Clinical features of acute coronary syndromes in patients with human immunodeficiency virus infection

BACKGROUND

Patients with HIV infection exhibit increased rates of coronary events; however, the clinical features of acute coronary syndromes (ACS) in HIV-infected patients have not been well defined.

METHODS AND RESULTS

Between 1993 and 2003, 68 HIV-infected patients were hospitalized with ACS. We compared the clinical features and outcome of these patients with those of 68 randomly selected control patients with ACS without HIV. HIV patients were on average more than a decade younger than controls and more likely to be male and current smokers and to have low HDL cholesterol. They were less likely than controls to have diabetes or hyperlipidemia, and their TIMI (Thrombolysis In Myocardial Infarction) risk scores on admission were significantly lower. At coronary angiography, the number of vessels with >50% stenosis was 1.3+/-1.0 in HIV patients and 1.9+/-1.2 in controls (P=0.007). Restenosis developed in 15 of 29 HIV patients who underwent percutaneous coronary intervention compared with 3 of 21 controls (52% versus 14%, P=0.006).

CONCLUSIONS

HIV patients with ACS are younger and more likely to be males and current smokers and to have low HDL cholesterol levels compared with other ACS patients. Their TIMI risk scores are lower, and they are more likely to have single-vessel disease; however, their restenosis rates after percutaneous coronary intervention are unexpectedly high.

Achieving Millennium Development Goals 4 and 5 in Nepal

The under 5 child mortality rate in Nepal is on track to achieve the target of 54 per 1000 live births by 2015 compared with 158 per 1000 live births in 1991. The maternal mortality rate also looks set to drop to its target of 134 per 100,000 live births by 2015 from 539 per 100,000 live births in 1991. A 3-year interim plan (2008-11) was established to provide free basic health care for all citizens and the safe delivery incentive programme has proved to help progression towards achieving Millennium Development Goals 4 and 5. The development of a policy targeting women, children and vulnerable populations in hard to reach places is a key feature. The principle of a primary healthcare approach is applied in the development and implementation of strategy plans and programmes. The focus is on ensuring that there are functioning facilities for essential obstetric care at health facilities and provision of trained personnel at delivery.

Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting

A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm × 2.3 cm) was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.

Development of a system to rank perennial ryegrass cultivars according to their economic value to dairy farm businesses in south-eastern Australia

Dairy production systems in south-eastern Australia are based primarily on grazed pasture. Perennial ryegrass (Lolium perenne L.) is the major grass species used in this region and farmers are faced with the challenge of choosing from more than 60 commercially available cultivars. This paper describes the development of a system termed as a forage value index that ranks the overall performance of perennial ryegrass cultivars relative to cultivar Victorian according to the summation of the estimated difference in the value of seasonal dry-matter (DM) yield of the cultivars. Average predicted seasonal DM yields were calculated by analysing the results of eight available perennial ryegrass plot trials across south-eastern Australia, using a multi-environment, multi-harvest linear mixed model. The differences in the model-predicted DM yield of each cultivar was compared with cultivar Victorian in each of five seasonal periods (autumn, winter, early spring, late spring, summer) to generate a series of performance values (1 per period) for each cultivar. Each performance value was then multiplied by an economic value (AU$/kg extra pasture grown) relating to each of four regions (Gippsland, northern Victoria, south-western Victoria, Tasmania) and seasonal period and aggregated to generate an overall forage value index rating for each cultivar. Economic values ranged from AU$0.11 to AU$0.39 per extra kilogram of DM grown, depending on the season and region, which translated into estimated benefits on dairy farms of up to AU$183 per ha per year for farmers that use high-yielding cultivars in place of cultivar Victorian perennial ryegrass.

Energy-transfer quantum dynamics of HeH+ with He atoms: Rotationally inelastic cross sections and rate coefficients

Two different ab initio potential energy surfaces are employed to investigate the efficiency of the rotational excitation channels for the polar molecular ion HeH⁺ interacting with He atoms. We further use them to investigate the quantum dynamics of both the proton-exchange reaction and the purely rotational inelastic collisions over a broad range of temperatures. In current modeling studies, this cation is considered to be one of the possible cooling sources under early universe conditions after the recombination era and has recently been found to exist in the interstellar medium. The results from the present calculations are able to show the large efficiency of the state-changing channels involving rotational states of this cation. In fact, we find them to be similar in size and behavior to the inelastic and reaction rate coefficients obtained in previous studies, where H atoms were employed as projectiles. The same rotational excitation processes, occurring when free electrons are the collision partners of this cation, are also compared with the present findings. The relative importance of the reactive, proton-exchange channel and the purely inelastic channels is also analyzed and discussed. The rotational de-excitation processes are also investigated for the cooling kinetics of the present cation under cold trap conditions with He as the buffer gas. The implications of the present results for setting up more comprehensive numerical models to describe the chemical evolution networks in different environments are briefly discussed.

The use of oxidative stress biomarkers in live animals (in vivo) to predict meat quality deterioration postmortem (in vitro) caused by changes in muscle biochemical components

This study was conducted to determine whether circulating concentrations of blood isoprostanes can be used as an effective biomarker in lambs to predict degradation of color and/or lipid stability in meat. Lambs ( = 84) were fed diets of either lucerne pasture, annual ryegrass pasture, a commercial feedlot pellet, or a combination of annual ryegrass and feedlot pellet for 8 wk, including a 2-wk adaptation period. Blood isoprostane concentration at wk 0, 4, 6 or 8 of feeding was determined. Blood isoprostane concentration for each animal was then correlated with muscle biochemical components that impact color and/or lipid oxidative status during retail display. This included lipid oxidation levels in muscle assessed by thiobarbituric acid reactive substances and meat redness determined by a HunterLab colorimetric spectrometer. Lambs that consumed the commercial feedlot pellet had a lower muscle vitamin E level (< 0.01) and a greater level of -6 PUFA ( < 0.001) compared with lambs finished on annual ryegrass or lucerne. Lipid oxidation levels were greatest for lambs finished on the feedlot ration, lowest in lambs finished on the ryegrass diet, and intermediate for lambs finished on lucerne and ryegrass-feedlot combination ( < 0.01). After 8 wk of feeding, blood isoprostane concentration was positively correlated with lipid oxidation of meat displayed for 72 h in simulated retail conditions ( < 0.01). There was a negative linear relationship between isoprostane concentration and muscle vitamin E concentration ( = 0.07), lipid oxidation and muscle vitamin E concentration ( < 0.01) but a positive linear relationship between isoprostane concentration and muscle -6 PUFA ( < 0.001) or lipid oxidation and muscle -6 PUFA concentration ( < 0.001). Blood isoprostane concentration and lipid oxidation in meat were influenced by muscle vitamin E and -6 PUFA but not by -3 PUFA. There was no significant relationship observed between blood isoprostane concentration at 0, 4, 6 or 8 wk feeding vs. overall meat color (redness of meat) at 0 and 72 h of display, stored under simulated retail conditions. The results indicate that circulating blood isoprostane concentration can be a useful tool to predict the oxidative status of postmortem meat. Future work will examine the impact of this relationship on meat flavor/aroma deterioration post farm.

HeH+ Collisions with H2: Rotationally Inelastic Cross Sections and Rate Coefficients from Quantum Dynamics at Interstellar Temperatures

We report for the first time an accurate ab initio potential energy surface for the HeH⁺–H₂ system in four dimensions (4D) treating both diatomic species as rigid rotors. The computed ab initio potential energy point values are fitted using an artificial neural network method and used in quantum close coupling calculations for different initial states of both rotors, in their ground electronic states, over a range of collision energies. The state-to-state cross section results are used to compute the rate coefficients over a range of temperatures relevant to interstellar conditions. By comparing the four dimensional quantum results with those obtained by a reduced-dimensions approach that treats the H₂ molecule as an averaged, nonrotating target, it is shown that the reduced dimensionality results are in good accord with the four dimensional results as long as the HeH⁺ molecule is not initially rotationally excited. By further comparing the present rate coefficients with those for HeH⁺–H and for HeH⁺–He, we demonstrate that H₂ molecules are the most effective collision partners in inducing rotational excitation in HeH⁺ cation at interstellar temperatures. The rotationally inelastic rates involving o-H₂ and p-H₂ excitations are also obtained and they turn out to be, as in previous systems, orders of magnitude smaller than those involving the cation. The results for the H₂ molecular partner clearly indicate its large energy-transfer efficiency to the HeH⁺ system, thereby confirming its expected importance within the kinetics networks involving HeH⁺ in interstellar environments.

Nutritive characteristics of perennial ryegrass cultivars: have they changed over time?

Improvement in nutritive characteristics resulting from breeding perennial ryegrass (PRG) cultivars used in Australia from the 1970s to the present day was quantified in a grazed field experiment in south-western Victoria. The experiment was sown in May 2014 with measurements undertaken over 3 years. The experiment contained 36 PRG treatments (cultivar–endophyte combinations), which were replicated four times, with herbage nutritive characteristics measured at each grazing. The treatments differed in estimated metabolisable energy (ME), crude protein and neutral detergent fibre (NDF) concentrations at each harvest date. The decade of cultivar release had little effect on the ME or the NDF concentration of the cultivars released from 1970s onward. Early season diploids had a lower ME concentration than did later-maturing diploid cultivars (11.0 vs 11.4 MJ/kg DM), predominantly due to a lower ME concentration in late spring and early summer (10.3 vs 11.1 MJ/kg DM). The tetraploid cultivars had a higher ME concentration (11.8 vs 11.4 MJ/kg DM) and a lower NDF (480 vs 505 g/kg DM) concentration than did the mid- and late-season diploid cultivars. These differences are likely to be of economic importance at the farm level.

Efficiency of rovibrational cooling of HeH+ by collisions with He: Cross sections and rate coefficients from quantum dynamics

By extending an earlier study [Gianturco et al., J. Chem. Phys. 154, 054311 (2021)] on the purely rotational excitation of HeH⁺ by He atoms, we report in this paper integral cross sections and rate coefficients for rovibrational excitation and de-excitation processes in HeH⁺ due to collisions with He. The data were obtained using a new ab initio potential energy surface that includes the vibrational degree of freedom. The results are compared with those computed using the earlier potential energy surface by Panda and Sathyamurthy [J. Phys. Chem. A 107, 7125 (2003)] that additionally accounts for the proton-exchange reaction between HeH⁺ and He. It is shown that the exchange channel contributes nearly as much as the inelastic channel to the vibrational excitation and de-excitation processes and that the total rate constants pertaining to the purely inelastic processes are largely of the same magnitude as those obtained when both inelastic and reactive channels are included in the dynamics. The inelastic rovibrational rate coefficients involving this astrophysical cation are also found to be much larger than those obtained for anions present in similar interstellar environments.

Fetal biophysical profile score and perinatal outcome

BACKGROUND

Sudden fetal demise, perinatal morbidity and mortality are still some of the major obstetrical challenges. Reduced fetal movements may have some bearing to fetal asphyxia and death, so timely detection of such condition and measures taken can prevent such mishaps.

METHODS

A descriptive prospective study was conducted at Tribhuvan University Teaching Hospital, Department of Obstetrics and Gynecology from January to December 2002 in 55 cases to find out the relationship of Biophysical Profile Score with perinatal outcome in pregnant mothers with decreased fetal movement counts at or above 34 weeks of gestational age. The mode of delivery, Apgar score, neonatal admission and perinatal mortality were analyzed.

RESULTS

The study demonstrated that most of the fetuses were in good condition with 87% of the cases scoring 8-10 BPS (normal), 6% scoring six (equivocal) and only 7% got four score (abnormal). Having the abnormal BPS of four significantly increased the risk of perinatal mortality by 50% (p=0.000). This study could not detect any significant association between Apgar score and neonatal morbidities, but showed significant correlation between BPS and caesarean section. The patients having lower BPS tended to undergo more caesarean section delivery than patients having normal BPS (p=0.009).

CONCLUSIONS

An abnormal BPS of four in cases of reduced fetal movement counts significantly influenced the risk of perinatal death. However reduced fetal movements only did not raise the risk of fetal morbidity and mortality. So BPS should be beneficial to detect the fetuses at risk in the patients having less fetal movements for the proper management at right time.

Early Life Nutrition and its Effects on the Developing Heifer: Growth, nutritive intakes, and metabolism

We aimed to assess the effects of preweaning nutrition and postweaning growth rates on the metabolic characteristics of replacement dairy heifers until 20 mo of age. At birth heifers, were allocated to one of 4 treatment groups which were a combination of preweaning (high or low preweaning nutritional treatment), and postweaning treatments (high or low postweaning growth rate). In the preweaning phase (birth until weaning at 10 weeks of age) heifers were subject to either a High (8 L/day) or Low (4 L/day) milk feeding strategy, then at weaning either a high or low postweaning growth rate. Heifers in the high preweaning treatment groups recorded greater growth rates until weaning compared with heifers in the low preweaning treatment groups. Heifers in the high preweaning groups consumed approximately twice the amount of milk and half the amount of concentrate. Blood samples taken at 6 weeks of age had lower BHB and higher glucose and IGF-1 concentrations in the high preweaning treatment in the preweaning phase; these differences disappeared postweaning. Additionally, insulin levels were also higher, and QUICKI index results were lower for heifers on the high preweaning treatment and for those on the high postweaning treatment, at 6 weeks and 13 mo of age. No differences between treatments were detected at 8 mo of age. Results indicate a positive effect of accelerated preweaning nutrition and post weaning growth rate (at 13 mo of age) on these metabolic biomarkers, however these treatment effects were independent of one another and reflected the nutritional input at the time.

Late onset systemic sclerosis with seronegativity: a rare presentation of an uncommon disease

Systemic sclerosis (SSc) is an uncommon connective tissue disorder characterized by multisystem involvement with fibrosis of skin and internal organs. Antibody formation is one of the hallmarks of SSc. Antinuclear antibodies (ANA) are positive in 97% of patients with SSc. We report a rare case where the patient was negative for ANA, Anti-topoisomerase I, Anti-centromere and Anti-RNA polymerase III antibodies.

Milk production of cows grazing pasture supplemented with grain mixes containing canola meal or corn grain or both over the first 100 days of lactation

Grain mixes varying in proportions of wheat grain, barley grain, canola meal, and corn grain were fed to grazing dairy cows in early lactation to determine the contribution of canola meal and corn grain to milk yield, BW, BCS, eating behavior, and blood serum metabolite concentrations. The experiment used 80 multiparous, seasonally calving Holstein-Friesian dairy cows during the first 100 d of lactation, the treatment period, and over the subsequent carryover period of 100 d, during which all cows were fed a common diet. Cows were divided into 4 cohorts (blocks) based on calving date and within each cohort, 5 cows were randomly allocated to each of the 4 treatments. Dietary treatments included disc-milled grain mixes comprising (on a DM basis) (1) a control treatment of wheat (25%) and barley (75%); (2) wheat (25%), barley (50%), and canola meal (25%); (3) wheat (25%), barley (50%), and corn (25%), and (4) wheat (25%), barley (25%), canola meal (25%), and corn (25%). Treatment diets were introduced at 19 DIM ± 4.7 d, which included a 7-d adaptation period and were applied up until 100 DIM. Each grain mix was fed at 9 kg of DM/cow per day, offered twice daily, in equal proportions in the parlor at milking times. In addition to the grain mix, all cows grazed perennial ryegrass pasture at a daily allowance of ∼35 kg of DM/cow per day (measured to ground level). Results were analyzed in terms of corn and canola presence or absence in the diet. Including canola meal in grain mixes increased grain intake and pasture intake by 0.6 and 2.1 kg of DM/cow per day, respectively, resulting in an increased milk yield of 2.6 kg/cow per day during the first 100 d of lactation. Including canola meal also increased yields of milk fat and protein, and concentrations of milk fat, as well as increasing mean BW and BCS over the 100 d. The inclusion of canola meal in the grain mixes also resulted in greater blood serum BHB and urea concentrations, compared with feeding grain mixes that did not contain canola meal. The inclusion of corn grain provided no milk production benefits and did not change BW, BCS, or any feeding behavior variables. There were no carryover effects on milk production from either canola meal or corn grain after the treatment period. In summary, the results demonstrate that the provision of canola meal in grain mixes can improve milk production and increase mean BCS. Further, there are no benefits to milk yield when a proportion of barley is substituted for corn, in a wheat and barley grain mix fed to grazing dairy cows in early lactation. However, these results are dependent on the level of inclusion and the feeding system employed.