Predictors of 90-day outcome in patients stabilized after acute coronary syndromes

AIMS

We investigated predictors of 90-day risk among patients surviving the early period after an acute coronary syndrome (ACS).

METHODS AND RESULTS

The study population included 15 904 stabilized ST-segment elevation or non-ST-segment elevation ACS patients randomized in SYMPHONY and 2nd SYMPHONY. We developed risk models for death, death or myocardial infarction (MI), and death, MI, or severe recurrent ischaemia (SRI) using Cox proportional-hazards techniques. Demographic, history, and pre-randomization clinical and medication variables were tested. Validation techniques included development of individual trial models, backward elimination and bootstrapping. Of 118 variables, 17 independently predicted mortality. The strongest associations included greater age (chi(2)=31.1), higher randomization heart rate (chi(2)=27.4), and heart failure (HF) variables (HF between qualifying event and randomization, chi(2)=21.8; history of HF, chi(2)=12.2). Higher creatinine clearance (chi(2)=17.7) and percutaneous coronary intervention between qualifying event and randomization (chi(2)=11.1) most strongly predicted lower risk. Similar characteristics entered the double and triple composite models, but HF variables and age less strongly predicted these end-points.

CONCLUSIONS

In patients stabilized after ACS, those at highest risk over the next 90 days can be identified. Typical clinical markers are better at identifying risk of death than non-fatal MI or SRI. Novel risk markers are needed for these outcomes.

Refinement of the nickel site structure in Desulfovibrio gigas hydrogenase using range-extended EXAFS spectroscopy

We have reexamined the Ni EXAFS of oxidized, inactive (as-isolated) and H(2) reduced Desulfovibrio gigas hydrogenase. Better spatial resolution was achieved by analyzing the data over a 50% wider k-range than was previously available. A lower k(min) was obtained using the FEFF code for phase shifts and amplitudes. A higher k(max) was obtained by removing an interfering Cu signal from the raw spectra using multiple energy fluorescence detection. The larger k-range allowed us to better resolve the Ni-S bond lengths and to define more accurately the Ni-O and Ni-Fe bond lengths. We find that as-isolated, hydrogenase has two Ni-S bonds at approximately 2.2 A, but also 1-2 Ni-S bonds in the 2.35+/-0.05 A range. A Ni-O interaction is evident at 1.91 A. The as-isolated Ni-Fe distance cannot be unambiguously determined. Upon H(2) reduction, two short Ni-S bonds persist at approximately 2.2 A, but the remaining Ni-S bonds lengthen to 2.47+/-0.05 A. Good simulations are obtained with a Ni-Fe distance at 2.52 A, in agreement with crystal structures of the reduced enzyme. Although not evident in the crystal structures, an improvement in the fit is obtained by inclusion of one Ni-O interaction at 2.03 A. Implications of these distances for the spin-state of H(2) reduced H(2)ase are discussed.

Skylab nutritional studies

Precise nutritional specifications arising from both physiological and experimental requirements necessitated a comprehensive study of the chemical composition of the Skylab food supply. Each of the approximately seventy different food items was analyzed for digestible and non-digestible carbohydrate, and for protein, amino acids, fat, fatty acids, vitamins and minerals. Menus were formulated to provide at least the National Research Council's Recommended Dietary Allowance of all essential nutrients and, in addition, to provide constant daily intakes of calcium, phosphorus, magnesium, sodium, potassium and protein. In general, the crew members adhered to their programmed menus. The ability to swallow and digest food was unaffected by prolonged weightlessness. Taste acuity also appeared to be undiminished in flight. The bone and muscle changes which occurred in previous flights were more pronounced in Skylab. It is concluded that these changes did not develop as a result of nutritional deficit. If such changes are nutritionally related, they point to the existence of nutritional requirements in weightlessness which differ quantitatively from those observed on earth.

Attention constraints of semantic activation during visual word recognition

The reduction of semantic priming following letter search of the prime suggests that semantic activation can be blocked if attention is allocated to the letter level during word processing. Is this true even for the very fast-acting component of semantic activation? To test this, the authors explored semantic priming of lexical decision at stimulus onset asynchronies (SOAs) of either 200 or 1,000 ms. Following semantic prime processing, priming occurred at both SOAs. In contrast, no priming occurred at the long SOA following letter-level processing. Of greatest interest, at the short SOA there was priming following the less demanding consonant/vowel task but not following the more attention-demanding letter search task. Hence, semantic activation can occur even when attention is directed to the letter level, provided there are sufficient resources to support this activation. The authors conclude that the default setting during word recognition is for fast-acting activation of the semantic system.

Hypertension in hemodialysis patients

Hypertension is very common and often poorly controlled in patients undergoing chronic hemodialysis. While high blood pressure has been documented to adversely impact several intermediate outcomes of cardiovascular disease, whether hypertension is an independent risk factor for mortality in this population is not clear. Expansion of extracellular fluid volume is the major pathophysiologic mechanism for the development of hypertension in these patients; however, alterations in other humoral mechanisms also play a significant role. Optimization of volume status is, therefore, the cornerstone of therapy with additional use of antihypertensive medications as needed. Good quality prospective studies are urgently needed to define the measurement techniques and blood pressure goals, and to develop therapeutic strategies for more effective management of hypertension in this high-risk population.

Attention constraints of semantic activation during visual word recognition

The reduction of semantic priming following letter search of the prime suggests that semantic activation can be blocked if attention is allocated to the letter level during word processing. Is this true even for the very fast-acting component of semantic activation? To test this, the authors explored semantic priming of lexical decision at stimulus onset asynchronies (SOAs) of either 200 or 1,000 ms. Following semantic prime processing, priming occurred at both SOAs. In contrast, no priming occurred at the long SOA following letter-level processing. Of greatest interest, at the short SOA there was priming following the less demanding consonant/vowel task but not following the more attention-demanding letter search task. Hence, semantic activation can occur even when attention is directed to the letter level, provided there are sufficient resources to support this activation. The authors conclude that the default setting during word recognition is for fast-acting activation of the semantic system.

Identification of Streptococcus pneumoniae revisited

The sensitivities and specificities of several different diagnostic assays for Streptococcus pneumoniae were assessed using 99 clinical isolates of S. pneumoniae and 101 viridans streptococci and were as follows: Pneumoslide, 99 and 87%, respectively; Directigen, 100 and 85%, respectively; Phadebact, 100 and 98%, respectively; deoxycholate drop test, 99 and 98%, respectively; deoxycholate tube test, 100 and 99%, respectively; optochin, 99 and 98%, respectively; and Gram Positive Identification Card, 90 and 96%, respectively. Identification of clinical isolates of S. pneumoniae should be confirmed using one or more diagnostic assays with well-documented high (e.g., > or =95%) sensitivities and specificities.

1H-Pyrrole-2-carbothioamide

The reaction of ethoxycarbonylpyrrole-2-thiocarboxamide with sodium hydroxide affords the known title compound, C(5)H(6)N(2)S, whose structure shows a three-dimensional hydrogen-bonded lattice.

Glycosylation of a Streptomyces coelicolor A3(2) cell envelope protein is required for infection by bacteriophage phi C31

Mutants of Streptomyces coelicolor A3(2) J1929 (Delta pglY) were isolated that were resistant to the Streptomyces temperate phage phi C31. These strains could be transfected with phi C31 DNA, but could not act as infective centres after exposure to phage. Thus, it was concluded that infection was blocked at the adsorption/DNA injection step. The mutants fell into three classes. Class I mutants were complemented by a gene, SCE87.05, isolated from the cosmid library of S. coelicolor A3(2). The product of SCE87.05 had good overall homology to a Mycobacterium tuberculosis hypothetical protein and regions with similarity to dolichol phosphate-D-mannose:protein O-D-mannosyltransferases. Concanavalin A (ConA) inhibited phi C31 infection of S. coelicolor J1929, and this could be partially reversed by the addition of the sugar, alpha-D-methyl-pyranoside. Moreover, glycosylated proteins from J1929, but not from the class I mutant DT1017, were detected using ConA as a probe in Western blots. Class I and II mutants were sensitive to phi C31hc, a previously isolated phage exhibiting an extended host range phenotype, conferred by h. A phage with the same phenotype, phi DT4002, was isolated independently, and a missense mutation was found in a putative tail gene. It is proposed that the phi C31 receptor is a cell wall glycoprotein, and that the phi C31h mutation compensates for the lack of glycosylation of the receptor.

Decision points in the integrative research review process: a flow-chart approach

With the ever increasing volume of research information appearing in the literature, research syntheses are becoming more popular among researchers in various disciplines. This phenomenon demands application of rigorous and systematic review methodologies. Using Cooper's five-stage process for conducting an integrative research review, the authors have constructed a flow chart for health sciences librarians and others using this approach to identify decision points in this process. The accompanying narrative details the information that must be considered and analyzed. Included in the flow chart and text is an elaboration of meta-analysis and an integrative review to accommodate both quantitative and qualitative research results. A case is made for a collaborative relationship between the researcher and the librarian.

Modulating semantic feedback in visual word recognition

According to the interactive activation framework proposed by McClelland and Rumelhart (1981), activation spreads both forward and backward between some levels of representation during visual word recognition. An important boundary condition, however, is that the spread of activation from lower to higher levels can be prevented (e.g., explicit letter processing during prime processing eliminates the well-documented semantic priming effect). Can the spread of activation from higher to lower levels also be prevented? This question was addressed with a choice task procedure in which subjects read a prime word and then responded to a target, performing either lexical decision or letter search depending on the color of the target. A semantic context effect was observed in lexical decision, providing evidence of semantic-level activation. In contrast, there was no semantic context effect in the letter search task, despite evidence of lexical involvement: Words were searched faster than nonwords. Further evidence of lexical involvement in the letter search task appeared in Experiment 2 in the form of greater identity priming for words than for nonwords. The results of these experiments are consistent with the conclusion that feedback from the semantic level to the lexical level can be blocked. Hence, between-level activation blocks can be instantiated in both bottom-up and top-down directions.

'See and treat' at colposcopy--achieving the standard

The National Health Service Cervical Screening Programme has issued quality standards for the colposcopy service nationally. One standard is that for women who undergo treatment at their first colposcopy clinic visit, 90% should have proven cervical intra-epithelial neoplasia (CIN) on histology. We have assessed data from a teaching hospital colposcopy clinic over a 9-year period to assess the criteria that should be satisfied in order to achieve this target. We propose that only those women with severe dyskaryosis on the referral smear and a colposcopic appearance of CIN 2 or 3, or those in whom the colposcopic appearance suggests CIN 3 with any grade of dyskaryosis undergo treatment at their first visit.

Stories of lesbian in/visibility in nursing

In this article, a study of the life histories of 5 self-identified lesbian women in nursing is reported. A metastory of "In/Visibility" captured the essence of lesbians being the focus of intense scrutiny while at the same time feeling the pressure to keep their lifestyle and identity hidden from others. Seven story themes were elaborated: closeting of lesbianism in nursing, isolating and hiding from self and others, living a double-life, self-loathing and shame, experiencing discrimination from others, keeping safe, and threatening others who are closeted.

Control of directionality in the site-specific recombination system of the Streptomyces phage phiC31

The genome of the Streptomyces temperate phage phiC31 integrates into the host chromosome via a recombinase belonging to a novel group of phage integrases related to the resolvase/invertase enzymes. Previously, it was demonstrated that, in an in vitro recombination assay, phiC31 integrase catalyses integration (attP/attB recombination) but not excision (attL/attR). The mechanism responsible for this recombination site selectivity was therefore investigated. Purified integrase was shown to bind with similar apparent binding affinities to between 46 bp and 54 bp of DNA at each of the attachment sites, attP, attB, attL and attR. Assays using recombination sites of 50 bp and 51 bp for attP and attB, respectively, showed that these fragments were functional in attP/attB recombination and maintained strict site selectivity, i.e. no recombination between non-permissive sites, such as attP/attP, attB/attL, etc., was observed. Using bandshifts and supershift assays in which permissive and non-permissive combinations of att sites were used in the presence of integrase, only the attP/attB combination could generate supershifts. Recombination products were isolated from the supershifted complexes. It was concluded that these supershifted complexes contained the recombination synapse and that site specificity, and therefore directionality, is determined at the level of stable synapse formation.

OctreoTher: ongoing early clinical development of a somatostatin-receptor-targeted radionuclide antineoplastic therapy

OctreoTher ((90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide, a.k.a. (90)Y-SMT 487) consists of a somatostatin peptide analogue (Tyr(3)-octreotide), coupled with a complexing moiety (DOTA), and labeled with a tightly bound beta-emitter (yttrium-90). By targeting somatostatin receptor-positive tumors (as imaged by OctreaScan it may deliver a tumoricidal dose of radiation. Phase I clinical trials, conducted in patients with neuroendocrine tumors, established the safety and tolerability of the dose selected for further study and demonstrated the capacity of OctreoTher to deliver radiation doses to tumors that resulted in significant neuroendocrine tumor shrinkage. Novartis-sponsored phase II studies will soon begin to test the efficacy of OctreoTher in breast and small cell lung cancer. A fixed-dose regimen of 120 mCi/cycle x 3 cycles administered with concomitant amino acid infusion has been chosen for the study. Phase I data and published literature support that this fixed dose regimen will be safely tolerated.

Cross-sectional study of the association of abomasal displacement or volvulus with serum electrolyte and mineral concentrations in dairy cows

The objective of this study was to evaluate serum mineral and electrolyte concentrations at the time of on-farm diagnosis of left displaced abomasum, right displaced abomasum, or abomasal volvulus in dairy cows. Data were collected from 104 affected cows and 96 control cows matched with cases, based on herd, parity, and stage of lactation. Cows with abomasal displacement or volvulus had significantly lower calcium, phosphorous, magnesium, potassium, and chloride concentrations and increased anion gap at the time of diagnosis compared with control cows from the same herds. The percentages of cases and controls with total serum calcium concentrations below the lower limit of the laboratory reference range (2.08 mmol/L [8.3 mg/dL]) were 70% and 23%, respectively. Based on the large percentage of cases with hypocalcemia, administering calcium salts at the time of treatment of field cases of abomasal displacement or volvulus may be beneficial.

On the interaction between linguistic and pictorial systems in the absence of semantic mediation: evidence from a priming paradigm

Use of the letter search task in the context of the priming paradigm has proved to be an invaluable tool for the investigation of the strategic control of processes involved in word recognition. In particular, previous findings that letter search on a prime word interferes with the priming of semantically/associatively related targets, but not with the priming of either identical or morphologically related targets, suggests that letter search may selectively interfere with semantic processing, leaving other levels of processing intact. In the present experiments, this investigation was extended by exploring the priming of pictures following letter search of either a same-concept word (repetition priming) or a semantically/associatively related word (semantic priming). There was significant repetition priming of picture categorization following both silent reading and letter search of the prime word (Experiments 1 and 2). In contrast, semantic priming of pictures was found only following silent reading of the prime; there was no semantic priming following letter search of the prime (Experiment 2). This pattern of results suggests that focusing attention at the letter level during prime processing selectively attenuates activation of the semantic system by the prime. It does not prevent the spread of activation between the lexical and pictogen levels of representation of a given concept.