Miracle-dz/UniFAR-FTUs huggingface dataset:
Impact of anti-tachycardia pacing on atrial fibrillation burden when added on top of preventive pacing algorithms: results of the prevention or termination (POT) trial.

AIMS The efficacy of preventive pacing algorithms (PPA) and anti-tachycardia pacing (ATP) in reducing atrial fibrillation (AF) burden remains controversial. The aim of this study was to assess whether ATP on top of PPA decreases AF burden. METHODS AND RESULTS A series of 199 consecutive patients, with conventional indications for pacing, and documented AF, received a DDDR (rate adaptive dual chamber pacemaker) pacemaker with ATP capabilities (AT 500 Medtronic). After 3 months of conventional DDDR pacing at 70 b.p.m. , AF burden was analysed. If patients had >30 min/week of AF, they were randomized to PPA or to PPA+ATP for 3 months (period 1). They were then crossed to the alternative therapy (period 2) and followed three additional months with a 1-month wash out period in-between. A group of 85 patients were randomized. Mean age 68 +/- 8 years, 61% men. Both groups showed a significant decrease in AF burden at the end of period 1 (64 and 81%, respectively). CONCLUSIONS Atrial pacing with PPA decreases AF burden in patients with pacing indication. We did not observe a further decrease in AF burden or in the number of episodes when adding ATP on top of PPA.
Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease

The concept of neuromyelitis optica (NMO) has changed considerably during the past few years. The identification of autoantibodies in the sera generated against the water channel aquaporin 4 (AQP4) has increased the specificity of diagnosis and modified guidelines. A pathogenic role of anti‐AQP4 antibodies has recently been indicated; they evoke the pathological and clinical hallmarks of the disease on transfer and cause necrosis of astrocytes expressing AQP4. The diagnosis of NMO is based on clinical, neuroimaging and serological criteria. Early therapy preventing relapses is mandatory, because neurological impairment accumulated during relapses is the main cause of permanent disability. In a number of cases defined as NMO spectrum diseases, the clinical manifestation is spatially limited. Such events of separate myelitis or relapsing/bilateral optic neuritis challenge diagnosis and might delay proper therapy. Here, current concepts of diagnosis and treatment of NMO and NMO spectrum diseases are summarized. Diagnostic and treatment decisions in different clinical situations are shown by discussion of cases. (Clin. Exp. Neuroimmunol. doi: 10.1111/j.1759‐1961.2010.00011.x, 2010)
AMPICILLIN USAGE AND AMPICILLIN RESISTANT (AMPR) PLASMIDS MEDIATED ESCHERICHIA COLI ISOLATED FROM DIARRHEAGENIC PATIENTS ATTENDING SOME TEACHING HOSPITAL IN NIGERIA

From 2001 to 2004, we carry on a survey on the utilization of ampicillin among some diarrheagenic patients attending some Teaching Hospitals in Nigeria. From the result 723(58.2%) volunteers responded to the questionnaires, where only 83(11.4%) consult a doctor for prescription, 397(54.9%) from drug retailers while 142(20.1%) self prescribe and 56(7.7%) prescription was base on the advice of friends and relatives. The results also indicate that 229 (31.7%) take full regimen if prescribed by a doctor and 494(68.3%) stop the consumption of the drug when the signs and symptoms subside. Of the 249 diarrheagenic clinical isolates of E coli strains obtained from 2001 to 2004, 78 (31.3%) were obtained from UBTH, 41(16.5%) from ABUTH, 38(15.3%) from NAUTH and 92(36.9%) from UCH with a mean average of 63(25.3%). Among the antibiotics tested, ampicillin was the least susceptible antibiotics while the quinolones were the most susceptible. Most of the E coli strains screened had one or more resistant R plasmids. 52% of the E coli harbour ampicillin resistant plasmids of different molecular weights that ranged from ≤0.451kbp to ≥1.254kbp. Mostly Chromosomal DNA mediated most of the E coli isolates resistant to tetracycline, erythromycin, and ciprofloxacin. None of the Teaching Hospital had a surveillance method for evaluating the emergence of resistance pathogens.
Manufacturer's response to case reports of PML.

To the Editor: In the letters from Ermis et al.1 and van Oosten et al.2 published in this issue of the Journal, progressive multifocal leukoencephalopathy (PML) is reported in two patients with psoriasis who were being treated with Fumaderm (Biogen Idec) or a compounded version of fumaric acid esters (FAEs) referred to as Psorinovo (compounding pharmacy, Mierlo-Hout). Compounded FAEs and other compounded products are not approved by regulatory authorities and may be associated with risks.3 Fumaderm, an approved, fixed-combination product, contains four active ingredients: dimethyl fumarate and three monoethyl hydrogen fumarates (calcium, magnesium, and zinc salts). The compounded product Psorinovo .
Chest wall lymphomas: Fine needle aspiration cytodiagnosis and review of the literature

Compared to other chest wall malignancies, lymphoma is a common disease. However, published literature on a series of lymphoma cases involving the chest wall is scarce. The aim of the present study, was to describe experience with chest wall swellings diagnosed as lymphoid neoplasms on fine needle aspiration (FNA) cytology.
Fibrillatory rate response to candesartan in persistent atrial fibrillation.

INTRODUCTION Angiotensin-receptor blockers may exert favourable anti-arrhythmic effects in atrial fibrillation (AF), but their mechanisms are not fully understood. In this study, we tested the hypotheses that (i) candesartan reduces atrial fibrillatory rate and (ii) fibrillatory rate and its response to candesartan are related with the outcome of cardioversion. For this purpose, a post hoc subanalysis of the randomized, placebo-controlled CAPRAF (Candesartan in the Prevention of Relapsing Atrial Fibrillation) trial was performed. METHODS AND RESULTS Patients with AF undergoing electrical cardioversion were randomized to receive candesartan 8 mg once daily (n = 58) or matching placebo (n = 66) and no additional class I or III anti-arrhythmic drugs. Fibrillatory rate was determined from ECG lead V1 at baseline and at the day of cardioversion using spatiotemporal QRST cancellation and time-frequency analysis. The median time on treatment was 29 days. Candesartan reduced fibrillatory rate [399 +/- 48 vs. 388 +/- 49 fibrillations/min (fpm), P = 0.04], but not placebo (402 +/- 58 vs. 402 +/- 61 fpm, P = 0.986). Candesartan effects were only observed if the baseline fibrillatory rate was high [>420 fpm: 445 +/- 21 vs. 415 +/- 49 fpm, P = 0.006 vs. intermediate (360-420 fpm): 397 +/- 19 vs. 391 +/- 37 fpm, P = 0.351 vs. low (<360 fpm): 326 +/- 26 vs. 338 +/- 29 fpm, P = 0.179]. Cardioversion success was 100% in patients with an on-treatment rate <360 fpm vs. 83% in patients with higher rates (P = 0.02). Risk for AF recurrence was similar in patients with low (64%), intermediate (75%), or high on-treatment rates (63%, P = 0.446) and was also independent of candesartan effects on the fibrillatory rate. CONCLUSION In patients with persistent AF, candesartan decreases the fibrillatory rate, but this effect is restricted to patients with high baseline fibrillatory rates and is not associated with improved cardioversion outcome. Fibrillatory rates <360 fpm are associated with successful cardioversion, but not with AF recurrence.
Dendritic cells in hyperlipidemia-associated atherosclerosis

Unlike conventional dendritic cells (cDCs), plasmacytoid DCs (pDCs) are poor in antigen presentation and critical for type I interferon response. While proposed to be present in human atherosclerotic lesions, their role in atherosclerosis remains elusive. We show that pDCs are scarcely present in human atherosclerotic lesions, and almost absent in mouse plaques. Surprisingly, pDC depletion by 120G8 mAb administration was seen to promote plaque T cell accumulation and exacerbate lesion development and progression in low-density lipoprotein receptor deficient (Ldlr) mice. pDC depletion was accompanied by increased CD4 T cell proliferation, IFN-γ expression by splenic T cells and plasma IFN-γ levels. Lymphoid tissue pDCs from atherosclerotic mice showed increased indoleamine 2,3-dioxygenase (IDO) expression and IDO blockage abrogated the pDC suppressive effect on T cell proliferation. In conclusion, our data reveal a protective role for pDCs in atherosclerosis, possibly by dampening T cell proliferation and activity in peripheral lymphoid tissue, rendering pDCs an interesting target for future therapeutic interventions. 3 | Plasmacytoid dendritic cells in atherosclerosis
Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices.

AIMS Implantable cardioverter defibrillator (ICD) technology has become more complex, particularly with respect to biventricular resynchronization devices. The incidence of hardware-related complications in single (SC)-, dual (DC)-, and triple (BiV)-chamber devices requiring surgical revision has not been investigated systematically. METHODS AND RESULTS We analysed data from consecutive ICD recipients implanted between January 2000 and December 2007 with respect to the need of surgical re-intervention for device- or lead-related complications. Generator exchanges due to normal battery depletion were not considered. From 816 patients (81% male, 69% ischaemic cardiomyopathy, 48% secondary prevention ICDs) followed for 31 +/- 24 months (2118 cumulative patient-years), 98 patients underwent 110 revisions (5.2% per patient-year). Complications included lead-related revision procedures in 81 cases and generator-related problems in 29 cases. The annual incidence of surgical revision due to complications was 11.8% in BiV compared with 4.9% in SC and 4.1% in DC patients (P = 0.002). This higher revision rate was mainly caused by lead-related complications. Implantation of a BiV system was an independent risk factor of the need for surgical revision (relative risk 2.37, 95% confidence interval 1.38-4.04). CONCLUSION Even with long-lasting operator experience, complications requiring surgical revision remain a clinically important problem of ICD therapy. The incidence of complications is significantly higher in BiV resynchronization devices than in SC and DC systems.
Rabies preventive behaviors of dog owners in Nakhon Pathom Province of Thailand

A cross-sectional study was conducted to investigate rabies preventive behavior of dog owners and related factors. Multi-stage cluster sampling was used to collect data in four health centers of Nakorn Pathom province, Thailand. Structured questionnaires were distributed to 319 dog owners in March 2012. Chi-square tests and multiple logistic regression were used to examine associations between independent variables and rabies preventive behavior. The results showed that 38.5 % of respondents had good preventive behavior against rabies. Factors significantly associated with preventive behavior were knowledge (p-value = 0.004), perception (p-value = 0.003), dog carers (p-value = 0.008), number of dogs (p-value = 0.024), experience of bitten by a dog (p-value = 0.039), heard about rabies (p-value = 0.006) and accessibility to rabies information (p-value = 0.025). When adjusted for other factors, perceptions towards rabies was the strongest predictor of preventive behavior (odds ratio = 1.99, 95% CI;1.11 – 3.59). Dog owners who had positive perception about rabies prevention were about two times more likely to have good preventive behavior against rabies. The findings suggested that good knowledge and positive perceptions about rabies prevention should be promoted among dog owners and family members.
Antibiotic cement impregnated nailing in the management of infected non-union of femur and tibia

Infected non-union of long bones present a complex problem to the treating surgeon. The treatment of non-union follows traditionally followed a two staged procedure. More recently, single stage procedures such a sas debridement and application of Ilizarov fixator or use of antibiotic cement impregnated intramedullary nails (ACIINs) have been described in the literature . This is a report of a prospective study of 18 non-union cases ( femur or tibia) teated with ACIIN. Aims and objectives To evaluate the results of antibiotic cement impregnated nailing in the management of infected non-union of femur and tibia. Materials and methods This prospective study was done on 18 cases of infected non-union of femur and tibia at Government Medical College, Thrissur during the period 2010-2011. Functional results were evaluated with regards to control of infection, bony union, deformity, limb length discrepancy and complications (intra and post-operative). Results Infection was eradicted in 10 cases with ACIIN and the fractures united. In eight case, though the infection was controlled with ACIIN, they required subsequent procedures to achieve bony union. Conclusion Antibiotic cement impregnated nailing is a simple, economical and very effective procedure than the traditional methods in management of infected non-unions of long bones.
Selective site pacing in paediatric patients--technology or function?

This editorial refers to 'Selective-site pacing in paediatric patients: a new application of the Select Secure system' by F. Cantuet al., on page 601 While the debate about the role of selective site pacing in adults with structurally normal hearts continues, many in the paediatric pacing fraternity have adopted the new technologies available with open arms as a means to address some of the long-standing difficulties associated with pacing infants, children, and young adults. The chal- lenges for endocardial pacing in the paediatric population are many, but include unusual anatomy, smaller access vessels, need for active fixation, need for good manoeuvrability of the lead/delivery system, ability to deal with growth and leads with very high expectations of longevity and reliability. In many ways, a new catheter-delivered
The Food and Drug Administration Amendments Act and postmarketing commitments.

The Food and Drug Administration Amendments Act and Postmarketing Commitments Because rare but potentially serious adverse events of prescription drugs are often discovered only after market approval,1 observational postmarketing studies constitute an important part of the US drug safety system.2 In most instances prior to 2007, the US Food and Drug Administration (FDA) could only request that drug manufacturers voluntarily agree to conduct postmarketing safety studies.2 An Office of Inspector General report3 in 2006 found inadequacies in drug companies’ fulfillment of these postmarketing studies and weaknesses in FDA’s regulatory authority to enforce these commitments. In 2007, Congress passed the Food and Drug Administration Amendments Act (FDAAA), which authorized the FDA to require postmarketing studies for a prescription drug’s approval and mandate adherence to study deadlines.2,4 We examined how fulfillment of these postmarketing studies has changed over time.
The Prognostic Implications of TIMI Risk Scores in Jordanian Patients with Acute Coronary Syndrome. Results from the Glucometabolic Abnormalities in Acute Coronary Syndrome in Jordan (GLORY) Study

Background and Aims: Western studies have shown that TIMI (Thrombolysis In Myocardial Infarction) risk scores predict adverse events in patients with non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation myocardial infarction (STEMI). Whether this also applies to Jordanian patients is largely unknown. Materials and Methods: We prospectively followed up 656 patients with ACS for total mortality, combined events of death, nonfatal MI or urgent coronary revascularization up to one year after admission. Results: Of the whole group, 472 patients (72%) had NSTEACS, and 184 patients (28%) had STEMI. Among NSTEACS patients, 31.0% had a low risk score (total points 0 - 2 of 7), 43.5% had an intermediate risk score (total points 3 - 4), and 25.5% had a high risk score (total points 5 - 7). In-hospital mortality was not different in the respective risk score groups (1.4%, 0.5%, and 3.4%, p = 0.123). At 1 year, mortality was significantly higher in the high risk score group (12.8%) compared with the intermediate (4%) and low (1.4%) risk groups (p = 0.001). Among STEMI patients, 58.6% had a low risk score (total points 0 - 3 of 13 - 14), 31.0% had a low intermediate risk score (total points 4 - 6), 8.0% had a high intermediate score (total points 7 - 9), and 2.4% had a high risk score (total points > 10). In-hospital mortality rate was significantly higher in the two intermediate risk score groups (7.4%, 14.3%, respectively) and the high risk score group (50%) compared with the low risk score group (1.0%, p = 0.001). The high risk and the two intermediate risk groups also had higher one-year mortality (75%, 28.6% and 16.7%, respectively) than the low risk group (3.9%, p = 0.001). Similarly, composite events occurred at a significantly higher rate in patients with high risk scores than intermediate or low risk scores among NSTEACS and STEMI patients. Conclusions: In Jordanian ACS patients, high TIMI risk scores were associated with a high risk of cardiovascular events. Such patients are candidates for early aggressive therapeutic strategies.
Preserved cardiac synchrony and function with single-site left ventricular epicardial pacing during mid-term follow-up in paediatric patients.

AIMS Right ventricular (RV) pacing may cause dyssynchronous left ventricular (LV) contraction and systolic dysfunction. Left ventricular-based pacing may prevent such deterioration. The aim of this study was to evaluate ventricular synchrony and function with permanent LV pacing (LVP) vs. RV pacing (RVP) in paediatric patients with normal cardiac anatomy. METHODS AND RESULTS Twenty-five paediatric patients with normal cardiac anatomy and single-site epicardial RV apex pacing (RVP, n=10, pacing duration: 7.9+/-2.9 years) or LV free wall pacing (LVP, n=15, pacing duration: 4.3+/-2.6 years) for complete heart block were enrolled. A total of 15 healthy children served as a control group. Conventional echocardiography, myocardial circumferential (LV), and longitudinal (RV) 2D strain (2Ds) analysis were obtained. Paced QRS duration did not differ between groups (P=0.915). Interventricular mechanical delay (LVP: 17+/-10, RVP: 62+/-15 ms; P<0.0001), septal-to-posterior wall motion delay (LVP: 59+/-23, RVP: 294+/-84 ms; P<0.0001), septal-to-lateral wall motion delay (LVP: 40+/-19, RVP: 59+/-12 ms; P=0.009), and LV mechanical delay (LVP: 35+/-9, RVP: 63+/-17 ms; P<0.0001) were preserved for LVP but not for RVP. Right ventricular mechanical delay was similar among paced groups (P=0.639). Left ventricular ejection fraction was normal for LVP but not for RVP (LVP: 60+/-6%, RVP: 45+/-6%; P=0.012). Left ventricular pacing did not differ from controls for synchrony or function. CONCLUSION Conventional and 2Ds echocardiographic measurements indicate preserved LV synchrony and function in paediatric patients with LVP compared with RVP. Permanent LVP has no impact on RV synchrony.
Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures.

AIMS The coronary sinus (CS) is a commonly cannulated structure in patients undergoing electrophysiology studies, catheter ablation of arrhythmias, implantation of resynchronization therapy devices and, more recently, percutaneous mitral valve repair. The advent of these procedures has led to a renewed interest in the anatomy of the coronary venous system including its various components. To improve our understanding of this structure, we studied the anatomy of the human CS, including the valve that guards its ostium, the Thebesian valve. METHODS AND RESULTS In 75 randomly selected autopsied human hearts, we measured the transverse and craniocaudal dimensions of the CS ostium and characterized the shape, composition, per cent coverage, and attachment points of the Thebesian valve when present. Of the 75 hearts examined, 54 had organic heart disease including atherosclerotic coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy, rheumatic heart disease, infective endocarditis, and non-rheumatic valvular heart disease. A wide variety of Thebesian valve morphologies were seen, ranging from the absence of any valve to those where the valve was completely occluding the CS ostium. A Thebesian valve was present in the majority of the hearts examined (55/75 hearts-73%). The average transverse dimension of the CS ostium in hearts with Thebesian valves (7.3+/-2.8 mm) was significantly shorter than those without Thebesian valves (9.4+/-2.9 mm, P=0.005). Similarly, the average craniocaudal dimension of the CS ostium in hearts with Thebesian valves (7.9+/-2.7 mm) was also significantly shorter than those without Thebesian valves (9.3+/-2.9 mm, P=0.045). CONCLUSION Our study shows that some form of Thebesian valve is present in the majority of hearts (>70%). Of these, a significant minority (16%) had a valve morphology (covering >75% of the ostium, a fibrous, fibromuscular, or muscular composition, and devoid of fenestrations) that makes them a 'potentially complicating' structure interfering with the cannulation of the CS.
Long-term mortality after stroke among adults aged 18 to 50 years.

IMPORTANCE Long-term data on mortality after first-ever stroke in adults aged 18 through 50 years are scarce and usually restricted to ischemic stroke. Moreover, expected mortality not related to first-ever stroke is not taken in account. OBJECTIVES To investigate long-term mortality and cause of death after acute stroke in adults aged 18 through 50 years and to compare this with nationwide age- and sex-matched mortality rates. DESIGN, SETTING, AND PARTICIPANTS The Follow -Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, a prospective cohort study of prognosis after transient ischemic attack (TIA), ischemic stroke, or hemorrhagic stroke in adults aged 18 through 50 years admitted to Radboud University Nijmegen Medical Centre, the Netherlands, between January 1, 1980, and November 1, 2010. The survival status of 959 consecutive patients with a first-ever TIA (n = 262), ischemic stroke (n = 606), or intracerebral hemorrhage (n = 91) was assessed as of November 1, 2012. Mean follow-up duration was 11.1 (SD, 8.7) years (median, 8.3 [interquartile range, 4.0-17.4]). Observed mortality was compared with the expected mortality, derived from mortality rates in the general population with similar age, sex, and calendar-year characteristics. MAIN OUTCOME MEASURES Cumulative 20-year mortality among 30-day survivors of stroke. RESULTS At the end of follow-up, 192 patients (20.0%) had died. Among 30-day survivors, cumulative 20-year risk of death was 24.9% (95% CI, 16.0%-33.7%) for TIA, 26.8% (95% CI, 21.9%-31.8%) for ischemic stroke, and 13.7% (95% CI, 3.6%-23.9%) for intracerebral hemorrhage. Observed mortality was increased compared with expected mortality (standardized mortality ratio [SMR], 2.6 [95% CI, 1.8-3.7] for TIA, 3.9 [95% CI, 3.2-4.7] for ischemic stroke, and 3.9 [95% CI, 1.9-7.2 for intracerebral hemorrhage, respectively). For ischemic stroke, cumulative 20-year mortality among 30-day survivors was higher in men than in women (33.7% [95% CI, 26.1%-41.3%] vs 19.8% [95% CI, 13.8%-25.9%]). The SMR was 4.3 (95% CI, 3.2-5.6) for women and 3.6 (95% CI, 2.8-4.6) for men. For all etiologic subtypes of ischemic stroke, observed mortality exceeded expected mortality. CONCLUSIONS AND RELEVANCE Among adults aged 18 through 50 years, 20-year mortality following acute stroke was relatively high compared with expected mortality. These findings may warrant further research evaluating secondary prevention strategies in these patients.