An evaluation of the impact of social interaction skills training for facially disfigured people

Facially disfigured people can experience significant psychological problems, commonly relating to difficulties in social interaction. The effect of social interaction skills workshops on the psychological well-being of 64 facially disfigured participants is described. Participants completed the Hospital Anxiety and Depression Scale (HAD), the Social Avoidance and Distress Scale (SAD) and an open-ended questionnaire, before a workshop and at 6 weeks and 6 months follow-up. The high levels of anxiety evident prior to the workshop fell significantly 6 weeks post-workshop (HSD = 1.297, P < 0.01) and remained significantly lower at 6 month follow-up (HSD = 1.563, P < 0.01). Similarly, SAD scores fell significantly at 6 weeks (HSD = 1.89, P < 0.05) and again at 6 month follow-up (HSD = 2.26, P < 0.01). 6 weeks post-workshop, participants reported feeling more confident in the company of strangers (HSD = -1.266, P < 0.01) and about meeting new people (HSD = -1.159, P < 0.01). This increase in confidence was maintained at 6 months (HSD = -1.068 and -1.042 respectively, P < 0.01 for both). 61% of those who experienced problems before the workshop reported a positive change in these situations. The potential of these workshops as an addition to surgical intervention is discussed.

Visual pigments, oil droplets and cone photoreceptor distribution in the european starling (Sturnus vulgaris)

Microspectrophotometric measurements of retinal photoreceptors from the European starling (Sturnus vulgaris) revealed four classes of single cone, containing visual pigments with wavelengths of maximum absorbance (&lt;IMG src="/images/symbols/lambda.gif" WIDTH="8" HEIGHT="12" ALIGN="BOTTOM" NATURALSIZEFLAG= "3"&gt;max) at 563, 504, 449 and close to 362 nm. The two longer-wave-sensitive single cones contained brightly coloured oil droplets which cut off light below 572 and 514 nm, respectively. The 449 nm &lt;IMG src="/images/symbols/lambda.gif" WIDTH="8" HEIGHT="12" ALIGN="BOTTOM" NATURALSIZEFLAG="3"&gt;max pigment was associated with a 'colourless' oil droplet with peak measured absorptance below 400 nm. The ultraviolet-sensitive visual pigment was paired with a transparent oil droplet which showed no significant absorption above 350 nm. A single class of double cone was identified, both members of which contained the longwave-sensitive (&lt;IMG src="/images/symbols/lambda.gif" WIDTH="8" HEIGHT= "12" ALIGN="BOTTOM" NATURALSIZEFLAG="3"&gt;max 563 nm) visual pigment. The principal member of the double cone contained an oil droplet with a topographically variable cut-off wavelength below 471 nm; the oil droplet found in the accessory member was only measured in the ventral retina and displayed three distinct peaks of absorption at approximately 430, 450 and 480 nm. Rod photoreceptors had a &lt;IMG src="/images/symbols/lambda.gif" WIDTH="8" HEIGHT="12" ALIGN="BOTTOM" NATURALSIZEFLAG="3"&gt;max at 503 nm. A new polynomial for fitting visual pigment templates to ultraviolet-sensitive visual pigment data is given. Topographic density measurements of the different cone classes were made using Nitroblue-tetrazolium chloride to label selectively bleached photoreceptors. The two classes of shortwave-sensitive single cone were more abundant in the dorsal retina, and longwave-sensitive single cones were notably less abundant in the dorso-temporal region of the retina, which subserves binocular vision.

Comparative properties of bacteriophage phi6 and phi6 nucleocapsid

Nonionic detergent treatments released a nucleocapsid from the enveloped bacteriphage phi6. The nucleocapsid sedimented at nearly the same rate as the whole phage in sucrose density gradients, but the buoyant density in Cs2S04 changed from 1.22 g/cm3 for the whole phage to 1.33 g/cm3 for the nucleocapsid. The detergent completely removed the lipid and 5 of the 10 proteins from the phage. Surface labeling of the phage and nucleocapsid with 125I revealed that protein P3 was on the outer surface of the whole phage and P8 was on the surface of the nucleocapsid. Both the phage and the nucleocapsid were stable between pH 6.0 and 9.5. Low concentrations of EDTA (10-4 M) dissociated the nucleocapsid but had no effect on the whole phage. The nucleocapsid contained all three double-stranded RNA segments, as well as RNA polymerase activity.

Characterization of the extent of internal motions in oligosaccharides

A detailed investigation has been undertaken on the extent and nature of torsional fluctuations about the glycosidic linkage of the model disaccharide Man alpha 1-3Man alpha 1-OMe. In particular, we sought to determine whether the three nuclear Overhauser effects and the two long-range heteronuclear 3JCH spin coupling constants measurable across the glycosidic linkage were consistent with a single conformation or multiple conformations about that linkage. Within experimental error, we have found that these five parameters can be interpreted in terms of a single, rigid geometry. Alternatively, the data are also consistent with a model in which the glycosidic torsional angles exhibit significant but restricted fluctuations about the global minimum energy conformation. Evidence from restrained molecular dynamics simulations both in vacuo and with explicit inclusion of solvent water and from 13C relaxation measurements upon an oligomannose glycan in covalent association with protein suggests that the latter model is the most accurate representation of the conformational behavior of oligosaccharides in solution.

Post-embryonic expression of C. elegans microRNAs belonging to the lin-4 and let-7 families in the hypodermis and the reproductive system

MicroRNAs (miRNAs) are regulatory molecules that negatively control gene expression by binding to complementary sequences on target mRNAs. The most thoroughly characterized miRNAs, lin-4 and let-7, direct cell fate determination during the larval transitions in C. elegans and act as key regulators of temporal gene expression. lin-4 and let-7 are founding members of two distinct families of miRNA genes sharing strong sequence homology primarily in the 5' end of the mature miRNAs. In this report, we characterize the temporal and spatial expression patterns of lin-4 and let-7 family members using northern blot analysis and mir::gfp fusion studies. Our results show that lin-4 and let-7 homologues possess distinct temporal and spatial expression patterns during nematode development and that known heterochronic genes regulate their expression. We find that certain lin-4 and let-7 family members display overlapping expression patterns in the hypodermis and the reproductive system, suggesting that combinations of miRNAs from across families may control common developmental events.

Coronary calcification score: the coronary-risk impact factor

CONTEXT

Identification of asymptomatic high-risk individuals is integral to current policies for preventing coronary heart disease, but existing methods of estimating risk lack sensitivity. To overcome this limitation increasing use is being made of non-invasive methods to detect subclinical coronary artery disease--eg, computed tomography (CT) to scan for coronary artery calcification. The location and extent of calcification correlate closely with pathological and angiographic abnormalities, but whether such calcification predicts clinical events, especially in younger individuals, is equivocal. Most data on coronary calcification have been obtained with electron-beam CT, but recently multislice CT, which is more versatile, less expensive, and available in most large hospitals, has been increasingly used.

STARTING POINT

Leslee Shaw and colleagues (Radiology 2003; 228: 826-33) showed that the coronary calcification score predicted total mortality within subsets of patients classified at low, intermediate, or high risk according to Framingham criteria. In a cohort of over 10000 individuals, 5-year risk-adjusted survival was 95% when the score was over 1000 compared with 99% for scores of 10 or less. These results agree with other recent studies showing strong correlations between coronary calcification and coronary heart disease events. WHERE NEXT? The increasing use of multislice CT scanners should generate more data for comparison with those obtained from electron-beam CT. Radiation dose, which is higher with multislice than with electron-beam procedures, needs to be reduced, and calcification in scans needs to be quantified more accurately than with existing computer-based analyses. Further studies are needed to establish the predictive power of the coronary calcification score for clinical events and the effects of therapeutic intervention on both these outcomes. It would also be worth investigating the relation between coronary calcification and risk factors not quantified in Framingham-based estimates, including familial and racial predisposition to premature coronary heart disease.

Rapid identification of protein phosphatase 1-binding proteins by mixed peptide sequencing and data base searching. Characterization of a novel holoenzymic form of protein phosphatase 1

Microcystin-affinity chromatography was used to purify 15 protein phosphatase 1 (PP1)-binding proteins from the myofibrillar fraction of rabbit skeletal muscle. To reduce the time and amount of material required to identify these proteins, proteome analysis by mixed peptide sequencing was developed. Proteins are resolved by SDS-polyacrylamide gel electrophoresis, electroblotted to polyvinylidene fluoride membrane, and stained. Bands are sliced from the membrane, cleaved briefly with CnBr, and applied without further purification to an automated Edman sequencer. The mixed peptide sequences generated are sorted and matched against the GenBank using two new programs, FASTF and TFASTF. This technology offers a simple alternative to mass spectrometry for the subpicomolar identification of proteins in polyacrylamide gels. Using this technology, all 15 proteins recovered in PP-1C affinity chromatography were sequenced. One of the proteins, PP-1bp55, was homologous to human myosin phosphatase, MYPT2. A second, PP-1bp80, identified in the EST data bases, contained a putative PP-1C binding site and a nucleotide binding motif. Further affinity purification over ATP-Sepharose isolated PP-1bp80 in a quaternary complex with PP-1C and two other proteins, PP-1bp29 and human p20. Recombinant PP-1bp80 also bound PP-1C and suppressed its activity toward a variety of substrates, suggesting that the protein is a novel regulatory subunit of PP-1.

Activity and mobility of subtilisin in low water organic media: hydration is more important than solvent dielectric

The relationship between hydration, catalytic activity and protein dynamics was investigated for subtilisin Carlsberg in organic solvents with low water content. The organic media were cyclohexane, dichloromethane or acetonitrile, with controlled thermodynamic water activity (aw). Catalytic rate profiles showed the same dependence on aw for the three different solvents. The structural mobility of the enzyme in air and organic media was probed by proton solid-state NMR relaxation measurements. Both spin-lattice relaxation time (T1 ) and line width at half height (apparent spin-spin relaxation time (T2)) were determined for protein which was exchanged and hydrated with D2O. We found NMR relaxation was much more dependent on aw than medium identity (despite very different dielectrics) showing that enzyme hydration is the primary determinant of mobility. Results suggest that initial hydration up to aw 0.22 causes rigidification of part of the protein structure. As aw is increased further, enzyme mobility is found to increase. Above aw 0.44, a large increase in the proportion of more mobile protons coincides with a steep rise in catalytic activity for the enzyme in each of the solvents studied.

Recurrence of recipient Langerhans' cell histiocytosis following bilateral lung transplantation

Langerhans' cell histiocytosis may cause irreversible respiratory failure due to progressive destruction of lung parenchyma and widespread cystic change. Transplantation offers a therapeutic option. A case is described of recurrence of Langerhans' cell histiocytosis which was associated with deterioration in lung function four years following bilateral lung transplantation. Patients transplanted for Langerhans' cell histiocytosis should be followed up with this complication in mind.

Radiation dose reduction without compromise of image quality in cardiac angiography and intervention with the use of a flat panel detector without an antiscatter grid

OBJECTIVE

To test the hypothesis that replacing the antiscatter grid with an air gap will reduce patient radiation exposure without significant compromise of image quality.

METHODS

457 patients having either uncomplicated diagnostic studies or a single vessel angioplasty (percutaneous transluminal coronary angioplasty (PTCA)) on a flat plate system (GE Innova) were studied. For two months their total dose-area product score was recorded on standard gridded images and then for two months on images made with the grid out, with an air gap used to reduce scatter. Detector magnification was reduced one step when an air gap was used to achieve the same final image size. A sample set of studies was reviewed blind by five observers, who scored sharpness and contrast on a non-linear scale.

RESULTS

The average dose-area product was significantly reduced, both in the diagnostic group (n = 276), from a mean (SD) of 26.2 (14.7) Gy.cm2 with the grid in to 16.1 (12) Gy.cm2 with the grid out (p = 0.01), and in the PTCA group (n = 181), from 48.2 (36.2) to 37 (27.5) (p = 0.01). The mean image quality scores of the gridless cohort were not significantly different from those of the gridded cohort.

CONCLUSION

With the use of a flat plate detector, air gap gridless angiography reduces the radiation dose to the patient and, in consequence, to the operator without significantly affecting image quality. It is proposed that gridless imaging should be the default technique for adults and children and in most installations.

Psychological and social aspects of burns

Although the literature on the psychological consequences of burns is fairly extensive, the evidence gathered by the charity 'Changing Faces' over the last 2 years suggests that the resources allocated to psychological rehabilitation are still far from adequate. This article draws on the personal experience of one of the authors who was in a car fire 24 years ago, reviews some of the literature, briefly looks at the work done by Changing Faces and discusses some of the tasks of the 'burns team'. The authors are aware that generalizations about the consequences of burns are fraught with risk because every fire has its own causes and complications, but it is hoped that the themes expressed here do raise important general points.

Medium term results of lung transplantation for end stage pulmonary sarcoidosis

BACKGROUND

Lung transplantation is an accepted therapeutic option for patients with end stage pulmonary sarcoidosis. However, the medium term outcome of transplantation in this patient group is unknown.

METHODS

This study was performed to evaluate our experience with lung transplantation for end stage pulmonary sarcoidosis. Between July 1988 and July 1997 12 patients (nine men) underwent lung transplantation for sarcoidosis at our institution. Ten underwent single lung transplantation and two double lung transplantation.

RESULTS

Survival at three and five years was 70% and 56%, respectively. Three patients developed obliterative bronchiolitis at six, 18, and 45 months. One died at the time of retransplantation. Sarcoid granulomas have recurred in the donor organ in three patients. In one the development of granulomas has been associated with clinical deterioration, necessitating retransplantation. Mean (SD) forced expiratory volumes in one second at three and five years were 1.37 (0.67) 1 and 1.34 (0.13) 1, respectively.

CONCLUSIONS

Lung transplantation is a viable option for patients with end stage pulmonary sarcoidosis. The medium term results are comparable with patients undergoing lung transplantation for other indications. Despite histological recurrence of sarcoidosis, the risk of clinically important recurrence is low.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Vitamin D receptor gene polymorphism is associated with reduced disability in multiple sclerosis

Ultraviolet radiation (UVR) may contribute to multiple sclerosis (MS) outcome by a mechanism involving vitamin D and the vitamin D receptor (VDR). In 512 patients with MS duration of 10 or more years, we studied the association of VDR single nucleotide polymorphisms (A/G1229, C/G3444, G/A3944, CC20965, CC30056, F/f30875, C/T48200, T/t65013) with outcome or disability. ff30875 frequency was lower in cases with EDSS ≥ 6.0 than with scores < 6.0 (odds ratio = 0.38, 95% CI = 0.20–0.70). The association of ff30875 with outcome was not mediated by cumulative exposure to UVR as assessed by questionnaire; low exposure (odds ratio = 0.42, 95% CI = 0.14–1.34) and high exposure (odds ratio = 0.34, 95% CI = 0.16–0.73).

A barley lectin that binds free amino sugars. I. Purification and characterization

A lectin was isolated from barley seen which bound the coat glycoprotein of barley stripe mosaic virus (Type strain) and precipitated the virus from solution. Purification of the barley lectin was achieved by fractionation with ammonium sulfate and successive column chromatography on DEAE cellulose and cellulose phosphate. The barley lectin was homogeneous as ascertained by polyacrylamide gel electrophoresis, isoelectric focusing, and from immunochemical tests. No isolectins were detected. The lectin has a molecular weight of 31 000 daltons and is not a glycoprotein. Each virion can accomodate between 200 to 300 molecules of lectin. Barley lectin was shown to be specific for D-glucosamine, D-galactosamine and D-mannosamine with little distinction among the epimeric configurations at carbons 2 and 4. Free amino groups of D-glucosamine and D-galactosamine were detected on the coat glycoprotein of Type strain barley stripe mosaic virus and these sugars appear to serve as receptors for the barley lectin.

Effect of physician specialty on use of necessary coronary angiography

OBJECTIVES

This study sought to determine whether having a cardiologist as a regular source of care influences likelihood of undergoing necessary coronary angiography.

BACKGROUND

An important element of the current health policy debate is the respective roles of primary care and specialist physicians. However, there are few data on interspecialty differences in quality of care for patients with ischemic heart disease.

METHODS

We contacted 243 patients by telephone (response rate 72%) who had positive (or very positive) exercise stress test results and met additional clinical criteria for necessary coronary angiography. Study patients were randomly sampled from those undergoing exercise stress testing at one university and three public hospitals in Los Angeles between January 1, 1990 and June 30, 1991. Patients were asked whether they had a regular source of care during the time after their exercise stress test and, if so, whether that provider was a cardiologist or cardiology clinic.

RESULTS

Among survey responders, 47% underwent necessary coronary angiography within 3 months of exercise testing and 61% within 12 months. After adjustment for sociodemographics and clinical presentation, patients with a cardiologist as a regular source of care were more likely than all other patients to have undergone necessary angiography within 3 months (52% vs. 38%, p = 0.05) and within 12 months (74% vs. 44%, p = 0.0001) of the exercise test. At 3 months, there was a trend toward a more pronounced effect of ongoing cardiologic care within the public hospitals compared with the private hospital (p = 0.09 for interaction between hospital types).

CONCLUSIONS

Patients with a cardiologist as a regular source of care were more likely than all other patients to undergo clinically necessary coronary angiography within both 3 and 12 months of exercise stress testing.

A novel 13C isotopic labelling strategy for probing the structure and dynamics of glycan chains in situ on glycoproteins

A protocol is described for uniform 13C labelling of terminal galactose residues of the glycan chains of glycoproteins, using an enzymatic method which does not perturb the protein. The technique is illustrated by application to the biantennary N-linked glycan chains attached at Asn 297 of immunoglobulin G (IgG). Isotope-edited NMR experiments on this glycoprotein yield data which suggest that the galactose residues on the glycan exist in two discrete environments, with the galactose in one environment having greater mobility than that in the other. These data are qualitatively consistent with crystallographic data on an Fc fragment, which suggest that one arm of the glycan is in contact with the protein, while the other projects into the space between the C gamma 2 domains. Quantitatively, however, these data cannot be rationalized with the crystallographic data, which implies subtle differences in oligosaccharide structure and dynamics between the solution and crystal states of Fc.

The radiological evaluation of atrial situs

Visceral situs, as evidenced by the position of the stomach and liver on the plain film, does not predict atrial situs as accurately as does bronchial situs. In particular situs ambiguus of the atria is not reliably indicated by visceral situs, and its subdivision into either right and left isomerism, where both atria show either right or left morphology respectively, cannot be made. As a result serious abnormalities of venous connections, which are common in the isomerisms, can be missed. Bronchial situs indicates atrial situs much more reliably and can be determined from penetrated chest radiographs or tomograms since the right and left main bronchi normally show different lengths. A ratio of lengths of 2 : 1 or more diagnoses bronchial situs solitus if the longer bronchus is on the left or situs inversus if the longer bronchus is on the right. A ratio of 1.5 : 1 or less indicates an isomerism. Data are presented from which the type of isomerism can be deduced and ratios between 2 and 1.5 : 1 clarified as isomerism or no isomerism.

A mathematical model of the mechanical link between shortening of the cardiomyocytes and systolic deformation of the left ventricular myocardium

BACKGROUND

Left ventricular myocytes are arranged in a complex three-dimensional mesh. Since all myocytes contract approximately to the same degree, mechanisms must exist to enable force transfer from each of these onto the framework as a whole, despite the transmural differences in deformation strain. This process has hitherto not been clarified in detail.

OBJECTIVE

To present a geometrical model that establishes a mechanical link between the three-dimensional architecture and the function of the left ventricular myocardium.

METHODS

The left ventricular equator was modeled as a cylindrical tube of deformable but incompressible material, composed of virtual cardiomyocytes with known diastolic helical and transmural angles. By imposing reference circumferential, longitudinal, and torsional strains onto the model, we created a three-dimensional deformation field to calculate passive shortening of the myocyte surrogates. We tested two diastolic architectures: 1) a simple model with longitudinal myocyte surrogates in the endo- and epicardium, and circular ones in the midwall, and 2) a more accurate architecture, with progressive helical angle distribution varying from -60° in the epicardium to 60° in the endocardium, with or without torsion and transmural cardiomyocyte angulation.

RESULTS

The simple model caused great transmural unevenness in cardiomyocyte shortening; longitudinal surrogates shortened by 15% at all depths equal to the imposed longitudinal strain, whereas circular surrogates exhibited a maximum shortening of 23.0%. The accurate model exhibited a smooth transmural distribution of cardiomyocyte shortening, with a mean (range) of 17.0 (13.2-20.8)%. Torsion caused a shortening of 17.0 (15.2-18.9)% and transmural angulation caused a shortening of 15.2 (12.4-18.2)%. Combining the effects of transmural angulation and torsion caused a change of 15.2 (13.2-16.5)%.

CONCLUSION

A continuous transmural distribution of the helical angle is obligatory for smooth shortening of the cardiomyocytes, but a combination of torsional and transmural angulation changes is necessary to execute systolic mural thickening whilst keeping shortening of the cardiomyocytes within its physiological range.

An in vitro FluoroBlok tumor invasion assay

The hallmark of metastatic cells is their ability to invade through the basement membrane and migrate to other parts of the body. Cells must be able to both secrete proteases that break down the basement membrane as well as migrate in order to be invasive. BD BioCoat Tumor Invasion System provides cells with conditions that allow assessment of their invasive property in vitro(1,2). It consists of a BD Falcon FluoroBlok 24-Multiwell Insert Plate with an 8.0 micron pore size PET membrane that has been uniformly coated with BD Matrigel Matrix. This uniform layer of BD Matrigel Matrix serves as a reconstituted basement membrane in vitro providing a true barrier to non-invasive cells while presenting an appropriate protein structure to study invasion. The coating process occludes the pores of the membrane, blocking non-invasive cells from migrating through the membrane. In contrast, invasive cells are able to detach themselves from and migrate through the coated membrane. Quantitation of cell invasion can be achieved by either pre- or post-cell invasion labeling with a fluorescent dye such as DiIC(12;)(3) or calcein AM, respectively, and measuring the fluorescence of invading cells. Since the BD FluoroBlok membrane effectively blocks the passage of light from 490-700 nm at >99% efficiency, fluorescently-labeled cells that have not invaded are not detected by a bottom-reading fluorescence plate reader. However, cells that have invaded to the underside of the membrane are no longer shielded from the light source and are detected with the respective plate reader. This video demonstrates an endpoint cell invasion assay, using calcein AM to detect invaded cells.

Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) - Vietnam, 2009-2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus

INTRODUCTION

Given the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking.

METHODS

Data and stored specimens from Vietnam's 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection.

RESULTS

Among 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68).

CONCLUSION

The prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam.

Left ventricular function during support with an asynchronous pulsatile left ventricular assist device

BACKGROUND

Left ventricular assist devices (LVADs) are frequently used to maintain patients with severe heart failure until heart transplantation becomes possible. Some patients may experience recovery of LV function during such support. Therefore, it is essential to be able to monitor changes in LV function in this setting.

METHODS

We studied LV function in 10 patients (median age 34 years, 9 male) who had LVADs implanted because of severe heart failure due to dilated cardiomyopathy a median of 4 months previously. Median pre-implant ejection fraction was 27% and all patients had been on maximal medical therapy, including intravenous inotropic support, prior to insertion of the LVAD.

RESULTS

During LVAD support there were cyclical variations in LV dimensions, fractional shortening (FS) and transmitral flow, related to changes in the phase relationship of the LV and the LVAD. The "best" FS occurred when LV systole coincided with device filling and the "worst" FS when LV systole coincided with device ejection. Median FS with the pump switched off was 18% (10% to 32%). Pump-off FS was significantly greater than the "worst" FS with the pump on (5%, p = 0.002), and similar to the "best" pump-on FS (19%, p = NS).

CONCLUSIONS

LV function could be studied echocardiographically during LV support and brief periods of interruption in support. Function varied according to the phase relationship of the LV and LVAD. The "best" FS measured during LVAD support was more closely related to the FS with the device switched off than the "worst" pump on FS. The "best" pump-on LV function is therefore most representative of intrinsic LV performance and can be used as a guide to recovery and the potential need for pump-off studies.