Limitations of comparing left ventricular volumes by two dimensional echocardiography,myocardial markers and cineangiography

Measurement of left ventricular volume at end-diastole or end-systole with both two dimensional echocardiography and either Cineangiography or radionuclide scans, not recorded simultaneously, has shown large echocardiographic underestimation of volumes even in normal ventricles. In this study fluoroscopic and two dimensional echocardiographic recordings were obtained in 18 patients with abnormal wall motion and previously implanted myocardial markers. The echocardiographic values for volume and those derived from myocardial markers correlated well (r = 0.87), and there were no statistically significant differences in values obtained with the two methods at end-diastole or end-systole. The ejection fractions obtained with two dimensional echocardiography (mean ± standard deviation 46 ± 7 percent) and with fluoroscopic recording of the markers (41 ± 9 npercent) did not differ statistically.These results were compared with those in another 18 patients (nine with abnormal wall motion) having two dimensional echocardiography within 24 hours of a 30 ° right anterior oblique contrast left ventriculogram. Again, two dimensional echocardiographic ventricular volume correlated well with the angiographic volume (r = 0.85), although echocardiographic end-diastolic volume was consistently 20 percent less than angiographic end-diastolic volume (p < 0.01). Ejection fraction obtained with echocardiography (47 ± 8 percent) was less than that obtained with angiography (60 ± 7 percent) (p < 0.001). Interobserver variability in calculating volume with echocardiography was 4 percent.Probable reasons for the lack of severe underestimation of volume with echocardiography even in very abnormal ventricles, relative to that demonstrated in prior reports, include improvements in ultrasonic beam width, tracing method, transducer position and scan plane orientation within the ventricle. In addition, the possible effects of angiographic dye in the ventricular trabeculae are discussed and the effect of simultaneous studies by two different methods are compared.     

In situ localization of mRNA for the fibrinolytic factors uPA, PAI-1 and uPAR in endometriotic and endometrial tissue

Endometriotic tissue grows invasively. The plasminogen-activating system is suggested to participate in degradation of extracellular matrix (ECM) and modulation of cell adhesion and migration. We have previously demonstrated elevated levels of the fibrinolytic factors urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1) in endometriotic tissue and endometrium from women with endometriosis. The aim of the present study was to localize the uPA, PAI-1 and urokinase plasminogen activator receptor (uPAR) mRNA in endometriotic tissue and in endometrium both from women with and without endometriosis. With in situ hybridization, we found that uPA mRNA seems to be up-regulated in endometriotic glands and endometrial stroma as well as PAI-1 mRNA in endometriotic and endometrial stroma from women with endometriosis. uPAR mRNA likewise appears to be up-regulated in both glands and stroma in endometriotic tissue and in endometrial glands from patients compared to endometrial glands and stroma from healthy women. These differences might be important for menstrual shedding and adherence of endometrial fragments to peritoneal lining in women developing endometriosis and for the invasive growth of endometriotic tissue.     

Elevated expression of tumour necrosis factor alpha in cultured granulosa cells from women with endometriosis

Fertilization and oocyte cleavage rates have previously been demonstrated to be lower for women with endometriosis undergoing IVF compared with controls. This might be related to impaired oocyte function, possibly due to an inflammatory milieu in the pelvis of these women, where an elevated concentration of many cytokines is documented. The aim of this study was to examine whether granulosa cells from women with endometriosis deviated with respect to production of the inflammatory cytokines interleukin-1beta, interleukin-6, interleukin-8 and tumour necrosis factor alpha (TNFalpha) compared with granulosa cells from healthy women, undergoing IVF for male infertility. The effect of human chorionic gonadotrophin on cytokine production was also investigated. Granulosa cells in follicular fluid were obtained at oocyte retrieval for IVF. Incubated cell culture media were analysed by enzyme-linked immunosorbent assay. The basal production of all four cytokines was higher in cells from women with endometriosis when compared to controls, although the increase was only significant for TNFalpha. Chorionic gonadotrophin had no significant effect, although it had a tendency to suppress cytokine release in both patient categories. Whether aberrant cytokine production in granulosa cells from women with endometriosis may disturb fertilizing capacity of oocytes requires study.     

Effectiveness of web-based versus folder support interventions for young informal carers of persons with mental illness: A randomized controlled trial

Objective

Compare the impact of two interventions, a web-based support and a folder support, for young persons who care for people who suffer from mental illness.

Methods

This study was a randomized control trial, following the CONSORT statements, which compared the impact of two interventions. Primary outcome variable was stress, and secondary outcome variables were caring situation, general self-efficacy, well-being, health, and quality of life of young informal carers (N = 241). Data were collected in June 2010 to April 2011, with self-assessment questionnaires, comparing the two interventions and also to detect changes.

Results

The stress levels were high in both groups at baseline, but decreased in the folder group. The folder group had improvement in their caring situation (also different from the web group), general self-efficacy, well-being, and quality of life. The web group showed increase in well-being.

Conclusion

Young informal carers who take on the responsibility for people close to them; suffer consequences on their own health. They live in a life-situation characterized by high stress and low well-being. This signals a need for support.

Practice implications

The non-significant differences show that each intervention can be effective, and that it depends upon the individual's preferences. This highlights the importance of adopting person-centered approach, in which young persons can themselves choose support strategy.     

Semi-conducting properties of titanium dioxide surfaces on titanium implants

The properties of the TiO₂ layer on titanium implant surfaces are decisive for good contact with the surrounding tissue. The oxide properties can be deliberately changed by for example chemical etching, ion incorporation or anodisation. In the present study impedance spectroscopy was used to study the semi-conducting properties of the naturally formed oxide for different pre-treatment of the surface. A turned surface was used as a reference and both physical (blasting) and chemical (hydrofluoric acid etching) treatments were investigated. Blasting of a titanium sample introduces defects in the metal surface and the study clearly shows that also the oxide layer contains defects leading to a higher number of charge carriers (increased conductivity) compared with the oxide on the turned surface. The hydrofluoric acid etching of the blasted surface results in an oxide film with even higher conductivity. Indication of the defect oxide structure for fluoride treated samples was also seen when analysing the TiO⁺/Ti⁺ ratio from ToF-SIMS data. The lowest value of this ratio was obtained for the HF etched sample, indicating a less stoichiometric oxide compared to the other surfaces. This is a result of incorporation of fluoride ions in the oxide, as proven by adsorption studies on a TiO₂ suspension. The results were treated in the context of surface complexation and two surface complexes were identified. Our results are discussed in relation to pull-out data on rabbit. The pull-out forces depend primarily on surface roughness but the contribution from the hydrofluoric acid etching might be explained by fluoride ion incorporation and the resulting increase in oxide conductivity.     

The role of illness beliefs, treatment beliefs, and perceived severity of symptoms in explaining distress in cancer patients during chemotherapy treatment

The authors investigated cancer patients' interpretations of their physical symptoms and their illness beliefs with the objective of establishing the importance of these variables in predicting distress during chemotherapy treatment. Past researchers have suggested that causal attributions of physical symptoms and beliefs about illness progression and its consequences may serve as important mediators between number and perceived severity of symptoms and psychological adjustment in cancer patients during the treatment phase. Our aim in this study was to further these findings using the Self-Regulation Model as a theoretical framework. The study was cross-sectional in design, testing 72 patients with cancer receiving intravenous chemotherapy as outpatients in the United Kingdom. The participants completed questionnaires measuring number and perceived severity of symptoms, the causal attributions of these, illness and treatment beliefs, anxiety, and depression. The results showed that consequence beliefs serve as important mediators between number of symptoms and distress, explaining 15% of the variance in anxious mood and 5% of the variance in depressed mood. The authors found perceived severity of symptoms to be an independent predictor of anxious mood, explaining 7% of the variance. Its role in predicting depressed mood was not significant.     

Treatment with anti-TNF monoclonal antibody (c5N) reduces the extent of induced endometriosis in the baboon

BACKGROUND: Inflammatory cytokines, including interleukin (IL)-1, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-alpha), are important in the pathogenesis of endometriosis. We assessed the efficacy of anti-TNF monoclonal antibody (mAb, c5N), known to prevent induced endometriosis in baboons, in reducing established endometriosis in baboons. METHODS: This prospective, randomized, blinded, controlled study was conducted in baboons at the Institute of Primate Research (IPR), Nairobi, Kenya. Endometriosis was induced in 18 adult female baboons (Papio anubis) with regular menstrual cycles and a normal pelvis; the extent of endometriosis was documented by videolaparoscopy 25 days later. The baboons were then randomly assigned to receive a single infusion of either placebo (n=7, 5 ml/kg) or c5N (n=11, 5 mg/kg). Follow-up laparoscopy was performed 25 days later to document any differences in the number, surface area and estimated volume of lesions between the two groups and between the first and the second laparoscopies in each group. Representative biopsies of at least one endometriotic lesion per baboon were obtained at the final laparoscopy. RESULTS: Significant reductions in total surface area, estimated total volume of endometriotic lesions and both number and surface area of red lesions were observed after treatment with c5N, but not after placebo treatment, when compared to the initial laparoscopy. Conversely, a significant increase in the number of typical and red lesions was observed after placebo treatment when compared to the initial laparoscopy. Neither c5N nor placebo treatment affected the menstrual cycle. CONCLUSION: In baboons with induced endometriosis, anti-TNF-mAb (c5N) treatment significantly reduced the extent of endometriosis, mainly due to reducing both the number and surface area of red lesions. These findings suggest that anti-TNF-mAb therapy may have therapeutic potential for active peritoneal endometriosis.     

Down regulation of TRPC1 by shRNA reduces mechanosensitivity in mouse dorsal root ganglion neurons in vitro

Mechanosensitivity is a crucial but poorly understood property of the sensory nervous system. Transient receptor potential (TRP) channels, which have been found to be responsible for the detection of other sensory stimuli such as temperature and pungent chemicals, have been suggested to also recognize stretch or pressure to cell membranes. TRPC1 is one candidate from studies in oocytes but evidence in native sensory neurons has been lacking. Therefore, we have measured an increase in intracellular Ca²⁺ levels upon mechanical activation of native mouse dorsal root ganglion (DRG) neurons in culture using hypoosmolar buffer. Our results show that down regulation of TRPC1 with short hairpin RNA results in a 65% reduction of neurons with stretch activated responses. These results implicate a direct or indirect involvement of TRPC1 in the mechanosensitivity of DRG neurons.