Emmonsiellopsis,a new genus related to the thermally dimorphic fungi of the family Ajellomycetaceae

Two interesting fungi were isolated from fluvial sediments collected in the North of Spain. They were morphologically related to the thermally dimorphic fungi of the family Ajellomycetaceae, but the analysis of the internal transcribed spacer region of the rDNA, and the domains D1 and D2 of the 28S rRNA gene sequences confirmed that they were different from all the species described in that family. They were accommodated in the new genus Emmonsiellopsis as E. coralliformis sp. nov. and E. terrestris sp. nov. The two species are distinguished mainly by the maximum temper‐ature of growth (up to 33 °C for E. coralliformis and to 42 °C for E. terrestris), the dendritic mycelium of E. coralliformis and the conidial ornamentation (verrucose in E. coralliformis and spinulose in E. terrestris). In addition, the phylogenetic data demonstrated that Ajellomyces griseus also represents a new genus within the Ajellomycetaceae, namely Helicocarpus. This new genus is easily distinguished by the lack of asexual morph, the production of brownish gymnothecial ascomata and oblate to lenticular, sparingly pitted ascospores. The proposal of both new genera was confirmed by the analysis of actin gene sequences.     

Changes in the visual field following laser in situ keratomileusis for myopia

Purpose: To assess the changes of the visual field (VF) caused by transient intraocular pressure (IOP) peaks during laser in situ keratomileusis (LASIK) surgery for myopia using automated perimetry. Methods: This prospective study involved 94 eyes of 94 patients who underwent a conventional LASIK procedure. A complete eye examination was carried out in which the IOP measurement, and Humphrey 24‐2 SITA standard VF were tested prior to LASIK and 6 and 12 months after LASIK. Patients were divided into two subgroups according to their refractive error. VF global indices, Glaucoma Hemifield Test and the number of depressed points deviating at p < 5%, p < 2%, p < 1% and p < 0.5% on the Pattern Deviation probability maps were compared using the analysis of variance. Results: In the low myopia group, there were no significant differences in the analysed variables, except a slight decrease in mean deviation (MD) when comparing results prior to and 6 months following LASIK (p = 0.036; anova ) that returned to baseline values at 12 months after surgery. In the moderate and high myopia group, there were no statistically significant differences in any of the variables analysed. No significant correlation was found between the transitory reduction in MD and any of the variables studied. Conclusions: In patients with low myopia, the VF undergoes a transitory increase in diffuse defects 6 months after surgery, with spontaneous recovery at 12 months after LASIK procedure. Possible explanations for these findings are discussed.     

Changes in left ventricular filling pattern during dobutamine stress Doppler echocardiography.

AIMS: To study the left ventricular filling pattern during stress Doppler echocardiography and its utility in the detection of myocardial ischaemia. METHODS AND RESULTS:Fifty-seven consecutive patients underwent dobutamine stress echocardiography. The left ventricular filling pattern (E-wave velocity; A-wave velocity; E/A ratio; E-wave deceleration time) was analysed at baseline and at maximum heart rate reached. The percentage increase in these parameters from baseline to peak heart rate was also determined. Myocardial ischaemia (regional contractility worsening) was induced in 19 cases (ischaemic group) but not in 38 cases (non-ischaemic group). There were no differences between both groups at baseline. E-wave deceleration time decreased in the non-ischaemic group (197+/-63 vs. 167+/-65 ms, P=0.01) and increased in the ischaemic group (203+/-42 vs. 315+/-135 ms, P<0.0001). A percentage increase in E-wave deceleration time of >30% showed a positive predictive value of 93% and a negative predictive value of 86% for detecting ischaemia, and in the multivariate analysis it was the only Doppler parameter (P<0.0001) that predicted the induction of ischaemia. CONCLUSION: We conclude that myocardial ischaemia provokes an increase in E-wave deceleration time. Analysis of left ventricular filling could help in the identification of those cases which are positive for ischaemia.     

Predictors of short-term outcome in acute chest pain without ST-segment elevation

BACKGROUND: Management of acute chest pain in the emergency room constitutes a challenge. METHODS: Seven hundred and one consecutive patients were evaluated by clinical history (chest pain score and risk factors), ECG, troponin I and early (<24 h) exercise testing in low risk patients (n=165). A composite end-point (recurrent unstable angina, acute myocardial infarction or cardiac death) was recorded during hospital stay or in ambulatory care settings for patients discharged after early exercise testing. RESULTS: The end-point occurred in 122 patients (17%). Multivariate analysis identified the following predictors: chest pain score > or =11 points (OR=1.8, 2-2.8, 95% CI, P=0.007), age > or =68 (OR 1.6, 1.1-2.4 CI 95%, P=0.03), insulin-dependent diabetes mellitus (OR 1.9, 1.1-3.4 CI 95%, P=0.02), a history of coronary surgery (OR 3.3, 1.5-7.2 CI 95%, P=0.003), ST-segment depression (OR 1.9, 1.2-3.0 CI 95%, P=0.009) and troponin I elevation (OR 1.6, 1.1-2.5, CI 95%, P=0.05). ST-segment depression produced a high end-point increase (31 vs. 13%, P=0.0001). Troponin I elevation increased the risk in the subgroup without ST-segment depression (20 vs. 11%, P=0.006) but did not further modify the risk in the subgroup with ST depression (31 vs. 28%, ns). Nevertheless, the negative ECG and troponin I subgroup showed a non-negligible end-point rate (16% when pain score > or =11 or 7% when pain score <11, P=0.004). Finally, no patient with a negative exercise test presented events compared to 7% of those with a non-negative test (RR=2.5, 2.1-3.1 95% CI, P=0.01). CONCLUSIONS: Emergency room evaluation of chest pain should not focus on a single parameter; on the contrary, the clinical history, ECG, troponin and early exercise testing must be globally analysed.     

Surgery of lung metastases

The aim of surgical treatment of lung metastases is to eliminate all known tumoral disease. After a clinical diagnosis of lung metastases, the criteria for selecting patients who are candidates for surgical treatment, the route of access to the thoracic cavity and the technique for metastases resection are not universally defined. Moreover, half of all patients will show recurrence and the advisability of further surgery will have to be reconsidered. The present article discusses aspects related to the oncological and functional limits of surgical resection of lung metastases, preoperative workup, postoperative follow-up, and the surgical approaches and resection techniques.     

Antigen carbohydrate 125 and creatinine on admission for prediction of renal function response following loop diuretic administration in acute heart failure

Background

The use of loop diuretics in acute heart failure (AHF) is largely empirical and has been associated with renal function impairment by reducing renal perfusion but also renal improvement by decreasing renal venous congestion. Antigen carbohydrate 125 (CA125) has emerged as a proxy for fluid overload. We sought to evaluate whether the early changes in creatinine (ΔCr) induced by intravenous furosemide doses (ivFD) differ among clinical groups defined by overload status (CA125) and creatinine on admission (Cr).

Methods and results

We included 526 consecutive patients admitted for AHF. All patients received intravenous furosemide for the first 48 hours. CA125 and Cr were dichotomized at 35 U/ml and 1.4 mg/dl, respectively, and grouped as follows: C1 [Cr < 1.4, CA125 ≤ 35 (n = 151)]; C2 [Cr < 1.4, CA125 > 35 (n = 241)]; C3 [Cr ≥ 1.4, CA125 ≤ 35 (n = 45)]; and C4 [Cr ≥ 1.4, CA125 > 35 (n = 89)]. Clinicians in charge of the management of patients were blind to CA125 values. ΔCr was estimated as the absolute difference in Cr between admission and 48–72 hours. Multivariable linear regression analysis was used for modeling purposes. The adjusted analysis showed a differential effect of ivFD on ΔCr. Per increase in 20 mg/day of ivFD, the mean ΔCr was 0.010 mg/dl (p = 0.464) in C1, 0.002 mg/dl (p = 0.831) in C2, 0.045 mg/dl (p = 0.032) in C3, and − 0.045 mg/dl (p < 0.001) in C4 (omnibus p < 0.001). A similar pattern of response was observed in a validation cohort.

Conclusions

In patients with AHF, the magnitude and direction of ΔCr attributable to ivFD were differentially associated with values of CA125 and Cr on admission.     

Induction of partial alterations in atrioventricular conduction in dogs by percutaneous emission of high-frequency currents

Ten anesthetized dogs were studied in an attempt to provoke partial alterations in atrioventricular (AV) conduction by high-frequency current (HFC) transcatheter ablation. A discharge power (10 to 15 W) was used for less than 5 seconds after reaching complete AV block (CAVB). The catheter was placed within an area having an A/V ratio = 1 with His bundle deflection. If following discharge, no appreciable lengthening an AH, AV nodal block cycle length (Wenckebach point, WP), and/or functional nodal refractory period (FRPAVN) was observed, the procedure was repeated. Four dogs (group I) were killed immediately, and the other six (group II) after 2 to 4 weeks. The AH interval, WP, and FRPAVN were found to prolong significantly following HFC, without variations in HV interval. In group II, two dogs progressed to CAVB, whereas the other four maintained 1:1 AV conduction with AH, WP, and FRPAVN greater than before the power discharge. In conclusion, HFC is an efficient technique to induce partial alterations in AV conduction, since the discharge can be adjusted and the ablation can be localized to specific regions.