Mathematical modelling of intra-aortic balloon pump

Background: Ischemic heart diseases now afflict thousands of Iranians and are the major cause of death in many industrialised countries. Mathematical modelling of an intra-aortic balloon pump (IABP) could provide a better understanding of its performance and help to represent blood flow and pressure in systemic arteries before and after inserting the pump.

Methods: A mathematical modelling of the whole cardiovascular system was formulated using MATLAB software. The block diagram of the model consists of 43 compartments. All the anatomical data was extracted from the physiological references. In the next stage, myocardial infarction (MI) was induced in the model by decreasing the contractility of the left ventricle. The IABP was mathematically modelled and inserted in the model in the thoracic aorta I artery just before the descending aorta. The effects of IABP on MI were studied using the mathematical model.

Results: The normal operation of the cardiovascular system was studied firstly. The pressure–time graphs of the ventricles, atriums, aorta, pulmonary system, capillaries and arterioles were obtained. The volume–time curve of the left ventricle was also presented. The pressure–time curves of the left ventricle and thoracic aorta I were obtained for normal, MI, and inserted IABP conditions. Model verification was performed by comparing the simulation results with the clinical observations reported in the literature.

Conclusions: IABP can be described by a theoretical model. Our model representing the cardiovascular system is capable of showing the effects of different pathologies such as MI and we have shown that MI effects can be reduced using IABP in accordance with the modelling results. The mathematical model should serve as a useful tool to simulate and better understand cardiovascular operation in normal and pathological conditions.     

CLUSTERED PRIMARY BRANCH 1, a new allele of DWARF11, controls panicle architecture and seed size in rice

Panicle architecture and seed size are important agronomic traits that directly determine grain yield in rice (Oryza sativa L.). Although a number of key genes controlling panicle architecture and seed size have been cloned and characterized in recent years, their genetic and molecular mechanisms remain unclear. In this study, we identified a mutant that produced panicles with fascicled primary branching and reduced seeds in size. We isolated the underlying CLUSTERED PRIMARY BRANCH 1 (CPB1) gene, a new allele of DWARF11 (D11) encoding a cytochrome P450 protein involved in brassinosteroid (BR) biosynthesis pathway. Genetic transformation experiments confirmed that a His360Leu amino acid substitution residing in the highly conserved region of CPB1/D11 was responsible for the panicle architecture and seed size changes in the cpb1 mutants. Overexpression of CPB1/D11 under the background of cpb1 mutant not only rescued normal panicle architecture and plant height, but also had a larger leaf angle and seed size than the controls. Furthermore, the CPB1/D11 transgenic plants driven by panicle‐specific promoters can enlarge seed size and enhance grain yield without affecting other favourable agronomic traits. These results demonstrated that the specific mutation in CPB1/D11 influenced development of panicle architecture and seed size, and manipulation of CPB1/D11 expression using the panicle‐specific promoter could be used to increase seed size, leading to grain yield improvement in rice.     

Molecular markers locate genes for resistance to the Colorado potato beetle,Leptinotarsa decemlineata,in hybrid Solanum tuberosum x S. berthaultii potato progenies

The wild Bolivian potato, Solanum berthaultii Hawkes, has been used as a source of resistance to the Colorado potato beetle (CPB), Leptinotarsa decemlineata Say, one of the most significant pests of potato. In this study, two reciprocal backcross S. tuberosum x S. berthaultii potato progenies, BCB and BCT, were mapped with RFLP markers and screened for resistance to CPB consumption, oviposition and defoliation. The genotypic and phenotypic data were combined and analysed to locate quantitative trait loci (QTLs) for resistance to CPB. Three QTLs on three chromosomes in BCB, and two QTLs on two chromosomes in BCT influenced resistance. The QTLs were generally additive but one instance of epistasis was noted. Each QTL accounted for 4–12% of the phenotypic variation observed in resistance. In the more resistant BCB population, a three QTL model explained ca. 20% of the variation in CPB oviposition. When alleles at the three QTLs were homozygous S. berthaultii, oviposition was reduced ca. 60% compared to the heterozygotes. The QTLs for resistance to CPB were compared to those previously identified for the type A and B glandular trichomes, which have been implicated in resistance in the same progenies. Generally, the QTLs for resistance to CPB coincided with loci associated with the glandular trichomes confirming the importance of the glandular trichomes in mediating resistance. However, a relatively strong and consistent QTL for insect resistance in both BCB and BCT on chromosome 1 was observed that was not associated with any trichome traits, suggesting the trichomes may not account for all of the resistance observed in these progenies.     

One-dimensional and three-dimensional models of cerebrovascular flow

The Circle of Willis is a ring-like structure of blood vessels found beneath the hypothalamus at the base of the brain. Its main function is to distribute oxygen-rich arterial blood to the cerebral mass. One-dimensional (1D) and three-dimensional (3D) computational fluid dynamics (CFD) models of the Circle of Willis have been created to provide a simulation tool which can potentially be used to identify at-risk cerebral arterial geometries and conditions and replicate clinical scenarios, such as occlusions in afferent arteries and absent circulus vessels. Both models capture cerebral haemodynamic autoregulation using a proportional-integral (PI) controller to modify efferent artery resistances to maintain optimal efferent flow rates for a given circle geometry and afferent blood pressure. The models can be used to identify at-risk cerebral arterial geometries and conditions prior to surgery or other clinical procedures. The 1D model is particularly relevant in this instance, with its fast solution time suitable for real-time clinical decisions. Results show the excellent correlation between models for the transient efferent flux profile. The assumption of strictly Poiseuille flow in the 1D model allows more flow through the geometrically extreme communicating arteries than the 3D model. This discrepancy was overcome by increasing the resistance to flow in the anterior communicating artery in the 1D model to better match the resistance seen in the 3D results.     

Simulation of 3D Solid Tumour Angiogenesis Including Arteriole,Capillary and Venule

In this paper, a 3D mathematical model of tumour angiogenesis is developed, to generate a functional tumour vasculature for blood microcirculation. The model follows that of Anderson and Chaplain (1998) ^[1] with three exceptions: (a) extending the model from 2D to 3D, one arteriole and one venule is induced as two parent vessels to form an intact circulation network for blood flow; (b) generating networks able to penetrate into the tumour interior rather than the exterior only; (c) considering branching generations with different diameters, based on which three groups of vessels, such as arterioles, venules and capillaries are classified. The present study contains four steps: 1. Generation of 3D angiogenic vasculature induced from one arteriole and one venule, with branching generations considered. 2. Examination of vessel connectivity among each other to construct a functional network for blood circulation, investigation of sensitivity of network architectures to changes in some model parameters. 3. Simulation of blood flow in the developed vasculatures. 4. Comparisons of blood flow calculated on the networks induced from an arteriole-venule system and from a single parent vessel.
The networks from simulations could present basic geometric and morphological features of tumour vasculatures. The sensitivity analysis indicates the controllability of the created networks, which could construct architectures of some specific geometric features to suit different types of tumours. The comparisons of blood flow mentioned above demonstrate the validity of the present vasculature, which could be served as a more realistic network structure for research of microcirculation, drug delivery in solid tumors.     

Genetic relationships of introduced Colorado potato beetle Leptinotarsa decemlineata populations in Xinjiang,China

The Colorado potato beetle (CPB), Leptinotarsa decemlineata (Say), is an infamous invasive species worldwide that aggressively attacks potato and other Solanaceae crops. CPB was first found in China in 1993 and has since spread across 2.77 × 10⁵ km² in Xinjiang Uygur Autonomous Region. To better understand genetic variation and migration patterns, we used seven polymorphic microsatellite loci to elucidate the genetic relationships and gene flow among 10 CPB populations across Xinjiang. (i) Overall low levels of genetic diversity were detected on the entire population in Xinjiang but most of the diversity was retained among populations during invasion. (ii) The mean pairwise F_ST was low (0.071 ± 0.043) among populations. The genetic differentiation was little (pairwise F_ST 0.038 ± 0.016) between the five interior populations (Wusu, Urumqi, Jimsar, Qitai and Mulei) and Tacheng population. The six populations might come from the same genetic group via Bayesian clustering and were closely related on a neighbor‐joining tree. Combining the history data, the five interior populations may have originated from Tacheng. (iii) Gene flow was frequent, especially among the five interior populations. Individuals from the interior populations could be assigned to Tacheng at higher probabilities (means 0.518 ± 0.127) than vice versa (means 0.328 ± 0.074), suggesting that the beetle population has spread from the border to the interior in Xinjiang.     

HTK液与冷血停搏液在心脏瓣膜手术中应用对比：倾向得分匹配分析

目的:比较HTK液与冷血停搏液在心脏瓣膜手术中应用效果,为临床心肌保护灌注策略提供依据。方法:采用单中心数据回顾性分析,选取2015年5月-2018年8月在体外循环下(CPB, Cardiopulmonary Bypass)应用灌注停跳液停跳的瓣膜手术患者529例,分为冷停液组(n=326)及HTK液组(n=203),采用倾向得分匹配方法将上述两组资料进行匹配,确定选取73对可匹配病例进行比较。采集的临床结果主要为CPB时间,阻断时间,ICU停留时间(intensive care unit length of stay,ICU LOS)以及血清钠术中术后浓度变化等参数。其次为,术后呼吸机辅助时间,IABP(Intra aortic ballon pump)的使用及新发透析,30天死亡率与术后主要并发症情况。结果:匹配后两组中冷停液组较HTK液组的主动脉平均阻断时间及CPB时间长,差异具有统计学意义(P0.05),HTK液组存在短暂性低血钠血症(P0.05),ICU LOS以及其余各临床结果无显著差异。结论:心脏瓣膜手术中应用HTK液与冷血停搏液临床早期结果一致,可根据手术操作流程及病人经济水平进行合理选择。     

A three-dimensional multiscale model for the prediction of thrombus growth under flow with single-platelet resolution

Modeling thrombus growth in pathological flows allows evaluation of risk under patient-specific pharmacological, hematological, and hemodynamical conditions. We have developed a 3D multiscale framework for the prediction of thrombus growth under flow on a spatially resolved surface presenting collagen and tissue factor (TF). The multiscale framework is composed of four coupled modules: a Neural Network (NN) that accounts for platelet signaling, a Lattice Kinetic Monte Carlo (LKMC) simulation for tracking platelet positions, a Finite Volume Method (FVM) simulator for solving convection-diffusion-reaction equations describing agonist release and transport, and a Lattice Boltzmann (LB) flow solver for computing the blood flow field over the growing thrombus. A reduced model of the coagulation cascade was embedded into the framework to account for TF-driven thrombin production. The 3D model was first tested against in vitro microfluidics experiments of whole blood perfusion with various antiplatelet agents targeting COX-1, P₂Y₁, or the IP receptor. The model was able to accurately capture the evolution and morphology of the growing thrombus. Certain problems of 2D models for thrombus growth (artifactual dendritic growth) were naturally avoided with realistic trajectories of platelets in 3D flow. The generalizability of the 3D multiscale solver enabled simulations of important clinical situations, such as cylindrical blood vessels and acute flow narrowing (stenosis). Enhanced platelet-platelet bonding at pathologically high shear rates (e.g., von Willebrand factor unfolding) was required for accurately describing thrombus growth in stenotic flows. Overall, the approach allows consideration of patient-specific platelet signaling and vascular geometry for the prediction of thrombotic episodes.     

Negative dietary effects of Colorado potato beetle eggs for the larvae of native and introduced ladybird beetles

Aphidophagous ladybird beetles (Coleoptera: Coccinellidae) are attracted to and feed heavily on aphids, but many species will also feed opportunistically on other prey that they encounter. In potatoes (Solanum tuberosum L.) in Washington State, USA, coccinellids feed on both green peach aphids (“GPA,” Myzus persicae Sulzer) and eggs of the Colorado potato beetle (“CPB,” Leptinotarsa decemlineata Say). The guild of aphidophagous ladybirds includes two native species, Hippodamia convergens Guérin-Méneville and Coccinella transversoguttata Brown. Recently, an introduced species, Coccinella septempunctata L., has invaded and apparently displaced its native congener. A second exotic, Harmonia axyridis Pallas, has colonized the area and is becoming more abundant. We compared larval development of each species on a monotypic diet of GPA, a monotypic diet of CPB eggs, or a mixed diet of both GPA and CPB eggs. Our goal was to answer two questions: (1) do larvae of the four ladybird species benefit from including CPB eggs in their diet and (2) do the four ladybird species differ in their ability to utilize CPB eggs as prey? No larva of any species completed development on a pure diet of CPB eggs, and survivorship was highest for all species when they fed on a pure diet of GPA. One native species, H. convergens, and one exotic species, H. axyridis, exhibited significantly lower survivorship on a mixed diet of both CPB eggs and GPA, compared to a pure GPA diet; H. axyridis also took longer to develop from egg to adult when both prey were provided. Survivorship of the two Coccinella spp. was not altered by the inclusion of CPB eggs with GPA, although CPB eggs lengthened the development time of C. transversoguttata. Adult size was not consistently affected by diet for any of the coccinellids. Overall, no ladybird species benefited from the inclusion of potato beetle eggs in its diet. The two Coccinella species responded similarly to the inclusion of CPB eggs, and so we would not expect any difference in the success of coccinellid larval development in potato fields following the replacement of C. transversoguttata by C. septempunctata. Hippodamia convergens and H. axyridis, the two species whose survivorship was depressed by combining CPB egg and aphid prey, were also the two species that consumed the greatest number of CPB eggs during successful larval development. A comparison of total egg consumption by each species cohort suggested that displacement of the other species by H. axyridis would not alter CPB biological control, because the higher per capita feeding rate by H. axyridis larvae compensated for individuals’ greater mortality risk on a diet including CPB eggs.     

The use of multiple-vessel,open flow systems to investigate carbon flow in anaerobic microbial communities

Five vessels, connected in series, were used for a continuous flow system to model carbon flow in anaerobic microbial communities. Two such 5-vessel systems were constructed, the inflows containing 10 mM sulfate and either 10 mM glucose or benzoate. Dilution was slow (D=0.0018 h^?1 for the whole system). Analyses of dissolved organic and inorganic carbon, and of CO₂ and CH₄, showed that the systems attained steady states in which biomass was constant, although there was net biosynthesis in the early vessels and net mineralization in succeeding vessels. Examination of the distributions of sulfate reduction, methanogenesis, and of H₂+CO₂-utilizing fatty acid-forming bacteria revealed spatial separation of these functional groups of bacteria in different vessels of the array, resembling the vertical spatial separation found in many natural sediments. Such model systems should, therefore, prove valuable in investigating the many microbial activities that contribute to the flow of carbon in anaerobic microbial communities.     

The effects of flow on schooling Devario aequipinnatus: school structure,startle response and information transmission

To assess how flow affects school structure and threat detection, startle response rates of solitary and small groups of giant danio Devario aequipinnatus to visual looming stimuli were compared in flow and no‐flow conditions. The instantaneous position and heading of each D. aequipinnatus was extracted from high‐speed videos. Behavioural results indicate that (1) school structure is altered in flow such that D. aequipinnatus orient upstream while spanning out in a crosswise direction, (2) the probability of at least one D. aequipinnatus detecting the visual looming stimulus is higher in flow than no flow for both solitary D. aequipinnatus and groups of eight D. aequipinnatus; however, (3) the probability of three or more individuals responding is higher in no flow than in flow. These results indicate a higher probability of stimulus detection in flow but a higher probability of internal transmission of information in no flow. Finally, results were well predicted by a computational model of collective fright response that included the probability of direct detection (based on signal detection theory) and indirect detection (i.e. via interactions between group members) of threatening stimuli. This model provides a new theoretical framework for analysing the collective transfer of information among groups of fishes and other organisms.     

1D simulation of blood flow characteristics in the circle of Willis using THINkS

One-dimensional (1D) simulation of the complete vascular network, so called THINkS (Total Human Intravascular Network Simulation) is developed to investigate changes of blood flow characteristics caused by the variation of CoW. THINkS contains 158 major veins, 85 major arteries, and 77 venous and 43 arterial junctions. THINkS is validated with available in vivo blood flow waveform data. The overall trends of flow rates in variations of the CoW, such as the missing anterior cerebral artery (missing-A1) or missing posterior cerebral artery (missing-P1), are confirmed by in vivo experimental data. It is demonstrated that the CoW has the ability to shunt blood flow to different areas in the brain. Flow rates in efferent arteries remain unaffected under the variation of CoW, while the flow rates in afferent vessels can be subject to substantial changes. The redistribution of blood flow can cause particular vessels to undergo extra flow rate and hemodynamic stresses.     

Prey Preference by the StinkbugPerillus bioculatus,a Predator of the Colorado Potato Beetle

Perillus bioculatus(F.) is sometimes considered a generalist but has most often been recorded as predator of Colorado potato beetle (CPB),Leptinotarsa decemlineata.(Say). This study was designed to analyze prey selection inP. bioculatuswith respect to factors that may lead to specialization. To establish if parental prey determines preference in na?̈ve progeny, prey selection experiments were conducted with the CPB and two unusual prey, the yellow mealwormTenebrio molitor(L.) and the house cricketAcheta domesticus(L.). Na?̈ve nymphs reared from yellow mealworm-fed parents in the absence of contact with the CPB initiated feeding more frequently on CPB (81.4%) than on cricket prey (69.6%) (P = 0.038), suggesting genetically inheritable preference for CPB. Progeny from CPBfed parents initiated feeding more frequently on CPB prey (93.3%) than on yellow mealworm prey (76.6%) (P = 0.0001), but progeny from yellow mealwormfed parents initiated feeding on yellow mealworm prey as frequently (89.2%) as on CPB (95.0%) (P = 0.613). Similarly, progeny from CPB-fed parents established proboscis contact more frequently on CPB (39.2%) than on house cricket prey (25.0%) (P = 0.008), whereas those from cricket-fed parents probed house cricket prey as frequently (12.5%) as CPB prey (15.4%) (P = 0.416). Results confirm specialization ofP. bioculatustoward CPB or related prey and suggest genetically inheritable as well as maternally reinforcible affinity toward CPB prey. However, affinity of na?̈ve nymphs for the CPB can be lowered by rearing parents on alternative prey, increasing their chances of survival when alternative prey must be relied upon.     

Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler – a systematic review of the literature

Background

Transcranial Doppler Ultrasound (TCD) is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV). This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB).

Methodology

We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring".

Discussion

Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA) blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF) during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption.

Conclusion

In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography) that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.     

Invasion of Colorado potato beetle,Leptinotarsa decemlineata,in China: dispersal,occurrence, and economic impact

Colorado potato beetle (CPB), Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae), is a global destructive pest of potato, Solanum tuberosum L. (Solanaceae). It is also an important quarantine pest in China, but its dispersal history, occurrence, and economic impact in China have not yet been reported. We determined the current distribution of CPB and reconstructed its dispersal routes. We also investigated the density of CPB in China in 2006, 2007, 2009, and 2010, and estimated the economic impact of CPB in China. In 1993, CPB was first detected in Xinjiang and subsequently spread eastward. The CPB entered China at three distinct points in Xinjiang: in Huocheng County, Tacheng City, and Habahe County. As of 2010, CPB had invaded 38 counties and cities in China, with a distribution area of 277 000 km², between 42°40′–48°28′N and 80°15′–90°41′E. The distribution area could be divided into four zones (from south to north): Ili River Valley, northern slope of the Tianshan Mountains, Tacheng Basin, and Altay. The average annual dispersal rates in the four zones were 18, 45, 12, and 24 km year^?1, respectively. In China, CPB seriously damages potato, impacts eggplant, Solanum melongena L., and occasionally harms tomato, Solanum lycopersicum L. The current annual economic loss caused by CPB in China is estimated to be 3.2 million USD. The potential annual economic losses after completion of its invasion in China is estimated to be 235 million USD. Future invasion pathways, factors affecting CPB dispersal, and control measures were discussed.     

Impact of crimson clover dying mulch on two eggplant insect herbivores

Eggplant Solanum melongena L., is often colonized by two early season insect defoliators. The Colorado potato beetle (CPB), Leptinotarsa decemlineata (Say), and flea beetles Epitrix spp., emerge from their overwintering sites in early spring and seek out emerging host plants such as eggplant. During the 2009 and 2010 growing season, field studies were conducted to investigate the impact of inter‐planting eggplant into a crimson clover (CC), Trifolium incarnatum L., winter cover crop on populations of flea beetles, CPB and their associated arthropod predators. The experiment consisted also of two levels of insecticide usage such as an application of azadirachtins plus pyrethrins followed by several applications of spinosad or no insecticide sprays as subplot treatments. During both study years, significantly fewer (adults, larvae and egg masses) were found on eggplant inter‐planted into CC than in bare‐ground (BG) eggplant plots. Although flea beetle abundance was greater in BG eggplant during 2010, they appeared to be less influenced by the presence of CC than were CPB. Additionally, there was no apparent impact of insecticide treatment on CPB populations on eggplant inter‐planted into CC. However, there was a decline in CPB following treatments with insecticides in BG eggplant plots. This suggests that a winter cover crop such as CC can be used to help manage CPB in eggplant, however, using this tactic in tandem with insecticide sprays may not result in greater CPB management.     

A comparison of two methods for measuring vessel length in woody plants

Vessel lengths are important to plant hydraulic studies, but are not often reported because of the time required to obtain measurements. This paper compares the fast dynamic method (air injection method) with the slower but traditional static method (rubber injection method). Our hypothesis was that the dynamic method should yield a larger mean vessel length than the static method. Vessel length was measured by both methods in current year stems of Acer, Populus, Vitis and Quercus representing short‐ to long‐vessel species. The hypothesis was verified. The reason for the consistently larger values of vessel length is because the dynamic method measures air flow rates in cut open vessels. The Hagen–Poiseuille law predicts that the air flow rate should depend on the product of number of cut open vessels times the fourth power of vessel diameter. An argument is advanced that the dynamic method is more appropriate because it measures the length of the vessels that contribute most to hydraulic flow. If all vessels had the same vessel length distribution regardless of diameter, then both methods should yield the same average length. This supports the hypothesis that large‐diameter vessels might be longer than short‐diameter vessels in most species.     

Changes in α-tocopherol and retinol levels during cardiopulmonary bypass correlate with maximal arterial partial pressure of oxygen

Cardiopulmonary bypass (CPB) is associated with oxidative stress. This study examined antioxidant levels in adults undergoing CPB surgery and their correlation with clinical variables. Arterial blood samples were obtained from 27 patients undergoing CPB. The time-course variation of vitamin C (spectrofluorimetry), α-tocopherol and retinol (HPLC) levels were determined. Plasma vitamin C rose initially but gradually decayed during reperfusion until 60% reduction of baseline values post-surgery. α-Tocopherol and retinol were reduced along CPB with post-operative values ～25% lower than baseline. No significant changes were found for selenium and glutathione peroxidase. PaO₂ values rose steadily throughout CPB. A correlation existed for α-tocopherol and retinol depletion vs maximal PaO₂ throughout CPB but no correlation was found for antioxidant consumption vs duration of ischaemia and reperfusion and hypothermia level. In conclusion, consumption of arterial blood antioxidant vitamins occurs with CPB in relation with PaO₂ levels but not for other clinical variables measured in this study.     

Maize Leaf Rolling Initiation

Maize plants of CPB2 and CPB8 hybrids were kept under water deficit for 22 d. In the CPB8 hybrid, leaf rolling initiated at the 9^th d of water deficit period, while in CPB2 hybrid it was at the 15^th d. Both hybrids showed leaf rolling initiation at the same leaf water potential, Ψ_W of -0.480±0.095 MPa. At leaf rolling initiation, the leaf osmotic potential, Ψ_S was -0.730±0.085 MPa in CPB8 and 0.630±0.110 MPa in CPB2. The leaf temperature and stomatal conductance were higher in CPB8 than in CPB2. Values of leaf Ψ_W, ribulose-1,5-bisphosphate carboxylase activity, chlorophyll content, and specific leaf area were similar in both hybrids. Phosphoenolpyruvate carboxylase activity and protein content were lower in the CPB2 hybrid than in CPB8. In both hybrids leaf rolling initiation was associated with: (1) higher leaf temperature, with leaf rolling effect related to leaf temperature reduction, and (2) lower leaf Ψ_S, related to osmotic adjustment as an additional component of drought-tolerance strategy. This revised version was published online in June 2006 with corrections to the Cover Date.     

Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock

Background

Guidelines strongly recommend additional intra-aortic balloon pump (IABP) therapy in STEMI patients with cardiogenic shock (CS) treated by primary percutaneous coronary intervention (PCI). However, there is no randomised evidence suggesting survival benefit of IABP treatment in CS. It is suggested that timing of initiation of IABP therapy could be of great importance. Therefore, we compared mortality rates of IABP therapy versus no IABP therapy in the setting of STEMI complicated by CS. In addition, we investigated the effect of initiation of IABP therapy on mortality.

Methods

From a cohort of 292 STEMI patients with CS treated by primary PCI, 199 patients received IABP therapy (IABP group) and 93 patients received no support (no IABP group). The IABP group was divided into two subgroups based on timing of initiation of support, i.e. ‘IABP pre PCI’ (n = 59) and ‘IABP post PCI’ (n = 140). Outcomes were assessed by propensity stratification and multivariate logistic regression.

Results

All-cause 30-day mortality for the IABP versus the no IABP group was 47 % vs. 28 %, respectively, in univariate analysis resulting in an odds ratio (OR) of 1.67 (95%CI, 1.16 to 2.39). However, analyses adjusting outcomes by propensity stratification and logistic regression, respectively, neutralised this OR. In the IABP pre-PCI group vs. the post-PCI group 30-day mortality was 64 % vs. 40 %, resulting in an OR of 1.56 (95 % CI, 1.18 to 2.08). However, after propensity stratification analysis and multivariate logistic regression analysis, there were no significant differences in odds of 30-day mortality.

Conclusion

In our cohort of patients with STEMI complicated by CS treated with primary PCI we observed a difference in mortality between those treated with IABP and those treated without IABP in favour of the ‘no IABP’ group. The mortality difference was eliminated after adjustment for differences in case mix by propensity stratification or by logistic regression analysis. Neither did we observe any difference in mortality between patients whose IABP treatment was initiated before or immediately after PCI.