bluuebunny/crossref_metadata_2025 huggingface dataset:
Antifungal activity of the silver ion against contaminated fabric
Authors: Jung Woo Kyung , Kim So Hyun , Koo Hye Cheong , Shin Sook , Kim Jun Man , Park Young Kyung , Hwang Sun Young , Yang Hyesoon , Park Yong Ho
Published: March 2007

An anti‐fungal efficacy test of the silver laundry machine, which electrically generates silver ions, was carried out against four fungi –Trichophyton rubrum,Candida albicans,Microsporum canisandAspergillus flavus– which cause major fungal infection in humans and animals. Compared with the conventional laundry machine, washing with the silver laundry machine regardless of detergent use was effective against most of the fungi with about 4 log10(CFU ml−1) reduction and eliminated almost all the fungi when using the detergent. Moreover, the cleaning activity of the silver laundry machine with detergent was higher than that of the conventional laundry machine with detergent both after wash and after final spin step against all four examined fungi. The silver laundry machine may be useful in preventing skin irritation caused by fungi‐contaminated fabric in the hospital and in the home.
An integrated methodology for separating closure and residual stress effects from fatigue crack growth rate data
Authors: DONALD J. KEITH , LADOS DIANA A.
Published: March 2007

To properly interpret the results of standard fatigue crack growth tests it is often necessary to incorporate corrective techniques to the ΔK applied data. This is especially true in the near‐threshold regime where long crack data need to be closure corrected to predict small crack behaviour. It is also an issue in the presence of residual stress. A methodology to separate the influence of sample size, geometry, crack length and residual stress from the standard crack growth test data to obtain a true material response is presented. Stress ratio and residual stress contributions from known combinations of assumed crack size, applied stress and residual stress are also addressed and incorporated in the fatigue crack growth behaviour.
A literature survey on the stability and significance of residual stresses during fatigue
Authors: McCLUNG R. C.
Published: March 2007

Many manufacturing processes can induce residual stresses in components. These residual stresses influence the mean stress during cyclic loading and so can influence the fatigue life. However, the initial residual stresses induced during manufacturing may not remain stable during the fatigue life. This paper provides a broad and extensive literature survey addressing the stability of surface and near‐surface residual stress fields during fatigue, including redistribution and relaxation due to static mechanical load, repeated cyclic loads, thermal exposure and crack extension. The implications of the initial and evolving residual stress state for fatigue behaviour and life prediction are addressed, with special attention to fatigue crack growth. This survey is not a critical analysis; no detailed attempt is made to evaluate the relative merits of the different explanations and models proposed, to propose new explanations or models or to provide quantitative conclusions. Primary attention is given to the residual stresses resulting from four major classes of manufacturing operations: shot peening and related surface treatments, cold expansion of holes, welding and machining.
Colourful coexistence of red and green picocyanobacteria in lakes and seas
Authors: Stomp Maayke , Huisman Jef , Vörös Lajos , Pick Frances R. , Laamanen Maria , Haverkamp Thomas , Stal Lucas J.
Published: March 2007

Hutchinson's paradox of the plankton inspired many studies on the mechanisms of species coexistence. Recent laboratory experiments showed that partitioning of white light allows stable coexistence of red and green picocyanobacteria. Here, we investigate to what extent these laboratory findings can be extrapolated to natural waters. We predict from a parameterized competition model that the underwater light colour of lakes and seas provides ample opportunities for coexistence of red and green phytoplankton species. To test this prediction, we sampled picocyanobacteria of 70 aquatic ecosystems, ranging from clear blue oceans to turbid brown peat lakes. As predicted, red picocyanobacteria dominated in clear waters, whereas green picocyanobacteria dominated in turbid waters. We found widespread coexistence of red and green picocyanobacteria in waters of intermediate turbidity. These field data support the hypothesis that niche differentiation along the light spectrum promotes phytoplankton biodiversity, thus providing a colourful solution to the paradox of the plankton.
Tolerability and efficacy of duloxetine in a nontrial situation
Authors: Duckett JRA , Vella M , Kavalakuntla G , Basu M
Published: March 2007

Objective  To assess the tolerability and efficacy of duloxetine in a nontrial situation.

Design  Prospective observational study.

Setting  Urogynaecology Unit, District General Hospital, UK.

Population  Two hundred and twenty‐two women with a diagnosis of urodynamic stress incontinence (USI) or mixed USI and detrusor overactivity (DOA) took duloxetine for 4 weeks.

Methods  The results of therapy were assessed with a Patient Global Impression of Improvement (PGI‐I) questionnaire. One hundred and forty‐eight (67%) women were initially treated with 40 mg twice a day, 67 (30%) women were treated with an escalating dose initially at 20 mg twice a day increasing to 40 mg twice a day after 2 weeks and seven (3%) women were started on a dose of 20 mg twice a day which they continued.

Main outcome measures  Discontinuation rates and PGI‐I scores.

Results  Overall 146/222 (66%) women discontinued therapy due to adverse effects or lack of efficacy. Significantly more women starting on the 40 mg twice a day dose stopped due to adverse effects when compared with the escalating dose (P < 0.025). Of the women who tolerated therapy, 80 out of 120 (67%) had a PGI‐I score indicating an improvement. However, the overall rate of improvement was 37%. PGI‐I scores and discontinuation rates were not significantly different between the group with USI and the group with mixed USI and DOA (P > 0.05).

Conclusion  In a nontrial situation duloxetine is poorly tolerated. Introducing an escalating dose may improve tolerability. A similar number of women with USI and mixed incontinence had a PGI‐I score indicating improvement.
Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up
Authors: Morgan DJ , Hunter DC , McCracken G , McClelland HR , Price JH , Dobbs SP
Published: March 2007

Objective  To compare a new surgical approach, laparoscopically assisted radical vaginal hysterectomy (LARVH) with open radical hysterectomy in women with cervical cancer. Can selected women benefit from the minimally invasive approach without compromising safety (recurrence rate) and morbidity (complications)?

Design  Retrospective case control study.

Setting  A tertiary referral unit for gynaecological malignancies.

Population  Thirty women undergoing LARVH were included and compared with 30 women undergoing open radical surgery. The control group was matched for age, body mass index and disease stage.

Methods  Retrospective collection of data from patient files and follow up.

Main outcome measures  Recurrence rate, complication rate, hospital stay, nodal counts, blood loss, operating time.

Results  Recurrence rates were equal (6.7%). There was one death, in the LARVH group. Follow up was mean 31 months in the LARVH group and 30.9 months in the open group. Blood loss as measured by mean drop in haemoglobin was greater in the open group (2.03 versus 3.01 g/dl, P= 0.02). Transfusions were given in 40% of women in the open group and 16.7% in the LARVH group. Hospital stay was significantly less in the LARVH group (5.9 versus 7.8 nights, P= 0.003). Mean operating time was longer in the LARVH group (131 versus 187 minutes P= 0.0001). Mean nodal counts did not differ significantly (17.4 in open vs 14.8 in LARVH, P > 0.05). There were seven perioperative complications in the open group and four in the LARVH group. There have been two recurrences in each group (6.67%) at mean follow up of 31 (LARVH) and 30.9 (open) months.

Conclusions  The first 30 LARVH procedures performed in this unit are comparable in terms of safety (recurrence rate and complication rate) and economic factors (shorter hospital stay mitigating longer operating time). Further development of this technique is warranted.
Randomized controlled trial for the efficacy of hepatic arterial occlusion during radiofrequency ablation for small hepatocellular carcinoma – direct ablative effects and a long‐term outcome
Authors: Kobayashi Masahiro , Ikeda Kenji , Kawamura Yusuke , Hosaka Tetsuya , Sezaki Hitomi , Yatsuji Hiromi , Akuta Norio , Suzuki Fumitaka , Suzuki Yoshiyuki , Arase Yasuji , Kumada Hiromitsu
Published: March 2007

Objective: To evaluate the efficacy of temporary balloon arterial occlusion during radiofrequency ablation (RFA), randomized controlled trial was performed.

Methods: Twenty patients with hypervascular hepatocellular carcinoma measuring ≤30 mm were randomly treated with RFA combined with arterial occlusion (group A), or RFA alone (group B). Tumour ablation was performed in both groups using our ‘stepwise hook extension technique.’

Results: Median diameters of the longer and shorter axis of RF‐induced area measured on computer tomography were 38 mm (range, 31–52) and 36 mm (25–40) in group A, and 34 mm (26–45) and 26 mm (22–32) in group B respectively. Although the longer axis was not statistically significant, the shorter axis of group A was significantly larger than in group B (P=0.003). The median volume of the ablated lesion was 25.3 cm3 (15.6–48.7) in group A and 16.1 cm3 (9.3–23.8) in group B. The lesion volume was significantly larger in group A than in group B (P=0.005). The time and energy requirement of RFA of both groups were not significantly different. In addition, no serious adverse effects were observed in both groups. Intrasubsegmental tumour recurrence was found in 0% in group A and 30% in group B at the end of the third year (P=0.082).

Conclusions: Hepatic arterial balloon occlusion during RFA is useful for extending the area of ablation in RF‐induced lesions, and the procedure tended to decrease tumour recurrence from the same subsegment of ablated tumour.
Decreased portal flow volume increases the area of necrosis caused by radio frequency ablation in pigs
Authors: Yoshimoto Tsuyoshi , Kotoh Kazuhiro , Horikawa Yuki , Kohjima Motoyuki , Morizono Shusuke , Yamashita Shinsaku , Enjoji Munechika , Nakamuta Makoto
Published: March 2007

Background/aims: Although radio frequency ablation (RFA) has been widely accepted as an effective treatment for hepatocellular carcinoma (HCC), severe complications are not uncommon. Major complications seem to occur as a result of over‐ablation beyond the intended area. As most patients with HCC have underlying cirrhosis, we speculated that decreased portal flow might cause the necrosis associated with RFA. To confirm this hypothesis, we examined the area of necrosis resulting from RFA under varying conditions of portal flow in a porcine model.

Methods: RFA was performed using ultrasonographic guidance in anesthetized pigs. During the RFA procedure, portal flow was regulated by a balloon catheter, which was set in a portal trunk. The necrosis area was measured after sacrifice and was compared with the hyperechoic area that appeared during ablation. In another session, RFA was performed close to the hepatic vein and endothelial damage was examined.

Results: The necrosis area caused by RFA was significantly larger when the portal flow volume was decreased by 50% or more. The hyperechoic lesion was always larger than the area of pathological necrosis regardless of portal flow volume. Under conditions of decreased portal flow, the vessel endothelium near the ablated area was more readily damaged.

Conclusion: Decreased portal flow volume resulted in enlargement of the area of necrosis caused by RFA. Our results indicate that over‐ablation could easily occur in patients with advanced cirrhosis, and that this could lead to major complications. Ultrasonographic guidance may be helpful for avoiding over‐ablation.
Efficacy and Tolerability of Levetiracetam in Children Younger than 4 Years: A Retrospective Review
Authors: Perry M. Scott , Benatar Michael
Published: March 2007

Summary:  Purpose: To review our experience of the efficacy and tolerability of levetiracetam (LEV) in children younger than 4 years.

Methods: We used retrospective chart review to identify 122 children with seizures who were younger than 4 years and followed for ≥6 months. Efficacy was evaluated on the basis of the occurrence and durability of seizure remission. Tolerability was based on parent‐ and patient‐reported side effects.

Results: Seventy (57%) subjects achieved seizure remission, and 52 (43%) did not. In univariate analysis, those achieving seizure remission were more likely to have partial epilepsy, require lower maintenance doses of LEV, and have fewer than two seizures per month at initiation of the medication. Only seizure frequency at initiation of LEV remained significant in multivariate analysis. The median duration of seizure freedom (8.9 months) was not influenced by age, epilepsy type, gender, or pretreatment seizure frequency. The dose of LEV was the only significant predictor of the duration of seizure remission, with longer duration of seizure remission seen in those taking <30 mg/kg/day compared with those taking >30 mg/kg/d (median, 12.8 months vs. 3 months; p < 0.0001). Side effects of LEV occurred in 34% of subjects but required discontinuation in only 16%, most commonly because of behavioral disturbances.

Conclusions: LEV is an effective medication in children younger than 4 years and at doses lower than previously reported. It is also well tolerated, suggesting that it represents an important option for the treatment of epilepsy in this age group.
Founder Effect with Variable Age at Onset in Arab Families with Lafora Disease and EPM2A Mutation
Authors: Gomez‐Abad Cristina , Afawi Zaid , Korczyn Amos D. , Misk Adel , Shalev Stavit A. , Spiegel Ronen , Lerman‐Sagie Tally , Lev Dorit , Kron Katherine L. , Gómez‐Garre Pilar , Serratosa Jose M. , Berkovic Samuel F.
Published: March 2007

Summary:  Purpose: We observed three apparently unrelated and geographically separate Arab families with Lafora disease in Israel and the Palestinian territories.

Methods: We clinically evaluated the families and analyzed their DNA for EPM2A mutations.

Results: Of seven individuals with Lafora disease, the clinical onset varied from 13 to 20 years. All three families shared the same novel homozygous deletion in EPM2A. Haplotype analysis around the deletion showed that the families shared a common homozygous haplotype. The boundaries of this haplotype varied between families and even within one family.

Conclusions: We conclude that considerable variability in the age at onset of Lafora disease can occur within families. Identical mutations can be associated with the classic adolescent presentation, as well as late‐onset cases. Haplotype analysis suggests that this EPM2A mutation arose many generations previously, so it may be of importance for cases distributed more widely in the Middle East.
Epilepsy and Language Development: The Continuous Spike‐Waves during Slow Sleep Syndrome
Authors: Debiais Séverine , Tuller Laurie , Barthez Marie‐Anne , Monjauze Cécile , Khomsi Amedh , Praline Julien , De Toffol Bertrand , Autret Alain , Barthelemy Catherine , Hommet Caroline
Published: March 2007

Summary: Background:Continuous spike‐waves during slow sleep syndrome (CSWSS) is a rare epileptic syndrome occurring in children, which is characterized by the association of epilepsy, neuropsychological disorders, and abnormal paroxysmal electroencephalographic (EEG) discharges activated by sleep. Language can be affected but, to date, language disorders and their long‐term outcome have been documented only rarely.

Purposes:Description of language impairment in patients with the CSWSS.

Methods:We performed a detailed language testing in 10 right‐handed children and adolescents with the CSWSS. Their pragmatic performance was compared to that of a control population of 36 children aged 6—10 years.

Results:Patients with CSWSS had lower scores in tests measuring their lexical, morphosyntactic, and pragmatic skills compared to controls. Comprehension remains unaffected. In addition, language impairment was found to be just as severe in patients in remission as those still in an active phase.

Conclusions:We found severe language impairments in lexical and syntactic skills. The language profile is different from that observed in the Landau–Kleffner syndrome. Moreover patients in remission and those in an active phase of the CSWSS have the same language impairment profiles. This confirms the poor long‐term neuropsychological prognosis. Our results raise points about the relationship between epileptic activity and language development. This pilot study underscores the need to assess language, and especially pragmatic skills, and to study long‐term outcome in such childhood epileptic syndromes.
Social Functioning and Psychological Well‐Being of 347 Young Adults with Epilepsy Only—Population‐Based, Controlled Study from Finland
Authors: Koponen Anne , Seppälä Ullamaija , Eriksson Kai , Nieminen Pirkko , Uutela Antti , Sillanpää Matti , Hyvärinen Leena , Kälviäinen Reetta
Published: March 2007

Summary:  Purpose: To explore social functioning and psychological well‐being in a population‐based cohort of epilepsy patients compared to matched controls.

Methods: A random sample of patients with epilepsy (N = 347) and a healthy control group (N = 430) matched for age, gender and domicile were identified through National Registry of Social Insurance Institution in Finland. The data were collected by postal questionnaire assessing various factors related to social and psychological well‐being and were analyzed by using linear regression analysis to compare the study and control groups.

Results: The age at onset of epilepsy was significantly associated with the level of further education and the level of seizure control with the employment status. The patients with epilepsy and lower level of basic education had also significantly lower level of further education, employment, and fewer social relations. Some differences in psychological well‐being were also seen in those with matriculation examination when compared to matched controls.

Conclusions: In young adults with well‐controlled epilepsy and successful basic education, social functioning is comparable with healthy peers. The importance of all social and educational support during the time of basic education may be crucial to favorable intellectual, functional, and social development later in life. Both professional and informal support is needed in adjunct to conventional treament of epilepsy, which is emphasized.
Induction of the Wnt Inhibitor, Dickkopf‐1, Is Associated with Neurodegeneration Related to Temporal Lobe Epilepsy
Authors: Busceti Carla Letizia , Biagioni Francesca , Aronica Eleonora , Riozzi Barbara , Storto Marianna , Battaglia Giuseppe , Giorgi Filippo S. , Gradini Roberto , Fornai Francesco , Caricasole Andrea , Nicoletti Ferdinando , Bruno Valeria
Published: March 2007

Summary:  Inhibition of the Wnt pathway by the secreted glycoprotein, Dickkopf‐1 (Dkk‐1) has been related to processes of excitotoxic and ischemic neuronal death. We now report that Dkk‐1 is induced in neurons of the rat olfactory cortex and hippocampus degenerating in response to seizures produced by systemic injection of kainate (12 mg/kg, i.p.). There was a tight correlation between Dkk‐1 expression and neuronal death in both regions, as shown by the different expression profiles in animals classified as “high” and “low” responders to kainate. For example, no induction of Dkk‐1 was detected in the hippocampus of low responder rats, in which seizures did not cause neuronal loss. Induction of Dkk‐1 always anticipated neuronal death and was associated with a reduction in nuclear levels of β‐catenin, which reflects an ongoing inhibition of the canonical Wnt pathway. Intracerebroventricular injections of Dkk‐1 antisense oligonucleotides (12 nmol/2 μL) substantially reduced kainate‐induced neuronal damage, as did a pretreatment with lithium ions (1 mEq/kg, i.p.), which rescue the Wnt pathway by acting downstream of the Dkk‐1 blockade. Taken collectively, these data suggest that an early inhibition of the Wnt pathway by Dkk‐1 contributes to neuronal damage associated with temporal lobe epilepsy. We also examined Dkk‐1 expression in the hippocampus of epileptic patients and their controls. A strong Dkk‐1 immunolabeling was found in six bioptic samples and in one autoptic sample from patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis. Dkk‐1 expression was undetectable or very low in autoptic samples from nonepileptic patients or in bioptic samples from patients with complex partial seizures without neuronal loss and/or reactive gliosis in the hippocampus. Our data raise the attractive possibility that drugs able to rescue the canonical Wnt pathway, such as Dkk‐1 antagonists or inhibitors of glycogen synthase kinase‐3β, reduce the development of hippocampal sclerosis in patients with temporal lobe epilepsy.
Fetal Exposure to GABA‐Acting Antiepileptic Drugs Generates Hippocampal and Cortical Dysplasias
Authors: Manent Jean‐Bernard , Jorquera Isabel , Mazzucchelli Iolanda , Depaulis Antoine , Perucca Emilio , Ben‐Ari Yehezkel , Represa Alfonso
Published: March 2007

Summary:  Purpose: The management of epilepsy during pregnancy entails a number of concerns. While seizures may affect adversely maternal and fetal outcome, antiepileptic drugs (AEDs) may increase the incidence of congenital abnormalities and possibly affect postnatal cognitive development in the offspring. Experimental animal studies can aid in assessing teratogenic features associated with individual AEDs and/or with seizures, and to identify the mechanisms involved. The purpose of this study was to investigate the consequences of prenatal exposure to (a) different AEDs and (b) maternal seizures on brain maturational processes in rats.

Methods: Pregnant rats received from embryonic days 14 to 19 intraperitoneal injections of carbamazepine (20 mg/kg/day), vigabatrin (200 mgkg/day), and valproate (100 mg/kg/day) at doses not widely different from those used clinically. Pups exposed to AEDs in utero were analyzed postnatally. Animals born to “kindled” pregnant animals that had experienced one generalized convulsive seizure per day during the same gestational period were analyzed in parallel.

Results: Prenatal exposure to vigabatrin and valproate, which act on GABA signaling, induced hippocampal and cortical dysplasias, which were likely to result from a neuronal migration defect and neuronal death. By contrast, offspring of rats exposed to carbamazepine (which at the dose used produced low plasma concentrations) or to generalized convulsive seizures showed no clear‐cut evidence of dysplasias.

Conclusions: We suggest that AEDs that increase the extracellular concentration of GABA might induce severe neuronal migration disorders. Drugs acting through other molecular targets would also perturb cortical maturation. The potential clinical relevance of these results should be a subject of future research.
4 Human Rights, Global Justice, and Disaggregated States: John Rawls, Onora O'Neill, and Anne‐Marie Slaughter
Authors: Bernstein Alyssa R.
Published: March 2007

Abstract.  Human rights are urgently important rights that all individual persons may validly claim and that all governments are obligated to respect. According to some philosophers, no government can plausibly claim legitimate authority unless its legal and political system ascribes such rights, and no society can plausibly claim to be just unless it has a legitimate government. John Rawls presents his own version of this conception in the context of his account of the moral basis of a just global system of public law, which he calls the Law of Peoples. According to some of his critics, including Onora O'Neill, not only is the Law of Peoples statist, but also it relies on a false view of the state. O'Neill has developed a new conception of an ideally just global order in which states have fewer, and corporations more, powers and obligations to secure human rights, in contrast to Rawls's conception. Her conception is consistent with Anne‐Marie Slaughter's account of the transformation of state sovereignty due to globalization. However, contrary to initial appearances, it is not the case that O'Neill's and Slaughter's views taken together require significant modification of Rawls's conception of human rights. There is no fundamental conflict between Rawls's conception of human rights and Slaughter's account of state transformation. And O'Neill's criticisms of Rawls's view are unwarranted.
5 Beyond Intrinsic Value: Undermining the Justification of Ecoterrorism
Authors: Brown Charles S.
Published: March 2007

Abstract.  Both Aldo Leopold's “land ethic” and Arne Naess's “deep ecology” have been criticized as providing intellectual justifications for both a misanthropic ecofascism and a policy of ecoterrorism for environmental activists. This chapter argues that each of these two approaches to providing a ground or framework for an environmental ethics is subject to the charges of ecofascism or ecoterrorism only to the extent that each is committed to the notion of “intrinsic value” as a nonnegotiable moral absolute or, as Kant puts it, “a value beyond all price.” This chapter begins by describing shared value experience between humans and animals and then points the way to an alternative and pragmatic concept of value that can better guide environmental thinking on matters of law, policy, and activism. This concept of value emerges from an experiential and epistemic understanding of the inherent rationality of value experience. A description of value experience reveals that the lived significance of value experience exhibits a meaningful and referential structure in which anticipations of future experience are either satisfied or frustrated in future experience. This meaningful structure of value experience, in which value experiences point to their own confirmation or disconfirmation, constitutes a self‐correcting tendency or a prima facie rationality inherent in value experience. The result is a pragmatic conception of value that takes all value intuition and attribution to be intrinsically revisable in light of future experience. As such, value experience is always subject to negotiation, dialogue, and the weight of future experience. This conception of value undercuts the intellectual, psychological, and moral justification for ecofascism or ecoterrorism.
6 Does Kant Have Anything to Teach Us about Environmental Ethics?
Authors: Lucht Marc
Published: March 2007

Abstract.  Immanuel Kant's thought typically is represented as hostile to environmental concerns, but his aesthetics offers significant resources for environmental ethics. His account of the disinterestedness of taste raises the possibility of a manner of motivating a noninstrumental and responsive—rather than self‐interested and consumerist—attitude toward nature. The aesthetic consciousness thus can help situate us within rather than pit us against the natural world. Kant's thinking about the beautiful and the sublime point to an ambiguous conception of subjectivity, a picture of the subject who experiences itself both as immersed within a meaningful world and as raised above a world to which it is morally superior. Such a conception may orient investigations in environmental philosophy by providing a more realistic view of the relationship between human beings and nature than do either dualistic or monistic theories.
8 Culture, Evil, and Horror
Authors: Santilli Paul
Published: March 2007

Abstract.  This chapter develops a concept of aesthetic and existential horror and suggests its importance for understanding modern and postmodern culture. It makes three distinct claims. First, the experience of horror signifies a breakdown in the symbolic categories and valuations of a culture. Second, this experience has ontological significance because in horror the human is exposed to the naked fact of being. This latter point is derived from Heidegger's comments on anxiety and Emmanuel Levinas's notion of the “il y a” or “there is.” A third claim follows from these two, namely, that horror is distinct from evil. Evil is defined within a cultural matrix; horror is the undefined other of a culture. Evil represents the negation of being; horror shows the sickening presence of being as being. The essay concludes with a reflection on the possibility of a postmodern ethics that takes responsibility for the “horrors of being” generated by globalization.
Electrophysiological Differences of the Spontaneous Onset of Paroxysmal and Persistent Atrial Fibrillation
Authors: WEBER STEFAN , NDREPEPA GJIN , SCHNEIDER MICHAEL , DEISENHOFER ISABEL , ZRENNER BERNHARD , SCHMITT CLAUS
Published: March 2007

Background: Information about the spatiotemporal organization of atrial activity at the onset of atrial fibrillation (AF) is still limited.

Methods: AF mapping was performed in 30 patients with AF (mean age 53 ± 9 years, 26 males) by deploying a noncontact mapping balloon in the left atrium (LA). Twenty‐four patients had paroxysmal AF and six patients had persistent AF. Three types of AF episodes were analyzed: nonsustained AF (lasting ≤ 30 seconds), sustained AF (lasting > 30 seconds, with spontaneous conversion or requiring internal cardioversion and subsequent stable sinus rhythm), and persistent AF episodes (stable sinus rhythm lasting ≤ 1 minute after cardioversion).

Results: A total of 101 spontaneous AF onset episodes were analyzed. Analysis of AF onset showed that there was a progressive shortening of the initial cycle lengths from nonsustained episodes to sustained episodes and to persistent AF episodes. There was an earlier and more rapid reduction in the cycle lengths from persistent episodes to sustained episodes and to nonsustained episodes of AF (P < 0.05 for persistent vs sustained and for sustained vs nonsustained episodes). The development of multiwavelet activity and disorganization of conduction occurred earlier in persistent and sustained episodes than in nonsustained AF episodes. LA size was greater in patients with persistent AF episodes compared with patients with sustained or nonsustained AF episodes.

Conclusions: Electrophysiological events that develop at the onset of AF seem to be different in different types of AF. A more rapid degeneration into the fibrillatory activity was observed in persistent and sustained AF than in nonsustained AF episodes.
Tachycardia Circuit in Typical Atrial Flutter: The Role of a Posterolateral Line of Block in the Perpetuation of the Tachycardia
Authors: YAMABE HIROSHIGE , TANAKA YASUAKI , MORIHISA KENJI , UEMURA TAKASHI , KAWANO HIROAKI , NAGAYOSHI YASUHIRO , KOJIMA SUNAO , OGAWA HISAO
Published: March 2007

Background: The essential boundaries in typical atrial flutter (AF) are unknown.

Methods: To examine the role of the tricuspid annulus (TA) and posterolateral line of block (LB) in maintaining AF, single extrastimuli were delivered during AF both around the LB and the TA in 29 patients. Single extrastimuli were delivered from the superior, middle, and inferior third of the anterior LB, superior, middle, and inferior third of the posterior LB, and the superior, lateral, inferior, and septal portions of the TA. The longest coupling interval (LCI) of single extrastimuli that reset AF and subsequent return cycle (RC) were analyzed.

Results: The resetting response showed two patterns (groups 1 and 2). The differences between the AF cycle length (AFCL) and the LCI (AFCL−LCI) at the superior, lateral, inferior, and septal portions of the TA were the shortest, and were significantly shorter than those at the other sites (P < 0.0001) in group 1. However, the AFCL−LCI at the superior, middle, and inferior third of the anterior LB, and the superior, lateral, inferior, and septal portions of the TA were the shortest, and were significantly shorter than those at the other sites (P < 0.0001) in group 2. The difference between the RC and the AFCL exhibited the same two patterns, similar to the AFCL−LCI. In group 1, a single extrastimulus produced an artificial conduction across the LB, but AF was not reset.

Conclusions: Two types of reentry circuits exist in AF; one has its essential reentry circuit confined to the TA and thus the LB acts as a bystander, while the LB and the TA are essential boundaries in the other one.
Thermal Mapping of Right Ventricular Outflow Tract Tachycardia
Authors: CLYNE CHRISTOPHER A. , ATHAR HARIS , SHAH ANUJ , KAHR ROSEMARIE , RENTAS ANGEL
Published: March 2007

Background: Acute and long‐term success of catheter ablation of right ventricular outflow tract tachycardia (RVOT VT) may be limited by the inability to reproduce the arrhythmia at the time of activation (AM) and pace mapping (PM). We have observed early initiation of the clinical VT when subtherapeutic radiofrequency (RF) energy was applied to the target area (TA), defined as a 2‐cm2 area around a pace match. We describe a novel approach using thermal mapping (TM) to guide the ablation of RVOT VT.

Methods: Thirteen patients (10 female, mean age 46.2 ± 13.7 years) with symptomatic VT of left bundle branch block (LBBB) inferior axis morphology and no structural heart disease underwent standard electrophysiologic evaluation with PM (n = 13), AM (n = 13), and 3D noncontact mapping (n = 4). Thermal mapping was performed after standard techniques failed to induce stable sustained VT for mapping in all 13 patients: RF was applied for 5–10 seconds in the TA to achieve a tip temperature of 45–50°C. At sites where morphologically consistent with the clinical VT was induced, RF was applied at target temperature between 50 and 60°C for 30–60 seconds. TM was repeated before and after intravenous Isoproterenol infusion until no further VT could be induced by low temperature application.

Results: Noninducibility was achieved in all 13 patients. During a mean follow‐up of 29 months (9–69 months), all patients remain arrhythmia‐free, off antiarrhythmic medications.

Conclusion: Thermal mapping is a safe and effective adjunctive technique for the mapping and ablation of RVOT VT when sustained tolerated clinical VT cannot be induced.
Chronic Renal Insufficiency Is an Independent Predictor of Mortality in Implantable Cardioverter‐Defibrillator Recipients
Authors: CHEN‐SCARABELLI CAROL , SCARABELLI TIZIANO M.
Published: March 2007

Background: Chronic renal insufficiency (CRI) has been associated with increased risk of cardiovascular morbidity and mortality. However, there is limited knowledge regarding this association and the effect of renal dysfunction on survival benefit in patients with implantable cardioverter‐defibrillators (ICDs).

Methods: We investigated whether there was an association between CRI (defined as serum creatinine levels ≥1.5 mg/dL) and increased risk of mortality in ICD recipients. We retrospectively studied all patients (n = 336) followed within our ICD clinic in a 2.5‐year period. CRI, ventricular tachycardia (VT), cardiomyopathy (CM), and mortality were recorded. Ischemic CM was defined as the presence of coronary artery disease (CAD) and left ventricular ejection fraction ≤ 30%.

Results: Despite no significant difference in CAD and VT occurrence between CRI and non‐CRI groups in the overall population, there was a significantly higher mortality rate in the CRI group (P < 0.0001).

Conclusion: CRI is a significant independent predictor of mortality in ICD recipients. Further investigation is needed to determine whether prevention, early detection, and more aggressive intervention in the treatment of CRI will reduce the incidence of mortality in this population.
The Effect of Gender on Mortality or Appropriate Shock in Patients with Nonischemic Cardiomyopathy Who Have Implantable Cardioverter‐Defibrillators
Authors: CHEN HENRY A. , HSIA HENRY H. , VAGELOS RANDALL , FOWLER MICHAEL , WANG PAUL , AL‐AHMAD AMIN
Published: March 2007

Background: As heart disease is increasingly recognized in women and as important studies have elucidated the benefit of implantable cardioverter defibrillators (ICDs) in patients with nonischemic cardiomyopathy (NICM), little is known regarding the effect of gender difference on arrhythmic risk in this population. We sought to determine if there are gender differences in arrhythmic risk and potential defibrillator benefit in patients with NICM.

Methods: The records of 767 consecutive patients who underwent ICD implant at the Stanford Medical Center from 1984 to 2002 were reviewed. Only patients with NICM were considered (n = 201, 26.2%). Of these, 140 patients had clinical follow‐up information available. Baseline variables were examined, including age, baseline heart rate, ejection fraction, and medications. We evaluated the time to first shock as well as all‐cause mortality in this patient population. Kaplan‐Meier survival curves were plotted, a log‐rank test was used to evaluate significance, and Cox‐proportional hazards test was used for multivariate analysis.

Results: There were 88 (62.9%) men and 52 (37.1%) women. Between male and female patients, there were no significant differences in baseline mean age (54.8 ± 1.9 years vs 53.1 ± 2.3 years, respectively), ejection fraction (35.2 ± 2.0% vs 33.3 ± 2.3%, respectively), and mean left ventricular end‐diastolic dimension (6.4 ± 0.3 cm vs 5.9 ± 0.2 cm, respectively). Mean follow‐up time was 30.8 months. Thirty‐two male patients (36.4 ± 0.05%) received appropriate shocks compared with 20 female patients (38.5 ± 0.07%). Mean time to the first appropriate shock was 11.9 ± 3.9 months for male patients and 21.3 ± 5.8 months for female patients (P = 0.2). Nineteen male patients (21.6 ± 0.05%) died or received heart transplant during the follow‐up period compared with 6 female patients (11.5 ± 0.04%) (P = 0.11).

Conclusion: Male and female patients with NICM who received ICDs had similar rate of appropriate shock and mortality. In this population gender does not appear to be an important risk factor for mortality or arrhythmic events.
Coronary Sinus Lead Fragmentation 2 Years After Implantation with a Retained Guidewire
Authors: NÄGELE HERBERT , HASHAGEN SANDRA , ERGIN MEHMET , AZIZI MOJGAN , BEHRENS STEFAN
Published: March 2007

Cardiac Resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of inter‐ and intraventricular conduction delays. However implantation of CS leads is somewhat challenging due to a high number of peri‐ or postoperative dislocations at a rate of about 10%. The retained guidewire technique has been proposed for the implantation of coronary sinus leads for stabilization in case of repetitive intraoperative dislocations. This report describes CS lead and guidewire fracture 2 years after such an implant.
Mapping and Ablation of Trigger Premature Ventricular Contractions in a Case of Electrical Storm Associated with Ischemic Cardiomyopathy
Authors: OKADA TARO , YAMADA TAKUMI , MURAKAMI YOSHIMASA , YOSHIDA NAOKI , NINOMIYA YUUICHI , TOYAMA JUNJI
Published: March 2007

We report a case of polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) storm associated with ischemic cardiomyopathy (ICM). The electrocardiogram (ECG) monitor revealed frequent premature ventricular contractions (PVCs) initiated PVT/VF. Electroanatomic mapping revealed the plausible origins of PVCs were located in the scar border zone at the posterior septum of the left ventricle. Purkinje‐like potentials (PLPs) always preceded PVCs and a decremental property for the PLPs and infarcted myocardium junction was observed. Ablation at these sites eliminated both PVCs and PVT/VF.
Multilist Population Estimation with Incomplete and Partial Stratification
Authors: Sutherland Jason M. , Schwarz Carl James , Rivest Louis‐Paul
Published: March 2007

SummaryMultilist capture–recapture methods are commonly used to estimate the size of elusive populations. In many situations, lists are stratified by distinguishing features, such as age or sex. Stratification has often been used to reduce biases caused by heterogeneity in the probability of list membership among members of the population; however, it is increasingly common to find lists that are structurally not active in all strata. We develop a general method to deal with cases when not all lists are active in all strata using an expectation maximization (EM) algorithm. We use a flexible log‐linear modeling framework that allows for list dependencies and differential probabilities of ascertainment in each list. Finally, we apply our method of estimating population size to two examples.
Sample Size Determination for Hierarchical Longitudinal Designs with Differential Attrition Rates
Authors: Roy Anindya , Bhaumik Dulal K. , Aryal Subhash , Gibbons Robert D.
Published: March 2007

SummaryWe consider the problem of sample size determination for three‐level mixed‐effects linear regression models for the analysis of clustered longitudinal data. Three‐level designs are used in many areas, but in particular, multicenter randomized longitudinal clinical trials in medical or health‐related research. In this case, level 1 represents measurement occasion, level 2 represents subject, and level 3 represents center. The model we consider involves random effects of the time trends at both the subject level and the center level. In the most common case, we have two random effects (constant and a single trend), at both subject and center levels. The approach presented here is general with respect to sampling proportions, number of groups, and attrition rates over time. In addition, we also develop a cost model, as an aid in selecting the most parsimonious of several possible competing models (i.e., different combinations of centers, subjects within centers, and measurement occasions). We derive sample size requirements (i.e., power characteristics) for a test of treatment‐by‐time interaction(s) for designs based on either subject‐level or cluster‐level randomization. The general methodology is illustrated using two characteristic examples.
Detection and identification of Anaplasma phagocytophilum, Borrelia burgdorferi, and Rickettsia helvetica in Danish Ixodes ricinus ticks
Authors: SKARPHÉDINSSON S. , LYHOLM B. F. , LJUNGBERG M. , SØGAARD P. , KOLMOS H. J. , NIELSEN L. P.
Published: March 2007

Borreliosis is an endemic infection in Denmark. Recent serosurveys have indicated that human anaplasmosis may be equally common. The aim of this study was to look for Anaplasma phagocytophilum and related pathogens in Ixodes ricinus ticks and estimate their prevalence, compared to Borrelia, using PCR. Ticks were collected from three locations in Denmark: Jutland, Funen, and Bornholm. Ticks from Jutland and Funen were analysed individually, ticks from Bornholm were analysed in pools of 20. A. phagocytophilum was found in ticks from all areas. A. phagocytophilum was found in 23.6% of ticks from Jutland and Funen, while 11% were positive for Borrelia burgdorferi. The Borrelia genotype B. afzelii was most prevalent, followed by B. valaisiana, B. burgdorferi s.s. and B. garinii.A. phagocytophilum was found in 14.5% of nymphs and 40.5% of adult ticks, while Borrelia was found in 13% of nymphs and 8% of adult ticks. The difference in prevalence between Anaplasma and Borrelia in adult ticks supports the idea that their maintenance cycles in nature may be different. Ticks were also infected with Rickettsia helvetica. Our study indicates that A. phagocytophilum prevalence in ticks in Denmark is as high as Borrelia prevalence and that human anaplasmosis may be unrecognized.
C‐kit protein expression in uterine and ovarian mesenchymal tumours
Authors: ERDOGAN GÜLGÜN , BASSORGUN C. IBRAHIM , PESTERELI H. ELIF , SIMSEK TAYYÜP , KARAVELI SEYDA
Published: March 2007

The protooncogene c‐kit encoding transmembrane tyrosine kinase receptor protein plays an important role in the signal transduction pathway that regulates cellular growth and repair. Gene product KIT overexpression has been shown in a number of different neoplasms, particularly in mastocytosis and gastrointestinal stromal tumours (GIST). The morphologic similarity of uterine mesenchymal tumours and GIST, and the presence of KIT protein in normal uterine tissue, suggests that uterine sarcomas may have the same c‐kit overexpression. The purpose of this study was to determine the overexpression of c‐kit protein in uterine and ovarian sarcomas. Immunohistochemical staining using a polyclonal anti‐c‐kit antibody was performed on tissue blocks from 12 carsinosarcomas, 14 leiomyosarcomas, 8 endometrial stromal sarcomas, 2 adenosarcomas, 1 atypical leiomyoma, 1 leiomyoma with limited experience, and 10 leiomyomas. The slides were evaluated by a semiquantitative method. C‐kit was positive in 10 of 12 (83%) carcinosarcomas, 10 of 14 (71%) leiomyosarcomas, 6 of 8 75(%) endometrial stromal sarcomas, 1 of 2 (50%) adenosarcomas, 1 leiomyoma with limited experience, and 1 of 10 (10%) leiomyomas. The uterine sarcomas express c‐kit, like GISTs. It seems that KIT may have a significant role in the oncogenesis of mesenchymal tumours of the uterus and ovary.
Molecular characterization of Neisseria gonorrhoeae identifies transmission and resistance of one ciprofloxacin‐resistant strain
Authors: UNEMO MAGNUS , SJÖSTRAND ANNELI , AKHRAS MICHAEL , GHARIZADEH BABACK , LINDBÄCK EMMA , POURMAND NADER , WRETLIND BENGT , FREDLUND HANS
Published: March 2007

A highly discriminative and objective genetic characterization of N. gonorrhoeae, which increases our knowledge of strain populations in different geographic areas, is crucial for the development of improved control measures. In the present study, conventional phenotypic characterization and genetic characterization by means of pulsed‐field gel electrophoresis (PFGE), sequencing of the entire porB gene, N. gonorrhoeae multiantigen sequence typing (NG‐MAST), and pyrosequencing of a quinolone resistance determining region (QRDR) of the gyrA gene of Swedish ciprofloxacin‐resistant N. gonorrhoeae serovar IB‐10 isolates (n=45) were performed. The genetic characterization identified one widely spread ciprofloxacin‐resistant N. gonorrhoeae ST147 strain. In addition, isolates with slightly different genetic characteristics, which presumably reflect the ongoing evolution only, were also identified. All the isolates contained single nucleotide polymorphisms in QRDR of the gyrA gene that are highly correlated with ciprofloxacin resistance. Consequently, comprehensive characterization identified the first confirmed large domestic transmission, mainly among young heterosexuals, of one ciprofloxacin‐resistant N. gonorrhoeae strain in Swedish society during 2002–2003. In conclusion, a precise, i.e. genetic, characterization for identification of individual strains is a very valuable support to the crucial active surveillance of the epidemiological characteristics and the antibiotic susceptibility of N. gonorrhoeae in the effective treatment of gonorrhoea.