bluuebunny/crossref_metadata_2025 huggingface dataset:
Clarithromycin Resistance of Helicobacter pylori Strains Isolated from Children’ Gastric Antrum and Fundus as Assessed by Fluorescent In‐situ Hybridization and Culture on Four‐Sector Agar Plates
Authors: Caristo Elisa , Parola Andrea , Rapa Anna , Vivenza Daniela , Raselli Barbara , Dondi Elena , Boldorini Renzo , Oderda Giuseppina
Published: November 2008

Aim:  To assess validity of culture on four‐sector agar plates and fluorescent in‐situ hybridization (FISH) test, and clarithromycin resistance rate in Helicobacter pylori strains isolated from children in the last 10 years.

Methods:  In the last 5 years, gastric biopsy specimens from antrum and fundus were taken from 89 consecutive children (median age 9 years) with H. pylori gastritis and from 21 controls. Culture was performed on 176 gastric biopsies (89 from antrum, 87 from fundus) on four‐sector agar plates, and FISH test with DNA ProbeMix®. After its validity was evaluated, FISH test was applied on additional 119 biopsies from 68 children (68 from the antrum, 51 from the fundus) stored in the Pathology archive in the previous 5 years.

Results:  Culture was positive in 157 of 176 biopsies (sensitivity: 89.2%, 95% confidence interval (CI) 85–94). In 33 of 89 children (37%) resistant strains were found in one or both gastric sites. FISH test was positive in 148 of 176 biopsies from infected children (sensitivity 84.1%, 95%CI 79–89) and in none of 42 biopsies from controls (specificity 100%). When applied on archive biopsies, FISH test was positive in 96 of 119 (80.7%, 95%CI 74–88). Total children harboring resistant strains in the last 10 years, as assessed by FISH test, were 66 of 157 (42%). Mixed infection with both sensitive and resistant strains were found in 40 children (25%) and in 12 of them resistant strains were in the fundus only.

Conclusions:  Culture on four‐sector agar plates and FISH test had a high sensitivity and specificity and showed co‐presence of sensitive and resistant strains. In one‐third of children with mixed infection, the resistant strains were in the fundus only. Clarithromycin resistance should be assessed in biopsies both from the antrum and the fundus, utilizing antral biopsies only can underestimate its prevalence.
Effect of CYP2C19 Genetic Polymorphisms on the Efficacy of Proton Pump Inhibitor‐Based Triple Therapy for Helicobacter pylori Eradication: A Meta‐Analysis
Authors: Zhao Fujun , Wang Jing , Yang Yanmei , Wang Xiaoyong , Shi Ruihua , Xu Zekuan , Huang Zuhu , Zhang Guoxin
Published: November 2008

Objective: CYP2C19 polymorphisms have been inconsistently reported to associate with the efficacy of proton pump inhibitor (PPI)‐based triple therapies for eradicating Helicobacter pylori infection. The aim of this meta‐analysis was to determine whether CYP2C19 polymorphism affect H. pylori eradication rates obtained with first‐line PPI‐based triple therapies.

Methods: A systematic literature search was conducted up to July 2007 using Medline, PubMed, EMBase, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, CNKI (Chinese), and Wanfang (Chinese) digital database. MeSH terms and keywords included proton pump inhibitor, omeprazole, lansoprazole, rabeprazole, pantoprazole, or esomeprazole, cytochromeP4502C19 or CYP2C19, and Helicobacter pylori or H. pylori. Twenty articles met the inclusion criteria, and were included in the meta‐analysis by using Review Manager 4.2.8.

Results: Eradication rates were significantly different between poor metabolizers (PM) and heterozygous extensive metabolizers (HetEM) (odds ratio (OR) = 1.73, p = .002) and between PM and homozygous extensive metabolizers (HomEM) (OR = 2.79, p < .0001). Moreover, eradication rates were also significant difference between HetEM and HomEM (OR = 2.00, p < .0001). Triple omeprazole and lansoprazole therapies achieved higher H. pylori eradication rates in PM than in HomEM (OR = 4.28, p = .0005 for omeprazole and OR = 3.06, p = .001 for lansoprazole), and higher in HetEM than those in HomEM (OR = 3.22, p < .0001 for omeprazole and OR = 1.95, p = .040 for lansoprazole). Rabeprazole therapies had no significant effect on H. pylori eradication rates (between PM and HomEM, OR = 1.35, p = .610 and between HetEM and HomEM, OR = 1.57, p = .190). No significant difference in H. pylori eradication rates between PM and HetEM was observed in the three individual PPI therapies.

Conclusion: The efficacy of omeprazole‐ and lansoprazole‐based first‐line triple therapies at the standard doses is dependent on CYP2C19 genotype status, which appears not to affect the efficacy of the regimens including rabeprazole.
Muc1 Limits Helicobacter felis Binding to Gastric Epithelial Cells But Does not Limit Colonization and Gastric Pathology Following Infection
Authors: Every Alison L. , Chionh Yok‐Teng , Skene Caroline D. , McGuckin Michael A. , Sutton Philip
Published: November 2008

Background:  The mucin Muc1 is constitutively expressed by the gastric mucosa and is likely the first point of direct contact between the host stomach and the adherent pathogens. The expression of Muc1 has been shown to limit colonization of mice by Helicobacter pylori, known to adhere to the gastric epithelium, as well as associated pathology. However, the potential role of this mucin against nonadherent Helicobacter has not been previously studied. We therefore examined the importance of Muc1 on the pathogenesis of Helicobacter felis, believed not to adhere to the murine mucosa.

Methods and results:  Using primary cell cultures, we found that H. felis can bind gastric epithelial cells in vitro, and adherence to epithelial cells deficient in Muc1 was increased compared to controls that expressed the mucin. However, following infection of deficient mice, we found that Muc1 did not impact on H. felis colonization or pathogenesis in vivo, in contrast to previous observations with H. pylori.

Conclusions:  This demonstrates a variable effect of Muc1 on protection against closely related adherent and nonadherent Helicobacter species, and supports a key role for Muc1 in limiting attachment of adherent bacteria to the gastric mucosal surface.
Helicobacter pylori Eradication Therapy May Facilitate Gastric Ulcer Healing After Endoscopic Mucosal Resection: A Prospective Randomized Study
Authors: Cheon Jae Hee , Kim Jie‐Hyun , Lee Sang Kil , Kim Tae Il , Kim Won Ho , Lee Yong Chan
Published: November 2008

Background and Aim:  It remains unclear whether Helicobacter pylori eradication therapy affects the healing rate of iatrogenic ulcers following endoscopic mucosal resection (EMR) for gastric tumors. The aim of our study was to prospectively evaluate the effect of H. pylori eradication therapy on gastric ulcer healing after EMR.

Methods:  After EMR, patients were randomly assigned to either the H. pylori eradication group (Hp group) (lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice a day for 7 days) or the noneradication group (proton pump inhibitor, PPI group) (lansoprazole 30 mg, twice a day for 7 days). Four weeks after EMR, the ulcer stages and size were compared between the two groups. Moreover, ulcer‐related symptoms, bleeding rates, adverse effects, and drug compliance were compared.

Results:  A total of 64 patients were enrolled. Of these, 17 patients were excluded from the study. The two groups were comparable in terms of baseline clinicopathologic characteristics. Four weeks after EMR, the two groups did not differ with respect to ulcer stage (p = .475) or ulcer‐related symptoms (p = .399). However, the ulcer reduction ratio was significantly higher in the Hp group (0.028 ± 0.024 vs. 0.065 ± 0.055, p < .05). No differences were observed between the two groups with regard to drug compliance, adverse drug event rates, or bleeding rates.

Conclusions:  Our results suggest that H. pylori eradication therapy might improve the ulcer healing rate after EMR.
Directors' Ownership in the U.S. Mutual Fund Industry
Authors: CHEN QI , GOLDSTEIN ITAY , JIANG WEI
Published: November 2008

This paper empirically investigates directors' ownership in the mutual fund industry. Our results show that, contrary to anecdotal evidence, a significant portion of directors hold shares in the funds they oversee. Ownership patterns are broadly consistent with an optimal contracting equilibrium. That is, ownership is positively and significantly correlated with most variables that are predicted to indicate greater value from directors' monitoring. For example, directors' ownership is more prevalent in actively managed funds and in funds with lower institutional ownership. We also show considerable heterogeneity in ownership across fund families, suggesting family‐wide policies play an important role.
Overconfidence, CEO Selection, and Corporate Governance
Authors: GOEL ANAND M. , THAKOR ANJAN V.
Published: November 2008

We develop a model that shows that an overconfident manager, who sometimes makes value‐destroying investments, has a higher likelihood than a rational manager of being deliberately promoted to CEO under value‐maximizing corporate governance. Moreover, a risk‐averse CEO's overconfidence enhances firm value up to a point, but the effect is nonmonotonic and differs from that of lower risk aversion. Overconfident CEOs also underinvest in information production. The board fires both excessively diffident and excessively overconfident CEOs. Finally, Sarbanes‐Oxley is predicted to improve the precision of information provided to investors, but to reduce project investment.
How and When Do Firms Adjust Their Capital Structures toward Targets?
Authors: BYOUN SOKU
Published: November 2008

If firms adjust their capital structures toward targets, and if there are adverse selection costs associated with asymmetric information, how and when do firms adjust their capital structures? We suggest a financing needs‐induced adjustment framework to examine the dynamic process by which firms adjust their capital structures. We find that most adjustments occur when firms have above‐target (below‐target) debt with a financial surplus (deficit). These results suggest that firms move toward the target capital structure when they face a financial deficit/surplus—but not in the manner hypothesized by the traditional pecking order theory.
Clinical Results of Far‐Field R‐Wave Reduction with a Short Tip‐Ring Electrode
Authors: DE GROOT JORIS R. , SCHROEDER‐TANKA JUTTA M. , VISSER JAAP , WILLEMS ALBERT R. , DE VOOGT WILLEM G.
Published: November 2008

Background: Far‐field R‐wave (FFRW) sensing of the atrial lead of AAI or DDD pacemakers causes incorrect mode switches and remains a problem in patients with atrial arrhythmias in whom low voltage sensing is essential. We studied a pacing electrode with a short tip‐ring distance (1.1 mm). We compared our findings with recordings from a conventional electrode with a larger tip‐ring distance (10 mm).

Methods: Thirty‐six consecutive patients with an indication for DDD pacing were implanted with the short tip‐ring electrode. Another 23 patients received the conventional electrode. FFRW and P‐wave amplitudes during pacing and intrinsic ventricular depolarization were measured at implantation. Measurements were repeated before hospital discharge and at follow‐up between 10 and 14 days after implantation.

Results: P‐wave amplitude was slightly smaller in the short tip‐ring group (2.71 ± 1.04 vs 3.17 ± 1.30 mV in the conventional group, respectively, P = NS). All P‐waves exceeded 1.2 mV. FFRW during pacing was 0.07 ± 0.05 in the short tip‐ring group and 0.54 ± 0.32 mV in the conventional group (P < 0.001). FFRW during intrinsic rhythm was 0.08 ± 0.04 and 0.55 ± 0.31 mV, respectively (P < 0.001). The ratio between P‐wave and FFRW was 48.6 ± 27.2 in the short tip‐ring group and 7.3 ± 4.4 in the conventional group (P < 0.001). FFRW and P‐wave amplitudes did not change at hospital discharge or during follow‐up.

Conclusion: FFRW can be suppressed without compromising P‐wave sensing by using a pacing electrode with a short tip‐ring distance. Whether reduced FFRW amplitude results in clinical endpoints remains to be determined.
Hemodynamic Parameters and Heart Rate Variability during a Tilt Test in Relation to Gene Polymorphism of Renin‐Angiotensin and Serotonin System
Authors: MITRO PETER , MUDRÁKOVÁ KLAUDIA , MIČKOVÁ HELENA , DUDÁŠ JÁN , KIRSCH PETER , VALOČIK GABRIEL
Published: November 2008

Purpose: The aim of the study was to evaluate the renin‐angiotensin system and serotonin transporter gene polymorphisms in relation to hemodynamic parameters and heart rate variability during a head‐up tilt test (HUT) in patients with vasovagal syncope.

Methods: DNA was collected from 191 patients (mean age 44 ± 18 years, 61 men, 130 women). The following gene polymorphisms were determined in genomic DNA: angiotensin‐converting enzyme insertion/deletion polymorphism (I/D ACE), angiotensinogen gene polymorphism (M 235), angiotensin II receptor type 1 (ATR1) polymorphism (A 11666C), and polymorphism of serotonin transporter gene (5HTTLPR).
Heart rate variability during HUT was assessed in 5‐minute intervals by low frequency, high frequency, standard deviation of the normal‐to‐normal (SDNN), and root mean square successive difference parameters.

Results: AA genotype of A 1166C polymorphism was associated with lower minimal systolic blood pressure (SBP) and diastolic blood pressure (DBP) during HUT compared with other genotypes (minimal SBP: AA 59.6 ± 21,8, AC 79.9 ± 22.7, CC 65.4 ± 22.7 mmHg, P = 0.007), (minimal DBP: AA 36.4 ± 22.7, AC 52.3 ± 22.9, CC 45.4 ± 19.5 mmHg, P = 0.007).
AA genotype was also associated with higher SDNN compared to other genotypes in the early phase of HUT (SDNN in 5 minutes of tilt: AA 59.7 ± 24.6, AC 50.6 ± 20.6, CC 46.0 ± 13.2, P = 0.01) and at syncope occurrence (SDNN: AA 71.0 ± 20.9, AC 58.2 ± 17.9, CC 58 ± 10, P = 0.04)

Conclusion: AA genotype of A 1166C polymorphism in the ATR1 gene may be associated with hypotension and decline in sympathetic tone during HUT. Its role in genetic predisposition to vasovagal syncope cannot be excluded.
Acute and Chronic Pulmonary Vein Reconnection after Atrial Fibrillation Ablation: A Prospective Characterization of Anatomical Sites
Authors: RAJAPPAN KIM , KISTLER PETER M. , EARLEY MARK J. , THOMAS GLYN , IZQUIERDO MAITE , SPORTON SIMON C. , SCHILLING RICHARD J.
Published: November 2008

Background:

Arrhythmia recurrence after atrial fibrillation (AF) ablation is often associated with pulmonary vein reconnection (PVR). We prospectively examined anatomical sites of both acute and chronic PVR.

Methods:

One hundred and fifty AF patients underwent PV wide encirclement and sites where immediate electrical isolation (EI) occurred were tagged using electroanatomic mapping/CT integration (Cartomerge™, Biosense Webster, Diamond Bar, CA, USA). After 30 minutes PVs were checked and acute PVR sites marked at reisolation. Chronic PVR sites were marked at the time of repeat procedures.

Results:

On the left, immediate EI sites were predominantly on the intervenous ridge (IVR) and PV‐left atrial appendage (PV‐LAA) ridge. On the right they were at the roof, IVR, and floor of the PVs. Ninety‐eight of one hundred and fifty patients had PVs checked after >30 minutes. Thirty‐two of ninety‐eight had acute PVR. This was mostly on the IVR and PV‐LAA ridge on the left (88%), and on the roof and IVR on the right (78%). At repeat procedure, 38/39 patients had chronic PVR, predominantly on the IVR (61%) and PV‐LAA ridge (21%) on the left, and on the roof, IVR, and floor of the right PVs (79%). There was minimal acute or chronic PVR posteriorly. Acutely PVR occurred close to the immediate EI site 60% of the time, but only 30% of the time chronically.

Conclusion:

Acute and chronic PVR sites have a preferential distribution. This may be determined by anatomical and technical factors. Knowledge of immediate EI sites may be beneficial acutely, but with chronic PVR a careful survey is required. These findings may help target ablation, improving safety and success.
Application of a Clinical Magnet over Implantable Cardioverter Defibrillators: Is It Safe and Useful?
Authors: PORRES JOSÉ M. , LAVIÑETA EDURNE , REVIEJO CARLOS , BRUGADA JOSEP
Published: November 2008

The growing number of implantable cardioverter defibrillator (ICD) implants mean that a high number of patients carrying these devices are attended by physicians. In an attempt to simplify their management, articles have been published on the safety of applying magnets to the ICD in order to avoid the administration of shocks during surgery. However, performance of these procedures without the supervision of expert personnel can be accompanied by serious and potentially fatal complications. We report a case where the use of a clinic magnet over an ICD caused it to switch to “end of life” in the battery indicator and lose some antitachycardia therapies.
Atrial Lead Dysfunction: An Unusual Feature of Hypothyroidism
Authors: PATTON KRISTEN K. , LEVY MATTHEW , VISWANATHAN MOHAN
Published: November 2008

Hypothyroidism is known to have a multitude of cardiac electrophysiologic effects, including bradycardia, atrioventricular block, prolonged QT interval, and elevated ventricular pacing thresholds. We report the case of a 36‐year‐old woman who presented with isolated dysfunction of her atrial pacemaker lead, which reversed with thyroid hormone replacement.
Extraction of Chronic Pacing Lead and Angioplasty for Complete Superior Baffle Obstruction in Complex Congenital Heart Disease
Authors: SADAGOPAN SHANKAR N. , VELDTMAN GRUSCHEN R , ROBERTS PAUL R.
Published: November 2008

Laser lead extraction in adult patients with congenital heart disease is safe and effective. Baffle angioplasty for obstruction in patients with a Mustard procedure is well established. We describe a unique combined interventional and electrophysiological approach on a patient with superior baffle obstruction. This technique utilized the channel created after extracting the chronic pacing lead to cross the obstruction and stent angioplasty of the superior baffle.
Pacing‐Induced Electromechanical Ventricular Dyssynchrony Does Not Acutely Influence Right Ventricular Function and Global Hemodynamics in Children with Normal Hearts
Authors: FRIEDBERG MARK K. , DUBIN ANNE M. , VAN HARE GEORGE F. , McDANIEL GEORGE M. , NIKSCH ALISA , ROSENTHAL DAVID N.
Published: November 2008

Background:
Right ventricular (RV) pacing may be detrimental to ventricular function. However, the acute effects of electromechanical dyssynchrony on RV function are not well characterized in children. We studied acute effects of electromechanical dyssynchrony, induced by RV apical and RV outflow pacing, in children with normal hearts, evaluating electromechanical synchrony, hemodynamic response, and RV function.

Methods:
Seventeen children (mean ± SD, 12 ± 4 years) with normal cardiac structure/function were paced after accessory pathway ablation, at baseline (AOO), and with AV pacing (DOO) from the RV apex and RV outflow. QRS duration was determined from surface ECG. Intra‐ and interventricular mechanical dyssynchrony and regional ventricular function were determined using tissue Doppler imaging. Global RV systolic and diastolic functions were assessed by RV dP/dTmax and RV dP/dTneg using pressure‐tipped transducers. Regional RV function was assessed by tissue Doppler imaging. Cardiac index (CI) and blood pressures were measured.

Results:
RV apical and outflow pacing induced significant electromechanical dyssynchrony manifested by lengthening of the QRS duration, increased LV intraventricular delay (49 ± 34 ms, 53 ± 43 ms, respectively, P < 0.001), and increased interventricular delay (60 ± 29 ms, 55 ± 37 ms, P < 0.0001) versus AOO pacing. However, there was no change in blood pressure, CI, RV dp/dTmax, RV dP/dTneg, or regional tissue Doppler velocities, indicating preserved hemodynamics and preserved global and regional RV systolic and diastolic function.

Conclusions:
In children with normal cardiac function and structure, pacing‐induced electromechanical dyssynchrony did not acutely affect RV systolic and diastolic function and did not acutely alter global hemodynamics. Therefore, electromechanical dyssynchrony may only be an important therapeutic target in the setting of decreased RV function.
Noninvasive Mapping of Human Atrial Fibrillation
Authors: GUILLEM MARIA S. , CLIMENT ANDREU M. , CASTELLS FRANCISCO , HUSSER DANIELA , MILLET JOSE , ARYA ARASH , PIORKOWSKI CHRISTOPHER , BOLLMANN ANDREAS
Published: November 2008

Introduction:
Invasive high‐density mapping of atrial fibrillation (AF) has revealed different patterns of atrial activation ranging from single wavefronts to disorganized activation with multiple simultaneous wavefronts. Whether or not similar activation patterns can also be observed using body surface recordings is currently unknown, and was consequently evaluated in this study.

Methods and Results:
Surface electrocardiographic mapping was performed in 14 patients (age 68 ± 14 years) with persistent AF (AF duration 12 ± 18 months). A total of 56 electrocardiographic leads were placed on the chest over the atria on the front (n = 40) and on the back (n = 16). Using 240‐second recordings, wavefront propagation maps were automatically computed and visually classified as either type I (single wavefront), II (single wavefront with wave breakages and splitting), or III (multiple simultaneous wavefronts). Almost half of the patients (n = 6) presented most predominantly type III atrial activation, while six patients mostly presented type I activation. The rest of the patients (n = 2) presented mixed type I and type III activations. This classification showed to be highly reproducible over 4 minutes.

Conclusions:
Using electrocardiographic body surface mapping during AF, interindividual differences of atrial fibrillatory activation can be observed. The surface activation pattern during AF shows an excellent short‐term reproducibility.
Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery Disease
Authors: Innocenti Francesca , Caldi Francesca , Tassinari Irene , Agresti Chiara , Burgisser Costanza , Fattirolli Francesco , Baldereschi Giorgio Jacopo , Marchionni Niccolò , Masotti Giulio , Pini Riccardo
Published: November 2008

Background: The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). Methods: The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged ≥75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all‐cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). Results: During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 ± 1.6 METs in G1 vs. 5 ± 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351–0.914, P = 0.020) was associated with higher mortality, while a high‐dose WMSI >2 (HR 5.123, CI 1.559–16.833, P = 0.007), viability (HR 3.354, CI 1.162–9.678, P = 0.025), and nonprescription of beta‐blockers (HR 0.328, CI 0.114–0.945, P = 0.039) predicted hard cardiac events. Conclusion: In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE.
Global Longitudinal Cardiac Strain and Strain Rate for Assessment of Fetal Cardiac Function: Novel Experience with Velocity Vector Imaging
Authors: Barker Piers C.A. , Houle Helene , Li Jennifer S. , Miller Stephen , Herlong James Rene , Camitta Michael G.W.
Published: November 2008

Background: Cardiac strain and strain rate are new methods to quantitate fetal cardiac function. Doppler‐based techniques are regional measurements limited by angle of insonation. Newer feature‐tracking algorithms permit angle independent measurements from two‐dimensional datasets. This report describes the novel measurement of global strain, strain rate, and velocity using Velocity Vector Imaging (VVI) in a group of fetuses with and without heart disease. Methods: Global and segmental longitudinal measurements were performed on the right and left ventricles in 33 normal fetuses and 15 fetuses with heart disease. Segmental measurements were compared to global measurements. Clinical outcome data were recorded for fetuses with heart disease. Results: Forty‐eight fetuses were evaluated with VVI. Cardiac strain and strain rate in normal fetuses were similar to normal adult values, but lower than pediatric values (LV strain=−17.7%, strain rate −2.4/sec; RV strain =−18.0%, strain rate −1.9/sec). No difference was present between segmental and global measurements of cardiac strain and strain rate, although basal and apical velocities were significantly different from global velocities for both right and left ventricles. In fetuses with heart disease, lower global cardiac strain appeared to correlate with clinical status, although there was no correlation with visual estimates of cardiac function or outcome. Conclusion: Measurement of global longitudinal cardiac strain and strain rate is possible in fetuses using VVI. Segmental measurements are not significantly different from global measurements; global measurements may be a useful tool to quantitate fetal cardiac function.
Lack of Association between Obesity and Left Ventricular Systolic Dysfunction
Authors: Movahed Mohammad Reza , Saito Yuji
Published: November 2008

Background: Previous studies have demonstrated that obesity is one of the risk factors for congestive heart failure (CHF). By analyzing a large database, we investigated any association between body mass index (BMI) and left ventricular (LV) systolic dysfunction. Methods: We retrospectively analyzed 24,265 echocardiograms performed between 1984 and 1998. Fractional shortening (FS) and BMI were available for 13,382 subjects in this cohort which were used for data analysis. FS was stratified into four groups: (1) FS > 25%, (2) FS 17.5–25%, (3) FS 10–17.5%, and (4) FS < 10%. Furthermore, we also used final diagnosis that was coded by the reading cardiologist as mild, moderate, and severe LV dysfunction separately for data analysis. BMI was divided into four groups: BMI < 18.5 kg/m2 (underweight), 18.5–24.9 kg/m2 (normal), 25–30 kg/m2 (overweight), and >30 kg/m2 (obese). Results: There was no association between different BMI categories and LV systolic function. The prevalence of mild, moderate, or severely decreased LV function (based on FS or subjective interpretation of reading cardiologists) was equally distributed between the groups. Obese patients (BMI > 30%) had normal FS of >25 in 16.9%, mildly decreased FS in 18%, moderately decreased FS in 18.4%, and severely decreased FS in 20.1% P = ns. Conclusion: Our study is consistent with previous trials suggesting that obesity is not related to systolic LV dysfunction. The underlying mechanism for the occurrence of congestive heart failure in obese patients needs further investigation.
High Echogenic Thickening of Proximal Coronary Artery Predicts the Far Advanced Coronary Atherosclerosis
Authors: Choi Yun‐Seok , Youn Ho‐Joong , Park Chul‐Soo , Oh Yong‐Seog , Chung Wook‐Sung , Kim Jae‐Hyung
Published: November 2008

Background: Detection of subclinical, nonobstructive coronary artery disease will require the evaluation of coronary arterial walls and external coronary diameter in order to detect increases in arterial wall thickness and compensatory remodeling before luminal narrowing. We assessed the meaning of high echogenic thickening (HET) on transthoracic coronary echogram of proximal coronary arteries and evaluated whether HET predicts the severity of coronary artery disease on angiogram. Methods: Ninety‐seven patients (M:F = 61:36, mean age = 61±8 years) referred for coronary angiography were included in this study. We detected proximal coronary artery using transthoracic coronary echogram. We defined that HET is more than 1.5 mm in thickness with high echogenicity and persistence. Of these patients, 29 vessels were examined by IVUS (intravascular ultrasound) Results: (1) HET on coronary echogram had a sensitivity of 44.4% and specificity of 95% for identifying calcification on IVUS. (2) HET had a sensitivity of 73.5% and specificity of 85.7% for identifying the significant stenosis of proximal left coronary artery. (3) HET was observed more frequently in three‐vessel diseases and more complex lesion compared to normal and one‐ or two‐vessel diseases (P < 0.05, respectively). Conclusion: HET may be related to the presence of calcification and predicts far advanced coronary atherosclerosis.
Oral Contrast Echocardiography for the Diagnosis of Left Atrial Encroachment
Authors: Bouzas‐Mosquera Alberto , Álvarez‐García Nemesio , Peteiro Jesús , García‐Bueno Lourdes , Castro‐Beiras Alfonso
Published: November 2008

The differential diagnosis of masses encroaching on the left atrium may be challenging. We describe a case in which contrast echocardiography using a carbonated drink provided a rapid and simple way to clarify the diagnosis of an incidental mass causing extrinsic compression of the left atrium. Given its simplicity and availability, we believe that it should be considered as a first line tool for clarifying the diagnosis in cases of echocardiographic evidence of left atrial encroachment of unknown origin.
Dissecting Intramyocardial Hematoma: Clinical Presentation, Pathophysiology, Outcomes and Delineation by Echocardiography
Authors: Vargas‐Barrón Jesús , Roldán Francisco‐Javier , Romero‐Cárdenas Ángel , Molina‐Carrión Marjorie , Vázquez‐Antona Clara‐Andrea , Zabalgoitia Miguel , Rios Marco‐Antonio Martínez , Pérez Julio E.
Published: November 2008

Background: In large necropsy studies dissecting intramyocardial hematoma (DIH) with serpiginous tracts across the myocardial fibers has been reported in both the septum and the left ventricle free wall. Methods: We studied 15 patients admitted to the hospital with acute myocardial infarction (AMI) in which DIH was demonstrated by either transthoracic and/or transesophageal and confirmed intraoperatively or by necropsy. Results: In nine patients the hemorrhagic dissection was predominantly in the septum and in the remaining it was in the free wall of the left ventricle (LV). Myocardial infarction involved the left ventricular inferior wall in two, and the anterior wall in 13 patients. The overall mortality was 47%, and in the group with septal hematoma it reached to 78%. Echocardiography disclosed the various acoustic densities of the evolving intramyocardial hematoma, its extension through the hemorrhagic dissection, its spontaneous reabsorption, as well as its communication with the ventricular cavities. Conclusions: Echocardiography is the method of choice for the noninvasive diagnosis of patients with suspected myocardial rupture and intramyocardial dissection postmyocardial infarction.
Assessment of Mitoxantrone‐Induced Cardiotoxicity in Patients with Multiple Sclerosis: A Tissue Doppler Echocardiographic Analysis
Authors: Pattoneri Paolo , Sozzi Fabiola , Pelà Giovanna , Montanari Enrico , Moruzzi Paolo , Borghetti Alberico , Cappellini Maria Domenica
Published: November 2008

Aim: Tissue Doppler echocardiography was investigated for its applicability in detecting subtle myocardial involvement in multiple sclerosis patients receiving a low dose of mitoxantrone. Methods and Results: Twenty Caucasian patients with multiple sclerosis (mean age 43.9±9.3 years, 12 males and 8 females) treated with mitoxantrone (mean cumulative dose 35.4±21.6 mg/m2), were compared to 20 healthy subjects (mean age 45.4±15.3 years, 11 males and 9 females) matched for age and gender. All subjects underwent conventional and Tissue Doppler echocardiography. Patients with heart failure, life‐threatening arrhythmias, and other prominent manifestations of heart disease were excluded. No differences were observed in blood pressure, heart rate, and conventional systolic and diastolic echocardiographic parameters. At Tissue Doppler echocardiography, patients with multiple sclerosis showed differences of the systolic mechanic expressed by a significant lower S‐wave peak velocity at the lateral site of mitral annulus (11.4±2.5 cm/sec vs. 15.0±4.1 cm/sec, P < 0.02). Such S‐wave peak velocity significantly correlated with a cumulative dose of mitoxantrone (r =−0.37, P < 0.05). Conclusion: Tissue Doppler echocardiography suggests an early involvement of the systolic myocardial function at the low dose of mitoxantrone. Therefore, Tissue Doppler echocardiography may be used as a noninvasive method for monitoring subclinical cardiotoxicity in multiple sclerosis patients receiving mitoxantrone.
Large‐Scale Mechanized Soybean Farmers in Amazônia: New Ways of Experiencing Land
Authors: Adams Ryan Thomas
Published: November 2008

The arrival of mechanized agriculture in the Amazon heralds a new landscape and a novel set of experiences related to the landscape. The social implications of this change are profound. The colonist and Caboclo small‐scale farmers who are being replaced by the expansion of mechanized agriculture had a particular set of relationships with the land, relationships that differ from those found on large‐scale mechanized farms. For mechanized large‐scale farmers, the creation of an idealized agricultural landscape and the way that land use is planned result in a bifurcated experience of place that reinforces the separation of large‐scale farmers from feedbacks related to the local agricultural and environmental conditions.
Aspects in post‐orthodontic removal of Orthosystem® implants
Authors: Nicolas Grognard , Bart Vande Vannet
Published: November 2008

Objectives: Problems encountered in the removal of a temporary anchorage device, such as the Orthosystems implant, specially designed for orthodontic anchorage purposes after insertion at the palatal side of the maxilla, are presented and discussed.

Material and methods: The removal of these osseo‐integrated implants was originally described to be executed by means of bone cutting around the implant with a trephine explanation burr. However, situations can be encountered in which the orthodontic tooth movement resulted in close contact between the implant and neighbouring teeth or the nasal cavity.

Results: Trephine burr bone cutting around the implant can thereby lead to damage of the adjacent tooth with subsequent endodontic problems or perforation of the nasal cavity. In these cases, simple untightening by counterclockwise torque or if unsuccessful, removal of the transmucosal part of the fixture allowing creeping mucosal covering of the implant, should be considered. Furthermore, generation of CT‐scan images performed after completion of active orthodontic therapy, with retraction of the upper anterior teeth, seems to be justified and indicated for planning the appropriate removal procedure.

Conclusion: Retrospectively, the use of the longer version of the Orthosystems implant (6 mm in length) seems to be obsolete when para‐median locations are chosen. Three cases are presented to illustrate these problems.
Oral implants placed in bone defects treated with Bio‐Oss®, Ostim®‐Paste or PerioGlas: an experimental study in the rabbit tibiae
Authors: Carmagnola Daniela , Abati Silvio , Celestino Silvio , Chiapasco Matteo , Bosshardt Dieter , Lang Niklaus P.
Published: November 2008

Objectives: To compare the histological features of bone filled with Bio‐Oss®, Ostim‐Paste® or PerioGlas placed in defects in the rabbit tibiae by evaluating bone tissue composition and the integration of titanium implants placed in the grafted bone.

Material and methods: Two cylindrical bone defects, about 4 mm in diameter and 6 mm in depth, were created in the tibiae of 10 rabbits. The defects were filled with either Bio‐Oss®, PerioGlas, Ostim®‐Paste or left untreated, and covered with a collagen membrane. Six weeks later, one titanium sandblasted and acid‐etched (SLA) implant was inserted at the centre of each previously created defect. The animals were sacrificed after 6 weeks of healing.

Results: Implants placed in bone previously grafted with Bio‐Oss®, PerioGlas or Ostim®‐Paste obtained a larger extent of osseointegration, although not statistically significant, than implants placed in non‐grafted bone. The three grafting materials seemed to perform in a similar way concerning their contribution towards implant osseointegration. All grafting materials appeared to be osteoconductive, thus leading to the formation of bridges of mineralized bone extending from the cortical plate towards the implants surface through the graft scaffold.

Conclusions: Grafting with the above‐mentioned biomaterials did not add any advantage to the osseointegration of titanium SLA implants in a self‐contained defect.
Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation
Authors: Becker Stephan Thomas , Terheyden Hendrik , Steinriede Anja , Behrens Eleonore , Springer Ingo , Wiltfang Jörg
Published: November 2008

Objectives: The aim of this study was to follow 41 intraoperative perforations of the Schneiderian membrane during sinus floor elevation and to identify potential differences from patients without perforations.

Material and methods: Two hundred and one sinus floor elevations were performed at the department of oral and maxillofacial surgery of the University Hospital of Schleswig‐Holstein in the years 2005 and 2006. Forty‐one intraoperative perforations (20.4%) were documented and treated according to the following scheme: defects smaller than 5 mm were covered with a collagen membrane. Larger defects were additionally sutured. Particulated jawbone mixed 50 : 50 with bone substitute (25 cases) and a 50 : 50 mix of particulated iliac crest bone and BioOss® (six cases) mainly served as graft material in the perforation group. In 12 cases, implants were installed at the time of sinus grafting, and in 27 cases, a second operation was performed.

Results: Four sinus lift procedures had to be discontinued intraoperatively. Over a mean control interval of 162 days, one implant of the 93 inserted had to be replaced in the perforation group. After 1 year, the implant survival rate was 14 out of 14 in the perforation group vs. 81/92 in the control group.

Conclusions: With appropriate treatment, intraoperative sinus membrane perforations did not represent an elevated risk for implant loss, infectious complications or displacement of graft material in the investigated population.
Amount and type of alcohol and periodontitis in the Copenhagen City Heart Study
Authors: Kongstad Johanne , Hvidtfeldt Ulla Arthur , Grønbæk Morten , Jontell Mats , Stoltze Kaj , Holmstrup Palle
Published: November 2008

Aim: The aim of this study was to study the association between alcohol consumption and periodontitis assessed as clinical attachment loss (CAL) and bleeding on probing (BOP) in a cross‐sectional design.

Material and Methods: The study included 1,521 adults aged 20–95 years, who underwent an oral examination including full‐mouth registration of CAL and BOP. Alcohol was ascertained using a food‐frequency questionnaire. The association between total and type‐specific alcohol and periodontitis was assessed by means of multivariate logistic regression.

Results: A lower odds ratio (OR) for CAL (defined as mean 3 mm) was observed in men consuming 21–34 [OR=0.51, 95% confidence interval (CI), 0.27–0.95] and 35+ drinks/week (OR=0.34, 95% CI, 0.15–0.79) compared with men drinking 1–13 drinks/week. Also, men with a weekly wine consumption of more than 14 drinks compared with men who reported no wine intake had lower OR for CAL (OR=0.24; 95% CI, 0.09–0.62). A higher OR for BOP (defined as 25%) among male abstainers was observed (OR=1.79, 95% CI, 1.03–3.12) compared with men in the light‐drinking group (1–13 drinks/week). No significant association was observed for either CAL or BOP in women.

Conclusions: The results indicate that higher alcohol consumption, particularly intake of wine, is inversely associated with CAL in men. Such an association is not found in women.
Treatment outcome of immediate, early and conventional single‐tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft‐tissue, aesthetics and patient satisfaction
Authors: Den Hartog Laurens , Huddleston Slater James J. R. , Vissink Arjan , Meijer Henny J. A. , Raghoebar Gerry M.
Published: November 2008

Aim: This study evaluated, through a systematic review of the literature, the outcome of single‐implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches.

Material and Methods: MEDLINE (1950–2008), EMBASE (1966–2008), and CENTRAL (1800–2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study‐design‐related assessment forms.

Results: Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta‐analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0–97.1)] after 1 year. A stratified meta‐analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri‐implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies.

Conclusion: The included literature suggested that promising short‐term results could be achieved for immediate, early and conventional single‐implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft‐tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single‐implant therapies would result in better treatment outcomes remained inconclusive due to lack of well‐designed controlled clinical studies.
Association between serum lipid levels and periodontal infection
Authors: Saxlin Tuomas , Suominen‐Taipale Liisa , Kattainen Anna , Marniemi Jukka , Knuuttila Matti , Ylöstalo Pekka
Published: November 2008

Objective: The aim of the study was to investigate the association between serum lipids and periodontal infection and the role of serum lipids in the association between body weight and periodontal infection.

Material and Methods: The Health 2000 Health Examination Survey, which included 8028 subjects aged 30 or older living in continental Finland. This study was based on a subpopulation of dentate, non‐diabetic subjects who had never smoked and were aged under 50 years (n=1297). Periodontal infection was defined as the presence of teeth with deepened periodontal pockets. Serum levels of triglycerides, high‐density lipoprotein (HDL)‐cholesterol and low‐density lipoprotein (LDL)‐cholesterol were analysed enzymatically.

Results: We found no consistent association between serum lipid levels and periodontal infection among normoweight subjects. There was an association of high serum triglycerides and low HDL with periodontal infection among obese subjects. The association between body mass index and periodontal infection was not essentially affected by serum lipids.

Conclusion: In this study population serum lipid levels were not associated with periodontal infection among normoweight subjects. Obese subjects with a high serum triglyceride level and/or a low HDL‐cholesterol level could be at higher risk of periodontal infection. Our results suggest that the association between body weight and periodontal infection was mainly mediated through a mechanism other than serum lipids.
Involvement of vascular endothelial growth factor, CD44 and CD133 in periodontal disease and diabetes: an immunohistochemical study
Authors: Lucarini Guendalina , Zizzi Antonid , Aspriello Simone Dohenico , Ferrante Luigi , Tosco Eugenio , Lo Muzio Lorenzo , Foglini Paolo , Mattioli‐Belmonte Monica , Di Primio Roberto , Piemontese Matteo
Published: November 2008

Aim: The aim of this study was to investigate the relationship between expression of angiogenic and regeneration markers and periodontal disease in subjects with/without diabetes mellitus.

Material and Methods: Immunohistochemical detection of vascular endothelial growth factor (VEGF), CD44 and CD133 was performed in 16 samples each of (1) healthy gingiva from non‐diabetic subjects (controls), (2) gingiva from non‐diabetic subjects with periodontitis, (3) gingiva from subjects with type 1 diabetes and periodontitis, (4) gingiva from subjects with type 2 diabetes and periodontitis.

Results: Diseased gingivae from patients with diabetes and periodontitis had greater clinical measures of periodontal disease than those with periodontitis only. VEGF expression was significantly enhanced in epithelial and endothelial cells from patients with periodontitis compared with controls (p<0.05). Epithelial CD44 expression was strong in all groups, while CD44 was significantly enhanced (p<0.05) in connective tissue cells from both diabetic groups. Epithelial and endothelial CD133 expression was comparable in all patients except those with type 2 diabetes and periodontitis, where it was not detected. Stromal CD133 expression was significantly lower in patients with type 2 diabetes and periodontitis and was increased in periodontitis patients (p<0.05).

Conclusions: The involvement and high expression of VEGF, CD44 and CD133 in periodontal disease may predict a greater regeneration capacity of gingival tissue.
Climate mediated exogenous forcing and synchrony in populations of the oak aphid in the UK
Authors: Estay Sergio A. , Lima Mauricio , Harrington Richard
Published: November 2008

Contemporary population dynamics theory suggests that animal fluctuations in nature are the result of the combined forces of intrinsic and exogenous factors. Weather is the iconic example of an exogenous force. The common approach for analyzing the relationship between population size and climatic variables is by simple correlation or using the climate as an additive covariable in statistical models. Here, we evaluated different functional forms in which climatic variables could influence population dynamics of the oak aphid Tuberculatus annulatus both in each locality and in relation to synchrony between localities. Results indicate that in at least four of eight aphid populations, climate influences population dynamics by modifying the carrying capacity of the system (lateral effect mediated by winter precipitation). Additionally, path analysis showed that synchrony in population dynamics is highly correlated with synchrony in winter precipitation regime, and the spatial scale of both processes is similar, which suggests that this is an example of the Moran effect. Our results show the key effects of precipitation on intra and inter population processes of this aphid. The methods used, mixing population dynamics modelling and test of synchrony, allowed us to connect the direct and indirect effects of exogenous variables into each population with patterns of synchrony inter populations.