[Prognostic value of transthoracic echocardiography in hemodynamically stable patients with acute symptomatic pulmonary embolism]

OBJECTIVE

To determine the prognostic value of transthoracic echocardiography in hemodynamically stable patients diagnosed with acute symptomatic pulmonary embolism.

PATIENTS AND METHODS

Hemodynamically stable outpatients diagnosed with acute symptomatic pulmonary embolism at a tertiary university hospital were prospectively included in the study. All patients underwent transthoracic echocardiography within 48 hours of diagnosis. The primary endpoint was all-cause mortality at 1 month.

RESULTS

Right ventricular dysfunction was documented by echocardiography in 86 of the 214 patients (40%) in our series. In the first month of follow-up, 7 patients died--4 with positive echocardiographic findings and 3 with negative findings (odds ratio, 2.0; 95% confidence interval, 0.4-9.3; P=.41). For the primary endpoint, the negative predictive value of transthoracic echocardiography was 98%, the positive predictive value was 5%, and the negative likelihood ratio was 0.7. The negative predictive value was 100% and the positive predictive value was 3% when we analyzed death due to pulmonary embolism only.

CONCLUSIONS

In our setting, transthoracic echocardiography is not useful for prognostic stratification of hemodynamically stable patients with pulmonary embolism.

Bent-core liquid-crystalline derivative of tetrathiafulvalene: photoresponsivity and deracemization

A bent-core mesogen containing a tetrathiafulvalene group is studied. The mesophase is an optically isotropic spongelike smectic phase without optical activity. The material responds to uv light in a peculiar way, showing photoconductivity and, in some circumstances, changing its mesomorphic properties. Under an electric field, large chiral domains are segregated from an initial racemic phase within a few minutes.

Barrier formation at organic interfaces in a Cu(100)-benzenethiolate-pentacene heterostructure

The energy level alignment at the metal-organic and organic-organic interfaces of the Cu(100)/benzenethiolate/pentacene heterostructure is studied by photoemission spectroscopy and discussed theoretically using a model that includes, in a consistent way, charge transfer, Pauli repulsion, intrinsic molecular dipoles, and interface screening as a function of coverage. Despite the different nature of the two interfaces, our model provides a unified explanation for the work-function changes at both junctions and enables us to determine the benzenethiolate orientation as a function of coverage.

[Difficult treatment of amiodarone-induced thyrotoxicosis: a case report]

Amiodarone causes changes in thyroid function tests in about 15-20% of patients, inducing either hypothyroidism or thyrotoxicosis. The iodine load and the destructive thyroiditis caused by amiodarone produce thyrotoxicosis. We report a case of amiodarone-induced thyrotoxicosis diagnosed when investigating the reason for worsening of cardiac function. Prognosis and treatment of cardiac disorder were determined by thyrotoxicosis. The management needed a closed monitoring of thyroid function. Treatment was based on high doses of propylthiouracil and dexamethasone, but they couldn t control cardiac condition and surgery was warranted. When amiodarone-induced thyrotoxicosis is refractory to medical treatment, we believe surgery should be considered earlier.

Controlled self-organization of atom vacancies in monatomic gallium layers

Ga adsorption on the Si(112) surface results in the formation of pseudomorphic Ga atom chains. Compressive strain in these atom chains is relieved via creation of adatom vacancies and their self-organization into meandering vacancy lines. The average spacing between these line defects can be controlled, within limits, by adjusting the chemical potential mu of the Ga adatoms. We derive a lattice model that quantitatively connects density functional theory (DFT) calculations for perfectly ordered structures with the fluctuating disorder seen in experiment and the experimental control parameter mu. This hybrid approach of lattice modeling and DFT can be applied to other examples of line defects in heteroepitaxy.

Relationship between structure and optical properties of lithium triborate

Measurements of the optical rotation of LiB3O5have been carried out using a high-accuracy universal polarimeter in the temperature range 298–503 K. The results have been analyzed within the framework of a point-dipole model for the optical rotation. Though the magnitude of the rotation is very small, its sign has been clearly determined and linked to the crystallographic structure. A slight modification of the point-dipole model also permits an explanation of the values of the second-order susceptibility coefficients for second-harmonic generation.

Liver Transplantation in Childhood With More Than 10 Years of Follow-up: Analysis of a Single-Center Experience

We pioneered pediatric liver transplantation (OLT) in Spain (June 1985). The aim of this study was to evaluate the current status of our OLT recipients with more than 10 years follow-up.

MATERIALS AND METHODS

The 50 patients with >10 years follow-up had a mean age at OLT of 5.6 years with 60% showing a main indication of biliary atresia. All but one (tacrolimus) received cyclosporine.

RESULTS

No patient loss occurred among these patients. Eighteen patients had follow-up >15 years and 12 >20 years. The incidence of acute rejection was 56%; chronic rejection, 16%; and lymphoproliferative disorders, 12%. Seven (14%) required retransplantation at a mean of 4.2 years after the first OLT due in four instances to chronic rejection. After 10 years of follow-up, one patient developed portal vein thrombosis and three biliary strictures. All patients remain on immunosuppression. In 64% cyclosporine was switched to tacrolimus or another agent. One patient developed acute rejection at 19.2 years. In 14% of patients the liver function test is abnormal with serum creatinine is >1.5 mg/dL in 10%; one requires insulin and three, antihypertensive drugs. Noncompliance with medications was detected in 10%. Three recipients had offspring.

CONCLUSIONS

OLT was an effective treatment with a good quality of life also on long-term follow-up.

Quantitative analysis of the x-ray diffraction intensities of undulated smectic phases in bent-core liquid crystals

X-ray diffraction diagrams of undulated smectic phases in bent-core liquid crystals have been theoretically studied. The intensities of the reflections have been obtained for different layer modulations, and a general expression has been deduced for orthogonal cells in terms of the different harmonics of the distortion. The case of sinusoidal modulation is especially simple and has been studied also in oblique cells. High-quality x-ray measurements of three compounds reported in the literature have been analyzed as examples. In all cases it has been deduced that the modulation is sinusoidal and its amplitude has been easily obtained by fitting the experimental intensities. Equatorial (h0) reflections have been also considered to obtain information about the structure of defects at the maxima and minima of the undulation.

Energy level alignment at metal/organic semiconductor interfaces: “Pillow” effect, induced density of interface states, and charge neutrality level

A unified model, embodying the "pillow" effect and the induced density of interface states (IDIS) model, is presented for describing the level alignment at a metal/organic interface. The pillow effect, which originates from the orthogonalization of the metal and organic wave functions, is calculated using a many-body linear combination of atomic orbitals Hamiltonian, whereby electron long-range interactions are obtained using an expansion in the metal/organic wave function overlap, while the electronic charge of both materials remains unchanged. This approach yields the pillow dipole and represents the first effect induced by the metal/organic interaction, resulting in a reduction of the metal work function. In a second step, we consider how charge is transferred between the metal and the organic material by means of the IDIS model: Charge transfer is determined by the relative position of the metal work function (corrected by the pillow effect) and the organic charge neutrality level, as well as by an interface parameter S, which measures how this potential difference is screened. In our approach, we show that the combined IDIS-pillow effects can be described in terms of the original IDIS alignment corrected by a screened pillow dipole. For the organic materials considered in this paper, we see that the IDIS dipole already represents most of the realignment induced at the metal/organic interface. We therefore conclude that the pillow effect yields minor corrections to the IDIS model.

Monotherapy with enoxaparin for the prevention of recurrent venous thromboembolism

This study aimed to determine whether a weight-adjusted dose of subcutaneous enoxaparin is as effective and safe as oral acenocoumarol for the secondary prophylaxis of pulmonary embolism. Three hundred and eighty consecutive noncancer outpatients hospitalized with an episode of symptomatic pulmonary embolism selected treatment with acenocoumarol or enoxaparin at a dose of 1 mg/kg once daily after being informed of the type of administration and expected frequency of laboratory monitoring for both medicinal products. Endpoints were symptomatic recurrent thromboembolic events evaluated by standard objective testing, and a composite endpoint of recurrent venous thromboembolism, major bleeding, and death from any cause. One hundred and ninety-nine patients (52%) chose acenocoumarol therapy and 181 chose enoxaparin monotherapy. Four patients in the enoxaparin group (2.2%) and six patients in the acenocoumarol group (3%) had an objective thromboembolic recurrence (hazard ratio, 1.35; 95% confidence interval, 0.38-4.79; P = 0.64). Nine patients in the enoxaparin group (5.0%) had a hemorrhagic complication compared with 11 in the acenocoumarol group (5.5%) (P = 0.81). The hospital length of stay was shorter with enoxaparin compared with acenocoumarol (11 versus 16 days, P = 0.0001). Enoxaparin is as effective and safe as acenocoumarol in the secondary prevention of recurrent thromboembolic disease and is associated with shorter hospitalization.

Haematopoietic stem cell transplantation trends in children over the last three decades: a survey by the paediatric diseases working party of the European Group for Blood and Marrow Transplantation

This paper describes the trends in haematopoietic stem cell transplantation (HSCT) activity for children in Europe over the last three decades. We analysed 31,713 consecutive paediatric HSCTs reported by the European Group for Blood and Marrow Transplantation (EBMT) centres between 1970 and 2002. Data were taken from the EBMT registry and were compared according to period and centre category (paediatric or combined). Since 1996, there has been a significant increase in the number of HSCTs performed exclusively by paediatric centres, as well as in the number of alternative donor HSCTs, and in the use of peripheral blood stem cells (P<0.0001). The number of allogeneic HSCTs (allo-HSCTs) for acute lymphoblastic leukaemia, acute myeloblastic leukaemia and chronic myeloid leukaemia remained stable, whereas it increased for myelodysplastic syndromes and lymphomas, and decreased significantly for non-malignant diseases (P<0.0001). Multivariate analysis showed that younger age, human leukocyte antigen genoidentical donors, HSCT performed after 1996 and transplant centres performing more than 10 allo-HSCT/year were all associated with decreased transplant-related mortality (TRM) (P<0.0001). The number of autologus HSCTs (auto-HSCTs) for acute leukaemia decreased significantly, whereas it increased for solid tumours (P<0.0001). Multivariate analysis showed that both auto-HSCT performed before 1996 and paediatric solid tumours (P<0.0001) had higher TRM. Indications for paediatric HSCT have changed considerably during the last seven years. These changes provide tools for decision making in health-care planning and counselling.

Structural study of a bent-core liquid crystal showing the B1-B2 transition

An experimental study of the B1-B2 transition is carried out in a bent-core liquid crystal. The study is essentially based on x-ray measurements as a function of temperature. The B1-B2 transition is extremely unusual and implies a deep structural change from a columnar phase to a lamellar phase. We have found that the B1 phase in our compound is similar to the so-called B1 reversed phase, with an additional splay of the polarization in the columns. On approaching the B2 phase the width of the cross section of the columns increases. The transition is clearly first order, with a large hysteresis though the enthalpy content is very small. A possible mechanism for the transition is briefly sketched.

Some aspects about the structure of the optically isotropic phase in a bent-core liquid crystal: chiral, polar, or steric origin

We have studied a bent-core liquid crystal where two different optically isotropic phases can be induced by a strong electric field. Depending on the field treatment the phases can present optical rotation or be optically inactive. The switching dynamics of the phases is studied by means of electrooptic and optical second-harmonic generation measurements. It is found that the ground state of the phases is locally antiferroelectric. The structure of the phases is consistent with a disordered version of the kind of structures recently proposed for the smectic blue phase: layered systems with high Gaussian curvature. The origin of the smectic layer distortion is discussed. It is concluded that the direct reason for the curvature of planes is of steric nature.

Pathological and aetiological studies of multifocal interstitial nephritis in wasted pigs at slaughter

Multifocal interstitial nephritis in pigs has been associated with several infectious agents. The objective of the present study was to investigate several different potential infectious agents associated with "white-spotted" kidneys in pigs suffering from wasting at slaughter (aged 6-8 months). Twenty-nine case kidneys (with a "white-spotted" gross appearance) classified into 3 macroscopic lesional grades, and 15 control kidneys (lacking gross lesions), were obtained from a pig abattoir. Laboratory analyses to detect potential associations with the aforementioned pathological condition with Leptospira spp., porcine circovirus type 2 (PCV2), porcine parvovirus (PPV), porcine reproductive and respiratory syndrome virus (PRRSV), and bacteria, were carried out. Microscopically, interstitial nephritis with a lymphofollicular inflammatory pattern (follicular nephritis) was observed in both case and control kidneys, with a higher frequency seen in the former ones. No leptospires were identified, although antibodies to the Pomona and Bratislava serovars were detected. Some pyogenic bacteria were also isolated from both case and control kidneys. PCV2 nucleic acid was only detected in 1 case kidney. PRRSV antigen was not found in any tested sample. Some pigs were tested positive for PPV by serology. Apparently, none of the studied agents were specifically associated as being the potential cause of the renal lesions in the studied wasted pigs. The fact that these chronic lesions may have been the consequence of a previous infection with one of these studied microorganisms, or more, and eventually with other non-tested infectious agents during the growing-finishing period, cannot be ruled out.

Soft phonon, dynamical fluctuations, and a reversible phase transition: indium chains on silicon

The In/Si(111)-(4 x 1) surface is a paradigmatic example of a quasi-one-dimensional system showing a reversible structural and electronic (metal-insulator) phase transition when the temperature is lowered. In this work, we use first-principles simulation techniques to uncover the atomic and electronic origin of this controversial transition. Our calculations show that the ground state consists of insulating (4 x 2) indium chains with a weak interchain coupling that induces opposite shear distortions in alternate chains. First-principles molecular dynamics simulations show that the (4 x 1) <--> (8 x 2) phase transition is due to the "dynamical fluctuations" the system undergoes when, at high temperature, it fluctuates chaotically between degenerate ground states. The metallicity of the In/Si(111)-(4 x 1) surface is related to the low energy cost for the shear distortion.

Structure of mesogens possessing B7 textures: the case of the bent-core mesogen 8-OPIMB-NO2

A structural investigation of the compound 8-OPIMB-NO2 is carried out. This material is a mesogen formed by bent-core molecules where the so-called B7 phase was originally proposed. X-ray data are successfully indexed in terms of a oblique two-dimensional lattice. Using additional information from optical second harmonic generation several possible structural models are proposed. The models are based on molecular packing considerations. All these structures are clearly different from those of other materials previously classified as B7. The necessity of a revised nomenclature for classifying the structures of these compounds is pointed out.

Convectively driven polymerase chain reaction thermal cycler

We have fabricated a low-cost disposable polymerase chain reaction thermal chamber that uses buoyancy forces to move the sample solution between the different temperatures necessary for amplification. Three-dimensional, unsteady finite element modeling and a simpler 1-D steady-state model are used together with digital particle image velocimetry data to characterize the flow within the device. Biological samples have been amplified using this novel thermal chamber. Time for amplification is less than 30 min. More importantly, an analysis of the energy consumption shows significant improvements over current technology.