Increased myocardial methionine‐enkephalin with reduced arterial oxygenation in congenital heart disease

Background: Cardiac opioid peptides have been identified to exert important adaptive metabolic signalling for cardioprotection against ischaemia or hypoxia‐related injury. Aims: To determine myocardial methionine‐enkephalin content in children with hypoxemic congenital heart defects and to correlate myocardial content of methionine‐enkephalin with the extent of arterial oxygen desaturation. Methods: Children (n= 20, median age of 16 months), undergoing cardiac surgical repair (tetralogy of Fallot, 17/20), were included in this study. Arterial oxygen saturation was measured on admission. Myocardial samples obtained during surgery were assayed via radioimmunochemistry for methionine‐enkephalin content. Results: Greater methionine‐enkephalin content was measured in the right ventricles of the patients suffering from recent cyanotic spells compared with those with no recent spells (cyanotic spells: 2418 ± 844 pg/g wet weight tissue, n= 6; no spells: 1175 ± 189 pg/g wet weight tissue, n= 14, P= 0.04). An inverse correlation was evident between the arterial oxygen saturation and myocardial methionine‐enkephalin content. Conclusion: Myocardial methionine‐enkephalin levels increase with the severity of hypoxic stress in congenital cardiac disease and may play an important adaptive role in countering adrenergic over‐activity and related excess demand on myocardial metabolic capacity.     

Cues on request: The efficacy of Multicue,a computer program for wordfinding therapy

Background: Semantic and word form cues have been shown to have long‐term effects on naming in aphasia. Multicue is a computer program that offers a variety of cues for improving word finding. It stimulates the users' independence by encouraging them to discover themselves which cues are most helpful. Aims: We investigated the effects of Multicue on naming and verbal communication. Methods & Procedures: A total of 18 individuals with aphasia caused by stroke, who had completed intensive impairment‐oriented treatment, were randomised to 10–11 hours of Multicue (n = 8) or no treatment (n = 10). Outcomes & Results: Only the Multicue group improved on the Boston Naming Test. However, mean improvement did not differ significantly between the treated and untreated groups, neither for the BNT (95% CI: ?4.5 to 26.1), nor for the ANELT‐A (95% CI: ?2.4 to 9.4). Conclusions: In the chronic phase of aphasia, following impairment‐oriented treatment, Multicue may have a beneficial effect on word finding in picture naming, but not on verbal communication. The effect of Multicue may be the result either of self‐cueing or of improved access. The lack of generalisation to verbal communication is discussed.     

Fatigue after myocardial infarction: Relationships with indices of emotional distress,and sociodemographic and clinical variables

Alsén P, Brink E, Brändström Y, Karlson BW, Persson L‐O. International Journal of Nursing Practice 2010; 16 : 326–334
Fatigue after myocardial infarction: Relationships with indices of emotional distress, and sociodemographic and clinical variables Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.     

Residual thymic tissue and lymph node involvement by acute myeloid leukaemia presenting as mediastinal,strongly 18FDG‐PET‐positive masses

We report on a multidisciplinary management of a 68‐year‐old AML patient presenting with a PET‐positive mediastinal tumour typical for lymph node metastasis. It was removed via minimally invasive thoracoscopic intervention and was identified as a thymus residual infiltrated by AML. Follow‐up PET‐CT scan after resection and remission induction chemotherapy was completely normal. To our knowledge, this is the first documented case report of AML presenting with PET‐positive infiltrates of thymic and lymph node tissue along the aortic bow mimicking a second intrathoracic malignancy. Our observation indicates the usefulness of this imaging technique and supports clarification of these unusual findings in AML patients, in case of need also by invasive diagnostic procedures, to enable an adequate therapeutic decision.     

Influence of routine computed tomography on predicted survival from blunt thoracoabdominal trauma

Introduction  

Many scoring systems have been proposed to predict the survival of trauma patients. This study was performed to evaluate the influence of routine thoracoabdominal computed tomography (CT) on the predicted survival according to the trauma injury severity score (TRISS).     

Sports and Leisure Time Physical Activity During Pregnancy in Nulliparous Women

To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.