Errors in the classification of pregnant women according to Robson ten-group classification system.

Objectives: The Robson Ten-Group Classification System (TGCS) is widely used as a classification system for perinatal analyses such as Caesarean section (CS) rates. In Germany, standardised data sets on deliveries are classified by quality assurance institutions using the TGCS. This observational study aims to evaluate potential errors in the TCGS classification of deliveries.

Pericarditis with Resultant Pulmonary Trunk Compression Secondary to Mycotic Pseudoaneurysm.

Purulent pericarditis is a rare disease in the era of antibiotics, with being a possible, though uncommon etiology. Even more uncommon are mycotic aneurysms secondary to group A strep purulent pericarditis and bacteremia. We report a case of an 18-year-old female with a history of strep pharyngitis develop purulent pericarditis with subsequent ventricular fibrillation (VF).

Acute myocardial infarction with isolated congenitally corrected transposition of the great arteries.

Congenital cardiac abnormalities diagnosed at the time of acute coronary syndrome are rare. A 43-year-old man presented to the emergency department complaining of recurring, severe chest pain. Subsequent emergent coronary angiography demonstrated unusual coronary anatomy: 1) one small caliber bifurcating vessel originating from the right sinus of Valsalva; 2) one very large vessel arising from the posterior sinus; and 3) no coronary artery from the normal left sinus of Valsalva.

Comparison of clinical interpretation with visual assessment and quantitative coronary angiography in patients undergoing percutaneous coronary intervention in contemporary practice: the Assessing Angiography (A2) project.

Background: Studies conducted decades ago described substantial disagreement and errors in physicians' angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently undertaken.

Methods And Results: We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011.

United States version of the Stroke Driver Screening Assessment: a pilot study.

Background: Most stroke survivors who resume driving in the United States do so within the first year. More than 87% of these individuals resume driving without a formal evaluation of their fitness to drive because of the absence of standard practices and generally accepted and valid screening tools. The Stroke Driver Screening Assessment (SDSA) is an established battery for predicting stroke survivors' driving performance but is not currently used in the United States.

Should we establish a new protocol for the treatment of peripartum myocardial infarction?

Peripartum myocardial infarction is a rare event that is associated with high mortality rates. The differential diagnosis includes coronary artery dissection, coronary artery thrombosis, vascular spasm, and stenosis. Our evaluation of 2 cases over a 5-year time period has led to a hypothesis that peripartum myocardial infarction is an immune-mediated event secondary to coronary endothelial sensitization by fetal antigen.

Isolated right superior vena cava drainage into the left atrium diagnosed noninvasively in the peripartum period.

Isolated right superior vena cava drainage into the left atrium is an extremely rare cardiac anomaly, especially in the absence of other cardiac abnormalities. Only 28 of 5,127 reported consecutive congenital cardiac cases involved superior vena cava drainage into the left atrium, and all were associated with other cardiac anomalies. Of 19 reported cases of right superior vena cava drainage into the left atrium, most patients have been children who were experiencing mild hypoxemia and cyanosis.

Guidewire pacing safely and effectively treats bradyarrhythmias induced by rheolytic thrombectomy and precludes the need for transvenous pacing: the Scott & White experience.

Rheolytic thrombectomy (RT) is useful in certain percutaneous coronary interventions but may be associated with transient bradyarrhythmias. Clinicians have devised numerous strategies to deal with these arrhythmias apart from transvenous right ventricular pacing, some of which are described in other parts of this supplement. We report the Scott & White experience utilizing guidewire pacing to quickly and safely pace the heart in the event of bradyarrhythmia.

Urinary levels of matrix metalloproteinase 9 and 2 and tissue inhibitor of matrix metalloproteinase in patients with coronary artery disease.

Objectives: To evaluate the feasibility of an assay for urinary levels of matrix metalloproteinases (MMPs) and the potential usefulness of urinary MMPs as a marker of coronary atherosclerosis or acute coronary syndromes (ACS).

Methods And Results: We measured urine and plasma MMP-9, MMP-2 and urine tissue inhibitor of metalloproteinase (TIMP-1) in patients with ACS (n=27), patients with coronary artery disease (CAD), but no clinical instability (n=47) and a group of healthy volunteers (n=15) who were <35 years of age, had no risk factors for CAD and did not undergo angiography. Compared with volunteers, patients with ACS and CAD had higher urine MMP-9, urine TIMP-1, plasma MMP-9 and plasma MMP-2 levels, but these did not differ between those with CAD and ACS.

Three-dimensional reconstruction of enamel thickness and volume in humans and hominoids.

Enamel thickness is an important diagnostic characteristic in Hominoidea. However, the sample size is extremely small, relying upon mostly fractured specimens and a few sectioned specimens, providing an estimate of enamel thickness only. What is needed to fully understand the significance of enamel thickness is a non-destructive technique that is able to obtain the thickness, density, and volume of the dental hard tissues of large samples, thereby providing an accurate means of relating thickness, area, volume, and the pattern of distribution of both enamel and dentin.

Effects of methionine and lysine on fermentation in vitro and in vivo, nutrient flow to the intestine, and milk production.

Three experiments were conducted to investigate the feasibility of using crystalline methionine and lysine as protein supplements for lactating Holstein cows. In the first experiment, Met (dl-methionine) and Lys (l-lysine-HCl) were added to diets used in continuous culture bioreactors to estimate optimal concentrations for use in subsequent in vivo experiments. The second experiment measured ruminal fermentation and nutrient flow to the small intestine when Met and Lys were top-dressed on diets fed to nonlactating cows.

All-terrain vehicle injuries: are they dangerous? A 6-year experience at a level I trauma center after legislative regulations expired.

All-terrain vehicles (ATVs) have increased in popularity and sales since 1971. This rise in popularity led to an increase in injuries resulting in voluntary industry rider safety regulations in 1988, which expired without renewal in 1998. Our purpose was twofold, to determine the incidence and severity of ATV injuries in our patient population and what, if any impact the safety regulations had.

Relation of atmospheric pressure changes and the occurrences of acute myocardial infarction and stroke.

Previous studies have demonstrated variation in vascular events with respect to season and time of day. Changes in barometric pressure display daily and seasonal variations and could modulate the occurrence of vascular events. The objective of this study was to determine whether a relation exists between changes in barometric pressure and occurrence of stroke or acute myocardial infarction (AMI).

Effects of zinc and sodium monensin on ruminal degradation of lysine-HCl and liquid 2-hydroxy-4-methylthiobutanoic acid.

Four nonlactating, mature, Holstein cows were fitted with ruminal cannula and used in a 4 x 4 Latin square-designed experiment to evaluate the impact of supplemental Zn and monensin on ruminal degradation of Lys and liquid 2-hydroxy-4-methylthiobutanoic acid (HMB). Cows were fed 4.54 kg (as fed) of alfalfa hay top-dressed with 4.

Temporary coronary guidewire pacing during percutaneous coronary intervention.

Temporary pacing is occasionally required during percutaneous coronary artery interventions. This can be accomplished by the insertion of a temporary transvenous pacemaker wire into the right ventricle, but there is some risk and inconvenience associated with this approach. Temporary pacing using the coronary artery guidewire was described in 1985 but is used infrequently.

Effectiveness and safety of manual hemostasis facilitated by the SyvekPatch with one hour of bedrest after coronary angiography using six-French catheters.

Manual hemostasis facilitated by a SyvekPatch with 1 hour of bedrest after coronary angiography using 6Fr catheters was evaluated in a study of 200 patients. There were no major adverse events and 2% minor adverse events, all of which were managed successfully with additional bedrest of 1 to 2 hours. The findings suggest that the 1-hour bedrest protocol using the SyvekPatch is safe and effective in low-risk patients.

Assessment of anticoagulation using activated clotting times in patients receiving intravenous enoxaparin during percutaneous coronary intervention.

Enoxaparin is being used more frequently in patients undergoing percutaneous coronary intervention (PCI). In this study, we determined the effect of intravenous enoxaparin on activated clotting time (ACT) measurements in the setting of PCI. In 67 consecutive patients, either 1 mg/kg intravenous enoxaparin alone was given for anticoagulation or 0.

Hospital disposition and long-term follow-up of patients aged >/=80 years undergoing coronary artery revascularization.

Coronary artery revascularization by either percutaneous coronary intervention or coronary artery bypass graft surgery in patients >/=80 years of age can be accomplished with acceptable in-hospital and 2-year clinical outcomes. However, up to 20% of patients have a prolonged recovery and are unable to immediately return home. It is important that this information become part of the discussion with patients and their families so realistic expectations can be developed.

Effects of feeding milk replacer once versus twice daily on glucose metabolism in Holstein and Jersey calves.

Eighteen Holstein (experiment 1) and 15 Jersey (experiment 2) heifer calves were fed milk replacer once or twice daily to determine effects of feeding frequency on weight gain, starter intake, and glucose metabolism. Body weights were measured weekly from birth to 8 wk. Blood samples were collected at wk 1 through 6 from all calves before and at 30, 60, 90, 120 and 180 min after the morning feeding.

Evolutionary and functional significance of hominoid tooth enamel.

The purpose of this investigation is to evaluate enamel thickness in extant and extinct hominoids. The material used in this study spans the evolutionary history of this group, from 20 million years ago to the present. The objectives of this investigation are to test three hypotheses: (1) the Loading Hypothesis: loading areas of the crown have thicker enamel than non-loading areas; (2) the Phyletic Hypothesis: differences in enamel thickness provide a basis for determining evolutionary relationships; and (3) the Functional Hypothesis: differences among hominoids result from adaptations to differing dietary and ecological habitats, that is from folivory to frugivory to hard object feeding and from tropical to forest to savanna habitats.