Periprocedural routines of coronary angioplasty--extreme diversity with unrevealed consequences

Our objective was to evaluate the current trends of coronary angioplasty periprocedural care in the state of Israel. PTCA technology has undergone through some major developments and refinements, which have yielded new algorithms and routines. With this shift of paradigms, some of the periprocedural routines (these include medications and dosing before, during and after the procedure, as well as the handling of anti-coagulation, femoral sheath removal and the extent of patient monitoring post-PTCA) have been partially re-established. In order to assess trends in periprocedural care, we elected to analyze the current state of practice in the state of Israel. A questionnaire was sent to every cardiac catheterization laboratory in Israel that performs PTCA. An authorized senior cardiologist representing the laboratory submitted the information required for our survey. A nurse-to-nurse telephone questionnaire was conducted simultaneously to cross-examine the validity of the data. All centers submitted results. The average heparin dose for PTCA varied between 5000 and 15 000 units, ACT was monitored routinely by some and not at all by others, post-PTCA heparin administration was routinely administered by some institutions and not by others, and the mean femoral sheath dwell time ranged from 4 to 18 h. Post-PTCA cardiac monitoring varied from 6 to more than 24 h. Some institutions prescribed to all patients nitrates, calcium channel blockers and low-molecular-weight heparin, while others did not. We conclude that there is profound variability in the periprocedural routines that may translate into a significant cost increase, patient discomfort, a prolonged monitoring and hospital stay, and potential patient morbidity. We suggest that these routines should be critically evaluated, and that if they do not contribute to the procedural success and patient well-being they should be abandoned.     

The regulation of pyocyanin production in Pseudomonas aeruginosa

Summary Pyocyanin was produced only after the exponential phase of growth on all media examined. Pyocyanin was also found to be produced in response to some nutrient limitation (for example, carbon or oxygen). Furthermore, by controlling the growth rate at less than approximately 0.1 h^–1 the repression of pyocyanin production could be overcome to a large degree. An inverse relationship existed at low growth rates between growth rate and pyocyanin production, with a decrease in growth rate resulting in increased pyocyanin levels.Therefore, pyocyanin production appeared to be regulated by the energy status of the cell which would be lowered under conditions of low nutrient concentration, resulting in a decrease in growth rate and an increase in the level of pyocyanin produced. Under conditions of readily available nutrients the energy generating capacity of the cell was increased resulting in an increased growth rate and repression of pyocyanin.The ability of uncouplers of oxidative phosphorylation (e.g. CCCP and FCCP) to induce pyocyanin production, and of inhibitors of the membrane-bound ATPase (e.g. DCCD and sodium azide) to repress pyocyanin production, confirmed the existance of an energy mediated regulatory mechanism. Indeed, the evidence presented here along with the reported regulatory role of inorganic phosphate in pyocyanin production, suggests that production of this antibiotic may be regulated by intracellular ATP levels.     

High frequencies of de novo CNVs in bipolar disorder and schizophrenia

While it is known that rare copy-number variants (CNVs) contribute to risk for some neuropsychiatric disorders, the role of CNVs in bipolar disorder is unclear. Here, we reasoned that a contribution of CNVs to mood disorders might be most evident for de novo mutations. We performed a genome-wide analysis of de novo CNVs in a cohort of 788 trios. Diagnoses of offspring included bipolar disorder (n?= 185), schizophrenia (n?= 177), and healthy controls (n?= 426). Frequencies of de novo CNVs were significantly higher in bipolar disorder as compared with controls (OR?= 4.8 [1.4,16.0], p?= 0.009). De novo CNVs were particularly enriched among cases with an age at onset younger than 18 (OR?= 6.3 [1.7,22.6], p?= 0.006). We also confirmed a significant enrichment of de novo CNVs in schizophrenia (OR?= 5.0 [1.5,16.8], p?= 0.007). Our results suggest that rare spontaneous mutations are an important contributor to risk for bipolar disorder and other major neuropsychiatric diseases.     

London Education and Inclusion Project (LEIP): Exploring Negative and Null Effects of a Cluster-Randomised School-Intervention to Reduce School Exclusion—Findings from Protocol-Based Subgroup Analyses

This paper presents subgroup analyses from the London Education and Inclusion Project (LEIP). LEIP was a cluster-randomised controlled trial of an intervention called Engage in Education-London (EiE-L) which aimed to reduce school exclusions in those at greatest risk of exclusion. Pupils in the control schools attended an hour-long employability seminar. Minimisation was used to randomly assign schools to treatment and control following baseline data collection. The study involved 36 schools (17 in treatment—373 pupils; 19 in control—369 pupils) with >28% free school meal eligibility across London and utilised on pupil self-reports, teacher reports as well as official records to assess the effectiveness of EiE-L. Due to multiple data sources, sample sizes varied according to analysis. Analyses of pre-specified subgroups revealed null and negative effects on school exclusion following the intervention. Our findings suggest that the design and implementation of EiE-L may have contributed to the negative outcomes for pupils in the treatment schools when compared to those in the control schools. These findings call into question the effectiveness of bolt-on short-term interventions with pupils, particularly those at the highest risk of school exclusion and when they are faced with multiple problems. This is especially pertinent given the possibility of negative outcomes.Trial Registration: Controlled Trials: ISRCTN23244695     

The behaviour of yeast flocs in hindered settling and fluidized bed regimes

Summary Sedimentation and fluidization of yeast flocs were found to be non-synonymous processes. The analysis of Richardson and Zaki (1954) was found not to hold when applied to yeast flocs in both regimes. Partial support and channelling were implicated in the deviations from idela behaviour. Other factors responsible for the behaviour of yeast flocs in these regimes are discussed.Symbols D bed height (cm) - g gravitational constant (981 cm·s^-1) - n constant (-) - R retardation factor (s) - S constant (-) - v liquid/particle velocity (cm·s^-1) - V _o particle terminal velocity (cm·s^-1) - bed voidage (-)     

The influence of yeast metabolism on dispersion in a fluidised yeast bed

Summary The effect of yeast metabolism on the dispersion characteristics of a fluidised bed fermentor containing flocs of the yeast Saccharomyces carlsbergensis was investigated. Dispersion in the metabolizing fluidised yeast floc system was compared with the dispersion in an inert yeast floc system and in a glass bead system. Breakdown in plug-flow was found to occur in the metabolically active yeast bed when the flow rate was increased over a relatively narrow operating range (up to a dilution rate of 0.08 h^-1). The superficial liquid velocity at which perfect mixing was approximated was some 18 times greater in the inert yeast floc system than in the metabolizing yeast floc system.Abbreviations C Tracer concentration - C ₀ Concentration of tracer at time t=0 - V Mixing chamber volume - v Volumetric flow rate - l Time - t Mean residence time - N Number of tanks in series - D/l Dispersion number - ² variance     

Beyond C4: Analysis of the complement gene pathway shows enrichment for IQ in patients with psychotic disorders and healthy controls

Variation in cognitive performance, which strongly predicts functional outcome in schizophrenia (SZ), has been associated with multiple immune‐relevant genetic loci. These loci include complement component 4 (C4A), structural variation at which was recently associated with SZ risk and synaptic pruning during neurodevelopment and cognitive function. Here, we test whether this genetic association with cognition and SZ risk is specific to C4A, or extends more broadly to genes related to the complement system. Using a gene‐set with an identified role in “complement” function (excluding C4A), we used MAGMA to test if this gene‐set was enriched for genes associated with human intelligence and SZ risk, using genome‐wide association summary statistics (IQ; N = 269 867, SZ; N = 105 318). We followed up this gene‐set analysis with a complement gene‐set polygenic score (PGS) regression analysis in an independent data set of patients with psychotic disorders and healthy participants with cognitive and genomic data (N = 1000). Enrichment analysis suggested that genes within the complement pathway were significantly enriched for genes associated with IQ, but not SZ. In a gene‐based analysis of 90 genes, SERPING1 was the most enriched gene for the phenotype of IQ. In a PGS regression analysis, we found that a complement pathway PGS associated with IQ genome‐wide association studies statistics also predicted variation in IQ in our independent sample. This association (observed across both patients and controls) remained significant after controlling for the relationship between C4A and cognition. These results suggest a robust association between the complement system and cognitive function, extending beyond structural variation at C4A.     

Neurons with Complex Karyotypes Are Rare in Aged Human Neocortex

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