Later exposure to perches and nests reduces individual hens' occupancy of vertical space in an aviary and increases force of falls at night

Tiered aviaries are intended to improve laying hen welfare by providing resources that enable them to perform essential behaviors. However, hens must be able to navigate these complex systems efficiently and safely. This study investigated the influence of providing perches and nests starting at 17 or 25 wk of age (WOA) on hens' use of vertical space in an aviary at 36 and 54 WOA. Three treatments were applied to pullets raised in floor pens until 17 WOA (4 units/treatment; 100 hens/unit). Control (CON) pullets were placed into aviaries at 17 WOA. Floor (FLR) pullets were placed into aviaries at 25 WOA. Perches and nests were placed in enriched (ENR) pullets' floor pens at 17 WOA prior to moving ENR birds to aviaries at 25 WOA. Five focal hens/unit (n = 20 total hens/treatment) were fitted with accelerometers, and their diurnal movement (g) and frequency (n) and acceleration (g) of falls at night were recorded. Direct observation of focal hens was conducted for 6 min/hen at morning, midday, and evening for 3 consecutive days at 36 and 54 WOA, and location and time spent on vertical tiers were recorded. At 36 WOA, FLR hens spent more time on litter than CON and ENR, which spent more time in the top tier (all P ≤ 0.05). ENR hens exhibited higher vertical movement than CON and FLR hens (0.8, 0.6, and 0.3 g; P = 0.003). CON hens fell most often at night (16 vs. 9 FLR and 5 ENR), whereas FLR hens had higher acceleration and calculated collision force than CON and ENR hens during falls (0.8, 0.5, 0.3 g and 15, 10, 5 N, respectively; P ≤ 0.05). At 54 WOA, hens' movement and vertical distribution were similar across treatments. Delaying birds' access to perches and nests until 25 WOA impacted their movement, vertical space use, and falls at night for at least 10 wk. However, providing perches and nests at 17 WOA, even in floor pens, considerably mitigated such impacts.

Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study

BACKGROUND AND PURPOSE

Dysphagia occurs in up to 50% of all patients with acute stroke. There is debate regarding which is the most effective screening tool in identifying aspiration in patients with acute stroke. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke (GLOBE-3S), which combines the Toronto Bedside Swallowing Screening Test (TOR-BSST©) with oxygen desaturation and laryngeal elevation measurement during swallowing.

METHODS

We prospectively enrolled consecutive patients with stroke within 72 h of symptom onset. All patients with stroke firstly underwent a standard neurological examination, then the GLOBE-3S evaluation and finally the fiberoptic endoscopic evaluation of swallowing (FEES). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and each other's evaluation, administered the GLOBE-3S and FEES examination. We assessed the accuracy of the GLOBE-3S in detecting post-stroke swallow impairment with aspiration using the FEES as the standard.

RESULTS

We enrolled 50 patients with acute stroke, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. A total of 33 patients (66%) failed the GLOBE-3S evaluation. The GLOBE-3S reached a sensitivity of 100% and a specificity of 77.3% (negative predictive value, 100%; positive likelihood ratio, 4.34). The median time required for the GLOBE-3S to be performed was 297 s.

CONCLUSIONS

GLOBE-3S is quick to perform at the bedside and can accurately identify aspiration in patients with acute stroke. By including the measurement of laryngeal elevation and monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.

Cerebral venous hemodynamic abnormalities in episodic and chronic migraine

Alterations of cerebral venous drainage have been demonstrated in chronic migraine (CM), suggesting that cerebral venous hemodynamic abnormalities (CVHAs) play a role in this condition. The aim of the present study was to look for a correlation between CM and CVHAs. We recruited 33 subjects suffering from CM with or without analgesic overuse, 29 episodic migraine (EM) patients with or without aura, and 21 healthy subjects as controls (HCs). CVHAs were evaluated by transcranial and extracranial echo-color Doppler evaluation of five venous hemodynamic parameters. CVHAs were significantly more frequent in the CM and EM patients than in the HCs. In the migraine patients, CVHAs were not correlated with clinical features. The significantly greater frequency of CVHAs observed in the migraineurs may reflect a possible relationship between migraine and these abnormalities. Prospective longitudinal studies are needed to investigate whether CVHAs have a role in the processes of migraine chronification.

Leucocyte esterase, glucose and C-reactive protein in the diagnosis of prosthetic joint infections: a prospective study

Analysis of joint fluid is of paramount importance for the diagnosis of prosthetic joint infections. Different markers of inflammation and/or infection in joint fluid have been proposed for diagnosis of these infections. In this study we evaluated the performance of leucocyte esterase, C-reactive protein (CRP) and glucose assays in synovial fluids from 129 patients with septic (n = 27) or aseptic (n = 102) prosthetic joint failure. Samples were collected in serum tubes and centrifuged to limit the presence of corpuscle interfering with the assays. Determinations of leucocyte esterase and glucose were carried out by means of enzymatic colorimetric reactions performed on strips for urine analysis. Tests were considered positive when graded + or ++ whereas traces or absence of colour were considered negative. CRP was measured using an automated turbidimetric method and considered suggestive for infections when >10 mg/L. Leucocyte esterase was positive in 25/27 infected patients and negative in 99/102 not infected patients (sensitivity 92.6%, specificity 97.0%). CRP was higher than the threshold in 22/27 infected patients and in 6/102 not infected patients (sensitivity: 81.5%; specificity: 94.1%) whereas glucose showed the lowest sensitivity (77.8%) and specificity (81.4%), being negative in 21/27 and 19/102 infected and not infected patients, respectively. CRP led to a correct diagnosis in 19 of 22 patients with discordant esterase and glucose results. In conclusion, evaluation of leucocyte esterase, glucose and CRP may represent a useful tool for rapid diagnosis of prosthetic joint infections.

On the Pt(+) and Rh(+) Catalytic Activity in the Nitrous Oxide Reduction by Carbon Monoxide

Nitrous oxide activation by CO in the presence of platinum and rhodium monocations was elucidated by density functional methods for ground and first excited states. Platinum and rhodium cations fulfill the thermodynamic request for the oxygen-atom transport that allows the catalytic cycle to be completed, but actually, just the first one meaningfully improves the kinetics of the process. For both catalysts, the reaction pathways show the only activation barrier in correspondence of nitrogen release and monoxide cation formation. The kinetic analysis of the potential energy profile, in agreement with ICP/SIFT MS experimental data, indicates that platinum performs more in the reduction, while the whole process is not sufficiently fast in the case of rhodium ionic catalyst.

Prolonging culture to 15 days improves bacterial detection in bone and joint infections

Since the optimal incubation period of cultures for diagnosis of bone and joint infections is still a matter of debate, the present study aimed to evaluate the effects of different incubation periods (5 and 15 days) on microbial isolation. Samples from 387 patients with bone and joint infections (including prosthetic ones) were analyzed from March 2012 to February 2014. In 197 patients (51 %) growth was obtained within 48 hrs, while in 124 (32 %) and 66 (17 %) patients cultures yielded positive results within and after 5 days of incubation, respectively. Of 449 microorganisms isolated, 247 grew within 48 hrs, 131 within the first 5 days of incubation while 71 were isolated after 5 days. Staphylococcus aureus was the most frequently isolated pathogen within 48 hrs, while Propionibacteria were prevalently isolated after 5 days of incubation. Interestingly, about 25 % of microorganisms isolated after 5 days of incubation were coagulase-negative staphylococci. Extending incubation period of broth cultures improves isolation rates of pathogens involved in bone and joint infections thus improving management of these infections.

Comparison of postoperative complications in healthy dogs undergoing open and closed orchidectomy

OBJECTIVE

To compare closed and open orchidectomy in dogs and the associated complications.

METHODS

A randomised controlled blinded prospective clinical study of 73 cases was undertaken involving the recording of all complications during and in the 10 days following orchidectomy of dogs fulfilling the standardised inclusion criteria. The active variable was the surgical technique of either open or closed orchidectomy.

RESULTS

Dogs undergoing open orchidectomy experienced significantly more complication events than the dogs undergoing closed orchidectomy [24 of 34 (70%) versus 18 of 39 (46%), P = 0 · 04]. Dogs undergoing open orchidectomy were statistically more likely to develop scrotal complications (21 of 34, 61%) compared with dogs undergoing closed orchidectomy (13 of 39, 33%; P = 0 · 02).

CLINICAL SIGNIFICANCE

Open orchidectomy is associated with a higher overall complication rate in the first 10 days after surgery than closed orchidectomy. Open orchidectomy is also associated with increased scrotal complications including swelling, bruising and pain compared with closed orchidectomy.

UK owner preferences for treatment of feline injection site sarcomas

OBJECTIVES

Feline injection site sarcomas are therapeutically challenging because of their locally invasive nature. Several protocols recommend that the two perceived high-risk adjuvanted vaccines should be administered into distinct anatomical sites ("left hind leg leukaemia, right hind leg rabies"), which should aid surgical resection. This has resulted in a change in tumour distribution with an increased proportion situated caudal to the diaphragm when such a policy is adopted. The aim of this study was to determine UK cat owners' attitudes towards surgical treatments of different anatomical regions.

METHODS

A cross-sectional study of an anonymous convenience sample of UK cat owners was conducted from September to December, 2012 using an internet-based survey.

RESULTS

There were a total of 208 respondents: 39% would pursue surgery regardless of tumour site. One percent would not pursue surgery. Of the remainder, respondents would not allow amputation of the forelimb (20%), hindlimb (15%) or tail (15%). Twenty-six, 32 and 27% would not have surgical treatment of the inter-scapular region, chest or abdomen, respectively. The majority of respondents were willing to travel up to 100 miles for radiotherapy or chemotherapy (66 and 69%, respectively).

CLINICAL SIGNIFICANCE

The current feline vaccine site recommendations may not be appropriate for UK cat owners.

Cardioembolic stroke: Protective effect of a severe internal carotid artery stenosis in a patient with cardiac embolism

Cardioembolic stroke is generally caused by intracranial artery occlusion. Clots may be identified in the intracranial vessels by means of conventional neuroimaging in the acute phase. High-resolution ultrasonography may show some features suggestive of cardiac emboli when occluding extracranial carotid arteries. We describe a patient with cardioembolic ischemic stroke in the right hemisphere in whom a left internal carotid artery stenosis paradoxically protected the ipsilateral hemisphere from distal intracranial embolism. The patient also presented multiple acute ischemic embolic lesions in the right middle cerebral artery territory and in the right occipital lobe, which was fed by the posterior cerebral artery, anomally originating from the right carotid siphon. Interestingly, the left internal carotid artery--which showed a severe preexisting stenosis--was occluded by the cardiac clot, whereas the right internal carotid artery only presented a moderate stenosis that had probably allowed the clots to pass. Therefore, the severe left internal carotid artery stenosis may have blocked the cardiac embolus, preventing it from reaching the ipsilateral hemisphere.

Probiotics: immunomodulatory properties in allergy and eczema

In the last decades the prevalence of allergic diseases and eczema raised significantly, and today they are the most common chronic pathologies affecting children. It has been shown that a functional intestinal mucosa provides a defensive barrier to the host against potential dangerous antigens, regulating the tolerance to them. Some inflammatory diseases of the gut weaken the barrier causing an increase in the mucosa permeability and in antigenic transition. As a consequence, there is an aberrant immune response and the release of pro-inflammatory cytokines further compromises the barrier functionality. It has been demonstrated that a correlation between allergy and eczema onset and the intestinal microflora composition exists, and in particular, it has been showed that some microorganisms are able to influence the immune response. For these reasons it has been hypothesized that probiotics may have a beneficial role in preventing and treating allergies and eczema. However, the benefits of this treatment depend on many factors, such as the bacterial strain, the duration of administration, the pathology, the patient characteristics (age, diet, allergy predisposition). The aim of this work was to review the present knowledge about the use of probiotics in allergic diseases and eczema, highlighting their role in the aforementioned pathologies.

Stabilization of sacroiliac luxation in 40 cats using screws inserted in lag fashion

OBJECTIVE

To (1) identify prognostic indicators for stability after stabilization of sacroiliac luxation with screws inserted in lag fashion and (2) report dorsoventral dimensions of the sacrum in cats.

STUDY DESIGN

Multicenter retrospective study.

SAMPLE POPULATION

Cats (n=40) with sacroiliac luxation.

METHODS

Case records and radiographs of cats presented at the Queen's Veterinary School Hospital Cambridge and the Royal Veterinary College Hatfield for screw fixation of sacroiliac luxation were reviewed. Dorsoventral dimensions of 15 feline cadaveric sacral bodies were measured to identify the appropriate implant size for use in fixation with screws inserted in lag fashion.

RESULTS

Of 40 cats, 13 had left, 14 right, and 13 bilateral sacroiliac luxations. Of 48 screws analyzed, 42 (87.5%) were placed within the sacral body or exited ventrally and 6 (12.5%) were considered malpositioned. Screw purchase within the sacrum was statistically different between unstable and stable repairs (P=.001). Using confidence intervals for screw length within the sacrum and effect on stability, the lowest screw depth that contained 95% of the screws that did not loosen was approximately 60% of the sacral width. Mean dorsoventral sacral dimension at its narrowest point was 5.9+/-1.14 mm. There was no significant difference in the incidence of implant loosening between those luxations that were 100% reduced and those that were <100% reduced (P=.7837).

CONCLUSIONS

Screw purchase within the feline sacrum of at least 60% of the sacral width significantly reduces the risk of loosening.

CLINICAL RELEVANCE

Screw placement to a depth of 60% of the width of the feline sacrum is recommended.

A simple circuit for cerebral perfusion during cardiopulmonary bypass surgery of the ascending aorta and the aortic arch

Introduction A circuit was developed to allow for rapid reaction to the needs of perfusion during extracorporeal circulation (ECC) in surgery of the aortic arch and ascending aorta. Method From January 2008 through January 2010, a home-designed circuit was used on 30 patients with aortic dissection who underwent surgery to replace the ascending aorta and the aortic arch and, in some cases, the aortic valve and re-implant of the coronary arteries using Bentall’s technique.

Breast cancer testing strategies and the utilization of targeted therapies: Data from the real world

e17518

Background: HER2 testing and the use of trastuzumab is considered a prototype for the translation of a genomic therapy, yet almost nothing is known about use in practice. Uncertainties about the performance of the two types of HER2 tests, immunohistochemistry (IHC) and fluorescence-in-situ-hybridization (FISH) have led to debate about how best to identify women who are most likely to benefit from this costly treatment. Similarly, little is known about the use of gene expression profiling (GEP - e.g., OncotypeDx), which offers the possibility of better recurrence estimation to tailor the use of adjuvant chemotherapy. Methods: Cross-sectional record review of women, 36–64 years, with a new diagnosis of breast cancer in 2006–2007, identified using claims from a large, national health plan (n = 392 to date). Results: Almost all women had a HER2 test (97.7%): 56.2% had IHC alone, 17.4% had FISH alone, and 24.0% had both (2.4% had documentation of a test but not test type). Data for women with both IHC and FISH is shown below. Using the maximum of all available results, 24.9% were HER2-positive, 11.1% intermediate, and 63.9% HER2-negative. Only 55.2% of HER2-positive women received trastuzumab, compared to 16.7% of women with an intermediate score, and no HER2-negative women. The majority of women (85.7%) did not have GEP. Among women with GEP, 58.9% indicated low recurrence risk, 21.4% medium risk, and 5.4% high risk. Adjuvant chemotherapy was received by 27.3%, 91.7%, and 100% respectively (p < 0.001). Conclusions: HER2 tests, primarily IHC, are widely used. There are discrepancies in classification of HER2 status based on IHC vs. FISH. We did not find evidence of overuse of trastuzumab by women who were HER2-negative. Further work should clarify whether the lack of trastuzumab for HER2-positive women is clinically appropriate. We found modest adoption of GEP, and GEP score was associated with the use of adjuvant chemotherapy.

[Table: see text]

No significant financial relationships to disclose.

The role of glutathione in cadmium ion detoxification: coordination modes and binding properties--a density functional study

In this investigation the reduced form of glutathione molecule (GSH) was considered as a model in the coordination chemistry of Cd(2+) and group thiol-containing peptides. Three different forms of GSH, corresponding to the prevalent ones in gas-phase and in aqueous solution, were taken into account in the metallation process. The obtained complexes were characterized at the density functional B3LYP level with the purpose to give better insight in the chelation mechanism of GSH with heavy metal ions in living organisms. Solvent effects, whether with explicit water molecules or with polarizable continuum model (PCM), were considered on the most stable cadmium-complexes obtained by every GSH charged species examined.

On the Copper(II) Ion Coordination by Prion Protein HGGGW Pentapeptide Model

The interaction of the octapeptide domain of the prion protein with the transition-metal-ion Cu2+ was studied at the DFT level by using the HGGGW pentapeptide as a model to mimic the PHGGGWGQ octarepeat sequence. Ten complexes, in which the metal ion exhibits different coordinations, were considered. Our results indicate that the lowest-energy structure is characterized by a tetracoordinated metal center and that this tendency of the ion to assume the square planar geometry is strong enough to prevent the addition of a further water molecule in its coordination sphere. The role of tryptophan was found to cause a lowering of the system energy due to the stabilizing effect of the electrostatic interaction between the Trp aromatic indole and histidine imidazole rings.

Interaction of cysteine with Cu2+ and group IIb (Zn2+, Cd2+, Hg2+) metal cations: a theoretical study

The structure and energetics of complexes obtained upon interaction between cysteine and Zn2+, Cd2+, Hg2+ and Cu2+ cations were studied using quantum chemical density functional theory calculations with the 6-311++G** orbital basis set and relativistic pseudopotentials for the cations. Different coordination sites for metal ions on several cysteine conformers were considered. In their lowest energy complexes with the amino acid, the Zn2+ and Cd2+ cations appear to be three-coordinated to carbonyl oxygen, nitrogen and sulfur atoms, whereas the Cu2+ and Hg2+ ions are coordinated to both the carbonyl oxygen and sulfur atoms of one of the zwitterion forms of the amino acid. Bonds of metal cations with the coordination sites are mainly ionic except those established with sulfur, which show a small covalent character that become most significant when Cu2+ and Hg2+ are involved. The order of metal ion affinity proposed is Cu>Zn>Hg>Cd.

Hormone metabolism in the pulmonary circulation

We measured hormonal levels in blood samples from pulmonary and radial arteries in 117 patients undergoing aorto-coronary by-pass surgery with the aim of investigating the role of the pulmonary vessel endothelium in hormone metabolism. Insulin and glucagon concentrations were significantly higher in pulmonary artery blood with respect to radial artery blood (73 +/- 65 vs. 65 +/- 47 pmol/l, p < 0.005, and 80 +/- 49 vs. 73 +/- 51 ng/l, p < 0.01, respectively), while no difference was found for growth hormone, prolactin, C peptide, insulin-like growth factor I, follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, parathyroid hormone, thyroglobulin, triiodothyronine, thyroxine, free triiodothyronine, and free thyroxine. Moreover, prolactin concentrations were more than twice the normal levels, this being an effect of propafol and the opiate fentanyl used for the general anesthesia. Assuming that the arteriovenous differences observed are a marker of peptide hormone degradation, our study has demonstrated that with similar kinetics insulin and glucagon secreted into portal circulation and escaping from hepatic extraction undergo further homeostatic removal of about 9-10 % in the pulmonary circulation before entering the general circulation.

Potential energy surfaces for the gas-phase interaction between alpha-alanine and alkali metal Ions (Li+, Na+, K+). A density functional study

The conformations of alpha-alanine and those of the eight most stable adducts that it forms with lithium, sodium, and potassium cations were studied by means of the density functional theory using the hybrid B3LYP exchange correlation potential and the 6-311++G basis set. Minima and transition states characterizing the energetic paths for the interaction of the three metal ions with the free amino acid were explored in detail, and the results show that they are almost the same in the cases of lithium and sodium ions. At the absolute minimum, the Li+ and Na+ cations appear to be contemporaneously linked to the carbonyl oxygen and nitrogen atoms of alpha-alanine. Slight differences were found for potassium; the most stable adduct has the cation coordinated to both oxygen atoms of carboxyl function. The influence of the low-energy conformers in the determination of the gas-phase absolute affinities is demonstrated.

A primary intracavitary right atrial neurilemoma

Primary cardiac neurilemoma, a benign tumor, is extremely uncommon. To our knowledge only eight cases have been reported in the literature. We report a case of a 72-year-old man who presented with complaints of progressive shortness of breath and chest pain, seven years after a right nephrectomy for renal adenocarcinoma. An intra-right atrial tumor was surgically removed; the lesion was found to be a neurilemoma of the right atrium. This case report describes the surgical removal and rarity of neurilemomas, their predisposition to be right-sided in the heart and their coincidental association with other types of cancer.

Bond energies and attachments sites of sodium and potassium cations to DNA and RNA nucleic acid bases in the gas phase

Gas-phase metal affinities of DNA and RNA bases for the Na(+) and K(+) ions were determined at density functional level employing the hybrid B3LYP exchange correlation potential in connection with the 6-311+G(2df,2p) basis set. All the molecular complexes, obtained by the interaction between several low-lying tautomers of nucleic acid bases and the alkali ions on the different binding sites, were considered. Structural features of the sodium and potassium complexes were found to be similar except in some uracil and thymine compounds in which the tendency of potassium ion toward monocoordination appeared evident. B3LYP bond energies for both metal ions were in agreement with the available experimental results in the cases of uracil and thymine for which the most stable complex was obtained starting from the most stable tautomer of the free nucleic acid base. For adenine, although the interaction of the ions with the most stable free tautomer generated the least stable molecular complex, the best agreement with experiment was found in just this case. For the remaining cytosine and guanine bases, our calculations indicated that the metal ion affinity value closest to experiment should be determined taking into account the role played by the different tautomers of the free bases with similar energy and all the possible complexes obtained by them.

[Lithium poisoning and the use of nimesulide]

We describe a case of lithium intoxication, complicated by renal failure in a lithium treated women. She would take nimesulide, a selective cyclo-oxygenase-2 inhibitor, used in a variety of inflammatory, pain and fever states. This is the first report of the accumulation of lithium caused by nimesulide.

Density functional computations of proton affinity and gas-phase basicity of proline

The proton affinity and gas-phase basicity of proline were evaluated by using density functional theory coupling the B3-LYP hybrid functional with the extended 6--311++G** basis set. Cis and trans conformations of the carboxyl moiety for both exo and endo ring structures were considered for the neutral proline. The results show that the most stable structure of proline has the endo ring conformation with the carboxyl group in the cis position. The structure at the global minimum is stabilized by an intramolecular hydrogen bond. The nitrogen of the ring in the exo form is the preferred protonation site. The calculated proton affinity (924.3 kJ mol(-1)) and gas-phase basicity (894.4 kJ mol(-1)) are in very good agreement with the experimental counterparts.

Semiempirical molecular modeling into quercetin reactive site: structural, conformational, and electronic features

The conformational behavior, molecular geometry and electronic structure of quercetin were investigated using the semiempirical AM1 and PM3 methods. Results reveal that quercetin has a nonplanar molecular structure, with cross-conjugation occurring at the C ring. Calculations were also performed for quercetin radical species at the OH groups, showing the presence of three radicals in a narrow range of energy. An interpretation of the antioxidative process mechanism, exerted by quercetin as a free radical scavenger, relies on two isoenergetic radicals with extended electronic delocalization between adjacent rings, also having cross-conjugated systems and being affected by the experimental environment influencing their relative order.

Gas-phase metal ion (Li+, Na+, Cu+) affinities of glycine and alanine

The gas-phase metal affinities of glycine and alanine for Li+, Na+ and Cu+ ions have been determined theoretically employing the hybrid B3LYP exchange-correlation functional and using extended basis sets. All computations indicate that the metal ion affinity (MIA) decreases on going from Cu+ to Li+ and Na+ for both the considered amino acids. The absolute MIA values are close to the experimental counterparts with the exception of lithium for which a deviation of about 7 kcal/mol at the B3LYP level is obtained. The optimized structures indicate that Li+, Na+ and Cu+ prefer a bidentate coordination, bonding with both nitrogen and oxygen atoms of amino acids.

Siena's experience with pulmonary autograft operations: clinical and echocardiographic follow-up

As there is no perfect aortic valve substitute, there is a need to find out which one is the best option to replace the diseased aortic valve. Any type of mechanical or biological stented device has a residual gradient and does not reproduce the extremely sophisticated normal aortic valve function. This may influence the short- and long-term outcome, especially in dilated and poorly contracting left ventricles which do not tolerate even a mild stenosis. Thus, the potentially ideal valve to replace the aortic valve is either an aortic valve (aortic homograft) or a pulmonary autograft in aortic position. These grafts are also less subject to endocarditis. It has been demonstrated that pulmonary autografts can grow when implanted in children and as they remain viable, they maintain their dynamic behavior and possibly the internal innervation of the cusps. Unfortunately, pulmonary autograft surgery is more demanding and lasts longer, which may increase the risk of the operation. In addition, the exact indications and applications of the operation, particularly in patients with poor left ventricles or additional lesions, have not been clearly defined. Here we report our experience with this technique in 11 patients with severe aortic valve disease, including those with poor left ventricle function and/or associated disease. We describe our short- and medium-term follow-up, which shows optimal left ventricle recovery with no perioperative or postoperative complications, thus supporting a wider application of the operation.

Cardiac growth factors in human hypertrophy. Relations with myocardial contractility and wall stress

The aim of the present study was to investigate whether and which cardiac growth factors are involved in human hypertrophy, whether growth factor synthesis is influenced by overload type and/or by the adequacy of the hypertrophy, and the relationships between cardiac growth factor formation and ventricular function. Cardiac growth factor formation was assessed by measuring aorta-coronary sinus concentration gradient in patients with isolated aortic stenosis (n=26) or regurgitation (n=15) and controls (n=12). Gene expression and cellular localization was investigated in ventricular biopsies using reverse transcriptase-polymerase chain reaction and in situ hybridization. Cardiac hypertrophy with end-systolic wall stress <90 kdyne/cm2 was associated with a selective increased formation of insulin-like growth factor (IGF)-I in aortic regurgitation and of IGF-I and endothelin (ET)-1 in aortic stenosis. mRNA levels for IGF-I and preproET-1 were elevated and mainly expressed in cardiomyocytes. At stepwise analysis, IGF-I formation was correlated to the mean velocity of circumferential fiber shortening (r=0.86, P<0.001) and ET-1 formation to relative wall thickness (r=0.82, P<0. 001). When end-systolic wall stress was >90 kdyne/cm2, IGF-I and ET-1 synthesis by cardiomyocytes was no longer detectable, and only angiotensin (Ang) II was generated, regardless of the type of overload. The mRNA level for angiotensinogen was high, and the mRNA was exclusively expressed in the interstitial cells. Ang II formation was positively correlated to end-systolic stress (r=0.89, P<0.001) and end-diastolic stress (r=0.84, P<0.001). Multivariate stepwise analysis selected end-systolic stress as the most predictive variable and left ventricular end-diastolic pressure as the independent variable for Ang II formation (r=0.93, P<0.001). In conclusion, the present results indicate that the course of human left ventricular hypertrophy is characterized by the participation of different cardiac growth factors that are selectively related both to the type of hemodynamic overload and to ventricular function.

Mid-term outcome of surgical coronary ostial plasty: our experience

The conventional coronary artery bypass procedure that uses venous or arterial conduit for isolated critical stenosis of the left main coronary artery (LMCA) restores a less physiological perfusion of the myocardium and uses an appreciable length of bypass material. Coronary ostial plasty has been described as an alternative surgical technique in proximal obstructive coronary artery disease without calcifications. Here we report 23 patients (15 males and 8 females aged 37-78 years; mean age 57 years) who underwent surgical ostial plasty. Ostial reconstruction with fresh pericardial patch was performed in all patients: 15 patients with LMCA stenosis, 6 patients with right coronary (RC) ostial stenosis, and 2 patients with both RC artery and LMCA stenosis. In seven cases, coronary artery bypass grafting was added for contralateral distal stenosis with a total of five arterial conduits and six venous grafts. One patient died; the ostial plasty and grafts were patent at necropsy. Thallium-201 myocardial scintigraphy under stress at 30 days to 6 months after operation demonstrated good myocardial perfusion in 21 of 22 patients. Coronary angiography at follow-up (49 +/- 8 months) demonstrated good surgical ostial plasty results in 21 of 22 patients and good coronary flow in 19 of 22 patients; angiographic study at mid-term follow-up revealed only one failure of the surgical ostial plasty technique associated with venous graft obstruction. In 2 other patients CABG failure due to venous graft obstruction (1 patient) or distal stenotic lesions of the left coronary artery (1 patient) was noted. The overall successful outcome of the surgical ostial plasty was 22 of 23. We believe that surgical angioplasty of the coronary ostia may be used in the presence of proximal noncalcified obstructive lesions as an alternative technique, which offers a more physiological revascularization; it also spares grafting material and allows subsequent percutaneous transluminal angioplasty or coronary artery bypass surgery.

Antinociceptive and uterine relaxant activities of Viburnum toronis alive (Caprifoliaceae)

Petroleum ether, ethyl acetate and methanolic leaf extracts of Viburnum toronis Killip et Smith were studied. From the petroleum ether extract, fatty acids of methyl esters such as methyl myristate, methyl palmitate, methyl stearate and methyl araquidonate were identified by means of GC-MS. From the ethyl acetate extract, 2-methylbutanoic, 2-methyl-2-butenoic, 3-methylbutanoic acids and 4-hydroxy-4-methylpentanone were identified by means of GC-MS. Through the isolated organ technique, uterine relaxant was verified; and through the method of writhings induced by acetic acid, the antinociceptive activity of methanolic extracts and the extract in ethyl acetate were verified. It was found that the extract in ethyl acetate showed the greatest in both uterine relaxant and antinociceptive activity at doses of 250 mg/kg.

The diagnostic and prognostic value of cardiac Troponin T in bypass surgery

BACKGROUND

The purpose of this study was to verify the utility of serum Troponin T (TnT) in the diagnosis of myocardial damage after coronary surgery performed using different methods of myocardial protection. The prognostic value of TnT peak for a poor postoperative course was also investigated.

METHODS

Forty-three patients were enrolled and randomised in 2 group: Group A (n. 22) receiving warm blood cardioplegia and Group B (n. 21) receiving cold blood cardioplegia. According to TnT peak levels 3 subgroups were identified: Subgroup 1 (TnT peak < than 1 ng/ml); Subgroup 2 (TnT peak between 1 and 3 ng/ml), Subgroup 3 (TnT peak >3 ng/ml). A comparison with the standard criteria for diagnosis of myocardial ischemia was performed for each subgroup of patients. A 12 months follow-up for the patients of subgroups 1 and 2 was also completed in order to evaluate the prognostic value of a higher TnT peak.

RESULTS

The overall patients subdivision in subgroup 1, 2 and 3 was 20 (46.5%), 14 (32.5%) and 9 (20.9%) respectively with no statistical difference for Group A or B. Only 7 of the patients of subgroup 3 (87%) matched the WHO diagnostic criteria for myocardial infarction. At the overall follow-up, 2 (14.28%) patients of subgroup 2, and 4 (20.0%) of subgroup 3, revealed a residual ischemia at the ECG-stress test even if none of these needed reoperation.

CONCLUSIONS

Our data confirmed the high sensitivity and specificity of TnT measurement in the diagnosis of myocardial infarction and minor myocardial damage. This study, however, failed to show any statistically significant difference of the TnT peak when using different strategies of myocardial protection. The late prognostic value of the TnT increase in the early post-operative course has to be confirmed from a further study.

Theoretical calculations of glycine and alanine gas-phase acidities

The gas-phase acidities of glycine and alanine were determined by using a variety of high level theoretical methods to establish which of these would give the best results with accessible computational efforts. MP2, MP4, QCISD, G2 ab initio procedures, hybrid Becke3-LYP (B3LYP) and gradient corrected Becke-Perdew (BP) and Perdew-Wang and Perdew (PWP) nonlocal density functionals were used for the calculations. A maximum deviation of approximately 13 and 18 kJ/mol from experimental data was observed for the computed delta Hacid and delta Gacid values, respectively. The best result was obtained at G2 level, but comparable reliability was reached when the considerably less time consuming B3LYP, BP, and PWP density functional approaches were employed.