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We report the first characterization of a segmentation gene homologue in the basal polychaete Capitella capitatausing a pan-annelid cross-species antibody to the hunchback-like gene product. In flies, the gap segmentation gene hunchback(hb) encodes a C2H2zinc-finger transcription factor that plays a pivotal role in patterning the anterior region of the fly body plan. The hborthologue in Capitella(Cc-hb) is expressed maternally and in all micromere and macromere cells throughout cleavage. At gastrulation, nuclear Cc-hb protein is expressed in the micromere-derived surface epithelium that undergoes epiboly and in the large vegetal blastomeres that gradually become internalized. During organogensis, Cc-hb is expressed in the developing gut epithelium, the prostomial and pygidial epithelium, and in a subset of differentiated neurons in the adult central nervous system. Cc-hb is not expressed in the segmental precursor cells in the trunk. The Cc-hb expression domains in Capitellaare similar to those reported for the leech hborthologue (LZF2), and many of the observed differences between the annelid classes correlate with changes in life history. The lack of detectable annelid hb protein in the trunk at the time of AP pattern formation in leech and in polychaete suggests that the anterior organizing function of hbin flies originated in the arthropod or insect lineage.

To evaluate hemodynamic effectiveness and physiologic changes on the HeartMate 1000 IP left ventricular assist device (Thermo Cardiosystems, Inc., Woburn, Mass.), we studied 25 patients undergoing bridge to heart transplantation (35 to 63 years old, mean 50 years). All were receiving inotropic agents before left ventricular assist device implantation, 21 (84%) were supported with a balloon pump, and 7 (28%) were supported by extracorporeal membrane oxygenation. Six patients died, primarily of right ventricular dysfunction and multiple organ failure. Nineteen (76%) were rehabilitated, received a donor heart, and were discharged (100% survival after transplantation). Pretransplantation duration of support averaged 76 days (22 to 153 days). No thromboembolic events occurred in more than 1500 patient-days of support with only antiplatelet medications. Significant hemodynamic improvement was measured (before implantation to before explantation) in cardiac index (1.7 +/- 0.3 to 3.1 +/- 0.8 L/min per square meter; P < 0.001), left atrial pressure (23.7 +/- 7 to 9 +/- 7.5mm Hg; p < 0.001), pulmonary artery pressure, pulmonary vascular resistance, and right ventricular volumes and ejection fraction. Both creatinine and blood urea nitrogen levels were significantly higher before implantation in patients who died while receiving support. Renal and liver function returned to normal before transplantation. We conclude that support with the HeartMate device improved hemodynamic and subsystem function before transplantation. Long-term support with the HeartMate device a realistic alternative to medical therapy. (J THORAC CARDIOVASC SURG 1995; 109: 409-18)

Pulmonary venous flow measured by pulsed-wave Doppler transesophageal echocardiography reflects the effects of mitral regurgitation on left atrial pressure contour. To assess the relationship between pulmonary venous flow and left atrial pressure in patients with mitral regurgitation under altered loading conditions, we studied 25 patients with 3+ or 4+ mitral regurgitation and a control group by measuring pulmonary venous flow with transesophageal echocardiography and left atrial pressures after administering saline solution (n=6), nitroglycerin (n=6), phenylephrine (n=6), or nitroprusside (n=7). After administion, the left atrial pressure v wave increased in the group given phenylephrine, concomitant with an increased diastolic flow. In contrast, the left atrial pressure v wave decreased in the group given nitroglycerin, concomitant with a decreased diastolic flow. Changes in diastolic flow were closely related to changes in the left atrial pressure v wave under all loading conditions (r=0.91; p<0.0001). Numeric modeling of left atrial pressure and pulmonary venous diastolic flow corroborated the experimental findings. We conclude that changes in pulmonary venous diastolic flow are closely related to changes in the left atrial pressure v wave in mitral regurgitation, under altered loading conditions.