Prediction of Arrhythmic Events After Acute Myocardial Infarction Using Two Methods for Late Potentials Recording

One hundred consecutive patients recovering from an acute myocardiai infarction underwent, prior to home discharge, signal-averaged electrocardiography (ECG), left ventriculography. and 24-hour Holter ECG recording. The signal-averaged ECG was recorded and analyzed using two procedures: the orthogonal bipolar XYZ lead configuration with a bidirectional filter: and a precordial unipolar lead configuration with a uonrecursive digital filter. An abnormal signal-averaged ECG was seen in 40% of patients with the XYZ system and in 30% of patients in the precordial method, abnormal ejection fraction (< 40%) in 24% of patients and high grade ectopy activity in 22%. During the 24-month follow-up period, 12 patients (12%) had an arrhythmic event defined as either sudden death (11 patients) or sustained ventricular tachycardia (1 patient). Neither the signal-averaged ECG with the XYZ configuration, the abnormal ejection fraction, nor the high grade ectopy were able to statistically predict a higher arrhythmic event rate. The signal-averaged ECG with the precordial configuration was able to statistically predict a higher arrhythmic event rate, P < 0.03; odds ratio = 3.96. The combination of the orthogonal XYZ configuration signal-averaged ECG with the ejection fraction (P < 0.01, odds ralio = 7.33), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio = 6.17) was able to predict a higher arrhythmic event rate. The combination of the precordial configuration signal-averaged ECG with the ejection fraction (P < 0.002, odds ratio = 14.4), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio =10) was able to better predict a higher arrhythmic event rate. The combination of a normal or abnormal signal-averaged ECG and ejection fraction gave a sensitivity, specificity, positive, or negative value prediction of arrhythmic events of 60%, 90.6%, 37.5%, and 96%, respectively. It must be emphasized that the number of arrhythmic events during the 2-year follow-up was small and further study is required to determine the true predictive value of each method for arrhythmic events.     

Glycosaminoglycans in human skin

Small skin biopsies of thirty-nine human subjects were assayed for the qualitative and quantitative analysis of glycosaminoglycans. The following results were obtained:

• 1 Besides the presence of hyaluronic acid and dermatan sulphate, evidence has been presented for the presence of heparan sulphate.
• 2 The content of glycosaminoglycans was higher in biopsies from healthy individuals than the values reported for post-mortem human skin.
• 3 Variation of the concentration of either hyaluronic acid or dermatan sulphate plus heparan sulphate in relation to the region of the body could not be demonstrated.
• 4 With advancing age a decrease in dermatan sulphate plus heparan sulphate could be demonstrated. However, hyaluronic acid content could not be demonstrated to correlate with age.

     

Studies on the Biochemical Alterations of the Protein Synthesizing Apparatus in Maturing Rabbit Reticulocytes: I. Maturation in Vivo

The study of maturation of rabbit reticulocytes in vivo revealed an essentialcorrelation between the degree of reticulocytosis, the RNA content of thecirculating red blood cells and their ability to carry out amino acid incorporation into protein. The nevertheless frequent occurrence of considerablequantitative discrepancies between these parameters during the progress ofmaturation appears to be attributable to fluctuations in the reticulocyte population due to intrinsic difference in the life span of these cells and to release ofyoung reticulocytes from the hyperplastic bone marrow into the circulation.The distortions in the pattern of maturation kinetics by the continued contribution of the bone marrow seem to be largely eliminated by blockingerythropoiesis at the height of reticulocytosis with the aid of actinomycin Dtreatment.

Submitted on March 22, 1965 Accepted on August 6, 1965     

CORRELATES OF DISSATISFACTION WITH TREATMENT IN PATIENTS WITH PROSTATE CANCER DIAGNOSED THROUGH SCREENING

PURPOSE: We evaluated correlates of patient reported dissatisfaction with treatment of prostate cancer detected by screening. MATERIALS AND METHODS: We performed a cross-sectional retrospective study to evaluate the correlates of dissatisfaction with treatment in 1,651 patients in whom prostate cancer was detected through serial screening. We included demographic and clinical characteristics in the independent and control variables, and we validated measurements of quality of life outcomes. RESULTS: Overall 11% of patients were dissatisfied with the treatment received. Differences in the rates of dissatisfaction with treatment were not statistically significant across treatment groups (11% for retropubic radical prostatectomy, 21% for perineal radical prostatectomy, 14% for radiotherapy, 8% for observation, 8% for hormonal treatment and 4% for cryoablation, p = 0.1). Patient age, race, followup interval, marital status, education and co-morbid conditions were not significant correlates of dissatisfaction with treatment (for all characteristics p> or =0.05). Urinary function and bothersomeness were associated with dissatisfaction with treatment (p<0.0001), whereas sexual function and bothersomeness were not (p>0.05). Multivariate analysis revealed that urinary function and bothersomeness were also the only significant correlates of dissatisfaction with treatment. CONCLUSIONS: Of patients in whom prostate cancer was detected by screening 11% were dissatisfied with treatment. Urinary function and bothersomeness were the only important correlates of dissatisfaction.     

Enhancement of factor VIIa haemostatic efficacy by formulation with PEGylated liposomes

Summary.  Recombinant activated factor VII (rFVIIa) is an effective treatment of the haemophilia patient with inhibitors and acquired haemophilia. However, on account of its relatively short half-life (HL), achieving therapeutic efficacy with FVIIa requires repeated injections. The development of a long-acting FVIIa product would therefore be beneficial. The formulation of factor VIII with PEGylated liposomes (PEGLip) was previously shown to extend the bleeding-free period in haemophilia patients. We report here an enhancement of haemostatic efficacy by similarly formulating FVIIa with PEGLip. Surface plasmon resonance analysis indicated that FVIIa binds non-covalently but with high affinity and specificity to PEGLip. A one-stage clotting assay demonstrated that formulation of FVIIa with PEGLip does not affect FVIIa activity and stability. A pharmacokinetic study in rats demonstrated that PEGLip formulation of FVIIa extends circulation time and results in higher FVIIa levels several hours after injection. Thromboelastography experiments indicated that PEGLip-FVIIa induces faster clot formation and higher clot stability than standard formulated FVIIa. These results suggest that formulation of FVIIa with PEGLip may lead to a safe and effective long-acting FVIIa that improves the care of haemophilic patients with inhibitors and acquired haemophilia.     

Towards a more comprehensive definition of shift work tolerance

The aim of the present study was to define the nature of individual differences in shift work tolerance (SWT). This was investigated by an exploratory factor analysis of scores from a wide range of established instruments designed to measure sleep, sleepiness, fatigue, social functioning, as well as physical and mental health. Data were collected from a representative sample of 1,529 Norwegian nurses engaged in rotating shift work. The analyses yielded two factors that seemed to be especially relevant for SWT, namely “Well-being” and “Physical health”. Both factors were related to several demographic and personality variables. In addition, both factors were related to job satisfaction, social support and negative acts, while Well-being was also related to coping. These results support the construct and concurrent validity of the Well-being and Physical factors of SWT. Our findings represent a step towards answering calls from previous research concerning the establishment of a wider definition of individual differences in SWT.     

ST segment depression in aVL: a sensitive marker for acute inferior myocardial infarction

In a substantial percentage of patients with acute myocardialinfarction, especially in those with inferior wall involvement,no ST elevation is detected on the electrocardiogram. In manyof them, ST depression is found in leads oriented to remotesegments of the heart. The importance of those reciprocal changesfor early diagnosis of acute inferior myocardial infarctionin patients without ST elevation has not been stressed. In orderto find the prevalence of reciprocal ST depression, we evaluatedthe admission electrocardiograms of 107 consecutive patientswith evolving first acute inferior mvocardial infarction. Ninety-threepatients had ST elevation of at least 0.1 mV in at least oneof the inferior leads: II, III or a VF (group A) and in 14 patientsST displacement did not reach 0·1 mV in any of theseleads (group B). In both groups, reciprocal ST depression occurredmore frequently in a VL than in any other lead. Only three patientshad no ST depression in a VL. in eight patients (7·5%ST depression in a VL was the sole early electrocardiographicsign of the inferior infarction, a VL is the only lead thatis facing the superior part of the left ventricle and thus isthe only lead that is truly opponent to the inferior wall. Itseems that ST depression in a VL, by contrast to that in theprecordial leads, is found in the majority of patients withevolving inferior wall myocardial infarction and is not influencedby extension of the infarclion to the right ventricle or tothe posterior wall. We conclude that transient ST depressionin a VL is a sensitive early electrocardiographic sign of acuteinferior wall myocardial infarction.