In Vitro Assessment of Cardiac Fibroblast Activation at Physiologic Stiffness

Cardiac fibroblasts (CF) are an essential cell type in cardiac physiology, playing diverse roles in maintaining structural integrity, extracellular matrix (ECM) synthesis, and tissue repair. Under normal conditions, these cells reside in the interstitium in a quiescent state poised to sense and respond to injury by synthesizing and secreting collagen, vimentin, hyaluronan, and other ECM components. In response to mechanical and chemical stimuli, these "resident" fibroblasts can undergo a transformation through a continuum of activation states into what is commonly known as a "myofibroblast," in a process critical for injury response. Despite progress in understanding the contribution of fibroblasts to cardiac health and disease, much remains unknown about the signaling mediating this activation, in part owing to technical challenges in evaluating CF function and activation status in vitro. Given their role in monitoring the ECM, CFs are acutely sensitive to stiffness and pressure. High basal activation of isolated CFs is common due to the super-physiologic stiffness of traditional cell culture substrates, making assays dependent on quiescent cells challenging. To overcome this problem, cell culture parameters must be tightly controlled, and the use of dishes coated with biocompatible reduced-stiffness substrates, such as 8-kPa polydimethylsiloxane (PDMS), has shown promise in reducing basal activation of fibroblasts. Here, we describe cell culture protocol for maintaining CF quiescence in vitro to enable a dynamic range for the assessment of activation status in response to fibrogenic stimuli using PDMS-coated coverslips. Our protocol provides a cost-effective tool to study fibroblast signaling and activity, allowing researchers to better understand the underlying mechanisms involved in cardiac fibrosis. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Generation of 8-kPa polydimethylsiloxane (PDMS)/gelatin-coated coverslips for cardiac fibroblast cell culture Basic Protocol 2: Isolation of adult cardiac fibroblasts and plating onto PDMS coverslips Basic Protocol 3: Assessment of cardiac fibroblast activation by α smooth muscle actin (αSMA) immunocytochemistry.

The interaction and interference of preformed metal crowns on magnetic resonance imaging: a scoping review with a systematic methodology

Purpose

Preformed metal crowns are widely used to restore primary and permanent teeth. Children may require magnetic resonance imaging (MRI) for diagnosis and monitoring of diseases in the head and neck region. Metallic objects, in the field of view, may compromise the diagnostic value of an MRI. The impact on the diagnostic quality of an MRI in children who have had preformed metal crowns placed has not been assessed. The aim of this systematic review was to evaluate the impact that PFMCs have on MRI imaging quality and thus the overall diagnostic value.

Methods

Electronic searches of the following databases were completed: MEDLINE, EMBASE, Cochrane Library, Web of Science and Open Grey. Primary in vivo studies on children who had at least one preformed metal crown placed and required an MRI investigation were to be included. PRISMA guidelines were followed and screening/data extraction was carried out by two independent calibrated reviewers.

Results

A total of 7665 articles were identified. After removing duplicates, 7062 were identified for title and abstract screening. Thirty-four articles underwent full-text review, of which none met the inclusion criteria. Most common reasons for exclusion were not placing preformed metal crowns (n = 16) or in vitro studies (n = 12).

Conclusion

No in vivo studies were identified to establish the hypothetical impact preformed metal crowns would have on the diagnostic quality of an MRI in the head and neck region. Decision making needs to be guided on a case by case basis. Further high-quality clinical studies are required.

Dental status, visits, and functional ability and dietary intake of elderly in Israel

Background

Epidemiological studies have shown deterioration in dental health accompanying the ageing process. Tooth loss increases with age. Chewing ability is closely correlated with number of natural teeth present: there is a threshold of 20–21 teeth, below which chewing ability declines. The government of Israel is currently considering adding dental treatment for elderly to the basket of services of the National Health Insurance Law. Information on the influence of elderly’s dental health on nutrition and general health status can contribute to the decision making process.

Methods

Secondary analysis of data collected on a subsample (N = 1776) of the cross-sectional Mabat Zahav - National Health and Nutrition Survey of the Elderly was done. Intakes of energy, fiber, protein, fruits and vegetables, associations with dental visits, dentures presence and functional ability were analyzed. Linear regression adjusted for confounders was performed.

Results

Statistically significant differences in dietary intake of energy, fiber, protein and vegetables were found between elderly who visited a dentist in the last year and those who did not. Elderly who possessed dentures had lower dietary intakes than their dentate counterparts. Elderly with functional problems such as impaired chewing had worse dietary intakes than the others. This was so after controlling for education, degree of interest in the relationship between nutrition and health and reading the nutrition label.

Conclusions

The findings in our study suggest that those who visited a dentist in the last year, had natural teeth and no denture/s and reported no chewing problems had better dietary intake. The results emphasize the importance of maintaining adequate dental health, preserving natural teeth and regular dental visits in the elderly to assure adequate nutrient status in this age group.

The demographic and morbidity characteristics of a population receiving food support in Israel

BACKGROUND

Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients.

METHODS

In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only.

RESULTS

The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension.

DISCUSSION AND CONCLUSIONS

The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).

Texture-modified foods and thickened fluids used in dysphagia: Israeli standardised terminology and definitions

BACKGROUND

Texture-modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture-modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards.

METHODS

A multidisciplinary committee of speech-language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture-modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture-modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017.

RESULTS

Twenty-six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture-modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology.

CONCLUSIONS

The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.

Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes

Purpose: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes.

Material and Methods: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears.

Results: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year).

Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.

Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries

BACKGROUND/OBJECTIVES

The Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel.

METHODS

Data from the US National Health and Nutrition Survey (NHANES) 1999-2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005-2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS).

RESULTS

Among 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2 y and 74.9 y, 20% and 27% had low MDS (0-2), 66% and 62% had a medium score (3-5), and 14% and 11% had a high score (6-9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511-0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540-1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276-0.934).

CONCLUSIONS

Adherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.

Urinary concentrations of organophosphate pesticide metabolites in adults in Israel: demographic and dietary predictors

Exposure to organophosphate pesticides (OPs) in agricultural and urban populations has been associated with a range of adverse health effects. The purpose of the current study was to estimate exposure to OPs in the general adult population in Israel and to determine dietary and demographic predictors of exposure. We measured six non-specific organophosphate pesticide metabolites (dialkyl phosphates) in urine samples collected from 247 Israeli adults from the general population. We collected detailed demographic and dietary data from these individuals, and explored associations between demographic and dietary characteristics and urinary dialkyl phosphate concentrations. OP metabolites were detectable in all urine samples. Concentrations of several dialkyl phosphate metabolites (dimethylphosphate, dimethylthiophosphate, diethylphosphate) were high in our study population relative to the general populations in the US and Canada and were comparable to those reported in 2010 in France. Total dialkyl phosphates were higher in individuals with fruit consumption above the 75th percentile. In a multivariate analysis, total molar dialkyl phosphate concentration increased with age and was higher in individuals with high income compared to individuals with the lowest income. Total diethyl metabolite concentrations were higher in females and in study participants whose fruit consumption was above the 75th percentile. In conclusion, we found that levels of exposure to OP pesticides were high in our study population compared to the general population in the US and Canada and that intake of fruits is an important source of exposure.

Urinary concentrations of environmental contaminants and phytoestrogens in adults in Israel

BACKGROUND

The Ministry of Health Biomonitoring Study estimated exposure of individuals in the Israeli population to bisphenol A (BPA), organophosphate (OP) pesticides, phthalates, cotinine, polycyclic aromatic hydrocarbons (PAHs), and the phytoestrogenic compounds genistein and daidzein.

METHODS

In 2011, 250 individuals (ages 20-74) were recruited from five different regions in Israel. Urine samples were collected and questionnaire data were obtained, including detailed dietary data (food frequency questionnaire and 24hour recall). Urinary samples were analyzed for BPA, OP metabolites (dialkyl phosphates), phthalate metabolites, cotinine, PAH metabolites, genistein, and daidzein.

RESULTS AND DISCUSSION

BPA urinary concentrations were above the limit of quantification (LOQ) in 89% of the samples whereas urinary concentrations of phthalate metabolites were above the LOQ in 92-100% of the samples. PAH metabolites were above the LOQ in 63-99% of the samples whereas OP metabolites were above the LOQ in 44-100% of the samples. All non-smoking participants had detectable levels of cotinine in their urine; 63% had levels above the LOQ, and the rate of quantification was high compared to the general non-smoking population in Canada. Median creatinine adjusted concentrations of several OP metabolites (dimethyl phosphate, dimethyl thiophosphate) were high in our study population compared to the general US and Canadian populations. Median creatinine adjusted urinary BPA concentrations in the study population were comparable to those in Belgium and Korea; higher than those reported for the general US, German, and Canadian populations; and very low compared to health-based threshold values. Phthalate concentrations were higher in our study population compared to the general US population but values were very low compared to health-based threshold values. Median creatinine adjusted PAH concentrations were generally comparable to those reported for the general US population; median creatinine adjusted daidzein concentrations were high in our population compared to the general US population whereas genistein concentrations were comparable.

CONCLUSIONS

We interpreted observed urinary contaminant levels observed in our study by comparing values with health-based threshold values and/or values from international human biomonitoring studies. Using this data interpretation scheme, we identified two contaminants as being of potential public health concern and high priority for public health policy intervention: environmental tobacco smoke (ETS) and OP pesticides. We used the data collected in this study to support public health policy interventions. We plan to conduct a follow-up biomonitoring study in 2015 to measure ETS and OP exposure in the general population in Israel, to evaluate the effectiveness of relevant policy interventions.

Adolescents' physical activity habits--results from a national health survey

BACKGROUND

  The MABAT Youth National Health and Nutrition Survey was conducted in Israel by the Ministry of Health and the Center for Disease Control. This article presents results of physical activity (PA) habits in Israel, in relation to recommendations by world health organizations.

METHODS

  Participants were 6274 adolescents, grades 7-12, enrolled in a cross-sectional, representative, school-based survey. Sufficient level of PA was defined as any moderate and vigorous level of PA that adds up daily to 60 min/day. Light PA was considered to be an insufficient level of PA.

RESULTS

  Only 10.5% of the participants reported performing sufficient PA. Large gender differences were found, with 17.7% of boys versus only 4.6% of girls meeting the guidelines.

CONCLUSIONS

  Results highlight the need to develop programmes for school children in Israel to promote PA. Such programmes have been initiated in many countries that have a large percentage of adolescents with a sedentary lifestyle.

Effects of Active vs. Passive Recovery on Work Performed During Serial Supramaximal Exercise Tests

The current investigation was undertaken to determine the effects of active versus passive recovery on work performance during repeated bouts of supramaximal exercise. Six healthy sedentary subjects and 9 moderately trained healthy hockey players performed serial 30-second Wingate anaerobic power tests (WAnT) on a bicycle ergometer interposed with 4 minutes of active recovery at a work rate corresponding to 28 % of VO(2)max or passive recovery at rest. Peak power, mean power, total work achieved, and fatigue index were calculated for the serial WAnT. Capillary blood lactate was determined at 5-minute intervals after the last WAnT during 30 minutes of active or passive recovery. Mean power was significantly greater during active recovery in sedentary subjects when compared with passive recovery (388 +/- 42 vs. 303 +/- 37 W, p < 0.05), but did not differ according to recovery mode in moderately trained hockey players (589 +/- 22 W active vs. 563 +/- 26 W passive, p = 0.14). Total work achieved significantly increased during active when compared with passive recovery in sedentary subjects (34 890 +/- 3768 vs. 27 260 +/- 3364 J, p < 0.02) and moderately trained hockey players (86 763 +/- 9151 vs. 75 357 +/- 8281 J, p < 0.05). Capillary blood lactate levels did not differ during active when compared with passive recovery in sedentary subjects but were significantly lower during active when compared with passive recovery in moderately trained hockey players. These data demonstrate that active recovery at a work rate corresponding to 28 % of VO(2)max increases total work achieved during repeated WAnT when compared with passive recovery in sedentary subjects and moderately trained hockey players.

Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure

OBJECTIVE

To characterise the effects of acetylcholinesterase inhibition with pyridostigmine on parasympathetic tone in patients with chronic heart failure (CHF).

DESIGN

Prospective randomised, double blind crossover trial.

SETTING

University hospital outpatient heart failure clinic.

PATIENTS

20 ambulatory subjects with stable CHF (mean age 55 years, mean ejection fraction 24%).

INTERVENTIONS

Oral administration of a single dose of pyridostigmine 30 mg and matching placebo on separate days.

MAIN OUTCOME MEASURES

Heart rate recovery at one minute and three minutes after completion of maximal exercise.

RESULTS

Heart rate recovery at one minute after exercise was significantly greater after administration of pyridostigmine than after administration of placebo (mean (SEM) 27.4 (3.2) beats/min v 22.4 (2.4) beats/min, p < 0.01). Heart rate recovery at three minutes after exercise did not differ after administration of pyridostigmine and placebo (mean (SEM) 44.4 (3.9) beats/min v 41.8 (3.6) beats/min, NS). Peak heart rate, peak oxygen uptake, peak respiratory exchange ratio, plasma noradrenaline (norepinephrine) concentrations, and plasma brain natriuretic peptide concentrations did not differ after administration of pyridostigmine and placebo.

CONCLUSIONS

Acetylcholinesterase inhibition with pyridostigmine increased heart rate recovery at one minute but not at three minutes after exercise. A specific effect of pyridostigmine on heart rate one minute after exercise suggests that pyridostigmine augments parasympathetic tone in patients with CHF.

Dietary folate and the incidence and prevention of neural tube defects: a proposed triple intervention approach in Israel

The efficacy of folic acid in the prevention of neural tube defects depends on whether it is administered to women during the period surrounding conception. Optimizing the compliance of women at this critical time is a public health challenge. We assess the need for formulation of public health policy in Israel aimed at enhancing folate intake by women, examine policy implementation strategies, and review policy options regarding the approaches to enhance folic acid intake.

The effect on heart rate and facial skin temperature of wearing respiratory protection at work

Twelve New Zealand workers from a range of occupations were studied to investigate the effect of wearing air-filtering respiratory protection on heart rate (HR) and facial skin temperature (Tlip and Tcheek) whilst working. All variables were measured continuously during simulated and actual work. The former allowed physiological measurements to be undertaken during the physical activities carried out during the work task without respirators and without exposure to hazardous airborne substances. Mean heart rates in subjects moving without respirators ranged from 75 to 94 beats/min and from 77 to 98 beats/min during respirator use at work. Mean skin temperature under the mask (Tlip) increased in 11 of the 12 subjects while using respirators (range 1.2-4.8 degrees C) but Tcheek only increased in four (range 0.6-1.5 degrees C). The use of simulated work tasks in the experiment was a compromise. The heart rate data from the real and simulated work indicated that effort and workload, though not identical, were similar. The increase in skin temperature under the mask may account for the reluctance of individuals to wear respiratory protection at work. This region of the face is very thermosensitive.

Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes

PURPOSE

To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes.

MATERIAL AND METHODS

Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears.

RESULTS

A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year).

CONCLUSION

Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.

Cardiovascular exercise and wellness. Exercise training for cardiac rehabilitation patients: meeting the challenges of the millennium

Exercise training for cardiac rehabilitation has evolved over the past decades in response to a growing knowledge base in exercise physiology, an expanding understanding to the knowledge base of coronary disease, and a change in the patients presenting for cardiac rehabilitation. The patient population has changed from a post myocardial infarction patient group, to patients who have had coronary artery revascularization (coronary artery bypass surgery or percutaneous transluminal coronary angioplasty) with the implantation of intraarterial stents. Program goals have evolved from enhancing endurance fitness in deconditioned patients to initiating the long-term adoption of an active exercising lifestyle with the use of strength training to complement endurance training. An increased understanding of behavioral issues in the adoption of an active lifestyle will influence the evolution of cardiac rehabilitation exercise training. During the next several years, it is anticipated that the patient population will change to include patients with significant left ventricular systolic dysfunction and congestive heart failure. The exercise training programs will then further evolve to reflect the successful exercise training formats utilized in the multicenter trials of exercise training for patients with congestive heart failure. (c) 2000 by CHF, Inc.

Comparison of two calcium blockers on hemodynamics, left ventricular mass, and coronary vasodilatory in advanced hypertension

Dihydropyridine and nondihydropyridine calcium channel blockers (CCB) differ in pharmacologic characteristics. Few clinical studies distinguish effects of CCB as monotherapy. We conducted a comprehensive comparison of two CCB on patients with moderate to severe hypertension. Thirty patients with pretreatment diastolic blood pressures > or = 100 mm Hg were randomly assigned to either nifedipine-GITS or verapamil-SR. Dose titration achieved a diastolic blood pressure of < or = 95 mm Hg or a decrease of > or = 15 mm Hg over 4 weeks. Clinic blood pressure (BP), 24-h ambulatory BP, exercise BP, left ventricular mass, systolic and diastolic function by echocardiography, and coronary flow reserve by split-dose thallium-201 imaging with adenosine were assessed at baseline, end of titration, 3 months and 6 months of treatment. Plasma renin activity, atrial natriuretic peptide, norepinephrine, and epinephrine were assayed. Both drugs caused similar reductions in clinic and 24-h ambulatory BP and similar reductions in left ventricular mass index. Compared to nifedipine-GITS, verapamil-SR produced a significantly lower resting and peak exercise heart rate. Nifedipine-GITS elicited a lower peak exercise systolic BP. At end titration nifedipine-GITS produced lower plasma atrial natriuretic peptide levels, no longer apparent by 6 months. Plasma norepinephrine was lower with verapamil-SR, also at end titration and at 3 months, but not at 6 months. Plasma epinephrine and plasma renin activity were unchanged by either drug. There was no difference for systolic or diastolic left ventricular function or coronary flow reserve between the two treatments. Once daily nifedipine-GITS and verapamil-SR are equally effective for reduction of arterial pressure in moderate to severe hypertension. Differences in their hemodynamic profiles and neurohormonal responses are consistent with preclinical pharmacologic characteristics. The clinical implications of their similarities and differences remain to be fully evaluated in outcome studies.

Experience with an up-flow biological aerated filter (BAF) for tertiary treatment: from pilot trials to full scale implementation

Biofilters can be added to existing non-nitrifying activated sludge plants for tertiary ammonia removal and effluent polishing. It is a convenient, efficient, and cost effective way of meeting more stringent consents. In order to prove this technology, a biofilter pilot plant was installed in a large activated sludge plant with challenging conditions, since almost half of the load is industrial effluent and the water temperature can be as low as 7 degrees C. Trials were conducted over a two year period, providing the following information: low water temperature does not affect the process; the optimum rise rate at nominal flow is 8.5 m/h for this wastewater; the consent can be achieved for ammonia loads up to 0.94 kgNH4N/M3 media/day; about 50% of the post-secondary TSS and BOD can be removed in the BAF; a large proportion of industrial effluent has not had any noticeable effect on the beads after two years. A full scale plant with a nominal flow of 8257 l/s was then built and commissioned in summer 1998. Seeding was completed within three weeks of starting the filters. Two months later, a 28 day takeover was started. Results obtained on full scale plant during and after this test confirm the results obtained on the pilot.

Comparison of functional capacity in patients with end-stage heart failure following implantation of a left ventricular assist device versus heart transplantation: results of the experience with left ventricular assist device with exercise trial

BACKGROUND

Use of a permanent left ventricular assist device (LVAD) has been proposed as an alternate treatment of patients with end-stage heart failure. The purpose of this study was to compare the functional capacity of patients following implantation of a LVAD vs heart transplant (HTx).

METHODS

Eighteen patients from 6 centers who received an intracorporeal LVAD as a bridge to HTx underwent treadmill testing 1 to 3 months post-LVAD and again post-HTx. Baseline and peak measurements, including oxygen consumption, blood pressures, and respiratory rate were made during each treadmill test.

RESULTS

Peak oxygen consumption was 14.5+/-3.9 ml/kg/minute post-LVAD and 17.5+/-5.0 ml/kg/minute post-HTx (p < .005). The percentage of the predicted peak oxygen consumption based on gender, weight, and age was 39.5%+/-5.5% post-LVAD and 47.7%+/-10.9% post-HTx (p < .005). Exercise duration was lower post-LVAD than post-HTx (10.3+/-4.2 minute vs 12.5+/-5.4 minute, p < .05). After LVAD implantation, peak total oxygen consumption correlated with peak LVAD rate and output. Eight patients reached an LVAD rate of 120 beats per minute (bpm) before the conclusion of exercise, the maximum rate for the outpatient electric device. The peak respiratory exchange ratio post-LVAD was 1.15+/-0.22 and post-HTx was 1.15+/-0.18, consistent with a good effort in both groups.

CONCLUSIONS

Patients demonstrated a lower functional capacity post-LVAD than post-HTx. For some patients functional capacity post-LVAD may be improved by a higher maximum LVAD rate and output.

Genetic and physiologic analysis of the role of uncoupling protein 3 in human energy homeostasis

By virtue of its potential effects on rates of energy expenditure, uncoupling protein 3 (UCP3) is an obesity candidate gene. We identified nine sequence variants in UCP3, including Val9Met, Val102Ile, Arg282Cys, and a splice site mutation in the intron between exons 6 and 7. The splice mutation results in an inability to synthesize mRNA for the long isoform (UCP3L) of UCP3. Linkage (sib pair), association, and transmission disequilibrium testing studies on 942 African-Americans did not suggest a significant effect of UCP3 on body composition in this group. In vastus lateralis skeletal muscle of individuals homozygous for the splice mutation, no UCP3L mRNA was detectable; the short isoform (UCP3S) was present in an increased amount. In this muscle, we detected no alterations of in vitro mitochondrial coupling activity, mitochondrial respiratory enzyme activity, or systemic oxygen consumption or respiratory quotient at rest or during exercise. These genetic and physiologic data suggest the following possibilities: UCP3S has uncoupling capabilities equivalent to UCP3L; other UCPs may compensate for a deficiency of bioactive UCP3L; UCP3L does not function primarily as a mitochondrial uncoupling protein.

The long isoform uncoupling protein-3 (UCP3L) in human energy homeostasis

The biological role(s) proposed for UCP3 in energy homeostasis have been based primarily upon amino acid sequence homology to UCP1. Spontaneous mutations of UCP3> have been described in humans, but not in rodents. The functional consequences-or lack thereof-of these mutations in humans will be of great importance in elucidating the biology of this protein. The results of two such studies are summarized here.

Resting diastolic function and left ventricular mass are related to exercise capacity in hypertensive men but not in women

We evaluated the impact of diastolic function and gender on exercise capacity in sedentary, untreated hypertensive subjects (34 men, 23 women) using echocardiography and a bicycle ergometry with measurement of oxygen consumption (VO2). In men, peak (A) mitral inflow velocity and left ventricular (LV) mass were inversely related to peak VO2 (r = -0.64) and maximal workload (r = -0.57) and were the sole independent determinants of exercise capacity. In women, there was no relationship between any echocardiographic measure and exercise capacity. Thus, LV mass and Doppler-determined diastolic function predict maximal VO2 in hypertensive men but not in women. This finding may be related to gender differences in the contribution of diastolic filling to exercise capacity or may reflect limitations of resting Doppler echocardiography to predict exercise diastolic filling in hypertensive women.

Comparison of exercise performance in patients with chronic severe heart failure versus left ventricular assist devices

BACKGROUND

Left ventricular assist devices (LVADs) are frequently used as a bridge to cardiac transplantation and may be useful as long-term therapy. The purpose of this study was to compare the exercise performance of LVAD patients with that of ambulatory heart failure patients.

METHODS AND RESULTS

Exercise testing with hemodynamic and respiratory gas measurements was performed in 65 congestive heart failure (CHF) patients (age 53+/-10 years) and 20 LVAD patients (age 49+/-8 years). Peak Vo2 was significantly higher in the LVAD than the CHF patients (CHF, 12+/-3; LVAD, 15. 9+/-3.8 mL . kg-1 . min-1; P<0.001), as was the Vo2 at the anaerobic threshold (CHF, 8.1+/-2.1; LVAD, 12.2+/-2.9 mL . kg-1 . min-1; P<0.001). At rest, mean arterial blood pressure (CHF, 87+/-11; LVAD, 94+/-9 mm Hg) and cardiac output (CHF, 4+/-1; LVAD, 4. 9+/-0.9 L/min) were increased, whereas mean pulmonary artery pressure (CHF, 28+/-11; LVAD, 18+/-4 mm Hg) and pulmonary artery wedge pressure (CHF, 16+/-10; LVAD 5+/-3 mm Hg) were reduced (all P<0.01). At peak exercise, heart rate (CHF,125+/-24; LVAD, 148+/-24 bpm), blood pressure (CHF, 87+/-14; LVAD,96+/-12 mm Hg), and cardiac output (CHF, 7.6+/-2.2; LVAD, 11.2+/-2.6 L/min) were higher (all P<0. 01), whereas mean pulmonary artery pressure (CHF, 48+/-12; LVAD, 30+/-5 mm Hg) and mean pulmonary capillary wedge pressure (CHF, 31+/-11; LVAD, 14+/-6 mm Hg) were lower in the LVAD group (both P<0. 001). In the LVAD patients, Fick cardiac output was higher than LVAD flow sensor value measurements (Fick, 11.6+/-2.5; LVAD, 8.1+/-1.2 L/min; P<0.001).

CONCLUSIONS

Hemodynamic measurements at rest and during exercise are significantly improved in patients with devices compared with those in ambulatory heart failure patients awaiting cardiac transplantation. Similarly, the exercise capacity of device patients is better than that of transplant candidates and in the majority of patients is similar to that of patients with mild CHF.

A novel substance associated with gallamine-induced myoclonus

If gallamine or d-tubocurarine gains access to the central nervous system it produces a myoclonus, a synchronized jerking of many skeletal muscles. Each jerk is accompanied by a slow wave in the inferior olive. The jerking continues for 24 h or more after the gallamine or d-tubocurarine can no longer be detected in the CSF. We report here that a novel substance appears in the CSF and persists for a long period of time, possibly as long as the twitching. This substance is not corticotrophin-releasing factor (CRF) nor does CRF or harmaline (a substance causing a tremor by an action on the inferior olive) lead to the appearance of the novel substance. At present the nature of this substance is not known.

Changes in plasma endothelin-1 levels reflect clinical response to beta-blockade in chronic heart failure

Plasma levels of endothelin-1 are elevated in patients with chronic heart failure; however, it is unknown whether changes in plasma endothelin-1 levels accurately reflect clinical response to therapy in these patients. To determine this, we measured plasma endothelin-1 in addition to functional, hemodynamic, and other neurohormonal parameters as part of a double-blind, placebo-controlled study of the beta-blocker vasodilator carvedilol in patients with moderate to severe chronic heart failure. Patients were assigned (2:1 randomization) to receive carvedilol (25 mg twice daily, n = 10) or placebo (n = 5) for 14 weeks, with evaluations made before and after therapy. Compared to patients receiving placebo, patients receiving carvedilol improved significantly as assessed by the parameters described. These changes were paralleled by significant falls in endothelin-1 with carvedilol (-2.1 + 3.8 pg/ml) in comparison to placebo (2.2 + 3.9 pg/ml; p < 0.05 for between-group differences). Changes in endothelin-1 after treatment in both groups correlated significantly with changes in symptom severity, New York Heart Association class, 6-minute walk distance (r = 0.64 to 0.80; p < 0.05), hemodynamic parameters (ejection fraction, right atrial pressure, pulmonary artery diastolic pressure, pulmonary wedge pressure, right atrial pressure, and stroke volume index; r = 0.54 to 0.86; p < 0.05), and neurohormonal parameters (serum aldosterone and plasma norepinephrine (r = 0.74 to 0.76; p < 0.05). By stepwise regression analysis, change in endothelin-1 was an independent, noninvasive predictor of functional and hemodynamic responses to therapy in these patients. These findings suggest that endothelin-1 accurately reflects functional, hemodynamic, and neurohormonal responses to beta-blocker therapy in patients with congestive heart failure. Measurement of endothelin-1 may therefore be a useful, noninvasive approach to the evaluation of clinical response to drug therapy in these patients.

Role of endothelin in the exercise intolerance of chronic heart failure

In conclusion, plasma levels of the endothelial-derived vasoconstrictor endothelin-1 (but not those of other neurohormonal vasoconstrictor factors), measured during exercise correlated closely with objective variables of exercise capacity in patients with heart failure. These findings suggest that endothelin-1 may contribute to exercise intolerance in patients with heart failure, perhaps by limiting the ability of the peripheral vasculature to dilate during exercise.

Three- to 7-year follow-up after albendazole treatment of 68 patients with cystic echinococcosis (hydatid disease)

Sixty-eight cystic echinococcosis patients were each treated with 800 mg albendazole/day in four 28-day courses separated by 14-day drug-free intervals. Follow-up for 3-7 years showed that this treatment alone eradicated the cysts in many patients; in most of the remainder, disease progression stopped. Of the 59 patients with liver cyst(s), 41% were cured (all cysts disappeared), 17% showed marked improvement (> 25% contraction, complete consolidation), 24% limited improvement and 15% no change. Of the 12 patients with lung cyst(s), 72% were cured, 9% showed limited improvement and 18% showed no change (18%). No patient worsened but a recurrence occurred in two patients at about 56 months. The times taken to detect an initial cyst change and to detect cure were longer than is generally expected; initial cyst changes and cure could only be detected after 1 year in 12% and 69% of patients with liver cysts and 22% and 37% of those with lung cysts, respectively.

The perception of physical fitness as a guide to its evaluation in firemen

There is increasing interest in the acquisition and measurement of physical fitness in general populations (Bassey and Fentem 1981). Measuring fitness can be uncomfortable and exhausting for subjects and expensive and time-consuming for experimenters (Andersen et al. 1971). Various authors have described and/or evaluated methods for the prediction of VO2 max (Astrand and Rhyming 1954, Davies 1968, Fitchett 1985, Harrison et al. 1980, Jette 1979, Jette et al. 1982, Shephard 1975, Shephard et al. 1979). A valid, safe, socially-acceptable alternative for such measurements applicable to a population would be of benefit. Asking subjects how they perceive their own physical fitness might be such an alternative. The validity and reliability of the data contained from such a questionnaire could be tested against conventional measures of physical fitness. A study which incorporated questionnaire surveys as one method of determining physical fitness in a large population was undertaken on Fire Service personnel in England, Scotland, and Wales (Ellam et al. 1985); a subsample of the population were questioned in the same way but in addition their fitness was assessed by physiological measurements. This paper describes the characteristics of the physical fitness of an average fireman as revealed by responses to questionnaires and how firemen felt their fitness was related to their working duties; it further examines these in relation to objective measurements.

Initial training as a stimulus for optimal physical fitness in firemen

In this investigation the physical fitness of 34 recruits to the UK Fire Service was assessed before and after their initial training (tests 1-2) and on three occasions (tests 3-5) during the first 18 months of their service (n = 34 + 6 = 40). The initial training (test 2-test 1) resulted in an increase in maximum aerobic power (11% p < 0.05), body mass (2 kg, p < 0.001), lean body mass (2.02 kg, p < 0.001), grip and lifting strengths (p < 0.001), and in calf girth (p < 0.05). But no change in waist girth, maximum anaerobic power or measures of lung function was noted. There was evidence therefore that the men became physically fitter. In the first eighteen months of their service, subjects' maximum oxygen consumption declined to pre-training levels, while body mass continued to increase with a decrease in lean body mass (p < 0.001). Strength remained unaltered or tended to fall with a decrease in calf girth (p < 0.05). These changes reflected a return towards pre-training physical fitness levels. It is suggested that the initial training, while ill-matched to the firemen's habitual activity, produced levels of physical fitness which may approximate more closely to the infrequent peak requirements experienced by the men during actual fire fighting. Consequently it is concluded that the physical training during service was insufficiently intense and that a more effective programme could be designed to maintain an appropriate level of physical fitness.

Serosurvey of some major zoonotic infections in children and teenagers in Bali, Indonesia

One hundred and ninety serum samples, mainly from children and teenagers, from northeast Bali were tested for the presence of antibodies against five zoonotic agents: Brucella abortus, Coxiella burnetii, Toxoplasma gondii, Toxocara canis and Trichinella spiralis. All children were negative for brucellosis and Q fever. A high prevalence rate was found for toxocariasis (63.2%) and trichinosis (19.5%). Antibody prevalence against T. gondii was found to be rather low (3.1%). To our knowledge, this is the first evidence of toxoplasmosis, toxocariasis and trichinosis infection in humans on Bali. Eating habits and poor hygiene may explain the frequency of parasitic infestations in the children and teenagers in Bali.

[Hydatid disease in Israel]

The prevalence pattern of hydatid disease (echinococcosis) in Israel has changed during the past 40 years. Until 1948 it was mainly common in the non-Jewish community; after 1948 its prevalence was high in Jews who immigrated to Israel from Arab countries; and since 1967 endemicity has gradually increased in some rural and semirural Arab and Druze communities. Of 224 surgically-confirmed cases of hydatid disease from these communities during 1960-1989, 52 were from Yirka, a Druze community with a population of 8200. In that town 8% of 63 dogs tested after an arecoline purge and 10% of 255 sheep at the local abattoir were found to be infected. Randomized serosurvey of 758 inhabitants indicated a 1.6% cumulative percentage of hydatid infections, leading to an extrapolated rate of 1583/100,000. Yirka thus is one of the most highly endemic areas for hydatid disease in the world.

The plastic envelope method, a simplified technique for culture diagnosis of trichomoniasis

Although culture of Trichomonas vaginalis is more sensitive than wet mounts in the diagnosis of trichomoniasis, the lack of convenience of culture prevents it from being widely used. To improve the acceptability of diagnosis by culture, a plastic envelope method (PEM) was devised. PEM permits both immediate examination and culture in one self-contained system. The medium consists of dry ingredients that are reconstituted with water before use. The effectiveness of immediate examinations by PEM was compared with that of wet mounts, and the effectiveness of culture by PEM was compared with that of culture in Trichomonas Medium No. 2 (Oxoid). Of 710 vaginal secretion specimens from symptomatic and asymptomatic women that were tested by the four methods, 62 (9%) were positive for T. vaginalis. The sensitivity was 66% by wet mount, 66% by immediate examination by PEM, 89% by cultures in Oxoid medium, and 97% by culture by PEM. The two culture methods had equivalent sensitivities but were significantly (P less than 0.0001) more sensitive than the two immediate methods. The combined immediate examination by PEM plus culture was more convenient to use than wet mounts plus culture in Oxoid medium. The long shelf-life of PEM's dry medium and its anticipated low cost are additional advantages.

Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children

Hepatitis E virus (HEV) is thought to be a cause of enterically transmitted non-A, non-B (ET-NANB) hepatitis. Waterborne epidemics have been recorded in many developing countries, mainly affecting young-to-middle-aged adults; sporadic infection and overt illness in children are rare. However, a convenient and sensitive diagnostic test for HEV infection is not yet available. We now report the use of a solid-phase enzyme-linked immunoassay (ELISA) that detects IgM and IgG antibody to HEV. In a prospective study of endemic acute hepatitis during 1986 in rural Benha, Egypt, 15 (42%) of 36 children with NANB hepatitis (from whom convalescent-phase sera were available every 3 months to 9 or 12 months) were positive for anti-HEV-IgG by ELISA. Of 20 sera from healthy Benha children (controls), 5 (25%) were also positive for anti-HEV-IgG. When evaluated for anti-HEV-IgM, 6 of the 15 IgG-positive children, but none of the controls, were IgM positive and were thus regarded as having confirmed acute HEV infections. These 6 cases together with 2 presumptive cases (IgM negative, IgG seroconversion from positive to negative) presented sporadically over 9 months. This ELISA is a convenient method for the diagnosis of HEV infection; we have shown that the disease is present in Egypt, that it can occur endemically as sporadic cases, and that children do have overt infection.

High prevalence of human hydatid disease (echinococcosis) in communities in northern Israel: epidemiologic studies in the town of Yirka

The resurgence of hydatid disease in communities in northern Israel led to epidemiologic studies in 1988 in the town of Yirka, a semirural Druze community of 8200 persons. In domestic animal surveys, 8% of 63 dogs tested after an arecoline purge and 10% of 255 sheep at the abattoir were found to be infected. In a randomized serosurvey of 758 persons using the indirect hemagglutination test (positive titer greater than or equal to 1:512), 9% (68) had a titer greater than or equal to 1:64, 2.2% had a titer greater than or equal to 1:256 and 0.9% had a titer greater than or equal to 1:512. Of those with titers greater than or equal to 1:64, 59 were evaluated by abdominal sonography and chest x-ray: 6 of the 59 were found to be persons who previously had had a liver or a lung hydatid cyst surgically removed; 6 other persons (5 with negative indirect hemagglutination titers) were found to have a newly detected asymptomatic cyst. Of the latter group, hydatid confirmation was subsequently obtained by surgery for 2 persons and by arc 5 and/or immunoblot assay for 4 persons. Thus, the cumulative percentage of confirmed present or recent past hydatid infections was 12/758 (1.6%) leading to an extrapolated rate of 1583/100,000 persons. This ranks Yirka among the highly endemic areas for hydatidosis worldwide. The study also showed that imaging methods were more sensitive than the indirect hemagglutination serologic test for conducting a prevalence survey.