Ventricular assist devices in acute heart failure

In Western countries, the incidence of acute heart failure has been growing rapidly and is associated with increased incidence of mortality. Acute heart failure encompasses an extended spectrum of clinical presentation. From these, cardiogenic shock remains its most dramatic entity and is burdened by a dismal prognosis. As the initial therapeutic armamentarium (pressor agents, non-invasive or invasive ventilation using positive end-expiratory pressure, treatment of the damaging agent, ultrafiltration and intra-aortic balloon counterpulsation) might be soon overcome, implantation of mechanical ventricular assistance should be considered. Constant technical improvements have allowed quick and percutaneous implantation of such left ventricular assistance devices (LVADs). Herein, we review the technical characteristics and clinical data of the percutaneous LVADs currently available in Europe for treatment of overt cardiogenic shock.

Search for neutrinoless double-beta decay in 136Xe with EXO-200

We report on a search for neutrinoless double-beta decay of 136Xe with EXO-200. No signal is observed for an exposure of 32.5 kg yr, with a background of ∼1.5×10(-3)  kg(-1) yr(-1)  keV(-1) in the ±1σ region of interest. This sets a lower limit on the half-life of the neutrinoless double-beta decay T(1/2)(0νββ)(136Xe)>1.6×10(25)  yr (90% C.L.), corresponding to effective Majorana masses of less than 140-380 meV, depending on the matrix element calculation.

To catch a starling: testing the effectiveness of different trap and lure types

Context Worldwide, invasive fauna species present one of the most intractable problems for agriculture and natural systems. Our ability to improve control techniques to combat the global invasive species predicament is constrained within the bounds of both economic and ethical considerations. In south-eastern Australia, the common starling (Sturnus vulgaris) is an established invasive avian pest that is now making incursions into areas of Western Australia (WA) that are currently free of this species. The most cost-effective and widely implemented starling control tool is trapping with live-lure birds. In recent years, the use of live-lure birds has been questioned on both economic and ethical grounds, and consequently alternative lure methods need investigating. Aims To evaluate the effectiveness of different trap and lure combinations for the capture of starlings in western South Australia (SA). Methods Modified Australian Crow (MAC) traps, used traditionally in WA to trap starlings, and Myna traps, originally designed for trapping common mynas (Sturnus tristis), were set during the peaks in starling flocking activity (Austral summer, 2007) using three different lure types: (1) live lure (live starlings); (2) moving water; and (3) acoustic lures. A trapping grid consisting of a single Myna trap with live lure and three MAC traps, each with one type of lure (live, water or acoustic) was established at five sites on the Eyre Peninsula in SA and monitored twice daily for 28 days. Key results Live lures were significantly more effective at attracting starlings into traps compared with both water and sound lures. We also trapped at an additional three sites and showed that Myna traps caught ~1.5 times more starlings than MAC traps when both traps were fitted with live-lure birds. Conclusions Neither moving water nor acoustic play-back lures proved suitable replacements for the use of live-lure birds to capture starlings. The efficacy of alternative lure types may depend on several factors and may include neophobic response(s) to novel signals and also the length of time that an invasive population has been established. Implications We recommend that use of live lures is continued in ongoing starling control programs, and that MAC traps currently in use be modified to capitalise on known starling behaviour. Further research and development of traps that do not contain live lures will improve the welfare of invasive species control programs.

Observation of two-neutrino double-beta decay in 136Xe with the EXO-200 detector

We report the observation of two-neutrino double-beta decay in (136)Xe with T(1/2) = 2.11 ± 0.04(stat) ± 0.21(syst) × 10(21) yr. This second-order process, predicted by the standard model, has been observed for several nuclei but not for (136)Xe. The observed decay rate provides new input to matrix element calculations and to the search for the more interesting neutrinoless double-beta decay, the most sensitive probe for the existence of Majorana particles and the measurement of the neutrino mass scale.

A magnetically driven piston pump for ultra-clean applications

A magnetically driven piston pump for xenon gas recirculation is presented. The pump is designed to satisfy extreme purity and containment requirements, as is appropriate for the recirculation of isotopically enriched xenon through the purification system and large liquid xenon time projection chamber of EXO-200. The pump, using sprung polymer gaskets, is capable of pumping more than 16 standard liters per minute of xenon gas with 750 Torr differential pressure.

Can the functional assessment of multiple sclerosis adapt to changing needs? A psychometric validation in patients with clinically isolated syndrome and early relapsing–remitting multiple sclerosis

Background: The Functional Assessment of Multiple Sclerosis (FAMS) is widely used in clinical trial programmes; however, it was developed before the rise in trials targeted at early stage multiple sclerosis (MS) and clinically isolated syndrome (CIS).

Objective: The aim of this study was to assess the psychometric properties of the FAMS within two clinically distinct populations, CIS and early relapsing–remitting MS (RRMS), and discern the appropriateness of the FAMS within these populations.

Methods: Secondary analysis was conducted on FAMS data from two clinical trials assessing interferon beta–1b in early RRMS and CIS. The statistical analysis assessed the scale acceptability, reliability, validity and responsiveness of the FAMS. Item response theory (IRT) was also conducted on the early RRMS sample in order to assess how well the FAMS discriminated amongst individuals with less severe MS.

Results: Results from both trials demonstrated an improvement in the FAMS psychometric properties with increased baseline disease severity. However, high ceiling effects were evident amongst less severe patients, and there was an overall lack of responsiveness to improvement and poor construct validity. IRT also demonstrated its lack of discrimination/sensitivity in early RRMS.

Conclusions: In trials involving patients with early stage RRMS and CIS, modifications to the FAMS based on a qualitative assessment of its content validity in these populations would be required in order to potentially improve the FAMS psychometric properties and sensitivity.

Interferon β-1b and glatiramer acetate effects on permanent black hole evolution

OBJECTIVE

To compare interferon β-1b (IFNβ-1b) and glatiramer acetate (GA) on new lesion (NL) (gadolinium-enhancing, new T2) evolution into permanent black holes (PBH)--a marker of irreversible tissue damage--in patients with relapsing-remitting multiple sclerosis (RRMS).

METHODS

BEYOND was a large, phase III, clinical trial comparing IFNβ-1b 250 μg, IFNβ-1b 500 μg, and GA (2:2:1). Patient scans were reexamined post hoc for PBH in a rater-blinded manner. Two predefined coprimary endpoints compared IFNβ-1b 250 μg with GA: first, number of PBH per patient at year 2 evolving from year 1 NL, then proportion of year 1 NL evolving into PBH at year 2. IFNβ-1b 500 μg and GA were compared in an exploratory fashion.

RESULTS

Approximately 90% (1,957/2,244) of patients had NL at year 1 with follow-up at year 2. Mean numbers of PBH per patient at year 2 evolving from year 1 NL were lower for IFNβ-1b 250 μg than GA (0.30 vs 0.43; p = 0.0451). The proportion of NL evolving into PBH was similar (IFNβ-1b 250 μg vs GA: 21.6% vs 23.5%; p > 0.20). For IFNβ-1b 500 μg, both the mean PBH number per patient at year 2 evolving from year 1 NL (0.26 vs 0.43; p = 0.0037) and proportion of NL evolving into PBH (16.3% vs 23.5%; p = 0.0409) were lower relative to GA.

CONCLUSION

IFNβ-1b affected PBH development to a similar or better extent than GA. IFNβ-1b favorably influences an MRI outcome indicative of permanent tissue destruction in the brains of patients with multiple sclerosis.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that IFNβ-1b is associated with a reduction in MRI PBH formation and evolution compared with GA between years 1 and 2 of treatment.

Safety and tolerability of cladribine tablets in multiple sclerosis: the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study

BACKGROUND

Cladribine is a synthetic deoxyadenosine analogue in development as an oral multiple sclerosis (MS) therapy.

OBJECTIVE

To report in detail the safety findings from the 96-week, phase III, double-blind CLARITY study, which evaluated treatment with cladribine tablets in relapsing-remitting MS.

METHODS

A total of 1,326 patients were randomized 1:1:1 to two short-course regimens of cladribine tablets (3.5 or 5.25 mg/kg cumulative dose over 96 weeks) or placebo. Safety assessments included monitoring for adverse events (AEs), routine physical and neurologic examinations and frequent laboratory parameter assessments.

RESULTS

Of the randomized patients, 88.6% completed treatment with cladribine tablets versus 86.3% with placebo. Lymphopenia was the most commonly reported AE in patients treated with cladribine tablets and was anticipated based on the mechanism of action. The incidence of infections was 48.3% with cladribine tablets and 42.5% with placebo, with 99.1% and 99.0% rated mild-to-moderate by investigators. Herpes zoster infections developed in 20 (2.3%) cladribine-treated patients; all cases were dermatomal. There were no herpes zoster infections in the placebo group. Nine (1.0%) patients experienced events related to uterine leiomyomas in the cladribine tablets groups versus one (0.2%) with placebo. Three isolated cases of malignancy were reported in cladribine-treated patients during the study; a fourth was reported during post-study surveillance. A pre-malignant cervical carcinoma in situ was also reported. The incidence of malignancies during the study did not exceed the expected rate in a population standardized for country, gender and age.

CONCLUSION

The safety and tolerability profile observed in the CLARITY study together with the reported efficacy support the potential for cladribine tablets as an MS therapy.

Integrated constructed wetlands: water management as a land-use issue, implementing the 'Ecosystem Approach'

Awareness of the need for social, economic and environmental coherence in the management of water is becoming evermore apparent. Water supply as well as treatment is becoming more costly; a challenge that is not only limited to developing countries. The use of wetlands, natural and constructed, is now more widely accepted as a means of tackling a range of problems in water management to deliver this coherence. The use of 16 Integrated Constructed Wetlands that mimic shallow, emergent-vegetated, palustrine wetlands in a 2,500 ha catchment in County Waterford, Southeast Ireland, has shown a number of distinct advantages in implementing the all encompassing 'Ecosystem Approach', addressing the key elements for sustainable water management in an intensively used agricultural area. The significant increase in water quality, biodiversity, social amenities and acceptance by the local rural community provided by this 'real' field-scale demonstration show the benefits that such a joined-up approach can have on catchment management in the widest sense.

A simple radionuclide-driven single-ion source

We describe a source capable of producing single barium ions through nuclear recoils in radioactive decay. The source is fabricated by electroplating (148)Gd onto a silicon α-particle detector and vapor depositing a layer of BaF(2) over it. (144)Sm recoils from the alpha decay of (148)Gd are used to dislodge Ba(+) ions from the BaF(2) layer and emit them in the surrounding environment. The simultaneous detection of an α particle in the substrate detector allows for tagging of the nuclear decay and of the Ba(+) emission. The source is simple, durable, and can be manipulated and used in different environments. We discuss the fabrication process, which can be easily adapted to emit most other chemical species, and the performance of the source.

Squamous cell carcinoma of the renal pelvis associated with kidney stones: a case report

A 70-year-old female with a long-standing history of kidney calculi presented with vague abdominal pain. Work-up included a CT and MRI of the kidneys. A mass was demonstrated in the superior pole of the left kidney. The mass was biopsied percutaneously under CT guidance. Pathology revealed a poorly differentiated carcinoma, but was inconclusive for a definitive cell type. The patient subsequently underwent a nephrectomy that revealed squamous cell carcinoma of the renal collecting system. She had an uneventful postoperative recovery. Chronic renal calculi pose a risk for the development of squamous metaplasia that may lead to squamous cell carcinoma. Although this malignancy is rare in the upper urinary tracts, patients with long-standing nephrolithiasis should be monitored. This diagnosis should be included in one's differential when evaluating a renal mass that is associated with chronic inflammatory conditions.

How accurately does a simulation glove reflect function compared to rheumatoid arthritis sufferers?

INTRODUCTION

This study assessed the ability of gloves to simulate rheumatoid arthritis of the hand.

SUBJECTS AND METHODS

Assessments were made in the dominant hand of 24 healthy volunteers with no glove, glove A (simulating stiffness only) and glove B (simulating stiffness and pain). Results were compared to data held on 23 rheumatoid arthritis patients. Sollerman score was used as a standardised measure of hand function and time taken to complete testing was recorded. Grip strength was also measured in volunteers.

RESULTS

Both gloves simulate a reduction in power and prolong time taken to complete Sollerman hand-function testing. The gloves are less able to simulate a matched reduction in function when compared to rheumatoid arthritis sufferers. Sollerman score is 9.7% less in rheumatoid arthritis hands than a healthy volunteer using the glove.

CONCLUSIONS

The glove could, therefore, be used to guide future design of tools and aides that accommodate for hand disorders. More work on the usefulness of such disease simulation in the design of tools for such patients is needed.