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Gutierrez-Benitez L, Biarge G, Salcedo E, Asaad M. Scharioth macula lens: Three-year follow-up. J Fr Ophtalmol 2024; 47:104006. [PMID: 37925324 DOI: 10.1016/j.jfo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023]
Affiliation(s)
- L Gutierrez-Benitez
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain.
| | - G Biarge
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - E Salcedo
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - M Asaad
- Ophthalmology department, Consorci Sanitari de Terrassa, Hospital de Terrassa, Carr. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
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Salas B, Ferrera-Alayón L, Espinosa-López A, Vera-Rosas A, Salcedo E, Kannemann A, Alayon A, Chicas-Sett R, LLoret M, Lara P. Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study. Clin Transl Radiat Oncol 2024; 45:100753. [PMID: 38433951 PMCID: PMC10907515 DOI: 10.1016/j.ctro.2024.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Background Pancreatic Stereotactic Body Radiotherapy (SBRT) allows for the administration of a higher biologically effective doses (BED), that would be essential to achieve durable tumor control. Escalating treatment doses need a very accurate tumor positioning and motion control during radiotherapy.The aim of this study to assess the feasibility and safety of a Simultaneous Integrated Boost (SIB) dose-escalated protocol at 45 Gy, 50 Gy and 55 Gy in 5 consecutive daily fractions, in Border Line Resectable Pancreatic Cancer (BRCP) /Locally Advanced Pancreatic Cancer (LAPC) by means of a standard LINAC platform. Methods Patients diagnosed of BRPC/LAPC, candidates for neoadjuvant chemotherapy and SBRT, in four university hospitals of the province of Las Palmas (Canary Islands, Spain) were included in this prospective study. Radiotherapy was administered using standard technology (LINACS) with advanced positioning (Lipiodol® and metallic stent used as fiducial markers) and tumor motion control (4D, DBH, Calypso®). There were 3 planned dose-escalated SIB groups, 45 Gy/5f (9 patients) 50 Gy/5f (9 + 9 patients) and 55 Gy/5f (9 patients). The defined primary end points of the study were the safety and feasibility of the proposed treatment protocol. Secondary endpoints included radiological tumor response after SBRT, local control and survival. Results From June 2017 to December 2022, sixty-two patients were initially assessed for eligibility in the study in the four participating centers, and 49 were candidates for chemotherapy (CHT). Forty-one were referred to radiotherapy after CHT and 33 finally were treated by escalated-dose SIB, 45 Gy (9 patients) 50 Gy (16 patients), 55 Gy(8 patients). All patients completed the scheduled treatment and no acute or late severe (≥grade3) gastrointestinal toxicity was observed.Local response was analyzed by CT/MRI two months after the end of SBRT. Ten patients (31,25 %) achieved objective response (2/9:45 Gy, 5/15:50 Gy, 3/8:55 Gy). Follow-up was closed as July 2023. Freedom from local progression at 1-2y were 89,3% (95 %CI:83,4-95,2%) and 66 % (95 %CI:54,6-77,4%) respectively. The 1-2y survival rates were 95,7% (95 %CI:91,4-100 % and 48,6% (95 %CI:37,7-59,5%) respectively. Conclusion These promising results should be confirmed by further studies with larger sample size and extended follow-up period.
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Affiliation(s)
- B. Salas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - L. Ferrera-Alayón
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
| | - A. Espinosa-López
- Department of Radiation Oncology, University Hospital Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120 El Palmar (Murcia), Spain
| | - A. Vera-Rosas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - E. Salcedo
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Kannemann
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Alayon
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - R. Chicas-Sett
- Department of Radiation Oncology, ASCIRES GRUPO BIOMEDICO, Valencia, Spain
| | - M. LLoret
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
- Instituto Canario de Investigacion del Cáncer ICIC
| | - P.C. Lara
- Instituto Canario de Investigacion del Cáncer ICIC
- Canarian Comprehensive Cancer Center, Department of Oncology University Hospital San Roque, C. Dolores de la Rocha, 5, 35001 Las Palmas de Gran Canaria, Spain
- Fernando Pessoa Canarias University, Calle la Juventud, s/n, 35450 Guía, Las Palmas de Gran Canaria, Spain
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Cannata A, Merlo M, Manca P, Dal Ferro M, Paldino A, Artico J, Gentile P, Jirikowic J, Todd E, Salcedo E, Graw S, McDonagh T, Taylor M, Mestroni L, Sinagra G. The late-onset dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Dilated Cardiomyopathy (DCM) represents a specific subgroup of non-ischemic cardiomyopathies. Little is known about the genotypic characterization of dilated cardiomyopathy (DCM) patients diagnosed over 60 years of age.
Aim
To investigate prevalence, characterization and prognostic impact of the genetic background of late-onset DCM patients.
Methods
We analyzed a study population of 566 DCM patients from two international referral centers. Genetic background was analyzed and patients were grouped into typical-onset DCM (<60 years of age at diagnosis) or late-onset DCM (>60 years of age at diagnosis).
Results
Approximately 12% of patients (n=70) had late-onset DCM and female sex was significantly more frequent in the late-onset DCM cohort (p<0.001). Diagnostic yield of genetic testing was comparable between typical- and late-onset DCM (53% vs 50%, respectively p=0.438) whereas the prevalence of Titin gene truncation variants (TTNtv) was higher in the late-onset DCM group compared to the younger cohort (23% vs 13% respectively; p<0.05). Notably, patients with late-onset genetic DCM had comparable long-term outcomes to those with typical-onset DCM.
Conclusions
Late-onset DCM patients have nearly double the rate of TTNtv mutations and are more likely to be female compared to younger DCM patients. These observed differences in mutational makeup and sex may reveal insights into age and sex dependent mechanisms for TTNtv and should prompt further study. Notably, the increased prevalence of TTNtv and female sex did not translate into noticeable differences in rates of measurable cardiac events.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cannata
- King's College London, London, United Kingdom
| | - M Merlo
- University of Trieste, Trieste, Italy
| | - P Manca
- University of Trieste, Trieste, Italy
| | | | - A Paldino
- University of Trieste, Trieste, Italy
| | - J Artico
- University of Trieste, Trieste, Italy
| | - P Gentile
- University of Trieste, Trieste, Italy
| | - J Jirikowic
- University of Colorado Health, Denver, United States of America
| | - E Todd
- University of Colorado Health, Denver, United States of America
| | - E Salcedo
- University of Colorado Health, Denver, United States of America
| | - S Graw
- University of Colorado Health, Denver, United States of America
| | - T McDonagh
- King's College London, London, United Kingdom
| | - M Taylor
- University of Colorado Health, Denver, United States of America
| | - L Mestroni
- University of Colorado Health, Denver, United States of America
| | - G Sinagra
- University of Trieste, Trieste, Italy
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Vicente S, Ruperto M, Germán Díaz M, Garriga M, Luna C, Salcedo E, López Neyra A, Lamas A. Clinical and nutritional features in Phe.508del homozygous cystic fibrosis pediatric patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stratford JM, Larson ED, Yang R, Salcedo E, Finger TE. 5-HT 3A -driven green fluorescent protein delineates gustatory fibers innervating sour-responsive taste cells: A labeled line for sour taste? J Comp Neurol 2017; 525:2358-2375. [PMID: 28316078 DOI: 10.1002/cne.24209] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 12/29/2022]
Abstract
Taste buds contain multiple cell types with each type expressing receptors and transduction components for a subset of taste qualities. The sour sensing cells, Type III cells, release serotonin (5-HT) in response to the presence of sour (acidic) tastants and this released 5-HT activates 5-HT3 receptors on the gustatory nerves. We show here, using 5-HT3A GFP mice, that 5-HT3 -expressing nerve fibers preferentially contact and receive synaptic contact from Type III taste cells. Further, these 5-HT3 -expressing nerve fibers terminate in a restricted central-lateral portion of the nucleus of the solitary tract (nTS)-the same area that shows increased c-Fos expression upon presentation of a sour tastant (30 mM citric acid). This acid stimulation also evokes c-Fos in the laterally adjacent mediodorsal spinal trigeminal nucleus (DMSp5), but this trigeminal activation is not associated with the presence of 5-HT3 -expressing nerve fibers as it is in the nTS. Rather, the neuronal activation in the trigeminal complex likely is attributable to direct depolarization of acid-sensitive trigeminal nerve fibers, for example, polymodal nociceptors, rather than through taste buds. Taken together, these findings suggest that transmission of sour taste information involves communication between Type III taste cells and 5-HT3 -expressing afferent nerve fibers that project to a restricted portion of the nTS consistent with a crude mapping of taste quality information in the primary gustatory nucleus.
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Affiliation(s)
- J M Stratford
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado.,Rocky Mountain Taste and Smell Center, University of Colorado School of Medicine, Aurora, Colorado
| | - E D Larson
- Rocky Mountain Taste and Smell Center, University of Colorado School of Medicine, Aurora, Colorado.,Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - R Yang
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado.,Rocky Mountain Taste and Smell Center, University of Colorado School of Medicine, Aurora, Colorado
| | - E Salcedo
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado.,Rocky Mountain Taste and Smell Center, University of Colorado School of Medicine, Aurora, Colorado
| | - T E Finger
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado.,Rocky Mountain Taste and Smell Center, University of Colorado School of Medicine, Aurora, Colorado
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Rolen SH, Salcedo E, Restrepo D, Finger TE. Differential localization of NT-3 and TrpM5 in glomeruli of the olfactory bulb of mice. J Comp Neurol 2014; 522:1929-40. [PMID: 24288162 DOI: 10.1002/cne.23512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/25/2013] [Accepted: 11/26/2013] [Indexed: 12/13/2022]
Abstract
Olfactory sensory neurons that express transient receptor potential channel M5 (TrpM5) or neurotrophin-3 (NT-3) project to defined clusters of glomeruli situated ventrally in the main olfactory bulb. Using genetically labeled mice, we investigated whether expression of NT-3-driven βgal and TrpM5-driven GFP marked overlapping sets of glomeruli and whether expression of these markers was coordinated. Our results indicate that these markers largely characterize independent sets of olfactory sensory neuron axons and glomeruli. Further, in glomeruli in which both TrpM5-GFP and NT-3-βgal labeled axons occur, they are expressed independently. The nature of staining for these two markers also differs within glomeruli. Within each labeled TrpM5-positive glomerulus, the level of TrpM5-GFP expression was similar throughout the glomerular neuropil. In contrast, NT-3-driven βgal expression levels are heterogeneous even within heavily labeled glomeruli. In addition, a population of very small TrpM5-GFP positive glomeruli is apparent while no similar populations of NT-3-βgal glomeruli are evident. Taken together, these data suggest that TrpM5 and NT-3 characterize two largely independent receptor populations both conveying odorant information to the ventral olfactory bulb.
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Affiliation(s)
- S H Rolen
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045
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Pineda L, Salcedo E, Vilhena C, Juez L, Alcázar JL. Interobserver agreement in assigning IOTA color score to adnexal masses using three-dimensional volumes or digital videoclips: potential implications for training. Ultrasound Obstet Gynecol 2014; 44:361-364. [PMID: 24816975 DOI: 10.1002/uog.13404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To estimate the interobserver agreement between a trainer and trainees in assigning the International Ovarian Tumor Analysis (IOTA) color score to adnexal masses using three-dimensional (3D) volumes and videoclips. METHODS Fifty-one digital videoclips and 3D volumes of a non-consecutive series of adnexal masses were used for this study. One trainer and four trainees evaluated first the 3D volume and 1 week later a videoclip from the same mass. They had to assign IOTA color scores according to their impression of the amount of color content in each case. Interobserver agreement between trainer and trainees was assessed using Cohen's weighted kappa index with 95% CIs and percentage of agreement. RESULTS When using 3D volumes, interobserver agreement was good for three out of four pairs of comparisons and very good for one (kappa values of 0.70, 0.68, 0.81 and 0.71 for trainees A, B, C and D, respectively). When using videoclips, interobserver agreement was very good for two out of four pairs of comparisons and good for two (kappa values of 0.84, 0.80, 0.68 and 0.86 for Trainees A, B, C and D, respectively). CONCLUSION Evaluation of IOTA color scores in adnexal masses using either videoclips or 3D volumes is reproducible even in the hands of trainees after a short training program.
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Affiliation(s)
- L Pineda
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Castilla J, Moran J, Martinez-Artola V, Reina G, Martinez-Baz I, Garcia Cenoz M, Alvarez N, Irisarri F, Arriazu M, Elia F, Salcedo E. Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis. Euro Surveill 2011; 16:19799. [PMID: 21345321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We defined a cohort of people with major chronic conditions (152,585 subjects) in Navarre, Spain, using electronic records from physicians, to obtain 2010/11 mid-season estimates of influenza vaccine effectiveness. The adjusted estimates of the effectiveness of the 2010/11 trivalent influenza vaccine were 31% (95% confidence interval (CI): 20–40%) in preventing medically attended influenza-like illness, and 58% (95% CI: 11–80%) in preventing laboratory-confirmed influenza. Having received the monovalent influenza A(H1N1)2009 vaccine in the 2009/10 season had an independent preventive effect against medically attended influenza-like illness (17%, 95% CI: 1–30%), and having received both vaccines had 68% (95% CI: 23–87%) effectiveness in preventing laboratory-confirmed influenza.
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Affiliation(s)
- J Castilla
- Public Health Institute of Navarre, Pamplona, Spain.
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Castilla J, Moran J, Martínez-Artola V, Reina G, Martínez-Baz I, García Cenoz M, Alvarez N, Irisarri F, Arriazu M, Elía F, Salcedo E. Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis. Euro Surveill 2011. [DOI: 10.2807/ese.16.07.19799-en] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- J Castilla
- Instituto de Salud Pública de Navarra (Public Health Institute of Navarre), Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (Biomedical Research Network of Epidemiology and Public Health)
| | - J Moran
- Dirección de Atención Primaria, Servicio Navarro de Salud (Primary Health Care Department), Pamplona, Spain
| | - V Martínez-Artola
- Complejo Hospitalario de Navarra (Navarre Hospital Complex), Pamplona, Spain
| | - G Reina
- Clínica Universidad de Navarra (University Clinic of Navarra), Pamplona, Spain
| | - I Martínez-Baz
- CIBER de Epidemiología y Salud Pública (Biomedical Research Network of Epidemiology and Public Health)
- Instituto de Salud Pública de Navarra (Public Health Institute of Navarre), Pamplona, Spain
| | - M García Cenoz
- Instituto de Salud Pública de Navarra (Public Health Institute of Navarre), Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (Biomedical Research Network of Epidemiology and Public Health)
| | - N Alvarez
- Servicio Navarro de Salud (Navarre Health Service), Pamplona, Spain
| | - F Irisarri
- Instituto de Salud Pública de Navarra (Public Health Institute of Navarre), Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (Biomedical Research Network of Epidemiology and Public Health)
| | - M Arriazu
- CIBER de Epidemiología y Salud Pública (Biomedical Research Network of Epidemiology and Public Health)
- Instituto de Salud Pública de Navarra (Public Health Institute of Navarre), Pamplona, Spain
| | - F Elía
- Dirección de Atención Primaria, Servicio Navarro de Salud (Primary Health Care Department), Pamplona, Spain
| | - E Salcedo
- Complejo Hospitalario de Navarra (Navarre Hospital Complex), Pamplona, Spain
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Castilla J, Morán J, Fernández-Alonso M, Martínez Artola V, Zamora MJ, Mazón A, Fernández C, García Cenoz M, Elía F, Reina G, Salcedo E, Irisarri F, Barricarte A. [The 2009 H1N1 flu pandemic in Navarre, Spain]. An Sist Sanit Navar 2011; 33:287-95. [PMID: 21233864 DOI: 10.4321/s1137-66272010000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To describe flu activity during the 2009-2010 pandemic in Navarre and compare it to previous seasons. METHODS An analysis was made of all flu cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. RESULTS Influenza A (H1N1) Virus 2009 was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of flu syndrome per 1,000 inhabitants were registered. The epidemic threshold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives. There were 224 hospitalisations (36 per 100,000 inhabitants) with confirmation of Influenza A (H1N1) Virus 2009, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. CONCLUSION In spite of not having a specific vaccine available until the season was very well advanced, Influenza A (H1N1)Virus 2009 produced a flu wave with similar levels to those of other seasons and its repercussion in hospitalisations and serious cases was moderate.
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Abstract
The hysteresis of multilayer nanowires composed by a soft magnetic cylindrical wire, a non-magnetic spacer layer and an external hard magnetic shell is investigated. The external magnetic shell originates a non-homogeneous magnetic field on the inner wire, which is responsible for a displacement and a change of the width of the hysteresis curve of the wire. Moreover, different reversal modes occur at each branch of the hysteresis loop, which can be understood by analyzing the interaction magnetostatic field along the wire. Our results open the possibility of controlling two parameters of the hysteresis loop, the coercivity and the bias, providing an interesting system to be investigated.
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Affiliation(s)
- S Allende
- Departamento de Física, Universidad de Santiago de Chile (USACH), Avenida Ecuador 3493, 917-0124 Santiago, Chile
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Klein AJ, Kim MS, Salcedo E, Fagan T, Kay J. The missing leak: a case report of a baffle-leak closure using real-time 3D transoesophageal guidance. European Journal of Echocardiography 2009; 10:464-7. [DOI: 10.1093/ejechocard/jen335] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60:925-31. [PMID: 16055622 PMCID: PMC1747235 DOI: 10.1136/thx.2005.040527] [Citation(s) in RCA: 1233] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. METHODS Multivariate techniques were used to analyse the prognostic influence of acute exacerbations of COPD treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, co-morbidity, long term oxygen therapy, forced spirometric parameters, and arterial blood gas tensions in a prospective cohort of 304 men with COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and forced expiratory volume in 1 second was 46 (17)%. RESULTS Only older age (hazard ratio (HR) 5.28, 95% CI 1.75 to 15.93), arterial carbon dioxide tension (HR 1.07, 95% CI 1.02 to 1.12), and acute exacerbations of COPD were found to be independent indicators of a poor prognosis. The patients with the greatest mortality risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80 to 9.41). CONCLUSIONS This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital.
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Affiliation(s)
- J J Soler-Cataluña
- Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casablanca s/n 46340, Requena (Valencia), Spain.
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Galiano RF, Martínez-Garcia MA, Cabero Salt L, Salcedo E, Soler Cataluña JJ, Román Sánchez P. [Ischemic stroke and sleep apnea. Relationship between sleep breathing disorders and carotid stenosis]. Neurologia 2005; 20:283-9. [PMID: 16007511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE To investigate the possible relation between the number of sleep breathing disorders (SBD) and significant extracranial carotid stenosis (ECS) in patients suffering ischemic stroke or transient ischemic attack (TIA). PATIENTS AND METHODS Sixty-eight patients (72.2 years; 68 % males) surviving two months after ischemic stroke or TIA were studied, with the collection of general and anthropometric variables, the characteristics and repercussions of stroke, and the clinical manifestations related to sleep apnea-hypopnea syndrome (SAHS). Neurovascular status was evaluated by carotid continuous doppler flowmetry and transcraneal doppler, with cerebral MR-angio and/or arteriography when suspecting stenosis > 50 %, and respiratory polygraphy after the acute phase to assess the number and type of SBD. RESULTS Fifteen patients (22.1 %) presented ECS. Of these, 80 % had an apnea-hypopnea index (AHI) > 30. The patients with ECS presented increased drowsiness (p = 0.01), greater AHI (36.2 vs 21.9; p = 0.003), and increased nocturnal oxygen desaturation (p = 0.01). Arterial hypertension (AHT) was also significantly more prevalent in this group of patients (p = 0.003), as was diabetes mellitus (p = 0.01) and hypercholesterolemia (p = 0.02) though logistic regression analysis only showed AHT (odds ratio [OR]: 12,7) and AHI > 30 (OR: 13,6) to exhibit independent ECS predictive capacity. CONCLUSIONS The presence of numerous SBD is predictive of ECS, independently of the presence of AHT. Patients with ECS have more SAHS related clinical manifestations prior to stroke; as a result, SAHS could be anterior to the neurological event and act as a risk factor for the latter in this group of patients.
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Affiliation(s)
- R F Galiano
- Unidad de Neurología, Hospital de Requena, Valencia.
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15
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Salcedo E, Cortese JF, Plowe CV, Sims PF, Hyde JE. A bifunctional dihydrofolate synthetase--folylpolyglutamate synthetase in Plasmodium falciparum identified by functional complementation in yeast and bacteria. Mol Biochem Parasitol 2001; 112:239-52. [PMID: 11223131 DOI: 10.1016/s0166-6851(00)00370-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Folate metabolism in the human malaria parasite Plasmodium falciparum is an essential activity for cell growth and replication, and the target of an important class of therapeutic agents in widespread use. However, resistance to antifolate drugs is a major health problem in the developing world. To date, only two activities in this complex pathway have been targeted by antimalarials. To more fully understand the mechanisms of antifolate resistance and to identify promising targets for new chemotherapies, we have cloned genes encoding as yet uncharacterised enzymes in this pathway. By means of complementation experiments using 1-carbon metabolism mutants of both Escherichia coli and Saccharomyces cerevisiae, we demonstrate here that one of these parasite genes encodes both dihydrofolate synthetase (DHFS) and folylpolyglutamate synthetase (FPGS) activities, which catalyse the synthesis and polyglutamation of folate derivatives, respectively. The malaria parasite is the first known example of a eukaryote encoding both DHFS and FPGS activities in a single gene. DNA sequencing of this gene in antifolate-resistant strains of P. falciparum, as well as drug-inhibition assays performed on yeast and bacteria expressing PfDHFS--FPGS, indicate that current antifolate regimes do not target this enzyme. As PfDHFS--FPGS harbours two activities critical to folate metabolism, one of which has no human counterpart, this gene product offers a novel chemotherapeutic target with the potential to deliver a powerful blockage to parasite growth.
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Affiliation(s)
- E Salcedo
- Department of Biomolecular Sciences, University of Manchester Institute of Science and Technology, PO Box 88, Manchester M60 1QD, UK
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16
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Lee CS, Salcedo E, Wang Q, Wang P, Sims PF, Hyde JE. Characterization of three genes encoding enzymes of the folate biosynthetic pathway in Plasmodium falciparum. Parasitology 2001; 122 Pt 1:1-13. [PMID: 11197757 DOI: 10.1017/s0031182000006946] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the folate metabolic pathway in malaria parasites is a major chemotherapeutic target, resistance to currently available antifolate drugs is an increasing problem. This pathway, however, includes a number of enzymes that, to date, have not been characterized despite their potential for clinical exploitation. As a step towards evaluation of additional targets in this pathway, we report the isolation and characterization of 3 new genes that encode homologues of GTP cyclohydrolase I (GTP-CH), dihydrofolate synthase/folylpolyglutamate synthase (DHFS/FPGS) and serine hydroxymethyltransferase (SHMT). The genes encoding GTP-CH and SHMT are unambiguously assigned to chromosome 12, while that for DHFS/FPGS is tentatively assigned to chromosome 13. All 3 genes are expressed in blood-stage parasites, yielding transcripts of which only ca 60-70% is accounted for by coding sequence. All 3 of the proteins predicted to be encoded by these genes display sequence differences compared to the human host homologues that may be of functional significance. These data bring the complement of cloned genes that encode activities in the pathway to seven, leaving only the gene encoding dihydroneopterin aldolase (DHNA) to be identified in the route from GTP to folate synthesis and folate turnover in the thymidylate cycle.
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Affiliation(s)
- C S Lee
- Department of Biomolecular Sciences, University of Manchester Institute of Science and Technology (UMIST), UK
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17
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Abstract
UNLABELLED Angiotensin II antagonists (AIIA) are part of a new rational treatment of hypertension. Because adverse circulatory effects during anesthesia can occur in patients chronically treated with angiotensin-converting enzyme inhibitors, some clinicians discontinue them at least 24 h before operation. No data are available concerning AIIA administration in patients scheduled for vascular surgery performed under general anesthesia. The aim of this prospective randomized study was to compare hemodynamics during induction of anesthesia in patients chronically treated with AIIA and those of patients not receiving this drug on the morning before operation. Thirty-seven patients chronically treated with AIIA for hypertension were randomly assigned to two groups: Group I: AIIA discontinued on the day before surgery (n = 18); Group II: AIIA given 1 h before anesthesia (n = 19). Patients received sufentanil 0.4 microg/kg, propofol 1.5 mg/kg, and atracurium 0.5 mg/kg. During the procedure, the anesthesiologist was required to maintain systolic blood pressure and heart rate within 30% of baseline values using intravascular fluid administration and vasoconstric- tors (e.g. , ephedrine, phenylephrine, or terlipressin). Hemodynamic variables were recorded each 1 min. Hemodynamic study ended at incision. The number and duration of hemodynamic events were collected, and total doses of vasoactive drugs were noted in each group. Systolic arterial pressure was significantly decreased in Group II at 5, 15 and 23 min after induction of anesthesia (*P < 0.05). In this group, the decrease in systolic arterial pressure was associated with more frequent episodes of hypotension (AIIA withdrawn: 1 +/- 1; AIIA given: 2 +/- 1; P < 0.01), with a larger number of patients developing at least 1 episode of hypotension (AIIA withdrawn: 12; AIIA given: 19; P < 0.01), and a longer duration of an episode of hypotension (AIIA withdrawn: 3 +/- 4 min; AIIA given: 8 +/- 7 min; P < 0.01), and an increased need for vasoactive drugs. In conclusion, blockade of the renin-angiotensin system increases the potential hypotensive effect of anesthetic induction. A severe hypotensive episode, requiring vasoconstrictor treatment, occurs after induction of general anesthesia in patients chronically treated with AIIA. Recommendations to discontinue AIIA drugs on the day before the surgery may be justified. IMPLICATIONS This prospective randomized study demonstrated that more severe hypotensive episodes, requiring vasoconstrictor treatment, occur after induction of general anesthesia in patients chronically treated with AIIA and receiving this drug on the morning before operation, in comparison with those in whom AIIA were discontinued on the day before operation. Recommendations to discontinue these drugs on the day before the surgery may be justified.
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Affiliation(s)
- M Bertrand
- Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
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18
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Abstract
Invertebrate opsins are unique among the visual pigments because the light-activated conformation, metarhodopsin, is stable following exposure to light in vivo. Recovery of the light-activated pigment to the dark conformation (or resting state) occurs either thermally or photochemically. There is no evidence to suggest that the chromophore becomes detached from the protein during any stage in the formation or recovery processes. Biochemical and structural studies of invertebrate opsins have been limited by the inability to express and purify rhodopsins for structure-function studies. In this study, we used Drosophila to produce an epitope-tagged opsin, Rh1-1D4, in quantities suitable for spectroscopic and photochemical characterization. When expressed in Drosophila, Rh1-1D4 is localized to the rhabdomere membranes, has the same spectral properties in vivo as wild-type Rh1, and activates the phototransduction cascade in a normal manner. Purified Rh1-1D4 visual pigment has an absorption maximum of the dark-adapted state of 474 nm, while the metarhodopsin absorption maximum is 572 nm. However, the metarhodopsin state is not stable as purified in dodecyl maltoside but decays with kinetics that require a double-exponential fit having lifetimes of 280 and 2700 s. We investigated the primary properties of the pigment at low temperature. At 70 K, the pigment undergoes a temperature-induced red shift to 486 nm. Upon illumination with 435 nm light, a photostationary state mixture is formed consisting of bathorhodopsin (lambda(max) = 545 nm) and isorhodopsin (lambda(max) = 462 nm). We also compared the spectroscopic and photochemical properties of this pigment with other vertebrate pigments. We conclude that the binding site of Drosophila rhodopsin is similar to that of bovine rhodopsin and is characterized by a protonated Schiff base chromophore stabilized via a single negatively charged counterion.
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Affiliation(s)
- B W Vought
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244-4100, USA
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19
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Toussaint S, Salcedo E, Kamino H. Benign epidermal proliferations. Adv Dermatol 2000; 14:307-57. [PMID: 10643503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- S Toussaint
- Department of Dermatology, New York University Medical Center, New York, USA
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20
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Salcedo E, Huber A, Henrich S, Chadwell LV, Chou WH, Paulsen R, Britt SG. Blue- and green-absorbing visual pigments of Drosophila: ectopic expression and physiological characterization of the R8 photoreceptor cell-specific Rh5 and Rh6 rhodopsins. J Neurosci 1999; 19:10716-26. [PMID: 10594055 PMCID: PMC6784940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Color discrimination requires the input of different photoreceptor cells that are sensitive to different wavelengths of light. The Drosophila visual system contains multiple classes of photoreceptor cells that differ in anatomical location, synaptic connections, and spectral sensitivity. The Rh5 and Rh6 opsins are expressed in nonoverlapping sets of R8 cells and are the only Drosophila visual pigments that remain uncharacterized. In this study, we ectopically expressed Rh5 and Rh6 in the major class of photoreceptor cells (R1-R6) and show them to be biologically active in their new environment. The expression of either Rh5 or Rh6 in "blind" ninaE(17) mutant flies, which lack the gene encoding the visual pigment of the R1-R6 cells, fully rescues the light response. Electrophysiological analysis showed that the maximal spectral sensitivity of the R1-R6 cells is shifted to 437 or 508 nm when Rh5 or Rh6, respectively, is expressed in these cells. These spectral sensitivities are in excellent agreement with intracellular recordings of the R8p and R8y cells measured in Calliphora and Musca. Spectrophotometric analyses of Rh5 and Rh6 in vivo by microspectrophotometry, and of detergent-extracted pigments in vitro, showed that Rh5 is reversibly photoconverted to a stable metarhodopsin (lambda(max) = 494 nm), whereas Rh6 appears to be photoconverted to a metarhodopsin (lambda(max) = 468 nm) that is less thermally stable. Phylogenetically, Rh5 belongs to a group of short-wavelength-absorbing invertebrate visual pigments, whereas Rh6 is related to a group of long-wavelength-absorbing pigments and is the first member of this class to be functionally characterized.
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Affiliation(s)
- E Salcedo
- Institute of Biotechnology, Department of Molecular Medicine, University of Texas Health Science Center, San Antonio, Texas 78245, USA
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21
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Abstract
This article describes the histopathology and immunohistochemistry of benign and malignant fibrous and fibrohistiocytic tumors. Some of the benign fibrohistiocytic proliferation's have atypical variants which could be misinterpreted as malignant processes. Key points for the diagnosis of these entities based on routine histology and immunohistochemistry are presented.
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Affiliation(s)
- H Kamino
- Dermatopathology Section, New York University Medical Center, New York, USA
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22
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Carrascosa AJ, Salcedo E, Gallego ME, Bermúdez JL, Yuste JA, Lledó G. [Hyponatremia in the postoperative period after a neurosurgical tumor condition]. Rev Esp Anestesiol Reanim 1999; 46:40-4. [PMID: 10073082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A four-year-old girl suffered difficult-to-diagnose hyponatremia resistant to treatment following surgery for a suprasellar tumor. The final diagnosis was diabetes insipidus evolving in three stages. Hyponatremia is a common problem following surgery to remove brain tumors. Early diagnosis and treatment of this electrolytic imbalance are essential for preventing serious neurological symptoms or death. The conditions most closely related to hyponatremia are inappropriate antidiuretic hormone secretion syndrome (IADHSS) and cerebral salt wasting syndrome (CSWS). The latter has become more common in recent years among patients undergoing brain surgery. Whereas IADHSS is treated by restricting fluids, CSWS requires administration of salt and volume fluid volume. We believe that for differential diagnosis of postoperative hyponatremia, a fluid restriction test takes priority over of fluid loading following neurosurgery. The course of hyponatremia must be carefully monitored and a complete endocrinological workup must be performed to detect the possible presence of hypophyseal deficiencies, particularly hypothyroidism and suprarenal insufficiency.
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Affiliation(s)
- A J Carrascosa
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
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23
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Townson SM, Chang BS, Salcedo E, Chadwell LV, Pierce NE, Britt SG. Honeybee blue- and ultraviolet-sensitive opsins: cloning, heterologous expression in Drosophila, and physiological characterization. J Neurosci 1998; 18:2412-22. [PMID: 9502802 PMCID: PMC6793122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The honeybee (Apis mellifera) visual system contains three classes of retinal photoreceptor cells that are maximally sensitive to light at 440 nm (blue), 350 nm (ultraviolet), and 540 nm (green). We performed a PCR-based screen to identify the genes encoding the Apis blue- and ultraviolet (UV)-sensitive opsins. We obtained cDNAs that encode proteins having a high degree of sequence and structural similarity to other invertebrate and vertebrate visual pigments. The Apis blue opsin cDNA encodes a protein of 377 amino acids that is most closely related to other invertebrate visual pigments that are thought to be blue-sensitive. The UV opsin cDNA encodes a protein of 371 amino acids that is most closely related to the UV-sensitive Drosophila Rh3 and Rh4 opsins. To test whether these novel Apis opsin genes encode functional visual pigments and to determine their spectral properties, we expressed them in the R1-6 photoreceptor cells of blind ninaE mutant Drosophila, which lack the major opsin of the fly compound eye. We found that the expression of either the Apis blue- or UV-sensitive opsin in transgenic flies rescued the visual defect of ninaE mutants, indicating that both genes encode functional visual pigments. Spectral sensitivity measurements of these flies demonstrated that the blue and UV visual pigments are maximally sensitive to light at 439 and 353 nm, respectively. These maxima are in excellent agreement with those determined previously by single-cell recordings from Apis photoreceptor cells and provide definitive evidence that the genes described here encode visual pigments having blue and UV sensitivity.
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Affiliation(s)
- S M Townson
- Institute of Biotechnology and Department of Molecular Medicine, The University of Texas Health Science Center, San Antonio, Texas 78245, USA
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24
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Stewart WJ, Rodkey SM, Gunawardena S, White RD, Luvisi B, Klein AL, Salcedo E. Left ventricular volume calculation with integrated backscatter from echocardiography. J Am Soc Echocardiogr 1993; 6:553-63. [PMID: 8311961 DOI: 10.1016/s0894-7317(14)80172-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Integrated backscatter analysis (IB) is a new echocardiographic method for automatically differentiating tissue from blood on the basis of differences in the amplitude of reflected ultrasound. Left ventricular volume was estimated with IB by use of a modification of Pappus' theorem and a summated ellipsoid method. IB measurements correlated well with a standard biplane area-length method derived off-line from endocardial borders drawn by hand from the same echocardiographic data (y = 1.09 x - 35, r = 0.95). Integrated backscatter measurement of ventricular volume derived from six imaging planes with both the Pappus' rule and the summated ellipsoid methods correlated well with magnetic resonance imaging volume estimates (r = 0.91 and r = 0.90, respectively), whereas use of one imaging plane correlated less well (r = 0.75). Automated analysis of integrated backscatter differentiates tissue from blood sufficiently to allow accurate volume calculations compared with magnetic resonance imaging and to standard hand-drawn echo techniques. This method provides accurate measurement of left ventricular volumes that should be useful in clinical hemodynamic assessments.
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Affiliation(s)
- W J Stewart
- Department of Cardiology, Cleveland Clinic Foundation, Ohio
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25
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Abstract
This report describes a patient who became hypoxic and hypotensive while awaiting cardiac surgery. An urgent transesophageal echocardiogram in the operating room showed a mass at the junction of the main and right pulmonary arteries consistent with thrombus. The thrombus was removed surgically, and the patient then had a successful aortic valve replacement. Transesophageal echocardiography is therefore useful in the evaluation of the critically ill patient.
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Affiliation(s)
- A L Klein
- Department of Cardiology, Cleveland Clinic Foundation, OH 44106
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26
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Detrano R, Salcedo E, Leatherman J, Day K. Computer-assisted versus unassisted analysis of the exercise electrocardiogram in patients without myocardial infarction. J Am Coll Cardiol 1987; 10:794-9. [PMID: 3309003 DOI: 10.1016/s0735-1097(87)80272-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Computer-assisted interpretation of the exercise electrocardiogram has been advocated to improve the accuracy of diagnosing coronary artery disease. Its accuracy was compared with a blinded visual interpretation of exercise-induced ST depression in 271 consecutive subjects without prior myocardial infarction who were referred for coronary angiography. The sensitivity of the visual and computer readings was 0.51 and 0.51, respectively, at a specificity of 0.87. Receiver operating characteristic curves were generated for the visual and computer ST depression in lead V5. Analysis of the areas under these curves showed no significant difference between them, indicating that computer-assisted analysis was not superior to unmodified visual analysis. A similar analysis was applied to two other computer indexes reported to be superior to visual assessments (treadmill exercise score and ST index). These computer indexes were not superior to a conventional visual analysis of leads I, II, V2, V4 and V5 in predicting severe disease (greater than 50% luminal narrowing). These results suggest that computer-assisted interpretation does not improve the accuracy of exercise electrocardiography in diagnosing coronary artery disease in subjects without prior myocardial infarction.
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Affiliation(s)
- R Detrano
- Department of Cardiology, Cleveland Clinic Foundation, Ohio
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Abstract
To compare four recently proposed methods of analyzing the exercise electrocardiogram with the conventional analysis of ST segment depression, 303 consecutive patients without myocardial infarction who had been referred for coronary arteriography underwent stress electrocardiography and stress thallium imaging. The specificity for the prediction of a greater than 50% coronary obstruction of 0.5, 1.0, 1.5 and 2.0 mm ST segment depression measured in the conventional way was 0.59, 0.73, 0.88 and 0.94, respectively. The specificity of a thallium perfusion defect was 0.79. Sensitivities of the conventional ST depressions, thallium defect, the change in the sum of the R amplitudes and the slope adjusted for heart rate increase were calculated and compared at the cited levels of specificity. R wave changes had a significantly lower sensitivity than did the conventionally analyzed ST depression at each level of specificity. Slope-adjusted ST depression had a slightly higher sensitivity than that of conventional ST depression only at a specificity of 0.73 (0.68 versus 0.65, p = 0.07). R wave-adjusted ST depression was significantly more sensitive than conventional ST depression only at a specificity of 0.94 (0.45 versus 0.36, p = 0.01). Heart rate-adjusted ST depression was more sensitive than conventional ST depression at all of the specificities except 0.59. This pattern of superior accuracy of heart rate-adjusted ST depressions was preserved for the prediction of multivessel coronary disease. Heart rate adjustment is a simpler and more accurate modification of the conventional electrocardiographic analysis than are the other three methods studied.
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Abstract
A transvenous left ventricular endocardial pacemaker catheter is a potential source of systemic arterial embolization. The case of a woman who presented with left-eye amaurosis fugax is reported. The patient had a history of contralateral carotid atherosclerosis; however, the digital subtraction angiography of the carotid arteries was not sufficiently abnormal to account for her present symptoms. The patient had a history of two myocardial infarctions and the tachycardia-bradycardia syndrome for which she was treated with a demand ventricular pacemaker. The chest x-ray and electrocardiogram suggested pacemaker catheter malposition. By M-mode and two-dimensional echocardiography, the catheter was shown to cross the atrial septum and the mitral valve to implant in the left ventricular endocardium. The approach to diagnosis and therapy that led to surgical removal of the pacing catheter is presented. The causes of the electrocardiographic right bundle branch block pattern in cardiac pacing and the usefulness of echocardiography in evaluating pacing catheters are discussed.
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Abstract
Twelve patients with anorexia nervosa (mean age 17.6 years) underwent noninvasive cardiac evaluation. All patients had normal sinus rhythm at rest, during exercise, and following 24-hr electrocardiographic monitoring. The chest roentgenograms demonstrated a small heart secondary to a loss of left ventricular mass. Three of four patients studied had left ventricular mass measurements less than 100 g (normal is 90-360 g). Most patients had an elevated heart rate response to exercise with a slightly blunted systolic and a normal diastolic blood pressure response. Eleven of the 12 patients had reduced overall maximal working capacity. All but one had normal left ventricular ejection fraction at rest. There was no evidence of arrhythmias at rest, during exercise, or with continuous electrocardiographic recording. Young patients with anorexia nervosa appeared to have essentially normal cardiac function with a reduction in left ventricular muscle mass.
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Chaignon M, Chen WT, Tarazi RC, Nakamoto S, Salcedo E. Acute effects of hemodialysis on echographic-determined cardiac performance: improved contractility resulting from serum increased calcium with reduced potassium despite hypovolemic-reduced cardiac output. Am Heart J 1982; 103:374-8. [PMID: 7064771 DOI: 10.1016/0002-8703(82)90276-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The hemodialysis session leads to reduction in circulating blood volume (TBV) and arterial pressure (BP) plus correction of electrolyte imbalance. The effect of these alterations on cardiac performance was evaluated in 18 patients with end-stage renal disease. Hemodialysis for 5 hours led to significant reduction (p less than 0.001) in weight TBV, and BP. Neither ejection fraction nor percentage fiber shortening was altered, whereas mean velocity of circumferential fiber shortening (mean VCF) and mean systolic ejection rate (MSER) were both significantly increased (1.17 +/- 0.20 to 1.38 +/- 0.28 circ/sec and 2.38 +/- 0.27 to 2.80 +/- 0.40 EDV/sec, respectively; p less than 0.001 for each). Since both venous return and systolic BP were decreased, increase in velocity of ventricular contraction implies enhancement of cardiac performance beyond what would be expected from alterations in ventricular filling and resistance to ejection. This enhancement is possibly related to concomitant reduction in serum potassium (p less than 0.001) and increase in serum calcium (p less than 0.005) achieved by hemodialysis.
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