Complete genome sequence of Methanobacterium thermoautotrophicum deltaH: functional analysis and comparative genomics

The complete 1,751,377-bp sequence of the genome of the thermophilic archaeon Methanobacterium thermoautotrophicum deltaH has been determined by a whole-genome shotgun sequencing approach. A total of 1,855 open reading frames (ORFs) have been identified that appear to encode polypeptides, 844 (46%) of which have been assigned putative functions based on their similarities to database sequences with assigned functions. A total of 514 (28%) of the ORF-encoded polypeptides are related to sequences with unknown functions, and 496 (27%) have little or no homology to sequences in public databases. Comparisons with Eucarya-, Bacteria-, and Archaea-specific databases reveal that 1,013 of the putative gene products (54%) are most similar to polypeptide sequences described previously for other organisms in the domain Archaea. Comparisons with the Methanococcus jannaschii genome data underline the extensive divergence that has occurred between these two methanogens; only 352 (19%) of M. thermoautotrophicum ORFs encode sequences that are >50% identical to M. jannaschii polypeptides, and there is little conservation in the relative locations of orthologous genes. When the M. thermoautotrophicum ORFs are compared to sequences from only the eucaryal and bacterial domains, 786 (42%) are more similar to bacterial sequences and 241 (13%) are more similar to eucaryal sequences. The bacterial domain-like gene products include the majority of those predicted to be involved in cofactor and small molecule biosyntheses, intermediary metabolism, transport, nitrogen fixation, regulatory functions, and interactions with the environment. Most proteins predicted to be involved in DNA metabolism, transcription, and translation are more similar to eucaryal sequences. Gene structure and organization have features that are typical of the Bacteria, including genes that encode polypeptides closely related to eucaryal proteins. There are 24 polypeptides that could form two-component sensor kinase-response regulator systems and homologs of the bacterial Hsp70-response proteins DnaK and DnaJ, which are notably absent in M. jannaschii. DNA replication initiation and chromosome packaging in M. thermoautotrophicum are predicted to have eucaryal features, based on the presence of two Cdc6 homologs and three histones; however, the presence of an ftsZ gene indicates a bacterial type of cell division initiation. The DNA polymerases include an X-family repair type and an unusual archaeal B type formed by two separate polypeptides. The DNA-dependent RNA polymerase (RNAP) subunits A', A", B', B" and H are encoded in a typical archaeal RNAP operon, although a second A' subunit-encoding gene is present at a remote location. There are two rRNA operons, and 39 tRNA genes are dispersed around the genome, although most of these occur in clusters. Three of the tRNA genes have introns, including the tRNAPro (GGG) gene, which contains a second intron at an unprecedented location. There is no selenocysteinyl-tRNA gene nor evidence for classically organized IS elements, prophages, or plasmids. The genome contains one intein and two extended repeats (3.6 and 8.6 kb) that are members of a family with 18 representatives in the M. jannaschii genome.

Mutational analysis of the mouse mitochondrial cytochrome b gene

The protonmotive cytochrome b protein of the mitochondrial bc1 respiratory chain complex contains two reactions centers, designated Qo and Qi, which can be distinguished by the effects of different inhibitors. The nucleotide sequences have been determined of the mitochondrial cytochrome b genes from a series of mouse cell mutants selected for increased inhibitor resistance. Each mutant contains a single nucleotide change which results in an amino acid substitution. When the proximity of the altered amino acid residues to the histidines involved in heme ligation is considered, the results support a model for cytochrome b folding in which there are eight transmembrane domains rather than the nine of the Widger-Saraste model. Replacement of the Gly38 residue by valine results in resistance to the Qi inhibitors antimycin A and funiculosin but not 2-n-heptyl-hydroxyquinoline-N-oxide. Based upon sequence comparisons of mitochondrial and bacterial cytochrome b and chloroplast b6 proteins, the region of the molecule involved in antimycin binding is as highly conserved as those domains involved in heme ligation. It is suggested that the antimycin binding domain of cytochrome b is involved in forming the Qi reaction center. Alterations of the Gly142 and Thr147 residues result in resistance to myxothiazol and stimatellin, respectively. While both inhibitors block the Qo reaction center, the two mutations do not confer cross-resistance to each other. This region of cytochrome b is the most highly conserved during evolution and these inhibitor binding sites probably occur within the protein domain constituting the Qo reaction center. In addition, there is a less conserved region of the protein, defined by the Leu294 residue, which may function in binding the hydrophobic portions of Qo inhibitors.

Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery

BACKGROUND

Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared.

OBJECTIVE

To compare four existing methods for predicting perioperative cardiac risk.

DESIGN

Prospective cohort study.

SETTING

Two teaching hospitals in London, Ontario, Canada.

PATIENTS

2,035 patients referred for medical consultation before elective or urgent noncardiac surgery.

MEASUREMENTS

Myocardial infarction, unstable angina, acute pulmonary edema, or death. The indices were compared by examining the areas under their respective receiver-operating characteristic (ROC) curves.

RESULTS

Cardiac complications occurred in 6.4% of patients. The area under the ROC curve was 0.625 (95% CI, 0.575 to 0.676) for the American Society of Anesthesiologists index, 0.642 (CI, 0.588 to 0.695) for the Goldman index, 0.601 (CI, 0.544 to 0.657) for the modified Detsky index, and 0.654 (0.601 to 0.708) for the Canadian Cardiovascular Society index. These values did not significantly differ.

CONCLUSIONS

Existing indices for prediction of cardiac complications perform better than chance, but no index is significantly superior. There is room for improvement in our ability to predict such complications.

Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia

PURPOSE

To assess the patterns of antimicrobial use, costs of antimicrobial therapy, and medical outcomes by institution in patients with community-acquired pneumonia.

PATIENTS AND METHODS

The route, dose, and frequency of administration of all antimicrobial agents prescribed within 30 days of presentation were recorded for 927 outpatients and 1328 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial costs were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral agents, plus the costs associated with preparation and administration of parenteral therapy. Thirty-day outcome measures were mortality, subsequent hospitalization for outpatients, and hospital readmission for inpatients.

RESULTS

Significant variation (P <0.05) in prescribing practices occurred for 17 of the 23 antimicrobial agents used in outpatients across 5 treatment sites, and for 18 of the 20 parenteral agents used in inpatients across 4 treatment sites. The median duration of antimicrobial therapy for treatment site ranged from 11 to 13 days for outpatients (P=0.01), and from 13 to 15 days for inpatients (P=0.49). The overall median cost of antimicrobial therapy was $12.90 for outpatients, and ranged from $10.80 to $58.90 among treatment sites (P <0.0001). The overall median cost of antimicrobial therapy was $228.70 for inpatients, and ranged from $183.70 to $315.60 among sites (P <0.0001). Mortality and hospital readmission for inpatients were not significantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness severity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial costs.

CONCLUSION

Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia. Although variation in antimicrobial prescribing practices across institutions results in significant differences in antimicrobial costs, patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.

Cryptogenic epilepsy: an infectious etiology?

PURPOSE

Cryptogenic epilepsy, the group of epilepsy syndromes for which an etiology is unknown, comprises approximately 20% of all epilepsy syndromes. We selected patients in this subgroup of epilepsy and tested them for evidence of Toxoplasma gondii IgG antibodies by the enzyme-linked immunosorbent assay. T. gondii is found in up to 20% of the U.S. population forming dormant brain cysts in the latent bradyzoite form. We investigated the hypothesis that dormant T. gondii infection might be associated with cryptogenic epilepsy.

METHODS

We selected patients with cryptogenic epilepsies and tested them for evidence of T. gondii IgG antibodies by the enzyme-linked immunosorbent assay. A control group was also tested for comparison.

RESULTS

We have found a statistically-significant elevation of T. gondii antibodies among cryptogenic epilepsy patients as compared to controls [59% increase in optical density (OD), p = 0.013]. This association persisted after adjustment for subjects' gender and age in a multiple logistic regression model; however, it was no longer as statistically significant.

CONCLUSIONS

Our results suggest that chronic T. gondii infection with brain cysts may be a cause of cryptogenic epilepsy.

A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty

BACKGROUND

Given the high cost of autologous blood donation for elective surgery, it would be desirable to predict which patients are most likely to benefit from the procedure. The purpose of this study was to develop a point score system for predicting the likelihood of blood transfusion in hip and knee arthroplasty.

STUDY DESIGN AND METHODS

A database of 599 patients undergoing elective surgery at a teaching hospital was used for the analysis. Variables were analyzed to determine their univariate association with postoperative blood transfusion. Significant factors were entered into a multiple logistic regression model, and a point score system was developed on the basis of the regression coefficients. Four strata of transfusion risk were constructed.

RESULTS

Factors independently associated with blood transfusion included preoperative hemoglobin, type of arthroplasty, primary versus revision surgery, autologous donor status, and patient weight. Four factors were used to create a point score system with four strata. The likelihood of blood transfusion for patients in the four risk strata was 1.7, 11.0, 40.0, and 78.3 percent. The calculated area under the receiver operating characteristic curve was 0.86.

CONCLUSION

The likelihood of a postoperative blood transfusion can be predicted by using this simple point score system. Autologous blood donation can subsequently be targeted to the high-risk patients.

Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness

BACKGROUND

Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI to predict fluid responsiveness at three sites of measurement (the forehead, ear, and finger) in mechanically ventilated patients under general anaesthesia.

METHODS

We studied 28 subjects after induction of general anaesthesia. Subjects were monitored with a pulmonary artery catheter and three pulse oximeter sensors (the finger, ear, and forehead). Pulse pressure variation, central venous pressure, cardiac index (CI), and PVI measured at the forehead, ear, and finger (PVI(forehead), PVI(ear), and PVI(finger)) were recorded before and after fluid loading (FL). Subjects were responders to volume expansion if CI increased >15% after FL.

RESULTS

Areas under the receiver-operating curves to predict fluid responsiveness were 0.906, 0.880, and 0.836 for PVI(forehead), PVI(ear), and PVI(finger), respectively (P<0.05). PVI(forehead), PVI(ear), and PVI(finger) had a threshold value to predict fluid responsiveness of 15%, 16%, and 12% with sensitivities of 89%, 74%, and 74% and specificities of 78%, 74%, and 67%, respectively.

CONCLUSIONS

PVI can predict fluid responsiveness in anaesthetized and ventilated subjects at all three sites of measurement. However, the threshold values for predicting fluid responsiveness differ with the site of measurement. These results support the use of this plethysmographic dynamic index in the cephalic region when the finger is inaccessible or during states of low peripheral perfusion.

Non-social adaptation defers a tragedy of the commons in Pseudomonas aeruginosa quorum sensing

In a process termed quorum sensing (QS), the opportunistic bacterial pathogen Pseudomonas aeruginosa uses diffusible signaling molecules to regulate the expression of numerous secreted factors or public goods that are shared within the population. But not all cells respond to QS signals. These social cheaters typically harbor a mutation in the QS receptor gene lasR and exploit the public goods produced by cooperators. Here we show that non-social adaptation under growth conditions that require QS-dependent public goods increases tolerance to cheating and defers a tragedy of the commons. The underlying mutation is in the transcriptional repressor gene psdR. This mutation has no effect on public goods expression but instead increases individual fitness by derepressing growth-limiting intracellular metabolism. Even though psdR mutant populations remain susceptible to invasion by isogenic psdR lasR cheaters, they bear a lower cheater load than do wild-type populations, and they are completely resistant to invasion by lasR cheaters with functional psdR. Mutations in psdR also sustain growth near wild-type levels when paired with certain partial loss-of-function lasR mutations. Targeted sequencing of multiple evolved isolates revealed that mutations in psdR arise before mutations in lasR, and rapidly sweep through the population. Our results indicate that a QS-favoring environment can lead to adaptations in non-social, intracellular traits that increase the fitness of cooperating individuals and thereby contribute to population-wide maintenance of QS and associated cooperative behaviors.

Vagotomy prevents the effect of probiotics on caspase activity in a model of postmyocardial infarction depression

BACKGROUND

Myocardial infarction (MI) is associated with apoptosis in the amygdala and, ultimately, with clinical signs of depression. Different treatments have proven to be beneficial in preventing depression, including combination of the probiotics Lactobacillus helveticus and Bifidobacterium longum for prophylaxis. We have speculated previously that the benefit of these probiotics is due to their anti-inflammatory properties, and evidence suggests that an intact vagus nerve is important for this effect to occur. This study was designed to ascertain vagus nerve involvement in the beneficial influence of probiotics on caspase activities in our post-MI animal model of depression.

METHODS

Probiotics and/or vehicle were administered daily to male adult rats, 14 days before MI and until euthanasia. Vagotomy was performed in subgroups of rats 40 min before MI. They were sacrificed after 3 days of reperfusion, and MI size was assessed along with caspase-3 and -8 activities in the amygdala.

KEY RESULTS

Probiotics had no effect on infarct size but vagotomy increased it. Caspase-3 and caspase-8 activities in the amygdala were higher in MI than in sham-operated rats, and this outcome was reversed by probiotics. The beneficial influence of probiotics was abolished by vagotomy.

CONCLUSIONS & INFERENCES

Our data indicate that the effect of probiotics on caspase activities in the amygdala after MI depends on an intact vagus nerve.

Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement

BACKGROUND

The purpose of this study was to validate a previously published point score system for predicting the likelihood of a postoperative blood transfusion following hip or knee replacement.

STUDY DESIGN AND METHODS

Data were collected prospectively on 460 sequential patients undergoing elective hip and knee replacement at two academic hospitals. Blood transfusion frequency was determined for patients in each of the four risk strata, as defined by the point score system. The accuracy of the system was validated by calculating the area under the receiver operating characteristic (ROC) curve for each site. Data were then combined and inappropriate blood transfusions were eliminated, by using the American College of Physicians guidelines. The frequencies of blood transfusion within each strata were recalculated along with an ROC curve.

RESULTS

The point score system accurately predicted the likelihood of blood transfusion at both hospitals, despite marked differences in overall transfusion frequencies. The calculated areas under the ROC curves were 0.78 and 0.79 for the two sites. The point score system also proved valid when only appropriate blood transfusions were considered, with a calculated area under the ROC curve of 0.74.

CONCLUSION

The point score system can accurately predict the likelihood of postoperative blood transfusion following hip or knee replacement. Such a system can be used to target high-risk patients for preoperative autologous blood donation.

Modulation of bacteriolysis by cooperative effects of penicillin-binding proteins 1a and 3 in Escherichia coli

Escherichia coli characteristically lyses upon treatment with most beta-lactam antimicrobial agents. In contrast, an investigational aminothiazole cephem, CGP 31523A, produced a new combination of antibacterial effects: it was highly bactericidal without causing cell wall degradation or lysis. Killing was associated with the formation of vacuolated filaments. Because the compound bound to penicillin-binding proteins (PBPs) 1a and 3, we investigated the role of PBP 3 in modulation of lysis caused by inhibition of PBP 1a. A temperature-sensitive mutant with a nonfunctional PBP 3 lysed when treated with CGP 31523A. The combination of a PBP 1 inhibitor (cefsulodin) and a PBP 3 inhibitor (aztreonam) also caused filamentation and death without lysis of wild-type cells over a narrow concentration range. We conclude that cooperative effects between PBPs in E. coli can lead to a dissociation of bacterial killing and lysis.

Pathologic findings and liver elements in hibernating bats with white-nose syndrome

Two groups of vespertilionid bats were collected from affected hibernacula. In group 1 (n, 14; pathology and microbiology), the average body weights of all species were at the lower limit of published ranges. Twelve bats (86%) had mycotic growth in the epidermis, hair follicles, and sebaceous glands. Geomyces destructans, with its characteristic curved conidia, was observed microscopically, cultured, and confirmed by polymerase chain reaction. Dermatitis and mural folliculitis was nil to mild. When focally coinfected with Gram-negative bacteria, there was necrosis and pustules. Fat stores were little to abundant in 12 bats (86%) and nil in 2. Thirteen bats (93%) had pulmonary congestion and 7 (50%) had bone marrow granulocytosis. In group 2 (n, 24; liver elements), 3 bats (13%) had potentially toxic lead levels and 1 (4%), potentially toxic arsenic level. There was no evidence of major organ failure or consistent element toxicity.

Staging of laryngeal cancer using 64-channel multidetector row CT: comparison of standard neck CT with dedicated breath-maneuver laryngeal CT

BACKGROUND AND PURPOSE

With a 64-channel multidetector row CT, imaging acquisition during speech, swallowing, or phonation has become feasible. However, the actual benefit of these additional focused images should be critically evaluated with respect to radiation dose. The purpose of this study was to determine if dedicated laryngeal CT using breath-holding and straw-blowing improved the accuracy of TNM-staging for patients with biopsy-proved laryngeal carcinomas in comparison with a standard neck CT.

MATERIALS AND METHODS

A total of 27 patients underwent a standard neck CT and a laryngeal CT with additional images acquired while patients held their breath or blew through a straw. Two radiologists interpreted the neck CT and later the laryngeal CT and assigned a TNM-stage for each case. These interpretations were compared with a TNM-stage determined by surgery and/or clinical examination for the individual patients. The accuracy of standard neck CT was compared with the accuracy of laryngeal CT.

RESULTS

The overall accuracy was not significantly different between standard neck CT and the additional laryngeal CT and was, in fact, lower in cases with additional larynx images. The accuracy of staging was slightly improved with the additional laryngeal CT for glottic cancers; however, it was decreased for supraglottic cancers. The accuracy of a dichotomous diagnosis of early-versus-advanced-stage cancer was 0.86 for the standard neck CT and 0.80 for the laryngeal CT. The readers' confidence levels did not improve with the use of the additional images.

CONCLUSIONS

In the era of isovoxel multidetector CT technology and judicious monitoring of radiation dose, a standard neck CT with coronal and sagittal reformats should suffice for the staging of laryngeal cancer.

Deaths of cyclists in London 1985-92: the hazards of road traffic

OBJECTIVE

To determine the characteristics of cyclists and vehicles involved in fatal cycling accidents.

DESIGN

Analysis of data routinely collected by police for each accident from January 1985 to December 1992 and held in a national master file (Stats 19) by the Department of Transport.

SETTING

Greater London, which comprises inner London (12 boroughs and the City of London) and outer London (20 boroughs).

SUBJECTS

178 cyclists who died (78 in inner London and 100 in outer London; age range 3-88).

MAIN OUTCOME MEASURES

Associations between characteristics of cyclists, type of vehicle involved, and place of accident.

RESULTS

Motor vehicles were involved in 173 deaths. Heavy goods vehicles were involved in 75 deaths (30/100 (30%) in outer London and 45/78 (58%) in inner London); cars in 74 (54/100) (54%) in outer London and 20/78 (26%) in inner London); light goods vehicles in 12/178 (7%); and buses in 6/178 (3%). Thirty five of the people who died were children aged < or = 16. Female cyclists were especially at risk from heavy goods vehicles in inner London (22 deaths), while male cyclists were especially at risk from cars in outer London (50 deaths).

DISCUSSION

Cyclists who died in urban areas are more likely to be adults than children. In inner London, in relation to their traffic volume, heavy goods vehicles are estimated to cause 30 times as many cyclists' deaths as cars and five times as many as buses. Until the factors leading to this excess risk are understood, a ban on heavy goods vehicles in urban areas should be considered.

Investigations on the variability of haptoglobin, transferrin and Gc polymorphisms in Assam, India

Ten different population groups of Assam - Brahmins, Kalitas, Kaibartas, Rajbanshis, Muslims, Ahoms, Chutias, Kacharis, Karbis and Sandwals - have been typed for haptoglobin and for transferrin (Tf) and Gc subtype polymorphisms. Tf and Gc allele subtype frequencies show a considerable inter-population heterogeneity. From genetic distance analysis it appears that the populations under study form some distinct clusters, which can be explained by the historical and ethnic affiliations of these populations. Especially the distribution of Gc subtype alleles reveals some Mongoloid admixture among Assamese populations, which is reflected by the presence of Gc1A8 alleles in them.

Cyclist road deaths in London 1985-1992: drivers, vehicles, manoeuvres and injuries

We used coroners' records to investigate the fatal accidents of cyclists recorded on death certificates in London during 1985-1992. There were 124 deaths: 68 cyclists were injured in London and 56 injured in the "home counties" around London and died in London hospitals. The cyclists' ages were from 8-88, and 70% were male; the drivers were aged 17-74, and 96% were male. Of the 108 vehicles involved, 53 were cars (including one parked) and 40 heavy goods vehicles (HGVs) (including 14 large lorries and 18 articulated lorries), 5 light goods vehicles, 5 buses and coaches and 5 motorcycles. Fatal accidents occurred with a wide range of manoeuvres; of vehicles turning left (driving is on the left in the U.K.), 14 out of 15 were HGVs. Accidents were most often on 2 lane roads and one half were near a road junction. Law violations were recorded in half the accidents; alcohol intoxication contributed only rarely. While injuries to the head were the commonest reported direct cause of death, Inner London deaths were frequently due to multiple injuries. The study confirms the serious danger to cyclists (particularly women) in Inner London from large and articulated lorries, causing death from multiple injuries.

Genetic markers among Meiteis and Brahmins of Manipur, India

Genetic polymorphism of 16 red-cell antigens, enzymes, serum proteins and Hb variants was investigated in 214 male and female individuals belonging to the Meiteis and a Brahmin caste group living in Imphal (Manipur, Northeast India). Ethnohistorical records suggest that the Meiteis are of Mongoloid origin, while the original Brahmin settlers represent the easternmost part of the so-called Caucasoids. The markers studied are: A1A2BO, MNSs, Rh-system, Duffy, Diego; Gm, Km, Gc, Hp, Tf, Cp; Hb; aP, AK, EsD and LDH. The comparison between the two groups on the basis of the markers studied showed that the Meiteis and Brahmins are very close to each other with respect to most of the loci except Gm, EsD and Hb, where significant statistical differences were found.

Short-term effects of inhaled albuterol on maternal and fetal circulations

Short-term circulatory effects with the maximum recommended dose of inhaled albuterol (Proventil) were studied on 12 asthmatic patients between 33 and 39 weeks' gestation. The mean maternal blood pressures and heart rates, systolic/diastolic ratios of the uterine arcuate and umbilical arteries, and fetal heart rates and aortic velocities were unaffected during the first 2 hours after dosing.

Effects of losartan on whole body, skeletal muscle and vascular insulin responses in obesity/insulin resistance without hypertension

AIMS

Renin-angiotensin system antagonists have been found to improve glucose metabolism in obese hypertensive and type 2 diabetic subjects. The mechanism of these effects is not well understood. We hypothesized that the angiotensin receptor antagonist losartan would improve insulin-mediated vasodilation, and thereby improve insulin-stimulated glucose uptake in skeletal muscle of insulin-resistant subjects.

METHODS

We studied subjects with obesity and insulin resistance but without hypertension, hypercholesterolaemia or dysglycaemia [age 39.0 ± 9.6 yr (mean ± SD), body mass index (BMI) 33.2 ± 5.9 kg/m(2) , BP 115.8 ± 12.2/70.9 ± 7.2 mmHg, LDL 2.1 ± 0.5 mmol/l]. Subjects were randomized to 12 weeks' double-blind treatment with losartan 100 mg once daily (n = 9) or matching placebo (n = 8). Before and after treatment, under hyperinsulinaemic euglycaemic clamp conditions we measured whole-body insulin-stimulated glucose disposal, insulin-mediated vasodilation, and insulin-stimulated leg glucose uptake by the limb balance technique.

RESULTS

Whole-body insulin-stimulated glucose disposal was not significantly increased by losartan. Insulin-mediated vasodilation was augmented following both treatments [increase in leg vascular conductance: pretreatment 0.7 ± 0.3 l/min/mmHg (losartan, mean ± SEM) and 0.9 ± 0.3 (placebo), posttreatment 1.0 ± 0.4 (losartan) and 1.3 ± 0.6 (placebo)] but not different between treatment groups (p = 0.53). Insulin's action to augment nitric oxide (NO) production and to augment endothelium-dependent vasodilation was also not improved. Leg glucose uptake was not significantly changed by treatments, and not different between groups (p = 0.11).

CONCLUSIONS

These findings argue against the hypothesis that losartan might improve skeletal muscle glucose metabolism by improving insulin-mediated vasodilation in normotensive insulin-resistant obese subjects. The metabolic benefits of angiotensin receptor blockers may require the presence of hypertension in addition to obesity-associated insulin resistance.

Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study

BACKGROUND

Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE.

METHODS

Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation.

RESULTS

There were 387 (78.3%) negative and 107 (21.7%) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5% (95% confidence interval 98.1-99.9%).

CONCLUSION

Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.

Gel filtration analysis of vanadium in Ascidia nigra blood cell lysate

Fractions from a Sephadex gel filtration of homogenized Ascidia nigra blood cell lysate were analyzed for vanadium by atomic absorption spectroscopy. The results were unaffected by temperature from 4-21 degrees C, and by ionic strength in the range 0.09-1.0 M (NaCl). Appreciable loss of vanadium in the supernatant was experienced above pH 2.2. Experiments at pH 2.1 under anaerobic conditions show that the green chromogen and the vanadium-containing bands elute separately. Under these experimental conditions, the vanadium-containing species is of relatively low (congruent to 1,000) molecular weight.