bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Patients with Right Ventricular Outflow Tract Ventricular Arrhythmias Have a Normal Right Ventricular Wall Motion?
Authors: Indik Julia H. , Dallas William J. , Ovitt Theron , Wichter Thomas , Gear Kathleen , Marcus Frank I.
Published: June 2005

Background/Aim: Patients with ventricular ectopy from the right ventricular (RV) outflow tract (RVOT) are often referred for RV angiography to exclude disorders such as arrhythmogenic RV cardiomyopathy/dysplasia (ARVC/D). This is usually based on a qualitative assessment of the wall motion. We present a method to quantify the wall motion and to apply this method to compare patients with RVOT ectopy to normal subjects. Methods: RV angiograms were analyzed from 19 normal subjects and 11 subjects with RVOT ventricular arrhythmias (RVOT arrhythmia subjects) who had no other clinical or other evidence for ARVC/D. By a newly developed computer-based method, RV contours were first traced from multiple frames spanning the entire cardiac cycle. The fractional change in area between contours was then calculated as a serial function of time and location to determine both total contour area change and timing of contour movement. Contour area strain, defined as the differential change in area between nearby regions, was also computed. Results: The contour area change was greatest in the tricuspid valve region and least in the RVOT and midanterior regions. The onset of contraction was earliest in the RVOT region and latest in the apical, inferior, inferoapical, and subtricuspid valve regions. The contour strain was largest in superior tricuspid valve and inferior wall and near zero within the lateral tricuspid valve region. There were significant pairwise differences in contraction area, timing, and strain in the various regions. There were no significant differences between normal subjects and RVOT arrhythmia subjects. Conclusions: The RV wall motion is nonuniform in contour area change, strain, and timing of motion. Patients with RVOT ventricular ectopy demonstrate wall motion parameters similar to those of normal subjects. This technique should be applicable in analyzing RV wall motion in patients suspected of having ARVC/D.
Effect of Beta-Blocker Therapy on Myocardial Perfusion Defects in Thallium-201 Scintigraphy in Patients with Dilated Cardiomyopathy
Authors: Hara Yuji , Inoue Katsuji , Ogimoto Akiyoshi , Ohtsuka Tomoaki , Shigematsu Yuji , Nakata Shigeru , Higaki Jitsuo
Published: June 2005

Background: Thebeneficial effects of β-blocker therapy in patients with heart failure have been confirmed. However, the effects of β-blockers on myocardial perfusion defects are unclear. The aim of this study was to evaluate the effect of β-blockers on myocardial perfusion defects estimated by thallium-201 myocardial scintigraphy in patients with dilated cardiomyopathy (DCM) and to investigate the relationships between β-blocker treatment and myocardial damage and cardiac function. Methods:201Tl and echocardiography were performed in 37 patients before and after 6 months of β-blocker therapy. Extent score (ES) by 201Tl was used to quantitate myocardial perfusion defects before and after treatment. Results: ES was significantly decreased by β-blocker therapy. According to the change in ES, DCM patients were classified into three groups, patients who improved, patients showing no change and patients who deteriorated. In the improvement and no-change groups, β-blocker therapy induced a reduction in left ventricular dimensions and an associated increase in ejection fraction. However, in the deterioration group, left ventricular dimensions and ejection fraction were unchanged. There was a significant relationship between the change in left ventricular dimension at end-diastole and the change in ES. Conclusions: β-Blocker therapy could attenuate myocardial perfusion defects in some patients with DCM. The improvement in left ventricular function associated with β-blocker therapy may be related to the attenuation in myocardial perfusion defects.
Diabetic Nephropathy, Percutaneous Coronary Interventions, and Blockade of the Renin-Angiotensin System
Authors: Reinecke Holger , Matzkies Fritz , Fobker Manfred , Breithardt Günter , Schaefer Roland M.
Published: June 2005

Since recent studies demonstrated an impaired outcome after percutaneous coronary interventions (PCI) in patients with chronic renal failure but did not address the aetiology of renal failure, we now analysed the outcome of patients with diabetic nephropathy in 721 consecutive patients undergoing PCI. Diabetic nephropathy was present in 37 patients (5.1%), and diabetes alone in 126 patients (17.5%); 178 patients (24.7%) suffered from renal insufficiency of other causes; the other 380 patients (52.7%) were used as controls. Although angiographic success rates were similar in the subgroups (94–97%), 30-day and long-term mortality after 4 years was significantly higher in patients with diabetic nephropathy (8.1 and 27%, respectively) than in diabetics (1.6 and 8.7%, respectively), patients with renal insufficiency (3.9 and 16.8%, respectively), or controls (2.4 and 5.0%, respectively, each p < 0.001, log-rank test). Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a marked decrease in 2-year mortality in patients with diabetic nephropathy (19.4 vs. 33.3%, respectively, p = 0.02, log-rank test).
Advanced Interatrial Block: A Classic Electrocardiogram
Authors: Ariyarajah V. , Spodick D.H.
Published: June 2005

Interatrial block (IAB; P wave ≧110 ms) indicates conduction delay between the right and left atria. IAB can present as partial or advanced and is denoted on the electrocardiogram (ECG) by bifid or biphasic P waves, respectively, the latter in inferior leads. The importance of IAB cannot be overemphasized due to high prevalence, especially at ages 60 and over, and due to grave associations with atrial flutter and fibrillation as well as congestive heart failure. Thus, we present a classic ECG of the much less common form of IAB, namely advanced IAB, as it serves as an excellent yardstick and teaching tool to help clinicians understand this medical entity thoroughly and to easily recognize this often missed type of block.
Serial Antiarrhythmic Therapy: Role of Amiodarone in Prevention of Atrial Fibrillation Recurrence – A Lesson from the HOT CAFE Polish Study
Authors: Kosior Dariusz A. , Opolski Grzegorz , Wozakowska-Kaplon Beata , Rabczenko Daniel
Published: June 2005

Antiarrhythmic drug prophylaxis is known to improve long-term success of electrical cardioversion (CV) in persistent atrial fibrillation (AF). This prospective study evaluates the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after successful elective CV in patients with persistent nonvalvular AF. Materials and Methods: One hundred and twenty-eight patients (61 ± 8 years old) with persistent AF underwent CV. Mean AF duration preceding CV was 268 ± 99 days. Following SR restoration, patients were treated sequentially with either of the following antiarrhythmic drugs: propafenone, sotalol or disopyramide. Where arrhythmia recurred, patients received another CV and a new drug from the range defined above. Where such treatment failed, patients were loaded with 14.0- to16.0-gram doses of amiodarone and a third CV was performed. If the first CV failed to restore SR, patients received a loading dose of amiodarone followed by another CV. When successful, amiodarone was administered on continuous basis. Results: The first CV proved successful in 55.5% of patients. During 1-year of follow-up, 31 patients (43.7%) presented with SR were treated with one antiarrhythmic agent (median does not exist). Application of the second drug proved to be effective in 6 patients (15.0%; median 13 days). Amiodarone was administered as the third antiarrhythmic agent to patients who had AF recurrence on the first two antiarrhythmic agents (propafenone, sotalol or disopyramide). It proved to be effective in 18 patients (52.9%; median does not exist) remaining free from AF for a period of 1 year as of commencement of the sequential antiarrhythmic therapy. Fifty-seven patients, in whom the first CV was ineffective, received amiodarone. During the loading period, SR was restored in 7 patients (12.3%). The remaining 50 patients underwent repeated CV, with SR restored in 37 (74.0%) of them. Long-term amiodarone treatment maintained SR in 30 (68.2%) patients during the follow-up period. Amiodarone helped to maintain SR in a total of 56.5% of patients. Conclusions: Amiodarone seems to be the drug most effectively restoring and maintaining SR in patients with persistent AF resistant to CV and standard antiarrhythmic drug prophylaxis.
Neuropsychological Correlates of MRI Measures in the Continuum of Cognitive Decline at Old Age
Authors: van der Flier Wiesje M. , Middelkoop Huub A.M. , Weverling-Rijnsburger Annelies W.E. , Admiraal-Behloul Faiza , Bollen Eduard L.E.M. , Westendorp Rudi G.J. , van Buchem Mark A.
Published: June 2005

Objective: To investigate the independent associations between medial temporal lobe atrophy and white matter hyperintensities (WMH) and cognitive functions in the elderly. Methods: Cognitive functions of 41 Alzheimer’s disease patients, 20 patients with mild cognitive impairment and 28 elderly subjects without memory complaints were assessed using a neuropsychological test battery. Quantitative MRI measures of medial temporal lobe volume and WMH were obtained. Multiple regression analyses were performed to assess the independent contribution of MRI measures to impairment in several cognitive functions. Results: Scores on the Wechsler Memory Scale and Trails B depended selectively on medial temporal lobe volume, whereas WMH selectively contributed to performance on Trails A. Medial temporal lobe volume and WMH both contributed to scores on the Cambridge Cognitive Examination and the Boston naming task. Conclusions: MRI measures suggestive of Alzheimer-type pathology and microvascular pathology independently contribute to cognitive decline at old age. Memory impairment as measured using the Wechsler Memory Scale and performance on Trails B primarily depended on medial temporal lobe atrophy. Psychomotor slowness, as measured using Trails A, mainly depended on WMH. These results suggest that vascular pathology and Alzheimer-type pathology each have specific cognitive correlates.
Genotype-Phenotype Correlation in Italian Families with Stargardt Disease
Authors: Simonelli Francesca , Testa Francesco , Zernant Jana , Nesti Anna , Rossi Settimio , Allikmets Rando , Rinaldi Ernesto
Published: June 2005

Autosomal recessive Stargardt disease (STGD) has been associated with substantial genetic and phenotypic heterogeneity. By systematic clinical analyses of STGD patients with complete genetic data (i.e. identified mutations on both alleles of the ABCA4 gene), we set out to determine phenotypic subtypes and to correlate these with specific ABCA4 alleles. Twenty-eight patients from 18 families with STGD/fundus flavimaculatus were investigated. All patients were submitted to complete ophthalmologic examination, electrophysiology, fluorescein angiography and ABCA4 gene chip analysis. Two main clinical phenotypes were observed among the examined patients. The severe phenotype was characterized by the onset of the disease <20 years and reduced ERG response, whereas the mild phenotype presented with later onset of the disease and a normal ERG response. Genetic analysis of the ABCA4 gene revealed, in the severe group, more frequently deletions, stop codons and insertions as compared to the mild phenotype group (p = 0.0113 by Fisher’s exact test). Moreover, the compound heterozygous mutations G1961E/5018 + 2T → C found in 7 patients from 3 unrelated STGD families were associated with a mild phenotype in all subjects, except 1. This study documented variability of the clinical expression of STGD in relation to the age of onset of the disease, fundus appearance and the ERG response and allowed to subdivide patients into a severe and a mild phenotype group. These findings suggest that an extensive and comprehensive genetic analysis of STGD patients combined with thorough clinical evaluation, including the careful recording of the age of onset of the disease, would allow a more precise prognostic evaluation.
Current Concepts in Therapy of Chronic Rhinosinusitis and Nasal Polyposis
Authors: Gosepath Jan , Mann Wolf J.
Published: June 2005

The exact pathophysiological mechanisms leading to chronic rhinosinusitis (CRS) still to a large extent remain obscure. However, recently there has been some progress in elucidating the etiology of nasal polyposis, especially regarding tissue eosinophilia as well as the role of aspirin intolerance and eicosanoid mediators. Endonasal sinus surgery has evolved to be the treatment of choice in CRS and nasal polyposis in all cases where conservative treatment has failed or resulted in only a partial or temporary relief. Today, state of the art in surgical technique includes the ability to combine microscopic and endoscopic procedures. Regardless of technical advances like powered instrumentation or computer-aided surgery, in a modern protocol, surgical therapy can offer only one option within a complex and individually tailored therapeutical concept. This review discusses current concepts and new developments in the diagnosis and treatment of CRS and nasal polyposis.
Second Branchial Anomalies in Children
Authors: Karabulut Ramazan , Sönmez Kaan , Türkyilmaz Zafer , Özen İ. Onur , Demiroğulları Billur , Güçlü M. Meral , Başaklar A. Can , Kale Nuri
Published: June 2005

Aim: The aim of this study was to evaluate the data of our patients who had been treated for second branchial anomalies in the last 10 years. Here we report our clinical experience in second branchial anomalies with a review of the literature. Patients and Methods: We evaluated retrospectively the data of 14 patients, who had been operated on between 1994 and 2004 for second branchial anomalies, in relation to age, sex, complaint at application, diagnostic test, surgical procedures and histopathologic findings. Results: The mean age of the patients (8 female, 6 male) was 5.3 years (range = 1.5–16). The anomalies were usually located on the left side of the neck (n = 6). There were only 3 cases with bilateral anomalies. The majority of the lesions were sinuses (93%). The most frequent clinical feature was the presence of persistent discharge from an external (cutaneous) orifice. All lesions were excised by performing a second step ladder incision. Eight of the lesions were removed under the guidance of 3/0 polypropylene suture. No postoperative complication or recurrence was observed during the follow-up period. Conclusions: Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently encountered in children. Definitive treatment for these lesions is surgical excision. A polypropylene suture can be inserted into the tract as a guide to prevent incomplete excision.
Aneurysms in Twig-Like Middle Cerebral Artery
Authors: Liu Hon-Man , Lai Dar-Ming , Tu Yong-Kwang , Wang Yao-Hung
Published: June 2005

Background: We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. Methods: Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. Results: In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. Conclusion: This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.
Effects of Maternal Nicotine Exposure during Lactation on Breast-Fed Rat Pups
Authors: Özokutan Bülent Hayri , Özkan K. Uğur , Sarı İbrahim , İnanç Fatma , Güldür M. Emin , Kılınç Metin
Published: June 2005

Background: Nicotine is known to be associated with adverse effects in infants and children. It is concentrated in breast milk and is absorbed by the infant. The aim of this study was to investigate the effects on breast-fed rat pups of maternal nicotine exposure during lactation. Methods: In the experimental group (n = 6), nicotine was given to lactating dams (2 mg/kg/day) after delivery and continued for 10 days during lactation. Control animals (n = 4) received saline for the same duration. The suckling rats were weighed and killed on postnatal day 10, and samples were taken from the lung, liver, kidney, spleen and small intestine for histopathological examination. Superoxide dismutase (SOD), catalase (CAT) activities and malondialdehyde (MDA) levels were measured in the liver of the dam and the offspring. Results: Histopathological changes in the liver of the nicotine-exposed group showed portal inflammatory infiltrate, ballooning degeneration of hepatocytes, and focal necrosis in the parenchyma. Thickening of alveolar walls because of interstitial inflammation was noted in the lungs. Histopathological examination of kidney, spleen and small intestine tissue did not reveal any abnormality. In the experimental group, SOD and CAT activities were significantly decreased (p <0.001) but MDA levels were significantly increased (p <0.001) compared with the control group. Conclusion: These results indicate that maternal nicotine exposure induces oxidative stress and causes detrimental histopathological changes in the lung and liver of lactating offspring.
Maternal Basal Metabolic Rate in Twin Pregnancy
Authors: Shinagawa Shino , Suzuki Shunji , Chihara Hiromitsu , Otsubo Yasuo , Takeshita Toshiyuki , Araki Tsutomu
Published: June 2005

Objective: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. Methods: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 ± 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 ± 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 ± 132 kcal/day; p < 0.05). Conclusion: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed.
Experimental Intrauterine Growth Retardation in the Rat Causes a Reduction of Pancreatic B-Cell Mass, Which Persists into Adulthood
Authors: Styrud J. , Eriksson U.J. , Grill V. , Swenne I.
Published: June 2005

Background and Objectives: The aim of this study was to investigate the possibility that intrauterine growth retardation (IUGR) causes alterations of glucose tolerance, insulin secretory response to glucose, and pancreatic B-cell growth, and if such changes may persist into adulthood. Methods: Pregnant rats were operated on day 16 of pregnancy ad modum Wigglesworth to induce IUGR. Operated rats gave birth to viable offspring but litter size was reduced. The mothers nursed their pups, which were subsequently weaned and reared to an age of 3 months in apparent good health. Results: At 1 day of age, IUGR pups were 10% lighter than control newborns whose mothers had been subjected to a sham operation. Pancreatic B-cell mass and insulin content were reduced by 35–40% in newborn IUGR offspring. Postnatal growth did not differ between IUGR and control animals of either sex and the difference in body weight at birth was not apparent from 1 week of age and onwards. Tests performed at 3 months of age could not demonstrate differences in glucose tolerance between IUGR and control animals. In females, but not in males, the peak insulin secretory response to glucose was lower in IUGR animals compared to controls. In the 3-month-old rats, B-cell mass was reduced by 40% in male and by 45% in female IUGR rats compared to controls, a reduction corresponding to a similar decrease in pancreatic insulin content (male reduction 48%, female reduction 45%). Conclusions: In the rat, IUGR causes a diminution of pancreatic B-cell mass which persists into adulthood. Normal glucose tolerance could be maintained but it is conceivable that increasing demands on insulin secretion may not be met by the reduced B-cell mass and that impaired glucose tolerance and even diabetes would hence develop.
Pathophysiology of Acute Experimental Pancreatitis: Lessons from Genetically Engineered Animal Models and New Molecular Approaches
Authors: Schäfer Claus , Tietz Anne Barbara , Göke Burkhard
Published: June 2005

The incidence of acute pancreatitis is growing and worldwide population-based studies report a doubling or tripling since the 1970s. 25% of acute pancreatitis are severe and associated with histological changes of necrotizing pancreatitis. There is still no specific medical treatment for acute pancreatitis. The average mortality resides around 10%. In order to develop new specific medical treatment strategies for acute pancreatitis, a better understanding of the pathophysiology during the onset of acute pancreatitis is necessary. Since it is difficult to study the early acinar events in human pancreatitis, several animal models of acute pancreatitis have been developed. By this, it is hoped that clues into human pathophysiology become possible. In the last decade, while employing molecular biology techniques, a major progress has been made. The genome of the mouse was recently sequenced. Various strategies are possible to prove a causal effect of a single gene or protein, using either gain-of-function (i.e., overexpression of the protein of interest) or loss-of-function studies (i.e., genetic deletion of the gene of interest). The availability of transgenic mouse models and gene deletion studies has clearly increased our knowledge about the pathophysiology of acute pancreatitis and enables us to study and confirm in vitro findings in animal models. In addition, transgenic models with specific genetic deletion or overexpression of genes help in understanding the role of one specific protein in a cascade of inflammatory processes such as pancreatitis where different proteins interact and co-react. This review summarizes the recent progress in this field.
Utility of Electrogastrography in Differentiating Parkinson’s Disease with or without Gastrointestinal Symptoms: A Prospective Controlled Study
Authors: Chen Chien-Lin , Lin Hsien-Hong , Chen Shin-Yuan , Lin Shinn-Zong
Published: June 2005

Background/Aims: Parkinson’s disease (PD) may be associated with various gastrointestinal symptoms. This study was designed to assess the gastric myoelectrical functioning in patients with PD and in healthy controls by using electrogastrography (EGG) with the water load test and to determine the clinical utility of EGG in differentiating PD patients with or without upper gastrointestinal symptoms. Methods: Twenty patients (13 men, mean age 63 years) with PD and 11 healthy controls (5 men, mean age 55 years) were studied. The PD patients were stratified into two subgroups: 9 were assessed as PD without upper gastrointestinal symptoms (group A) and 11 as PD with upper gastrointestinal symptoms (group B). The gastric myoelectrical activity was assessed using cutaneous electrodes to record EGG before and after the subjects ingested water until full. Results: The PD patients drank significantly less water until full as compared with the controls (303 ± 45 vs. 627 ± 67 ml, p < 0.05). At baseline, the PD patients had a significantly higher 1.0- to 2.5-cpm activity as compared with the controls (44 ± 3 vs. 33 ± 3%, p < 0.05). These differences persisted after ingestion of the water load. The PD patients had a significantly lower 2.5- to 3.75-cpm activity late after ingestion of the water load as compared with the controls (33 ± 4 vs. 49 ± 5%, p < 0.05). No statistically significant differences were found in any EGG variables or the water load between the two groups of PD patients. Conclusions: This study has shown that the gastric myoelectrical activity is impaired in both groups of PD patients. EGG appears to have a limited, if any, clinical utility in the differentiation of PD patients with or without upper gastrointestinal symptoms.
Neurological Eponyms Derived from Literature and Visual Art
Authors: Budrys Valmantas
Published: June 2005

Eponyms are common in medicine, and neurology is not an exception. Most neurological eponyms originate from the names of those who first described a disease or pathological condition, as well as from the names of characters from the literature and mythical or biblical heroes. The article describes en block both widespread and nowadays seldom used or even forgotten neurological eponyms derived from literature and visual art.
Individualised Surgical Treatment of Patients with an Adenocarcinoma of the Distal Oesophagus or Gastro-Oesophageal Junction
Authors: Hulscher J.B.F. , van Lanschot J.J.B.
Published: June 2005

In this review we discuss the different strategies to improve surgical outcomes after potentially curative resection for oesophageal adenocarcinoma. For tumours of the distal oesophagus, there is a 17% survival benefit after transthoracic resection with two-field lymph node dissection when compared with transhiatal resection. This survival benefit is absent for tumours of the gastro-oesophageal junction or gastric cardia. These patients should, in the absence of tumour-positive lymph nodes at or proximal to the carina, undergo a transhiatal resection to minimise peri-operative complications. New developments include endoscopic resection or minimally invasive oesophagectomy, but these therapies should still be considered experimental.
The Accommodation of Lens Implants
Authors: Weale R.A.
Published: June 2005

Efforts devoted to the production of accommodative lens implants may be premature as there is conflicting information about the functional performance of the aged ciliary muscle which may determine their performance. Additional doubts exist on the performance of the ageing lenticular capsule in connection with some types of implant. Not only do these matters need resolving, but the change in the optical power of the eye needs also to be large enough for reading glasses to become unnecessary. However, not all these strictures apply to the development of accommodative lens implants for children who may be aphakic following operations, e.g. for congenital cataracts.
Role of Calcitonin Gene-Related Peptide in Hypertension-Induced Renal Damage
Authors: Bowers Mark C. , Katki Khurshed A. , Rao Arundhati , Koehler Michael , Patel Parag , Spiekerman Alvin , DiPette Donald J. , Supowit Scott C.
Published: June 2005

Calcitonin gene-related peptide, a potent vasodilator neuropeptide, is localized in perivascular sensory nerves. We have reported that α-calcitonin gene-related peptide knockout mice have elevated baseline blood pressure and enhanced hypertension-induced renal damage compared with wild-type controls. Thus, the aim of this study was to determine the mechanism and functional significance of this increased hypertension-induced renal damage. We previously demonstrated by telemetric recording that the deoxycorticosterone–salt protocol produces a 35% increase in mean arterial pressure in both α-calcitonin gene-related peptide knockout and wild-type mice. Both strains of mice were studied at 0, 14, and 21 days after deoxycorticosterone–salt hypertension. Renal sections from hypertensive wild-type mice showed no pathological changes at any time point studied. However, on days 14 and 21, hypertensive knockout mice displayed progressive increases in glomerular proliferation, crescent formation, and tubular protein casts, as well as the inflammatory markers intercellular adhesion molecule-1, vascular adhesion molecule-1, and monocyte chemoattractant protein-1. There was a significant increase in 24-hour urinary isoprostane, a marker of oxidative stress-induced lipid peroxidation, levels at days 14 and 21 in the hypertensive knockout compared with hypertensive wild-type mice. Urinary microalbumin was significantly higher (2-fold) at day 21 and creatinine clearance was significantly decreased 4-fold in the hypertensive knockout compared with hypertensive wild-type mice. Therefore, in the absence of α-calcitonin gene-related peptide, deoxycorticosterone–salt hypertension induces enhanced oxidative stress, inflammation, and renal histopathologic damage, resulting in reduced renal function. Thus, sensory nerves, via α-calcitonin gene-related peptide, appear to be renoprotective against hypertension-induced damage.
Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes
Authors: Ruiz Juan , Monbaron David , Parati Gianfranco , Perret Sophie , Haesler Erik , Danzeisen Claude , Hayoz Daniel
Published: June 2005

The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25±2.80 ms/mm Hg versus 7.55±3.79 ms/mm Hg;
P
<0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (
r
2
=0.08,
P
=0.04 and
r
2
=0.04,
P
=0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1±0.5 versus 6.1±0.4 ms/mm Hg, respectively;
P
=0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratio=5.1,
P
=0.028 versus F ratio=1.9,
P
=0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.
Changes in False Lumen After Transluminal Stent-Graft Placement in Aortic Dissections
Authors: Kusagawa Hitoshi , Shimono Takatsugu , Ishida Masaki , Suzuki Tomoaki , Yasuda Fuyuhiko , Yuasa Uhito , Onoda Koji , Yada Isao , Hirano Tadanori , Takeda Kan , Kato Noriyuki
Published: June 2005

Background—

Transluminal stent-graft placements (TSGPs) are a new, less invasive procedure now recognized as the choice for aortic disease repair. Treatment of aortic dissections with TSGPs has resulted in good early results, but the long-term results and changes in the false lumen have not been elucidated in detail.

Methods and Results—

TSGPs were performed in 49 patients with primary tears in their descending aortas, and the follow-up period ranged from 4 months to 6 years. The patients were divided into 32 acute-onset and 17 chronic dissections; of the acute-onset cases, there were 15 Stanford type A retrograde dissections. Periodic enhanced spiral CT was conducted after TSGP. The false lumen in the ascending aorta in 14 (93%) of the Stanford type A cases was obliterated completely within 3 months. The CT study was continued for >2 years for 17 acute-onset dissection and 11 chronic dissection patients. The average false lumen diameters of the proximal, middle, and distal descending aorta before treatment were 15.9, 16.2, and 15.6 mm in the acute-onset dissection group and 28.1, 25.2, and 21.0 mm in the chronic dissection group, respectively. The false lumen diameters 2 years after treatment were 3.0, 3.7, and 3.1 mm in the acute-onset dissection group and 10.6, 10.5, and 11.9 mm in the chronic dissection group, respectively. Two years after TSGPs, the false lumen of the thoracic aorta totally disappeared in 76% of the acute-onset dissection group and 36% of the chronic dissection group. No cases showed rupture after TSGP.

Conclusions—

Complete obliteration of the false lumen is more likely in acute-onset cases than in chronic cases.
Delayed Onset of Subendocardial Diastolic Thinning at Rest Identifies Hypoperfused Myocardium
Authors: Wang Jianwen , Abraham Theodore P. , Korinek Josef , Urheim Stig , McMahon Eileen M. , Belohlavek Marek
Published: June 2005

Background—

Onset of myocardial relaxation is highly energy dependent. Perfusion and therefore energy substrate delivery are predominantly reduced in the subendocardial myocardium in the early stages of progressive ischemia. We hypothesized that delayed onset of subendocardial diastolic thinning will functionally identify regionally hypoperfused resting myocardium.

Methods and Results—

Progressive left anterior descending coronary artery stenosis was induced by an ameroid occluder and maintained for 1 or 2 weeks (end point) in 12 dogs. M-mode tissue Doppler images of the anterior apical and middle segments (testing region) and middle inferior segment (control region) were acquired selectively in the subendocardium and subepicardium. The time to the onset of thinning was measured with the use of tissue Doppler velocity (TOTv) and a thickness function (TOTt). At the end point in the testing region, myocardial flow was significantly lower in the subendocardial layer (
P
<0.05) in all animals, whereas viability staining showed preserved transmural viability in 10 dogs and thin subendocardial necrosis in 2 dogs. Both TOTv and TOTt were significantly (
P
<0.01) prolonged in the testing region. The mean difference between subendocardial and subepicardial TOTv values versus that in the control region identified the ischemic region, even when only dogs with hypoperfused but transmurally viable myocardium were considered (
P
<0.05). Systolic and diastolic myocardial velocities did not identify subendocardial hypoperfusion.

Conclusions—

In resting myocardium subtended to progressive coronary stenosis, a delayed onset of subendocardial thinning suggests an early stage of hypoperfusion, before the development of local wall motion abnormalities.
Dietary Linolenic Acid Is Inversely Associated With Calcified Atherosclerotic Plaque in the Coronary Arteries
Authors: Djoussé Luc , Arnett Donna K. , Carr J. Jeffrey , Eckfeldt John H. , Hopkins Paul N. , Province Michael A. , Ellison R. Curtis
Published: June 2005

Background—

High dietary intake of linolenic acid is associated with a lower risk of cardiovascular disease mortality. However, little is known about the association between linolenic acid and subclinical atherosclerosis.

Methods and Results—

To examine the association between dietary linolenic acid measured by food frequency questionnaire and calcified atherosclerotic plaque in the coronary arteries (CAC) measured by cardiac CT, we studied 2004 white participants of the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study aged 32 to 93 years. The presence of CAC was defined on the basis of total CAC score of ≥100. We used generalized estimating equations to estimate odds ratios for the presence of CAC across quintiles of linolenic acid. The average consumption of dietary linolenic acid was 0.82±0.36 g/d for men and 0.69±0.29 g/d for women. From the lowest to the highest quintile of linolenic acid, adjusted odds ratios (95% CI) for the presence of CAC were 1.0 (reference), 0.61 (0.42 to 0.88), 0.55 (0.35 to 0.84), 0.57 (0.37 to 0.88), and 0.35 (0.22 to 0.55), respectively (
P
for trend <0.0001), after we controlled for age, gender, education, family risk group, smoking, fruit and vegetable intake, history of coronary artery disease, hypertension, diabetes mellitus, and statin use. When linolenic acid was used as a continuous variable, the multivariate adjusted odds ratio was 0.38 (95% CI, 0.24 to 0.46) per gram of linolenic acid intake. Use of different cut points for CAC score yielded similar results.

Conclusions—

Consumption of dietary linolenic acid is associated with a lower prevalence of CAC in a dose-response fashion in white men and women.
Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation
Authors: Karch Martin R. , Zrenner Bernhard , Deisenhofer Isabel , Schreieck Jürgen , Ndrepepa Gjin , Dong Jun , Lamprecht Katrin , Barthel Petra , Luciani Etienne , Schömig Albert , Schmitt Claus
Published: June 2005

Background—

Data on the comparative value of the circumferential pulmonary vein and the segmental pulmonary vein ablation for interventional treatment of atrial fibrillation are limited. We hypothesized that the circumferential pulmonary vein ablation approach was superior to the segmental pulmonary vein ablation approach.

Methods and Results—

One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential (n=50) or segmental pulmonary vein ablation (n=50). Freedom from atrial tachyarrhythmias in a 7-day Holter monitoring at 6 months was the primary end point. Secondary end points were freedom of arrhythmia-related symptoms and a composite of pericardial tamponade, thromboembolic complications, and pulmonary vein stenosis (safety end point). On the basis of the results of the 7-day Holter monitoring at 6 months, 21 patients (42%) after circumferential pulmonary vein ablation and 33 patients (66%) after segmental pulmonary vein ablation (
P
=0.02) were free of atrial tachyarrhythmia episodes. During the 6-month follow-up period, 27 patients (54%) after circumferential pulmonary vein ablation and 41 patients (82%) after segmental pulmonary vein ablation remained free of arrhythmia-related symptoms (
P
<0.01). No significant difference was found in the safety end point (6 versus 7 events;
P
=0.77) in the circumferential versus segmental pulmonary vein ablation group, respectively.

Conclusions—

This study demonstrates no superiority of the circumferential pulmonary vein ablation over segmental pulmonary vein ablation for treatment of atrial fibrillation in terms of efficacy and safety.
Intracellular Calcium Dynamics and Anisotropic Reentry in Isolated Canine Pulmonary Veins and Left Atrium
Authors: Chou Chung-Chuan , Nihei Motoki , Zhou Shengmei , Tan Alex , Kawase Ayaka , Macias Edgar S. , Fishbein Michael C. , Lin Shien-Fong , Chen Peng-Sheng
Published: June 2005

Background—

Rapid activations due to either focal discharge or reentry are often present during atrial fibrillation (AF) in the pulmonary veins (PVs). The mechanisms of these rapid activations are unclear.

Methods and Results—

We studied 7 isolated, Langendorff-perfused canine left atrial (LA) and PV preparations and used 2 cameras to map membrane potential alone (Vm, n=3) or Vm and intracellular calcium simultaneously (Ca
i
, n=4). Rapid atrial pacing induced 26 episodes of focal discharge from the proximal PVs in 5 dogs. The cycle lengths were 223±52 ms during ryanodine infusion (n=13) and 133±59 ms during ryanodine plus isoproterenol infusion (n=13). The rise of Ca
i
preceded Vm activation at the sites of focal discharge in 6 episodes of 2 preparations, compatible with voltage-independent spontaneous Ca
i
release. Phase singularities during pacing-induced reentry clustered specifically at the PV-LA junction. Periodic acid-Schiff (PAS) stain identified large cells with pale cytoplasm along the endocardium of PV muscle sleeves. There were abrupt changes in myocardial fiber orientation and increased interstitial fibrosis in the PV and at the PV-LA junction.

Conclusions—

PV muscle sleeves may develop voltage-independent Ca
i
release, resulting in focal discharge. Focal discharge may also be facilitated by the presence of PAS-positive cells that are compatible with node-like cells. During reentry, phase singularities clustered preferentially at sites of increased anisotropy such as the PV-LA junction. These findings suggest that focal discharge caused by spontaneous calcium release and anisotropic reentry both contribute to rapid activations in the PVs during AF.
Reduced Number of Circulating Endothelial Progenitor Cells Predicts Future Cardiovascular Events
Authors: Schmidt-Lucke Caroline , Rössig Lothar , Fichtlscherer Stephan , Vasa Mariuca , Britten Martina , Kämper Ulrike , Dimmeler Stefanie , Zeiher Andreas M.
Published: June 2005

Background—

The maintenance of endothelial integrity plays a critical role in preventing atherosclerotic disease progression. Endothelial progenitor cells (EPCs) were experimentally shown to incorporate into sites of neovascularization and home to sites of endothelial denudation. Circulating EPCs may thus provide an endogenous repair mechanism to counteract ongoing risk factor–induced endothelial injury and to replace dysfunctional endothelium.

Methods and Results—

In 120 individuals (43 control subjects, 44 patients with stable coronary artery disease, and 33 patients with acute coronary syndromes), circulating EPCs were defined by the surface markers CD34
+
KDR
+
and analyzed by flow cytometry. Cardiovascular events (cardiovascular death, unstable angina, myocardial infarction, PTCA, CABG, or ischemic stroke) served as outcome variables over a median follow-up period of 10 months. Patients suffering from cardiovascular events had significantly lower numbers of EPCs (
P
<0.05). Reduced numbers of EPCs were associated with a significantly higher incidence of cardiovascular events by Kaplan-Meier analysis (
P
=0.0009). By multivariate analysis, reduced EPC levels were a significant, independent predictor of poor prognosis, even after adjustment for traditional cardiovascular risk factors and disease activity (hazard ratio, 3.9;
P
<0.05).

Conclusions—

Reduced levels of circulating EPCs independently predict atherosclerotic disease progression, thus supporting an important role for endogenous vascular repair to modulate the clinical course of coronary artery disease.
Individual and Neighborhood Characteristics Associated with Environmental Exposure
Authors: Keller-Olaman Susan J. , Eyles John D. , Elliott Susan J. , Wilson Kathi , Dostrovsky Nathaniel , Jerrett Michael
Published: June 2005

Environmental exposure research tends to emphasize the monitoring and regulation of emissions, with fewer investigations of exposure experienced in the general population. To help bridge the gap between environmental quality and perceived exposure, this study examines ambient exposures among 300 residents from each of 4 neighborhoods and among a control group of 300 residents in Hamilton, Ontario, Canada. Logistic regression analyses determined how individual, neighborhood, and housing characteristics influenced self-reported exposure in the workplace, inside the home, and around the home. Blue-collar occupations, neighborhood dislikes, and a home in disrepair were associated with work exposure. Neighborhood dislikes, renting, and indicating how the neighborhood could be healthier were associated with indoor exposure. Pesticide exposure was linked to professional occupations and to a specific neighborhood. Older homes were also associated with pesticide and indoor exposure. The findings highlight the need for further research on indoor exposure indices and on perceptions of neighborhood quality.
Adolescent Environmental Behaviors
Authors: Meinhold Jana L. , Malkus Amy J.
Published: June 2005

This article examines the relationships among adolescent environmental behaviors and self-efficacy, knowledge, and attitudes. It was hypothesized that adolescents who demonstrate more proenvironmental attitudes are more likely to demonstrate proenvironmental behaviors. It was further hypothesized that perceived self-efficacy would have a moderating effect on the environmental attitude-behavior relationship in that the relationship between proenvironmental attitudes and behaviors would be stronger among adolescents with high levels of self-efficacy. Participants were 848 students from three academically achieving high schools on the West coast. Hierarchical regression analyses were used for all subsequent analyses. Results indicated that proenvironmental attitudes significantly predicted proenvironmental behaviors and that environmental knowledge was a significant moderator for the relationship between environmental attitudes and environmental behaviors. This was especially true for males.
Environmental Sensitivity in a Developing Country
Authors: Bodur Muzaffer , Sarigöllü Emine
Published: June 2005

Past research on consumers’ attitudes toward the environment has been conducted mostly in the context of developed countries. There is a need to investigate this topic in less affluent societies. This article investigates the relationship between Turkish consumers’ attitudes and their behaviors toward the environment. A multistage area sampling procedure was used to select 1,000 residences in Istanbul at which at-home personal interviews were conducted using standard surveys. A consumer cluster analysis based on behaviors toward the environment was conducted, and three distinct segments were identified: active concerned, passive concerned, and unconcerned. For each cluster, attitudinal, demographic, socioeconomic, and leisure activity profiles were delineated. Attitudes toward specific behaviors were found to be the best predictors of behavior, followed by general attitudes, education, and locus of control. Policy implications are provided for each cluster.
Instrumentality, Aesthetics, and Symbolism of Office Design
Authors: Vilnai-Yavetz Iris , Rafaeli Anat , Yaacov Caryn Schneider
Published: June 2005

This article suggests that the analysis of physical environments in organizations should recognize three separate dimensions: instrumentality, aesthetics, and symbolism. A theoretical framework is presented based on an expansive survey of multiple bodies of literature that study the effects of physical environments of organizations. Two different methodologies are employed to study employee perceptions of the physical environment of their office space and to test and support the three-dimension framework. In a qualitative study, narratives of in-depth interviews relating to office design are evaluated. In a quantitative study, data collected in a survey of 148 office employees provide evidence for the construct validity of three separate dimensions. The three-dimension model described and validated in this study may facilitate the planning and evaluation of office design.
Using Collaboration as a Governance Strategy
Authors: Imperial Mark T.
Published: May 2005

This article utilizes a comparative cross-case analysis of six watershed programs to examine how collaboration is used to enhance governance of networks where problem-solving capacity is widely dispersed and few organizations accomplish their missions by acting alone. A conceptual framework that illustrates how collaboration occurs at the operational, policy-making, and institutional levels is presented. Understanding these structural relationships is important and can help public managers design effective collaborative processes. The article concludes with a discussion of the implications for future research and advice for public managers using collaboration as a strategy for enhancing network governance.