Morphologic features of the rheumatic mitral regurgitant valve by three-dimensional echocardiography

BACKGROUND

Rheumatic fever remains a significant worldwide cause of mitral regurgitation (MR). We describe morphologic features of the rheumatic MR valve by quantitative 3-dimensional (3D) echocardiography.

METHODS

Eight healthy subjects and 16 patients with less than moderate (n = 7) or more than or equal to moderate (n = 9) rheumatic MR underwent 3D echocardiography by use of freehand transthoracic scanning. Left ventricular (LV) borders, mitral chordae, papillary muscles and annuli were traced at end-diastole (ED) and end-systole (ES) with LV surfaces and mitral annulus reconstructed in 3D. Regional LV function was quantified by myocardial thickening. Regional LV shape was assessed by alignment of diseased ED endocardial surfaces to a reference normal surface.

RESULTS

In the diseased group, LVs were more spheric and had regional shape abnormality in the area of anterior papillary muscle attachment. LV volumes, ejection fraction, and regional function in the areas of papillary attachment were not different. Mitral annular length and area were increased and correlated with LVED volume but were no different in height, sphericity, or beat-to-beat deformity. Chordal and papillary muscle lengths were not reduced. The interchordal angle (between the anterior and posterior chordae) was more acute in MR.

CONCLUSION

Alterations in LV geometry and mitral apparatus morphologic features contribute to rheumatic regurgitant disease. Consequent changes include malalignment of the papillary muscles and a narrowed interchordal angle that is opposite to the widening seen in MR from dilated cardiomyopathy. We hypothesize that leaflet involvement with retraction causes increased tension on the chordae, a reduction in the interchordal angle, and a consequent coaptation defect.

Search for the lepton family number violating process nu(mu)e(-) --> mu(-)nu(e)

The NuTeV experiment at Fermilab has used a sign-selected neutrino beam to perform a search for the lepton number violating process nu(mu)e(-)-->mu(-)nu(e), and to measure the cross section of the standard model inverse muon decay process nu(mu)e(-)-->mu(-)nu(e). NuTeV measures the inverse muon decay asymptotic cross-section slope sigma/E to be (13.8 +/- 1.2 +/- 1.4) x 10(-42) cm(2)/GeV. The experiment also observes no evidence for lepton number violation and places one of the most restrictive limits on the cross-section ratio sigma(nu(mu)e(-)-->mu(-)nu(e))/sigma(nu(mu)e(-)-->mu(-)nu(e)) < or = 1.7% at 90% C.L. for V-A couplings and < or = 0.6% for scalar couplings.

Search for heavy particles decaying into electron-positron pairs in pp collisions

We present results of searches for technirho (rho(T)), techniomega (omega(T)), and Z' particles, using the decay channels rho(T),omega(T),Z'-->e(+)e(-). The search is based on 124.8 pb(-1) of data collected by the D0 detector at the Fermilab Tevatron during 1992-1996. In the absence of a signal, we set 95% C.L. upper limits on the cross sections for the processes pp-->rho(T),omega(T),Z'-->e(+)e(-) as a function of the mass of the decaying particle. For certain model parameters, we exclude the existence of degenerate rho(T) and omega(T) states with masses below about 200 GeV. We exclude a Z' with mass below 670 GeV, assuming that it has the same couplings to fermions as the Z boson.

Observation of an anomalous number of dimuon events in a high energy neutrino beam

A search for long-lived neutral particles ( N0's) with masses above 2.2 GeV/c(2) that decay into at least one muon has been performed using an instrumented decay channel at the NuTeV experiment at Fermilab. Data were examined for particles decaying into the final states mumu, mu(e), and mu(pi). Three mumu events were observed over an expected standard model background of 0.069+/-0.010 events; no events were observed in the other modes.

Lower respiratory tract infections in Inuit infants on Baffin Island

BACKGROUND

It has long been suspected that Canadian Inuit children suffer from frequent severe lower respiratory tract infections (LRTIs), but the causes and risk factors have not been documented. This study assessed the infectious causes and other epidemiologic factors that may contribute to the severity of LRTI in young Inuit children on Baffin Island.

METHODS

A prospective case study was carried out at the Baffin Regional Hospital in Iqaluit, Nunavut, of infants less than 6 months of age, who were admitted to hospital between October 1997 and June 1998 with a diagnosis of LRTI. Immunofluorescent antibody testing was used to identify respiratory viruses, and enzyme immunoassay (EIA) and polymerase chain reaction (PCR) were used to test for Chlamydia trachomatis. Demographic and risk factor data were obtained through a questionnaire.

RESULTS

The annualized incidence rate of admission to hospital for bronchiolitis at Baffin Regional Hospital was 484 per 1000 infants who were less than 6 months of age; 12% of the infants were intubated. Probable pathogens were identified for 18 of the 27 cases considered in our study. A single agent was identified for 14 infants: 8 had respiratory syncytial virus, 2 adenovirus, 1 rhinovirus, 1 influenza A, 1 parainfluenza 3 and 1 had cytomegalovirus. For 4 infants, 2 infectious agents were identified: these were enterovirus and Bordetella pertussis, adenovirus and enterovirus, cytomegalovirus and respiratory syncytial virus, and respiratory syncytial virus and adenovirus. C. trachomatis was not identified by either EIA or PCR. All infants were exposed to maternal smoking in utero, second-hand smoke at home and generally lived in crowded conditions.

INTERPRETATION

Inuit infants in the Baffin Region suffer from an extremely high rate of hospital admissions for LRTI. The high frequency and severity of these infections calls for serious public health attention.

An evaluation of the use of proton pump inhibitors

OBJECTIVES

To review whether Proton Pump Inhibitors (PPIs) are prescribed for appropriate indications and to assess the quality of information being supplied to GPs on discharge.

METHOD

Prospective study of 85 patients consecutively admitted on, or initiated on, PPIs comparing prescribing patterns with the health authority consensus statement on PPIs and reviewing the quality of information provided to GPs on discharge.

RESULTS

39 patients were admitted on PPIs; 30% had absolute indications for prescribing, 3% had possible indications for prescribing and 67% were for indications other than those in the consensus statement. 46 patients had PPIs initiated as inpatients; 39% had absolute indications for prescribing, 10% had possible indications for prescribing and 51% were for indications other than those in the consensus statement. 10% of patients admitted on PPIs had therapy reviewed prior to discharge, whilst 60% of patients initiated on PPIs during admission were reviewed prior to discharge. Information provided to GPs on discharge usually included dosage and frequency. 18% of discharge letters indicated the intended duration of therapy and 7% suggested a review date. For those initiated on PPIs as inpatients 51% of discharge letters gave an indication.

CONCLUSION

Frequent review of therapy and improved communications between primary and secondary care are vital to rationalise the use of PPIs and to reduce expenditure.

Quasi-model-independent search for new high p(T) physics at D0

We apply a quasi-model-independent strategy ("Sleuth") to search for new high p(T) physics in approximately 100 pb(-1) of pp collisions at square root of (s) = 1.8 TeV collected by the D0 experiment during 1992-1996 at the Fermilab Tevatron. We systematically analyze many exclusive final states and demonstrate sensitivity to a variety of models predicting new phenomena at the electroweak scale. No evidence of new high p(T) physics is observed.

Turicella otitidis as an unusual agent causing a posterior auricular abscess

A posterior auricular abscess in a 3-year-old girl was confirmed to have been caused by an unusual organism, Turicella otitidis.

Ratio of jet cross sections at square root of s = 630 GeV and 1800 GeV

The D0 Collaboration has measured the inclusive jet cross section in barpp collisions at square root of s = 630 GeV. The results for pseudorapidities (eta)<0.5 are combined with our previous results at square root of s = 1800 GeV to form a ratio of cross sections with smaller uncertainties than either individual measurement. Next-to-leading-order QCD predictions show excellent agreement with the measurement at 630 GeV; agreement is also satisfactory for the ratio. Specifically, despite a 10% to 15% difference in the absolute magnitude, the dependence of the ratio on jet transverse momentum is very similar for data and theory.

Ratios of multijet Cross Sections in p p collisions at radical(s) = 1.8 TeV

We report on a study of the ratio of inclusive three-jet to inclusive two-jet production cross sections as a function of total transverse energy in p&pmacr; collisions at a center-of-mass energy sqrt[s] = 1.8 TeV, using data collected with the D0 detector during the 1992-1993 run of the Fermilab Tevatron Collider. The measurements are used to deduce preferred renormalization scales in perturbative O(alpha(3)(s)) QCD calculations in modeling soft-jet emission.

Inclusive jet production in pp(macro) collisions

We report a new measurement of the pseudorapidity (eta) and transverse-energy ( E(T)) dependence of the inclusive jet production cross section in pp(macro) collisions at square root of s = 1.8 TeV using 95 pb(-1) of data collected with the D0 detector at the Fermilab Tevatron. The differential cross section d(2)sigma/(dE(T)d eta) is presented up to eta = 3, significantly extending previous measurements. The results are in good overall agreement with next-to-leading order predictions from QCD and indicate a preference for certain parton distribution functions.

Search for large extra dimensions in dielectron and diphoton production

We report a search for effects of large extra spatial dimensions in pp collisions at a center-of-mass energy of 1.8 TeV with the D0 detector, using events containing a pair of electrons or photons. The data are in good agreement with the expected background and do not exhibit evidence for large extra dimensions. We set the most restrictive lower limits to date, at the 95% C.L. on the effective Planck scale between 1.0 and 1.4 TeV for several formalisms and numbers of extra dimensions.

Intravenous self-administration of heroin/cocaine combinations (speedball) using nose-poke or lever-press operant responding in mice

Acquisition and dose-related self-administration of heroin (H)/cocaine (C) combinations in C57BL/6 x SJL mice were studied in nose-poke or lever-press operant responding procedures. C57BL/6 x SJL mice readily acquired self-administration in both operant procedures with a combination of doses known to be ineffective when each drug was used alone (H: 15 microg/kg and C: 150 microg/kg per injection). Similar numbers of infusions were obtained under conditions of fixed-ratio (FR) 3 versus 1 for the nose-poke and lever-press responses, respectively. Dose-effect curves for heroin:cocaine combinations revealed a pattern corresponding to a leftward shift of the dose-response for intravenous cocaine self-administration. Curves were similar whether generated with 1 or 3 days of availability per dose, or including subjects that did not respond preferentially (> 70% responses) to the hole or lever associated with drug delivery, along with those that did. Motor activity induced by a combination of low doses for each drug was examined (H: 0.375 mg/kg and C: 3.75 mg/kg, i.p.). Under these conditions, the combination of both drugs induced an initial cocaine-like stimulation of horizontal activity, in contrast to the tendency of heroin to decrease activity. It is concluded that heroin:cocaine combinations used in the present study had reinforcing effects in C57BL/6 x SJL mice, and produced a cocaine-like effect in the early part of drug-induced activity sessions, followed by a locomotor profile corresponding to the average of both drugs.