Adaptive cardiac binding: a new method for treatment of dilated cardiomyopathy

Adaptive cardiac binding, a new surgical procedure for advanced heart failure, allows a gradual increase in compression on the dilated heart, with separate loads on the left and right ventricles. A canine model of biventricular heart failure (anastomosis between the carotid artery and jugular vein and doxorubicin administration) was created. Twenty-four dogs were divided into 4 groups: control, adynamic cardiomyoplasty, plastic cardiac binding, and adaptive cardiac binding. In the adaptive cardiac binding group, fluid was added (35, 15, and 10 mL) to each side of the pouch at weeks 1, 2, and 3. Left ventricular ejection fraction was 59%+/-4% before induction of heart failure and 27%+/-2% 6 weeks later. Immediately after the main operation, left ventricular ejection fractions were 35+/-3% (cardiomyoplasty), 34%+/-4% (plastic cardiac binding), and 35%+/-4% (adaptive cardiac binding). Four weeks later, left ventricular ejection fraction had not changed in the cardiomyoplasty (37%+/-3%) and plastic cardiac binding (32%+/-2%) groups, but significantly increased in the adaptive cardiac binding group (48%+/-5%); it had decreased to 23%+/-4% in controls. Adaptive cardiac binding is a promising new surgical approach for patients with end-stage heart failure.     

Analyses of muscle spindles in the soleus of six inbred mouse strains

Adult muscle size and fibre‐type composition are heritable traits that vary substantially between individuals. We used inbred mouse strains in which soleus muscle mass varied by an order of magnitude to explore whether properties of muscle spindles can also be influenced by genetic factors. Skip‐serial cross‐sections of soleus muscles dissected from 15 male mice of BEH, BEL, C57BL/6J, DUH, LG/J and SM/J strains were analysed for number of muscle spindles and characteristics of intrafusal and extrafusal fibres following ATPase staining. The BEL and DUH strains determined the range of: soleus mean size, a 10‐fold difference from 2.1 to 22.3 mg, respectively; the mean number of extrafusal fibres, a 2.5‐fold difference from 497 to 1249; and mean fibre‐cross‐sectional area, three‐fold difference, e.g. for type 1 fibres, from 678 to 1948 μm². The range of mean proportion of type 1 fibres was determined by C57BL/6J (31%) and DUH (64%) strains. The mean number of spindles per muscle ranged between nine (LG/J) and 13 (BEL) (strain effect P < 0.02). Genetic correlations between spindle count and muscle weight or properties of extrafusal fibres were weak and not statistically significant. However, there was a strong correlation between the proportion of spindles with more than one bag₂ fibre and the proportion of extrafusal fibres that were of type 1, and strain‐dependent variation in the numbers of such spindles was statistically significant. The numbers of intrafusal fibres per spindle ranged from 2 to 8, with the most common complement of four found in 75.6% of spindles. There were no significant differences between the strains in the mean numbers of intrafusal fibres; however, the variance of the number was significantly less for the C57BL/6J strain than for any of the others. We conclude that abundance of muscle spindles and their intrafusal‐fibre composition are substantially determined by genetic factors, which are different from those affecting muscle size and properties of the extrafusal fibres.     

Comparison of subjective perception of safe antibiotic use between European Union states

Objectives

Irresponsible antibiotic use is a major problem worldwide. European Union (EU) states implement antibiotic policy which aim is to reduce antibiotic use. Subjective perception of safe antibiotic use (PSAU) can be one of the factors which may affect antibiotic use. This study aimed to measure and to determine progress and tendency of subjective PSAU and its changes in 28 EU states with different implementation of antibiotic policies during the period of 2009–2016.

Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective

Background

In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients.

Methods

On admission for BT surgery, 200 patients (69 % women; age 55.8?±?14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %).

Results

Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %–49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β?=?0.23, p?<?0.001) and general health (β?=?0.18, p?=?0.01) scores, and greater TIPI consciousness score, with greater SF-36 emotional well-being score (β?=?0.13, p?=?0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values?≤?0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β?=?0.36, p?<?0.001). MMSE score was associated with all but emotional well-being and social functioning SF-36 scores.

Conclusions

Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.     

Cerebral computed tomographic angiography scan delay in subarachnoid hemorrhage

CONTEXT: Computed tomographic angiography (CTA) is widely applied in the evaluation of cerebral vessels. Contrast enhancement in cerebral CTA without care or test bolus is not always sufficient for high-quality images. AIMS: Evaluation of the possibilities of calculation of scan delay for cerebral CTA in case of subarachnoid hemorrhage (SAH), based on clinical data of a patient and to find out prognostic error of the model. SETTINGS AND DESIGN: Prospective study in Neurosurgery and Radiology departments. MATERIALS AND METHODS: Scan delay in 53 patients suffering an acute SAH was measured employing test bolus technique. Cerebral CTA was performed afterwards. STATISTICAL ANALYSIS USED: SPSS for Windows v.10.1 software package was applied for dispersion analysis, including one-sample Kolmogorov-Smirnov's test and Levene's Test of Equality of Error Variances. RESULTS: A statistical model for the prediction of scan delay in SAH was developed. Cerebral CTA scan delay was dependent upon age, neurological status and impact of the latter factors together (P< 0.05). The determined mean square error of prognosis of scan delay of the developed model equals 3.3 sec. CONCLUSION: Using our proposed model it is possible to estimate an optimal delay time for CTA in most patients with SAH with a determined error.     

Hemodynamic results of acute thoracic aortomyoplasty in a canine model: comparison of stimulation regimens

Our previous investigations in a sheep model demonstrated that when electrical stimulation (ES) was applied to a newly mobilized latissimus dorsi muscle (LDM) in a work-rest regimen and at a rate of 15 contractions per minute, it did not damage this muscle. This regimen was used twice during a 60 minute period, once a day for 16 days, with no LDM damage. The goal of our current investigation was to apply this regimen in studies of acute thoracic aortomyoplasty. In two experimental groups, we mobilized the LDM but left it in situ. Two hours later, contractile force (CF) testing (20 g/kg preload, six impulses per burst) was performed until CF dropped to 50% of baseline. Recovery time needed to completely restore CF was calculated. In one group (six sheep), we applied continuous ES; in another (six sheep), we applied ES in a work-rest regimen (1 min work, 1 min rest). In two other groups of six dogs each, aortomyoplasty was performed; the LDM flap was subjected to ES immediately postoperatively (six impulses per burst; ventricular-LDM delay, 290 ms). Again, one group received continuous ES, and the other received work-rest ES. In the mobilized LDM under continuous ES, CF decreased to 50% of baseline values after 52 +/- 8 minutes, and returned to baseline after 84 +/- 16 minutes of rest. Under the work-rest regimen, this decrease took 105 +/- 8 minutes, and the return to baseline took 25 +/- 6 minutes (p < 0.05). In LDM subjected to work-rest ES, light microscopy revealed no additional damage to LDM tissue than was seen immediately after mobilization. However, LDM subjected to continuous ES had evidence of increased basophilic degeneration and wavy fibers. After acute thoracic aortomyoplasty, assisted hemodynamic values under the continuous ES exceeded unassisted values for only 40 minutes, compared with 100 minutes for work-rest ES (p < 0.05). When counterpulsation was completed, for continuous ES, recovery time to baseline was 96 +/- 9 minutes; for work-rest ES, it was only 43 +/- 6 minutes. In conclusion, a work-rest regimen of ES can be started safely immediately postprocedure.     

Suicidal ideation in patients undergoing brain tumor surgery: prevalence and risk factors

Purpose

Suicidal ideation (SI) is an important complication in cancer patients that should be promptly recognized and adequately managed. We investigated the prevalence rate and correlates of pre-operative SI in brain tumor (BT) patients admitted for elective BT surgery.

Methods

Two hundred and eleven consecutive patients (70 % women; mean age 55.9 ± 15.4 years) scheduled for BT surgery were evaluated for SI (“suicidal thought” item from the Beck Depression Inventory-II), depressive/anxiety symptom severity (Hospital Anxiety and Depression scale (HADS)), health-related quality of life (SF-36 scale), functional status (Barthel Index), and psychiatric histories and treatments. The majority of patients were diagnosed with meningioma (39 %) and high-grade glioma (17 %).

Results

SI was self-reported by 12 (6 %) patients. Patients expressing SI were most commonly diagnosed with meningioma (50 %). Patients with SI were more likely to have a past history of psychiatric disorders, scored higher on the HADS anxiety subscale, and reported worse health-related quality of life across physical and mental health domains. In multivariate regression analyses, worse perceived mental health was associated with increased risk for SI independently from clinical, sociodemographic, and other patient-oriented variables considered in the study.

Conclusions

SI was self-reported by 6 % of BT patients before surgical intervention and was associated with a past history of psychiatric disorders and worse perceived health status. Poor mental health was an independent correlate of SI. The perception of health status by a patient should be considered as an important determinant of poor mental health in BT patients.

     

Echocardiographic Parameters in Athletes of Different Sports

Competitive athletics is often associated with moderate left ventricular (LV) hypertrophy, and it has been hypothesized that training mode and type of exercise modulates long-term cardiac adaptation. The purpose of the study was to compare cardiac structure and function among athletes of various sports and sedentary controls. Standard transthoracic two-dimensional M-mode and Doppler echocardiography was performed at rest in Caucasian male canoe/kayak paddlers (n = 9), long distance runners (LDR, n = 18), middle distance runners (MDR, n = 17), basketball players (BP, n = 31), road cyclists (n = 8), swimmers (n = 10), strength/power athletes (n = 9) of similar age (range, 15 to 31 yrs), training experience (4 to 9 years), and age-matched healthy male sedentary controls (n = 15). Absolute interventricular septum (IVS) thickness and LV wall thickness, but not LV diameter, were greater in athletes than sedentary controls. Left ventricular mass of all athletes but relative wall thickness of only BP, swimmers, cyclists, and strength/power athletes were higher as compared with controls (p < 0.05). Among athletes, smaller IVS thickness was observed in MDR than BP, cyclists, swimmers or strength/power athletes, while LDR had higher body size-adjusted LV diameter as compared to BP, cyclists and strength/power athletes. In conclusion, relative LV diameter was increased in long distance runners as compared with basketball players, cyclists, and strength/power athletes. Basketball, road cycling, strength/power, and swimming training were associated with increased LV concentricity as compared with paddling or distance running.

Key points

• The type of cardiac hypertrophy seems to be only moderately exercise-specific.
• Long-distance runners develop larger left ventricular dilation as compared with basketball players, cyclists, and strength/power athletes.
• Myocardial wall thickening is triggered by different sporting activities that involve large muscle groups.

Key words: Myocardial hypertrophy, left ventricle, echocardiography, athlete     

Localization of Knops system antigens in the long homologous repeats of complement receptor 1

BACKGROUND: The Sl(a) (Knops system) located on complement receptor 1 (CR1) has been associated with malarial rosetting, a process associated with severe malarial infections. Moreover, the long homologous repeats (LHRs) B and C of CR1 were implicated in rosette formation. As a step toward mapping the location of Knops system antigens, truncated CR1 proteins have been expressed and their ability to inhibit antibodies to the high-incidence Knops system antigens was assessed. STUDY DESIGN AND METHODS: Individual LHRs (A, B, C, and D) of CR1 of the common CR1*1 (F) allotype were expressed as secreted forms in 293T cells. Their abilities to specifically neutralize Knops system antibodies were tested by both hemagglutination and flow cytometry. RESULTS: Three examples of anti-Kn(a) (n = 6) were almost completely inhibited by LHR-C and three by LHR-D. Two examples of anti-McC(a) (n = 2) and seven examples of anti-Sl(a) (n = 8) were inhibited by LHR-D. Both examples of anti-Yk(a) (n = 2) were partially inhibited by LHR-D. CONCLUSION: The high-incidence Knops system antigens reside within LHR-D and to a lesser extent within LHR-C. Because of the role of Sl(a) antigen in malaria rosetting, these results indicate that LHR-D may represent an additional malaria interaction region in CR1.