Sickle cell trait and the aviator

Sickle cell trait (SCT) for years has been a controversial disorder within the aerospace medicine community. Some authorities consider SCT to be an entirely benign condition without particular significance, at least to moderate altitudes. Others are in disagreement and consider it a serious enough threat that flying duties should be precluded for all individuals with this disorder. These issues are addressed by reviewing SCT, its relationship to altitude, and its risk to aviation. The author concludes that flying organizations must establish their own policy on flying status for individuals with SCT based upon mission peculiarities and the assessment of risk inherent in that mission.     

Abnormal iron parameters in the pregnancy syndrome preeclampsia

OBJECTIVE: Our purpose was to investigate iron status parameters in preeclampsia with a view to exploring their possible contribution to the etiology. STUDY DESIGN: In prepared serum samples from 40 preeclamptic women and matched pregnant control subjects at the John Radcliffe Hospital, Oxford, a number of iron status parameters were measured. Statistical analysis was by the Wilcoxon signed rank test and linear regression. RESULTS: Serum iron concentration, ferritin, and percent saturation of transferrin were significantly higher in the preeclamptic patients than in control subjects, whereas unsaturated iron-binding capacity and apotransferrin levels were significantly lower. No difference was found in hemopexin concentrations in the two groups. Gestational age at the time of sampling was correlated (positively) with only two parameters, total and unsaturated iron-binding capacity, but only in the preeclampsia group. Eighteen percent of preeclamptic subjects had percent transferrin saturation levels in the region associated with iron overload. CONCLUSION: Released iron species in preeclampsia may contribute to the etiology and will exacerbate lipid peroxidation and endothelial cell injury. Given the high prevalence of heterozygosity for hemochromatosis with the associated reduced ability to exclude ingested iron, it would seem inadvisable, in the absence of evidence of iron deficiency, to give iron supplements to pregnant women at high risk for preeclampsia.     

Analysis of the learning curve in telerobotic,beating heart coronary artery bypass grafting: a 90 patient experience

BACKGROUND: Recent articles have commented on the "learning curve" in robotic-assisted coronary artery bypass grafting. We systematically studied this phenomenon using standard statistical and cumulative sum (CUSUM) failure methods. METHODS: Ninety patients underwent internal thoracic artery (ITA) takedown and an attempt at ITA to coronary bypass on the beating heart using the Zeus telerobotic system from September 1999 to December 2001. The rates of mortality and 11 predefined major complications were compared in five quintiles of 18 consecutive patients each and a CUSUM curve was generated for the entire cohort. RESULTS: All patients but one underwent successful endoscopic ITA takedown. Thirteen patients had a totally endoscopic anastomosis, whereas in 61 a small mini-thoracotomy or mini-sternotomy was used. Sixteen patients (17.8%) were converted electively to a sternotomy: 11 patients underwent off-pump and 5 patients on-pump surgery. There were no deaths; 13 patients (14.4%) incurred one or more of the 11 major complication(s), including 5, 1, 2, 3, and 2 in each of the five quintiles (p = 0.39). Standard statistical analyses identified a significant decrease in operating room time (p < 0.0001), as well as a decrease in the incidence of an occluded graft or wrong vessel grafted from quintiles 1 to 5 (p = 0.03). On CUSUM analysis, the failure curve was steep for the first 18 to 20 patients, before moderating its slope for the remainder of the experience. CONCLUSIONS: Robotic ITA to coronary bypass on the beating heart has a moderately steep learning curve, which is mitigated by further experience. CUSUM analysis complimented standard statistical methods in detecting a cluster of suboptimal results during the early experience with this procedure.     

Chronic Arsenic Poisoning From Burning High-Arsenic-Containing Coal In Guizhou, China

Optimization of a previously disclosed sorbitol dehydrogenase inhibitor (SDI, II) for potency and duration of action was achieved by replacing the metabolically labile N,N-dimethylsulfamoyl group with a variety of heterocycles. Specifically, this effort led to a series of novel, in vitro potent SDIs with longer serum half-lives and acceptable in vivo activity in acutely diabetic rats (e.g., 62, 67, and 69). However, the desired in vivo potency in chronically diabetic rats, ED90 less than or equal to 5 mg/kg/day, was achieved only through further modification of the piperazine linker. Several members of this family, including 86, showed better than the targeted potency with ED90 values of 1-2 mg/kg/day. Compound 86 was further profiled and found to be a selective inhibitor of sorbitol dehydrogenase, with excellent pharmacodynamic/pharmacokinetic properties, demonstrating normalization of sciatic nerve fructose in a chronically diabetic rat model for approximately 17 h, when administered orally at a single dose of 2 mg/kg/day.     

冠状动脉粥样硬化ADAMTS7新位点的发现和冠状动脉粥样硬化中ABO位点与心肌梗死的相关性:两项全基因组关联研究

<正>背景:该研究旨在评价在现有的冠状动脉粥样硬化的病变中,遗传因素对粥样硬化斑块进展及特异性心肌梗死是否存在显著作用。方法:对欧洲后裔参与者冠状动脉造影表型进行了两项全基因组关联研究(GWAS),为寻找冠状动脉疾病(CAD)易感性基因位点,研究比较了有异常(n=12393)和无异常的(对照组n=7383)个体;为寻找心肌梗死易感性基因位点,也同时比较了造影证实存在CAD并且有心肌梗死的个体(n=5783)与虽有CAD但无心肌梗死的个体(n=3644)。