Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction

Introduction

Coronary microvascular dysfunction (CMD) may be a manifestation of systemic small vessel disease, including the brain. The prevalence of cognitive impairment in CMD patients is poorly understood.

Purpose

To assess the prevalence of cognitive impairment in patients with CMD.

Methods

Between April 2018-March 2020, we enrolled patients with chest discomfort who were admitted to a chest pain observation unit and underwent 3D cardiac positron emission tomography/computed tomography (PET/CT). Exclusions included myocardial infarction, hypertensive urgency, and heart failure. Patients were categorized as 1) Normal: coronary flow reserve (CFR) ≥2.5 without perfusion defect or calcification, 2) Possible CMD: CFR 2–2.5 without perfusion defects or calcification, 3) CMD: CFR <2 without perfusion defects or calcification and 4) coronary artery disease (CAD/CALC): any CFR with perfusion defects or calcifications. We assessed cognitive function with the Montreal Cognitive Assessment (MoCA) and used <23 as the cutoff for impaired cognition. We added 1 point to the total score for those with 12 years of education or less. Odds ratios of cognitive impairment in each group were calculated with the normal group as reference, adjusting for age, sex, and race.

Results

Of 111 patients consented, 109 patients had complete data for analysis. (Table 1) Mean age was 57 years (± 11), 68% were female, and 49% were non-White. All 11 patients with CMD were females, with a mean age of 59 years (±12). The majority (72%) of CMD patients had cognitive impairment on the MoCA compared to 25% of patients with normal flows (unadjusted OR: 8.00 [95% CI 1.70–37.67]), even after adjustment for age, sex, and race (OR: 37.23 (95% CI 2.01–677.05). MoCA scores did not differ significantly between the normal and the CAD/CALC group (unadjusted OR: 0.95 [95% CI 0.30–3.070]), or the possible CMD group (1.44 [95% CI 0.50–4.14]). Additionally, non-White patients were more likely to demonstrate cognitive impairment on MoCA than White patients (OR: 9.47 [95% CI 3.48–25.81]). There was no significant nonparametric correlation between CFR and the MoCA score (r=0.05, p=0.6).

Conclusion

Patients with CMD are more likely to have cognitive impairment, supporting the need to further investigate the heart-brain connection in systemic small vessel disease.

FUNDunding Acknowledgement

Type of funding sources: None.

Sub-Kelvin cooling for two kilopixel bolometer arrays in the PIPER receiver

The Primordial Inflation Polarization Explorer (PIPER) is a balloon-borne telescope mission to search for inflationary gravitational waves from the early universe. PIPER employs two 32 × 40 arrays of superconducting transition-edge sensors, which operate at 100 mK. An open bucket Dewar of liquid helium maintains the receiver and telescope optics at 1.7 K. We describe the thermal design of the receiver and sub-Kelvin cooling with a continuous adiabatic demagnetization refrigerator (CADR). The CADR operates between 70 and 130 mK and provides ≈10 μW cooling power at 100 mK, nearly five times the loading of the two detector assemblies. We describe electronics and software to robustly control the CADR, overall CADR performance in flightlike integrated receiver testing, and practical considerations for implementation in the balloon float environment.

Polarisation of equine pregnancy outcome associated with a maternal MHC class I allele: Preliminary evidence

Identification of risk factors which are associated with severe clinical signs can assist in the management of disease outbreaks and indicate future research areas. Pregnancy loss during late gestation in the mare compromises welfare, reduces fecundity and has financial implications for horse owners. This retrospective study focussed on the identification of risk factors associated with pregnancy loss among 46 Thoroughbred mares on a single British stud farm, with some but not all losses involving equid herpesvirus-1 (EHV-1) infection. In a sub-group of 30 mares, association between pregnancy loss and the presence of five common Thoroughbred horse haplotypes of the equine Major Histocompatibility Complex (MHC) was assessed. This involved development of sequence specific, reverse transcriptase polymerase chain reactions and in several mares, measurement of cytotoxic T lymphocyte activity. Of the 46 mares, 10 suffered late gestation pregnancy loss or neonatal foal death, five of which were EHV-1 positive. Maternal factors including age, parity, number of EHV-1 specific vaccinations and the number of days between final vaccination and foaling or abortion were not significantly associated with pregnancy loss. In contrast, a statistically significant association between the presence of the MHC class I B2 allele and pregnancy loss was identified, regardless of the fetus/foal's EHV-1 status (p=0.002). In conclusion, this study demonstrated a significantly positive association between pregnancy loss in Thoroughbred mares and a specific MHC class I allele in the mother. This association requires independent validation and further investigation of the mechanism by which the mare's genetic background contributes to pregnancy outcome.

A case report on over-replacement of oral calcium supplements causing acute pancreatitis

A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.

Monitoring agricultural rodenticide use and secondary exposure of raptors in Scotland

Despite the documented risk of secondary poisoning to non-target species by anticoagulant rodenticides there is no statutory post-approval monitoring of their use in the UK. This paper presents results from two Scottish monitoring schemes for the period 2000-2010; recording rodenticide use on arable farms and the presence of residues in raptor carcasses. More than three quarters of arable farms used anticoagulant rodenticides; predominately the second generation compounds difenacoum and bromadiolone. There was widespread exposure to anticoagulant rodenticides in liver tissues of the raptor species tested and the residues encountered generally reflected agricultural use patterns. As found in other studies, Red Kites (Milvus milvus) appeared to be particularly vulnerable to rodenticide exposure, 70 % of those sampled (n = 114) contained residues and 10 % died as a result of rodenticide ingestion. More unexpectedly, sparrowhawks (Accipiter nisus), which prey almost exclusively on birds, had similar exposure rates to species which prey on rodents. Although, with the exception of kites, confirmed mortality from rodenticides was low, the widespread exposure recorded is concerning. Particularly when coupled with a lack of data about the sub-lethal effects of these compounds. This raises questions regarding whether statutory monitoring of use is needed; both to address whether there are deficiencies in compliance with approval conditions or whether the recommended risk management procedures are themselves adequate to protect non-target wildlife.

Intussusception secondary to a solitary peritoneal lung metastasis

We report a 77-year-old woman, newly diagnosed with a malignant lung neoplasm of indeterminate nature who presented with profuse bilious vomiting without abdominal distension, pain or constipation. CT confirmed proximal small bowel obstruction. Laparotomy found a large area of intussusception from an intraluminal mass in the small bowel, which was resected and a primary anastomosis performed. Histology reported the mass as metastatic non-small-cell carcinoma and brought clarity to the primary tumour diagnosis. The patient made a good recovery from the operation, but unfortunately died a few months later from complications of her metastatic disease.

Flocs through the looking glass

The paper describes the investigation of how the make up of raw water influences the physical properties of flocculated suspensions. The work focuses on the properties of four characteristic organic fractions separated as a function of their hydrophobicity. Mesoscale data indicates that the hydrophobic fractions dominate the make up of the water and are the most easily removed. Microscale and nanoscale data reveals that the fulvic acid fraction (FAF) generates statistically smaller and more compact flocs than those formed by the other fractions and the hydrophilic fractions form the most internally open and dendritic structures. The FAF fraction was also seen to dominate the zeta potential response of the raw water.

A quadricuspid pulmonic valve diagnosed in a live newborn by two-dimensional echocardiography

Quadricuspid pulmonic valve is a rare congenital anomaly which appears to occur in the absence of other cardiac or systemic anomalies. It predominates in males and tends to be clinically quiescent. The first case of quadricuspid pulmonic valve in a live newborn infant diagnosed by two-dimensional echocardiography is presented here with a review of the literature.

Construction of a high-affinity receptor site for dihydropyridine agonists and antagonists by single amino acid substitutions in a non-L-type Ca2+ channel

The activity of L-type Ca2+ channels is increased by dihydropyridine (DHP) agonists and inhibited by DHP antagonists, which are widely used in the therapy of cardiovascular disease. These drugs bind to the pore-forming alpha1 subunits of L-type Ca2+ channels. To define the minimal requirements for DHP binding and action, we constructed a high-affinity DHP receptor site by substituting a total of nine amino acid residues from DHP-sensitive L-type alpha1 subunits into the S5 and S6 transmembrane segments of domain III and the S6 transmembrane segment of domain IV of the DHP-insensitive P/Q-type alpha1A subunit. The resulting chimeric alpha1A/DHPS subunit bound DHP antagonists with high affinity in radioligand binding assays and was inhibited by DHP antagonists with high affinity in voltage clamp experiments. Substitution of these nine amino acid residues yielded 86% of the binding energy of the L-type alpha1C subunit and 92% of the binding energy of the L-type alpha1S subunit for the high-affinity DHP antagonist PN200-110. The activity of chimeric Ca2+ channels containing alpha1A/DHPS was increased 3.5 +/- 0.7-fold by the DHP agonist (-)Bay K8644. The effect of this agonist was stereoselective as in L-type Ca2+ channels since (+) Bay K8644 inhibited the activity of alpha1A/DHPS. The results show conclusively that DHP agonists and antagonists bind to a single receptor site at which they have opposite effects on Ca2+ channel activity. This site contains essential components from both domains III and IV, consistent with a domain interface model for binding and allosteric modulation of Ca2+ channel activity by DHPs.

Fine mapping of the autosomal recessive retinitis pigmentosa locus (RP12) on chromosome 1q; exclusion of the phosducin gene (PDC)

In a previous study on a large pedigree from a genetically isolated population in the Netherlands, we localized a gene for autosomal recessive retinitis pigmentosa with paraarteriolar preservation of the retinal pigment epithelium (PPRPE) on the long arm of chromosome 1. In this study, we present an integrated genetic map of the target region. The resulting genetic order of the markers was used to construct haplotypes and to screen for key-recombinants in the pedigree. The obligate RP12 region was reduced from 16 cM to 5 cM between the markers D1S533 and CACNL1A3. The CACNL1A3 and phosducin (PDC) genes were placed outside the candidate gene region, thereby excluding the involvement of these genes in retinitis pigmentosa with PPRPE. Our data result in the following order of the markers and genes in the region 1q31 --> q32.1: cen-D1S158-(D1S238-D1S422)/PDC- D1S533-RP12/(F13B-D1S413)-CACNL1A3-DIS4 77-D1S306-D1S53-tel.

Survival depends on effective partnerships with suppliers, management, and physicians

Partnering in health care materiel management circles is a concept that has been discussed for years. We, as materiel managers, have never accomplished effective partnering; but I propose that if we are to have a professional future, we should learn to establish effective partnership arrangements with our various customers--externally and internally.

Once bitten, twice shy

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Cancer biotherapy with interferon, interleukin-2 and tumor-derived activated cells (TDAC)

Interleukin-2 (Il-2) allows for the therapeutic augmentation of immunity in vivo and/or in vitro. In extensive studies in nearly 1000 patients with advanced cancer, we have demonstrated that Il-2 by continuous infusion, with cellular therapy (LAK or TDAC), is feasible, cost effective and useful in selected patients with melanoma and kidney cancer. Studies in patients with other tumor types are underway.

Stability of photorefractive spatial solitons

We present a theoretical analysis of the stability of photorefractive spatial solitons along with experimental results that show that the solitons are stable for small-scale perturbations but break down when the perturbations exhibit a transverse scale comparable with the soliton size (cross section).

Dimensionality and size of photorefractive spatial solitons

We study experimentally self-trapping of optical beams in photorefractive media and show that the trapping is inherently asymmetric with respect to the two (transverse) trapping dimensions. We also present experimental results that show how the sizes of the resultant photorefractive spatial solitons are independent (within their range of existence) of the amplitude of the externally applied electric field used to generate them.

A teaching tool for patients receiving continuous i.v. infusion recombinant interleukin-2 therapy

PURPOSE/OBJECTIVES

To present a tool developed to facilitate education of patients and families undergoing continuous i.v. therapy with interleukin-2 (IL-2).

DATA SOURCES

Published articles, book chapters, authors' clinical experience.

DATA SYNTHESIS

Topics covered in the teaching tool include development of IL-2, immune functioning, common side effects, side effect management, and when to contact healthcare providers.

CONCLUSIONS

Well-received by patients, families, and healthcare providers who reviewed the material.

IMPLICATIONS FOR NURSING PRACTICE

Use of a written patient education tool enables nurses to effectively teach patients with efficient use of nursing time.

Case management of the hospitalized patient receiving interleukin-2

Patients receiving intermediate-dose CI rIL-2 therapy require hospitalization for assessment and management of the potentially severe side effects, primarily those involved with cardiopulmonary and renal toxicities. Once the tolerable dose level has been identified for a particular patient, the severity of the side effects on subsequent cycles of therapy may decrease. During therapy, nursing management includes interventions to minimize distressing side effects such as fever, flu-like symptoms, fatigue, anorexia, and pruritus. Because the side effects of rIL-2 therapy are predictable, nurses can focus on early detection of these side effects and institute prompt interventions to reduce, minimize, or eliminate the symptoms. As oncology nurses prepare to care for hospitalized patients receiving rIL-2, a knowledge of the agent's side effect profile provides the foundation on which to base nursing practice.

Autosomal dominant retinitis pigmentosa: localization of a disease gene (RP6) to the short arm of chromosome 6

DNA from members of an Irish pedigree presenting with late onset autosomal dominant retinitis pigmentosa (ADRP) have been typed with a series of genetic markers from chromosome 6p. Positive two-point lod scores have been obtained with five markers (D6S89: theta = 0.10, Z = 3.338; D6S109: theta = 0.10, Z = 3.932; D6S105: theta = 0.00, Z = 6.081; HLA-DRA: theta = 0.00, Z = 4.364; and RDS: theta = 0.00, Z = 5.376). In a series of overlapping multipoint analyses a lod score of 6.6 was obtained, maximizing at HLA-DRA and hence localizing the ADRP gene (RP5) segregating in this pedigree to 6p. These data provide direct evidence for an additional autosomal dominant RP locus and strongly implicate the human equivalent of the mouse retinal degeneration slow (rds) gene, peripherin-rds, as a candidate for autosomal dominant retinitis pigmentosa.

Evaluation and clinical relevance of patient immune responses to intravenous therapy with murine monoclonal antibodies conjugated to adriamycin

A retrospective study was performed in order to examine the clinical relevance of human anti-murine antibodies (HAMA) to concurrent clinical events in 21 patients receiving intravenous therapy with cocktails of murine monoclonal antibodies conjugated to Adriamycin. In vivo tumor localization of the murine antibodies was also evaluated. Serum levels of HAMA, human-murine immune complexes (HMIC), and murine antibodies were measured using an automated fluorescence immunoassay. Immunohistochemical staining was performed on frozen sections of tumor biopsies from eight of the patients to examine the in vivo binding of the murine antibodies. The patients were divided into low, intermediate, and high antibody dose groups. The incidence of allergic symptoms (80%) and HAMA correlation (75%) were highest in the low dose group. Specific IgM HAMA was the most highly correlated with allergic reactions, being present in 61.5% of the allergic patients. Thirteen of the 21 patients studied (61.9%) developed allergic symptoms after one or more doses of the murine monoclonal antibody conjugates. The percentages of total antibody doses in the patients' sera at varying intervals post-infusion varied widely from patient to patient for any given time point and dose, suggesting complex factors in the distribution and clearance of the murine antibodies. All eight of the patients biopsied during or post-therapy exhibited tumor localization of the murine monoclonal antibodies. Six of the eight had concurrent HAMA in their sera. Thus, the presence of HAMA did not prevent in vivo localization of the murine antibodies in the target tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent advances in the management of biotherapy-related side effects: fatigue

Limited information about fatigue patterns in patients with cancer exists in the biotherapy literature. When fatigue is mentioned, it is usually to state whether or not it was a dose-limiting side effect. No further data are provided on how fatigue was measured; which patterns were noted and when; and which relationships were found between fatigue and demographic characteristics, type of biologic response modifier, route of administration, or cumulative dose. Thus, there is little available in the biotherapy literature to guide nursing practice in managing this side effect. Theory that guides practice, however, often emanates from the personal experiences of the patients and from the clinical observations and intuitive hunches of the nurses and physicians participating in clinical trials. These individuals have been most generous in sharing their insights and unpublished data with the authors. This paper presents a comprehensive view of current knowledge on fatigue to guide present nursing practice with patients receiving biotherapy and to provide direction for future nursing and clinical trial research.

Linkage analysis of human chromosome 4: exclusion of autosomal dominant retinitis pigmentosa (ADRP) and detection of new linkage groups

As part of our ongoing linkage studies of degenerative retinal diseases, we tested seven DNA markers and two classical genetic markers from chromosome 4 in two extended families with autosomal dominant retinitis pigmentosa (ADRP). Our goals were (1) to detect or exclude linkage of ADRP to markers spanning most of chromosome 4 and (2) to contribute useful new information regarding the linkage map of this chromosome. Our results exclude linkage of ADRP from more than 82% of chromosome 4. We detected four new linkage relationships: loose linkage of K082 (D4S10) and G1E5 (D4S21) at a distance of 21 cM; loose linkage of 4F2 (D4S18) and GC protein at a distance of 19 cM; tight linkage (i.e., no recombinants) between B3D (D4S44), B5A (D4S40), and the MNS blood group; and tight linkage between 4F2 and GDS5 (D4S23). These data, combined with previously reported data, exclude ADRP from approximately 35% of the human genome.

Glossal cysts in four infants

Cysts at the base of the tongue causing stridor may be fatal if they are not recognised and treated. Digital palpation along the surface of the tongue to the epiglottis is a useful diagnostic method. An operative technique that might avoid the need for tracheostomy is described.

An improved method for the generation of human lymphokine activated killer cells

In an effort to make interleukin-2/lymphokine-activated killer cell (IL-2/LAK) therapy safer for cancer patients, we examined the efficacy of using Fenwal PL732 bags as tissue culture flasks. These bags can be sterilly connected using tubing kits thus reducing the risk of contamination to the cells. Peripheral blood mononuclear cells were obtained from normal donors or cancer patients undergoing IL-2/LAK cell therapy. Following Ficoll-Hypaque purification, these cells were incubated in the presence of IL-2 in either PL732 plastic bags or standard tissue culture flasks. Our results showed that LAK cells could be generated from either normal donors or cancer patients in the bags as well as in the flasks. Comparisons were made of the LAK cell populations obtained from the two sources and showed that each was similar in terms of morphology as determined by Wright stain differentials. The populations of cells were also similar in regard to cell surface phenotype as determined by flow cytometric analysis. In addition, recoveries from either tissue culture vessel as well as cell viability of the LAK cells were comparable. Finally, the LAK cells obtained from both sources were assessed for cytolytic activity against the tumor cell lines K562 and Daudi. These results showed that the cytolytic activity of the LAK cells against these target cells was the same whether the cells were obtained from the flasks or the bags.