Blunt chest trauma as a cause of acute myocardial infarction

Chest pain after thoracic trauma may be a symptom of cardiac injury or myocardial infarction. A 63-year-old healthy man had chest pain after blunt chest trauma in a motor vehicle accident. Chest computed tomography scan showed a displaced sternal fracture, lung contusion in the left upper lobe, atelectasis and consolidation in both lower lobes, and bilateral haemothorax. Electrocardiography showed ST elevation (2 mm) in leads II, III, and aVF and ST depression (2 mm) in leads I and aVL, consistent with acute inferior myocardial infarction. Urgent coronary angiography showed ostial occlusion of the right coronary artery. After the right coronary occlusion was passed with a guide wire, dissection of the right coronary artery was observed and treated with a balloon and stent to reestablish normal flow. This case emphasizes the importance of a high index of suspicion for coronary artery injury and myocardial infarction after blunt chest trauma.

Treatment of tar burns: two case reports

Hot tar burns are still a challenging clinical form because the removal of tar is very difficult for the emergency physician and there is no specified appropriate agent for the removal of tar. In this study, two patients with hot tar burns who were treated with diesel, sunflower oil and mayonnaise are presented.

D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department

OBJECTIVES

The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients.

METHODS

In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy.

RESULTS

Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism.

CONCLUSION

A D-dimer level <0·35 μg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 μg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.

Synthesis, Crystal Structure and Magnetic Properties of a Novel GdIII -CuII Heterodinuclear Complex

Preparation, crystal structure and magnetic properties of a heterodinuclear complex, LCu(Me2CO)Gd(NO3)3 (L = (N,N′-bis(3-methoxysalicylidene)propane- 1,2-diamine) are reported. The crystal structure of the complex was determined by X-ray diffraction methods at 200 K. (C19H22N2O4 )Cu(C3H6O)Gd(NO3)3, monoclinic, space group P21/c, with a = 9.795(9), b = 18.763(3), c = 15.579(2) Å , β = 95.297(2) V = 2850.9(7) Å3 and Z= 4. The central region of the complex is occupied by Cu(II) and Gd(III) ions which are bridged by two phenolato oxygen atoms of the ligand. The copper ion adopts a square-based 4+1 coordination mode, the equatorial N2O2 donors being afforded by the ligand while the axial position is occupied by an oxygen atom of the acetone molecule. The Gd(III) ion is deca-coordinated. In addition to the two phenolate oxygen atoms, the coordination sphere contains two oxygen atoms of the OMe side arms of L and six oxygen atoms from the three bidentate nitrate ions. The Gd... Cu separation is 3.425(3) Å and the dihedral angle between the GdO(l)Cu and GdO(2)Cu planes is 164.8°. The magnetic susceptibility of the complex was measured over the range 5 - 350 K and the observed data were successfully simulated by the equation based on the spin-Hamiltonian operator (H = -JSCu · SGd), giving the exchange integral J(Cu-Gd) = 5.6(1) cm-1. This indicates a weak ferromagnetic spin exchange interaction. The nature of the magnetic super-exchange interaction of the title compound is compared with similar [Gd(III)-Cu(II)] heterodinuclear complexes.

Antiferromagnetic Coupling In A (μ-Hydroxo)(μ-Pyrazolato)Dicopper(II) Complex. Synthesis, Crystal Structure, Magnetic Properties, And Theoretical Studies

Preparation, crystal structure and magnetic properties of a 3,5-dimethylpyrazolate bridged binuclear copper(II) complex [Cu2(L1)(3,5 prz)] (L1 = 1,3-Bis(2-hydroxy-1-napthylideneamino) propan-2-ol) (1) are reported. Variable-temperature magnetic susceptibility measurements for a powdered sample of the complex were carried out in the temperature range 5 - 350 K and analysed to obtain values of the parameter J in the exchange Hamiltonian H = -2JS1·S2 . In the dicopper(II) complex [Cu2(L2)(3,5 prz)], (L2 = l,3-Bis(2-hydroxy-5-chlorosalicylideneamino) propan-2-ol) (2) reported recently the antiferromagnetic interaction is much less than that of 1 (-27 = 440 cm-1 ), as result which is difficult to explain in terms of structural factors on the basis of widely accepted criteria. The differences in the magnetic behaviour now have been rationalized using the “ligand orbital complementary” concept

Synthesis, Crystal Structure and Magnetic Properties of a (μ-Hydroxo)(μ-Pyrazolato) Dicopper(II) Complex

Preparation and magnetic properties of a 3,5-dimethylpyrazolate bridged binuclear copper(II) complex [Cu2(L)(3 ,5 -pyz)] (L = 1,3-Bis(2-Hydroxy-5-Chlorosalicylideneamino)propan- 2-ol) is reported. The crystal structure determined by X-ray diffraction methods. (C22H20N4O3CI2CU2), triclinic, space group P1̄, a = 9.622(3), b = 10.921(2), c = 11.420(3) Å, α = 100.73(2), β = 94.04(2), Υ = 108.08(2)°, V = 1110.2(5) Å3, Z = 2. Two copper(II) ions in a square-planar coordination are bridged via alkoxide oxygen and 3,5-dimethyl pyrozolate nitrogen atoms to form a dinuclear unit. The metal coordination sphere is four-coordinate, planar with an N2O2 donor set. The dihedral angle between the two coordination planes is 166.83°. There are significant intermolecular interactions between neighbouring binuclear entities. The shortest intermolecular Cu (1) ... Cu(1)i distance is 3.383(1) Å and the Cu(1) - O ( 1)i distance is 2.666(3) Å (i = 1 -x, -y, 1 - z). The variable-temperature magnetic susceptibility measurement for a powdered sample of the complex was carried out in the temperature range 5 - 350 K and analysed to obtain values of the parameter J in the exchange Hamiltonian ℋ = -2JScu Scu; 2J = -164 cm-1. The magnetic moment at 300 K is about 2.42 μB, and 0.22 μB at 5 K. The weak antiferromagnetism of the present complex is reasonably explained in terms of the orbital countercomplementary effect based on Hoffmann's theory for super-exchange interaction

Abstract P6-05-22: Young-onset breast cancer exhibits a more aggressive tumor biology

Objective: Previous studies demonstrated poorer survival in patients with young-onset breast cancer. Therefore, we investigated the distinguishing molecular characteristics associated with young onset breast cancer.

Material and Methods: Between September and February 2013, 506 patients with breast cancer, who underwent surgery at our institution, were retrospectively analyzed tailored by age ≤40 (n = 94; 18.6%) and &gt;40 to determine clinicopathological and biological differences. Therefore, molecular subtypes were determined by immunohistochemistry for ER, PR, Ki67, and HER2-neu.

Results: The median age was 50 (27-87). Patients aged ≤40 presented with more advanced disease (stage III/IV; 34% for ≤40 vs 20% for &gt;40, p = 0.003). Among patients, who underwent surgery as initial treatment (n = 411), patients ≤40 were more likely to have or tumors with invasive ductal carcinoma type (p = 0.049), or tumors &gt;20 mm (p = 0.033), or axillary positivity (p = 0.003), or with multifocality/multicentricity (p&lt;0.001), or with high nuclear grade (p = 0.019), or with histological grade (p = 0.023), or lymphovascular invasion (p = &lt;0.001), higher Ki-67 expression (%15≤) rates (p = 0.014), or lower luminal A rates (luminal-A vs other; p = 0.04) compared with patients aged &gt;40. Furthermore, logistic regression analyses revealed presence of multifocality/multicentricity (OR:2.6; 95% CI: 1.4-4.5; p = 0.001), lymphovascular invasion (OR:2.1; 95% CI: 1.2-3.6; p = 0.008), and molecular subtype other than luminal A (OR:2.4; 95% CI: 1.1-5.1; p&lt;0.001) were significant features that were associated with breast cancer aged ≤40.

Conclusion: Our results suggest that tumors of patients with younger age exhibit a more aggressive biology compared to patients older than 40 as shown by molecular subtype analyses that could result in poor prognosis.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-22.

Propagation of dynamic nuclear polarization across the xenon cluster boundaries: elucidation of the spin-diffusion bottleneck

Earlier Dynamic Nuclear Polarization (DNP) experiments with frozen xenon/1-propanol/trityl mixtures have demonstrated spontaneous formation of pure xenon clusters above 120 K, enabling spectrally-resolved real-time measurements of (129)Xe nuclear magnetization in the clusters and in the surrounding radical-rich matrix. A spin-diffusion bottleneck was postulated to explain the peculiar time evolution of (129)Xe signals in the clusters as well as the apparent discontinuity of (129)Xe polarization across the cluster boundaries. A self-contained ab initio model of nuclear spin diffusion in heterogeneous systems is developed here, incorporating the intrinsic T1 relaxation towards the temperature-dependent equilibrium polarization and the spin-diffusion coefficients based on the measured NMR line widths and the known atomic densities in each compartment. This simple model provides the physical basis for the observed spin-diffusion bottleneck and is in a good quantitative agreement with the earlier measurements. A simultaneous fit of the model to the time-dependent NMR data at two different DNP frequencies provides excellent estimates of the cluster size, the intrinsic sample temperature, and (129)Xe T1 constants. The model was also applied to the NMR data acquired during relaxation towards the thermal equilibrium after the microwaves were turned off, to estimate T1 relaxation time constants inside and outside the clusters. Fitting the model to the data during and after DNP provides consistent estimates of the cluster size.

Lineshape-based polarimetry of dynamically-polarized (15)N2O in solid-state mixtures

Dynamic nuclear polarization (DNP) of (15)N2O, known for its long-lived singlet-state order at low magnetic field, is demonstrated in organic solvent/trityl mixtures at ∼1.5 K and 5 T. Both (15)N polarization and intermolecular dipolar broadening are strongly affected by the sample's thermal history, indicating spontaneous formation of N2O clusters. In situ (15)N NMR reveals four distinct powder-pattern spectra, attributed to the chemical-shift anisotropy (CSA) tensors of the two (15)N nuclei, further split by the intramolecular dipolar coupling between their magnetic moments. (15)N polarization is estimated by fitting the free-induction decay (FID) signals to the analytical model of four single-quantum transitions. This analysis implies (10.2±2.2)% polarization after 37 h of DNP, and provides a direct, instantaneous probe of the absolute (15)N polarization, without a need for time-consuming referencing to a thermal-equilibrium NMR signal.

Evaluation of hbetaD-1 and hbetaD-2 levels in saliva of patients with oral mucosal diseases

OBJECTIVE

This study aimed to determine a possible correlation between oral mucosal disease and salivary concentrations of the antimicrobial peptides human beta-defensin-1 (hbetaD-1) and human beta-defensin-2 (hbetaD-2).

METHOD

The present work focussed on the establishment of a reversed phase-high performance liquid chromatography (RP-HPLC) procedure to quantify human beta-defensins (hbetaD-1 and hbetaD-2) in saliva samples of patients with oral diseases such as lichen planus (n = 10), Behçet (n = 10) and recurrent apthous stomatitis (n = 10).

RESULTS

Linear calibration range for hbetaD-1 and hbetaD-2 defensins was 1.67-200 microg mL-1 and 3.13 -100 PG mL-1 with R2 values of 0.9998 and 0.996, correspondingly. The concentration of beta-defensins in saliva was determined by comparing the peak areas of eluted hbetaD-1 and hbetaD-2 with that of their standards. The variation of the amount of beta-defensins was evaluated by comparisons of the results obtained from the patients with oral mucosal diseases before and after treatments and the control subjects. The limit of detection (LOD) and limit of quantification (LOQ) were found to be 1.62 microg mL-Sand 5.39 microg mL-1 for hbetaD-1 and 0.94 mig mL-1 and 3.13 microg mL-1 for hbetalD-2, respectively.

CONCLUSION

The salivary beta-defensin concentration was significantly higher in patients with oral mucosal diseases than in healthy volunteers; furthermore, in patients with oral mucosal diseases, the concentration was significantly higher before treatment than after treatment.

Cluster formation restricts dynamic nuclear polarization of xenon in solid mixtures

During dynamic nuclear polarization (DNP) at 1.5 K and 5 T, (129)Xe nuclear magnetic resonance (NMR) spectra of a homogeneous xenon/1-propanol/trityl-radical solid mixture exhibit a single peak, broadened by (1)H neighbors. A second peak appears upon annealing for several hours at 125 K. Its characteristic width and chemical shift indicate the presence of spontaneously formed pure Xe clusters. Microwave irradiation at the appropriate frequencies can bring both peaks to either positive or negative polarization. The peculiar time evolution of (129)Xe polarization in pure Xe clusters during DNP can be modelled as an interplay of spin diffusion and T(1) relaxation. Our simple spherical-cluster model offers a sensitive tool to evaluate major DNP parameters in situ, revealing a severe spin-diffusion bottleneck at the cluster boundaries and a significant sample overheating due to microwave irradiation. Subsequent DNP system modifications designed to reduce the overheating resulted in four-fold increase of (129)Xe polarization, from 5.3% to 21%.

The effects of ubiquinone (CoQ10) on heart tissue in cardiac toxicity related to organophosphate poisoning

The aim of this study was to examine the effects of ubiquinone (CoQ10) on heart tissue and erythrocytes in acute organophosphate poisoning (AOP). A total of 20 rabbits were divided into three groups: sham (n = 8), pralidoxime (PAM) + atropine (n = 6), and CoQ10 + PAM + atropine (n = 6). Blood samples were taken from each test subject to measure the values of acetylcholinesterase (AChE), nitric oxide (NO), and malondialdehyde (MDA) in the plasma and erythrocyte before administration of 50 mg/kg dichlorvos by orogastric tube. Blood samples were then taken at 1, 12, and 24 h post-dichlorvos to determine plasma and erythrocyte levels of AChE, NO, and MDA. Sham group received no treatment. PAM + atropine group received 0.05 mg/kg atropine with repeated doses and PAM: first a 30-mg/kg intravenous (IV) bolus, then a 15-mg/kg IV bolus every 4 h. CoQ10 + PAM + atropine group received same dose PAM and atropine and a 50-mg bolus of IV CoQ10. Thoracotomy was performed in all the animals 24 h after poisoning and then heart tissue samples were obtained. At 12 and 24 h, erythrocyte AChE levels in the CoQ10 animals were considerably higher than those in PAM + atropine animals (p = 0.023 and 0.017, respectively). At 12 and 24 h, erythrocyte MDA and NO levels in CoQ10 animals were significantly lower than those in PAM + atropine animals (p < 0.05). Heart tissue AChE levels in CoQ10 animals were considerably higher than those of the sham and PAM + atropine animals (p = 0.001). Heart tissue MDA and NO levels of CoQ10 animals were significantly lower than those of the sham and PAM + atropine animals (p < 0.01). Treatment of AOP with CoQ10 + PAM + atropine in this animal model had a beneficial effect on both erythrocyte and heart tissue lipid peroxidation and AChE activity.