bluuebunny/crossref_metadata_2025 huggingface dataset:
Raynaud's phenomenon: blood supply to fingers during indirect cooling, evaluated by laser Doppler flowmetry
Authors: Engelhart M. , Kristensen J. K.
Published: September 2010

Summary. The effect of indirect cooling on finger‐tip blood flow patterns were recorded in 31 patients suffering from Raynaud's phenomenon. Fifteen were suffering from generalized scleroderma with acrosclerosis (GS), and 16 from primary Raynaud's phenomenon (PR), and were compared to 13 healthy controls without cold sensitivity. Finger blood flow (FBF) was monitored by a laser Doppler flowmeter.

Resting blood flow values were significantly lower in patients compared to controls.

After two min of body cooling no difference could be observed in relative flow decrease between patients and controls or between PR and GS, but after 10 min of body cooling, relative flow decrease tended to be more pronounced in GS than in PR. Only in GS was the zero flow situation observed.

During the resting condition, skin vessel vasomotion was observed as rhythmical variations in the blood flow of 5–10 cycles per minute. These seemed to be preserved in patients and in chronically sympathectomized patients, and could not be abolished by nerve blockade of the finger. The influence from sympathetic vasomotor fibres on FBF could be observed during cooling as irregular coarse flow fluctuations. This was observed in both patients and controls but not in the chronically sympathectomized patients and disappeared after nerve blockade of the finger. Finger temperature was measured simultaneously during body cooling, but significant changes were observed only in normals and PR.

The conclusions were that (1) during body cooling, flow decrease in GS tends to be more pronounced than in PR, and only in GS could the zero flow situation be elicited; (2) influence on finger blood vessels from the sympathetic nervous system could be observed in both patients and control persons; (3) GS and PR patients seem to have preserved local vasomotion in cutaneous microvessels; (4) finger‐tip temperature in sclerotic skin is an imprecise blood flow indicator.
Sensibility after burn injury
Authors: Hermanson A. , Jonsson C.‐E. , Lindblom U.
Published: September 2010

Summary. Thresholds for touch, temperature, pain and two‐point discrimination were examined in 27 healthy subjects and in 36 burn patients. Three groups of injuries were examined; superficial dermal burns, which were allowed to heal spontaneously, deep dermal and subdermal burns treated by either early or late excision and skin grafting. Uninjured areas on the contralateral side served as control. In spontaneously healed superficial burns, the sensibility recovered to normal, except for touch. In deep dermal or subdermal burns all thresholds were significantly higher than in the corresponding control areas. There was no recovery beyond one month after the injury. The sensibility was better on the upper than on the lower extremities and also in deep dermal than in subdermal burns. There was no significant difference in sensibility between burns excised and grafted early or late, respectively.

The results indicate that current treatment of deep dermal and subdermal burns is not followed by complete recovery of cutaneous sensation. Furthermore, even superficial burns results in incomplete recovery of touch sensibility.
Validation of a non‐invasive method for localization of atherosclerotic occlusive disease in the legs
Authors: Jonason Tommy , Bäckbro Bengt , Ringqvist Ivar , Trella Jan
Published: September 2010

Summary. The accuracy in determining the level of haemodynamically significant occlusive arterial disease (stenosis of ≥50%) in the leg by a combination of segmental blood pressure measurements and evaluation of pulses with the Doppler shift technique was assessed in 50 patients (100 legs), using angiography as the reference method. For aorto‐iliac disease the sensitivity was 72%, the specificity 97% and the diagnostic accuracy 87%. For femoro‐popliteal disease the corresponding figures were 87%, 78% and 85%, respectively. The accuracy of a positive diagnosis was 93% for both levels. Similar results were obtained for combined aorto‐iliac and femoro‐popliteal disease. The accuracy in detecting calf disease was poor.
Impaired autoregulation of cerebral blood flow in long‐term Type I (insulin‐dependent) diabetic patients with nephropathy and retinopathy
Authors: Kastrup J. , Rørsgaard S. , Parving H.‐H. , Lassen N. A.
Published: September 2010

Summary. Autoregulation of cerebral blood flow, i.e., the maintenance of cerebral blood flow within narrow limits during changes in arterial perfusion pressure, was studied in nine healthy control subjects and in 12 long‐term Type I (insulin‐dependent) diabetic patients with clinical microangiopathy. Cerebral blood flow was measured by the intravenous 133Xenon method. Mean arterial blood pressure was elevated approximately 30 mmHg by intravenous infusion of angiotensin amide II and lowered about 10 mmHg by intravenous infusion of trimethaphan camsylate. In the control subjects the flow/pressure curve was horizontal indicating perfect autoregulation. In the diabetic patients the flow/pressure curve showed a significant slope with a 1·9% change in CBF per 10 mmHg change in mean arterial blood pressure as compared to a slope value of ‐0·4% in the control subjects (P<0·05). Our results confirm the previous findings suggesting that autoregulation of cerebral blood flow is impaired in some long‐term Type I diabetic patients with clinical microangiopathy (arteriolar hyalinosis).
Assessment of glucose metabolism in humans with the simultaneous use of indirect calorimetry and tracer techniques
Authors: Tappy L. , Paquot N. , Tounian P. , Schneiter P. , Jéquier E.
Published: September 2010

Summary. Concomitant measurements of sytemic glucose delivery and carbohydrate oxidation are frequently performed in human investigations. Systemic glucose delivery (SGD) is usually determined using dilution of infused glucose tracers; net carbohydrate oxidation rate (net CHOox) can be calculated from respiratory gas exchanges and urinary nitrogen excretion (indirect calorimetry); alternatively, glucose oxidation can be measured from labelled CO2 production during infusion of carbon‐labelled glucose tracers. In this paper, the theory underlying the use of each of these techniques is briefly reviewed and qualitative differences are outlined.

SGD represents the sum of hepatic glucogenolysis, gluconeogenesis from amino acids or glycerol, and, according to the glucose tracer used, glucose cycles (glucose‐phosphate cycle, fructose‐phosphate cycle, Cori and glucose‐alanine cycles); systemic delivery of exogenous glucose after oral or i. v. glucose administration is also measured. Net CHOox represents oxidation of glucose arising from hepatic or muscle glycogen or from exogenous glucose; it does not take into account oxidation of glucose formed from amino acids or glycerol, which is included in net protein or lipid oxidation. In contrast, isotopic determination of glucose oxidation corresponds to oxidation of glucose originating from hepatic glycogen breakdown, of exogenously administered glucose, and of glucose formed from amino acids and glycerol. Non‐oxidative glucose disposal, calculated as SGD‐net CHCox, corresponds to the sum of gluconeogenesis from amino acids or glycerol (which are included in net protein and lipid oxidation), glucose cycles, and glycogen synthesis.
Effect of 6 months of exercise training on cardiovascular responses to head‐up tilt in the elderly
Authors: Carroll J. F. , Convertino V. A. , Pollock M. L. , Graves J. E. , Lowenthal D. T.
Published: September 2010

Summary. The purpose of this investigation was to evaluate the effect of 6 months of exercise training on cardiovascular responses to 70° head‐up tilt (HUT) in the elderly. Forty‐four elderly men and women (ages 60–82 years) were assigned to endurance training alone (n=18), endurance training in combination with selected resistance exercises (n=17), or to a non‐exercising control group (n=9). Head‐up tilt testing at the start (T1) and end (T2) of 26 weeks of training consisted of 30 min of supine rest, 15 min of 70° HUT, and 15 min of supine recovery. Endurance training consisted of uphill treadmill walking or stair climbing exercise 3 times per week, 30–45 min/day, at 75–85% of maximal heart rate reserve. In addition, the endurance/resistance group completed one set of 8–15 repetitions of biceps curl (BC), triceps extension (TE), and leg press, 3 times per week. After 26 weeks, increases in VD2max averaged 16.2% and 12.3% for endurance and endurance/resistance groups, respectively. In addition, the endurance resistance group increased BC and TE strength by 25.3% and 26.1%, respectively. Results from the HUT test indicated that only the endurance group increased supine resting stroke volume (SV) and cardiac output (Q) from T1 to T2; however, SV and Q during HUT were not augmented as a result of training. Training did not affect heart rate, blood pressure, or peripheral resistance responses at rest or during HUT in any of the groups. These results suggest that 6 months of endurance training, alone or in combination with selected resistance exercises, is not detrimental to blood pressure controlling mechanisms to head‐up tilt in the elderly.
Recycling Modernity: Waste and Environmental History
Authors: Cooper Tim
Published: September 2010

In this article, I discuss some of the questions that arise for environmental historians from recent historical and theoretical studies of waste. This article is not an attempt to methodically review the entire corpus of work on waste within the social sciences and humanities. Rather I seek to draw attention to the ways in which waste constitutes an important problem for environmental history in particular. The article is in four sections. The first two deal with conceptual approaches to waste that are presently popular and draws an analytical distinction between waste and dirt, terms that are often collapsed into one another but which, when kept distinct, can do more useful work. The third and fourth sections discuss present historical treatments of waste, their capacities and limitations, before I mark out possible ways in which historians can take seriously the analytical distinctiveness of ‘waste’.
Population‐Based Study of Cesarean Section After In Vitro Fertilization in Australia
Authors: Sullivan Elizabeth A. , Chapman Michael G. , Wang Yueping A. , Adamson G. David
Published: September 2010

Abstract:  Background:  Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF).

Methods:  Retrospective population‐based study was conducted using national registry data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section.

Results:  Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation‐specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% CI: 1.95–2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% CI: 1.74–2.11]) were significantly higher.

Conclusions:  Rates for cesarean section appear to be disproportionately high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010)
Onset of Vocal Interaction Between Parents and Newborns in Skin‐to‐Skin Contact Immediately After Elective Cesarean Section
Authors: Velandia Marianne , Matthisen Ann‐Sofi , Uvnäs‐Moberg Kerstin , Nissen Eva
Published: September 2010

Abstract:  Background:  Cesarean section is associated with delayed mother‐infant interaction because neither the mother nor the father routinely maintains skin‐to‐skin contact with the infant after birth. The aim of the study was to explore and compare parent‐newborn vocal interaction when the infant is placed in skin‐to‐skin contact either with the mother or the father immediately after a planned cesarean section.

Methods:  A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin‐to‐skin contact either with fathers or mothers after an initial 5 minutes of skin‐to‐skin contact with the mothers after birth. The newborns’ and parents’ vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns’ and parents’ soliciting, newborns’ crying and whining, and parental speech directed to the other parent and to the newborn.

Results:  Newborns’ soliciting increased over time (p = 0.032). Both fathers and mothers in skin‐to‐skin contact communicated more vocally with the newborn than did fathers (p = 0.003) and mothers (p = 0.009) without skin‐to‐skin contact. Fathers in skin‐to‐skin contact also communicated more with the mother (p = 0.046) and performed more soliciting responses than the control fathers (p = 0.010). Infants in skin‐to‐skin contact with their fathers cried significantly less than those in skin‐to‐skin contact with their mothers (p = 0.002) and shifted to a relaxed state earlier than in skin‐to‐skin contact with mothers (p = 0.029).

Conclusions:  Skin‐to‐skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin‐to‐skin contact and exposed to the parents’ speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin‐to‐skin contact after cesarean section, to support the early onset of the first vocal communication. (BIRTH 37:3 September 2010)
Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review
Authors: Bayrampour Hamideh , Heaman Maureen
Published: September 2010

Abstract:  Background:  The increasing pregnancy rate at advanced maternal age is contemporaneous with the increasing rate of cesarean birth. Several studies have found that advanced maternal age is a risk factor for cesarean birth. The objective of this systematic review was to assess the relationship between advanced maternal age and cesarean birth among nulliparous and multiparous women.

Methods:  To identify relevant studies, we searched the literature for articles published from January 1, 1995 to March 1, 2008, using Medline, EMBASE, PsychINFO, and CINAHL. We also hand‐searched the bibliographies of retrieved articles to identify additional related studies. We included all cohort studies and all case‐control studies that examined this association in developed countries. The Cochrane Collaboration’s Review Manager software (5.0) was used to summarize the data.

Results:  Twenty‐one studies met the inclusion criteria and were included in the review. All studies demonstrated an increased risk of cesarean birth among women at advanced maternal age compared with younger women, for both nulliparas and multiparas (relative risk varied from 1.39 to 2.76). Because we found extreme heterogeneity (both statistical and clinical) among the included studies, we did not provide a pooled estimate of the risk of cesarean birth.

Conclusions:  All included studies illustrated an increased risk of cesarean birth among older women. Fifteen studies adjusted this association for potential confounders, which suggests that a valid and independent association is likely to exist between advanced maternal age and cesarean birth. However, the associated factors for this increased risk are not totally understood in the literature. (BIRTH 37:3 September 2010)
IN THE LITERATURE: Elective Induction, Selective Deduction, and Cesarean Section
Authors: Keirse Marc J. N. C.
Published: September 2010

Abstract:  A recent systematic review found no “good quality evidence” that elective induction of labor confers substantial benefits to either mothers or babies, but concluded that elective induction is associated with a decreased risk of “cesarean delivery.” Admittedly, elective induction was qualified as “at 41 weeks of gestation and beyond” with 42 weeks being proclaimed as the cutoff point between “elective” and “medically indicated.” Major predictors of the success of any induction and the subsequent mode of delivery, such as parity and cervical status, were not taken into account. Crucial boundaries between what is elective and what is selective, what is medically indicated and what is not, and what is maternal request or persuasive coercion, remain as vague as ever. (BIRTH 37:3 September, 2010)
Behavioral Interventions for Lung Cancer‐Related Breathlessness
Authors: Gallo‐Silver Les , Pollack Barbara
Published: September 2010

Purpose:The purpose of this report is to present behavioral interventions to assist persons with lung cancer in the management of feelings of breathlessness and, thus, also to enhance their quality of life.

Overview:Breathlessness is a serious symptom that adversely affects the quality of life of persons with lung cancer. A review of the literature points to the value of exercises in assisting patients to breathe more effectively and to manage related anxiety. However, the professional literature frequently does not describe these basic interventions in enough detail to enable oncology professionals to learn them. Instructional materials, found in the popular wellness and self‐help literature, are included in this article to more easily facilitate acquisition of these skills. Interventions described include exercises that enhance the use of the diaphragm when breathing and those that help to alter the breathing rhythm and to exhale more effectively.

clinical Implications:All oncology professionals should be aware of the importance of breathlessness as a problem that diminishes the quality of life for patients with lung cancer. Addressing breathlessness through the use of psychosocially oriented behavioral interventions can act as an adjunct to the medical management of this debilitating symptom.
Factors Influencing Oral Mucositis in Patients Receiving Chemotherapy
Authors: Dodd Marylin J. , Miaskowski Christine , Dibble Suzanne L. , Paul Steven M. , MacPhail Laurie , Greenspan Deborah , Shiba Gayle
Published: September 2010

Purpose: Oral mucositis is a painful complication of chemotherapy and can greatly affect patients' morbidity and mortality. Findings from two previous studies suggested a decrease in the prevalence of chemotherapy‐induced mucositis in patients with solid tumors. The purposes of this study were to follow a large cohort of outpatients to determine the prevalence of mucositis and to identify whether certain clinical factors were significant in the development of mucositis.

description of Study: In this prospective study, a convenience sample of 199 outpatients was followed for three cycles or until mucositis developed. The clinical factors monitored included the following: pretreatment dental examination/repair; initial standard chemotherapy dosage; prophylactic use of colony‐stimulating factors; and use of preventive mouthwashes or other prophylactic measures.

Results: Oral mucositis developed in 50 patients (25.1%). Prechemotherapy dental examination/repair and initial standard chemotherapy dosage were equivalent among both groups. Of the 48 patients in whom mucositis developed, 10 (20.8%) received prophylactic colony‐stimulating factors. Of 134 patients in whom mucositis did not develop, 46 (34.3%) received prophylactic colony‐stimulating factors. This difference was statistically nonsignificant.

clinical Implications: Differences in the clinical factors investigated could not explain the lower prevalence of oral mucositis among the current patient cohort. The reason for the diminishing prevalence of this side effect remains unclear, and additional parameters, particularly detailed oral hygiene practices, should be evaluated. In the meantime, oncology clinicians should consider the teaching of patients and urging them to use good oral hygiene practices as necessary and potentially preventive measures against chemotherapy‐induced mucositis.
Lake Superior Rural Cancer Care Project
Authors: Elliott Thomas E. , Elliott Barbara A. , Regal Ronald R. , Renier Colleen M. , Crouse Byron J. , Gangeness David E. , Witrak Martha T. , Jensen Patricia B.
Published: September 2010

Purpose: The purpose of this article is to report the main learning outcomes of the Lake Superior Rural Cancer Care Project.

Description of Study: The authors designed and tested a multimodal intervention directed at rural providers and their healthcare systems in a large rural area in the north central United States. An experimental design was used to randomize rural providers at the group level. The intervention consisted of providing increased education for rural providers with a number of approaches, including the use of clinical opinion leaders. The main outcome of the intervention was knowledge scoring on discipline‐specific cancer management tests.

Results: Knowledge scores for providers in the experimental group significantly increased from pretest to post‐test: 66 to 79 for physicians (and physician assistants) (P = .02); 58 to 71 for nurses (P = .01); and 54 to 64 for pharmacists (P = .01). At post‐test, participating providers in the experimental group performed significantly better on the knowledge tests (P < .01) than those in the control groups.

Clinical Implications: This study may be the first to test educational interventions to improve rural providers' knowledge about cancer practice using an experimental design. The intervention may possibly change provider practice behaviors and, thus, patient outcomes, data that will be reported in a future issue. Finally, this educational intervention may prove useful for providers in other rural areas.
Cancer and Folie à Deux.
Authors: SanjurjoHartman Teresita , Weitzner Michael A. , Santana Carlos , Devine Charles , Grendys Edward
Published: September 2010

Purpose: This report describes the uncommon psychopathological state best known as folie à deux, or shared psychotic disorder, in a unique case in which the grandiose, religious delusions of a woman with uterine cancer are shared with her husband.

Overview: More than 50% of patients with cancer meet the criteria for diagnosis of major psychiatric disorders. Certainly, these disorders may occur as a result of the stress of the cancer diagnosis and treatment, but also because of a predisposition to psychiatric illness or a pre‐existing psychiatric illness. In the medical setting, the phenomenon of folie à deux poses significant problems not only for the patient, but also for the involved family member, psychiatric consultant, and healthcare team.

Clinical implications: In this case, the patient's delusional system had a grave impact on her ability to make rational healthcare decisions, for which she was deemed incompetent. The first choice for her healthcare surrogate, her husband, was so affected by his sharing of her psychotic condition that he could not fulfill this role. In assessing a suspected case of folie à deux, awareness of several issues—the point at which religious overideation becomes delusional, the spectrum of competency, informed consent, and treatment refusal—is important.
The Treatment of Prostate Cancer.
Authors: Pirtskhalaishvili Georgi , Hrebinko Ronald L. , Nelson Joel B.
Published: September 2010

Purpose: The purpose of this report is to discuss the current treatment options available to the patient with prostate cancer in all stages of the disease.

Overview: With the exception of skin cancer, prostate cancer is the most common cancer in men in the United States. Most patients in the current era will present with organ‐confined disease, amenable to curative treatment. Treatment for organ‐confined disease includes watchful waiting, radical prostatectomy, radiation therapy, and cryosurgery in selective cases. Hormone therapy is the cornerstone of treatment of patients with advanced prostate cancer. There is no curative treatment for hormone‐refractory prostate cancer.

Clinical implications: The availability of several therapeutic options for localized prostate cancer warrants careful consideration when planning treatment with curative intent. Patients need to be active participants in decision making, and they must be aware of the benefits and possible complications of the different types of treatment. Patients with advanced prostate cancer need to be aware that hormone treatment will provide temporization and palliation in the majority of cases. Hormone‐resistant prostate cancer is refractory to most forms of conventional and experimental therapy.
Hemicrania Continua: A Second Case in Which the Remitting Form Evolved From the Chronic Form
Authors: Yablon Lisa A. , Newman Lawrence C.
Published: September 2010

We report the case of a woman with a 15‐year history of chronic hemicrania continua, which over time evolved to remitting hemicrania continua. This is the second reported case in the literature documenting this transition.

(Headache 2010;50:1381‐1389)
Hemodynamic Correlates of the Third Heart Sound and Systolic Time Intervals
Authors: Shah Sanjiv J. , Michaels Andrew D.
Published: September 2010

Bedside diagnostic tools remain important in the care of patients with heart failure. Over the past two centuries, cardiac auscultation and phonocardiography have been essential in understanding cardiac pathophysiology and caring for patients with heart disease. Diastolic heart sounds (S3 and S4) and systolic time intervals have been particularly useful in this regard. Unfortunately, auscultation skills have declined considerably, and systolic time intervals have traditionally required carotid pulse tracings. Newer technology allows the automated detection of heart sounds and measurement of systolic time intervals in a simple, inexpensive, noninvasive system. Using the newer system, the authors present data on the hemodynamic correlates of the S3 and abnormal systolic time intervals. These data serve as the foundation for using the system to better understand the test characteristics and pathophysiology of the S3 and systolic time intervals, and help to define their use in improving the bedside diagnosis and management of patients with heart failure.
Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation in Patients with Lone Atrial Fibrillation and Patients with Hypertension
Authors: Carlsson Joerg , Appel Karl‐Friedrich , von Essen Rainer , Jansen Wolfgang , Miketic Sinisa , Stammwitz Ekkehard , Kettner Wolfgang , Tebbe Ulrich ,   for the ALKK‐Study Group
Published: September 2010

Background: The success rate and prognosis of cardioversion of atrial fibrillation (AF) in patients with organic heart disease is well known. In contrast, little data exist about cardioversion success and maintenance of sinus rhythm (SR) in patients with lone AF and in patients with hypertension as the only underlying cardiovascular disease.

Methods: In a prospective cardioversion registry 148 of 181 patients (81.8%) with lone AF (age 58 ± 13 years, duration of AF 7.6 ± 19 weeks) and 120 of 148 patients (81.1%) with hypertension (age 62 ± 10 years, duration of AF 6.6 ± 21 weeks) had successful cardioversion and were followed for 7.7 ± 1.9 months.

Results: At follow‐up, 120 patients (81.1%) with lone AF were in SR, and 18 of these patients had had repeated cardioversion during follow‐up (AF total recurrence rate 31.1%). In stepwise regression analysis, the number of previous cardioversions was predictive of rhythm at follow‐up (P = 0.0453). Rhythm at follow‐up did not differ between patients who were or were not on antiarrhythmic drugs. At follow‐up 96 patients (80%) with hypertension were in SR, and 9 of these had had repeated cardioversion during follow‐up (AF total recurrence rate 27.5%). As in lone AF, the recurrence rate of AF did not differ between patients with or without antiarrhythmic drug treatment, and in multivariate regression analysis, the number of previous cardioversions was the only clinical predictor of rhythm at follow‐up (P = 0.0284).

Conclusions: Even in patients with such benign conditions as lone AF or hypertension as the only underlying disease, the prognosis of cardioversion in terms of maintenance of SR is poor. Future studies of rhythm control versus rate control need to include not only patients with organic heart disease but also patients with lone AF and patients with hypertension, since the long‐term benefits of these two strategies remain unclear even in these subsets of patients.
Atrial Ectopics Prior to Atrial Fibrillation Onset
Authors: Waktare Johan E.P. , Hnatkova Katerina , Murgatroyd Francis D. , Guo Xiaohua , Camm A. John , Malik Marek
Published: September 2010

Background: This study examined the possible role of atrial ectopics and short runs of atrial tachycardia in the initiation of episodes of paroxysmal atrial fibrillation (PAF).

Methods: Holter recordings from patients participating in pharmacotherapy trials for the prevention of PAF were examined. Treatment comprised placebo, digoxin, disopyramide, or atenolol. The frequency of atrial ectopic beats during each 30 seconds over the 5 minutes prior to PAF and whether this was also associated with atrial tachycardia (3 or more ectopics in succession) was calculated.

Results: The mean number of ectopics was 4.1 in the final minute, but patients receiving disopyramide or atenolol had significantly more ectopics than those on placebo (P > 0.05 for both). Those on digoxin had a similar number of ectopics to placebo patients. There was no relationship between heart rate at PAF onset and ectopic frequency, nor any association between the presence of one or more episodes of atrial tachycardia and ectopic frequency.

Conclusion: Atrial ectopics increase in frequency prior to PAF onset, and this study suggests that antiarrhythmic therapy may increase the number of ectopics required to initiate PAF.
Nonlinear Analysis of ECG in Normal Subjects and Acute Myocardial Infarction Patients
Authors: Goranitou Georgia S. , Chrissos Dimitrios N. , Harissis Haralampos V. , Kontoyianni Dimitra D. , Antonatos Panagiotis G.
Published: September 2010

Background:In the last two decades, methods from nonlinear analysis and chaos theory have been used for the characterization of cardiac dynamics. Previous studies, mainly in the analysis of RR time series, indicated the diagnostic and prognostic value of such techniques in several pathological conditions, but also generated disputes regarding the presence of true nonlinearities in the data. The application of such methods to ECG time series analysis, in normal subjects as well as in patients with heart disease, is less investigated. The present study was undertaken to test whether nonlinear analysis of ECG can define possible changes in the complexity of cardiac dynamics in patients with acute myocardial infarction (AMI).

Methods:We examined 10 normal subjects and 20 AMI patients in sinus rhythm for 3 consecutive days. Correlation dimension (D2) measurements were obtained with a combination of the SingularValue Decomposition and the Grassberger‐Procaccia methods and compared with the results from corresponding surrogate data series, in order to detect the presence of nonlinearities. The reproducibility of ECG D2 measurements was tested with the coefficient of variation.

Results:No difference was found in ECG D2 between normals and patients. The surrogate data score was above two in all measurements, which indicates the presence of nonlinearities in the ECG signal. The intraindividual reproducibility of D2 measurements was moderate to good in normals and AMI patients.

Conclusion:The results of this study support the hypothesis that the ECG signal is produced by a low‐dimensional dynamic system. D2 analysis of ECG is a nonlinear quantitative method with moderate to good reproducibility, but with no evident discriminating capabilities between normals and AMI patients.
Pharmacotherapy of Atrial Fibrillation
Authors: Chevalier Philippe , Touboul Paul
Published: September 2010

Atrial fibrillation is a common medical problem that has a wide clinical spectrum ranging from a benign condition, such as “lone” atrial fibrillation, to a life‐threatening arrhythmia, when there is an accessory pathway. There is a striking contrast between the frequency of atrial fibrillation and the absence of well‐defined, scientifically based medical management. At least four considerations guide the pharmacological treatment of patients with atrial fibrillation: (1) restoration of sinus rhythm; (2) acute and long‐term control of the ventricular rate; (3) maintenance of sinus rhythm; and (4) anticoagulation. Pharmacological cardioversion is best achieved with intravenous flecainide, intravenous propafenone, or intravenous ibutilide. During episodes of atrial fibrillation, the drugs of first choice for control of the ventricular rate are calcium antagonists and beta‐blockers. Digitalis is helpful in elderly patients and in cases with congestive heart failure. Maintenance of sinus rhythm is a complex task, owing to the proarrhythmic potential of antiarrhythmic drugs, and the treatment should be tailored to the individual patient's needs. No one drug is clearly better than another. As for amiodarone, its benefit/risk ratio remains to be evaluated prospectively. Usually, most of the patients benefit from serial electrical cardioversion, with the longest possible interval between cardioversion sessions being sought. The question about whether the aim of the treatment of atrial fibrillation should be to control the ventricular rate or to restore sinus rhythm will be answered by ongoing trials. The effectiveness of low‐dose anticoagulation in preventing stroke in patients with nonrheumatic atrial fibrillation has been validated by seven separate studies. Anticoagulation with warfarin should be monitored carefully in order to achieve an International Normalized Ratio (INR) of between 2.0 and 3.0. This targeted INR decreases the embolic rate and eliminates the risk of intracranial bleeding. The role of aspirin alone in decreasing the risk of stroke remains to be established. Pharmacological management of patients with atrial fibrillation has to be improved, by better risk stratification and the development of new drugs with an optimal benefit/risk ratio. Ongoing trials are expected to provide important guidelines, corresponding to the needs of the many different types of patients with atrial fibrillation.
Impact of Left Ventricular Remodeling on Ventricular Repolarization and Heart Rate Variability in Patients after Myocardial Infarction Treated with Primary PCI: Prospective 6 Months Follow‐up
Authors: Szydlo Krzysztof , Wita Krystian , Trusz‐Gluza Maria , Urbanczyk Dagmara , Filipecki Artur , Orszulak Witold , Tabor Zbigniew , Krauze Jolanta , Kwasniewski Wojciech , Myszor Jaroslaw , Turski Maciej , Kolasa Jaroslaw , Szczogiel Jan
Published: September 2010

Background: The relation between postinfarction left ventricle remodeling (LVR), autonomic nervous system and repolarization process is unclear. Purpose of the study was to assess the influence of LVR on the early (QTpeak) and late (TpeakTend) repolarization periods in patients after myocardial infarction (MI) treated with primary PCI. The day‐to‐night differences of repolarization parameters and the relation between QT and heart rate variability (HRV) indices, as well left ventricle function were also assessed.

Methods: The study cohort of 104 pts was examined 6 months after acute MI. HRV and QT indices (corrected to the heart rate) were obtained from the entire 24‐hour Holter recording, daytime and nighttime periods.

Results: LVR was found in 33 patients (31.7%). The study groups (LVR+ vs LVR−) did not differ in age, the extent of coronary artery lesions and treatment. Left ventricle ejection fraction (LVEF) was lower (38%± 11% vs 55%± 11%, P < 0.001), both QTc (443 ± 26 ms vs 420 ± 20 ms, P < 0.001) and TpeakTendc (98 ± 11 ms vs 84 ± 12 ms, P < 0.005) were longer in LVR + patients, with no differences for QTpeakc. Trends toward lower values of time‐domain (SDRR, rMSSD) HRV parameters were found in LVR+ pts. Day‐to‐night difference was observed only for SDRR, more marked in LVR‐group. Remarkable relations between delta LVEF (6 months minus baseline), delta LVEDV and TpeakTendc were found, with no such relationships for QTpeakc.

Conclusions: The patients with LVR have longer repolarization time, especially the late phase‐ TpeakTend, which represents transmural dispersion of repolarization. Its prolongation seems to be related to local attributes of myocardium and global function of the left ventricle but unrelated to the autonomic nervous influences. Remodeling with moderate LV systolic dysfunction is associated with insignificant decrease in HRV indices and preserved circadian variability.
QT Intervals and QT Dispersion Determined from a 12‐Lead 24‐Hour Holter Recording in Patients with Coronary Artery Disease and Patients with Heart Failure
Authors: Hansen Stig , Rasmussen Verner , Torp‐Pedersen Christian , Jensen Gorm Boje
Published: September 2010

Background: QT dispersion is considered an index of spatial inhomogeneity of repolarization duration and increased dispersion of ventricular repolarization is supposed to increase the risk of ventricular arrhythmia. Circadian variation in QT dispersion was investigated.

Methods: Three different modes of lead selection was used: all 12‐leads (QTdisp 12), only precordial leads (QTdisp 6), and one pair of preselected leads (QTdisp 2) in a 24‐hour Holter recording every fourth hour each comprising 10 consecutive measurements in 54 healthy subjects, 29 patients with coronary artery disease (CAD), and 29 patients with heart failure (HF).

Results: A significant circadian variation was observed in healthy subjects when modes QTdisp 12 and QTdisp 6 were used (Mean ± SD 35.58 ± 16.48 ms; P < 0.0001; and 28.82 ± 16.02 ms; P < 0.0001, respectively), and in patients with CAD (Mean ± SD 37.86 ± 17.87 ms; P < 0.01; and 28.72 ± 17.06 ms; P < 0.0001, respectively), whereas no circadian variation was observed in QTdisp 2. No circadian variation was observed in patients with HF irrespectively of lead selection. Patients with CAD without myocardial infarction (MI) had a circadian variation in QTdisp 12 (Mean ± SD 33.13 ± 14.86 ms; P < 0.05), whereas no circadian variation was observed in patients with MI (Mean ± SD 40.35 ± 18.80 ms; P = NS).

Conclusions: Circadian variation of QT dispersion was detected in healthy subjects and in patients with uncomplicated CAD, but not in those who had suffered a previous MI and in patients with HF. The number of leads among which selection of the longest and shortest QT intervals took place was critical for the disclosure of circadian variation of QT dispersion.
Enhanced Vagal Withdrawal During Mild Orthostatic Stress in Adolescents with Chronic Fatigue
Authors: Wyller Vegard Bruun , Barbieri Riccardo , Thaulow Erik , Saul J. Philip
Published: September 2010

Background: Hemodynamic abnormalities have been documented in the chronic fatigue syndrome (CFS), indicating functional disturbances of the autonomic nervous system responsible for cardiovascular regulation. The aim of this study was to investigate autonomic heart rate control during mild orthostatic stress in adolescents with CFS.

Methods: A total of 14 CFS patients and 56 healthy controls having equal distribution of age and gender underwent lower body negative pressure (LBNP) of ─20 mmHg. The RR interval (RRI) was recorded continuously, and spectral power densities were computed in the low‐frequency (LF) band (0.04–0.15 Hz) and the high‐frequency (HF) band (0.15–0.50 Hz) from segments of 120‐second length, using an autoregressive algorithm. In addition, the time‐domain indices SDNN, pNN50, and r‐MSSD were computed.

Results: At rest, CFS had lower RRI than controls (P < 0.05), but indices of variability were similar in the two groups. During LBNP, compared to controls, CFS patients had lower normalized and absolute HF power and r‐MSSD (P < 0.05), and higher RRI (P < 0.001), normalized LF power and LF/HF (P < 0.05).

Conclusions: During mild orthostatic stress, adolescents with CFS appear to have enhanced vagal withdrawal, leading to a sympathetic predominance of heart rate control compared to controls. Possible underlying mechanisms include hypovolemia and abnormalities of reflex mechanisms.
Frequent Premature Ventricular Complexes Originating from the Right Ventricular Outflow Tract Are Associated with Left Ventricular Dysfunction
Authors: Kanei Yumiko , Friedman Meir , Ogawa Naomi , Hanon Sam , Lam Patrick , Schweitzer Paul
Published: September 2010

Background: Recent case series have shown reversal of left ventricular (LV) dysfunction after catheter ablation of frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT). We conducted a retrospective study to evaluate the prevalence of patients with frequent RVOT PVCs (≥10 per hour) and LV dysfunction.

Methods: RVOT PVC was defined as PVC with left bundle branch block morphology and inferior axis on a 12‐lead ECG. We included patients with frequent RVOT PVCs on 24‐hours Holter monitor who had a recent evaluation of LV function. Patients with structural heart disease, including obstructive coronary artery disease, were excluded. Patients were divided into three groups based on the number of PVCs (<1000/24 hour, 1000–10,000/24 hour, ≥10,000/24 hour), and the prevalence of LV dysfunction was evaluated in each group.

Results: Our analysis included 108 patients: 24 patients had <1000PVCs/24 hour, 55 patients had 1000–10,000PVCs/24 hour, and 29 patients had ≥10,000PVCs/24 hour. The prevalence of LV dysfunction was 4%, 12%, and 34%, respectively (P = 0.02). With logistic regression analysis, non‐sustained ventricular tachycardia was an independent predictor of LV dysfunction with odds ratio of 3.6 (1.3–10.1).

Conclusion: We demonstrated a significant association between frequent RVOT PVCs and LV dysfunction in patients without structural heart disease.
Standard Template of Adult Magnetocardiogram
Authors: Kandori Akihiko , Ogata Kuniomi , Miyashita Tsuyoshi , Watanabe Yasushi , Tanaka Kimio , Murakami Masahiro , Oka Yuji , Takaki Hiroshi , Hashimoto Syuji , Yamada Yuko , Komamura Kazuo , Shimizu Wataru , Kamakura Shiro , Watanabe Shigeyuki , Yamaguchi Iwao
Published: September 2010

Background:We need to know the magnetocardiogram (MCG) features regarding waveform and two‐dimensional current distribution in normal subjects in order to classify the abnormal waveform in patients with heart disease. However, a standard MCG waveform has not been produced yet, therefore, we have first made the standard template MCG waveform.

Methods and Results:We used data from 464 normal control subjects' 64‐channel MCGs (268 males, 196 females) to produce a template MCG waveform. The measured data were averaged after shortening or lengthening and normalization. The time interval and amplitude of the averaged data were adjusted to mean values obtained from a database. Furthermore, the current distributions (current arrow maps [CAMs]) were calculated from the produced templates to determine the current distribution pattern.

The produced template of the QRS complex had a typical shape in six regions that we defined (M1, M2, M3, M4, M5, and M6). In the P wave, the main current arrow in CAMs pointing in a lower‐left direction appeared in M1. In the QRS complex, the typical wave appeared in each region, and there were two main current arrows in M2 and M5. There were negative T waves in M1, M4, and M5, and positive T waves in M3 and M6, and the main current arrow pointing in a lower‐left direction appeared in M2.

Conclusion:Template MCG waveforms were produced. These morphologic features were classified into six regions, and the current distribution was characterized in each region. Consequently, the templates and classifications enable understanding MCG features and writing clinical reports.
Ethnic Differences in ST Height in the Multiethnic Study of Atherosclerosis
Authors: Reddy Vikram K. , Gapstur Susan M. , Prineas Ronald , Colangelo Laura A. , Ouyang Pamela , Kadish Alan H.
Published: September 2010

Background: ST elevation in precordial leads has been associated with genetic syndromes of arrhythmias and sudden death. ST height data in different ethnic groups are limited.

Methods: ST height was determined in 4612 African‐American, Chinese, Hispanic, and non‐Hispanic white men and women aged 45–84 years in the Multiethnic Study of Atherosclerosis (MESA). For leads I, II, and V1 to V6, ST height, measured at the J point and 60 ms after the J point, adjusted for covariates were compared between non‐Hispanic white and other ethnic groups using analysis of covariance (ANCOVA).

Results: Among men, ST height was significantly different across all ethnic groups at both time points for all leads (P < 0.01), except at the J point for limb lead II (P = 0.2). Among women, differences were also significant at the J point and 60 ms past the J point (P < 0.01). ST height was lowest for non‐Hispanic whites in all leads and at both time points. At the J point, Chinese had the highest ST height for leads V1 and V2, whereas African Americans had the greatest ST height for leads I and V3 to V6. At 60 ms past the J point, Chinese men had the greatest ST height for lead I and V1 to V6; and Chinese women had greatest ST height for leads V1 to V3.

Conclusions: There were significant differences in ST height among ethnic groups in all ECG leads. The physiological mechanisms and clinical significance of these differences and the possible association with arrhythmias require further study.
Neighborhood Streets as Meaningful Spaces: Claiming Rights to Shared Spaces in Tokyo
Authors: SORENSEN ANDRÉ
Published: September 2010

The focus of this paper is the strategies of civic actors in a central Tokyo neighborhood to claim a voice in managing changes to their community and creating shared meanings for neighborhood streets and public spaces. In Yanaka an active community movement has worked to protect and improve shared community spaces by celebrating them as a historic legacy and a shared community resource, investing new and more complex values and claims on shared spaces, and redefining public streets as civic spaces in their neighborhood. They assert the rights of community participation in managing urban change by creating a neighborhood constitution, organizing art events and festivals in the streets, engaging new participants in shared property rights, proposing new criteria for evaluating urban change, and telling stories of a strong and distinct community. Claiming ownership of the meaning and management of local public spaces is a political strategy of self empowerment by community groups that has been relatively successful in this case.