Effects of Levosimendan on cardiac function, size and strain in heart failure patients.

Levosimendan improves cardiac function in heart failure populations; however, its exact mechanism is not well defined. We analysed the short-term impact of levosimendan in heart failure patients with ischemic and non-ischemic cardiomyopathy (CMP) using multiparametric cardiac magnetic resonance (CMR). We identified 33 patients with ischemic or non-ischemic CMP who received two consecutive CMR scans prior to and within one week after levosimendan administration. Changes in LV ejection fraction (LVEF) and LV volumes, as well as changes in strain rates, were measured prior to and within one week after levosimendan infusion. LV scarring, based on late gadolinium enhancement (LGE), was correlated to changes in LV size and strain rates. Both LV endiastolic (EDV) and endsystolic volumes (ESV) significantly decreased (EDV: p=0,001; ESV: p=0,002) after levosimendan administration, with no significant impact on LVEF (p=0.41), cardiac output (p=0.61), and strain rates. Subgroup analyses of ischemic or non-ischemic CMP showed no significant differences between the groups in terms of short-term LV reverse remodeling. The presence and extent of scarring in LGE did not correlate with changes in LV size and strain rates. CMR is able to monitor cardiac effects of levosimendan infusion. Short-term follow-up of a single levosimendan infusion using CMR shows a significant decrease in LV size, but no impact on LVEF or strain measurements. There was no difference between patients with ischemic or non-ischemic CMP. Quantification of LV scarring in CMR is not able to predict changes in LV size and strain rates in response to levosimendan.

Controls on arsenic speciation and solid-phase partitioning in the sediments of a two-basin lake.

Arsenic (As) regeneration from sediments of Spy Pond, a two-basin lake near Boston, MA, continues to result in seasonally elevated As levels despite the several decades that have elapsed since the pond's historical contamination by a pulse input of As. Solid-phase speciation and partitioning of As in the sediments appear to be primary determinants of both potential As regeneration rate and, conversely, the rate at which long-term burial of the pond's As burden will occur. Although iron (Fe) chemistry often controls As speciation in lakes, a higher rate of As regeneration in the south basin, accompanied by the absence of a correlation between regenerated As and Fe in this basin, suggest that additional factors operate to control As cycling in this lake. Solid-phase As speciation was remarkably similar between sediments of the two basins of this lake, about 40% of sedimentary As in upper sediments being in relatively labile (ionically bound and strongly adsorbed) fractions and a larger fraction of As being associated with recalcitrant minerals, likely sulfides. Extraction, X-ray fluorescence, and acid-volatile sulfide data collectively suggest that sedimentary As cycling in both basins is largely controlled by the formation of sulfide minerals. An accounting of the size of sulfur (S) pools supports this conclusion, showing that sufficient S exists in the north basin to control both Fe and As, while the south basin has lower S levels resulting in seasonal accumulation of Fe in the porewater.

Dentistry's role in the recognition and reporting of domestic violence, abuse, and neglect.

Domestic violence is epidemic in western society. Child abuse, intimate partner abuse, and elder abuse victims often have signs of injury that are readily visible to dentists. Dentists have a moral and legal obligation to recognize and report suspected abuse. This article offers information and illustrations to assist in diagnosing abuse. Reporting guidelines and legal obligation information sources for every state in the United States are included.

Amphibious vision in Coryphoblennius galerita L. (Perciformes).

The morphology of the ophthalmic cornea in the blenniid fish Coryphoblennius galerita (Teleostei) shows adaptation to the amphibious life. Amphibious vision is provided by a flattened area within the cornea. Eyes of other, non-amphibious blenniids are compared with those of C. galerita.

Reliable detection of individuals seropositive for the human immunodeficiency virus (HIV) by competitive immunoassays using Escherichia coli-expressed HIV structural proteins.

We molecularly cloned the gag and env genes of the human immunodeficiency virus (HIV) and expressed fragments of these genes in Escherichia coli. Using the recombinant core and envelope proteins, we developed two competitive immunoassays (CIAs). Samples that recognized either the envelope or core proteins were considered positive for antibodies to HIV. This test system was comparable with western blot in detecting antibodies in patients with AIDS or AIDS-related complex that were repeatably reactive in the HIV screening test. All 360 individuals who were positive by western blot were positive by the CIA. A total of 844 samples repeatably reactive by an ELISA screening test were negative both by western blot and by the CIA; 48 samples positive by ELISA, but negative or indeterminate by western blot, were positive by the CIA. Alternate research procedures verified the positivity of these individuals. These data indicate that the CIA described here may be useful as an adjunct or alternative to the western blot.

Long-term evaluation of HIV antigen and antibodies to p24 and gp41 in patients with hemophilia. Potential clinical importance.

To investigate the relation between human immunodeficiency virus (HIV) antigenemia and clinical manifestations of HIV infections, we studied 96 patients with hemophilia who were positive for HIV antibody, for a median of 34 months. Every 4 to 10 months a clinical and laboratory examination was performed and serum samples were tested for three HIV markers: HIV antigen, antibody to p24, and antibody to gp41. Twenty-two subjects (23 percent) were found to be positive for HIV antigen: 8 were positive upon entry and remained so (Group 1), and 14 became positive during the study, 4 to 26 months after HIV antibody appeared (seroconversion), 13 of whom remained positive for HIV antigen (Group 2). Most subjects positive for HIV antigen had low or undetectable titers of antibody to p24, whereas the antibody titer to gp41 remained high. In Group 2, patients with low p24 antibody titers had further decreases in their titers before or at the time HIV antigen appeared. Once present, HIV antigen persisted and tended to increase in concentration. In contrast to Group 3 (negative for HIV antigen, low anti-p24 titer) and 4 (negative for HIV antigen, high anti-p24 titer), the groups positive for HIV antigen had significantly higher incidences of acquired immunodeficiency syndrome (P = 0.05), immunodeficiency-related infections (P less than 0.001), and immune thrombocytopenia (P = 0.001), and had more severe disease as measured by the Walter Reed staging system (P less than 0.001). In this study, HIV antigen appeared to be a better predictive marker of HIV-related complications than the absolute T4+ count. These results suggest that HIV antigenemia indicates a poor clinical prognosis.

Serological markers in early stages of human immunodeficiency virus infection in haemophiliacs.

Immunoassays for human immunodeficiency virus antigen (HIV Ag) and for antibody to HIV core and envelope (CIA-RA) were done on serial specimens from 40 haemophiliacs who had become seropositive on screening by enzyme-linked immunosorbent assay (ELISA). HIV Ag was detectable in 9 subjects and antibodies to envelope in 11 subjects before ELISA seroconversion. The apparent sequence of markers is HIV Ag, antibody to envelope, then antibody to core. Antigenaemia could be detected as soon as 2 weeks after infection and lasted 3-5 months. 82% agreement was seen between CIA-RA and western blot; CIA was more sensitive to envelope antibody and western blot was more sensitive to core antibody.

A hypothalamic channel-system in the inferior lobes of a trigger-fish (Rhinecanthus aculeatus, Balistidae).

In the course of a general investigation of the optic system in some trigger-fishes, a hypothalamic, ventricular channel-system with pores, leading to the outside of the brain, has been discovered in the inferior lobes of Rhinecanthus aculeatus (Balistidae). A description of the morphological relations of the channel-system to the blood-vessel-supply and the cranium suggests that the organ-systems involved form a functional unit. The possibility of a hormone-producing system is discussed in the light of physiological and ecological aspects.