Intracardiac echo guided valvuloplasty of a stenotic tricuspid prosthetic valve in a patient with idiopathic hypereosinophilic syndrome

A 52-year-old male with idiopathic hypereosinophilic syndrome (HES) was transferred to our institution following the development of acute respiratory failure and shock. He had previously undergone tricuspid valve replacement with bioprosthetic valves on two occasions: the initial surgery for severe native tricuspid valve stenosis and the redo surgery for severe prosthetic valve stenosis and regurgitation. Conventional imaging assessment using transoesophageal echocardiography was suboptimal and comprehensive assessment of prosthetic valve function was aided by the use of intracardiac echocardiography (ICE). ICE provided high quality 2D imaging of the prosthesis demonstrating thrombus-like material coating the inner surfaces of the prosthetic valve stents effectively forming a tunnel-like obstruction. Unusual hemodynamics secondary to severe tricuspid stenosis were demonstrated by CW Doppler with intermittent signal fusion resulting from blunted respiratory variation in the markedly elevated right atrial pressure relative to right ventricular pressure. Successful balloon valvuloplasty was performed with ICE proving highly valuable in guiding balloon position as well as monitoring the efficacy of the subsequent inflations.

Basal-like breast carcinomas: clinical outcome and response to chemotherapy

Background: Grade-III invasive ductal carcinomas of no special type (IDCs-NST) constitute a heterogeneous group of tumours with different clinical behaviour and response to chemotherapy. As many as 25% of all grade-III IDCs-NST are known to harbour a basal-like phenotype, as defined by gene expression profiling or immunohistochemistry for basal cytokeratins. Patients with basal-like breast carcinomas (BLBC) are reported to have a shorter disease-free and overall survival. Material and methods: A retrospective analysis of 49 patients with BLBC (as defined by basal cytokeratin expression) and 49 controls matched for age, nodal status and grade was carried out. Histological features, immunohistochemical findings for oestrogen receptor (ER), progesterone receptor (PgR) and HER2, and clinical outcome and survival after adjuvant chemotherapy were compared between the two groups. Results: It was more likely for patients with BLBCs to be found negative for ER (p < 0.0001), PgR (p < 0.0001) and HER2 (p < 0.01) than controls. Patients with BLBCs were found to have a significantly higher recurrence rate (p < 0.05) and were associated with significantly shorter disease-free and overall survival (both p, 0.05). In the group of patients who received anthracycline-based adjuvant chemotherapy (BLBC group, n = 47; controls, n = 49), both disease-free and overall survival were found to be significantly shorter in the BLBC group (p < 0.05). Conclusions: BLBCs are a distinct clinical and pathological entity, characterised by high nuclear grade, lack of hormone receptors and HER2 expression and a more aggressive clinical course. Standard adjuvant chemotherapy seems to be less effective in these tumours and new therapeutic approaches are indicated.

Fatigue crack propagation in a sintered 2xxx series aluminium alloy

Many potential applications for sintered aluminium are limited by the poor fatigue properties of the material. In order to increase understanding of the fatigue mechanisms in sintered aluminium, fatigue tests were carried out on a sintered 2xxx series aluminium alloy, AMB-2712. The alloy has a fatigue endurance strength of approximately 145 MPa (R = 0.1). Three regions were identified on the fatigue fracture surfaces. Region I contains the initiation site and transgranular crack propagation. When the size of the cyclic plastic zone ahead of the crack becomes comparable to the grain size, microstructural damage at the crack tip results in a transition to intergranular propagation. Region 2 mainly contains intergranularly fractured material, whilst the final fracture area makes up Region 3, in the form of dimple coalescence and intergranular failure. Transgranular fractographic features observed on fatigued specimens include fissure-type striations, cross-hatched grains, furrowed grains and grains containing step-like features. (c) 2006 Elsevier B.V. All rights reserved.

Transpiration efficiency in a segregating population of sunflower: Inheritance, correlation with other traits and association with hybrid grain yield

Plants incorporate isotopes of carbon into their tissue at different rates because of discrimination against 13C relative to 12C during photosynthesis. This difference in discrimination has been negatively correlated with transpiration efficiency (TE) in many C3 species and so, carbon isotope discrimination (Δ) of leaf tissues has been proposed as a potential tool for selecting genotypes with improved performance under water limited conditions. The relationship between Δ and TE in sunflower has been described previously using diverse genotypes, but this relationship has not been investigated with material selected from a segregating population. In this study, the TE of twenty recombinant inbred lines from a population (HAR4 x SA52) segregating for Δ was evaluated in a rainout shelter experiment. A strong negative genetic correlation between TE and Δ was observed (rg = -0.58), confirming previous studies of sunflower with unrelated lines. In addition, TE was strongly correlated to plant height at the final harvest (rg = 0.64) and TDW (rg = 0.58), and moderately correlated to SLW (rg = 0.46) and SPAD (rg = 0.21) but not leaf number (rg = 0.02). Estimates of narrow sense heritability of TE and Δ were very high (0.82 and 0.77, respectively) suggesting that selection for these traits could occur in early generations of segregating populations. Grain yield evaluations under field conditions of hybrids contrasting for Δ showed that low Δ (high TE) hybrids had a yield advantage between 22-35% in dry environments where the yield was less than 2t/ha. While this level of yield advantage may not be realized in commercial breeding programs, computer simulations suggest that 10-15% yield improvements may be possible. Low Δ material selected from the population HAR4 x SA52 has been distributed to private seed companies for further evaluation.

Long-distance signaling in nodulation directed by a CLAVATA1-like receptor kinase

Proliferation of legume nodule primordia is controlled by shoot-root signaling known as autoregulation of nodulation (AON). Mutants defective in AON show supernodulation and increased numbers of lateral roots. Here, we demonstrate that AON in soybean is controlled by the receptor-like protein kinase GmNARK (Glycine max nodule autoregulation receptor kinase), similar to Arabidopsis CLAVATA1 (CLV1). Whereas CLV1 functions in a protein complex controlling stem cell proliferation by short-distance signaling in shoot apices, GmNARK expression in the leaf has a major role in long-distance communication with nodule and lateral root primordia.