Home About us Contact
|
Home About us Contact | ||
|
|
||
Leaflets
Kinds of Leaflets Selected AbstractsRepair of Flail Leaflet of the Tricuspid Valve by a Simple Cusp Remodeling TechniqueJOURNAL OF CARDIAC SURGERY, Issue 4 2007Xiubin Yang M.D. We try to present an alternative method and midterm results. Methods: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 ± 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. Results: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 ± 12.5 mm to a mean of 23.6 ± 5.3mm (p < 0.01). Mean follow up was 50 ± 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. Conclusion: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae. [source] Feasibility of Myxomatous Mitral Valve Repair Using Direct Leaflet and Chordal Radiofrequency AblationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2008JEFFREY L. WILLIAMS M.D., M.S. Objective: Minimally invasive repair of mitral valve prolapse (MVP) causing severe mitral regurgitation (MR) should reduce MR and have chronic durability. Our ex vivo, acute in vivo, and chronic in vivo studies suggest that direct application of radiofrequency ablation (RFA) to mitral leaflets and chordae can effect these repair goals to decrease MR. Methods: A total of seven canines were studied to assess the effects of RFA on mitral valve structure and function. RFA was applied ex vivo (n = 1), acutely in vivo using a right lateral thoracotomy and cardiopulmonary bypass (n = 3), and chronically in vivo using percutaneous access to the heart (n = 3). RFA was applied to the mitral valve and its associated chordae. Mitral valve structure and function (in vivo preparations) were then assessed. Results: Ex vivo application of RFA resulted in qualitative reduction in mitral leaflet surface area and chordal length. Acute in vivo application of RFA to canines found to have MVP causing severe MR demonstrated a 43.7,60.7% statistically significant (P = 0.039) reduction in postablation MR. Chronic, in vivo, percutaneous application of RFA was found to be feasible and the engendered alterations durable. Conclusion: These data suggest that myxomatous mitral valve repair using radiofrequency energy delivered via catheter is feasible. [source] Photic Regulation of mt1 Melatonin Receptors in the Siberian Hamster Pars Tuberalis and Suprachiasmatic Nuclei: Involvement of the Circadian Clock and Intergeniculate LeafletJOURNAL OF NEUROENDOCRINOLOGY, Issue 3 2000Schuster In the Siberian hamster suprachiasmatic nuclei and pars tuberalis of the pituitary, high affinity mt1 melatonin receptors are present. We have previously shown that night applied light pulse induced an increase in mt1 mRNA expression in the suprachiasmatic nuclei of this species, independently of the endogenous melatonin. Here, we report the photic regulation of melatonin receptor density and mRNA expression in the suprachiasmatic nuclei and pars tuberalis of pinealectomized Siberian hamsters and the implication in this control of either the circadian clock or the intergeniculate leaflet. The results show that: (1) A 1-h light pulse, delivered during the night, induces a transitory increase in mt1 mRNA expression in the suprachiasmatic nuclei and pars tuberalis. After 3 h this increase has totally disappeared (suprachiasmatic nuclei) or is greatly reduced (pars tuberalis). (2) The melatonin receptor density, in the suprachiasmatic nuclei, is not affected by 1 or 3 h of light, while it is strongly increased in the pars tuberalis. (3) In hamsters kept in constant darkness, the mt1 mRNA rise is gated to the subjective night in the suprachiasmatic nuclei and pars tuberalis. In contrast, the light-induced increase in melatonin binding is also observed in the subjective day in the pars tuberalis. (4) intergeniculate leaflet lesion totally inhibits the mt1 mRNA expression rise in the suprachiasmatic nuclei, while it has no effect on the light-induced increase in mt1 mRNA in the pars tuberalis. However, the light-induced increase in melatonin receptor density is totally prevented by the intergeniculate leaflet lesion in the pars tuberalis. These results show that: (1) the photic regulations of mt1 mRNA expression and receptor density are independent of each other in both the suprachiasmatic nuclei and pars tuberalis; and (2) the circadian clock and the intergeniculate leaflet are implicated in the photic regulation of melatonin receptors but their level of action differs totally between the suprachiasmatic nuclei and pars tuberalis. [source] Fabrication of a Novel Hybrid Heart Valve Leaflet for Tissue Engineering: An In Vitro StudyARTIFICIAL ORGANS, Issue 7 2009Hao Hong Abstract The objective of this study was to fabricate biomatrix/polymer hybrid heart valve leaflet scaffolds using an electrospinning technique and seeded by mesenchymal stem cells. Mesenchymal stem cells were obtained from rats. Porcine aortic heart valve leaflets were decellularized, coated with basic fibroblast growth factor/chitosan/poly-4-hydroxybutyrate using an electrospinning technique, reseeded, and cultured over a time period of 14 days. Controls were reseeded and cultured over an equivalent time period. Specimens were examined biochemically, histologically, and mechanically. Recellularization of the hybrid heart valve leaflet scaffolds was significantly improved compared to controls. Biochemical and mechanical analysis revealed a significant increase of cell mass, 4-hydroxyproline, collagen, and strength in the hybrid heart valve leaflets compared to controls. This is the first attempt in tissue-engineered heart valves to fabricate hybrid heart valve leaflets using mesenchymal stem cells combined with a slow release technique and an electrospinning technique. [source] Regulation of Exocytosis in Chromaffin Cells by Trans -Insertion of Lysophosphatidylcholine and Arachidonic Acid into the Outer Leaflet of the Cell MembraneCHEMBIOCHEM, Issue 12 2006Christian Amatore Prof. Abstract Vesicular exocytosis is an important complex process in the communication between cells in organisms. It controls the release of chemical and biochemical messengers stored in an emitting cell. In this report, exocytosis is studied amperometrically (at carbon fiber ultramicroelectrodes) at adrenal chromaffin cells, which release catecholamines after appropriate stimulation, while testing the effects due to trans -insertion of two exogenous compounds (lysophosphatidylcholine (LPC) and arachidonic acid (AA)) on the kinetics of exocytotic events. Amperometric analyses showed that, under the present conditions (short incubation times and micromolar LPC or AA solutions), LPC favors catecholamine release (rate, event frequency, charge released) while AA disfavors the exocytotic processes. The observed kinetic features are rationalized quantitatively by considering a stalk model, for the fusion pore formation, and the physical constraints applied to the cell membrane by the presence of small fractions of LPC and AA diluted in its external leaflet (trans -insertion). We also observed that the detected amount of neurotransmitters in the presence of LPC was larger than under control conditions, while the opposite trend is observed with AA. [source] A survey of the quality and accuracy of information leaflets about skin cancer and sun-protective behaviour available from UK general practices and community pharmaciesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2009S Nicholls Abstract Background, Better information promotes sun protection behaviour and is associated with earlier presentation and survival for malignant melanoma. Aim, To assess the quality of patient information leaflets about skin cancer and sun-protective behaviour available from general practices and community pharmacies. Design of study, A structured review of patient information leaflets. Setting, All community pharmacies and general practices in one Primary Care Trust were invited to supply leaflets. Methods, Readability was assessed using the SMOG scoring system. Presentation and content were reviewed using the Ensuring Quality Information for Patients (EQIP) guidelines. Three consultant dermatologists assessed each leaflet for accuracy. Results, Thirty-one different patient information leaflets were returned. Thirteen (42%) were published in the previous 2 years, but 10 (32%) were over 5 years old. Nine (29%) leaflets were produced by the NHS or Health Education Authority, and 8 (27%) were linked to a commercial organization. One leaflet had readability in the primary education range (SMOG score = 6), and none with the recommended range for health education material (SMOG score , 5). Two leaflets (6%) were in the highest quartile of EQIP score for presentation and content. Five leaflets (17%) had a major inaccuracy such as over-reliance on sun screen products instead of shade and clothing. Conclusions, Leaflets were of variable quality in presentation and content. All required a reading age higher than recommended. All leaflets with major inaccuracies had links with commercial organizations. This study raises important issues about the potential conflict between marketing and health messages in the way sun creams are promoted. Conflicts of interest None declared [source] Staphylococcus aureus Infective Endocarditis Mimicking a Hydatid CystECHOCARDIOGRAPHY, Issue 8 2010Jeroen Walpot M.D. We report an atypical echocardiographic presentation of Staphylococcus aureus infective endocarditis (IE) of the mitral valve in an octogenarian female. Echocardiography revealed perforation of the anterior mitral valve leaflet (AMVL), with a large cystic mass seemingly attached to the AMVL and surrounded by a thin membranous structure. These images were strongly reminiscent of a hydatid cyst. The significant comorbidity of the patient did not justify an urgent surgical approach, and the patient subsequently expired of cardiogenic and septic shock. Autopsy revealed a large vegetation attached to the interatrial septum in the immediate proximity of the AMVL, without signs of the membranous structure and without pathological evidence for septic embolism. This atypical presentation of IE prompted us to discuss a brief review of intracardiac cystic masses. (Echocardiography 2010;27:E80-E82) [source] Lesions of the Mitral Valve as a Cause of Central Retinal Artery Occlusion: Presentation and Discussion of Two CasesECHOCARDIOGRAPHY, Issue 1 2010Maryam Ayati M.D. We present two cases of mitral valve lesions that manifested with unilateral blindness caused by central retinal artery occlusion (CRAO): Case 1. A 68-year-old woman was admitted to our clinic for sudden blindness. Retinal artery angiogram showed CRAO. Transthoracic and transesophageal echocardiography (TEE) documented a mass attached to the ventricular side of the posterior mitral leaflet, which at pathology was identified as a blood cyst. Case 2. A 67-year-old man was admitted for a sudden unilateral painless loss of vision. Retinal angiogram documented CRAO, and TEE showed a highly mobile, spherical, lesion on the atrial side of anterior mitral leaflet. In this case, the pathological finding was a degenerated calcified thrombosis. We report on two cases of very rare abnormalities of the mitral valve presenting with a very rare embolic complication, i.e., CRAO. Like for cryptogenic stroke, transesophageal echocardiography plays a central role in the diagnosis of cardiogenic embolic sources. (Echocardiography 2010;27:E1-E3) [source] Reference Values Describing the Normal Mitral Valve and the Position of the Papillary MusclesECHOCARDIOGRAPHY, Issue 7 2007Petrus Nordblom M.Sc. In patients with functional mitral regurgitation (MR), the principal mechanisms are insufficient coaptation due to dilatation of the mitral annulus (MA), global ventricular dysfunction with tethering of leaflets, or restricted leaflet motion with incorrect apposition due to regional ventricular dysfunction and displacement of the papillary muscles (PMs). These different entities often coexist and for this reason, knowledge of the normal reference values describing the shape and size of the MA and the position of the PMs is essential. In the present study, we describe the MA dimensions and the position of the PMs in a group of normal individuals (n = 38, 60% women, age [mean ± SD] 51 ± 9 years and BSA 1.83 ± 0.16 m2) investigated with transthoracic echocardiography. The anteroposterior dimension (AP) of the ellipse-shaped MA was measured in a parasternal long axis, while the distance from the posteromedial (PoM) to the anterolateral (AL) commissure was measured in a parasternal short axis (CC). The annular area was calculated assuming elliptic geometry. The MA shape was described by the ratios AP/CC and AP/length of the anterior leaflet. The PMs' position was described by the following distances: (a) from the MA to the tip of the PoM and AL, PMs measured in a modified two-chamber view where both PMs could be identified, (b) the interpapillary distance, and (c) the tethering distance from the tip of the PM to the contralateral MA. These data on the normal mitral valve morphology should provide useful information when assessing the underlying mechanism of functional MR. [source] Assessment of the Tilting Properties of the Human Mitral Valve during Three Main Phases of the Heart Cycle: An Echocardiographic StudyECHOCARDIOGRAPHY, Issue 4 2006Daniel Vanhercke B.N., N.F.E.S.C., R.D.C.S. Rationale and Objectives: In experimental models of the left heart, the mitral valve (MV) is commonly implanted perpendicular to a central axis of the apex/MV. To adapt this to a more correct anatomical model, as well as for further studies of the left ventricle, we created a database of implantation angles of the MV and annulus during three main phases of the heart cycle, based on standard cardiac ultrasound measurements. Materials and Methods: Twenty-eight patients were studied with the standard cardiac ultrasound equipment. From the apical echo window, an anteroposterior (AP) plane and a perpendicular commisure-commisure (CC) plane were generated during three critical moments in the heart cycle: systole (S); diastole early filling (E); and diastole late filling (A). In both planes, the angles between the annular plane and each mitral leaflet, as well as the angle between a theoretical longitudinal axis through the apex and center of the MV orifice and the mitral annulus plane, were measured with a custom-made application of Matlab R14. Results: We observed an inclination of the angle mitral annulus/central left ventricle axis, with its lowest point in the direction of the aortic valve (AP plane) of 85°± 7° in systole (S), 88°± 8° in early diastole (E), and 88°± 7° in late diastole (A). In the CC plane, we observed an almost horizontal implantation of 91°± 5° in systole (S), 91°± 8° in early diastole (E), and 91°± 7° in late diastole (A). [source] Extremely Rapid Formation of Mitral Valve Ring Abscess in Infective EndocarditisECHOCARDIOGRAPHY, Issue 6 2004Balaram Shrestha M.D., Ph.D. A patient with infective endocarditis (IE) due to methicillin-resistant staphylococcus aureus (MRSA) was found to have conversion of the hypoechoic region of the posterior mitral valve ring apparatus into a clearly delineated echolucent space by repeating transthoracic echocardiography at an interval of 1 week. Color Doppler showed features of blood entry into this space. Abscess formation in IE due to MRSA may be quick and repeated echocardiography may help detect the complications of IE. Semiurgent mitral valve plasty was performed for the associated prolapse of the posterior mitral leaflet using a hand-made, rolled, twisted autologous pericardial ring. [source] Necrotizing Vasculitis: A Cause of Aortic Insufficiency and Conduction System DisturbanceECHOCARDIOGRAPHY, Issue 7 2003Miquel Gómez Pérez M.D. Cardiac involvement in vasculitis syndromes is uncommon. We describe a 50-year-old male who presented with progressive dyspnea and myalgies. Echocardiogram revealed significant thickening of aortic root, aortic cusps, and anterior mitral valve leaflet, with severe aortic regurgitation that required aortic valve replacement. Furthermore, this patient suffered progressive atrioventricular block that needed implantation of a pacemaker. The study performed disclosed the presence of necrotizing vasculitis positive for perinuclear antineutrophil cytoplasmic antibody. (ECHOCARDIOGRAPHY, Volume 20, October 2003) [source] Differences in attitudes between patients with primary colorectal cancer and patients with secondary colorectal cancer: is it reflected in their willingness to participate in drug trials?EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2005G. GARCEA mrcs Recruitment of patients into drug trials is essential in order to evaluate new treatments. Knowing why patients enter drug trials and their fears regarding them can be used in future research to ensure good recruitment and provide a supportive atmosphere for patients. Forty patients with colorectal cancer and 30 patients with colorectal liver metastases were asked to participate in a drug trial involving the oral consumption of a diet-derived agent of unknown therapeutic action. All patients agreeing or refusing to participate were asked to complete a short questionnaire with a series of options detailing the reasons behind their decision. Patients with colorectal hepatic metastases were motivated by altruism in entering the trial (e.g. helping others, helping the investigator) and displayed a realistic expectation that the drug would give little direct benefit to them. Patients with primary colorectal tumours were motivated by more ,selfish' reasons such as helping themselves and displayed an unrealistic expectation concerning any therapeutic benefit from the trial drug. Over 90% of all patients polled stated that their decision was made after reading the patient information leaflet. Patients with different stages of the same disease have very different fears and anticipations of drug trials, which need to be addressed specifically. The importance of the initial contact is demonstrated. Unrealistic expectations regarding the trial drug are common despite clear information to the contrary. [source] A randomized controlled trial of a smoking cessation intervention based in community pharmaciesADDICTION, Issue 2 2001T. A. Maguire Aims. To evaluate whether a structured community pharmacy-based smoking cessation programme (the PAS model) would give rise to a higher smoking cessation rate compared with ad hoc advice from pharmacists. Design. A randomized controlled trial comparing a structured intervention with usual care. Setting. One hundred pharmacists working in community pharmacies in N. Ireland and 24 in London took part in the study and were each asked to enroll 12 smokers; 44% of pharmacists who were trained managed to recruit one or more smokers during the recruitment period of approximately 1 year. Participants. A total of 484 smokers were enrolled by the pharmacists and individually randomized into the PAS intervention group ( N = 265) or the control group ( N = 219). Intervention. The PAS intervention involved a structured counselling programme, an information leaflet and a follow-up weekly for the first 4 weeks then monthly as needed. Measurements. The primary outcome measure of this study was self-reported smoking cessation for 12 months with cotinine validation at the 12-month follow-up. Findings. Of smokers in the PAS group, 14.3% (38) were abstinent up to 12 months compared with 2.7% (6) in the control group ( p < 0.001 for the difference). Conclusion. The community pharmacy-based PAS smoking cessation service can be an effective method of helping people stop smoking when delivered by pharmacists willing to adopt this approach. [source] Blockade of the NPY Y5 receptor potentiates circadian responses to light: complementary in vivo and in vitro studiesEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 4 2004P. C. Yannielli Abstract Neuropeptide Y (NPY) is delivered to the suprachiasmatic nuclei (SCN) circadian pacemaker via an input from the thalamic intergeniculate leaflet. NPY can inhibit light-induced responses of the circadian system of Syrian hamsters. Here we studied whether an antagonist to NPY receptors can be used to potentiate photic phase shifts late in the subjective night. First we determined by in situ hybridization that both NPY Y1 and Y5 receptor mRNA are expressed in the SCN of Syrian hamsters. Second, similar to our previous findings at Zeitgeber time 14 (ZT 14, where ZT 12 was the time of lights off), we found that NPY applied at ZT 18.5 onto the SCN region of brain slices maintained in vitro could block NMDA-induced phase advances of the spontaneous firing rate rhythm, and this blocking effect was probably mediated by the Y5 receptor, since co-application of Y5 receptor antagonists completely reversed the effect of NPY, while application of a Y1 receptor antagonist had no effect under the same conditions. Third, we found that co-treatment with a Y5 receptor antagonist in vivo (s.c., 10 mg/kg) not only reversed the effect of NPY applied to the SCN in vivo through a cannula but also significantly potentiated the light-induced phase advance in the absence of NPY. This is the first report of a NPY receptor antagonist having such an effect, and indicates that NPY Y5 receptor antagonists could be clinically useful for potentiating circadian system responses to light. [source] Role of the plasma membrane leaflets in drug uptake and multidrug resistanceFEBS JOURNAL, Issue 5 2010Hagar Katzir The present study aimed to investigate the role played by the leaflets of the plasma membrane in the uptake of drugs into cells and in their extrusion by P-glycoprotein and multidrug resistance-associated protein 1. Drug accumulation was monitored by fluorescence resonance energy transfer from trimethylammonium-diphenyl-hexatriene (TMA-DPH) located at the outer leaflet to a rhodamine analog. Uptake of dye into cells whose mitochondria had been inactivated was displayed as two phases of TMA-DPH fluorescence quenching. The initial phase comprised a rapid drop in fluorescence that was neither affected by cooling the cells on ice, nor by activity of mitochondria or ABC transporters. This phase reflects the association of dye with the outer leaflet of the plasma membrane. The subsequent phase of TMA-DPH fluorescence quenching occurred in drug-sensitive cell lines with a half-life in the range 20,40 s. The second phase of fluorescence quenching was abolished by incubation of the cells on ice and was transiently inhibited in cells with active mitochondria. Thus, the second phase of fluorescence quenching reflects the accumulation of dye in the cytoplasmic leaflet of the plasma membrane, presumably as a result of flip-flop of dye across the plasma membrane and slow diffusion from the inner leaflet into the cells. Whereas activity of P-glycoprotein prevented the second phase of fluorescence quenching, the activity of multidrug resistance-associated protein 1 had no effect on this phase. Thus, P-glycoprotein appears to pump rhodamines from the cytoplasmic leaflet either to the outer leaflet or to the outer medium. [source] A consultation leaflet to improve an older patient's involvement in general practice care: a randomized trialHEALTH EXPECTATIONS, Issue 4 2005Raymond Wetzels MD Abstract Objective, To evaluate the effects of a programme to enhance the involvement of older patients in their consultations in general practice. Design, Cluster randomized trial, in which data was collected from different cohorts. Setting and participants, Twenty-five general practices in the south-east part of the Netherlands and their patients aged 70 years and over. Intervention, Patients in the intervention group received a leaflet to help them prepare for the consultation. General practitioners (GPs) received an outreach visit to optimize older patients' involvement when visiting their GP. Patients in the control group received usual care. Main outcome measures, Questionnaires measuring involvement (COMRADE), enablement (Patient Enablement Index) and satisfaction with their care (EUROPEP). Results, Pre-intervention 315 patients and post-intervention 263 patients were included. Subjects were satisfied with their involvement and the GP's behaviour during the consultation. No differences in effect as a result of the leaflet on involvement, enablement or satisfaction were found between the intervention and the control group. Of 318 patients who received the leaflet and visited their GP in the intervention period, 47 patients used the leaflet. These users were more accustomed to prepare themselves for consultations. Users reported more psychological problems than non-users. Conclusions, No relevant effects of the implementation programme on involvement, enablement or satisfaction were found. Other strategies are needed to enhance involvement of older patients in their care. Alternatively, older patients may perceive themselves sufficiently involved. [source] Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team,Based Fall-Prevention InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007Wolfgang Von Renteln-Kruse MD Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It was a prospective cohort study with historical control including all 4,272 patients (mean age 80, 69% female) before and 2,982 (mean age 81, 69% female) after introduction of the intervention. The intervention included fall-risk assessment on admission and reassessment after a fall; risk alert; additional supervision and assistance with the patients' transfer and use of the toilet; provision of an information leaflet; individual patient and caregiver counseling; encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices; and staff education. Measurements included standardized fall-incidence reporting, activity of daily living and mobility status, number of falls and injurious falls, and number of patients who fell. Before the intervention was introduced, 893 falls were recorded. After the intervention was implemented, only 468 falls were recorded (incidence rate ratio (IRR)=0.82, 95% confidence interval (CI)=0.73,0.92), 240 versus 129 total injurious falls (IRR=0.84, 95% CI=0.67,1.04), 10 versus nine falls with fracture (IRR=1.40, 95% CI=0.51,3.85) and 611 versus 330 fallers. The relative risk of falling was significantly reduced (0.77, 95% CI=0.68,0.88). A structured multifactorial intervention reduced the incidence of falls, but not injurious falls, in a hospital ward setting with existing geriatric multidisciplinary care. Improvement of functional competence and mobility may be relevant to fall prevention in older hospital inpatients. [source] Resistance to tearing of calf and ostrich pericardium: Influence of the type of suture material and the direction of the suture lineJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2004José María García Páez Abstract The tearing of the valve leaflet of a cardiac bioprosthesis can cause early failure of this device, which is employed to replace a diseased native valve. This report involves the study of the behavior of 312 tissue samples (152 of calf pericardium and 160 of ostrich pericardium) treated with glutaraldehyde and subsequently subjected to tear testing. The samples were cut in the two principal directions: longitudinally, or root to apex, and transversely. They included a series of control samples that were left unsutured, and the remaining samples were repaired with the use of two different suture techniques: a running suture in the direction of the load and a telescoping suture perpendicular to the load. Four commercially available suture materials were employed: Pronova®, nylon, Gore-Tex®, or silk. The unsutured control samples of both types of pericardium exhibited a similar anisotropic behavior in the tear test. The mean resistance to tearing of the calf pericardium was 24.29 kN m in samples cut longitudinally and 34.78 kN m in those cut transversely (p = .03); the values were 28.08 kN m and 37.12 kN m (p = .002), respectively, in ostrich pericardium. The series repaired with the telescoping suture always exhibited greater resistance to tearing, with values that ranged between 44.34 and 64.27 kN for the samples of calf pericardium and from 41.65 to 47.65 kN for those obtained from ostrich. These assays confirm the anisotropic behavior of calf and ostrich pericardium treated with glutaraldehyde when subjected to tear testing, as well as the loss of this behavior in ostrich pericardium after suturing. Suturing techniques, such as the telescoping model, that provide a greater resistance to tearing should be studied for use in the design of the valve leaflets of cardiac bioprostheses made of biological materials. © 2004 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 69B: 125,134, 2004 [source] Usefulness of Intraoperative Real-Time 3D Transesophageal Echocardiography in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 6 2008Thierry V. Scohy M.D. Methods: Preoperative transthoral echocardiography (TTE) revealed: hypertrophic ventricular septum (TTE:19.3 mm), systolic anterior motion (SAM) not causing obstruction and malcoaptation of the anterior mitral valve leaflet (AMVL), and posterior mitral valve leaflet (PMVL) with severe mitral regurgitation. Results: Intraoperative TEE with a x7-2t MATRIX-array transducer (Philips, Andover, MA, USA) with a transducer frequency of x7,2 t mHz, connected to a iE33 (Philips), shows us that the main mechanism and site of regurgitation was an AMVL cleft. We also measured a 24.3-mm thickness of the ventricular septum and analyzing the 3D full volume acquisition revealed that there was no SAM. Conclusion: Intraoperative RT3DTEE permitted comprehensive 3D viewing of the mitral valve revealing the mechanism of mitral valve regurgitation, SAM, and the exact width of the hypertrophic ventricular septum. [source] Chordal Cutting VIA Aortotomy in Ischemic Mitral Regurgitation: Surgical and Echocardiographic StudyJOURNAL OF CARDIAC SURGERY, Issue 1 2008Georges Fayad M.D. In addition, MR may exacerbate during exercise not only trough exercise-induced ischemia but also through an increase in tenting area. Accordingly, we aimed to perform chordal cutting through aortotomy in patients with exercise-induced ischemic worsening of MR. Methods: Five patients with ischemic MR, due to anterior leaflet tenting, whichworsened during exercise echocardiography were enrolled. All patients underwent cutting of the 2 basal chordae attached to the anterior mitral leaflet associated with myocardial revascularization. Three patients had additional mitral valve annuloplasty. Postoperative MR was evaluated using exercise echocardiography. Results: Age ranged from 63 to 78 years and 4 patients were male. Preoperative LV ejection fraction averaged 39 ± 3%. Chordal cutting was performed through aortotomy allowing comfortable access to the anterior mitral valve. Mitral effective regurgitant orifice at rest and at peak exercise was reduced by surgery (10 ± 3 to 0.6 ± 0.5 mm2 at rest and from 20 ± 3 to 6 ± 2 mm2 at peak exercise; p = 0.03). Mitral tenting area at rest and at peak exercise was concomitantly reduced by surgery (1.83 ± 0.21 cm2 to 0.50 ± 0.4 cm2 at rest and from 3.11 ± 0.58 to 1.7 ± 0.5 cm2 at peak exercise; p = 0.03). Left ventricular size and function remained unchanged after surgery. Conclusions: Chordal cutting through aortotomy may be an effective option to treat ischemic MR due to anterior leaflet tenting. Associated with myocardial revascularization, it resulted in a decrease of MR at rest and during exercise through a decrease in tenting area without impairment of LV function. [source] Repair of Flail Leaflet of the Tricuspid Valve by a Simple Cusp Remodeling TechniqueJOURNAL OF CARDIAC SURGERY, Issue 4 2007Xiubin Yang M.D. We try to present an alternative method and midterm results. Methods: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 ± 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. Results: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 ± 12.5 mm to a mean of 23.6 ± 5.3mm (p < 0.01). Mean follow up was 50 ± 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. Conclusion: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae. [source] Posttraumatic Tricuspid Insufficiency Successfully Repaired by Conventional TechniqueJOURNAL OF CARDIAC SURGERY, Issue 4 2005Ph.D., Shoh Tatebe M.D. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair. [source] Effects of ageing on carbonyl stress and antioxidant defense in RBCs of obese Type 2 diabetic patientsJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 3 2005Alina Constantin Abstract In this study we investigated the effects of ageing on the carbonyl stress (protein carbonyls and 4-hydroxy-2-nonenal groups) and glutathione antioxidant defense in red blood cells (RBCs) of obese Type 2 diabetic patients with/without hypertensive complications. To this purpose the following methods were used: spectrophotometry (protein carbonyls, glutathione and glutathione peroxidase assays), immunofluorescence (4-hydroxy-2-nonenal localization), western blotting (immunodetection of carbonylated proteins). The results showed that compared to RBCs of healthy subjects, in obese Type 2 diabetics, ageing is associated with: (i) an increase in the concentration and expression of carbonylated proteins, a marker of oxidative stress; (ii) a decrease of both non-enzymatic and enzymatic endogenous glutathione defenses; (iii) a severely disturbed oxidant/antioxidant balance when obesity was associated with hypertension. The simultaneous insults of high blood pressure, obesity, and diabetes conducted to the highest carbonyl strss, exposure of 4-hydroxy-2-nonenal Michel adducts at the outer leaflet of RBCs plasmalemma, and the lowest glutathione antioxidant potential, particularly in elderly patients. These results can explain the gradual age-dependent diminishment of the detoxification potenital of RBCs that at the old age can not overcome the deleterious effects of the high systemic oxidative stress. [source] Medicines information and adherence in HIV/AIDS patientsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2006L. E. Mansoor BPharm Summary Background:, Providing written medicines information is being legislated in an increasing number of countries worldwide, with the patient information leaflet (PIL) being the most widely used method for conveying health information. The impact of providing such information on adherence to therapy is reportedly unpredictable. Therapy for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and related opportunistic infections usually involves polytherapy and complex regimens, both of which are risk factors for non-adherence. The objective of this study was to assess the impact of medicines information on adherence to chronic co-trimoxazole therapy in low-literate HIV/AIDS patients. Methods:, Two different PILs were designed for co-trimoxazole tablets and were available in both English and isiXhosa. Participants were randomly allocated to a control group (receiving no PIL), group A (receiving a ,complex PIL') and group B (receiving a ,simple PIL' incorporating pictograms). At the first interview, demographic data were collected and the time, date and day that the participant would take his/her first tablet of the month's course was also documented. In a follow-up interview adherence to therapy was assessed using two methods; self-report and tablet count. Results:, The medicines information materials incorporating simple text and pictograms resulted in significantly improved adherence to therapy in the short term, whereas a non-significant increase in adherence was associated with the availability of the more complex information. This was shown by both the self-reported assessment as well as the tablet count. Conclusion:, This research suggests that appropriately designed written material can have a positive impact in improving adherence and, together with verbal consultation, are essential for enabling patients to make appropriate decisions about their medicine taking. [source] Characterization of apoptosis induced by grouper iridovirus in two newly established cell lines from barramundi, Lates calcarifer (Bloch)JOURNAL OF FISH DISEASES, Issue 11 2008Y-S Lai Abstract Two new cell lines have been established from the muscle and swim bladder tissues of barramundi, Lates calcarifer, and designated as BM (barramundi muscle) and BSB (barramundi swimbladder), respectively. The cells multiplied well at 28 °C in Leibovitz's L-15 medium supplemented with 10% foetal bovine serum, and have been continuously subcultured more than 100 times to date. Morphologically, BM cells were mostly fibroblastic, whereas BSB were mostly epithelial. Both cell lines were susceptible to grouper iridovirus (GIV) and displayed characteristics of apoptosis after viral infection. The induction of apoptosis was further assayed in GIV-infected BM and BSB cells by various methods. The inhibition of cell growth by GIV was demonstrated by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. Morphological observations revealed typical apoptotic features in the infected cells, including cell shrinkage and rounding, chromosome condensation and formation of apoptotic body-like vesicles. Chromosome fragmentation was detected by DNA laddering and TUNEL assays. Finally, the appearance of phosphotidylserine on the outer leaflet of apoptotic cell membranes was confirmed by annexin V staining. This is the first report of apoptosis induced by GIV in fish cells. [source] A2. The carer's perception of dietitians' advice and its impact on the management of patients receiving haemodialysisJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000M. A. Rezaie Background Patients with end stage renal disease and their carers suffer many changes in their daily life style as a result of haemodialysis (HD) treatment. Information and education concerning the management of dietary requirements and restrictions for renal patients should be aimed at both patients and their carers. Aim This study investigated the impact of dietitians' involvement and advice on the carers' ability to manage patients' dietary/fluid requirements. Method A total of 36 carers of renal patients receiving unit haemodialysis treatment were randomly recruited into this study from a hospital in Cardiff, Wales. All the carers completed the Haemodialysis carers questionnaire (HCQ), specifically designed for this study, delivered to them in the outpatient clinic by the dietitian. Results Of the 36 carers, 22 (61%) were female, six (16.7%) were male and eight (22%) did not report their gender. Thirteen (36%) of the carers were between the ages of 20,54 years and 23 (64%) were 55 years of age and older. Twenty-six (72%) of the carers involved in this study were spouses and 34 (94.4%) of the carers lived with the patient. The mean duration of haemodialysis treatment for the patient was found to be 20 months. The results indicated that although the majority of the carers were informed about patients' dietary and fluid restrictions, 45% had not received any dietary information. Dietitians' one-to,one interactions with the carer was the most effective way of providing information in enabling them to better manage the patient compared to other methods such as leaflet and information packs (P = 0.01). The majority of the carers knew how to contact the renal dietitian, however, many did not (P = 0.001). Almost all the carers considered receiving information about the purpose of HD, feed back on the patients' condition, fluid/dietary restriction and details of available community resources as very important. Those carers who had the benefit of a dietitian's involvement believed that their advice was very helpful and enabled them to cope better with the management and complications of patient fluid and dietary requirements (P < 0.02). Strong correlations were found (rs = 0.67; P < 0.01) between the amount of information received by the carers and the level of the carers satisfaction with this information. In contrast, there were no significant correlations between the amount of information received by the carers and different aspects of managing the patients' diet, because 45% of the carers received none or little information. Conclusions Dietitians should involve the carers in the management of HD patient's dietary/fluid requirements and restrictions in order to provide better quality of care and quality of life for both the patient and the carer. [source] Leaflet Movement of Robinia pseudoacacia in Response to a Changing Light EnvironmentJOURNAL OF INTEGRATIVE PLANT BIOLOGY, Issue 4 2007Cheng-Cheng Liu Abstract Diurnal and nocturnal leaflet movement of black locust (Robinia pseudoacacia L.) was investigated under three light schemes: 100% natural irradiance, 50% shading, and 90% shading. Changes in leaf mid-vein angle were described by measurements of two planes: (i) ,, the angle formed by the bottom of the petiolule and its relation to the horizontal plane; and (ii) ,, the angle between the petiolule and the main leaflet vein. The two highest light regimens had a significant effect on ,. Variation in , tends to make the leaflet more erect, thereby minimizing any negative impact of high irradiance on leaf lamina. Light-dark rhythms induced variation in , (termed nyctinastic movement). Nyctinastic movement is important during the low light levels experienced by leaflets in early morning and late afternoon. At low light levels, the leaflet stopped nyctinastic movement and , was fixed at an angle that may have enabled the leaf lamina to maximize light interception. After the light-dark cycle was reestablished, nyctinastic movement was restored. Taken together, our results suggest that irradiance induces variation in , leading to diurnal leaflet movement (diaheliotropism), whereas the light-dark cycle influences ,, which results in nocturnal leaflet movement. Both angles are important for describing patterns of leaf movement in R. pseudocacia. [source] Photic Regulation of mt1 Melatonin Receptors in the Siberian Hamster Pars Tuberalis and Suprachiasmatic Nuclei: Involvement of the Circadian Clock and Intergeniculate LeafletJOURNAL OF NEUROENDOCRINOLOGY, Issue 3 2000Schuster In the Siberian hamster suprachiasmatic nuclei and pars tuberalis of the pituitary, high affinity mt1 melatonin receptors are present. We have previously shown that night applied light pulse induced an increase in mt1 mRNA expression in the suprachiasmatic nuclei of this species, independently of the endogenous melatonin. Here, we report the photic regulation of melatonin receptor density and mRNA expression in the suprachiasmatic nuclei and pars tuberalis of pinealectomized Siberian hamsters and the implication in this control of either the circadian clock or the intergeniculate leaflet. The results show that: (1) A 1-h light pulse, delivered during the night, induces a transitory increase in mt1 mRNA expression in the suprachiasmatic nuclei and pars tuberalis. After 3 h this increase has totally disappeared (suprachiasmatic nuclei) or is greatly reduced (pars tuberalis). (2) The melatonin receptor density, in the suprachiasmatic nuclei, is not affected by 1 or 3 h of light, while it is strongly increased in the pars tuberalis. (3) In hamsters kept in constant darkness, the mt1 mRNA rise is gated to the subjective night in the suprachiasmatic nuclei and pars tuberalis. In contrast, the light-induced increase in melatonin binding is also observed in the subjective day in the pars tuberalis. (4) intergeniculate leaflet lesion totally inhibits the mt1 mRNA expression rise in the suprachiasmatic nuclei, while it has no effect on the light-induced increase in mt1 mRNA in the pars tuberalis. However, the light-induced increase in melatonin receptor density is totally prevented by the intergeniculate leaflet lesion in the pars tuberalis. These results show that: (1) the photic regulations of mt1 mRNA expression and receptor density are independent of each other in both the suprachiasmatic nuclei and pars tuberalis; and (2) the circadian clock and the intergeniculate leaflet are implicated in the photic regulation of melatonin receptors but their level of action differs totally between the suprachiasmatic nuclei and pars tuberalis. [source] A survey of the quality and accuracy of information leaflets about skin cancer and sun-protective behaviour available from UK general practices and community pharmaciesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2009S Nicholls Abstract Background, Better information promotes sun protection behaviour and is associated with earlier presentation and survival for malignant melanoma. Aim, To assess the quality of patient information leaflets about skin cancer and sun-protective behaviour available from general practices and community pharmacies. Design of study, A structured review of patient information leaflets. Setting, All community pharmacies and general practices in one Primary Care Trust were invited to supply leaflets. Methods, Readability was assessed using the SMOG scoring system. Presentation and content were reviewed using the Ensuring Quality Information for Patients (EQIP) guidelines. Three consultant dermatologists assessed each leaflet for accuracy. Results, Thirty-one different patient information leaflets were returned. Thirteen (42%) were published in the previous 2 years, but 10 (32%) were over 5 years old. Nine (29%) leaflets were produced by the NHS or Health Education Authority, and 8 (27%) were linked to a commercial organization. One leaflet had readability in the primary education range (SMOG score = 6), and none with the recommended range for health education material (SMOG score , 5). Two leaflets (6%) were in the highest quartile of EQIP score for presentation and content. Five leaflets (17%) had a major inaccuracy such as over-reliance on sun screen products instead of shade and clothing. Conclusions, Leaflets were of variable quality in presentation and content. All required a reading age higher than recommended. All leaflets with major inaccuracies had links with commercial organizations. This study raises important issues about the potential conflict between marketing and health messages in the way sun creams are promoted. Conflicts of interest None declared [source] | ||||||||||||||||||||||||||||||||||