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BackgroundSymptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging.AimTo evaluate the performance of a clinical decision rule (CDR), with or without N-Terminal pro-B type natriuretic peptide (NT-proBNP) assay, for identifying heart failure.Design and settingProspective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England.MethodThe outcome was test performance of the CDR and natriuretic peptide test in determining a diagnosis of heart failure. The reference standard was an expert consensus panel of three cardiologists.ResultsThree hundred and four participants were recruited, with 104 (34.2%; 95% confidence interval [CI] = 28.9 to 39.8) having a confirmed diagnosis of heart failure. The CDR+NT-proBNP had a sensitivity of 90.4% (95% CI = 83.0 to 95.3) and specificity 45.5% (95% CI = 38.5 to 52.7). NT-proBNP level alone with a cut-off ConclusionAt the low threshold of NT-proBNP

© 2015 American Chemical Society. Highly active catalysts for the oxygen evolution reaction (OER) are required for the development of photoelectrochemical devices that generate hydrogen efficiently from water using solar energy. Here, we identify the origin of a 500-fold OER activity enhancement that can be achieved with mixed (Ni,Fe)oxyhydroxides (Ni1-xFexOOH) over their pure Ni and Fe parent compounds, resulting in one of the most active currently known OER catalysts in alkaline electrolyte. Operando X-ray absorption spectroscopy (XAS) using high energy resolution fluorescence detection (HERFD) reveals that Fe3+ in Ni1-xFexOOH occupies octahedral sites with unusually short Fe-O bond distances, induced by edge-sharing with surrounding [NiO6] octahedra. Using computational methods, we establish that this structural motif results in near optimal adsorption energies of OER intermediates and low overpotentials at Fe sites. By contrast, Ni sites in Ni1-xFexOOH are not active sites for the oxidation of water. (Graph Presented).

Despite mounting experimental evidence that cyclosporine inhibits pancreatic islet cell function, clinical data on posttransplant diabetes mellitus (PTDM) in renal allograft recipients in the cyclosporine era are scarce. Between June 1983 and December 1988, 39 of 337 (11.6%) cyclosporine-treated adult renal transplant recipient whose grafts survived longer than 1 year developed PTDM. Of these, 43.6% and 74.4% were diagnosed by 3 and 12 months posttransplant, respectively, and 51.3% were insulin-dependent. Incidence of PTDM was highest in blacks (19.8%) and Hispanics (21.3%) and in those with HLA-A 30 and Bw 42 antigens. Older recipients and those that received cadaveric kidneys were more likely to develop diabetes than those who received living related allografts (14% vs. 5.3%, P less than 0.05). The rate of PTDM appeared to be independent of the type of induction, immunosuppressant therapy, incidence of rejection, total steroid and cyclosporine dose, percentage of body weight gain in the first posttransplant year, and serum creatinine concentration. Actuarial 5-year, decaying from 100% at 1 year, patient and graft survival rates were 87% and 70%, respectively, in the PTDM group compared with 93% and 90%, respectively, in controls. Causes of graft failure among the diabetics included chronic rejection (6), patient death (3), noncompliance with immunosuppressants (2), and sepsis (1). The incidence of infectious complications was significantly higher in the PTDM group compared with the control group (53% vs. 16%, P less than 0.05), with all 5 deaths among the diabetics being sepsis-related.

ObjectivesThis study sought to derive age-, sex-, and ethnic-appropriate adult reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF) derived from geographically diverse population studies.BackgroundThe current recommended reference values for measurements from echocardiography may not be suitable to the diverse world population to which they are now applied.MethodsPopulation-based datasets of echocardiographic measurements from 22,404 adults without clinical cardiovascular or renal disease, hypertension, or diabetes were combined in an individual person data meta-analysis. Quantile regression was used to derive reference values at the 95th percentile (upper reference value [URV]) and fifth percentile (lower reference value [LRV]) of each measurement against age (treated as linear), separately within sex and ethnic groups.ResultsThe URVs for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume, and LV stroke volume (SV) were highest in Europeans and lowest in South Asians. Important sex and ethnic differences remained after indexation by body surface area or height for these measurements, as well as for the LRV for SV. LVEDV and SV decreased with increasing age for all groups. Importantly, the LRV for EF differed by ethnicity; there was a clear apparent difference between Europeans and Asians. The URVs for LV end-diastolic diameter and LV end-systolic diameter were higher for Europeans than those for East Asian, South Asian, and African people, particularly among men. Similarly, the URVs for LA diameter and volume were highest for Europeans.ConclusionsSex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.

AIS has been shown to be a potent inhibitor of B-cell function, suppressing E. Coli plaque formation when given up to 3 days before or 3 days after antigen administration, and inhibiting hemolysin-coated SRBC rosette formation. Further, AIS inhibits T-lymphocyte function in vitro as demonstrated by suppression of both SRBC plaque and rosette formation. A single dose of AIS increases the survival of first set skin allografts from 12.4 to 18.4 days, and second set skin allografts from 7.2 to 12.4 days. It is likely, but by no means certain, that the effectiveness of AIS involves interference with those surface immunoglobulins which act as antigen receptors. Since there is increasing evidence that humoral immunity has a role in transplant rejection, and that even cellular immunity might depend on activation of immunoglobulin-like surface receptors, AIS may be of value as a clinical immunosuppressant.

Heterologous anti-immunoglobulin (AI) is a potent immunosuppressive agent which compares favorably to anti-thymocyte serum (ATS) in inhibiting E and EAC-rosette formation and diminishing the secondary antibody response to sheep erythrocytes and E. coli lipopolysaccharide. AI prolongs H-2 incompatible skin allograft survival than either antiserum used alone, without evidence of toxicity to recipient mice. AI does not cause significant immune complex glomerular or renovascular deposition and may act by interference with antigen binding.

Twenty-six consecutive recipients of cadaver-kidney transplants were treated with rabbit antihuman lymphocyte globulin (ALG) in addition to conventional immunosuppressive therapy. Each of the first 10 of these recipients has been followed for more than 12 months. The one-year transplant survival in this group was 90 per cent. Rabbit ALG administration was well tolerated. Most patients had no symptoms related to ALG injections. There were four acute transplant rejection episodes in the first 10 patients and four episodes in 16 subsequent patients followed for more than four months. All acute rejection episodes occurred six weeks or more after transplantation, and all were easily and promptly reversed by a temporary increase in the dose of steroid therapy. Immediate, hyperacute rejection by preformed antibodies was the only cause of kidney transplant loss in the entire series.

• Of seven infants with Salmonella sepsis, three had meningitis. A review of these cases and others previously reported demonstrated that among infants less than 1 year old in Arkansas, Salmonella infection developed in 383 over a 3½-year period. The reported incidence of sepsis and/or meningitis was 1.8%; for those less than 2 months of age, it was 5.0%. Epidemiologic investigation failed to disclose a consistent source of the Salmonella colonization for young infants. Treatment of meningitis with ampicillin sodium was frequently associated with relapse or clinical failure, while chloramphenicol or a chloramphenicol-ampicillin combination appeared to offer superior efficacy. Consideration should be given to antibiotics for the routine treatment of Salmonella gastroenteritis in infants less than 3 months of age. ( Am J Dis Child 1981;135:1096-1099)

The clinical presentation, embryologic and etiologic factors, and repair of left paraduodenal hernia are presented. A new operative procedure for cure of left paraduodenal hernia is presented that deals effectively with the sac and predisposing arch containing the inferior mesenteric vein without section of the vein. Repair is based upon the embryologically normal anatomy with restoration of the inferior mesenteric vein to its normal retroperitoneal position. This procedure has been successfully utilized in a case in which the paraduodenal hernia of small bowel was encountered concomitantly with a perforated duodenal ulcer.

The results obtained by placing reversed autogenous saphenous vein bypass grafts in either isolated popliteal artery segments or tibial vessels distal to the popliteal artery segments or tibial vessels distal to the popliteal artery are compared. Fifty-five patients with arteriosclerotic peripheral vascular disease who were threatened with limb loss were followed up from six months to nine years prior to this report. The success rate at one year was 94 per cent for the isolated popliteal segment grafts and 73 per cent for the tibial vessel grafts. The success rate after four years was 70 per cent for the isolated popliteal segment grafts and 63 per cent for the tibial vessel grafts. The clinical factors associated with the success of isolated popliteal segment bypass grafts and the factors apparently associated with failure of vein grafts in both of these groups with very poor distal arterial outflow are discussed. Our results suggest that either an isolated popliteal artery segment graft or a tibial vessel graft is a satisfactory means of treating these patients; however, a graft to an isolated popliteal segment is probably preferable to a graft to a tibial artery.

Heterologous anti-immunoglobulin (AI) is a potent immunosuppressant which prolongs H-2-incompatible skin graft survival and in conjunction with anti-thymocyte serum (ATS) results in greater prolongation of graft life than either antiserum used alone. Combination treatment of recipient mice with AI, ATS, and donor spleen cells produces long-term allograft survival to the lifetime of the host and can result in specific immune unresponsiveness of sufficient strength to permit acceptance of a second set graft.

Serial measurement of plasma gonadotropin by radioimmunoassay has been employed as a measure of growth in the hamster cheek pouch of implants of human choriocarcinoma. Five days after tumor implantation plasma HCG concentration and tumor size bear a close correlation. Suppression of immune rejection of the tumor with heterologous antilymphocyte serum (ALS) allows a more accurate assessment of response to a dose of the oncolytic agent methotrexate than when this response is intact. For this purpose immunosuppression with ALS is more effective than that obtained with cortisone.

To determine the impact of rapid access chest pain clinics (RACPC) on patient management, a systematic search (1966-2000) was performed of electronic databases, recent conference abstracts, citations of all identified studies, and by contact with other researchers. Studies of any design were included. Assessment of eligibility, methodological quality of studies and data abstraction was conducted independently by two reviewers. Outcome measures were sought in terms of admission rate of patients without acute coronary syndrome detection rate of acute coronary syndrome unrecognised by the GP, timing of specialist assessment of patients with stable angina and speed and accuracy of detection of those with non-cardiac chest pain. Nine relevant studies were found, but all had methodological flaws when considered as evaluative studies. All clinics described reviewed patients within 24 hours of referral. Only three studies made comparisons with control groups, none of which were randomised, and a further three provided follow-up data only. Limited data were found for all four outcome measures, indicating possible benefits of RACPCs. However, all findings could be explained by potential biases in the original studies. In conclusion, the evidence base for the introduction of rapid access chest pain clinics is poor. The introduction of these clinics should include a randomised prospective evaluation of their worth.

Human choriocarcinoma has been transplanted to the pulmonary vasculature of seven adult rhesus monkeys and to the brains of ten adult rhesus and four newborn cynomolgus monkeys. Progressive tumor growth was noted in all of the adults receiving solid implants of tumor in the cerebral cortex and half of the newborns who had a mince of choriocarcinoma injected into the cortex through a needle placed through the coronal suture. Tumor was transplanted from these lesions back into the cheek pouch of hamsters as a test of viability. Death of the monkeys bearing transplants was preceded by localizing neurologic signs of expanding intracranial lesions. The administration of heterologous antilymphocyte sera did not affect the pattern of tumor growth nor the host's cellular reaction around the tumor. No growth was seen when tumor was injected into the inflow tract of the right side of the heart and then flushed into the pulmonary vasculature. Three monkeys treated this way received cortisone and a progestational agent. The other four underwent thymectomy and then received heterologous antilymphocyte sera, a form of treatment which had been shown to be effective in suppressing a homograft response in this species.