Muscular Subaortic Stenosis: The Initial Left Ventricular Inflow Tract Pressure as Evidence of Outflow Tract Obstruction

Two types of intraventricular pressure differences within the left ventricle of man are described. The first is encountered in cases of muscular (or fibrous) subaortic stenosis, in which the outflow tract pressure distal to the stenosis (and proximal to the aortic valve) is low, whereas all pressures recorded in the left ventricle proximal to the stenosis, including that just inside the mitral valve (the initial inflow tract pressure) are high.The second type of intraventricular pressure difference may be recorded in patients without muscular subaortic stenosis when a heart catheter is advanced to the left ventricular wall in such a manner that it becomes imbedded or entrapped by cardiac muscle in systole. Such an entrapped catheter records a high intraventricular pressure that is believed to reflect intramyocardial tissue pressure, which normally exceeds intracavitary pressure. In such cases the initial inflow tract pressure is not high and is precisely equal to the outflow tract systolic pressure, i.e. both are recording intracavity pressure. This type of intramyocardial to intracavitary pressure difference may also be encountered in the left ventricle of dogs.The recent suggestion that intraventricular pressure differences in the left ventricle of cases of muscular subaortic stenosis are due to catheter entrapment by cardiac muscle is refuted by using the initial inflow tract pressure as the means of differentiation between the two types of intraventricular pressure differences outlined.     

Variable site of airway narrowing among obstructive sleep apnea patients

The purpose of this was to determine whether the site of physiological narrowing within the upper airway was uniform or differed among patients with obstructive sleep apnea. Inspiratory pressures were measured with an esophageal balloon catheter and three catheters located at different sites along the upper airway: supralaryngeal airway, oropharynx, and nasopharynx. Peak inspiratory pressure differences between catheters allowed assessment of pressure gradients across three airway segments: lungs-larynx-retroepiglottal airway (esophageal-supralaryngeal pressure), hypopharynx (supralaryngeal-oropharynx pressure), and transpalatal airway (oropharynx-nasopharynx pressure). In five patients, hypopharyngeal obstruction was present, and in four patients no hypopharyngeal obstruction existed. In these four patients the site of obstruction was located at the level of the palate. In a given subject, the site of obstruction was the same during repeated measurements. The presence or absence of hypopharyngeal narrowing during sleep was not predictable from gradients measured across different segments of the upper airway during wakefulness. We conclude that the site of physiological upper airway obstruction varies among patients with obstructive sleep apnea and is not predictable from pressure measured during wakefulness. We speculate that uvulopalatopharyngoplasty may not relieve obstructive apneas in patients with hypopharyngeal obstruction.     

Electric Dipole Theory of Chemical Synaptic Transmission

In this paper we propose that chemicals such as acetylcholine are electric dipoles which when oriented and arranged in a large array could produce an electric field strong enough to drive positive ions over the junction barrier of the post-synaptic membrane and thus initiate excitation or produce depolarization. This theory is able to explain a great number of facts such as cleft size, synaptic delay, nonregeneration, subthreshold integration, facilitation with repetition, and the calcium and magnesium effects. It also shows why and how acetylcholine could act as excitatory or inhibitory transmitters under different circumstances. Our conclusion is that the nature of synaptic transmission is essentially electrical, be it mediated by electrical or chemical transmitters.     

Wedge pressure in large vs. small pulmonary arteries to detect pulmonary venoconstriction

Pulmonary arterial wedge pressure measures the pressure where blood flow resumes on the venous side. By occlusion of a large artery, the point where blood flow resumes will be in or near the left atrium. However, by occlusion of a small artery, it is possible to shift the point where flow resumes to a more proximal site in the veins and thus measure a pressure within the small veins. Increased pulmonary venous pressure, as a result of partial obstruction in the large veins, may not be detected by wedging a Swan-Ganz catheter in a large artery but may be detected by wedging in a small artery. We demonstrated this phenomenon in open-chest dogs by mechanically obstructing the left lower lobar vein or by infusing histamine to cause a generalized pulmonary venoconstriction. The wedge pressure measured by a 7-F Swan-Ganz catheter, with its balloon inflated in the main left lower lobar artery, nearly equaled left atrial pressure. On the other hand, the wedge pressure measured with a 7-F, 5-F, or a PE-50 catheter advanced into a small artery (without a balloon) was considerably higher than left atrial pressure. These results suggest that high resistance in the pulmonary veins can be demonstrated with the Swan-Ganz catheter by comparing the pressures obtained with the catheter wedged in a small and large artery.     

90% of general hospital care now accredited

Embolization of catheter fragments or fractured spring guidewires used during cardiac catheterization or fractured central venous pressure (CVP) lines is not uncommon. Although CVP lines are usually used in seriously ill patients, often with complications secondary to prior surgical intervention, if the catheter fragments are not removed they can give rise to serious illness or death in about 50% of patients. Experience with the removal of nine such catheter fragments is reported. In eight patients a helical basket was available for removal through a Dotter retrieval catheter. With prolonged hyperalimentation therapy polyethylene catherters become very brittle. They are relatively easy to grip with the wire basket. Silicone elastomer catheters remain pliable but are so bouncy that they are difficult to grip. For removal of catheter fragments from vessels of small diameter, such as the subclavian vein, or vessels in which the catheter has to take an acute bend to enter, such as the right or left pulmonary artery, a smaller, more pliable Bean-Smith-Mahorner biliary stone helical basket was adapted by extending the length of wire to 100 cm. For removal of catheter fragments from the right pulmonary artery it is probably better to use a softer, 100-cm-long no. 8 French right heart catheter. A Dotter retriever catheter set with both large and small helical wire baskets should be available in any cardiac catheterization laboratory.     

A Transtracheal Catheter for Recording the Static Tracheal Pressure in the Exercising Horse

After giving an account of the principles of pressure measurement in flowing air and a review of the literature on tracheal catheters, the authors describe the construction, the introduction and the function of their own transtracheal catheter. This is a teflon catheter with several side–ports which is introduced into the cervical trachea by a guide technique. After introduction, the catheter is stiffened by the insertion of 2 steel wires. The catheter was studied in model experiments concerning: a) the ability to measure the static pressure in flowing air, and b) the dynamic accuracy of a recording system built up around the catheter. The results indicated that the intratracheal pressure sensed in exercising horses well reflected the static pressure, and that the dynamic accuracy of the recording system was good to about 60 Hz. The present technique of recording the intratracheal pressure was used on 122 occasions in 69 exercising horses with only one complication referable to the catheter occurring. The transtracheal route of catheterisation may be superior, as catheters introduced by this route do not appear to influence the function of the pharynx and larynx. In contrast, nasotracheal catheters that traverse the larynx, might interfere with the respiratory function. kw|Keywords|k]upper airway obstruction k]frequency response     

Effect of catheter size on pressures recorded in small pulmonary veins in dog lung.

Controversy continues about the contribution of the veins to pulmonary vascular resistance. From data obtained in studies using intravascular catheters, it appears that a major fraction (up to 44%) of the total pulmonary vascular pressure drop resides in larger (greater than 1.0 mm diam) veins, whereas micropuncture data and various models give much less pressure drop. Theoretically, artifactual pressure drops can be obtained if an intravascular catheter partly obstructs the vessel. We made measurements of pressure in the same lung vein with two different-sized catheters (1.2 and 0.6 mm OD, respectively). In paired experiments the larger catheter always measured a higher pressure than the smaller one, except close to the large lobar vein outlet. In some of the experiments we measured the diameter of the vessel containing the indwelling catheter by freezing the lung and then serial-sectioned the frozen lung. From these data we could infer that the range of vein diameter in the which the smaller catheter measured a lower pressure was 1.5-4 mm. We conclude that the larger catheter overestimated the pressure because of greater obstruction. The pressures obtained with the smaller catheter suggest that little (less than 10%) of the total pulmonary vascular resistance resides in veins larger than approximately 1 mm diam under zone 3 baseline conditions.     

In search of a 9q13 latent centromere in 9qh polymorphic inversions

In search of a 9q13 latent centromere in 9qh polymorphic inversions: The presence of alphoid sequences in 9q13 has prompted the suggestion that such a region could harbor a latent centromere which under certain circumstances may appear as a neocentromere. We tested this hypothesis by means of FISH with a centromere 9-specific alphoid probe in lymphocyte metaphases from 13 unrelated individuals with a 9qh polymorphic inversion. Since all inverted chromosomes had the alphoid signal onto the primary constriction, it was not possible to identify any neocentromere . We believe, however, that the number of cases was not enough to conclude that all the polymorphic inversions of chromosome 9 are genuine.     

Vacuum-assisted perfusion of the dog hindlimb

A method for rapidly changing perfusion pressure to the relatively intact dog hindlimb using vacuum assistance is proposed and demonstrated. The hindlimb of an anesthetized dog is inserted into a rigid sealed enclosure for application of a partial vacuum. The circulation of the hindlimb remains entirely intact except for a single large noncollapsible catheter placed in the femoral vein and connected to a servo-pump. The servo-pump maintains the venous pressure equal to the enclosure pressure even when this pressure is in the partial vacuum state. The automatically adjusted pumping rate of this pump also provides a continuous measure of the blood flow in the limb as it returns the blood via a jugular catheter. In nine dogs the systemic arterial pressure was maintained constant, and the enclosure pressure and venous pressure were set to subatmospheric levels, thus changing the perfusion pressure to any desired value up to 220 mmHg. The procedure had minimal impact on the central circulation, suggesting that the technique may be useful in studying hemodynamics of the hindlimb or other organs at high perfusion pressure, which has always been difficult to achieve experimentally. In the nine dogs, blood flow responses were observed at both elevated and reduced perfusion pressure. The changes in measured blood flow induced by the changes in perfusion pressure were variable but were generally directly proportional to perfusion pressure in the steady state.     

Recommendations for the routine sampling of diatoms for water quality assessments in Europe

Many methods for using diatoms for routine monitoring of water quality have been developed in Europe and, in some countries, these are being used to enforce environmental legislation. In order to facilitate their wider use, particularly with respect to European Union legislation, steps are being taken to harmonize methodology. In this paper, the principles and practice of sampling are described in relation to the main habitat types encountered in Europe. Although details of methods and sampling programmes have to be tailored to particular circumstances and the overall objectives of the monitoring, a number of generalizations can be made. Where available, rocks and other hard surfaces are the preferred substrates and methods for sampling these are described. If such substrata are not available, then introduced ('artificial') substrata have many applications. Various types of introduced substrata can be used successfully, so long as some basic precautions are described. Other types of substrata such as macrophytes and macroalgae may also be useful under certain circumstances, although there is less consensus in the literature on the most appropriate methods, and of the validity of comparisons between indices computed from epiphytic and epilithic communities. When designing surveys, it is recommended that as far as possible, extremes of non-water quality factors (e.g. shade, current speed, etc) are avoided, unless these are characteristic of the system under investigation. Detailed guidelines for sampling epilithon are described. Along with the recommendations for sampling other substrata, it is hoped that these provide a framework that can be adapted to most river types in Europe. This revised version was published online in June 2006 with corrections to the Cover Date.     

High blood pressure: hunting the genes.

High blood pressure is a disease of unknown cause. Family history of the disease indicates higher risk, but it is not known which genes are involved or how they interact with environmental influences to produce the disorder. Molecular biology offers an approach to problems that have not so far been solved by classical physiology or biochemistry. By analysing polymorphic variation in chromosome markers such as minisatellite sequences, or by restriction fragment polymorphism analysis of candidate genes, attempts are being made to link genetic variations with hypertension. In genetically hypertensive rats, hypertension is associated with a polymorphism of the renin gene and with other loci on chromosomes 10 and 18. The role of these loci in human hypertension remains to be determined. Other genes such as sodium-lithium countertransport may be involved. Environmental factors such as stress or salt intake could influence the rate or timing of expression of certain genes and thus result in hypertension.     

Assisted migration within species range ignores biotic interactions and lacks evidence

In the context of climate change, many plant species may have problems adapting or dispersing rapidly enough to keep pace with changing environmental conditions. Given these potential problems, some experts argue against using local plant ecotypes for ecosystem restoration. Instead, they propose to use foreign ecotypes that are adapted to the predicted climate in an approach called assisted migration within species range or predictive provenancing. I argue that such actions may cause a mismatch in biotic interactions and have negative effects on other organisms. As such, assisted migration should only be considered in cases when the local ecotypes would fail to ensure ecosystem services. In fact, there is little experimental evidence on the assisted migration approach so far, and what little there is does not seem to support its use. Even in altered climates, local ecotypes mostly performed equally well or better than foreign ones selected for their adaptations to these climates. The reason is that even if adaptation to climate plays a role, this factor may be overridden by other drivers of local adaptation, such as soil or biotic interactions. Despite assisted migration being a popular concept that is repeatedly commended in scientific literature and propagated among practitioners, it should not be considered a universal tool to improve restoration outcomes during climate change. Given the lack of hard experimental data, I call for large‐scale multispecies experimental studies that will provide the necessary evidence to derive general guidelines and recommendations for management of ecosystems during climate change.     

A self-powered constant infusion device for use in unrestrained rats

We developed a device that delivers fluid through a catheter at a constant rate and can be used in conscious animals to solve a variety of problems. For example, this device can be used for delivering drugs and maintaining intravascular catheter patency. The device provides infusions at low flows (1.0-1.5 ml/day), so that experimental agents may be administered with minimal volume loading of the rat. Arterial and venous catheter patency is maintained by infusion of heparinized saline through indwelling catheters attached to the device. The catheters exit from the rat in the intrascapular area and are routed through a protective spring to the device, which is suspended above the cage. The catheters may be attached to pressure transducers, blood may be sampled, and injections or infusions may be made without disturbing the rat. Because the device is self-contained, it can be suspended by a fluid-free swivel that rotates through 360 degrees, providing minimal restraint. The device has been used successfully to measure arterial and central venous blood pressures in two studies using rats.     

Fumarate: Multiple functions of a simple metabolite

Although much is now known about fumarate metabolism, our knowledge of some aspects of its biological function remain far from comprehensive. In this short review we begin with an introductory overview of the role of fumarate in both plant and non-plant systems. We next highlight the relative importance of fumarate in relation to cell type and circumstance in contrast to other chemically similar organic acids. Considerable cumulative evidence is suggestive of a role for fumarate in pH regulation during nitrate assimilation and that fumarate has similar effects as malate during stomatal movement. Indeed it is currently difficult to separate the biological function of fumarate from malate under certain circumstances. However, in other cases this can be easily performed. This physiological complexity notwithstanding it remains possible that the engineering of fumarate metabolism may provide opportunities to improve plant growth and performance.     

A framework for phylogenetic sequence alignment

A phylogenetic alignment differs from other forms of multiple sequence alignment because it must align homologous features. Therefore, the goal of the alignment procedure should be to identify the events associated with the homologies, so that the aligned sequences accurately reflect those events. That is, an alignment is a set of hypotheses about historical events rather than about residues, and any alignment algorithm must be designed to identify and align such events. Some events (e.g., substitution) involve single residues, and our current algorithms can successfully align those events when sequence similarity is great enough. However, the other common events (such as duplication, translocation, deletion, insertion and inversion) can create complex sequence patterns that defeat such algorithms. There is therefore currently no computerized algorithm that can successfully align molecular sequences for phylogenetic analysis, except under restricted circumstances. Manual re-alignment of a preliminary alignment is thus the only feasible contemporary methodology, although it should be possible to automate such a procedure.     

Evolutionarily stable defence and signalling of that defence

We examine the evolution and maintenance of defence and conspicuousness in prey species using a game theoretic model. In contrast to previous works, predators can raise as well as lower their attack probabilities as a consequence of encountering moderately defended prey. Our model predicts four distinct possibilities for evolutionarily stable strategies (ESSs) featuring maximum crypsis. Namely that such a solution can exist with (1) zero toxicity, (2) a non-zero but non-aversive level of toxicity, (3) a high, aversive level of toxicity or (4) that no such maximally cryptic solution exists. Maximally cryptic prey may still invest in toxins, because of the increased chance of surviving an attack (should they be discovered) that comes from having toxins. The toxin load of maximally cryptic prey may be sufficiently strong that the predators will find them aversive, and seek to avoid similar looking prey in future. However, this aversiveness does not always necessarily trigger aposematic signalling, and highly toxic prey can still be maximally cryptic, because the increased initial rate of attack from becoming more conspicuous is not necessarily always compensated for by increased avoidance of aversive prey by predators. In other circumstances, the optimal toxin load may be insufficient to generate aversion but still be non-zero (because it increases survival), and in yet other circumstances, it is optimal to make no investment in toxins at all. The model also predicts ESSs where the prey are highly defended and aversive and where this defence is advertised at a cost of increased conspicuousness to predators. In many circumstances there is an infinite array of these aposematic ESSs, where the precise appearance is unimportant as long as it is highly visible and shared by all members of the population. Yet another class of solutions is possible where there is strong between-individual variation in appearance between conspicuous, poorly defended prey.     

Coronary pressure and FFR predict long-term outcome after PTCA

Although coronary stents have been the most important improvement in percutaneous coronary interventions in the last 10 years, it is well known to interventionalists that many patients after percutaneous transluminal coronary angioplasty (PTCA) have a favourable outcome without stenting. Coronary angiography, however, is not sensitive enough to identify those particular patients and it has been suggested that a combination of angiographic and functional criteria would be more suitable to distinguish patients with a low restenosis chance after plain balloon angioplasty. In the present study, the authors investigated the value of coronary pressure measurement for conditional stenting in 85 patients. It was demonstrated that in patients in whom a high fractional flow reserve (FFR) was present (> 0.90), the incidence of coronary events at two-year follow-up was almost three times lower than in those patients with an FFR below 0.90. Such high FFRs could be obtained in approximately 45% of all patients. In an additional group of patients, it was demonstrated by intravascular ultrasound (IVUS) studies that the mechanism of a high FFR after plain balloon angioplasty is most likely the result of a larger lumen compared with patients with a suboptimal FFR. This means that, in patients in whom both the angiographic and the functional result after PTCA is optimal, a restenosis rate is achieved similar to that achieved by stenting. Obviously, in such patients, additional stenting and a number of problems in the long-term possibly related to stenting can be avoided. Therefore, coronary angiography and coronary pressure measurement have a complementary value in the evaluation of PTCA results and such information can be easily obtained by using a pressure wire instead of a regular guidewire.     

Reflections on the history and ethics of the proper attribution and misappropriation of merit

One would expect that the first to arrive at a new observation, discovery, or concept would be properly acknowledged as such. Unfortunately, it is not unusual that someone else receives the credit. This is not just unfair and unethical, but it also distorts the history of science. In addition, the victims of misattribution are deeply affected by losing not only the recognition of being first, but also the credit, kudos, and other benefits that derive from their contribution. This issue deserves far more attention than it currently receives. It continues to cause much mischief in the most unexpected places and under circumstances that should not be tolerated. This article looks at the consequences of some instances of misattribution in the history of science and argues that researchers should make a stronger effort to expose and rectify such cases. In most instances, all that is required is to double-check the data.     

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and cardiac arrest. This elevation may result in further neurological injury, in the form of transtentorial herniation^1,2,3,4, midbrain compression, neurological deficit or increased cerebral infarct^2,4. Current therapies are often inadequate to control elevated ICP in the clinical setting^5,6,7 . Thus there is a need for accurate methods of ICP measurement in animal models to further our understanding of the basic mechanisms and to develop new treatments for elevated ICP.In both the clinical and experimental setting ICP cannot be estimated without direct measurement. Several methods of ICP catheter insertion currently exist. Of these the intraventricular catheter has become the clinical ''gold standard'' of ICP measurement in humans⁸. This method involves the partial removal of skull and the instrumentation of the catheter through brain tissue. Consequently, intraventricular catheters have an infection rate of 6-11%⁹. For this reason, subdural and epidural cannulations have become the preferred methods in animal models of ischemic injury. Various ICP measurement techniques have been adapted for animal models, and of these, fluid-filled telemetry catheters¹⁰ and solid state catheters are the most frequently used^{11,12,13,14,15}. The fluid-filled systems are prone to developing air bubbles in the line, resulting in false ICP readings. Solid state probes avoid this problem (Figure 1). An additional problem is fitting catheters under the skull or into the ventricles without causing any brain injury that might alter the experimental outcomes. Therefore, we have developed a method that places an ICP catheter contiguous with the epidural space, but avoids the need to insert it between skull and brain. An optic fibre pressure catheter (420LP, SAMBA Sensors, Sweden) was used to measure ICP at the epidural location because the location of the pressure sensor (at the very tip of the catheter) was found to produce a high fidelity ICP signal in this model. There are other manufacturers of similar optic fibre technologies¹³ that may be used with our methodology. Alternative solid state catheters, which have the pressure sensor located at the side of the catheter tip, would not be appropriate for this model as the signal would be dampened by the presence of the monitoring screw. Here, we present a relatively simple and accurate method to measure ICP. This method can be used across a wide range of ICP related animal models.     

Fulminating necrotizing amebic colitis with perforation: case report and review.

A seriously ill patient with diffuse abdominal tenderness of unknown cause is described. The diagnosis proved to be fulminating necrotizing amebic colitis with perforation. This case report serves as a reminder that amebiasis may occur in patients who have not been outside Canada, that it may readily be confused with other types of inflammatory bowel disease, and that particular care should be taken in obtaining a history of exposure. Before inflammatory bowel disease is diagnosed not only should the usual diagnostic tests such as stool examination and mucosal biopsy be done, but also serologic testing for amebiasis should be carried out.