Mike Walker

α2(VIII) Collagen Substrata Enhance Endothelial Cell Retention Under Acute Shear Stress Flow via an α2β1 Integrin–Dependent Mechanism An In Vitro and In Vivo Study

Background— Essential to tissue-engineered vascular grafts is the formation of a functional endothelial monolayer capable of resisting the forces of blood flow. This study targeted &agr;2(VIII) collagen, a major component of the subendothelial matrix, and examined the ability of and mechanisms by which endothelial cells attach to this collagen under static and dynamic conditions both in vitro and in vivo. Methods and Results— Attachment of human endothelial cells to recombinant &agr;2(VIII) collagen was assessed in vitro under static and shear conditions of up to 100 dyne/cm2. &agr;2(VIII) collagen supported endothelial cell attachment in a dose-dependent manner, with an 18-fold higher affinity for endothelial cells compared with fibronectin. Cell attachment was significantly inhibited by function-blocking anti-&agr;2 (56%) and -&bgr;1 (98%) integrin antibodies but was not RGD dependent. Under flow, endothelial cells were retained at significantly higher levels on &agr;2(VIII) collagen (53% and 51%) than either fibronectin (23% and 16%) or glass substrata (7% and 1%) at shear rates of 30 and 60 dyne/cm2, respectively. In vivo studies, using endothelialized polyurethane grafts, demonstrated significantly higher cell retention rates to &agr;2(VIII) collagen-coated than to fibronectin-coated prostheses in the midgraft area (P<0.05) after 24 hours’ implantation in the caprine carotid artery. Conclusions— These studies demonstrate that &agr;2(VIII) collagen has the potential to improve both initial cell attachment and retention of endothelial cells on vascular grafts in vivo, which opens new avenues of research into the development of single-stage endothelialized prostheses and the next generation of tissue-engineered vascular grafts.

Inflammatory Abdominal Aortic Aneurysms (IAAA): Past and Present

Aim: The aim of the study is to determine whether presentation and outcomes of inflammatory abdominal aortic aneurysms (IAAA) have changed over the last five decades. Methods: Comparison of current outcomes (January 2001 to December 2007) with results of the earliest report from our unit in 1972. Results: In contemporary series, 421 patients underwent AAA repair; 38 (9%) were IAAA. In 58% patients, IAAA was an incidental finding, whereas 42% patients were symptomatic with abdominal or back pain. Of those, 32% were ruptured IAAA. Male-to-female ratio was 12:1. Thirty-day mortality was 13%; elective 11.5%; emergency 17%. Comparison with 1972 study showed no change in the incidence and gender predilection. Presentation as an incidental finding and rupture increased 4- and 2-folds, respectively. Conclusion: The incidence and gender predilection of IAAA have remained unchanged. The 4-fold increase in the presentation as an incidental finding reflects current trends in patient evaluation.

103 Prevalence And Significance Of Anterior T Wave Inversion In Females

Purpose Anterior T wave inversion (V1-V4) is the hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, it is widely perceived that anterior T wave inversion is also common in female individuals. Previous studies in small cohorts of female athletes have demonstrated a highly variable prevalence of anterior T wave inversion of up to 14%. This study investigated the prevalence and significance of anterior T wave inversion in a large, unselected cohort of female athletic and non-athletic individuals who underwent cardiac screening. Methods Between May 2007 and September 2013, 17,708 individuals (n = 5,234; 29.6% females) aged 14–35 underwent cardiac screening with health questionnaire, 12-lead ECG and consultation with a cardiologist. Further evaluation was dictated by initial results. The ECGs of female subjects were analysed placing emphasis on the presence of anterior T wave inversion, defined as T wave inversion in ≥2 contiguous anterior leads. Results T wave inversion was present in 322 (6.2%) females, the majority confined to the anterior leads; 73% anterior, 14% lateral, 13% inferior. Anterior T wave inversion was more prevalent in competitive athletes compared to non-athletes (7.02 vs 3.78%, p < 0.001) and in black females compared to white females (14.62 vs 4.21%, p < 0.001). Anterior T-wave inversions persisted in 5.29% of females >16 years of age. The majority of anterior T wave inversion (n = 171; 73%) was confined to leads V1-V2, with only 1.2% of females exhibiting T wave inversion beyond V2, raising the suspicion of ARVC. Multivariate analysis identified black ethnicity as the sole, independent predictor for the presence of anterior T wave inversion (OR 3.1, 95% CI 1.2–8.4, p = 0.03). Conclusion In the largest unselected cohort of females to date, the overall prevalence of anterior T wave inversion was higher (4.5%) than those in previously reported studies. This was also the case for females of Caucasian ethnicity. Anterior T wave inversion persisted in a considerable proportion of females >16 years, excluding the ‘juvenile’ pattern. Although we did not identify ARVC in any females with anterior T wave inversion, given the low prevalence of T wave inversion beyond V2, particularly in Caucasian individuals (1.06%), such patterns not be considered a normal finding and should trigger further clinical evaluation.

Rupture of an Abdominal Aortic Aneurysm Post EVAR: A Rare Presentation of Retroperitoneal Liposarcoma

Endoleak is the classical cause of rupture of aneurysms previously treated by endovascular means. We report a rare case of a retroperitoneal liposarcoma (LIS) invading an abdominal aortic aneurysm (AAA), previously treated by endovascular repair (EVAR), causing rupture. Furthermore, a brief discussion of the diagnostic challenges posed by retroperitoneal tumors is presented with a closing note on their management.

Interpreter services in an inner city teaching hospital: a 6-year experience.

INTRODUCTIONnBeing able to communicate effectively with patients is essential not only from a medicolegal standpoint but more importantly from clinical governance perspectives. Issues such as informed consent and patient choice within the NHS are currently being highlighted; for these to be available to patients, their language requirements are paramount.nnnPATIENTS AND METHODSnAn audit was performed by the Linkworkers office at the Central Manchester & Manchester Childrens Hospital NHS (CMMC) Trust on the total number of attendances and refusals per language in the period 1998-2003.nnnRESULTSnIn the CMMC Trust, Urdu/Punjabi, Bengali, Cantonese, Somali, Arabic and French represent the majority of the workload, comprising almost 80% of cases in 2003. In the same year, an increase in demand for languages of Eastern European countries became evident. Finding interpreters for these languages even via agencies can be extremely difficult.nnnCONCLUSIONSnIf the current trend continues, requirement for these services will increase exponentially. For this demand to be met adequately these issues must be kept at the forefront of NHS planning.

Emergency response facilities including primary and secondary prevention strategies across 79 professional football clubs in England

Aim To assess the emergency response planning and prevention strategies for sudden cardiac arrest (SCA) across a wide range of professional football clubs in England. Methods A written survey was sent to all professional clubs in the English football league, namely the Premiership, Championship, League 1 and League 2. Outcomes included: (1) number of clubs performing cardiac screening and frequency of screening; (2) emergency planning and documentation; (3) automated external defibrillator (AED) training and availability; and (4) provision of emergency services at sporting venues. Results 79 clubs (86%) responded to the survey. 100% clubs participated in cardiac screening. All clubs had AEDs available on match days and during training sessions. 100% Premiership clubs provided AED training to designated staff. In contrast, 30% of lower division clubs with AEDs available did not provide formal training. Most clubs (n=66; 83%) reported the existence of an emergency action plan for SCA but formal documentation was variable. All clubs in the Premiership and League 1 provided an ambulance equipped for medical emergencies on match days compared with 75% of clubs in the Championship and 66% in League 2. Conclusions The majority of football clubs in England have satisfactory prevention strategies and emergency response planning in line with European recommendations. Additional improvements such as increasing awareness of European guidelines for emergency planning, AED training and mentorship with financial support to lower division clubs are necessary to further enhance cardiovascular safety of athletes and spectators and close the gap between the highest and lower divisions.

83 The Effects of Training and Detraining on T Wave Inversion in a Cohort of Athletes

Purpose T wave inversion (TWI) is the electrical hallmark of cardiac conditions such as hypertrophic cardiomyopathy (HCM) or arrhythmogenic right ventricular cardiomyopathy (ARVC), which may be the substrate for sudden cardiac death in the young athlete. Such repolarization anomalies can feature on the ECG of an apparently healthy athlete and pose major diagnostic dilemmas in sports cardiology, as regular, prolonged high intensity, physical activity is associated with such repolarization changes. Athletes themselves are reluctant to detrain during the season, which makes interpreting any reversible effects of exercise on the ECG more difficult. This study aimed to investigate the effect of detraining on TWI in athletes. Methods Between 2013–2014, 36 professional footballers demonstrated TWI at mid-season ECG screenings (trained period). They were followed up during the “off-season” after a period of detraining (6–8 weeks). TWI was defined as −0.1 mV or greater 2 or more contiguous leads, in the anterior leads-V2-V3/4; inferior-II, III, aVF; or lateral-beyond V4 +/- aVL. Comparisons were drawn by 2 independent cardiologists, between trained and detrained ECG repolarization patterns. Every individual was subsequently investigated for an underlying cardiomyopathy. Results Athletes were male and aged 24.5+/-2.7 years. 27 (75%) were Afro-Caribbean and 25% Caucasian (p = 0.0141). TWI was most commonly observed in the anterior leads (n = 20, 55%), followed by inferior (n = 10, 28%) and lateral (n = 6, 17%). No Caucasian player had TWI in the lateral leads. After detraining, 16 players demonstrated resolution of anterior TWI (80%, p = 0.0293), 8 in inferior leads (80%, p = 0.2353) and 4 in the lateral leads (67%, p = 0.638) (Figure 1). All players with abnormal TWI according to consensus guidelines were comprehensively evaluated with no cardiomyopathy identified. Abstract 83 Figure 1 Bar chart of anterior/inferior/lateral TWI according to trained status in Afro-Caribbean and Caucasian athletes Conclusion/implications Convincing athletes to detrain in order to interpret repolarisation anomalies is particularly difficult, due to enthusiasm for continued participation and reluctance to stop exercising. In our cohort of athletes who did detrain during the ‘off-season’, we observed resolution of TWI in the majority of athletes (both Afro-Caribbean and Caucasian) after a relatively brief period of detraining which may be deemed a physiological phenomenon. This was statistically significant in the anterior leads. However, TWI in the inferior and/or lateral leads should always raise the suspicion of an underlying cardiomyopathy, especially if persistent after detraining.