Effects of oral anticoagulation with various INR levels in deep vein thrombosis cases

AIM: In order to avoid the complications associated with thromboembolic disease, patients with this condition typically are placed on long-term anticoagulant therapy. This report compares bleeding complications in this patient population by level of achieved INR. MATERIALS AND METHODS: During the 6-year period between January 1997 and January 2003, 386 patients with venous thromboembolism of the lower extremities were admitted to the Cardiovascular Surgery Outpatient Clinic of Alsancak State Hospital. Of the 386 patients, 198 (51.2%) were women, and the average age was 52.3 years. All diagnoses of venous thromboembolism were confirmed by means of Doppler ultrasonography. Further investigation showed occult neoplasms in 22 (5.6%) of the cases. We excluded the patients with occult disease, and the remaining 364 constituted our study population. RESULTS: Oral anticoagulation was standardized at 6 months' duration in all cases. We divided the patients into two groups. Group I consisted of 192 patients (52.7%) with INR values between 1.9 and 2.5; Group II comprised 172 patients with INR values between 2.6 and 3.5. Complications in each group were assessed and compared. The minor hemorrhage rate was 1.04% in Group I and 4.06% in Group II. The major hemorrhage rate was also 1.04% in Group I and was 6.3% in Group II. We determined that the complication rates for both minor and major hemorrhage were significant in patients with INR values above 2.5. CONCLUSION: Oral anticoagulation must be followed closely in patients with venous thromboembolism. Higher INR levels are associated with significant increases in hemorrhage and associated complications. INR values of 2.0 to 2.5 are sufficient for long-term anticoagulant therapy, ensuring ideal anticoagulation levels and minimizing the complication rate.     

Sex Differences in Treatment Quality of Self-Managed Oral Anticoagulant Therapy: 6,900 Patient-Years of Follow-Up

Background

Patient-self-management (PSM) of oral anticoagulant therapy with vitamin K antagonists has demonstrated efficacy in randomized, controlled trials. However, the effectiveness and efficacy of PSM in clinical practice and whether outcomes are different for females and males has been sparsely investigated.The objective is to evaluate the sex-dependent effectiveness of PSM of oral anticoagulant therapy in everyday clinical practice.

Methods

All patients performing PSM affiliated to Aarhus University Hospital and Aalborg University Hospital, Denmark in the period 1996–2012 were included in a case-series study. The effectiveness was estimated using the following parameters: stroke, systemic embolism, major bleeding, intracranial bleeding, gastrointestinal bleeding, death and time spent in the therapeutic international normalized ratio (INR) target range. Prospectively registered patient data were obtained from two databases in the two hospitals. Cross-linkage between the databases and national registries provided detailed information on the incidence of death, bleeding and thromboembolism on an individual level.

Results

A total of 2068 patients were included, representing 6,900 patient-years in total. Males achieved a significantly better therapeutic INR control than females; females spent 71.1% of the time within therapeutic INR target range, whereas males spent 76.4% (p<0.0001). Importantly, death, bleeding and thromboembolism were not significantly different between females and males.

Conclusions

Among patients treated with self-managed oral anticoagulant therapy, males achieve a higher effectiveness than females in terms of time spent in therapeutic INR range, but the incidence of major complications is low and similar in both sexes.     

Retention of N and P by zebra mussels (<Emphasis Type="Italic">Dreissena polymorpha</Emphasis> Pallas) and its quantitative role in the nutrient budget of eutrophic Lake Ekoln,Sweden

We quantified cover, population densities, size distribution and biomass of zebra mussels along 7 transects in eutrophic Lake Ekoln (Sweden). We also analyzed the elemental (C, N, P) composition of zebra mussel soft tissue and computed their retention rates of N and P their quantitative role in the lake’s nutrient budget. We hypothesized that zebra mussels play an important role in the nutrient budget of the lake and speculate that the successive harvesting of cultured mussels could contribute to the lake’s rate of recovery from cultural eutrophication. At depths exceeding 5 m, mussels covered consistently less than 5% or were absent. Similarly, mean densities were 3,158 ± 2,143 ind m⁻² between 2 and 4 m, but rapidly declined at larger depths. Calculated clearance rates averaged 19.4 ± 2.3 km³ y⁻¹, implying the entire lake is filtered every 8–10 days. Concentrations of N and P in mussel soft tissue averaged 100.9 ± 1.5 mg N g⁻¹ DW and 9.3 ± 0.2 mg P g⁻¹ DW. The lake population was estimated to 22.2 ± 2.6 × 10¹⁰ mussels, corresponding to a standing stock biomass of 362 ± 42 ton DW, or conservative estimates of 36.6 ± 4.3 ton N and 3.4 ± 0.4 ton P. Assuming a life span of 2–3 years gives a retention estimate of 1.2–1.8 ton P y⁻¹ by mussels, corresponding to 50–77% of the annual P influx from Uppsala sewage treatment plant to the lake. Similarly, annual N-retention by zebra mussels makes up 13–20 ton N y⁻¹, largely equaling the annual N-deposition from atmospheric sources on the lake’s surface. These retention rates correspond to only a few percent of the annual P-load from agricultural sources, but we argue that the quantitative role of zebra mussels in nutrient budgets is much larger if these budgets are adjusted for the bias introduced by coarse estimates of N and P pools that include a large share of refractory P.     

Evaluation of endogenous acidic metabolic products associated with carbohydrate metabolism in tumor cells

Tumor cells have a high tolerance for acidic and hypoxic microenvironments, also producing abundant lactic acid through accelerated glycolysis in the presence or absence of O₂. While the accumulation of lactate is thought to be a major contributor to the reduction of pH-circumscribing aggressive tumors, it is not known if other endogenous metabolic products contribute this acidity. Furthermore, anaerobic metabolism in cancer cells bears similarity to homo-fermentative lactic acid bacteria, however very little is known about an alternative pathway that may drive adenosine triphosphate (ATP) production independent of glycolysis. In this study, we quantify over 40 end-products (amines, acids, alcohols, aldehydes, or ketones) produced by malignant neuroblastoma under accelerated glycolysis (+glucose (GLU) supply 1–10 mM) ± mitochondrial toxin; 1-methyl-4-phenylpyridinium (MPP⁺) to abate aerobic respiration to delineate differences between anaerobic vs. aerobic cell required metabolic pathways. The data show that an acceleration of anaerobic glycolysis prompts an expected reduction in extracellular pH (pH_ex) from neutral to 6.7 ± 0.006. Diverse metabolic acids associated with this drop in acidity were quantified by ionic exchange liquid chromatography (LC), showing concomitant rise in lactate (Ctrls 7.5 ± 0.5 mM; +GLU 12.35 ± 1.3 mM; +GLU + MPP 18.1 ± 1.8 mM), acetate (Ctrl 0.84 ± 0.13 mM: +GLU 1.3 ± 0.15 mM; +GLU + MPP 2.7 ± 0.4 mM), fumarate, and a-ketoglutarate (<10 μM) while a range of other metabolic organic acids remained undetected. Amino acids quantified by o-phthalaldehyde precolumn derivatization/electrochemical detection–LC show accumulation of l-alanine (1.6 ± .052 mM), l-glutamate (285 ± 9.7 μM), l-asparagine (202 ± 2.1 μM), and l-aspartate (84.2 ± 4.9 μM) produced during routine metabolism, while other amino acids remain undetected. In contrast, the data show no evidence for accumulation of acetaldehyde, aldehydes, or ketones (Purpald/2,4-dinitrophenylhydrazine—Brady's reagent), acetoin (Voges–Proskauer test), or alcohols (NAD⁺-linked alcohol dehydrogenase). In conclusion, these results provide preliminary evidence to suggest the existence of an active pyruvate–alanine transaminase or phosphotransacetylase/acetyl-CoA synthetase pathway to be involved with anaerobic energy metabolism of cancer cells.     

LOW PROFILE BIOPROSTHESIS FOR CARDIAC VALVE REPLACEMENT: EARLY CLINICAL RESULTS

Between May 1976 and April 1977, 100 patients underwent cardiac valve replacement with a unique low profile glutaraldehyde-treated porcine aortic xenograft. These patients were classified in four groups: Group I, 43 patients who underwent isolated mitral valve replacement (MVR); Group II, 27 patients who had isolated aortic valve replacement (AVR); Group III, 10 patients who had MVR and AVR; and Group IV, 20 patients who had MVR or AVR associated with other cardiac procedures. The operative mortality for Group I was 2.3% (1 of 43) and 15% (3 of 20) in Group IV. The total operative mortality was 4% (4 of 100) and the late mortality was 1.02% (1 of 96 survivors), who died apparently secondary to a cardiac arrhythmia. During a follow-up period extending for 16 months, thromboembolic complications occurred early in the postoperative period in 3% (3 of 100), one patient with neurological residual, and two patients with transient symptoms only. The embolic complications occurred only in Group I. Considering all patients in whom the mitral valves were replaced, the incidence of emboli was 4.9% (3 of 61). The 96 patients did not receive anticoagulant therapy. Reoperation was necessary in one patient because of periprosthetic leak. The incidence of endocarditis was 1.02% (1 of 96 survivors). We recommend anticoagulant therapy for eight to twelve weeks postoperatively in MVR patients after bioprosthetic insertion.     

An initial comparison of tubular netting versus tie–tie methods of cultivation for Kappaphycus alvarezii (Rhodophyta, Solieriaceae) on the south coast of Rio de Janeiro State, Brazil

A new cultivation technique for Kappaphycus alvarezii was used in the Brazilian southeastern coast (23°02′25″ S and 43°53′39″ W), the tubular netting on floating rafts. The tubular net technique (TN) was compared with the current method of tie–tie (TT). After 47 days, the daily growth rate (mean ± SD of TN and TT = 3.4 ± 0.7% day⁻¹), carrageenan yield (mean ± SD of TN and TT = 36 ± 1.3%), gel strength (mean ± SD of TN and TT = 730 ± 114.5 g cm2), and viscosity (mean ± SD of TN and TT = 350 ± 60.4 cP) did not differ between the two techniques (p > 0.05). The amount of time used to plant (TT = 30.2 ± 2.3 min and TN = 13.3 ± 3.4 min) and to harvest the seedlings (TT = 36.2 ± 2.7 min and TN = 17.8 ± 3.7 min) were lower in TN (p < 0.001). It is concluded that TN was more effective than TT, the cultivation management (time rates used to plant and harvest the seedlings) was 53.6% faster, no seedlings were lost, the cost was lower, and an estimated return in 1 year of nearly 20% more than that of the TT technique.     

The TTX metabolite 4,9-anhydro-TTX is a highly specific blocker of the Na(v1.6) voltage-dependent sodium channel

The blocking efficacy of 4,9-anhydro-TTX (4,9-ah-TTX) and TTX on several isoforms of voltage-dependent sodium channels, expressed in Xenopus laevis oocytes, was tested (Na_v1.2, Na_v1.3, Na_v1.4, Na_v1.5, Na_v1.6, Na_v1.7, and Na_v1.8). Generally, TTX was 40–231 times more effective, when compared with 4,9-ah-TTX, on a given isoform. An exception was Na_v1.6, where 4,9-ah-TTX in nanomole per liter concentrations sufficed to result in substantial block, indicating that 4,9-ah-TTX acts specifically at this peculiar isoform. The IC₅₀ values for TTX/4,9-ah-TTX were as follows (in nmol/l): 7.8 ± 1.3/1,260 ± 121 (Na_v1.2), 2.8 ± 2.3/341 ± 36 (Na_v1.3), 4.5 ± 1.0/988 ± 62 (Na_v1.4), 1,970 ± 565/78,500 ± 11,600 (Na_v1.5), 3.8 ± 1.5/7.8 ± 2.3 (Na_v1.6), 5.5 ± 1.4/1,270 ± 251 (Na_v1.7), and 1,330 ± 459/>30,000 (Na_v1.8). Analysis of approximal half-maximal doses of both compounds revealed minor effects on voltage-dependent activation only, whereas steady-state inactivation was shifted to more negative potentials by both TTX and 4,9-ah-TTX in the case of the Na_v1.6 subunit, but not in the case of other TTX-sensitive ones. TTX shifted steady-state inactivation also to more negative potentials in case of the TTX-insensitive Na_v1.5 subunit, where it also exerted profound effects on the time course of recovery from inactivation. Isoform-specific interaction of toxins with ion channels is frequently observed in the case of proteinaceous toxins. Although the sensitivity of Na_v1.1 to 4,9-ah-TTX is not known, here we report evidence on a highly isoform-specific TTX analog that may well turn out to be an invaluable tool in research for the identification of Na_v1.6-mediated function, but also for therapeutic intervention. sodium channel; tetrodotoxin     

Cross-talk between one-carbon metabolism and xenobiotic metabolism: implications on oxidative DNA damage and susceptibility to breast cancer

The aim of this case–control study is to explore the role of aberrations in xenobiotic metabolism in inducing oxidative DNA damage and altering the susceptibility to breast cancer. Cytochrome P4501A1 (CYP1A1) m1 (OR: 1.41, 95% CI 1.08–1.84), CYP1A1 m4 (OR: 5.13, 95% CI 2.68–9.81), Catecholamine-O-methyl transferase (COMT) H108L (OR: 1.49, 95% CI 1.16–1.92), and glutathione S-transferase (GST) T1 null (OR: 1.68, 95% CI 1.09–2.59) variants showed association with breast cancer risk. Reduced folate carrier 1 (RFC1) 80A/CYP1A1 m1/CYP1A1 m4 and RFC1 80A/thymidylate synthase (TYMS) 5′-UTR 2R/methionine synthase (MTR) 2756G/COMT 108L genetic combinations were found to inflate breast cancer risk under the conditions of low dietary folate (345 ± 110 vs. 379 ± 139 μg/day) and low plasma folate (6.81 ± 1.25 vs. 7.09 ± 1.26 ng/ml) by increasing plasma 8-oxo-2′-deoxyguanosine (8-oxodG). This increase in 8-oxodG is attributed to low methionine (49.38 ± 23.74 vs. 53.90 ± 23.85 μmol/l); low glutathione (378 ± 242 vs. 501 ± 126 μmol/l) and GSTT1 null variant; and hypermethylation of CpG island of extracellular-superoxide dismutase (EC-SOD) (92.78 ± 11.49 vs. 80.45 ± 9.86%), which impair O-methylation of catechol estrogens to methoxy estrogens, conjugation of glutathione to semiquinones/quinones and free radical scavenging respectively. Our results suggest cross-talk between one-carbon metabolism and xenobiotic metabolism influencing oxidative DNA damage and susceptibility to breast cancer.     

Periovulatory time courses of plasma estradiol and progesterone in the Japanese monkey (Macaca fuscata)

Periovulatory time courses of plasma estradiol and progesterone were determined in 21 menstrual cycles of 20 Japanese monkeys. Both steroids were measured by radioimmunoassay. Ovulation was detected by serial laparoscopic observations of the ovaries. Three of the 21 cycles were anovulatory cycles. In the remaining 18 ovulatory cycles, a preovulatory estradiol peak occurred on day 12.2±1.4 (range 10–15) of the menstrual cycle. The estradiol concentration at the peak was 431±199 (range 210–930) pg/ml. The time interval between the estradiol peak and ovulation was within 48 hr; the shortest interval was 10–13 hr and the longest 32–48 hr. Although the progesterone levels began to increase slightly (0.6–1.4 ng/ml) before ovulation, they did not show a continuous increase but decreased once before ovulation. The increase in progesterone with development of the corpus luteum after ovulation was very gradual during the first 2 days after ovulation. Subsequently, in 13 of 18 ovulatory cycles the progesterone levels rose rapidly and reached a maximum, 4.0±1.2 (range 2.3–5.7) ng/ml, 4–8 days after ovulation. In 5 of the 18 cycles, the progesterone levels did not rise at all or did not exceed 2.0 ng/ml even if they showed more or less an increase. In the 5 cycles, the length of the luteal phase was 8.2±1.6 (range 6–10) days, which was significantly shorter than that of the former 13 cycles with 14.0±1.1 (range 13–16) days.     

<Emphasis Type="Italic">Kosteletzkya virginica</Emphasis> displays mixed mating in response to the pollinator environment despite strong inbreeding depression

Mixed mating systems often evolve despite strong inbreeding depression, but there have been few experimental tests of this observation. Kosteletzkya virginica, a perennial dicot halophytic species of the Family Malvaceae, is native to brackish portions of coastal tidal marsh in the United States of America and was introduced into China in 1993. Pollination of K. virginica occurs through insect vectors and by delayed self-pollination via stylar movement. In the same two naturalized populations of K. virginica during 2005–2007, we measured (i) inbreeding depression across a range of life-cycle stages, (ii) pollination failure rate, and (iii) selfing rate estimated by AFLP markers. Results indicate that inbreeding depression values for the two naturalized populations during 2005–2007 ranged from 0.620 ± 0.036 to 0.656 ± 0.032, and mean inbreeding depression was 0.640 ± 0.006. Pollinator failure rates at the two naturalized K. virginica populations during 2005–2007 ranged from 0.091 ± 0.039 to 0.174 ± 0.061, and selfing rate ranged from 0.247 ± 0.018 to 0.468 ± 0.031. Population selfing rates are significantly and positively correlated with field estimates of pollinator failure (P = 0.008 < 0.01, R ² = 0.857). Our data provide an empirical demonstration of a mixed mating system response to the pollinator environment in the presence of strong inbreeding depression.     

Ultrasound-guided axillary vein puncture for cardiac devices implantation in patients under antithrombotic therapy

BackgroundUltrasound-guided axillary venous puncture (UGAVP) for cardiac devices implantation has been developed because of its rapidity, safety and potential long-term lead protection. Early work excluded defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures. Compared to the cephalic approach, in previous studies, there was a greater use of pressure dressings with this technique, suggesting a higher risk of bleeding.AimsTo assess UGAVP in patients under antithrombotic therapy (ATT) undergoing cardiac devices implantation including CRT/ICD.MethodsProspectively, consecutive patients eligible for a pacemaker or ICD implantation were included. All procedures were performed by a single operator, experienced with UGAVP for femoral access, and fluoroscopy-guided axillary vein access. Guidewires insertion time (from lidocaïne administration), and complications were systematically studied.ResultsFrom 457 cardiac device implantations, 200 patients (77.8 ± 10 y, male 58%) 360 leads were implanted by UGAVP including 36 ICD, 54 CRT and 14 upgrade procedures. A majority (90%) was under ATT: Vitamin K Antagonist or Heparin (n = 58, 29%), direct oral anticoagulant (n = 46, 23%), dual antithrombotic therapy (n = 18, 9%) and single antiplatelet drug (n = 82, 41%). UGAVP was successful in 95.78%. Mean insertion time for 1.8 guidewires per patient was 4.68 ± 3.6 min. No complication (no hematoma) was observed during the follow-up (mean of 45 ± 10 months). Guidewires insertion time reached its plateau after 15 patients.ConclusionUGAVP is fast, feasible and safe for patients under ATT undergoing device implantation including CRT/ICD and upgrade procedures, with a short learning curve.     

Screening for anticoagulant activity in marine algae from the Northwest Mexican Pacific coast

Disorders in blood coagulation can lead to an increased risk of bleeding (hemorrhage) or clotting (thrombosis). These illnesses have increased over the last decades and no useful new substances have been discovered to remediate them. In search of new compounds from marine natural resources, macroalgae from the Northwest Mexican Pacific coast were investigated in order to detect anticoagulant activity. Egregia menziesii, Ulva neumatoidea, Porphyra perforata, Silvetia compressa, and Codium fragile were collected from Ensenada coasts. Collected materials were cleaned, dried, milled, and stored until use. Proximate chemical composition and sulfate content were determined in dried powder. Hot and cold aqueous extracts were obtained from the dried algae in order to isolate polysaccharides and similar compounds. Methanol-soluble compounds were separated by means of Soxhlet extraction. Organic and aqueous extracts were screened for anticoagulant activity in both intrinsic and extrinsic pathways of clot formation. Clotting activity was studied by standardized plasma coagulation tests (activated partial thromboplastin time (aPTT) and prothrombin time (PT)). Heparin, a sulfated glycosaminoglycan widely used in anticoagulant therapy, was used as reference. Effects were defined either as aPTT index (Sample aPTT/Control aPTT ratio) or PT index (Sample PT/Control PT ratio). Some of the fractions showed anticoagulant activity over intrinsic pathways, whereas they were found to be coagulants on the extrinsic pathway. The highest aPTT index was 1.8 for U. nematoidea (1 μg mL⁻¹). Hot aqueous extracts from E. menziesii (1 μg mL⁻¹) showed the highest potency, with an aPTT index of 1.4. Sulfate content and anticoagulant activity were not correlated.     

The relationship between environmental temperature and clothing insulation across a year

People adapt to thermal environments, such as the changing seasons, predominantly by controlling the amount of clothing insulation, usually in the form of the clothing that they wear. The aim of this study was to determine the actual daily clothing insulation on sedentary human subjects across the seasons. Thirteen females and seven males participated in experiments from January to December in a thermal chamber. Adjacent months were grouped in pairs to give six environmental conditions: (1) January/February = 5°C; (2) March/April = 14°C; (3) May/June = 25°C; (4) July/August = 29°C; (5) September/October = 23°C; (6) November/December = 8°C. Humidity(45 ± 5%) and air velocity(0.14 ± 0.01 m/s) were constant across all six experimental conditions. Participants put on their own clothing that allowed them to achieve thermal comfort for each air temperature, and sat for 60 min (1Met). The clothing insulation (clo) required by these participants had a significant relationship with air temperature: insulation was reduced as air temperature increased. The range of clothing insulation for each condition was 1.87–3.14 clo at 5°C(Jan/Feb), 1.62–2.63 clo at 14°C(Mar/Apr), 0.87–1.59 clo at 25°C(May/Jun), 0.4–1.01 clo at 29°C(Jul/Aug), 0.92–1.81 clo at 23°C (Sept/Oct), and 2.12–3.09 clo at 8°C(Nov/Dec) for females, and 1.84–2.90 clo at 5°C, 1.52–1.98 clo at 14°C, 1.04–1.23 clo at 25°C, 0.51–1.30 clo at 29°C, 0.82–1.45 clo at 23°C and 1.96–3.53 clo at 8°C for males. The hypothesis was that thermal insulation of free living clothing worn by sedentary Korean people would vary across seasons. For Korean people, a comfortable air temperature with clothing insulation of 1 clo was approximately 27°C. This is greater than the typical comfort temperature for 1 clo. It was also found that women clearly increased their clothing insulation level of their clothing as winter approached but did not decrease it by the same amount when spring came.     

Spawning grounds and nests of Trachidermus fasciatus (Cottidae) in the Kashima and Shiota estuaries system facing Ariake Bay, Japan

 The spawning grounds of a cottid fish, Trachidermus fasciatus, were investigated off the mouth of the Kashima River in Ariake Bay from January to March, 1996–1999. The nests were found about 1.1–2.3 km off the mouth of the river, where the bottom salinity was 8‰–21‰ at low tides. Oyster shells were mainly found to be used as nests. A male, a pair, a male and egg clusters, a pair and egg clusters, or a female were found inside shells. The average number of guarded egg clusters per male in shells was 1.3 ± 0.4. Received: March 2, 2001 / Revised: September 17, 2001 / Accepted: November 13, 2001     

Hydrobiological analysis of a peat bog with emphasis on its planktonic diversity and population dynamics in Bumdeling Wildlife Sanctuary, eastern Bhutan

A pioneering limnological investigation was carried out in Bhutan in a small peat bog in the Trashiyangtse district (1950 m above sea level) from February 2000 to January 2002. The sampled pond water had low transparency (55.0–95.0 cm), was typically acidic (pH 5.69–6.58) with soft water (alkalinity, 11.0–36.0 mg/l; total hardness, 10.0–34.0 mg/l), and had low to moderate specific conductivity (17.0–62.0 μS/cm). Further, moderate Na (2.0–6.8 mg/l), K (1.8–13.5 mg/l), sulphate (0.85–2.99 mg/l), and silicate (2.5–15.0 mg/l) concentrations as well as low nutrient levels such as phosphate (0.006–0.170 mg/l) and nitrate (0.003–0.180 mg/l) characterize the water in the peat bog. The recorded net plankton comprised 27 species of phytoplankton and 49 species of zooplankton, with the latter indicating greater homogeneity and breaking down into Rotifera (23 species) > Cladocera (13 species) > Rhizopoda (8 species) > Copepoda (3 species) > Ostracoda = Nematoda (1 species each). On the other hand, the net plankton density ranged between 93 and 692 number/l (n/l) with numerical dominance by phytoplankton (68.5% ± 12%), of which Chlorophyceae were predominant (90 ± 63 n/l). Zooplankton showed moderately high diversity (2.745 ± 0.293) and evenness (0.925 ± 0.049) and exhibited almost equal abundance of four recorded groups, namely Cladocera (20 ± 15 n/l) > Rotifera (15 ± 6 n/l) > Copepoda (14 ± 7 n/l) > Rhizopoda (14 ± 4 n/l). While no significant impact of abiotic factors was recorded on zooplankton density, rainfall alone was the most important factor that influenced net plankton and various groups of phytoplankton. Comments on some comparative limnological attributes are also made with similar as well as different habitats in the nearby Himalayan countries.     

Growth pattern of <Emphasis Type="Italic">Bidens cernua</Emphasis> L.: relationships between relative growth rate and its physiological and morphological components

Seedlings of Bidens cernua L. emerged when mean air temperature was 17.0±1.3 °C. The highest net photosynthetic rate (P _N), 13.8±0.8 μmol(CO₂) m⁻² s⁻¹, was monitored during the vegetative period (May–August), decreasing on an average by 50 % during flowering (August–September) and during fruiting (September–November) phases. The senescence phase (October–November) was characterised by 79, 58, and 18 % decrease of P _N, chlorophyll content, and leaf area (LA), respectively, from the maximum values. The time span from seedling emergence to the end of fruiting phase was 202 d. The total plant biomass was 1.58±0.05 g of which 81 % was aboveground plant portion. The total dry mass relative growth rate averaged over the assimilation period was 0.0804±0.0002 kg kg⁻¹ d⁻¹, and it was correlated to both the net assimilation rate (NAR) and the leaf area ratio (LAR).     

A fatal free floating thrombus in left atrium

An 81 year old woman, diagnosed with rheumatic mitral valve disease and atrial fibrillation ten years previous, was admitted due to a right carotid transient ischemic attack and a acute coronary syndrome. No ST elevation was noted in the region supplied by the anterior descending artery coronary (troponin T increased and anterolateral negative waves T). In recent years years, she had maintained with (anticoagulants) an INR of 2.5-3.5; however, in the previous month the INR had dropped to 1.8. The transthoracic echocardiography showed an anterolateral hypokinesis and a globular hyperechoic mass of 2 x 4 cm which appeared to be a free floating thrombus in the dilated left atrium. This occasionally caused occlusion of the mitral valve, which itself had a severe rheumatic stenosis of approximately 1 cm2. Due to the high risk of occlusion of the mitral valve and systemic embolisms, the mitral valve replacement and thrombectomy was recommend to the patient. The patient refused this treatment and subsequently died 5 days later. This case emphasizes the importance of a suitable level of anticoagulation (INR between 2,5 and 3,5) in patients with mitral stenosis and chronic atrial fibrillation. These cases have a the high risk of thromboembolism, and urgent surgery is mandatory when a free floating left atrial thrombus is observed.     

Viability of free and encapsulated Escherichia coli overexpressing cyclopentanone monooxygenase monitored during model Baeyer–Villiger biooxidation by confocal laser scanning microscopy

Baeyer–Villiger biooxidation of 4-methylcyclohexanone–5-methyloxepane-2-one catalysed by recombinant Escherichia coli overexpressing cyclopentanone monooxygenase encapsulated in polyelectrolyte complex capsules was used to investigate effect of substrate conversion on the viability of cells. Confocal laser scanning microscopy (CLSM) was used to assess cell viability using propidium iodide fluorescence marker for necrosis, and flavin autofluorescence to identify living bacteria. Viability of encapsulated cells decreased with increasing substrate concentration from 99 ± 1 to 83 ± 4%, while substrate conversions from decreased 100 to 6 ± 1%. Storage stabilization of encapsulated cells was observed by increased substrate conversion form 68 ± 2 to 96 ± 3%. Measurements by CLSM with standard deviations up to 5% may be regarded as powerful tool for recombinant cell viability determination during Baeyer–Villiger biooxidations.     

Open-heart surgery in elderly patients.

Between March 1975 and March 1980, 50 patients aged 70 to 78 years underwent open-heart surgery at the Montreal Heart Institute. Coronary bypass was performed in 23 patients, valve replacement in 16 and combined coronary and valve surgery in 11. There were four early deaths, all due to cardiac causes. Early postoperative complications occurred in 58% of the patients. There were seven late deaths, five in the valve replacement groups and two in the isolated coronary bypass group. The cumulative survival rate 5 years after surgery was estimated at 76%. While 82% of the survivors were in functional class III or IV before surgery, 90% were in class I or II when last seen, after an average postoperative follow-up of 3 years. Nonfatal late complications occurred in eight of the survivors, one of whom suffered a major hemorrhage due to anticoagulant therapy. Thus, open-heart operations can be offered to the elderly, with a low risk of operative death. The late clinical improvement, with a return to a normal lifestyle, justifies a surgical approach for patients in otherwise good general condition.     

Heavy snoring with upper airway resistance syndrome may induce intrinsic positive end-expiratory pressure

We studied eightheavy snorers with upper airway resistance syndrome to investigatepotential effects of sleep on expiratory airway and lungresistance, intrinsic positive end-expiratory pressure,hyperinflation, and elastic inspiratory work of breathing (WOB).Wakefulness and non-rapid-eye-movement sleep with high- and withlow-resistance inspiratory effort (H-RIE and L-RIE, respectively) werecompared. No differences in breathing pattern were seen across thethree conditions. In contrast, we found increases in expiratory airwayand lung resistance during H-RIE compared with L-RIE and wakefulness(56 ± 24, 16 ± 4, and 11 ± 4 cmH₂O · l¹ · s,respectively), with attendant increases in intrinsic positive end-expiratory pressure (5.4 ± 1.8, 1.4 ± 0.5, and 1.3 ± 1.3 cmH₂O, respectively) andelastic WOB (6.1 ± 2.2, 3.7 ± 1.2, and 3.4 ± 0.7 J/min, respectively). The increase in WOB during H-RIE is partly causedby the effects of dynamic pulmonary hyperinflation produced by theincreased expiratory resistance. Contrary to the Starling model, amultiple-element compliance model that takes into account theheterogeneity of the pharynx may explain flow limitation duringexpiration.