bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial neural networks to predict presence of significant pathology in patients presenting to routine colorectal clinics
Authors: Maslekar S. , Gardiner A. B. , Monson J. R. T. , Duthie G. S.
Published: July 2009

Aim  Artificial neural networks (ANNs) are computer programs used to identify complex relations within data. Routine predictions of presence of colorectal pathology based on population statistics have little meaning for individual patient. This results in large number of unnecessary lower gastrointestinal endoscopies (LGEs – colonoscopies and flexible sigmoidoscopies). We aimed to develop a neural network algorithm that can accurately predict presence of significant pathology in patients attending routine outpatient clinics for gastrointestinal symptoms.

Method  Ethics approval was obtained and the study was monitored according to International Committee on Harmonisation – Good Clinical Practice (ICH‐GCP) standards. Three‐hundred patients undergoing LGE prospectively completed a specifically developed questionnaire, which included 40 variables based on clinical symptoms, signs, past‐ and family history. Complete data sets of 100 patients were used to train the ANN; the remaining data was used for internal validation. The primary output used was positive finding on LGE, including polyps, cancer, diverticular disease or colitis. For external validation, the ANN was applied to data from 50 patients in primary care and also compared with the predictions of four clinicians.

Results  Clear correlation between actual data value and ANN predictions were found (r = 0.931; P = 0.0001). The predictive accuracy of ANN was 95% in training group and 90% (95% CI 84–96) in the internal validation set and this was significantly higher than the clinical accuracy (75%). ANN also showed high accuracy in the external validation group (89%).

Conclusion  Artificial neural networks offer the possibility of personal prediction of outcome for individual patients presenting in clinics with colorectal symptoms, making it possible to make more appropriate requests for lower gastrointestinal endoscopy.
Stoma complications: a literature overview
Authors: Shabbir J. , Britton D. C.
Published: July 2009

Stoma formation is a commonly performed procedure in colorectal surgery as a part of operations performed for malignant‐ and inflammatory bowel disease. Stoma formation is a simple, but not trivial, undertaking. When performed badly, it can leave the patients with a legacy of complications such as leakage, prolapse, parastomal hernia and retraction. Various studies have reported a complication rate of 21–70%. We performed a literature search using the Medline, Ovid and Google scholar database for all the articles published between January 1980 and December 2008. The search terms used were colostomy, ileostomy, stoma, parastomal hernia, stenosis, prolapse, necrosis and complications. The following article summarizes the common complications associated with stomas.
Long‐term compliance with endoscopic surveillance for familial adenomatous polyposis
Authors: Douma K. F. L. , Bleiker E. M. A. , Aaronson N. K. , Cats A. , Gerritsma M. A. , Gundy C. M. , Vasen H. F. A.
Published: July 2009

Aim  The study assessed compliance of patients with familial adenomatous polyposis (FAP) with endoscopic surveillance.

Method  In this nationwide, cross‐sectional study, individuals from FAP families registered with the Netherlands Foundation for the Detection of Hereditary Tumours were invited to complete a questionnaire on endoscopic screening experiences.

Results  A total of 328 individuals were eligible for the study of whom 85 were at risk for FAP, 108 had an intact rectum after a colectomy with ileorectal anastomosis (IRA), and 135 had had a pouch following a proctocolectomy with ileoanal anastomosis (IPAA). Based on medical record data, 20% of the at‐risk group and 26% of the IRA‐group were found to be undercompliant with surveillance advice which was associated significantly with perceived self‐efficacy, use of sedatives during surveillance, pain after surveillance and low perceived benefits of surveillance (P < 0.05).

Conclusion  One in five individuals at risk for FAP and one in four with a retained rectum are undercompliant with screening advice. We recommend that sedatives should be patient‐tailored for FAP individuals undergoing surveillance and that adequate pain medication be provided after endoscopy.
Downregulation of caspase‐9 is a frequent event in patients with stage II colorectal cancer and correlates with poor clinical outcome
Authors: Shen X.‐G. , Wang C. , Li Y. , Wang L. , Zhou B. , Xu B. , Jiang X. , Zhou Z.‐G. , Sun X.‐F.
Published: July 2009

Objective  To evaluate the clinical significance of caspase‐9 mRNA expression and investigate its prognostic value in stage II colorectal cancer.

Method  Quantitative real‐time RT–PCR was used to analyse caspase‐9 mRNA expression in cancer tissue and corresponding normal mucosa from 120 patients.

Results  Compared with normal mucosa, the expression of caspase‐9 mRNA was found to be downregulated in cancer tissue (P = 0.001). Poorly differentiated cancer showed lower mRNA expression than cancer with greater differentiation (P = 0.031). The Kaplan–Meier survival analysis demonstrated that patients with downregulated caspase‐9 showed a worse overall survival (P = 0.012) and disease‐free survival (P = 0.022). Cox’s proportional hazards regression model confirmed that expression of caspase‐9 was the strongest prognostic factor in stage II colorectal cancer.

Conclusion  The mRNA expression of caspase‐9 can be used as an independent prognostic factor for patients with stage II colorectal cancer.
Agreement of Self-Reported Migraine With ICHD-II Criteria in the Women's Health Study
Authors: Schürks M , Buring JE , Kurth T
Published: July 2009

Migraine is a common headache disorder that is increasingly being evaluated in population-based studies. The American Migraine Study II and the Women's Health Study (WHS) have successfully used ‘modified’ International Classification of Headache Disorders, 1st edition (ICHD-I) criteria to classify patients. Investigating agreement of self-reported migraine in large epidemiological studies with the criteria of the revised version [International Classification of Headache Disorders, 2nd edition (ICHD-II)] is sparse. We have investigated 1675 women with self-reported migraine participating in the WHS, who provided additional information on a detailed migraine questionnaire that allowed us to apply all ICHD-II criteria. In this sub-cohort, we confirmed self-reported migraine in > 87% of women when applying the ICHD-II criteria for migraine (71.5%) and probable migraine without aura (16.2%). In conclusion, there is excellent agreement between self-reported migraine and ICHD-II-based migraine classification in the WHS. In addition, questionnaire-based migraine assessment according to full ICHD-II criteria in large population-based studies is feasible.
An integrative research review of preventive home visits among older people – is an individual health resource perspective a vision or a reality?
Authors: Fagerström Lisbeth , Wikblad Annika , Nilsson Jenny
Published: July 2009

This study has two aims: (i) to explore and evaluate the health‐promoting effect of preventive home visit (PHV) by analysing the activities conducted during the PHV and the reported results, and (ii) to critically analyse if PHV is characterized by an individualized health resource perspective. The material was compiled through a systematic literature search in the databases Ebsco, CINAHL, Medline, Science Direct and CSA from the period 1984 to 2004. The result of the systematic database search was a total number of 49 scientific research articles, of which 18 are included in this study. The analysing method was a four‐step integrating research review. The review describes the following content concerning (i) activities during home visits: screening, observation and evaluation, guidance, support, referral to care and other services, follow‐up and individual aim; (ii) positive effects: reduced mortality, improved ability to function, improved life quality, improved subjective health, fewer admittances for care, older people’s experiences of home visits and increased knowledge on health and (iii) unclear/negative effects: admittance to care, no effect on mortality, unaffected ability to function, unaffected general health and uninfluenced life quality. PHVs had been implemented based on an individual perspective in a total of 13 studies out of 18. The focus on sickness was surprisingly clear, and in 10 studies out of 18 a health resource perspective was lacking. The effects of PHVs have been questioned. Despite this, current research results imply that this method has a positive affect on older people’s health and well‐being. This form of care must still be developed to include extensive screenings and interventions, as well as a health resource perspective where the starting point during every home visit is the older person’s individual needs and wishes.
Polish medical students’ perceptions of the nursing profession: a cross‐sectional study
Authors: Marcinowicz Ludmiła , Foley Mary , Zarzycka Danuta , Chlabicz Sławomir , Windak Adam , Buczkowski Krzysztof
Published: July 2009

This study explored perceptions of the nursing profession held by medical students in Poland. Specifically, this study aimed to: (i) elicit medical students’ opinions about the nursing profession; (ii) identify what skills and abilities they perceive as important for nurses and (iii) ascertain what nursing functions are considered a major component of the nurse’s job. A cross‐sectional study, based on the social construct of role theory, was conducted in medical universities from 2005 to 2006 in three cities situated in different regions of Poland: Białystok, Bydgoszcz and Kraków. A total of 900 medical students, 300 students in each region, in medical school years 1, 3 and 6 completed the Professional Nursing Image Survey. The most favourable nurse characteristics were: ‘professional reliability’, ‘demonstration of good technical skills’ and the personal characteristics of friendliness and courteousness. Medication administration, recording vital signs and administering intravenous therapy were most frequently identified as a major part of the nurses’ role. In conclusion, the opinions of Polish medical students suggest that nursing therapeutic activities trump independent nursing practice activities.
Stroma‐free mass production of clinical‐grade red blood cells (RBCs) by using poloxamer 188 as an RBC survival enhancer
Authors: Baek Eun Jung , Kim Han‐Soo , Kim Ju‐Hye , Kim Nahn Ju , Kim Hyun Ok
Published: July 2009

BACKGROUND: In vitro generation of red blood cells (RBCs) is an important alternative to donor RBCs. It was impossible, however, to generate a large quantity of RBCs due to necessity of supporting stromal cells or xenogeneic or human serum for in vitro culture, which had restrictions in safety, supplies, and expenses. In addition, the low viability of erythroblasts during terminal maturation in vitro required highly efficient production protocols. Here, we present a protocol for mass production of clinical‐grade RBCs from cord blood (CB) CD34+ cells in stroma‐free culture by using poloxamer 188 (P188), a polymer known to be cytoprotective against hydrodynamic stress.

STUDY DESIGN AND METHODS: Umbilical CB CD34+ cells were cultured for 21 days in medium containing several cytokines, and roughly fibrin‐eliminated CB derived plasma was added from Day 13. To enhance the final RBC production, P188 was added from Day 13 and the cell count and viability were compared with controls lacking P188.

RESULTS: Erythroid expansion between Day 17 and Day 21 was significantly higher in cultures treated with P188, with a mean of 1.5 times and maximum of 3.6 times higher expansion than in controls lacking P188. The enhanced survival resulted from increased stability of the RBC membrane and decreased fragility. The erythroid cells were enucleated up to 95% and demonstrated hematologic variables similar to those of reticulocytes.

CONCLUSION: This RBC production protocol is a simple stroma‐ and serum‐free culture method ensuring enhanced viability of terminally mature erythroid cells and can be easily applicable to mass production of clinical‐grade RBCs as well as erythropoiesis research.
The Relationship between Surface Temperature, Tissue Temperature, Microbubble Formation, and Steam Pops
Authors: THOMPSON NATHANIEL , LUSTGARTEN DANIEL , MASON BRYAN , MUELLER ENKHTUYAA , CALAME JAMES , BELL STEPHEN , SPECTOR PETER
Published: July 2009

Background: It has been proposed that microbubble (MB) monitoring can be used to safely titrate radiofrequency (RF) power. However, MB formation has been found to be an insensitive indicator of tissue temperature during RF delivery. We hypothesized that MB formation corresponds to surface—not tissue—temperature, and therefore would be an insensitive predictor of steam pops.

Methods: An in vitro bovine heart model was used to measure surface and tissue temperatures during RF delivery under conditions designed to cause steam pops. Sensitivity of type II MB (MBII) formation as a predictor of steam pops and for surface temperatures more than 80°C was calculated.

Results: Of 105 lesions delivered, 99 steam pops occurred. Twenty‐one steam pops were preceded by MBII. MBII were seen in 26 lesions, five of which were not associated with steam pop. Surface temperature at onset of MBII was 87 ± 9°C versus a tissue temperature of 78 ± 23°C (P = 0.044). Surface temperature at the time of steam pops was 71 ± 17°C versus a tissue temperature of 102 ± 17°C (P < 0.0001). The sensitivity of MBII for steam pops was 21%, and 58% for detecting surface temperature in excess of 80°C.

Conclusions: MBII correlated better with surface temperature than with tissue temperature; steam pops, on the other hand, correlated better with tissue temperature. MBII was an insensitive marker of steam pops and surface temperature in excess of 80°C. Therefore, MBII should not be used to titrate RF power.
Contact versus Noncontact Mapping for Ablation of Ventricular Tachycardia in Patients with Previous Myocardial Infarction
Authors: PRATOLA CLAUDIO , BALDO ELISA , TOSELLI TIZIANO , NOTARSTEFANO PASQUALE , PAOLO ARTALE , FERRARI ROBERTO
Published: July 2009

Introduction: The aim of this study was to compare contact versus noncontact mapping for radiofrequency (RF) ablation of any sustained post‐myocardial infarction (MI) ventricular tachycardia (VT).

Methods: Forty patients with tolerated VT post‐MI were randomized to RF ablation with contact (group 1) or noncontact (group 2) mapping systems. In both groups ablation of tolerated VT was guided by VT activation map confirmed by concealed entrainment. When untolerated VTs were induced, ablation was performed in group 1 according to pace mapping starting from the scar border zone and in group 2 according to the VT activation map confirmed by pace mapping.

Results: No differences were seen between the groups in terms of acute success rate of clinical VT ablation (95% vs 100%, respectively; P = ns) and in the noninducibility of any VT at the end of the procedure (55% vs 85%, respectively; P = 0.08). Moreover, untolerated VTs were eliminated in 30% of group 1 versus 83.3% of group 2 patients (P < 0.05). The mean total procedural and fluoroscopy times were 236.4 ± 42.7 and 29.0 ± 7.8 minutes in group 1 and 144.5 ± 50.8 and 23.4 ± 5.8 minutes in group 2 (P < 0.001 and < 0.05, respectively). At a mean follow‐up of 15.2 ± 6.7 months no differences were seen in VT recurrences between groups, but noninducibility at the end of the procedure was predictive of freedom from recurrences (P < 0.001).

Conclusion: Both systems are useful for ablation of tolerated VT. Noncontact mapping is more effective for ablation of untolerated VT and allows the reduction of procedural and fluoroscopy times. Noninducibility at the end of the procedure seems predictive of freedom from recurrences during follow‐up.
Transmural Mapping of Myocardial Refractoriness and Endocardial Dispersion of Repolarization in an Ovine Model of Chronic Myocardial Infarction
Authors: POULIOPOULOS JIM , THIAGALINGAM ARAVINDA , EIPPER VICKI E. , CAMPBELL CRAIG , ROSS DAVID L. , KOVOOR PRAMESH
Published: July 2009

Background:Myocardial refractoriness and repolarization is an important electrophysiological property that, when altered, increases the risk of arrhythmogenesis. These electrophysiological changes associated with chronic myocardial infarction (MI) have not been studied in detail. We assessed the influence of left ventricular (LV) scarring on local refractoriness, repolarization, and electrogram characteristics.

Methods:MI was induced in five sheep by percutaneous left anterior descending artery occlusion for 3 hours. Mapping was performed at 19 ± 6 weeks post‐MI. A total of 20 quadripolar transmural needles were deployed at thoracotomy in the LV within and surrounding scar. Bipolar pacing was performed from each needle to assess the effective refractory period (ERP) of the subendocardium and subepicardium. The activation (AT) and repolarization (RT) times, and modified activation recovery interval (ARIm) were determined from endocardial unipolar electrograms recorded in sinus rhythm simultaneously from all needles. Scarring was quantified histologically and compared with electrophysiological characteristics.

Results:Increased scarring corresponded with increased ERP (P < 0.01), decreased subendocardial electrogram amplitude (P < 0.001), and slope (P < 0.001). ERP did not differ between endocardium and epicardium (P > 0.05). The ARImand RT were prolonged during early myocardial activation (P < 0.001). After adjusting for AT, the RT and ARImwere prolonged in areas of scarring (P < 0.001). After adjusting for electrogram amplitude, the ARImwas prolonged in dense scar (P < 0.05).

Conclusions:We confirmed histologically that scarring contributes to prolongation of repolarization, increased refractoriness, and reductions in conduction and voltage post‐MI. Prolongation of repolarization may be further augmented when local activation is earliest or electrogram voltage is decreased within scar.
Psychogenic Syncope? A Cautionary Note
Authors: KANJWAL KHALIL , KANJWAL YOUSUF , KARABIN BEVERLY , GRUBB BLAIR P.
Published: July 2009

Introduction: In some patients with recurrent syncope, the etiology may remain unclear despite extensive evaluation. These patients may sometimes be labeled as having a “psychogenic” cause for their syncope.

Methods: We report on three patients with recurrent unexplained syncope (despite extensive evaluation) who were labeled as having a psychogenic cause for their events. In each patient following placement of an implantable loop recorder, their syncopal events were found to be due to periods of prolonged asystole and/or complete heart block. One patient had prolonged asystole for 44 seconds. In each patient, episodes of syncope were eliminated following permanent pacemaker implantation.

Conclusion: We conclude that physicians should exercise great caution before labeling any patient's syncope as psychogenic and that prolonged monitoring may be necessary to exclude a potential cardiac rhythm‐related etiology.
The Undetermined Geometrical Factors Contributing to the Transverse Conduction Block of the Crista Terminalis
Authors: MORITA NORISHIGE , KOBAYASHI YOSHINORI , HORIE TSUTOMU , IWASAKI YU‐KI , HAYASHI MEISO , MIYAUCHI YASUSHI , ATARASHI HIROTSUGU , KATOH TAKAO , MIZUNO KYOICHI
Published: July 2009

Background: The crista terminalis (CT) is known to be a functional barrier during typical atrial flutter (AFL). The relationship between the CT structural characteristics and its transverse conduction block, however, has not been understood well.

Methods: This study consisted of AFL (group 1, N = 15) and non‐AFL patients (group 2, N = 13). The CT structural characteristics were determined with intracardiac echocardiography. A 20‐pole electrode catheter was located along the CT and pacing at progressively faster rates from either low anterolateral right atrium (LRA) or coronary sinus (CS) was applied.

Results: The CT height, width, and area were significantly greater in group 1 than in group 2 (P < 0.001). In both groups, at the longest pacing cycle length during CS pacing resulting in CT transverse conduction block at some levels, the width and area were significantly greater at the levels with block than at those without block. During LRA pacing, the area was also significantly larger at the levels with block than at those without in group 1, but not in group 2. The slope angle of CT ridge was significantly steeper at the levels with block than at those without in both groups (P < 0.01), but that was not the case with CS pacing. CT arborization in its inferior portion was more frequently documented in group 1 than group 2 (P < 0.05).

Conclusions: The CT structural characteristics that may influence its transverse conduction differ between LRA and CS pacing. Steep slope and arborization of the CT are implicated as a geometric factor in its transverse conduction block.
Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series
Authors: FOO DAVID , WALKER BRUCE D. , KUCHAR DENNIS L. , THORBURN CHARLES W. , TAY ANDRE , HAYWARD CHRISTOPHER S. , MACDONALD PETER , KEOGH ANNE , KOTLYAR EUGENE , SPRATT PHILIP , JANSZ PAUL
Published: July 2009

Background: Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter‐defibrillators (ICDs) or cardiac resynchronization therapy‐pacemaker (CRT‐P) or cardiac resynchronization therapy‐defibrillator (CRT‐D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown.

Methods: We reviewed case records and device logs of 15 patients with ICDs or CRT‐P or CRT‐D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated.

Results: Right ventricular (RV) sensing decreased in the first 6 months post‐LVAD. Mean R‐wave amplitude preimplant was 10.9 ± 5.25 mV compared with 7.2 ± 3.4 mV during follow‐up (P = 0.02). RV impedance also decreased from 642 ± 240 ohms at baseline to 580 ± 212 ohms at follow‐up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 ± 0.6 V at baseline to 1.4 ± 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy.

Conclusions: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.
Safety of Transesophageal Pacing for 24 Hours in a Canine Model
Authors: GREEN HENRY W. , SANDERS ROBERT A. , RAMOS‐VARA JOSE , HOGAN DANIEL F. , BATRA ANJAN S.
Published: July 2009

Background: Temporary epicardial pacing is often necessary following surgical correction of congenital heart disease. Epicardial pacing wires, while generally effective, can, however, become nonfunctional. Transesophageal atrial pacing (TEAP) can be a useful adjunct in this setting. The potential for esophageal damage with sustained TEAP is unknown. We assessed the safety of continuous (24 hours) TEAP by evaluating gross and histological changes to the esophagus in a canine model.

Methods: Thirteen juvenile beagle dogs were fitted with a 4‐Fr multipolar catheter placed transnasally into the esophagus to a level to sustain atrial capture. Pacing was established in nine dogs for 24 hours while four control dogs had catheters but no pacing stimulus applied. Paced dogs were divided into two groups: group A (n = 5) that were euthanized immediately and group B (n = 4) that were euthanized 7 days after the pacing period. Nonpaced dogs (group C, n = 4) were treated similar to group A. Gross and histological examination of the esophageal tissue was completed.

Results: Gross and histological evidence of mild esophagitis was noted in dogs from groups A and C but not in dogs from group B. There was no evidence of esophageal stricture or fibrosis in any dog from any group.

Conclusions: TEAP did not result in permanent esophageal changes after 24 hours of stimulation. Microscopic lesions of mild erosive esophagitis, seen after 24 hours of TEAP, were absent 7 days postpacing. Mechanical irritation from the catheter cannot be ruled out as a cause of these changes.
Pacing from the Right Ventricular Septum: Is There a Danger to the Coronary Arteries?
Authors: TEH ANDREW W. , MEDI CAROLINE , ROSSO RAPHAEL , LEE GEOFFREY , GURVITCH RONEN , MOND HARRY G.
Published: July 2009

Background: Pacing from right ventricular (RV) septal sites has been suggested as an alternative to RV apical pacing in an attempt to avoid long‐term adverse consequences on left ventricular function. Concern has been raised as to the relationship of the left anterior descending coronary artery (LAD) to pacing leads in these positions.

Methods and Results: We retrospectively analyzed three cases in which patients with RV active‐fixation leads in situ also had coronary angiography. Multiple fluoroscopic views were used to determine the relationship of the lead tip at various pacing sites to the coronary arteries. A lead placed on the anterior wall was in close proximity to the LAD, whereas septal and free wall positioning was not.

Conclusion: Placement of RV active‐fixation leads on the septum avoids potential coronary artery compromise.
In Vivo Model of Human Pathogen Infection and Demonstration of Efficacy by an Antimicrobial Pouch for Pacing Devices
Authors: HANSEN LINDA K. , BROWN MARY , JOHNSON DAVID , PALME II DONALD F. , LOVE CHARLES , DAROUICHE RABIH
Published: July 2009

Background: Device‐related infections represent a significant clinical challenge. Once established, these infections prove difficult to treat with existing antibiotic regimens, compromising the health of device recipients, and usually requiring surgical intervention to resolve.

Objective: The purpose of this study was to determine the efficacy of the AIGISRX™ antibacterial envelope (TyRx Pharma, Inc., Monmouth Junction, NJ, USA) designed to reduce device‐related infections by incorporating minocycline and rifampin in a controlled release polymer.

Methods: An infection was established in a rabbit model by creating bilateral subcutaneous implant pockets, into which a pacing device with or without AIGISRX™ was placed. The incisions were closed, and a defined dose of bacteria was infused into each implant pocket. After 7 days, devices were explanted and sampled for viable bacteria by swabbing and sonication.

Results: Initial studies evaluated the ability of the AIGISRX pouch to reduce Staphylococcus epidermidis (S. epi) infection in this model using clinical and quantitative microbial endpoints. Results demonstrate S. epi infection in all control samples, while no pathogens were recovered from samples with the AIGISRX™ pouch. Systemic antibiotic levels were undetectable. Additional studies tested the efficacy of the AIGISRX™ pouch with additional bacterial strains, Staphylococcus capitis, Escherichia coli, and Acinetobacter Baumannii. In each case, the device and implant pocket with the AIGISRX™ pouch was free of any signs of infection. An assessment of biofilm produced by Acinetobacter demonstrated the elimination of biofilm formation on the implanted device.

Conclusion: These results demonstrate that in this animal model, the AIGISRX™ device reduces the risk for infection of viable pathogens within implant pockets.
The Dual Role of Implantable Loop Recorder in Patients with Potentially Arrhythmic Symptoms: A Retrospective Single‐Center Study
Authors: KABRA RAJESH , GOPINATHANNAIR RAKESH , SANDESARA CHIRAG , MESSINGER CATHERINE , OLSHANSKY BRIAN
Published: July 2009

Background: Unexplained and potentially arrhythmic symptoms often lead to electrophysiology referral for evaluation. Implantable loop recorder (ILR) correlation of the symptom to the rhythm can secure a definitive arrhythmic diagnosis after a standard, yet nondiagnostic workup.

Methods: This large single‐center retrospective study sought to assess the role of ILR in the evaluation of potentially arrhythmic symptoms, both in terms of diagnosis of an arrhythmia as well as to rule out an arrhythmic cause. Clinical data, indications for ILR, interrogation reports, and further management strategies were collected in all 86 patients who received ILR from June 1999 to April 2008 at the University of Iowa Hospitals and Clinics. The indications for ILR were unexplained syncope (76%), palpitations (14%), and presyncope or dizziness (10%).

Results: During a mean follow‐up period of 10 ± 7 months, 53 patients (62%) had recurrent symptoms after ILR placement with the mean time to recurrence of 12 ± 17 weeks. Of these, an arrhythmic diagnosis was established in 12 patients (14%). Forty‐one patients (48%) did not have any arrhythmia during their symptoms. These patients were discharged from the electrophysiology clinic. Thirty‐three patients (38%) did not have any symptoms following ILR placement. Out of these, device was explanted in 10 patients, while the rest are still being followed.

Conclusions: In patients with potentially arrhythmic symptoms, ILR plays an important role not only in diagnosing an arrhythmia, but also to rule out an arrhythmic cause.
Left Ventricular Ejection Fraction as Criterion for Implantation of an Implantable Cardioverter‐Defibrillator in Heart Failure Patients Undergoing Surgical Left Ventricular Reconstruction
Authors: MOLLEMA SJOERD A. , KLEIN PATRICK , HEERSCHE JOGIEN , SCHALIJ MARTIN J. , VAN DER WALL ERNST E. , VERSTEEGH MICHEL I.M. , KLAUTZ ROBERT J.M. , VAN ERVEN LIESELOT , BAX JEROEN J.
Published: July 2009

Background: Besides implantation of an implantable cardioverter‐defibrillator (ICD), a proportion of patients with left ventricular (LV) dysfunction due to ischemic cardiomyopathy are potential candidates for surgical LV reconstruction (Dor procedure), which changes LV ejection fraction (LVEF) considerably. In these patients, LVEF as selection criterium for ICD implantation may be difficult. This study aimed to determine the value of LVEF as criterium for ICD implantation in heart failure patients undergoing surgical LV reconstruction.

Methods: Consecutive patients with end‐stage heart failure who underwent ICD implantation and LV reconstruction were evaluated. During admission, two‐dimensional (2D) echocardiography (LV volumes and LVEF) was performed before surgery and was repeated at 3 months after surgery. Over a median follow‐up of 18 months, the incidence of ICD therapy was evaluated.

Results: The study population consisted of 37 patients (59 ± 11 years). At baseline, mean LVEF was 23 ± 5%. Mean left ventricular end‐systolic volume (LVESV) and left ventricular end‐diastolic volume (LVEDV) were 175 ± 73 mL and 225 ± 88 mL, respectively. At 3‐month follow‐up, mean LVEF was 41 ± 9% (P < 0.0001 vs. baseline), and mean LVESV and LVEDV were 108 ± 65 mL and 176 ± 73 mL, respectively (P < 0.0001 vs. baseline). During 18‐month follow‐up, 12 (32%) patients had ventricular arrhythmias, resulting in appropriate ICD therapy. No significant relations existed between baseline LVEF (P = 0.77), LVEF at 3‐month follow‐up (P = 0.34), change in LVEF from baseline to 3‐month follow‐up (P = 0.28), and the occurrence of ICD therapy during 18‐month follow‐up.

Conclusion: LVEF before and after surgical LV reconstruction is of limited use as criterium for ICD implantation in patients with end‐stage heart failure.
A Case of Cardiomyopathy Induced by Inappropriate Sinus Tachycardia and Cured by Ivabradine
Authors: WINUM PIERRE‐FRANCOIS , CAYLA GUILLAUME , RUBINI MADELEINE , BECK LIONEL , MESSNER‐PELLENC PATRICK
Published: July 2009

We present the case of a 67‐year‐old woman with cardiomyopathy induced by inappropriate sinus tachycardia (IST) and a particularly high average heart rate. The patient was resistant and/or intolerant to treatment with conventional rate‐slowing medications. We used ivabradine—a specific sinus node If current inhibitor—and successfully lowered the heart rate (33 beats per minute mean heart rate decrease). Symptoms, systolic function, and heart rate variability parameters recovered dramatically. No side effect was noted. We suggest that ivabradine—evaluated in trials to treat stable angina—should be considered as a second‐line treatment in patients with very symptomatic and refractory IST.
An Unusual Cause of Asystole during a Routine Pacemaker Generator Change
Authors: CAN ILKNUR , THOLAKANAHALLI VENKAT , LI JIAN‐MING
Published: July 2009

A 74‐year‐old pacemaker‐dependent male patient, who underwent a pacemaker generator change due to elective replacement indicator, had a 4‐second pause during interrogation of the new pacemaker generator out of the device pocket due to a specific feature that was programmed on called“enhanced transtelephonic monitoring.”
Compensatory Accessory Pathway for Complete Atrioventricular Block: 28‐Year Follow‐Up
Authors: SACHER FRÉDÉRIC , DOUARD HERVÉ , WRIGHT MATTHEW , VIRCOULON BERNARD , BROUSTET JEAN‐PAUL
Published: July 2009

We report a case of atrioventricular (AV) block diagnosed 28 years ago compensated by a functional accessory pathway. During follow‐up, the accessory pathway conduction properties at rest deteriorated while the refractory properties were unchanged. At 46 years, the patient became symptomatic from bradycardia and a dual‐chamber pacemaker was implanted. Although rare, concealed AV block due to an accessory pathway has to be recognized before radiofrequency ablation.
Utility of Noninvasive, Mobile, Continuous Outpatient Rhythm Monitoring to Diagnose Seizure‐Related Arrhythmias
Authors: DRIVER KEVIN , GILLIAM FRANK , DIZON JOSE , WHANG WILLIAM , EHLERT FREDERICK , HICKEY KATHLEEN , GARAN HASAN , BIVIANO ANGELO B.
Published: July 2009

The identification of patients with a diagnosis of seizure disorder who are also at risk for clinically significant bradycardia and/or tachycardia may require long‐term cardiac rhythm monitoring. Noninvasive, continuous, outpatient cardiac rhythm monitoring may be useful for such clinical scenarios. The study group consisted of two male patients with a history of seizure disorder involving loss of consciousness. Clinical data and results of electrocardiography, echocardiography, electroencephelography, and continuous, mobile, outpatient cardiac rhythm monitoring are described. In the first patient, while cardiac bradyarrhythmias were secondary to seizures, sinus arrest most likely complicated the episodes by leading to more prolonged states of unconsciousness. In the second patient, permanent pacemaker implantation for AV block averted all clinical events previously attributed to seizures. Despite the different causal relationships between seizures and bradyarrhythmias in these two patients, mobile, cardiac outpatient telemetry was successful in diagnosing the contribution of cardiac dysrhythmia, leading to permanent pacemaker implantation. A diagnostic strategy that incorporates mobile, noninvasive, continuous, outpatient cardiac rhythm monitoring can effectively be utilized to diagnose significant seizure‐related arrhythmias.
Monomorphic Ventricular Tachycardia Caused by Electrocautery during Pacemaker Generator Change in a Patient with Normal Left Ventricular Function
Authors: GOEL ANIL K. , KOROTKIN STEVEN , WALSH DANIEL , BESS MARIANNE , FRAWLEY SUSAN
Published: July 2009

Pacemaker generator replacement is a simple procedure that is mostly done on outpatient basis. Electrocautery is almost universally used for bleeding control and tissue dissection. Ventricular fibrillation (VF) caused by electrocautery in these procedures is a very uncommon occurrence and an underappreciated possibility with modern day devices. We report a case of monomorphic ventricular tachycardia induced by electrocautery in a patient with normal left ventricular ejection fraction during elective pacemaker generator change.
Overcoming Electromagnetic Interference by LVADs on ICD Function by Shielding the ICD Programmer Wand and Extension Cable
Authors: BIVIANO ANGELO , MANCINI DONNA , NAKA YOSHIFUMI , ARELLANO JERRY , GARAN HASAN
Published: July 2009

Patients with end‐stage cardiomyopathy and congestive heart failure are increasingly undergoing implantation with left ventricular assist devices (LVADs). In addition, implantable cardioverter‐defibrillator (ICD) therapy has been proven to be an important part of the treatment for cardiomyopathy/congestive heart failure. Previous reports have noted a potential and dramatic electromagnetic interference from LVADs on ICDs that cause impaired telemetry communication between the ICD and ICD programmer. Such interference has necessitated explantation and generator replacement in order to resume communication between the ICD and programmer. We report two patients with advanced congestive heart failure and ICD programming impairment caused by a HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA, USA) that was overcome by placing aluminum shielding around the ICD programmer wand and steel shielding around the extension cable during ICD interrogation.
Increased expression of focal adhesion kinase correlates with cellular proliferation and apoptosis during 4‐nitroquinoline‐1‐oxide‐induced rat tongue carcinogenesis
Authors: Xia Juan , Lv Na , Hong Yun , Li Chunyang , Tao Xiaoan , Chen Xiaohua , Cheng Bin
Published: July 2009

Background:  Oral carcinogenesis is a multistep process and requires accumulation and interplay of a series of molecular genetic events. Focal adhesion kinase (FAK) is a non‐receptor tyrosine kinase that plays an important role in signalling pathways that are initiated at sites of integrin‐mediated cell adhesions and by growth factor receptors. Overexpression of FAK has been linked to oral squamous cell carcinoma (OSCC). So, it is hypothesized that FAK expression might contribute to oral carcinogenesis.

Methods:  During 4‐nitroquinoline‐1‐oxide‐induced rat tongue carcinogenesis, FAK protein expression, proliferating cell nuclear antigen (PCNA) and apoptotic nuclei (TUNEL assay) were examined by means of immunohistochemistry.

Results:  Along with the progress of multistage carcinogenesis, FAK expression increased significantly among different histopathological groups with normal mucosa, mild‐dysplastic epithelia, moderate‐dysplastic epithelia, severe‐dysplastic epithelia and in turn OSCC. Furthermore, FAK immunohistochemical index and PCNA‐labelling index displayed positive correlation (r = 0.946, P < 0.05), while negative associations were revealed between apoptotic index and final FAK index (r = −0.959, P < 0.05).

Conclusion:  Our results implicated a role for FAK in oral carcinogenesis. Inhibition of FAK might be a potential novel treatment strategy in this disease.
Expression of cytokeratin 17 mRNA in oral squamous cell carcinoma cells obtained by brush biopsy: preliminary results
Authors: Toyoshima T. , Koch F. , Kaemmerer P. , Vairaktaris E. , Al‐Nawas B. , Wagner W.
Published: July 2009

Background:  The aim of this study was to determine the detection of cytokeratin (CK) mRNA in oral squamous cell carcinoma (OSCC) cells and to evaluate the CK relevance for OSCC diagnosis in a brush biopsy test.

Methods:  Fifty‐two pairs of OSCC cells and normal oral mucosal cells were obtained by brush biopsy from OSCC patients. mRNA was extracted from cell pellets for real‐time quantitative reverse transcriptase polymerase chain reaction (RT‐qPCR). The over‐expression levels of CK 17, CK 19 and CK 20 mRNA in OSCC cells were examined by SYBR green real‐time RT‐qPCR.

Results:  Compared to normal mucosal cells, the over‐expression of CK 17 mRNA was detectable in 40 OSCC cells (76.9%), that of CK 19 mRNA in 19 (36.5%), while that of CK 20 mRNA was not detectable. Compared with CK 19, the mean value of CK 17 mRNA expression level was significantly higher in all 52 patients (P < 0.02). Moreover, the value of CK 17 was significantly higher in T1 and T2 OSCC patients (P < 0.03, respectively), in patients without metastases of neck lymph nodes (P < 0.04), in stage I and stage II patients (P < 0.03 and P < 0.05, respectively) and in well differentiated OSCC patients (P < 0.05).

Conclusion:  Brush biopsy properly serves for detection of CK mRNA using real‐time RT‐qPCR. This preliminary study demonstrates the CK 17 possibility for application; however, pivotal studies are encouraged to confirm CK 17 as a diagnostic marker of OSCC in a brush biopsy test.
The Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints
Authors: Shiboski C. H. , Patton L. L. , Webster‐Cyriaque J. Y. , Greenspan D. , Traboulsi R. S. , Ghannoum M. , Jurevic R. , Phelan J. A. , Reznik D. , Greenspan J. S. ,   The Oral HIV/AIDS Research Alliance, Subcommittee of the AIDS Clinical Trial Group
Published: July 2009

The Oral HIV/AIDS Research Alliance (OHARA) is part of the AIDS Clinical Trials Group (ACTG), the largest HIV clinical trials organization in the world. Its main objective is to investigate oral complications associated with HIV/AIDS as the epidemic is evolving, in particular, the effects of antiretrovirals on oral mucosal lesion development and associated fungal and viral pathogens. The OHARA infrastructure comprises: the Epidemiologic Research Unit (at the University of California San Francisco), the Medical Mycology Unit (at Case Western Reserve University) and the Virology/Specimen Banking Unit (at the University of North Carolina). The team includes dentists, physicians, virologists, mycologists, immunologists, epidemiologists and statisticians. Observational studies and clinical trials are being implemented at ACTG‐affiliated sites in the US and resource‐poor countries. Many studies have shared end‐points, which include oral diseases known to be associated with HIV/AIDS measured by trained and calibrated ACTG study nurses. In preparation for future protocols, we have updated existing diagnostic criteria of the oral manifestations of HIV published in 1992 and 1993. The proposed case definitions are designed to be used in large‐scale epidemiologic studies and clinical trials, in both US and resource‐poor settings, where diagnoses may be made by non‐dental healthcare providers. The objective of this article is to present updated case definitions for HIV‐related oral diseases that will be used to measure standardized clinical end‐points in OHARA studies, and that can be used by any investigator outside of OHARA/ACTG conducting clinical research that pertains to these end‐points.
Peroxiredoxin I is overexpressed in oncocytic lesions of salivary glands
Authors: Demasi Ana P. D. , Furuse Cristiane , Altemani Albina , Junqueira José L. C. , Oliveira Paulo R. G. , Araújo Vera C.
Published: July 2009

Background:  Oncocytic lesions, particularly frequent in the salivary glands, are characterized by cells with an atypical accumulation of mitochondria. This accumulation has been recognized as a compensatory mechanism to intrinsic functional defects of these organelles, resulting in energy production impairment and increased generation of reactive oxygen species (ROS), including hydrogen peroxide (H2O2). Peroxiredoxin I (Prx I) is a H2O2 scavenging protein and the expression of its yeast homolog was reported to be influenced by mitochondrial function.

Methods:  In this study, we evaluated Prx I expression in oncocytic lesions of salivary glands by immunohistochemistry.

Results:  Our results showed that Prx I is overexpressed in oncocytes regardless of the salivary gland lesion where they appear.

Conclusions:  These results suggest that Prx I expression in oncocytes is related to its ability to decompose mitochondrial‐derived H2O2 and that it could provide to the cells a protective role in an environment that, by continuously producing potential DNA‐damaging ROS, predisposes to genome instability and cellular transformation.
Nuclear BCL10 in primary Sjögren’s syndrome
Authors: Gatumu Margaret K. , Jonsson Malin V. , Øijordsbakken Gunnvor , Skarstein Kathrine
Published: July 2009

Background:  The events following triggering of antigen receptors and subsequent activation of the transcription factor nuclear factor kappa B (NFκB) need to be carefully controlled to prevent abnormal immune responses. BCL10 links the antigen receptor to NFκB. The aim of this study was to determine the expression pattern of BCL10 and NFκB in minor salivary gland infiltrates of patients with primary Sjögren’s syndrome (pSS).

Methods:  Minor salivary glands from patients with primary SS (n = 17) and sicca controls (n = 4) were evaluated by single and double immunohistochemistry and immunofluorescence for confocal microscopy. BCL10 and NFκB‐p65 expression were evaluated in the infiltrating lymphocytes. Ectopic germinal centers (GCs) were investigated by CD21. Tonsil, lymph node and lymphoma tissue were used as positive controls.

Results:  BCL10 nuclear positive cells were observed in focal lymphocytic infiltrates in the investigated minor salivary glands and were not restricted to patients with ectopic GCs. By double‐staining, some of the BCL10 nuclear positive cells were identified as B cells. There was, however, no constitutive activation of NFκB as depicted by the exclusive cytoplasmic expression of p65 in the infiltrating lymphocytes in the pSS.

Conclusion:  Nuclear expression of BCL10 in infiltrating lymphocytes was a common occurrence in pSS minor salivary glands indicating it as a possible marker of autoimmune induced chronic inflammation. There was, however, no constitutive activation of NFκB.
Loss of maspin is a negative prognostic factor for invasion and metastasis in oral squamous cell carcinoma
Authors: Yoshizawa Kunio , Nozaki Shinichi , Okamune Ayako , Kitahara Hiroko , Ohara Teruhisa , Kato Koroku , Kawashiri Shuichi , Yamamoto Etsuhide
Published: July 2009

Objective:  Maspin, a 42‐kDa protein, belongs to the serpin family of protease inhibitors and is known to have tumor‐suppressor function. In this study, we investigated the interrelationship between clinicopathologic findings and maspin expression in oral squamous cell carcinoma (OSCC).

Methods:  Using immunohistochemical techniques to examine the expression levels of maspin in OSCC, maspin expression in OSCC was detected in 46 (64.8%) of 71 cases. We also compared the clonicopathologic features of OSCC cases with maspin expression levels. Moreover, we examined expression of maspin in eight cell lines derived from OSCC using reverse transcriptase‐polymerase chain reaction (RT‐PCR) and Western blotting.

Results:  There was a significant correlation between decreased maspin expression and T‐category (P < 0.01), lymph metastasis (P < 0.0001), and mode of invasion (P < 0.0001). Patients with positive maspin expression had a significantly better prognosis (P < 0.001). Lower expression of maspin was also seen in cell lines derived from grade 4D, which shows stronger invasive potential than other grades of OSCC.

Conclusion:  Maspin may be a useful marker to identify the potential for progression in OSCC.