Age and gender affect ventricular-vascular coupling during aerobic exercise.

Objectives: The goal of this study was to examine the age-associated differences in ventricular-vascular coupling, defined by the ratio of arterial elastance (EaI) to left ventricular systolic elastance (E(LV)I), and its components, at rest and during exercise.

Background: Ejection fraction (EF) increases during exercise, but the EF reserve decreases with aging. Ejection fraction is inversely related to EaI/E(LV)I, an index of the interaction between arterial and ventricular properties, which is an important determinant of cardiac performance.

Costs of on-demand and prophylactic treatment for severe haemophilia in Norway and Sweden.

The expected annual cost (in the year 2000 prices) for a 30-year-old patient with average individual and treatment characteristics for on-demand EUR 51,832 (95% CI: 44,324-59,341) and for prophylaxis EUR 146,118 (95% CI: 129,965-162,271), was obtained from panel-data analysis of an 11-year retrospective panel of 156 patients with severe haemophilia in Norway and Sweden. Costs included haemophilia-related treatment costs within the health-care sector (factor concentrate, doctors' visits, diagnostic procedures, hospitalisation, invasive procedures, etc.) and cost for haemophilia-related resource use in other sectors (lost production, use of special equipment, adaptation of workplace and domicile, etc).

Continuous infusion of B-domain deleted recombinant factor VIII (ReFacto) in patients with haemophilia A undergoing surgery: clinical experience.

This retrospective, open-label, non-comparative study evaluated continuous infusion of recombinant factor VIII (ReFacto), B-domain deleted recombinant FVIII (BDDrFVIII), in patients with haemophilia A undergoing surgery and requiring >5 consecutive days of treatment. Sixteen patients from eight centres underwent a total of 20 procedures. Haemostatic outcome was assessed as 'excellent' or 'good' in 75% of procedures, and target FVIII:C levels were maintained throughout the continuous infusion period.

Voiding dysfunction in children.

The practicing urologist commonly sees children with lower-urinary tract dysfunction who wet or have recurrent urinary tract infections. This article identifies the proposed etiologies of such behavior in children in whom there are no anatomic or neuropathic causes, outlines the approach to evaluating affected children, and describes a stepwise,interdisciplinary approach to treatment.

The tautomerism of Omeprazole in solution: a 1H and 13C NMR study.

The tautomerism of 5(6)-methoxy-2-([(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl] sulfinyl)-1H-benzimidazole (omeprazole) was determined in solution, K(T) = 0.59 in THF at 195 K, in favor of the 6-methoxy tautomer. The assignment of the signals was made by comparison with its two N-methyl derivatives in acetone-d6 and through theoretical calculations of the absolute shieldings (GIAO/DFT/6-311++G**).

Development and validation of a patient questionnaire to determine New York Heart Association classification.

Background: New York Heart Association (NYHA) classification correlates with quality of life and is useful in tracking changes in status in clinical trials. We explored methods to determine NYHA class in multicenter trials where double-blind conditions could not be maintained.

Methods And Results: A questionnaire was developed containing 7 major questions based on the standard definitions of NYHA classes.

A clinical comparison of two commercially available pediatric hemoconcentrators.

Hemoconcentration is a technique that involves selective removal of plasma water and some dissolved solutes by way of an ultrafiltration membrane. Hemoconcentrators (HC) are routinely used during pediatric cardiopulmonary bypass (CPB) to remove free plasma water and various inflammatory mediators. This paper examines two different commercial HCs, the Dideco DHF0.

North American neonatal extracorporeal membrane oxygenation (ECMO) devices: 2002 survey results.

In mid 2002, surveys of active extracorporeal membrane oxygenation (ECMO) centers in the United States and Canada were conducted via E-mail regarding neonatal equipment and personnel. Seventy-four out of 99 (75%) North American ECMO centers listed in the Extracorporeal Life Support Organization (ELSO) directory responded to the survey. Of the responding centers, 95% use roller pumps, and the remaining 5% use centrifugal pumps.

Prospective evaluation of the relationship between platelet-leukocyte conjugate formation and recurrent myocardial ischemia in patients with acute coronary syndromes.

Platelet-leukocyte conjugates are increased in patients with coronary artery disease but the relationship between conjugate formation and myocardial ischemic outcome is unknown. We prospectively evaluated the relationship between conjugate formation and the development of recurrent myocardial ischemia in patients with acute coronary syndromes (ACS). Platelet-leukocyte conjugate formation (induced by thrombin receptor activating peptide (TRAP)) and platelet aggregation (induced by ADP and arachidonic acid) were assessed in 30 patients with unstable angina or non-ST elevation myocardial infarction.

Coping, commitment, and attitude: quantifying the everyday burden of enuresis on children and their families.

Objective: To develop and evaluate a parent-completed questionnaire for use by clinicians as part of routine care to assess the burden of diurnal and nocturnal enuresis on children and their families.

Methods: The questionnaire consisted of items that measure the impact on the child and his/her parent, the child's coping ability and commitment to treatment, previous treatment success, family frustration and overall cohesion, and parental attitudes about enuresis and its treatment. Questionnaires (n = 208) were completed by parents during the child's scheduled office visit for enuresis at 5 specialty clinics across the United States.

Why is factor Xa not a better target than factor IIa for therapeutic inhibition of coagulation?

The rapid development of new and selective anticoagulant agents has triggered the question of which activated coagulation factor would be a better target for the inhibition of coagulation. Indirect comparisons between studies on the different drugs are problematic due to the plethora of characteristics that may differ between them. Even head-to-head comparisons in the same study may not determine the optimal target due to differences in pharmacokinetics between the agents.

Acquired hemophilia masked by warfarin therapy: report on two cases.

Spontaneous appearance of acquired anticoagulants is a rare phenomenon. We present two cases, where such antibodies against factor VIII were masked by warfarin therapy. The two patients were anticoagulated with warfarin due to mechanical heart valve and recurrent thromboembolic events, respectively.

Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximelagatran.

Background: For many patients with venous thromboembolism, secondary prevention with vitamin K antagonists is not extended beyond six months, since the risk of recurrence may be outweighed by the risk of major bleeding.

Methods: In a double-blind, multicenter trial, we randomly assigned 1233 patients with venous thromboembolism who had undergone six months of anticoagulant therapy to extended secondary prevention with the oral direct thrombin inhibitor ximelagatran (24 mg) or placebo, taken twice daily, for 18 months without monitoring of coagulation. At base line, bilateral ultrasonography of the legs and perfusion lung scanning were performed.

Addressing the potential risks associated with ephedra use: a review of recent efforts.

The appropriate amount of oversight for dietary supplements has been a subject of debate for over a decade. This debate has come to a head recently with herbal ephedra, which may be associated with adverse events including heart attack, stroke, seizure, and death. This article reviews and puts into context recent findings on the safety concerns related to ephedra, based primarily on adverse event reports.

Thrombosis in inherited factor VII deficiency.

Thrombosis in congenital factor (F) VII deficiency was investigated through extensive phenotypic and molecular-genetic studies. Patients with a history of thrombosis among 514 entries in the FVII Deficiency Study Group database were evaluated. Thrombotic events were arterial in one case, disseminated intravascular coagulation in another and venous in seven.

Effects of maternal nicotine exposure on branching morphogenesis of mouse fetal lung: in vivo and in vitro studies.

Epidemiological evidence suggests that premature infants born to mothers who smoke have a lower incidence of neonatal respiratory distress syndrome. The mechanism has been proposed to be due to increased lung maturity. This in vivo study investigated the effect of maternal nicotine on lung development by evaluating the airway branching morphogenesis (ABM) in mice fetuses.

Platelet-leukocyte aggregation under shear stress: differential involvement of selectins and integrins.

Platelets and leukocytes can form heterotypic aggregates. We studied how shear stress influences platelet-leukocyte aggregation (PLA). Shear stress was applied to hirudinized blood, using a cone-and-plate(let) analyzer.

On-demand vs. prophylactic treatment for severe haemophilia in Norway and Sweden: differences in treatment characteristics and outcome.

Using an 11-year panel of 156 Norwegian and Swedish patients with severe haemophilia, and including retrospective case-book data from birth, we compared the differences in the haemophilia-related resource use between on-demand and prophylactic treatment. Patients treated on-demand had more surgery (arthrodeses, prostheses implantations and synovectomies) and more days lost from work. Median annual factor-concentrate consumption among adults (18+) was 211,000 IU [interquartile range (IQR) 154,000-268,000] or 3,024 IU kg-1 year(-1) for patients on prophylactic treatment and 55,000 IU (IQR 28,000-91,000) for on-demand patients (780 IU kg(-1) year(-1)).

Novel anticoagulant agents: introduction.

In this Minisymposium three principles for anticoagulant therapy are discussed and examples of novel, selective coagulation inhibitors at the stage of advanced clinical trials are given. This introduction attempts to explain the different mechanisms of action on a broad scale, and also includes a brief look at effects on inflammation and cancer.