Prolonged signal-averaged P wave duration as a prognostic marker for morbidity and mortality in patients with congestive heart failure

OBJECTIVE: To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF). DESIGN: The SAPWD was assessed from a signal-averaged electrocardiogram (SAECG), and the plasma levels of N-terminal pro-atrial natriuretic peptide (Nt-proANP) and N-terminal pro-brain natriuretic peptide (Nt-proBNP) were measured in 43 consecutive patients with stable CHF without prior supraventricular arrhythmia. Echocardiographic and clinical data were also recorded. Time to death, hospitalization due to deteriorated CHF, or ECG-documented atrial fibrillation (AF) was recorded over a 438-day median follow-up. RESULTS: During follow-up, 17 patients met an endpoint defined as death, AF, or hospitalization due to deteriorated CHF. Proportional hazard regression including the variables high age, prolonged SAPWD, raised levels of Nt-proANP and Nt-proBNP, and low ejection fraction (EF) showed that only prolonged SAPWD > or =149 ms was associated with an increased risk of meeting an early endpoint; the hazard ratio 3.94 with 95% confidence interval 1.50-10.42; p = 0.006. CONCLUSION: Prolonged SAPWD appears to predict early death, AF development, or hospitalization due to deterioration of CHF in patients with stable CHF.     

微电极靶点定位外科治疗帕金森病

目的探讨微电极记录技术在帕金森病外科治疗中的作用。方法采用微电极电生理记录技术监测术中靶点，对帕金森病31例进行手术治疗，其中苍白球毁损术14例、丘脑毁损术6例、深部脑电刺激术11例。结果最终毁损靶点较MR定位靶点位置更换率为80．6％，手术效果优良，有效率100％，原有症状术后改善率达87．1％，无永久并发症。结论微电极记录技术的应用能显著提高定位精度，减少并发症和提高手术效果。     

Analysis of cerebroarterial Doppler flow velocity waveforms in newborn infants: towards an index of cerebrovascular resistance

Doppler ultrasound has been used extensively to study cerebral hemodynamics in the human newborn. This report presents a continuous recording in an infant with epileptic seizures. Heart rate, mean aortic blood pressure and mean flow velocity, obtained from the anterior cerebral artery by Doppler ultrasound, all increased markedly during the seizures. The Poucelot index was calculated from the cerebral blood flow velocity waveform and is supposed to reflect cerebrovascular resistance. This index decreased. Three mutually contradictive interpretations were possible in terms of cerebral metabolic rate, cerebral blood flow, metabolism-flow coupling and pressure-flow autoregulation. Sympathetic activation and its effects on cerebral hemodynamics is discussed. It is pointed out that the competence of the pressure-flow autoregulation may not be studied reliably during changes in blood pressure associated with altered sympathetic activity. An electrical model of the systemic arterial system is presented and used to demonstrate that the resistance index is likely to be severely affected by changes in cerebroarterial compliance, peripheral resistance, duration of systole as a fraction of heart cycle and patency of the arterial ductus. A pulsatility index ratio, which is corrected for arterial pulse pressure, is suggested to avoid some of these errors.     

Species identification of clinical isolates of anaerobic bacteria: a comparison of two matrix-assisted laser desorption ionization-time of flight mass spectrometry systems

We compared two matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems (Shimadzu/SARAMIS and Bruker) on a collection of consecutive clinically important anaerobic bacteria (n = 290). The Bruker system had more correct identifications to the species level (67.2% versus 49.0%), but also more incorrect identifications (7.9% versus 1.4%). The system databases need to be optimized to increase identification levels. However, MALDI-TOF MS in its present version seems to be a fast and inexpensive method for identification of most clinically important anaerobic bacteria.     

The presence of the d3-growth hormone receptor polymorphism is negatively associated with fetal growth but positively associated with postnatal growth in healthy subjects

CONTEXT: A common polymorphism in the GH receptor (GHR) gene has been linked to increased growth response in GH-treated patients. No former study has focused on the association to prenatal growth. OBJECTIVE: The aim of the study was to evaluate the association between the d3-GHR isoforms and spontaneous pre- and postnatal growth. DESIGN: A prospective study was conducted on third-trimester fetal growth velocity (FGV), birth weight, birth length, and postnatal growth. SETTING: The study was conducted at Copenhagen University Hospital. PARTICIPANTS: A total of 115 healthy adolescents were divided into those born small for gestational age (SGA) and appropriate for gestational age with or without intrauterine growth restriction. MAIN OUTCOME MEASURES: FGV was measured by serial ultrasonography, birth weight, birth length, and adolescent height. Isoforms of the d3-GHR gene (fl/fl, d3/fl, and d3/d3) were determined. RESULTS: The prevalence of the d3-GHR isoforms was 50% but differed among the groups (P = 0.006), with a high prevalence (88%) in the group born SGA with verified intrauterine growth restriction. The d3-GRH allele were associated with decreased third-trimester FGV (P = 0.05) in SGA subjects. In the entire cohort, carriers of the d3-GHR allele had a significantly increased height (-0.10 vs. 0.34 SD score; P = 0.017) and change in height from birth to adolescence compared with carriers of the full-length GHR allele (0.57 vs. -0.02 SD score; P = 0.005). CONCLUSIONS: This study showed an increased spontaneous postnatal growth velocity in the carriers of the d3-GHR allele. Interestingly, we found the opposite effect on prenatal growth in the SGA group, with a decreased FGV in carriers of the d3-GHR allele.     

Adiponectin levels measured in dried blood spot samples from neonates born small and appropriate for gestational age

OBJECTIVE: Adiponectin levels measured in neonatal dried blood spot samples (DBSS) might be affected by both prematurity and being born small for gestational age (SGA). The aim of the study was to measure adiponectin levels in routinely collected neonatal DBSS taken on day 5 (range 3-12) postnatal from infants. DESIGN: A retrospective case-control study. SUBJECTS AND METHODS: One hundred and twenty-two infants: 62 very premature (34 SGA) and 60 mature infants (27 SGA). Adiponectin concentrations were determined in stored neonatal DBSS using a sandwich immunoassay based on flow metric Luminex xMap technology. RESULTS: Adiponectin was measurable in all samples, and repeated measurements correlated significantly (r = 0.94). Adiponectin concentrations were negatively associated with both SGA (B = -0.283, P = 0.04) and prematurity (B = -2.194, P < 0.001), independently of each other. In the premature but not the mature group, adiponectin levels increased with increasing postnatal age at blood sampling (B = 0.175, P < 0.001). CONCLUSIONS: Reliable quantification of adiponectin in stored DBSS is feasible and may be used to study large populations of routinely collected samples. Low levels of adiponectin in neonatal DBSS are associated with SGA as well as prematurity. Blood adiponectin levels increase with postnatal age in premature infants, suggesting a rapid yet unexplained metabolic adaptation to premature extrauterine life.     

Signal-averaged P wave duration and the long-term risk of permanent atrial fibrillation

OBJECTIVE: To assess the long-term risk of developing permanent AF in relation to the signal-averaged P wave duration (SAPWD) and clinical and echocardiographic characteristics. DESIGN: In an observational study design we studied 131 patients with earlier ECG-documented AF and successfully restored sinus rhythm attending a long-term, follow-up visit at hospital or at home. Established permanent AF was examined in relation to primary clinical, echocardiographic, and electrophysiological parameters. RESULTS: Only prolonged SAPWD (p=0.006) was associated with an increased risk of development of permanent AF. The risk of permanent AF after 3 years follow-up was 0.72 with an SAPWD equal to 180 ms versus 0.39 with a normal SAPWD (130 ms). We found no prognostic effect of age, gender, dilated left atrium, long duration of AF history, or long duration of the most recent episode of AF. Co-existing hypertension reduced the risk of permanent AF; this could be explained by concomitant treatment with angiotensin-converting-enzyme-inhibitors. CONCLUSION: Prolonged SAPWD (a marker of atrial remodelling) appears to be a risk factor for long-term development of permanent AF.     

Gender difference and economic gradients in the secular trend of population Systolic Blood Pressure

To a large extent population blood pressure (PBP) affects morbidity and mortality in the society. Reports indicated that PBP decreased in many western countries. The associations between the main cardiovascular risk factors and the changing PBP have been described. The aim of this study was to investigate association between income factors and trends in population BP and hypertension. Copenhagen City Heart Study is a prospective longitudinal epidemiological study on almost 20 000 individuals through four surveys from 1976 to 2003. The BP measurement was fully standardised. Questionnaires on household income and CV risk factors were completed by the participants. After adjustment for cardiovascular risk factors there were no significant differences in systolic BP (SBP) trend associated to income among men. Among women, however, there was a reverse relationship between SBP and income. In addition, there was a trend towards a lowering of risk-factor adjusted SBP in the high income women with time. The mechanism that lies behind the associations between trend in SBP and income is not known but data suggest that poor lifestyle may explain some of the differences. The treated hypertensives are treated without income associated treatment differences. In conclusion: Women in higher income groups have lower SBP than women in low-income groups and the gap between SBP in high-income women and low-income women increased with time. There were no significant differences in SBP-trend associated to income among men. Results in treating hypertension did not differ between the income groups.