bluuebunny/crossref_metadata_2025 huggingface dataset:
Deterioration of Regional Wall Motion Immediately after Coronary Artery Bypass Graft Surgery Is Associated with Long-term Major Adverse Cardiac Events
Authors: Swaminathan Madhav , Morris Richard W. , De Meyts Daniel D. , Podgoreanu Mihai V. , Jollis James G. , Grocott Hilary P. , Milano Carmelo A. , Newman Mark F. , Mathew Joseph P.
Published: March 2009

Background

Patients undergoing coronary artery bypass graft (CABG) surgery frequently develop wall motion abnormalities diagnosed by intraoperative transesophageal echocardiography. However, the relation between deterioration in wall motion and postoperative morbidity or mortality is unclear. Therefore, the authors hypothesized that deterioration in intraoperative left ventricular regional wall motion immediately after CABG surgery is associated with a higher risk of adverse cardiac events.

Methods

With institutional review board approval, data were gathered from 1,412 CABG surgery patients. Echocardiographic wall motion score (WMS) was derived using a 16-segment model. Outcomes data were gathered for up to 2 yr after surgery. The primary outcome, major adverse cardiac event, was a composite index of myocardial infarction, need for subsequent coronary revascularization, or all-cause mortality during the follow-up period.

Results

Two hundred twenty-one patients (16%) had 254 primary outcome events during follow-up. Postbypass WMS did not change in 812 patients (58%), deteriorated in 219 patients (16%), and improved in 368 patients (26%). Kaplan-Meier analysis showed that patients with deterioration in WMS after CABG experienced significantly lower major adverse cardiac event-free survival than patients with either no change or improvement in WMS (P = 0.004). Cox proportional hazards regression modeling revealed a significant association between deterioration in WMS and the composite adverse outcome (hazard ratio, 1.47 [1.06-2.03]; P = 0.02).

Conclusions

The authors confirmed their hypothesis that deterioration in wall motion detected by intraoperative echocardiography after CABG surgery is associated with increased risk of long-term adverse cardiac morbidity. Worsening wall motion after CABG surgery should be considered a prognostic indicator of adverse cardiovascular outcome.
A Randomized Trial of Ultrasound Image–based Skin Surface Marking versus Real-time Ultrasound-guided Internal Jugular Vein Catheterization in Infants
Authors: Hosokawa Koji , Shime Nobuaki , Kato Yuko , Hashimoto Satoru
Published: March 2009

Background

Ultrasound-guided central venous catheterization has been recommended to increase the procedural success rate and enhance patient safety. However, few studies have examined the potential advantages of one ultrasound technique with another, specifically in small infants.

Methods

The authors randomly assigned 60 neonates and infants weighing less than 7.5 kg to an ultrasound-guided skin-marking method (n = 27) versus real-time ultrasound-assisted internal jugular venous catheterization (n = 33). The times to successful puncture of the internal jugular vein and to catheterization were measured. Attempts at needle punctures for successful catheterization were counted. Procedural complications were recorded.

Results

In the real-time group, compared with the skin- marking group, venous puncture was completed faster (P = 0.03), the time required to catheterize was shorter (P < 0.01), and fewer needle passes were needed. Specifically, fewer than three attempts at puncture were made in 100% of patients in the real-time group, versus 74% of patients in the skin-marking group (P < 0.01). A hematoma and an arterial puncture occurred in one patient each in the skin-marking group.

Conclusions

The real-time ultrasound guidance method could enhance procedural efficacy and safety of internal jugular catheterization in neonates and infants.
Effects of the Beach Chair Position, Positive End-expiratory Pressure, and Pneumoperitoneum on Respiratory Function in Morbidly Obese Patients during Anesthesia and Paralysis
Authors: Valenza Franco , Vagginelli Federica , Tiby Alberto , Francesconi Silvia , Ronzoni Giulio , Guglielmi Massimiliano , Zappa Marco , Lattuada Ezio , Gattinoni Luciano
Published: March 2009

Background

The authors studied the effects of the beach chair (BC) position, 10 cm H2O positive end-expiratory pressure (PEEP), and pneumoperitoneum on respiratory function in morbidly obese patients undergoing laparoscopic gastric banding.

Methods

The authors studied 20 patients (body mass index 42 +/- 5 kg/m2) during the supine and BC positions, before and after pneumoperitoneum was instituted (13.6 +/- 1.2 mmHg). PEEP was applied during each combination of position and pneumoperitoneum. The authors measured elastance (E,rs) of the respiratory system, end-expiratory lung volume (helium technique), and arterial oxygen tension. Pressure-volume curves were also taken (occlusion technique). Patients were paralyzed during total intravenous anesthesia. Tidal volume (10.5 +/- 1 ml/kg ideal body weight) and respiratory rate (11 +/- 1 breaths/min) were kept constant throughout.

Results

In the supine position, respiratory function was abnormal: E,rs was 21.71 +/- 5.26 cm H2O/l, and end-expiratory lung volume was 0.46 +/- 0.1 l. Both the BC position and PEEP improved E,rs (P < 0.01). End-expiratory lung volume almost doubled (0.83 +/- 0.3 and 0.85 +/- 0.3 l, BC and PEEP, respectively; P < 0.01 vs. supine zero end-expiratory pressure), with no evidence of lung recruitment (0.04 +/- 0.1 l in the supine and 0.07 +/- 0.2 in the BC position). PEEP was associated with higher airway pressures than the BC position (22.1 +/- 2.01 vs. 13.8 +/- 1.8 cm H2O; P < 0.01). Pneumoperitoneum further worsened E,rs (31.59 +/- 6.73; P < 0.01) and end-expiratory lung volume (0.35 +/- 0.1 l; P < 0.01). Changes of lung volume correlated with changes of oxygenation (linear regression, R2 = 0.524, P < 0.001) so that during pneumoperitoneum, only the combination of the BC position and PEEP improved oxygenation.

Conclusions

The BC position and PEEP counteracted the major derangements of respiratory function produced by anesthesia and paralysis. During pneumoperitoneum, only the combination of the two maneuvers improved oxygenation.
Competitive Inhibition at the Glycine Site of the N -Methyl-d-aspartate Receptor by the Anesthetics Xenon and Isoflurane
Authors: Dickinson Robert , Peterson Brian K. , Banks Paul , Simillis Constantinos , Martin Juan Carlos Sacristan , Valenzuela Carlos A. , Maze Mervyn , Franks Nicholas P.
Published: March 2009

Background

Inhibition of N-methyl-D-aspartate (NMDA) receptors by anesthetic gases and vapors may play an important role in anesthesia and neuroprotection. However, the site of action of these agents on the NMDA receptor is unknown. The authors show that xenon and isoflurane compete for the binding of the coagonist glycine on the NMDA receptor NR1 subunit.

Methods

Using a novel application of grand canonical Monte Carlo simulations, the authors predict the binding site of xenon on NMDA receptors. They test this prediction using electrophysiology on recombinant NMDA receptors.

Results

The authors' modeling predicts that xenon binds at the glycine site of the NMDA receptor. The authors show that inhibition of NMDA receptors by xenon and isoflurane increases as glycine concentration is decreased, consistent with the prediction of competitive inhibition at the glycine site. Lineweaver-Burk analysis shows that isoflurane inhibition seems purely competitive with glycine, but for xenon, there is an additional component of noncompetitive inhibition. The loss of inhibitory effect of xenon and isoflurane in mutant NR1(F639A)/NR2A receptors is explained by increased glycine affinity of the mutant receptors, and inhibition is restored at low glycine concentrations.

Conclusions

Xenon and isoflurane inhibit NMDA receptors by binding at the same site as the coagonist glycine. This finding may have important implications for general anesthesia and neuroprotection. Neuroprotectants that act at the glycine site of the NMDA receptor antagonists are well tolerated in patients, being devoid of psychotomimetic side effects, and the mechanism of inhibition may play a role in their clinical profile.
Involvement of the Basal Cholinergic Forebrain in the Mediation of General (Propofol) Anesthesia
Authors: Laalou Fatem-Zohra , de Vasconcelos Anne Pereira , Oberling Philippe , Jeltsch Hélène , Cassel Jean-Christophe , Pain Laure
Published: March 2009

Background

Recent studies have pointed out the involvement of the basal forebrain gamma-aminobutyric acid-mediated system in mediating the effects of general anesthesia. In this study, the authors asked whether the basal forebrain cholinergic system is also involved in mediating the effects of general anesthetics such as propofol.

Methods

Cholinergic lesions were produced by administration of the selective immunotoxin 192 immunoglobulin G-saporin into the lateral ventricles, the medial septum, or the nucleus basalis magnocellularis. The anesthetic potency of propofol was determined using an anesthetic score with a crossover counterbalanced design. Animals were given intraperitoneal propofol (25 or 50 mg/kg) repeatedly every 15 min to set up a subanesthetic (low-dose) or anesthetic (high-dose) state. The anesthetic score was assessed for each cumulative dose. Control of the cholinergic depletion was performed using histochemical acetylcholinesterase staining on brain slices.

Results

A shift from a subanesthetic state to an anesthetic state was observed mainly in the rats with the immunotoxin injected into the lateral ventricles or the medial septum and vertical diagonal band of Broca, compared with controls. In those rats, the density of acetylcholinesterase reaction products was normal in the striatum and the thalamus, but reduced in the cortex and the hippocampus.

Conclusion

The anesthetic potency of propofol was increased in all rats with hippocampal lesions, whatever the injection sites, compared with controls. These results demonstrate that a cholinergic dysfunction in the basal forebrain potentiates the anesthetic effects of propofol.
Developing Consensus on Appropriate Standards of Disaster Care for Children
Authors: Kanter Robert K. , Andrake John S. , Boeing Nancy M. , Callahan James , Cooper Arthur , Lopez-Dwyer Christine A. , Marcin James P. , Odetola Folafoluwa O. , Ryan Anne E. , Terndrup Thomas E. , Tobin Joseph R.
Published: March 2009

Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.

Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process. Interventions were chosen such that workload per staff member would not exceed the previously validated maximum according to the Therapeutic Intervention Scoring System. Based on published models, it was assumed that the usual numbers of staff would care for a disaster surge of 4 times the usual number of intensive care and non–intensive care hospital patients.

Results: Using a single set of assumptions on constrained resources and overwhelming needs, the panel ranked and agreed on essential interventions. A number of standard interventions would exceed crisis workload constraints, including detailed recording of vital signs and fluid balance, administration of vasoactive agents, invasive monitoring of pressures (central venous, intraarterial, intracranial), dialysis, and tube feedings.

Conclusions: The quantitative methodology and consensus development process described in the present report may have utility in future planning. Groups with appropriate expertise must develop action plans according to authority within each jurisdiction, addressing likely disaster scenarios, according to the needs in each medical service region, using available regional resources, and accounting for the capabilities of each institution. (Disaster Med Public Health Preparedness. 2009;3:27–32)
Variations in Disaster Preparedness by Mental Health, Perceived General Health, and Disability Status
Authors: Eisenman David P. , Zhou Qiong , Ong Michael , Asch Steven , Glik Deborah , Long Anna
Published: March 2009

Objectives:Chronic medical and mental illness and disability increase vulnerability to disasters. National efforts have focused on preparing people with disabilities, and studies find them to be increasingly prepared, but less is known about people with chronic mental and medical illnesses. We examined the relation between health status (mental health, perceived general health, and disability) and disaster preparedness (home disaster supplies and family communication plan).

Methods:A random-digit-dial telephone survey of the Los Angeles County population was conducted October 2004 to January 2005 in 6 languages. Separate multivariate regressions modeled determinants of disaster preparedness, adjusting for sociodemographic covariates then sociodemographic variables and health status variables.

Results:Only 40.7% of people who rated their health as fair/poor have disaster supplies compared with 53.1% of those who rate their health as excellent (P< 0.001). Only 34.8% of people who rated their health as fair/poor have an emergency plan compared with 44.8% of those who rate their health as excellent (P< 0.01). Only 29.5% of people who have a serious mental illness have disaster supplies compared with 49.2% of those who do not have a serious mental illness (P< 0.001). People with fair/poor health remained less likely to have disaster supplies (adjusted odds ratio [AOR] 0.69, 95% confidence interval [CI] 0.50–0.96) and less likely to have an emergency plan (AOR 0.68, 95% CI 0.51–0.92) compared with those who rate their health as excellent, after adjusting for the sociodemographic covariates. People with serious mental illness remained less likely to have disaster supplies after adjusting for the sociodemographic covariates (AOR 0.67, 95% CI 0.48–0.93). Disability status was not associated with lower rates of disaster supplies or emergency communication plans in bivariate or multivariate analyses. Finally, adjusting for the sociodemographic and other health variables, people with fair/poor health remained less likely to have an emergency plan (AOR 0.66, 95% CI 0.48–0.92) and people with serious mental illness remained less likely to have disaster supplies (AOR 0.67, 95% CI 0.47–0.95).

Conclusions:People who report fair/poor general health and probable serious mental illness are less likely to report household disaster preparedness and an emergency communication plan. Our results could add to our understanding of why people with preexisting health problems suffer disproportionately from disasters. Public health may consider collaborating with community partners and health services providers to improve preparedness among people with chronic illness and people who are mentally ill. (Disaster Med Public Health Preparedness. 2009;3:33–41)
Thermal Stress and Point-of-Care Testing Performance: Suitability of Glucose Test Strips and Blood Gas Cartridges for Disaster Response
Authors: Louie Richard F. , Sumner Stephanie L. , Belcher Shaunyé , Mathew Ron , Tran Nam K. , Kost Gerald J.
Published: March 2009

Objective:Point-of-care testing (POCT) devices are deployed in the field for emergency on-site testing under a wide range of environmental conditions. Our objective was to evaluate the performance of glucose meter test strips and handheld blood gas analyzer cartridges following thermal stresses that simulate field conditions.

Methods:We evaluated electrochemical and spectrophotometric glucose meter systems and a handheld blood gas analyzer. Glucose test strips were cold-stressed (–21°C) and heat-stressed (40°C) for up to 4 weeks. Blood gas cartridges were stressed at –21°C, 2°C, and 40°C for up to 72 hours. Test strip and cartridge performance was evaluated using aqueous quality control solutions. Results were compared with those obtained with unstressed POCT strips and cartridges.

Results:Heated glucose test strips and blood gas cartridges yielded elevated results. Frozen test strips and cooled cartridges yielded depressed glucose and blood gas results, respectively. Frozen cartridges failed.

Conclusions:The performance of glucose test strips and blood gas cartridges was affected adversely by thermal stresses. Heating generated elevated results, and cooling depressed results. Disaster medical assistance teams and emergency medical responders should be aware of these risks. Field POCT devices must be robust to withstand adverse conditions. We recommend that industry produce POCT devices and reagents suitable for disaster medical assistance teams. (Disaster Med Public Health Preparedness. 2009;3:13–17)
Influence of time spent on TV viewing and vigorous intensity physical activity on cardiovascular biomarkers. The Inter 99 study
Authors: Aadahl Mette , Kjær Michael , Jørgensen Torben
Published: March 2009

Introduction

Sedentary behaviour, especially TV viewing, has been identified as a possible risk factor for cardiovascular disease, whereas physical activity seems to protect against major cardiovascular risk factors: obesity, dyslipidemia and hypertension. The aim of this study was to explore the association between both time spent on TV viewing and vigorous intensity physical activity in relation to body mass index, waist circumference, waist/hip ratio, serum lipids and blood pressure.

Methods

A total of 1693 men and women, 33-64 years of age, from the 3-year follow-up of a population-based intervention study, The Inter 99 study, were included in this cross-sectional design. Information on TV viewing, physical activity and other lifestyle habits was obtained by self-report questionnaire. Associations between TV viewing/physical activity and biological cardiovascular risk factors were explored by multiple linear regression analyses.

Results

Data from 835 (51%) men and 805 (49%) women were included. Mean age was 50.8 years (33.0-64.6). Men had a higher overall physical activity score than women ( P < 0.0001). TV viewing was significantly, positively associated with waist/hip ratio ( P = 0.005), body mass index ( P = 0.03), triglycerides ( P = 0.005), low density lipoprotein cholesterol ( P = 0.03), total cholesterol ( P = 0.01), systolic ( P = 0.05) and diastolic blood pressure ( P = 0.03), but not with waist circumference and high density lipoprotein cholesterol (HDL). Engaging in vigorous intensity physical activity was associated with higher HDL ( P = 0.0006) and lower waist circumference ( P < 0.0001).

Conclusion

TV viewing and physical activity should be regarded as separate types of behaviour that relate to different cardiovascular disease risk factors. Eur J Cardiovasc Prev Rehabil 14:660-665 © 2007 The European Society of Cardiology
Effects of chronic smoking on exercise tolerance and on heart rate-systolic blood pressure product in young healthy adults
Authors: Papathanasiou George , Georgakopoulos Dimitris , Georgoudis George , Spyropoulos Panagiotis , Perrea Despina , Evangelou Angelos
Published: March 2009

Background

Smoking is a major cause of cardiovascular disease and mortality. Smoking-related deaths in Greece account for 23%, whereas 41% of young Greeks are smokers, the highest percentage in Europe. The purpose of this study was to examine the effects of chronic smoking on the rate-pressure product and exercise tolerance in young, healthy male smokers.

Design and methods

Forty-two smokers and 51 nonsmokers were selected from a population of 543 students based on their age, sex, body mass index, physical fitness, smoking habit and health status. All participants were tested with the standard Bruce treadmill protocol. The rate-pressure product was obtained at rest and during exercise at a given submaximal workload. The evaluation of exercise tolerance was based on peak workload achieved and maximal exercise test duration.

Results

The smokers had a higher rate-pressure product at rest ( P < 0.001) due to their higher resting heart rate ( P < 0.001). Resting values of blood pressure did not differ significantly between the two groups. During exercise, smokers had a greater rate-pressure product ( P < 0.001), mainly due to their significantly higher systolic blood pressure ( P = 0.008). The smokers had a higher submaximal heart rate ( P = 0.005), but the differences in heart rate between groups were reduced for smokers during exercise when compared to rest. The smokers' exercise tolerance was impaired and their maximal exercise test duration time was significantly shorter ( P < 0.001).

Conclusions

Chronic smoking was found to affect young male smokers' cardiovascular fitness, impairing the economy and decreasing the capacity of their circulatory system. Eur J Cardiovasc Prev Rehabil 14:646-652 © 2007 The European Society of Cardiology
Trends in cardiovascular risk factor prevalence (1995-2000-2005) in northeastern Spain
Authors: Grau Maria , Subirana Isaac , Elosua Roberto , Solanas Pascual , Ramos Rafel , Masia Rafel , Cordon Ferran , Sala Joan , Juvinyà Dolors , Cerezo Carlos , Fitó Montserrat , Vila Joan , Covas Maria Isabel , Marrugat Jaume ,   REGICOR Investigators
Published: March 2009

Background

High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain.

Design

Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain.

Methods

An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age.

Results

A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol > 3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.913.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends < 0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends = 0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends = 0.018).

Conclusions

The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs. Eur J Cardiovasc Prev Rehabil 14:653-659 © 2007 The European Society of Cardiology
Hyperglycaemia, in relation to sex, and mortality after acute coronary syndrome
Authors: Cubbon Richard M. , Rajwani Adil , Abbas Afroze , Gale Christopher P. , Grant Peter J. , Wheatcroft Stephen B. , Barth Julian H. , Kearney Mark T. , Hall Alistair S. ,   EMMACE-2 (Evaluation of Methods Management of Acute Coronary Events) Study Group
Published: March 2009

Aims

Both diabetes mellitus (DM) and hyperglycaemia are known to predict outcome after acute coronary syndrome (ACS). Recent work has suggested women with DM have greater baseline cardiovascular risk and poorer outcome after ACS. The interaction between sex and abnormal glucose homoeostasis in patients without diabetes is unexplored; we aimed to assess this relationship.

Methods and results

Retrospective analysis of data from a prospective cohort study of 1575 patients with a confirmed ACS and no previous diagnosis of DM in 11 UK hospitals. Multivariable analysis was performed to assess the value of clinical variables, including hyperglycaemia and sex, in predicting 2 year all-cause mortality. Sex and hyperglycaemia interacted in predicting mortality. In men, mortality risk increased more steeply with incremental levels of glycaemia than in women (glucose ≥ 11.1 mmol/l, hazard ratio, 2.19; 95% confidence interval, 1.2-4.0). In both sex groups increasing glycaemia predicted mortality at levels currently not recommended for acute therapeutic intervention (7.8-11.0 mmol/l).

Conclusions

In patients not known to have diabetes, hyperglycaemia is a concentration-dependent predictor of long-term mortality after ACS; this predictive value is stronger in men than women. Eur J Cardiovasc Prev Rehabil14:666-671 © 2007 The European Society of Cardiology
Predictors of blood pressure in a cohort of school-aged children
Authors: Mirzaei Masoud , Taylor Richard , Morrell Stephen , Leeder Stephen R.
Published: March 2009

Objectives

To examine anthropometric measures and birthweight as predictors of blood pressure (BP) in a cohort of children.

Design

Cross-sectional and longitudinal study comprising baseline anthropometric and BP measurements conducted in 1994 ( n = 1230), with follow-up in 1997 ( n = 628).

Setting

Seventy-five inner-Sydney primary schools.

Participants

School children aged 8-9 years at baseline and 11-12 years at follow-up.

Main outcome measures

Systolic and diastolic BP (SBP and DBP).

Study factors

Current weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), weight gain since birth and birth weight. Potential confounders: age, sex and socioeconomic status (on the basis of the area of residence).

Results

Current weight was significantly associated with both SBP and DBP in boys and girls at baseline and follow-up. BMI and WC were similar predictors of SBP and DBP in each survey, but longitudinal BMI change has a stronger association with SBP ( r = 0.43, P <0.001) and DBP ( r = 0.26, P < 0.001) than changes in WC (r = 0.18, P < 0.001 for SBP and r = 0.16, P < 0.001 for DBP) and WHR in boys with the similar results for girls. The unadjusted associations between SBP and DBP and birthweight were nonsignificant. After adjustments for age, height and socioeconomic status, however, the association becomes negative and significant in boys (β = −1.47, P = 0.04 for SBP and β = −1.33, P = 0.03 for DBP).

Conclusion

Longitudinal change in BMI is a better predictor of BP than change in WC or the WHR, although cross-sectional measurements of BMI and WC are very similar predictors of BP. In preventing subsequent adverse effects on BP, attending to body weight during childhood is important. Eur J Cardiovasc Prev Rehabil 14:624-629 © 2007 The European Society of Cardiology
Quality of life assessment in heart failure interventions: a 10-year (1996–2005) review
Authors: Morgan Karen , McGee Hannah , Shelley Emer
Published: March 2009

The increasing prevalence and poor prognosis associated with heart failure have prompted research to focus on improving quality of life (QoL) for heart failure patients. Research from 1996–2005 was systematically reviewed to identify randomized controlled trials that assessed QoL in heart failure. In 120 studies, 44 were medication trials; 19 surgical/procedural interventions; and 57 patient care/service delivery interventions. Studies were summarized in terms of aim, population, QoL measures used and QoL findings. Studies used 47 different measures of QoL-generic, health-related, condition-specific, domain-specific and utility measures. Most used a single QoL measure. In 87%, a condition specific QoL measure was used, with the Minnesota Living with Heart Failure Questionnaire being the favoured assessment tool. The range of QoL measures in use poses challenges for development of cumulative knowledge. Although comparability across studies is important, this must be informed by the responsiveness of the instrument selected. As carried out in other cardiac groups, comparative evaluations of instrument responsiveness are needed in heart failure. Eur J Cardiovasc Prev Rehabil 14:589-607 © 2007 The European Society of Cardiology
Effects of exercise training on the glutathione antioxidant system
Authors: Elokda Ahmed S. , Nielsen David H.
Published: March 2009

Purpose

The glutathione (GSH) antioxidant system has been shown to play an important role in the maintenance of good health and disease prevention. Various approaches have been used to enhance GSH availability including diet, nutritional supplementation, and drug administration, with minor to moderate success. Exercise training has evolved as a new approach. The purpose of this study was to investigate the effects of aerobic exercise training (AET), circuit weight training (CWT), and combined training (AET + CWT) on general adaptations, and resistance to acutely induced oxidative stress, as assessed by changes in the GSH antioxidant system.

Methods

Eighty healthy sedentary volunteers participated in the study who were randomly assigned to four groups: control (no exercise); AET, CWT, and AET + CWT. Exercise training programs were designed to simulate outpatient cardiac rehabilitation (40 min × 3 days × 6 weeks). Venous blood sampling was taken at rest and post maximal graded exercise test (GXT). A new improved spectrophotometric venous assay analysis technique was used. A mixed model repeated measures analysis of variance design was used with t-tests for preplanned comparisons evaluated at Bonferroni-adjusted α levels.

Results

Effectiveness of the exercise training programs was demonstrated by significant between-group (exercise group versus control) comparisons. AET, CWT, and AET + CWT showed significant pretraining-posttraining increases in resting GSH and glutathione-glutathione disulfide ratio (GSH:GSSG), and significant decreases in GSSG levels ( P <0.005). AET + CWT showed the most pronounced effect compared with AET or CWT alone ( P <0.025).

Conclusion

This study represents the first longitudinal investigation involving the effects of multiple modes of exercise training on the GSH antioxidant system with evidence, suggesting the GHS:GSSG ratio as the most sensitive change marker. The significant findings of this study have potential clinical implications to individuals involved in cardiac and pulmonary rehabilitation. Eur J Cardiovasc Prev Rehabil 14:630-637 © 2007 The European Society of Cardiology
Cardiovascular event risk in relation to dietary fat intake in middle-aged individuals: data from The Malmö Diet and Cancer Study
Authors: Leosdottir Margret , Nilsson Peter M. , Nilsson Jan-Åke , Berglund Göran
Published: March 2009

Background and design

The hypothesis that diets rich in total and saturated fat and poor in unsaturated fats increase the risk for cardiovascular disease is still vividly debated. The aim of this study was to examine whether total fat, saturated fat, or unsaturated fat intakes are independent risk factors for cardiovascular events in a large population-based cohort.

Methods

28098 middle-aged individuals (61% women) participated in the Malmö Diet and Cancer Study between 1991 and 1996. In this analysis, individuals with an earlier history of cardiovascular disease were excluded. With adjustments made for confounding by age and various anthropometric, social, dietary, and life-style factors, hazard ratios (HR) were estimated for individuals categorized by quartiles of fat intake [HR (95% confidence interval, CI), Cox's regression model].

Results

No trend towards higher cardiovascular event risk for women or men with higher total or saturated fat intakes, was observed. Total fat: HR (95% CI) for fourth quartile was 0.98 (0.77-1.25) for women, 1.02 (0.84-1.23) for men; saturated fat: 0.98 (0.71-1.33) for women and 1.05 (0.83-1.34) for men. Inverse associations between unsaturated fat intake and cardiovascular event risk were not observed.

Conclusions

In relation to risks of cardiovascular events, our results do not suggest any benefit from a limited total or saturated fat intake, nor from relatively high intake of unsaturated fat. Eur J Cardiovasc Prev Rehabil14:701-706 © 2007 The European Society of Cardiology
The impact of sexual therapy on patients after cardiac events participating in a cardiac rehabilitation program
Authors: Klein Rivka , Bar-on Elchanan , Klein Jacob , Benbenishty Rami
Published: March 2009

Aims

To assess the impact of a sexual therapy module on male patients participating in phase 2 cardiac rehabilitation after a cardiac event.

Methods and results

We randomly assigned 92 consecutive male patients (age ≤ 70 years, mean age 58 years), on their admission to phase 2 cardiac rehabilitation after myocardial infarction/acute coronary syndromes and/or coronary artery bypass graft, into a ‘sexual therapy group’ ( n = 47) and a ‘control group’ ( n = 45). Two cotherapists met with the patient and spouse for 5 h in three sessions, in addition to cardiac rehabilitation. Sexual therapy included patient education, cognitive restructuring, emotional support, guided imagery, and medication (Viagra). Controls participated in cardiac rehabilitation without sexual therapy. Self-report questionnaires were used three times: before, 1, and 4 months after sexual therapy. Baseline characteristics of both groups were similar. More sexual therapy patients resumed sexual activity within 1 month (87% vs. 50% in control). Sexual therapy patients improved more than controls in quality of sexual function in terms of libido, confidence to attain erection, satisfaction with sexual relationship, frequency of erection, and enjoyment of sex. Sexual therapy patients were highly satisfied with cardiac rehabilitation and sexual therapy.

Conclusion

Sexual therapy is significantly effective in improving the frequency and quality of sexual activity in a patient's postcardiac event beyond the usual cardiac rehabilitation. Sexual therapy should be an integral part of cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil14:672-678 © 2007 The European Society of Cardiology
Radiofrequency Turbinate Reduction: A NOSE Evaluation
Authors: Harrill Willard C. , Pillsbury Harold C. , McGuirt W Frederick , Stewart Michael G.
Published: March 2009

Background: The symptoms and treatments for nasal obstruction are numerous and common. Yet, a consensus on a surgical approach or, even more importantly, how to define the success of any approach is lacking in the literature. A disease‐specific outcomes instrument recently developed by the American Academy of Otolaryngology, known as the Nasal Obstruction Symptom Evaluation (NOSE) scale, has allowed for a validated, uniform method to compare different treatments for nasal obstruction.

Methods: Using the NOSE scale, we prospectively compared the use of bilateral radiofrequency inferior turbinate reduction (BRITR) only with that of BRITR with septoplasty in the treatment of nasal obstruction caused by the combination of septal deviation and turbinate hypertrophy. NOSE scores were obtained pretreatment and at 3 month and 6 month follow‐up.

Results: Our data demonstrated significant improvement from baseline after 6 months for the NOSE scores in both the BRITR (P < .001) and BRITR/septoplasty groups (P = .023). No statistical difference was noted in the amount of postoperative improvement between the two treatment groups (P = .304). Both groups did demonstrate a large, clinically important effect using a distribution‐based assessment of clinical change. Despite equal clinically effective results, estimated costs for each treatment option differed significantly, with the office‐based BRITR only group providing significant cost savings compared with the hospital‐based BRITR/septoplasty group.

Conclusions: This study suggests that BRITR should be considered as an initial treatment option for nasal obstruction rather than a septoplasty with turbinate reduction in patients with the clinical findings of both a septal deviation and turbinate hypertrophy after failure of medical therapy.
Return of Vocal Cord Movement: An Independent Predictor of Response to Nonsurgical Management of Laryngeal Cancers
Authors: Iloabachie Kenny , Nathan Cherie‐Ann O. , Ampil Fred , Morgan Matthew L. , Caldito Gloria
Published: March 2009

Objective: To determine whether return of vocal cord function after treatment of T2b/T3 laryngeal carcinoma is an independent prognostic factor for locoregional recurrence.

Study Design: A retrospective review of patients treated with radiation ± chemotherapy between 2000 and 2005 for T2 with vocal cord paresis and T3 laryngeal carcinoma was conducted.

Methods: Only those patients obtained from the tumor registry with pre‐and posttreatment video stroboscopies were included. Patients' charts were reviewed for local and regional recurrence after treatment. Fisher's exact test was used to determine significant association between recurrence and possible risk factors.

Results: Fourteen patients met the inclusion criterion. Six patients had T2 lesions with vocal cord paresis, and eight patients had T3 lesions. Fifty percent of patients with T2 and 75% of patients with T3 lesions had return of vocal cord function after treatment. Five of 14 patients did not have return of vocal cord function, and of these, 100% had locoregional recurrence. Of the nine patients who had return of vocal cord movement, none of the patients had recurrence. The proportion of recurrence was significantly higher for those whose vocal function did not return compared with the patients whose vocal function returned (100% vs. 0%, P < .01).

Conclusion: The immobile vocal cord is associated with a worse prognosis and is therefore factored into the American Joint Commission on Cancer staging for laryngeal tumors. We show that vocal cord immobility is an independent prognostic factor of recurrence even after treatment and can predict treatment failure in T2 and T3 lesions of the larynx.
Cryptosporidium Infection in Patients With Primary Immunodeficiencies
Authors: Wolska‐Kusnierz Beata , Bajer Anna , Caccio Simone , Heropolitanska‐Pliszka Edyta , Bernatowska Ewa , Socha Piotr , van Dongen Jacques , Bednarska Malgorzata , Paziewska Anna , Sinski Edward
Published: March 2009

Background:

Cryptosporidium species infection is usually self‐limited in immunocompetent populations, but can be severe and life‐threatening among immunocompromised individuals, particularly in patients with AIDS and in these patients with primary immunodeficiencies (PIDs).

Patients and Methods:

A group of 5 patients with genetically confirmed hyper‐IgM syndrome type 1 (XHIM) and one patient with primary CD4 lymphopenia were enrolled in the study. At least 2 stool samples and a bile sample in one patient were examined for Cryptosporidium oocysts by a modified Ziehl‐Neelsen technique, by immunofluorescence assay using a commercial kit, as well as by molecular analysis followed by genotyping. Immunological status at the time of PID diagnosis and the complex picture of disease are presented.

Results:

Chronic cryptosporidiosis was confirmed in 3 patients with XHIM and in one patient with primary CD4 lymphopenia. Molecular diagnosis showed the presence of C parvum, C hominis, and C meleagridis in analyzed specimens.

Conclusions:

Cryptosporidium infection with serious clinical symptoms observed in patients with hyper‐IgM syndrome calls for regular, repeated screening in this group of patients.
The Double‐wire Technique as an Aid to Selective Cannulation of the Common Bile Duct During Pediatric Endoscopic Retrograde Cholangiopancreatography
Authors: Kramer Robert E , Azuaje Rafael E , Martinez Jose M , Dunkin Brian J
Published: March 2009

Background:

Selective cannulation of the common bile duct (CBD) during endoscopic retrograde cholangiopancreatography (ERCP) can be difficult. Several techniques have been described to assist endoscopists in obtaining access when initial cannulation fails. The objective of this report is to describe our initial experience with the “double‐wire technique” in the pediatric population.

Patients and Methods:

Sixty ERCPs were performed in children with ages ranging from 8 months to 18 years and the technique was used in 8 cases. After wire‐guided access to the pancreatic duct is obtained, the wire is left in place within the pancreatic duct to aid subsequent selective cannulation of the CBD.

Results:

In 2 of these cases, transient increase in pancreatic enzymes was observed after ERCP. Nevertheless, in this small series of patients it was found to be an effective and useful tool in cases in which repeated attempts have yielded only pancreatic duct cannulation.

Conclusions:

This technique is a useful aid for the endoscopist attempting to selectively cannulate the CBD in difficult cases. Further study will be needed to establish the safety of this technique in the pediatric population.
Determining IgA and IgG Antigliadin, IgA Antitransglutaminase, and Antiendomysial Antibodies in Monkey Esophagus and in Umbilical Cord for Diagnosis of Celiac Disease in Developing Countries
Authors: Bahia Magda , Penna Francisco José , Sampaio Ivan Barbosa Machado , Silva Geraldo Magela Fritz , Andrade Eugênio Marcos Goulart
Published: March 2009

Objectives:

To assess the efficiency of determining IgA and IgG antigliadin antibodies (IgA‐ and IgG‐AGA, respectively), antitransglutaminase (TgA), and anti‐endomysial antibodies (AEA) in human umbilical cord (CO) and monkey esophagus for diagnosis of celiac disease; to determine the correlation between serological markers and celiac disease.

Patients and Methods:

A total of 400 patients were divided in 3 groups: group 1 with 37 patients with celiac disease, group 2 with 208 patients with no enteropathies, and group 3 with 155 patients with other enteropathies. IgA‐AGA, IgG‐AGA, and TgA were assessed using enzyme‐linked immunosorbent assay, whereas AEA was evaluated by indirect immunofluorescence.

Results:

Sensitivity and specificity of IgA‐AGA were 81.1% and 95.2%, of IgG‐AGA 89.2% and 95.2%, of TgA 83.9% and 96.8%, of AEA‐CO 87.9% and 100%, and of AEA of monkey esophagus 88.6% and 100%, respectively. Positive predictive values were 75.0%, 76.7%, 83.9%, and 100%. Negative predictive values were 96.6%, 98.0%, 96.8%, and 97.7% for IgA‐AGA, IgG‐AGA, TgA, and AEA, respectively. Multivariate analysis showed a strong association between AEA‐CO and celiac disease and a good correlation with other markers (TgA, IgA‐AGA, and IgG‐AGA).

Conclusions:

TgA has been recommended for screening patients with celiac disease. Considering the similar sensitivity and specificity of IgA‐AGA and TgA and their correlations in the multivariate analysis, both are applicable for this purpose. However, because TgA tests are highly costly and celiac disease is associated with IgA deficiency, the determination of IgA‐AGA and IgG‐AGA, followed by AEA‐CO, is suitable for screening in developing countries, provided a cutoff point for these examinations is established. The results of antiendomysial antibodies in umbilical cord overlapped those in monkey esophagus. Therefore, umbilical cord should be used as a substrate instead of specimens from endangered species.
Short‐term Outcome in the First 10 Morbidly Obese Adolescent Patients in the FDA‐approved Trial for Laparoscopic Adjustable Gastric Banding
Authors: Holterman Ai‐Xuan , Browne Allen , Dillard Barney E , Tussing Lisa , Gorodner Veronica , Stahl Christiane , Browne Nancy , Labott Sue , Herdegen James , Guzman Grace , Rink Andy , Nwaffo Ifeoma , Galvani Carlos , Horgan Santiago , Holterman Mark
Published: March 2009

Background:

We received the LAP‐BAND Investigational Device Exemption (IDE) from the US Food and Drug Administration in December 2004 to conduct a prospective longitudinal trial examining the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in morbidly obese adolescents ages 14 to 17 years.

Objectives:

To report the short‐term results of LAGB in the first 10 adolescents with complete 9 months of follow‐up.

Patients and Methods:

Baseline characteristics and outcome data were analyzed in 10 patients enrolled between March 2005 and February 2006.

Results:

All of the patients were girls. Their mean body mass index (±SD) was 50 ± 13 kg/m2, and excess weight was 171 ± 79 pounds. Comorbidities included depression (3 patients), sleep apnea (3), hypertension (6), dyslipidemia (7), insulin resistance (9), metabolic syndrome (9), and steatohepatitis (in 4 of 5 patients with liver biopsy). Operative time was 45 ± 9 minutes, and discharges were within 23 hours of surgery. Band‐related complications were as follows: 2 dehydration, 1 pouch dilation, and 1 port revision. All of the patients lost weight, with a 9‐month excess weight loss of 30% ± 16% (range 14%–57%). Hypertension and the metabolic syndrome were resolved in 100% of patients (P = 0.04) and 80% of the patients (P = 0.01), respectively, along with significant improvement in the Pediatric Quality of Life and Beck Depression Inventory scores and a trend toward improvement in high‐density lipoprotein cholesterol abnormalities (P = 0.08).

Conclusions:

At short‐term follow‐up, weight loss occurred with minimal complications, leading to early resolution of major obesity‐related comorbidities. Continued evaluation of the long‐term safety and efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program is warranted.
Methods of Sedation in Pediatric Endoscopy: A Survey of NASPGHAN Members
Authors: Lightdale Jenifer R , Mahoney Lisa B , Schwarz Steven M , Liacouras Chris A
Published: March 2009

The performance of endoscopy in children generally requires the concomitant administration of sedation to ensure the patient's safety, comfort, and cooperation throughout the procedures. New pharmacological agents, increased procedural volume, variable access to anesthesia support, and improvement in endoscopic technique have contributed to vast differences in sedation regimens for gastrointestinal procedures in patients of all ages. To better understand variation in practice patterns among pediatric gastroenterologists, the NASPGHAN Endoscopy and Procedures Committee surveyed 103 NASPGHAN members during a recent NASPGHAN national meeting. The results of this survey confirm that sedation practices vary widely and reflect continued uncertainty regarding optimal sedation regimens for pediatric endoscopy.
Feeding Experiences and Growth Status in a Rett Syndrome Population
Authors: Oddy Wendy H , Webb Kathryn G , Baikie Gordon , Thompson Susan M , Reilly Sheena , Fyfe Susan D , Young Deidra , Anderson Alison M , Leonard Helen
Published: March 2009

Objectives:

Feeding difficulties in Rett syndrome are complex and multifactorial. In this study, we describe the feeding experiences in Rett syndrome and examine the factors affecting growth.

Materials and Methods:

Using questionnaire data related to a population‐based cohort, ages 2 to 29 years (n = 201), we measured the feeding experiences, growth, and factors affecting growth (enteral nutritional support, mutations, mobility, breath‐holding, hyperventiliation) in subjects with Rett syndrome.

Results:

The mean weight, height, and body mass index z scores in subjects with Rett syndrome were below that of their age group and decreased steadily with age. Twenty percent of subjects had enteral nutrition support, and it was more common in the older age group. Those with truncating mutations had significantly less enteral nutrition support than the other mutation groups. Furthermore, those with low mobility had lower mean body mass index z scores than those with higher mobility, and increased frequency of breath‐holding and hyperventilation also was associated with lower body mass index z scores.

Conclusions:

Routine monitoring of growth should continue to determine the severity of nutritional problems in Rett syndrome. Active nutritional management is recommended to ensure females affected with Rett syndrome have the best opportunity to reach their growth potential.