Self-organization threshold scaling for thermal atoms coupled to a cavity.

We make a detailed experimental study of the threshold for the self-organization of thermal 87Rb atoms coupled to a high-finesse cavity over a range of atom numbers and cavity detunings. We investigate the difference between probing with a traveling wave and a retroreflected lattice. These two scenarios lead to qualitatively different behavior in terms of the response of the system as a function of cavity detuning with respect to the probe. In both cases, we confirm a N(-1) scaling of the threshold with atom number.

Serum adiponectin level is not only decreased in metabolic syndrome but also in borderline metabolic abnormalities.

OBJECTIVE: Along with the increasing prevalence of obesity and related diseases, particularly atherosclerotic diseases, metabolic syndrome (MetS) is now a common and major public health issue in many countries around the world. Adiponectin, a protein secreted by the adipose tissue, has become recognized as a key player in the development of MetS. These days, not only MetS but also borderline metabolic/physiological abnormalities, such as impaired fasting glucose, high normal blood pressure and high normal plasma cholesterol, have been reported to be risk factors for atherosclerotic disease. Therefore, we undertook this study to determine the relationship between adiponectin and borderline metabolic/physiological abnormalities, as well as MetS. DESIGN: A cross-sectional study performed from April 2007 to November 2009. SUBJECTS: In 16 892 Japanese adults (10 008 men and 6884 women), we examined the relationship between the serum adiponectin concentration and borderline metabolic/physiological abnormalities or MetS by a questionnaire survey about medical treatment, body size measurement and measurement of laboratory parameters including the serum adiponectin concentration. RESULTS: Adiponectin showed a significant negative correlation with the number of MetS components. In subjects without overt diabetes mellitus, hypertension or dyslipidemia, the adiponectin concentration also showed a significant negative correlation with the number of borderline metabolic abnormalities. CONCLUSION: The decrease of circulating adiponectin may start before the development of diabetes mellitus, hypertension, dyslipidemia or MetS. Adiponectin is an important biomarker for reflecting the adverse influence of visceral fat in persons with MetS, and also in these subclinical states.

Early identification of impaired myocardial reperfusion with serial assessment of ST segments after percutaneous transluminal coronary angioplasty during acute myocardial infarction.

To evaluate the relation between ST-segment analysis and microvascular reperfusion in patients with acute myocardial infarction (AMI), we studied 51 patients with first AMI who were successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The lead showing the greatest ST-segment elevation on the 12-lead electrocardiogram (ECG) was serially investigated until 24 hours after PTCA. Successful reperfusion was determined by technetium-99m tetrofosmin single-photon emission computed tomography. Impaired reperfusion (group 1: < 4 change in the sum of the defect score from before to immediately after PTCA) was observed in 24 patients, and successful reperfusion (group 2) was observed in 27 patients. Although ST-segment elevation was reduced significantly at 30 minutes after PTCA in group 2 (2.2 +/- 1.4 to 1.7 +/- 1.3 mm, p = 0.01), there was no significant change in group 1 (1.9 +/- 1.9 to 2.4 +/- 1.7 mm). Ten of 14 patients (71%) with persistent ST-segment elevation (DeltaST > 0 mm change in ST segment from before to 30 minutes after PTCA > 0) were in group 1, whereas 23 of 37 patients (62%) with ST-segment resolution (DeltaST < or = 0) were in group 2. The sensitivity and specificity of persistent ST-segment elevation for predicting impaired microvascular reperfusion were 42% and 85%, respectively. Thus, persistent ST-segment elevation 30 minutes after primary PTCA was a highly specific electrocardiographic marker of impaired reperfusion in patients with AMI.

Accuracy of technetium-99m tetrofosmin myocardial perfusion imaging in the detection of spontaneous recanalization in patients with acute anterior myocardial infarction.

To avoid the haemorrhagic risk of unnecessary thrombolysis in acute myocardial infarction (MI), early and precise diagnosis of spontaneous recanalization (SR) of the infarct-related artery is required. To clarify the accuracy of technetium-99m tetrofosmin myocardial single-photon emission tomography (SPET) in the detection of SR in patients with acute anterior MI, electrocardiography (ECG), echocardiography and 99mTc-tetrofosmin SPET imaging were performed in 49 patients with acute anterior MI before emergency coronary angiography. Defect score was calculated as the sum of the perfusion defects of each segment: from 3 (complete defect) to 0 (normal perfusion). Echocardiographic asynergic score (the sum of asynergic grades) and the greatest ST elevation of the 12-lead ECG on admission were also measured. SR was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow on emergency coronary angiography. Defect score in 11 patients with SR (9.2 +/- 3.7) was significantly lower than that in 38 patients without SR (18.5 +/- 5.0) (P < 0.001), whereas there were no significant differences in asynergic score and ST elevation between the two groups. From the receiver operating characteristic curves, the optimal cut-off points of defect score, asynergic score and ST elevation for the detection of SR were calculated to be 12, 13 and 3.5, respectively. The sensitivity and specificity of the scintigraphic defect score (91% and 89%) were significantly higher than those of the asynergic score (64% and 68%) and ST elevation (73% and 71%). Thus, 99mTc-tetrofosmin SPET imaging on admission is a very accurate method for the detection of SR in patients with acute anterior MI.

Accuracy of technetium-99m tetrofosmin myocardial perfusion imaging in the detection of spontaneous recanalization in patients with acute anterior myocardial infarction.

To avoid the haemorrhagic risk of unnecessary thrombolysis in acute myocardial infarction (MI), early and precise diagnosis of spontaneous recanalization (SR) of the infarct-related artery is required. To clarify the accuracy of technetium-99m tetrofosmin myocardial single-photon emission tomography (SPET) in the detection of SR in patients with acute anterior MI, electrocardiography (ECG), echocardiography and (99m)Tc-tetrofosmin SPET imaging were performed in 49 patients with acute anterior MI before emergency coronary angiography. Defect score was calculated as the sum of the perfusion defects of each segment: from 3 (complete defect) to 0 (normal perfusion). Echocardiographic asynergic score (the sum of asynergic grades) and the greatest ST elevation of the 12-lead ECG on admission were also measured. SR was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow on emergency coronary angiography. Defect score in 11 patients with SR (9.2±3.7) was significantly lower than that in 38 patients without SR (18.5±5.0) (P<0.001), whereas there were no significant differences in asynergic score and ST elevation between the two groups. From the receiver operating characteristic curves, the optimal cut-off points of defect score, asynergic score and ST elevation for the detection of SR were calculated to be 12, 13 and 3.5, respectively. The sensitivity and specificity of the scintigraphic defect score (91% and 89%) were significantly higher than those of the asynergic score (64% and 68%) and ST elevation (73% and 71%). Thus, (99m)Tc-tetrofosmin SPET imaging on admission is a very accurate method for the detection of SR in patients with acute anterior MI.

Kind strangers? Physicians through the eyes of Tennessee Williams.

In Louisiana, Tennessee Williams is usually thought of as a famous denizen of the French Quarter or perhaps as our greatest playwright. Medicine rarely enters into it. Illness, however, particularly mental illness, shaped much of Williams' life and his work. The playwright had mixed feelings about physicians and their effect on his life and that of his close relations. These feelings worked their way into his plays. Through it all Williams gives a vivid, humorous, and deeply truthful image of the doctor-patient relationship in the first half of the twentieth century. Here we give a brief review of medicine in Williams' work.

Adjustable silicone gastric banding and band erosion: personal experience and hypotheses.

BACKGROUND: Adjustable silicone gastric banding (ASGB) has been advocated as a minimally invasive procedure that is completely reversible for the surgical treatment of morbid obesity. Band erosion (BE) is one of the possible complications of ASGB. The authors report their experience with BE and discuss its possible causes. METHODS: Between February 1993 and February 1998, the authors performed 122 ASGB: 51 open and 71 laparoscopic procedures. RESULTS: Two cases of BE occurred (1.6%). CONCLUSION: Band erosion is a possible complication of ASGB that is often not diagnosed immediately. Prevention is essential and consists primarily in correct placement of the band. There appears to be only one solution to BE: removal of the band. Placement of a new band after removal is possible; the minimum interval is not known.

Early detection of the no-reflow phenomenon in reperfused acute myocardial infarction using technetium-99m tetrofosmin imaging.

Evaluation of myocardial perfusion in the early stage of acute myocardial infarction (MI) is clinically important for adjunctive therapies to minimize infarct size. To determine the role of early scintigraphic detection of impaired myocardial reperfusion after primary coronary angioplasty (PTCA) in patients with acute MI, semiquantitative technetium-99m tetrofosmin single-photon emission tomographic (SPET) imaging was performed before primary PTCA (before; area at risk), 60 min after PTCA (after) and at 1 month (1 M; final infarct) in 35 patients with acute MI. The left ventricle was divided into 13 segments and the defect score was calculated as the sum of the perfusion defect of each segment, from 3 (complete defect) to 0 (normal perfusion). A significant myocardial perfusion change after PTCA was defined as a change in the defect score (before minus after PTCA) of >/=4. The echocardiographic asynergic score was defined as the number of asynergic (severe hypokinetic or akinetic) segments corresponding to the analogous segments on SPET images, and recovery of wall motion was calculated as absolute change in the asynergic score (before PTCA minus 1 M). Among the 35 patients, 15 (43%) had a change in the defect score of <4 (no reflow: group 1) while 20 had a change in the defect score of >/=4 (reflow: group 2). There were no significant differences between the two groups with respect to the time between admission to PTCA, revascularization time, collateral grade or Thrombolysis in Myocardial Infarction (TIMI) flow grade before PTCA. Despite the lack of a difference in area at risk between the two groups (group 1 = 12.8+/-4.3 and group 2 = 15.1+/-4.7), final infarct size in group 1 was significantly larger compared with that in group 2 (8.1+/-4.3 vs 4.9+/-3.0, P<0.001). Recovery of wall motion was significantly smaller in group 1 than in group 2 (4.3+/-1.7 to 3.5+/-1.5 vs 4. 1+/-2.1 to 1.6+/-1.6, P<0.001). In conclusion, a small change (<4) in defect score (scintigraphic no-reflow phenomenon) after primary PTCA indicates persisting impaired myocardial perfusion or irreversible cellular damage just after PTCA which is associated with poor recovery of wall motion, as compared with that observed in cases of reflow (>/=4 in defect score).

Coronary artery diameter and left ventricular function in patients on maintenance hemodialysis treatment: comparison between diabetic and nondiabetic patients.

BACKGROUND/AIMS: This study examined the role of diabetes mellitus on determining left ventricular function by evaluating coronary artery diameter in patients with end-stage renal disease on maintenance hemodialysis treatment. METHODS: We studied 12 diabetic and 12 nondiabetic patients on maintenance hemodialysis treatment without significant stenoses of the major epicardial coronary arteries. Patients were matched for age, sex distribution, duration of dialysis and incidence of major coronary risk factors. Left ventricular wall thickness (septal and posterior walls) and left ventricular diameter (end-diastolic and systolic phases), were measured by echocardiography. Hemodynamic measurements and coronary angiography were performed on the day of hemodialysis and coronary artery diameter at the proximal and mid portion of three major coronary arteries were measured using the computed densitometry method. RESULTS: Right and left anterior descending and circumflex coronary artery diameters were all significantly smaller and the frequency of coronary artery calcification was higher in diabetic (58%) compared to nondiabetic (8%) patients. Although there were no significant differences in left ventricular wall thickness, left ventricular diameter, mean right atrial pressure and cardiac index between the two groups, left ventricular end-diastolic pressure was significantly higher in diabetic (22 +/- 9 mm Hg) compared to nondiabetic patients (14 +/- 5 mm Hg). CONCLUSION: Despite that there were no significant stenoses of the major epicardial coronary arteries, diffuse luminal narrowing of the epicardial coronary arteries in diabetic patients on maintenance hemodialysis treatment was associated with increased left ventricular end-diastolic pressure.

Identification of war victims from mass graves in Croatia, Bosnia, and Herzegovina by use of standard forensic methods and DNA typing.

The postmortem remains of sixty-one war victims were excavated from 6 mass graves in Bosnia and Herzegovina one and a half years after interment Using standard identification methods, including the matching of medical and dental records, the recognition of distinguishing characteristics such as the use of clothing and belongings, and video superimposition, 35 persons were identified. For the remaining 26 persons identification efforts continue. DNA typing was performed at the HLA DQA1 locus and five PM system loci. Results from DNA typing were confirmed by other methods. DNA profiles of family members of 150 missing persons are now being developed using the 6 loci. These DNA profiles will then be compared with those generated from the bone and teeth remains of the unidentified victims.

Laparoscopic transperitoneal mesh repair of inguinal hernia. A preliminary review of 120 cases.

From april 1992 to april 1994 we performed 120 laparoscopic transperitoneal hernia repairs using a polypropylene mesh. This paper is a preliminary review of the method we used and our results. We operated upon 105 patients including 40 direct, 79 indirect and 1 femoral hernias. The inguinal region is approached transperitoneally through 3 trocars placed in the lower abdominal region. A dissection of the pre-peritoneal inguinal space is performed and a 14 x 8 cm mesh is fixed using a stapling device. We have had some peroperative complications (injury to the epigastric vessels and the vas deferens, bowel injury), mainly in our early experience with this new technique. Postoperative complications consisted of minor problems (scrotal seroma and induration of the spermatic cord) 3 infections, 1 patient with prolonged pain and 1 recurrence. Some of these problems can be resolved by adjusting the technique. There seems to be less postoperative pain and a shorter convalescence period allowing active persons to return to work earlier than with classic herniorrhaphy. Since this is a new technique, no definite conclusions can be drawn at the moment.

Receptor-stimulated guanine-nucleotide-triphosphate binding to guanine-nucleotide-binding regulatory proteins. Nucleotide exchange and beta-subunit-mediated phosphotransfer reactions.

In order to study whether phosphate transfer reactions are involved in the binding of guanine nucleotide triphosphates to guanine-nucleotide-binding regulatory proteins, binding of the GTP analogues, guanosine 5'-[gamma-thio]triphosphate, GTP[S], and guanosine 5'-[beta, gamma-imino]triphosphate, p[NH]ppG, and the regulation of binding by the formyl-peptide-receptor agonist, fMet-Leu-Phe, were studied in membranes of differentiated HL-60 cells. For fMet-Leu-Phe-stimulated binding of either GTP analogue, a competing nucleotide was required. With GDP as the competing nucleotide, initial rates of fMet-Leu-Phe-stimulated binding of GTP[S] and p[NH]ppG were similar for up to approximately 30 s. Thereafter, receptor-stimulated binding of p[NH]ppG rapidly reached equilibrium, whereas the binding of GTP[S] proceeded further. At equipotent concentrations of p[NH]ppG and GTP[S], maximal fMet-Leu-Phe-stimulated binding of GTP[S] was approximately twofold higher than that of p[NH]ppG. Finally, for half-maximal receptor-stimulated binding of GTP[S], approximately fivefold higher concentrations of both Mg2+ and GDP were required than for p[NH]ppG binding. With p[NH]ppG as the competing nucleotide, the extent of receptor-stimulated binding of GTP[S] as well as its Mg2+ requirement and time course were similar to the receptor-stimulated p[NH]ppG binding observed in the presence of GDP. However, with GTP[S] as the competing nucleotide, fMet-Leu-Phe reduced the binding of p[NH]ppG, a reaction further enhanced when GDP was additionally present. Under similar conditions as used in the binding studies, GTP[S] thiophosphorylated a 35-kDa protein, which is most likely a guanine-nucleotide-binding regulatory protein beta subunit [Wieland, T., Nürnberg, B., Ulibarri, I., Kaldenberg-Stasch, S., Schultz, G. & Jakobs, K. H. (1993) J. Biol. Chem. 268, 18111-18118]. The thiophosphorylation state of this protein was regulated by guanine nucleotides, Mg2+ and, most importantly, by activated formyl-peptide receptors. The data thus provide evidence for an essential difference between GTP[S] and p[NH]ppG binding to guanine-nucleotide-binding regulatory proteins and suggest that, in addition to the nucleotide-exchange reaction, a (thio)phosphate-group-transfer process via guanine-nucleotide-binding regulatory protein beta subunits is involved in the receptor-stimulated binding of guanine nucleotide triphosphates to guanine-nucleotide-binding regulatory proteins.

Relationship between the coronary diameter and occurrence of vasospastic angina in patients with normal coronary arteries.

Coronary artery diameters were measured after various interventions in 30 patients without angina pectoris (group 1) and in 15 with angina pectoris (group 2: rest, or rest and effort angina) who had normal coronary arteries. The coronary artery diameters were significantly smaller in many coronary segments in group 2 than in group 1 during a control state, after exercise and ergonovine, but became nearly identical after isosorbide dinitrate in both groups. Patients in group 1 had diffuse narrowing but no focal vasoconstriction after ergonovine and all the segments had a diameter of more than 50% of that after isosorbide dinitrate. The change of coronary artery diameter in group 2 patients who had no vasospasm by ergonovine was the same as that in group 1. Patients in whom vasospastic angina was induced had local vasoconstriction or severe diffuse narrowing (less than 45%). These results indicate that angina pectoris patients with normal coronary arteries had an acceleration of coronary arterial basal tone, but vasospastic angina pectoris was not induced just by the general response of the coronary artery to various interventions in addition to the accentuated basal tone. For vasospastic angina to occur, local abnormal response to various interventions must be present.