bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Seprafilm® in Abdominal Surgery for Ventriculoperitoneal Shunt Malfunction: A Report of Two Pediatric Cases
Authors: Otake Kohei , Uchida Keiichi , Inoue Mikihiro , Matsushita Kohei , Hashimoto Kiyoshi , Ide Shozo , Matsubara Toshio , Tanaka Kouji , Mohri Yasuhiko , Kusunoki Masato
Published: November 2011

Temporary external drainage with adequate antibiotic treatment followed by ventriculoperitoneal (VP) shunt reinsertion is necessary to treat VP shunt malfunction with infection. In surgeries for VP shunt reinsertion, the key factors that determine whether the reinserted VP shunt will function sufficiently are adequate adhesiolysis and safe placement of the VP shunt within a satisfactory peritoneal location. Based on these factors, the prevention of postoperative adhesions after surgery for VP shunt malfunction is very important. We present two cases of shunt malfunction related to infection and report their successful treatment using Seprafilm®. Seprafilm may improve the safety of VP shunt reinsertion and preserve the function of the reinserted VP shunt after VP shunt malfunction with infection.
Risk of Falling in Parkinson’s Disease at the Hoehn-Yahr Stage III
Authors: Kataoka Hiroshi , Tanaka Noriyuki , Eng M. , Saeki Keigo , Kiriyama Takao , Eura Nobuyuki , Ikeda Masanori , Izumi Tesseki , Kitauti Takanori , Furiya Yoshiko , Sugie Kazuma , Ikada Yoshito , Ueno Satoshi
Published: November 2011

Background: It is difficult to predict the risk of falling, especially in patients with good motor ability, and the mechanisms underlying the relation between gait patterns and falling in Parkinson’s disease (PD) remain unclear. We investigated factors related to falling, including walking speed and time, in patients with Hoehn-Yahr stage III PD. Methods: We performed clinical assessments and evaluated balance in 30 patients with PD. Information on falling was obtained from questionnaires and personal interviews. Gait patterns were analyzed with the use of an originally designed, suddenly narrowed path. Results: Gait velocity was slower in fallers than in non-fallers (p = 0.047). Unified Parkinson’s Disease Rating Scale part II (UPDRS part II) score, fear of falling, and gait velocity were significantly related to falling on analysis with a single logistic model. When a multiple logistic model was used, the UPDRS part II score was significantly related to falling (OR: 1.48, p = 0.037, 95% CI: 1.02–2.16). Conclusions: Patients with Hoehn-Yahr stage III PD showed slow gait velocity attributed to fear of falling before arrival at a narrowed entrance or while walking on a narrowed path. The UPDRS part II score is significantly related to the risk of future falls.
Functional Enrichment Analysis with Structural Variants: Pitfalls and Strategies
Authors: Webber C.
Published: November 2011

Interpreting the phenotypic consequences of human structural variation remains challenging. Functional enrichment analysis, which can identify functional enrichments among genes affected by structural variants, is providing significant biological insights into the genotype-phenotype relationship. In this review, we discuss the different approaches and choices in the application of this technique to human structural variation. We consider the importance of choosing the right background distribution for detection, the significance of the gene selection criteria, the effects of tissue-specific gene length biases and discuss sources of functional annotations with a focus on Gene Ontology and mouse phenotypic resources. Throughout this review, we highlight potential sources of significant bias that are of particular concern to the analysis of structural variants, and illustrate the importance of examining the expectations upon which enrichment analysis techniques depend.
Oral Findings and Salivary Parameters in Children with Celiac Disease: A Preliminary Study
Authors: Acar Sibel , Yetkıner Arzu Aykut , Ersın Nazan , Oncag Ozant , Aydogdu Sema , Arıkan Cigdem
Published: November 2011

Objective: The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects. Subjects and Methods: Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted. Results: The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups. Conclusion: CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.
Percutaneous Management of Ureteral Stenosis of Transplanted Kidney: Technical and Clinical Aspects
Authors: Leonardou Polytimi , Gioldasi Sofia , Pappas Paris
Published: November 2011

In the field of renal transplantation, advances in the management of graft rejection have led to improved graft and patient survival rates, however other types of complications have now become more apparent, e.g. vascular or urological. The most common urological complications following renal transplantation are ureteral stenosis or obstruction, constituting a significant problem of the renal graft’s survival. The most important aspects concerning these complications are early diagnosis and prompt treatment since any delay in their management may lead to renal graft dysfunction or even graft loss. Developments in interventional radiology have provided minimally invasive means to treat urological complications with low complication rates. Herein we review the literature in order to evaluate the efficacy of percutaneous management of ureteral stenosis regarding its safety, immediate and long-term results, complications as well as rate of recurrence.
A Case of Churg-Strauss Syndrome Treated with Montelukast
Authors: Anar Ceyda , Ünsal İpek , Ozanturk Murat Erdal , Halilçolar Hüseyin , Yucel Nur
Published: November 2011

Objective: To report a case of Churg-Strauss syndrome who had asthma and allergic rhinitis treated with montelukast. Clinical Presentation and Intervention: A nonsmoking 59-year-old woman presented with fever, hemoptysis and dyspnea. Past medical history included allergic rhinitis and asthma which were diagnosed 18 years ago. The asthma was treated successfully with inhaled salmeterol and beclamethasone. She also received montelukast (10 mg/day) for 3 years. Although her chest X-ray was normal a week earlier, she had widespread bilateral pulmonary infiltrates on admission. She had leukocytosis (12.5 × 109/l) with eosinophilia (15.6%). Her total IgE count was 550 U/ml. Testing for protoplasmic-staining antineutrophil cytoplasmic antibodies was positive. Bronchoalveolar lavage could not be performed due to bronchospasm and severe hypoxemia; however, mucosal biopsies were obtained, which revealed eosinophil leukocytes in the lumen and walls of small vessels. She was diagnosed to have Churg-Strauss syndrome and had remarkable clinical improvement on day 5 with high-dose of oral prednisolone (50 mg/day). Radiological improvement was detected at the end of the second week. Conclusion: This case shows the importance of being aware that leukotriene receptor antagonists could cause Churg-Strauss syndrome, in spite of the uncertainty about its mechanism.
Contribution of Cystatin C Gene Polymorphisms to Cerebral White Matter Lesions
Authors: Mitaki Shingo , Nagai Atsushi , Sheikh Abdullah M. , Terashima Masaharu , Isomura Minoru , Nabika Toru , Yamaguchi Shuhei
Published: November 2011

Background: Vascular remodeling plays an important role in the development of arteriosclerosis and any of the resulting white matter lesions in the brain. An imbalance between cysteine proteases and the cysteine protease inhibitor cystatin C (CST3) may exacerbate vascular remodeling through degradation of extracellular matrix proteins. Therefore, we evaluated the association between functional polymorphisms in the CST3 gene and the development of cerebral white matter lesions. Methods: In a total of 2,676 participants, 3 CST3 genepolymorphisms were genotyped in 92 cases with severe deep white matter hyperintensity (DWMH), and 184 subjects were randomly selected age- and sex-matched controls without any signs of DWMH. The genetic effects of these polymorphisms on DWMH and plasma CST3 levels were examined. CST3 expression vectors were transfected into an astrocytoma cell line and the expression level of CST3 mRNA was analyzed by quantitative RT-PCR. Intracellular and secreted levels of CST3 in the cell culture were quantified by Western blot and ELISA, respectively. Results: A significant association was found between one CST3 gene haplotype and DWMH (p = 0.002). This haplotype was also associated with lower plasma CST3 levels (p = 0.01). An in vitro transfection study revealed that the +148A allele, which is included in the risk haplotype, significantly reduced the secretion and increased the intracellular accumulation of CST3; however, it had no effect on the mRNA expression. Conclusions: Our study shows that polymorphisms in the CST3 gene are significantly associated with the likelihood of DWMH. Substitution of A for G at +148 of the CST3 gene decreased the extracellular availability of CST3 in vitro, which might result in the activation of protease activity.
Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial
Authors: Lim Ji Won , Lee Hyo Kyoung , Shin Min Cheol
Published: November 2011

Purpose: To compare the effect of an intravitreal injection of bevacizumab alone (IVB) or combined with triamcinolone (IVB/IVT) versus triamcinolone (IVT) in patients with diabetic macular edema (DME). Methods: In this randomized three-arm clinical trial, eligible eyes were assigned randomly to one of the three study arms: the IVB group, 2 injections of 1.25 mg of bevacizumab with 6-week intervals; the IVB/IVT group, 1.25 mg of IVB with 2 mg of IVT, and the IVT group, 2 mg of IVT. The clinical course of best-corrected visual acuity and central macular thickness by optical coherence tomography was monitored for up to 12 months after the initial injection. Results: One hundred eleven eyes of 105 patients with DME completed 12 months of follow-up. The IVB/IVT group and the IVT group showed better visual acuity and reduced central macular thickness at 6 weeks and 3 months, compared with the IVB group (p = 0.041, p = 0.02 at 6 weeks; p = 0.045, p = 0.043 at 3 months, respectively). However, no significant difference in visual acuity and central macular thickness was observed between the three groups at 12 months (p = 0.088, p = 0.132, respectively). The frequency of retreatment was lower in the IVB/IVT and IVT groups during the 12-month period (p < 0.001). No significant differences in visual acuity or central macular thickness were observed between the IVB/IVT and IVT groups during the follow-up. Conclusion: IVB/IVT and IVT showed more pronounced effects during the earlier postinjection period. However, levels of visual acuity or central macular thickness at 12 months were comparable in the three study groups. No beneficial effect of the combination injection was observed.
Anatomical and Morphometric Study of the Bony Nasolacrimal Canal Using Computed Tomography
Authors: Lee Hwa , Ha Sukgyu , Lee Younghen , Park Minsoo , Baek Sehyun
Published: November 2011

Aims: To determine the diameters, angles and sectional area of the bony nasolacrimal canal using computed tomography for obtaining detailed anatomical knowledge of the drainage system and utilizing these measurements in planning interventions for nasolacrimal duct obstruction in adults and children. Methods: Using standard computed tomographic images, we measured the diameters, angles and sectional area of the bony nasolacrimal duct in 228 patients without nasolacrimal duct disease. Results: There was no statistically significant difference in other parameters between males and females. In particular, age had a significant effect on the angle between the bony nasolacrimal canal and the nasal floor in the pediatric patients (<10 years; p = 0.00), and pediatric patients had more acute angles than adult patients (>10 years old). Conclusions: In nasolacrimal probing of congenital nasolacrimal duct obstruction, the probe should be passed more to the posterior part of the nasal cavity. In other words, the distal part of the probe should form a more obtuse angle with the forehead in pediatric patients than in adults. This study may contribute to the establishment of a detailed anatomical and morphometric baseline of the bony nasolacrimal canal and provide useful information for the planning of interventions for nasolacrimal duct obstruction in adults and children.
Small Cell Carcinoma Arising from the Bulbar Urethra: A Case Report and Literature Review
Authors: Kanagarajah Prashanth , Ayyathurai Rajinikanth , Saleem Umar , Manoharan Murugesan
Published: November 2011

Primary neuroendocrine carcinomas of the genitourinary tract are rare and aggressive tumors carrying a bad prognosis. With squamous cell and transitional cell carcinoma being the most commonly reported urethral malignancies, primary small cell carcinoma (SCC) of the urethra is extremely rare. To date, only 5 cases have been reported in the literature. We present the first case of primary SCC occurring in the bulbar urethra in an 89-year-old male. We discuss the clinical, histological and immunohistochemical features of SCC of the urethra. Furthermore, we summarize the available literature and discuss the possible treatment options for this rare yet aggressive neoplasm.
Antibodies after Botulinum Toxin A Injection into Musculus Detrusor Vesicae: Incidence and Clinical Relevance
Authors: Hegele Axel , Frohme Carsten , Varga Zoltan , Olbert Peter , Kranz Julia , Hofmann Rainer
Published: November 2011

Objectives: Botulinum toxin A (BTX-A) injection into the detrusor muscle has changed therapy options for patients with overactive bladder (OAB). However, in some patients, therapy fails or the effects of BTX-A decrease. The aim of this prospective study was to evaluate the incidence of BTX-A antibodies (BTX-A Abs) after injection of BTX-A and its clinical relevance. Methods: 31 patients (27 women, 4 men) were treated with BTX-A for OAB between January 2009 and August 2010. Eleven patients were treated once, 16 patients were treated twice and 4 patients were treated three times. Blood was collected before and 3 months after the BTX-A injection and BTX-A Abs were determined. Results: In 5 patients (16%) BTX-A Abs were detectable after the BTX-A injection. The BTX-A Ab titer was clearly positive in 1 patient (3.2%). This patient showed complete failure of BTX-A therapy. In 4 patients (13%) BTX-A Abs were slightly positive after the first BTX-A injection. The second BTX-A injection showed no positive effects in only 1 patient with borderline BTX-A Ab titers; the second BTX-A injection was successful in 2 patients. Conclusions: The incidence of BTX-A Abs should be verified in nonresponders. More data are necessary to check the clinical relevance and risk of BTX-A Ab formation, especially in long-term follow-up, to optimize patient selection for this minimally invasive treatment option in OAB.
Disorders of Sexual Development in Wild and Captive Exotic Animals
Authors: Mastromonaco G.F. , Houck M.L. , Bergfelt D.R.
Published: November 2011

Disorders of sexual development (DSDs) are an increasing concern in both captive and free-ranging wildlife species. Partial or complete reduction in fertility that results from intersex conditions or gonadal dysgenesis is detrimental to the reproductive potential of wildlife populations, and consequently, to their long-term survival. Compared to the wealth of information available on humans and domestic species, a better understanding of the factors influencing sexual development in wildlife is essential for developing and improving population management or conservation plans. This review attempts to bring together the different facets of DSDs as studied in the fields of reproductive physiology, endocrinology, ecotoxicology, wildlife biology, and environmental health.
Effect of Ezetimibe on Remnant-Like Particle Cholesterol in Subjects with Metabolic Syndrome
Authors: Kotani Kazuhiko , Sakane Naoki , Taniguchi Nobuyuki
Published: November 2011

Objective: To investigate the influence of ezetimibe monotherapy on remnant-like particle cholesterol (RLP-C) in subjects with metabolic syndrome (MetS). Materials and Methods: Ezetimibe (10 mg/daily) was prescribed over a 12-week period for hypercholesterolemic subjects divided into groups with MetS (n = 28; male/female = 13/15; mean age 67 years) and without MetS (n = 22; male/female = 9/13; mean age 66 years). In the pre- and post-treatment phases, BMI, blood pressure and fasting blood levels of glucose, lipid panels and RLP-C were measured. Results: The group with MetS showed significantly higher RLP-C levels than the group without MetS [median level: 0.18 vs. 0.12 mmol/l (7.1 vs. 4.4 mg/dl), p < 0.01] in the pre-treatment phase. In the post-treatment phase, the low-density lipoprotein cholesterol levels were significantly reduced in both groups to a similar level (p < 0.001 in both), while there was a significantly greater reduction in RLP-C in the group with MetS than the group without MetS [median level: 0.12 vs. 0.11 mmol/l (4.8 vs. 4.1 mg/dl), p < 0.05]. This difference in RLP-C remained significant after adjusting for confounding factors. Conclusion: Ezetimibe monotherapy may be associated with a greater reduction in RLP-C levels in subjects with MetS than in those without MetS.
Sports Injuries among Professional Male Athletes in Kuwait: Prevalence and Associated Factors
Authors: Marwan Yousef , Behbehani Abdullah , Al-Mousawi Abdullah , Mulla-Juma'a Ali , Sadeq Husain , Shah Nasrah
Published: November 2011

Objectives: To assess a 12-month period and the lifetime prevalence of sports injuries among male athletes according to type of sport, type of injury and its seriousness, and to examine the association of injuries with sociodemographic, lifestyle and preventive factors. Subjects and Methods: In this cross-sectional study, we approached 475 professional athletes participating in ball sports, aged 15 years and older, from 5 sports clubs in Kuwait. Of them, 452 responded. Four ball games - football (soccer), basketball, handball and volleyball - were included. Data were collected through a self-administered questionnaire. Bivariate and multivariate relationships between associated factors and experience of injury were tested by using χ2 and logistic regression. Results: The overall 12-month and lifetime prevalence of sports injuries were 73.8 and 89.8%, respectively. Prevalence was highest among volleyball athletes (79%) and lowest among football (soccer) athletes (69%). Lower limbs (73.1%) were the most common site of injuries and joint injuries (43.6%) were the most common type. For the most recent injury, 138 (42%) of athletes took more than 10 days off practice. Compared to volleyball, football (soccer) and handball athletes were 2.9 times (95% CI: 1.3-6.3) and 3.4 times (95% CI: 1.5-7.8) more likely to take more than 10 days off practice. Athletes who sometimes wore protective gears were 3.1 times (95% CI: 1.7-5.8) more likely to report an injury compared with those who never wore protective gears (p < 0.001). Conclusions: Sports injuries are highly prevalent among professional athletes in Kuwait. Future studies are needed to provide guidelines for interventions that may reduce such injuries.
Gonadal and Sex Differentiation Abnormalities of Dogs and Cats
Authors: Meyers-Wallen V.N.
Published: November 2011

The molecular steps in normal sexual development were largely discovered by studying patients and animal models with disorders of sexual development (DSD). Although several types of DSD have been reported in the cat and dog, which are often strikingly similar to human DSD, these have been infrequently utilized to contribute to our knowledge of mammalian sexual development. Canine and feline cases of DSD with sufficient evidence to be considered as potential models are summarized in this report. The consensus DSD terminology, and reference to previous terminology, is used to foster adoption of a common nomenclature that will facilitate communication and collaboration between veterinarians, physicians, and researchers. To efficiently utilize these unique resources as molecular tools continue to improve, it will be helpful to deposit samples from valuable cases into repositories where they are available to contribute to our understanding of sexual development, and thus improve human and animal health.
Kidney Function Decline in the Elderly: Impact of Lipoprotein-Associated Phospholipase A2
Authors: Peralta Carmen A. , Katz Ronit , Shlipak Michael , Dubin Ruth , DeBoer Ian , Jenny Nancy , Fitzpatrick Annette , Koro Carol , Kestenbaum Bryan , Ix Joachim , Sarnak Mark , Cushman Mary
Published: November 2011

Background: Whether lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are associated with kidney function decline has not been well studied. Methods: We investigated associations of Lp-PLA2 antigen and activity with kidney function decline and rapid decline over 5.7 years in the Cardiovascular Health Study (n = 4,359). We estimated kidney function by cystatin C (eGFRcys) in repeated measures, and defined rapid decline as ≧3 ml/min/1.73 m2 per year. We stratified by baseline preserved GFR (≧60 ml/min/1.73 m2). Results: Mean age was 72 ± 5 years. Average eGFRcys decline was –1.79 ml/min/1.73 m2 (SD = 2.60) per year. Among persons with preserved GFR, compared to the lowest quartile of Lp-PLA2 antigen, eGFRcys decline was faster among persons in the second, β –0.31 (95% CI –0.52, –0.10), third –0.19 (–0.41, 0.02) and fourth quartiles –0.26 (–0.48, –0.04) after full adjustment. Persons in the highest quartile of Lp-PLA2 antigen had increased odds of rapid decline 1.34 (1.03, 1.75), compared to the lowest. There was no significant association between levels of Lp-PLA2 activity and eGFRcys decline or rapid decline. Associations were not statistically significant among persons with low eGFR (<60 ml/min/1.73 m2) at baseline. Conclusion: Higher levels of Lp-PLA2 antigen but not activity were significantly associated with faster rates of kidney function decline. These findings may suggest a novel vascular pathway for kidney disease progression.
In vivo Imaging of Bile Accumulation and Biliary Infarction after Common Bile Duct Ligation in Rats
Authors: Harnoss J.-C. , Heidecke C.D. , Vollmar B. , Eipel C.
Published: November 2011

Obstructive cholestasis is caused by mechanical constriction or occlusion leading to reduced bile flow. Serious complications such as jaundice and even death may follow. Little is known about the initial phase of cholestasis and its consequences for the hepatic microarchitecture. This in vivo study aimed to characterize the nature and kinetics of developing obstructive cholestasis and focused on areas with biliary stasis and infarction by visualizing the autofluorescence of bile acids using intravital microscopy of the liver over a period of 30 h after bile duct ligation in rats. The innovation resided in performing fluorescence microscopy without applying fluorescent dyes. In animals subjected to obstructive cholestasis, the most significant changes observed in vivo were the concomitant appearance of (1) areas with bile accumulation increasing in size (6 h: 0.163 ± 0.043, 18 h: 0.180 ± 0.086, 30 h: 0.483 ± 0.176 mm2/field) and (2) areas with biliary infarction (6 h: 0.011 ± 0.006, 18 h: 0.010 ± 0.004, 30 h: 0.010 ± 0.050 mm2/field) as well as (3) a relation between the formation of hepatic lesions and enzyme activity in serum. The sequential in vivo analysis presented herein is a new method for the in vivo visualization of the very early changes in the hepatic parenchyma caused by obstructive cholestasis.
Sitagliptin, a Dipeptidyl Peptidase-IV Inhibitor, Improves Psoriasis
Authors: Nishioka Tatsuya , Shinohara Masayuki , Tanimoto Noriyasu , Kumagai Chizuru , Hashimoto Kozo
Published: November 2011

A patient with a 17-year history of plaque psoriasis accompanied by type 2 diabetes mellitus discontinued cyclosporine and steroid ointment given for treatment of psoriasis because she was dissatisfied with the effects of the drugs. After sitagliptin, a dipeptidyl peptidase-IV (DPP-IV) inhibitor, was administered for control of blood glucose, psoriatic skin lesions were gradually diminished, although HbA1c did not improve. Three months after the administration of sitagliptin, infiltration, scales and erythema on all psoriatic plaques disappeared, leaving pigmentation on flat skin. DPP-IV in serum degrades the incretin hormones which stimulate β-cell insulin secretion. DPP-IV inhibitors, as incretin enhancers, cause an increase in glucose-dependent insulin secretion, and are applied for the treatment of diabetes mellitus. DPP-IV is also expressed on T cells as CD26, a surface antigen which plays an important role in activating T cells. As helper T cells are involved in the pathogenesis of psoriasis, it is possible that DPP-IV inhibitors improve psoriatic skin lesions by inhibiting T cell activation, independently of glycemic control. DPP-IV inhibitors could be an alternative for the treatment of psoriasis.
Trigger-Based Mechanism of the Persistence of Atrial Fibrillation and Its Impact on the Efficacy of Catheter Ablation
Authors: Inoue Koichi , Kurotobi Toshiya , Kimura Ryusuke , Toyoshima Yuko , Itoh Norihisa , Masuda Masaharu , Higuchi Yoshiharu , Date Motoo , Koyama Yasushi , Okamura Atsunori , Iwakura Katsuomi , Fujii Kenshi
Published: November 2011

Background—

We investigated the possibility that a frequent trigger action might play a role in the development of persistent atrial fibrillation (PeAF) and the presence of a substrate.

Methods and Results—

In 263 consecutive patients who underwent catheter ablation (CA) for PeAF, electric cardioversion was performed at the beginning of the procedure to determine the presence or absence of an immediate recurrence of AF (IRAF). We defined an IRAF as a reproducible AF recurrence within 90 s after restoration of sinus rhythm by electric cardioversion. We performed a mean±SD of 1.3±0.5 sessions of CA, including pulmonary vein isolation and ablation of the premature atrial contractions that triggered the IRAF (IRAF triggers), and observed the patients for 17 (10–27) months. An IRAF was observed in 70 patients (27%), but we could not ablate the IRAF triggers in 16 (23%) of these IRAF patients. The recurrence rate of PeAF was higher in patients with an unsuccessful IRAF trigger ablation than in those with successful IRAF trigger ablation (63% versus 11%;
P
<0.001). A multivariable analysis also revealed that an unsuccessful IRAF trigger ablation was 1 of the independent predictors of recurrent PeAF (odds ratio, 10.9; 95% CI, 3.4–36.7).

Conclusions—

In the PeAF patients with an IRAF, successful elimination of the IRAF triggers, in addition to pulmonary vein isolation, resulted in a successful CA. These results imply that such triggers play a major role in the AF persistence in these PeAF patients.
Association of Genetic Variants and Incident Coronary Heart Disease in Multiethnic Cohorts
Authors: Franceschini Nora , Carty Cara , Bůžková Petra , Reiner Alex P. , Garrett Tiana , Lin Yi , Vöckler Jens-S , Hindorff Lucia A. , Cole Shelley A. , Boerwinkle Eric , Lin Dan-Yu , Bookman Ebony , Best Lyle G. , Bella Jonathan N. , Eaton Charles , Greenland Philip , Jenny Nancy , North Kari E. , Taverna Darin , Young Alicia M. , Deelman Ewa , Kooperberg Charles , Psaty Bruce , Heiss Gerardo
Published: November 2011

Background—

Genome-wide association studies identified several single nucleotide polymorphisms (SNP) associated with prevalent coronary heart disease (CHD), but less is known of associations with incident CHD. The association of 13 published CHD SNPs was examined in 5 ancestry groups of 4 large US prospective cohorts.

Methods and Results—

The analyses included incident coronary events over an average 9.1 to 15.7 follow-up person-years in up to 26 617 white individuals (6626 events), 8018 black individuals (914 events), 1903 Hispanic individuals (113 events), 3669 American Indian individuals (595 events), and 885 Asian/Pacific Islander individuals (66 events). We used Cox proportional hazards models (with additive mode of inheritance) adjusted for age, sex, and ancestry (as needed). Nine loci were statistically associated with incident CHD events in white participants: 9p21 (rs10757278;
P
=4.7×10
−41
), 16q23.1 (rs2549513;
P
=0.0004), 6p24.1 (rs499818;
P
=0.0002), 2q36.3 (rs2943634;
P
=6.7×10
−6
),
MTHFD1L
(rs6922269,
P
=5.1×10
−10
),
APOE
(rs429358;
P
=2.7×10
−18
),
ZNF627
(rs4804611;
P
=5.0×10
−8
),
CXCL12
(rs501120;
P
=1.4×10
−6
) and
LPL
(rs268;
P
=2.7×10
−17
). The 9p21 region showed significant between-study heterogeneity, with larger effects in individuals age 55 years or younger and in women. Inclusion of coronary revascularization procedures among the incident CHD events introduced heterogeneity. The SNPs were not associated with CHD in black participants, and associations varied in other US minorities.

Conclusions—

Prospective analyses of white participants replicated several reported cross-sectional CHD-SNP associations.
Randomized Trial of Cutting Balloon Compared With High-Pressure Angioplasty for the Treatment of Resistant Pulmonary Artery Stenosis
Authors: Bergersen Lisa , Gauvreau Kimberlee , Justino Henri , Nugent Alan , Rome Jonathon , Kreutzer Jacqueline , Rhodes John , Nykanen David , Zahn Evan , Latson Larry , Moore Phillip , Lock James , Jenkins Kathy
Published: November 2011

Background—

We sought to determine the safety and efficacy of Cutting Balloon therapy (CB) compared with conventional high-pressure balloon therapy (HPB) for the treatment of pulmonary artery stenosis.

Methods and Results—

This prospective, randomized, multicenter, investigational device exemption trial compared CB with HPB. Patient eligibility was determined at the precatheterization assessment; vessel eligibility was determined at catheterization. In all vessels, low-pressure balloon dilation to 8 atm was performed, and if it was not successful, the vessel was randomized to CB or HPB. The primary efficacy outcome was percent change in minimum lumen diameter. A core laboratory performed all vessel measurements and angiographic assessment of vessel damage. The primary safety outcome was any serious adverse event attributable to vessel dilation as assessed by the Data and Safety Monitoring Board. Seventy-three patients from 8 institutions were enrolled between 2004 and 2008. In these patients, 72 vessels responded to low-pressure balloon dilation. Of the 173 vessels that met eligibility criteria, 107 were randomized to CB and 66 to HPB. In randomized vessels, CB therapy was associated with greater percent increase in lumen diameter (85% versus 52%;
P
=0.004). After crossover was introduced, 26 of 47 vessels treated with HPB underwent CB therapy and experienced an additional 48% increase in lumen diameter; the final diameter after CB was 99% greater than the initial diameter. There were no serious adverse events related to treatment in a study vessel.

Conclusion—

CB therapy for pulmonary artery stenosis not responsive to low-pressure balloon is more effective than HPB therapy and has an equivalent safety profile.
Derivation and Validation of a Simple Exercise-Based Algorithm for Prediction of Genetic Testing in Relatives of LQTS Probands
Authors: Sy Raymond W. , van der Werf Christian , Chattha Ishvinder S. , Chockalingam Priya , Adler Arnon , Healey Jeffrey S. , Perrin Mark , Gollob Michael H. , Skanes Allan C. , Yee Raymond , Gula Lorne J. , Leong-Sit Peter , Viskin Sami , Klein George J. , Wilde Arthur A. , Krahn Andrew D.
Published: November 2011

Background—

Genetic testing can diagnose long-QT syndrome (LQTS) in asymptomatic relatives of patients with an identified mutation; however, it is costly and subject to availability. The accuracy of a simple algorithm that incorporates resting and exercise ECG parameters for screening LQTS in asymptomatic relatives was evaluated, with genetic testing as the gold standard.

Methods and Results—

Asymptomatic first-degree relatives of genetically characterized probands were recruited from 5 centers. QT intervals were measured at rest, during exercise, and during recovery. Receiver operating characteristics were used to establish optimal cutoffs. An algorithm for identifying LQTS carriers was developed in a derivation cohort and validated in an independent cohort. The derivation cohort consisted of 69 relatives (28 with LQT1, 20 with LQT2, and 21 noncarriers). Mean age was 35±18 years, and resting corrected QT interval (QTc) was 466±39 ms. Abnormal resting QTc (females ≥480 ms; males ≥470 ms) was 100% specific for gene carrier status, but was observed in only 48% of patients; however, mutations were observed in 68% and 42% of patients with a borderline or normal resting QTc, respectively. Among these patients, 4-minute recovery QTc ≥445 ms correctly restratified 22 of 25 patients as having LQTS and 19 of 21 patients as being noncarriers. The combination of resting and 4-minute recovery QTc in a screening algorithm yielded a sensitivity of 0.94 and specificity of 0.90 for detecting LQTS carriers. When applied to the validation cohort (n=152; 58 with LQT1, 61 with LQT2, and 33 noncarriers; QTc=443±47 ms), sensitivity was 0.92 and specificity was 0.82.

Conclusions—

A simple algorithm that incorporates resting and exercise-recovery QTc is useful in identifying LQTS in asymptomatic relatives.
Controlling for High-Density Lipoprotein Cholesterol Does Not Affect the Magnitude of the Relationship Between Alcohol and Coronary Heart Disease
Authors: Magnus Per , Bakke Eirin , Hoff Dominic A. , Høiseth Gudrun , Graff-Iversen Sidsel , Peggy Knudsen Gun , Myhre Ronny , Trygve Normann Per , Næss Øyvind , Tambs Kristian , Thelle Dag S. , Mørland Jørg
Published: November 2011

Background—

This study tested the hypothesis that moderate alcohol intake exerts its cardioprotective effect mainly through an increase in the serum level of high-density lipoprotein cholesterol.

Methods and Results—

In the Cohort of Norway (CONOR) study, 149 729 adult participants, recruited from 1994 to 2003, were followed by linkage to the Cause of Death Registry until 2006. At recruitment, questionnaire data on alcohol intake were collected, and the concentration of high-density lipoprotein cholesterol in serum was measured. Using Cox regression, we found that the adjusted hazard ratio for men for dying from coronary heart disease was 0.52 (95% confidence interval, 0.39–0.69) when consuming alcohol more than once a week compared with never or rarely. The ratio changed only slightly, to 0.55 (0.41–0.73), after the regression model included the serum level of high-density cholesterol. For women, the corresponding hazard ratios were 0.62 (0.32–1.23) and 0.68 (0.34–1.34), respectively.

Conclusions—

Alcohol intake is related to a reduced risk of death from coronary heart disease in the follow-up of a large, population-based Norwegian cohort study with extensive control for confounding factors. Our findings suggest that the serum level of high-density cholesterol is not an important intermediate variable in the possible causal pathway between moderate alcohol intake and coronary heart disease.
Renal Function After Catheter Ablation of Atrial Fibrillation
Authors: Takahashi Yoshihide , Takahashi Atsushi , Kuwahara Taishi , Okubo Kenji , Fujino Tadashi , Takagi Katsumasa , Nakashima Emiko , Kamiishi Tetsuo , Hikita Hiroyuki , Hirao Kenzo , Isobe Mitsuaki
Published: November 2011

Background—

Kidney function is a known predictor of cardiovascular morbidity and mortality. Although patients with atrial fibrillation (AF) often have kidney dysfunction, less is known about the association between AF and kidney function. We sought to assess changes in kidney function after catheter ablation of AF.

Methods and Results—

Patients who underwent catheter ablation of AF were recruited for the present prospective study. Estimated glomerular filtration rate (eGFR) was evaluated before and 1 year after the ablation. Three hundred eighty-six patients (paroxysmal AF, 135; persistent AF, 106; longstanding persistent AF, 145) were studied. Their baseline eGFR was 68±14 mL · min
−1
· 1.73 m
−2
. Sixty-six percent and 26% of patients had eGFR of 60 to 89 and 30 to 59 mL · min
−1
· 1.73 m
−2
, respectively. Overall, 278 patients (72%) were arrhythmia free over a 1-year follow-up. In patients free from arrhythmia, eGFR increased 3 months later and was maintained until 1 year, whereas in patients with recurrences, eGFR had decreased over 1 year. Changes in eGFR over 1 year in patients free from arrhythmia differed significantly compared with those with recurrences (3±8 versus −2±8 mL · min
−1
· 1.73 m
−2
;
P
<0.0001). In all quartiles of baseline eGFR, changes in eGFR over 1 year after the ablation were greater in patients free from arrhythmia compared with those with recurrences.

Conclusion—

Elimination of AF by catheter ablation was associated with improvement of kidney function over a 1-year follow-up in patients with mild to moderate kidney dysfunction.
Description of Antihypertensive Use in Patients With Resistant Hypertension Prescribed Four or More Agents
Authors: Hanselin Michele R. , Saseen Joseph J. , Allen Richard R. , Marrs Joel C. , Nair Kavita V.
Published: November 2011

Data describing the use of recommended antihypertensive agents in the resistant hypertension population are limited. Treatment recommendations for resistant hypertension include maximizing diuretic therapy by using chlorthalidone and/or adding an aldosterone antagonist. Additional recommendations include combining antihypertensive agents from different drug classes. This retrospective cohort study describes antihypertensive use in patients with resistant hypertension defined as the concurrent use of ≥4 antihypertensive agents. Claims data from the Medstat MarketScan Commercial Claims and Encounter database were used to identify patients with resistant hypertension based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes and National Drug Codes between May 1, 2008 and June 30, 2009. Of the 5 442 410 patients with hypertension in the database, 140 126 met study criteria. The most frequently prescribed antihypertensive classes were angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (96.2%), diuretics (93.2%), calcium channel blockers (83.6%), and β-blockers (80.0%). Only 3.0% and 5.9% of patients were on chlorthalidone or an aldosterone antagonist, respectively. A total of 15.6% of patients were treated with angiotensin-converting enzyme inhibitor plus angiotensin receptor blocker. Our findings demonstrate that frequently prescribed antihypertensive agents for the treatment of resistant hypertension included guideline-recommended first-line agents. However, evidence-based and recommended agents, such as chlorthalidone and aldosterone antagonists, were underused. Moreover, minimally efficacious combinations, such as an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker, were prescribed at higher rates than evidence-based and recommended agents.
Gene Expression Profiling Reveals Renin mRNA Overexpression in Human Hypertensive Kidneys and a Role for MicroRNAs
Authors: Marques Francine Z. , Campain Anna E. , Tomaszewski Maciej , Zukowska-Szczechowska Ewa , Yang Yee Hwa J. , Charchar Fadi J. , Morris Brian J.
Published: November 2011

The kidney has long been invoked in the etiology of essential hypertension. This could involve alterations in expression of specific genes and microRNAs (miRNAs). The aim of the present study was to identify, at the transcriptome-wide level, mRNAs and miRNAs that were differentially expressed between kidneys of 15 untreated hypertensive and 7 normotensive white male subjects of white European ancestry. By microarray technology we found 14 genes and 11 miRNAs that were differentially expressed in the medulla. We then selected and confirmed by real-time quantitative PCR expression differences for
NR4A1
,
NR4A2
,
NR4A3
,
PER1
, and
SIK1
mRNAs and for the miRNAs hsa-miR-638 and hsa-let-7c. Luciferase reporter gene experiments in human kidney (HEK293) cells confirmed the predicted binding of hsa-let-7c to the 3′ untranslated region of
NR4A2
mRNA. In the renal cortex we found differential expression of 46 genes and 13 miRNAs. We then confirmed expression differences for
AIFM1
,
AMBP
,
APOE
,
CD36
,
EFNB1
,
NDUFAF1
,
PRDX5
,
REN
,
RENBP
,
SLC13A1
,
STX4
, and
TNNT2
mRNAs and for miRNAs hsa-miR-21, hsa-miR-126, hsa-miR-181a, hsa-miR-196a, hsa-miR-451, hsa-miR-638, and hsa-miR-663. Functional experiments in HEK293 cells demonstrated that hsa-miR-663 can bind to the
REN
and
APOE
3′ untranslated regions and can regulate
REN
and
APOE
mRNA levels, whereas hsa-miR-181a regulated
REN
and
AIFM1
mRNA. Our data demonstrated for the first time that miRNAs can regulate renin expression. The observed downregulation of 2 miRNAs in hypertension could explain the elevation in intrarenal renin mRNA. Renin, CD36, and other mRNAs, as well as miRNAs and associated pathways identified in the present study, provide novel insights into hypertension etiology.
TC-Permitting GCM Simulations of Hurricane Frequency Response to Sea Surface Temperature Anomalies Projected for the Late-Twenty-First Century
Authors: Zhao Ming , Held Isaac M.
Published: November 2011

A tropical cyclone–permitting global atmospheric model is used to explore the hurricane frequency response to sea surface temperature (SST) anomalies generated by coupled models for the late-twenty-first century. Results are presented for SST anomalies averaged over 18 models as well as from 8 individual models. For each basin, there exists large intermodel spread in the magnitude and even the sign of the frequency response among the different SST projections. These sizable variations in response are explored to understand features of SST distributions that are important for the basin-wide hurricane responses. In the North Atlantic, the eastern Pacific, and the southern Indian basins, most (72%–86%) of the intermodel variance in storm frequency response can be explained by a simple relative SST index defined as a basin’s storm development region SST minus the tropical mean SST. The explained variance is significantly lower in the South Pacific (48%) and much lower in the western Pacific basin (27%). Several atmospheric parameters are utilized to probe changes in tropical atmospheric circulation and thermodynamical properties relevant to storm genesis in the model. While all present strong correlation to storm response in some basins, a parameter-measuring tropospheric convective mass flux stands out as skillful in explaining the simulated differences for all basins. Globally, in addition to a modest reduction of total storm frequency, the simulations exhibit a small, but robust eastward and poleward migration of genesis frequency in both the North Pacific and the North Atlantic Oceans. This eastward migration of storms can also be explained by changes in convection.
MicroRNA Modulation in Obesity and Periodontitis
Authors: Perri R. , Nares S. , Zhang S. , Barros S.P. , Offenbacher S.
Published: November 2011

The aim of this pilot investigation was to determine if microRNA expression differed in the presence or absence of obesity, comparing gingival biopsies obtained from patients with or without periodontal disease. Total RNA was extracted from gingival biopsy samples collected from 20 patients: 10 non-obese patients (BMI < 30 kg/m2) and 10 obese patients (BMI > 30 kg/m2), each group with 5 periodontally healthy sites and 5 chronic periodontitis sites. MicroRNA expression patterns were assessed with a quantitative microRNA PCR array to survey 88 candidate microRNA species. Four microRNA databases were used to identify potential relevant mRNA target genes of differentially expressed microRNAs. Two microRNA species (miR-18a, miR-30e) were up-regulated among obese individuals with a healthy periodontium. Two microRNA species (miR-30e, miR-106b) were up-regulated in non-obese individuals with periodontal disease. In the presence of periodontal disease and obesity, 9 of 11 listed microRNAs were significantly up-regulated (miR-15a, miR-18a, miR-22, miR-30d, miR-30e, miR-103, miR-106b, miR-130a, miR-142-3p, miR-185, and miR-210). Predicted targets include 69 different mRNAs from genes that comprise cytokines, chemokines, specific collagens, and regulators of glucose and lipid metabolism. The expression of specific microRNA species in obesity, which could also target and post-transcriptionally modulate cytokine mRNA, provides new insight into possible mechanisms of how risk factors might modify periodontal inflammation and may represent novel therapeutic targets.
The Changing Picture of Earnings Inequality in Britain and the Role of Regional and Sectoral Differences
Authors: Stewart Mark B.
Published: November 2011

This paper examines differences in inequality between regions and between sectors of the economy. The growth in overall inequality since the mid-1990s is found to have been driven primarily by that in London (with a smaller difference for the South East and East Anglia) and by that in the financial sector (with a smaller difference for the business activities sector). While these differences for London and the financial sector overlap to some extent, they also have significant separate influences once each other is controlled for. The changes in inequality in the rest of Britain and in the other sectors of the economy are numerically small and statistically insignificant.
Expenditure and Disposable Income Trends of UK Households: Evidence from Micro-Data
Authors: van de Ven Justin
Published: November 2011

The view that there is an ‘under-savings’ problem in the UK domestic sector has had an important bearing on the contemporary agenda for policy reform. This paper considers the temporal variation of household expenditure and disposable income described by micro-data observed during the past four decades (1971 to 2009). I find a very close correspondence between the growth of expenditure and disposable income over the sample period, with the implication that households have not offset the well-documented decline in occupational pension provisions during the period through increased private saving out of disposable income.