VEGF PROMOTER HAPLOTYPE AND AMYOTROPHIC LATERAL SCLEROSIS (ALS)

Vascular endothelial growth factor (VEGF) is a cytokine essential for angiogenesis. A recent study found that haplotypes, determined by three SNPs ( ? 2,578C/A, ? 1,154 G/A, and ? 634G/C) in the VEGF upstream promoter/leader sequence, were associated with risk of amyotrophic lateral sclerosis (ALS). We used samples and data from a case-control study to examine the relation of ALS to VEGF haplotype. Genotypes at each of the three polymorphic sites were determined using allele-specific primer extension reactions followed by MALDI-TOF. We found a 3-fold increased risk among individuals homozygous for the AAG or AGG haplotypes (95% CI = 0.7 ? 13.4), consistent with the findings of the previous study. Given the wide confidence interval, our findings should be interpreted cautiously.     

Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults: Feasibility,Safety, and Efficacy

Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults Background: Catheter ablations are traditionally performed using fluoroscopic guidance, exposing both patients and medical staff to the risks of radiation. Nonfluoroscopic catheter ablation has been used successfully to treat limited types of arrhythmias in children, but whether this approach has broad application in adults is uncertain. The purpose of this study was to evaluate the feasibility, safety, and efficacy of fluoroless catheter ablation in adults being treated for a range of arrhythmias. Methods and Results: Retrospective analysis was performed in 2 patient groups (both n = 60): (1) the nonfluoroscopy (NF) group consisting of consecutive adult patients, in which catheter positioning was accomplished exclusively with intracardiac electrograms (IE), electroanatomic mapping (EAM), and intracardiac echocardiography (ICE); and (2) the fluoroscopy (F) group, in which catheter positioning was additionally guided by fluoroscopy. The patients in the F group were selected to match the types of arrhythmias in the NF group. All ablation procedures were performed by one operator. The total procedure time did not differ between groups for any specific type of arrhythmia ablated. Acute procedural success was similar in both groups (NF, 59/60 [98%] and F, 60/60 [100%]). The complications were limited to a groin pseudoaneurysm in the NF group, and pericardial effusion and groin hematoma in the F group. Conclusion: Catheter ablations were efficiently and effectively performed in adults with a variety of arrhythmias using only IE, EAM, and ICE for catheter guidance. This nonfluoroscopic technique was feasible, posed no additional safety concerns, and should be readily implementable in most electrophysiology laboratories. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1078‐1086, October 2012)     

Organochlorine ingestion

A 48 year old man rapidly deteriorated and died following the intentional ingestion of a commercial pesticide mixture containing chlordane and dichloroethyl ether with kerosene as the solvent vehicle. After oral ingestion, chlordane is primarily a neurotoxin. Dichloroethyl ether is a respiratory tract irritant. Both have effects on several other systems. Kerosene is a potent cause of aspiration pneumonitis when inhaled and gastric emptying is not recommended unless it is the vehicle for other, more toxic substances, as in this case. Management for both chlordane and dichloroethyl ether ingestion is supportive, involving airway maintenance, decontamination, and gastric lavage and charcoal administration.     

Acute Respiratory Effects of Endotoxin-Contaminated Machining Fluid Aerosols in Guinea Pigs

Exposure to machining fluid aerosols in the automotive industryis associated with a variety of respiratory symptoms includingcross-shift changes in pulmonary function, cough, asthma, andphlegm. Lubricating and cooling fluids used in machining operationsare predominantly water and thus are susceptible to microbialgrowth. In the present study, the role of endotoxin in the acutepulmonary injury produced by machining fluid aerosols was examinedin guinea pigs. Animals were exposed to nebulized water, unusedmachining fluid, or used machining fluid. At the end of a 3-hrexposure, specific airway conductance (SGaw) was not affectedby exposure to the vehicle water, but was decreased in a dose-dependentmanner by exposure to aerosols of the used machining fluid.SGaw decreased from preexposure baseline values by 0, 7, and40% in animals exposed to 1, 10, and 100 mg/m³ used machiningfluid, respectively. These exposure levels also produced acutelung injury as evidenced by changes in cellular and biochemicalindices in lavage fluid. These adverse respiratory effects mayhave been due to microbial contamination of the used machiningfluid as the aerosol exposures were associated with airborneendotoxin concentrations of 0.3, 1.9, and 5.3 µg/rn³,respectively. Animals exposed to aerosols of the endotoxin-freeunused machining fluid had no statistically significant adversefunctional, cellular, or biochemical effects except for a fourfoldincrease in neutrophils at 100 mg/m³. These results suggestthat contamination of machining fluid during use or storagemay lead to the adverse respiratory effects of aerosolized machiningfluids. To examine whether contaminating endotoxin was responsiblefor these respiratory effects, animals were exposed to 10 or100 mg/m³ unused machining fluid to which endotoxin was addedto provide airborne endotoxin concentrations similar to thosedetermined in the used machining fluid studies. Endotoxin-contaminatedunused machining fluid produced significant decrements in SGaw(14 and 38% for 0.9 and 8.2 µg/m³ endotoxin, respectively)as well as significant increases in cellular and biochemicalparameters of acute lung injury in lavage fluid. Thus, endotoxinmay play a significant role in the adverse respiratory effectsof aerosolized machining fluids.     

Sinus disease in the bone marrow transplant population: Incidence, risk factors,and complications

BACKGROUND: Fever associated with sinus disease in the immunocompromised bone marrow transplant recipient requires prompt evaluation and therapy. Very little is known about the incidence, risk factors, and sequelae of nonsurgically treated sinus disease in this population. METHODS: A retrospective review of 107 consecutive allogeneic and autologous bone marrow transplant recipients from August 1987 to July 1989 was performed to determine (1) the overall incidence of sinus disease; (2) factors that influence the development of sinus disease; and (3) the sequelae of sinus disease treated nonsurgically. RESULTS: Overall 33 (31%) of 107 bone marrow transplant recipients had sinus disease defined as a radiographic abnormality with clinical symptoms. Eleven (10%) of 107 recipients had preexisting sinus disease. Sinus disease developed in 22 (21%) of 107 recipients after bone marrow transplantation. Sinus abnormalities were significantly higher among allografted bone marrow transplant recipients than among autografted recipients (p = 0.027). The diagnosis, stage of disease, cytoreductive regimen, or graft-vs.-host disease were not different between recipients in whom sinus disease did and did not develop. There were no deaths as a result of sinus complications. CONCLUSIONS: Sinus disease developed in 21% of the studied population after bone marrow transplantation. Allogeneic recipients had a higher incidence of sinus disease than autologous recipients. There were no deaths attributed to sinus complications. All sinus disease in this bone marrow transplant population was treated medically. No patient required surgical intervention either before or after bone marrow transplantation. (OTOLARYNGOL HEAD NECK SURG 1995;113:705-11.)     

Perioesthetic Approach to the Diagnosis and Treatment of Carious and Noncarious Cervical Lesions: Part I

Several factors can contribute to the development of noncarious cervical lesions. Therefore, these lesions can be described and classified according to their primary etiology. Traditionally, most dentists have treated noncarious cervical lesions only with restorative methods, for example, composite resin restorations. However, in many cases, a periodontal or a combined restorative/periodontal approach provides a better esthetic and functional result. In part I of this two-part report, we provide a review of noncarious cervical lesions and a series of clinical case reports showing surgical techniques used and the importance of the periodontal aspect of lesion management.     

Dietary Satisfaction Correlated with Adherence in the Modification of Diet in Renal Disease Study

Objective To measure satisfaction with modified protein eating patterns and the relationship of satisfaction to adherence and sociodemographic factors in a clinical trial.Design Participants completed the Dietary Satisfaction Questionnaire at baseline, at 6-month follow-up visits, at annual visits, and at the final visit. Satisfaction with diet was rated on a visual analog scale from 1 (dislike extremely) to 5 (like very much). Adherence to protein goals was assessed using urine urea nitrogen excretion from monthly 24-hour urine samples.Subjects 840 adults with chronic renal disease.Intervention Individual participants, randomly assigned to a usual-protein, low-protein, or very-low-protein group, received monthly counseling from a dietitian for an average of 26 months.Statistics Analyses of variance and two-sample t tests compared, among study/diet groups, satisfaction with diet, its relationship to adherence and sociodemographic characteristics, and changes in satisfaction over time. Paired t tests compared changes within diet groups from baseline to final visit.Results From the baseline visit to the final visit, satisfaction with the prescribed eating pattern increased slightly in the usual-protein group, declined slightly in the low-protein group, and declined significantly in the very-low-protein group. Participants in all of the eating pattern groups who were more satisfied at the final visit had mean protein intakes closer to their assigned protein goals. This relationship was significant in the low-protein group (P<.05). In men, satisfaction with diet declined significantly from baseline to the final follow-up visit in the very-low-protein group.Applications The Modification of Diet in Renal Disease Study Dietary Satisfaction Questionnaire may be useful in other research and clinical settings to assess and enhance dietary adherence. J Am Diet Assoc. 1995; 95:1301-1306.     

T-lymphocyte requirement for the induction of mouse macrophage procoagulant activity by Trypanosoma brucei

We have previously shown that peritoneal macrophages from Trypanosoma brucei infected mice, but not from uninfected mice, expressed high levels of procoagulant activity that could not be produced in vitro by incubation of unstimulated macrophages with bloodstream forms of trypanosomes. In the present study we demonstrate that trypanosome-induced macrophage activation can be achieved in vitro by providing either sensitized (day 7 of infection) lymphocytes and trypanosomes or the supernatant fluid from this interaction. The ability of lymphocytes to secrete macrophage-activating lymphokines is enhanced up to day 12 of infection but was absent in the later stages. Although enhancement of the procoagulant activity occurred in infected nude mice, it seems that macrophage function in African trypanosomiasis, as regards the expression of procoagulant activity, is regulated by T-lymphocytes.     

Phytohaemagglutinin reactivity in circulating peripheral blood lymphocytes during a Trypanosoma brucei infection: sequential studies in individual guinea-pigs

This study has analysed the response to phytohaemagglutinin of peripheral blood lymphocytes from guinea-pigs infected with Trypanosoma brucei brucei. By this means it was possible to follow the response of individual animals throughout an infection. A culture method using whole blood permitted fewer cell manipulations and eliminated the necessity to supplement cultures with heterologous serum. Selection of appropriate strains of T.b. brucei produced a relatively chronic infection in guinea-pigs. Results from this system indicate that, even late in the disease, significant mitogen reactivity still remains in some individuals. More significantly, these mitogen 'responders' controlled successive parasitaemic waves producing a fluctuating parasitaemia whereas the animals showing poor mitogen responsiveness—'non-responders' failed to control successive waves and showed plateau parasitaemias.