Patterns of myocardial cell adhesion molecule expression in human endomyocardial biopsies after cardiac transplantation. Induced ICAM-1 and VCAM-1 related to implantation and rejection.

Conflicting patterns of myocardial cell adhesion molecule expression associated with cardiac rejection have emerged from numerous studies of randomly selected cardiac biopsies. We designed a prospective, longitudinal study which reports both qualitative and quantitative levels of myocardial ICAM-1, VCAM-1, E-selectin, and P-selectin expression in sequential human cardiac allograft biopsies. Intense ICAM-1 and VCAM-1 staining was found in all biopsies during the first three weeks after transplant and coincided with elevated serum levels of troponin T, a sensitive marker of ischemic myocyte injury. Baseline ICAM-1 and VCAM-1 expression returned within three to four weeks, as did serum troponin T levels in all patients who did not develop rejection. All 29 rejection episodes encountered were associated with intense ICAM-1 staining, while 24 of the 29 (83%) had intense VCAM-1 staining. Increased ELAM-1 and CD62 staining was only rarely observed. Persistence of increased ICAM-1 and VCAM-1 staining after treated rejection episodes predicted a recurrent rejection episode within two months (75% positive and 100% negative predictive value). Objective quantitative measurements by radioimmunoassay (RIA) confirmed these patterns of induced ICAM-1 and VCAM-1 expression. Thus, longitudinal monitoring of serial biopsies for myocardial ICAM-1 and VCAM-1 expression could be useful in the early detection of rejection episodes and monitoring the efficacy of immunosuppressive therapy.     

Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke

BACKGROUND AND PURPOSE:Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.MATERIALS AND METHODS:We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.RESULTS:Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging–selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, P = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; P = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22–4.47), independent of baseline severity and reperfusion.CONCLUSIONS:In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.

Endovascular reperfusion therapy (ERT) for acute ischemic stroke has been associated with mixed results. In trials of carefully selected patients with middle cerebral artery occlusion, a benefit of intra-arterial thrombolysis over placebo was seen when patients were treated within 6 hours.^1,2 However, subsequent single-arm studies of mechanical embolectomy have observed less impressive results^3,4 and suggest that outcomes are related to several key factors, including patient characteristics (age, co-morbidities, and stroke severity) and treatment factors (time to reperfusion).^5–10 Radiographic features, including pretreatment tissue status by NCCT of the head, brain MR imaging, and perfusion imaging (CTP or MR perfusion [MRP]), may improve patient selection.^5,8,9,11 Few studies have compared NCCT-based selection with perfusion imaging–based selection of patients for ERT following acute ischemic stroke.^12,13 We, therefore, sought to compare NCCT selection with perfusion imaging selection as a predictor of good outcome following ERT. We hypothesized that perfusion imaging–based selection would be associated with better functional outcomes at 3 months compared with NCCT-based selection alone.     

Concentrations of Heavy Metals in Commercially Important Oysters from Goa,Central-West Coast of India

The major beds of oyster along the central-west coast of India are exposed to different anthropogenic activities and are severely exploited for human consumption. In this viewpoint, tissues of oyster Crassostrea madrasensis, C. gryphoides and Saccostrea cucullata were analyzed for Cu, Ni, Cd and Pb concentrations (dry weight) from Chicalim Bay, Nerul Creek and Chapora Bay in pre-monsoon, monsoon and post-monsoon seasons. A higher concentration of Cu (134.4–2167.9 mg kg^?1) and Cd (7.1–88.5 mg kg^?1) was found, which is greater than the recommended limits in all the three species (and sites). Moreover, significant (p?<?0.05) variations were observed for all the metals concentrations among the species, seasons and sites. The high concentrations of Cd and Cu in tissues of edible oyster pose a threat to human health. Therefore, continuous monitoring, people awareness and a stringent government policy should be implemented to mitigate the metal pollution along the studied sites.     

‘Wrong blood in tube’: solutions for a persistent problem

Background and Objectives This study was performed to determine the incidence of ‘wrong blood in tube’ (WBIT)‐type errors at our institution during the past 5 years, to analyse their root cause and to evaluate the efficacy of preventive measures that have been implemented since 2006. Methods All reports of mislabelled and miscollected specimens detected between January 2005 and December 2009 were reviewed. Of these, WBIT‐type errors were further analysed as they represent a major risk for mistransfusion. Results Between 2005 and 2009, 59 373 type and screens were performed at our institution and a total of 26 major errors (WBIT) were identified. Of the errors, eight were detected by discrepant typing results (in comparison with historic blood type), six were discovered by the clinical service and 12 were identified in the blood bank by other means. Our estimated ‘raw’ WBIT rate (1 in 2283 samples) is comparable to that (1:2262) in the published literature. Since 2006, our nursing policy mandates that ‘all type, screen and cross will have two witnesses to the correct ID of the patient and labeling is done at the bedside at the time of the draw.’ This has reduced (from 11 in 2006 to 5 in 2007), but did not eliminate, our WBIT problem that persisted into 2008 and 2009 (three and seven incidents, respectively). Since 2009, we also require a second, independently drawn sample in previously un‐typed patients who are likely to be transfused. Conclusion We conclude that WBITs continue to represent a leading cause of potential mistransfusions at our institution. Changes in nursing (two witnesses to correct ID) and/or blood bank policy (check‐type with a second specimen) may reduce, but not eliminate, this persistent problem. Clearly, additional safety measures are required to prevent WBIT‐type errors.     

A prospective, randomized, single-blind comparative evaluation of anesthetic efficacy of posterior superior alveolar nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations in patients with irreversible pulpitis

Introduction

The purpose of this study was to evaluate and compare the anesthetic efficacy of posterior superior alveolar (PSA) nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine in maxillary first molars with irreversible pulpitis.

Methods

Ninety-four adult patients participated in this prospective, randomized, single-blinded study. The patients were divided into 3 treatment groups on a random basis. Twenty-eight patients received a PSA nerve block, 33 patients received buccal infiltrations, and 33 patients received buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated 15 minutes after injection. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded as “none” or “mild” pain.

Results

Statistical analysis using nonparametric chi-square tests revealed that there was no statistical difference between the anesthetic success of PSA nerve blocks (64%), buccal infiltrations (54%), and buccal plus palatal infiltrations (70%).

Conclusions

None of the tested methods gave 100% anesthetic success rates in maxillary first molars with irreversible pulpitis.     

Opthalmoscopic Findings in Adult Patients with Severe Falciparum Malaria

Aim: To report the systemic and ocular findings of four Indian adult patients with severe Plasmodium falciparum infection. Materials and Methods: Case reports. Results: The commonest findings seen were posterior pole hemorrhages that were seen in all patients. These included superficial and subretinal hemorrhages. Some of the eyes with subretinal hemorrhages were associated with a premacular hemorrhage. The findings of retinal whitening and vascular changes were seen in one patient. Conclusions: A spectrum of ocular lesions was noted, including pre-retinal, subretinal hemorrhages, retinal whitening, and retinal vascular anomalies.