NuMe Vintage Hot Pink Limited Edition 1.25″ Solid Ceramic Flat Iron / Hair Straightener Dual Voltage 110v – 240v : AvaxHome — Your End Place UPLOADED.net and other file hosting services blocked in USA? NO PROBLEM! Try out Zevera.com, the revolutionary multihoster!. Detailed information on our oldies CDs on a variety ofmisclabels The CD pages on our site are arranged by CD label or alphabetically. Click on any graphic below .

Thіѕ Best Promotion NuMe Vintage Hot Pink Limited Journal 1.25″ Solid Ceramic Flat Iron / Hair Straightener Dual Voltage 110v – 240v tends to SELL-OUT In Small Time! If іt іѕ MUST HAVE items, mаkе sure to Peacefulness Rіght Now аt Amazon.com to stay οff frοm disappointment.

Best Rated

NuMe Vintage Hot Pink Limited Journal 1.25″ Solid Ceramic Flat Iron / Hair Straightener Dual Voltage 110v – 240v

All уου′ll еνеr need to initiation perfect mane, movement, number, аnd straight hair, thankfulness to іtѕ advanced technologies аnd smart features. NuMe’s Vintage professional styling iron features a dynamic Alignment Logic to ensure perfect contact between уουr hair аnd thе 100% solid ceramic plates. It equipment even heat distribution fοr truly silky hair. Itѕ ceramic ion equipment wіll generate gentle far-infrared heat аnd extra negative ions to initiation thе perfect frizz free hair without heat hυrt. Kiss tеrrіblе hair days goodbye. FEATURES * 100% solid ceramic plates * 1 1/4″ floating plates design * Infra Red Heat Equipment * Negative Ion Equipment * Exclusive Heat Optimization Equipment * Ergonomic Design * Versatile * Adjustable Temperature C

• Cаn bе used 110v to 240v electricity.
• Nume’s Ion rich plates reduce static аnd eliminate frizz fοr shinier , smoother hair
• Infra Red Heat seals іn hairs natural moisture to give уου extra shine аnd luster.
• 1 1/4″ floating plates design
• 100% solid ceramic plates

Wе certainly hаνе explored thе web to find thе best quality prices available. Click Here to come асrοѕѕ thе best places to bυу thе best price οn NuMe Vintage Hot Pink Limited Journal 1.25″ Solid Ceramic Flat Iron / Hair Straightener Dual Voltage 110v – 240v

Check fοr Unique Price Today!

Neuregulin-1 (NRG-1) is a paracrine factor released by microvascular endothelial cells that has cardioprotective effects in animal models of heart failure. However, circulating NRG-1 has not been studied in human heart disease. We used a novel immunoassay to test whether circulating NRG-1beta is associated with disease severity and clinical outcomes in chronic heart failure.

Methods and Results
Serum NRG-1beta was quantified in 899 outpatients in the Penn Heart Failure Study, a referral cohort representing a broad spectrum of systolic heart failure. Circulating NRG-1beta was significantly elevated in patients with worse disease severity (median, 6.2 ng/mL for New York Heart Association class IV versus 4.4 ng/mL for class I; P=0.002).

In adjusted models, NRG-1beta was independently associated with an increased risk of death or cardiac transplantation over a median follow-up of 2.4 years (adjusted hazard ratio, 1.58; 95% confidence interval, 1.04 to 2.39; P=0.03 comparing fourth versus first NRG-1beta quartile). Associations with outcome differed by heart failure cause and symptom severity, with the strongest associations observed in patients with ischemic cardiomyopathy (interaction P=0.008) and New York Heart Association class III/IV symptoms (interaction P=0.01).

These findings were all independent of brain natriuretic peptide, and assessment of NRG-1beta and brain natriuretic peptide jointly provided better risk stratification than each biomarker individually in patients with ischemic or New York Heart Association class III/IV heart failure. Conclusions-Circulating NRG-1beta is independently associated with heart failure severity and risk of death or cardiac transplantation.

These findings support a role for NRG-1/ErbB signaling in human heart failure and identify serum NRG-1beta as a novel biomarker that may have clinical applications.



"Neuregulin-1{beta} Is Associated With Disease Severity and Adverse Outcomes in Chronic Heart Failure"
Circulation. 2009 Jul 13; Ky B, Kimmel SE, Safa RN, Putt ME, Sweitzer NK, Fang JC, Sawyer DB, Cappola TP

Hypertension (HTN) is a risk factor for dementia, and animal studies suggest that centrally active angiotensin-converting enzyme (ACE) inhibitors (those that cross the blood-brain barrier) may protect against dementia beyond HTN control.

METHODS:
Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n = 1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs).

RESULTS:
Among 414 participants who were exposed to ACE inhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88-1.15), difference in 3MSE scores (-0.32 points per year; P = .15), or odds of disability in IADLs (odds ratio [OR], 1.06; 95% CI, 0.99-1.14).

Adjusted results were similar. However, centrally active ACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P = .01), and noncentrally active ACE inhibitors were associated with a greater risk of incident dementia (adjusted HR, 1.20; 95% CI, 1.00-1.43 per year of exposure) and greater odds of disability in IADLs (adjusted OR, 1.16; 95% CI, 1.03-1.30 per year of exposure) compared with other anti-HTN drugs.

CONCLUSIONS:
While ACE inhibitors as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-class differences in regard to these outcomes. These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and dementia.



"Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the cardiovascular health study"
Arch Intern Med. 2009 Jul 13; 169(13): 1195-202Sink KM, Leng X, Williamson J, Kritchevsky SB, Yaffe K, Kuller L, Yasar S, Atkinson H, Robbins M, Psaty B, Goff DC

Endothelin-1 (ET-1) has been implicated in many cardiovascular diseases, including acute heart failure (AHF) due to myocardial ischemia. Previously we described the oral endothelin-converting enzyme (ECE) inhibitor, PP36, and in this study, we investigated its cardioprotective effect in more detail, and examined the role of PP36 in the neurohormonal activation in rats that had been subjected to acute myocardial ischemia due to the microsphere embolization of coronary microcirculation.

PP36 treatment (3.5x10-5 M/kg/day) led to a significant four-fold decrease in hypertensive response when big-ET-1 was administered to healthy, conscious rats. ECE inhibition did not affect mortality during the first 48 hours after ischemia initiation.

Systemic hemodynamic, heart function, and neurohormonal activation were analyzed in the healthy control group, the acute heart failure group, and the AHF+PP36 group two days after acute heart failure induction. In conscious rats in the AHF+PP36 group, mean arterial pressure (MAP) was restored and became similar to that of the MAP of the control group.

In anesthetized rats, in the AHF+PP36 group, MAP was not restored and was 22% lower than the MAP of the control group. Myocardial contractility was partially restored and cardiac relaxation significantly improved after PP36 application. Further analysis of cardiac output and peripheral resistance in anesthetized rats revealed no differences between the acute heart failure group and the AHF+PP36 group.

There were no differences in plasma ET-1 concentration, serum angiotensin converting enzyme activity, and in the adrenal glands' catecholamine content between the acute heart failure group and the AHF+PP36 group. However, rats in the AHF+PP36 group demonstrated a 60% decrease in cardiac endothelial nitric oxide synthase (eNOS) protein expression, and a 56% reduction of myocardial norepinephrine release, when compared with the acute heart failure group's animals.

These results suggest that PP36 can preserve heart function during the recovery from acute ischemic injury, and may modulate the cardiac norepinephrine release and eNOS protein level.



"Endothelin-converting enzyme inhibition in the rat model of acute heart failure: heart function and neurohormonal activation"
Exp Biol Med (Maywood). 2009 Jul 13; Rufanova VA, Pozdnev VF, Kalenikova EI, Postnikov AB, Storozhilova AN, Masenko VP, Gomazkov OA, Medvedev OS, Medvedeva NA

Hormonal therapy (HT) when added to radiation therapy (RT) for treating unfavorable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity. However, it is unknown which comorbid conditions eliminate this survival benefit.

OBJECTIVE:
To assess whether neoadjuvant HT use affects the risk of all-cause mortality in men with prostate cancer and coronary artery disease (CAD)-induced congestive heart failure (CHF) or myocardial infarction (MI), coronary artery disease (CAD) risk factors, or no comorbidity. DESIGN,

SETTING, AND PATIENTS:
A total of 5077 men (median age, 69.5 years) with localized or locally advanced prostate cancer were consecutively treated with or without a median of 4 months of neoadjuvant HT followed by RT at a suburban cancer center between 1997 and 2006 and were followed up until July 1, 2008. Cox regression multivariable analyses were performed assessing whether neoadjuvant HT use affected the risk of all-cause mortality, adjusting for age, year and type of RT, treatment propensity score, and known prostate cancer prognostic factors in each comorbidity group.

MAIN OUTCOME MEASURE:
Risk of all-cause mortality.

RESULTS:
Neoadjuvant HT use was not associated with an increased risk of all-cause mortality in men with no comorbidity (9.6% vs 6.7%, adjusted hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.72-1.32; P = .86) or a single coronary artery disease (CAD) risk factor (10.7% vs 7.0%, adjusted HR, 1.04; 95% CI, 0.75-1.43; P = .82) after median follow-ups of 5.0 and 4.4 years, respectively. However, for men with CAD-induced congestive heart failure (CHF) or MI, after a median follow-up of 5.1 years, neoadjuvant HT use was significantly associated with an increased risk of all-cause mortality (26.3% vs 11.2%, adjusted HR, 1.96; 95% CI, 1.04-3.71; P = .04).

CONCLUSION:
Neoadjuvant HT use is significantly associated with an increased risk of all-cause mortality among men with a history of CAD-induced congestive heart failure (CHF) or MI but not among men with no comorbidity or a single coronary artery disease risk factor.



"Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease-induced congestive heart failure or myocardial infarction."
JAMA. 2009 Aug 26; 302(8): 866-73Nanda A, Chen MH, Braccioforte MH, Moran BJ, D'Amico AV

Trastuzumab prolongs survival in patients with human epidermal growth factor receptor type 2-positive breast cancer. Sequential left ventricular (LV) ejection fraction (EF) assessment has been mandated to detect myocardial dysfunction because of the risk of heart failure with this treatment. Myocardial deformation imaging is a sensitive means of detecting LV dysfunction, but this technique has not been evaluated in patients treated with trastuzumab.

The aim of this study was to investigate whether changes in tissue deformation, assessed by myocardial strain and strain rate (SR), are able to identify LV dysfunction earlier than conventional echocardiographic measures in patients treated with trastuzumab.

METHODS:
Sequential echocardiograms (n = 152) were performed in 35 female patients (51 +/- 8 years) undergoing trastuzumab therapy for human epidermal growth factor receptor type 2-positive breast cancer.

Left ventricular EF was measured by 2- and 3-dimensional (2D and 3D) echocardiography, and myocardial deformation was assessed using tissue Doppler imaging and 2D-based (speckle-tracking) strain and SR. Change over time was compared every 3 months between baseline and 12 months.

RESULTS:
There was no overall change in 3D-EF, 2D-EF, myocardial E-velocity, or strain. However, there were significant reductions seen in tissue Doppler imaging SR (P < .05), 2D-SR (P < .001), and 2D radial SR (P < .001). A drop > or =1 SD in 2D longitudinal SR was seen in 18 (51%) patients; 13 (37%) had a similar drop in radial SR. Of the 18 patients with reduced longitudinal SR, 3 had a concurrent reduction in EF > or =10%, and another 2 showed a reduction over 20 months follow-up.

CONCLUSIONS:
Myocardial deformation identifies preclinical myocardial dysfunction earlier than conventional measures in women undergoing treatment with trastuzumab for breast cancer.


"Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab."
Am Heart J. 2009 Aug; 158(2): 294-301Hare JL, Brown JK, Leano R, Jenkins C, Woodward N, Marwick

This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF).

The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in Heart Failure.

Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 +/- 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings.

Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I Heart Failure had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction.

In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients.

These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with Heart Failure.


Ambulatory Blood Pressure and Physical Activity in Heart Failure
Biol Res Nurs. 2009 Jul 17; Tai MK, Meininger J, Frazier L, Chan W (Hubmed)


Related:
Study: Heart failure risk of blacks under 50 is 20 times
But the researchers found that a disproportionate number of blacks developed high blood pressure in their young adulthood and went on to suffer heart failure.
Heart failure can mean many things - Health and Science
The stethoscope that is used to check blood pressure will also be used to listen to your lungs for any signs of congestion and to detect abnormal heart sounds suggestive of failure.
Mineralocorticoid Signaling in Transition to Heart Failure
After anesthesia, instrumentation, and autonomic blockade, blood pressure was lower, whereas left ventricular (LV) systolic elastance, LV diastolic stiffness
Living With Heart Failure-How Congestive Heart Failure Impacts
It increases the heart rate and blood pressure while having a negative impact on the oxygen level in the blood. All of these things cause the heart to work harder.

J Gen Physiol. 2009 Jul 13; Brunet S, Scheuer T, Catterall WAL-type Ca(2+) currents conducted by Ca(v)1.2 channels initiate excitation-contraction coupling in cardiac myocytes. Intracellular Mg(2+) (Mg(i)) inhibits the ionic current of Ca(v)1.2 channels. Because Mg(i) is altered in ischemia and heart failure, its regulation of Ca(v)1.2 channels is important in understanding cardiac pathophysiology. Here, we studied the effects of Mg(i) on voltage-dependent inactivation (VDI) of Ca(v)1.2 channels using Na(+) as permeant ion to eliminate the effects of permeant divalent cations that engage the Ca(2+)-dependent inactivation process. We confirmed that increased Mg(i) reduces peak ionic currents and increases VDI of Ca(v)1.2 channels in ventricular myocytes and in transfected cells when measured with Na(+) as permeant ion. The increased rate and extent of VDI caused by increased Mg(i) were substantially reduced by mutations of a cation-binding residue in the proximal C-terminal EF-hand, consistent with the conclusion that both reduction of peak currents and enhancement of VDI result from the binding of Mg(i) to the EF-hand (K(D) approximately 0.9 mM) near the resting level of Mg(i) in ventricular myocytes. VDI was more rapid for L-type Ca(2+) currents in ventricular myocytes than for Ca(v)1.2 channels in transfected cells. Coexpression of Ca(v)beta(2b) subunits and formation of an autoinhibitory complex of truncated Ca(v)1.2 channels with noncovalently bound distal C-terminal domain (DCT) both increased VDI in transfected cells, indicating that the subunit structure of the Ca(v)1.2 channel greatly influences its VDI. The effects of noncovalently bound DCT on peak current amplitude and VDI required Mg(i) binding to the proximal C-terminal EF-hand and were prevented by mutations of a key divalent cation-binding amino acid residue. Our results demonstrate cooperative regulation of peak current amplitude and VDI of Ca(v)1.2 channels by Mg(i), the proximal C-terminal EF-hand, and the DCT, and suggest that conformational changes that regulate VDI are propagated from the DCT through the proximal C-terminal EF-hand to the channel-gating mechanism.

Medicine (Baltimore). 2009 Jul; 88(4): 236-43Neumann T, Manger B, Schmid M, Kroegel C, Hansch A, Kaiser WA, Reinhardt D, Wolf G, Hein G, Mall G, Schett G, Zwerina JCardiac disease is a major contributor to disease-related death in Churg-Strauss syndrome (CSS). We conducted the current study to determine the prevalence and clinical impact of cardiac involvement in CSS patients. We performed a multicenter, cross-sectional analysis of patients diagnosed with CSS. Cardiac workup included electrocardiography, echocardiography, cardiac magnetic resonance imaging (MRI), and endomyocardial biopsy.We analyzed 49 patients with CSS: 22 patients had clinical evidence of cardiac involvement. A negative antineutrophil cytoplasmic antibodies (ANCA) test and much higher eosinophil counts (9947 vs. 3657/microL, respectively, p < 0.001) distinguished patients with cardiac involvement from those without. Impaired left ventricular function (50%), mild to severe valvular insufficiencies (73%), and pericardial effusions (41%) were common findings in these patients. Endomyocarditis was found in 13 patients (59%) as detected by cardiac MRI, cardiac thrombus formation, and endomyocardial biopsy, and was associated with impaired cardiac function. After a mean follow-up of 47 months, most patients had regained or maintained good cardiac function. However, patients with endomyocarditis had a more severe outcome. Two patients died (61 and 99 mo after diagnosis, respectively), both due to severe cardiomyopathy and heart failure.Cardiac involvement is common in patients with CSS and is associated with the absence of ANCA and high eosinophil counts. Endomyocarditis may represent the most severe manifestation eventually causing fatal outcome. A structured clinical assessment incorporating cardiac imaging with echocardiography and MRI can identify impaired cardiac function and endomyocardial abnormalities.

Exp Physiol. 2009 Jul 10; Boyett MThe Cardiac Conduction System (CCS), consisting of the sinoatrial node, atrioventricular node and His-Purkinje system, is responsible for the initiation and coordination of the heart beat. In the last decade, our understanding of the CCS has been transformed. Immunohistochemistry used in conjunction with anatomical techniques has transformed our understanding of its anatomy: arguably, we now understand the position of the sinoatrial node (not the same as in medical textbooks) and our new understanding of the atrioventricular node anatomy means that we can compute its physiological and pathophysiological behaviour. Ion channel expression in the CCS has been shown to be fundamentally different to that in the working myocardium. Dysfunction of the CCS has previously been attributed to fibrosis, but it is now clear that remodelling of ion channels plays an important role in dysfunction during ageing, heart failure and atrial fibrillation. Differences in ion channel expression may even be responsible for the bradycardia in the athlete and differences in heart rate among different species (such as human and mouse). Recent work has highlighted less well known components of the CCS, including tricuspid, mitral and aortic rings and even a third (retroaortic) node. These additional tissues do not participate in the initiation and coordination of the heart beat and instead they are likely to be the source of various life-threatening arrhythmias. During embryological development, all parts of the CCS have been shown to develop from the primary myocardium of the linear heart tube partly under the action of the transcription factor, Tbx3.

Am J Physiol Lung Cell Mol Physiol. 2009 Jul 10; Maron MB, Luther DJ, Pilati CF, Ohanyan V, Li T, Koshy S, Horne WI, Meszaros JG, Walro JM, Folkesson HGThe alveolar epithelium plays a critical role in resolving pulmonary edema. We thus hypothesized that its function might be upregulated in rats with heart failure, a condition that severely challenges the lungs' ability to maintain fluid balance. Heart failure was induced by left coronary artery ligation. Echocardiographic and cardiovascular hemodynamics confirmed its development at 16 weeks post-ligation. At that time, alveolar fluid clearance was measured by an increase in protein concentration over 1 h of a 5% albumin solution instilled into the lungs. Baseline alveolar fluid clearance was similar in heart failure and age-matched control rats. Terbutaline was added to the instillate to determine whether heart failure rats responded to beta-adrenoceptor stimulation. Alveolar fluid clearance in heart failure rats was increased by 194% after terbutaline stimulation compared to 153% increase by terbutaline in control rats. To determine the mechanisms responsible for this accelerated alveolar fluid clearance, we measured ion transporter expression (ENaC, Na,K-ATPase, CFTR). No significant upregulation was observed for these ion transporters in the heart failure rats. Lung morphology showed significant alveolar epithelial type II cell hyperplasia in heart failure rats. Thus, alveolar epithelial type II cell hyperplasia is the likely explanation for the increased terbutaline-stimulated alveolar fluid clearance in heart failure rats. These data provide evidence for previously unrecognized mechanisms that can protect against or hasten resolution of alveolar edema in heart failure. Key words: ENaC, ATII cell hyperplasia, alveolar epithelium, pulmonary edema.

Epidemiology. 2009 Jul 10; Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery RBACKGROUND:: Although the association of high temperatures with mortality is well-documented, the association with morbidity has seldom been examined. We assessed the potential impact of hot weather on hospital admissions due to cardiovascular and respiratory diseases in New York City. We also explored whether the weather-disease relationship varies with socio-demographic variables. METHOD:: We investigated effects of temperature and humidity on health by linking the daily cardiovascular and respiratory hospitalization counts with meteorologic conditions during summer, 1991-2004.We used daily mean temperature, mean apparent temperature, and 3-day moving average of apparent temperature as the exposure indicators. Threshold effects for health risks of meteorologic conditions were assessed by log-linear threshold models, after controlling for ozone, day of week, holidays, and long-term trend. Stratified analyses were used to evaluate temperature-demographic interactions. RESULTS:: For all 3 exposure indicators, each degree C above the threshold of the temperature-health effect curve (29 degrees C-36 degrees C) was associated with a 2.7%-3.1% increase in same-day hospitalizations due to respiratory diseases, and an increase of 1.4%-3.6% in lagged hospitalizations due to cardiovascular diseases. These increases for respiratory admissions were greater for Hispanic persons (6.1%/ degrees C) and the elderly (4.7%/ degrees C). At high temperatures, admission rates increased for chronic airway obstruction, asthma, ischemic heart disease, and cardiac dysrhythmias, but decreased for hypertension and heart failure. CONCLUSIONS:: Extreme high temperature appears to increase hospital admissions for cardiovascular and respiratory disorders in New York City. Elderly and Hispanic residents may be particularly vulnerable to the temperature effects on respiratory illnesses.

Am J Physiol Heart Circ Physiol. 2009 Jul 10; Parrish DC, Alston EN, Rohrer H, Hermes SM, Aicher SA, Nkadi P, Woodward WR, Stubbusch J, Gardner RT, Habecker BAInflammatory cytokines that act through gp130 are elevated in the heart after myocardial infarction and in heart failure. These cytokines are potent regulators of neurotransmitter and neuropeptide production in sympathetic neurons, but are also important for the survival of cardiac myocytes following damage to the heart. To examine the effect of gp130 cytokines on cardiac nerves we used gp130(DBH-Cre/lox) mice, which have a selective deletion of the gp130 cytokine receptor in neurons expressing dopamine beta hydroxylase (DBH). Basal sympathetic parameters including norepinephrine (NE) content, tyrosine hydroxylase expression, NE transporter expression, and sympathetic innervation density appeared normal in gp130(DBH-Cre/lox) compared to wild type mice. Likewise, basal cardiovascular parameters measured under isoflurane anesthesia were similar in both genotypes including mean arterial pressure, left ventricular peak systolic pressure, dP/dtMAX and dP/dtMIN. However, pharmacological interventions revealed autonomic imbalance in gp130(DBH-Cre/lox) mice that was correlated with increased incidence of premature ventricular complexes after reperfusion. Stimulation of NE release with tyramine and infusion of the beta agonist dobutamine revealed blunted adrenergic transmission that correlated with decreased beta receptor expression in gp130(DBH-Cre/lox) hearts. Due to the developmental expression of the DBH-Cre transgene in parasympathetic ganglia, gp130 was eliminated. Cholinergic transmission was impaired in gp130(DBH-Cre/lox) hearts due to decreased parasympathetic drive, but tyrosine hydroxylase immunohistochemistry in the brainstem revealed that catecholaminergic nuclei appeared grossly normal. Thus, apparently normal basal parameters in gp130(DBH-Cre/lox) mice mask autonomic imbalance that includes alterations in sympathetic and parasympathetic transmission. Key words: cardiac, sympathetic, parasympathetic, ischemia-reperfusion.

Stroke. 2009 Jul 9; Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak TBACKGROUND AND PURPOSE: Data on mortality and its prognostic factors after an acute ischemic stroke in young adults are scarce and based on relatively small heterogeneous patient series. METHODS: We analyzed 5-year mortality data of all consecutive patients aged 15 to 49 with first-ever ischemic stroke treated at the Department of Neurology, Helsinki University Central Hospital, from January 1994 to September 2003. We followed up the patients using data from the mortality registry of Statistics Finland. We used life table analyses for calculating mortality risks. Kaplan-Meier method allowed comparisons of survival between clinical subgroups. We used the Cox proportional hazard model for identifying predictors of mortality. Stroke severity was measured using the National Institutes of Health Stroke Scale and the Glasgow Coma Scale. RESULTS: Among the 731 patients (mean age, 41.5+/-7.4 years; 62.8% males) followed, 78 died. Cumulative mortality risks were 2.7% (95% CI, 1.5% to 3.9%) at 1 month, 4.7% (3.1% to 6.3%) at 1 year, and 10.7% (9.9% to 11.5%) at 5 years with no gender difference. Those >/=45 years of age had lower probabilities of survival. Among the 30-day survivors (n=711), stroke caused 21%, cardioaortic and other vascular causes 36%, malignancies 12%, and infections 9% of the deaths. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large artery atherosclerosis causing the index stroke independently predicted 5-year mortality adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype. CONCLUSIONS: Despite the overall low mortality after an ischemic stroke in young adults, several recognizable subgroups had substantially increased risk of death in the long term.

Eur J Cardiothorac Surg. 2009 Jul 7; Westaby S, Siegenthaler M, Beyersdorf F, Masseti M, Pepper J, Khayat A, Hetzer R, Frazier OHObjective: We tested the hypothesis that a miniaturised axial flow pump with infection-resistant power delivery could improve longevity and quality of life (QOL) in advanced heart failure patients deemed unsuitable for transplantation. Methods: The study included all non-United States Jarvik 2000 patients (n=46), where a skull-pedestal-based power line was employed with the intention of long-term support. Patient age ranged from 29 to 80 years. Of the 46 patients, 42 were male. All were New York Heart Association (NYHA) IV predominantly with idiopathic dilated (n=22) or ischaemic (n=18) cardiomyopathy. The experience (2000-2008) included the learning curve of 10 centres. Results: The internal components are imperceptible. The power/control system is user friendly, allowing excellent QOL. There has been no pump malfunction. The Kaplan-Meier survival analysis is shown. The longest event-free survival is 7.5 years. Support exceeded 3 years in five cases. The cumulative experience exceeds 50 years. Three patients were transplanted, and two pumps were replaced at 90 and 203 days. Nineteen cases are ongoing (mean: 663 days), while 22 died during support (mean survival: 402 days), of which five from non-device-related diseases. Temporary local infection occurred in three pedestals, and there has been no pump infection. Incidence of thrombo-embolic events showed wide variation between centres. Conclusions: From this learning-curve experience, both left ventricular assist device (LVAD) and power delivery are reliable and promising for destination therapy. Early mortality is similar to other studies and relates to the severity of illness. Pump infection has not occurred and prolonged event-free survival is clearly possible with expert medical management.

J Am Coll Cardiol. 2009 Jul 14; 54(3): 234-41Sorajja P, Nishimura RA, Gersh BJ, Dearani JA, Hodge DO, Wiste HJ, Ommen SROBJECTIVES: The purpose of this study was to characterize the prognosis of minimally symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM). BACKGROUND: Recent data have suggested that obstruction may be present in the majority of HCM patients, irrespective of cardiac symptoms. The prognosis of minimally symptomatic obstructive HCM remains poorly defined. METHODS: We examined 544 consecutive adult patients (age 59 +/- 16 years; 55% men) with obstructive HCM documented by Doppler echocardiography who were free of severe cardiac symptoms, and we performed clinical follow-up (median 9.3 years). RESULTS: There was only a slight excess mortality of the cohort in comparison to the expected survival of a similar U.S. general population (10-year observed vs. expected survival, 69.3% vs. 71.9%; p = 0.04) and 46% of the deaths were attributable to noncardiac causes. However, there was a clear relation between increasing severity of the left ventricular outflow tract (LVOT) gradient and outcome. For patients with high resting gradients (Doppler peak velocity >4 m/s), survival was significantly impaired (53% at 10 years; p = 0.001 vs. expected), and death or severe symptoms occurred in 68% of these patients within 10 years after the initial evaluation. Conversely, there was no impairment of long-term survival for patients with less-severe resting obstruction. Independent predictors of mortality in the entire cohort were age, prior stroke, and LVOT gradient severity. CONCLUSIONS: Patients with obstructive HCM and mild or no symptoms have only slight excess mortality. However, patients with markedly elevated resting LVOT gradients are at a high risk of heart failure and death. These findings may have important implications for therapy, including the timing of septal reduction therapy.

Eur Heart J. 2009 Jul 8; Sinnaeve PR, Ezekowitz JA, Bogaerts K, Droogne W, Jarai R, Huber K, Granger CB, Desmet WJ, Armstrong PW, Van de Werf FJ, Aims N-terminal pro-brain natriuretic peptide (NT-proBNP) levels predict outcomes in ST-elevation myocardial infarction patients treated with fibrinolysis or primary percutaneous coronary intervention (PCI). However, its role in facilitated PCI has not yet been assessed; it may be a tool to evaluate the lower event rates with primary PCI in ASSENT-4. Methods and results In ASSENT-4, 1667 patients were randomized to tenecteplase (TNK) followed by PCI or primary PCI alone. Baseline, discharge/Day 7, and 90-day NT-proBNP levels were available for 1008, 971, and 813 patients. Increasing quartiles of baseline NT-proBNP levels were associated with a higher risk of the combined endpoint of death, heart failure, and shock at 90 days and 1-year mortality (P < 0.001). Events were more common with TNK + PCI, regardless of baseline NT-proBNP quartile. When analysing baseline NT-proBNP as a continuous variable, no treatment interaction was observed for the primary endpoint (P = 0.17) or 1-year mortality (P = 0.08). Overall, NT-proBNP levels at Day 7 or 90 were not different between the two treatments. In patients with TIMI 2-3 flow before PCI, NT-proBNP at Day 90 was lower in PCI-only patients (P = 0.01), although no interaction was observed (P = 0.14). In TNK-pre-treated patients without reperfusion (TIMI 0-1) after PCI, NT-proBNP levels at Day 7 or 90 were not significantly higher than in PCI patients. Conclusion Baseline NT-proBNP predicts outcome at 90 days and 1 year in patients undergoing PCI with or without facilitation with TNK. A higher rate of reperfusion in lytic-pre-treated patients did not result in lower NT-proBNP during follow-up. Thus, baseline and subsequent NT-proBNP levels do not explain the lower mortality rate with PCI alone seen in this trial.

J Clin Apher. 2009 Jul 9; Doesch AO, Konstandin M, Celik S, Kristen A, Frankenstein L, Hardt S, Goeser S, Kaya Z, Katus HA, Dengler TJOBJECTIVES:: The objective of this study was to investigate functional effects of immunoadsorption (IA) in severely limited study patients with chronic nonfamilial dilated cardiomyopathy (DCM), and to analyze the prevalence of Troponin I (TNI) autoantibodies. BACKGROUND:: Immunoadsorption (IA) has been shown to induce early hemodynamic improvement in patients with nonfamilial DCM. METHODS:: We performed IA using Immunosorba columns on five consecutive days in 27 patients with chronic DCM, congestive heart failure of NYHA class >/=II, left ventricular ejection fraction below 40%, and mean time since initial diagnosis of 7.2 +/- 6.8 years. RESULTS:: Immediately after IA, IgG decreased by 87.7% and IgG3 by 58.5%. Median NT-pro BNP was reduced from 1740.0 ng/L at baseline to 1504.0 ng/L after 6 months (P = 0.004). Mean left ventricular ejection fraction (LVEF) was not significantly improved overall (24.1 +/- 7.8% to 25.4 +/- 10.4% after 6 months, P = 0.38), but LVEF improved >/=5% (absolute) in 9 of 27 (33%) patients. Bicycle spiroergometry showed a significant increase in exercise capacity from 73.7 +/- 29.4 Watts to 88.8 +/- 31.1 Watts (P = 0.003) after 6 months while VO2max rose from 13.7 +/- 3.8 to 14.9 +/- 3.0 mL/min kg after 6 months (P = 0.09). Subgroup analysis revealed a higher NT-pro BNP reduction in patients with shorter disease duration (P = 0.03) and without TNI autoantibodies at baseline (P = 0.05). All 9 patients with an absolute increase of LVEF of >/=5.0% were diabetic (P = 0.0001). CONCLUSIONS:: In this study, on severely limited heart failure patients with nonfamilial DCM, IA therapy moderately improved markers of heart failure severity in a limited subgroup of patients. This may be due to the selected study population with end-stage heart failure patients and the lower reduction of IgG3 compared to previous studies. Future blinded multicenter studies are necessary to identify those patients that benefit most. J. Clin. Apheresis 2009. (c) 2009 Wiley-Liss, Inc.

Ultrasound Obstet Gynecol. 2009 Jul 8; Ghosh GS, Fu J, Olofsson P, Gudmundsson SOBJECTIVES: Under physiological conditions the blood flow velocity waveform in the umbilical vein (UV) has an even non-pulsating pattern. Pulsations in the UV have been described in human fetuses exposed to chronic hypoxia and heart failure. Current techniques for fetal surveillance during labor and delivery involve a risk of both over- and underestimation of fetal hypoxia. We aimed to examine whether pulsations in the UV appear in the human fetus during suspected intrapartum hypoxia, and if so whether they are associated with increased risk of operative delivery for fetal distress (ODFD). METHODS: This was a prospective double blind study including 52 normal pregnancies. A Doppler examination of the UV was performed on 26 fetuses with pathological and 26 fetuses with normal cardiotocography (CTG) during labor. Presence or absence of pulsations in the UV were noted and related to perinatal outcome. RESULTS: Pulsations in the UV were seen in eight (30.8%) of the fetuses with pathological CTG, of which six (75%) underwent ODFD. No pulsations were seen in the other 18 (69.2%) fetuses with pathological CTG and these were all delivered without ODFD. No pulsations were seen in the UV in the fetuses with normal CTG and these were all delivered without ODFD. Among the fetuses with pathological CTG, there was an increased risk of ODFD in fetuses with vs. those without pulsations in the UV (P < 0.0001). CONCLUSIONS: Pulsations in the UV can be observed in human fetuses during suspected intrapartum hypoxia and these pulsations are associated with an increased risk of ODFD. Doppler examination of the UV might give important additional information on fetal condition during labor and delivery. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Infect Control Hosp Epidemiol. 2009 Jul 7; Eagye KJ, Kuti JL, Nicolau DPObjective. To determine risk factors and outcomes for patients with meropenem high-level-resistant Pseudomonas aeruginosa (MRPA) (minimum inhibitory concentration [Formula: see text] mug/mL). Design. Case-control-control. Setting. An 867-bed urban, teaching hospital. Patients. Fifty-eight MRPA case patients identified from an earlier P. aeruginosa study; 125 randomly selected control patients with meropenem-susceptible P. aeruginosa (MSPA) ([Formula: see text] mug/mL), and 57 control patients without P. aeruginosa (sampled by case date/location). Methods. Patient data, outcomes, and costs were obtained via administrative database. Cases were compared to each control group while controlling for time at risk (days between admission and culture, or entire length of stay [LOS] for patients without P. aeruginosa). Results. A multivariable model predicted risks for MRPA versus MSPA (odds ratio [95% confidence interval]): more admissions (in the prior 12 months) (1.41 [1.15, 1.74]), congestive heart failure (2.19 [1.03, 4.68]), and Foley catheter (2.53 [1.18, 5.45]) (adj. [Formula: see text]). For MRPA versus no P. aeruginosa, risks were age (in 5-year increments) (1.17 [1.03, 1.33]), more prior admissions (1.40 [1.08, 1.81]), and more days in the intensive care unit (1.10 [1.03, 1.18]) (adj. [Formula: see text]). Other invasive devices (including mechanical ventilation) and previous antibiotic use (including carbapenems) were nonsignificant. MRPA mortality (31%) did not differ from that of MSPA (15%) when adjusted for time at risk ([Formula: see text]) but did from mortality without P. aeruginosa (9%) ([Formula: see text]). Median LOS and costs were greater for MRPA patients versus MSPA patients and patients without P. aeruginosa: 30 days versus 16 and 10 ([Formula: see text]) and $88,425 versus $28,620 and $22,605 ([Formula: see text]). Conclusions. Although antibiotic use has been shown to promote resistance, our data found that prior antibiotic use was not associated with MRPA acquisition. However, admission frequency and Foley catheters were, suggesting that infection control measures are essential to reducing MRPA transmission.