The impact of social media on citation rates in coloproctology

AIM

This study aimed to investigate the association between Twitter exposure and the number of citations for coloproctology articles.

METHOD

Original articles from journals using Twitter between June 2015 and May 2016 were evaluated for the following characteristics: publishing journal; article subject; study design; nationality, speciality and affiliation of the author(s); and reference on Twitter. Citation data for these articles were retrieved from Google Scholar (https://scholar.google.com) in January 2018. We performed a univariate analysis using these data followed by a multivariate, logistic regression analysis to search for factors associated with a high citation level, which was defined as accrual of more than five citations.

RESULTS

Out of six coloproctology journals listed on the InCites JCR database, three (Diseases of the Colon & Rectum, Colorectal Disease and Techniques in Coloproctology) used Twitter, where 200 (49.5%) out of a total of 404 articles had been featured. Citation rates of articles that featured on Twitter were significantly higher than those that did not (11.4 ± 9.2 vs 4.1 ± 3.1, P < 0.001). In multivariate analysis, Twitter exposure (OR 8.6, P = 0.001), European Union nationality (OR 2.4, P = 0.004), Colorectal Disease journal (OR 3.3, P = 0.005) and systematic review articles (OR 3.4, P = 0.009) were associated with higher citation levels.

CONCLUSION

Article exposure on Twitter was strongly associated with a high citation level. Medical communities should encourage journals as well as physicians to actively utilize social media to expedite the spread of new ideas and ultimately benefit medical society as a whole.

Comparison of body surface area-based and weight-based dosing format for oral prednisolone administration in small and large-breed dogs

This study compared the pharmacokinetics of Prednisolone (PDS) in small- and large breed dogs with a dosing format based on body surface area (BSA) or body weight (BW). The maximum concentration and area under the curve in large-breed dogs orally administered 2 mg/kg PDS were significantly greater than those in small-breed dogs given 2 mg/kg and in large-breed dogs given 40 mg/m2. The higher blood concentrations that result from BW-based dosing of oral PDS in large-breed dogs can be more than required for effect. Meanwhile, BSA dosing at 40 mg/m may be suboptimal. These findings confirm important differences between standard PDS dosing schemes in dogs while highlighting the need to further optimize PDS dosing in large-breed dogs.

Triazolium cyclodextrin click cluster-resin conjugate: an enrichment material for phosphatidylinositol (3,4,5)-triphosphate

UltraLink was functionalized with a triazolium cyclodextrin click cluster (CCC) which provides a well-oriented, multivalent, positively charged binding site for PtdIns(3,4,5)P₃. MALDI TOF MS and LC ESI MS/MS MRM analysis of spiked PtdIns(3,4,5)P₃ in lipid extract suggest that triazolium CCC-UltraLink conjugate can be used as an enrichment material for PtdIns(3,4,5)P₃.

Pharmacokinetic study of meropenem in healthy beagle dogs receiving intermittent hemodialysis

Meropenem, a second carbapenem antimicrobial agent with a broad spectrum of activity, is used to treat sepsis and resistant-bacterial infections in veterinary medicine. The objective of this study was to identify the pharmacokinetics of meropenem in dogs receiving intermittent hemodialysis (IHD) and to determine the proper dosing in renal failure patients receiving IHD. Five healthy beagle dogs were given a single i.v. dose of 24 mg/kg of meropenem and received IHD. The blood flow rate, dialysate flow, and ultrafiltration rate were maintained at 40 mL/min, 300 mL/min, and 40 mL/h, respectively. Blood samples were collected for 24 h from the jugular vein and from the extracorporeal arterial and venous line. Urine samples and dialysate were also collected. The concentrations of meropenem were assayed using HPLC/MS/MS determination. The peak plasma concentration was 116 ± 37 μg/mL at 15 min. The systemic clearance was 347 ± 117 mL/h/kg, and the steady-state volume of distribution was 223 ± 67 mL/kg. Dialysis clearance was 71.1 ± 34.3 mL/h/kg, and the extraction ratio by hemodialysis was 0.455 ± 0.150. The half-life (T_1/2 ) in dogs with IHD decreased compared with those without IHD, and the reduction in T_1/2 was greater in renal failure patients than in normal patients. Sixty-nine percent and 21% of the administered drug were recovered by urine and dialysate in the unchanged form, respectively. In conclusion, additional dosing of 24 mg/kg of meropenem after dialysis could be necessary according to the residual renal function of the patient based on the simulated data.

Field Effect and Strongly Localized Carriers in the Metal-Insulator Transition Material VO(2)

The intrinsic field effect, the change in surface conductance with an applied transverse electric field, of prototypal strongly correlated VO(2) has remained elusive. Here we report its measurement enabled by epitaxial VO(2) and atomic layer deposited high-κ dielectrics. Oxygen migration, joule heating, and the linked field-induced phase transition are precluded. The field effect can be understood in terms of field-induced carriers with densities up to ∼5×10(13)  cm(-2) which are trongly localized, as shown by their low, thermally activated mobility (∼1×10(-3)  cm(2)/V s at 300 K). These carriers show behavior consistent with that of Holstein polarons and strongly impact the (opto)electronics of VO(2).

Altered expression of microRNA-451 in eutopic endometrium of baboons (Papio anubis) with endometriosis

STUDY QUESTION

Are microRNAs (miRs) altered in the eutopic endometrium (EuE) of baboons following the induction of endometriosis?

SUMMARY ANSWER

Induction of endometriosis causes significant changes in the expression of eight miRs, including miR-451, in the baboon endometrium as early as 3 months following induction of the disease.

WHAT IS KNOWN ALREADY

Endometriosis is one of the most common gynecological disorders and causes chronic pelvic pain and infertility in women of reproductive age. Altered expression of miRs has been reported in women and has been suggested to play an important role in the pathophysiology of several gynecological disorders including endometriosis.

STUDY DESIGN, SIZE, DURATION

EuE was obtained from the same group of baboons before and 3 months after the induction of endometriosis. The altered expression of miR-451 was validated in the eutopic and ectopic endometrium of additional baboons between 3 and 15 months following disease induction. Timed endometrial biopsies from women with and without endometriosis were also used to validate the expression of miR-451.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Total RNA was extracted from EuE samples before and after the induction of endometriosis, and miRNA expression was analyzed using a 8 × 15 K miR microarray. Microarray signal data were preprocessed by AgiMiRna software, and an empirical Bayes model was used to estimate the changes. The present study focused on quantitative RT-PCR validation of the microarray data, specifically on miR-451 and its target genes in both baboons (n = 3) and women [control (n = 7) and endometriosis (n = 19)]. Descriptive and correlative analysis of miR-451 and target gene expression was conducted using in situ hybridization and immunohistochemistry, while functional analysis utilized an in vitro 3' untranslated region (UTR) luciferase assay and overexpression of miR-451 in human endometrial and endometriotic cell lines.

MAIN RESULTS AND THE ROLE OF CHANCE

Induction of endometriosis results in the altered expression of miR-451, -141, -29c, -21, -424, -19b, -200a and -181a in the baboon endometrium. In the baboon, induction of endometriosis significantly decreased the expression of miR-451 at 3 months (P < 0.001), which was also associated with increased expression of its target gene YWHAZ (14.3.3ζ). A similar significant (P < 0.0001) decrease in miR-451 expression was observed in women with endometriosis. The 3' UTR luciferase assay confirmed the regulation of YWHAZ expression by miR-451. Furthermore, overexpression of miR-451 in 12Z cells (immortalized human endometriotic epithelial cell line) led to the decreased expression of its target YWHAZ and this was correlated with decreased cell proliferation.

LIMITATIONS, REASONS FOR CAUTION

The study focused only on miR-451 and one of its targets, namely YWHAZ. A single miR could target number of genes and a single gene could also be regulated by number of miRs; hence, it is possible that other miRs and their regulated genes may contribute to the pathophysiology of endometriosis.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggest that the presence of ectopic lesions in baboon causes changes in EuE miR expression as early as 3 months postinduction of the disease, and some of these changes may persist throughout the course of the disease. We propose that the marked down-regulation of miR-451 in both baboons and women with endometriosis increases the expression of multiple target genes. Increased expression of one of the target genes, YWHAZ, increases proliferation, likely contributing to the pathophysiology of the disease.

Comparison of clinical outcomes in hepatitis B virus-positive kidney transplant recipients with or without pretransplantation antiviral therapy

BACKGROUND

Antiviral agents have improved the outcomes of hepatitis B virus (HBV)-positive kidney transplant recipients (KTRs). Preemptive therapy has been the main approach to forestall HBV reactivation. We sought to compare prophylactic and preemptive approaches.

METHODS

We divided the 69 HBV-positive KTRs into treatment and historical control groups, according to the time of starting pretransplantation antiviral therapy. The treatment group was further divided into prophylactic and preemptive therapy groups.

RESULTS

The treatment group showed a significant improvement in 10-year graft (82% vs 34%) and patient (91% vs 57%) survivals. Among the historical control group, the main causes of graft failure were patient deaths (68%), which were mostly caused by liver diseases. In contrast, there was no liver-related death in the treatment group. In addition, there was no difference in graft or patient survival between the prophylactic and preemptive groups, but the incidence of HBV reactivation was lower in the prophylactic group. Antiviral therapy was an independent factor for the improved patient survival (P = .005).

CONCLUSIONS

Pretransplantation antiviral therapy is essential to improve clinical outcomes. Prophylactic may be better than preemptive antiviral therapy to decrease HBV reactivation.

Cross-hemispheric functional connectivity in the human fetal brain

Compelling evidence indicates that psychiatric and developmental disorders are generally caused by disruptions in the functional connectivity (FC) of brain networks. Events occurring during development, and in particular during fetal life, have been implicated in the genesis of such disorders. However, the developmental timetable for the emergence of neural FC during human fetal life is unknown. We present the results of resting-state functional magnetic resonance imaging performed in 25 healthy human fetuses in the second and third trimesters of pregnancy (24 to 38 weeks of gestation). We report the presence of bilateral fetal brain FC and regional and age-related variation in FC. Significant bilateral connectivity was evident in half of the 42 areas tested, and the strength of FC between homologous cortical brain regions increased with advancing gestational age. We also observed medial to lateral gradients in fetal functional brain connectivity. These findings improve understanding of human fetal central nervous system development and provide a basis for examining the role of insults during fetal life in the subsequent development of disorders in neural FC.

A mathematical model for examining growth and sporulation processes of Bacillus subtilis

A mathematical model for the growth process of the bacterium Bacillus subtilis is described. The model is a highly structured one. The driving motivation for development of the model and explicit accounting of major interactions of metabolic networks in the model is related to our eventual goal that the model will be used in the analysis of complex biological patterns. Bacillus subtilis was chosen in our study due to the interesting sporulation process that these cells undergo in response to adverse environmental conditions including nutrient limitation. Sporulation process in B. subtilis represents a primordial prototype of cellular differentiation in higher cellular systems. Thus a model for the B. subtilis growth process should prove extremely useful for understanding questions of developmental biology. The model is capable of simulating the transition between the exponential and stationary phase of growth in a batch culture. Since during the transition period the growth process and the metabolism become decoupled and many transient processes are taking place, such predictions are a severe test for the validity of any model. A strategy to examine the leading hypothesis on B. subtills sporulation implementing GTP as a component which signals sporulation initiation is described.

Inhibition of the PI3K-Akt pathway suppresses sFlt1 expression in human placental hypoxia models in vitro

OBJECTIVE

Although elevated expression of soluble fms-like tyrosine kinase 1 (sFlt1) plays a major role in the pathogenesis of pre-eclampsia, it is unclear how hypoxia regulates placental sFlt1 expression. Thus, we investigated sFlt1 expression in placentas from normal and preeclamptic pregnancies and in human placental hypoxia models in vitro to examine the role of the PI3K-Akt pathway in regulating the expression of this molecule.

METHODS

We examined the expression of VEGF, PlGF, sFlt1, PI3K, Akt, and HIF-1 in placental samples from ten women with pre-eclampsia and ten normotensive control patients and in human choriocarcinoma trophoblast cells treated with 600muM CoCl(2) by Western blotting. Using models of placental hypoxia, we also determined whether inhibition of the PI3K-Akt pathway plays a direct role in regulating the expression of sFlt1.

RESULTS

The VEGF, PlGF, sFlt1, PI3K, Akt, and HIF-1 levels were significantly higher in the preeclamptic placentas than the normal placentas. In the placental hypoxia models, the expression of VEGF and PlGF increased in a time-dependent manner, whereas the expression of sFlt1 plateaued after 3h of CoCl(2) treatment. The expression levels of p-Akt and PI3K were maximal after 6 and 12h of CoCl(2) treatment, respectively. The expression of HIF-1alpha increased in a time-dependent manner with CoCl(2) treatment. Inhibition of the PI3K-Akt pathway with the PI3K-specific inhibitor LY294002 leads to decreased sFlt1 levels and unchanged or increased VEGF and PlGF levels.

CONCLUSION

Inhibition of the PI3K-Akt pathway may be a useful therapeutic approach, if it were to decrease sFlt1 secretion without inhibiting VEGF or PlGF secretion. This pathway provides a potential target for a new treatment strategy in patients with pre-eclampsia.

An outbreak of highly pathogenic avian influenza at a public animal exhibit in seoul, Korea, during 2008

This study describes the first recorded outbreak of HPAI in the city of Seoul, in captive birds held in an exhibition for public viewing at a local district office. The index cases were two pheasants, which had been introduced into the exhibit on 24 April, 4 days prior to death, from a store in a local market in Gyeonggi-do. Ducks and chickens from an HPAI outbreak farm, subsequently confirmed on 4 May, had also been held in this store. This outbreak highlights the potential role of local markets in AIV transmission. This outbreak led to considerable public health concern in Korea, however, no human cases were reported. The non-commercial poultry sector needs to be considered in national plans for preparedness and response.

Comparison of conductive fabric sensor and Ag-AgCI sensor under motion artifacts

A wearable electrocardiogram(ECG) device using conductive fabric sensor was compared with traditional Ag-AgCl electrode ECG device. The ECG signals were measured under existence of motion artifacts on variable running speed using treadmill to verify that wearable device can substitute traditional ECG device. A signal to noise ratio (SNR) and RR interval were compared between the two devices. The SNR of wearable device was similar or higher than that of clinical device and difference of RR interval was 2ms. The results show that the wearable ECG device using conductive fabric sensor can make similar performance with ECG device using Ag-AgCl electrode even under motion artifacts.

The Severe Cognitive Impairment Rating Scale--an instrument for the assessment of cognition in moderate to severe dementia patients

BACKGROUND/AIMS

This study aimed to develop a brief, reliable and valid test for cognitive function of severely demented patients.

METHODS

We constructed the Severe Cognitive Impairment Rating Scale, which consisted of 11 items covering memory, language, visuospatial function, frontal function and orientation, and investigated its reliability and validity on 267 subjects [normal: 65, very mild Alzheimer's disease (AD): 42, mild AD: 58, moderate AD: 36, severe AD: 44, profound AD: 22].

RESULTS

The internal consistency obtained by Cronbach's coefficient alpha was 0.93. The interrater reliability and test-retest reliability in the moderately to severely impaired subjects with an MMSE score of <or=14 was 0.99 (p < 0.001) and 0.90 (p < 0.001), respectively. It showed significant correlation with Severe MMSE (r = 0.96, p < 0.01), MMSE (r = 0.86, p < 0.01) and Clinical Dementia Rating (r = -0.83, p < 0.01). It was robust to both the floor effect in the severe/profound stage of AD and the ceiling effect in the mild/moderate stage of AD. Exploratory factor analysis yielded 2 factors (automatic informational processing and controlled informational processing) accounting for 73.5% of the total variance.

CONCLUSIONS

The Severe Cognitive Impairment Rating Scale is a valid and reliable test for evaluating the cognitive function of advanced AD patients.

A normative study of the Revised Hasegawa Dementia Scale: comparison of demographic influences between the Revised Hasegawa Dementia Scale and the Mini-Mental Status Examination

BACKGROUND/AIMS

We investigated the demographic influence on the performance of the Revised Hasegawa Dementia Scale (HDS-R) and provided normative data of the HDS-R in the elderly.

METHODS

The HDS-R was administered to 803 community-dwelling cognitively normal elderly subjects aged 55 years or over. Cognitive disorders and psychiatric disorders were strictly excluded using the CERAD-K assessment packet and the Mini-International Neuropsychiatric Interview. The demographic influence on the performance of the HDS-R was examined using multiple linear regression analyses, and compared with that on the performance of the Mini-Mental Status Examination (MMSE) using the Chow test and t statistics. Overlapping strata were used in developing age-, education- and gender-specific normative data of the HDS-R.

RESULTS

Age, education, and gender influenced significantly the performance of the HDS-R, and explained 22.5% of the total score variance. Older age, lower education, and male gender were associated with lower performance of the HDS-R. However, the demographic influence on the HDS-R was much weaker than that on the MMSE (t = 5.578, d.f. = 800, p < 0.001). The normative data of the HDS-R stratified by age (60-69, 70-79, > or =80), education (0-6, 7-12, > or =13), and gender were presented.

CONCLUSIONS

The HDS-R was more robust to demographic influences than the MMSE, and normative data may contribute to improving further its diagnostic accuracy for dementia.

Depression in vascular dementia is quantitatively and qualitatively different from depression in Alzheimer's disease

BACKGROUND/AIMS

To compare the prevalence and characteristics of depression in vascular dementia (VaD) and Alzheimer's disease (AD) after adjusting for dementia severity and gender.

METHODS

One hundred and eight pairs of VaD and AD patients matched for dementia severity and gender were assessed.

RESULTS

Major depressive disorder (MDD) was more prevalent in the VaD group than in the AD group (20.4% in VaD, 10.2% in AD, p = 0.04, Cochran-Mantel-Haenszel, CMH, test) regardless of the dementia severity and gender. The odds ratio for developing MDD in the VaD group versus the AD group was estimated to be 2.20 (95% confidence interval = 1.02-4.74). Neurovegetative symptoms such as 'felt tired and weak all the time' (30.6% in VaD, 13.9% in AD, p = 0.003, CMH test) and 'changed weight without trying' (16.7% in VaD, 6.5% in AD, p = 0.02, CMH test) were more prevalent in the VaD group than in the AD group.

CONCLUSION

Depression in VaD was quantitatively and qualitatively different from that in AD regardless of the severity of dementia and gender; depression was more prevalent, severer and more retarded and vegetative in VaD than in AD.

Induction of membrane-type matrix metalloproteinase-1 stimulates angiogenic activities of bovine aortic endothelial cells

Matrix metalloproteinases (MMPs) have been reported to play critical roles in endothelial cell migration and matrix remodeling during the angiogenic process. Among these MMPs, membrane-type MMP-1 (MT1-MMP) is an important molecule that can trigger the invasion of tumor cells by activating MMP-2 on their plasma membrane. However, the precise involvement of MT1-MMP in the angiogenic process has not been determined. To investigate the roles of the MT1-MMP by the matrix remodeling of endothelial cells, MT1-MMP expression vector was transfected into bovine aortic endothelial cells (BAECs). Increased expression of MT1-MMP in BAECs enhanced the activation of MMP-2, invasion and migration of BAECs. Moreover, the capacity of tube formation was increased in MT1-MMP transfectants. However, cotransfection with antisense MT1-MMP expression vector abolished the effects of MT1-MMP overexpression. These observations indicate that MT1-MMP is involved in the angiogenic process of endothelial cells in vitro.

Delayed diagnosis of purulent pericarditis caused by esophagopericardial fistula by computed tomography scan and echocardiography

We report a case of esophagopericardial fistula with subsequent purulent pericarditis that was diagnosed with computed tomography and echocardiography. In a patient with non-specific chest pain and vague past history, serial echocardiography demonstrated rapid aggravation of pyopneumopericardium and chest CT scan showed a foreign body that caused the fistula in the esophageal wall. Removal of a piece of fish bone, closure of the fistula, and creation of a pericardial window for continuous drainage were performed through a low lateral thoracotomy.

Characterization of the CDC10 product and the timing of events of the budding site of Saccharomyces cerevisiae

Budding cells of the yeast Saccharomyces cerevisiae possess a ring of septin filaments of unknown biochemical nature that lies under the inner surface of the plasma membrane in the neck that connects the mother cell to its bud. Mutants, defective in any of the four genes (CDC3, CDC10, CDC11, CDC12), lack these septin filaments and display a pleiotropic phenotype that involves abnormal bud growth and an inability to complete cytokinesis. The cloned CDC10 was fused to bacterial genes to generate antibodies specific for the CDC10 product was a constituent of the septin filaments. Cdc10p-specific antibodies for septin staining and actin-specific rhodamine-phalloidine were used to investigate the timing of the localization of septin and actin at the budding site using the immunofluorescence microscopic technique. In wild-type cells, the timing of the appearance and disappearance of these proteins was indistinguishable. In addition, the cdc10 mutant did not prevent actin localization at the budding site. The mutant that was blocked in the actin function also did not prevent the septin localization of the Cdc10p. This result may suggest an organizational independence between these proteins in the bud formation. Finally, the localization of septin and actin in the cdc24 mutant cell was examined. It was found that the CDC24 function was necessary for the organization of septin and actin at the budding site.

Molecular cloning and high-level expression of G2 protein of hantaan (HTN) virus 76-118 strain in the yeast Pichia pastoris KM71

Hantaan viral G2 envelope gene, which is known to be one of major antigens and induce neutralizing antibodies, was cloned into expression vector pHIL-S1 which consists of AOX1 promoter, PHO1 signal sequence, HIS4 gene and other components. The recombined plasmid was transformed into methylotropic yeast, Pichia pastoris of KM71 and recombinant strains harboring multi-copy of G2 gene were selected. Expression of the cloned G2 gene was confirmed with Western blot analysis using anti-sera of guinea pig immunized with the carboxyl terminal region of G2 protein expressed in Escherichia coli. The expression of G2 gene from the recombinant strain was tightly repressed by dextrose and effectively induced by methanol, an inducer of AOX1 promoter. The highest expression level was observed from 1 day after induction and maintained at the same level for up to 4 days.

Glucocorticoid receptor-induced down-regulation of MMP-9 by ginseng components, PD and PT contributes to inhibition of the invasive capacity of HT1080 human fibrosarcoma cells

We examined the effects of the purified ginseng components, panaxadiol (PD) and panaxatriol (PT), on the expression of matrix metalloproteinase-9 (MMP-9) in highly metastatic HT1080 human fibrosarcoma cell line. A significant down-regulation of MMP-9 by PD and PT was detected by Northern blot analysis. However, the expression of MMP-2 was not changed by treatment with PD and PT. Quantitative gelatin based zymography confirmed a markedly reduced expression of MMP-9, but not MMP-2 in the treatment of PD and PT. To investigate whether the reduced level of MMP-9 by PD and PT affects the invasive capacity of HT1080 cells, we conducted an in vitro invasion assay with PD and PT treated cells. The results of the in vitro invasion assay revealed that PD and PT reduced tumor cell invasion through a reconstituted basement membrane in the transwell chamber. Because of the similarity of chemical structure between PD, PT and dexamethasone (Dexa), a synthetic glucocorticoid, we investigated whether the down-regulation of MMP-9 by PD and PT were mediated by the nuclear translocation of glucocorticoid receptor (GR). Increased GR in the nucleus of HT1080 human fibrosarcoma cells treated by PD and PT was detected by immunocytochemistry. Western blot and gel retardation assays confirmed the increase of GR in the nucleus after treatment with PD and PT. These results suggest that GR-induced down-regulation of MMP-9 by PD and PT contributes to reduce the invasive capacity of HT1080 cells.

Changes of the carotid artery Doppler flow velocity pattern after sublingual nitroglycerin in patients with hypertension

OBJECTIVE

To evaluate the applicability of carotid Doppler echography for the assessment of changes of peripheral hemodynamics in the hypertensives.

SUBJECTS

28 hypertensives (17 males, 11 females), mean age of 64 yrs and 40 normal controls (24 males, 16 females) mean age of 49 yrs.

METHODS

We recorded the right common carotid arterial Doppler flow velocity (BFV) pattern and measured the peak velocities of the percussion wave (P) and late rising tidal wave (T), the ratio of the two (P/T), the time interval between the two peaks corrected by heart rate (P-Tc), systolic flow velocity integral (FVI) and carotid artery diameter (CAD) before and after 0.4 mg dose of subligual nitroglycerin (NTG).

RESULTS

1) In hypertensives, the P wave velocity showed lower and P-Tc interval shorter than those of the normal controls at baseline. 2) After NTG, the P-Tc and P/T increased, but the T and FVI decreased significantly in both groups of subjects. 3) The P/T ratio was less significantly increased after NTG in the hypertensives than in the controls. These results suggest that NTG might have been involved in concomitant reduction and delay of the wave reflection from the peripheral vessels, preferentially in the normal subjects than in hypertensives.

CONCLUSIONS

The carotid Doppler echography can be useful for the evaluation of the changes of hemodynamics in the peripheral vessel such as carotid artery in hypertensive subjects.

A case of cor triatriatum in an eighty-year-old man: transesophageal echocardiographic observation of multiple defects

An 80-year-old man was admitted to the hospital because of recurrent syncope caused by sick sinus syndrome. Conventional transthoracic echocardiography showed a membranelike echo-dense structure across the left atrium. Subsequently we confirmed the diagnosis of cor triatriatum with multiple defects and shunt flows across the membrane by transesophageal color flow Doppler echocardiography. There were no other associated congenital anomalies. The patient recovered well and was discharged from the hospital after implantation of a permanent VVI pacemaker for sinus node dysfunction. No other cardiac intervention for the cor triatriatum was done except follow-up with echocardiography. About 1 year after discharge, he died of massive cerebral infarction. The cardiac autopsy findings were compatible with the transesophageal echocardiogram. This is a rare case of uncorrected cor triatriatum in an elderly patient.

Comparison of anaerobic components of the Wingate and Critical Power tests in males and females

The purpose of the study was to reexamine the relationship between the Wingate and Critical Power tests of anaerobic capacity (AC) and anaerobic reserve (AR), respectively. A second purpose was to observe gender differences. Both tests were administered to 16 female and 13 male subjects (N = 29) on a Monark cycle ergometer with six subjects repeating AR measurement. The results show that AC (240.2 +/- 30.5 J-kg-1, calculated from total work for 30 s) and AR (184.0 +/- 1.2 J.kg-1) were not well-correlated (r = 0.07, P > 0.72). When expressed as total energy independent of body mass, the relationship was significant but low (r = 0.41, P > 0.02). Since AR was 23% lower than AC, which is believed to underestimate true anaerobic capacity, the data suggest that the Critical Power and Wingate tests do not assess the same anaerobic compartments. AR from the Critical Power test may not include the energy component of anaerobic glycolysis. Therefore, intrinsic methodological and theoretical differences between the tests make the absolute comparison of AC and AR problematic.

Binary phase spatial modulation using photoinduced anisotropy in amorphous As(2)S(3) thin film

We present a method for binary phase spatial modulation that uses photoinduced anisotropy in a chalcogenide amorphous As(2)S(3) thin film and its application to binary phase-only filters in a VanderLugt optical correlator. The time-dependent light-transmission properties of the photoilluminated As(2)S(3) thin film are analytically examined by use of third-order nonlinear polarization theory. Experimental results on optical correlation are discussed.

Acute hemodynamic improvement by thermal vasodilation in congestive heart failure

BACKGROUND

A warm-water bath (WWB) or sauna bath (SB) has generally been considered inappropriate for patients with severe congestive heart failure (CHF). However, a comprehensive investigation of the hemodynamic effects of thermal vasodilation in CHF has not been previously undertaken.

METHODS AND RESULTS

To investigate the acute hemodynamic effects of thermal vasodilation in CHF, we studied 34 patients with chronic CHF (mean age, 58 +/- 14 years). Clinical stages were New York Heart Association functional class II in 2, III in 19, and IV in 13 patients. Mean ejection fraction was 25 +/- 9%. After a Swan-Ganz catheter was inserted via the right jugular vein, the patient had a WWB for 10 minutes at 41 degrees C or an SB for 15 minutes at 60 degrees C. Blood pressure, ECG, echo-Doppler, expiration gas, and intracardiac pressures were recorded before, during, and 30 minutes after each bath. Oxygen consumption increased mildly, pulmonary arterial blood temperature increased by 1.2 degrees C, and heart rate increased by 20 to 25 beats per minute on average at the end of WWB or SB. Systolic blood pressure showed no significant change. Diastolic blood pressure decreased significantly during SB (P < .01). Cardiac and stroke indexes increased and systemic vascular resistances decreased significantly during and after WWB and SB (P < .01). Mean pulmonary artery, mean pulmonary capillary wedge, and mean right atrial pressures increased significantly during WWB (P < .05) but decreased significantly during SB (P < .05). These pressures decreased significantly from the control level after each bath (P < .01). Mitral regurgitation associated with CHF decreased during and 30 minutes after each bath. Cardiac dimensions decreased and left ventricular ejection fraction increased significantly after WWB and SB. In an additional study, plasma norepinephrine increased significantly during SB in healthy control subjects and in patients with CHF and returned to control levels by 30 minutes after SB.

CONCLUSIONS

Hemodynamics improve after WWB or SB in patients with chronic CHF. This is attributable to the reduction in cardiac preload and afterload. Thus, thermal vasodilation can be applied with little risk if appropriately performed and may provide a new nonpharmacological therapy for CHF.

Partial annular plication for atrioventricular valve regurgitation

Various annuloplasty techniques are used to correct tricuspid or mitral valve regurgitation. We performed a partial annular plication procedure, a modification of the annuloplasty introduced by Davila, in 23 consecutive patients with moderate to severe tricuspid regurgitation or moderate mitral regurgitation. A slender plastic tube was used to tighten snugly the suture during intraoperative saline flushing test for assessment of the valve competency. This technique enabled us to add one stitch or two for more plication before the suture was tied if necessary. During a mean follow-up period of 13.8 months postoperatively, 10 patients (43.5%) had no valve regurgitation, 12 patients (52.2%) had grade 1+ regurgitation, and 1 patient (4.3%) grade 2+ on color Doppler echocardiography. The regurgitation grade remained unchanged or improved after the initial postoperative study. Our surgical experience indicates that the adjustable procedure of partial annular plication is a simple, exact, and durable procedure in patients of all ages with moderate to severe functional atrioventricular regurgitation.

[Effects of hot water bath or sauna on patients with congestive heart failure: acute hemodynamic improvement by thermal vasodilation]

The acute hemodynamic effects of thermal vasodilation caused by exposure to hot water bath or sauna in chronic congestive heart failure were investigated in 32 patients (mean age 57 +/- 15 years old) with dilated cardiomyopathy (25 idiopathic and 7 ischemic). The clinical symptoms were New York Heart Association Class II in 2 patients, III in 17 and IV in 13, and the mean ejection fraction was 25 +/- 9% (9-44%). Exposure to hot water bath was for 10 minutes at 41 degrees C in a semi-sitting position, and to sauna for 15 minutes at 60 degrees C in a supine position using a special far infrared ray sauna chamber. Blood pressure, electrocardiogram, two-dimensional and Doppler echocardiograms, expiration gas, and intracardiac pressure tracings were recorded before (control), during, and 30 minutes after hot water bath or sauna. 1. The increase in oxygen consumption was only 0.3 Mets during hot water bath or sauna, and returned to the control level 30 minutes later. 2. The deep temperature in the main pulmonary artery increased by 1.0-1.2 degrees C on average at the end of hot water bath or sauna. 3. Heart rate increased significantly (p < 0.01) by 20-25/min during bathing and still increased 30 min later. 4. Systolic blood pressure did not change significantly during and after hot water bath or sauna, while, diastolic blood pressure decreased significantly during (p < 0.05) and after sauna (p < 0.01), and after hot water bath (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Significance of hepatitis B core antigen in the liver in patients with chronic hepatitis B and its relation to hepatitis B virus DNA

Liver biopsies from 52 patients with chronic hepatitis B were investigated for the presence and distribution of HBcAg and the results were compared with the status of hepatitis B virus deoxyribonucleic acid (HBV-DNA). The patients consisted of 37 men and 15 women, aged 16-55 years (mean = 34 years). Serum alanine aminotransferase (ALT) was elevated in 50 patients (range: 18-969 U/L; mean = 290 U/L). Serological testing showed HBsAg in all, HBeAg in 45 (87%), and HBV-DNA in 28 (54%). Liver biopsies demonstrated HBcAg in 35 (67%) patients. HBcAg was not only present in 31 of 45 (69%) patients who were seropositive for HBeAg, but also in four of seven (57%) with antibody to HBeAg (anti-HBe). In 28 of 35 (80%) patients with HBcAg in the liver, serum HBV-DNA was detected. However, no serum HBV-DNA was detected in 17 patients who had no detectable HBcAg in the liver. The distribution of HBcAg in the liver was rather cytoplasmic and nuclear than nuclear alone. Among 33 patients with cytoplasmic HBcAg in the liver, 15 (45%) had an evidence of acute exacerbation of hepatitis with marked ALT elevation (range: 168-894 U/L; mean = 385 U/L) and nine patients showed severe chronic active hepatitis and confluent necrosis, histologically. These results indicate that the presence of HBcAg in the liver correlates with the amount of circulating hepatitis B virus as quantified by serum level of HBV-DNA. The predominant cytoplasmic HBcAg in the liver may suggest the possibility of multiple episodes of acute exacerbation and more severe ongoing hepatitis during the clinical course.

A case of subcutaneous seeding of hepatocellular carcinoma after fine needle aspiration biopsy

Cancer spread along the needle track following fine needle aspiration biopsy is said to be a rare complication. The authors report a case of subcutaneous implantation of hepatocellular carcinoma following ultrasono-guided fine needle aspiration biopsy. The patient, a 67-year-old Korean male was found to have a large hepatocellular carcinoma diagnosed by fine needle aspiration biopsy. Four months later, the patient felt two subcutaneous growing lumps at the previous aspiration site. The authors confirmed them histologically 11 months after aspiration.