Using (123)I-ADAM SPECT, treatment with paroxetine 20 mg/day leads to more than 60% SERTocc on average in cerebral regions with known high SERT density. Data from this study do not support the existence of SERT availability differences between drug-free MDD patients and healthy volunteers. Finally, the E (max) model is suitable for the study of paroxetine Cp relationship to (123)I-ADAM SPECT-measured SERTocc. This approach may be useful for pharmacokinetic-pharmacodynamic relationships in drug development.

The common feature of the reports by Franco et al 1 and Oliver et al 2 is the use of spiral (or volumetric) computed tomography to demonstrate features which would not be readily identifiable on conventional computed tomographic (CT) scanning. The advantages of spiral CT over conventional CT scanning are twofold: increased speed of data acquisition and volumetric (rather than slice by slice) data acquisition. The attribute of speed means that most thoracic examinations can be performed within a single breath hold and the timing of intravenous contrast administration can be precisely tailored, thus allowing reproducible enhancement of any desired part of the vasculature-for example, the pulmonary arteries in cases of suspected pulmonary embolism. Because an entire volume of data is acquired (with almost equal spatial resolution in the three axes) it is possible to reconstruct images in any plane, including threedimensional (3-D) reconstructions.3 Most examinations acquired with spiral CT scanning are presented as a series of transaxial slices, reflecting the traditional presentation of conventional CT images.In the report by Franco et al 1 the clarity with which the anomalous arteries feeding the sequestrated lung are shown on the 3-D reconstructions is striking. In the past a separate preoperative examination (either aortography or possibly magnetic resonance angiography) to identify the vascular supply would have been regarded as mandatory. Other imaging tests such as radionuclide scintigraphy or ultrasound may answer specific questions in cases of pulmonary sequestration, but the wealth of information now available from a single spiral CT examination is remarkable. Quite apart from their aesthetic appeal, the main benefit of these readily produced 3-D reconstructions is an easy appreciation of what can be complex anatomy. Nevertheless, claims for the increased diagnostic gain from these 3-D reconstructions should not be too extravagant: the anomalous vessels would be identifiable on images presented in the standard transaxial format, although without such immediacy. Furthermore, demonstration of the venous drainage into the pulmonary circulation (for the classic intralobar sequestrations) may not be so readily obtained with a single spiral CT examination. However, the ability to extract so much information from a spiral CT examination represents a substantial advance on conventional CT scanning. Spiral CT pulmonary angiography is an eVective way of demonstrating pulmonary embolism in segmental and larger arteries. 4 The basic sign of a filling defect within a well opacified pulmonary artery is straightforward enough. The case report by Oliver et al 2 highlights the fact that there may be ancillary signs of pulmonary embolism on spiral CT scanning-in this case shift of the interventricular septum-which corroborates the diagnosis and, more controversially, provides prognostic information. Shift of the interventricular septum and other signs of right ventricular dysfunction are readily demonstrated on echocardiog...

COVID-19 is a zoonotic disease caused by SARS-CoV-2. Infections of animals with SARS-CoV-2 have recently been reported, and an increase of severe lung pathologies in domestic dogs has also been detected by veterinarians in Spain. Therefore, further descriptions of the pathological processes in those animals that show symptoms similar to those described in humans affected by COVID-19 would be highly valuable. The potential for companion animals to contribute to the continued transmission and community spread of this known human-to-human disease is an urgent issue to be considered. Forty animals with pulmonary pathologies were studied by chest X-ray, ultrasound analysis, and computed tomography. Nasopharyngeal and rectal swabs were analyzed to detect canine pathogens, including SARS-CoV-2. An additional twenty healthy dogs living in SARS-CoV-2-positive households were included. Immunoglobulin detection by several immunoassays was performed. Our findings show that sick dogs presented severe alveolar or interstitial patterns with pulmonary opacity, parenchymal abnormalities, and bilateral lesions. The forty sick dogs were negative for SARS-CoV-2 but Mycoplasma spp. was detected in 26 of 33 dogs. Five healthy and one pathological dog presented IgG against SARS-CoV-2. Here we report that despite detecting dogs with α-SARS-CoV-2 IgG, we never obtained a positive RT-qPCR for SARS-SoV-2, not even in dogs with severe pulmonary disease; suggesting that even in the case of canine infection, transmission would be unlikely. Moreover, dogs living in COVID-19-positive households could have been more highly exposed to infection with SARS-CoV-2.

Aims  The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results  Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions  The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

Several changes in smoking patterns over the past decades in Spain can be expected to result in a shift in lung-cancer mortality rates. We examined time trends in lung-cancer mortality from 1973-1997 using a log-linear Poisson ageperiod-cohort model. The standardized lung-cancer mortality rate for men almost doubled, from 31.4 per 100,000 in 1973 to 58.6 in 1997, with an average annual increase of 2.7%. Mortality increased for male generations born until 1952 as a consequence of the increasing cigarette smoking in successive birth cohorts. However, the slight downward trend observed for the 2 youngest generations suggests a more favorable outcome of the lung-cancer epidemic among Spanish males in the coming years, if this trend continues. For women, mortality rates were 5 to 9 times lower than those for men, 6.3 per 100,000 in 1973 and 6.4 in 1997. However, the increasing mortality among younger generations born since 1942 reflects the rise in the prevalence of smoking women during the last decades and can be expected to spread to older age groups as a cohort effect, indicating the early phase of the smoking-related lung-cancer epidemic among Spanish females. The decreasing mortality trend observed in women until the late 1980s could be attributed to a lower exposure to environmental tobacco smoke at home as a result of a significant reduction in the prevalence of smoking men. In Mediterranean countries and in Spain since 1990, malignant tumors are the leading cause of death, whereas heart diseases are placed second. 1 Lung cancer is the most frequent fatal cancer among men in Spain 2 as well as in many other developed countries.Because of the poor survival from lung cancer, there is a close correlation between incidence and mortality. The overall 5-year survival rate of 10 -13% has not changed over the past 2 decades, though the implementation of multimodality therapy in locally advanced disease has begun to modestly improve survival in patients with more advanced stages of disease. 3 Cigarette smoking plays a dominant role in lung-cancer causation, being responsible for up to 90% of the lung-cancer epidemic, not only directly but indirectly (passive smoking) and in association with other substances such as asbestos and radon. 4 Smoking patterns have changed markedly and in different directions in several countries over the past decades; therefore, time trends in lung-cancer mortality differ between countries, cohorts and sexes. 5 Several changes in smoking habits in Spain, such as a decline in the prevalence of smoking among men and a rise among women, can be expected to result in a shift in lung-cancer mortality trends.Because tobacco smoking habits are generally established at an early age and are characteristic for a given birth cohort, 5 the development of the lung-cancer epidemic can be analyzed most accurately by studying age-specific rates by birth cohort. 6 We analyzed trends in lung-cancer mortality in Spain from 1973-1997, using a Poisson log-linear age-period-cohort model. MATERIAL AND METHODSPopula...