bluuebunny/crossref_metadata_2025 huggingface dataset:
ADVANCE DIRECTIVES IN TURKEY'S CULTURAL CONTEXT: EXAMINING THE POTENTIAL BENEFITS FOR THE IMPLEMENTATION OF PATIENT RIGHTS
Authors: GUVEN TOLGA , SERT GURKAN
Published: February 2010

Advance directives are not a part of the healthcare service in Turkey. This may be related with the fact that paternalism is common among the healthcare professionals in the country, and patients are not yet integrated in the decision‐making process adequately.

However, starting from the enactment of the Regulation of Patient Rights in 1998, this situation started to change. While the paternalist tradition still appears to be strong in Turkey, the Ministry of Health has been taking concrete measures in the recent years to ensure that patient rights are implemented in healthcare practice. Therefore, Turkey now seems to be in a transitional period where a move towards a more patient‐autonomy centred approach is being supported by the regulatory authorities, as well as the academic circles and the public at large. In the light of this background, this paper aims to examine the potential benefits of advance directives, particularly with regard to their possible effect in the clinical decision‐making process of Turkey's context. It will be argued that advance directives, if correctly understood and implemented in the right settings, may be beneficial, particularly for improving communication between patients and healthcare professionals and for implementing of the right to refuse treatment.
The Value of Reanalysis: TV Viewing and Attention Problems
Authors: Foster E. Michael , Watkins Stephanie
Published: February 2010

Using data from the National Longitudinal Survey of Youth (N = 1,159), this study reexamines the link between maternal reports of television viewing at ages 1 and 3 and attention problems at age 7. This work represents a reanalysis and extension of recent research suggesting young children’s television viewing causes subsequent attention problems. The nonlinear specification reveals the association between television watching and attention problems exists—if at all—only at very high levels of viewing. Adding 2 covariates to the regression model eliminated even this modest effect. The earlier findings are not robust. This study also considers whether its own findings are sensitive to unobserved confounding using fixed‐effects estimation. In general, it finds no meaningful relation between television viewing and attention problems.
Using the sensory garden as a tool to enhance the educational development and social interaction of children with special needs
Authors: HUSSEIN HAZREENA
Published: February 2010

This study summarises the findings based on two case study sensory gardens in the United Kingdom, in terms of the educational development and social interaction of children with special needs and the staff who care for them. The aim was to observe and record the users' behaviour when engaging with features in the sensory garden. The data collection included interviews with teachers and therapists, and behavioural observation, which was used in conjunction with affordance theory. The study was supported with a few noteworthy incidents that the author recorded as anecdotal evidence. A selection of photographs was chosen to illustrate these incidents.
The Apparent‐Time Construct and stable variation: Final /z/ devoicing in northwestern Indiana1
Authors: José Brian
Published: February 2010

As real‐time language data becomes increasingly available for sociolinguistic research, a growing number of studies are benefitting from it in order to study language changes in progress, some of which even explicitly seek to scrutinize the Apparent‐Time Construct itself. Vanishingly few real‐time studies, however, have focused specifically on stable sociolinguistic variables, leaving an important gap in our understanding of the Apparent‐Time Construct's abilities to model real‐time facts. In an effort to address this gap, the present study analyzes a presumably stable sociolinguistic variable – final /z/ devoicing – in extreme northwestern Indiana through real and apparent time. A series of Varbrul analyses indicate that this variable is, indeed, stable throughout the 20 years of real time covered by the data and that its stability is successfully modeled in apparent time. Additionally, similarities in /z/ devoicing between this community and some other communities where it has also been studied are identified and discussed.
The role of marriage in linguistic contact and variation: Two Hmong dialects in Texas1
Authors: Stanford James N.
Published: February 2010

The role of marriage in linguistic contact and variation has been under‐represented in sociolinguistic research. In any practice‐based analysis, individual interactions and relationships are crucial. Therefore, marriage relationships – small but intense communities of practice – deserve variationist attention for their role in dialect construction and identity. This investigation of cross‐dialectal marriages explores how dialect practices and choices are negotiated between partners. The results show the importance of viewing this linguistic behavior in terms of community ideology, culture, and individual choice, rather than primarily as a matter of the amount and intensity of contact. Likewise, the study shows how less commonly studied minority communities can bring new insights to the study of dialect acquisition and linguistic contact. Specifically, this investigation focuses on marriages between speakers of two different dialects of Hmong, a Hmong‐Mien language of Southeast Asia. On the basis of home visits to ten Hmong immigrant households in Texas, the study analyzes lexical and phonetic contrasts and ethnographic interviews. Results suggest that macro‐level shifts in Hmong social organization and gender roles are being reflected and constructed by gendered, marriage‐level dialect practices. The linguistic behavior in these marriages is best viewed as a matter of community ideology in tension with individual choice: individual wives are choosing to challenge the traditional Hmong ideology regarding language behavior in cross‐dialect marriages.
Sustaining Low Pay in Aged Care Work
Authors: Palmer Elyane , Eveline Joan
Published: February 2010

This article examines the ways in which employers in the Australian aged care sector justify and sustain low pay for work that is both highly skilled and in high demand. We build on a large body of feminist research that analyses why care work is devalued by showing how such devaluing is produced at the level of the organization. To do so we examine some of the specific discursive mechanisms that sustain low pay. We show that aged care employers actively reproduce a familial logic of care that represents paid aged care work as unskilled and natural for women and therefore not deserving of higher pay. We argue that in order to achieve their goals employers must develop and sustain an opposition between care as love‐centred and work as money‐centred, while upholding the notion that they provide quality care for care recipients.
THE VILLAIN WHO CONFUSED MORAL THEOLOGY
Authors: WALSH FRANCIS MICHAEL
Published: February 2010

The call of the Second Vatican Council for the renewal of moral theology has received very divergent responses. This article identifies and compares three such proposals. The underlying presupposition for this analysis is that each proposal begins with a divergent understanding of where the tradition went awry. Hence, the proposed cures ended up irreconcilable. This article seeks to describe ‘as precisely as possible the nature of the confusion and its sources, showing where attention must be directed if a solution is to be discovered.’1
The Use of the R2 as a Measure of Firm‐Specific Information: A Cross‐Country Critique
Authors: Alves Paulo , Peasnell Ken , Taylor Paul
Published: February 2010

Abstract:  Recent research uses the degree of stock returns co‐movement as a measure of the quality of a country's information environment. It has been argued that stronger property rights, better corporate governance regimes and more efficient enforcement mechanisms lead to prices incorporating more firm‐specific information and, therefore, co‐moving less with the market. In this paper, we use a much more comprehensive international data set than in prior research, encompassing forty countries over twenty years, to evaluate the reliability of this approach in a cross‐country setting and to analyse the behaviour of the measure used. Our results demonstrate severe limitations in the use of co‐movement as a measure of information quality. We highlight the instability of the measure and show that it can produce results that are often difficult to reconcile with such an informational explanation.
Migration Creation and Diversion in the European Union: Is Central and Eastern Europe a ‘Natural’ Member of the Single Market for Labour?
Authors: MARQUES HELENA
Published: February 2010

This article applies the concepts of trade creation and trade diversion to immigration into the EU‐15 in order to investigate whether during 1986–2006 there were any significant preference effects in favour of the CEECs (central and eastern European countries) that make them ‘natural’ members of the EU single market for labour. If this hypothesis is true, there should have been strong migration creation but little migration diversion in the last 20 years. The results broadly support migration creation for the CEECs prior to their EU membership. At the same time, the evidence of diversion away from other world regions is mixed. The combined impact of a common language and established communities, compared to distance and a common border, may contribute to the preservation of migration channels from outside Europe. Within Europe, to be an EU outsider can have a negative impact on migration channels. Moreover, whilst liberal immigration policies increase immigration contemporaneously, restrictive immigration policies only show an impact with a two‐year lag.
EU Enlargement and Migration: Assessing the Macroeconomic Impacts
Authors: BARRELL RAY , FITZGERALD JOHN , RILEY REBECCA
Published: February 2010

Enlargement of the European Union in May 2004 was followed by an increase in migration from the poorest of the central and eastern European New Member States (NMS) to other Member States. We consider the macroeconomic impacts of these migration flows across Europe, highlighting impacts in receiving and sending countries.
Power is Always in Fashion: State‐Centric Realism and the European Security and Defence Policy
Authors: SELDEN ZACHARY
Published: February 2010

The European Security and Defence Policy (ESDP) is in large part a product of the institutional development of the EU and the consolidation of its authority over internal issues. This parallels the development of the United States as a global actor shortly after the federal government consolidated power over domestic affairs in the 1890s.
Measuring and Comparing the Europeanization of National Legislation: A Research Note
Authors: TÖLLER ANNETTE ELISABETH
Published: February 2010

There is an urgent need for a method to measure quantitatively the Europeanization of national public policies, meaning the scope and extent to which national policies are shaped by European law and policy. Research on the Europeanization of public policies has so far mostly been limited to qualitative analysis. While such case studies, or comparative case or country studies have produced valuable insights into the nature of Europeanization, the challenge to measure how much national policy‐making has been influenced by European law and policies has not yet been mastered by the discipline. After outlining both the scholarly and the political context of the debate, the article briefly discusses different methods that have been developed so far to measure the Europeanization of national legislation in the UK, the Netherlands, Denmark, France and Germany. Their common feature is that they aim to measure Europeanization – and that they do so by using diverse methods and measures. Not only do they display some flaws in how they measure the Europeanization of legislation, but the results of these diverse studies are by no means comparable. Based on a short discussion of these approaches that have been developed so far, I will outline how this challenge could be faced. I will then present a concept for the development of an analytical tool to measure the scope and extent of the Europeanization of national public policies across policy fields, time and countries, as a means of improving our knowledge and as a starting point for explaining variance across policy fields, across time and, most interesting, across countries. Finally more and less fundamental objections to this enterprise are discussed.
Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence
Authors: Sobanski Esther , Banaschewski Tobias , Asherson Philip , Buitelaar Jan , Chen Wai , Franke Barbara , Holtmann Martin , Krumm Bertram , Sergeant Joseph , Sonuga‐Barke Edmund , Stringaris Argyris , Taylor Eric , Anney Richard , Ebstein Richard P. , Gill Michael , Miranda Ana , Mulas Fernando , Oades Robert D. , Roeyers Herbert , Rothenberger Aribert , Steinhausen Hans‐Christoph , Faraone Stephen V.
Published: February 2010

Background:  The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD.

Methods:  One thousand, one hundred and eighty‐six children with ADHD combined type and 1827 siblings (aged 6–18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS‐R:L; CTRS‐R:L). Analyses of variance, regression analyses, χ2‐tests or loglinear models were applied.

Results:  Mean age and gender‐standardized ratings of EL in children with ADHD were >1.5 SD above the mean in normative samples. Severe EL (>75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive‐impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive‐impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive‐impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co‐segregate within families.

Conclusion:  EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity‐impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.
In vitro activation of GAT1 transporters expressed in spinal cord gliosomes stimulates glutamate release that is abnormally elevated in the SOD1/G93A(+) mouse model of amyotrophic lateral sclerosis
Authors: Milanese Marco , Zappettini Simona , Jacchetti Emanuela , Bonifacino Tiziana , Cervetto Chiara , Usai Cesare , Bonanno Giambattista
Published: February 2010

J. Neurochem. (2010) 113, 489–501.

The effect of GABA on glutamate release from astrocytes has been studied in healthy mice and in a murine transgenic model of amyotrophic lateral sclerosis (ALS), using mouse spinal cord gliosomes labeled with [3H]d‐aspartate ([3H]d‐ASP). GABA concentration‐dependently evoked the release of [3H]d‐ASP. The effect of GABA was not mimicked by GABAA or GABAB receptor agonists or counteracted by antagonists, excluding receptor involvement. However, it was prevented by the GABA transport inhibitor N‐(4,4‐phenyl‐3‐butenyl)‐nipecotic acid (SKF 89976A), suggesting participation of GABA transporters type 1 (GAT1) placed on glutamate‐releasing astrocyte‐derived gliosomes. Accordingly, GAT1 co‐expressed with glutamate–aspartate transporter (GLAST) and glutamate transporter type 1 (GLT1) in the majority of glial particles. [3H]d‐aspartate release was Ca2+‐independent and not blocked by the glutamate uptake inhibitor dl‐threo‐b‐benzyloxyaspartic acid (dl‐TBOA); instead, it was abrogated by the anion channel blockers niflumic acid and 5‐nitro‐2‐(3‐phenylpropylamino) benzoic acid (NPPB). The GAT1‐mediated release of [3H]d‐ASP was significantly enhanced in spinal cord gliosomes from the mouse model of ALS. This excessive [3H]d‐ASP release was very precocious, largely preceding the onset of the disease symptoms. These data indicate that GAT1, GLAST and GLT1 coexist on the same gliosome in mouse spinal cord and that activation of GAT1 transporters elicits glutamate release by anion channel opening. This phenomenon might have pathological relevance, because [3H]d‐ASP release is enhanced in experimental ALS.
The selective β1‐adrenoceptor antagonist nebivolol is a potential oestrogen receptor agonist with neuroprotective abilities
Authors: Manthey D , Gamerdinger M , Behl C
Published: February 2010

Background and purpose:  Nebivolol, a selective β1‐adrenoceptor antagonist mediating rapid vasodilating effects, is used clinically to treat hypertension. Recently, it was reported that nebivolol also acts as an oestrogen receptor (ER) agonist. To investigate the neuroprotective potential of oestrogens, we assessed the oestrogenic effects of nebivolol in several in vitro neuronal models.

Experimental approach:  Human neuroepithelioma SK‐N‐MC cells stably transfected with human ER α and β, and mouse N2A neuroblastoma cells expressing human APP695SWE[N2Aswe, stably transfected with the Swedish mutation form of the Alzheimer‐associated amyloid precursor protein (APPswe, K670M/N671L)] were incubated with different concentrations of nebivolol and 17β‐oestradiol (E2) for 24–48 h. ER activation was detected in a specific reporter assay, and ER‐dependent gene expression was measured by quantitative real‐time PCR (qRT PCR). Furthermore, cell survival rates were determined, and oxidative stress was induced by hydrogen peroxide and paraquat. Amyloid β protein precursor (APP) processing was investigated, and the cleavage fragments sAPPα and Aβ were quantified via α‐, β‐ and γ‐secretase activity assays. Alterations of secretase expression levels were determined by qRT PCR.

Key results:  Nebivolol induces oestrogen‐dependent gene transcription, and protects neuronal cells against oxidative stress even at low and physiological concentrations (10−8 M). Moreover, nebivolol modulates processing of APP in mouse neuronal N2Aswe cells by increasing α‐secretase activity, ultimately leading to enhanced release of soluble non‐amyloidogenic sAPPα.

Conclusions and implications:  We showed that nebivolol acts as ER agonist in neuronal cell lines, and suggest oestrogen‐like neuroprotective effects mediated by nebivolol.
The Futile Paradigm: In Quest of Feudalism in Early Medieval Japan
Authors: Friday Karl
Published: February 2010

How useful is ‘feudalism’ as a paradigm for understanding medieval Japan? While the construct has a venerable history in application to the Japanese past, it is rarely invoked by specialists today, who tend to focus comparative analyses on fundamental differences, rather than superficial parallels between medieval Japan and medieval Europe. This article examines both the history and the utility of the feudal construct, discussing problems inherent to definitions of ‘feudalism’ and surveying changing scholarly perceptions of late classical and early medieval Japan, particularly with regard to three key processes: the appearance of the samurai, the emergence of warrior‐aristocrats as rulers, and the evolution of vassalage and its relationship to benefice.
The Making of the Juvenile Delinquent in Nigeria and South Africa, 1930–1970
Authors: Fourchard Laurent
Published: February 2010

In Nigeria as in South Africa, youth crime is perceived by officials and some academics as a major social and political contemporary concern. The understanding of the origins of youth violence, youth destitution and public policies towards the youth is, however, inadequately informed by academic research. Only a few works have been produced on Nigerian youth crime history while it has become an important subfield of research in the case of South Africa in the framework of the rise of the new social history in this country since the 1980s. In both countries, however, the understanding of youth crime from the point of view of officials remains largely unexplored. It is argued in this article that juvenile delinquency became a central notion popularized from the 1930s onward by officials, politicians, welfare officers, academics and later on by some international organizations, before declining in the 1980s and 1990s. The discovery of ‘delinquents’ by welfare officers or academics actually led to the implementation in both countries of new administrative and judiciary machinery which combined two processes: it legislated ‘juvenile delinquency’ into existence as a clearly identifiable social problem and criminalized a large portion of urban youth. As such the history of the juvenile delinquent in Africa strictly follows state or academic discovery of youth destitution and the setting up of juvenile state institutions rather than it really informs on the history of youth crime. It is thus considered that colonial, post colonial and apartheid policies towards the youth and the children were a central part of the problem of juvenile delinquency not a solution to it.
Impact of severe epilepsy on development: Recovery potential after successful early epilepsy surgery
Authors: Roulet‐Perez Eliane , Davidoff Véronique , Mayor‐Dubois Claire , Maeder‐Ingvar Malin , Seeck Margitta , Ruffieux Christiane , Villemure Jean‐Guy , Deonna Thierry
Published: February 2010

Purpose:  Epilepsy surgery in young children with focal lesions offers a unique opportunity to study the impact of severe seizures on cognitive development during a period of maximal brain plasticity, if immediate control can be obtained. We studied 11 children with early refractory epilepsy (median onset, 7.5 months) due to focal lesion who were rendered seizure‐free after surgery performed before the age of 6 years.

Methods:  The children were followed prospectively for a median of 5 years with serial neuropsychological assessments correlated with electroencephalography (EEG) and surgery‐related variables.

Results:  Short‐term follow‐up revealed rapid cognitive gains corresponding to cessation of intense and propagated epileptic activity [two with early catastrophic epilepsy; two with regression and continuous spike‐waves during sleep (CSWS) or frontal seizures]; unchanged or slowed velocity of progress in six children (five with complex partial seizures and frontal or temporal cortical malformations). Longer‐term follow‐up showed stabilization of cognitive levels in the impaired range in most children and slow progress up to borderline level in two with initial gains.

Discussion:  Cessation of epileptic activity after early surgery can be followed by substantial cognitive gains, but not in all children. In the short term, lack of catch‐up may be explained by loss of retained function in the removed epileptogenic area; in the longer term, by decreased intellectual potential of genetic origin, irreversible epileptic damage to neural networks supporting cognitive functions, or reorganization plasticity after early focal lesions. Cognitive recovery has to be considered as a “bonus,” which can be predicted in some specific circumstances.
Long‐term outcomes of children treated with the ketogenic diet in the past
Authors: Patel Amisha , Pyzik Paula L. , Turner Zahava , Rubenstein James E. , Kossoff Eric H.
Published: February 2010

Purpose:  The ketogenic diet has well‐established short‐ and long‐term outcomes for children with intractable epilepsy, but only for those actively receiving it. However, no information exists about its long‐term effects years after it has been discontinued.

Methods:  Living subjects were identified who were treated at the Johns Hopkins Hospital with the ketogenic diet from November 1993 to December 2008 for ≥1 month, and had discontinued it ≥6 months prior to this study. Of 530 patients who were eligible, 254 were successfully contacted by phone or e‐mail with a survey and request for laboratory studies.

Results:  Questionnaires were completed by 101 patients, with a median current age of 13 years (range 2–26 years). Median time since discontinuing the ketogenic diet was 6 years (range 0.8–14 years). Few (8%) still preferred to eat high fat foods. In comparison to the 52% responder rate (>50% seizure reduction) at ketogenic diet discontinuation, 79% were now similarly improved (p = 0.0001). Ninety‐six percent would recommend the ketogenic diet to others, yet only 54% would have started it before trying anticonvulsants. Lipids were normal (mean total cholesterol 158 mg/dl), despite most being abnormal while on the ketogenic diet. The mean Z scores for those younger than age 18 years were −1.28 for height and −0.79 for weight. In those 18 years of age or older, the mean body mass index (BMI) was 22.2.

Discussion:  This is the first study to report on the long‐term effects of the ketogenic diet after discontinuation. The majority of subjects are currently doing well with regard to health and seizure control.
Optimal Timing of Implantable Cardioverter‐Defibrillator Implantation After Myocardial Infarction: A Decision Analysis
Authors: PICCINI JONATHAN P. , AL‐KHATIB SANA M. , MYERS EVAN R. , ANSTROM KEVIN J. , BUXTON ALFRED E. , PETERSON ERIC D. , SANDERS GILLIAN D.
Published: February 2010

ICD Implant Timing. Background: The optimal timing of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death after myocardial infarction (MI) remains unknown.

Methods and Results:
We developed a Markov model to investigate the optimal timing of ICD implantation after MI (no ICD, ICD at 60 days, 6 months, and 1 year) in patients who meet current guidelines. Estimates of arrhythmic death (baseline risk 6%, range 1–20% per year), nonarrhythmic death, and ICD efficacy were based upon MADIT‐II and other contemporary post‐MI clinical trials. We used both deterministic and stochastic modeling processes in our analysis. After 10 years follow‐up, the baseline probability of survival was higher in those treated with ICD implantation versus not (42% vs 30%, P < 0.001). Survival was highest with ICD implantation at 60 days versus 6 months versus 1 year: 42.4%, 42.3%, and 42.0% (P = 0.0028). ICD implantation at 60 days provided a mean incremental survival of 0.28 months and 0.84 months per patient (compared with implantation at 6 months and 1 year). In sensitivity analyses, patients’ competing risk for nonarrhythmic death was the primary determinant of benefit from ICD implantation. Overall, ICD implantation at 60 days resulted in the greatest life expectancy over a wide range of plausible nonarrhythmic and arrhythmic death rates.

Conclusions:
The benefits of early ICD implantation are modest when compared with delayed implantation at 6 months/1 year. Our results suggest that making sure a patient receives an ICD, when appropriate, may be more important than the timing of the implantation procedure. (J Cardiovasc Electrophysiol, Vol. pp. 791‐798, July 2010)
Mapping of Atrial Tachycardia by Remote Magnetic Navigation in Postoperative Patients With Congenital Heart Disease
Authors: WU JINJIN , PFLAUMER ANDREAS , DEISENHOFER ISABEL , HOPPMANN PETRA , HESS JOHN , HESSLING GABRIELE
Published: February 2010

Remote Magnetic Mapping in Congenital Heart Disease. Objectives: The purpose of this study was to investigate if remote magnetic navigation (RMN) offers a reduction of fluoroscopy time when used for atrial tachycardia (AT) mapping in a spectrum of patients with congenital heart disease (CHD) after “simple” or “complex” atrial surgery.

Background:
Data about AT mapping using RMN in larger populations of patients with CHD are scarce.

Methods:
RMN in combination with electroanatomic mapping was used for AT mapping in 22 patients. According to anatomic complexity, patients were classified into 3 groups: Group 1: patients after minor atrial surgery (n = 7); Group 2: patients after the Fontan operation (n = 9); and group 3: patients after the Senning/Mustard operation (n = 6).

Results:
Atrial mapping with a nonirrigated tip RMN catheter was completed successfully in all patients. In Group 1 no significant reduction in fluoroscopy time was noticed over time (mean fluoroscopy time 7.9 minutes). In the 15 patients of group 2 and group 3 with complex CHD, the fluoroscopy time for mapping in the last 9 patients (6.4 ± 2.8 minutes) was significantly shorter than in the first 6 patients (29.7 ± 10.5 minutes, P < 0.0001). Acutely successful ablation was achieved in 21 of 22 patients (97%) using the RMN catheter (n = 3) or a conventional catheter (n = 18) without procedural complications.

Conclusions:
RMN for AT mapping in patients with complex atrial anatomy leads to a significant reduction of fluoroscopy time. (J Cardiovasc Electrophysiol, Vol. pp. 751‐759, July 2010)
The Permanency of Pulmonary Vein Isolation Using a Balloon Cryoablation Catheter
Authors: AHMED HUMERA , NEUZIL PETR , SKODA JAN , D’AVILA ANDRE , DONALDSON DAVID M. , LARAGY MARGARET C. , REDDY VIVEK Y.
Published: February 2010

Chronic PV Isolation With the Cryoballoon. Background: Because of its technical feasibility and presumed safety benefits, balloon cryoablation is being increasingly employed for pulmonary vein (PV) isolation. While acute isolation has been demonstrated in most patients, little data are available on the chronic durability of cryoballoon lesions.

Methods and Results:
Twelve atrial fibrillation patients underwent PV isolation using either a 23‐mm or 28‐mm cryoballoon. For each vein, after electrical isolation was verified with the use of a circular mapping cathether, 2 bonus balloon ablation lesions were placed. Gaps in balloon occlusion were overcome using either a spot cryocatheter or a “pull‐down” technique. A prespecified second procedure was performed at 8–12 weeks to assess for long‐term PV isolation. Acute PV isolation was achieved in all PVs in the patient cohort (n = 48 PVs), using the cryoballoon alone in 47/48 PVs (98%); a “pull‐down” technique was employed for 5 PVs (1 right superior pulmonary vein, 2 right inferior pulmonary veins, and 2 left inferior pulmonary veins). The gap in the remaining vein was ablated with a spot cryocatheter. During the second mapping procedure, 42 of 48 PVs (88%) remained isolated. One vein had reconnected in 2 patients, while 2 veins had reconnected in another 2 patients. All PVs initially isolated with the “pull‐down” technique remained isolated at the second procedure.

Conclusions:
Cryoballoon ablation allows for durable PV isolation with the use of a single balloon. With maintained chronic isolation in most PVs, it may represent a significant step toward consistent and lasting ablation procedures. (J Cardiovasc Electrophysiol, Vol. pp. 731‐737, July 2010)
Bradycardiomyopathy: The Case for a Causative Relationship Between Severe Sinus Bradycardia and Heart Failure
Authors: CALISKAN KADIR , BALK AGGIE H.M.M. , JORDAENS LUC , SZILI‐TOROK TAMAS
Published: February 2010

Bradycardiomyopathy.  A 28‐year‐old man presented with progressive fatigue. Physical examination and ECG revealed severe sinus bradycardia. Echocardiography showed features of noncompaction cardiomyopathy and moderate aortic valve regurgitation. We hypothesized that the chronic volume overload exaggerated by prolonged diastole due to the bradycardia resulted in heart failure and noncompaction cardiomyopathy look‐alike features. After implantation of an AAI pacemaker, his symptoms and signs of cardiomyopathy were fully recovered. (J Cardiovasc Electrophysiol, Vol. pp. 822‐824, July 2010)
Role of the Transient Outward Current in Regulating Mechanical Properties of Canine Ventricular Myocytes
Authors: DONG MIN , YAN SUJUAN , CHEN YAMEI , NIKLEWSKI PAUL J. , SUN XIAOYIN , CHENAULT KATHRYN , WANG HONG‐SHENG
Published: February 2010

Ito and Myocyte Contractility. 

Introduction:
The transient outward current (Ito) is a major repolarizing current in the heart. Reduction of Ito density is consistently observed in human heart failure (HF) and animal HF models. It has been proposed that Ito, via its influence on phase‐1 repolarization of the action potential, facilitates L‐type Ca2+ current (ICa–L) activation and sarcoplasmic reticulum Ca2+ release, and that its down‐regulation may contribute to the impaired contractility in failing heart.

Methods and Results:
We used the dynamic clamp to quantitatively examine the influence of Ito on the mechanical properties of canine left ventricular myocytes at 34°C. In endocardial myocytes, where the native Ito is small, simulation of an epicardial‐level artificial Ito accentuated the phase‐1 repolarization and significantly suppressed cell shortening. The peak amplitude of Ca2+ transient was also reduced in the presence of simulated Ito, although the rate of rise of the Ca2+ transient was increased. Conversely, subtraction, or “blockade” of the native Ito enhanced contractility in epicardial cells. These results agree with the inverse correlation between Ito levels and myocyte contractility and Ca2+ transient amplitude in epicardial and endocardial myocytes. Action potential clamp studies showed that the phase‐1 repolarization/Ito versus ICa–L relationship had an inverted‐J shape; small Ito enhanced peak ICa–L while moderate‐to‐large Ito decreased peak ICa–L and markedly reduced early Ca2+ influx.

Conclusion:
Our results show that epicardial‐level of Ito acts as a negative, rather than positive regulator of myocyte mechanical properties in canine ventricular myocytes. (J Cardiovasc Electrophysiol, Vol. 21, pp. 697‐703, June 2010)
Higher Rate of Recurrent Atrial Flutter and Atrial Fibrillation Following Atrial Flutter Ablation After Cardiac Surgery
Authors: AKTAS MEHMET K. , KHAN MOHAMMED N. , DI BIASE LUIGI , ELAYI CLAUDE , MARTIN DAVID , SALIBA WALID , CUMMINGS JENNIFER , SCHWEIKERT ROBERT , NATALE ANDREA
Published: February 2010

Atrial Flutter After Cardiac Surgery. Introduction: Atrial flutter (AFL) is common after cardiac surgery. However, the types of post‐cardiac surgery AFL, its response to catheter‐based radiofrequency ablation, and its relationship to atrial fibrillation (AF) are unknown.

Methods and Results: We retrospectively studied all patients who underwent mapping and ablation for AFL after cardiac surgery from January 1990 to July 2004. One hundred randomly selected patients without prior cardiac surgery (PCS) who underwent mapping and ablation of AFL served as the control population. A total of 236 patients formed the study population (mean age 62 + 13 years, 22% female) and 100 patients formed the control population (mean age 60 + 13 years, 25% female). The majority of patients without PCS had cavo‐tricuspid isthmus (CTI)‐dependent AFL when compared to patients with PCS (93% vs 72%, respectively, P < 0.0001). In contrast, scar‐related AFL was more common in patients with PCS as compared to patients without PCS (22% vs 3%, P < 0.0001). Predictors of scar related AFL in multivariable regression analysis included PCS and left‐sided AFL. Acute success rates and complications were similar between the groups. When compared to patients with AFL ablation without PCS, those that had AFL after PCS had higher rates of recurrence of both AFL (1% vs 12%, P < 0.0001; mean time to recurrence 1.85 years) and AF (16% vs 28%, P = 0.02; mean time to recurrence 2.67 years).

Conclusion: Despite ablation of AFL, patients with PCS have a higher rate of AFL and AF when compared to patients without PCS who underwent ablation of atrial flutter during long‐term follow‐up. (J Cardiovasc Electrophysiol, Vol. pp. 760‐765, July 2010)
Right Coronary Artery Occlusion During RF Ablation of Typical Atrial Flutter
Authors: MYKYTSEY ANDREW , KEHOE RICHARD , BHARATI SAROJA , MAHESHWARI PRADEEP , HALLERAN SEAN , KRISHNAN KOUSIK , RAZMINIA MANSOUR , MINA ADEL , TROHMAN RICHARD G.
Published: February 2010

RCA Occlusion During RF Ablation.  Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus‐dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication. (J Cardiovasc Electrophysiol, Vol. pp. 818‐821, July 2010)
Impact of Pharmacological Autonomic Blockade on Complex Fractionated Atrial Electrograms
Authors: KNECHT SÉBASTIEN , WRIGHT MATTHEW , MATSUO SEIICHIRO , NAULT ISABELLE , LELLOUCHE NICOLAS , SACHER FRÉDÉRIC , KIM STEVEN J. , MORGAN DENNIS , AFONSO VALTINO , SHINZUKE MIYAZAKI , HOCINI MÉLÈZE , CLÉMENTY JACQUES , NARAYAN SANJIV M. , RITTER PHILLIPE , JAÏS PIERRE , HAÏSSAGUERRE MICHEL
Published: February 2010

Autonomic Blockade During Atrial Fibrillation. Introduction: The influence of the autonomic nervous system on the pathogenesis of complex fractionated atrial electrograms (CFAE) during atrial fibrillation (AF) is incompletely understood. This study evaluated the impact of pharmacological autonomic blockade on CFAE characteristics.

Methods and Results:
Autonomic blockade was achieved with propanolol and atropine in 29 patients during AF. Three‐dimensional maps of the fractionation degree were made before and after autonomic blockade using the Ensite Navx® system. In 2 patients, AF terminated following autonomic blockade. In the remaining 27 patients, 20,113 electrogram samples of 5 seconds duration were collected randomly throughout the left atrium (10,054 at baseline and 10,059 after autonomic blockade). The impact of autonomic blockade on fractionation was assessed by blinded investigators and related to the type of AF and AF cycle length. Globally, CFAE as a proportion of all atrial electrogram samples were reduced after autonomic blockade: 61.6 ± 20.3% versus 57.9 ± 23.7%, P = 0.027. This was true/significant for paroxysmal AF (47 ± 23% vs 40 ± 22%, P = 0.003), but not for persistent AF (65 ± 22% vs 62 ± 25%, respectively, P = 0.166). Left atrial AF cycle length prolonged with autonomic blockade from 170 ± 33 ms to 180 ± 40 ms (P = 0.001). Fractionation decreases only in the 14 of 27 patients with a significant (>6 ms) prolongation of the AF cycle length (64 ± 20% vs 59 ± 24%, P = 0.027), whereas fractionation did not reduce when autonomic blockade did not affect the AF cycle length (58 ± 21% vs 56 ± 25%, P = 0.419).

Conclusions:
Pharmacological autonomic blockade reduces CFAE in paroxysmal AF, but not persistent AF. This effect appears to be mediated by prolongation of the AF cycle length. (J Cardiovasc Electrophysiol, Vol. pp. 766‐772, July 2010)
Reduction of Ventricular Sodium Current in a Mouse Model of HIV
Authors: GRANDY SCOTT A. , BROUILLETTE JUDITH , FISET CÉLINE
Published: February 2010

Effect of HIV on Cardiac Sodium Current. Introduction: Cardiac arrhythmias have been reported in AIDS patients. Arrhythmias can arise from alterations in ventricular Na+ channel function. However, it is unknown whether HIV affects cardiac Na+ channel function. Therefore, the purpose of this study was to characterize the effect of HIV on ventricular Na+ current (INa) in a transgenic model of HIV (CD4C/HIV mice), which exhibit a severe AIDS‐like disease.

Methods and Results:
Patch‐clamp techniques were used to examine INa and action potentials (AP) in ventricular myocytes isolated from HIV and wild‐type (WT) mice. In HIV myocytes peak INa was reduced (at −50 mV: HIV, −55.3 ± 4.3 pA/pF, n = 15; WT, −79.4 ± 5.2 pA/pF, n = 16, P < 0.05), whereas late INa was similar in both groups (HIV, −4.3 ± 0.4 pA/pF; WT, −4.4 ± 0.4 pA/pF, n = 22/group). AP amplitude (HIV 91.5 ± 4.7 mV, n = 12; WT 104.4 ± 3.1 mV, n = 15, P < 0.05) and the maximal velocity of the AP upstroke (Vmax; HIV, 57.2 ± 9.3 mV/ms, n = 12; WT, 113.5 ± 8 mV/ms, n = 15, P < 0.05) were decreased in HIV myocytes. ECG recordings revealed that the QRS complex was prolonged in HIV mice (HIV, 15.7 ± 0.2 ms, n = 22; WT, 14.1 ± 0.5 ms, n = 10, P < 0.05). The serum levels of interleukin‐1β were elevated in HIV mice (HIV, 18.1 ± 3.1 pg/mL, n = 3; WT, 5.1 ± 1.1 pg/mL, n = 4, P < 0.05) in line with previous evidence that suggests that elevated levels of cytokines can affect cardiac ion currents.

Conclusion:
Overall, our observations suggest that elevated levels of proinflammatory cytokines in CD4C/HIV mice could alter Na+ channel function, thus altering cardiac depolarization and contribute to the generation of arrhythmias. (J Cardiovasc Electrophysiol, Vol. 21, pp. 916‐922, August 2010)
Atrial Tachycardia Confined Within the Left Atrial Appendage
Authors: MIYAZAKI SHINSUKE , NAULT ISABELLE , JAÏS PIERRE , HAÏSSAGUERRE MICHEL
Published: February 2010

AT Confined Within the LAA.  Left atrial tachycardias are often seen following catheter ablation of persistent atrial fibrillation (AF). We report here an unusual case where AF was converted to sinus rhythm following catheter ablation, but ongoing atrial tachycardia confined within the left atrial appendage (LAA) was observed. Although the LAA tachycardia was dissociated from the atrium in sinus rhythm, bidirectional conduction between the left atrium and the LAA was, however, demonstrated after tachycardia termination. (J Cardiovasc Electrophysiol, Vol. 21, pp. 933‐935, August 2010)
Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer
Authors: CHOI JUNG HYE , SONG YOUNG SOO , YOON JIN SUN , SONG KANG WON , LEE YOUNG YIUL
Published: February 2010

Choi JH, Song YS, Yoon JS, Song KW, Lee YY. Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer. APMIS 2010; 118: 196–202.

The enhancer of zeste homolog 2 (EZH2), a member of the polycomb group of proteins, plays an important role in cell proliferation and cell cycle regulation. EZH2 is overexpressed in aggressive forms of prostate, breast, bladder, and endometrial cancers. However, the role of EZH2 expression in gastric cancer has not been fully determined. This study was conducted to investigate the correlation between EZH2 and cell cycle‐related molecules, and the clinical value of EZH2 expression in gastric cancer. We analyzed EZH2 expression using Western blotting in AGS, MKN‐28, SNU‐16, SNU‐484, SNU‐601, and SNU‐638 gastric cancer cell lines. After transfection of EZH2 siRNA into MKN‐28 cells, the change in cell cycle‐related molecules was assessed by Western blot analysis. Expression of EZH2, Ki‐67, and p53 was determined by immunohistochemical staining of tissue microarrays from specimens of 137 cases of resected gastric cancer. We found high expressions of EZH2 in all of the tested gastric cancer cell lines. RNA interference of EZH2 induced upregulation of p53 and HDAC1 and downregulation of cyclin D1 and cyclin E. High EZH2 expression was observed in 60.6% of gastric cancers and in 6.7% of non‐neoplastic gastric tissues (p < 0.01); 40.1% were positive for p53 in gastric cancers. High EZH2 expression was correlated with Ki‐67 and p53 expressions and was significantly associated with distant metastases and non‐signet ring cells. Our results suggest that high EZH2 expression is associated with tumor cell proliferation and metastasis in gastric cancer.
Diversity of Veillonella spp. from subgingival plaque by polyphasic approach
Authors: LEUCKFELD INGA , PASTER BRUCE J. , KRISTOFFERSEN ANNE K. , OLSEN INGAR
Published: February 2010

Leuckfeld I, Paster BJ, Kristoffersen AK, Olsen I. Diversity of Veillonella spp. from subgingival plaque by polyphasic approach. APMIS 2010; 118: 230–42.

In a biofilm such as the subgingival microflora, strain‐specific properties or factors induced by the host may impart a survival advantage to some bacterial strains. Periodontal disease has been associated with chronic obstructive pulmonary disease (COPD) and we previously found high amounts of Veillonella in the subgingival microflora of COPD subjects. Differentiation of Veillonella is difficult. The aims of this study were to identify subgingival Veillonella isolates by phenotypic, genetic typing and molecular genetic methods, and further, to assess if Veillonella strain properties or identity correlated with periodontal disease or COPD. From 22 subjects, 26 subgingival Veillonella isolates and one pulmonary isolate were analysed. The majority of the subgingival Veillonella isolates were identified as Veillonella parvula. Genotyping showed heterogeneity within strains of the same species. A subgingival and pulmonary isolate in one COPD subject was found to be genetically identical strains of V. parvula. Scanning electron microscopy of the lung biopsy confirmed single small cocci adhering or coaggregating with larger cocci on the airway epithelium. Apart from a variation in cellular fatty acid composition of six subgingival isolates from periodontitis subjects, no correlation between the subgingival Veillonella strains or genotypes and the presence of either periodontitis or COPD was found. In conclusion, V. parvula was the predominant subgingival Veillonella species with high genetic variability within strains of the same species. Subgingival V. parvula can translocate to the lungs; however, Veillonella identity or genotype did not correlate with periodontal disease or COPD.
‘Epidermotropism’ vs. ‘exocytosis’ of lymphocytes 101: definition of terms
Authors: Fung Maxwell A.
Published: February 2010

The terms ‘epidermotropism’ and ‘exocytosis’ are commonly used to describe intraepithelial lymphocytes in the mycosis fungoides (MF) variant of cutaneous T cell lymphoma (CTCL). However, both terms have not been uniformly or consistently defined. In this study, definitions of both terms were requested from 34 experts. In definitions provided by 19 responders, ‘epidermotropism’ correlated with MF/CTCL, and ‘exocytosis’ correlated with benign conditions. Use of these terms often reflected the observer's interpretation, as they were not always used in purely descriptive fashion.

Fung MA. ‘Epidermotropism’ vs. ‘exocytosis’ of lymphocytes 101: definition of terms.