave in V5 or V6, the echocardiographic left ventricular mass and cross-sectional area, the presence or absence of asymmetrical septal thickening, granular and sparkling myocardial appearance, thickened heart valves, systolic anterior motion of the mitral valve, and pericardial effusion. A granular and sparkling appearance of the myocardium and thickened heart valves were found to be the best predictors of cardiac amyloidosis, while low QRS amplitudes in relation to echocardiographic left ventricular mass and a pericardial effusion seemed less important. The presence of systolic anterior movement of the mitral valve, a large left ventricular mass and a sum of S in V1 and R in V5 or V6 greater than 35 mm indicated hypertrophic cardiomyopathy. When the four strongest predictors (left ventricular mass, thickened heart valves, a granular sparkling myocardial appearance, and systolic anterior movement of the mitral valve) were used to reclassify the present patients, 28 of 29 amyloidosis patients and 21 of 22 patients with hypertrophic cardiomyopathy were correctly categorized. Noninvasive methods may thus be useful for detecting the myocardial infiltrative process, and cardiac amyloidosis may be confidently diagnosed by typical noninvasive findings together with histopathological documentation of amyloid in an organ other than the heart.

Two-dimensional echocardiography in systemic amyloidosis has in most cases shown highly refractile myocardial echoes. The morphological basis for this finding has so far been little examined. In the present study, echocardiographic examinations were performed in vitro on autopsied hearts from ten patients with familial amyloidosis with polyneuropathy (FAP). An ultrasonically visible needle was used to localize the abnormal echoes, and samples were taken for histological analysis of the region of the echocardiographic abnormality. Our results indicate that the highly refractile myocardial echoes in FAP are due to nodules composed of collagen and amyloid.

Bus and coach traffic is considered to be one of the safest means of travelling. Still, there is a problem with accidents due to crosswind gusts. Therefore it is a need of improving the crosswind p ...

With improving prognosis the prevalence of adult congenital heart disease (ACHD) is increasing. Patients with type 2 diabetes mellitus (T2DM) have a shorter life expectancy compared with the general population. We investigated, in a large national diabetes registry, the prevalence of ACHD in combination with T2DM to estimate the associated clinical risk, outcome and patient characteristics.Data from the Swedish National Diabetes Register (NDR) were linked with the Swedish National Patient Register (NPR) and the Cause of Death Register.833 ACHD patients were matched with 5 controls each. ACHD patients had significantly lower body mass index or BMI, higher creatinine and were more sedentary as compared with patients with T2DM but without congenital heart disease. The overall mortality was 26.2% for ACHD patients as compared with 19.9% (P0.001) for the control group, and five-year mortality rates were 5.2 versus 3.4%, P = 0.014.Congenital heart disease and secondary risk factors for cardiovascular disease frequently coexist and the development of T2DM also in the ACHD population is not uncommon with an estimated prevalence of between 4 and 8%. Treatment of conventional cardiovascular risk factors in patients with congenital heart disease could be considered secondary prevention given the relatively high morbidity and high risk for mortality observed in patients with the combination of ACHD and T2DM.

Code cloning is a part of many commercial and open source development products. Multiple methods for detecting code clones have been developed and finding the clones is often used in modern quality assurance tools in industry. There is no consensus whether the detected clones are negative for the product and therefore the detected clones are often left unmanaged in the product code base. In this paper we investigate how obstructive code clones of Type I (duplicated exact code fragments) are in large software systems from the perspective of the quality of the product after the release. We conduct a case study at Ericsson and three of its large products, which handle mobile data traffic. We show how to use automated analogy-based classification to decrease the classification effort required to determine whether a clone pair should be refactored or remain untouched. The automated method allows classifying 96% of Type I clones (both algorithms and data declarations) leaving the remaining 4% for the manual classification. The results show that cloning is common in the studied commercial software, but that only 1% of these clones are potentially obstructive and can jeopardize the quality of the product if left unmanaged.

It has been suggested that human scent works as a signal in mate selection, but the empirical evidence is scarce. Here, we examined whether women’s olfactory preferences for a man’s scent could be correlated with his testosterone, estradiol, or cortisol concentrations, and whether these preferences change along with the menstrual cycle. In line with previous studies, women in their most fertile period gave the highest attractiveness ratings to all men. However, the intensity ratings by women at different menstrual phases did not significantly differ statistically. Interestingly, we found that cortisol concentration in saliva correlated positively with the attractiveness but not with the intensity ratings of male T-shirt odor by all women’s groups. However, neither testosterone nor estradiol was significantly associated with the ratings of attractiveness or intensity. Thus, our study suggests that there could be a novel mechanism for odor-based selection in humans.

This article presents the proceedings of a symposium at the 2004 meeting of the International Society for Biomedical Research on Alcoholism, held in Mannheim, Germany. The symposium was organized by Etienne Quertemont and chaired by C. J. Peter Eriksson. The presentations were (1) Brain ethanol metabolism and its behavior consequences, by Sergey M. Zimatkin and P. S. Pronko; (2) Acetaldehyde increases dopaminergic neuronal activity: a possible mechanism for acetaldehyde reinforcing effects, by Marco Diana and Milena Pisano; (3) Contrasting the reinforcing actions of acetaldehyde and ethanol within the ventral tegmental area (VTA) of alcohol-preferring (P) rats, by Zachary A. Rodd and Richard R. Bell; (4) Molecular and biochemical changes associated with acetaldehyde toxicity, by Roberta J. Ward; and (5) Role of acetaldehyde in human alcoholism and alcohol abuse, by C. J. Peter Eriksson.

Not only is alcoholism one of the world’s major public health problems because of the significant morbidity caused by alcohol abuse disorder but it is also a big social problem. An atypical allele (ALDH2∗487Lys, former name ALDH2∗2) in low Km aldehyde dehydrogenase (ALDH2), which is highly prevalent in Asian populations, is associated with drinking behavior and some alcohol-related diseases (Yoshida, 1994; Yokoyama et al., 2003). There are some differences in its frequency among Asian populations of different geographic areas. In our previous study, the frequency of the ALDH2∗487Lys allele was much lower (12%) in Wuhan Han Chinese and much higher (31%) in Guangdong Han Chinese populations than that reported in other Oriental populations (Chen et al., 1999; Luo et al., 2001; Luo and Zhang, 2004). Recent developments in gene therapy allow a long-term inhibition of gene expression. Garver et al. (2001) asserted that antisense oligonucleotides

We examined associations of testosterone (T) and alcohol use in adolescent twin brothers, conducting both between- and within-family analyses. The twins completed semi-structured interviews, provided two saliva samples to assay T, and reported their drinking patterns and pubertal development. We adjusted T levels for diurnal/seasonal effects and association with pubertal maturation. In analyses of twins as individuals, higher T levels characterized boys reporting ever drinking, more frequent intoxication, high density drinking, more alcohol symptoms, and diagnosed alcohol dependency on interview. Adjusting for pubertal development, only associations with symptom count and diagnosis remained significant. The association with frequent intoxication replicated among drinking-discordant twin brothers, effectively ruling out between-family confounds, but that association was not significant after adjustment for pubertal development. The phenotypic correlation between T and pubertal maturation is largely genetic, inviting study of the magnitude and meaning of linkages between testosterone and symptoms of alcoholism on follow-up in early adulthood.

Background: Patients with right bundle branch block comprise 5–9% of all patients with acute myocardial infarction. In spite of this, limited data exist on early diagnosis or the usefulness of continuous electrocardiographic monitoring in these patients. Methods: A prospective multicenter study with 14 Swedish coronary care units. Patients with right bundle branch block and suspicion of acute myocardial infarction with less than 6 hours symptom duration were included. All patients were monitored with continuous vectorcardiography for 12–24 hours. Results: Seventy-nine patients were included, 43% had acute myocardial infarction. Patients with acute myocardial infarction had significantly higher initial ST-vector magnitude values (P = 0.0014) compared to patients without acute myocardial infarction. Patients with acute myocardial infarction also showed gradual regression of ST-vector magnitude over time that was not seen for patients without acute myocardial infarction (P = 0.005). ST-vector magnitude measured at the J-point differentiated best between patients with and without acute myocardial infarction. A cutoff value of 125 μV for initial ST-vector magnitude resulted in 55% sensitivity and 87% specificity for the diagnosis of acute myocardial infarction. Over time, patients with acute myocardial infarction showed greater changes in QRS-vector difference compared to patients without acute myocardial infarction (P = 0.052). Conclusion: Vectorcardiographic monitoring shows good diagnostic abilities for patients with right bundle branch block and clinical suspicion of acute myocardial infarction and could be useful for continuous monitoring of these patients.

In a retrospective study of 51 consecutive patients undergoing transcatheter closure of secundum type atrial septal defects (ASDs), we examined the reliability of transesophageal echocardiography (TEE) prior to catheterization and compared the diameter with that obtained by balloon measurement during catheterization. The TEE diameter was 16.3 ± 4.6 mm compared with 22.5 ± 6.0 mm for the stretched diameter obtained during catheterization (p < 0.001). There was no gender difference. The degree of left-to-right shunting correlated poorly with the size of the defect. We conclude that although TEE is accurate for diagnosis of an ASD, the measurement of its size to determine the size of the closure device is at best inaccurate.

The Saccharomyces cerevisiae Nhp6 protein is related to the high-mobility-group B family of architectural DNA-binding proteins that bind DNA nonspecifically but bend DNA sharply. Nhp6 is involved in transcriptional activation by both RNA polymerase II (Pol II) and Pol III. Our previous genetic studies have implicated Nhp6 in facilitating TATA-binding protein (TBP) binding to some Pol II promoters in vivo, and we have used a novel genetic screen to isolate 32 new mutations in TBP that are viable in wild-type cells but lethal in the absence of Nhp6. The TBP mutations that are lethal in the absence of Nhp6 cluster in three regions: on the upper surface of TBP that may have a regulatory role, near residues that contact Spt3, or near residues known to contact either TFIIA or Brf1 (in TFIIIB). The latter set of mutations suggests that Nhp6 becomes essential when a TBP mutant compromises its ability to interact with either TFIIA or Brf1. Importantly, the synthetic lethality for some of the TBP mutations is suppressed by a multicopy plasmid with SNR6 or by an spt3 mutation. It has been previously shown that nhp6ab mutants are defective in expressing SNR6, a Pol III-transcribed gene encoding the U6 splicing RNA. Chromatin immunoprecipitation experiments show that TBP binding to SNR6 is reduced in an nhp6ab mutant. Nhp6 interacts with Spt16/Pob3, the yeast equivalent of the FACT elongation complex, consistent with nhp6ab cells being extremely sensitive to 6-azauracil (6-AU). However, this 6-AU sensitivity can be suppressed by multicopy SNR6 or BRF1. Additionally, strains with SNR6 promoter mutations are sensitive to 6-AU, suggesting that decreased SNR6 RNA levels contribute to 6-AU sensitivity. These results challenge the widely held belief that 6-AU sensitivity results from a defect in transcriptional elongation.

Background: Moderate alcohol consumption is inversely associated with cardiovascular diseases. Changes in hormone levels might in part help explain the positive health effect. This study was performed to examine the effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate (DHEAS), testosterone, and estradiol levels. Methods: In a randomized, diet-controlled, crossover study, 10 middle-aged men and 9 postmenopausal women, all apparently healthy, nonsmoking, and moderate alcohol drinkers, consumed beer or no-alcohol beer with dinner during two successive periods of 3 weeks. During the beer period, alcohol intake equaled 40 and 30 g per day for men and women, respectively. The total diet was supplied and had essentially the same composition during these 6 weeks. Before each treatment there was a 1 week washout period, in which the subjects were not allowed to drink alcoholic beverages. At the end of each of the two experimental periods, fasting blood samples were collected in the morning. Results: Moderate alcohol consumption increased plasma DHEAS level by 16.5% (95% confidence interval, 8.0-24.9), with similar changes for men and women. Plasma testosterone level decreased in men by 6.8% (95% confidence interval, -1.0 - -12.5), but no effect was found in women. Plasma estradiol level was not affected. Serum high-density lipoprotein cholesterol level increased by 11.7% (95% confidence interval, 7.3-16.0), with similar changes for men and women. The overall alcohol-induced relative changes in DHEAS, testosterone, and estradiol correlated positively with the relative increase in high-density lipoprotein cholesterol (adjusted for the relative change in body weight); however, findings were only borderline significant for DHEAS and estradiol (r =0.44, p = 0.08; r = 0.32, p = 0.21; and r = 0.46, p = 0.06, respectively). Conclusions: A protective effect of moderate alcohol consumption for cardiovascular disease risk may in part be explained by increased plasma DHEAS level.

Objectives. Patients with left bundle branch block comprise 5–9% of all patients with acute myocardial infarction. Limited data exist on the usefulness of continuous electrocardiographic monitoring of these patients. We have investigated prospectively the usefulness of real-time continuous vectorcardiography for monitoring patients with left bundle branch block and suspicion of acute myocardial infarction. Design. A prospective multi-centre study. Setting. Fourteen Swedish coronary care units. Subjects. Patients with left bundle branch block and suspicion of acute myocardial infarction with

It is a long held assumption that women have concealed ovulation, which means that men do not know when women's menstrual cycles are in their most fertile phase. Recent empirical results have provided evidence that ovulation may not be totally concealed from pair-bonded males, but the generality and the mechanisms of the finding demand further study. To examine the possible adaptive value of the phenomenon, it is necessary to study whether the ability to detect ovulation is confined to males. We studied these questions in an experiment in which male and female raters rated the sexual attractiveness and intensity of T-shirts' odors worn by 42 women using oral contraceptives (pill users) and by 39 women without oral contraceptives (nonusers). Males rated the sexual attractiveness of nonusers highest at midcycle. However, female raters showed only a nonsignificant trend for this relationship. Neither sex rated attractiveness of the odors of pill users according to their menstrual cycle. The results indicate that men can use olfactory cues to distinguish between ovulating and nonovulating women. Furthermore, the contrasting results between pill users and nonusers may indicate that oral contraceptives demolish the cyclic attractiveness of odors. Together, these findings give more basis for the study of the role of odors in human sexual behavior. Copyright 2004.

This study investigated the stability and reproducibility of urinary ethyl glucuronide (EtG) and the 5-hydroxytryptophol (5-HTOL) to 5-hydroxyindole-3-acetic acid (5-HIAA) ratio, both of which are used as biochemical markers of recent alcohol consumption, after single and multiple oral doses of ethanol in healthy human subjects.Nine females aged 19-27 years drank ethanol (8%, w/v, in juice) or placebo (juice) in random order. The intervention consisted of 0.4 g/kg (22-28 g) of ethanol or placebo twice daily (in the morning and evening) during 8 consecutive days, starting in the evening on day 1. Spot urine samples of the first morning void were collected during the 8-day drinking period and for another 3 days (days 9-11) with no intake of ethanol or placebo. Ethanol, EtG, 5-HTOL and 5-HIAA were determined in the urine samples by headspace GC, LC-MS, GC-MS and HPLC, respectively.The individual results during the drinking period were highly variable, both within and between subjects, ranging from 0-7.3 mmol/l for ethanol, 1.4-71.0 mg/l for EtG, 0.1-4.5 mg/mmol for the EtG/creatinine ratio, and 2-109 nmol/ micro mol for 5-HTOL/5-HIAA. The placebo group consistently showed negative values for ethanol (0.1 mmol/l) and 5-HTOL/5-HIAA (15 nmol/ micro mol), but two samples were positive for EtG (0.1 mg/l). In the morning of day 9 (i.e. approximately 14-15 h after the last dose), ethanol was no longer measurable in urine and the 5-HTOL/5-HIAA ratio had returned to below the reference value, but detectable levels of EtG (11.3 +/- 6.0 mg/l, mean +/- SD) and the EtG/creatinine ratio (1.0 +/- 0.3 mg/mmol) were found in all samples.The results confirm the increase in urinary EtG and 5-HTOL levels during acute ethanol intake, although the individual values were highly variable both within and between subjects. No significant accumulation of either compound occurred upon multiple-dose administration of 0.8 g/kg (44-57 g) ethanol per day for approximately 1 week.

Background: Previous studies have reported associations between human alcohol drinking and testosterone levels. Methods: In this study we investigated serum testosterone concentrations without and under the influence of alcohol in alcohol-preferring (AA) and nonpreferring (ANA) rat lines. Animals were tested in both mornings and afternoons and the alcohol doses were 0.75 and 1.50 g/kg. Results: Higher basal serum testosterone levels were detected in the AA rats compared with the ANA rats in both mornings (152%, p= 0.028) and afternoons (75%, p= 0.035). The high alcohol dose decreased the testosterone concentrations of both the AA and the ANA rats (p= 0.001–0.01). The low dose, however, decreased testosterone concentrations only in the ANA line (line difference in the morning:p= 0.027; in the afternoon p= 0.000). Conclusion: The present results support previous indications of a positive association between testosterone and alcohol drinking. Furthermore, the present results, together with earlier reports on the AA and ANA rats, introduce the possibility of a connection between this association and the hypothalamic opiate system, which is also involved in the feedback regulation of testosterone synthesis.

Transcriptional activation of the yeast HO gene involves the sequential action of DNA-binding and chromatin-modifying factors. Here we examine the role of the SAGA complex and the Nhp6 architectural transcription factor in HO regulation. Our data suggest that these factors regulate binding of the TATA-binding protein (TBP) to the promoter. A gcn5 mutation, eliminating the histone acetyltransferase present in SAGA, reduces the transcription of HO, but expression is restored in a gcn5 spt3 double mutant. We conclude that the major role of Gcn5 in HO activation is to overcome repression by Spt3. Spt3 is also part of SAGA, and thus two proteins in the same regulatory complex can have opposing roles in transcriptional regulation. Chromatin immunoprecipitation experiments show that TBP binding to HO is very weak in wild-type cells but markedly increased in an spt3 mutant, indicating that Spt3 reduces HO expression by inhibiting TBP binding. In contrast, it has been shown previously that Spt3 stimulates TBP binding to the GAL1 promoter as well as GAL1 expression, and thus, Spt3 regulates these promoters differently. We also find genetic interactions between TBP and either Gcn5 or the high-mobility-group protein Nhp6, including multicopy suppression and synthetic lethality. These results suggest that, while Spt3 acts to inhibit TBP interaction with the HO promoter, Gcn5 and Nhp6 act to promote TBP binding. The result of these interactions is to limit TBP binding and HO expression to a short period within the cell cycle. Furthermore, the synthetic lethality resulting from combining a gcn5 mutation with specific TBP point mutations can be suppressed by the overexpression of transcription factor IIA (TFIIA), suggesting that histone acetylation by Gcn5 can stimulate transcription by promoting the formation of a TBP/TFIIA complex.

Pure coronary ectasia differs from atherosclerosis : morphological and risk factors analysis

Spt16/Cdc68, Pob3, and Nhp6 collaborate in vitro and in vivo as the yeast factor SPN, which is homologous to human FACT. SPN/FACT complexes mediate passage of polymerases through nucleosomes and are important for both transcription and replication. An spt16 mutation was found to be intolerable when combined with a mutation in any member of the set of functionally related genes HIR1, HIR2/SPT1, HIR3/HPC1, or HPC2. Mutations in POB3, but not in NHP6A/B, also display strong synthetic defects with hir/hpc mutations. A screen for other mutations that cause dependence on HIR/HPC genes revealed genes encoding members of the Paf1 complex, which also promotes transcriptional elongation. The Hir/Hpc proteins affect the expression of histone genes and also promote normal deposition of nucleosomes; either role could explain an interaction with elongation factors. We show that both spt16 and pob3 mutants respond to changes in histone gene numbers, but in opposite ways, suggesting that Spt16 and Pob3 each interact with histones but perhaps with different subsets of these proteins. Supporting this, spt16 and pob3 mutants also display different sensitivities to mutations in the N-terminal tails of histones H3 and H4 and to mutations in enzymes that modulate acetylation of these tails. Our results support a model in which SPN/FACT has two functions: it disrupts nucleosomes to allow polymerases to access DNA, and it reassembles the nucleosomes afterward. Mutations that impair the reassembly activity cause chromatin to accumulate in an abnormally disrupted state, imposing a requirement for a nucleosome reassembly function that we propose is provided by Hir/Hpc proteins.

The present investigation was designed to study steroid hormones, alcohol and aggression interactions in men with a history of alcohol-related aggression (AGG+) and in a cross-sectional control population (AGG-).AGG+ (n = 40) and AGG- (n = 44) male volunteers completed the Buss-Perry Aggression Questionnaire and the revised Michigan Alcoholism Screening Test (MAST), after which plasma-free and total testosterone, 5alpha-dihydrotestosterone (DHT) and cortisol were determined.The AGG+ men displayed significantly (p.05) higher aggression and MAST measures compared with the AGG- men; however, no significant group differences were observed regarding the hormone values. Independently of the steroid hormones, MAST correlated positively with the hostility subscale in both AGG- and AGG+ groups. Free and total testosterone correlated positively with anger and DHT correlated positively with verbal aggression and anger, whereas cortisol correlated negatively with physical aggression and anger in the AGG- group. No significant correlations between steroid hormones and aggression parameters were observed in the AGG+ group. The age factor explained part of the MAST and steroid hormone correlations with aggression. A hormone and MAST independent moderation effect of age upon aggression was also found.The present study demonstrates an association between alcohol drinking and self-reported sober-state aggression, which implies that the etiology of alcohol misuse and aggressive behavior may involve common biological and/or social factors. These mechanisms, as well as age, androgens and cortisol, all represent factors that, in combination, regulate human aggression.

Morning and afternoon levels of saliva testosterone levels in Finnish imprisoned rapists (n = 10) and child molesters (n = 10) were compared to those in randomly selected control subjects (n = 31). The associations of saliva testosterone with sexual behavior and antisocial personality traits were explored in all groups. The sexual offenders and control subjects did not differ in the between-subjects main effect estimated for the averaged morning and afternoon testosterone levels. Seven rapists and three child molesters met the criteria for antisocial personality disorder (ASP). In the sexual offenders, a summed ASP index was positively correlated with mean saliva testosterone. Sexual activity as estimated from self-reports of sexual intercourse and masturbation was significantly related to testosterone in both rapists and child molesters but not in the control males. The implications of these results are discussed.

Background: 4-Methylpyrazole (4-MP), a selective inhibitor of alcohol dehydrogenase (ADH), recently has been approved for clinical use in humans. The objective was to evaluate the use of 4-MP in human alcohol research and to study the effect of 4-MP on various parameters of alcohol metabolism during alcohol intoxication. Methods: 4-MP (10–15 mg/kg orally) or placebo was given in double-blind fashion to 22 premenopausal women, 12 of whom were using oral contraceptives, and 13 men followed by intake of alcohol (0.5 g/kg orally) or placebo. Results: A 30% to 40% decrease in the ethanol elimination rate was observed in the different groups during pretreatment with 4-MP. The alcohol-induced increase in plasma acetate was partially inhibited by 4-MP. A significant positive correlation was observed between the effect of 4-MP on the alcohol-induced lactate and acetate elevations. The acetaldehyde was nondetectable (

Healthy, premenopausal women completed the Buss-Perry Aggression Questionnaire. Venous blood samples were taken at the mid-cycle phase of the menstrual cycle to determine plasma androgen levels. Total and free testosterone, 5α-dihydrotestosterone, androstenedione, and dehydroepiandrosterone were assessed. Path analyses were aimed at finding out which of the five circulating hormones might best predict a latent aggression construct derived from the four subscales of the Aggression Questionnaire. A significant correlation was found between free testosterone and physical and verbal aggression subscales. In addition, the results demonstrate for the first time in women a significant link between 5α-dihydrotestosterone and anger. Thus, both testosterone and 5α-dihydrotestosterone may affect, by separate pathways, the basal regulation of aggression-proneness in women. Aggr. Behav. 28:273–280, 2002. © 2002 Wiley-Liss, Inc.

Importance Mortality in patients with congenital heart disease (CHD) has markedly decreased during recent decades because of advancement in pediatric care. However, there are limited data on survival trends in children and young adults with CHD compared with the general population. Objective To determine survivorship in children and young adults with CHD compared with matched controls. Design, Setting, and Participants A registry-based, prospective, matched-cohort study was conducted in Sweden. Data from the national patient and cause of death registers were linked to identify individuals with CHD born between January 1, 1970, and December 31, 1993, who were registered at or after birth. Follow-up and comorbidity data were collected until December 31, 2011. Survival analyses were performed with the Cox proportional hazards model; these analyses were performed from January 1, 1970, to December 31, 2011. A total of 21 982 patients with CHD in Sweden were identified. The mean (SD) follow-up time was 27.0 (8.86) years. Children serving as controls (n = 219 816) (10 for each patient), matched for birth year, sex, and county, were randomly selected from the general population. Main Outcomes and Measures Survivorship in young patients with CHD and controls. Results Of the 21 982 patients who were born between 1970 and 1993 and were registered with the diagnosis of CHD, 10 650 were female (48.4%). Median age at index registration was 4.22 years (interquartile range, 17.07 years). Survivorship among children younger than 5 years was increased from 96% in those born in 1970-1979 to 98% in those born in 1990-1993. Hazard ratios (HRs) of death in relation to that in control individuals decreased from 225.84 (95% CI, 136.84-372.70) to 33.47 (95% CI, 22.54-49.70). A substantial, but less pronounced, absolute and relative increase in survivorship was found in older patients (HRs ranged from 24.52; 95% CI, 11.72-51.26, at 5-9 years to 4.27; 95% CI, 2.29-7.95, at 18-29 years). According to a hierarchical CHD classification, the group of patients with the most severe complex defects (ie, common arterial trunk, transposition of the great vessels, double inlet ventricle, hypoplastic left heart syndrome, tetralogy of Fallot, and atrioventricular septal defect) had the highest risk for death (HR, 64.07; 95% CI, 53.39-76.89). Conclusions and Relevance Despite substantially increasing absolute and relative survivorship in children and young adults with CHD, the mortality risk remains high compared with the risk in matched controls. Further research on reducing the death rate in this vulnerable group is required.

Aims Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical therapy to reduce the risk of recurrent stroke, whereas randomized clinical trials have not shown significant differences. This study aims to compare long-term outcomes of PFO closure versus non-closure. Methods and results Patients with PFO and stroke considered for PFO closure were invited to a long-term clinical follow-up. Of the 314 patients, 151 (48%) were accepted for closure and 163 (52%) were not accepted (mean age 50 vs. 58years). The cumulative incidence of all-cause mortality, stroke or transient ischemic attacks (TIAs) for closure vs. non-closure under a mean follow-up time of five years was 10.6% (16 events) vs. 12.9% (21 events), p=0.53. Six patients, 3.7% vs. 3.6%, died in each group, but no deaths were associated with PFO closure, recurrent stroke or TIA. The incidence of recurrent stroke or TIA for closure vs. non-closure was 6.6% (10 events) vs. 9.2% (15 events), p=0.63. The respective event rates for stroke were 3.9% (6 events) vs. 5.5% (9 events), p=0.50 and for TIA, 2.6% (4 events) vs. 3.7% (6 events), p=0.59. Conclusion PFO closure was associated with a low risk of recurrent events; however, compared to the non-closure group, no significant differences could be demonstrated. Careful patient selection can avoid under- as well as over-treatment of PFO patients.

Alcohol drinking increases the risk for a number of cancers. Currently, the highest risk (Group 1) concerns oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast, as assessed by the International Agency for Research on Cancer (IARC). Alcohol and other beverage constituents, their metabolic effects, and alcohol-related unhealthy lifestyles have been suggested as etiological factors. The aim of the present survey is to evaluate the carcinogenic role of acetaldehyde in alcohol-related cancers, with special emphasis on the genetic-epidemiological evidence. Acetaldehyde, as a constituent of alcoholic beverages, and microbial and endogenous alcohol oxidation well explain why alcohol-related cancers primarily occur in the digestive tracts and other tissues with active alcohol and acetaldehyde metabolism. Genetic-epidemiological research has brought compelling evidence for the causality of acetaldehyde in alcohol-related cancers. Thus, IARC recently categorized alcohol-drinking-related acetaldehyde to Group 1 for head and neck and esophageal cancers. This is probably just the tip of the iceberg, since more recent epidemiological studies have also shown significant positive associations between the aldehyde dehydrogenase ALDH2 (rs671)*2 allele (encoding inactive enzyme causing high acetaldehyde elevations) and gastric, colorectal, lung, and hepatocellular cancers. However, a number of the current studies lack the appropriate matching or stratification of alcohol drinking in the case-control comparisons, which has led to erroneous interpretations of the data. Future studies should consider these aspects more thoroughly. The polymorphism phenotypes (flushing and nausea) may provide valuable tools for future successful health education in the prevention of alcohol-drinking-related cancers.

Alcohol drinking increases the risk for a number of cancers. Currently, the highest risk (Group 1) concerns oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast, as assessed by the International Agency for Research on Cancer (IARC). Alcohol and other beverage constituents, their metabolic effects, and alcohol-related unhealthy lifestyles have been suggested as etiological factors. The aim of the present survey is to evaluate the carcinogenic role of acetaldehyde in alcohol-related cancers, with special emphasis on the genetic–epidemiological evidence. Acetaldehyde, as a constituent of alcoholic beverages, and microbial and endogenous alcohol oxidation well explain why alcohol-related cancers primarily occur in the digestive tracts and other tissues with active alcohol and acetaldehyde metabolism. Genetic–epidemiological research has brought compelling evidence for the causality of acetaldehyde in alcohol-related cancers. Thus, IARC recently categorized alcohol-drinking-related acetaldehyde to Group 1 for head and neck and esophageal cancers. This is probably just the tip of the iceberg, since more recent epidemiological studies have also shown significant positive associations between the aldehyde dehydrogenase ALDH2 (rs671)*2 allele (encoding inactive enzyme causing high acetaldehyde elevations) and gastric, colorectal, lung, and hepatocellular cancers. However, a number of the current studies lack the appropriate matching or stratification of alcohol drinking in the case-control comparisons, which has led to erroneous interpretations of the data. Future studies should consider these aspects more thoroughly. The polymorphism phenotypes (flushing and nausea) may provide valuable tools for future successful health education in the prevention of alcohol-drinking-related cancers.

Background Bundle branch block (BBB) has been regarded as a disease of the conduction system, but occurs in mice lacking connexin 40 (expressed in atria, proximal conduction system) or connexin 43 (expressed in Purkinje cells, cardiomyocytes). Objective The aim of this paper is to explore whether BBB is heritable, and whether polymorphisms at connexin 40 and connexin 43 loci are associated with BBB. Methods To assess BBB heritability, we screened descendants of men with BBB in the population cohort ‘The Study of Men Born 1913’. DNA samples from 80-year-old men with extreme QRS-duration phenotypes were used to search for polymorphisms at connexin 40 and 43 loci. Associations between identified polymorphisms and BBB were evaluated in an independent cohort (INTERGENE). Results Seventy-seven men from ‘The Study of Men Born 1913’ with BBB had 116 descendants. Among the 76 participating descendants, 2 sons (6.4%) had BBB at 54 years of age. At the same age, 0.9% of men born in 1913 had BBB. We identified 6 single nucleotide polymorphisms (SNPs) in connexin 40 and 1 polymorphism in connexin 43. In the INTERGENE cohort, the connexin 43 polymorphism was associated with left BBB (LBBB) (4 of 35 LBBB vs 16 of 232 without BBB, χ 2 =7.4, p=0.03), but not with right BBB (RBBB) or overall BBB. None of the connexin 40 SNPs or haplotypes were associated with LBBB or RBBB. Conclusions These findings indicate that conduction by connexin 43 within the ventricular muscle distal to the specialised conduction system may be important for LBBB development.

Background— The atrial switch operation, the Mustard or Senning operation, for the transposition of the great arteries (TGA) was introduced in the late 1950s and was the preferred surgery for TGA until the early 1990s. The Mustard and Senning operation involves extensive surgery in the atria and leaves the right ventricle as the systemic ventricle. The Mustard and Senning cohort is now well into adulthood and we begin to see the long-term outcome. Methods and Results— All the 6 surgical centers that performed Mustard and Senning operations in Sweden and Denmark identified all operated TGA patients. Information about death was obtained in late 2007 and early 2008 from the Danish and Swedish Centralised Civil Register by using the patients’ unique national Civil Registration Numbers. Four hundred sixty-eight patients undergoing the atrial switch operation were identified. Perioperative 30-day mortality was 20%, and 60% were alive after 30 years of follow-up. Perioperative mortality was significantly increased by the presence of a ventricular septal defect, left ventricular outflow obstruction, surgery early in the Mustard and Senning era. However, only pacemaker implantation is predictive of long-term outcome (hazard ratio, 1.90; 95% confidence interval, 1.05–3.46, P =0.04), once the TGA patient has survived the perioperative period. The risk of reoperation was correlated to the presence of associated defects and where the first Mustard/Senning operation was performed. Conclusions— The long-term survival of patients with Mustard and Senning correction for TGA appears to be primarily determined by factors in the right ventricle and tricuspid valve and not the timing of or the type of surgery in childhood. Cardiac function necessitating the implantation of a pacemaker is associated with an increase in mortality.

Patients with congenital heart disease may be operated with surgical reconstruction of the right ventricular outflow tract (RVOT). Reintervention is common in this group of patients. The aim of this study was to examine longitudinal self-reported health measured by the EQ-5D questionnaire.Data were collected from the Swedish Registry of Congenital Heart Disease. EQ-5D, which measures health outcome, was introduced into the registry in 2005. All adult patients with previous surgical reconstruction of the RVOT who had EQ-5D data from their first and latest visit were analyzed.Among 103 patients (65 male and 38 female), mean age 31 (range 19-78 years), the diagnoses were: tetralogy of Fallot (n = 66); truncus, transpositions, and double outlet right ventricle (n = 23); and Ross-operated congenital aortic valve disease (n = 14). Time from first to latest visit was 3 years (range 1-7 years). Eighteen patients underwent 26 reinterventions in the observational period from the first to latest visit, including operations, percutaneous interventions, pacemaker implantations, and ablations. Health perception, mean EQ-5D visual analog scale, VAS, declined from 84.4 (standard deviation (SD) = 14.6) to 78.6 (SD = 18.3) at the latest visit, P = .001. The decline is almost exclusively seen in patients without reinterventions. Low EQ-VAS was associated with symptoms and New York Heart Association class II-IV. Patient-reported problems in the EQ-5D dimension usual activities were more common in the patients having reinterventions (25%) than those without reintervention (7%), P = .04.In this longitudinal cohort study of patients with previous surgical reconstruction of the RVOT, health perception declined over time. The decline was not observed in patients undergoing any additional interventions.

Schizophrenia is a highly heritable disorder. Genetic risk is conferred by a large number of alleles, including common alleles of small effect that might be detected by genome-wide association studies. Here we report a multi-stage schizophrenia genome-wide association study of up to 36,989 cases and 113,075 controls. We identify 128 independent associations spanning 108 conservatively defined loci that meet genome-wide significance, 83 of which have not been previously reported. Associations were enriched among genes expressed in brain, providing biological plausibility for the findings. Many findings have the potential to provide entirely new insights into aetiology, but associations at DRD2 and several genes involved in glutamatergic neurotransmission highlight molecules of known and potential therapeutic relevance to schizophrenia, and are consistent with leading pathophysiological hypotheses. Independent of genes expressed in brain, associations were enriched among genes expressed in tissues that have important roles in immunity, providing support for the speculated link between the immune system and schizophrenia.

The quartz crystal microbalance-dissipation technique (QCM-D) is used in two different measurement strategies to monitor the mass change and rigidity of populations of excitable cells during exocytosis and subsequent retrieval of dense-core vesicles. Two cell lines, NG 108-15 and PC 12, were grown to confluence on piezoelectric quartz crystals and were examined separately to demonstrate differences in release and retrieval with cells of different morphology, size, and number of dense-core vesicles. Stimulating the cells to exocytosis with media containing an elevated potassium concentration resulted in an increase in the frequency response corresponding to loss of mass from the cells owing to release of vesicles. In Ca2+-free media, the response was completely abolished. The amplitude and peak area in the frequency response corresponding to mass change with stimulated release was larger for PC 12 cells than for NG 108-15 cells, whereas the initial rate constants for the frequency responses were similar. The data suggest (1) that a greater number and larger size of vesicles in PC 12 cells results in a greater amount of release from these cells vs NG 108-15 cells, (2) the recycling of vesicles utilizes similar fusion/retrieval mechanisms in both cell types, (3) that the control of excess retrieval might be related to the number and size of released vesicles, and (4) that measured retrieval has a rapid onset, masking exocytosis and implying a rapid retrieval mechanism in the early stages of release. These results demonstrate that measurements of complex dynamic processes relating to dense-core vesicle release and retrieval can be simultaneously accomplished using the QCM-D technique.

Two new accelerated laboratory corrosion tests for electronic components in automotive applications have been developed, based on the use of metallic copper as a meter for corrosivity. The accelerated tests are designed so that they reproduce the same kind of corrosion effects as observed with exposure of copper in real vehicle environments. The test cycle that best simulates the corrosion characteristics of an engine compartment is composed of the following steps: a) exposure to neutral salt spray for 2 h; b) drying at 23/spl deg/C and 50% RH for 22 h; c) exposure to a test atmosphere of 1.5 ppm NO/sub 2/ and 0.5 ppm SO/sub 2/ at 25/spl deg/C and 95% RH for five days; d) drying at 23/spl deg/C and 50% RH for one day. The predominating corrosion products of copper, formed both during service exposure and in the accelerated test, are Cu/sub 2/O and Cu/sub 2/Cl(OH)/sub 3/, with a small amount of sulphur-containing corrosion products in the form of sulphates. In terms of corrosivity of copper, a test duration of six weeks corresponds to 7.5 years of exposure in the reference engine compartment selected for this study. The test cycle designed for the passenger compartment contains the steps: a) exposure for five days to a test atmosphere of 10 ppm NO/sub 2/ and 95% RH at 35/spl deg/C, followed by b) drying at 23/spl deg/C and 50% RH for two days. In this case, Cu/sub 2/O is the predominating corrosion product. In terms of corrosivity of copper, a test duration of four weeks corresponds to 7.5 years of exposure in the reference passenger compartment of this study.

An acute elevation in estradiol during alcohol intake has been reported in postmenopausal women on estrogen replacement therapy. The objective of the present study was to investigate the acute and long-term effect of alcohol on ethinylestradiol, the estrogen component found in most oral contraceptives. Nine healthy premenopausal women with regular use of an oral contraceptive containing 30 microg ethinylestradiol and 75 microg gestodene were challenged with alcohol (0.4 g/kg p.o., approximately 2-3 standard drinks) 2 h after intake of the oral contraceptive pill at menstrual cycle day 14. Blood samples were taken at 0, 2, 3, 4, 5, and 6 h from intake of alcohol. The challenge was repeated after a 7-day period of controlled alcohol intake (0.8 g/kg/day) at cycle day 21. The same experiments were carried out during placebo conditions. At day 21 an increase in the alcohol elimination rate was observed compared with day 14. No significant acute or long-term effect of alcohol on ethinylestradiol was found. The lack of an acute effect comparable to that reported for estradiol may be due to the protection of the ethinyl group at the 17-position of ethinylestradiol.

We studied the effects of ethanol and acetaldehyde on myocardial gene expression of atrial natriuretic peptide (ANP) and growth of rats. Combined ethanol and calcium carbimide treatment increased blood-acetaldehyde levels and ANP mRNA levels by 40-60% in 2-8 day experiments, compared to the controls. The results suggest a role for acetaldehyde in the development of alcoholic heart dysfunction.

Background: There is compelling evidence that genetic factors play a major role in the development of alcohol dependence. Platelet adenylyl cyclase (AC) activity has been proposed as a biochemical marker for differentiating alcohol-dependent and nondependent subjects, but the sensitivity and specificity of this marker have not been ascertained. The objective of this study was to determine the sensitivity and specificity of platelet AC activity in identifying alcohol-dependent subjects and to ascertain the effect of medical/psychiatric variables, drinking and smoking history, and age and body weight on AC activity. Methods: The cross-sectional study was conducted from 1995 to 1998. Participants were 210 Australian White men who were community volunteers and alcohol treatment inpatients in Sydney, Australia. There were 41 nondrinkers, 140 drinkers, and 29 men who were entering alcohol treatment. The main outcome measure was platelet AC activity. Classification variables were plasma ethanol, gamma-glutamyltransferase, aspartate aminotransferase, serum carbohydrate-deficient transferrin (CDT), and urinary 5-hydroxytryptophol-hydroxyindoleacetic acid (5-HTOL/5-HIAA) levels, and World Health Organization/International Society for Biomedical Research on Alcoholism Interview Schedule variables, which included alcohol use and dependence criteria. Results: Among subjects who reported abstinence for at least 4 days, both cesium fluoride (CsF)- and forskolin-stimulated platelet AC activities were significantly lower in those with a lifetime history of alcohol dependence compared with those with no such history (p < 0.005 and p < 0.05, respectively). The sensitivity and specificity of CsF-stimulated AC activity to discriminate individuals with a lifetime history of alcohol dependence were 75% and 79%, respectively. Similar values for sensitivity and specificity for CsF-stimulated AC activity were calculated when discriminating current alcohol dependence in the subjects in our sample. Irrespective of the history of alcohol dependence, persons who had consumed alcohol recently (within the last 3-4 days) showed significantly higher mean basal, CsF-stimulated, and forskolin-stimulated AC activity (p < 0.001), as did those who had elevated 5-HTOL/5-HIAA ratios or CDT levels, indicative of recent (heavy) drinking The normalization of platelet AC activity to baseline levels after an individual stops drinking may be related to the generation of new platelets during the abstinence period. Conduct disorder and antisocial personality disorder were not associated with low AC activity, but low forskolin-stimulated AC activity was associated with major depression. Conclusions: We found that CsF- and forskolin-stimulated platelet AC activity discriminates between subjects with and without alcohol dependence in a population of subjects who had not consumed significant quantities of ethanol recently. Recent alcohol consumption is a confounding variable that can alter the measured levels of AC activity. Forskolin-stimulated platelet AC activity also may be influenced by a history of major depression.

During transcatheter interventions, correct distance measurements are mandatory for proper device selection. We present a new calibration procedure in which distance calibration is performed with a high contrast metallic rod placed in the esophagus as a scaling device. Distortion related to differences in Calibration and object planes as well as axial angles were analyzed and appropriate correction factors calculated. A cardiac phantom served to test the accuracy and precision of the new measuring system. The mean measurement error was < 1.7% (range 0.1%–4.9%), and the mean measurement variability 1% (range 0.3%–1.9%). The accuracy of angiographic measurements can be significantly improved using a calibration device in the esophagus in combination with appropiate mathematical corrections.

Background and Objective. To compare the usefulness of carbohydrate-deficient transferrin (CDT), the ratio of CDT to total transferrin, and hemoglobin-acetaldehyde adducts with mean cell volume (MCV) and gamma-glutamyl transferase (GGT) in the follow-up of alcohol abuse during pregnancy. Methods. Forty-four pregnant drug and alcohol abusing female patients attending a special outpatient clinic were followed from the 8th to 24th gestational week onwards. A population of sixty-two healthy pregnant women was recruited to assess the effect of gestation on the markers. Results. Eight of thirteen heavy drinking (8 drinks/week) patients delivered infants with fetal alcohol effects (FAE). MCV and GGT were higher among heavy drinking patients than in moderately drinking (

The aim of the present study was to investigate the effect of alcohol on androgen levels among premenopausal women. Eighty-seven women in the mid-cycle phase of the menstrual cycle, 47 of whom used oral contraceptives (OC+), were included in the study. The range for reported alcohol consumption was 0-4 drinks/day. The total testosterone levels were significantly higher after alcohol intake (0.5 g/kg) than after placebo at 45 min and 90 min from the start of drinking among both OC- and OC+ subjects. This effect was also seen in the free testosterone fraction. The effect on testosterone was more prominent among OC+ subjects. Androstenedione levels were significantly lowered and the testosterone:androstenedione ratio significantly elevated by alcohol among both OC- and OC+ subjects. No effect of alcohol on dehydroepiandrosterone or dihydrotestosterone levels was observed. A positive correlation was observed between the change in testosterone levels and the change in androstenedione levels during placebo conditions. The correlation was significantly reduced during alcohol conditions among OC+ subjects, indicating an increased androstenedione to testosterone conversion. No significant dose (0.34, 0.68 and 1.02 g/kg) or time (45, 90 and 150 min) effects on total testosterone were observed in a substudy involving 10 OC+ subjects. The present results suggest that the testosterone effect is related to the zero-order mechanism of ethanol oxidation. The observed testosterone and androstenedione effects are suggested to be the result of an increased androstenedione to testosterone conversion in the liver caused by the alcohol-mediated elevation in the [NADH]:[NAD(+)] ratio. The present findings may be relevant in the development of hyperandrogenism and loss of female sexual characteristics associated with heavy alcohol consumption.

To study early diagnosis, treatment and outcome in patients with bundle branch block and clinically suspected acute myocardial infarction.A prospective multicenter study including 14 Swedish coronary care units. The study included 257 consecutive patients with bundle branch block and clinical suspicion of acute myocardial infarction.Left bundle branch block was present in 62% of patients and right bundle branch block in 38%. Thrombolytic treatment of acute myocardial infarction in the left and right bundle branch block was 16% and 36%, respectively. Of those undergoing thrombolytic therapy, 20% of patients with left and 13% with right bundle branch block did not develop an acute myocardial infarction. Patients with left bundle branch block had higher mortality rates than those with right bundle branch block. After one year there was no difference in mortality rates between patients with and those without acute myocardial infarction on admission.Patients with bundle branch block and suspected acute myocardial infarction receive suboptimal treatment. Thus better diagnostic regimes are needed to identify those patients with bundle branch block and acute myocardial infarction who are suitable for thrombolytic treatment.

The clinical outcome after successful conventional coronary balloon angioplasty is compared with that of stent implantation after 30 days and 12 months. The study took place at the Divisions of Cardiology and Thoracic Radiology, Norrland University Hospital, Umea, a referral centre for northern Sweden. The first 100 consecutive patients with stable or unstable angina undergoing successful percutaneous transluminal coronary angioplasty (PTCA) in 1994 and the first 100 consecutive patients undergoing successful coronary stent implantation in 1995 were included. The cardiac endpoints studied were death, myocardial infarction, need for repeat PTCA or coronary artery bypass grafting (CABG). Significantly more adverse cardiac events were observed in the PTCA group compared with the stent group. Event-free 12 months' follow-up (no deaths, myocardial infarction or re-intervention) was 64% in the PTCA group and 86% in the stent group (p < 0.005). The main explanation for the observed difference was a reduction in the need for a repeat PTCA (7 vs 18, p < 0.05) or CABG (4 vs 12, p < 0.05) in the stent group. Patients with stable or unstable angina who can be treated with a stent have a better clinical outcome than those treated with coronary balloon angioplasty only.