bluuebunny/crossref_metadata_2025 huggingface dataset:
GLYCOCONJUGATE ORGANIZATION OF ENTEROMORPHA (=ULVA) FLEXUOSA AND ULVA FASCIATA (CHLOROPHYTA) ZOOSPORES1
Authors: Michael Teena Shen
Published: June 2009

Ecologically successful algae that colonize natural and artificial substrates in the marine environment have distinct strategies for opportunistic dispersal and settlement. The objective of this research was to visualize molecular architecture of zoospores from Enteromorpha (=Ulva) flexuosa (Wulfen) J. Agardh and Ulva fasciata Delile that coexist but alternate in dominance on an intertidal bench. Multiple fluorescent lectins were used to stabilize and probe for diverse zoospore glycoconjugates (GC) that could be involved in cell and substrate interactions. Results from epifluorescence microscopy showed distinct cellular and extracellular polymeric substance (EPS) domains of GC relative to settlement morphologies. Glycoconjugates were similar for both species with (1) α‐d mannose and/or glucose moieties localized on flagella, the anterior domes and anterior regions, the plasma membranes, and EPS; (2) α‐fucose localized on flagella and anterior regions; (3) N or α,ß‐N acetylglucosamine localized on flagella, the anterior regions, and EPS; and (4) varied N‐acetylgalactosamine and/or galactose moieties localized on each domain for both species excluding the plasma membranes. Some differences in lectin binding were observed for each species at the flagella, the anterior domes, and the plasma membranes. Glycoconjugate distributions shifted with morphological changes that followed initial adhesion. TEM of E. flexuosa zoospore stages following carbohydrate‐stabilizing fixations and gold‐conjugated lectin probes resolved GC with α‐d mannose and/or glucose, and/or N‐acetylglucosamine at the plasma membrane, ER and diverse vesicles of the anterior pole, EPS, and discontinuous regions or knobs associated with flagellar surfaces. The distinct distribution and diversity of zoospore GC may be central to recognition and attachment on diverse substrata by these algae.
Comparison of Three Clinical Techniques for the Diagnosis of Laryngeal Paralysis in Dogs
Authors: RADLINSKY MARYANN G. , WILLIAMS JAMIE , FRANK PAUL M. , COOPER TANYA C.
Published: June 2009

Objectives—To evaluate laryngeal function using 3 diagnostic techniques: echolaryngography (EL), transnasal laryngoscopy (TNL), and laryngoscopy per os (LPO).

Study Design—Prospective clinical study.

Animals—Dogs with laryngeal paralysis (n=5) and control dogs (n=10); 5 age‐ and breed‐matched dogs and 5 young, breed‐matched dogs.

Methods—Laryngeal function was evaluated in conscious dogs using EL. All examinations were recorded and evaluated by separate, blinded observers upon completion of the study. The methods were compared with a standard evaluation incorporating all clinical knowledge of the case (STD) using sensitivity, specificity, positive, and negative predictive values.

Results—Three dogs with bilateral laryngeal paralysis requiring surgery were diagnosed as unilaterally affected or normal on EL. Three dogs had paradoxic motion on TNL and LPO, 2 of those were considered normal on EL, and 1 had no motion on EL. Paralysis was diagnosed in 1 age‐matched and 3 young control dogs on EL. LPO and TNL falsely diagnosed lack of arytenoid movement in 2 age‐matched controls and 1 young control. Two age‐matched and 1 young control dog were misdiagnosed as paralyzed with TNL and LPO.

Discussion—Direct observation of the larynx allowed better evaluation of laryngeal function compared with EL. TNL did not require induction of anesthesia, but did not improve the ability to assess laryngeal function compared with LPO.

Conclusions—EL was not as effective as direct observation of the larynx. TNL did not improve the evaluation of laryngeal function compared with LPO.

Clinical Relevance—We use LPO combined with knowledge of the clinical history and physical examination to diagnose laryngeal paralysis in preference to EL and TNL.
In Vitro and In Vivo Evaluation of Ferric‐Hyaluronate Implants for Delivery of Amikacin Sulfate to the Tarsocrural Joint of Horses
Authors: CRIBB NICOLA C. , BOURÉ LUDOVIC P. , BRAD HANNA W. J. , AKENS MARGARETE K. , MATTSON SHAWN E. , MONTEITH GABRIELLE J. , WEESE J. SCOTT
Published: June 2009

Objective—To assess the antimicrobial elution characteristics, toxicity, and antimicrobial activity of amikacin‐impregnated ferric‐hyaluronate implants (AI‐FeHAI) for amikacin delivery to the tarsocrural joint of horses.

Study Design—Experimental study.

Sample Population—AI‐FeHAI implants, equine cartilage, and synovium, and horses (n=6).

Methods—In vitro study: Five AI‐FeHAI were placed in saline solution with daily replacement until implant degradation. Eluent was tested for amikacin concentration and bioactivity. Synovial and cartilage explants were incubated in the presence or absence of AI‐FeHAI for 72 hours and subsequently assessed for morphology, viability, and composition. Synovial explants were incubated withStaphylococcus aureusin the presence or absence of AI‐FeHAI. Spent medium was cultured daily and explants were assessed for morphology and viability after 96 hours.In vivo study: AI‐FeHAI were placed in 6 tarsocrural joints. Standard cytologic analysis and amikacin concentration (SFAC) were determined in synovia obtained regularly for 28 days thereafter. Similar analyses were conducted after a single intra‐articular injection of amikacin 6 months later.

Results—In vitro study: Amikacin concentrations exceeded 16 μg/mL and inhibitedS. aureusgrowth for 8 days. AI‐FeHAI had no effect on cartilage explants. AI‐FeHAI eliminated bacteria from synovial explants.In vitro study: After AI‐FeHAI placement, SFAC was highest (140.78+63.81 μg/mL) at first sampling time. By 24 hours SFAC was <16 μg/mL. After intra‐articular injection, SFAC was the highest (377.91 ± 40.15 μg/mL) at first sampling time. By 48 hours SFAC was <16 μg/mL.

Conclusions—A single intra‐articular amikacin injection demonstrated superior pharmacokinetics than AI‐FeHAI prepared as described.

Clinical Relevance—AI‐FeHAI cannot be recommended for clinical use.
Correction of Rotational Deformity of the Pes with External Skeletal Fixation in Four Dogs
Authors: PETAZZONI MASSIMO , PIRAS ALESSANDRO , JAEGER GAYLE H. , MARIONI CLAUDIO
Published: June 2009

Objective— To report unilateral correction and initial stabilization with external skeletal fixation (ESF) of metatarsal rotation in 4 immature Bernese Mountain Dogs.

Study Design— Case series.

Animals— Bernese Mountain Dogs (n=4).

Methods— The limb deformity, including degree and origin of the deformity at the level of the proximal intertarsal joint and involvement of the central tarsal bone, was characterized by clinical and radiographic assessment. Unilateral surgical correction of the most severely affected limb was performed by disrupting the ligaments and debriding the articular cartilage of the proximal intertarsal joint to allow for derotation of the deformity and arthrodesis of the proximal intertarsal joint stabilized with either circular or linear ESF.

Results— Initial metatarsal rotation of the corrected limbs ranged from 60° to 80° of external rotation (mean, 72.5°). Three limb corrections were stabilized with circular ESF and 1 with a biplanar linear ESF. Implants were removed at the time of radiographic bony union (range, 7–10 weeks; mean, 8.6 weeks). Residual deformity was minimal, ranging from 6° to 15° (mean, 11°). Two minor complications (loosening of 1 pin, serous drainage from 1 pin) resolved with treatment.

Conclusion— Correction of rotational deformity of the pes with intertarsal arthrodesis yielded an excellent clinical outcome, with only a mild residual deformity.

Clinical Relevance— Rotational metatarsal deformities can have a significant impact on gait, ambulation, and appearance. Correction of these deformities and stabilization with ESF and intratarsal arthrodesis can yield an excellent functional outcome, with improved gait and ambulation.
Meniscal Release in Cruciate Ligament Intact Stifles Causes Lameness and Medial Compartment Cartilage Pathology in Dogs 12 Weeks Postoperatively
Authors: LUTHER JILL K. , COOK CRISTI R. , COOK JAMES L.
Published: June 2009

Objective— To evaluate after 12 weeks the effects of caudal medial meniscal release (MR) in the cranial cruciate ligament‐intact canine stifle.

Study Design— Blinded, prospective in vivo study.

Animals— Purpose‐bred hound dogs (n=10).

Methods— Either MR (n=5) or a sham (SH) surgery (n=5) was performed via arthroscopy. Orthopedic examination and subjective lameness evaluation were performed in each dog preoperatively and at 4, 8, and 12 weeks after surgery. Twelve weeks postoperatively, ultrasonographic, radiographic, and arthroscopic examinations were performed on the operated stifles. Gross pathology of the articular cartilage, cruciate ligaments, and menisci was assessed. India ink staining of the femoral and tibial articular surfaces was performed to determine the percent area of articular cartilage damage.

Results— At 8 and 12 weeks after surgery, MR dogs were lamer than SH dogs. At 12 weeks, the degree of radiographic OA was significantly higher in MR stifles than in SH stifles. Gross and sonographic meniscal pathology was more severe in MR stifles compared with SH stifles. MR stifles had significantly more severe articular cartilage pathology compared with SH stifles 12 weeks after surgery; pathology was most severe in the medial compartment.

Conclusions— MR alone is associated with articular cartilage loss, further meniscal pathology, degenerative joint disease, and lameness.

Clinical Relevance— Subsequent osteoarthritis and dysfunction of the stifle joint should be considered when making clinical decisions regarding MR in dogs.
External Fixator Clamp Reuse Degrades Clamp Mechanical Performance
Authors: GILLEY ROBERT S. , BEASON DAVID P. , SNYDER DAVID M. , BOSTON RAYMOND C. , RADIN ALEX , KAPATKIN AMY S. , SMITH GAIL K. , SOSLOWSKY LOUIS J.
Published: June 2009

Objective—To determine the effects of clamp reuse for the Kirschner–Ehmer (KE); Securos; and the IMEX–SK clamp.

Study Design—Experimental bench test of mechanical properties.

Methods—Specially designed fixtures were used to mechanically test 18 clamps of each type with respect to 6 mechanical variables: fixator pin slippage, connecting bar slippage, fixator pin rotation, connecting bar rotation, and clockwise and counterclockwise clamp–bolt axis pivot. Each clamp was tested 6 times for each variable at 7.68 Nm of clamp–bolt tightening torque. Results were compared using repeated measures ANOVA.

Results—For the IMEX–SK clamp, a significant degradation in the force required to cause slippage was found for connecting bar slippage and fixator pin rotation; however, this clamp also had a significant increase in the force to initiate slippage for clockwise clamp–bolt axis pivot with reuse. The Securos clamp had significant degradation in connecting bar slippage, connecting bar rotation, and fixator pin rotation whereas the KE clamp had significant degradation in connecting bar slippage only.

Conclusions—All 3 external fixator clamp types degraded in 1 or more movement variables in their ability to resist motion with reuse. The IMEX and Securos clamps were more subject to degradation than the KE clamp and this may have clinical importance for fixator composite rigidity.

Clinical Relevance—Fracture‐reduction stability is related to the ability to resist motion within a clamp. The unpredictable nature of degradation we found cautions against repeated use. Clinicians should consider reuse of external fixator clamps with the knowledge that repeated use degrades clamp mechanical performance.
Ventral Locking Compression Plate for Treatment of Cervical Stenotic Myelopathy in a 3‐Month‐Old Warmblood Foal
Authors: REARDON RICHARD , KUMMER MARTIN , LISCHER CHRISTOPH
Published: June 2009

Objective—To report a novel technique for cervical vertebral fusion in a foal with cervical vertebral malformation (CVM).

Study Design—Case report.

Methods—A 3‐month‐old Warmblood filly with ataxia, weakness, and stenotic myelopathy at the level of the articulation of the 6th (C6) and 7th (C7) cervical vertebrae had a 7‐hole broad locking compression plate (LCP) applied to the ventral aspect of C6 and C7 using seven 5.0‐mm locking screws. Revision surgery was required to replace the self‐drilling screws, which had migrated, with longer non self‐drilling screws. Fusion and growth of the vertebrae were monitored radiographically at 4, 10, and 16 months using radiography and the filly was followed for 32 months.

Results—The filly recovered well from the surgical procedures and by 30 months had improved by 2.5 neurologic grades. Ventral inter‐central joint fusion was evident by 10 months. Continued vertebral growth occurred in all but the cranial physis of the C7 vertebral body.

Conclusions—A ventrally placed LCP provided adequate support for fusion and stability of cervical vertebrae.

Clinical Relevance—Use of an LCP applied ventrally offers an alternative to basket use in small or immature horses for fusion of cervical vertebrae.
Laser‐Doppler Measurements of Spinal Cord Blood Flow Changes During Hemilaminectomy in Chondrodystrophic Dogs with Disk Extrusion
Authors: MALIK YASMINDA , SPRENG DAVID , KONAR MARTIN , DOHERR MARCUS G. , JAGGY ANDRE , HOWARD JUDITH , FORTERRE FRANCK
Published: June 2009

Objectives— (1) To assess spinal cord blood flow (SCBF) during surgical treatment of disk extrusion in dogs and (2) to investigate associations between SCBF, clinical signs, presurgical MRI images, and 24‐hour surgical outcome.

Study Design— Cohort study.

Animals— Chondrodystrophic dogs with thoracolumbar disk extrusion (n=12).

Methods— Diagnosis was based on clinical signs and MRI findings, and confirmed at surgery. Regional SCBF was measured intraoperatively by laser‐Doppler flowmetry before, immediately after surgical spinal cord decompression, and after 15 minutes of lavaging the lesion. Care was taken to ensure a standardized surgical procedure to minimize factors that could influence measurement readings.

Results— A significant increase in intraoperative SCBF was found in all dogs (Wilcoxon's signed‐rank test; P=.05) immediately after spinal cord decompression and after 15 minutes. Changes in SCBF were not associated with duration of clinical signs; initial or 24‐hour neurologic status; or degree of spinal cord compression assessed by MRI.

Conclusion— SCBF increases immediately after spinal cord decompression in dogs with disk herniation; however, increased SCBF was not associated with a diminished 24‐hour neurologic status.

Clinical Relevance— An increase in SCBF does not appear to be either associated with the degree of spinal cord compression or of a magnitude sufficient to outweigh the benefit of surgical decompression by resulting in clinically relevant changes in 24‐hour outcome.
Splenectomy for Treatment of Suppurative Splenitis caused by a Reticular Foreign Body in a Heifer
Authors: NUSS KARL , FORSTER EVA , REICHERT CHRISTOF , MUGGLI EVELYNE , BRAUN UELI
Published: June 2009

Objective:To report the clinical findings and treatment of a heifer with suppurative splenitis.

Study design:Clinical report.

Animals:A 30‐month‐old heifer.

Methods:Splenectomy in the standing calf after local anesthesia and 13th rib resection.

Results:The heifer had an uneventful recovery but was culled because of septic tarsitis 3 months later.

Conclusions:Splenectomy is a useful treatment for cattle with traumatic splenitis if diagnosed early. Partial splenectomy may have prevented the late complication of septic tarsitis.

Clinical Relevance:Suppurative splenitis is usually a complication of hardware disease and has a grave prognosis unless splenectomy is carried out.
Hemodynamic Changes During Laparoscopic Radiofrequency Ablation of Normal Adrenal Tissue in Dogs
Authors: FRANSSON BOEL A. , KEEGAN ROBERT D. , RAGLE CLAUDE A. , HALDORSON GARY J. , GREENE STEPHEN A.
Published: June 2009

Objective—To determine the hemodynamic response to radiofrequency ablation (RFA) of normal adrenal tissue in dogs.

Study Design—Experimental study.

Animals—Healthy adult mixed‐breed dogs (n=6).

Methods—During general anesthesia a Swan–Ganz thermodilution catheter was flow directed into the pulmonary artery and used to quantify cardiac output. An arterial catheter was used for direct blood pressure measurements. An RFA device was introduced into the left adrenal gland under observation through laparoscopic instrumentation. Blood samples were collected and hemodynamic variables studied after a stable surgical anesthetic depth was achieved (time 1), during CO2insufflation of the abdomen (time 2), during adrenal RFA (time 3), and after completed RFA (time 4). Catecholamine determinations were performed with a human enzyme immunoassay. Histopathology was performed to verify medullary necrosis.

Results—Arterial, pulmonary arterial and central venous pressure, and plasma norepinephrine increased more during RFA than during abdominal insufflation. Heart rate and cardiac index did not differ between time points. High baseline epinephrine was present and significant differences between time points were not detected. Systemic vascular resistance had very high individual variation and differences were not detected.

Conclusions—RFA of normal adrenal tissues is associated with severe hemodynamic alterations. Further studies of the optimal blockage of catecholamine‐induced hypertension in dogs are warranted.

Clinical Relevance—Clinicians should prepare for potential hypertensive crisis during RFA of adrenal masses, especially if treating a margin of normal tissue.
Surgical Treatment of a Canine Intranasal Meningoencephalocele
Authors: MARTLÉ VALENTINE A. , CAEMAERT JACQUES , TSHAMALA MULENDA , VAN SOENS IRIS , BHATTI SOFIE F. M. , GIELEN INGRID , PIRON KOEN , CHIERS KOEN , TIEMESSEN ILSE , VAN HAM LUC M.
Published: June 2009

Objective—To report the clinical signs, diagnosis, and surgical treatment of an intranasal meningoencephalocele in a dog.

Study Design—Case report.

Animal—Female Border collie, 5 months old.

Methods—A right intranasal meningoencephalocele was identified by computed tomography and magnetic resonance imaging.

Results—The lesion was approached by a modified transfrontal craniotomy. Surgical closure of the defect at the level of the cribriform plate and removal of extruded brain tissue resulted in regression of lacrimation and coincided with absence of seizuring. Treatment with phenobarbital was gradually reduced and stopped at 7 months after surgery. At 28 months the dog remained free of seizures.

Conclusion—Meningoencephalocele, although rare, can cause seizures in dogs and can be treated surgically.

Clinical Relevance—A transfrontal craniotomy with excision of the meningoencephalocele and closure of the defect can be an effective treatment for an intranasal meningoencephalocele in dogs.
Video‐Assisted Left Partial Arytenoidectomy by Diode Laser Photoablation for Treatment of Canine Laryngeal Paralysis
Authors: OLIVIERI MASSIMO , VOGHERA SIMONA G. , FOSSUM THERESA. W.
Published: June 2009

Objectives—To evaluate the clinical outcome of left partial arytenoidectomy by video‐assisted laser diode photoablation as a surgical treatment for canine laryngeal paralysis (LP).

Study Design—Case series.

Animals—Dogs with bilateral LP (n=20).

Methods—After endoscopic diagnosis of bilateral LP, left partial arytenoidectomy was performed by photoablation of arytenoid cartilage tissue using a diode laser (600 μm diameter, 15 W power, 980 nm wave length) to increase the width of the rima glottidis. Outcome was evaluated endoscopically (1 and 6 months) and clinically (1, 6, and 12 months).

Results—No substantial complications occurred during photoablation or in the immediate postoperative period. Postoperative width of the rima glottidis ranged from 6 to 10 mm at its widest aspect. At 1 month, respiratory function after walking and short running appeared good. Clinical and endoscopic examination revealed good outcome at 1 and 6 months. At 6 months, there was no evidence of hypertrophic scar, hypertrophic granulation tissue, or stricture of the laryngeal glottis in any dog. Two dogs developed aspiration pneumonia after 12 months.

Conclusions—Partial arytenoidectomy using video‐assisted diode laser photoablation appears to be an effective technique for treating LP.

Clinical Relevance—Partial arytenoidectomy by diode laser photoablation should be considered as an alternative technique for treatment of canine LP.
Arytenoid Lateralization for Treatment of Laryngeal Paralysis in 10 Cats
Authors: HARDIE ROBERT J. , GUNBY JESSICA , BJORLING DALE E.
Published: June 2009

Objective—To describe the signalment, history, clinical signs, surgical technique, and outcome for cats with laryngeal paralysis that had arytenoid lateralization.

Study Design—Case series.

Animals—Cats with laryngeal paralysis (n=10).

Methods—Medical records (1996–2002) for cats with laryngeal paralysis that had arytenoid lateralization were reviewed for signalment, history, clinical signs, degree of paralysis, cause, concurrent medical conditions, surgical technique, and outcome. Follow‐up information was obtained from owners or referring veterinarians.

Results—Of 10 cats, 9 had bilateral and 1 had unilateral laryngeal paralysis. Arytenoid lateralization were unilateral (n=7), bilateral (1), and staged bilateral procedures (2), 10 days and 3 years apart, respectively. Postoperatively, 1 cat had persistent inspiratory noise because of minimal enlargement of the rima glottidis and 2 cats required a temporary tracheostomy for management of laryngeal swelling. Three cats developed aspiration pneumonia and died 4, 7, and 150 days after surgery; all 3 had bilateral (simultaneous or staged) procedures. Of the 7 remaining cats, 4 were alive at follow‐up and 3 had died of causes unrelated to arytenoid lateralization. The calculated mean survival time for all 10 cats was 406 days (median, 150 days; range, 4–1825 days).

Conclusions—Arytenoid lateralization was effective at enlarging the rima glottidis and reducing signs of airway obstruction in most cats.

Clinical Relevance—Unilateral arytenoid lateralization is a feasible option for the surgical management of cats with marked clinical signs; however, bilateral procedures should be avoided or at least performed with considerable caution because of the apparent risk for aspiration pneumonia.
Synovial Hemangioma in a Dog
Authors: ARIAS J. IGNACIO , TORRES CRISTIAN , SAEZ DANIEL
Published: June 2009

Objective— To report arthroscopic diagnosis and treatment of synovial hemangioma in a dog.

Study Design— Case report.

Animal— Standard Poodle (8‐year‐old neutered male).

Methods— A soft tissue density mass observed radiographically in the left stifle joint of a dog with a 2‐month history of recurrent lameness, hemarthrosis, and a slight cranial drawer sign, was located by diagnostic arthroscopy and surgically excised via arthrotomy.

Results— Histologic evaluation revealed tissue composed of variably sized cavernous vascular spaces filled with erythrocytes that were considered compatible with synovial hemangioma.

Conclusions— In this dog, synovial hemangioma evident as a soft tissue mass on radiographs was associated with chronic lameness and hemarthrosis, and resolved with surgical excision.

Clinical Relevance— Synovial hemangioma, although seemingly rare in dogs, should be considered in the differential diagnosis for nontraumatic, recurrent lameness, and unresponsive to anti‐inflammatory therapy when there is a circumscribed intracapsular soft tissue mass evident radiographically together with hemarthrosis.
Safe and Rapid Isolation of Pulmonary Veins Using a Novel Circular Ablation Catheter and Duty‐Cycled RF Generator
Authors: FREDERSDORF SABINE , WEBER STEFAN , JILEK CLEMENS , HEINICKE NORBERT , VON BARY CHRISTIAN , JUNGBAUER CARSTEN , RIEGGER GÜNTER A. , HAMER OKKA W. , JERON ANDREAS
Published: June 2009

Background: Ablation of atrial fibrillation (AF) has been one of the most difficult and time‐consuming electrophysiological procedures. Due to the rapidly increasing demand for ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore, we investigated the feasibility of a single‐catheter technique for pulmonary vein (PV) isolation utilizing a decapolar catheter combined with a duty‐cycled, unipolar–bipolar radiofrequency (RF) generator.

Methods: AF mapping and ablation was performed in 21 consecutive patients (mean age 59 ± 12 years, 9 males) with paroxysmal AF (n = 17) and persistent AF (n = 4). The ablation catheter was forwarded to the LA via single‐transseptal puncture. All electrodes were energized in 2 to 5 applications per vein, followed by segmental RF applications, as needed, to achieve electrical isolation. To assess left atrial anatomy for purposes of catheter manipulation, and later evaluate the possibility of asymptomatic PV‐stenosis, CT or MR imaging was performed both prior to ablation and at 6‐month follow‐up.

Results: Isolation could be achieved in 85/86 veins (99%). Procedure time for ablation was 81 ± 13 minutes, and fluoroscopy time was 30 ± 11 minutes. There were no procedural complications. Success rate at 6 months was 86% (18/21). MR or CT imaging excluded asymptomatic PV‐stenosis.

Conclusion: Mapping and ablation of PVs can be performed in a safe and efficient manner using a single‐catheter technique, with short procedure times and minimal learning curve. Thus, this system may be of high interest not only for high volume but all centers performing AF ablation.
Characterization of In Vitro and In Vivo Lesions Made by a Novel Multichannel Ablation Generator and a Circumlinear Decapolar Ablation Catheter
Authors: WIJFFELS MAURITS C.E.F. , VAN OOSTERHOUT MATTHIJS , BOERSMA LUCAS V.A. , WERNETH RANDY , KUNIS CHRIS , HU BETTY , BEEKMAN JET D.M. , VOS MARC A.
Published: June 2009

Introduction: The aim of this study is to characterize ablation lesions using varying ratios of bipolar:unipolar energy and to show the feasibility of a circular decapolar pulmonary vein ablation catheter (PVAC™) to create transmural lesions in an in vivo porcine superior vena cava (SVC) model.

Methods and Results: Ablations were performed on (1) isolated blocks of bovine myocardium, (2) thigh muscle preparations (4 pigs), and (3) the junction between SVC and right atrium (6 pigs). Radiofrequency (RF) energy was delivered simultaneously to all electrodes (target temperature 60°C, maximum power 10 W/electrode) with various ratios of bipolar:unipolar energy. (1) In vitro PVAC™ resulted in circumscript lesions. Changing RF energy mode from unipolar only to bipolar:unipolar 1:1, 2:1 and 4:1 and bipolar only decreased lesion depth significantly (6.7 ± 0.2 vs. 5.0 ± 0.2, 4.1 ± 0.3, 3.6 ± 0.1 and 3.1 ± 0.1 mm, P < 0.001). (2) Similar results were obtained in vivo (thigh muscle) showing less deep lesions with more bipolar energy modes (e.g., 5.4 ± 1.3 for unipolar only vs. 4.1 ± 0.8 mm for bipolar only, P < 0.05). (3) Ablation at the SVC did not result in device‐related complications. All animals survived and were sacrificed after 7 ± 1 days except for one pig, which died immediately postoperatively from an unknown cause. Macroscopy and microscopy showed circumferential transmural SVC lesions.

Conclusions: Temperature‐controlled, power‐limited RF energy with the PVAC™ is feasible for creating circumferential transmural lesions (SVC) that sometimes extended to neighboring structures. Lesion depth can be titrated by varying the bipolar:unipolar energy ratio. This novel ablation system paves the way for single‐catheter ablation of AF.
Rationale and Design for the Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation (DETERMINE) Trial
Authors: KADISH ALAN H. , BELLO DAVID , FINN J. PAUL , BONOW ROBERT O. , SCHAECHTER ANDI , SUBACIUS HARIS , ALBERT CHRISTINE , DAUBERT JAMES P. , FONSECA CARISSA G. , GOLDBERGER JEFFREY J.
Published: June 2009

Background: Cardiac magnetic resonance imaging (CMR) can accurately determine infarct size. Prior studies using indirect methods and CMR to assess infarct size have shown that patients with larger myocardial infarctions have worse prognoses. Implantable cardioverter defibrillators (ICD) have been shown to improve survival among patients with severe left ventricular (LV) dysfunction. However, the majority of cardiac arrests occur in patients with higher ejection fractions.

Methods: The Defibrillators To Reduce Risk By Magnetic Resonance Imaging Evaluation study (DETERMINE) is a prospective, multicenter, randomized, clinical trial in patients with coronary artery disease (CAD) and mild‐to‐moderate LV dysfunction. The purpose of this trial is to test the hypothesis that patients with an infarct size ≥10% of LV mass, randomized to ICD plus appropriate medical therapy will have improved survival compared with patients randomized to medical therapy alone. Cine and myocardial delayed contrast CMR will be performed in patients with CAD. The primary endpoint will be death from any cause. At least 10,000 patients with CAD will undergo CMR. The target enrollment is 1,550 patients with an estimated 36‐month enrollment period. The patients will be followed up for 24 months after the last patient randomization. During the follow‐up period, 330 deaths are estimated to occur. This study is powered to detect a 28% reduction in mortality by ICD therapy.

Conclusion: The DETERMINE trial will assess the efficacy of ICD therapy to improve survival among patients with CAD, mild‐to‐moderate LV dysfunction, and infarct size ≥10% of LV mass as measured by CMR.
Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation?
Authors: HOF IRENE , CHILUKURI KARUNA , ARBAB‐ZADEH ARMIN , SCHERR DANIEL , DALAL DARSHAN , NAZARIAN SAMAN , HENRIKSON CHARLES , SPRAGG DAVID , BERGER RONALD , MARINE JOSEPH , CALKINS HUGH
Published: June 2009

Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV) anatomy, evaluated by computed tomography (CT) prior to ablation, will predict AF recurrence following catheter ablation.

Methods and Results: We included 146 patients (mean age 57 ± 11 years, 83% male) with symptomatic AF (55% paroxysmal, 18% persistent, 27% long‐standing persistent). All patients underwent CT scanning prior to catheter ablation to evaluate LA volume and PV anatomy. Circumferential PV isolation was performed guided by Cartomerge electroanatomical mapping. The outcome was defined as complete success, improvement, or failure.

After a mean follow‐up of 19 ±7 months, complete success was achieved in 59 patients (40%), and 38 patients (26%) demonstrated improvement. LA volume was found to be an independent predictor of AF recurrence with an adjusted OR of 1.14 for every 10‐mL increase in volume (95% CI 1.00–1.29, P = 0.047). PV variations were equally distributed among the different outcomes of the ablation procedure, and therefore univariate analysis did not identify PV anatomy as a predictor of outcome.

Conclusion: LA volume is an independent predictor of AF recurrence after catheter ablation. Additionally, PV anatomy did not have any effect on the outcome. These findings suggest that an assessment of LA volume may be incorporated into the preprocedural evaluation of patients being considered for AF ablation.
Pacing Threshold Testing Induced Ventricular Fibrillation Following Acute Rate Control of Atrial Fibrillation
Authors: DAY GEOFFREY A. , PADANILAM BENZY J. , FOGEL RICHARD I. , PRYSTOWSKY ERIC N.
Published: June 2009

Background: A properly placed stimulus on the T‐wave during ventricular repolarization can result in ventricular fibrillation (VF). Initiation of VF with pacing on T‐wave is a rare event with a few reported cases in the literature. We present a unique case of induced VF attributed to a pacing stimulus on T‐wave during ventricular pacing threshold testing of a permanent pacemaker.

Case Report: A 64‐year‐old woman with persistent atrial fibrillation (AF) and a permanent pacemaker for tachycardia–bradycardia syndrome presented with symptomatic AF with rapid ventricular response. Acute rate control was achieved with intravenous diltiazem. During ventricular pacing threshold testing, noncapture occurred followed by a pacing spike on T‐wave initiating VF. Cardiopulmonary resuscitation and defibrillation converted the rhythm to rate‐controlled AF. An acute prolongation of the QT was noted and normalized within 12 hours. No antiarrhythmic medications were used. Postevent laboratory values were within normal limits. She was free of ischemia and an echocardiogram revealed normal left ventricular function. She recovered from the event and was discharged with rate‐controlled AF. No further pacing‐induced arrhythmias have occurred during follow‐up pacemaker interrogation and 12‐lead electrocardiograms continued to show normal QT intervals.

Conclusion: Pacemaker‐induced VF is an extraordinarily rare complication of cardiac pacing. Alterations in ventricular repolarization with rapid slowing of the heart rate demonstrated by acute prolongation of QT intervals may play a role. This report should alert physicians to the possibility of QT prolongation and an increased risk of ventricular arrhythmias following acute rate control of AF.
Continuing Medical Education Program in Journal of Cardiovascular Electrophysiology
Authors: HAMMILL STEPHEN C. , TEH ANDREW W. , KISTLER PETER M. , KALMAN JONATHAN M.
Published: June 2009

Article Title: Using the 12‐Lead ECG to Localize the Origin of Ventricular and Atrial Tachycardias: Part 1. Focal Atrial Tachycardia.
Sleep, Hunger, Satiety, Food Cravings, and Caloric Intake in Adolescents
Authors: Landis Andrea M. , Parker Kathy P. , Dunbar Sandra B.
Published: June 2009

Background and Purpose:Prevalence of adolescent obesity has increased worldwide. Although diet and exercise patterns are major determinants of weight, recent studies with adults and children have shown that total amount of sleep is inversely associated with body mass index (BMI). The purpose of this study was to examine associations among total sleep time (TST), hunger, satiety, food cravings, and caloric intake in a sample of healthy adolescents.

Design‐Methods:Participants were recruited from the community and a local high school. Demographic data such as sleeping habits, pubertal status, food cravings, caloric intake, physical activity, height, and weight were collected between October 2006 and April 2007. Participants also completed a 7‐day sleep‐hunger‐satiety diary. Descriptive and parametric procedures were used for data analyses (α=.05).

Findings:The sample (N=85) included 56% females (n=48), 76% African American (n=65) adolescents. Mean age was 15.6±1.4 years and mean BMI was 24.3±5.4 kg/m2. Mean reported 7‐day cumulative nocturnal sleep was 52.9 (±6.0) hours; mean reported cumulative daytime sleep (or napping) was 3.7 (±3.4) hours. Multiple regression analyses showed age, gender, and race were associated with feelings of hunger, satiety, total food cravings and caloric intake. A greater total food‐cravings score was associated with increased daytime sleep.

Conclusions:These findings indicate an unexpected association between increased daytime sleep and eating behaviors that potentially lead to obesity. Longitudinal studies using objective measures of sleep, appetite regulation, and caloric intake are needed to better understand relationships between appetite and sleep in adolescents from varying racial and gender groups.

Clinical Relevance:By carefully considering adolescent sleep (especially daytime sleep), race, and gender, clinicians and school health nurses in the US and other countries are in a unique position to develop novel approaches to prevent and reduce obesity.
ICU Nurses’ Oral‐Care Practices and the Current Best Evidence
Authors: Ganz Freda DeKeyser , Fink Naomi Farkash , Raanan Ofra , Asher Miriam , Bruttin Madeline , Nun Maureen Ben , Benbinishty Julie
Published: June 2009

Purpose: The purpose of this study was to describe the oral‐care practices of ICU nurses, to compare those practices with current evidence‐based practice, and to determine if the use of evidence‐based practice was associated with personal demographic or professional characteristics.

Design: A national survey of oral‐care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004–05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral‐care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics.

Findings: The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients’ teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67±27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence‐based protocol and demographic and professional characteristics or with the priority given to oral care.

Conclusions: While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence‐based, oral‐care protocols.

Clinical Relevance: Practicing ICU nurses in this survey were often not adhering to the latest evidence‐based practice and therefore need to be educated and encouraged to do so in order to improve patient care.
Hmong American Women Living With Diabetes
Authors: Yang Avonne , Xiong Dal , Vang Eslee , Pharris Margaret Dexheimer
Published: June 2009

Purpose: To understand how to better care for Hmong women with diabetes using nursing theory praxis.

Design: Qualitative phenomenologic design, specifically community‐based collaborative action research based on Margaret Newman's theory of health as expanding consciousness (HEC).

Methods: Five Hmong women with Type 2 diabetes and HgbA1c levels over 7.0 were recruited from a community‐health clinic. Audiotaped in‐home interviews were conducted and data were analyzed to identify common patterns and then developed into a play by the research team with the help of a female Hmong playwright. Community dialogue about the findings generated meaningful actions for health.

Conclusions: This study indicates the value of nursing praxis rooted in the theory of health as expanding consciousness and the importance of engaging communities to identify meaningful patterns of health and needed actions.

Clinical Relevance: Evidence‐based practice is lacking in the care of Hmong women with diabetes. Community‐based collaborative action research rooted in the HEC perspective is a new way to envision models of care.
Patients’ Adherence to Anti‐Retroviral Therapy in Botswana
Authors: Kip Esther , Ehlers Valerie J. , Van Der Wal Dirk M.
Published: June 2009

Purpose: To identify factors influencing patients’ anti‐retroviral therapy (ART) adherence at four clinics in Botswana.

Design: Quantitative descriptive. Structured interviews were conducted with a random sample of 400 patients out of the population of all patients attending the four randomly selected ART clinics in Botswana during April and May 2007.

Methods: Data were analysed using SPSS version 13. Chi‐square and p‐value calculations were done to test significance of the relationships between categories or variables.

Findings: Patient‐centred barriers to ART adherence included inadequate knowledge about ART, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), CD4 cell and viral‐load results, stigma, travelling costs, waiting times at clinics, side effects of ART, use of traditional (indigenous or folk) medicines, and abuse of alcohol. Service‐centred barriers included nurses’ attitudes and knowledge, health workers’ inability to conduct home visits and to contact defaulters, limited clinic hours, delays in getting CD4 and viral‐load results.

Conclusions: ART adherence requires more than free ART. Adherence levels will improve if both patient‐centred and service‐centred barriers are addressed.

Clinical Relevance: Nurses play key roles in educating patients about ART adherence and side effects, but they should also educate patients about CD4 and viral‐load test results and about the dangers of using traditional medicines and alcohol with ART. Shorter waiting times at clinics could make ART patients’ lives more manageable.
Evaluation of “Magnet Journey to Nursing Excellence Program” in Russia and Armenia
Authors: Aiken Linda H. , Poghosyan Lusine
Published: June 2009

Objective: To provide an outcomes‐evaluation of an intervention to strengthen professional nursing practice in Russian and Armenian hospitals.

Design: The Nursing Quality Improvement Initiative using the ANCC Forces of Magnetism to develop professional nurse practice was implemented in four hospitals in Russia and Armenia. Cross‐sectional survey data were collected at two time points from 840 nurses in Wave 1 and 859 nurses in Wave 2. Comparisons were undertaken between targeted units in each hospital compared to nontargeted units, and each hospital served as its own control in surveys that took place in years 1 and 3 of the demonstration.

Methods: Descriptive information on nurse samples was derived from survey items. Changes in characteristics of nurse practice environments, nurse‐reported patient care quality, and nurse burnout in Russia and Armenia, overall and separately for targeted and nontargeted units, were tested using chi‐square statistics and difference of means tests.

Findings: Practice environment features such as nurses' involvement in hospital affairs, better collegial relationships with physicians, more support for nursing care from administrators, and continuity of nursing care improved after the intervention. Resource adequacy indicators did not change over the demonstration period. Changes in indicators of patient care quality were favorable, though differences in changes in targeted and nontargeted units were equivocal.

Conclusions: Changes consistent with evolving professional nursing practice were associated with program implementation. Forces of magnetism appear to have the same potential for transforming nursing practice in countries with fewer resources as in wealthier Western countries.

Clinical Relevance: Magnet Recognition, an evidence‐based best practice for improving the nursing‐care environment developed in Western countries, was feasible to implement in countries with transitioning economies, limited resources, and truncated professional nursing education.
Case Management Workforce in the United States
Authors: Park Eun‐Jun , Huber Diane L.
Published: June 2009

Purpose: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession.

Design: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs).

Methods: Descriptive statistics, Chi‐square tests, and correlation coefficients were calculated.

Findings: The majority of the case‐management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN‐CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed‐care enrollees.

Conclusions: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce.

Clinical Relevance: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging‐of‐the‐workforce issues in the US.
Nurses' Perceptions of Safety Culture in Long‐Term Care Settings
Authors: Wagner Laura M. , Capezuti Elizabeth , Rice Julie C.
Published: June 2009

Purpose: To describe perceptions of workplace safety culture among nurses employed in long‐term care (LTC) settings.

Design: A cross‐sectional survey. Respondents were licensed nurses (N=550) with membership in gerontological nursing professional organizations in the United States (n=296), Canada (n=251), and other (n=3).

Methods: An anonymous, self‐administered, mail‐in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported.

Findings: Nurse‐managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government‐run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations.

Conclusions: Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers.

Clinical Relevance: Enhancing safety culture in long‐term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.