Surgical anterior ventricular endocardial restoration (SAVER) for dilated ischemic cardiomyopathy.

Anterior infarction changes ventricular shape and volume. Akinesia is most commonly observed after early reperfusion. Dyskinesia develops in the absence of reperfusion. Both produce heart failure by dysfunction of the remote muscle. Traditional surgery deals with dyskinesia. This study evaluates surgical anterior ventricular endocardial restoration (SAVER), an operation that excludes the apical and septal scar in both akinesia and dyskinesia. A new international group of cardiologists and surgeons from 13 centers, the RESTORE Group) investigated SAVER in ischemic cardiomyopathy following anterior infarction. From January 1998 to July 2000, 662 patients underwent surgery. Early and 3-year outcomes were investigated. Concomitant procedures included coronary artery bypass grafting (CABG) in 92%, mitral repair in 22%, and mitral replacement in 3%. Hospital mortality was 7.7%. Mortality among 606 patients with SAVER and CABG alone was 4.9%. It was 8.1% among 147 patients who underwent concomitant mitral valve repair. Few patients required IABPs (8.4%), LVADs (0.4%), or ECMO (0.6%). Postoperatively, ejection fraction increased from 29.7% +/- 11.3% to 40.0% +/- 12.3% and left ventricular end systolic volume decreased from 96 +/- 63 to 62 +/- 39 mL/m(2) (P <. 05). At 3 years, the survival rate was 89.4% +/- 1.3%. Survival was lower among those with preoperative volume >80 mL/m(2) compared with volume < or = 80 mL/m(2) (83.5% +/- 3.3% v 94.5% +/- 2.0%). Freedom from readmission to hospital for heart failure was at 88.7% at 3 years and was not related to preoperative volume. SAVER is a safe and effective procedure for treating the remodeled dilated anterior ventricle following anterior myocardial infarction.

Grasping the handrails during treadmill walking does not alter sagittal plane kinematics of walking.

OBJECTIVE: To determine whether grasping the handrails during treadmill walking affects sagittal plane kinematic parameters selected to describe walking style. DESIGN: Crossover trial. SETTING: A university motion analysis laboratory. PARTICIPANTS: A convenience sample comprised of 15 apparently healthy college-age volunteers. INTERVENTION: After being acclimatized to treadmill walking, subjects were videotaped while completing two treadmill walking bouts. Each bout was 10 minutes in duration and was conducted at a walking speed of 1.5m/sec. Subjects were instructed to grasp the handrails in one bout (GRASP) but to refrain from using the handrails in the other (FREE). Both bouts were conducted in a single session and were separated by a 10-minute rest period. The order in which subjects completed the bouts was randomized. MAIN OUTCOME MEASURES: Five successive strides occurring during the last 30 seconds of each bout were digitized. The coordinate data were numerically filtered and the following parameters derived: stride length, percentage of stride cycle spent in double-support, and the hip, knee, and ankle angles at heel-strike and toe-off. The results for the five strides in each bout were averaged and the average value was used in the statistical analysis. The FREE and GRASP conditions were compared with t tests for dependent samples (p < or = .05). RESULTS: There were no differences between the FREE and GRASP conditions for any of the parameters assessed. CONCLUSIONS: Subjects may grasp the treadmill handrails without affecting sagittal plane kinematic parameters of walking style.

Is running style and economy affected by wearing respiratory apparatus?

The purposes of this investigation were to compare selected gait parameters characteristic of running without respiratory apparatus on a treadmill (NOR) with those displayed while wearing a mouthpiece-breathing valve apparatus (MP) and while wearing a respiratory face mask (MASK), and to compare the running economy (RE) measured during MP with that measured during MASK. Seventeen male volunteers [age = 32 +/- 5 yr (mean +/- SD); mass = 72.4 +/- 9.0 kg] performed three treadmill runs in randomly assigned order. All runs were identical in terms of duration (10 min), speed [200 m. min-2 (7.5 mph)], and grade (0%). During the last minute of each run, RE was measured and coordinate data were collected for determination of mechanical variables. The mechanical analyses were limited to 12 subjects. Stride length, vertical oscillation of the center of mass, hip and ankle range of motion, and average internal mechanical power output were not different for NOR, MP, and MASK. Knee range of motion was significantly less (P < or = 0.05) during MP than during NOR and MASK, primarily due to a significant reduction in maximum knee flexion during nonsupport. MASK RE was not significantly different (P > 0.05) from MP RE. It was concluded that wearing MP or MASK generally does not affect running style of individuals running at comfortable, submaximal running speeds and that RE measured with MP is not different from that measured with MASK.

Electromyographic analysis of bow string release in highly skilled archers.

A predominant archery coaching tenet holds that the most effective means of releasing the bow string is by relaxation of the finger flexor muscles without activation of finger extensors. To evaluate the validity of this view, EMG patterns of the flexor digitorum superficialis and extensor digitorum muscles of the draw arm were examined using surface EMG electrodes in 15 highly skilled archers as each performed six shots. Each archer displayed consistent EMG patterns from shot-to-shot and two distinct flexor-extensor patterns were exhibited by the sample. The first, characterized by eight of the archers, supported the relaxation principle. For these archers, both flexor and extensor digitorum activity decreased markedly immediately prior to or at arrow release. The second pattern, characteristic of the remaining seven archers, contradicted the coaching tenet. While the flexor digitorum pattern was essentially the same as that described for the first pattern, the extensor digitorum displayed a marked increase in activity just prior to release, indicating that string release was facilitated by an active extension of the fingers. It was concluded that highly skilled archers do not predominantly reflect a release consistent with the coaching canon and that factors other than the string release mechanism discriminate the performances of skilled archers.

Small hospitals: a case report.

The author spent one half of 1987 working as an institutional pharmacist and the other half working as a community pharmacist. After quizzing administrators, educators, laboratory technicians, nurses, pharmacists, physicians, secretaries, and consumers throughout central Illinois, a picture of the small hospital in transition began to emerge. Exciting new roles for institutional pharmacists are developing, but the future for the "tiny" hospital (smaller than 100 beds), the health service providers who staff them, and the communities they serve is in doubt. This article is intended to provide a view of what is happening in small and very small hospitals in some communities in Illinois.

Comparison of personality variables and values among dental students, practitioners, and faculty.

Changes in personality and values in four classes of dental students at the University of Alabama School of Dentistry were reported in a previous paper. The purposes of this study were to determine the permanency of these changes after graduation and to compare the personalities and values of students and graduates to those of the faculty. Data were collected using the Myers-Briggs type indicator and the All-port-Vernon-Lindzey study of values. Analysis of variance was used to determine differences among the three groups. Graduates tended to resemble themselves as students. On nine of the ten variables, the faculty clustered differently from the students, the graduates, or both groups, raising the issue of the extent to which faculty members serve as role models.

High-pressure liquid chromatographic methods for determining arabinosyladenine-5'-monophosphate, arabinosyladenine, and arabinosylhypoxanthine in plasma and urine.

New high-pressure liquid chromatographic methods for determining concentrations of arabinosyladenine (Ara-A), its 5'-monophosphate (Ara-AMP), and arabinosylhypoxanthine (Ara-H) in plasma and urine are presented. A fluorescence detector is used for Ara-A and Ara-AMP, which are first converted to highly fluorescent derivatives with chloroacetaldehyde. This increases sensitivity greatly over previous methods. The sensitivities of the methods (in micrograms per milliliter) are as follows: in plasma, Ara-AMP, 0.002; Ara-A, 0.0015; and Ara-H, 0.35; and in urine, 9 times these values, respectively. Drug concentration data are also presented, which were obtained after doses of Ara-AMP were given intramuscularly to two patients treated with this drug for severe herpes zoster. One patient was given 13 mg of Ara-AMP per kg of body weight once daily, and the other was given 6.5 mg/kg twice daily. Peak Ara-AMP and Ara-A levels in plasma occurred within 1 h after the doses, and neither exceeded 2 micrograms/ml. Ara-AMP and Ara-A concentrations in plasma fell to less than 0.01 micrograms/ml in both patients by 4 to 6 h after the doses. Peak Ara-H concentrations in plasma occurred within 1 to 2 h after doses and were 21 micrograms/ml in patient 1 and 2. The highest concentration of Ara-AMP in urine was 0.09 micrograms/ml. The highest Ara-A concentration in urine was 62 micrograms/ml, and the highest Ara-H concentration in urine was 1,080 micrograms/ml. An interfering substance of unknown nature, cochromatographing with Ara-H, was encountered sporadically in urine samples. An algorithm based on differential spectrophotometry to identify and correct for this problem is described. Estimates of the renal clearances of Ara-AMP, Ara-A, and Ara-H are also given.

Analysis of personality traits of the contemporary dental student.

The Allport-Vernon-Lindzey Study of Values (AVL) and the Myers-Briggs Type Inventory (MBTI) were administered to four classes of students upon their matriculation into dental school and readministered during each year until graduation. Over the four years, scores on the economic and political scales of the AVL increased significantly but decreased significantly on the social scale. Female students were more aesthetic than males and less politically inclined. On the MBTI, scores remained relatively stable over the entire four years. However, females were significantly more intuitive and more feeling than males. In general, this sample of dental students, who graduated in 1979, 1980, 1981, and 1982, was quite similar in personality to samples of dental students of the early 1960s.

An efficient computer algorithm for interactive calculation of scintillation crystal response to gamma rays.

Quantitative tests of random sampling versus Monte Carlo algorithms in calculation of scintillation crystal response to gamma rays show that considerable improvement in computational efficiency can be realized by using Monte Carlo methods.

Parameters of mortality in human populations with widely varying life spans.

A three-component, competing-risk mortality model, developed for animal survival data, fits human life table data for all ages over a range of mean life spans from 16 to 74 years. The competing risks are a novel exponentially-decreasing hazard, dominant during immaturity; a constant hazard, dominant during adulthood; and an exponentially increasing Gompertzian hazard, dominant during senescence. By fitting the model to a specific life table using non-linear techniques, estimates of the five model parameters and their standard errors obtain; the proportion of deaths expected from each hazard alone may then be calculated. Preliminary analysis of 13 life tables indicates that for human populations under heavy stress, with very short mean life spans of about 20 years, the three hazard components account for roughly equal numbers of deaths; for modern populations, with mean life spans of about 75 years, nearly all deaths are due to the hazard of senescence. Factor analysis of the correlation matrix of parameter values for the 13 populations shows a two-factor structure. One factor involves only the multiplicative constants (initial values) of the three hazards, but not the hazard rates of change; the second factor involves only the parameter of the immaturity hazard and the rate of acceleration of the senescence hazard, but not the constant hazard nor the multiplicative constant (initial value) of the senescence hazard.

Cholesterol dynamics in autoimmune hyperlipidemia.

A 69-year-old white male with autoimmune hyperlipidemia for 19 years characterized by high serum levels (1,5000 to 3,400 mg. per deciliter) of IgA firmly bound to very-low- and low-density lipoproteins (serum total cholesterol 852 +/- 51 mg./dl., free cholesterol 340 +/- 52, triglyceride 1638 +/- 411, phospholipid 934 +/- 84) received intravenously a tracer dose of cholesterol-4-14C. Serum cholesterol specific activity was followed for 337 days and analyzed by two methods: (1) compartmental analysis which revealed the best fit of a two-compartment model with rapidly exchangeable pool 710 gm. (2,563 per cent of the mean of 15 normal subjects), slowly exchangeable pool 317 gm. (651 per cent), mean transit time 92.5 days (167 per cent), turnover rate 9.23 gm. per day (654 per cent), and excretory coefficient 0.013 (25 per cent); (2) a simulated five-compartment model involving serum free, esterified, red blood cell, and rapidly and slowly exchangeable tissue cholesterols for which pool sizes of 17, 25, 2.4, 674, and 350 gm., respectively, were calculated and a turnover rate of 9.44 gm./day agreed well with that of the two-compartment model. The extreme hyperlipoproteinemia and expanded body cholesterol pools were primarily due to the impairment of feedback control of cholesterol synthesis as a consequence of the complexing of lipoprotein and IgA.