High levels of Lp(a) lipoprotein in a family ith cases of severe pre-eclampsia

We report a family with two cases of severe pre-eclampsia/eclampsia in which very high levels of Lp(a) lipoprotein were found. The serum level of Lp(a) lipoprotein is genetically determined and the Lp(a) apolipoprotein has a close homology to plasminogen. Very high levels of Lp(a) lipoprotein might interfere with the fibrinolytic/thrombolytic process in man. A previous report suggested that a high maternal serum Lp(a) lipoprotein level can cause fetal growth retardation, and it is proposed that very high levels might lead to increased deposition of fibrin in the uterine spiral arteries in pregnancy, which is central in the pathogenesis of pre-eclampsia. If confirmed, a very high Lp(a) lipoprotein level could be one risk factor for pre-eclampsia that is genetically determined.     

Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation

Journal of Occupational Rehabilitation - Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on...     

Expression of the integrin subunits alpha 5, alpha 6 and beta 1 in the testes of the common marmoset

Integrin subunits alpha 5, alpha 6 and beta 1 were localized in the testis of pre-pubertal or adult non-human primates (Callithrix jacchus) by immunofluorescence staining and in situ hybridization. In animals of all ages subunits alpha 5 and beta 1 were localized in cells of the lamina propria of the seminiferous epithelium. In prepubertal animals, the integrin subunits alpha 5, alpha 6, as well as beta 1, were distributed all over the plasma membrane of Sertoli cells. In adult animals the integrin subunits were confined to those plasma membrane regions of Sertoli cells which are assigned to the basal compartment, including the basement membrane of the seminiferous tubules. Protein expression of integrin subunits alpha 6 and beta 1 was most pronounced in tubular stages in which elongated spermatids were not yet present in the adluminal compartment of the epithelium, suggesting that these integrin subunits are particularly essential at certain developmental stages of spermatogenesis. Non-radioactive in situ hybridization revealed that the mRNA for integrin subunits alpha 5, alpha 6 and beta 1 was expressed by Sertoli cells. In situ hybridization, together with immunofluorescence data, shows that these integrin subunits were exclusively synthesized in Sertoli cells. As to functional aspects, it is concluded that during primate spermatogenesis. Sertoli cell integrins may be involved in both cell matrix as well as cell-cell interactions, particularly during early spermatogenesis.     

Narrowing effect of off-pump CABG on the LIMA-LAD anastomosis: epicardial ultrasound assessment

AIM: Effects of off-pump CABG on LIMA-LAD anastomotic dimensions vs. on-pump CABG assessed by epicardial ultrasound imaging. MATERIAL AND METHODS: LIMA-LAD anastomoses were performed off-pump in 38 patients and on-pump in 12. Intra-operative imaging was by a GE Vivid 7 ultrasound scanner and i13L transducer. Length of the anastomosis (DA), LAD diameters at the toe (D1) and heel (D3) of the anastomosis, the reference downstream LAD (D2) were measured in diastole by two-dimensional imaging (B-mode). Relationships between these dimensions were compared between on- and off-pump patients. RESULTS: In off-pump patients, D3 dimension was smaller than D1 (p=0.004). Both D3 and D1 were smaller than D2 (p<0.01). Ratio D3/D2 was smaller than D1/D2 (p=0.009). In on-pump patients, these ratios were similar. D3/D2 ratio was smaller in off- than in on-pump patients (p=0.01), D1/D2 were similar in the two groups. CONCLUSION: Off-pump CABG may cause a narrowing of the coronaries, especially at the anastomotic heel. The anastomotic technique at the heel may have to be modified to improve its patency.     

Up-regulation of connexin45 in heart failure

INTRODUCTION: Heart failure is associated with reduced expression of the major gap junction protein connexin43 (Cx43), which may contribute to arrhythmias and sudden cardiac death in this patient population. Other cardiac connexins may be altered as well. Because connexin45 (Cx45) has been shown to colocalize with Cx43, we determined whether the number, size, or distribution of Cx45 gap junctions is altered in the failing heart. METHODS AND RESULTS: Cx45 expression levels were measured by immunoblotting and quantitative immunostaining in failing and control human left ventricles. Total Cx45 protein was significantly (P = 0.021) up-regulated 1.8-fold in failing hearts. Cx45 immunohistochemical signal was increased by 80% (P = 0.005) due to a 3.5-fold increase in the number of gap junctions containing Cx45. Cx45 mRNA was not altered in failing hearts, suggesting reduced degradation of Cx45 protein in the failing heart. Cx43 signal, on the other hand, was reduced by 49% in failing hearts. Double-label experiments demonstrated colocalization of Cx45 and Cx43 in the same gap junctions. CONCLUSION: Cx45 is markedly enhanced in the failing heart. Up-regulation of Cx45 in conjunction with down-regulation of Cx43 could result in abnormal impulse propagation and generation of ventricular arrhythmias, thereby predisposing patients in heart failure to sudden cardiac death.     

Battery powered neuromuscular stimulator circuit for use during simultaneous recording of myoelectric signals

Surface Functional Electrical Stimulation (FES) requires high stimulation voltages. A step-up transformer in the output stage of the stimulation circuit is often used. In the present technical paper a voltage controlled current source (VCCS) is presented as an alternative to the transformer coupling. Two (master–slave) coupled transconductance amplifiers (TAs)—in series with pre-charged capacitors—are used to drive the output current. After each stimulation pulse the capacitors are recharged to a high voltage by a switch mode power supply (SMPS). A multiplexer in the output stage is used to provide biphasic output. Output rise-time (10–90%) was less than 2 μs at 100 mA output. Biphasic charge balanced stimulation current can be produced with a net current to ground of less than 20 nA, thus virtually separated from ground. The circuit permits recording of the volitional myoelectric signal from the stimulated muscle. It is part of a portable myoelectrically controlled FES system powered by 2 AA batteries and currently used in clinical trials.     

Clinical state transitions during advanced life support (ALS) in in-hospital cardiac arrest

Background

When providing advanced life support (ALS) in cardiac arrest, the patient may alternate between four clinical states: ventricular fibrillation/tachycardia (VF/VT), pulseless electrical activity (PEA), asystole, and return of spontaneous circulation (ROSC). At the end of the resuscitation efforts, either death has been declared or sustained ROSC has been obtained. The aim of this study was to describe and analyze the clinical state transitions during ALS among patients experiencing in-hospital cardiac arrest.

Methods and results

The defibrillator files from 311 in-hospital cardiac arrests at the University of Chicago Hospital (IL, USA) and St. Olav University Hospital (Trondheim, Norway) were analyzed (clinicaltrials.gov: NCT00920244). The transitions between clinical states were annotated along the time axis and visualized as plots of the state prevalence according to time. The cumulative intensity of the state transitions was estimated by the Nelson–Aalen estimator for each type of state transition, and for the intensities of overall state transitions. Between 70% and 90% of patients who eventually obtained sustained ROSC had progressed to ROSC by approximately 15–20 min of ALS, depending on the initial rhythm. Patients behaving unstably after this time period, i.e., alternating between ROSC, VF/VT and PEA, had a high risk of ultimately being declared dead.

Conclusions

We provide an overall picture of the intensities and patterns of clinical state transitions during in-hospital ALS. The majority of patients who obtained sustained ROSC obtained this state and stabilized within the first 15–20 min of ALS. Those who continued to behave unstably after this time point had a high risk of ultimately being declared dead.