Mental stress and acute myocardial infarction.
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Adult↗
Biomedical subjects
A Roth
Publications and source records attributed to A Roth.
Wnt-5a and Wnt-7a are expressed in the developing chick limb bud in a manner suggesting roles in pattern formation along the proximodistal and dorsoventral axes.
The Wnt gene family encodes a group of secreted signalling molecules that have been implicated in the regulation of cell fate and pattern formation during embryogenesis. We have examined the patterns of expression of two members of the chicken Wnt family, Wnt-5a and Wnt-7a, during development of the chick limb bud. Wnt-5a is expressed in the apical ectodermal ridge which directs outgrowth of limb mesoderm. Wnt-5a also exhibits three quantitatively distinct domains of expression along the proximodistal (PD) axis of the limb mesoderm that may correspond to the regions which will give rise to the three distinct PD segments of the limb, the autopod, zeugopod, and stylopod. In contrast, Wnt-7a expression in the limb bud is specifically limited to the dorsal ectoderm. These observations suggest possible roles for Wnt-5a and Wnt-7a in pattern formation along the PD and dorsoventral axes of the developing chick limb bud. In addition, Wnt-5a and Wnt-7a exhibit spatially discrete domains of expression in several other regions of the chick embryo consistent with developmental roles for these genes in a variety of other tissues.
Amino Acid Sequence↗
Time-consuming procedures and prehospital thrombolytic treatment.
OBJECTIVES: To assess time-consuming procedures in the prehospital stage of acute myocardial infarction patients who had received thrombolytic therapy at the scene, and to evaluate their effect on the clinical outcome. DESIGN: Prospective study. SETTING: Mobile intensive care unit staffed by an intern or a hospital-based physician. PARTICIPANTS AND INTERVENTIONS. Thrombolytic therapy with recombinant tissue-type plasminogen activator (total dose of 120 mg/6 hrs) was initiated at the scene in 167 patients. Treatment continued during transportation and thereafter in the cardiac care unit. During hospitalization, radionuclide ventriculograms and coronary angiography were performed in most patients. MEASUREMENTS AND MAIN RESULTS: Correct diagnosis was confirmed in 165 of 167 patients. Mean time to treatment was 96 +/- 42 (SD) mins with no significant difference between patients treated at home (n = 105) or in public places (n = 60). Global duration of treatment was significantly shorter when thrombolytic therapy was given in public as compared with treatment applied at home (50 +/- 13 vs. 57 +/- 16 mins, respectively, p < .002). CONCLUSION: If patients and physicians become aware of the potential advantages of prompt initiation of thrombolytic therapy at the scene, critical time may be saved in delivering thrombolysis to the clotted coronary artery.
Emergency Medical Services↗
Rapid resolution of new right bundle branch block in acute anterior myocardial infarction patients after thrombolytic therapy.
The objectives of this retrospective study are to describe the effect of thrombolytic treatment on the clinical course of patients with acute anterior myocardial infarction complicated by acute right bundle branch block. Patients admitted to the intensive cardiac care unit within < 4 hours from onset of symptoms, and demonstrating an acute right bundle branch block with, or without left axis deviation, on the qualifying ECG were included. All were given intravenous thrombolytic treatment consisting of: streptokinase (1,500,000 IU/40 min) or recombinant tissue type plasminogen activator (120 mg/6 hours). Following admission, patients were continuously monitored and a 12-lead ECG was recorded during each of the first 3 hours and then every 3 hours over the next 21 hours. Eight patients were included (8/211 = 3.8%). Their mean age was 62 +/- 7 years and time elapse from onset to treatment was 122 +/- 26 minutes. Complete resolution of the right bundle branch block occurred within < 3 hours in all and left axis deviation normalized in two patients. Mean peak creatine kinase was 1214 +/- 604 IU and global left ventricular ejection fraction, measured by isotope ventriculography within 24 hours from admission, was 39% +/- 15%. Only one patient was prophylactically paced. In the others, rapid normalization of the conduction block with reperfusion exceeded the logistics required for the transvenous pacemaker implantation procedure. Coronary angiography performed in six patients during 72 hours from admission revealed high grade stenoses in the proximal portion of the left anterior descending coronary artery in five patients and complete occlusion in one.(ABSTRACT TRUNCATED AT 250 WORDS)
Bundle-Branch Block↗
Postexercise syncope: evidence for increased activity of the sympathetic nervous system.
This report describes an association of postexertional syncope with increased levels of circulating catecholamines. A 36-year-old male who experienced postexercise bradycardia and asystole had higher basal plasma norepinephrine (120 versus 68 +/- 6 pg/ml) and epinephrine (18 versus less than 10 pg/ml) but a similar vagal tone (vagal tone index of 5.44 versus 5.81 +/- 1.00 U) when compared with 6 closely matched subjects who underwent an uneventful stress test.
Adult↗
Organophosphates and the heart.
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Animals↗
[Impact of Shahal (Cardiac Emergency Services) on daily life of subscribers].
SHAHAL (Cardiac Emergency Services) provides professional 24-hour mobile emergency medical service monitored by intensive care nurses via a central computerized operations unit. All subscribers carry a "cardiobeeper" for transtelephonic transmission of a 3-lead electrocardiogram, and an automatic intramuscular self-injector containing 300 mg lidocaine. In this retrospective study we assessed the impact of SHAHAL on subscribers' mental stress, self-confidence and ultimately, quality of life. Answers to a written questionnaire (n = 1034) and a personal interview (n = 55) were analyzed. It was shown that SHAHAL is effective in decreasing mental stress and improving self-confidence in the majority of subscribers. It was especially beneficial in women, the elderly, those of lower socioeconomic status, pessimists and chronic worriers, and the ill more than the healthy. Those whose functional capacities were very limited benefited less, but for them SHAHAL's function as a life-saving and rescue system is more valuable. Lastly, subscription to SHAHAL also improved the self-confidence of the subscriber's family.
Aged↗
Hospital admissions of young children for status asthmaticus in Honolulu, Hawaii, 1986 to 1989.
Asthma admissions of children aged 5 years or younger to the Kaiser Foundation Hospital in Honolulu were analyzed for the years 1986-1989. Admissions increased at an annual rate of 4.5% during the study period, in agreement with a worldwide trend. Most children wheezed before their first admission, but their diagnosis was bronchitis rather than asthma. This shows that physicians find it difficult to diagnose asthma in young children. Pneumonia was the initial diagnosis in 25% of admissions, mainly due to overinterpretation of chest radiographs, and this contributed to the overuse of antibiotics. Inpatient treatment with inhaled and systemic bronchodilators and anti-inflammatory agents conformed to standard practice. Recent adoption of the guidelines by the National Asthma Education program and the establishment of an outreach program and asthma register should promote more appropriate outpatient treatment and a reduction of admissions for asthma.
Asthma↗
[Insertion of the Tenon capsule onto the rectus muscles].
The localisation and definition of the capsule of Tenon insertion on the rectus muscles is of prime importance to the strabismus surgeon. The depth of the superior sub-Tenon space was measured on 22 adult human eyes after fixation in formalin. Although the measurements revealed major differences between the eyes, the following results were found: inferior rectus muscle = 7.8 mm +/- 1.79 (5.2-13.0), medial rectus = 12.6 mm +/- 2.15 (8.4-17.2), superior rectus muscle = 16.7 mm +/- 2.39 (12.7-21.5), and lateral rectus muscle = 19.0 mm +/- 2.19 (14.5-22.0). Histological studies of 2 other human eyes confirmed the notion of a band of insertion on rectus muscles as the posterior limit of the sub-Tenon space. As far as this insertion, the capsule of Tenon is a dense connective tissue composed of many collagen and elastin fibers, but after the band insertion, it becomes virtual through its fusion with the perimysium of the rectus muscle.
Adult↗
Clonidine for patients with rapid atrial fibrillation.
OBJECTIVE: To determine whether clonidine can slow ventricular rate in patients with rapid atrial fibrillation. DESIGN: Randomized, controlled trial, with a 4-hour follow-up period. SETTING: Emergency room of a university hospital. PATIENTS: A consecutive sample of 18 hemodynamically stable patients who were evaluated or treated for rapid atrial fibrillation. Exclusion criteria included acute or terminal illness; current use of antiarrhythmic agents, calcium-channel blockers, or beta-blockers; excessive hypertension; pulmonary, valvular, or pericardial disease; and electrolyte imbalance. INTERVENTIONS: Patients were randomly assigned to receive either "no treatment" (control group) or clonidine, 0.075 mg orally, at baseline and after 2 hours if heart rate did not decrease by at least 20%. MEASUREMENTS: Blood pressure was measured by the same nurse in the same arm for 4 consecutive hours, and a full 12-lead electrocardiographic evaluation was done. MAIN RESULTS: Heart rate decreased to below 100 beats/min in eight of nine patients receiving clonidine compared with two of nine patients in the control group. The difference in the mean decreases in heart rate was 38 beats/min (95% CI, 20 to 56 beats/min). Six patients who were treated with clonidine and one patient in the control group reverted to normal sinus rhythm. Systolic blood pressure decreased slightly in both groups, without significant differences. Clinical follow-up was uneventful. CONCLUSION: Low-dose clonidine was an easy, efficient, and effective treatment for patients with rapid atrial fibrillation who were hemodynamically stable.
Adrenergic alpha-Agonists↗
Safety of pyridostigmine in hypertensive patients receiving beta blockers.
In the last decade, pyridostigmine, a quaternary carbamate that reversibly inhibits the enzyme acetylcholinesterase, was proposed for pretreatment of nerve gas (organophosphate) poisoning. The objective of this study was to assess the cardiovascular effects of pyridostigmine in patients treated with beta blockers. Eight hypertensive patients receiving regular treatment with beta blockers were randomized in a double-blind crossover study to receive pyridostigmine (30 mg 3 times daily) or placebo for 2 days. Heart rate and blood pressure in the supine and standing positions were recorded every 2 hours during the day, and 24-hour Holter monitoring was performed. In addition, a symptom-limited exercise test was performed, and plasma catecholamine levels were determined at rest and at peak exercise. Pyridostigmine, as compared with placebo, did not induce any significant effect on heart rate, plasma catecholamine levels or resting blood pressure. Both systolic and diastolic blood pressures increased in accordance with exercise intensity (p less than 0.01), although a significantly lower diastolic blood pressure was observed when pyridostigmine was used (average decrease 5 mm Hg compared with placebo; p less than 0.01). No clinical adverse reactions were observed, confirming the relative safety of the combination of low-dose pyridostigmine with beta-adrenergic blocking agents.
Adrenergic beta-Antagonists↗
Application of the polymerase chain reaction in the diagnosis of pulmonary toxoplasmosis in immunocompromised patients.
Bronchoalveolar lavage (BAL) fluid from 47 immunocompromised patients (26 with AIDS and 21 patients on immunosuppressive therapy) was analysed for the presence of Toxoplasma gondii DNA by means of the polymerase chain reaction (PCR). Specific target DNA derived from the B1 and P30 gene of Toxoplasma gondii was detected in BAL fluids from three patients with AIDS (6.4%). Pneumonia as the presenting feature of disseminated toxoplasmosis was confirmed by both clinical findings and by detection of Toxoplasma gondii DNA in blood obtained from two patients. The findings indicate that PCR has potential value in the detection of Toxoplasma gondii as an etiologic agent of atypical pneumonia in immunocompromised patients.
Animals↗
The complex for replication initiation of Escherichia coli.
We probed the complex between oriC and DnaA protein using two types of mutants in oriC. Base changes in the DnaA binding sites, DnaA boxes, had little effect on origin function. Mutations which change the distance between DnaA boxes R3 and R4, on the other hand, inactivated oriC unless the mutation deleted or inserted one complete helical turn. Origins with other 10 base pair insertions in the interval between DnaA boxes R2 and R3 were functional, but not insertions in the R1-R2 interval. FIS protein binds to a bipartite site in oriC between DnaA boxes R2 and R3. A model for the oriC/DnaA complex based on these results suggests an array of DnaA monomers with a 34 A spacing upon which oriC is arranged.
Bacterial Proteins↗
Assessment of flap perfusion in a porcine model with a heated laser Doppler probe.
Skin and musculocutaneous flaps in a pig model were studied for their response to heating of the laser Doppler probe, both in the perfused state and in conditions of vascular occlusion. Even though heating the probe resulted in an elevation of perfusion of the flaps with no occlusions, it also increased the apparent perfusion of flaps that were occluded. The ability of flows to a augment with heating, therefore, could not be perfectly correlated with impeded vascular flow. The addition of a heated perfusion reading for assessment of vascular occlusion did not improve the accuracy of the laser Doppler for monitoring of capillary-bed perfusion to detect vascular occlusion.
Animals↗
[Strabismus induced by peripheral vestibular lesions].
Little attention has been paid in the ophthalmological literature to strabismus resulting from lesions located in the peripheral vestibular system. However, this phenomenon is commonly encountered in clinical practice. As a rule, this kind of strabismus shows a prominent vertical component. It is generally combined with a change in perception of verticality, conjugate cyclotorsion of the eyes, and head tilt. This association is known as "ocular tilt reaction". It occurs in a number of clinical settings which are believed to be related with alteration in the otolithical and/or vertical semicircular canal pathways. Strabismus occurring as a feature of ocular tilt reaction might result from different mechanisms according to the location of the lesion, e.g. in the utricles, in the midbrain tegmentum, and in the dorso-lateral medulla oblongata. This phenomenon is illustrated here with the report of a patient suffering from Ménière disease, who underwent selective vestibular neurectomy. Methods of ophthalmological evaluation in such cases is described.
Aged↗
SOS induction in Escherichia coli by infection with mutant filamentous phage that are defective in initiation of complementary-strand DNA synthesis.
We report that the SOS response is induced in Escherichia coli by infection with mutant filamentous phage that are defective in initiation of the complementary (minus)-strand synthesis. One such mutant, R377, which lacks the entire region of the minus-strand origin, failed to synthesize any detectable amount of primer RNA for minus-strand synthesis. In addition, the rate of conversion of parental single-stranded DNA of the mutant to the double-stranded replicative form in infected cells was extremely slow. Upon infection, R377 induced the SOS response in the cell, whereas the wild-type phage did not. The SOS induction was monitored by (i) induction of beta-galactosidase in a strain carrying a dinD::lacZ fusion and (ii) increased levels of RecA protein. In addition, cells infected with R377 formed filaments. Another deletion mutant of the minus-strand origin, M13 delta E101 (M. H. Kim, J. C. Hines, and D. S. Ray, Proc. Natl. Acad. Sci. USA 78:6784-6788, 1981), also induced the SOS response in E. coli. M13Gori101 (D. S. Ray, J. C. Hines, M. H. Kim, R. Imber, and N. Nomura, Gene 18:231-238, 1982), which is a derivative of M13 delta E101 carrying the primase-dependent minus-strand origin of phage G4, did not induce the SOS response. These observations indicate that single-stranded DNA by itself induces the SOS response in vivo.
Coliphages↗
The FIS protein binds and bends the origin of chromosomal DNA replication, oriC, of Escherichia coli.
The FIS protein (factor for inversion stimulation) is known to stimulate site-specific recombination processes, such as the inversion of the G segment of bacteriophage Mu, by binding to specific enhancer sequences. It has also been shown to activate transcription from rRNA promoters both in vitro and in vivo. We have identified a specific binding site for FIS in the center of the origin of chromosomal DNA replication, oriC. The DNA bends upon FIS binding. Occupation of the FIS site and binding of DnaA, the initiator protein, to its adjacent binding site (R3) are mutually exclusive. A fis mutant strain can not be efficiently transformed with plasmids which carry and replicate from oriC, suggesting that FIS is required for minichromosome replication.
Bacterial Proteins↗
Prognostic importance of delayed Q-wave evolution 3 to 24 hours after initiation of thrombolytic therapy for acute myocardial infarction.
The timing of Q-wave evolution and its prognostic significance was studied in 201 patients who received thrombolytic therapy for a first acute myocardial infarction (AMI). One hundred forty-one patients (70%) had evidence of a Q-wave AMI within 3 hours of the initiation of thrombolytic therapy, 31 (16%) developed Q waves after 3 hours but before hospital discharge, and 29 (14%) were discharged with a non-Q-wave AMI. Laboratory indicators of myocardial damage and in-hospital morbidity and mortality were greater among patients with Q-wave AMIs than with non-Q-wave AMIs. When these indexes were examined with respect to the timing of Q-wave evolution, the prognosis of patients with delayed Q-wave development was similar to that of patients with non-Q-wave AMIs. Thus, compared to patients with early (less than or equal to 3 hours) Q-wave evolution, patients with delayed Q-wave evolution or with a non-Q-wave AMI had a smaller creatine kinase peak (mean 661 to 1,081 vs 1,251 to 1,541 IU; p = 0.005), better preservation of left ventricular function as measured by radionuclide ventriculography before discharge (mean +/- standard deviation 54 +/- 11% vs 47 +/- 13%; p less than 0.01), and a lower incidence of congestive heart failure at discharge (3 vs 15%; p = 0.02). In-hospital mortality was lower among patients with delayed Q-wave evolution or with a non-Q-wave AMI (5 of 141 vs 0 of 60; difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗