WASP: (Write a Scientific Paper). Doctors in Star Trek - Correctly compassionate, caring Kantian Zampolit.

Doctors in Star Trek are vital and central characters, often crucial in helping their captains to reach command decisions. They are also interdisciplinarians, performing not only medical tasks but also any form of work related to all fields of biology. Furthermore, these doctors also carry out any required research that pertains to the biological sciences. It is perhaps this unique blend of skills, combined with a fundamental orientation towards humanism and compassion, that leads to their default position, de facto, if not de jure, as the crew's ethics officers, a role that they embrace with as much dedication and zeal as the former Soviet communist political officers/commissars (the Zampolit) did theirs. This paper will show that from the very inception of Star Trek, doctors strictly adhered to deontological tenets which lead them to actively influence command decisions that pertain not only to health, but also to any ethical decisions that may have to be taken by Starfleet officers. This portrayal of future doctors signals the wishes of contemporary audiences: that future doctors remain humane, compassionate and ethical guardian angels, and not only superb medics.

Revascularization with percutaneous coronary intervention does not affect androgen status in males with chronic stable angina pectoris.

There is a clear association between low serum testosterone and coronary artery disease (CAD) in men. Hypotestosteronaemia is associated with accelerated atherosclerosis and a quarter of men with CAD are biochemically hypogonadal. Amongst those with CAD, hypotestosteronaemia is associated with increased mortality. Testosterone vasodilates coronary arteries, and exogenous testosterone reduces ischaemia. Whether hypotestosteronaemia is a cause or a consequence of CAD remains unanswered. The aim of this prospective observational study was to investigate whether coronary revascularization affected androgen status in men with stable angina pectoris. Twenty five men (mean age 62.7, SD 9.18) with angiographically significant CAD and symptomatic angina underwent full coronary revascularization by percutaneous coronary intervention. Androgen status and symptoms of angina, stress, depression and sexual function were assessed before, and at one and 6 months after the coronary revascularization. All patients underwent complete revascularization which was associated with a significant reduction in angina symptoms and ischaemia. No significant difference was seen in total testosterone (11.33 nmol/L baseline; 12.56, 1 month post; 13.04 at 6 months; p = 0.08). A significant and sustained rise in sex hormone-binding globulin was seen (33.99 nm/L baseline; 36.11 nm/L 1 month post PCI; 37.94 nm/L at 6 months; p = 0.03) Overall, there was no significant alteration in any other marker of androgen status including free testosterone or bioavailable testosterone. There was no change in symptoms of anxiety, depression or sexual function. Coronary revascularization has no sustained effect on androgen status. This supports the hypothesis that hypotestosteronaemia is not a consequence of angina pectoris or myocardial ischaemia.

4,4'-, 5,5'-, and 6,6'-dimethyl-2,2'-bipyridyls: the structures, phase transitions, vibrations, and methyl group tunneling of their complexes with chloranilic acid.

The crystal and molecular structures of 4,4(')- and 6,6(')-dimethyl-2,2(')-bipyridyl complexes with 2,5-dichloro-3,6-dihydroxy-p-benzoquinone (chloranilic acid, CLA) have been determined and compared with those of the complex with the 5,5(')-derivative, which is known to possess interesting antiferroelectric properties. In the crystalline state, all three compounds form hydrogen bonded chains with N(+)-H···O(-) and O-H···N bridges on both sides of the bipyridyl constituent. The comparison of three derivatives indicates that the N(+)-H···O(-) hydrogen bonds are shortest for the 5,5(')-dimethyl complex. The 4,4(')- and 6,6(')-derivatives do not show any ferroelectric feature. The 6,6(')-one is, however, characterized by a continuous phase transition, revealed in the differential scanning calorimetry, dilatometric, and dielectric characteristics. The tunneling splitting measured by neutron backscattering in the energy range ±30 µeV for the neat dimethyl bipyridyls and their complexes with CLA indicates that the different splittings are primarily due to the crystal packing effect and that charge transfer between interacting compounds plays only a minor role.

The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm-Case Report and Review of the Literature.

A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

The structure of diaminodurene and the dynamics of the methyl groups.

Diaminodurene crystallizes in the orthorhombic space group Pbca, with eight molecules in the unit cell. Four inequivalent methyl groups with different environments exist in a molecule. The amino groups are also different, which is well reflected in infrared spectra. Two tunneling modes are resolved at 23.7 and 7.0 microeV at 4.5 K. Their intensities are consistent with the presence of two further unresolved tunneling modes. Quasielastic spectra are composed of three Lorentzians of equal intensities. The two low activation energies and tunnel modes are modeled into consistent rotational potentials. The third activation energy and a librational band are used to guess the strength of the two stronger rotational potentials. The internal modes related to the torsional/librational vibrations mix with ring torsions in the range of 70-220 cm(-1). This way the tunnel modes couple to ring torsions whose energy determines the broadening of both tunnel bands. The calculations for free molecules yield mode frequencies a little bit lower than the experimental inelastic neutron scattering (INS) values. Application of theoretical methods elaborated for the crystalline state leads to a satisfactory consistency. It is also valid for bending modes of NH(2) groups, which in the solid state show much higher frequencies than in the gas phase, as expected.

X-ray diffraction and inelastic neutron scattering study of 1:1 tetramethylpyrazine chloranilic acid complex: temperature, isotope, and pressure effects.

The x-ray diffraction studies of the title complex were carried out at room temperature and 14 K for H/D (in hydrogen bridge) isotopomers. At 82 K a phase transition takes place leading to a doubling of unit cells and alternation of the hydrogen bond lengths linking tetramethylpyrazine (TMP) and chloranilic acid molecules. A marked H/D isotope effect on these lengths was found at room temperature. The elongation is much smaller at 14 K. The infrared isotopic ratio for O-H(D)...N bands equals to 1.33. The four tunnel splittings of methyl librational ground states of the protonated complex required by the structure are determined at a temperature T=4.2 K up to pressures P=4.7 kbars by high resolution neutron spectroscopy. The tunnel mode at 20.6 microeV at ambient pressure shifts smoothly to 12.2 microeV at P=3.4 kbars. This is attributed to an increase of the strength of the rotational potential proportional to r(-5.6). The three other tunnel peaks show no or weak shifts only. The increasing interaction with diminishing intermolecular distances is assumed to be compensated by a charge transfer between the constituents of deltae/e approximately 0.02 kbar(-1). The phase transition observed between 3.4 and 4.7 kbars leads to increased symmetry with only two more intense tunneling bands. In the isotopomer with deuterated hydrogen bonds and P=1 bar all tunnel intensities become equal in consistency with the low temperature crystal structure. The effect of charge transfer is confirmed by a weakening of rotational potentials for those methyl groups whose tunnel splittings were independent of pressure. Density functional theory calculations for the model TMP.(HF)2 complex and fully ionized molecule TMP+ point out that the intramolecular rotational potential of methyl groups is weaker in the charged species. They do not allow for the unequivocal conclusions about the role of the intermolecular charge transfer effect on the torsional frequencies.

Unexpected result of percutaneous coronary intervention-two for the price of one.

Anomalous coronary arteries are uncommon. This case illustrates an unusual result of percutaneous coronary intervention to the right coronary artery (RCA), where the circulation was also restored in the left anterior descending artery (LAD) territory via an anomalous vessel.

Low frequency internal modes of 1,2,4,5-tetramethylbenzene, tetramethylpyrazine and tetramethyl-1,4-benzoquinone INS, Raman, infrared and theoretical DFT studies.

The results of inelastic neutron scattering (INS), Raman and infrared (IR) studies on 1,2,4,5-tetramethylbenzene (durene), tetramethylpyrazine (TMP) and tetramethyl-1,4-benzoquinone (TMBQ) in the solid state are reported. The observed frequencies are analyzed on the basis of DFT calculations. The low frequency region, below 400 cm(-1), related to the torsional and bending out-of-plane vibrations of the CH(3) groups, is of particular interest. The detailed analysis is possible due to the simulation of the INS spectra by using the auntie-CLIMAX program. It is shown that the observed low frequency INS bands are dramatically shifted, compared to the calculated ones, towards higher frequencies. Although one cannot exclude deficiencies of theoretical methods as applied to low frequency modes, it seems more probable the interpretation based on an existence of non-conventional CH(...)pi, CH(...)N, CH(...)O hydrogen bonds formed by the methyl groups in crystalline phases.

One year results of the Middlesbrough early revascularisation to limit infarction (MERLIN) trial.

OBJECTIVE: To report one year results of the MERLIN (Middlesbrough early revascularisation to limit infarction) trial, a prospective randomised trial comparing the strategy of coronary angiography and urgent revascularisation with conservative treatment in patients with failed fibrinolysis complicating ST segment elevation myocardial infarction (STEMI). The 30 day results have recently been published. At the planning stage of the trial, it was determined that follow up of trial patients would continue annually to three years to determine whether late benefit occurred. SUBJECTS: 307 patients who received a fibrinolytic for STEMI but failed to reperfuse early according to previously described ECG criteria and did not develop cardiogenic shock. METHODS: Patients were randomly assigned to receive either emergency coronary angiography with a view to proceeding to urgent revascularisation (rescue percutaneous coronary intervention (rPCI) arm) or continued medical treatment (conservative arm). The primary end point was all cause mortality at 30 days. The secondary end points included the composite end point of death, reinfarction, stroke, unplanned revascularisation, or heart failure at 30 days. The same end points were evaluated at one year and these results are presented. RESULTS: All cause mortality at one year was similar in the conservative arm and the rPCI arm (13.0% v 14.4%, p = 0.7, risk difference (RD) -1.4%, 95% confidence interval (CI) -9.3 to 6.4). The incidence of the composite secondary end point of death, reinfarction, stroke, unplanned revascularisation, or heart failure was significantly higher in the conservative arm (57.8% v 43.1%, p = 0.01, RD 14.7%, 95% CI 3.5% to 25.5%). This was driven almost exclusively by a significantly higher incidence of subsequent unplanned revascularisation in the conservative arm (29.9% v 12.4%, p < 0.001, RD 17.5%, 95% CI 8.5% to 26.4%). Reinfarction and clinical heart failure were numerically, but not statistically, more common in the conservative arm (14.3% v 10.5%, p = 0.3, RD 3.8%, 95% CI -3.7 to 11.4, and 31.2% v 26.1%, p = 0.3, RD 5.0%, 95% CI -5.1 to 15.1). There was a strong trend towards fewer strokes in the conservative arm (1.3% v 5.2%, p = 0.06, RD -3.9%, 95% CI -8.9 to 0.06). CONCLUSION: At one year of follow up, there was no survival advantage in the rPCI arm compared with the conservative arm. The incidence of the composite secondary end point was significantly lower in the rPCI arm, but this was driven almost entirely by a highly significant reduction in the incidence of further revascularisation.

Inelastic neutron scattering study of tetramethylpyrazine in the complex with chloranilic acid.

The tunnel splitting of the methyl librational ground states in the hydrogen bonded tetramethylpyrazine-chloranilic acid (TMP-CLA) complex are determined for temperatures T≤28 K by high resolution neutron spectroscopy. Three tunnel modes are resolved at T = 2.4 K. Their relative intensities show that the crystal structure must be different from the proposed space group. Tunnelling and methyl librational modes from the measured density of states are combined into rotational potentials. There are discrepancies of activation energies calculated for these potentials and those obtained from quasielastic scattering of neutrons at T≥50 K due to structural differences in the two respective temperature regimes. Rotational potentials in TMP-CLA are significantly weaker as in pure TMP.

Inelastic neutron scattering studies on dichloro-1,4-benzoquinones.

Inelastic neutron scattering (INS) spectra of 2,6-dichloro- and 2,5-dichloro-1,4-benzoquinone were compared with Raman and infra-red (IR) spectra and analysed in detail below 1800 cm(-1). The analysis was based on calculations tending towards simulation of spectra by using GAUSSIAN (HF, DFT/B3LYP and BLYP/6-31G(d,p)), and auntieCLIMAX programs. The correlations between calculated and experimental (either INS or Raman and IR) frequencies enabled to analyse the problem of scaling factors (SFs). The advantages of INS technique was shown in studies of low frequency vibrations with participation of H-atoms. The macroscopic lattice effect at low temperatures on INS spectra is discussed.

Inelastic neutron scattering (INS) studies on 2,5-dihydroxy-1,4-benzoquinone (DHBQ).

Inelastic neutron scattering (INS) spectra of solid 2,5-dihydroxy-1,4-benzoquinone were measured and compared with IR and Raman data. The INS spectrum is very well reproduced in the region below 1000 cm(-1) by DFT calculations on the B3LYP/6-311++G** level using Gaussian and Climax programs. To get a better agreement one should take into account additional interactions of OH groups in the solid state leading to an increase of the gamma(OH) frequency and to a decrease of frequencies for modes in which the delta(OH) participates. The studies of the deuterated compound in IR enabled to correct the assignment of gamma(OH) vibrations. Highly asymmetric nu(OH) band observed in IR spectrum with sharp maximum at about 3300 cm(-1) is discussed in terms of a stochastic approach to the analysis of hydrogen bonded systems.

Early and late reactions after the use of iopamidol 340, ioxaglate 320, and iodixanol 320 in cardiac catheterization.

BACKGROUND: Although modern contrast agents have tolerability superior to older agents, significant differences remain between the agents currently in use. METHODS: To investigate the incidence of early (<24 hours) and late (>24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization, we performed a randomized, prospective, double-blind trial in which 2001 patients received one of the following agents: iopamidol 340, a nonionic monomer; ioxaglate 320, an ionic dimer; and iodixanol 320, a nonionic dimer. Possible reactions to contrast were recorded during the hospital admission and after discharge by means of a questionnaire, telephone follow-up, or both. RESULTS: Early reactions occurred in 22.2% of those receiving ioxaglate, 7.6% of those receiving iodixanol, and 8.8% of those receiving iopamidol (P <.0001). Late skin reactions occurred in 12.2% of those receiving iodixanol, 4.3% of those receiving ioxaglate, and 4.2% of those receiving iopamidol (P <.0001). CONCLUSIONS: The early side effect profile of certain ionic contrast agents suggests that these agents should no longer be used routinely in cardiac catheterization. The use of nonionic agents, however, is associated with late skin reactions, but there are notable differences between the monomeric and dimeric compounds. Although the skin reactions are generally benign, this is not always the case. Patients should be advised accordingly.

Selective use of abciximab in coronary stenting: overall outcomes can still be equivalent to those in the EPISTENT treatment group.

BACKGROUND: The EPISTENT trial reported improved early outcomes with routine use of abciximab after coronary stenting. Increasing use of stents means that routine abciximab adds significantly to costs of percutaneous coronary intervention (PCI). This paper reports the results of a protocol encouraging restriction of abciximab therapy to high-risk patients only. METHODS: Data were collected prospectively over a 34-month period for patients undergoing PCI with stenting. In addition to those who fulfilled criteria for inclusion in the EPISTENT trial, patients treated in the setting of acute myocardial infarction (AMI) were studied. Demographic data, procedural details and early clinical outcomes were recorded. RESULTS: Of 808 patients studied, 601 fulfilled EPISTENT inclusion criteria and comprised 367 patients (45%) treated for stable angina and 234 (30%) treated for unstable or post-infarct angina. The additional 207 patients (25%) were treated during AMI. The 808 patients received a total of 981 stents. Abciximab was given in only 88 cases (10.9%). Major adverse clinical events occurred in 39 patients (4.8%). CONCLUSION: Selective use of abciximab for patients undergoing coronary stenting can be associated with outcomes equivalent to those reported for routine use, but with significant cost savings.

Vibrational spectra of the adduct of 1,8-bis(dimethylamino)naphthalene with dichloromaleic acid (DMAN x DCM).

The infra-red (IR), Raman (R) and inelastic incoherent neutron scattering (IINS) spectra, particularly in low frequency region, of the title ionic adduct were studied. It is shown that all low frequency vibrations (below 200 cm(-1)) of (CH3)2N groups of protonated 1,8-bis(dimethylamino)naphthalene (DMAN)--clearly observed in IINS spectra--are sensitive to the environment, i.e. to the type of counterion forming short contacts with C-H bonds of methyl groups. The internal frequencies were also calculated by ab initio method. The results are consistent with numerous observations of the counteranion effect on the geometry of the protonated DMAN. The conclusions are compared with structural and NMR studies reported recently for the 1,8-bis(dimethylamino)naphthalene with dichloromaleic acid (DMAN x DCM) adduct. The single crystal R polarized spectra taken over the frequency range 20-3200 cm(-1) were analyzed in detail. We have shown that a substantial difference in the IR spectrum of the dichloromaleic acid (DCM) anion in the DMAN adduct and in the potassium salt results from different geometries of OHO hydrogen bonds. In the case of potassium salt the chains of longer intermolecular hydrogen bonds are formed described by means of a double minimum potential.

Reappraising the role of immediate intervention following thrombolytic recanalization in acute myocardial infarction.

Early studies indicated that after successful thrombolytic recanalization, adjunctive percutaneous transluminal coronary angioplasty (PTCA) was not appropriate, even when a significant residual stenosis was present. The aim of this study was to assess in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful recanalization after thrombolytic therapy. The relation between repeat AMI/unstable angina and the severity of the stenosis, as well as other angiographic and clinical features was also examined. One hundred patients with AMI of <10 hours underwent coronary angiography 2 hours after receiving thrombolytic therapy. Salvage PTCA +/- stenting was performed if recanalization was unsuccessful (Thrombolysis In Myocardial Infarction [TIMI] trial grade 0 to 2), and no PTCA was undertaken if there was brisk anterograde flow (TIMI 3). Angiographic analysis was performed to assess the severity of the residual lesion, as well as the presence or absence of thrombus. Forty patients had unsuccessful recanalization, and of these, 36 underwent attempted PTCA. Of the 60 patients with TIMI 3 flow, 15 required repeat angiography and PTCA after repeat AMI (n = 13) or unstable angina (n = 2) within 5 days. Receiver-operating characteristic analysis indicated an optimum percent diameter stenosis predictor of 85% for repeat AMI/unstable angina. There was no additional relation to age, gender, time to thrombolysis, the infarct-related artery, or the presence of culprit lesion thrombus. After recanalization, a high-grade stenosis >85% is common (n = 25, 42.4%). This is associated with a 54% repeat AMI/unstable angina risk-a ninefold increase in the incidence of such events than in patients with lesions <85%. Thus, patients with narrowings >85% may benefit from early intervention rather than a conservative approach. Narrowings <85% have a 94% probability of no repeat AMI/unstable angina and do not require early intervention.

Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method.

OBJECTIVE: To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment. DESIGN: Cohort study. SETTING: Regional cardiothoracic unit. PATIENTS: 100 sequential patients with acute myocardial infarction. INTERVENTIONS: Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel. RESULTS: The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm. This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%. CONCLUSIONS: Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase. These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel. They may be used without recourse to sophisticated equipment or complex analyses. Such patients can then be considered for alternative treatments or enrollment into appropriate research protocols.

Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis.

OBJECTIVE: To assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis. DESIGN: A cohort study. SETTING: Regional cardiothoracic unit. PATIENTS: 197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion. INTERVENTIONS: Emergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow. MAIN OUTCOME MEASURES: Hospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way. RESULTS: 197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%. CONCLUSIONS: A policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality.