Development of a pediatric cardiac computer aided auscultation decision support system.

Developing countries have a large population of children living with undiagnosed heart murmurs. As a result of an accompanying skills shortage, most of these children will not get the necessary treatment. The objective of this paper was to develop a decision support system. This could enable health care providers in developing countries with tools to screen large amounts of children without the need for expensive equipment or specialist skills. For this purpose an algorithm was designed and tested to detect heart murmurs in digitally recorded signals. A specificity of 94% and a sensitivity of 91% were achieved using novel signal processing techniques and an ensemble of neural networks as classifier.

Pacemaker lead infection: report of three cases and review of the literature.

Pacemaker lead infection is a rare condition, most often occurring when intervention is needed after pacemaker implantation. Diagnosis is by blood cultures and confirmation by transoesophageal echocardiography; transthoracic echocardiography is often inadequate. A literature review indicated the microorganism most responsible for late lead infection is Staphylococcus epidermidis (which can grow on plastic material). A retrospective analysis of patient files from the authors' institution (1993-97) yielded three patients with proven pacemaker lead endocarditis. The diagnosis of pacemaker endocarditis was by transoesophageal echocardiography. The endocarditis appeared after a long period and in two of the three patients there was S epidermidis infection. Thoracotomy with removal of the infected system was performed because of the large dimensions of the vegetations. A new pacemaker was implanted: in one patient with endocardial leads, in the other two with epicardial leads. All three patients recovered well and follow up was uneventful for at least one year.

Differential sensitivity to ACTH, but not stress, in two sources of outbred Sprague-Dawley rats.

Adrenocorticotropic hormone (ACTH) is the major regulator of adrenocortical steroidogenesis in mammals. By comparing the sensitivity to ACTH of isolated adrenocortical cells from two sources of the same strain (Sprague-Dawley, SD) of outbred rats, we have identified a source of rat with low sensitivity to ACTH in vitro. Cells isolated from Holtzman SD rats had a high sensitivity to ACTH (minimal effective concentration 50 pg/ml), whereas Taconic SD rats had a low sensitivity (minimal effective concentration 250 pg/ml; maximal steroidogenesis < 50% of Holtzman cells). The responsiveness to analogues of cyclic adenosine monophosphate and cholesterol was also significantly lower in Taconic SD rats. Taconic adrenals were smaller, had significantly more mitochondria per cell, but approximately 20% less total lipid droplet volume per cell. There was no difference in latency to ACTH in vitro; however, steroidogenesis plateaued in Taconic cells after 25 min, while Holtzman cells secreted corticosterone almost linearly for at least 120 min. By contrast, the cyclic adenosine monophosphate secretion increased at the same rate for at least 120 min in cells from both sources. There were no differences between cells from the two sources in immunoreactive steroidogenic enzyme content. In vivo, the magnitude of the ACTH and corticosterone responses to two types of stress were similar in both sources. The thymus glands of Holtzman rats were significantly larger than those of Taconic rats. It is concluded that: (1) reduced sensitivity to ACTH in vitro in Taconic SD rats results from differences in the later stages of the steroidogenic pathway; (2) factors in addition to ACTH are required for maximal steroidogenesis in Taconic SD rats: (3) a comparison of the steroidogenic pathways in adrenal cells from these two sources of outbred rats should be useful in further delineating the relative importance of putative intracellular signalling mechanisms involved in initiation and maintenance of steroidogenesis, and (4) these data suggest that different sources of the same strain of rats sufficiently diverge over time to become separate strains ('substrains'). Overreliance on a single source of laboratory rodent may obscure natural variability in endocrine responses to stress and provide a misleading indication of homogeneity of responses.

Fatty acids inhibit adrenocorticotropin-induced adrenal steroidogenesis.

Unsaturated long chain fatty acids modulate hormone secretion from a variety of endocrine glands, including the adrenal cortex. Oleic acid and linoleic acid have been shown to stimulate production of glucocorticoids in the absence of adrenocorticotropic hormone, but at a high concentration appeared to inhibit the action of this hormone. In the present study, the concentration dependence of the inhibitory actions of these two fatty acids was tested in collagenase-dispersed rat adrenal fasciculata cells, and the effects of both lipids on cAMP production were also determined. Adrenocorticotropic hormone stimulated steroid production from isolated cells approximately ten-fold above unstimulated cells. Oleic and linoleic acid significantly inhibited the response to this hormone by 44% and 54%, respectively. The half-maximally effective inhibitory concentration of both lipids was between 75-100 microM. A maximal concentration of adrenocorticotropic hormone increased cAMP secretion 138-fold above unstimulated cells. Oleic and linoleic acids inhibited the increase in cAMP secretion by 47% and 33%, respectively. It is concluded that pathophysiological concentrations of unsaturated fatty acids inhibit the action of adrenocorticotropic hormone on the adrenal gland, and that the mechanism of action of the lipids may be partly via inhibition of cAMP production.

Zinc absorption, mineral balance, and blood lipids in women consuming controlled lactoovovegetarian and omnivorous diets for 8 wk.

Zinc absorption, mineral balance, and blood lipid concentrations were measured in 21 women aged 33 +/- 7 y (range: 20-42 y) consuming controlled lactoovovegetarian and nonvegetarian diets for 8 wk each in a crossover design. The lactoovovegetarian and nonvegetarian diets, respectively, provided (by analysis) 973 and 995 mg Ca, 1.8 and 1.3 mg Cu, 367 and 260 mg Mg, 5.9 and 2.5 mg Mn, 1457 and 1667 mg P, 9.1 and 11.1 mg Zn, and (by calculation) 40 and 16 g dietary fiber, 2.5 and 0.8 mmol phytic acid, molar ratios of phytate to Zn of 14 and 5, and millimolar ratios of (phytate x Ca) to Zn of 344 and 111. Dietary zinc absorption was measured by extrinsic isotopic labeling and whole-body counting. Plasma cholesterol, cholesterol fractions, and lipoproteins were reduced 7-12% with the lactoovovegetarian diet, consistent with predictions based on dietary cholesterol and fat. Blood pressure was unaffected. Calcium, copper, magnesium, and phosphorus balances were not different between diets; manganese balance tended to be greater with the lactoovovegetarian diet (P < 0.07). The lactoovovegetarian diet was associated with a 21% reduction in absorptive efficiency that, together with a 14% reduction in dietary zinc, reduced the amount of zinc absorbed by 35% (2.4 compared with 3.7 mg/d) and reduced plasma zinc by 5% within the normal range. Zinc balance was maintained with both diets. Although there is a greater risk of zinc deficiency in persons consuming lactoovovegetarian compared with omnivorous diets, with inclusion of whole grains and legumes zinc requirements can be met and zinc balance maintained.