Reversible temperature-dependent high- to low-spin transition in the heme Fe–Cu binuclear center of cytochrome ba3 oxidase

A reversible temperature-dependent high-spin to low-spin transition with T_1/2 = −60 °C has been observed in the resonance Raman spectra of the equilibrium reduced and photoreduced heme a₃ of the thermophilic ba₃ heme–copper oxidoreductase. The transition is based on the frequency shifts of the spin-state marker bands ν₂ (C_bC_b) and ν₁₀ (C_aC_m) and is attributed to the displacement of the heme iron along the heme normal as a consequence of the Fe–Np repulsion at temperature below −40 °C which will increase the ligand field strength forcing the pairing of d electrons into the lower energy orbitals.

A reversible temperature-dependent high- to low-spin transition with T_1/2 = −60 °C has been observed in the resonance Raman spectra of the equilibrium reduced and photoreduced heme a₃ of the thermophilic ba₃ heme–copper oxidoreductase.     

Worldwide Analyses of Maxillary First Molar Second Mesiobuccal Prevalence: A Multicenter Cone-beam Computed Tomographic Study

Introduction

Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment.

Abnormal signal-averaged electrocardiograms in patients with incomplete right bundle-branch block

Background and hypothesis: A hypothesis was formulated that regional delayed activation of the right ventricle, as seen in incomplete right bundle-branch (IRBBB) aberrancy, may simulate late potential activity and may be responsible for abnormal signal-averaged electrocardiograms (SAECGs). No previous studies have specifically addressed this issue in this particular group of patients (with IRBBB). Therefore, the aim of the present study was to investigate the incidence of abnormal SAECGs in patients with IRBBB. If this were confirmed, our purpose would further be to investigate ways of reducing the false positive results. Methods: The study group included 53 patients (28 men and 25 women), aged 53 ± 13 years, with no history of previous myocardial infarction or ventricular tachycardia and who had an electrocardiogram (ECG) showing IRBBB. An SAECG was also performed in a control group of 19 age-matched individuals with a normal ECG. Time domain analysis was performed using a band pass filter of 40–250 Hz. The following parameters were considered normal: filtered QRS duration (QRSD) < 114 ms, root mean square of the voltage of the last 40 ms of the QRS complex (RMS) > 20 μV, and the duration of the low amplitude signal (< 40 μV) at the terminal portion of the QRS (LAS) < 38 ms. An SAECG was considered abnormal if any two of these criteria were abnormal. Results: The mean values of the SAECG parameters were: QRSD 101 ± 11 ms, RMS 32 ± 20 μV, LAS 32 ± 12 ms, and noise 0.29 ± 0.13 μV. Abnormal SAECGs with at least two criteria satisfied were present in 16 of 53 (30%) patients compared with 0 (0%) of 19 individuals in the control group (p = 0.02). Abnormal values included the combination of RMS and LAS in 12 patients and all three parameters in 4 patients. However, if the definition of late potentials were limited to the combination of abnormal QRSD and either RMS or LAS values, the incidence of false positive results (4 patients) (7.5%) would be significantly decreased (p = 0.007). At 21 months of follow-up, no arrhythmic events occurred. Conclusions: Delayed terminal conduction observed in IRBBB may cause a high incidence of false positive late potentials on SAECGs. Based on this study, we propose that this can be largely remedied if the optimal criteria for the presence of late potentials in patients with IRBBB always include the combination of QRSD and either RMS or LAS.     

Usefulness of Reperfusion Ventricular Arrhythmias in Non-invasive Prediction of Early Reperfusion and Sustained Coronary Artery Patency in Acute Myocardial Infarction

Background: Established tenets of occurrence of reperfusion ventricular arrhythmias in acute myocardial infarction (AMI) do not provide insight into the timing of achieving reperfusion or whether coronary artery patency is sustained. We assessed the significance of ventricular arrhythmias in the non-invasive prediction of timely reperfusion and sustained restoration of coronary patency after thrombolysis in patients with AMI. Methods: 24-hour Holter monitors were placed in 163 patients with an AMI before administration of thrombolytic therapy. Patients were classified into 3 groups of early (within 2 hours) or late reperfusion, or no-reperfusion, according with clinical and continuous ST-segment electrocardiographic criteria. Ventricular fibrillation, ventricular tachycardia (VT) and accelerated idioventricular rhythm (AIVR) were also categorized as having occurred early (within the first 2 hours) or late (after the first 2-hour period). Angiographic confirmation of coronary patency was determined 2 to 6 days after AMI. Results: Early reperfusion was predicted by early sustained AIVR in 86% of patients and early non-sustained AIVR in 62.5% of patients, with sensitivity 38% and 77%, and specificity 96% and 69%, respectively; p<0.0001. Late non-sustained AIVR was commonly seen in early and late reperfused patients (92–97%) as well as in non-reperfused patients (74%). Sustained coronary patency was predicted by early sustained AIVR in 93% of patients, as well as by early non-sustained AIVR in 86% of patients and late non-sustained AIVR in 79% of patients, with sensitivity 22%, 55% and 94%, and specificity 95%, 71% and 18%, respectively; p<0.05. Conclusion: Only the occurrence of sustained AIVR, and probably early non-sustained AIVR convey useful information about both early reperfusion and sustained coronary artery patency. The absence of AIVR does not preclude successful thrombolysis. Abbreviated Abstract. This study investigated the prognostic value of reperfusion ventricular arrhythmias in non-invasive prediction of early reperfusion (at the 2-hour cutoff-point after thrombolysis) and sustained restoration of coronary patency in patients with acute myocardial infarction. Only sustained accelerated idioventricular rhythm (AIVR) and early episodes of non-sustained AIVR could be used as surrogate markers of early reperfusion and sustained coronary patency. Non-sustained AIVR does not have any prognostic significance occurring irrespective of reperfusion status.     

Cystatin C levels in patients with β-thalassemia during deferasirox treatment

Deferasirox (Exjade®) is a once-daily, oral iron chelator approved for the treatment of transfusional iron overload. This study was conducted to analyze changes in cystatin C concentration, an endogenous marker of glomerular filtration rate (GFR), in patients with thalassemia receiving daily deferasirox therapy over a period of at least 9 months. One hundred and fifty β-thalassemia patients were treated with deferasirox at doses of 20–40 mg/kg/day for 9 consecutive months. Cystatin C concentrations were measured at regular intervals and GFR was calculated according to the cystatin C-based prediction equation. Plasma concentrations of NGAL protein and NT-proBNP were also monitored as indicators of renal function and LVEF, respectively. Serum ferritin concentration was also measured to assess iron overload. Throughout the 9 months of deferasirox treatment cystatin C concentration remained stable (p > 0.850). The baseline cystatin C mean values were 0.97 ± 0.27 mg/L and reached a maximum of 1.01 ± 0.29 mg/L at 4 months of treatment. No correlation was found between cystatin C and NGAL concentrations (p > 0.674). Cystatin C and NT-proBNP concentrations correlated positively with a binomial equation (p < 0.004), as also did cystatin C and serum ferritin (p < 0.001). These findings suggest that slight changes of cystatin C during deferasirox treatment may not reflect renal injury. However hemodynamic signals such as LVEF alterations and iron mobilization do appear to affect changes in cystatin C concentration.     

Insulin-like Growth Factor I and its binding protein 3 in sepsis

ObjectiveTo investigate the Growth Hormone (GH)/Insulin-like Growth Factor-I (IGF-I) axis and identify the factors that determine IGF-I levels in adult septic patients of variable severity, i.e., with sepsis, severe sepsis or septic shock, in the acute phase of disease.DesignIn 107 consecutive septic patients (44 with sepsis, 13 with severe sepsis, and 50 with septic shock), GH, IGF-I, Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), insulin, cortisol, albumin, thyroid hormones, C-reactive protein and interleukin-6 serum levels were measured once within 48 h after onset of a septic episode. Twenty-nine healthy volunteers served as controls.ResultsIGF-I and IGFBP-3 levels were decreased in patients with sepsis and severe sepsis (versus controls), decreasing further in patients with septic shock (versus sepsis). IGF-I levels were positively related to IGFBP-3, albumin, triiodothyronine and thyroxine, and inversely related to cortisol, sepsis severity, C-reactive protein, interleukin-6 and age. In multiple regression analysis, IGF-I levels were independently related to IGFBP-3 and albumin (lower in patients with decreased IGFBP-3 and albumin levels) (p < 0.001 and p = 0.01, respectively), and cortisol (lower in patients with increased cortisol levels) (p = 0.04). IGFBP-3 accounted for most of the variance explained by the model (R² = 0.519). GH levels were not related to IGF-I levels or mortality. IGF-I and IGFBP-3 levels were not associated with mortality.ConclusionsThe GH/IGF-I axis is severely disrupted in septic patients. IGFBP-3 is the major determinant of IGF-I levels.