A safe technique of exposing of a "hidden" left anterior descending artery

We describe a safe, easy, and fast technique of exposing the left anterior descending artery (LAD), when this is embedded under the myocardium or excessive epicardial fat tissue, during coronary artery bypass grafting (CABG) or off-pump coronary artery bypass (OPCAB). The vessel is opened as distal as possible, then a fine intravascular probe is introduced retrogradely. Through palpation of the tip, the course of LAD is confined together with the site of distal anastomosis formation. The suggested technique minimizes the risk of injuring the vessel or ventricles, reduces the ischemia-time, and allows the performance of anastomosis as paroximal as possible in the cases of OPCAB with embedded LAD.     

Underwater Stroke Kinematics During Breathing and Breath-holding Front Crawl Swimming

The aim of the present study was to determine the effects of breathing on the three - dimensional underwater stroke kinematics of front crawl swimming. Ten female competitive freestyle swimmers participated in the study. Each subject swam a number of front crawl trials of 25 m at a constant speed under breathing and breath-holding conditions. The underwater motion of each subject''s right arm was filmed using two S-VHS cameras, operating at 60 Hz, which were positioned behind two underwater viewing windows. The spatial coordinates of selected points were calculated using the DLT procedure with 30 control points and after the digital filtering of the raw data with a cut-off frequency of 6 Hz, the hand''s linear displacements and velocities were calculated. The results revealed that breathing caused significantly increases in the stroke duration (t₉ = 2.764; p < 0.05), the backward hand displacement relative to the water (t₉ = 2.471; p<0.05) and the lateral displacement of the hand in the X - axis during the downsweep (t₉ = 2.638; p < 0.05). On the contrary, the peak backward hand velocity during the insweep (t₉ = 2.368; p < 0.05) and the displacement of the hand during the push phase (t₉ = -2.297; p < 0.05) were greatly reduced when breathing was involved. From the above, it was concluded that breathing action in front crawl swimming caused significant modifications in both the basic stroke parameters and the overall motor pattern were, possibly due to body roll during breathing.

Key points

• The breathing action increases the duration of the total underwater pull.
• The breathing action increases the absolute backward displacement of the hand.
• The breathing action caused significant modifications in the overall motor pattern, possibly due to body roll during breathing.

Key words: Swimming, front crawl, three-dimensional kinematic analysis     

Bladder stone formation after a tension-free vaginal tape procedure: report on two cases

We present 2 cases of large bladder stones formed on a tension-free vaginal tape (TVT) which was inadvertently passed through the bladder during the continence procedure. The stones together with the intravesical portion of the slings were removed using a suprapubic approach. High clinical suspicion of bladder complications is necessary when evaluating patients with urinary symptoms after a TVT operation.     

An integrated computational approach to the phenomenon of potent and selective inhibition of aurora kinases B and C by a series of 7-substituted indirubins

A variation of the bromine substitution from 6- to 7-position converts the glycogen synthase kinase-3alpha/beta-(GSK-3-alpha/beta) selective inhibitor 6-bromoindirubin-3'-oxime (6BIO) to a potent inhibitor of Aurora B and C kinases. The novel indirubin analogue 7-bromoindirubin-3'-oxime (7BIO) demonstrated unexpected selectivity against these two kinases since the homologous kinase Aurora A was poorly inhibited. A hypothesis regarding the 7BIO selectivity profile was stated and validated by docking, molecular dynamics, and free energy perturbation calculations. The residue (Thr217AurA, Glu161AurB, Glu127AurC) located in the active site was identified as a major contributor to the enhanced affinity of 7BIO for Aurora B and C versus Aurora A. Furthermore, the docking events of 7BIO and several of its analogues were approached by quantitative models based on semiempirical scoring functions. In the course of model construction and optimization, a number of important factors influencing the quality of each model like the application of force constraints or the sampling method were determined. Among these factors, the presence and treatment of structurally important water molecules had a pronounced impact on the quality of each model. The final model was validated by use of free energy perturbation calculations.     

Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution

Purpose

We evaluated the prevalence and progression of Libman-Sacks endocarditis in patients with systemic lupus erythematosus and any association between this valvulopathy and their clinical and laboratory characteristics.

Methods

Doppler echocardiography was performed in 342 consecutive patients with systemic lupus erythematosus (297 females and 45 males). The clinical and laboratory data were recorded. Patients were reevaluated after a follow-up period of 4 years.

Results

Libman-Sacks endocarditis was found in 38 patients (11%). In 24 of 38 patients, mitral valve involvement was found, resulting in regurgitation in all (mild in 18, moderate in 4, and severe in 2), whereas stenosis co-occurred with regurgitation in 9 patients (mild in 6 and moderate in 3). Thirteen (34%) of 38 patients had aortic valve involvement; 11 had regurgitation (mild) and 8 had stenosis (mild), coexistent with regurgitation in 6 of them. One patient had mild tricuspid regurgitation. A significant association was found between Libman-Sacks endocarditis and disease duration and activity, thromboses, stroke, thrombocytopenia, anticardiolipin antibodies, and antiphospholipid syndrome. During the follow-up period, 252 of 342 patients were reevaluated echocardiographically. Among the 38 patients with Libman-Sacks vegetations, 5 with mild mitral regurgitation at the beginning developed moderate (n = 4) and severe mitral regurgitation (n = 1), 2 patients with mitral stenosis (mild in 1 and moderate in 1) developed severe mitral regurgitation, and 2 patients with mild aortic regurgitation developed moderate and severe mitral regurgitation, whereas a significant deterioration of aortic stenosis was found. Two patients who were candidates for surgery died. Among the 213 patients without vegetations at the beginning, 8 developed new Libman-Sacks lesions.

Conclusions

Libman-Sacks vegetations can be found in approximately 1 of 10 patients with systemic lupus erythematosus, and they are associated with lupus duration, disease activity, anticardiolipin antibodies, and antiphospholipid syndrome manifestations. A progression of valve lesions may occur during long-term follow-up.     

Intron 4 a/b polymorphism of the endothelial nitric oxide synthase gene is associated with both type 1 and type 2 diabetes in a genetically homogeneous population

Current classifications of diabetes distinguish between type 1 diabetes (T1D) and type 2 diabetes (T2D), however recent evidence highlights overlap between T1D and T2D. Earlier studies have suggested altered nitric oxide (NO) metabolism in both T1D and T2D. In the present case-control study, we investigated whether the endothelial NO synthase gene intron 4 a/b polymorphism is associated with T1D and T2D in the island of Crete, a well-defined area with genetically homogeneous population. Mutated allele "a" was more common in individuals with both T1D and T2D than in controls (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.06-2.77, p = 0.013; and OR = 1.50, 95% CI = 0.930-2.42, p = 0.047, respectively). Mutated genotype (a/a or a/b) was more common in individuals with T1D than in nondiabetic individuals (OR = 1.93, 95% CI = 1.12-3.32, p = 0.008); this increased frequency was also observed for T2D, although not at a significant level (OR = 1.38, 95% CI = 0.802-2.37). No difference was found in the frequency of mutated allele a or mutated genotype (a/a or a/b) between T1D and T2D populations. In conclusion, our results indicate that allele a of the intron 4 endothelial NO synthase gene is associated with susceptibility to both T1D and T2D and may represent a common genetic factor for diabetes.