bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of a breath test with a substrate of natural 13C‐abundance and isotope‐selective non‐dispersive infrared spectrometry: A preliminary study
Authors: JONDERKO KRZYSZTOF , KASICKA‐JONDERKO ANNA , SYRKIEWICZ‐TREPIAK DANUTA , BŁOŃSKA‐FAJFROWSKA BARBARA
Published: July 2005

Background and Aims:  Isotope‐selective non‐dispersive infrared spectrometry (NDIRS) is a cheaper alternative to isotope ratio mass spectrometry (IRMS). We checked on the efficiency of NDIRS to perform a breath test with naturally 13C‐enriched maize starch.

Methods:  Fifty‐six healthy volunteers were examined. After a basal fasted sample of their expiratory air was collected, the subjects ate a test breakfast of 50 g (CF50 group, n = 9) or 100 g (CF100 group, n = 47) cornflakes with 175 g yoghurt. For 6 h thereafter, exhaled air was collected every 30 min for the NDIRS measurement of 13CO2 concentration.

Results:  The time‐course of the curves of 13CO2 concentration resembled those obtained previously with IRMS. A dose‐response to the amount of ingested cornflakes was observed – the maximum postprandial net increment in 13CO2 was statistically significantly higher in the CF100 than CF50 group: 4.78 ± 0.13 versus 3.12 ± 0.17‰ (P < 0.001), whereas the time needed to reach the maximum did not differ after the intake of 50 g (233 ± 13 min) or 100 g (248 ± 9 min) cornflakes. The 5‐h area‐under‐the‐curve of cumulative 13CO2 net recovery (AUC60‐360) was statistically significantly greater after ingestion of 100 g compared to 50 g cornflakes (97.6 ± 2.2 versus 61.7 ± 2.2 µmol, P < 0.001) and it also exhibited a stable between‐subject variability.

Conclusion:  The obtained proof of technical feasibility of a breath test with the use of naturally 13C‐enriched starch and NDIRS provides background for future research on the clinical usefulness of this method for a non‐invasive assessment of the pancreatic exocrine function.
Mechanical characterization of single crystal silicon and UV‐LIGA nickel thin films using tensile tester operated in AFM
Authors: LEE Y. , TADA J. , ISONO Y.
Published: July 2005

This paper describes the mechanical characteristics of microscale single crystal silicon (SCS) and UV‐LIGA nickel (Ni) films used for microelectromechanical systems (MEMS). A compact tensile tester, operated in an atomic force microscope (AFM), was developed for accurate evaluation of Young's modulus, tensile strain and tensile strength of microscale SCS and UV‐LIGA Ni specimens. SCS specimens with nominal dimensions of 20 μm in thickness, 50 μm in width and 600 μm in length were prepared by a conventional photolithography and etching process. UV‐LIGA Ni specimens, with a thickness of 15 μm, a width of 50 μm and a length of 600 μm in nominal dimensions, were also fabricated by electroplating using a UV thick photoresist mould. All specimens have line patterns on their specimen gauge section to measure axial elongation under tensile loading. The SCS specimens showed a linear stress–strain response and fractured in a brittle manner, whereas the UV‐LIGA Ni specimens showed elastic–inelastic deformation behaviour. Young's modulus of SCS and UV‐LIGA Ni specimens obtained from tensile tests averaged 169.2 GPa and 183.6 GPa, respectively, close to those of bulk materials. However, the tensile strength of both materials showed a larger value than the bulk materials: 1.47 GPa for the SCS and 0.98 GPa for the Ni specimens. Yield stress and breaking elongation of UV‐LIGA Ni specimens were also quite different from those of the bulk Ni because of the specimen size effect on inelastic properties.
Fracture tests of microsized TiAl specimens
Authors: HALFORD T. P. , TAKASHIMA K. , HIGO Y. , BOWEN P.
Published: July 2005

γ‐TiAl‐based materials have the ability to provide superior creep strength, high yield strength and Young's modulus at temperatures as high as 700 °C. This has led to the consideration of γ‐TiAl‐based materials for use in microelectromechanical systems (MEMS) intended for application at elevated temperatures. One γ‐TiAl‐based material under consideration for these applications is the composition known as Alloy 7/Ti–46Al–5Nb–1W (at%). In this case, this material is tested in the as‐wrought form with a fully lamellar structure and a colony size ≈75 μm. The effect of loading volumes of this material smaller than conventional samples is investigated. This is carried out in order to improve understanding of the fracture toughness behaviour, which ultimately will be required of components of this material with a cross‐section ≈18 × 6 μm. Here, we focus upon a specially developed machine, which provides accurate loading of microsized cantilever beams through a diamond tip. The directional nature of the fracture toughness properties of this material is considered in relation to the local orientation of the lamellar microstructure and the resulting failure modes occurring.
Fracture toughness measurement of thin‐film silicon
Authors: ANDO T. , LI X. , NAKAO S. , KASAI T. , TANAKA H. , SHIKIDA M. , SATO K.
Published: July 2005

The fracture toughness of single‐crystal silicon thin films oriented to (100) and (110) was investigated by tensile testing under both 〈100〉 and 〈110〉 loading conditions. The specimen was fabricated from a p‐type Czochralski (CZ)‐grown wafer and passed through a thermal process during the fabrication of the test device. The measured fracture toughness is dependent on the loading direction in the tensile test and independent of the specimen surface orientation. The test results were 1.94 MPa√m in the 〈100〉 direction and 1.17 MPa√m in the 〈110〉. In these tests, no longitudinal size effect on the fracture stress or fracture toughness was observed. The SEM photographs obtained from the fracture specimens after the tensile test show that the crack initiated from the notch tip and propagated straight in the across‐the‐width direction on the (110) or (111) cleavage plane.
Niche heterogeneity determines bacterial community structure in the termite gut (Reticulitermes santonensis)
Authors: Yang Hong , Schmitt‐Wagner Dirk , Stingl Ulrich , Brune Andreas
Published: July 2005

Differences in microenvironment and interactions of microorganisms within and across habitat boundaries should influence structure and diversity of the microbial communities within an ecosystem. We tested this hypothesis using the well characterized gut tract of the European subterranean termite Reticulitermes santonensis as a model. By cloning and sequencing analysis and molecular fingerprinting (terminal restriction fragment length polymorphism), we characterized the bacterial microbiota in the major intestinal habitats – the midgut, the wall of the hindgut paunch, the hindgut fluid and the intestinal protozoa. The bacterial community was very diverse (> 200 ribotypes) and comprised representatives of several phyla, including Firmicutes (mainly clostridia, streptococci and Mycoplasmatales‐related clones), Bacteroidetes, Spirochaetes and a number of Proteobacteria, all of which were unevenly distributed among the four habitats. The largest group of clones fell into the so‐called Termite group 1 (TG‐1) phylum, which has no cultivated representatives. The majority of the TG‐1 clones were associated with the protozoa and formed two phylogenetically distinct clusters, which consisted exclusively of clones previously retrieved from the gut of this and other Reticulitermes species. Also the other clones represented lineages of microorganisms that were exclusively recovered from the intestinal tract of termites. The termite specificity of these lineages was underscored by the finding that the closest relatives of the bacterial clones obtained from R. santonensis were usually derived also from the most closely related termites. Overall, differences in diversity between the different gut habitats and the uneven distribution of individual phylotypes support conclusively that niche heterogeneity is a strong determinant of the structure and spatial organization of the microbial community in the termite gut.
Design and validation of 16S rRNA probes to enumerate members of the Clostridium leptum subgroup in human faecal microbiota
Authors: Lay Christophe , Sutren Malène , Rochet Violaine , Saunier Katiana , Doré Joël , Rigottier‐Gois Lionel
Published: July 2005

Among human faecal bacteria, many members of the Clostridium leptum subgroup are fibrolytic and butyrate producing microorganisms thereby contributing to processes important to colonic health. Yet this phylogenetic subgroup remains poorly described to date. To improve detection and description of members of the C. leptum subgroup, the Clep 866 group probe was developed. Its association with probes targeting the Clostridium viride cluster (Cvir 1414) and Eubacterium desmolans species (Edes 635) allowed for the first time the detection of all members found in this phylogenetic group in human faecal microbiota. A species‐specific probe was also designed to detect members of the Ruminococcus callidus species (Rcal 733). The design of signature regions was based on alignment of 16S rRNA sequences isolated from faeces of five healthy adults. Furthermore, an oligonucleotide competitor strategy was developed in order to improve the specificity of the probes formerly validated or designed in this study. The oligonucleotide probes were tested using a collection of target and non‐target strains using FISH combined with flow cytometry. These new probes were added to a panel of 18 phylogenetic probes selected to describe faecal microbiota composition in 21 human faeces of healthy adults. Clostridium leptum subgroup represented 22% of the total faecal bacteria and codominated with members of Clostridium coccoides group. The cluster Faecalibacterium prausnitzii was the dominant component of the C. leptum subgroup and 20% of the latter subgroup remained unidentified at the species level.
Study of the occurrence of Vibrio vulnificus in oysters in India by polymerase chain reaction (PCR) and heterogeneity among V. vulnificus by randomly amplified polymorphic DNA PCR and gyrB sequence analysis
Authors: Parvathi Ammini , Kumar H. Sanath , Karunasagar Indrani , Karunasagar Iddya
Published: July 2005

The pathogenic bacterium Vibrio vulnificus is widely distributed in estuarine waters throughout the world. In this study, the presence of V. vulnificus in oysters was studied both by conventional culture and DNA‐based molecular technique. Following enrichment in alkaline peptone water (APW), the bacteria were lysed and a nested polymerase chain reaction (PCR) for vvhA gene was performed. The effect of duration of enrichment on the sensitivity of detection by PCR was evaluated. The organism was isolated from 43% of samples after 18 h enrichment in APW by conventional culture method. Nested PCR amplifying a fragment of vvhA gene detected the organism in 11%, 60% and 81% of samples following 0, 6 and 18 h of enrichment. All the biochemically identified V. vulnificus strains possessed vvhA gene and belonged to biotype 1. The genetic relatedness among the strains was studied by randomly amplified polymorphic DNA (RAPD) PCR and gyrB sequence analysis. The results suggest the presence of two distinct clonal groups of V. vulnificus in oysters in India. The study demonstrates, for the first time that gyrB sequence analysis could be used to study the genetic diversity of V. vulnificus.
Worldwide distribution of Pseudomonas aeruginosa clone C strains in the aquatic environment and cystic fibrosis patients
Authors: Römling Ute , Kader Abdul , Sriramulu Dinesh Diraviam , Simm Roger , Kronvall Göran
Published: July 2005

Highly successful bacterial clones have the ability to effectively colonize environmental niches and patients. However, the factors which determine the complex interplay between the colonization of environmental niches and patients are mainly unknown. In this study we show that Pseudomonas aeruginosa clone C strains are distributed worldwide and highly prone to infect cystic fibrosis (CF) patients in Canada, England, France and Germany. In Hanover, Germany and Vancouver, Canada, clone C strains are highly prevalent in the CF patient community, although the mechanisms of acquisition may have been different. All clone C strains showed highly related macrorestriction fragment pattern of the whole genome as visualized by pulsed‐field gel electrophoresis and harboured the 102 kbp plasmid pKLC102. Comparison of three prevalent P. aeruginosa clones with different distribution between the environment and patients revealed that neither enhanced biofilm formation nor antibiotic resistance was responsible for the spread of clone C. Clone M, which was highly prevalent in the clinical environment such as sanitary facilities, lacked motility, which could explain its relatively low prevalence in CF patients. Elucidation of the mechanisms which lead to the prevalence of clone C strain in patients and the environment requires the investigation of additional phenotypes.
Reputation and Strength of Ties in Predicting Commercial Success and Artistic Merit of Independents in the Italian Feature Film Industry*
Authors: Delmestri Giuseppe , Montanari Fabrizio , Usai Alessandro
Published: July 2005

abstract We investigate what factors are required in order to succeed in project‐based cultural industries. In particular, we focus on the effects of relational stability and reputation on two key dimensions of movies’ success: commercial success and artistic merit. We combine the two dimensions of films’ performance for a more accurate understanding of how authenticity and artistic merit are manufactured in the movie industry. We examine this question by analysing a sample of Italian films and focusing on the role of the film director. We argue that commercial success is favoured by a director's strong vertical ties (with producers and distributors) and economic reputation, while artistic merit is positively affected by a director's weak horizontal ties (with other creative partners) and artistic reputation. We propose an explanation in terms of varying degrees of task routineness and we use it to account for the divergence between our results and others in the cultural and organizational literature.
On eliminating d‐structure: the case of binominal each
Authors: Boeckx Cedric , Hornstein Norbert
Published: July 2005

Abstract.  This paper provides a minimalist analysis of the binominal each phenomenon. The analysis incorporates key ideas behind Safir and Stowell's (1988) seminal paper but avoids the complications that this approach entails. Our proposal provides one more empirical argument for movement into θ‐position, sideward movement, the primacy of movement over binding in matters of construal, and the virtues of a very derivational view of syntax. It is also consistent with a framework that dispenses with LF movement entirely.
THE LIFE OF BUILDINGS: MINOAN BUILDING DEPOSITS IN AN ECOLOGICAL PERSPECTIVE
Authors: HERVA VESA‐PEKKA
Published: July 2005

Summary.This paper discusses the interpretation of the objects deliberately hidden and sealed up in the structure of Minoan buildings. These building deposits are usually interpreted in terms of religion and ritual but this conventional view may actually be based on fallacious assumptions about the nature of human‐environment relations in Bronze Age Crete. The present paper outlines an alternative ecological approach, which allows a degree of sociality between humans and non‐human entities, and treats building deposits as an essentially practical means of manipulating the relations between humans and the (built) environment in situations of potential stress. It will be argued that buildings and other artefacts can, in some respects, be understood to live and grow similarly as organisms. Thus, in order to appreciate their significance, Minoan building deposits need to be related to the life‐cycle of buildings.
WOAD, TATTOOING AND IDENTITY IN LATER IRON AGE AND EARLY ROMAN BRITAIN
Authors: CARR GILLIAN
Published: July 2005

Summary. This paper explores the archaeological evidence for the practice of facial and corporeal dyeing, painting and tattooing in the later Iron Age and early Roman period. The aim is to construct a hypothesis which explains how, why, when and by whom such pigments were worn. Although this hypothesis discusses woad‐derived indigo, this is used mainly, although not exclusively, as an experimental tool, as no conclusive archaeological evidence exists which reveals the identity of the ‘real’ pigment(s). Woad has also long held a place in the popular imagination as the source of the dye which the ancient Britons used to paint themselves.

This paper explores the possibility that the cosmetic grinder was the focal artefact used in body painting or tattooing, and was used for grinding and mixing body and face paint. It is suggested that, rather than being a ‘Roman’‐style tool for cosmetic application from the start, it may have begun life as an artefact first used by the later Iron Age Britons for body painting and expressing indigenous identities.
In the era of highly active antiretroviral therapy, why are HIV‐infected patients still admitted to hospital for an inaugural opportunistic infection?
Authors: Perbost I , Malafronte B , Pradier C , Santo LDI , Dunais B , Counillon E , Vinti H , Enel P , Fuzibet JG , Cassuto JP , Dellamonica P
Published: July 2005

Objectives

To identify factors related to delayed testing, and delayed or interrupted care‐seeking or treatment uptake, among HIV‐infected patients.

Design

HIV‐infected patients hospitalized for an opportunistic infection (OI) cases were included in a prospective study and compared with controls matched by age and sex who had regular follow‐up and treatment. Patients were asked to complete a questionnaire about their therapeutic itinerary and their socioeconomic, psychological and medical characteristics.

Results

Seventy patients were matched with 140 controls. According to their therapeutic itinerary prior to admission, cases were subdivided into four groups among which three will be more particularly studied: nontested patients (NT) (24%; n=17), known HIV‐infected patients with no medical follow‐up (NF) (30%; n=21); and noncompliant patients (NC) (36%, n=25). Characteristics of NT and NF patients included a predominantly sexual mode of contamination (P=0.01), continuing occupational activity (P=0.01) despite a low mean Karnofsky index (P=0.001) and unfavourable virological and immunological parameters. NT patients displayed a low degree of anxiety, and lacked awareness concerning risk of contamination and HIV‐related symptoms. HIV‐status announcement (P=0.04) and the benefits of medical follow‐up (P=0.05) were less favourably perceived by NF patients than by controls, and were associated with a high degree of anxiety in NF patients. NC patients had a weaker commitment to follow‐up and treatment, and more frequent treatment discontinuation associated with a higher rate of interruption of follow‐up in a context of social difficulties.

Conclusions

Patients ignorant of their HIV status, patients NF and NC have very specific characteristics. More appropriate approaches are needed regarding screening and access to care in order to reduce the incidence of delayed care‐seeking.
Influence of RANTES, SDF‐1 and TGF‐β levels on the value of interleukin‐7 as a predictor of virological response in HIV‐1‐infected patients receiving double boosted protease inhibitor‐based therapy
Authors: Boulassel MR , Smith GHR , Edwardes MDdeB , Young M , Klein M , Gilmore N , MacLeod J , LeBlanc R , René P , Allan J , Lalonde RG , Routy JP
Published: July 2005

Objectives

Interleukin‐7 (IL‐7), RANTES (regulated on activation, normal T cell expressed and secreted), stromal cell‐derived factor‐1 (SDF‐1) and transforming growth factor‐beta (TGF‐β) appear to share certain biological properties in vitro and all are involved in HIV‐1 disease progression. Our earlier observations indicated that IL‐7 levels decrease upon CD4 T‐cell recovery and represent a new, independent predictor of virological response. Here, we examine associations among circulating levels of IL‐7, RANTES, SDF‐1 and TGF‐β in hopes of gaining insight into their contribution to the predictive value of IL‐7.

Methods

Levels of IL‐7, RANTES, SDF‐1 and TGF‐β, and immune and viral parameters were assessed in HIV‐1‐infected patients.

Results

Cross‐sectional (n=148) and longitudinal (n=36) analyses showed that levels of IL‐7, but not RANTES, SDF‐1 or TGF‐β, were increased in HIV‐1‐infected adults compared with those of healthy controls. In the cross‐sectional study, levels of IL‐7 were correlated with RANTES (r=0.31, P=0.002) and TGF‐β (r=0.53, P<0.001) but not with SDF‐1 (r=0.12, P=0.22), and these associations were more pronounced in patients with CD4 T‐cell counts >200 cells/μL. In contrast to IL‐7, levels of RANTES, SDF‐1 and TGF‐β were not correlated with CD4 T‐cell counts. Longitudinal analysis revealed a marked decline in IL‐7 levels accompanied by an increase in CD4 T‐cell count following antiretroviral therapy (ART), but no changes in RANTES, SDF‐1 or TGF‐β levels. Multivariate regression analysis showed no influence of baseline RANTES, SDF‐1 or TGF‐β levels on the value of IL‐7 as a predictor of virological response at 48 weeks.

Conclusions

Collectively, these results indicate that changes in IL‐7 levels did not induce changes in RANTES, SDF‐1 or TGF‐β. Furthermore, they indicate that RANTES, SDF‐1 or TGF‐β levels do not explain the predictor value of IL‐7 in patients receiving ART.
Incidence of and risk factors for tenofovir‐induced nephrotoxicity: a retrospective cohort study
Authors: Antoniou T , Raboud JM , Chirhin S , Yoong D , Govan V , Gough K , Rachlis A , Loutfy MR
Published: July 2005

Objectives

Despite the recent publication of case reports describing various manifestations of tenofovir‐related nephrotoxicity, data regarding the incidence of and risk factors for this adverse effect are currently lacking.

Methods

A retrospective cohort study of patients from four centres in Toronto, Canada, enrolled in the tenofovir expanded access programme with a minimum of 3 months follow up, was carried out.

Results

A total of 172 patients receiving tenofovir disoproxil fumarate (TDF) for a median of 16 months (range 3–25 months) were included in the study. Seven (4%) patients developed grade 1 (>44 μmol/L from baseline) increases in serum creatinine (SCr) during follow up; no patient developed grade 2 or higher nephrotoxicity. Fifteen (8.7%) patients had an increase in SCr of greater than 1.5 times baseline values during follow up. Four (2.3%) patients discontinued TDF because of an increase in SCr and/or abnormal urinalysis. Of 62 patients with a urinalysis, grade 1 or higher proteinuria (< 3 g/L) was observed in 27 (43%) patients. Only baseline SCr [odds ratio (OR)=0.51 per 10 μmol/L increase; P=0.0005] and baseline creatinine clearance (1.26 per 10 mL/min increase; P=0.01) were significantly associated with ever having a 1.5‐fold increase in serum creatinine. Twenty‐eight (16%) and 11 (6%) patients developed grade 1 (serum phosphorus≤0.71 mmol/L) and grade 2 (serum phosphorus≤0.61 mmol/L) hypophosphataemia during follow‐up, respectively.

Conclusions

Although slight increases in SCr did occur after starting TDF, clinically significant nephrotoxicity was rare. The clinical significance of TDF‐related hypophosphataemia and proteinuria requires further study.
But malice aforethought: cities and the natural history of hatred
Authors: Thrift Nigel
Published: July 2005

I take as my starting point the fact that Western cities are often depicted as on the brink of catastrophe. Indeed some contemporary authors would argue that they have never been closer to that brink. The first part of this paper argues against this tendency by focusing on the preponderance of activities of repair and maintenance. Having looked at the state of this forgotten infrastructure, in the second part of the paper I turn to an examination of why this Cassandra interpretation is so prevalent. I argue that, in particular, it draws on wellsprings of misanthropy which are rarely voiced in writings on cities because sociality is too often confused with liking. Yet it seems vital to me to tackle misanthropy head on. Then, in the third part of the paper, I argue that currently there is a coming together in cities of all kinds of affective politics of concern which can act, through all manner of small achievements, as a counter to misanthropy but which do not mistake the practice of this politics for a search after perfection.
Constructing free trade: from Manchester boosterism to global management
Authors: Sheppard Eric
Published: July 2005

The free trade doctrine, now global common knowledge, has followed a complex spatio‐temporal path of knowledge production from its origins in Manchester at the turn of the nineteenth century. While grounded in normative and cognitive claims, its transformation from local self‐interest to global doctrine was a result of the scale‐jumping tactics of the Anti‐Corn Law League, combined with the popularity in Western Europe of private property liberalism and the hegemonic global positionality of early nineteenth‐century Britain. Corn Law repeal in 1846 in London was constructed as the point in space–time where doctrine became practice, and Britain's subsequent prosperity was seen as proof of its validity. After 1880, except in Britain until 1914 and the colonies, performance belied the doctrine as progressive liberalism became influential, and import‐substituting industrialization an effective catch‐up strategy, for other nations. The free trade doctrine was reasserted, however, with the emergence of US hegemony, as a rationale for breaking up non‐US colonial preference systems and, more recently, neoliberalism. The free trade doctrine is now performed routinely under the auspices of the World Trade Organization. Nevertheless, it remains a local epistemology, whose truth‐like status is kept insulated from rigorous challenge by alternative epistemologies and practices.
The strange geography of health inequalities
Authors: Smith Susan J , Easterlow Donna
Published: July 2005

Place is undoubtedly relevant to health, and geography is a central character in the story of how rich societies handle inequalities in death and disease. But the text is incomplete, its scope limited by a too‐delicate encounter between research and policy, and by a strange subdisciplinary divide. Accounts of the geography in health inequalities are largely, albeit subtly, locked into ‘context’. They document the complex extent to which different (material, social and cultural) environments undermine or enhance resilience. They tell the tale of risky places. Our complementary narrative is written around the findings of qualitative ‘compositional’ research. It is about the way health itself is drawn into the structuring of society and space.Thisgeography is a map of health discrimination, illustrated in the processes of selective placement, entrapment and displacement. By drawing attention to the ‘healthism’ of politics and policy in ‘care‐less’ competition economies, this enlarged perspective might enhance the role of geography (and geographers) in both understanding and managing health inequalities.
‘As solid as the Rock’? Place, belonging and the local appropriation of imperial discourse in Gibraltar
Authors: Lambert David
Published: July 2005

Although imperialism is firmly on the geographical agenda at present, rarely does the British Overseas Territory of Gibraltar feature, even though it is the only remaining formal colony in Europe. Seized in 1704, Gibraltar has come to stand as a symbol of British imperial resilience, a status encapsulated by the phrase ‘as solid as the Rock’. The paper explores how such a place‐based imperial discourse has served to marginalize the civilian population and yet, paradoxically, has been appropriated locally to articulate a distinctive sense of belonging. More generally, the paper considers how a surviving colony such as Gibraltar, with its apparently loyal population, complicates postcolonial categories, periodizations and assumptions.
Vector Mapping in Localizing the Transverse Conduction Site of the Crista Terminalis in Patients with Typical Atrial Flutter
Authors: YAMABE HIROSHIGE , TANAKA YASUAKI , YAMAMURO MEGUMI , OGAWA HISAO , KIMURA YOSHIHIRO , HOKAMURA YOUICHI
Published: July 2005

Background: The difference in the conduction properties of the crista terminalis (CT) along its course, has not been fully clarified. Using the vector mapping method, we localized the transverse conduction (TC) site of the CT and elucidated its conduction capabilities in patients with typical atrial flutter (AF).

Methods: The TC site of the CT was localized by the analysis of the polarity reversal of the double potentials recorded at 10 sites along the CT using a 20‐pole deflectable catheter in 17 patients. The conduction capabilities of the TC site were analyzed during incremental pacing delivered from 100 beats/min to 2‐to‐1 local capture at the low anterior (LARA) and posterior (LPRA) right atrium.

Results: At a pacing rate of 100 beats/min, TC at a single site was observed in 15 patients during LARA pacing and 7 patients during LPRA pacing, respectively. TC sites were distributed from superior to middle third of the CT in all patients. TC was bidirectional in 4 sites, but was unidirectional in the remaining 14 sites. Following an increase in the pacing rate, TC was blocked in all 7 sites during LPRA pacing and 11 of 15 sites during LARA pacing. Shift in the location of the TC site was not observed in any of the patients before TC block. The conduction block rate during pacing from LARA was significantly higher than that from LPRA (211 ± 59 beats/min vs 145 ± 66 beats/min, P < 0.01).

Conclusions: The superior to middle third of the CT provides TC capabilities. The TC across the CT was caused by a preferential conduction site and most of these TC were unidirectional, and stable in location irrespective of the change in the conduction rate.
Radiofrequency Catheter Ablation of Common Atrial Flutter in a Patient with Anomalous Inferior Vena Cava and Azygos Continuation
Authors: MALAVASI VINCENZO L. , CASALI EDOARDO , ROSSI LUCA , GRAZIA MODENA MARIA
Published: July 2005

We describe a case of isthmus‐dependant atrial flutter ablation with a superior approach due to an anomalous inferior vena cava (IVC), azygos, and emiazygos continuation. A 56‐year‐old man was referred to our institution for the treatment of a common atrial flutter. Two years prior, the patient had an attempted electrophysiological study not performed due to the inability to advance the guidewire through IVC. A computed tomography of the abdominal venous system revealed the absence of the subrenal IVC, azygos, and emiazygos continuation. Following double puncture of the left subclavian vein, two catheters were inserted into the coronary sinus and into the right atrium. Programmed atrial stimulation was performed and a sustained isthmus‐dependant right atrial tachycardia was obtained. After 11 applications of radiofrequency energy with an inversion technique, sinus rhythm was restored and a repeat atrial programmed stimulation failed to induce any arrhythmia.
Protected Circumferential Conduction in the Posterior Atrioventricular Vestibule of the Left Atrium: Electrophysiologic and Anatomic Correlates
Authors: CHENG JIE , YANG YANFEI , URSELL PHILIP C. , LEE RANDALL J. , DOROSTKAR PARVIN C. , BOAHENE KWABENA A. , SCHEINMAN MELVIN M.
Published: July 2005

Background: The anatomic substrate for protected isthmus conduction in the right atrium has been well defined. Little is known of similar substrates in the left atrium (LA).

Methods: Patients (pts) with reentrant tachycardia (AVRT) supported by a single left‐sided accessory pathway were studied retrospectively (n = 64) and prospectively (n = 31). Intracardiac electrograms were recorded from the His bundle position and coronary sinus (CS). The LA was mapped with a steerable catheter using the transseptal approach. LA anatomy was examined grossly and histologically in six cadaver hearts after removal of endocardium.

Results: A distal‐to‐proximal CS activation sequence during AVRT was seen in all patients with a left lateral accessory pathway before ablation. After one to three radiofrequency (RF) energy deliveries that did not interrupt accessory pathway conduction, the CS activation sequence was reversed in three patients in the retrospective group and bidirectional conduction block in the posterior atrioventricular vestibule of the LA (PAVV) was demonstrated in nine patients in the prospective group. Four of the six cadaver hearts showed a distinct circumferential inferoposterior myocardial bundle that coursed parallel to the CS in the PAVV.

Conclusions: We described evidence of bidirectional intraatrial block in the PAVV after application of RF energy during accessory pathway ablation. Such conduction block may mimic the presence of a second accessory pathway. Our data suggest that circumferential conduction in the PAVV may be poorly coupled to the rest of the LA and may be involved in the macro‐reentrant circuit around the mitral annulus. The circumferential inferoposterior myocardial bundle may serve as the underlying anatomic substrate
Effect of Cardiac Resynchronization Therapy on Left Ventricular Diastolic Filling Pattern in Responder and Nonresponder Patients
Authors: AGACDIKEN AYSEN , VURAL AHMET , URAL DILEK , SAHIN TAYFUN , KOZDAG GULIZ , KAHRAMAN GOKSEL , BILDIRICI ULAS , URAL ERTAN , KOMSUOGLU BAKI
Published: July 2005

Background: The aim of this study was to investigate the short‐ and long‐term effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT.

Methods: Twenty‐three patients with systolic heart failure and complete left bundle‐branch block underwent implantation of biventricular pacemaker devices. In order to follow the changes in diastolic function, mitral inflow, pulmonary venous flow, and LV flow propagation (Vp) velocities were measured with pulsed‐wave and color M‐mode Doppler echocardiography 1 week before and 1 and 6 months after pacemaker implantation. At the 6‐month follow‐up, patients were divided into two groups according to their response to CRT defined as a relative increase in LV ejection fraction (LVEF) ≥25% versus baseline.

Results: After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Compared to baseline, the ratio of early‐to‐late peak velocities (E/A) decreased significantly at the 6th month (E/A ratio: from 1.5 ± 0.9 to 0.8 ± 0.5 at the 6th month (P = 0.02)). Pulmonary systolic flow to diastolic flow ratio (PVs/PVd) increased with CRT after 6 months (PVs/PVd ratio: from 0.9 ± 0.4 to 1.3 ± 0.7 at the 6th month (P = 0.02)). E/Vp ratio decreased significantly at the 1st and 6th month (E/Vp ratio: from 2.7 ± 0.8 to 2 ± 0.8 at the 1st (P < 0.002) and to 1.9 ± 0.7 at the 6th month (P < 0.02)). In responders (n: 17, 74%), E wave and PVra velocity decreased, E‐wave deceleration time increased, and E/Vp ratio improved significantly, whereas in nonresponders, changes in LV diastolic parameters remained insignificant. However, diastolic filling pattern improved significantly at the 1st and 6th month of CRT in both responders and nonresponders.

Conclusion: CRT enhances diastolic filling patterns in both responder and nonresponder patients. This may be related to improvement in symptoms even in nonresponders who have a relative increase in LVEF <25%.
Spontaneous Twisting of a Pacemaker Lead in an Unusual Site
Authors: CAY SERKAN , OZTURK SEZGIN , KORKMAZ SULE
Published: July 2005

Spontaneous twisting of a pacemaker electrode is a rare complication following implantation. If present, the electrode usually is twisted close to the pacemaker. This report presents the case of a 71‐year‐old female patient without any complaint associated with the twisting of the electrode. Telemetric study showed no abnormality thus, any intervention was not performed.
Late Right Ventricular Perforation After Permanent Pacemaker Implantation: How Far Can the Lead Go?
Authors: SANOUSSI AHMED , EL NAKADI BADIH , LARDINOIS INES , DE BRUYNE YASMINE , JORIS MARC
Published: July 2005

This case report describes the incredible dislocation of a right ventricular lead 1 month after pacemaker implantation. The lead's tip was found in the subcutaneous fat beneath the left breast. Extraction was uneventful. The key steps in the diagnosis and management of this rare complication are discussed.
Postmortem Anatomy of the Coronary Sinus Pacing Lead
Authors: BULAVA ALAN , LUKL JAN
Published: July 2005

Biventricular pacing nowadays represents a recognized method of nonpharmacological treatment of severe congestive heart failure refractory to medication. A growing number of biventricular implants is likely to bring an increasing demand for the extraction of specially designed coronary sinus (CS) leads for left ventricular pacing. There is a lot of data regarding conventional pacing or defibrillation lead extractions, but only very limited experience with the CS lead extractions. We describe the pathological–anatomical findings of a woman who died after 26 months postimplantation due to refractory ventricular fibrillation with focus on the left ventricular pacing lead course and feasibility of extraction.
Clinical Subtypes of Lone Atrial Fibrillation
Authors: PATTON KRISTEN K. , ZACKS ERAN S. , CHANG JOSEPH Y. , SHEA MARISA A. , RUSKIN JEREMY N. , MACRAE CALUM A. , ELLINOR PATRICK T.
Published: July 2005

Aims: In the face of increasing evidence of underlying genetic heterogeneity for lone atrial fibrillation (LAF), we undertook a clinical analysis of subjects to identify the phenotypic subsets of this arrhythmia.

Methods and Results: We evaluated serial patients who presented with LAF between July 5, 2001 and December 19, 2003. Subjects underwent a standardized interview to elicit a detailed medical history, prior therapies, and precipitants of atrial fibrillation. The results of a physical exam, electrocardiogram and echocardiogram were reviewed. One hundred and eighty subjects with a mean age of 45 years (15–67 years) at the time of diagnosis were enrolled. The majority of patients originally presented with paroxysmal fibrillation (94%), and 7.8% progressed to permanent AF. Reported triggers for AF included sleeping (44%), exercise (36%), alcohol use (36%), and eating (34%). Women with LAF had distinct symptoms, triggers for episodic AF, and over one‐fourth had an underlying rheumatologic condition. Several subsets of AF including familial AF (39%), exercise‐induced AF (32%), and conduction system disease requiring pacemaker implantation (7%), were identified.

Conclusions: Family history, exercise as a trigger of AF, and a history of a pacemaker identified subtypes of LAF.
Ventricular Fibrillation Frequency
Authors: CALLIHAN J. , ROEDER R. , GEDDES L.A. , OTLEWSKI M. , KEMENY A.
Published: July 2005

Background: Ventricular‐fibrillation (VF) wave frequency is known to decrease with prolonged, untreated VF. VF wave frequency is used as an algorithm to identify VF in AEDs and ICDs; yet the nature of the frequency change is not appreciated.

Methods: In this study, anesthetized pigs were used and VF was induced electrically. VF wave frequency was measured each second during VF for periods up to 200 sec. Defibrillation was achieved with transchest electrodes. VF wave frequency was plotted for each second during VF. In 2 animals, CPR was applied and VF wave frequency was measured.

Results: In all cases VF wave frequency decreased with increasing duration of VF. At the onset of VF, the VF wave frequency ranged from 5 to 12/sec. A plot of the normalized ratio of VF wave frequency during fibrillation to the VF frequency at induction decreased to between 0.1 and 0.8 of the initial frequency. In one of the animals, VF was initiated, CPR was provided and the VF wave frequency was measured over a 200‐second period. Then, the procedure was repeated without CPR. Beyond 130 seconds, the VF frequency with CPR was higher than that without CPR, indicating myocardial oxygenation.

Conclusion: Those who use VF wave frequency to identify the presence of VF should be aware of the nature of the VF wave frequency decrease with the passage of time.
A case of hydrocephalus occlusus presenting as bipolar disorder
Authors: Reisch T. , Brekenfeld C. , Barth A.
Published: July 2005

Objective:  This case highlights the fact that manic and depressive symptoms can be related to hydrocephalus occlusus even in the absence of neurological symptoms.

Method:  Single case report.

Results:  A 22‐year‐old male patient presented with a 2‐year history of manic and depressive symptoms. He was admitted to psychiatric in‐patient care fulfilling sufficient criteria of bipolar disorder presenting with a hypomanic state. No neurological symptoms could be detected. Three months later, a MRI of the brain showed a hydrocephalus occlusus because of a space‐occupying lesion of 5 mm in the lamina tecti obstructing the aqueduct of Silvius. The MRI also showed parahippocampal changes, which were probably related to the hydrocephalus. After the implantation of a ventriculo‐peritoneal shunt, manic symptoms resolved, but the patient continued to suffer from adynamic symptoms. Follow‐up MRIs over 3 years showed no progression of the lesion of unknown etiology.

Conclusions:  In this case, early routine neuroimaging might have reduced long‐term brain damage. The case underlines that even in the absence of neurological symptoms, brain imaging in bipolar disorder might be crucial. The feasibility of routine brain imaging in bipolar patients is discussed.
Bipolar disorder in women: reproductive events and treatment considerations
Authors: Freeman M. P. , Gelenberg A. J.
Published: July 2005

Objective:  Bipolar disorders are prevalent in women. Women with bipolar disorder often present with different clinical features than men. Reproductive events and hormonal treatments may impact the course of bipolar disorder. Our main objectives are to i) assess the impact of reproductive events on the course of the disorder, and ii) to discuss the relationships between reproductive events and psychiatric treatments.

Method:  A literature search was conducted of MEDLINE journals from 1965 to present. Manual literature searches were also conducted. We review the presentation, clinical course, and treatment considerations of bipolar disorder in women, with emphasis on treatment considerations in the context of reproductive events. Treatment‐related issues such as teratogenicity, breastfeeding, polycystic ovarian syndrome, weight gain and obesity, and medication interactions with oral contraceptives are reviewed.

Results:  Women with bipolar disorder may be more vulnerable to mood episodes in the context of reproductive events, particularly postpartum. In women of reproductive age, mood stabilizers must be selected with teratogenic risks in mind, with the highest reported risks in pregnancy with valproate, and the greatest concern during breastfeeding with lithium use. In the areas of the perimenopause and polycycstic ovarian syndrome, more data are needed to advise treatment decisions.

Conclusion:  We urgently need further study in these areas to deliver care that is appropriate to women with bipolar disorder.
The Temperament and Character Inventory‐Revised (TCI‐R): psychometric characteristics of the French version
Authors: Pelissolo A. , Mallet L. , Baleyte J.‐M. , Michel G. , Cloninger C. R. , Allilaire J.‐F. , Jouvent R.
Published: July 2005

Objective: To explore the psychometric characteristics of a modified version of the Cloninger's personality questionnaire, the Temperament and Character Inventory‐Revised (TCI‐R).

Method: A 482‐subject sample, including clinical and non‐clinical subjects, completed the TCI‐R. We performed principal component analyses and explored the factorial structure of the questionnaire, and the internal consistency of each dimension.

Results: The factorial structure of the TCI‐R was well defined as expected and similar to those shown with the TCI. Robust factors were obtained for Reward Dependence and Persistence in the TCI‐R, even more clearly than in the original TCI. All dimensions obtained higheralphaCronbach coefficients with the TCI‐R than with the TCI. We obtained highly satisfying reliability coefficients in test‐retest and TCI/TCI‐R comparisons.

Conclusion: The TCI‐R seems to have similar psychometric and feasibility characteristics as those of the initial version, but with significant improvements in terms of factorial structure and internal consistency of most dimensions.
Evidence for theory of mind deficits in euthymic patients with bipolar disorder
Authors: Bora E. , Vahip S. , Gonul A. S. , Akdeniz F. , Alkan M. , Ogut M. , Eryavuz A.
Published: July 2005

Objective:  i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non‐ToM cognitive deficits on ToM abilities.

Method:  Forty‐three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition.

Results:  The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention.

Conclusion:  Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.
Atrophic tongue associated with Candida
Authors: Terai Haruhiko , Shimahara Masashi
Published: July 2005

Background:  Traditionally, total atrophic tongue has been due to nutritional deficiencies, such as vitamin B12, folic acid, or iron deficiencies, and partial atrophic tongue has been well known as median rhomboid glossitis or geographic tongue. The other cause of atrophic tongue is oral candidiasis.

Methods:  Forty patients with atrophic change of the tongue were examined on a relation to candidiasis. All of them complained of tongue pain on spicy or hot diet. Laboratory examinations included blood examination for diabetes and anemia, culture test and direct cytologic examination. The intensity of tongue pain was evaluated pre‐ and post‐treatment using visual analogue scale (VAS).

Results:  Twenty‐four of 40 (60%) had pre‐disposing factors of candidiasis including diabetes mellitus, malignancy, systemic steroid therapy, long‐term antibiotic therapy and others in their medical history. Blood examinations revealed mild anemia and/or Fe deficiency in 5 (12.5%), mild diabetes in 4 (10.0%), both in two, while residual 29 patients (72.5%) were within reference levels. In the culture examination, candidal species were isolated in 72.5%, and almost all of them were candida albicans. The direct cytologic examination performed in 17 of 40 patients, witch revealed pseudohyphae of fungi in 14 patients (82.4%). After the antifungal treatment, the tongue pain disappeared or improved markedly in 80%. Simultaneously, the regenerative tendency of filifolm papilla of the tongue dorsum was observed in these patients.

Conclusion:  Atrophic tongue associated with pain at eating, even though it is mild atrophic change, has a high probability of being a candida‐induced lesion. Long disease duration and no benefit by topical steroids are suggestive and diagnostic factors of this disease.