bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Coronary Calcium Screening in Preventive Cardiology
Authors: Raggi Paolo
Published: June 2007

Over 7 million people in this country have coronary artery disease, and more than 500,000 die from its complications annually. Over 1 million Americans have an acute myocardial infarction each year, and in the majority of cases the event announcing the presence of coronary atherosclerosis is either sudden death or a disabling myocardial infarction. Therefore, the most desirable approach to such an epidemic is prevention rather than delayed treatment. Yet, statistics from primary care and subspecialty practices indicate that the preventive attitude of the majority of physicians is not sufficiently developed and remains limited in most training programs. Though traditional risk factors are very helpful in predicting the development of cardiovascular disease, many individuals suffer events in the absence of established risk factors for atherosclerosis. To meet the challenge of coronary artery disease, several tools have been developed to identify atherosclerotic disease in its preclinical stages in the hope of modifying its natural history. This review deals with the utilization of electron beam tomography for detection of coronary artery calcification as an additional tool available for use by preventive cardiologists and internists.
Gender Differences on the Risk Evaluation of Acute Coronary Syndromes: The CARDIO2000 Study
Authors: Chrysohoou Christina , Panagiotakos Demosthenes B. , Pitsavos Christos , Kokkinos Peter , Marinakis Nick , Stefanadis Christodoulos , Toutouzas Pavlos K.
Published: June 2007

Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000–2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3±8 vs. 59.7±10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.
Homocysteine and Lipoprotein Levels Following Resistance Training in Older Adults
Authors: Vincent Kevin R. , Braith Randy W. , Bottiglieri Teodoro , Vincent Heather K. , Lowenthal David T.
Published: June 2007

This investigation examined the effect of 6 months of high‐ or low‐intensity resistance exercise on serum homocysteine and lipoprotein (a) levels in adults aged 60–80 years. Forty‐three men and women completed the study protocol. Subjects were randomly assigned to a control (n=10), low‐intensity (LEX, n=18), or high‐intensity (HEX, n=15) group. Subjects performed 6 months of resistance training at either 50% of their one‐repetition maximum for 13 repetitions (LEX) or 80% of one‐repetition maximum for eight repetitions (HEX) 3 times per week for 24 weeks. The load was increased by 5% when their rating of perceived exertion dropped below 18. One‐repetition maximum; serum homocysteine; lipoprotein (a); total and high‐density lipoprotein cholesterol; and dietary intake of vitamins B12, B6, and folic acid were measured pre‐ and poststudy. Upper and lower body strength significantly (p<0.05) increased for the LEX and HEX groups. Serum homocysteine decreased 5.30% and 5.34% for the LEX and HEX groups, respectively (p<0.05), but increased 6.1% for the control group. A significant increase in lipoprotein (a) levels was noted in the control and LEX groups from pre‐ to poststudy. No significant differences were noted either pre‐ or poststudy for total and high‐density lipoprotein cholesterol or any dietary variables. These data indicate that significant reductions in serum levels of homocysteine in the elderly can be derived from resistance exercise training.
Bridging the Treatment Gap: Improving Compliance With Lipid‐Modifying Agents and Therapeutic Lifestyle Changes
Authors: Pearson Thomas , Kopin Laurie
Published: June 2007

Despite the large burden of cardiovascular disease on society, abnormal lipid levels, which are associated with an increase in coronary heart disease mortality, are not being adequately managed in many individuals. Poor patient compliance with therapeutic lifestyle changes and lipid‐modifying therapies contribute to this treatment gap. If management of lipid levels is to reduce cardiovascular mortality effectively, poor compliance with treatment needs to be understood and addressed. Educating and motivating patients to understand the need for compliance with continued therapy is an important step for ensuring that the benefits of lipid management cited in clinical trials are translated to the general population. This will require a proactive approach from both patients and physicians. Well‐tolerated and effective therapies may also help compliance by reducing the incidence of side effects and the need for complex dosing regimens. Suboptimal treatment of lipid levels is currently limiting the effectiveness of primary and secondary prevention of coronary heart disease; methods for improving compliance should be a key strategy to overcoming this problem.
Body Size and Cardiovascular Risk Factors in a Preschool Population
Authors: Williams Christine L , Strobino Barbara , Bollella Marguerite , Brotanek Jane
Published: June 2007

Data on weight, height, blood pressure, and blood lipids were obtained for 1215 children entering New York Head Start preschools from 1995–1997. In this population, 17% were overweight and 15% were obese; the risk was greatest in Hispanic children. Overall, 13% had high blood pressure. African‐American children were at increased risk of elevated blood pressure but had a more favorable lipid profile (high high‐density lipoprotein cholesterol level and low triglycerides level) than white or Hispanic children. Body size was a significant predictor of elevated blood pressure, low high‐density lipoprotein cholesterol, and increased triglycerides. The association between obesity and blood pressure was evident in white and Hispanic children only. Neither ethnicity nor obesity was associated with total cholesterol level. Obese preschoolers had approximately three times the risk of having high systolic blood pressure and twice the risk of low high‐density lipoprotein cholesterol level compared with nonobese children, indicating that at‐risk populations can be identified and primary prevention begun at a young age.
Coronary Risk Factor Management in the Framework of a Community Hospital‐Based Ambulatory Exercise Training Program
Authors: Leibowitz Morton , Bental Tamir , Neuman Yoram , Bar‐On Yigal , Khaskia Abdelrahim , David Daniel
Published: June 2007

Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk‐factor management is limited. The authors measured the ability of a community hospital‐based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk‐factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3‐month period of training and counseling by a multidisciplinary team with follow‐up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty‐two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low‐density lipoprotein cholesterol level (−4.5%), high‐density lipoprotein cholesterol level (+7%), body mass index (−2%), systolic blood pressure (−3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital‐based risk management exercise program is an effective method for improving the long‐term management of patients with chronic ischemic heart disease.
Subclinical Calcified Atherosclerosis in Men and Its Association With Family History of Premature Coronary Heart Disease in First‐ and Second‐Degree Relatives
Authors: Taylor Allen J. , Bindeman Jody , Bhattarai Saroj , Feuerstein Irwin M. , O'Malley Patrick G.
Published: June 2007

The authors examined the associations between coronary artery calcification and a family history of premature coronary heart disease in either first‐degree (immediate family) or second‐degree (grandparents, aunts, uncles) relatives in 1619 asymptomatic healthy men ages 40–50 years. The prevalence of any coronary artery calcification was 19.3% in participants (n=1102) with no family history, 26.6% in those with a first‐degree family history (n=203; 12.5%), 26.5% in those with a second‐degree family history (n=215, 13.3%), and 30.3% with both (n=99, 6.1%, p=0.003). After controlling for the Framingham risk score, body mass index, and ethnicity, all categories of family history were significant predictors of coronary artery calcification. The odds ratios for coronary artery calcification associated with a first‐ (1.49; p=0.026) and second‐degree (1.41; p=0.049) family history of coronary heart disease were similar. Clinical coronary risk assessments should broadly include an assessment of premature coronary heart disease in both first‐ and second‐degree relatives.
Cholesterol Management and the Reduction of Cardiovascular Risk
Authors: Nixon J.V.
Published: June 2007

The increasing number of outcomes‐based clinical trials addressing cardiovascular risk factor reduction using statin therapy has resulted in a substantial revision of the management of patients at risk for cardiovascular events. The clinical trials involve both primary and secondary preventive care. This review outlines the trials addressing primary and secondary prevention, detailing the more recently published studies, their place in risk‐factor management, and their relationship to the National Cholesterol Education Program guidelines. Available data in elderly patients are reviewed, as are the adverse effects of the different statins and the statin drugs undergoing preliminary trials but not yet approved for general clinical use. The underuse of statin therapy is also addressed. Conclusions are drawn regarding the appropriate use of statin therapy in the contemporary primary and secondary preventive management of patients to reduce cardiovascular mortality and morbidity.
Non‐High‐Density Lipoprotein Cholesterol: An Alternate Target for Lipid‐Lowering Therapy
Authors: Bittner Vera
Published: June 2007

Non‐high‐density lipoprotein (non‐HDL) cholesterol level is determined by subtracting the high‐density lipoprotein cholesterol level from the total cholesterol level and thus encompasses not only low‐density lipoprotein cholesterol, but also the cholesterol contained in atherogenic, triglyceride‐rich particles like remnants. This review summarizes data extracted from English‐language publications accessible through MEDLINE on the population distribution of non‐HDL cholesterol, its relationship to cardiovascular disease, and the potential benefits of treatment. Non‐HDL cholesterol levels in the population vary by age, sex, and race and are closely linked to measures of obesity, especially visceral obesity. Several studies in populations with and without cardiovascular disease show that non‐HDL cholesterol levels relate to atherosclerosis severity and subsequent cardiovascular morbidity and mortality. Preliminary data also suggest that pharmacologically induced changes in non‐HDL cholesterol levels relate to prognosis. In the National Cholesterol Education Program Adult Treatment Panel III report, non‐HDL cholesterol has been designated a secondary target of therapy among patients with hypertriglyceridemia.
Efficacy of Nonsteroidal Anti‐Inflammatory Medications for Prevention of Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery
Authors: Cheruku Kiran K. , Ghani Abdul , Ahmad Faheem , Pappas Pat , Silverman Paul R. , Zelinger Allan , Silver Marc A.
Published: June 2007

This study was designed to test whether nonsteroidal anti‐inflammatory medications could reduce the frequency of atrial fibrillation after coronary artery bypass graft surgery. The study was designed as an open‐label, randomized trial. Patients undergoing first‐time coronary artery bypass graft surgery were considered eligible. Patients with a history of atrial fibrillation, serum creatinine >2.0 mg/dL, on antiarrhythmic treatment, and those undergoing concomitant valvular surgery were excluded. The study was conducted in a single, university‐affiliated community hospital. The researchers' role in the study was restricted to randomizing the patients and collecting data. The primary clinical care team made all decisions regarding patient care. One hundred patients were randomized to two groups: one received 30 mg ketorolac intravenously every 6 hours until able to take oral medications, at which point the patients were switched to 600 mg ibuprofen orally three times a day; the other group received conventional treatment. The primary end point of the study was incidence of atrial fibrillation in the immediate postoperative period. Atrial fibrillation occurred in 14 patients (28.6%) in the conventional treatment group vs. five patients (9.8%) in the ibuprofen group (p<0.017). Nonsteroidal anti‐inflammatory medications were relatively safe and effective in significantly reducing the incidence of atrial fibrillation after coronary artery bypass graft surgery.
The Effects of Niacin on Lipoprotein Subclass Distribution
Authors: Morgan John M. , Carey Christina M. , Lincoff Anne , Capuzzi David M.
Published: June 2007

Dyslipidemia is a heterogeneous metabolic condition; high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), and very‐low‐density lipoprotein represent families of lipoprotein particles that differ in size and composition and vary in atherogenicity. Lipoprotein subclasses containing apolipoprotein B promote atherosclerosis, of which the most atherogenic appear to be the small, dense LDL and large very‐low‐density lipoprotein subclasses, while the large HDL2 subclass, which transports esterified cholesterol from the periphery to the liver, is considered the more cardioprotective. Niacin has long been known to improve concentrations of all major lipids and lipoproteins, but it also has consistently favorable effects on subclass distribution. A MEDLINE search was conducted for clinical studies reporting the effects of niacin on lipoprotein subclasses. The niacinassociated elevations in HDL cholesterol likely stem from differential drug effects on subclasses, producing favorable changes in levels of HDL2 and apolipoprotein A‐I. Niacin has more moderate LDL cholesterol‐lowering efficacy, but this change is associated with an increase in LDL particle size and a shift from small LDL to the less atherogenic, large LDL subclasses. In addition, it also tends to decrease concentrations of the larger very‐lowdensity lipoprotein subclasses. Niacin confers diverse benefits with respect to both the quantity and quality of lipid and lipoprotein particles.
Elevated Levels of Low‐Density Lipoprotein Cholesterol, Homocysteine, and Lipoprotein(a) Are Associated With the Occurrence of Symptomatic Bypass Graft Disease 1 Year Following Coronary Artery Bypass Graft Surgery
Authors: Harris Melodee , Shammas Nicolas W. , Jerin Michael
Published: June 2007

Severe coronary artery bypass graft disease occurs at a rate of approximately 16%–31% within the first year of surgery. Clinical and laboratory variables, including postoperative lipid profiles closest to the 1‐year follow‐up, lipoprotein(a) levels, and homocysteine levels, were assessed as predictors of early (≤1 year) symptomatic coronary artery bypass graft disease. Of 77 living consecutive patients (from the practice of one cardiologist) who underwent bypass surgery, 60 were asymptomatic at 1 year, and 17 had developed recurrent symptoms and had an angiogram that confirmed >50% lesion in at least one saphenous bypass graft. Using multivariate analysis, the strongest predictors of early symptomatic coronary artery bypass graft disease within 1 year of bypass surgery were elevated levels of low‐density lipoprotein cholesterol (>100 mg/dL) (odds ratio [OR], 8:1; p=0.034), homocysteine (>10 μmol/L) (OR, 8:1; p=0.019), and lipoprotein(a) (>30 mg/dL) (OR, 4:1; p=0.011). Male gender was associated with a reduced risk (OR, 1:9; p=0.01) of symptomatic graft disease within 1 year of surgery. The authors conclude that low‐density lipoprotein, homocysteine, and lipoprotein(a) levels are associated with symptomatic coronary artery bypass graft disease at 1 year after surgery.
Coronary Heart Disease Risk Reduction in Postmenopausal Women: The Role of Statin Therapy and Hormone Replacement Therapy
Authors: Clearfield Michael
Published: June 2007

The incidence of coronary heart disease in women rises sharply in the years following menopause, and prescribing of hormone replacement therapy in the belief that it might compensate for the loss of estrogen‐mediated cardioprotection is widespread. However, controlled trials have failed to show a beneficial effect of hormone replacement therapy on the incidence of coronary events, and recent evidence suggests that hormone replacement therapy may even have a deleterious effect on primary coronary heart disease prevention. Statins are recommended as first‐line treatment for lowering low‐density lipoprotein cholesterol levels in women and are extremely valuable in reducing coronary heart disease risk in this group. An awareness of the benefits of appropriate statin treatment, and evidence showing that they can be safely added to hormone replacement therapy prescribed for the relief of menopausal symptoms and osteoporosis, provides the opportunity to optimize clinical outcomes for coronary heart disease among the large and expanding population of postmenopausal women.
Electron Beam Computed Tomographic Scanning in Preventive Medicine
Authors: King David G.
Published: June 2007

Undetected coronary atherosclerosis is present in the majority of patients suffering myocardial infarction or sudden death. Electron beam computed tomography affords noninvasive scanning of the heart to detect and measure coronary calcification. These data permit dramatically improved assessment of both short term and future risk for cardiac and other events. Knowledge of this risk gives the physician an opportunity for timely and cost‐effective interventions.
Prevention of Sudden Death in Patients With Coronary Artery Disease: Do Lipid‐Lowering Drugs Play a Role?
Authors: De Sutter Johan , Firsovaite Vida , Tavernier Rene
Published: June 2007

Ventricular arrhythmias are the most common cause of sudden cardiac death in patients with coronary artery disease. Since treatment of hypercholesterolemia in patients with coronary artery disease reduces the risk of major coronary events by about 30%, one could speculate that this treatment could also result in a reduction of arrhythmic episodes in high‐risk patients. In this review, the importance of myocardial ischemia as a trigger for ventricular arrhythmias, as well as the available data that suggest a possible effect of anti‐ischemic treatments, including lipid‐lowering drugs, on these arrhythmias are presented. Also, possible mechanisms and future research to test the hypothesis that lipid‐lowering drugs can reduce life‐threatening ventricular arrhythmias are discussed.
Molecular Mechanisms of Diabetic Cardiovascular Disease
Authors: Hupfeld Christopher J. , Wong Gail A.
Published: June 2007

Cardiovascular disease is a major cause of morbidity and mortality in persons with diabetes mellitus. This population represents an important target for preventive therapies aimed at reducing atherosclerosis. Recent molecular research has uncovered many of the cellular mechanisms that lead to atherosclerosis in the diabetic patient. This review, part 1 of a 2‐part series, is geared toward clinicians and discusses these mechanisms as they pertain to prevention of cardiovascular disease in patients with diabetes.
Will Helical CT Replace Electron Beam CT in the Assessment of Coronary Calcium?
Authors: Schaefer Saul
Published: June 2007

Accurate determination of coronary calcification has, until recently, required the use of electron beam computed tomography to acquire images with sufficient time and spatial resolution. Recent technologic advances in helical computed tomography, including rapid gantry rotation, multidetector arrays, and the use of electrocardiographic gating have resulted in image acquisition which parallels that of electron beam computed tomography. Direct comparisons of these techniques have shown relative equivalence in calcium scores, and the availability of helical computed tomography suggests that this technique will result in the proliferation of coronary computed tomographic scanning.
Three‐Dimensional Coronary Anatomy in Contrast‐Enhanced Multislice Computed Tomography
Authors: Nieman Koen , Rensing Benno , Munne Arie , Geuns Robert‐Jan van , Pattynama Peter , Feyter Pim de
Published: June 2007

A number of three‐dimensional imaging modalities, such as magnetic resonance imaging, electron beam computed tomography, ultrasonography, and multislice computed tomography have been introduced in cardiovascular medicine. One of the most recently developed techniques, multislice computed tomographic coronary angiography, allows assessment of the small coronary vessels. The entire heart is scanned within a single breathhold and contrast‐enhanced images are reconstructed through retrospective electrocardiographic gating. Instead of the conventional two‐dimensional projection images, multislice computed tomographic data can be displayed in a three‐dimensional, volume‐rendered manner. This paper presents an overview of the cardiac and coronary morphology as it is imaged with contrast‐enhanced multislice computed tomography. Further imaging characteristics of computed tomographic angiography are discussed.
Some Thoughts on the Adult Treatment Panel III Report
Authors: Blum Conrad B.
Published: June 2007

The guidelines of the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program are similar to prior recommendations in focusing on elevations of low‐density lipoprotein (LDL) cholesterol as the primary target of therapy and in gauging the intensity of therapy to the degree of coronary heart disease risk. New elements in the current guidelines include: quantification of risk, heightened attention to the risk imparted by low high‐density lipoprotein levels, utilization of non‐high‐density lipoprotein cholesterol levels in risk assessment for hypertriglyceridemic individuals, and emphasis on the metabolic syndrome. Nonetheless, the current guidelines are not perfect. The recommended algorithm for treatment is excessively complex; this complexity may keep the guidelines from being widely used. This complexity is generated by a hybrid scheme of risk assessment utilizing both counting of categorical coronary heart disease risk factors and calculation of coronary heart disease using the Framingham model. This hybrid method also results in undesirable inconsistencies in treatment. ATP III explicitly agrees that the therapeutic LDL goal should be determined by the burden of non‐LDL risk factors. However, the current guidelines violate this principle by giving the baseline LDL cholesterol level a role in determining the therapeutic LDL goal. Additionally, the ATP III guidelines lead to under‐treatment of women. Simplification should be a goal of the next iteration of the guidelines. Specific suggestions are given for simplification of the guidelines and for enhanced treatment of women. Furthermore, it is urged that the risk‐assessing spreadsheet be provided in an “unlocked” form so that its details can be inspected.
Effects of Tongue Position and Base Circle Diameter on the Performance of a Centrifugal Blood Pump
Authors: Wong Yew‐Wah , Chan Weng‐Kong , Hu Wei
Published: June 2007

Abstract:  This article presents numerical investigations of the effect of radial gap and volute tongue position on the circumferential pressure distribution and the magnitude of resulting imbalanced radial force. A series of volute models was designed using the constant mean velocity method. The results indicate that a radial clearance of 10% is a good practical value that gives a relatively high head across the pump for a small radial force. The results show that the tongue position at 30 degrees gives the lowest radial force and pressure head. The tongue position at 15 degrees appears to give the best compromise results producing a generated head only 5% less than the maximum value while the radial force is about 22% less than the maximum force.
Pure Menstrual Cluster Headache
Authors: Rozen Todd D.
Published: June 2007

The influence of the menstrual cycle on female cluster headache is not well documented in the literature. A case patient is presented who had cluster headaches only during her menstrual cycles. This appears to be the first ever reported case of pure menstrual cluster headache.
Initial Perspectives from Midwestern Neurologists: Epilepsy Patients' Barriers and Motivators for Seeking Treatment
Authors: Hawley Suzanne R. , Paschal Angelia M. , Ablah Elizabeth , St. Romain Theresa , Liow Kore , Molgaard Craig A.
Published: June 2007

Summary:  Purpose: Epilepsy is a chronic neurological illness that affects 2.7 million people in the United States, but remains poorly understood. Care providers may not recognize their patients' need for epilepsy information, contributing to treatment barriers, such as stigmatization and poor patient‐provider communication.

Methods: The current study piloted a survey of epilepsy‐related attitudes and perceptions of 33 Midwestern neurologists. The survey included questions about perceived barriers to and motivators for treatment, thoughts on misperceptions of epilepsy in the community and in the patient population, and potential interventions to address misperceptions.

Results: Respondents perceived misinformation and lack of knowledge in patients and the general public that could be contributing to the barriers that exist to treat patients adequately. Respondents suggested potential methods for addressing misperceptions effectively.

Discussion: This study of neurologists' perceptions about epilepsy barriers and needs provides an important perspective for the development of interventions to address misperceptions and barriers among patients and the public.
A Cost‐Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia
Authors: O'Connor Alec B. , Noyes Katia , Holloway Robert G.
Published: June 2007

OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first‐line postherpetic neuralgia (PHN) medications.

DESIGN: Cost–utility analysis using published literature.

PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN.

INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.

MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality‐adjusted life‐year (QALY) gained. Costs were estimated using the perspective of a third‐party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1‐month and 6‐month horizons.

RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost‐effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.

CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost‐effective than pregabalin.
Frailty in Older Men: Prevalence, Progression, and Relationship with Mortality
Authors: Cawthon Peggy M. , Marshall Lynn M. , Michael Yvonne , Dam Thuy‐Tien , Ensrud Kristine E. , Barrett‐Connor Elizabeth , Orwoll Eric S. ,   for the Osteoporotic Fractures in Men Research Group
Published: June 2007

OBJECTIVES: To describe the association between frailty and health status, the progression of frailty, and the relationship between frailty and mortality in older men.

DESIGN: Cross‐sectional and prospective cohort study.

SETTING: Six U.S. clinical centers.

PARTICIPANTS: Five thousand nine hundred ninety‐three community‐dwelling men aged 65 and older.

MEASUREMENTS: Frailty was defined as three or more of the following: sarcopenia (low appendicular skeletal mass adjusted for height and body fat), weakness (grip strength), self‐reported exhaustion, low activity level, and slow walking speed. Prefrail men met one or two criteria; robust men had none. Follow‐up averaged 4.7 years.

RESULTS: At baseline, 240 subjects (4.0%) were frail, 2,395 (40.0%) were prefrail, and 3,358 were robust (56.0%). Frail men were less healthy in most measures of self‐reported health than prefrail or robust men. Frailty was somewhat more common in African Americans (6.6%) and Asians (5.8%) than Caucasians (3.8%). At the second visit, men who were frail at baseline tended to remain frail (24.2%) or die (37.1%) or were unable to complete the follow‐up visit (26.2%); robust men tended to remain robust (54.4%). Frail men were approximately twice as likely to die as robust men (multivariate hazard ratio (MHR)=2.05, 95% confidence interval (CI)=1.55–2.72). Mortality risk for frail men was greater in all weight categories than for nonfrail men but was highest for normal‐weight frail men (MHR=2.39, 95% CI=1.51–3.79, P for interaction=.01). The relationship between frailty and mortality was somewhat stronger in younger men than older men (P for interaction=.01).

CONCLUSION: Frailty in older men is associated with poorer health and a greater risk of mortality.
Treatment of a Patient with Severely Worn Dentition: A Clinical Report
Authors: Thongthammachat‐Thavornthanasarn Sudsukh
Published: June 2007

This clinical report documents the prosthodontic treatment of a Prosthodontic Diagnotstic Index Class IV 63‐year‐old white male, referred to the prosthodontic clinic by his general dentist for evaluation and treatment. The patient was concerned about the severe wear on his teeth and understood the need for comprehensive (full‐mouth) rehabilitation to restore his dental condition. The clinical findings, diagnosis, treatment plan, and sequence of treatment are presented.
Lengths of hepatitis B viremia and antigenemia in blood donors: preliminary evidence of occult (hepatitis B surface antigen–negative) infection in the acute stage
Authors: Yoshikawa Akira , Gotanda Yuko , Minegishi Kiyoshi , Taira Rikizo , Hino Satoru , Tadokoro Kenji , Ohnuma Hitoshi , Miyakawa Keiko , Tachibana Katsumi , Mizoguchi Hideaki ,   Japanese Red Cross NAT Screening Research Group
Published: June 2007

BACKGROUND: The Japanese Red Cross (JRC) implemented a fully automated pooling and nucleic acid amplification test (NAT) system for testing seronegative donations. The JRC sample repository and repeat blood donations allowed for lookback and follow‐up studies of hepatitis B virus (HBV) DNA–positive donors, who tested negative for hepatitis B surface antigen (HBsAg) and anti–hepatitis B core antigen in the JRC screening system.

STUDY DESIGN AND METHODS: From February 1, 2000, to March 31, 2003, 17,314,486 units were tested in 50‐sample pools with a semiautomated multiplex assay system (AMPLINAT MPX test, Roche). During this period, 328 HBV DNA–positive donations were found. From 26 of these donors, sequential samples were available at short intervals. This enabled us to examine the dynamics of viral markers in acute HBV infection. The length of detectable periods of plasma viremia and antigenemia were estimated by regression analysis from the results obtained in the quantitative polymerase chain reaction assay (JRC) and HBsAg enzyme immunoassay (Auszyme II, AxSYM, Abbott) and chemiluminescence immunoassay (Abbott).

RESULTS: The median length of detectable HBV DNA in individual donation and 20‐sample minipool (MP) NAT format was estimated to be 74 and 50 days, respectively, whereas the median length of detectable HBsAg was estimated to be 42 days. Six of the 26 donors were infected with mutant viruses, and 3 of these 6 donors did not develop detectable HBsAg during the entire observation period, despite a moderately high viral load of 104 to 105 HBV DNA copies per mL.

CONCLUSION: Transmission of mutant virus may cause occult HBV infection in the acute stage. HBV NAT, even in MP configuration, is more effective than HBsAg testing and capable of interdicting infected donors in the pre‐ and post‐HBsAg window periods.
Prevention of transfusion of platelet components contaminated with low levels of bacteria: a comparison of bacteria culture and pathogen inactivation methods
Authors: Nussbaumer Walter , Allersdorfer Doris , Grabmer Christoph , Rheinschmidt Margaret , Lin Lily , Schönitzer Diether , Lass‐Flörl Cornelia
Published: June 2007

BACKGROUND: This study compared the efficacy of bacterial detection with inactivation for reducing the risk associated with transfusion of platelet (PLT) components contaminated with low levels of bacteria.

STUDY DESIGN AND METHODS: Twenty‐one double‐dose PLTs were spiked with seven species of bacteria at three levels (0.003‐0.03, 0.03‐0.3, 0.3‐3 colony‐forming units [CFUs]/mL). After split, each PLT unit contained 1 to 10, 10 to 100, and 100 to 1000 CFUs. One unit was photochemically treated (PCT; 150 µmol/L amotosalen and 3 J/cm2 ultraviolet A). The other unit was untreated. All units were stored and sampled on Days 1, 2, and 5 of storage for aerobic and anaerobic culture in the BacT/ALERT system (bioMérieux). PLTs were classified as sterile when no bacterial growth was detected after 120 hours of culture.

RESULTS: In all PCT PLTs, no bacteria were detected throughout 5 days of storage regardless of species, level of contamination, and sampling time. In untreated PLTs, Staphylococcus aureus was consistently detected by culturing. Growth of 1 to 10 CFUs per unit Staphylococcus epidermidis, 1 to 100 CFUs per unit of Klebsiella pneumoniae, and 1 to 1000 CFUs per unit Propionibacterium acnes was delayed and only detectable after 5, 2, and 5 days of storage, respectively. Low levels of Streptococcus agalactiae (1‐10 CFUs/unit), Escherichia coli (1‐100 CFUs/unit), and Clostridium perfringens (1‐100 CFUs/unit) were not detected during 5 days of storage, although bacterial outgrowth was detected at higher levels of contamination.

CONCLUSIONS: For the seven bacterial species examined, contaminated PLTs may be released for transfusion on test‐negative‐to‐date status. In contrast, bacterial inactivation by PCT could reduce the risk associated with transfusion of PLTs contaminated with low levels of these bacteria.
Bacterial infections associated with blood transfusion: experience and perspective of infectious diseases consultants
Authors: Rao Preethi L. , Strausbaugh Larry J. , Liedtke Laura A. , Srinivasan Arjun , Kuehnert Matthew J. ,   the Infectious Diseases Society of America Emerging Infections Network
Published: June 2007

BACKGROUND: On March 1, 2004, the AABB adopted a new standard that requires member blood banks and transfusion services to implement measures to limit and detect bacterial contamination in all platelet (PLT) components. The AABB has since developed several guidelines to assist blood transfusion services and blood banks in this area, some of which are relevant to clinical practice. Knowledge and experience among clinicians (including infectious disease consultants, who can play an important role in managing patients with sepsis) concerning risk of bacterial infections associated with transfusion, however, are unknown.

STUDY DESIGN AND METHODS: Experience concerning management and prevention of transfusion‐associated bacterial infection, including knowledge of the AABB standard requiring bacterial screening of PLTs, was assessed through an Infectious Diseases Society of America Emerging Infections Network (IDSA/EIN) survey.

RESULTS: Overall, 405 (47%) EIN members responded to the survey; of those responding, 12 percent of respondents had encountered transfusion reactions potentially due to bacterial contamination in the prior 10 years, 36 percent were aware of the transmission risk of bacteria through blood transfusion, and 20 percent were aware of the new AABB standard for bacterial screening of PLTs.

CONCLUSIONS: Understanding by EIN infectious disease consultants of the significance of transfusion‐associated bacterial infection and associated AABB standards and guidelines may indicate lack of other clinicians' awareness on these issues. Improving awareness of the risk of bacterial contamination of PLTs appears warranted to improve clinical management of infected blood donors or recipients, particularly when follow‐up for transfusion of a culture‐positive PLT unit is needed.
Fetal blood group genotyping
Authors: Denomme Gregory A. , Fernandes Bernard J.
Published: June 2007

Blood group genotyping using DNA extracted from fetal tissue is useful to identify fetuses at risk for hemolytic disease of the fetus and newborn (HDFN) due to maternal red cell alloantibodies. Four considerations are important for fetal blood group genotyping. First, paternal heterozygosity must be established, including tests that evaluateRHDhemizygosity. Second, the source of fetal tissue for DNA extraction requires certain considerations. Third, because the fetal genotype is used to predict the expressed phenotype, a thorough knowledge of blood group genetics is required. Moreover, the test algorithm should include the evaluation of the parental phenotypes and genotypes to help identify variant alleles. Fourth, the blood group antigen expression at birth should be evaluated to confirm the inheritance. The identification of an antigen‐negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN. In the near future, fetal DNA in maternal plasma will likely replace fetal blood group genotyping forRHD. Significant challenges remain to detect other clinically significant blood group antigens using maternal plasma DNA.
IKs Block by HMR 1556 Lowers Ventricular Defibrillation Threshold and Reverses the Repolarization Shortening by Isoproterenol Without Rate‐Dependence in Rabbits
Authors: SO PETSY PUI‐SZE , BACKX PETER H. , HU XU‐DONG , DORIAN PAUL
Published: June 2007

Introduction: The slow delayed rectifier K+ current (IKs) contributes little to ventricular repolarization at rest. It is unclear whether IKs plays a role during ventricular fibrillation (VF) or ventricular repolarization at rapid rates during β‐adrenergic stimulation.

Methods and Results: In an in vivo rabbit model, we evaluated the effects of HMR 1556 (1 mg Kg−1+ 1 mg kg −1 hr −1 i.v.), a selective IKs blocker, on monophasic action potential duration at 90% repolarization (MAPD90), ventricular effective refractory period (VERP), and defibrillation threshold (DFT). In perfused rabbit hearts, the effects of HMR 1556 (10 and 100 nM) in the presence of isoproterenol (5 nM) on MAPD90 and VERP were studied at cycle lengths (CLs) 200–500 msec. In vivo, HMR 1556 prolonged MAPD90 by 6 ± 1 msec at CL 200 msec (P < 0.01, n = 6), lowered DFT from 558 ± 46 V to 417 ± 31 V (P < 0.01), and decreased the coefficient of variation in the VF inter‐beat deflection intervals from 8.9 ± 0.6% to 6.5 ± 0.4% (P < 0.05) compared with control. In perfused rabbit hearts, isoproterenol shortened MAPD90 by 5 ± 1 msec at CL 200 msec and 11 ± 4 msec at CL 500 msec (P < 0.05, n = 7). This shortening was reversed by HMR 1556 (P < 0.05), and both effects were rate‐independent.

Conclusion: IKs block increases VF temporal organization and lowers DFT, and IKs that is activated following β‐adrenergic stimulation contributes to ventricular repolarization without rate dependence.
Taser‐Induced Rapid Ventricular Myocardial Capture Demonstrated by Pacemaker Intracardiac Electrograms
Authors: CAO MICHAEL , SHINBANE JEROLD S. , GILLBERG JEFFREY M. , SAXON LESLIE A.
Published: June 2007

Introduction: A Taser weapon is designed to incapacitate violent individuals by causing temporary neuromuscular paralysis due to current application. We report the first case of a Taser application in a person with a dual‐chamber pacemaker demonstrating evidence of Taser‐induced myocardial capture.

Methods and Results: Device interrogation was performed in a 53‐year‐old man with a dual‐chamber pacemaker who had received a Taser shot consisting of two barbs delivered simultaneously. Assessment of pacemaker function after Taser application demonstrated normal sensing, pacing thresholds, and lead impedances. Stored event data revealed two high ventricular rate episodes corresponding to the exact time of the Taser application.

Conclusions: This report describes the first human case of ventricular myocardial capture at a rapid rate resulting from a Taser application. This raises the issue as to whether conducted energy devices can cause primary myocardial capture or capture only in association with cardiac devices providing a preferential pathway of conduction to the myocardium.
New Insights into Long‐Term Follow‐Up of Atrial Fibrillation Ablation: Full Disclosure by an Implantable Pacemaker Device
Authors: MARTINEK MARTIN , AICHINGER JOSEF , NESSER HANS‐JOACHIM , ZIEGLER PAUL D. , PURERFELLNER HELMUT
Published: June 2007

Introduction: Long‐term outcome of radiofrequency ablation (RFA) for atrial fibrillation (AF) is difficult to assess. This study sought to evaluate various aspects of very long‐term follow‐up (FU) by the properties of an implantable device.

Methods: Fourteen patients with an implanted pacemaker device (Medtronic AT500) were selected for RFA, due to drug‐refractory and highly symptomatic AF despite antibradycardic pacing.

Results: With a mean FU of 41.4 ± 15.1 months, we could achieve continuous monitoring for more than 400,000 hours after RFA. Based on symptomatic episodes, simulated 24‐hour, 48‐hour, or 7‐day Holter, 57% to 71% of the patients were classified as RFA responders. With permanent FU provided by the implanted device, 43% of the patients exhibited a positive treatment effect and only 21% had no tachyarrhythmic episode at all in long‐term FU. With a mean of 1.7 ± 0.7 RFA per subject, atrial tachyarrhythmia burden (ATB) was significantly reduced from a median of 3.6 to 0.3 hours per day (P < 0.001). Two out of 14 patients developed AF recurrences after a tachyarrhythmia‐free period of more than 12 months.

Conclusion: Continuous monitoring provided by an implantable device is able to detect significantly more AF episodes than routine FU. ATB is decreased significantly by (repeated) RFA over a very long‐term FU. AF may reoccur very late after long‐lasting (>1 year) episode‐free intervals. A subgroup of patients with drug‐aggravated bradycardia in brady‐tachy syndrome might be considered for PV isolation rather than pacemaker implantation.
Myocardial Asynchrony in Patients with Postinfarction Intraventricular Conduction Defects
Authors: Janion Marianna , Ciuraszkiewicz Katarzyna , Sielski Janusz , Grabowska Urszula , Gawor Zenon
Published: June 2007

Background: Postinfarction intraventricular conduction defects lead to asynchronous activation of the myocardium.
Hypothesis: The aim of the current study is to evaluate contraction asynchrony in postinfarction patients with intraventricular conduction defects.
Methods: A total of 158 patients 6 months postmyocardial infarction and 15 healthy subjects underwent echocardiography to evaluate atrioventricular, interventricular, intraventricular asynchrony, and myocardial performance index (MPI). A subgroup of 126 patients had intraventricular conduction defects in ECG, whereas 32 with normal QRS complex served as controls.
Results: All patients postmyocardial infarction showed intraventricular asynchrony and markedly higher MPI. Comparing groups with and without intraventricular conduction defects postmyocardial infarction, those with left bundle branch block (BBB) had significantly higher parameters of all asynchrony types; those with right BBB and left posterior hemiblock (LPH) had significantly higher interventricular asynchrony parameters; those with left anterior hemiblock did not show significant differences in asynchrony parameters as compared with subjects without postinfarction conduction defects.
Conclusions: (1) Patients 6 months postmyocardial infarction show intraventricular asynchrony and markedly higher MPI. (2) Postinfarction patients with LBBB have the highest parameters of atrioventricular, interventricular and intraventricular asynchrony as compared with postinfarction patients with other and without conduction defects. (3) In postinfarction patients with RBBB or LPH parameters of interventricular asynchrony are significantly higher as compared with postinfarction patients without intraventricular conduction defects.
“We Seem to Have Always Spoken in Prose . . .” Policy Analysis Is a Clinical Profession: Implications for Policy Analysis Practice and Instruction
Authors: Geva‐May Iris
Published: June 2007

The purpose of this article is (i) to propose the concept of policy analysis as a clinical profession, (ii) to relate to the clinical intellectual processes involved in policy analysis, and (iii) following studies in other clinical disciplines, to infer implications for policy analysis and policy analysis instruction. The article will highlight notions of clinical reasoning and clinical cognitive processes relevant to policy analysis and will address reasoning errors associated with bounded rationality and uncertainty in the clinical analytic process. The article seeks to promote awareness of clinical notions and of their relevance for policy analysis practice and instruction.