Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study

BACKGROUND: Inflammatory markers have been associated with adverse clinical outcome in patients with acute coronary syndromes (ACS). In addition, angiographic plaque morphology and extension of coronary artery disease has been related to worse prognosis in this group of patients. The aim of the present study was to determine if the clinical prognostic value of C-reactive protein (CRP), an inflammatory marker, can by associated with the angiographic findings in patients with non-ST elevation ACS. METHODS: This prospective multicenter cohort study included 1253 patients with non-ST elevation ACS. CRP, which was considered positive (+) if >/=3 mg/l, was measured at a median of 9 h from symptoms onset and were kept blinded until the end of the study. Coronary angiography was performed in 633 patients (50%). The presence of complex coronary lesions (CCLs) was defined as the presence of any of the following: thrombus (+), Thrombolysis In Myocardial Infarction (TIMI) flow 相似文献   

Cranial reconsctruction with titanium mesh and hydroxyapatite cement

We report the case of a 45 year old patient who was affected by an infectious disease of the temporal bone, after the surgical treatment of a meningioma in the greater sphenoid wing. This infection healed after the resection of the craniotomy flap. The remaining bone defect was reconstructed using a titanium mesh covered by hydroxyapatite cement (Norian). The result was excellent due to the strength of the titanium mesh and the volume and contour offered by the hydroxyapatite cement.     

Functional bracing in the treatment of delayed union and nonunion of the tibia

We treated 16 delayed unions and 57 nonunions of the tibial diaphysis with a below-the-knee functional brace. In 48 cases, bracing was preceded by fibular ostectomy, and ten patients had an additional bone graft. We were able to follow 67 patients, of whom six (8.7%) failed to respond to treatment. In patients with nonunion, bony healing occurred with a median of 4 months. There was no difference in the speed of healing according to the level of the defect. Shortening of the limb following ostectomy of the fibula had a mean of 3 mm in the delayed-union group and 5 mm in the nonunion group.     

Trihalomethanes in the drinking water of Carabobo State,Venezuela

OBJECTIVE: Disinfection of water with chlorine in water treatment plants leads to the formation of trihalomethanes (THMs). These compounds are associated with adverse health effects. The aim of this study was to analyze THM concentrations in the water provided for human consumption in the two main water treatment systems of Carabobo State: the Alejo Zuloaga plant and the Pao-Cachinche reservoir, which form the Central Regional System I (CRS I), and the Lucio Baldo Soules plant and the Pao-La Balsa reservoir, which form the Central Regional System II (CRS II).Methods: We analyzed 144 water samples collected in 6 samplings carried out in 2000 and 2001. THM concentrations were determined by gas chromatography using the headspace technique. The concentrations of the following THMs were measured: chloroform (CHCl3), bromoform (CHBr3), chlorodibromomethane (CHBr2Cl) and bromodichloromethane (CHCl2Br). RESULTS: The concentration of total THMs was between 47.84 g/l and 94.23 g/l. CHCl3 was the most commonly formed compound representing 83% of all THMs in the CRS I and 82% in the CRS II. The concentrations of total THMs in the CRS I, specifically in the Baja and San Diego networks, were significantly higher (p < 0.05) than permissible levels set by the American Environmental Protection Agency (80 g/l) for the sum of all four THMs. CONCLUSIONS: The results show that in the area studied there is a risk of adverse health effects due to THMs in drinking water, especially in the Baja and San Diego networks.     

Is combined partial hepatectomy with segmental resection of inferior vena cava justified for malignancy?

HYPOTHESIS: En bloc partial hepatectomy with inferior vena cava (IVC) resection may be the only curative strategy for patients with hepatic malignancies involving the IVC. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: All consecutive patients undergoing combined partial hepatectomy with segmental IVC resection and reconstruction between 1990 and 2002. Patients with tangential excision of the IVC were excluded. Follow-up was completed by outpatient clinic visits and mail correspondence. MAIN OUTCOME MEASURES: Perioperative outcomes; overall and recurrence-free survival. RESULTS: Nineteen patients (7 men and 12 women) underwent partial hepatectomy and segmental IVC resection and reconstruction. Median age was 59 years (range, 24-74 years). Diagnoses consisted of cholangiocarcinoma (9 patients), metastatic tumor (5 patients), sarcoma (3 patients), and hepatocellular carcinoma (2 patients). Major hepatectomies (>/=3 segments) were performed in 15 patients; the caudate lobe was resected in 13. Hepatic vascular isolation was used in 13 patients. Ringed polytef grafts were used for IVC reconstruction in all but 1 patient. Transfusion was necessary in 18 patients (median requirement, 5 U). Median operative time was 6.3 hours (range, 3.7-9.0 hours), and hospitalization was 10.5 days (range, 6-41 days). Negative margins of resection were achieved in 16 patients. Complications occurred in 8 patients (42%), including 1 perioperative death (5%). There was evidence of mural thrombosis of the graft in 2 patients (both nonocclusive); warfarin sodium was used postoperatively in 14. Late graft thrombosis was evident in 2 patients. Median overall survival was 38 months (5-year survival, 21%), and recurrence-free survival was 11.5 months (5-year survival, 0%). CONCLUSIONS: Patients with large tumors involving both the liver and the IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, long-term graft patency, and prolonged survival.     

Characteristics of degeneration in an unstable knee with a coronal surface step-off

To investigate the effect of instability on the remodelling of a minor articular surface offset, we created a 0.5 mm coronal step-off of the medial femoral condyle in 12 New Zealand white rabbits and transected the anterior cruciate ligament (ACL). A control group of 12 rabbits had only ACL resection and the opposite knee was used as the non-operated control. The osteoarthritic changes at 6, 12 and 24 weeks after surgery were evaluated histologically. In addition, changes in the immunological detection of 3-B-3(-) and 7-D-4 chondroitin-6-sulphate epitopes were determined because of the previous association of such changes with repair of cartilage and early osteoarthritis. In the instability/step-off group there was rapidly progressing focal degeneration of cartilage on the high side of the defect, not seen in previous step-off studies in stable knees. The rest of the femoral condyles and the tibial plateaux of the instability/step-off group had moderate osteoarthritis similar to that of the instability group. 3-B-3(-) was detectable in the early and the intermediate stages of osteoarthritis but no staining was seen in the severely damaged cartilage zones. Immunoreactivity with 7-D-4 increased as degeneration progressed.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6-7 and 13-14 yr old in Bogotá, Colombia.

This cross-sectional study of children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)-phase III. Asthma prevalence among the children was assessed using a parental self-administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6-7 year age-group were more likely to report current asthma symptoms than the 13-14 year age-group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6-7 year age-group included higher maternal education (OR = 1.7, [95% CI 1.2-2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0-2.3], p = 0.036), watching TV 1-2 hours/day (OR = 2.1, [95% CI 1.2-3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3-2.4], p < 0.001; OR = 2.2, [95% CI 1.7-2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4-2.5], p < 0.001). Among the 13-14 year age-group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4-2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1-1.9], p = 0.010; OR = 0.8, [95% CI 0.6-1.0], p = 0.046; OR = 0.6, [95% CI 0.4-1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Structure-based discovery of small molecule inhibitors targeted to protein tyrosine phosphatase 1B

Protein tyrosine phosphatases (PTPases) are involved in the control of tyrosine phosphorylation levels in the cell and are believed to be crucial for the regulation of a multitude of cellular functions. A detailed understanding of the role played by PTPases in various signaling pathways has not yet been achieved, and potent and selective PTPase inhibitors are essential in the quest to determine the functionality of individual PTPases. Using the DOCK methodology, we have carried out a structure-based, computer-assisted search of an available chemical database in order to identify low molecular weight, nonpeptidic PTP1B inhibitors. We have identified several organic molecules that not only possess inhibitory activity against PTP1B but which also display significant selectivity for PTP1B. This indicates that although structural features important for pTyr recognition are conserved among different PTPases, it is possible to generate selective inhibitors targeted primarily to the catalytic site. Kinetic analysis and molecular modeling experiments suggest that the PTP1B active site possesses significant plasticity such that substituted and extended aromatic systems can be accommodated. The newly identified molecules provide a molecular framework upon which therapeutically useful compounds can ultimately be based, and systematic optimization of these lead compounds is likely to further enhance their potency and selectivity.