Ge healthcare for $200 mn rural play

GE Healthcare is planning to invest $200 mn in India to tap the rural market for diagnostics and disease monitoring equipments such as ultrasound, CT scanners, magnetic resonance imaging (MRI) and X-rays. (Source: The Economic Times)

 

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Sagent pharmaceutical's sequential syringes

Sagent Pharmaceuticals of Schaumburg, IL, has acquired a multi-chamber sequential syringe delivery system from Infusive Technologies, a Utah company, which allows for multiple drug solution deliveries through one (conventional) syringe. Jeffrey M. Yordon, chairman, founder and chief executive officer of Sagent Pharmaceuticals notes that a single syringe push allows for the delivery of separate IV medications. This not only increases the speed of medication delivery but reduces the number of IV connections required (thus lowering the incidence of nosocomial infections), as well as reducing medication delivery errors.


Infusive's Chief Executive Officer, Bradley C. Robinson said "Syringes based on our unique, patented technologies have the potential to dramatically improve the delivery of IV medications, reduce the risk of medical error and hospital-acquired infection while at the same time lowering costs for healthcare providers. Infusive remains committed to providing quality IV medication delivery systems that enhance effectiveness and improve patient safety." Robinson says "I look forward to joining Jeff and the team at Sagent and to quickly make this exciting new device available to patients and caregivers."

The unique dual-chamber syringe can accommodate lyophilized (dried by freezing in a high vacuum), powder or liquid formulations in the front chamber combined with diluents, saline or heparin flush in the rear chamber.

More information about ChaSyr™ syringes can be found on Infusive website...

Press release: Sagent Pharmaceuticals acquires rights to multi-chamber syringe technology and launches device division...

Sagent Pharmaceuticals... (Source: Medgadget Anesthesiology)

 

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A meta-analysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease

Stable coronary artery disease may be effectively treated with medication alone, but does percutaneous coronary intervention improve long term survival when compared with medical management?
Journal of the American College of Cardiology (Source: Medscape Critical Care Headlines)

 

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Vessel furrows of the cranial vault (predominantly frontal)

15 year-old boy after a cranial trauma. No symptoms. Chance findings in a cranial X-ray (done here to rule out fracture).... (Source: Pediatric Radiology RSS News, Cases, Teaching Files and Publications)

 

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Interaction of low-energy nitrogen ions with gaas surfaces

Z. Majlinger, A. Bozanic, M. Petravic, K.-J. Kim, B. Kim et al. We have studied the interaction of low-energy nitrogen ions (0.32 keV N) with GaAs (100) surfaces by photoemission spectroscopy (PES) around N 1s and Ga 3d core levels and near-edge x-ray absorption fine structure (NEXAFS) around the N K edge. At the lowest bombardment energy, nitrogen forms bonds ... [J. Appl. Phys. 104, 063527 (2008)] published Fri Sep 26, 2008. (Source: Journal of Applied Physics)

Outcome of diabetic pregnancy with spontaneous labour after 38 weeks

Abstract  One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously
from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred
and twenty-four patients (84 per cent) had a normal vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent)
caesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed
4 Kg or more, however there was only 1 case of shoulder dystocia. We compared these results with those of the general hospital
population of 1987. The 2 main differences are; 1) the Caesarean section rate in labour was higher for this diabetic group
than for the general hospital population, 7 per cent versus 3.4 per cent, 2) the birth weight was heavier, 33 per cent of
infants of the diabetic group weighed 4 Kg or more versus 18 per cent of the general hospital population. The other parameters
were comparable. We conclude that conservative management of pregnancy in well controlled diabetic women is advantageous,
resulting in a high vaginal delivery rate without an increase in shoulder dystocia, and a low perinatal morbidity and mortality
rate.

Content Type Journal ArticleDOI 10.1007/BF02945844Authors
F. M. McAuliffe, National Maternity Hospital Dublin IrelandM. Foley, National Maternity Hospital Dublin IrelandR. Firth, National Maternity Hospital Dublin IrelandI. Drury, National Maternity Hospital Dublin IrelandJ. M. Stronge, National Maternity Hospital Dublin Ireland



Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265

Journal Volume Volume 168

Journal Issue Volume 168, Number 3 / April, 1999 (Source: Irish Journal of Medical Science)

 

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The initial atomic layer deposition of hfo[sub 2]/si(001) as followed in situ by synchrotron radiation photoelectron spectroscopy

Massimo Tallarida, Konstantin Karavaev, and Dieter Schmeisser We have grown HfO on Si(001) by atomic layer deposition (ALD) using HfCl and HO as precursors. The early stages of the ALD were investigated with high-resolution photoelectron spectroscopy and x-ray absorption spectroscopy. We observed the changes occurring in the Si2p, O1s, Hf4f, Hf4d, and Cl2p cor ... [J. Appl. Phys. 104, 064116 (2008)] published Thu Sep 25, 2008. (Source: Journal of Applied Physics)

Carestream develops new ris module

Carestream Health and the San Salvatore Hospital in the Province of
L’Aquila in the Abruzzo Region of Italy are developing a module for the
Kodak Carestream RIS that allows general practitioners to directly book
digital x-ray exams and receive results on their PC. (Source: Health Imaging News)

 

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Influence of diabetes mellitus on long-term survival in systematic off-pump coronary artery bypass surgery.

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Influence of diabetes mellitus on long-term survival in systematic off-pump coronary artery bypass surgery.

Ann Thorac Surg. 2008 Oct;86(4):1181-8

Authors: Marcheix B, Vanden Eynden F, Demers P, Bouchard D, Cartier R

BACKGROUND: Diabetic patients generally present a more diffuse and calcified coronary artery disease than nondiabetic patients that can affect long-term outcome especially if an off-pump coronary artery bybass graft (OPCABG) technique is used. The aim of this study was to compare long-term results of OPCABG surgery for diabetic and nondiabetic patients. METHODS: This is a retrospective analysis of prospectively gathered data over a 10-year period of 1,000 consecutive and systematic OPCABG patients operated on between September 1996 and April 2004. Average follow-up period was 66 +/- 28 months and was 97% complete. Overall survival as well as occurrence of major adverse cardiac events in diabetic and nondiabetic patients were specifically studied. RESULTS: In all, 278 diabetic patients and 722 nondiabetic patients were treated. There was no difference in 30-day mortality between the two groups (p = 0.70). Diabetic patients had more postoperative acute renal insufficiency (p = 0.01) and infections (sepsis; p = 0.002), and deep sternal infections (p = 0.04) Ten-year survival (p = 0.006) and survival free of major adverse cardiac events (p = 0.02) was decreased in the diabetic group. Age (hazard ratio [HR] = 1.06), peripheral vascular disease (HR = 1.72), carotid disease (HR = 1.53), congestive heart failure (HR = 1.51), incomplete revascularization (HR = 2.37), chronic renal insufficiency (HR = 1.93), left ventricular ejection fraction (HR = 0.13), and a lesser use of multiple internal thoracic artery grafts (HR = 0.67), but not diabetes mellitus (p = 0.13) were significant determinants of long-term mortality. Similarly, peripheral vascular disease (HR = 1.92), chronic renal insufficiency (HR = 2.36), emergent operation (HR = 1.71), chronic obstructive pulmonary disease (HR = 1.76), previous percutaneous coronary intervention (HR = 1.66), left ventricular ejection fraction (HR = 0.26), ischemic mitral regurgitation (HR = 1.83), and a lesser use of multiple internal thoracic artery grafts (HR = 0.72) were determinants of decreased survival free of major adverse cardiac events but not diabetes (p = 0.2). Breaking down the major adverse cardiac events, diabetes was found an independent predictive factor of recurrent myocardial infarction (HR = 1.85) and a borderline cause of readmission for congestive heart failure (p = 0.06). Need for new revascularization was comparable for both population (p = 0.37). CONCLUSIONS: In our series of OPCABG surgery patients, diabetic patients had a comparative operative mortality and perioperative myocardial infarction rate as nondiabetic patients. However, they had an increased prevalence of postoperative acute renal insufficiency and infections. They also had a worse outcome than nondiabetic patients, but that was mainly due to a higher prevalence of preoperative comorbidities and a lesser use of multiple internal thoracic artery grafts. However, diabetes itself was a potential risk factor for long-term occurrence of myocardial infarction and congestive heart failure.

PMID: 18805157 [PubMed - in process]

(Source: The Annals of Thoracic Surgery)

 

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Printed educational materials: effects on professional practice and health care outcomes.

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Printed educational materials: effects on professional practice and health care outcomes.

Cochrane Database Syst Rev. 2008;(3):CD004398

Authors: Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan JL, Wolf F

BACKGROUND: Printed educational materials (PEMs) are widely used passive dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines and appear to be the most frequently adopted method for disseminating information. OBJECTIVES: To determine the effectiveness of PEMs in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes. To explore whether the effect of characteristics of PEMs (e.g., source, content, format, mode of delivery, timing/frequency, complexity of targeted behaviour change) can influence process outcomes (including the behaviour of healthcare professionals and patient outcomes). SEARCH STRATEGY: The following electronic databases were searched up to July 2006: (a) The EPOC Group Specialised Register (including the database of studies awaiting assessment (see 'Specialised Register'under 'Group Details'); (b) The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness; (c) MEDLINE, EMBASE, CINAHL and CAB Health. An updated search of MEDLINE was done in March 2007. SELECTION CRITERIA: We included randomised controlled trials (RCTs) , controlled clinical trials (CCT), controlled before and after studies (CBAs) and interrupted time series analyses (ITS) that evaluated the impact of printed educational materials on healthcare professionals' practice and/or patient outcomes. There was no language restriction. Any objective measure of professional performance (sch as number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g., blood pressure, number of caesarean sections) were included. DATA COLLECTION AND ANALYSIS: Four reviewers undertook data abstraction independently using a modified version of the EPOC data collection checklist. Any disagreement was resolved by discussion among the reviewers and arbitrators. Statistical analysis was based upon consideration of dichotomous process outcomes, continuous process outcomes, patient outcome dichotomous measures and patient outcome continuous measures. We presented the results for all comparisons using a standard method of presentation where possible. We reported separately for each study the median effect size for each type of outcome, and the median of these effect sizes across studies. MAIN RESULTS: Twenty-three studies were included for this review. Evidence from this review showed that PEMs appear to have small beneficial effects on professional practice. RCTs comparing PEMs to no intervention observed an absolute risk difference median: +4.3% on categorical process outcomes (e.g., x-ray requests, prescribing and smoking cessation activities) (range -8.0% to +9.6%, 6 studies), and a relative risk difference +13.6% on continuous process outcomes (e.g., medication change, x-rays requests per practice) (range -5.0% to +26.6%, 4 studies). These findings are similar to those reported for the ITS studies, although significantly larger effect sizes were observed (relative risk difference range from 0.07% to 31%). In contrast, the median effect size was -4.3% for patient outcome categorical measures (e.g., screening, return to work, quit smoking) (range -0.4% to -4.6%, 3 studies)). Two studies reported deteriorations in continuous patient outcome data (e.g., depression score, smoking cessation attempts) of -10.0% and -20.5%. One study comparing PEMs with educational workshops observed minimal differences. Two studies comparing PEMs and education outreach did not have statistically significant differences between the groups. It was not possible to explore potential effect modifiers across studies. AUTHORS' CONCLUSIONS: The results of this review suggest that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. Despite this wide of range of effects reported for PEMs, clinical significance of the observed effect sizes is not known. There is insufficient information about how to optimise educational materials. The effectiveness of educational materials compared to other interventions is uncertain.

PMID: 18646106 [PubMed - in process]

(Source: Cochrane Database of Systematic Reviews)

 

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Rapid versus stepwise negative pressure application for vacuum extraction assisted vaginal delivery.

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Rapid versus stepwise negative pressure application for vacuum extraction assisted vaginal delivery.

Cochrane Database Syst Rev. 2008;(3):CD006636

Authors: Suwannachat B, Lumbiganon P, Laopaiboon M

BACKGROUND: Vacuum extraction is a common technique of assisted vaginal delivery. Traditionally, it has been recommended that the pressure is increased slowly in a stepwise procedure; some have advocated rapid increases in pressure. OBJECTIVES: To assess the efficacy and safety of rapid versus stepwise negative pressure application for assisted vaginal delivery by vacuum extraction. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008). SELECTION CRITERIA: Randomized controlled trials and quasi-randomized controlled trials of rapid compared with stepwise increase in negative pressure application of vacuum extraction. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: One trial of 94 women was included. Duration of vacuum procedure was reduced in rapid application group (mean difference -6.10 minutes, 95% confidence interval -8.83 to -3.37). There were no significant differences in detachment rate, degree of perineal tears, Apgar score less than seven at one and five minutes, umbilical venous pH less than 7.2, scalp laceration greater than a quarter, cephalhematoma and number of tractions. AUTHORS' CONCLUSIONS: The rapid negative pressure application for vacuum assisted vaginal birth reduces the duration of the procedure whilst there is no evidence of differences in maternal and neonatal outcome. Due to a small number of participants in the single included trial, the evidence is limited and either policy may be employed until further controlled trials provide conclusive evidence of benefit from one or other method.

PMID: 18646163 [PubMed - in process]

(Source: Cochrane Database of Systematic Reviews)

 

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Ferroelectric stripe domains in pbtio[sub 3] thin films: depolarization field and domain randomness

R. Takahashi, O. Dahl, E. Eberg, J. K. Grepstad, and T. Tybell Observation of stripe domains in PbTiO thin films using standard x-ray diffraction analysis at room temperature is discussed. High-quality c-axis oriented thin films of varying thickness, from 6 to 210 unit cells, were grown on buffered NHHF etched SrTiO(001) and Nb:SrTiO(001) substrates using off-a ... [J. Appl. Phys. 104, 064109 (2008)] published Mon Sep 22, 2008. (Source: Journal of Applied Physics)

[original articles] torticollis, facial asymmetry and plagiocephaly in normal newborns

Objective:
To evaluate the incidence and characteristics of torticollis, plagiocephaly and facial asymmetry in normal newborn infants.

Design:
102 healthy newborn infants were examined prospectively during their birth hospitalisation for torticollis with neck range of motion (ROM) assessment and for facial, mandibular and cranial asymmetry by photographic analysis.

Results:
73% of newborns had one or more asymmetry: torticollis (16%), asymmetry of the mandible (13%), facial asymmetry (42%) and asymmetry of the head (61%). Torticollis was associated with maternal report of the fetus being "stuck" in one intrauterine position for more than 6 weeks before delivery. Moderate facial asymmetry was associated with a longer second stage of labour, forceps delivery, a bigger baby and birth trauma. Moderate cranial and mandibular asymmetries were associated with birth trauma. More than one significant asymmetry was found in 10% of newborns.

Conclusions:
Asymmetries of the head and neck are very common in normal newborns, and sixteen (16%) of 102 study newborns were found to have torticollis. Such newborns, especially if they sleep supine, are thought to be at risk of developing deformational posterior plagiocephaly. Identification of affected infants may allow early implementation of positioning recommendations or physical therapy to prevent the secondary craniofacial deformations that are part of an increasingly common phenomenon. (Source: Archives of Disease in Childhood)

 

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Clinical efficacy of a de stent after an electively planned percutaneous coronary intervention under "real-life" conditions: prospective registry (first-in-man data).

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Clinical efficacy of a DE stent after an electively planned percutaneous coronary intervention under "real-life" conditions: prospective registry (first-in-man data).

Clin Hemorheol Microcirc. 2008;39(1-4):311-21

Authors: Ozbek C, Mailänder C, Schilling U, Bach R

PMID: 18503140 [PubMed - indexed for MEDLINE]

(Source: Clinical Hemorheology and Microcirculation)

 

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Bochdalek's hernia with pleuroperitoneal covering

At the age of 3.5 months, there was a short disturbance in breathing while lying on the stomach (tachypnea). Otherwise, the child was completely healthy. Presentation to pediatrician, X-rays were pe... (Source: Pediatric Radiology RSS News, Cases, Teaching Files and Publications)

 

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Femoral vascular access complications in adult congenital heart disease patients: audit from a single tertiary center

Objective. To determine the rate of vascular access complications in patients with adult congenital heart disease (ACHD).Background. Complications of femoral access following coronary angiography or percutaneous coronary intervention have been studied extensively, but the complication rate following catheterization and intervention in ACHD patients is poorly documented.Design, Setting, and Outcome Measures. We present a retrospective audit of vascular access complications in a large tertiary ACHD center over a 12-month period. Complications were defined as any clinically significant hematoma, pseudoaneurysm, arteriovenous fistula, or bleeding resulting in the need for imaging, transfusion, vascular or radiological intervention, or delayed discharge.Results. Of 197 procedures (102 interventions and 95 cardiac catheterizations), a complication rate of 3.6% was identified, comparable to that of coronary angiography and percutaneous coronary intervention. The main complications were femoral artery pseudoaneurysm and hematoma resulting in delayed discharge by a mean of 2⅔ days (range 1[ndash]4 days). Predictors of risk for vascular complications include female sex, history of diabetes, and anticoagulation; larger sheath sizes and obesity were not associated with higher complication rate.Conclusions. Adult congenital heart disease patients represent a unique and ever-growing population with a higher incidence of catheterization as children, surgical cut-down scars and anatomical variants. We present a low incidence of femoral access complications in interventional and diagnostic procedures in a large series of ACHD patients over a 12-month period. Patients with risk factors for vascular complications may be considered for device closure of the venous access site. (Source: Congenital Heart Disease)

 

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Lung sequestration, extralobar

1 9/12 year-old boy. Reoccurring respiratory infections. In the X-ray (sent to us from another clinic), segmental, basal opacities on the left side.... (Source: Pediatric Radiology RSS News, Cases, Teaching Files and Publications)

 

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Lung sequestrum, extralobular

11 month-old child. In the course of a feverish infection, an x-ray was obtained. This showed a segmental opacity in the lower right lobe. After a 10 day antiobiotic treatment, the x-ray was unaffe... (Source: Pediatric Radiology RSS News, Cases, Teaching Files and Publications)

 

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Study touts colon x-ray as less intrusive, cheaper

A long-awaited federal study of an X-ray alternative to the dreaded colonoscopy confirms its effectiveness at spotting most cancers, although it was far from perfect. Medicare is already considering paying for this cheaper, less intrusive option that could persuade more people to get screened for colon cancer. (Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire)

 

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Feasibility and long-term safety of elective impella-assisted high-risk percutaneous coronary intervention: a pilot two-centre study.

Page: 1004DOI: 10.2459/JCM.0b013e3282f9abe7Authors: Burzotta, Francesco a; Paloscia, Leonardo b; Trani, Carlo a; Mascellanti, Marco b; Mongiardo, Rocco a; Materazzo, Guido b; Niccoli, Giampaolo a; Di Marco, Massimo b; Leone, Antonio Maria a; Porto, Italo a; Mazzari, Mario Attilio a; Rebuzzi, Antonio Giuseppe a; Schiavoni, Giovanni a; Crea, Filippo a (Source: Journal of Cardiovascular Medicine)

 

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Surface characterization of proteins using multi-fractal property of heat-denatured aggregates.

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Surface characterization of proteins using multi-fractal property of heat-denatured aggregates.

Bioinformation. 2008;2(9):379-83

Authors: Lahiri T, Mishra H, Sarkar S, Misra K

Multi-fractal property of heat-denatured protein aggregates (HDPA) is characteristic of its individual form. The visual similarity between digitally generated microscopic images of HDPA with that of surface-image of its individual X-ray structures in protein databank (PDB) displayed using Visual Molecular Dynamics (VMD) viewer is the basis of the study. We deigned experiments to view the fractal nature of proteins at different aggregate scales. Intensity based multi-fractal dimensions (ILMFD) extracted from various planes of digital microscopic images of protein aggregates were used to characterize HDPA into different classes. Moreover, the ILMFD parameters extracted from aggregates show similar classification pattern to digital images of protein surface displayed by VMD viewer using PDB entry. We discuss the use of irregular patterns of heat-denatured aggregate proteins to understand various surface properties in native proteins.

PMID: 18795110 [PubMed - in process]

(Source: Bioinformation)

 

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Primary percutaneous coronary intervention vs conservative treatment for acute st elevation myocardial infarction.

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Primary Percutaneous Coronary Intervention vs Conservative Treatment for Acute ST Elevation Myocardial Infarction.

Circ J. 2008;72(9):1391-1396

Authors: Koyanagi R, Hagiwara N, Kasanuki H, Tsurumi Y, Ogawa H,

Background Because there is insufficient evidence to support primary percutaneous coronary intervention (PPCI) as the treatment of acute myocardial infarction (AMI), this study elucidated the efficacy of PPCI according to disease severity. Methods and Results Between January 1999 and June 2001, 3,021 AMI patients were registered at Tokyo Women's Medical University and 17 affiliated institutions. Of these, 1,994 patients with ST-elevation AMI were admitted within 12 h of onset. PPCI was performed in 1,143 and 294 were treated conservatively. The 1,437 patients were grouped according to Thrombolysis In Myocardial Infarction-risk score: PPCI was performed in 59.5% of the low-risk group, 61.8% of the moderate-risk group, and 56.2% of the high-risk group. Cardiac death was the primary outcome. In the low-risk group, no significant differences were observed between PPCI and conservative therapy for 30-day and long-term cardiac mortality rates. In the moderate-risk group, the 30-day cardiac mortality rate for PPCI was significantly lower; however, no significant intergroup differences were observed for long-term cardiac mortality. In the high-risk group, 30-day and long-term cardiac mortality for PPCI were significantly more favourable than for conservative therapy (p<0.001 and p=0.0032, respectively). Conclusions Although PPCI strongly correlated with low short- and long-term cardiac mortality rates in high-risk AMI patients, no similar correlation was found in low-risk patients. (Circ J 2008; 72: 1391 - 1396).

PMID: 18724011 [PubMed - as supplied by publisher]

(Source: Circulation Journal)

 

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Structure of ga2o3(zno)6: a member of the homologous series ga2o3(zno)m

The structure of Ga2O3(ZnO)6 was determined using single-crystal X-ray diffraction techniques in the space group Cmcm. The metal ion sublattice resembles some of the Zn ions in the wurtzite ZnO structure. The oxygen ion sublattice in Ga2O3(ZnO)6 also resembles some of the O ions in ZnO. Structural relationships between Ga2O3(ZnO)6 and ZnO are discussed, illustrating the process for obtaining the centrosymmetric Ga2O3(ZnO)6 structure from the noncentrosymmetric ZnO. Structures of phases in the homologous series Ga2O3(ZnO)m are predicted on the basis of the structural data for Ga2O3(ZnO)6. The structures of even m are constructed by simply extending the structure units seen in Ga2O3(ZnO)6, while those of odd m consist of structure units which are of different types from those used for even m. (Source: Acta Crystallographica Section B)

 

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Long-term impact of drug-eluting stents versus bare-metal stents on all-cause mortality

Objectives
Our purpose was to examine the incidence of all-cause mortality among drug-eluting stents (DES) and bare-metal stents (BMS) while adjusting for many confounding factors generally not considered in prior studies.

Background
DES use in the U.S. declined by up to 50% in recent years, primarily due to concerns about late stent thrombosis and possibly increased mortality. However, recent data suggest that DES are as safe as BMS and may actually be associated with a lower incidence of myocardial infarction and mortality.

Methods
All patients undergoing percutaneous coronary intervention with a DES or BMS alone from March 1, 2003, to June 30, 2007, at a tertiary care center were assessed. Multivariable Cox proportional hazards modeling was performed for overall and propensity-matched patients. Socioeconomic status was calculated using U.S. Census 2000 data. The primary end point was all-cause mortality.

Results
There were a total of 832 deaths over a 4.5-year interval among 8,032 patients. Of these, 6,053 received a DES and 1,983 patients had a BMS. All-cause mortality was significantly lower in unadjusted and adjusted Cox proportional models with DES (hazard ratio: 0.62, 95% confidence interval: 0.53 to 0.73; p < 0.001). Similarly, in the propensity-matched group, DES remained associated with lower mortality compared with BMS (adjusted hazard ratio: 0.54, 95% confidence interval: 0.45 to 0.66; p < 0.001).

Conclusions
DES were associated with lower mortality in this "real-world" setting. However, despite multiple adjustments, potential confounding may still play a role. (Source: Journal of the American College of Cardiology)

 

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The mode of hedgehog binding to ihog homologues is not conserved across different phyla

The mode of Hedgehog binding to Ihog homologues is not conserved across different phyla

Nature advance online publication 14 September 2008. doi:10.1038/nature07358

Authors: Jason S. McLellan, Xiaoyan Zheng, Glenn Hauk, Rodolfo Ghirlando, Philip A. Beachy
& Daniel J. Leahy
Hedgehog (Hh) proteins specify tissue pattern in metazoan embryos by forming gradients that emanate from discrete sites of expression and elicit concentration-dependent cellular differentiation or proliferation responses. Cellular responses to Hh and the movement of Hh through tissues are both precisely regulated, and abnormal Hh signalling has been implicated in human birth defects and cancer. Hh signalling is mediated by its amino-terminal domain (HhN), which is dually lipidated and secreted as part of a multivalent lipoprotein particle. Reception of the HhN signal is modulated by several cell-surface proteins on responding cells, including Patched (Ptc), Smoothened (Smo), Ihog (known as CDO or CDON in mammals) and the vertebrate-specific proteins Hip (also known as Hhip) and Gas1 (ref. 11). Drosophila Ihog and its vertebrate homologues CDO and BOC contain multiple immunoglobulin and fibronectin type III (FNIII) repeats, and the first FNIII repeat of Ihog binds Drosophila HhN in a heparin-dependent manner. Surprisingly, pull-down experiments suggest that a mammalian Sonic hedgehog N-terminal domain (ShhN) binds a non-orthologous FNIII repeat of CDO. Here we report biochemical, biophysical and X-ray structural studies of a complex between ShhN and the third FNIII repeat of CDO. We show that the ShhN–CDO interaction is completely unlike the HhN–Ihog interaction and requires calcium, which binds at a previously undetected site on ShhN. This site is conserved in nearly all Hh proteins and is a hotspot for mediating interactions between ShhN and CDO, Ptc, Hip and Gas1. Mutations in vertebrate Hh proteins causing holoprosencephaly and brachydactyly type A1 map to this calcium-binding site and disrupt interactions with these partners. (Source: Nature AOP)

 

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Exact solution of the phase problem in in situ x-ray reflectometry of a growing layered film

Igor Kozhevnikov, Luca Peverini, and Eric Ziegler The recent development of an exact solution of the phase retrieval problem is applied to the case of in situ x-ray reflectometry measurements performed during the growth of a tungsten film. The measurement of the phase variation during deposition provides information about the depth distribution of ... [J. Appl. Phys. 104, 054914 (2008)] published Fri Sep 12, 2008. (Source: Journal of Applied Physics)

Triple antithrombotic regimen questioned for af stent patients

Research published in the journal Chest highlights the difficulty in caring for patients with atrial fibrillation who require oral anticoagulation and percutaneous coronary intervention with stenting. (Source: MedWire News - Thrombosis)

 

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Trial femoral head loss in to the soft tissues of pelvis during primary total hip replacement: a case report

The loss of trial femoral head in the soft tissues is a rare per operative complication in total hips replacement. We report the loss of the femoral head in surrounding hip joint soft tissues and unsuccessful attempts to locate and remove it. Surgeons should be aware of such complication as trial femoral heads usually are made from non radiolucent material and cannot be detected by regular x-ray examination during surgery. The industry should consider manufacturing trial femoral heads from x-ray visible material. (Source: Cases Journal)

 

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Femtosecond laser blackening of platinum

A. Y. Vorobyev and Chunlei Guo Using a femtosecond laser processing technique, we produce the black platinum with absorptance of about 95% over a broad wavelength range from ultraviolet to infrared. From scanning electron microscopy and energy dispersive x-ray spectroscopy studies, we find that the enhanced absorption of the blac ... [J. Appl. Phys. 104, 053516 (2008)] published Wed Sep 10, 2008. (Source: Journal of Applied Physics)

 

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Early and midterm results of off-pump coronary artery bypass grafting without patient selection.

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Early and Midterm Results of Off-Pump Coronary Artery Bypass Grafting without Patient Selection.

Heart Surg Forum. 2008;11(4):E213-7

Authors: Suzuki T, Asai T

Background: Many reports have addressed the technical feasibility and early clinical results of off-pump coronary artery bypass grafting (OPCABG). It is uncertain, however, whether OPCABG provides midterm results equivalent to those of conventional CABG.Methods: At Shiga University of Medical Science Hospital from January 2002 to May 2007, 477 consecutive patients underwent isolated OPCABG myocardial revascularization performed by a single surgeon (T.A.). OPCABG surgery was performed on all patients, with no exclusion criteria. These 477 patients were followed up for time-related events, including death from all causes, cardiac death, myocardial infarction, percutaneous coronary intervention, reoperation, and the combined end-point of cardiac events. Follow-up was completed in 96.0% of the patients (458 of 477).Results: The number of distal anastomoses per patient was 3.46 +/- 0.9, and complete revascularization was achieved in 96.6% of patients. No patient required conversion from off-pump to on-pump surgery. The average operation time was 272 +/- 63 minutes. Thirteen patients (2.9%) required reoperation for bleeding. Deep sternal infection occurred in 5 patients (1.1%). One patient (0.2%) had a stroke and 4 patients (0.9%) had perioperative myocardial infarction. Acute renal failure requiring hemodialysis occurred in 10 patients (2.2%). Overall 30-day mortality was 1.1% (5 of 477). Follow-up was completed in 96.0% of patients. Mean follow-up was 3.0 +/- 1.3 years. Five-year freedom from death from any cause was 79.1%, freedom from cardiac death 93.4%, and freedom from the combined end-point of cardiac death, myocardial infarction, repeat coronary intervention, and heart failure was 75.8%.Conclusions: Our results demonstrate the safety of performing OPCABG surgery in all patients, without the use of exclusion criteria. Early and midterm outcomes were acceptable and encouraged continued use of the OPCABG approach in all CABG patients.

PMID: 18782699 [PubMed - in process]

(Source: The Heart Surgery Forum)

 

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The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography.

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The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography.

Clin Radiol. 2008 Oct;63(10):1073-85

Authors: Cowen AR, Davies AG, Sivananthan MU

Dynamic, flat-panel, solid-state, x-ray image detectors for use in digital fluoroscopy and fluorography emerged at the turn of the millennium. This new generation of dynamic detectors utilize a thin layer of x-ray absorptive material superimposed upon an electronic active matrix array fabricated in a film of hydrogenated amorphous silicon (a-Si:H). Dynamic solid-state detectors come in two basic designs, the indirect-conversion (x-ray scintillator based) and the direct-conversion (x-ray photoconductor based). This review explains the underlying principles and enabling technologies associated with these detector designs, and evaluates their physical imaging characteristics, comparing their performance against the long established x-ray image intensifier television (TV) system. Solid-state detectors afford a number of physical imaging benefits compared with the latter. These include zero geometrical distortion and vignetting, immunity from blooming at exposure highlights and negligible contrast loss (due to internal scatter). They also exhibit a wider dynamic range and maintain higher spatial resolution when imaging over larger fields of view. The detective quantum efficiency of indirect-conversion, dynamic, solid-state detectors is superior to that of both x-ray image intensifier TV systems and direct-conversion detectors. Dynamic solid-state detectors are playing a burgeoning role in fluoroscopy-guided diagnosis and intervention, leading to the displacement of x-ray image intensifier TV-based systems. Future trends in dynamic, solid-state, digital fluoroscopy detectors are also briefly considered. These include the growth in associated three-dimensional (3D) visualization techniques and potential improvements in dynamic detector design.

PMID: 18774353 [PubMed - in process]

(Source: Clinical Radiology)

 

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Survival benefit with concomitant oral platelet therapy after coronary angiography and before ad hoc percutaneous coronary intervention.

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Survival Benefit With Concomitant Oral Platelet Therapy After Coronary Angiography and Before Ad Hoc Percutaneous Coronary Intervention.

Mayo Clin Proc. 2008;83(9):978-979

Authors: Patel RA, White CJ

No Abstract Available.

PMID: 18775195 [PubMed - as supplied by publisher]

(Source: Mayo Clinic Proceedings)

 

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Structural and dynamical aspects of the phase transition in the new thiourea thiazolium bromide inclusion compound

A. Pajzderska, J. Wasicki, H. Maluszynska, P. Czarnecki, L. Toupet et al. A new thiourea thiazolium bromide inclusion compound is presented here. Detailed investigations of its phase transition were performed by differential scanning calorimetry, x-ray diffraction, and dielectric and nuclear magnetic resonance spectroscopy methods, completed by calculation of the steric h ... [J. Chem. Phys. 129, 104501 (2008)] published Mon Sep 8, 2008. (Source: Journal of Chemical Physics)

 

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Aggrastat(r), lowers incidence of heart attack, in patients who respond poorly to aspirin or clopidogrel, after elective coronary angioplasty

Antiplatelet medicine, AGGRASTAT® (tirofiban HCL), a glycoprotein IIb/IIIa inhibitor, has been shown to significantly lower the incidence of heart attack after elective coronary angioplasty, in patients with coronary artery disease who have shown poor response to standard oral antiplatelet agents such as aspirin and clopidogrel.1 These results were announced at the Annual European Society of Cardiology Congress in Munich, Germany. (Source: Cardiovascular / Cardiology News From Medical News Today)

 

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Doxycycline-induced ulceration mimicking esophageal cancer: a case report

IntroductionDoxycycline-induced esophageal ulcer patients are mostly young persons with no history of esophageal dysfunction. Heartburn, midsternal pain and dysphagia are the most common symptoms. It has generally a benign course. The present case is the first report of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments alongside, in the literature. Case presentationThis report describes a 16-year-old Caucasian girl who, while taking doxycycline capsules100 mg twice a day for acne vulgaris for 3 months, developed these symptoms. An upper endoscopy revealed multiple circumferential deep ulcerations surrounding fragile, irregular, hyperemic and hypertrophic mucosa at the level of the mid-esophagus and concomitantly in the lower esophageal sphincter. The lesions were biopsied to exclude esophageal carcinoma because of the suspicious appearance in the endoscopic examination. The histopathological examination, haematoxylin and eosin stained sections showed ulceration with a mixed inflammatory infiltrate. Doxycycline was discontinued and she was given sucralfate 1 g qid and omeprazole 20 mg bid orally. All symptoms of the patient were resolved on the third day of the treatment. After 4 weeks of the therapy, an upper endoscopic control examination demonstrated normal findings.
Conclusion:
The present case has been an uncommon presentation of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments, concomitantly. Even the lesions were biopsied to exclude esophageal carcinoma. A modification on the behavior of taking drugs can prevent these unpleasant complications. IntroductionDoxycycline-induced esophageal lesions had been examined mostly as mild esophagitis and sometimes as ulceration with a generally benign course. Common reason of this complication has been taking medications just before bedtime, and with a small amount of water [1, 2]. In general the certain drugs tend to cause the damage in a singular segment, as doxycycline in mid-esophageal segment [3]. Here we present a severe, unusual endoscopic appearance of a case of doxycycline- induced esophageal ulcers and tissue fragility mimicking esophageal cancer in the lower and mid-esophageal segments, simultaneously.
Case report
A 16-year-old Caucasian girl was admitted to our outpatient clinic with complains of heartburn, midsternal pain and dysphagia for 4 weeks. She had no fever, cough or any additional complain. Her cardiac and chest auscultation and throat examination were normal. Her whole blood count and erythrocyte sedimentation rate were also normal. Her electrocardiography and chest x-ray revealed no pathological findings. An upper endoscopy revealed multiple circumferential deep ulcerations surrounding fragile, irregular, hyperemic and hypertrophic mucosa at the level of the mid-esophagus (Figure 1) and lower esophageal sphincter (Figure 2). Because of the suspicious endoscopic appearance, the lesions were biopsied to exclude esophageal carcinoma. In her detailed history, she was taking doxycycline capsules 100 mg twice a day for acne vulgaris for 3 months. She was swallowing only the capsule in the recumbent position at midnight. In the histopathological examination, haematoxylin and eosin stained sections showed ulceration with a mixed inflammatory infiltrate (Figure 3). Doxycycline was discontinued and she was given sucralfate 1 g qid and omeprazole 20 mg bid orally to control of gastric acid reflux until her symptoms resolve. All symptoms of the patient were dramatically resolved on the third day of the treatment. A control endoscopy demonstrated normal findings, after 4 weeks of the therapy. DiscussionDrug-induced ulcer is thought not to be so common; however it is not an unusual clinical condition especially in patients taking certain drugs. Doxycycline-induced esophageal ulcer patients are mostly young persons with no history of esophageal dysfunction. The main reason for an increased transit time is to take the medication with a small amount of water immediately before sleeping, as the present case did [1, 2]. Drug-induced esophagitis is more frequent with capsule than with tablet, because of its easier adhesion to the esophageal surface [4]. As an acidic drug, doxycycline accumulation in the epithelial cells can also cause a focal contact esophagitis. With its subsequent local cytochemical effects, doxycycline can cause ulceration and friability of the adjacent esophageal mucosa. In addition, doxycycline can also inhibit protein synthesis functions in the esophagus [5,6].
Nevertheless history and upper endoscopy can confirm the diagnosis in almost all cases. In suspected conditions, exclusion of esophageal carcinoma by histology can be necessary [2], as it was the case in our patient.
Gencosmanoglu et al. revealed that tetracycline tends to cause distal esophagitis and doxycycline is more frequently associated with mid-esophageal ulceration [3]. However, in the present case, we identified doxycycline-induced ulcers in both distal and mid-esophageal localizations. Drug-induced esophagitis should be suspected in all patients presenting with chest pain and dysphagia and is a preventable cause of morbidity that consists of giving simple advice of how and when to take medication. The prevention could be achieved by swallowing the drug with at least 100 ml of water after swallowing the medication and remaining in the upright position thereafter.
In conclusion, the present case has been an uncommon presentation of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments. A modification on the behavior of taking drugs can prevent these unpleasant complications. (Source: Cases Journal)

Structures of two haptotropic isomers generated by the sliding of 1,3,5-triene ligands on a pd-pd-pd chain.

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Structures of two haptotropic isomers generated by the sliding of 1,3,5-triene ligands on a Pd-Pd-Pd chain.

Chem Commun (Camb). 2008 Sep 14;(34):4061-3

Authors: Murahashi T, Mino Y, Chiyoda K, Ogoshi S, Kurosawa H

Two haptotropic isomers of [Pd(3)(mu(3)-DMVC)(2)(CH(3)CN)(2)][BF(4)](2) (DMVC = 1,2-di-(E)-carbomethoxyvinylcyclopentene) were structurally determined by X-ray crystallographic analyses; a monoclinic crystal contained a symmetric sandwich complex (mu(3)-eta(2):eta(2):eta(2)-coordination of DMVC ligands) and a triclinic crystal contained an unsymmetric sandwich complex (mu(3)-eta(2):eta(3):eta(1)-coordination of DMVC ligands), where the latter are connected to each other by C-HO hydrogen bonds.

PMID: 18758626 [PubMed - in process]

(Source: Chemical Communications)

 

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Cypher® sirolimus-eluting coronary stent comparable to bypass surgery in key safety measures in patients with diabetes and multi-vessel disease

Data from the largest randomized trial of its kind performed to date indicate that the use of percutaneous coronary intervention (PCI) with the CYPHER® Sirolimus-eluting Coronary Stent was comparable to bypass surgery (coronary artery bypass grafting or CABG) in key safety endpoints in patients with multi-vessel disease and diabetes. (Source: Health News from Medical News Today)

 

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Nanotwin and phase transformation in tetragonal pb(fe[sub 1/2]nb[sub 1/2])[sub 1 - x]ti[sub x]o[sub 3] single crystal

C.-S. Tu, C.-T. Tseng, R. R. Chien, V. Hugo Schmidt, and C.-M. Hsieh This work is a study of phase transformation in (001)-cut Pb(FeNb)TiO (x=48%) single crystals by means of dielectric permittivity, domain structure, and in situ x-ray diffraction. A first-order T(T)-C(T) phase transition was observed at the Curie temperature T~=518 K upon zero-field heating. T, T, ... [J. Appl. Phys. 104, 054106 (2008)] published Fri Sep 5, 2008. (Source: Journal of Applied Physics)

 

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Sudden death due to acute pulmonary embolism from asymptomatic right atrial myxoma

Abstract: A 21-year-old man, in whom abnormal nodules had been detected in bilateral lung fields with no clinical symptoms for two years, was admitted to the hospital with sudden cardiopulmonary arrest. Acute pulmonary embolism with a large embolus was diagnosed, but the patient died soon after admission. When the examination was compared with X-ray taken 4 days earlier by chance, a large tumor was now detected in the right heart and was suspected to be the cause of this complication after his death. Necropsy found a 3.8×3.5×1.0cm myxoid tumor arising in the right atrium and a large fragment of this type of tumor was at the pulmonary trunk. Many old myxoma fragments were noted in the bilateral peripheral branch of the pulmonary artery. It was concluded that the abnormal nodules were old pulmonary fragments and the cause of death was pulmonary embolism of a large fragment originated from the atrial myxoma. An asymptomatic right atrial myxoma is extremely rare but nevertheless possible to unexpected death like this case. (Source: Journal of Forensic and Legal Medicine)

 

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Acute stent thrombosis in the setting of cocaine abuse following percutaneous coronary intervention

The treatment of acute coronary syndrome (ACS) in patients with documented cocaine abuse has always presented significant challenges. Issues related to medication compliance, the potential risks of beta adrenergic blockade, and possible continued cocaine abuse postmyocardial infarction necessitate a unique, individualized approach to these patients. Recent data in the era of extensive percutaneous coronary interventions (PCI) and intracoronary stent (ICS) implantation have raised questions regarding the safety of ICS in patients who may revert to cocaine abuse postacute coronary syndrome as a result of the potentially higher risk of stent thrombosis in these patients. While the precise reason as to why cocaine use may increase the risk of stent thrombosis is not fully understood, it is likely the result of a confluence of factors, including coronary vessel vasoconstriction, impaired vascular compliance, as well as the platelet-activating effect of cocaine. We present the case a 46-year-old male with a history of cocaine abuse who presented with an acute stent thrombosis 2 days post-PCI likely as a result of cocaine abuse on the day of discharge following initial stent implantation for a non-ST-elevation myocardial infarction (NSTEMI). We also review the literature regarding the safety of PCI in cocaine abusers. (J Interven Cardiol 2008;**:1[ndash]6) (Source: Journal of Interventional Cardiology)

 

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Electrical and structural properties of aln/gan and algan/gan heterojunctions

A. Y. Polyakov, N. B. Smirnov, A. V. Govorkov, A. V. Markov, T. G. Yugova et al. The electrical and structural properties of AlN/GaN heterostructures grown by molecular beam epitaxy on sapphire are compared with those of AlGaN/GaN heterostructures. The structural characteristics as assessed by x-ray diffraction show little difference but the electron density in the two-dimension ... [J. Appl. Phys. 104, 053702 (2008)] published Wed Sep 3, 2008. (Source: Journal of Applied Physics)

Fetal therapy in twin reserve arterial perfusion sequence pregnancies with alcohol ablation or bipolar cord coagulation

Abstract
Objective We aimed to evaluate perinatal outcome of seven pregnancies with twin reserve arterial perfusion sequence.



Materials and methods Study group included seven cases of acardiac twins. Out of seven acardiac twins, two cases were followed without interventions.
We performed four alcohol ablation and one bipolar caogulation. For alcohol ablation, a 20-gauge needle guided with color
Doppler USG was directed to abdominal insertion site of the single umbilical artery of the acardiac twin, and 1.0–2.0 mL of
absolute alcohol was injected. For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm
bipolar forceps. The procedures were performed under the guidance of transabdominal ultrasonography.



Results Gestational age of the cases at diagnosis and at delivery was 15–32 and 17–38 weeks, respectively. Two cases without intervention
were lost at 17 and 32 weeks. The mean time of procedure for bipolar coagulation and alcohol ablation were 30 and 10 min,
respectively. One of the four cases of alcohol ablation group was aborted although alcohol ablation was succesful. Another
one case was aborted after alcohol ablation due to lost of fetal cardiac activity of the pump fetus. In two other cases, umbilical
cord ablation with alcohol was successful, and they delivered live birth at 36 and 38 weeks. In one case, we performed bipolar
cord coagulation successfully, and the case delivered live birth at 39 weeks. The overall survival rate for intrauterine surgery
was 60% (N 3/5).



Conclusion In twin reserve arterial perfusion sequence pregnancies with findings of poor prognosis, alcohol ablation or bipolar cord
coagulation as fetal therapy under the guidance of ultrasonography can be done successfully, and should be offered as a choice
to families upon discussion of intervention or follow-up with own complications.



Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00404-008-0746-9Authors
Ahmet Gul, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyKemal Gungorduk, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyGokhan Yildirim, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyAli Gedikbasi, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyDogukan Yildirim, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyYavuz Ceylan, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul Turkey

Medicure inc.: medicure inc.: new data shows aggrastat offers significant benefits to patients with poor response to aspirin and/or clopidogrel

WINNIPEG, MANITOBA (MARKET WIRE) Medicure Inc. (TSX: MPH), a cardiovascular focused, biopharmaceutical company, today announced that new data presented at the annual European Society of Cardiology Congress in Munich, Germany showed AGGRASTAT(R) (tirofiban HCL) significantly lowers the incidence of heart attack after elective coronary angioplasty in coronary artery disease patients who have shown poor response to standard oral antiplatelet agents, aspirin and clopidogrel. The data comes from a double-blinded study of AGGRASTAT(R) entitled the 3T/2R Study (Tailoring Treatment with Tirofiban in patients showing Resistance to (Source: Market Wire - Pharmaceuticals and Biotech