bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal glycated haemoglobin, pre‐gestational weight, pregnancy weight gain and risk of large‐for‐gestational‐age babies: a Danish cohort study of 209 singleton Type 1 diabetic pregnancies
Authors: Nielsen G. L. , Dethlefsen C. , Møller M. , Sørensen H. T.
Published: March 2007

Aims  To examine the association between maternal glycated haemoglobin in the second half of diabetic pregnancies and the relative risk of delivering large‐for‐gestational‐age (LGA) babies, controlling for maternal body mass index (BMI) before pregnancy, weight gain, age, White class and smoking habits.

Methods  We identified all pregnant diabetic women in North Jutland County, Denmark from 1985 to 2003. Data on HbA1c values from the 20th gestational week to term were collected from medical records and the babies were classified as large, normal or small for gestational age. The association between glycated haemoglobin (HbA1c) and relative risk of delivering an LGA baby was quantified based on logistic regression models and stratified analysis controlling for the five covariates.

Results  We included 209 singleton pregnancies with assessable HbA1c values of which 59%[95% confidence interval (CI) 52–65%] terminated with an LGA baby. Increasing levels of HbA1c, BMI and weight gain were all associated with increasing risk of delivering an LGA baby. Analyses stratified according to maternal BMI showed that the association between HbA1c and risk of delivering an LGA baby was restricted to pregnancies with pre‐pregnancy BMI > 23 kg/m2. We found no association between HbA1c and risk of delivering an LGA baby in pregnancies with lower BMI.

Conclusion  The positive association between glycated haemoglobin and birth of an LGA baby seems to be restricted to women with BMI > 23 kg/m2.
Low HDL‐cholesterol is common in European Type 2 diabetic patients receiving treatment for dyslipidaemia: data from a pan‐European survey
Authors: Bruckert E. , Baccara‐Dinet M. , Eschwege E.
Published: March 2007

Aims  To measure the prevalence of low high‐density lipoprotein (HDL)‐cholesterol (men < 1.03 mmol/l; women < 1.29 mmol/l) in European Type 2 diabetic patients receiving treatment for dyslipidaemia.

Methods  The pan‐European Survey of HDL‐cholesterol measured lipids and other cardiovascular risk factors in 3866 patients with Type 2 diabetes and 4436 non‐diabetic patients undergoing treatment for dyslipidaemia in 11 European countries.

Results  Diabetic patients were more likely to be obese or hypertensive than non‐diabetic patients. Most patients received lifestyle interventions (87%) and/or a statin (89%); treatment patterns were similar between groups. Diabetic patients had [means (SD)] lower HDL‐cholesterol [1.22 (0.37) vs. 1.35 mmol/l (0.44) vs. non‐diabetic patients, P < 0.001] and higher triglycerides [2.32 (2.10) vs. 1.85 mmol/l (1.60), P < 0.001]. More diabetic vs. non‐diabetic patients had low HDL‐cholesterol (45% vs. 30%), high triglycerides (≥ 1.7 mmol/l; 57% vs. 42%) or both (32% vs. 19%). HDL‐cholesterol < 0.9 mmol/l was observed in 18% of diabetic and 12% of non‐diabetic subjects. Differences between diabetic and non‐diabetic groups were slightly greater for women. LDL‐ and total cholesterol were lower in the diabetic group [3.02 (1.05) vs. 3.30 mmol/l (1.14) and 5.12 (1.32) vs. 5.38 mmol/l (1.34), respectively, P < 0.001 for each].

Conclusions  Low HDL‐cholesterol is common in diabetes: one in two diabetic women has low HDL‐cholesterol and one diabetic man in four has very low HDL‐cholesterol. Management strategies should include correction of low HDL‐cholesterol to optimize cardiovascular risk in diabetes.
Ineffectiveness of Precordial Thump for Cardioversion of Malignant Ventricular Tachyarrhythmias
Authors: AMIR OFFER , SCHLIAMSER JORGE E. , NEMER SAMNIAH , ARIE MILITIANU
Published: March 2007

Background:The Precordial Thump (PT) is commonly used for cardiopulmonary resuscitations both in and out of hospitals. However, the support for its efficiency relies mainly on sporadic cases. In this current prospective large study, we tested the effectiveness and safety of PT in a wide range of malignant ventricular tachyarrhythmias.

Methods: The study included 80 patients who underwent electrophysiological study and/or implantation of a cardiodefibrillator device. During these procedures, once a malignant ventricular tachyarrhythmia was induced, PT was used as the first treatment option. If the PT failed, other means were used to discontinue the arrhythmia.

Results: Polymorphic ventricular tachycardia occurred in 32 (40%) patients, ventricular fibrillation in 28 (35%) patients, and 20 (25%) patients had sustained monomorphic ventricular tachycardia. Except in one patient with monomorphic ventricular tachycardia, the PT was unsuccessful in terminating any of the other malignant tachyarrhythmias, and internal or external defibrillation was eventually required in all other 79 (99%) patients. The PT was not associated with any damage either to the sternal bone, ribs, or to the cardiodefibrillator device.

Conclusions: PT is not effective in terminating malignant ventricular tachyarrhythmia and should be reserved to a situation in which a defibrillator is not available.
Effect of Programmed Number of Intervals to Detect Ventricular Fibrillation on Implantable Cardioverter‐Defibrillator Aborted and Unnecessary Shocks
Authors: GUNDERSON BRUCE D. , ABEYRATNE ATHULA I. , OLSON WALTER H. , SWERDLOW CHARLES D.
Published: March 2007

Introduction: Detection of self‐terminating arrhythmias by implantable cardioverter‐defibrillators (ICDs) causes unnecessary battery depletion and unnecessary shocks. Our goal was to estimate the effect of the programmed number of intervals to detect (NID) ventricular fibrillation (VF) on ICD temporal episode rate, unnecessary shocks, and delay in detection of VF.

Methods and Results: We analyzed 773 ICD‐detected VF episodes in 875 patients. The number of intervals to detect VF was programmed to 12 of 16 (NID 12) in 305 patients and 18 of 24 (NID 18) in 570 patients. For patients with NID 12, we estimated the increase of mean cumulative episode rate at 6 months since implant and decrease in detection time for VF compared with a hypothetical NID 18. For patients with NID 18, we estimated the decrease of mean cumulative episode rate and unnecessary shocks compared with a hypothetical NID 12.

Patients with NID 12 had a 17% increased episode rate resulting in unnecessary capacitor charging for self‐terminating arrhythmias. Patients with NID 18 had a 22% decreased episode rate. In patients with NID 12, hypothetical NID 18 would have delayed detection of 273 VF episodes in 1.8 seconds. In patients with NID 18, hypothetical NID 12 would have resulted in inappropriate delivery of 14 aborted shocks in 10% of patients with episodes.

Conclusion: In patients with self‐terminating device‐detected VF, increasing the number of intervals to detect VF from 12/16 to 18/24 results in a clinically significant decrease in ICD detections and fewer unnecessary shocks with minimal incremental delay in VF detection.
A Percutaneous Catheter‐Based System for the Measurement of Potential Gradients Applicable to the Study of Transthoracic Defibrillation
Authors: ROSBOROUGH JOHN P. , DENO D. CURTIS , WALKER ROBERT G. , NIEMANN JAMES T.
Published: March 2007

Background: The local electric (E) field or potential gradient produced by a shock reliably predicts VF termination. In this study we evaluated a multiple electrode, catheter‐based device for closed‐chest 3D measurements of E field from transthoracic defibrillation shocks.

Methods: Catheters with multiple electrodes on the tip were placed in intracardiac locations in anesthetized swine. An empirically derived calibration matrix and custom microprocessor was used to transform simultaneously measured voltages into orthogonal E field vector components. E fields produced in six intracardiac locations by 30 and 300 J shocks were compared in eight animals. Correlations were determined for measured current and E field at various shock strengths at two different transthoracic impedances in five additional animals. VF was induced in 12 animals and E field measured during defibrillation attempts.

Results: The E field measurements resulting for 30 J transthoracic shocks were not significantly different among different intracardiac sites. At 300 J, however, significant differences were observed between sites with the greatest intensities recorded in the coronary sinus and right ventricle. Within animals, the variability of the measurement at each site was small, ranging from 2.8 ± 1.6% to 5.7 ± 4.5%. Significant correlations (P < 0.001) between measured E field and peak current were observed at native impedance (34 ± 4 Ω, r = 0.81) and at adjusted impedance (76 ± 4 Ω, r = 0.78) with transthoracic shocks of 200, 300, and 360 J. In VF studies, the probability of defibrillation was closely fit by a sigmoidal dose response curve in the coronary sinus E field with an approximate threshold of 4.7 V/cm with 50% defibrillation success at 9.3 V/cm.

Conclusions: The measured intracardiac E field variability within animals and at a specific site was small, exhibiting a median value of 5.1%, contrasted to median variabilities across animals of 5–11% suggesting the capacity of this measurement system to provide subject specific information on the distribution of E fields. The measured E field magnitudes across animals in the coronary sinus were linearly correlated with applied shock current with a very strong linear relation to effective shock voltage observed in vitro in a saline tank. When evaluated as a predictor of shock success, the observed values were consistent with previously reported critical fields. This technique may be of value in evaluating waveforms for transthoracic defibrillation as well as electrode size, placement, and composition.
Ventricular Pacing Threshold Variations in the Young
Authors: SILVETTI MASSIMO STEFANO , DE SANTIS ANTONELLA , GROVALE NICOLETTA , GRUTTER GIORGIA , BACCARINI ANDREA , DRAGO FABRIZIO
Published: March 2007

Ventricular Capture Management™ (VCM) is a Medtronic Kappa pacemakers (PM) feature that automatically measures pacing threshold through detection of the evoked response after a pacing stimulus. The aim of this study was to evaluate the range of variation of ventricular pacing threshold in pediatric patients with endocardial and epicardial pacing leads. Thirty‐one patients (median age 6.5 years) were implanted with a Kappa 901 PM for atrioventricular block or sinus node dysfunction. Congenital heart defects (CHD) were present in 58% of patients. Ventricular leads were epicardial in 52% of patients. VCM was programmed to automatically measure threshold every 2 hours. In a median follow‐up of 12 months, 27,110 threshold measurements, 72% of which were successful, have been taken in 94% of patients. Measurement success was 99% in the endocardial leads group (age at implantation 12 ± 6 years) and 31% in epicardial leads (age 4 ± 5 years) (P < 0.05). Main reasons for unsuccessful measurements were high heart rate and, in a patient with an endocardial lead, competition with intrinsic rhythm. Undersensing or oversensing of the evoked responses was not detected. In all successful VCM measurements, epicardial pacing and CHD contributed to stability of thresholds (multivariate analysis). Pacing threshold showed specific circadian patterns: higher thresholds were found between 00.00 and 06.00 a.m., but the variation was low, 0.03 ± 0.01 V. In conclusion, children and young patients show stable ventricular thresholds, especially in presence of CHD, and epicardial leads are at least as stable as endocardial leads. Ventricular pacing threshold showed a circadian variability similar to that described in adults, that does not seem to influence VCM functioning and PM programming.
Permanent and Atrial‐Synchronized Ventricular Stimulation for Clinically Stable Patients with Normal or Impaired Left Ventricular Systolic Function
Authors: CHILADAKIS JOHN A. , KOUTSOGIANNIS NIKOLAOS , KALOGEROPOULOS ANDREAS , ZAGLI FANI , SIHLIMIRIS ILIAS , ALEXOPOULOS DIMITRIOS
Published: March 2007

Background: Ventricular desynchronization imposed by permanent dual‐chamber ventricular pacing (VDD) may compromise ventricular function.

Methods: We investigated the impact of background VDD pacing on the right and left ventricular (LV) function on 129 clinically stable outpatients (mean age 69 ± 10) implanted chronically with a dual‐chamber pacemaker or an automatic defibrillator by using echocardiographic techniques including tissue doppler imaging (TDI) and color M‐mode (CMM) examinations, and B‐type natriuretic peptide (BNP) measurements. Patients were divided into two groups of normal (n = 65) or impaired (n = 64) LV systolic function (ejection fraction 63 ± 6% and 38 ± 10%, respectively) according to clinical and echocardiographic criteria. Each patient group included two subgroups on the basis of the underlying permanent and atrial‐synchronized heart rhythm: either intrinsic ventricular activation (IVA) or VDD pacing.

Results: The BNP levels (mean, 95% CI) of patients with impaired LV systolic function were approximately threefold higher than those of patients with normal LV systolic function [189 (145–245) pg/mL vs 65 (50–85) pg/mL, P < 0.0001], but did not differ between subgroups of patients with IVA vs VDD pacing. By two‐way analysis of variance and analysis of covariance, and after adjustment for age and gender, significant VDD pacing effects were found in terms of lower E/A ratio (P < 0.05) and increased LV end‐systolic volume (P < 0.05). VDD pacing did not significantly affect the BNP levels and the LV filling pressures, as determined by the E/Ea and E/Vp ratios.

Conclusions: Long‐term VDD pacing may not be harmful in clinically stable patients with normal or moderately reduced LV systolic function.
Poor Prognosis for Patients with Chronic Kidney Disease Despite ICD Therapy for the Primary Prevention of Sudden Death
Authors: CUCULICH PHILLIP S. , SÁNCHEZ JOSÉ MAURICIO , KERZNER ROGER , GREENBERG SCOTT L. , SENGUPTA JAY , CHEN JANE , FADDIS MITCHELL N. , GLEVA MARYE J. , SMITH TIMOTHY W. , LINDSAY BRUCE D.
Published: March 2007

Introduction: Chronic kidney disease (CKD) has been independently associated with increased cardiovascular mortality. Little is known about the benefit of implantable cardioverter defibrillator (ICD) therapy for prevention of sudden death in this large, high‐risk population. We sought to evaluate the impact of CKD on survival in patients who received an ICD for primary prevention of sudden death.

Methods and Results: In this retrospective study of patients who underwent ICD implantation for primary prevention of sudden death, patients were stratified by CKD, defined as serum creatinine ≥2 mg/dL or dialysis use. Primary endpoint was mortality. CKD was identified in 35 of 229 patients (15.3%). There were 33 deaths during a follow‐up period of 18.0 ± 15.2 months: 17 of 35 CKD patients and 16 of 194 patients without CKD (48.6% vs 8.2%, P < 0.00001 by log‐rank). One‐year survival for patients with and without CKD was 61.2% and 96.3%, respectively. Cox regression analysis controlling for age, sex, comorbidities, ejection fraction, and medications proved CKD to be the strongest independent predictor of death (hazard ratio 10.5; 95% confidence interval 4.8–23.1; P = 0.0001). This risk was dependant on severity of CKD; a 10 mL/min reduction in creatinine clearance was associated with a 55% increase in hazard of death (P < 0.0001).

Conclusions: In patients receiving an ICD for primary prevention of sudden death, CKD significantly reduced long‐term survival. This poor prognosis may limit the impact of primary prevention ICD therapy in this patient population.
Rapid Atrial Pacing: A Useful Technique During Slow Pathway Ablation
Authors: LIBERMAN LEONARDO , HORDOF ALLAN J. , PASS ROBERT H.
Published: March 2007

Background: Catheter ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) with a success rate of 95–98%. The appearance of junctional rhythm during radiofrequency (RF) application to the slow pathway has been consistently reported as a marker for the successful ablation of AVNRT. Ventriculoatrial (VA) conduction during junctional rhythm has been used by many as a surrogate marker of antegrade atrioventricular nodal (AVN) function. However, VA conduction may not be an accurate or consistent marker for antegrade AVN function and reliance on this marker may leave some patients at risk for antegrade AVN injury.

Objective: The purpose of this study is to describe a technique to ensure normal antegrade AVN function during junctional rhythm at the time of RF catheter ablation of the slow pathway.

Methods: Retrospective review of all patients less than 21 years old who underwent RF ablation for AVNRT at our institution from January 2002 to July 2005. During RF applications, immediately after junctional rhythm was demonstrated, RAP was performed to ensure normal antegrade AVN function. Postablation testing was performed to assess AVN function and tachycardia inducibility.

Results: Fifty‐eight patients underwent RF ablation of AVNRT during the study period. The mean age ± SD was 14 ± 3 years (range: 5–20 years). The weight was 53 ± 15 Kg (range: 19–89 Kg). The preablation Wenckebach cycle length was 397 ± 99 msec (range: 260–700 msec). Fifty‐four patients had inducible typical AVNRT, and four patients had atypical tachycardia. The mean tachycardia cycle length ± SD was 323 ± 62 msec (range: 200–500 msec). Patients underwent of 8 ± 7 total RF applications (median: 7; range 1 to 34), for a total duration of 123 ± 118 seconds (median: 78 sec, range: 20–473 sec). Junctional tachycardia was observed in 52 of 54 patients. RAP was initiated during junctional rhythm in all patients. No patient developed any degree of transient or permanent AVN block. Following ablation, the Wenckebach cycle length decreased to 364 ± 65 msec (P < 0.01). Acutely successful RF catheter ablation was obtained in 56 of 58 patients (96%).

Conclusion: Rapid atrial pacing during radiofrequency catheter ablation of the slow pathway is a safe alternative approach to ensure normal AVN function.
Reinitiation of Ventricular Macroreentry within the His‐Purkinje System by Back‐Up Ventricular Pacing—A Mechanism of Ventricular Tachycardia Storm
Authors: REITHMANN CHRISTOPHER , HAHNEFELD ANTON , OVERSOHL NICO , ULBRICH MICHAEL , REMP THOMAS , STEINBECK GERHARD
Published: March 2007

Background: We describe immediate reinitiation of macroreentry ventricular tachycardia (VT) involving the His‐Purkinje system by ventricular pacing from the electrode of an implantable cardioverter defibrillator (ICD) as a mechanism of VT storm refractory to ICD therapy.

Methods and Results: Repetitive reinitiation of bundle branch reentry tachycardia (BBRT), interfascicular tachycardia, or both VTs by ventricular pacing was identified in four ICD patients presenting with VT storm or incessant VT. All patients had a pre‐existing prolonged HV interval (75 ± 9 ms) and left bundle branch block (LBBB) or bifascicular block during sinus rhythm. The VTs included BBRT with LBBB in three patients and interfascicular tachycardia with right bundle branch block (RBBB) and left anterior or left posterior fascicular block in two patients. The paced beats from the ICD electrode exhibited a LBBB pattern of depolarization in two patients and a RBBB contour in V1 and V2 with left axis deviation in two patients. The QRS complex during pacing from the ICD electrode closely resembled that of the recurrent VT in all four patients suggesting that the pacing site of the ICD electrode was in proximity to the myocardial exit site of the bundle fascicle used for antegrade conduction during the reinitiated VT. Ventricular pacing from the ICD electrode after termination of the VT apparently encountered the retrograde refractoriness of this bundle fascicle and allowed immediate re‐propagation of the wavefront orthodromically along the VT circuit. BBRT was eliminated by ablation of the right bundle branch. Successful ablation of the interfascicular tachycardias was achieved by targeting (1) an abnormal potential of the distal left posterior Purkinje network or (2) a diastolic potential during VT in the midinferior left ventricular (LV) septum.

Conclusions: Repetitive reinitiation of BBRT and interfascicular tachycardia by ventricular pacing from the ICD electrode should be considered as a mechanism of VT storm refractory to ICD therapy in patients with a pre‐existing conduction delay within the His‐Purkinje system.
Use of Noncontact Mapping and Saline‐Cooled Ablation Catheter for Sinus Node Modification in Medically Refractory Inappropriate Sinus Tachycardia
Authors: LIN DAVID , GARCIA FERMIN , JACOBSON JASON , GERSTENFELD EDWARD P. , DIXIT SANJAY , VERDINO RALPH , CALLANS DAVID J. , MARCHLINSKI FRANCIS E.
Published: March 2007

Background: Inappropriate sinus tachycardia (IST) is characterized by heart rate (HR) increase out of proportion to stress level. Radiofrequency (RF) modification of the sinus node (SN) is an accepted treatment modality for medically refractory IST. We describe a new technique using noncontact mapping and a saline irrigated catheter for SN modification.

Methods: Seven consecutive patients with medically refractory IST were referred for ablation. Intrinsic heart rate (IHR) was calculated with complete autonomic blockade by atropine and propranolol. Isoproterenol (ISO) 1 mcg/min was initiated and increased to 10 mcg/min. Site of earliest activation was tagged at each dose of ISO once stable HR was achieved. RF ablation to target site of earliest activation at peak HR on ISO 10 mcg/min was performed. With any change in P‐wave morphology, activation was reassessed and the new site of earliest activation targeted. Endpoint was a decrease in HR and change in P‐wave morphology in lead III and aVF.

Results: Five of seven patients had abnormal IHR. Mean number of RF lesions was 25 (10–52). All patients had either flattening of the P wave or development of negative P waves in leads III and aVF post RF associated with a decrease in HR of ≥25% from baseline off ISO. A caudal shift of the site of early activation compared with baseline was observed. One patient who had a prior SN modification developed symptomatic intermittent junctional bradycardia and required an atrial pacemaker 2 weeks later. The other 6 patients in follow‐up from 6 to 24 months had no further IST.

Conclusions: Noncontact mapping using the described technique in conjunction with the saline‐cooled ablation catheter for SN modification in the treatment of IST may provide effective HR control.
Using the Upper Limit of Vulnerability to Assess Defibrillation Efficacy at Implantation of ICDs
Authors: SWERDLOW CHARLES D. , SHEHATA MICHAEL , CHEN PENG‐SHENG
Published: March 2007

The upper limit of vulnerability (ULV) is the weakest shock strength at or above which ventricular fibrillation (VF) is not induced when the shock is delivered during the vulnerable period. The ULV, a measurement made in regular rhythm, provides an estimate of the minimum shock strength required for reliable defibrillation that is as accurate or more accurate than the defibrillation threshold (DFT). The ULV hypothesis of defibrillation postulates a mechanistic relationship between the ULV—measured during regular rhythm—and the minimum shock strength that defibrillates reliably. Vulnerability testing can be applied at implantable cardioverter defibrillator (ICD) implant to confirm a clinically adequate defibrillation safety margin without inducing VF in 75%–95% of ICD recipients. Alternatively, the ULV provides an accurate patient‐specific safety margin with a single fibrillation–defibrillation episode. Programming first ICD shocks based on patient‐specific measurements of ULV rather than programming routinely to maximum output shortens charge time and may reduce the probability of syncope as ICDs age and charge times increase. Because the ULV is more reproducible than the DFT, it provides greater statistical power for clinical research with fewer episodes of VF. Limited evidence suggests that vulnerability testing is safer than conventional defibrillation testing.
The relationship of medical and dental factors to perceived general and dental health
Authors: Richmond Stephen , Chestnutt Ivor , Shennan John , Brown Rebecca
Published: March 2007

Abstract –  Objective:  To determine the relative importance of dental and medical features in relation to perceived oral and general health in a sample of 31‐year‐old individuals.

Subjects and methods:  The present study used information collected from the longitudinal Cardiff Survey, which commenced in 1981. The initial sample consisted of 1018 11‐year‐old Caucasian schoolchildren. Three hundred and thirty‐seven individuals attended the latest examination in 2001 (aged 31 years). For every individual who attended in 2001, the following information was collected: perceived general and oral health recorded on a five‐point Likert scale; self‐reported medical history; SF‐36v2 questionnaire; assessment of dental features; and the Index of Complexity, Outcome and Need (ICON).

Results:  Ninety‐four and 82% of individuals reported good–excellent general and oral health, respectively. Females reported a higher level of physical health than males as measured using the SF‐36v 2. Four medical conditions were associated with perceived poor general health: mental [odds ratios (OR); 95% confidence limits (95% CI): 4.5; 1.1–18.4], gastrointestinal (OR 3.4; 95% CI 1.2–9.5) and genitourinary disorders (OR 7; 95% CI 1.6–30.2), and conditions that did not readily fit into a defined category or system (OR 12.8; 95% CI 3.9–42.3). The highest prevalence of dental factors was gingivitis followed by gingival recession and plaque. Photographically assessed dental factors associated with self‐reported poor/fair oral health were fillings (OR 0.45; 95% CI 0.2–0.9), root caries/abrasion (OR 0.37; 95% CI 0.1–0.9) and gingivitis (OR 0.31; 95% CI 0.1–0.9). There was a statistically significant association between oral and general health. Of those individuals reporting fair–poor oral health (18%), the proportion also reporting fair–poor general health was 63.6%. Unexpectedly, per‐unit increase in ICON score was also significantly associated with fair–poor general health (OR 0.97) with clinically relevant increases of 7 ICON units producing an OR of 0.82.

Conclusion:  The relative importance of the various dental and medical conditions has been identified. Further studies are required to explore the importance of ICON in perceived medical health and importance of the various conditions on oral and general health over different age groups.
Trends in palatine tonsillar cancer incidence and mortality rates in the United States
Authors: Golas Sylvia M.
Published: March 2007

Abstract –  Objective:  The purpose of this paper is to describe the extent of the public health problem presented by palatine tonsillar cancer in the United States by analyzing recent incidence and mortality rate trends.

Methods:  Using the National Cancer Institutes’ Surveillance, Epidemiology and End Results (SEER) Program database, age‐adjusted incidence rates (1973–2001) for five histological types of palatine tonsillar cancer by race and sex were calculated. For total palatine tonsillar cancer age‐specific incidence (1973–2001) and mortality (1969–2001) rates by race and sex were calculated. Mortality and population data were obtained from the National Center for Health Statistics (NCHS) and the U.S. Census Bureau. The Joinpoint Regression Model was employed to establish the statistical significance of incidence and mortality rate trends.

Results:  The majority of palatine tonsillar cases diagnosed in SEER‐9 registries from 1973 to 2001 occurred among white males, age 40–64 years, with squamous cell carcinoma (SCC). The highest incidence of palatine tonsillar cancer occurred in black males, followed by white males with SCC. For age 40–64 years, palatine tonsillar incidence rates significantly declined for white females and black females, rose and then declined for black males, but increased from 1988 for white males. For age 65+ years, incidence significantly declined among white males. Palatine tonsillar cancer mortality rates for age 40–64 years significantly declined for white females. Rates also declined for black females (1981–2001) and black males (1985–2001) in this age group while rates for white males declined significantly from 1969 to 1987, but stabilized at nearly 0.4 through 2001. Mortality for the age group, 65+, significantly rose and fell for white females and declined for white males.

Conclusions:  Beginning in the late 1980s, and continuing through 2001, the risk for white males, age 40–64 years, of developing palatine tonsillar cancer increased. In contrast, the risk for white males, age 65 years and older, of developing palatine tonsillar cancer and of dying from this disease decreased during the study period.
The value of caries preventive care among 19‐year olds using the contingent valuation method within a cost–benefit approach
Authors: Oscarson N. , Lindholm L. , Källestål C.
Published: March 2007

Abstract –  Objectives:  The aim of this study was to explore adolescents with high and no caries experience and their preferences for caries preventive dental care. Their willingness‐to‐pay (WTP) for preventive dental care was elicited using the contingent valuation method (CVM) within a cost–benefit approach.

Methods:  Eighty‐two individuals (19‐year olds) agreed to participate in an exploratory case–control study. Thirty individuals with high caries experience formed the test group. The control group consisted of 52 individuals with no caries experience, selected randomly from a caries‐free population. Using personal questionnaires in combination with the CVM, we elicited respondents’ WTP for preventive dental care. The data were used to: (a) compare WTP between study groups, and (b) calculate net social benefit (NSB) in cost–benefit analysis (CBA).

Results:  The result shows a mean yearly WTP for the high‐ and low‐risk group of 1405 SEK and 1087 SEK (7.70 SEK = US$1; July 2005), respectively. Two variables were associated with the differences between the groups: caries risk (i.e. group designation) and housing. Using these WTP values, the CBA showed positive NSB values for both study groups.

Conclusions:  Through use of the CVM, 19‐year olds’ WTP for caries preventive measures was elicited. An NSB >0 was found, which means that benefits exceeded the costs for prevention. Despite the small sample size and restriction to one Swedish county, the results indicate that the methods used in this study are suitable for further testing and analyses.
Dental practitioners’ views on the need to treat developmental defects of enamel
Authors: Wong Hai Ming , McGrath Colman , King Nigel M.
Published: March 2007

Abstract Objectives:  To assess dental practitioners' views on the need to treat developmental defects of enamel (DDE). In addition, to identify factors associated with practitioners’ treatment decision (tooth factors and dentist‐related).

Methods:  A random sample of 300 Hong Kong dentists were sent a booklet containing computer‐generated images of various forms of DDE and asked to rate the treatment need. In addition, some dentist‐related information was collected.

Results:  The response rate was 79% (237/300). The majority of the dental practitioners considered that aesthetic treatment was indicated for people with DDE subtypes of brown demarcated opacities (51.0%), confluent/patchy plus staining and/or loss of enamel (80.2%), missing enamel (67.1%) and the combination of discolouration and diffuse opacities (83.1%); their decisions were in relation to the type (P < 0.001), size (P = 0.001) and colour (P < 0.001) of the enamel defects. Dental professionals who were older, self‐employed, graduated from institutions overseas, or had postgraduate qualifications, tended to consider aesthetic treatment for the teeth that exhibited the milder forms of enamel defects (P < 0.05).

Conclusions:  Dentists frequently perceive that DDE constitutes a ‘great need’ for dental treatment. Dentists’ perceptions of the need to treat DDE is influenced by type, size and colour of DDE and associated with dentist‐related factors, principally the age of the dentist.
Overview and quality assurance for the National Health and Nutrition Examination Survey (NHANES) oral health component, 1999–2002
Authors: Dye B. A. , Barker L. K. , Selwitz R. H. , Lewis B. G. , Wu T. , Fryar C. D. , Ostchega Y. , Beltran E. D. , Ley E.
Published: March 2007

Abstract –  The Oral Health Component of the 1999–2002 National Health and Nutrition Examination Survey (NHANES) is a collaborative effort between the National Institute of Dental and Craniofacial Research (NIDCR), the National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health (NCCDPHP/DOH), and the National Center for Health Statistics (NCHS). The current NHANES is designed as a continuous survey with data released on a 2‐year cycle to represent the civilian, non‐institutionalized population of the US. Oral health data are currently available for 8082 and 9010 persons aged ≥2 years who participated in the 1999–2000 and 2001–2002 NHANES, respectively. This article provides background information on previous national examination surveys with oral health content. It also provides general analytical considerations, oral health content information, and evaluations of data quality in terms of examiner reliability statistics (percent agreements, kappa, and correlation coefficients) for the 1999–2002 NHANES Oral Health Component.
Time Scales of DNAPL Migration in Sandy Aquifers Examined via Numerical Simulation
Authors: Gerhard Jason I. , Pang TiWee , Kueper Bernard H.
Published: March 2007

The time required for dense nonaqueous phase liquid (DNAPL) to cease migrating following release to the subsurface is a valuable component of a site conceptual model. This study uses numerical simulation to investigate the migration of six different DNAPLs in sandy aquifers. The most influential parameters governing migration cessation time are the density and viscosity of the DNAPL and the mean hydraulic conductivity of the aquifer. Releases of between 1 and 40 drums of chlorinated solvent DNAPLs, characterized by relatively high density and low viscosity, require on the order of months to a few years to cease migrating in a heterogeneous medium sand aquifer having an average hydraulic conductivity of 7.4 × 10−3 cm/s. In contrast to this, the release of 20 drums of coal tar (ρD= 1061 kg/m3, μD= 0.161 Pa·s) requires more than 100 years to cease migrating in the same aquifer. Altering the mean hydraulic conductivity of the aquifer results in a proportional change in cessation times. Parameters that exhibit relatively little influence on migration time scales are the DNAPL–water interfacial tension, release volume, source capillary pressure, mean aquifer porosity, and ambient ground water hydraulic gradient. This study also demonstrates that low‐density DNAPLs (e.g., coal tar) give rise to greater amounts of lateral spreading and greater amounts of pooling on capillary barriers than high‐density DNAPLs such as trichloroethylene or tetrachloroethylene.
Comparative Study of Methods for WHPA Delineation
Authors: Paradis Daniel , Martel Richard , Karanta Gilbert , Lefebvre René , Michaud Yves , Therrien René , Nastev Miroslav
Published: March 2007

Human activities, whether agricultural, industrial, commercial, or domestic, can contribute to ground water quality deterioration. In order to protect the ground water exploited by a production well, it is essential to develop a good knowledge of the flow system and to adequately delineate the area surrounding the well within which potential contamination sources should be managed. Many methods have been developed to delineate such a wellhead protection area (WHPA). The integration of more information on the geologic and hydrogeologic characteristics of the study area increases the precision of any given WHPA delineation method. From a practical point of view, the WHPA delineation methods allowing the simplest and least expensive integration of the available information should be favored. This paper presents a comparative study in which nine different WHPA delineation methods were applied to a well and a spring in an unconfined granular aquifer and to a well in a confined highly fractured rock aquifer. These methods range from simple approaches to complex computer models. Hydrogeological mapping and numerical modeling with MODFLOW‐MODPATH were used as reference methods to respectively compare the delineation of the zone of contribution and the zone of travel obtained from the various WHPA methods. Although applied to simple ground water flow systems, these methods provided a relatively wide range of results. To allow a realistic delineation of the WHPA in aquifers of variable geometry, a WHPA delineation method should ensure a water balance and include observed or calculated regional flow characteristics.
BIOSCREEN‐AT: BIOSCREEN with an Exact Analytical Solution
Authors: Karanovic Marinko , Neville Christopher J. , Andrews Charles B.
Published: March 2007

BIOSCREEN is used extensively for screening‐level evaluation of the transport of dissolved contaminants in ground water. The code has an effective graphical user interface that makes it ideal for use in both professional practice and as a teaching aid. BIOSCREEN implements the approximate transport solution of Domenico (1987). This note describes an enhanced version of the program, BIOSCREEN‐AT, which supplements the Domenico solution with an exact analytical solution. The exact analytical solution has been integrated seamlessly within the BIOSCREEN interface and provides a simple and direct way to calculate an exact solution to the transport equation and, if desired, to assess the significance of the errors introduced by the Domenico (1987) solution for site‐specific applications. The modified version of BIOSCREEN is designated BIOSCREEN‐AT and can be downloaded free of charge from http://www.sspa.com/./software/BIOSCREEN.htm.
Religion of the Common People in Mesopotamia
Authors: Nemet‐Nejat Karen Rhea
Published: March 2007

The purpose of ‘Religion of the common people in Mesopotamia’ is to examine the religion of the ordinary people. Discovering this information has been difficult task as most written sources and archeological finds explain the official religion of kings, priest and priestesses, and wealthy individuals. This article has tried to trace personal religion for the common man from the development of the pantheon, the importance of myths, prayers, omens and the use of various forms of magic. This information helps us understand the ways in which the average man worshiped his gods, and, perhaps, entered the temples he helped build.
Identification of new immunogenic peptides in conserved regions of hepatitis C virus (HCV) 1b with the potentiality to generate cytotoxic T lymphocytes in HCV1b+ HLA‐A24+ patients
Authors: Takao Yukari , Yamada Akira , Yutani Shigeru , Takedatsu Hiroko , Ono Takeharu , Etoh Kojyu , Wang Yi , Suzuki Susumu , Ide Tatsuya , Shimotohno Kunitada , Sata Michio , Itoh Kyogo
Published: March 2007

Aim:  Hepatitis C virus (HCV) 1b is resistant to standard interferon therapy and has a high risk of developing into hepatocellular carcinoma at the late stage of infection. Therefore, new therapeutic modalities for HCV1b infection must be developed. One approach would be active specific immunotherapy with highly immunogenic HCV1b peptides.

Methods:  HCV1b‐derived 44 synthetic peptides were selected based on their binding scores to HLA‐A24. Peptide‐specific IgG were measured by ELISA. Peptide‐specific cytotoxic T‐lymphocytes (CTLs) were induced in vitro by repeated peptide‐stimulation.

Results:  We identified three novel candidate peptides of HCV1b proteins containing HLA‐A24 binding motifs. Each of them had the ability to induce HLA‐A24‐restricted and peptide‐specific CTL activity, and IgGs specific to each of them were detected in the plasma of HCV1b patients. Among these three peptides, a peptide NS5A 2132–2142 was recognized by both cellular and humoral immunities in the majority of blood samples of patients tested. More importantly, the peptide‐stimulated peripheral blood mononuclear cells (PBMCs) showed cytotoxicity against cells cotransfected with NS5A and HLA‐A2402 genes in an HLA‐restricted manner. This is an additional report to our previous study.

Conclusion:  These findings may provide a new insight into the development of a peptide‐based specific immunotherapy for HCV1b‐infected patients.
Angiotensin II receptor signalling
Authors: Daniels Derek , Yee Daniel K. , Fluharty Steven J.
Published: March 2007

Angiotensin II plays a key role in the regulation of body fluid homeostasis. To correct body fluid deficits that occur during hypovolaemia, an animal needs to ingest both water and electrolytes. Thus, it is not surprising that angiotensin II, which is synthesized in response to hypovolaemia, acts centrally to increase both water and NaCl intake. Here, we review findings relating to the properties of angiotensin II receptors that give rise to changes in behaviour. Data are described to suggest that divergent signal transduction pathways are responsible for separable behavioural responses to angiotensin II, and a hypothesis is proposed to explain how this divergence may map onto neural circuits in the brain.
Antibody Responses Are Generated to Immunodominant ELK/KLE-Type Motifs on the Nonstructural-1 Glycoprotein during Live Dengue Virus Infections in Mice and Humans: Implications for Diagnosis, Pathogenesis, and Vaccine Design
Authors: Falconar Andrew K. I.
Published: March 2007

Antibodies generated to the purified dengue type 2 virus (D-2V) nonstructural-1 (NS1) protein in mice and rabbits were compared with those generated to this protein in congeneic (H-2 class II) mouse strains and humans after D-2V infections. Unlike the profiles observed with the rabbits, similar antibody reaction profiles were generated by mice and humans with severe D-2V disease (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]). Many of these epitopes contained the core acidic-hydrophobic-basic (tri-amino-acid; ELK-type) motifs present in the positive or negative orientations. Antibody responses generated to these ELK/KLE-type motifs and the epitope LX1 on this protein were influenced by class II molecules in mice during D-2V infections; but these antibodies cross-reacted with human fibrinogen and platelets, as implicated in DHF/DSS pathogenesis. The core LX1 epitope (113YSWKTWG119), identified by the dengue virus complex-specific monoclonal antibody (MAb) 3D1.4, was prepared so that it contained natural I-Ad-binding and ELK-type motifs. This AFLX1 peptide, which appropriately displayed the ELK-type and LX1 epitopes in solid-phase immunoassays, generated a similar, but lower, immunodominant anti-ELK-motif antibody reaction in I-Ad-positive mice, as generated in mice and humans during D-2V infections. These antibody responses were much stronger in the high-responding mouse strains and each of the DHF/DSS patients tested and may therefore account for the association of DHF/DSS resistance or susceptibility with particular class II molecules and autoantibodies, antibody-stimulating cytokines (e.g., interleukin-6), and complement product C3a being implicated in DHF/DSS pathogenesis. These results are likely to be important for the design of a safe vaccine against this viral disease and showed the AFLX1 peptide and MAb 3D1.4 to be valuable diagnostic reagents.
Serum Antibody Response to Lytic and Latent Epstein-Barr Virus Antigens in Undifferentiated Nasopharyngeal Carcinoma Patients from an Area of Nonendemicity
Authors: Tedeschi Rosamaria , Pin Elisa , Martorelli Debora , Bidoli Ettore , Marus Alessia , Pratesi Chiara , Bortolin Maria Teresa , Zanussi Stefania , Vaccher Emanuela , Dolcetti Riccardo , De Paoli Paolo
Published: March 2007

Epstein-Barr virus (EBV)-associatedundifferentiatedcarcinoma of thenasopharyngealtype (UCNT) is highly prevalent in southeast China, where immunoglobulin A (IgA) antibodies to viral capsid antigen and early antigen (EA) represent important markers, routinely used to assist in diagnosing this malignancy. Our study aimed at determining the EBV serological profiles of 78 UCNT patients from Italy, an area of nonendemicity for this tumor, using different assays specific for both lytic and latent EBV antigens. Serum IgA against both EA and EBNA1 and IgG and IgA to the latent membrane protein 1 (LMP1), to EA, and to the EBV transactivator ZEBRA protein were assessed. These serological responses were then evaluated according to the clinicopathologic parameters at diagnosis. The sensitivities of the IgG assays were 37.7% for LMP1, 73.6% for EA, and 61.0% for ZEBRA. EA/EBNA1 IgA reactivity was 84.4%, and a high association (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 4.0) with UCNT was observed. When EBV serological reactivities were analyzed according to the tumor, node, and metastasis staging system (TNM), a statistically significant association was found between N stage and IgG antibody rates for EA (OR, 3.6; 95% CI, 1.2 to 10.9) and ZEBRA (OR, 2.6; 95% CI, 1.2 to 5.5) and between M stage and IgG antibody rates for ZEBRA (OR, 7.1; 95% CI, 3.2 to 16.0) and LMP1 (OR, 14.0; 95% CI, 1.8 to 110.9). Our results show that no single serological marker allows the detection of all UCNT cases. EA/EBNA1 IgA represents a reliable marker for diagnosis, with a high predictive value also in areas where UCNT is not endemic, such as Italy. The analysis of serological results according to TNM classification is consistent with a progressive impairment of humoral immune response to EBV as the disease advances and may be used to improve the accuracy of diagnosis.
Optimizing PCR Positivity Criterion for Detection of Herpes Simplex Virus DNA on Skin and Mucosa
Authors: Magaret Amalia S. , Wald Anna , Huang Meei-Li , Selke Stacy , Corey Larry
Published: March 2007

In 1997, we developed a PCR assay for the detection of herpes simplex virus (HSV) DNA. Recently, we determined an optimal positivity criterion based on research specimens and a dilution study. We found that a cutoff of 50 HSV DNA copies/ml of swab specimen, a level 10-fold lower than our previous cutoff, minimizes misclassification.