Sustained sympathetic activation contributes to the progression of myocardial cell injury, cardiac fibrosis, and left ventricular (LV) dysfunction in heart failure (HF).
This study investigated the ...effects of radiofrequency renal nerve denervation (RF-RDN) on the pathobiology of HF and the interaction between the renal sympathetic nerves and natriuretic peptide (NP) metabolism.
Spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY) were subjected to 45 min of coronary artery ligation and reperfusion for 12 weeks. At 4 weeks post-reperfusion, SHR and WKY underwent either bilateral RF-RDN or sham-RDN.
Following RF-RDN in both strains, LV ejection fraction remained significantly above those levels in respective sham-RDN rats, and at the end of the 12-week study, rats in both strains had significantly reduced LV fibrosis and improved vascular function. RF-RDN therapy significantly improved vascular reactivity to endothelium-dependent and -independent vasodilators as well as vascular compliance in the setting of severe HF. Improvements in LV function were accompanied by significant elevations in circulating NP as compared to those associated with sham-RDN. Further investigation into the cause of increased circulating NP levels demonstrated that RF-RDN significantly inhibited renal neprilysin activity in SHR and WKY with HF. Likewise, chronic treatment with the beta1 antagonist bisoprolol inhibited renal neprilysin activity and increased circulation NP levels in WKY with HF.
This study identifies a novel endogenous pathway by which the renal nerves participate in the degradation of cardioprotective NP. Furthermore, removal of the influence of the renal nerves on kidney function attenuates renal neprilysin activity, augments circulating NP levels, reduces myocardial fibrosis, and improves LV function in the setting of HF.
Display omitted
In the 1960s and 1970s Werner Fuchs of the Austrian Geological Survey (Vienna) described a significant number of new foraminiferal taxa that he considered ancestral to the planktonic foraminifera. ...All these taxa are well-curated in the collections of the Austrian Geological Survey and have been studied by one of us (Malcolm B. Hart). Some of these taxa, from the Triassic and lowermost Jurassic strata of Austria and northern Italy, are poorly preserved, possibly the result of having an original aragonitic wall structure. None of these taxa possess characters which give the appearance of a planktonic mode of life, although some of them (e.g. Oberhauserella, Praegubkinella) may well have been ancestral to the holoplanktonic foraminifera that appeared in the Toarcian and younger strata. Other taxa in the collections of the Austrian Geological Survey (part of GeoSphere Austria), from the Jurassic of Poland, are preserved as glauconitic steinkerns and are either unidentifiable as foraminifera or suspect in terms of their stratigraphical and evolutionary significance.
A sea ice record for Barrow Strait in the Canadian Arctic Archipelago (CAA) is presented for the interval 10.0–0.4
cal. kyr BP. This Holocene record is based primarily on the occurrence of a sea ice ...biomarker chemical, IP
25, isolated from a marine sediment core obtained from Barrow Strait in 2005. A core chronology is based on
14C AMS dating of mollusc shells obtained from ten horizons within the core. The primary IP
25 data are compared with complementary proxy data obtained from analysis of other organic biomarkers, stable isotope composition of bulk organic matter, benthic foraminifera, particle size distributions and ratios of inorganic elements. The combined proxy data show that the palaeo-sea ice record can be grouped according to four intervals, and these can be contextualised further with respect to the Holocene Thermal Maximum (HTM). Spring sea ice occurrence was lowest during the early–mid Holocene (10.0–6.0
cal. kyr BP) and this was followed by a second phase (6.0–4.0
cal. kyr BP) where spring sea ice occurrence showed a small increase. Between 4.0 and 3.0
cal. kyr BP, spring sea ice occurrence increased abruptly to above the median and we associate this interval with the termination of the HTM. Elevated spring sea ice occurrences continued from 3.0 to 0.4
cal. kyr BP, although they were more variable on shorter timescales. Within this fourth interval, we also provide evidence for slightly lower and subsequently higher spring sea ice occurrence during the Mediaeval Warm Period and the Little Ice Age respectively. Comparisons are made between our proxy data with those obtained from other palaeo-climate and sea ice studies for the CAA.
Objective:
Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy ...quality assurance system intended to enhance outcomes in patients at risk of treatment failure.
Method:
Original data from six major studies conducted at a large university counseling center and a hospital outpatient setting (
N
= 6,151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were reanalyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians so that they could intervene before treatment failure occurred. Meta-analytic and mega-analytic approaches were applied in intent-to-treat and efficacy analyses of the effects of feedback interventions.
Results:
Three forms of feedback interventions-integral elements of this quality assurance system-were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (clinical support tools and the provision of patient progress feedback to therapists).
Conclusions:
The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.
Understanding the vertical distribution and migratory behaviour of shelled holoplanktonic gastropods is essential in determining the environmental conditions to which they are exposed. This is ...increasingly important in understanding the effects of ocean acidification and climate change. Here we investigated the vertical distribution of atlantid heteropods by collating data from publications and collections and using the oxygen isotope (δ18O) composition of single aragonitic shells. Data from publications and collections show 2 patterns of migration behaviour: small species that reside in shallow water at all times, and larger species that make diurnal migrations from the surface at night to deep waters during the daytime. The δ18O data show that all species analysed (n = 16) calcify their shells close to the deep chlorophyll maximum. This was within the upper 110 m of the ocean for 15 species, and down to 146 m for a single species. These findings confirm that many atlantid species are exposed to large environmental variations over a diurnal cycle and may already be well adapted to face ocean changes. However, all species analysed rely on aragonite supersaturated waters in the upper <150 m of the ocean to produce their shells, a region that is projected to undergo the earliest and greatest changes in response to increased anthropogenic CO₂.
Species assemblage composition of marine microfossils offers the possibility to investigate ecological and climatological change on time scales inaccessible using conventional observations. ...Planktonic foraminifera - calcareous zooplankton - have an excellent fossil record and are used extensively in palaeoecology and palaeoceanography. During the Last Glacial Maximum (LGM; 19,000 - 23,000 years ago), the climate was in a radically different state. This period is therefore a key target to investigate climate and biodiversity under different conditions than today. Studying LGM climate and ecosystems indeed has a long history, yet the most recent global synthesis of planktonic foraminifera assemblage composition is now nearly two decades old. Here we present the ForCenS-LGM dataset with 2,365 species assemblage samples collected using standardised methods and with harmonised taxonomy. The data originate from marine sediments from 664 sites and present a more than 50% increase in coverage compared to previous work. The taxonomy is compatible with the most recent global core top dataset, enabling direct investigation of temporal changes in foraminifera biogeography and facilitating seawater temperature reconstructions.
Members of the Clinical Practice Committee, American Society of Transplantation, have attempted to define referral criteria for solid organ transplantation. Work done by the Clinical Practice ...Committee does not represent the official position of the American Society of Transplantation. Recipients for solid organ transplantation are growing in numbers, progressively outstripping the availability of organ donors. As there may be discrepancies in referral practice and, therefore, inequity may exist in terms of access to transplantation, there needs to be uniformity about who should be referred to transplant centers so the system is fair for all patients. A review of the literature that is both generic and organ specific has been conducted so referring physicians can understand the criteria that make the patient a suitable potential transplant candidate. The psychosocial milieu that needs to be addressed is part of the transplant evaluation. Early intervention and evaluation appear to play a positive role in maximizing quality of life for the transplant recipient. There is evidence, especially in nephrology, that the majority of patients with progressive failure are referred to transplant centers at a late stage of disease. Evidence-based medicine forms the basis for medical decision-making about accepting the patient as a transplant candidate. The exact criteria for each organ are detailed. These guidelines reflect consensus opinions, synthesized by the authors after extensive literature review and reflecting the experience at their major transplant centers. These guidelines can be distributed by transplant centers to referring physicians, to aid them in understanding who is potentially an acceptable candidate for transplantation. The more familiar physicians are with the exact criteria for specific organ transplantation, the more likely they are to refer patients at an appropriate stage. Individual transplant centers will make final decisions on acceptability for transplantation based on specific patient factors. It is hoped that this overview will assist insurers/payors in reimbursing transplant centers for solid organ transplantation, based on criteria for acceptability by the transplant community. The selection and management of patients with end-stage organ failure are constantly changing, and future advances may make obsolete some of the criteria mentioned in the guidelines. Most importantly, these are intended to be guidelines, not rules.
PDF
