Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study.

Background: Asthma epidemics associated with thunderstorms have had catastrophic effects on individuals and emergency services. Seasonal allergic rhinitis (SAR) is present in the vast majority of people who develop thunderstorm asthma (TA), but there is little evidence regarding risk factors for TA among the SAR population.

Objective: We sought to identify risk factors for a history of TA and hospital presentation in a cohort of individuals with SAR.

Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices.

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort.

Are Men at High Risk for Osteoporosis Underscreened? A Quality Improvement Project.

Context: Osteoporosis is a major cause of morbidity and mortality in both men and women. The mortality rate in men within 1 year of hip fracture is 37.5%, which is 51% higher than in women.

Collaboration between the coroner and emergency physicians: efforts to improve outcomes from aortic dissection.

The Coroners Prevention Unit at the Coroners Court of Victoria (CCV) is a multidisciplinary team that investigates deaths referred by the state's coroners, with a view to identifying prevention opportunities. The death of a woman from acute aortic dissection (AAD) after an emergency department attendance prompted the coroner to request a roundtable meeting with emergency physicians (EPs) from Melbourne. The round table was attended by 17 EPs from Melbourne hospitals, along with representatives from the CCV.

The effects of an early observational experience on medical students' attitudes toward end-of-life care.

End-of-life care is paramount in maintaining the quality of life of the terminally ill, protecting them from unnecessary treatment, and controlling costs incurred in their care. Training doctors to be effective end-of-life caregivers begins in medical school. A survey design was used to collect data from 166 first-year medical students before and after exposure to hospice or palliative care through an early clinical exposure program.

Estimation of the physical properties of nanocomposites by finite-element discretization and Monte Carlo simulation.

This paper reviews and enhances numerical models for determining thermal, elastic and electrical properties of carbon nanotube-reinforced polymer composites. For the determination of the effective stress-strain curve and thermal conductivity of the composite material, finite-element analysis (FEA), in conjunction with the embedded fibre method (EFM), is used. Variable nanotube geometry, alignment and waviness are taken into account.

Cardiovascular risk factor(s) prevalence in Greek hypertensives. Effect of gender and age.

The aim of this study was to determine cardiovascular (CV) risk factors (RFs) and target organ damage clustering in 21280 Greek hypertensives stratified by gender and age. Glycemic and lipid profile were determined, left ventricular mass index, estimated gromerular filtration rate (eGFR), 10-years CV risk according to Framingham risk score (FRS) and HeartScore (HS) were calculated. Only 10.

Urine albumin excretion, within normal range, reflects increasing prevalence of metabolic syndrome in patients with essential hypertension.

Microalbuminuria is a prognostic marker of cardiovascular disease and is related to metabolic syndrome (MetS). For this purpose, the authors examined the relationship of low grade albuminuria to MetS, using 4 current definitions and a MetS score. They studied 6650 consecutive, nondiabetic, hypertensive patients with normal microalbumin excretion.

Segmental diastolic compression of venous and arterial conduits post coronary artery bypass surgery.

In a case of constrictive pericarditis post coronary artery bypass surgery we describe the diastolic compression of venous and arterial conduits and the timing of compression, as demonstrated during angiography, before and after pericardiectomy. In conclusion, angiographic demonstration of conduit compression is only suggestive of constriction, and consideration of the timing of compression during diastole should be a more specific sign.

Differential impact of metabolic syndrome on arterial stiffness and wave reflections: focus on distinct definitions.

Background: Arterial stiffness and wave reflections are independent predictors of cardiovascular disease. Metabolic syndrome (MS) is related to increased aortic stiffness in several populations. However, it is unclear whether the association of MS with aortic stiffness differs according to the considered definition.

The effect of milrinone on metabolism after cardiopulmonary bypass.

Aim: The aim of this study was to examine the effects of milrinone on tissue metabolism perioperatively in cardiac surgery patients using extracorporeal circulation, in comparison to adrenaline and placebo. These effects were measured indirectly by measuring serum lactate, base excess and glucose levels at standard intervals.

Methods: Seventy-seven consecutive patients, who underwent elective cardiac surgery, were allocated in 3 groups.

Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients.

Background: Data relating dipping status to metabolic syndrome (MS) scores are not available. The purpose of this study is to investigate any possible association of different dipping patterns to MS scores in untreated patients with essential hypertension.

Methods: The study included 6256 consecutive, treatment-naive patients with essential hypertension who attended our outpatient clinics.

Successful repair of a huge right coronary artery to a right ventricular fistula: report of a case.

Congenital coronary artery fistulas account for only 0.27%-0.4% of all congenital cardiac defects.

Concomitant cholecystectomy and open heart surgery.

Purpose: Cholelithiasis may be present concomitantly with cardiac disease. We performed a retrospective study to verify the safety and efficacy of synchronous cholecystectomy and open heart surgery.

Methods: Between 1999 and 2004, we performed synchronous cholecystectomy and open heart surgery in nine patients (group A) and open heart surgery alone in 1248 patients (group B).

The effect of L-arginine and aprotinin on intestinal ischemia-reperfusion injury.

Background: Intestinal ischemia/reperfusion (I/R) results in local mucosal injury, systemic injuries, and organ dysfunction. These injuries are characterized by altered microvascular and epithelial permeability and villous damage. Activation of neutrophils, platelets, and endothelial factors are known to be involved in this process.

Totally endoscopic microwave ablation for lone atrial fibrillation: an alternative method of treatment.

Recent studies suggest that pulmonary vein isolation can be an effective method of treatment for atrial fibrillation. This procedure can be performed with minimally invasive, totally endoscopic cardiac surgical techniques. We report our first successful endoscopic isolation of the pulmonary veins in a patient with paroxysmal atrial fibrillation.

Elective resection of pheochromocytoma with concomitant abdominal aortic aneurysm repair: report of a case.

We report a rare case of coexistent pheochromocytoma and abdominal aortic aneurysm (AAA). The patient was a 72-year-old man who presented to the Emergency Department with severe dyspnea and hypertension. Physical examination revealed a pulsatile mass in his abdomen.

Cartilaginous and osseous metaplasia with bone marrow formation in the aortic valve of a patient with giant cell aortitis.

We describe the case of a 40-year-old man who presented with an ascending aortic aneurysm and aortic valve regurgitation. The patient underwent a Bentall surgical procedure. Pathologic findings were consistent with giant cell aortitis with synchronous cartilaginous and osseous metaplasia with bone marrow formation in the degenerated aortic valve.

The supportive value of pre-bypass L-glutamate loading in patients undergoing coronary artery bypass grafting.

Aim: Experimental studies have demonstrated that an exogenous supply of glutamate improves mechanical function and recovery of ischemic myocardium. The aim of the present study was to investigate the effect of myocardial pre-bypass loading with glutamate on myocardial protection during global ischemia and reperfusion of patients undergoing coronary artery bypass grafting (CABG).

Methods: The study was double blinded.

Left main coronary artery stenosis after aortic valve replacement.

We describe two cases with iatrogenic left main coronary artery stenosis where a symptomatology of unstable angina appeared within three months of aortic valve replacement surgery. One patient was treated with aortocoronary bypass and the other with angioplasty and stenting.

Non-CpG cytosine methylation of p53 exon 5 in non-small cell lung carcinoma.

Non-CpG methylation of cytosine residues, a mechanism associated with regulation of gene expression, has not been investigated in human cancer until now. Analysis of the p53 exon 5 mutation spectrum in mutation databases for lung cancer reveals frequent GC>AT transitions, several of which occur at non-CpG sequences. To investigate the involvement of cytosine methylation in this mutagenesis process, we analyzed the methylation profile of p53 exon 5, in lung carcinoma.

A comprehensive approach to enhancing sexual health education in the Case Western Reserve University School of Medicine.

We report on the Sexual Health Curriculum Enhancement project at Case Western Reserve University School of Medicine. Using a US dollars 100000 grant from Pfizer Pharmaceuticals, Inc., we have developed and are in the process of implementing a comprehensive, cross-disciplinary and innovative curriculum that is based on three primary objectives for teaching sexual health: attitude change, behavior change, and knowledge acquisition.