Independent relations of left ventricular structure with the 24-h urinary excretion of sodium and aldosterone

Objective: Previous studies reported on the association of left ventricular mass index (LVMI) with urinary sodium or with circulating or urinary aldosterone.We investigated the independent associations of LVMI with the urinary excretion of both sodium and aldosterone. Design and method: We randomly recruited 317 untreated subjects from a White population (45.1%women; mean age 48.2 years).Measurements included echocardiographic left ventricular (LV) properties, the 24 h urinary excretion of sodium and aldosterone, plasma renin activity (PRA), and proximal (RNaprox) and distal (RNadist) renal sodium reabsorption, assessed fromthe endogenous lithium clearance. Inmultivariable-adjusted models,we expressed changes in LVMI per 1 SD increase in the explanatory variables, while accounting for sex, age, systolic blood pressure and the waist-to-hip ratio. Results: LVMI increased independentlywith the urinary excretion of both sodium (+2.48 g/m2; P=0.005) and aldosterone (+2.63 g/m2; P=0.004). Higher sodium excretion was associated with increased mean wall thickness (MWT: +0.126 mm, P=0.054), but with no change in LV end-diastolic diameter (LVID: +0.12mm, P=0.64). In contrast, higher aldosterone excretion was associated with higher LVID (+0.54 mm; P=0.017), but with no change in MWT (+0.070mm; P=0.28).Higher RNadistwas associatedwith lower relativewall thickness (−0.81×10−2, P=0.017), because of opposite trends in LVID(+0.33 mm; P=0.13) and MWT (−0.130mm; P=0.040). LVMI was not associated with PRA or RNaprox. Conclusions: LVMI independently increased with both urinary sodium and aldosterone excretion. IncreasedMWT explained the association of LVMI with urinary sodium and increased LVID the association of LVMI with urinary aldosterone.

Metastatic leishmaniasis. A chronic inflammatory response to Leishmania's viral endosymbiont.

Leishmania parasites have been plaguing humankind for centuries as a range of skin diseases named the cutaneous leishmaniases (CL). Carried in a hematophagous sand fly, Leishmania usually infests the skin surrounding the bite site, causing a destructive immune response that may persist for months or even years. The various symptomatic outcomes of CL range from a benevolent self- healing reddened bump to extensive open ulcerations, resistant to treatment and resulting in life- changing disfiguration. Many of these more aggressive outcomes are geographically isolated within the habitats of certain Neotropical Leishmania species; where about 15% of cases experience metastatic complications. However, despite this correlation, genetic analysis has revealed no major differences between species causing the various disease forms. We have recently identified a cytoplasmic dsRNA virus within metastatic L. guyanensis parasites that acts as a potent innate immunogen capable of worsening lesionai inflammation and prolonging parasite survival. The dsRNA genome of Leishmania RNA virus (LRV) binds and stimulates Toll-Like-Receptor-3 (TLR3), inducing this destructive inflammation, which we speculate as a factor contributing to the development of metastatic disease. This thesis establishes the first experimental model of LRV-mediated leishmanial metastasis and investigates the role of non-TLR3 viral recognition pathways in LRV-mediated pathology. Viral dsRNA can be detected by various non-TLR3 pattern recognition receptors (PRR); two such PRR groups are the RLRs (Retinoic acid-inducible gene 1 like receptors) and the NLRs (nucleotide- binding domain, leucine-rich repeat containing receptors). The RLRs are designed to detect viral dsRNA in the cytoplasm, while the NLRs react to molecular "danger" signals of cell damage, often oligomerizing into molecular scaffolds called "inflammasomes" that activate a potent inflammatory cascade. Interestingly, we found that neither RLR signalling nor the inflammasome pathway had an effect on LRV-mediated pathology. In contrast, we found a dramatic inflammasome independent effect for the NLR family member, NLRP10, where a knockout mouse model showed little evidence of disease. This phenotype was mimicked in an NLR knockout with which NLRP10 is known to interact: NLRC2. As this pathway induces the chronic inflammatory cell lineage TH17, we investigated the role of its key chronic inflammatory cytokine, IL-17A, in human patients infected by L. guyanensis. Indeed, patients infected with LRV+ parasites had a significantly increased level of IL-17A in lesionai biopsies. Interestingly, LRV presence was also associated with a significant decrease in the correlate of protection, IFN-y. This association was repeated in our murine model, where after we were able to establish the first experimental model of LRV-dependent leishmanial metastasis, which was mediated by IL-17A in the absence of IFN-y. Finally, we tested a new inhibitor of IL-17A secretion, SR1001, and reveal its potential as a Prophylactic immunomodulator and potent parasitotoxic drug. Taken together, these findings provide a basis for anti-IL-17A as a feasible therapeutic intervention to prevent and treat the metastatic complications of cutaneous leishmaniasis. -- Les parasites Leishmania infectent l'homme depuis des siècles causant des affections cutanées, appelées leishmanioses cutanées (LC). Le parasite est transmis par la mouche des sables et réside dans le derme à l'endroit de la piqûre. Au niveau de la peau, le parasite provoque une réponse immunitaire destructrice qui peut persister pendant des mois voire des années. Les symptômes de LC vont d'une simple enflure qui guérit spontanément jusqu' à de vastes ulcérations ouvertes, résistantes aux traitements. Des manifestations plus agressives sont déterminées par les habitats géographiques de certaines espèces de Leishmania. Dans ces cas, environ 15% des patients développent des lésions métastatiques. Aucun «facteur métastatique» n'a encore été trouvé à ce jour dans ces espèces. Récemment, nous avons pu identifier un virus résidant dans certains parasites métastatiques présents en Guyane française (appelé Leishmania-virus, ou LV) et qui confère un avantage de survie à son hôte parasitaire. Ce virus active fortement la réponse inflammatoire, aggravant l'inflammation et prolongeant l'infection parasitaire. Afin de diagnostiquer, prévenir et traiter ces lésions, nous nous sommes intéressés à identifier les composants de la voie de signalisation anti-virale, responsables de la persistance de cette inflammation. Cette étude décrit le premier modèle expérimental de métastases de la leishmaniose induites par LV, et identifie plusieurs composants de la voie inflammatoire anti-virale qui facilite la pathologie métastatique. Contrairement à l'homme, les souris de laboratoire infectées par des Leishmania métastatiques (contenant LV, LV+) ne développent pas de lésions métastatiques et guérissent après quelques semaines d'infection. Après avoir analysé un groupe de patients atteints de leishmaniose en Guyane française, nous avons constaté que les personnes infectées avec les parasites métastatiques LV+ avaient des niveaux significativement plus faibles d'un composant immunitaire protecteur important, appelé l'interféron (IFN)-y. En utilisant des souris génétiquement modifiées, incapables de produire de l'IFN-y, nous avons observé de telles métastases. Après inoculation dans le coussinet plantaire de souris IFN-y7" avec des parasites LV+ ou LV-, nous avons démontré que seules les souris infectées avec des leishmanies ayant LV développent de multiples lésions secondaires sur la queue. Comme nous l'avons observé chez l'homme, ces souris sécrètent une quantité significativement élevée d'un composant inflammatoire destructeur, l'interleukine (IL)-17. IL-17 a été incriminée pour son rôle dans de nombreuses maladies inflammatoires chroniques. On a ainsi trouvé un rôle destructif similaire pour l'IL-17 dans la leishmaniose métastatique. Nous avons confirmé ce rôle en abrogeant IL-17 dans des souris IFN-y7- ce qui ralentit l'apparition des métastases. Nous pouvons donc conclure que les métastases de la leishmaniose sont induites par l'IL-17 en absence d'IFN-v. En analysant plus en détails les voies de signalisation anti-virale induites par LV, nous avons pu exclure d'autres voies d'activation de la réponse inflammatoire. Nous avons ainsi démontré que la signalisation par LV est indépendante de la signalisation inflammatoire de type « inflammasome ». En revanche, nous avons pu y lier plusieurs autres molécules, telles que NLRP10 et NLRC2, connues pour leur synergie avec les réponses inflammatoires. Cette nouvelle voie pourrait être la cible pour des médicaments inhibant l'inflammation. En effet, un nouveau médicament qui bloque la production d'IL-17 chez la souris s'est montré prometteur dans notre modèle : il a réduit le gonflement des lésions ainsi que la charge parasitaire, indiquant que la voie anti-virale /inflammatoire est une approche thérapeutique possible pour prévenir et traiter cette infection négligée.

Impact of the Advisa MRI pacing system on the diagnostic quality of cardiac MR images and contraction patterns of cardiac muscle during scans: Advisa MRI randomized clinical multicenter study results.

BACKGROUND: The Advisa MRI system is designed to safely undergo magnetic resonance imaging (MRI). Its influence on image quality is not well known. OBJECTIVE: To evaluate cardiac magnetic resonance (CMR) image quality and to characterize myocardial contraction patterns by using the Advisa MRI system. METHODS: In this international trial with 35 participating centers, an Advisa MRI system was implanted in 263 patients. Of those, 177 were randomized to the MRI group and 150 underwent MRI scans at the 9-12-week visit. Left ventricular (LV) and right ventricular (RV) cine long-axis steady-state free precession MR images were graded for quality. Signal loss along the implantable pulse generator and leads was measured. The tagging CMR data quality was assessed as the percentage of trackable tagging points on complementary spatial modulation of magnetization acquisitions (n=16) and segmental circumferential fiber shortening was quantified. RESULTS: Of all cine long-axis steady-state free precession acquisitions, 95% of LV and 98% of RV acquisitions were of diagnostic quality, with 84% and 93%, respectively, being of good or excellent quality. Tagging points were trackable from systole into early diastole (360-648 ms after the R-wave) in all segments. During RV pacing, tagging demonstrated a dyssynchronous contraction pattern, which was not observed in nonpaced (n = 4) and right atrial-paced (n = 8) patients. CONCLUSIONS: In the Advisa MRI study, high-quality CMR images for the assessment of cardiac anatomy and function were obtained in most patients with an implantable pacing system. In addition, this study demonstrated the feasibility of acquiring tagging data to study the LV function during pacing.

Extracellular vesicles from human cardiac progenitor cells inhibit cardiomyocyte apoptosis and improve cardiac function after myocardial infarction.

AIMS: Recent evidence suggests that cardiac progenitor cells (CPCs) may improve cardiac function after injury. The underlying mechanisms are indirect, but their mediators remain unidentified. Exosomes and other secreted membrane vesicles, hereafter collectively referred to as extracellular vesicles (EVs), act as paracrine signalling mediators. Here, we report that EVs secreted by human CPCs are crucial cardioprotective agents. METHODS AND RESULTS: CPCs were derived from atrial appendage explants from patients who underwent heart valve surgery. CPC-conditioned medium (CM) inhibited apoptosis in mouse HL-1 cardiomyocytic cells, while enhancing tube formation in human umbilical vein endothelial cells. These effects were abrogated by depleting CM of EVs. They were reproduced by EVs secreted by CPCs, but not by those secreted by human dermal fibroblasts. Transmission electron microscopy and nanoparticle tracking analysis showed most EVs to be 30-90 nm in diameter, the size of exosomes, although smaller and larger vesicles were also present. MicroRNAs most highly enriched in EVs secreted by CPCs compared with fibroblasts included miR-210, miR-132, and miR-146a-3p. miR-210 down-regulated its known targets, ephrin A3 and PTP1b, inhibiting apoptosis in cardiomyocytic cells. miR-132 down-regulated its target, RasGAP-p120, enhancing tube formation in endothelial cells. Infarcted hearts injected with EVs from CPCs, but not from fibroblasts, exhibited less cardiomyocyte apoptosis, enhanced angiogenesis, and improved LV ejection fraction (0.8 ± 6.8 vs. -21.3 ± 4.5%; P < 0.05) compared with those injected with control medium. CONCLUSION: EVs are the active component of the paracrine secretion by human CPCs. As a cell-free approach, EVs could circumvent many of the limitations of cell transplantation.

Movimentação de nitrato em horizonte superficial e subsuperficial de Latossolo e Nitossolo com cargas variáveis

O objetivo deste trabalho foi avaliar a movimentação de nitrato em colunas de solo considerando-se, principalmente, a quantidade total recuperada, o ajuste entre as curvas de transposição experimental e predita por um modelo matemático e os fatores de retardamento obtidos pelo modelo. Foram utilizadas amostras dos horizontes A e B de um Latossolo Vermelho acriférrico e de um Nitossolo Vermelho eutrófico (LV-A, LV-B, NV-A e NV-B). O experimento de lixiviação foi conduzido tendo em vista a teoria do deslocamento miscível, utilizando como pulso 100 mL de KNO3 10 mmol L-1. As quantidades lixiviadas de nitrato e recuperadas nas colunas, para os solos NV e LV nos horizontes A e B, variaram de 0,405 a 1,432 mmol L-1. Houve correlação significativa (p<0,05) entre as curvas experimentais e as ajustadas pelo modelo para as colunas NV-A, NV-B e LV-B. O modelo matemático utilizado é adequado para prever a lixiviação de nitrato em colunas do horizonte B dos solos Nitossolo Vermelho Eutrófico e Latossolo Vermelho Acriférrico. Nas colunas dos solos com bom ajuste entre dados experimentais e preditos, o fator de retardamento é maior do que 1, o que indica que a movimentação do nitrato é retardada em relação ao avanço da frente de molhamento do solo.

Drenagem interna como fator de diferenciação de Latossolos do Distrito Federal

O objetivo deste trabalho foi determinar a influência de características físico-hídricas dos solos em atributos diagnóstico de Latossolos. Realizou-se o levantamento de atributos morfológicos, químicos, físicos, mineralógicos e físico-hídricos de cinco perfis de Latossolos Vermelhos (LV) e cinco perfis de Latossolos Vermelho-Amarelos (LVA) petroplínticos, considerados representativos dessa classe de solos no Distrito Federal. Além da caracterização dos atributos diagnóstico, a oscilação do nível freático dos solos foi monitorada por meio de poços de observação de 2,5 m de profundidade, durante um ano. Os Latossolos estudados foram considerados semelhantes química e fisicamente. Contudo, diferiram quanto às caracterizações morfológica e mineralógica, com a presença de horizontes concrecionários e goethita nos LVA. A estabilidade da goethita nesses solos foi influenciada pela oscilação do lençol freático. Constatou-se menor condutividade hidráulica saturada e menor variação da profundidade freática nos LVA, em razão da deficiência de drenagem interna causada pela presença dos horizontes concrecionários. Os LVA apresentam, portanto, menor potencial agrícola que os LV, no Distrito Federal. As características físico-hídricas de Latossolos têm pouca influência sobre atributos diagnóstico, com exceção da mineralogia dos óxidos de ferro, que apresentam os teores de goethita aumentados em condições de baixa drenagem interna.

Rpe65-Gene Transfer Using an Integration-Deficient Lentiviral Vector

Purpose: We previously demonstrated efficient retinal rescue of RPE65 mouse models (Rpe65-/- (Bemelmans et al, 2006) and Rpe65R91W/R91W mice) using a HIV1-derived lentiviral vector encoding for the mouse RPE65 cDNA. In order to optimize a lentiviral vector as an alternative tool for RPE65-derived Leber Congenital Amaurosis clinical trials, we evaluated the efficiency of an integration-deficient lentiviral vector (IDLV) encoding the human RPE65 cDNA to restore retinal function in the Rpe65R91W/R91W mice. Methods: An HIV-1-derived lentiviral vector expressing either the hrGFPII or the human Rpe65 cDNA under the control of a 0.8 kb fragment of the human Rpe65 promoter (R0.8) was produced by transient transfection of 293T cells. A LQ-integrase mutant was used to generate the IDLV vectors. IDLV-R0.8-hRPE65 or hrGFPII were injected subretinally into 1 month-old Rpe65R91W/R91W mice. Functional rescue was assessed by ERG (1 and 3 months post-injection) and cone survival by immunohistology. Results: An increased light sensitivity was detected by scotopic ERG in animals injected with IDLV-R0.8-hRPE65 compared to hrGFPII-treated animals or untreated mice. However the improvement was delayed compared to integration-proficient LV and observed at 3 months but not 1 month post-injection. Immunolabelling of cone markers showed an increased number of cones in the transduced area compared to control groups. Conclusions: The IDLV-R0.8-hRPE65 vectors allow retinal improvement in the Rpe65R91W/R91W mice. Both rod function and cone survival were demonstrated even if there is a delay in the rescue as assessed by scotopic ERG. Integration-deficient vectors minimize insertional mutagenesis and thus are safer candidates for human application. Further experiments using large animals are now needed to validate correct gene transfer and expression of the RPE65 gene as well as tolerance of the vector after subretinal injection before envisaging a clinical trial application.

Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography.

Forty-six consecutive patients with pulmonary embolism (PE) who underwent pulmonary angiography, helical computed tomography (CT), and echocardiography in the investigators' emergency department were studied. It was determined that the CT right ventricular (RV)/left ventricular (LV) end-diastolic area ratio was correlated with PE obstruction and echocardiography. A CT RV/LV area ratio &gt;1 had a sensitivity of 88% and a specificity of 88% in diagnosing significant PE. The present study suggests that helical CT may be used as a triage tool in acute PE for selecting high-risk patients, using calculation of the RV/LV area ratio to detect RV dysfunction.

Tasasähkön hyödyntämismahdollisuudet sähkönjakelussa

Tässä työssä on tutkittu tasasähkönsiirron tuomia mahdollisuuksia sähkönjakelussa, kun pienjännitedirektiivin pienjännitemäärittelyn soveltamista laajennetaan koskemaan vaihtojännitteen lisäksi myös tasajännitettä. Aiemmin tasasähköjärjestelmiä on käytetty ainoastaan sähköistymisen alkuaikoina 1900-luvun alussa. Viime vuosikymmeninä on sähkönjakelussa käytetty pelkästään vaihtosähköverkkoja, koska tehoelektronisten laitteiden korkea hintataso ja tekniset ominaisuudet ovat mahdollistaneet tasasähkön käytön vain suurjännitteellä. Suomalaisten sähkönkäyttö on lisääntynyt muutamalla prosenttiyksiköllä vuosittain ja kasvun taantumista ei ole odotettavissa lähiaikoina. Samaan aikaan yhteiskunta muuttuu jatkuvasti yhä riippuvaisemmaksi sähköstä ja odotukset toteutuvasta sähkönlaadusta ovat jatkuvasti korkeammat. Sähkönlaadun näkökulmasta ilmasto on tuonut aiempia suurempia haasteita sähkön toimitusvarmuudelle, kun myrskyjen aiheuttamat tuhot ovat olleet yhä entisiä suurempia. Toimitusvarmuuden parantamiseksi ovat muutamat vuosikymmenen alun rajut myrskyt johtaneet pohdintaan tulevien haasteiden hoitamiseksi ja edelleen uuden 3-portaiseen 20/1/0,4 kV vaihtosähköjärjestelmän kehittämiseen. Tasasähkönsiirron avulla halutaan tuoda käyttöön niitä hyötyjä, joita järjestelmän vaihdolla on saavutettavissa. Täysimääräisellä tasajännitteen hyödyntämisellä voidaan saavuttaa mm. aiempaa edullisempia investointivaihtoehtoja,parempi sähkönlaatu, parempi hajautetun tuotannon liitettävyys verkkoon ja erilaisten asiakaskohtaisten laitteiden helppo integroitavuus osaksi jakelujärjestelmää. Tämän työn puitteissa on pohdittu sekä teknisiä ratkaisuja että järjestelmän teknistaloudellista käyttöaluetta. Lisäksi on pyritty hahmottamaan eri tekijöiden vaikutuksia sähkönjakeluun.

Altered high-energy phosphate metabolism predicts contractile dysfunction and subsequent ventricular remodeling in pressure-overload hypertrophy mice.

To study the role of early energetic abnormalities in the subsequent development of heart failure, we performed serial in vivo combined magnetic resonance imaging (MRI) and (31)P magnetic resonance spectroscopy (MRS) studies in mice that underwent pressure-overload following transverse aorta constriction (TAC). After 3 wk of TAC, a significant increase in left ventricular (LV) mass (74 +/- 4 vs. 140 +/- 26 mg, control vs. TAC, respectively; P < 0.000005), size [end-diastolic volume (EDV): 48 +/- 3 vs. 61 +/- 8 microl; P < 0.005], and contractile dysfunction [ejection fraction (EF): 62 +/- 4 vs. 38 +/- 10%; P < 0.000005] was observed, as well as depressed cardiac energetics (PCr/ATP: 2.0 +/- 0.1 vs. 1.3 +/- 0.4, P < 0.0005) measured by combined MRI/MRS. After an additional 3 wk, LV mass (140 +/- 26 vs. 167 +/- 36 mg; P < 0.01) and cavity size (EDV: 61 +/- 8 vs. 76 +/- 8 microl; P < 0.001) increased further, but there was no additional decline in PCr/ATP or EF. Cardiac PCr/ATP correlated inversely with end-systolic volume and directly with EF at 6 wk but not at 3 wk, suggesting a role of sustained energetic abnormalities in evolving chamber dysfunction and remodeling. Indeed, reduced cardiac PCr/ATP observed at 3 wk strongly correlated with changes in EDV that developed over the ensuing 3 wk. These data suggest that abnormal energetics due to pressure overload predict subsequent LV remodeling and dysfunction.

Dynamic drag modeling of submerged aquatic vegetation canopy flows

Vegetation has a profound effect on flow and sediment transport processes in natural rivers, by increasing both skin friction and form drag. The increase in drag introduces a drag discontinuity between the in-canopy flow and the flow above, which leads to the development of an inflection point in the velocity profile, resembling a free shear layer. Therefore, drag acts as the primary driver for the entire canopy system. Most current numerical hydraulic models which incorporate vegetation rely either on simple, static plant forms, or canopy-scaled drag terms. However, it is suggested that these are insufficient as vegetation canopies represent complex, dynamic, porous blockages within the flow, which are subject to spatially and temporally dynamic drag forces. Here we present a dynamic drag methodology within a CFD framework. Preliminary results for a benchmark cylinder case highlight the accuracy of the method, and suggest its applicability to more complex cases.

Extending the canopy flow model for natural, highly flexible macrophyte canopies

Flow structures above vegetation canopies have received much attention within terrestrial and aquatic literature. This research has led to a good process understanding of mean and turbulent canopy flow structure. However, much of this research has focused on rigid or semi-rigid vegetation with relatively simple morphology. Aquatic macrophytes differ from this form, exhibiting more complex morphologies, predominantly horizontal posture in the flow and a different force balance. While some recent studies have investigated such canopies, there is still the need to examine the relevance and applicability of general canopy layer theory to these types of vegetation. Here, we report on a range of numerical experiments, using both semi-rigid and highly flexible canopies. The results for the semi-rigid canopies support existing canopy layer theory. However, for the highly flexible vegetation, the flow pattern is much more complex and suggests that a new canopy model may be required.

Climate and human forcing of Alpine river flow

River flow in Alpine environments is likely to be highly sensitive to climate change because of the effects of warming upon snow and ice, and hence the intra-annual distribution of river runoff. It is also likely to be influenced strongly by human impacts both upon hydrology (e.g. flow abstraction) and river regulation. This paper compares the river flow and sediment flux of two Alpine drainage basins over the last 5 to 7 decades, one that is largely unimpacted by human activities, one strongly impacted by flow abstraction for hydroelectricity. The analysis shows that both river flow and sediment transport capacity are strongly dependent upon the effects of temperature and precipitation availability upon snow accumulation. As the latter tends to increase annual maximum flows, and given the non-linear form of most sediment transport laws, current warming trends may lead to increased sedimentation in Alpine rivers. However, extension to a system impacted upon by flow abstraction reveals the dominant effect that human activity can have upon river sedimentation but also how human response to sediment management has co-evolved with climate forcing to make disentangling the two very difficult.

Different degrees of ischaemic injury in the right and left ventricle in cases of severe, nonfatal, pulmonary embolism.

Pulmonary fat embolism (PFE) is a common complication of blunt force traumas with bone fractures. Severe forms cause impedance to right ventricular (RV) ejection, with eventual right heart ischaemia and failure. In a prospective study, we have investigated 220 consecutive autopsy cases (73 females, 147 males, mean age 52.1 years, min 14 years, max 91 years). PFE was detected in 52 cases that were divided into three groups according to the degree of PFE (1-3). A fourth group of cases of violent death without PFE was used for comparison. In each case, histology (H&E, Masson) and immunohistochemistry (fibronectin and C5b-9) were performed on six cardiac samples (anterior, lateral and posterior wall of both ventricles). The degree of cardiac damage was registered in each sample and the mean degree of damage was calculated in each case at the RV and left ventricle (LV). Moreover, a parameter ∆ that is the difference between the mean damage at the RV and the LV was calculated in each case. The results were compared within each group and between the groups. In the present study, we could not detect prevalent RV damage in cases of high degree PFE as we did in our previous investigation. In the group PFE3 the difference of the degree of damage between the RV and LV was higher than the one observed in the groups PFE0-2 with the antibody anti-fibronectin. Prevalent right ventricular stress in cases of severe PFE may explain this observation.