Pupillometric changes during gradual opiate detoxification correlate with changes in symptoms of opiate withdrawal as measured by the Weak Opiate Withdrawal Scale

The relationship between pupil size and subjective symptoms of opiate withdrawal during gradual opiate agonist detoxification has not yet been studied. In the current study, the authors sought to determine the relationship between pupil size and intensity of opiate withdrawal symptoms. To accomplish this, they examined 19 subjects meeting DSM-IV criteria for opiate dependence (304.00) on agonist therapy. All subjects were undergoing opiate detoxification with either methadone or the longer-acting 1-alpha acetylmethadol (LAMM). During two separate visits, subjects' pupil sizes were assessed in the dark using a pupillometer. At each visit, subjects completed two standardized assessment tools (the Subjective Opiate Withdrawal Scale [SOWS] and the Weak Opiate Withdrawal Scale [WOWS]) for measuring subjective symptoms of opiate withdrawal. It was found that changes in pupil size significantly correlated with WOWS, but not with SOWS, scores. Larger pupil sizes were associated with less withdrawal distress. The sensitivity of the pupillometric test to detect increases in opiate craving during opiate agonist medication reduction was 92%, with a specificity of 57%. The predictive value of a positive test was 79%, whereas the predictive value of a negative test was 80%. Pupillometry may provide an objective measure of the intensity of opiate withdrawal in subjects during gradual methadone detoxification.

Six-month angiographic and clinical follow-up of patients prospectively randomized to receive either tirofiban or placebo during angioplasty in the RESTORE trial. Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis

OBJECTIVES

This study sought to investigate the effects of tirofiban versus placebo on the incidence of adverse cardiac outcomes and coronary artery restenosis at 6 months.

BACKGROUND

Tirofiban is a highly selective, short-acting inhibitor of fibrinogen binding to platelet glycoprotein IIb/IIIa. In a recent clinical study, tirofiban reduced the incidence of adverse cardiovascular events at both 2 and 7 days after coronary angioplasty or directional coronary atherectomy. This reduction persisted but was no longer statistically significant at 30 days.

METHODS

The Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis (RESTORE) trial was a randomized, double-blind, placebo-controlled trial of tirofiban in patients undergoing balloon angioplasty or directional atherectomy within 72 h of presentation with either unstable angina pectoris or acute myocardial infarction. All patients received an initial bolus (10 microg/kg body weight over 3 min), followed by a 36-h infusion (0.15 microg/kg per min) of either tirofiban or placebo.

RESULTS

At 6 months the composite end point (either death from any cause, new myocardial infarction, bypass surgery for angioplasty failure or recurrent ischemia, repeat target vessel angioplasty or stent insertion for actual or threatened abrupt closure) occurred in 1,070 placebo group patients (27.1%) and 1,071 tirofiban group patients (24.1%, p = 0.11). Analysis of 6-month coronary arteriograms by means of quantitative coronary arteriography showed no significant difference between placebo- and tirofiban-treated patients in either the incidence of a > or =50% diameter stenosis (57% vs. 51%, p = NS), a loss of > or =50% of lumen diameter gained (50% vs. 50%, p = NS) or a loss of > or =0.72 mm of lumen diameter (44% vs. 42%, p = NS).

CONCLUSIONS

The 3% absolute reduction in the incidence of the composite end point at 6 months (27.1% placebo vs. 24.1% tirofiban) was similar to that previously reported at 2 days (8.7% vs. 5.4%, p < 0.005), and there does not appear to be any late effect of tirofiban on clinical end points between day 2 and 6 months. Tirofiban did not reduce the incidence of restenosis at 6 months when defined in a number of ways.

The Open Artery Hypothesis: Past, Present, and Future

The survival benefit following a reperfusion strategy, be it pharmacologic or mechanical, appears to be due to both full and early reperfusion. While the TIMI Flow Grade classification scheme has been a useful tool to assess coronary blood flow in acute syndromes, it has several limitations. A newer method of assessing coronary blood flow called the Corrected TIMI Frame Count method has the following advantages: (1) it is a continuous quantitative variable rather than a categorical qualitative variable; (2) the flow in the non-culprit artery is not assumed to be normal as it is in the assessment of TIMI Grade 3 Flow; (3) there is simplified reporting of reperfusion efficacy through the use of a single number instead of expressing the data in 2 to 4 categories; (4) because a single number rather than 4 categories is used to report the data, there is more efficient use of the dataset by increasing the statistical power; and finally (5) coronary flow can be expressed in intuitive terms (e.g. time or cm/sec for strategy A versus time or cm/sec for strategy B). This paper reviews the history of the open artery hypothesis and recent advances in the field.

Dietary intake of trace elements and minerals among adults in underprivileged communities of rural Rajasthan, India

In developing countries, data on dietary intake of trace elements, and even major elements, is limited. The dietary intake of 1277 adults of underprivileged communities of rural Rajasthan was studied. Intake was assessed by the 24-h dietary recall method from which the average daily intake of macronutrients, some major elements, and trace elements was computed. The zinc intake was 69.7 and 49.7% of the recommended daily allowance in males and non-pregnant non-lactating females, respectively. The intakes of manganese and molybdenum were adequate when compared with the suggested daily intakes. Element intake during the physiological stress conditions of pregnancy and lactation was 42.4 and 53.0% for zinc, 36.5 and 29.8% for copper, and 21.0 and 23.1% for calcium, respectively. The intake of iron was less than 20 mg/day for all female subjects studied. No significant difference was observed in the trace element intake of subjects with different grades of malnutrition. Assessment of dietary intake may provide a useful indication of the possible status of major and trace elements among adult subjects.

Thrombolysis in Myocardial Infarction frame count in saphenous vein grafts

BACKGROUND

Although the Thrombolysis in Myocardial Infarction flow grade system is a widely used index of coronary blood flow, it has important limitations. We recently described a new continuous measure of blood flow in native coronary arteries, the Thrombolysis in Myocardial Infarction frame count (TFC), and sought to extend this method to coronary artery bypass grafts.

METHODS

We retrospectively analyzed cinefilms of patients' status after coronary artery bypass grafting, excluding patients with recent myocardial infarction and grafts with stenoses in the graft or native vessel. We counted the cineframes required for dye to travel from the ostium of the graft to the graft anastomotic site (TFCg) and to a standardized distal coronary landmark (TFC).

RESULTS

For all vein grafts combined, TFCg was 19.2+/-5.7 frames (mean+/-SD, n = 93) and the TFC was 33.9+/-8.0 frames (n = 67). The upper limits for "normal" flow, calculated from the 95% confidence intervals, were 31 frames for TFCg and 50 frames for TFC.

CONCLUSIONS

The Thrombolysis in Myocardial Infarction frame counting method has now been extended to normal saphenous vein grafts, and normal reference values are provided.

Angioplasty guidewire velocity: a new simple method to calculate absolute coronary blood velocity and flow

The Thrombolysis In Myocardial Infarction (TIMI) frame count is a relative index of coronary flow that measures time by counting the number of frames required for dye to travel from the ostium to a standardized coronary landmark in a cineangiogram filmed at a known speed (frames/s). We describe a new method to measure distance along arteries so that absolute velocity (length divided by time) and absolute flow (area x velocity) may be calculated in patients undergoing percutaneous transluminal coronary angiography (PTCA). After PTCA, the guidewire tip is placed at the coronary landmark and a Kelly clamp is placed on the guidewire where it exits the Y-adapter. The guidewire tip is then withdrawn to the catheter tip and a second Kelly clamp is placed on the wire where it exits the Y-adapter. The distance between the 2 Kelly clamps outside the body is the distance between the catheter tip and the anatomic landmark inside the body. Velocity (cm/s) may be calculated as this distance (cm) divided by TIMI frame count (frames) x film frame speed (frames/s). Flow (ml/s) may be calculated by multiplying this velocity (cm/s) and the mean cross-sectional lumen area (cm2) along the length of the artery to the TIMI landmark. In 30 patients, velocity increased from 13.9 +/- 8.5 cm/s before to 22.8 +/- 9.3 cm/s after PTCA (p <0.001). Despite TIMI grade 3 flow both before and after PTCA in 18 patients, velocity actually increased 38%, from 17.0 +/- 5.4 to 23.5 +/- 9.0 cm/s (p = 0.01). For all 30 patients, flow doubled from 0.6 +/- 0.4 ml/s before to 1.2 +/- 0.6 ml/s after PTCA (p <0.001). In the 18 patients with TIMI grade 3 flow both before and after PTCA, flow increased 86%, from 0.7 +/- 0.3 to 1.3 +/- 0.6 ml/s (p = 0.001). Distance along coronary arteries (length) can be simply measured using a PTCA guidewire. This length may be combined with the TIMI frame count to calculate measures of absolute velocity and flow that are sensitive to changes in perfusion. TIMI grade 3 flow is composed of a range of velocities and flows.

Hydrogen peroxide inhibits human keratinocyte migration

BACKGROUND

Reepithelialization is an important component of wound healing. In the first 48 hours keratinocyte migration and proliferation are important events in this process. Although the literature agrees that the risk/benefit of antiseptics has not been established, hydrogen peroxide is still commonly used in the management of acute and chronic wounds.

OBJECTIVE

The purpose of this study was to evaluate the effect of hydrogen peroxide on human keratinocyte migration and proliferative potential.

METHODS

The viability and proliferative potential of human keratinocytes in the presence of hydrogen peroxide was assessed by trypan blue exclusion, cell morphology, substratum attachment, and thymidine incorporation. Using concentrations of hydrogen peroxide that do not affect keratinocyte viability, keratinocyte migration was evaluated by a standard motility assay.

RESULTS

Hydrogen peroxide in concentrations < or = 700 microM was found to have no effect on keratinocyte viability. At these low concentrations, however, hydrogen peroxide had a profound inhibitory effect upon keratinocyte migration on extracellular matrix and decreased the proliferative potential of the cells in a concentration-dependent fashion.

CONCLUSION

Hydrogen peroxide, in very low concentrations (1000-fold less than the "everyday use" dilution) inhibits keratinocyte migration and proliferation.

Characterisation of Vibrio cholerae 0139 isolated from diarrhoeal stools

A total of 174 samples of acute diarrhoeal stools received over a period of seven months, yielded 101 isolated morphologically and biochemically resembling Vibro cholerae. Serologically, 57(56.4 per cent) of the 101 isolates were identified as V. cholerae 01 and remaining 44 (43.6 per cent) as V. cholerae 0139. Keeping in mind the unique potential of 0139 among non 01 vibrio to cause epidemics, we decided to undertake the study of biochemical characters and physiological behaviour of all the 44 V. cholerae 0139 isolates. All the stains were Voges Proskauer's test positive' haemagglutinating and grew in the presence of 6 per cent sodium chloride. 13 (29.5 per cent) strains showed haemolytic activity. Nine (20.5 per cent) were polymyxin-B sensitive and 4 (9.0 per cent) fermented lactose. All the isolates showed considerable degree of homogeneity in their biochemical and physiological properties, some characters define them to be closer to El Tor biotype.

Percutaneous transluminal balloon angioplasty in suprahepatic IVC obstruction--Budd-Chiari syndrome

Encouraging results of Transluminal Angioplasty for Budd-Chiari Syndrome due to obstruction of Suprahepatic inferior vena cava have been reported in the last decade. We present our experience with two such patients, treated with balloon dilatation producing dramatic clinical improvements and control of disease on follow-up.

Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: relation to age and risk factors

We evaluated 675 men and 190 women who had no symptoms or history of clinical CHD, to determine the prevalence and risk factor correlates of CAC deposits as a marker of atherosclerosis. Measurements were taken noninvasively by ultrafast CT. The presence and extent of CAC deposits as measured by ultrafast CT was determined in all subjects, who also received personal and family medical history and risk factor questionnaire. The prevalence of CAC deposits increased significantly with age, ranging from 15% and 30% in men and women, respectively, < 40 years of age to 93% and 75% in those aged > or = 70 years. Prevalence and total score also increased by the number of risk factors present, although in those aged > 60 years a high prevalence (> 80% in men) of calcium was present regardless of the presence of risk factors. In multiple logistic regression, age, male gender, hypertension, diabetes, hypercholesterolemia, and obesity were independently associated with CAC deposits. These results suggest a high prevalence of atherosclerosis with increasing age and the presence of risk factors in men and women who have no symptoms. Studies to determine the prognostic value of CAC in individuals with no symptoms are needed to determine which populations may benefit most from CAC deposit screening.

Risk factor correlates of coronary calcium as evaluated by ultrafast computed tomography

Coronary artery calcium is invariably associated with atherosclerosis and has been linked to an increased risk of coronary events. Ultrafast computed tomography (CT) was recently used to document the presence and relative quantity of coronary calcium. The use of the self-reported coronary risk factors to identify persons with coronary calcium as documented by ultrafast CT screening was examined in 458 men and 139 women aged 26 to 81 years (88% asymptomatic). All subjects underwent ultrafast CT scanning, and received a questionnaire and underwent an interview regarding medical and risk factor history. Total calcium score was calculated as the sum of lesion-specific scores, each calculated as the product of density > or = 130 Hounsfield units and area > or = 0.51 mm2. The prevalence of coronary calcium increased significantly (p < 0.01) by age group, and the greater the number of risk factors present, the greater the likelihood of calcium. From multiple logistic regression, age (p < 0.01), male sex (relative risk [RR] 3.03; p < 0.01), and history of smoking (RR 1.85; p < 0.01) and hypertension (RR 1.65; p < 0.05) were independently associated with the probability of detectable calcium. Among asymptomatic subjects, an association with hypercholesterolemia was also seen (RR 1.56; p < 0.05). The results demonstrate that cardiovascular risk factors can help in identifying the likelihood of coronary calcium.

Reversible cardiomyopathy after high-dose interleukin-2 therapy

We observed two patients who developed moderate global myocardial dysfunction during therapy with high-dose interleukin-2 (IL-2). Although cardiac enzymes became markedly elevated at the completion of a full course of IL-2, patients exhibited no ischemic symptoms. Serial echocardiography documented global myocardial dysfunction, which resolved in 5 days in one patient but persisted beyond 4 weeks in another. Asymptomatic reversible myocardial injury can occur with high-dose IL-2 and can persist beyond 4 weeks after stopping therapy. Review of the literature suggests an IL-2-associated myocarditis as an etiology.

Glucose transport and microvillus membrane physical properties along the crypt-villus axis of the rabbit

Both transport function and microvillus membrane physical properties evolve as the enterocyte matures and migrates up the crypt-villus axis. We isolated enriched fractions of villus tip, mid-villus, and crypt enterocytes from which microvillus membrane vesicles were prepared. Using this material we characterized the alterations that occur in microvillus membrane fluidity as the rabbit enterocyte matures and correlated these with kinetic studies of glucose transport. With increasing maturity the microvillus membrane becomes more rigid due to both an increase in the cholesterol/phospholipid ratio and alterations in individual phospholipid subclasses. Maximal rates of glucose transport were greatest in microvillus membrane vesicles prepared from mature cells. However, the glucose concentration producing half-maximal rates of transport (Km) was significantly lower in crypt microvillus membrane vesicles, suggesting that a distinct glucose transporter existed in crypt enterocytes. This distinction disappeared when differences between membrane lipid environments were removed. By fluidizing villus-tip microvillus membrane vesicles, in vitro, to levels seen in the crypt microvillus membrane, we observed a reduction in the Km of this transport system. These data suggest that the kinetic characteristics of the sodium-dependent glucose transporter are dependent upon its local membrane environment.

A collection of strains containing genetically linked alternating antibiotic resistance elements for genetic mapping of Escherichia coli

We present a collection of 182 isogenic strains containing genetically linked antibiotic resistance elements located at approximately 1-min intervals around the Escherichia coli chromosome. At most positions both Tn10 (Tetr) and TN10kan (Kanr) elements are available, so that the collection contains a linked set of alternating antibiotic resistance markers. The map position of each insertion has been aligned to the E. coli genetic map as well as to the Kohara ordered clone bank. These strains are designed to be used in a rapid two-step mapping system in E. coli. In the first step, the mutation is localized to a 5- to 15-min region of the chromosome by Hfr mapping with a set of Hfr strains containing either Tn10 or Tn10kan elements located 20 min from their respective origins of transfer. In the second step, the mutation is localized to a 1-min region by P1 transduction, with a collection of isogenic insertion strains as donors. We discuss the uses of this collection of strains to map and eventually to clone a variety of mutations in E. coli.