Peripartum Cardiomyopathy: A Current Review

Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options

Commercial Fishing License Limitation in the State of Alaska: A Controversial System of Grandfather Rights

After two failed attempts to establish limited entry in its salmon fisheries,iii pursuant to legislation adopted by the Alaska Legislature in 1973, Alaska placed its primary salmon fisheries under limitation by 1975. Alaska persisted in seeking limited entry largely in response to declining salmon resources coupled with increasing levels of participation. Alaska’s system limited the number of gear licenses to a maximum number which must be equal to or greater than the highest number of units of gear present in a particular fishery during the four years prior to limitation. With all prior participants eligible to apply, the number of eligible applicants was generally far greater than the maximum number. Under an elaborate system of grandfather rights, permanent entry permits have been awarded to those fishers who demonstrated the most dependence upon a particular fishery, as measured by their past participation and economic dependence. Eligible fishers may continue to fish until there is a final determination on their applications. Permanent entry permits are, for the most part, freely transferable and inheritable, subject to some restriction (for example, permits may neither be leased nor pledged as security for a debt). Salmon fishers helped design Alaska’s program for Alaska’s salmon fleet, which consisted largely of individual fishers who owned and operated their own vessels. The program achieved a moratorium on new entrants and a gradual reduction of units of gear toward the maximum number as individual claims to permits were resolved. Alaska’s license limitation program contributes to limiting fishing capacity, because it is coupled with other limitations on effort such as vessel size and gear restriction. Taken together, Alaska’s license limitation and other management tools allow managers to calculate with some assurance the power of the fishing fleets they seek to control. Although the program is neutral as to residency, the percentages of permits held by Alaskans have tended to remain stable from the time of initial limitation. Alaska’s program has always been controversial. The allocation system is complicated, expensive, and requires years to complete. While the program has survived all major legal challenges, courts have modified the program. Although the percentage of permits held by Alaskan residents has remained stable, in some areas, the number of permits held by local, rural Alaska residents has declined. Additionally, the high cost of permits in valuable fisheries has made initial entry into some fisheries difficult. Alaska’s license limitation program is most useful in fisheries that resemble Alaska salmon fisheries. The more a fishery departs from the Alaska salmon fishery model (as a fleet of individual owner-operators), the less likely it is that Alaska’s form of license limitation would be of value

Plasma levels of sphingosine 1-phosphate are strongly correlated with haematocrit, but variably restored by red blood cell transfusions

Anaemia and RBC (red blood cell) transfusion may be associated with worse clinical outcomes, especially with longer blood storage duration prior to transfusion. The mechanisms underlying these harmful effects are unknown. RBCs have been proposed to buffer plasma S1P (sphingosine 1-phosphate), a lysophospholipid essential for the maintenance of endothelial integrity and important in the regulation of haematopoietic cell trafficking. The present study examined the effect of anaemia, RBC transfusion and RBC storage duration on plasma S1P levels. Plasma S1P from 30 individuals demonstrated a linear correlation with Hct (haematocrit; R2=0.51, P<0.001) with no evidence for a plateau at Hct values as low as 19%. RBC transfusion in 23 anaemic patients with baseline mean Hct of 22.2±0.34% (value is the mean±S.D.) increased Hct to 28.3±0.6% at 72 h. Despite an Hct increase, RBC transfusion failed to elevate plasma S1P consistently. A trend towards an inverse correlation was observed between RBC storage duration and the post-transfusion increase in plasma S1P. After 30 days of storage, RBC S1P decreased to 19% of that observed in fresh (3–7-day-old) RBC segments. RBC membranes contain low levels of both S1P phosphatase and S1P lyase activities that may account for the decline in S1P levels with storage. Our results support a role for RBCs in buffering plasma S1P and identify a disturbance in the capacity after transfusion. Changes in S1P content may contribute to an RBC storage lesion. Further studies should investigate the clinical significance of alterations in circulating S1P levels and the potential value of enriching stored RBCs with S1P

Formulation and characterization of antibacterial orthodontic adhesive

ABSTRACT Objective: The objective of this study was to formulate experimental orthodontic bracket adhesives and test their mechanical properties, fluoride release and antibacterial activity. Methods: Four experimental antibacterial orthodontic bracket adhesives were prepared with different compositions of synthesized antibacterial monomers replacing total 5% of dental monomers in the control Transbond XT (3M): 5%C11, 3.5%C11+1.5%C2, 5%C16, and 3.5%C16+1.5%C2. Transbond XT alone was used as control. These groups were used to bond premolar brackets to extracted premolars. Shear bond strength (SBS) was tested using an Instron machine. For antibacterial test, disk specimens (10mm diameter, 1mm thick, n=4) were fabricated and incubated with cultures of cariogenic Streptococcus mutans for 48h, and following gentle sonication, S. mutans biofilms in colony-forming-units (CFU) on the disks were enumerated by plating on agar medium. The data were analyzed using ANOVA and Tukey test (α=0.05). Results: All experimental groups had similar shear bond strength (no significant difference) to the control. All experimental groups showed significant inhibitory effect against S. mutans biofilm formation, when compared to the control, but there was no significant difference between experimental groups. Conclusion: Antibacterial orthodontic adhesive can be fabricated to have similar mechanical properties but better caries-inhibitory effect than current adhesive.</jats:p

Low to Moderate Dose Anthracycline-Based Chemotherapy Is Associated With Early Noninvasive Imaging Evidence of Subclinical Cardiovascular Disease

ObjectivesThe goal of this study was to determine if low to moderate doses of anthracycline-based chemotherapy (Anth-bC) are associated with subclinical cardiovascular (CV) injury.BackgroundCancer survivors who receive Anth-bC experience premature CV events. It is unknown whether low to moderate doses of anthracyclines promote early subclinical CV disease manifested by deteriorations in left ventricular ejection fraction (LVEF) or increases in aortic stiffness, or if these doses are associated with changes in quality of life (QOL).MethodsIn 53 men and women with breast cancer, leukemia, or lymphoma, we assessed left ventricular volumes, LVEF, circumferential strain, aortic pulse wave velocity, late gadolinium enhancement, serum B-type natriuretic peptide, troponin I, and the impact of treatment on QOL before and 1, 3, and 6 months after receipt of Anth-bC.ResultsParticipants averaged 50 ± 2 (range 19 to 80) years in age, 58% were women, 17% were black, and they each received a range of 50 to 375 mg/m2 of doxorubicin-equivalent chemotherapy. Left ventricular end-systolic volume (48 ± 3 ml to 54 ± 3 ml; p = 0.02), left ventricular strain (–17.7 ± 0.4 to –15.1 ± 0.4; p = 0.0003), pulse wave velocity (6.7 ± 0.5 m/s to 10.1 ± 1 m/s; p = 0.0006), and QOL deterioration (15.4 ± 3.3 to 28.5 ± 3.9; p = 0.008) increased, whereas LVEF (58 ± 1% to 53 ± 1%; p = 0.0002) decreased within 6 months after low to moderate doses of Anth-bC. All findings persisted after accounting for age, gender, race (white/black), doxorubicin-equivalent dose, doxorubicin administration technique, comorbidities associated with CV events, and cancer diagnosis (p = 0.02 to 0.0001 for all). There were no new late gadolinium enhancement findings after 6 months.ConclusionsIn these study patients, low to moderate doses of Anth-bC were associated with the early development of subclinical abnormalities of cardiac and vascular function that in other populations are associated with the future occurrence of CV events