Echocardiographic and electrocardiographic effects of atenolol versus sotalol in dogs with severe subaortic stenosis.

BACKGROUND: Subaortic stenosis (SAS) is a commonly diagnosed canine congenital cardiac defect, with severe forms of carrying a poor long-term prognosis. To date, an effective treatment strategy has not been developed in veterinary medicine. This study sought to determine if sotalol, a class III antiarrhythmic, may have salient echocardiographic and antiarrhythmic benefits for medical management for dogs affected with severe SAS. METHODS: Ten dogs diagnosed with severe SAS were enrolled in this prospective, double-blinded, crossover study. Dogs underwent physical exam, non-invasive blood pressure measurement, electrocardiography, echocardiography, and 24-h Holter monitoring. Diagnostics were repeated 12-16 days following randomization to oral atenolol (0.5-1 mg/kg) or sotalol (1-2 mg/kg) twice daily. After a medication taper and four-day washout, dogs were crossed-over to the alternate study medication, and the diagnostics were repeated in 12-16 days. Linear and multinomial mixed models were developed to evaluate the effects of treatments on echocardiographic and electrocardiographic variables. RESULTS: Indices of left ventricular systolic function were reduced based on the volumetric assessment when dogs received sotalol compared to atenolol. No difference was noted between groups in left ventricular systolic function based on the linear assessment. No difference was observed in the reduction in left ventricular outflow tract velocity. No significant differences were observed between treatment groups for any variable on 24-h Holter monitor. CONCLUSIONS: Sotalol may be a viable therapy to consider for dogs with severe SAS based on this pilot study. A larger, prospective study is necessary to investigate further.

Single left coronary ostium with a prepulmonic right coronary artery course in a French Bulldog with congenital valvular pulmonary stenosis.

A two-year-old, male castrated, French bulldog was presented for evaluation of coronary artery anatomy before balloon valvuloplasty for severe pulmonic valve stenosis. Multidetector computed tomography angiography showed a single left coronary ostium, absent right coronary ostium, and an anomalous, prepulmonic coursing right coronary artery. Medical management was elected to avoid the attendant risk associated with intervention. This case report documented the first known case of this specific anomaly in French bulldogs. Veterinary cardiologists should be aware of the potential for this specific coronary artery anomaly in this breed, given the predilection for the development of pulmonary stenosis. Routine screening of French bulldogs for anomalous, prepulmonic coronary arteries is recommended before interventional balloon valvuloplasty.

A systematic review of cardiovascular responses associated with ambient black carbon and fine particulate matter.

BACKGROUND: Exposure to fine particulate matter (PM2.5), an ambient air pollutant with mass-based standards promulgated under the Clean Air Act, and black carbon (BC), a common component of PM2.5, are both associated with cardiovascular health effects. OBJECTIVES: To elucidate whether BC is associated with distinct, or stronger, cardiovascular responses compared to PM2.5, we conducted a systematic review. We evaluated the associations of short- and long-term BC, or the related component elemental carbon (EC), with cardiovascular endpoints including heart rate variability, heart rhythm, blood pressure and vascular function, ST segment depression, repolarization abnormalities, atherosclerosis and heart function, in the context of what is already known about PM2.5. DATA SOURCES: We conducted a stepwise systematic literature search of the PubMed, Web of Science and TOXLINE databases and applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines for reporting our results. STUDY ELIGIBILITY CRITERIA: Studies reporting effect estimates for the association of quantitative measurements of ambient BC (or EC) and PM2.5, with relevant cardiovascular endpoints (i.e. meeting inclusion criteria) were included in the review. Included studies were evaluated for risk of bias in study design and results. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias evaluations assessed aspects of internal validity of study findings based on study design, conduct, and reporting to identify potential issues related to confounding or other biases. Study results are presented to facilitate comparison of the consistency of associations with PM2.5 and BC within and across studies. RESULTS: Our results demonstrate similar associations for BC (or EC) and PM2.5 with the cardiovascular endpoints examined. Across studies, associations for BC and PM2.5 varied in their magnitude and precision, and confidence intervals were generally overlapping within studies. Where differences in the magnitude of the association between BC or EC and PM2.5 within a study could be discerned, no consistent pattern across the studies examined was apparent. LIMITATIONS: We were unable to assess the independence of the effect of BC, relative the effect of PM2.5, on the cardiovascular system, nor was information available to understand the impact of differential exposure misclassification. CONCLUSIONS: Overall, the evidence indicates that both BC (or EC) and PM2.5 are associated with cardiovascular effects but the available evidence is not sufficient to distinguish the effect of BC (or EC) from that of PM2.5 mass.

Probabilistic Estimation of Stream Turbidity and Application under Climate Change Scenarios.

Streamflow-based rating curves are widely used to estimate turbidity or suspended sediment concentrations in streams. However, such estimates are often inaccurate at the event scale due to inter- and intra-event variability in sediment-streamflow relationships. In this study, we use a quantile regression approach to derive a probabilistic distribution of turbidity predictions for Esopus Creek, a major stream in one of the watersheds that supply drinking water to New York City, using measured daily mean streamflow-turbidity data pairs for 2003 to 2016. Although a single regression curve can underpredict or overpredict the actual observation, quantile regression can estimate a range of possible turbidity values for a given value of streamflow. Regression relationships for various quantiles were applied to streamflows simulated by a watershed model to predict stream turbidity under: (i) the observed historical climate, and (ii) a future climate derived from 20 global climate model (GCM) scenarios. Future scenarios using quantile regression in combination with these GCMs and a stochastic weather generator indicated an increase in the frequency and magnitude of hydrological events that may generate high stream turbidity and cause potential water quality challenges to the water supply. The methods outlined in this study can be used for probabilistic estimation of stream turbidity for operational decisions and can be part of a vulnerability-based method to explore climate impacts on water resources.

Setting up a parathyroid multidisciplinary team meeting: one year's experience, outcomes and learning points.

OBJECTIVE: A parathyroid multidisciplinary team meeting was set up at East Sussex Healthcare Trust, from November 2014 to November 2015, in order to improve and streamline services for patients with parathyroid pathology. METHODS: Data were collected on all new referrals for hyperparathyroidism, and on the outcomes for each patient discussed at the meeting, including the number of operations and management outcomes. A survey was sent out to the members of the multidisciplinary team meeting to determine their perception of its effectiveness. RESULTS: Seventy-nine new referrals were discussed throughout the year; 43 per cent were recommended for surgery, 41 per cent had a trial of conservative or medical management before re-discussion, and 16 per cent required further imaging. Ninety-two per cent of patients underwent an ultrasound, single-photon emission computed tomography/computed tomography or nuclear medicine (sestamibi) scan prior to the meeting. All ultrasound scans were performed by a consultant radiologist. CONCLUSION: The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.

Perceptual type error in everyday practice.

Discrepancy or quality improvement meetings are good practice and are now commonplace in most Radiology Departments, with the aim of improving diagnostic accuracy, preventing recurrent and common mistakes, improving the radiological report and thereby improving patient care. A total of 122 cases were assessed from a two-year period. This review highlights some of the more common, recurrent and important issues encountered within a general hospital with an emphasis on learning points and review areas.

The development of novel organically modified sol-gel media for use with ATR/FTIR sensing.

The ability to prepare and develop novel pre-concentration media by the sol-gel process, and their integration with mid-infrared transparent waveguides has been demonstrated. This research approach resulted in a mid-infrared sensing methodology in which the properties (porosity, functionality, polarity, etc.) of the recognition layer could be tailored by variation of the sol-gel precursors and processing conditions. Cross-linker type and concentration notably influenced p-xylene absorption and diffusion rate. Unreacted silanol groups appeared to be the dominant factor in the hydrophobicity of sol-gel layers. Variation of sol-gel precursors and thermal treatment altered both film cross-link density and polarity, as demonstrated by variation in the rate of analyte diffusion and equilibrium analyte concentration. The use of a novel 1 : 1 PTMOS : DPDMS material as pre-concentration medium in this analytical sensing approach was validated through the determination of p-nitrochlorobenzene in an aqueous environment. The response demonstrated linearity between 0-30 mg L(-1) with a correlation coefficient of 0.989 and a limit of detection of 0.7 mg L(-1). Sensing times for p-nitrochlorobenzene were also reduced from several hours to 24 minutes, without loss of measurement accuracy or sensitivity, by a 10 degrees C increase in the sensing temperature and the use of a predictive Fickian model previously developed by this research group.

Imaging of testicular tumours.

This article reviews the diagnosis, pathology and imaging of testicular tumours, predominantly germ cell tumours. It will discuss the imaging techniques used in their diagnosis, staging and surveillance.

Clarifications on breakpoints in HSAX and BTAX by comparative mapping of F9, HPRT, and XIST in cattle.

The coagulation factor IX gene (F9), the hypoxanthine phosphoribosyl transferase 1 gene (HPRT1), and the X-inactive specific transcript gene (XIST) were physically assigned in cattle to analyze chromosomal breakpoints on BTAX recently identified by radiation hybrid (RH) mapping experiments. Whereas the FISH assignment of XIST indicates a similar location on the q-arm of the human and cattle X chromosomes, the locus of HPRT1 supported the assumption of a chromosome rearrangement between the distal half of the q-arm of HSAX and the p-arm of BTAX identified by RH mapping. F9 previously located on the q-arm of BTAX was assigned to the p-arm of BTAX using RH mapping and FISH. The suggested new position of F9 close to HPRT1 supports the homology between HSAXq and BTAXp. The F9 locus corresponds with the gene order found in the homologous human chromosome segment. XIST was assigned on BTAXq23, HPRT1 and F9 were mapped to BTAXp22, and the verification of the location of F9 in a 5000 rad cattle-hamster whole genome radiation hybrid panel linked the gene to markers URB10 and HPRT1.

Long-term fate and persistence of the spilled metula oil in a marine salt marsh environment degradation of petroleum biomarkers.

Three coastal sites, heavily oiled from the 1974 Metula oil spill in the Strait of Magellan [two are salt marshes (East and West) and the third, an intertidal asphalt pavement], were examined during May 1998. Complete 'total oil analyses' were performed on the oil samples collected from these sites. Chemical fingerprinting data reveal, except for those samples from the East Marsh untreated plots which were only lightly to moderately weathered, that the spilled oil has undergone significant alteration in chemical composition after 24 years. There are no fundamental differences between the heavily weathered West Marsh and treated East Marsh samples. However, the effect of experimental filling action conducted in 1993 has been to substantially promote plant recolonization. The asphalt pavement samples indicate extremely high degradation of oil hydrocarbons, evidenced by a complete loss of n-alkanes from n-C8 to n-C41 and by depletion of greater than 98% of the alkylated polycyclic aromatic hydrocarbon homologues. Even the most refractory biomarker compounds showed some degree of biodegradation. The biomarkers were generally degraded in the declining order of importance as follows: diasteranes>C27 steranes>tricyclic terpanes>pentacyclic terpanes>norhapanes approximately C29-alphabetabeta-steranes.

Growing the vascular surgical practice: venous disorders.

For the 48th meeting of the International Society for Cardiovascular Surgery, North American Chapter in June 2000, we were asked to organize a presentation with the title displayed above. We welcomed this opportunity because the phrase 'growing the practice' literally means giving greater service to underserved patients with vascular disorders. Underserved individuals with vascular disorders include those with nonatherosclerotic arterial disorders, patients with lymphedema, and individuals with a variety of venous disorders including venous insufficiency. The majority of these conditions are not surgical, but venous insufficiency commands attention because its treatments are interventional. Therefore, this presentation will discuss prevalence of venous insufficiency, a unifying concept of its pathophysiology, how treatment may be selected, what the new technology provides, and then a description of coding issues and whether or not interventions are actually worthwhile from the point of view of the patient.

Attachment stability and emotional and behavioral regulation from infancy to preschool age.

Relations between attachment and child emotional and behavioral regulation were studied longitudinally in a sample of 223 children from urban, low-income families. Attachment in the Strange Situation at 12 and 18 months was scored using the infant classification system and at 24 months was scored using a preschool classification system. Only modest stability was found in attachment whether within or across classification systems, with the percentage of insecure attachments consistently increasing over time. Results indicated both concurrent and predictive associations with indices of child regulation based on observer ratings or maternal report. However, only the 24-month classification predicted maternal report of externalizing and internalizing behavior problems at age 3.5 years. with additional variance accounted for by selected measures of child emotional and behavior regulation from the same assessment. Attachment security (B) and atypical attachment classifications (D, A/C, and AD) appear to provide the most consistently useful information about child functioning. Results are discussed in terms of continuity and change from the perspective of developmental psychopathology.

Chromosome aberration assays in Pisum for the study of environmental mutagens.

From a literature survey, 117 chemicals are tabulated that have been assayed in 179 assays for their clastogenic effects in Pisum. Of the 117 chemicals that have been assayed, 65 are reported at giving a positive reaction (i.e. causing chromosome aberrations), 30 positive with a dose response, five borderline positive. Seventeen chemicals gave a negative response. Eighty-one percent of the chemicals gave a definite positive response. A c-mitotic effect was detected from treatment with 17 chemicals. In addition to the above tabulation of chemicals, 39 chemicals have been reported with an antimitotic effect. Thirteen assays have been recorded for five types of radiation, which with the exception of ultrasound reacted positively. The results of assays with 38 chemicals and/or radiations in combined treatments, as well as 15 chemicals and three types of radiations that induce somatic mutations are tabulated. The Pisum sativum (2n=14) bioassay has been shown to be a very good plant bioassay for assessing chromosome damage both in mitosis and meiosis for somatic mutations induced by chemicals, radiations, and environmental pollutants. For some chemicals, the Pisum assay is not as sensitive in assessing clastogenicity as the Allium assay, although this should be considered in relative terms. Pisum fulvum (2n=14) has been used in clastogenic studies also, but to a much lesser extent.

Internal to external carotid artery transposition to repair recurrent stenosis after carotid artery stenting.

Recently, carotid artery stenting (CAS) has emerged as a treatment option for carotid artery stenosis. Since the procedure is new, management of its complications is not standardized. This case report describes one method of arterial reconstruction after failed CAS. A 64-year-old male underwent CAS of his right internal carotid artery (ICA) for an asymptomatic 65% stenosis. Seven months later the stented area had narrowed to 95%. Arteriography revealed that the common and external carotid arteries (ECA) were free of disease so we elected to perform a transposition of the distal ICA onto the proximal ECA. The ECA and its branches were completely mobilized and the ascending pharyngeal and lingual arteries divided. The ICA was divided distal to the stent. Transection of the occipital artery provided an arteriotomy for an end ICA to side ECA anastamosis, thus preserving ECA flow. Postoperative surveillance after 8 months has revealed no recurrent stenosis. Operative repair of restenosis after CAS may be challenging if standard endarterectomy is not possible. Other options for reconstruction are feasible but if the common and external carotid arteries are disease-free, an ICA to ECA transposition provides a simple all-arterial repair that avoids bypass and prosthetic material.

Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment.

OBJECTIVES: To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA). METHOD: End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC"). RESULTS: The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt = 56%; Beh = 34%; CC = 25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant (p < .05). The psychosocial substitution effect remained negligible and nonsignificant. CONCLUSION: These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.

Infant and toddler pathways leading to early externalizing disorders.

OBJECTIVE: To examine pathways leading to specific types of early externalizing disorders. METHOD: Longitudinal data were collected on 310 low-income, male subjects followed from infancy until age 6 years. RESULTS: Support across informants was found for the importance of the caregiving environment during infancy in relation to the development of externalizing disorders at school entry. Support was also found for the significance of early child factors, but this was limited to child behavior at home. CONCLUSIONS: The results are consistent with social learning and attachment models, which suggest that severe conduct problems in early childhood are the result of deficits in the caregiving environment. Support was also found for Moffitt's hypothesis that children with the comorbid attention-deficit/hyperactivity disorder-oppositional defiant disorder/conduct disorder pattern experience multiple child and psychosocial risk factors that begin during infancy.