Effects of n-3 fatty acids from fish on premature ventricular complexes and heart rate in humans

BACKGROUND: A large body of evidence suggests that n-3 fatty acids from fish prevent fatal heart disease. They may be an effective and safe alternative to drug treatment for reducing the risk of arrhythmia and sudden cardiac death. OBJECTIVE: We investigated the effect of n-3 fatty acids on heart rate and premature ventricular complexes (PVCs), a common form of arrhythmia that may trigger arrhythmias that are more life-threatening. DESIGN: Patients (n=84) with >or=1440 PVCs/24 h in a previous Holter recording were randomly assigned to receive 1.5 g/d of either n-3 fatty acids or placebo. Two 24-h Holter recordings were made at baseline, and 2 were made after an intervention of approximately 14 wk. RESULTS: Treatment did not significantly affect the number of PVCs. The number decreased in the fish-oil group by 867/24 h more than it decreased in placebo group (95% CI: -3187, 1453). However, the mean 24-h heart rate was significantly affected, decreasing in the fish-oil group by a mean of 2.1 beats/min more than it decreased in the placebo group (95% CI: -3.9, -0.3). CONCLUSIONS: Supplementation with 1.5 g n-3 fatty acids/d from fish does not substantially suppress the number of PVCs in a patient population with frequent PVCs. However, n-3 fatty acids decreased heart rate by 2.1 beats/min, a significant decrease that predicts a lower risk of sudden death.     

Aging and transplant arteriosclerosis in absence of alloreactivity and immunosuppressive drugs in a rat aortic model: recipient age's contribution

BACKGROUND: Almost half of all transplanted vascularized organ grafts will be lost to transplant arteriosclerosis sometime posttransplantation. Organ shortage for primary transplants and retransplants has led to donor-pool expansion to include elderly donors, knowing that aging per se promotes arteriosclerosis. The current understanding that donor age negatively affects organ and/or patient survival outcome is undermined by variables such as the use of immunosuppressive drugs, their toxicity to the graft, degree of donor-recipient histocompatibility, and the resulting chronic rejection. The purpose of this study was to determine whether the donor's age or recipient's age matters the most in transplant arteriosclerosis in the absence of such variables. METHODS: A syngeneic combination was used where young (2-month-old) and old (22-month-old) donor aortas were injured to initiate neointimal thickening, then transplanted into age-mismatched recipients for 14, 60, and 90 days and then assessed for neointimal thickening. Base level injury response due ischemia and surgery was evaluated in age-matched and noninjured aortic grafts, respectively. RESULTS: Young aortas invariably developed thicker neointima when transplanted into old recipients than when transplanted into young ones. Correspondingly, old aortas transplanted in young recipients consistently developed less neointimal thickening than when transplanted into old recipients. CONCLUSIONS: Our findings strongly suggest that the severity of age-related neointima formation is primarily determined by the recipient's age rather than the donor's age. Therefore, in addition to focusing on donor-specific tolerance induction, strategies aiming at increasing the lifespan of vascularized organ grafts also have to take into consideration the recipient's aging milieu.     

Origin and natural history of deep vein thrombosis of the legs

Deep vein thrombosis (DVT) is a disorder frequently affecting the deep veins of the lower limbs; its onset is induced by known risk factors. The main complications of DVT are pulmonary embolism and postthrombotic syndrome (PST). Clinical pulmonary embolism occurs in a high proportion of cases of untreated proximal DVT and is associated with a mortality rate of 11-23% if not treated. PST, however, is a cause of increased morbidity and disability. The natural history of DVT is a dynamic process, with both thrombolysis and thrombus extension occurring after an episode of DVT. With the introduction of duplex scanning, several clinical studies have investigated and tried to clarify the natural history of DVT, the rate of recanalization of the thrombus, and the presence of reflux and its relation to lysis of the thrombus. These and other debated issues associated with PST are reviewed here. Knowledge of the evolution of these processes could result in better understanding of PST and be applied for improvement of medical and surgical management of venous thrombosis and its complications.     

A generalized physiological hyperreactivity to acute stressors in hypertensives

Hypertensives have consistently been found to have a more reactive cardiovascular system than normotensives. In the present study, it was examined whether this enhanced cardiovascular stress reactivity generalizes to the hypothalamus-pituitary-adrenal (HPA) axis and the immune system. Forty-two unmedicated hypertensives and 21 normotensive controls performed five passive coping and active coping stressful tasks in the laboratory. In addition to the expected greater mean diastolic blood pressure reactivity to the tasks, hypertensives exhibited enhanced (baseline corrected) task salivary cortisol and secretory immunoglobulin A (S-IgA) levels. Moreover, correlations were found between blood pressure responses and task related cortisol activity and between baseline blood pressure levels and task-induced S-IgA levels. These results indicate that hypertensives not only have a hyperreactive cardiovascular system, but also an enhanced HPA axis and immune system reactivity to stress. A central stress mechanism may be responsible for the heightened generalized stress response in hypertensives.     

Working mechanisms of computer-tailored health education: evidence from smoking cessation

To further develop tailored interventions, their working mechanisms must be identified. In the present study, three tailored messages that each contained one potential working mechanism--personalization, adaptation or feedback--were compared with a standard information condition. Two hundred and two students who smoked tobacco daily were randomly divided over four conditions. After the computer pre-test questionnaire, they read the information in their condition and filled in the immediate post-test. After 4 months, they were sent a follow-up questionnaire assessing their quitting activity. The data show that personalization (44.5%) and feedback (48.7%), but not adaptation (28.6%), led to significantly more quitting activity after 4 months than did the standard information (22.9%). Moreover, the effect of condition on quitting activity was completely mediated by individuals' evaluations of the tailoring.     

The organisational response to patient complaints: a case study in Taiwan

PURPOSE: To explore and evaluate how hospital staff respond to patient complaints. DESIGN/METHODOLOGY/APPROACH: A teaching hospital with 1,500 beds in Taiwan was purposefully chosen as a case study of hospital response to patients' complaints. Data was obtained through interviews with quality surveying managers (n = 53), government managers (n = 4), staff of non-government organizations (n = 3) and a senior social worker, as well as analysis of documents (September 2001-April 2002). FINDINGS: Using the managerial-operational-technical framework developed by the researchers, the study demonstrated problematic aspects of handling complaints at the case hospital. It was revealed that: complaint handlers were not sufficiently empowered, information sharing was limited within the organization, communication among professional staff and with management was inadequate, the physical safety of workers had been threatened, and improvements could not be sustained. Moreover, it became apparent that the case study hospital generally responded to patient complaints in a reactive and defensive manner. ORIGINALITY/VALUE: It is evident that the hospital did not use patient complaints as a source of learning that could have promoted higher standards of care. The case study reveals some of the constraints and identifies requirements for appropriate use of information and feedback from patients. The study raises some issues requiring further research to ensure more appropriate use of patient complaints to improve quality of care.     

Schwere Durchfälle bei niedrig malignem B-Zell-Lymphom

A 52-year old female presented with a low, malignant centroblastic-centrocytic lymphoma. After splenectomy and under steroid therapy it came to the eruption of a latent Strongyloides stercoralis infection, which the patient had presumably been suffering from for several years. Due to the immunodeficient condition and under continued steroid therapy even three courses of high dose anthelmintic therapy could not eradicate the parasites. The patient died of fulminant sepsis.     

CD44-independent hepatocyte growth factor/c-Met autocrine loop promotes malignant peripheral nerve sheath tumor cell invasion in vitro

Malignant peripheral nerve sheath tumors (MPNSTs) are invasive peripheral nerve neoplasms that express both the receptor tyrosine kinase c-Met and its ligand hepatocyte growth factor (HGF). The combined expression of these proteins has been implicated in tumor cell growth and metastasis. However, HGF/c-Met autocrine activity requires the presence of a serine protease, the HGF activator (HGFA), and, in some cells, the CD44 transmembrane glycoprotein. Here, we found that HGFA, HGF, c-Met, and CD44 are coexpressed in MPNSTs but their localization did not correlate with increased cell proliferation. The ST8814 MPNST cell line also expresses all of these proteins, can convert pro-HGF to active HGF, and exhibits constitutive c-Met phosphorylation. Blocking c-Met activity or expression inhibits the invasive behavior of these cells but not their proliferation. Interestingly, although a CD44 splice variant contributes to MPNST cell invasion and interacts with c-Met and HGF in ST8814 cells, it is not required for c-Met activation. These data indicate that an HGF/c-Met autocrine loop can promote MPNST invasion through a CD44-independent mechanism and suggest that c-Met, HGFA, and HGF are potential molecular targets to inhibit MPNST metastasis.