Minimal effects of levosimendan on coronary artery smooth muscle tone.
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Animals↗
Biomedical subjects
W Klein
Publications and source records attributed to W Klein.
[Behavioral pattern and behavioral characteristics of children in two pediatric clinics].
OBJECTIVES: To describe systematically patterns of behavior of children and parents in pediatric hospitals. METHODS: A questionnaire to systematically rate behavior of children and parents was administered by nurses to two independent samples in two different pediatric hospitals. At the von Haunersches Kinderspital, Klinikum Innenstadt of the Ludwig-Maximilian-University of Munich, 659 children were rated, at the Pediatric Hospital of the University of Freiburg, 484 children. Latent class analysis grouped children/parents according to similar patterns of behavior. RESULTS: In Munich a five-class model is most appropriate to classify children/parent behavior, in Freiburg a six-class model best first the data. Four classes in Munich and in Freiburg display nearly identical profiles. Three of them describe inconspicuous behavior of children in different age groups, whereas the fourth group describes disturbed children. These four groups classify 87% of the children in Munich and 73% of those in Freiburg. In Munich 25% of the children are rated as disturbed, as opposed to 39% in Freiburg. CONCLUSIONS: The questionnaire is suitable for everyday clinical practice. Results of both samples mostly correspond. Remaining differences are caused by type of hospital (pediatrics vs. pediatric surgery) and by the differing depth of nurses' rater training.
Child↗
Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty.
BACKGROUND: In patients with coronary artery disease (CAD), a rate of restenosis as high as 50% is observed after percutaneous transluminal coronary angioplasty (PTCA). Frequently, this results in further revascularization procedures. Lifestyle intervention has been shown to slow the progression of CAD and to reduce cardiovascular events after myocardial infarction. However, no information exists whether such treatment influences the rate of restenosis in patients with CAD. The present study was performed to investigate the effects of an intensified lifestyle intervention on the need for further revascularization procedures in patients with established CAD after successful PTCA. DESIGN: A total of 60 patients were included and randomized to either conventional treatment by cardiologists and general practitioners or additional intensified lifestyle intervention in a diabetes and metabolism outpatient clinic for 12 months. The mean observation time after successful PTCA was 26 months. The primary outcome variable was the need for further revascularization procedures because of clinical restenosis. Secondary outcome variables were lifestyle-related measures. RESULTS: Intervention resulted in a reduction in body weight and blood pressure, and in increased physical activity. Furthermore, nutritional habits were changed towards less fat intake, and body composition changed towards a higher proportion of fat-free mass. The need for further revascularization procedures was reduced from a total of 14 out of 32 in the conventionally treated group to 3 out of 28 in the intervention group. This resulted in an event-free survival probability of 0.89 in the intervention group and 0.57 in the control group (P = 0.0055, log rank) with a resulting relative risk of 0.26 (95% CI 0.09-0.74). CONCLUSION: In conclusion, our data strongly suggest that intensified lifestyle modification is able to reduce the need for further revascularization procedures after PTCA in patients with CAD.
Angina Pectoris↗
Inhibition of phosphatidylcholine and phosphatidylethanolamine biosynthesis in rat-2 fibroblasts by cell-permeable ceramides.
Phospholipids and sphingolipids are important precursors of lipid-derived second messengers such as diacylglycerol and ceramide, which participate in several signal transduction pathways and in that way mediate the effects of various agonists. The cross-talk between glycerophospholipid and sphingolipid metabolism was investigated by examining the effects of cell-permeable ceramides on phosphatidylcholine (PtdCho) and phosphatidylethanolamine (PtdEtn) synthesis in Rat-2 fibroblasts. Addition of short-chain C6-ceramide to the cells resulted in a dose- and time-dependent inhibition of the CDP-pathways for PtdCho and PtdEtn synthesis. Treatment of cells for 4 h with 50 microM C6-ceramide caused an 83% and a 56% decrease in incorporation of radiolabelled choline and ethanolamine into PtdCho and PtdEtn, respectively. Exposure of the cells for longer time-periods (>/= 16 h) to 50 microM C6-ceramide resulted in apoptosis. The structural analogue dihydro-C6-ceramide did not affect PtdCho and PtdEtn synthesis. In pulse-chase experiments, radioactive choline and ethanolamine accumulated in CDP-choline and CDP-ethanolamine under the influence of C6-ceramide, suggesting that synthesis of both PtdCho and PtdEtn were inhibited at the final step in the CDP-pathways. Indeed, cholinephosphotransferase and ethanolaminephosphotransferase activities in membrane fractions from C6-ceramide-treated cells were reduced by 64% and 43%, respectively, when compared with control cells. No changes in diacylglycerol mass levels or synthesis of diacylglycerol from radiolabelled palmitate were observed. It was concluded that C6-ceramide affected glycerophospholipid synthesis predominantly by inhibition of the step in the CDP-pathways catalysed by cholinephosphotransferase and ethanolaminephosphotransferase.
Animals↗
Decreased melatonin synthesis in patients with coronary artery disease.
AIMS: Decreased night-time plasma levels of melatonin were recently reported in patients with coronary artery disease, and it was postulated that melatonin production may be impaired, due to a lack of synthesizing enzymes. However, since artefacts possibly influencing the release pattern were not taken into account, this interpretation was strongly criticized. We therefore carefully investigated night-time melatonin production in patients with coronary artery disease using an appropriate experimental approach. Furthermore, we examined the effect of beta-blockers, a frequently used drug in coronary artery disease therapy. METHODS AND RESULTS: Forty-eight male patients with angiographically documented severe coronary artery disease, 24 of them taking beta-blockers daily in therapeutic dosages, were included. Eighteen age-matched men, with no evidence of coronary sclerosis, served as controls. To determine melatonin production, 6-sulfatoxymelatonin (aMT6s) was measured radioimmunologically from overnight urine. Urinary aMT6s concentration was significantly decreased in patients, and beta-blocker treatment did not further suppress melatonin production. CONCLUSIONS: The data obtained using this investigative approach provide clearcut evidence that melatonin production in patients with coronary artery disease is decreased. Whether a decreased melatonin level may be a predisposing factor for coronary artery disease, or whether the occurrence of coronary artery disease decreases melatonin synthesis remains to be determined.
Adrenergic beta-Antagonists↗
Spinodals, scaling, and ergodicity in a threshold model with long-range stress transfer.
We present both theoretical and numerical analyses of a cellular automaton version of a slider-block model or threshold model that includes long-range interactions. Theoretically we develop a coarse-grained description in the mean-field (infinite range) limit and discuss the relevance of the metastable state, limit of stability (spinodal), and nucleation to the phenomenology of the model. We also simulate the model and confirm the relevance of the theory for systems with long- but finite-range interactions. Results of particular interest include the existence of Gutenberg-Richter-like scaling consistent with that found on real earthquake fault systems, the association of large events with nucleation near the spinodal, and the result that such systems can be described, in the mean-field limit, with techniques appropriate to systems in equilibrium.
Journal Article↗
Structural constraints on the coordination of concurrent rotations of the head and a steering device.
Concurrent movements of different effectors are subject to structural constraints that facilitate certain patterns of coordination but impede others. The constraints for concurrent rotations of the head and a bimanually operated steering device were explored in two experiments. To indicate structural constraints, the difference between concurrent periodic rotations in same and different directions with respect to the variable error of synchronization was used. The first experiment showed less error for rotations in same directions than for rotations in opposite directions. In the second experiment, the same result was obtained with a horizontal and a backward-tilted steering wheel. Adding gaze shifts to head oscillations increased the accuracy of synchronization but did not affect the difference between both coordination patterns. In contrast to the synchronization of head and steering device, the variable error of synchronization of gaze and steering wheel did not differ between both modes of coordination; the error was again reduced when head oscillations were added to the saccades between eccentric fixation targets. This suggests space related (or allocentric) constraints, which most likely originate from concurrent specifications of movement directions in coupled spatiotopic maps so that the specification of rotations in the same direction is facilitated in comparison to rotations in opposite directions.
Adult↗
Cold shock response of Bacillus subtilis: isoleucine-dependent switch in the fatty acid branching pattern for membrane adaptation to low temperatures.
Bacillus subtilis has developed sophisticated mechanisms to withstand fluctuations in temperature. Membrane fatty acids are the major determinants for a sufficiently fluid membrane state to ensure the membrane's function at all temperatures. The fatty acid profile of B. subtilis is characterized by a high content of branched fatty acids irrespective of the growth medium. Here, we report on the importance of isoleucine for B. subtilis to survive cold shock from 37 to 15 degrees C. Cold shock experiments with strain JH642 revealed a cold-protective function for all intermediates of anteiso-branched fatty acid biosynthesis. Metabolites related to iso-branched or straight-chain fatty acid biosynthesis were not protective. Fatty acid profiles of different B. subtilis wild-type strains proved the altered branching pattern by an increase in the anteiso-branched fatty acid content and a concomitant decrease of iso-branched species during cold shock. There were no significant changes in the fatty acid saturation or acyl chain length. The cold-sensitive phenotype of isoleucine-deficient strains in the absence of isoleucine correlated with their inability to synthesize more anteiso-branched fatty acids, as shown by the fatty acid profile. The switch to a fatty acid profile dominated by anteiso-C(15:0) and C(17:0) at low temperatures and the cold-sensitive phenotype of isoleucine-deficient strains in the absence of isoleucine focused our attention on the critical role of anteiso-branched fatty acids in the growth of B. subtilis in the cold.
Adaptation, Physiological↗
N-terminal proatrial natriuretic peptide correlates with systolic dysfunction and left ventricular filling pattern in patients with idiopathic dilated cardiomyopathy.
OBJECTIVE: To investigate the diastolic Doppler filling pattern in patients with idiopathic dilated cardiomyopathy and its relation to N-terminal pro-atrial natriuretic peptide (NT-pro-ANP). METHODS: 32 patients (26 male, six female) with idiopathic dilated cardiomyopathy were investigated. All were in sinus rhythm. Conventional M mode echocardiography and Doppler echocardiography was done in each patient. Pulsed wave Doppler inflow signals were obtained and the following variables were measured: maximum E wave, maximum A wave, E/A ratio, E wave deceleration time, A wave deceleration time. NT-pro-ANP was measured using radioimmunoassay. RESULTS: Mean (SD) left ventricular ejection fraction was 34 (7)% and mean left ventricular end diastolic diameter on M mode echocardiography was 69 (7) mm. Left ventricular filling indices were as follows: maximum E wave velocity, 0.86 (0.22) m/s; maximum A wave velocity, 0.71 (0.24) m/s; E/A ratio, 1.41 (0.65). Mean E wave deceleration time was 140 (50) ms; mean A wave deceleration time was 100 (20) ms. In a stepwise forward regression model, NT-pro-ANP correlated significantly with left atrial diameter (r = 0.603; p < 0. 001), left ventricular ejection fraction (r = -0.758; p < 0.001), and Doppler derived E/A ratio (r = 0.740; p < 0.001). CONCLUSIONS: In patients with idiopathic dilated cardiomyopathy there is a relation between NT-pro-ANP and both systolic and diastolic variables. In a multivariate model NT-pro-ANP correlated with left atrial diameter, left ventricular ejection fraction, and Doppler derived E/A ratio on transmitral inflow.
Aged↗
Validity of the MMPI-2 and Beck Depression Inventory for making decisions of organ allocation in renal transplantation.
Psychosocial factors are presented which affect clinical decision-making regarding the allocation of renal organs. Patients were rated as being either High Risk or Low Risk transplant candidates. High Risk candidates were scored as being significantly different from the Low Risk candidates on many psychosocial variables. Interestingly, significant differences were not found between these two groups on either the MMPI-2 or the Beck Depression Inventory. The validity of using information from these inventories to allocate organs is discussed.
Attitude to Health↗
[Prevention of coronary heart diseases in clinical practice. Comment on the recommendations of the Second Joint Task Force of European Societies for Prevention of Coronary Disease].
The Second Joint Task Force of European Societies on Coronary Prevention (EAS-European Atherosclerosis Society, ESC-European Society of Cardiology, ESH-European Society of Hypertension) have established recommendations for the prevention of coronary heart disease in cooperation with the representatives of the International Society of Behavioral Medicine, the European Society of General Medicine/Family Medicine, and the European Heart-Network. These recommendations of the year 1998 are commented by Austrian cardiologists and lipidologists and supplemented with recent clinical findings.
Anticholesteremic Agents↗
Fairness and nurses' pay.
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Health Facility Merger↗
The role of ACE inhibitors.
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Angiotensin-Converting Enzyme Inhibitors↗
[Target blood pressure values from the cardiologic viewpoint].
Recent large intervention trials in hypertension have shown that diastolic blood pressure--even in the presence of ischemic heart disease--can be reduced below 90 mm Hg with further benefit for the patient. This has lead to discussions about a new definition of target blood pressure in hypertension treatment. From a cardiological point of view, the total cardiovascular risk of the patient has to be calculated according to a coronary risk profile. This risk stratification of the patient helps to make a decision about pharmacological treatment of blood pressure and target blood pressure. The higher the risk of the individual patient, the more aggressive blood pressure lowering is indicated.
Antihypertensive Agents↗
First description of recurrent pericardial effusion associated with borrelia burgdorferi infection.
Lyme disease is well known for affecting the myocardium in the form of carditis and dilated cardiomyopathy. Pericardial effusion associated with Lyme disease has not been described as yet. This article demonstrates a case of a female patient, 54 years of age, with Borrelia burgdorferi infection and associated pericardial effusion. Recurrent pericardiocenteses as well as conventional treatment of the condition were without success. Diagnosis of Borrelia infection and subsequent treatment with ceftriaxone led to permanent restitution of the pericardial effusion.
Borrelia burgdorferi Group↗
Images in cardiovascular medicine. Löffler's endocarditis.
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Anti-Inflammatory Agents↗
Etiological involvement of oncogenic human papillomavirus in tonsillar squamous cell carcinomas lacking retinoblastoma cell cycle control.
Two hundred eight primary squamous cell carcinomas of the head and neck have been analyzed with respect to the presence of the retinoblastoma tumor suppressor protein, pRb. Of these, 23 tumors (11%) that preferentially localized to the tonsils revealed complete absence or dramatic reduction in the amount of pRb. Other cell cycle components, cyclin D1 and p16INK4A, which are intimately related to pRb through an autoregulatory loop, were also dramatically decreased or overexpressed, respectively, in these pRb-defective tumors. On the other hand, the majority of the pRb-defective tumors contained the wild-type p53 gene. No evidence was found for genetic defects at the Rb locus in these tumors. Very significantly, in 11 of 12 pRb-defective tonsillar tumors, but in none of 9 pRb-positive tonsillar tumors (P < 10[-7]), DNA of oncogenic human papillomavirus types was identified, providing a strong indication for a human papillomavirus-associated etiology of these tumors and suggesting the functional inactivation of the pRb protein by the viral E7 gene product. In comparison to all head and neck squamous cell carcinomas studied, the pRb-defective tonsillar tumors were in general more poorly differentiated (P = 0.0059), and they were all metastatic at the time of resection. Of particular clinical interest, despite these adverse histopathological factors, the clinical outcome for these patients was relatively favorable, strongly implying that the pRb-defective tumors responded uniformly well toward postoperative radiation therapy.
Carcinoma, Squamous Cell↗
Management strategies for a better outcome in unstable coronary artery disease.
Unstable coronary artery disease is a term encompassing both unstable angina and non-Q-wave (non-ST-segment elevation) myocardial infarction. Patients with these conditions are at risk of early progression to acute myocardial infarction and death. Thus, management of these conditions must aim to reduce long-term mortality and morbidity. Risk stratification is crucial for the identification of patients whose risk of early progression is high; they may require coronary angiography and (if suitable) either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. No single variable can accurately predict risk, but considerable data are emerging to show that biochemical markers of myocardial injury, such as troponin-T and troponin-I, are valuable in combination with electrocardiographic findings and clinical features. Routine early invasive procedures (coronary angiography with or without revascularization) have not yet been shown to have any significant advantage over conservative regimens for the majority of patients. Antiplatelet, anticoagulant, and anti-ischemic agents remain the mainstay of treatment in the acute phase. New agents, such as glycoprotein IIb/IIIa receptor inhibitors and low-molecular-weight heparins, as well as antithrombins and Factor Xa inhibitors add to the treatments currently available. Thrombolytic agents are contraindicated in the absence of ST-segment elevation. After clinical stabilization, ongoing assessment should include exercise testing for all patients who are able; other imaging techniques should be used for patients unable to exercise. A profile indicating a high risk of future events is an indication for elective angiography and consideration for revascularization.
Algorithms↗