Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease

Objective

Atherosclerosis expression varies across not only coronary, cerebrovascular, and peripheral arteries but also within the peripheral vascular tree. The underlying pathomechanisms of distinct atherosclerosis phenotypes in lower extremity peripheral artery disease (PAD) is poorly understood. We investigated the association of cardiovascular risk factors (CVRFs) and atherosclerosis distribution in a targeted approach analyzing symptomatic patients with isolated anatomic phenotypes of PAD.

Methods

In a cross-sectional analysis of consecutive patients undergoing first-time endovascular recanalization for symptomatic PAD, data of patients with isolated anatomic phenotypes of either proximal (iliac) or distal (infrageniculate) atherosclerosis segregation were extracted. We performed a multivariable logistic regression model with backward elimination to investigate the association of proximal and distal PAD with CVRFs.

Results

Of the 637 patients (29% females) with endovascular recanalization, 351 (55%) had proximal and 286 (45%) had distal atherosclerosis. Female sex [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.20-0.54, p = 0.01], active smoking (OR 0.16, 95% CI 0.09-0.28, p < 0.001), and former smoking (OR 0.33, 95% CI 0.20-0.57, p < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93-5.46, p < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08-1.28, p < 0.001), and older age (OR 1.31, 95% CI 1.06-1.61, p = 0.01) were associated with distal disease.

Conclusion

Female sex, particularly in the context of smoking, is associated with clinically relevant, proximal atherosclerosis expression. Our additional findings that distal atherosclerosis expression is associated with DM, CKD, and older age suggest that PAD has at least two distinct atherosclerotic phenotypes with sex-specific and individual susceptibility to atherogenic risk factors.

Chronic in situ tissue cooling does not reduce lignification at the Swiss treeline but enhances the risk of 'blue' frost rings

In their 2013 paper, Lenz et al. illustrated how trees growing at the low-temperature limit respond to a chronic in situ warming or cooling by 3 K, by employing Peltier-thermostated branch collars that tracked ambient temperatures. The micro-coring-based analysis of seasonal tree ring formation included double-staining microtome cross sections for lignification, but these data had not been included in the publication. In this short communication, we complement these data, collected in 2009 at the Swiss treeline, and we show that a 3 K cooling that corresponds to a 500-600 m higher elevation, had no influence on lignification. However, when a frost event occurred during the early part of ring formation, the 3 K cooling produced a blue (non-lignified) layer of cells, followed by normally lignified cells for the rest of the season. Hence, the event did not affect the cambium, but interrupted cell wall maturation in cells that were in a critical developmental stage. We conclude, that chronic cooling does not affect lignification at treeline, but it increases the risk of frost damage in premature xylem tissue.

Fetal 4D flow MRI of the great thoracic vessels at 3 Tesla using Doppler-ultrasound gating: a feasibility study

OBJECTIVES

To evaluate the feasibility of Doppler-ultrasound (DUS)-gated 4D flow MRI of the fetal great thoracic vessels at 3T in a clinical setting.

METHODS

Sixteen consecutive fetuses (range 30⁺⁴-38⁺⁵ weeks) with (n = 11) and without (n = 5) cardiovascular anomalies underwent 4D flow MRI of the great thoracic vessels at 3T. Direct fetal cardiac gating was obtained using a MR-compatible DUS device. 4D flow MRI-based visualisation and quantification of four target regions (ascending aorta (AAo), descending aorta (DAo), main pulmonary artery (MPA), and ductus arteriosus (DA)) were performed using dedicated software.

RESULTS

Fetal 4D flow MRI of the great thoracic vessels was successful in 12/16 fetuses (75%) by adopting clinical 4D flow MR protocols in combination with direct fetal cardiac DUS-gating. Four datasets were excluded due to artefacts by fetal movement or maternal breathing. 4D flow MRI-derived time-velocity curves revealed typical arterial blood flow patterns in the aorta. 4D flow quantification was achieved for the pre-defined target regions. Average velocity and flow volume were 21.1 ± 5.2 cm/s and 6.0 ± 3.1 mL/s in the AAo, 24.3 ± 6.7 cm/s and 8.4 ± 3.7 mL/s in the DAo, 21.9 ± 6.4 cm/s and 7.8 ± 4.2 mL/s in the MPA, and 23.4 ± 4.7 cm/s and 5.9 ± 3.6 mL/s in the DA, respectively.

CONCLUSIONS

Combination of DUS-gating of the fetal heart and 4D flow MRI allows comprehensive visualisation and quantification of haemodynamics in the fetal great thoracic vessels. DUS-gated fetal 4D flow MRI may provide a new diagnostic approach for prenatal assessment of blood flow haemodynamics.

KEY POINTS

• Fetal cardiac Doppler-ultrasound (DUS) gating and 4D flow MRI can be successfully combined. • DUS-gated fetal 4D flow MRI allowed visualisation and evaluation of streamline directionality, illustration of blood flow variations, and pulsatile arterial waveforms in the target vessels. • 4D flow MRI-based visualisation and quantification of the fetal great thoracic vessels were successful and flow metrics agreed with echocardiographic reference values.

Continuous, transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

Background

Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring.

Purpose

We investigated the feasibility and accuracy of an additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO2) measurement during conscious sedation in complex electrophysiological catheter ablation procedures.

Methods

We evaluated the accuracy and additional value of tpCO2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses.

Results

We included 110 patients in this prospective observational study. Arterial pCO2 (paCO2) and tpCO2 showed good correlation throughout the procedures (r=0.60–0.87, p&lt;0.005). Venous pCO2 (pvCO2) were also well correlated to transcutaneous values (r=0.65–0.85, p&lt;0.0001). Analyses of the difference of pvCO2 and tpCO2 measurements showed a tolerance within &lt;10mmHg in up to 96–98% of patients. Hypercapnia (pCO2&lt;70mmHg) was detected more likely and earlier by continuous tpCO2 monitoring compared to half-hourly pvCO2 measurements.

Conclusion

Continuous tpCO2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety.

Funding Acknowledgement

Type of funding source: None

P1386Continuous, transcutaneous carbon-dioxide monitoring in complex electrophysiological procedures in conscious sedation - is there a safer way to sleep?

Funding Acknowledgements

Karolina Weinmann was supported by the Hertha-Nathorff fellowship from Ulm University

Background – Ablation of cardiac arrhythmias by complex electrophysiological procedures is a growing field. A moderate to deep sedation is needed to immobilize the patient to warrant a safe and effective intervention. The administrated medication to obtain an adequate sedation has respiratory depressant side effects and could cause respiratory complications, like hypercapnia and hypoxia.

Purpose – Our aim was to investigate the feasibility and accuracy of an additional, continuous transcutaneous carbon-dioxide (tpCO2) measurement during moderate to deep sedation in complex electrophysiological catheter ablations.

Methods – Consecutive patients received an electrophysiological intervention with need for deep sedation. Routine hemodynamic monitoring was performed by the measurement of non-invasive blood-pressure, oxygen saturation and half-hourly venous blood gas analysis. Additionally, patients received a tpCO2 sensor on the forehead with an automated, continuous documentation of transcutaneous oxygen saturation and carbon-dioxide. A precise sedation protocol was performed and administrated drugs were registered.

Results – We included 110 patients to the analysis. Fifty patients received cryoballoon pulmonary vein isolation, 58 patients 3D-mapping procedure and two patients ventricular tachycardia ablation. The mean procedure time was 135.1 ± 63.5 minutes and the fluoroscopy time was 21.5 ± 10.9 minutes. To achieve an adequate sedation a mean of 5.0 ± 0.8 mg midazolam, 583.8 ± 320.4 mg propofol, 72.0 ± 30.3 µg fentanyl and 0.2 ± 0.1 mg remifentanil were administrated.

Hypercapnia (pCO2 &gt; 70 mmHg) was detected in five patient by the tpCO2 monitoring and only in two patients using venous carbon-dioxide partial pressure (vpCO2) analysis. Correlation of tpCO2 and vpCO2 were analyzed half-hourly by Pearsons’ correlation coefficient. There was a good correlation during the investigated 120 minutes of procedure time (baseline: r = 0.65, p &lt; 0.0001; 30 minutes: r = 0.75, p &lt; 0.0001; 60 minutes: r = 0.77, p &lt; 0.0001; 90 minutes: r = 0.78, p &lt; 0.0001; 120 minutes: r = 0.85, p &lt; 0.0001). The detected difference between tpCO2 and vpCO2 was at baseline &lt;5 mmHg in 65% (79/110) and &lt;10 mmHg in 96% (103/110), after 30 minutes the difference was &lt;5 mmHg in 71% (78/110) and &lt;10 mmHg in 96% (105/110), after 60 minutes the difference was &lt;5 mmHg in 77% (60/78) and &lt;10 mmHg in 96% (75/78) and after 90 minutes the difference between the two methods was &lt;5 mmHg in 63% (30/48) and &lt;10 mmHg in 98% (47/48) of the cohort.

Conclusion – The continuous tpCO2 monitoring is a feasible and precise method with a good correlation to the venous blood gas carbon-dioxide analysis of the standard monitoring during complex catheter ablations in deep sedation. Randomized trials are required to further analyze if tpCO2 monitoring adds further safety to electrophysiological procedures in deep sedation.

Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial

IMPORTANCE

Individually calibrated biomechanical footwear therapy may improve pain and physical function in people with symptomatic knee osteoarthritis, but the benefits of this therapy are unclear.

OBJECTIVE

To assess the effect of a biomechanical footwear therapy vs control footwear over 24 weeks of follow-up.

DESIGN, SETTING, AND PARTICIPANTS

Randomized clinical trial conducted at a Swiss university hospital. Participants (N = 220) with symptomatic, radiologically confirmed knee osteoarthritis were recruited between April 20, 2015, and January 10, 2017. The last participant visit occurred on August 15, 2017.

INTERVENTIONS

Participants were randomized to biomechanical footwear involving shoes with individually adjustable external convex pods attached to the outsole (n = 111) or to control footwear (n = 109) that had visible outsole pods that were not adjustable and did not create a convex walking surface.

MAIN OUTCOMES AND MEASURES

The primary outcome was knee pain at 24 weeks of follow-up assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore standardized to range from 0 (no symptoms) to 10 (extreme symptoms). The secondary outcomes included WOMAC physical function and stiffness subscores and the WOMAC global score, all ranging from 0 (no symptoms) to 10 (extreme symptoms) at 24 weeks of follow-up, and serious adverse events.

RESULTS

Among the 220 randomized participants (mean age, 65.2 years [SD, 9.3 years]; 104 women [47.3%]), 219 received the allocated treatment and 213 (96.8%) completed follow-up. At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, -1.3 [95% CI, -1.8 to -0.9]; P < .001). The results were consistent for WOMAC physical function subscore (between-group difference, -1.1 [95% CI, -1.5 to -0.7]), WOMAC stiffness subscore (between-group difference, -1.4 [95% CI, -1.9 to -0.9]), and WOMAC global score (between-group difference, -1.2 [95% CI, -1.6 to -0.8]) at 24 weeks of follow-up. Three serious adverse events occurred in the biomechanical footwear group compared with 9 in the control footwear group (2.7% vs 8.3%, respectively); none were related to treatment.

CONCLUSIONS AND RELEVANCE

Among participants with knee pain from osteoarthritis, use of biomechanical footwear compared with control footwear resulted in an improvement in pain at 24 weeks of follow-up that was statistically significant but of uncertain clinical importance. Further research would be needed to assess long-term efficacy and safety, as well as replication, before reaching conclusions about the clinical value of this device.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02363712.

Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis

Levosimendan is a potent non-adrenergic inodilator agent. The net effect of hemodynamic changes may result in a hyperdynamic state with low systemic vascular resistance. We conducted a systematic review and meta-analysis assessing hemodynamics in cardiac surgery patients treated with levosimendan. English-language literature was searched systematically from 2006 until October 2018, including randomized controlled trials and case-matched or retrospective studies providing at least two sequentially measured hemodynamic variables in adult patients who underwent cardiac surgery with cardiopulmonary bypass and were treated with levosimendan in comparison to alternative drugs or devices. Cardiac index significantly increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized mean difference (95% CI); p = 0.003] from baseline to postoperative day (POD) 1, and by 0.75 (0.25 to 1.25; p = 0.003) from baseline to POD 7, when corrected for the standardized mean difference at baseline by a multivariate mixed effects meta-analysis model. With this correction for baseline differences, other hemodynamic variables including systemic vascular resistance did not significantly differ until POD 1 [−0.17 (−0.64 to 0.30), p = 0.48] and POD 7 [−0.13 (−0.61 to 0.34), p = 0.58] between the levosimendan and the comparator group. Levosimendan increases cardiac index in patients undergoing cardiac surgery. Although levosimendan has inodilator properties, this meta-analysis finds no clinical evidence that levosimendan produces vasopressor-resistant vasoplegic syndrome.

Three-dimensional structure of antiphase domains in GaP on Si(0 0 1)

Antiphase domains are three-dimensional crystal defects commonly arising at the interface of III-V semiconductors and Si. While control over their formation has been achieved, the geometry of the antiphase domain itself that is separated from the mainphase of the crystal by the so-called antiphase boundary, has not yet been fully understood. In this work, we first investigate the interface between GaP and Si itself by cross-sectional scanning tunneling microscopy (XSTM) to reveal possible intermixing within an 8 monolayers wide region. Furthermore, we present an extensive analysis combining transmission electron microscopy and XSTM to elucidate the shape of antiphase domains in GaP. To create a true-to-scale, three-dimensional model of an antiphase domain, firstly, plan-view transmission electron microscopy images are drawn on. Subsequently, the progression of many antiphase boundaries through the GaP crystal as viewed from the (1 1 0) and (1 [Formula: see text] 0) cleavage planes is analyzed all the way down to the atomic level by means of XSTM. This enables a detailed analysis of the shape and physical dimensions of the antiphase domains. A typical measured extension in growth directions is found to be a maximum of 60 nm and the maximum measured extension of the base plane in [[Formula: see text] 1 0] and [1 1 0] directions is about 160 nm and 50 nm, respectively. They appear as pyramids with anisotropic base planes whose side facets kink many times.

Frost hardening and dehardening potential in temperate trees from winter to budburst

We investigated how deciduous trees can adjust their freezing resistance in response to temperature during the progress of the ecodormancy phase, from midwinter to budburst. We regularly sampled twigs of four different temperate deciduous tree species from January to the leaf-out date. Using computer-controlled freezers and climate chambers, the freezing resistance of buds was measured directly after sampling and also after the application of artificial hardening and dehardening treatments, simulating cold and warm spells. The thermal time to budburst in forcing conditions (c. 20°C) was also quantified at each sampling as a proxy for dormancy depth. Earlier flushing species showed higher freezing resistance than late flushing species at either similar bud development stage or similar dormancy depth. Overall, freezing resistance and its hardening and dehardening potential dramatically decreased during the progress of ecodormancy and became almost nil during budburst. Our results suggest that extreme cold events in winter are not critical for trees, as freezing resistance can be largely enhanced during this period. By contrast, the timing of budburst is a critical component of tree fitness. Our results provide quantitative values of the freezing resistance dynamics during ecodormancy, particularly valuable in process-based species distribution models.

Fast acclimation of freezing resistance suggests no influence of winter minimum temperature on the range limit of European beech

Low temperature extremes drive species distribution at a global scale. Here, we assessed the acclimation potential of freezing resistance in European beech (Fagus sylvaticaL.) during winter. We specifically asked (i) how do beech populations growing in contrasting climates differ in their maximum freezing resistance, (ii) do differences result from genetic differentiation or phenotypic plasticity to preceding temperatures and (iii) is beech at risk of freezing damage in winter across its distribution range. We investigated the genetic and environmental components of freezing resistance in buds of adult beech trees from three different populations along a natural large temperature gradient in north-western Switzerland, including the site holding the cold temperature record in Switzerland. Freezing resistance of leaf primordia in buds varied significantly among populations, with LT50values (lethal temperature for 50% of samples) ranging from -25 to -40 °C, correlating with midwinter temperatures of the site of origin. Cambial meristems and the pith of shoots showed high freezing resistance in all three populations, with only a trend to lower freezing resistance at the warmer site. After hardening samples at -6 °C for 5 days, freezing resistance of leaf primordia increased in all provenances by up to 4.5 K. After additional hardening at -15 °C for 3 days, all leaf primordia were freezing resistant to -40 °C. We demonstrate that freezing resistance ofF. sylvaticahas a high ability to acclimate to temperature changes in winter, whereas the genetic differentiation of freezing resistance among populations seems negligible over this small geographic scale but large climatic gradient. In contrast to the assumption made in most of the species distribution models, we suggest that absolute minimum temperature in winter is unlikely to shape the cold range limit of beech. We conclude that the rapid acclimation of freezing resistance to winter temperatures allows beech to track changing climatic conditions, especially during unusually warm winters interrupted by very cold weather.

[Compartment syndrome caused by rhabdomyolysis in the context of pychogenic polydipsia]

Psychogenic polydipsia leading to severe hyponatremia is well documented in the literature. This electrolyte disorder can result in encephalopathy, cerebral edema and epileptic seizures. Another rare effect is rhabdomyolysis with all its well known complications (e.g. renal failure, hyperkalemia and cardiac arrhythmia) and even resulting in compartment syndrome due to severe muscle edema. We present the case of a patient with severe hyponatremia caused by psychogenic polydipsia leading to rhabdomyolysis and compartment syndrome.

A novel technique for the measurement of CBF and CBV with robot-arm-mounted flat panel CT in a large-animal model

BACKGROUND AND PURPOSE

Endovascular therapy is an emerging treatment option in patients with acute ischemic stroke and especially in cases presenting late after symptom onset. Information about remaining viable tissue as measured with perfusion imaging is crucial for proper patient selection. The aim of this study was to investigate whether perfusion imaging with C-arm CT in the angiography suite is feasible and provides measurements comparable with ones made by CTP.

MATERIALS AND METHODS

The MCA was occluded surgically in 6 sheep. Perfusion studies were performed before surgery, immediately after, and at 3 hours after MCA occlusion by using a robotic flat panel detector C-arm angiographic system. For comparison, conventional CTP was performed at the same time points. Two different protocols with the C-arm CT were tested. Images were analyzed by 2 readers with regard to the presence and size of perfusion abnormalities.

RESULTS

With C-arm CT, perfusion abnormalities were detected with a high sensitivity and specificity when vessel occlusion was confirmed by criterion standard DSA. No difference was found between lesions sizes measured with the 2 C-arm CT protocols and CTP. Growth of the CBV lesions with time was captured with C-arm CT and CTP.

CONCLUSIONS

In this small study, it was feasible to qualitatively measure CBV and CBF by using a flat panel detector angiographic system.

Physiological minimum temperatures for root growth in seven common European broad-leaved tree species

Temperature is the most important factor driving the cold edge distribution limit of temperate trees. Here, we identified the minimum temperatures for root growth in seven broad-leaved tree species, compared them with the species' natural elevational limits and identified morphological changes in roots produced near their physiological cold limit. Seedlings were exposed to a vertical soil-temperature gradient from 20 to 2 °C along the rooting zone for 18 weeks. In all species, the bulk of roots was produced at temperatures above 5 °C. However, the absolute minimum temperatures for root growth differed among species between 2.3 and 4.2 °C, with those species that reach their natural distribution limits at higher elevations also tending to have lower thermal limits for root tissue formation. In all investigated species, the roots produced at temperatures close to the thermal limit were pale, thick, unbranched and of reduced mechanical strength. Across species, the specific root length (m g(-1) root) was reduced by, on average, 60% at temperatures below 7 °C. A significant correlation of minimum temperatures for root growth with the natural high elevation limits of the investigated species indicates species-specific thermal requirements for basic physiological processes. Although these limits are not necessarily directly causative for the upper distribution limit of a species, they seem to belong to a syndrome of adaptive processes for life at low temperatures. The anatomical changes at the cold limit likely hint at the mechanisms impeding meristematic activity at low temperatures.

The interaction between freezing tolerance and phenology in temperate deciduous trees

Temperate climates are defined by distinct temperature seasonality with large and often unpredictable weather during any of the four seasons. To thrive in such climates, trees have to withstand a cold winter and the stochastic occurrence of freeze events during any time of the year. The physiological mechanisms trees adopt to escape, avoid, and tolerate freezing temperatures include a cold acclimation in autumn, a dormancy period during winter (leafless in deciduous trees), and the maintenance of a certain freezing tolerance during dehardening in early spring. The change from one phase to the next is mediated by complex interactions between temperature and photoperiod. This review aims at providing an overview of the interplay between phenology of leaves and species-specific freezing resistance. First, we address the long-term evolutionary responses that enabled temperate trees to tolerate certain low temperature extremes. We provide evidence that short term acclimation of freezing resistance plays a crucial role both in dormant and active buds, including re-acclimation to cold conditions following warm spells. This ability declines to almost zero during leaf emergence. Second, we show that the risk that native temperate trees encounter freeze injuries is low and is confined to spring and underline that this risk might be altered by climate warming depending on species-specific phenological responses to environmental cues.

European deciduous trees exhibit similar safety margins against damage by spring freeze events along elevational gradients

Minimum temperature is assumed to be an important driver of tree species range limits. We investigated during which period of the year trees are most vulnerable to freezing damage and whether the pressure of freezing events increases with increasing elevation. We assessed the course of freezing resistance of buds and leaves from winter to summer at the upper elevational limits of eight deciduous tree species in the Swiss Alps. By reconstructing the spring phenology of these species over the last eight decades using a thermal time model, we linked freezing resistance with long-term minimum temperature data along elevational gradients. Counter-intuitively, the pressure of freeze events does not increase with elevation, but deciduous temperate tree species exhibit a constant safety margin (5-8.5 K) against damage by spring freeze events along elevational gradients, as a result of the later flushing at higher elevation. Absolute minimum temperatures in winter and summer are unlikely to critically injure trees. Our study shows that freezing temperatures in spring are the main selective pressure controlling the timing of flushing, leading to a shorter growing season at higher elevation and potentially driving species distribution limits. Such mechanistic knowledge is important to improve predictions of tree species range limits.

Relative Change in NT-proBNP Level: An Important Risk Predictor of Cardiovascular Congestion in Haemodialysis Patients

Background

Cross-sectional studies have shown that B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are predictive of cardiovascular death in haemodialysis (HD) patients. In the present study, we tested the hypothesis that monitoring NT-proBNP measurements adds further prognostic information, i.e. predicts congestive heart failure (CHF) events.

Methods

In a prospective cohort of 236 HD patients, NT-proBNP levels were measured monthly during 18 months. Patients were divided according to the occurrence of CHF events. In a nested case-control study, we assessed the evolution of NT-proBNP levels.

Results

On average, the 236 HD patients were followed up for 12.5 months, a period during which 44 patients developed a CHF event (half requiring hospitalisation). At baseline, patients who developed a CHF event had significantly more dilated cardiomyopathy and/or altered left ventricular ejection fraction and higher NT-proBNP levels compared with patients who did not develop a CHF event. During follow-up, we observed a significant increase in NT-proBNP levels preceding the CHF event. At a 20% relative increase of NT-proBNP, the sensitivity of NT-proBNP as a predictor of CHF events was 0.57 and the specificity 0.77.

Conclusion

The relative change in NT-proBNP levels is a significant risk predictor of a CHF event.

Electrical stimulation of the rectus femoris during pre-swing diminishes hip and knee flexion during the swing phase of normal gait

Individuals who have suffered cerebral insults often exhibit stiff-knee gait, a condition characterized by reduced knee flexion during swing. We investigated the effect that an increment in normal rectus femoris (RF) activity can have on hip and knee joint angles during swing, as a first step to determining this muscle's involvement in stiff-knee gait. For this, we developed a protocol that electrically stimulated the RF during pre-swing or after toe-off in randomly selected strides of treadmill walking, consistent with the timing of RF activity during normal gait. Seven healthy young adults participated in the study. Pre-swing stimulation induced a significant (p < 0.05) reduction in peak knee flexion (avg 7.5°) in all subjects, with an accompanying decrease in hip flexion in four of the subjects. RF stimulation after toe-off diminished peak knee flexion in three subjects and reduced hip flexion in four subjects. When compared to muscle-actuated gait simulations that were similarly perturbed, the induced motion measures were generally consistent in direction but exhibited greater variability across strides and subjects. We conclude that excess RF activity during pre-swing has the potential to contribute to stiff-knee gait, and that clinical treatment should consider the "counter-intuitive" function that the RF has in extending the hip.

Cardiac hormones eliminate some human squamous lung carcinomas in athymic mice

BACKGROUND

Four cardiac hormones synthesized by the same gene, i.e. atrial natriuretic peptide, vessel dilator, long acting natriuretic peptide and kaliuretic peptide, have anticancer effects in vitro.

MATERIALS AND METHODS

These cardiac hormones were infused subcutaneously for 28 days with weekly fresh hormones at 0.3 nM kg(-1) body weight in athymic mice bearing human squamous cell carcinomas.

RESULTS

Vessel dilator, atrial natriuretic peptide and kaliuretic peptide each eliminated one in six (17%) of the human squamous cell lung carcinomas. Long-acting natriuretic peptide, although it did not eliminate any of the human squamous cell lung carcinomas did decrease the volume of one carcinoma to only 2% (P < 0.0001) of the untreated carcinomas. The squamous cell lung carcinomas that were not eliminated, with the exception of the one LANP-treated tumour that decreased to only 2% of the volume of the untreated cancers, grew rapidly but their growth velocity compared to controls decreased by 76%, 40%, 38% and 25% in the vessel dilator, atrial natriuretic peptide, kaliuretic peptide and long-acting natriuretic peptide groups respectively (P < 0.05).

CONCLUSIONS

Three of four cardiac hormones synthesized by the atrial natriuretic peptide gene can eliminate human squamous cell lung carcinomas in athymic mice when treated subcutaneously for 4 weeks. The 4th cardiac hormone, i.e. long-acting natriuretic peptide, decreased the volume of one squamous cell lung carcinoma to 2% of that of untreated animals, suggesting that it, too, has beneficial effects on squamous cell lung cancers.

[Life satisfaction and subjective importance of life domains in schizophrenia patients: the role of partnership and parenthood]

OBJECTIVE

The aim is to analyze determinants of subjective quality of life in schizophrenia patients.

METHODS

Life satisfaction and subjective importance of life domains were assessed in 107 patients (FLZ (M)) and compared with the general population (n = 2974).

RESULTS

Schizophrenia patients experience lower levels of life satisfaction as well as less meaningfulness in all life domains. According to the range-of-affect hypothesis, patients with low importance ratings judged their life satisfaction more homogenously. While the presence of a partnership increases life satisfaction, parenthood has only indirect influences on satisfaction.

CONCLUSION

Psychiatrists should not only explore life satisfaction, but also the importance of different life domains and the patient's family relations. Supporting beneficial family relations can increase the quality of life in schizophrenia patients.

The inhomogeneous structure of water at ambient conditions

Small-angle X-ray scattering (SAXS) is used to demonstrate the presence of density fluctuations in ambient water on a physical length-scale of approximately 1 nm; this is retained with decreasing temperature while the magnitude is enhanced. In contrast, the magnitude of fluctuations in a normal liquid, such as CCl(4), exhibits no enhancement with decreasing temperature, as is also the case for water from molecular dynamics simulations under ambient conditions. Based on X-ray emission spectroscopy and X-ray Raman scattering data we propose that the density difference contrast in SAXS is due to fluctuations between tetrahedral-like and hydrogen-bond distorted structures related to, respectively, low and high density water. We combine our experimental observations to propose a model of water as a temperature-dependent, fluctuating equilibrium between the two types of local structures driven by incommensurate requirements for minimizing enthalpy (strong near-tetrahedral hydrogen-bonds) and maximizing entropy (nondirectional H-bonds and disorder). The present results provide experimental evidence that the extreme differences anticipated in the hydrogen-bonding environment in the deeply supercooled regime surprisingly remain in bulk water even at conditions ranging from ambient up to close to the boiling point.

Electroproduction of the N*(1535) resonance at large momentum transfer

We report on the first lattice calculation of light-cone distribution amplitudes of the N*(1535) resonance, which are used to calculate the transition form factors at large momentum transfers using light-cone sum rules. In the region Q2>2 GeV2, where the light-cone expansion is expected to converge, the results appear to be in good agreement with the experimental data.

Self-organized formation of GaSb/GaAs quantum rings

Ring-shaped GaSb/GaAs quantum dots, grown by molecular beam epitaxy, were studied using cross-sectional scanning tunneling microscopy. These quantum rings have an outer shape of a truncated pyramid with baselengths around 15 nm and heights of about 2 nm but are characterized by a clear central opening extending over about 40% of the outer baselength. They form spontaneously during the growth and subsequent continuous capping of GaSb/GaAs quantum dots due to the large strain and substantial As-for-Sb exchange reactions leading to strong Sb segregation.

Influence of epidermal hydration on the friction of human skin against textiles

Friction and shear forces, as well as moisture between the human skin and textiles are critical factors in the formation of skin injuries such as blisters, abrasions and decubitus. This study investigated how epidermal hydration affects the friction between skin and textiles.The friction between the inner forearm and a hospital fabric was measured in the natural skin condition and in different hydration states using a force plate. Eleven males and eleven females rubbed their forearm against the textile on the force plate using defined normal loads and friction movements. Skin hydration and viscoelasticity were assessed by corneometry and the suction chamber method, respectively.In each individual, a highly positive linear correlation was found between skin moisture and friction coefficient (COF). No correlation was observed between moisture and elasticity, as well as between elasticity and friction. Skin viscoelasticity was comparable for women and men. The friction of female skin showed significantly higher moisture sensitivity. COFs increased typically by 43% (women) and 26% (men) when skin hydration varied between very dry and normally moist skin. The COFs between skin and completely wet fabric were more than twofold higher than the values for natural skin rubbed on a dry textile surface.Increasing skin hydration seems to cause gender-specific changes in the mechanical properties and/or surface topography of human skin, leading to skin softening and increased real contact area and adhesion.

An adaptive gaze stabilization controller inspired by the vestibulo-ocular reflex

The vestibulo-ocular reflex stabilizes vision in many vertebrates. It integrates inertial and visual information to drive the eyes in the opposite direction to head movement and thereby stabilizes the image on the retina. Its adaptive nature guarantees stable vision even when the biological system undergoes dynamic changes (due to disease, growth or fatigue etc), a characteristic especially desirable in autonomous robotic systems. Based on novel, biologically plausible neurological models, we have developed a robotic testbed to qualitatively evaluate the performance of these algorithms. We show how the adaptive controller can adapt to a time varying plant and elaborate how this biologically inspired control architecture can be employed in general engineering applications where sensory feedback is very noisy and/or delayed.