Sex differences in outcomes of heart failure in an ambulatory, population-based cohort from 2009 to 2013

BACKGROUND

Heart failure remains a substantial cause of morbidity and mortality in women. We examined the sex differences in heart failure incidence, mortality and hospital admission in a population-based cohort.

METHODS

All Ontario residents who were diagnosed with heart failure in an ambulatory setting between Apr. 1, 2009, and Mar. 31, 2014, were included in this study. Incident cases of heart failure were captured through physician billing using a validated algorithm. Outcomes were mortality and hospital admission for heart failure within 1 year of the diagnosis. Probability of death and hospital admission were calculated using the Kaplan-Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model.

RESULTS

A total of 90 707 diagnoses of heart failure were made in an ambulatory setting during the study period (47% women). Women were more likely to be older and more frail, and had different comorbidities than men. The incidence of heart failure decreased during the study period in both sexes. The mortality rate decreased in both sexes, but remained higher in women than men. The female age-standardized mortality rate was 89 (95% confidence interval [CI] 80-100) per 1000 in 2009 and 85 (95% CI 75-95) in 2013, versus male age-standardized mortality rates of 88 (95% CI 80-97) in 2009 and 83 (95% CI 75-91) in 2013. Conversely, the rates of incident heart failure hospital admissions after heart failure diagnosis decreased in men and increased in women.

INTERPRETATION

Despite decreases in overall heart failure incidence and mortality in ambulatory patients, mortality rates remain higher in women than in men, and rates of hospital admission for heart failure increased in women and declined in men. Further studies should focus on sex differences in health-seeking behaviour, medical therapy and response to therapy to provide guidance for personalized care.

Effect of obesity, dyslipidemia, and diabetes on trastuzumab-related cardiotoxicity in breast cancer

Background

Clinical trials have demonstrated an increased risk of cardiotoxicity in patients with breast cancer (bca) receiving trastuzumab-based therapy. Diabetes, dyslipidemia, and obesity are known risk factors for cardiovascular disease. Studies have yielded conflicting results about whether those factors increase the risk of cardiotoxicity in patients with bca receiving trastuzumab.

Methods

In this retrospective cohort study, data were collected for 243 patients with bca positive for her2 (the human epidermal growth factor receptor 2) who were receiving trastuzumab and who were referred to The Ottawa Hospital Cardio-oncology Referral Clinic between 2008 and 2013. The data collected included patient demographics, reason for referral, cardiac function, chemotherapy regimen (including anthracycline use), and 3 comorbidities (diabetes, dyslipidemia, obesity). Rates of symptomatic cancer treatment-related cardiac dysfunction (sctcd) and asymptomatic decline in left ventricular ejection fraction (adlvef) were calculated for patients with and without the comorbidities of interest.

Results

Of the 243 identified patients, 104 had either diabetes, dyslipidemia, or obesity. In that population, the most likely reason for referral to the cardio-oncology clinic was adlvef. The combination of 2 or 3 comorbidities significantly increased the incidence of sctcd in our population, reaching a rate of 67% for patients with obesity and dyslipidemia [relative risk (rr): 2.2; p = 0.04], 69% for patients with obesity and diabetes (rr: 2.3; p = 0.02), and 72% for patients with all 3 risk factors (rr: 2.4; p = 0.08).

Conclusions

The combination of 2 or 3 comorbidities significantly increases the incidence of symptomatic cancer treatment-related cardiotoxicity. Patients with bca experiencing cancer treatment-related cardiotoxicity who have a history of diabetes, dyslipidemia, and obesity might require more proactive strategies for prevention, detection, and treatment of cardiotoxicity while receiving trastuzumab-based treatment.

Comparison of Framingham risk score and chest-CT identified coronary artery calcification in breast cancer patients to predict cardiovascular events

BACKGROUND

In breast cancer patients, coincidental detection of CAC at chest CT may be important in determining cardiovascular (CV) outcomes and facilitate CV disease primary prevention strategies.

METHODS

408 consecutive breast cancer patients referred to cardiac oncology clinic were included in the study. 256 patients without a prior history of coronary artery disease had undergone a chest CT. CT images were reviewed to detect CAC. Framingham risk score (FRS) was calculated and patient electronic medical records were interrogated to document the incidence of a composite clinical end point of all-cause mortality and cardiac events (coronary revascularization, heart failure hospitalization and de novo atrial fibrillation). Prevalence of statin prescribing was also collected.

RESULTS

Patients were followed for a median of 6.5 years. 112 clinical events occurred. Clinical follow up was 98%. CAC was found in 26% of patients. On multivariable analysis, CAC and advance cancer stage, but not FRS predicted the composite clinical end point (OR for CAC 2.59, p < 0.01). CAC but not FRS also predicted the incidence of cardiac events (OR for CAC 4.90, p < 0.01). CAC was present in 7.3% of patients with low FRS; none had been prescribed a statin. In patients with CAC and FRS ≥ 10%, 45% were not on a statin.

CONCLUSION

CAC is a common coincidental finding at CT chest in breast cancer patients referred to cardiac oncology. CAC but not FRS was predictive of composite clinical events and cardiac events. Detection of CAC at chest CT could alter the prescribing of primary prevention strategies to help prevent future cardiac events in breast cancer patients.

Ammonium 2,2'-thiodiacetates - Selective and environmentally safe herbicides

2,2'-Thiodiacetic acid derivatives have a wide application potential, mainly in coordination chemistry. This research indicates that quaternary ammonium 2,2'-thiodiacetate salts may also be potent herbicidal agents used in agriculture. To provide a rationale for this statement, the toxic effect by a alkyl and aryl quaternary ammonium salts (QASs) on plant growth was investigated. The phytotoxicity of these compounds was tested against cultivated monocotyledonous (spring barley) and dicotyledonous (common radish) plants, whereas herbicidal activity was investigated in relation to popular weeds species (white goosefoot, sorrel and gallant-soldier). The results showed that aliphatic QASs possessed a low phytotoxicity to food crops and that some of them (in particular triethylammonium salt) had potent and selective herbicidal properties against common weeds, such as sorrel and gallant-soldier. However, the investigated compounds appeared to be ineffective herbicides against white goosefoot.

Paging the eCardiologist: insights into referral behaviour of primary care physicians from qualitative analysis of a cardiology eConsult service

Objective

The purpose of this study is to investigate determinants of primary care physician cardiology referrals by performing qualitative analysis of questions asked by primary care physicians in cardiology electronic consultation services (eConsults).

Setting

A health region in eastern Ontario, Canada, where primary care providers have had access to an eConsult service since 2010.

Participants

We included all consecutive cardiology eConsults initiated by registered primary care provider users of our eConsult service and who initiated one or more eConsult between July 2014 and January 2015. We excluded eConsults in which the primary care provider attached a document without asking a question. A convenience sample of 100 consecutive eConsults initiated by 61 primary care providers was analysed after excluding 14 eConsults.

Primary and secondary outcome measures: Primary care provider eConsult questions are categorised into thematic categories based on the constant comparison method of qualitative analysis with external validation by content experts. Secondary outcomes include sample primary care provider eConsult questions to illustrate each theme and any emergent subthemes.

Results

Thematic saturation occurred after analysis of 30 eConsults. An additional 70 eConsults were coded with no new emergent themes. Themes include exceptions to clinical guidelines (n=13), non-cardiac treatment in a cardiac patient (n=13), specific investigation/management (n=18), interpretation of diagnostic testing (n=46), clinical concerns despite normal testing (n=4) and screening for positive family history (n=6). Subthemes include multiple comorbidities and mild abnormalities on cardiac tests.

Conclusions

We report categories of clinical questions that drive primary care provider cardiology eConsults. Multimorbidity leads to cardiology eConsults as primary care providers try to apply treatment guidelines in medically complex patients. Mild test abnormalities unrelated to clinical problems commonly lead to cardiology eConsult requests. Further research is needed to determine how guidelines can better account for multimorbidity, and how cardiologists can better communicate with primary care providers to put cardiac test results in clinical context.

Sex-Specific Trends in Incidence and Mortality for Urban and Rural Ambulatory Patients with Heart Failure in Eastern Ontario from 1994 to 2013

BACKGROUND

Differences in outcomes have previously been reported between urban and rural settings across a multitude of chronic diseases. Whether these discrepancies have changed over time, and how sex may influence these findings is unknown for patients with ambulatory heart failure (HF). We examined the temporal incidence and mortality trends by geography in these patients.

METHODS AND RESULTS

We conducted a retrospective cohort study of 36,175 eastern Ontario residents who were diagnosed with HF in an outpatient setting from 1994 to 2013. The primary outcome was 1-year mortality. We examined temporal changes in mortality risk factors with the use of multivariable Cox proportional hazard models. The incidence of HF decreased in women and men across both rural and urban settings. Age-standardized mortality rates also decreased over time in both sexes but remained greater in rural men compared with rural women.

CONCLUSIONS

The incidence of HF in the ambulatory setting was greater for men than women and greater in rural than urban areas, but mortality rates remained higher in rural men compared with rural women. Further research should focus on ways to reduce this gap in the outcomes of men and women with HF.

An influence of structural changes in ammonium cations on ecotoxicity of 2,2'-thiodiacetate mono and bis-salts

2,2'-Thiodiacetates with their excellent complexing properties may be used as metal extraction agents, fluorescent and superparamagnetic materials, antibacterial and anticancer medical agents, however there are no data concerning the environmental impact of 2,2'-thiodiacetates derivatives and data definying the potential hazard connected with their use. This study describes the ecotoxicity assessment of seven 2,2'-thiodiacetates with non-metallic, alkyl and aryl ammonium cations, which were obtained in an environmentally friendly, solvent-free syntheses. The ecotoxicity of these water soluble compounds was tested in aquatic and benthic environments using luminescent marine bacteria Vibrio fischeri (Microtox^® test) and the crustaceans Heterocypris incongruens (Ostracodtoxkit F™), respectively. The antimicrobial and antifungal activity against Trichoderma viridis, Aspergillus niger, Rhizoctonia solani and Escherichia coli was also investigated. The results showed how structural changes within ammonium cations themselves influence ecotoxicity: the QASs with alkylammonium cations exhibited a similar, rather low toxicity both to Vibrio fischeri and Heterocypris incongruens, and they would not pose a risk to these organisms in case of leakage. Higher toxicity was observed in case of two isoquinolinium salts, however it was rather associated with the heteroaromatic cation, than with the 2,2'-thiodiacetate anion.

Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events

Background

The identification of coronary artery calcification (CAC) detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events.

Methods

408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study.

Results

CAC was identified in 70 patients (26%). CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01) and increased during the period of the study (p < 0.05).

Conclusions

CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population.

Women's Heart Health: Knowledge, Beliefs, and Practices of Canadian Physicians

BACKGROUND

Heart disease is a leading cause of morbidity and mortality in women. To date, the majority of knowledge regarding heart disease is based on research conducted in men. As a result, a male-oriented model of heart disease constitutes the basis for diagnostic and therapeutic strategies for both sexes. This article reports findings from the first survey of Canadian physicians to examine their knowledge, beliefs, and practices regarding heart disease in women.

MATERIALS AND METHODS

This cross-sectional survey, adapted from an instrument used in the United States, was undertaken in the spring of 2015. A sample of 504 physicians from a randomly selected sample of online responses was produced.

RESULTS

Overall, physician responses demonstrate a general lack of awareness regarding the prevalence and approaches to the identification of, and treatments for, heart disease in women. In addition, physicians did not provide high ratings of their own effectiveness in supporting female patients to prevent or manage heart disease. The barriers that physicians face and the strategies to support them in improving women's heart health were explored.

CONCLUSIONS

There is a clear need to educate physicians about heart disease in women and its prevention and management. More female-specific research, prevention, and clinical programs will enhance our ability to significantly improve cardiovascular health in Canadian women.

Degradation Processes of Pesticides Used in Potato Cultivations

Potato is one of the most important crops, after maize, rice and wheat. Its global production is about 300 million tons per year and is constantly increasing. It grows in temperate climate and is used as a source of starch, food, and in breeding industry.Potato cultivation requires application of numerous agro-technical products, including pesticides, since it can be affected by insects, weeds, fungi, and viruses. In the European Union the most frequently used pesticides in potato cultivations check are: thiamethoxam, lambda-cyhalothrin and deltamethrin (insecticides), rimsulfuron (herbicide) and metalaxyl (fungicide).Application of pesticides improves crop efficiency, however, as pesticides are not totally selective, it affects also non-target organisms. Moreover, the agrochemicals may accumulate in crops and, as a consequence, negatively influence the quality of food products and consumer health. Additional risks of plant protection products are related to their derivatives, that are created both in the environment (soil, water) and in plant organisms, since many of these compounds may exhibit toxic effects.This article is devoted to the degradation processes of pesticides used in potato crop protection. Attention is also paid to the toxicity of both parent compounds and their degradation products for living organisms, including humans. Information about the level of pesticide contamination in the environment (water, soil) and accumulation level in edible plants complement the current knowledge about the risks associated with widespread use of thiamethoxam, lambda-cyhalothrin and deltamethrin, rimsulfuron and metalaxyl in potato cultivation.

Right heart function deteriorates in breast cancer patients undergoing anthracycline-based chemotherapy

BACKGROUND

Cardiotoxicity from anthracycline-based chemotherapy is an important cause of early and late morbidity and mortality in breast cancer patients. Left ventricular (LV) function is assessed for patients receiving anthracycline-based chemotherapy to identify cardiotoxicity. However, animal studies suggest that right ventricular (RV) function may be a more sensitive measure to detect LV dysfunction. The purpose of this pilot study was to determine if breast cancer patients undergoing anthracycline-based chemotherapy experience RV dysfunction.

METHODS

Forty-nine breast cancer patients undergoing anthracycline-based chemotherapy at the Ottawa Hospital between November 2007 and March 2013 and who had 2 echocardiograms performed at least 3months apart were retrospectively identified. Right atrial area (RAA), right ventricular fractional area change (RV FAC) and RV longitudinal strain of the free wall (RV LSFW) were evaluated according to the American Society of Echocardiography guidelines.

RESULTS

The majority (48/49) of patients were females with an average age of 53.4 (95% CI: 50.1-56.7years). From baseline to follow-up study, average LV ejection fraction (LVEF) decreased from 62.22 (95% CI: 59.1-65.4) to 57.4% (95% CI: 54.0-60.9) (P=0.04). During the same time period, the mean RAA increased from 12.1cm(2) (95% CI: 11.1-13.0cm(2)) to 13.8cm(2) (95% CI: 12.7-14.9cm(2)) (P=0.02), mean RV FAC decreased (P=0.01) from 48.3% (95% CI: 44.8-51.74) to 42.1% (95% CI: 38.5-45.6%), and mean RV LSFW worsened from -16.2% (95% CI: -18.1 to -14.4%) to -13.81% (95% CI: -15.1 to -12.5%) (P=0.04).

CONCLUSION

This study demonstrates that breast cancer patients receiving anthracycline-based chemotherapy experience adverse effects on both right atrial size and RV function. Further studies are required to determine the impact of these adverse effects on right heart function and whether this represents an earlier marker of cardiotoxicity.

Continuum of care: Establishment of a comprehensive cardio-oncology program

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Background: Cardiac disease in individuals with cancer is common, impacts survival, the ability to tolerate cancer treatments and quality of life. Cardio-oncology is a novel interdisciplinary approach to the management of cancer patients with treatment-induced cardiotoxicity. The goal of our program is two-fold: a) establishment of a hospital based cardio-oncology clinic to rapidly assess and manage cancer patients with cardiotoxicity related to their cancer treatment and b) provide continuum of care for these patients with the establishment of a cardiovascular survivorship program. Methods: In 2008, in collaboration with oncologists, cardiologists, pharmacy and nursing we established a multidisciplinary cardio-oncology clinic at The Ottawa Hospital. Referrals are primarily form treating oncologists. The clinics take place 3-4 half days per month and are conducted by 3 dedicated cardiologists. Patient data including demographics, cancer type and treatment, cardiovascular risk factors, treatment and clinical outcomes of each patient are being collected. Results: We have seen over 800 patients with solid and hematological malignancies. Clinical outcomes of patients referred from 10/2008 to 01/2013 have previously been reported (Sulpher J. et al 2014). The majority of patients referred were able to successfully complete their cancer therapy (79.7%), reflective of the large breast cancer population seen in this clinic. A third of patients achieved stable left ventricular ejection fractions with cardiac intervention and 41% received cardiac medications. Overall survival and long term cardiac outcomes will be reported. Conclusions: While these initial results are encouraging the impact of cardiotoxicity experienced by cancer patients and long term cardiac outcomes are unknown. In an effort to improve the cardiovascular care of cancer survivors we are currently developing a Cardiovascular Survivorship Program; patients will be referred from our hospital based cardio-oncology clinic to a specialized community clinic, for long-term surveillance and optimization of cardiovascular health. This initiative represents a continuum of care from hospital to community and is the first such program in Canada.

Ottawa Cardiac Oncology Program wins 2013 Cancer Quality Council of Ontario Innovation Award

The Ottawa Cardiac Oncology Program (ocop) has won the 2013 Innovation award from the Cancer Quality Council of Ontario [...]

Heart disease as a risk factor for dementia

As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.

The experience of a multidisciplinary clinic in the management of early-stage breast cancer patients receiving trastuzumab therapy: an observational study

Background. We established a dedicated cardiac oncology clinic in 2008 for the rapid diagnosis and treatment of cardiotoxicity related to cancer therapy. In this retrospective observational study, we report on clinical outcomes in women with early-stage breast cancer (EBC) referred to this clinic. Methods. Patients with EBC treated with chemotherapy/trastuzumab and referred between October 2008 and December 2010. Data included patient demographics, staging, cancer treatment/completion, dose delays, left ventricular ejection fraction (LVEF) and cardiac treatment. Results. Forty eight patients: median age 55.5 years, stage I/II disease (77%) and HER-2 positive (98%). The majority of women (n = 32) were referred for decreases in LVEF (from baseline). Overall, 37 (77%) patients experienced at least one drop in LVEF while on treatment, of which 22 patients (59%) experienced a ≥10 percentage point drop. The majority of patients (30/37; 81%) experienced declines in LVEF while on trastuzumab. Interventions included trastuzumab delays (n = 16/48; 33%) and cardiac medication (12/48: 25%). A total of 81% of patients completed ≥90% of trastuzumab therapy and 15% of patients discontinued therapy due to cardiotoxicity. Conclusion. The majority of patients referred to our clinic completed therapy. Further studies are needed to determine the impact of this multidisciplinary approach on treatment completion and cardiac outcomes.

[The surgical procedure of mini-sling antiincontinence procedure AJUST, recommendations and ways of solution of possible special situations]

The objective of our work was to present and summarize the course of a joint meeting of surgeons with experience with AJUST in SUI anti-incontinence treatment. We would like to discuss the operation procedure and its individual steps. Further aim was to determine the optimal operation procedure, step by step, avoiding possible complications in the course of the procedure; simplifying the technique and publishing the recommendations how to solve possible complications in the course of, or after, the operation procedure, was important outcome of the meeting.

Simulations of ionization in a hot cavity surface ion source

A new numerical Monte Carlo method based model of a hot cavity surface ionization ion source is presented in this paper. The model, intended to support the studies on ionization phenomena in a widely used class of ion sources, takes into account geometry of the ion source and extraction system, ionizer temperature and other features. The results of ion source efficiency calculations for various configurations of the extraction field are reviewed. The dominant role of the ionizer region near the extraction opening is described. Simulated dependences of ionization efficiency on the working parameters like ionizer length and temperature, ionization potential of the substance, and extraction voltage are discussed. A good agreement of the experimental data (e.g., influence of ionizer temperature, current-voltage curve) and the predictions of the model is found. It is also shown that the contribution to the ionization yield from impact of thermionic electrons accelerated by the extraction field may be significant, especially for the substances of small surface ionization coefficient. The simulation results are compared to the predictions of different theoretical models of the ion source--the obtained simulation data are in accordance both with a well-known Kirchner formula and the so called spherical ionizer model.

Canadian Consensus Conference on menopause, 2006 update

OBJECTIVE

To provide guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor symptoms, urogenital, sexual, and mood and memory concerns and on specific medical considerations, and cardiovascular and cancer issues.

OUTCOMES

Prescription medications, complementary and alternative medicine (CAM), and lifestyle interventions are presented according to their efficacy in treating menopausal symptoms.

EVIDENCE

MEDLINE and the Cochrane database were searched for articles from March 2001 to April 2005 in English on subjects related to menopause, menopausal symptoms, urogenital and sexual health, mood and memory, hormone therapy, CAM, and on specific medical considerations that affect the decision of which intervention to choose.

VALUES

The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report (see Table 1).

SPONSORS

The development of this consensus guideline was supported by unrestricted educational grants from Berlex Canada Inc, Lilly Canada, Merck Frosst, Novartis, Novogen, Novo Nordisk, Proctor and Gamble, Schering Canada, and Wyeth Canada.

All-electrical measurement of the density of states in (Ga,Mn)As

We report on electrical measurements of the effective density of states in the ferromagnetic semiconductor material (Ga,Mn)As. By analyzing the conductivity correction to an enhanced electron-electron interaction the electrical diffusion constant was extracted for (Ga,Mn)As samples of different dimensionality. Using the Einstein relation allows us to deduce the effective density of states of (Ga,Mn)As at the Fermi energy.

Primary Percutaneous Coronary Angioplasty With and Without Eptifibatide in ST-Segment Elevation Myocardial Infarction

Background— Primary percutaneous coronary intervention, if performed promptly, is the preferred strategy to restore flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. We sought to determine whether eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor, given before catheterization would improve clinical outcomes in patients referred for primary percutaneous coronary intervention.

Methods and Results— We randomly assigned a total of 400 patients with ST-segment elevation myocardial infarction referred for primary percutaneous coronary intervention to treatment initiated before cardiac catheterization, with either heparin plus eptifibatide (201 patients) or heparin alone (199 patients), in addition to oral aspirin (160 mg) and high-dose clopidogrel (600 mg). The primary end point was a composite of death from any cause, recurrent myocardial infarction, or recurrent severe ischemia during the first 30 days after randomization. At 30 days, the primary end point was reached by 13 patients (6.47%) assigned to heparin plus eptifibatide and by 11 patients (5.53%) assigned to heparin alone (relative risk, 1.18; 95% CI, 0.52 to 2.70; P =0.69). The rates of major or minor bleeding were higher in patients assigned to heparin plus eptifibatide than that in patients assigned to heparin alone (22.4% versus 14.6%; relative risk, 1.69; 95% CI, 1.01 to 2.83; P =0.04).

Conclusions— In patients pretreated with high-dose clopidogrel who were referred for primary PCI, treatment with heparin plus eptifibatide, when compared with heparin alone, did not improve clinical outcomes and was associated with more bleeding complications.

Arc discharge ion source for europium and other refractory metals implantation

The best method for the impurity doping to the host material is the ion implantation. Due to high melting point of the rare earth standard metal ion sources are useless. One of the solution is to use chemical compounds of rare earths characterized by low melting point. In this paper we describe the novel design of the ion source suitable for refractory metal (e.g., rare earths) ion implantation. The dependencies of Eu(+) current on cathode and arc currents as well as on hydrogen flow are presented. Europium (III) chloride as the source of the europium atoms was used. Europium ions were produced during collisions of evaporated and decomposed EuCl(3) molecules with fast electrons. The typical current of the europium ion beam extracted from the ion source was 25 microA for the extraction voltage of 25 kV. The ion source works without maintenance breaks for approximately 50 h, which enables high dose implantation. The presented ion source needs neither advanced high power supplies nor high vacuum regime.

Response of canine cutaneous epitheliotropic lymphoma to lomustine (CCNU): a retrospective study of 46 cases (1999-2004)

BACKGROUND

Epitheliotropic lymphoma (ELSA) is an uncommon cutaneous canine malignancy of T lymphocytes. A consensus regarding the therapeutic standard of care is lacking, warranting evaluation of chemotherapeutic agents traditionally employed against canine nodal lymphoma in the treatment of ELSA.

HYPOTHESIS

The purpose of this retrospective, multi-institutional study was to evaluate the efficacy of 1-(2-chloroethyl)-3-cyclohexyl-l-nitrosourea (CCNU) in the treatment of ELSA.

ANIMALS

Forty-six dogs with adequate follow-up and treatment response information.

METHODS

All cases were diagnosed histopathologically. Immunohistochemisty (CD3, CD79a) was performed on 42/46 samples.

RESULTS

Presenting skin lesions included generalized scales (25/46), plaques or nodules (22/46), mucocutaneous lesions (14/ 46), and corneal involvement (1/46). Lymph node involvement and Sézary syndrome were documented in 7 and 2 dogs, respectively. The median number of CCNU treatments was 4 (range, 1-11), with a median starting dose of 60 mg/m(2) (range, 30-95). Of the 46 dogs, 15 achieved complete remission, 23 achieved partial remission, 5 had stable disease, and 3 had progressive disease, for an overall response rate of 83%. The median number of treatments to achieve a response was 1 (range, 1-6). The overall median duration of response was 94 days (range, 22-282). Sixteen dose reductions were required because of neutropenia (10/46), thrombocytopenia (1/46), anemia (1/46), increased liver enzyme activity (3/46), or unspecified reasons (1/46).

CONCLUSIONS AND CLINICAL IMPLICATIONS

Given the high response rate and well tolerated protocol, prospective studies are warranted to investigate the utility of CCNU alone or in multi-agent protocols for the treatment of ELSA.

Boron removal from wastewater using adsorbents

In the present study, boron adsorption on activated alumina and activated carbon impregnated with calcium chloride, tartaric acid and mannitol was investigated. The adsorbate in question was the wastewater from the chemical landfill in Tarnowskie Gory of 25-70 mg l(-1) boron content. The removal of boron from the above-described wastewater was examined in the static (batch) and dynamic (column) experiments. The static experiments were carried out to assess boron adsorption isotherms, based on which the most efficient adsorbent as well as the rough resin load was determined. On the basis of the dynamic experiment results, the boron adsorptive capacities of the examined resins were deduced. It was concluded that the use of the impregnants increased the ability of activated carbon to adsorb boron. Granulated activated carbon WG-12 impregnated with mannitol was found to be the most promising for the boron removal from wastewater of the Chemical Wastewater Plant in Tarnowskie Gory.

Experimental apparatus for investigation of sputtering and secondary ion emission induced by energetic ion beams

The construction of an experimental apparatus, for investigation of implantation, secondary ion emission and sputtering processes, during irradiation of samples with an ion beam of up to 70 keV energy, is described. The basis of the apparatus is an electromagnetic mass separator equipped with a quadrupole mass spectrometer located in the collector chamber. The computer data acquisition control system makes it possible to perform the experimental measurements with high accuracy and precision. Preliminary results of secondary ion mass spectral measurements, obtained for C, Al, Si and Cu targets bombarded with Ar(+) and Kr(+) ions, are presented.

Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL AMI Study)

OBJECTIVES

We compared a strategy of tenecteplase (TNK)-facilitated angioplasty with one of TNK alone in patients presenting with high-risk ST-segment elevation myocardial infarction (STEMI).

BACKGROUND

Previous trials show that thrombolysis followed by immediate angioplasty for the treatment of STEMI does not improve ischemic outcomes compared with thrombolysis alone and is associated with excessive bleeding complications. Since the publication of these trials, however, significant pharmacological and technological advances have occurred.

METHODS

We randomized 170 patients with high-risk STEMI to treatment with TNK alone (84 patients) or TNK-facilitated angioplasty (86 patients). The primary end point was a composite of death, reinfarction, recurrent unstable ischemia, or stroke at six months.

RESULTS

At six months, the incidence of the primary end point was 24.4% in the TNK-alone group versus 11.6% in the TNK-facilitated angioplasty group (p = 0.04). This difference was driven by a reduction in the rate of recurrent unstable ischemia (20.7% vs. 8.1%, p = 0.03). There was a trend toward a lower reinfarction rate with TNK-facilitated angioplasty (14.6% vs. 5.8%, p = 0.07). No significant differences were observed in the rates of death or stroke. Major bleeding was observed in 7.1% of the TNK-alone group and in 8.1% of the TNK-facilitated angioplasty group (p = 1.00).

CONCLUSIONS

In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications.

Impending paradoxical embolus: a case report and review of the literature

A case of a 43-year-old man with impending paradoxical embolism (IPE) is described. The patient initially presented with pulmonary embolism and was diagnosed with an IPE on transthoracic and transesophageal echocardiography. He was subsequently treated with heparin and thrombolysis. A comprehensive review of the English literature over the past 20 years identified 60 previously reported cases of IPE. This report discusses the main clinical features, the diagnostic role of echocardiography and the outcome of medical and surgical treatment strategies in patients with IPE. Based on the literature to date, we recommend that patients with impending paradoxical embolism be treated with initial systemic heparinization followed by emergent surgical embolectomy if the surgical risks are acceptable.

Speciation and removal of zinc from composted municipal solid wastes

This paper presents composting of the organic fraction of municipal solid waste containing 50,000 mg/kg of cellucotton and 7980 mg/kg of zinc carried out under laboratory conditions. In the initial material as well as the compost obtained, zinc, cadmium, copper, nickel, and lead were analyzed, and their forms were determined by means of sequential extraction. It was found that 65% of zinc occurs in the organically bound form. Removal of zinc from the waste through leaching and subsequent electrochemical separation from the leaching solution was also examined. A double extraction of the waste with sodium diphosphate(V) enables a reduction of zinc content to 1240 mg/kg. As a result of electrolysis of the leaching solution, 90.2% of Zn is separated on the cathode. This paper suggests a method for processing municipal solid waste with high zinc content based on extraction of the waste with sodium diphosphate(V) and composting. The leaching solution is recovered electrochemically.

Diagnostic value of the electrocardiogram in suspected pulmonary embolism

The electrocardiogram is shown to be of limited diagnostic value for determining pulmonary embolism in a prospective cohort study of unselected patients with suspected pulmonary embolism.

Aortitis with multiple aneurysms mimicking infective endocarditis

Aortitis usually produces aortic insufficiency by aortic root dilation. In rare cases the inflammation may involve the aortic valve cusps, causing valvular insufficiency. A patient in whom aortitis produced valvular masses, with aortic and peripheral arterial aneurysms, embolic episodes and aortic insufficiency is described. Valve replacement for suspected infective endocarditis was complicated by homograft dehiscence and multiple false aneurysms. Although immunosuppression was successful in decreasing the patient's vasculitis, he became infected and died of complications of aspergillus infection.

Cervical artery dissection is associated with widened aortic root diameter

OBJECTIVE

Dissection of the internal carotid and vertebral arteries is a well recognized cause of stroke, especially in the middle-aged. The exact etiology of this condition is controversial. According to one theory there is an underlying vasculopathy originating from disturbed development of the neural crest. The neural crest gives rise to several tissues, including the tunica media of large cervical arteries and the outflow tract of the heart. We attempted to test the theory that developmental abnormality at the level of the neural crest may play a role in dissection of the large cervical arteries.

METHODS

We designed a retrospective case control study. By means of transthoracic echocardiography we measured the aortic root diameter in a group of patients with radiographically determined dissection of at least one large artery in the neck. The results were compared to a control group.

RESULTS

In comparison to age matched controls, male patients were found to have a significantly larger aortic root. Although a similar trend was apparent in females, the difference between the patient and control group of females was not statistically significant.

CONCLUSIONS

Patients with cervical artery dissections may have other abnormalities in other organs arising from the neural crest. A larger prospective clinical study and further research are needed to establish a firm link between dissection of the cervical arteries and abnormalities in other organs.