bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Antiepileptic Drugs on Cognition: Patient Perceived Cognitive Problems of Topiramate versus Levetiracetam in Clinical Practice
Authors: Bootsma Hans‐Peter R. , Aldenkamp Albert P. , Diepman Leonie , Hulsman Jacques , Lambrechts Danielle , Leenen Loes , Majoie Marian , Schellekens Ad , De Krom Marc
Published: November 2006

Summary:  Introduction: Neurocognitive complaints may interfere with long‐term antiepileptic drug (AED) treatment and are an important issue in clinical practice. Most data about drug‐induced cognitive problems are derived from highly controlled short‐term clinical trials. We analyzed such cognitive complaints for the two most commonly used AEDs in a clinical setting using patient perceived problems as primary outcome measure.

Method: All patients of the epilepsy center Kempenhaeghe that received topiramate (TPM) or levetiracetam (LEV) from the introduction to mid 2004 were analyzed using a medical information system, an automated medical file. Patients were analyzed after 6, 12, and 18 months of treatment.

Results: Four hundred and two patients used either TPM (n = 260) or LEV (n = 142); 18 months retention showed a statistically significant difference, revealing 15% more patients that continued LEV compared to TPM: 18 months retention 46% for TPM and 61% for LEV [F (1.400) = 3.313, p = 0.043]. Neurocognitive complaints accounted for a significant number of drug discontinuations and especially the high frequency of neurocognitive complaints in the first period of TPM treatment appeared to be significant different from LEV [F(2,547) = 3.192, p = 0.042]. In the remaining patients, the difference in neurocognitive complaints was not statistically significant.

Conclusion: cognitive complaints are common in TPM treatment and frequently lead to drug withdrawal. The impact of LEV on cognitive function is only mild. This leads to a much higher (15%) drug discontinuation rate for TPM compared to LEV.
Effects of Antiepileptic Drugs on Mood and Behavior
Authors: Schmitz Bettina
Published: November 2006

Summary:  Psychiatric disorders in epilepsy have a multifactorial etiology, pharmacotherapy being only one of many risk factors, which can be both biological and psychosocial. Two important mechanisms of drug‐induced psychiatric changes are seizure control/forced normalization in psychosis and GABA‐ergic effects in depression. Among the psychiatric adverse events of antiepileptic drugs (AEDs), behavioral problems are the most commonly reported, followed by affective disorders. Psychosis is a relatively rare, although severe, complication. Psychotropic effects of AEDs warrant further research because many relevant parameters related to pathological mechanisms, frequency, psychopathology, and prognosis are not well understood. Behavioral side‐effect profiles of AEDs, both negative and positive psychotropic effects, should be considered in the choice of the optimal drug for an individual patient.
Cognition and Paroxysmal EEG Activities: From a Single Spike to Electrical Status Epilepticus during Sleep
Authors: Tassinari Carlo Alberto , Rubboli Guido
Published: November 2006

Summary:  Epileptic EEG paroxysms can interfere with cognitive processes producing transitory effects, such as those related to a single spike, as well as long‐lasting effects, such as in electrical status epilepticus during slow‐wave sleep (ESES). Focal spike‐related disruption of cortical functions can produce transitory cognitive impairment, with neuroanatomical specificity between the site of the epileptic focus and the impaired cognitive tasks. ESES represents a model of the long‐lasting effects of continuous spike‐wave activity on higher cortical functions. The duration of ESES and the localization of interictal foci seem to play a major role in influencing the degree and type of cognitive dysfunction, suggesting that the ESES clinical picture results from a localized disruption of EEG activity caused by focal epileptic activity during sleep. Recently, Giulio Tononi's group reported that a local increase of slow‐wave activity (SWA) during sleep after learning is associated with improved performance of the learned task after sleep (Huber et al., Nature 2004;430:78–81). On the basis of these findings, we can speculate that prolonged focal epileptic activity during sleep (as occurring in ESES) interferes with local SWA at the site of the epileptic focus, impairing the neural processes and, possibly, the local plastic changes associated with learning and other cognitive functions.
The Natural History of Myoclonic Astatic Epilepsy (Doose Syndrome) and Lennox‐Gastaut Syndrome
Authors: Stephani Ulrich
Published: November 2006

Summary:  The purpose of this article is to present a short review of the natural history of myoclonic astatic epilepsy (MAE; Doose syndrome) and the Lennox‐Gastaut syndrome (LGS). In the 1989 classification of the International League Against Epilepsy (ILAE, 1989), MAE and LGS were initially included in group 2.2: “Cryptogenic or symptomatic generalized epilepsies and syndromes.” The subsequent classification of the Proposed Diagnostic Scheme for People with Epileptic Seizures and with Epilepsy (see Ref. 8) placed MAE in axis 3 in the “generalized epilepsy” group and LGS, severe myoclonic epilepsy of infancy (SMEI or Dravet syndrome) and atypical benign partial epilepsy/pseudo‐Lennox syndrome (ABPE/PLS) in the “epileptic encephalopathy” group. The semiology of MAE and LGS and their differential diagnosis from SMEI and ABPE/PLS are described. Before the onset of SMEI, MAE, and ABPE/PLS, the development of the child is usually normal. In contrast, in LGS, development is frequently retarded at the onset, depending on the etiopathogenesis of the underlying brain disease. The course of MAE is highly variable with regard to seizure outcome (complete remission in some cases, persistent epilepsy in others) and cognitive development (normal or delayed). The course of LGS and SMEI is generally poor, both with regard to the epilepsy and to the cognitive development whereas the course and seizure outcome of ABPE/PLS is favorable; the patients will be seizure‐free at puberty. However, the neuropsychological outcome is less favorable; most patients remain mentally retarded.
The Spectrum of Idiopathic Rolandic Epilepsy Syndromes and Idiopathic Occipital Epilepsies: From the Benign to the Disabling
Authors: Gobbi Giuseppe , Boni Antonella , Filippini Melissa
Published: November 2006

Summary: Benign childhood epilepsy with centrotemporal spikes (BCECTS) is an idiopathic focal epilepsy syndrome, the benign characteristics of which are debated; in fact, stable or intermittent specific neuropsychological deficits are frequent and may affect scholastic or adaptive abilities. Cognitive dysfunction may be related to a marked increment of the interictal epileptic discharges in NREM sleep: different degrees of neuropsychological deficits depend on the extent of awake and sleep activity and the predominant discharge localization. The age of onset and duration of atypical sleep EEG patterns may correlate with permanent cognitive impairments. These atypical clinical and EEG evolutions have been reported in the literature as different syndromes that constitute the spectrum of idiopathic rolandic epilepsy. Moreover, a clinical link between BCECTS and early‐onset benign childhood occipital epilepsy has been demonstrated.

According to the neurobiological approach, the spectrum of Idiopathic Rolandic Epilepsy is based on an age‐dependent, idiopathic predisposition to focal seizures and sharp‐wave discharges, as an expression of nonlesional cortical excitability. The involvement of a given area of the cerebral cortex may depend on the brain maturational stage.
The Spectrum from BCECTS to LKS: The Rolandic EEG Trait—Impact on Cognition
Authors: Stephani Ulrich , Carlsson Goran
Published: November 2006

Summary:  The laboratory hallmark of BCECTS is the rolandic discharge (RD) in the EEG of patients, occurring in a characteristic topographical, vigilance‐related, event‐related, and age‐related pattern, disappearing during puberty. RDs are present in 2% of healthy children. About 8% of children with RDs have epilepsy. An increased prevalence rate of RDs is found in children with cognitive and behavioral disorders, with headaches and some genetic syndromes. In some patients, the cognitive disorders are transient but in others they are progressive, resulting in stable mental retardation after puberty. A recent study of 36 BCECTS patients addressed the following questions. (1) the possible relationship between the severity of RDs and the neuropsychological deficits; (2) the profile of neuropsychological deficits; (3) changes of cognition related to EEG changes; and (4) effects of therapy. No correlation was found between global IQ and the severity of the RDs. All the children had at least one specific learning disorder (sometimes long‐lasting). When the children were treated, a correlation between cognitive and EEG improvement could not be demonstrated. Recently, 21 patients without epilepsy but with attention deficit and hyperactivity and/or learning disorders were studied: an open treatment trial with sulthiame resulted in improved sustained and selective attention. The neurobiology of RDs and their relationship to cognitive dysfunction and epilepsy requires further study.
Neuropsychological Findings in Idiopathic Occipital Lobe Epilepsies
Authors: Chilosi Anna Maria , Brovedani Paola , Moscatelli M. , Bonanni Paolo , Guerrini Renzo
Published: November 2006

Summary:  Purpose: We reviewed the clinical charts of 22 patients (mean age 12 years) with idiopathic occipital lobe epilepsies (IOLE) to verify the presence of visuoperceptual difficulties.

Methods: All 22 patients underwent a standard neuropsychiatric examination and had a sleep electroencephalogram (EEG). Eleven had normal development and adequate scholastic achievements, so no formal testing was performed. Psychological assessment was carried out in the remaining 11 patients who had been referred because of learning and behavioral difficulties.

Results and conclusions: IQ was in the average/low‐average range in most patients, with a cognitive profile characterized by relatively better verbal than performance abilities (8/11). There was a high incidence of scholastic disabilities (7/11); psychiatric disorders in the form of anxiety and depressive disorders were also frequent (6/11). In the six patients who had neuropsychological assessment with specific visuoperceptual testing, a deficit in facial discrimination was found in four patients, associated with a line orientation deficit in three. Although preliminary, and based on a tertiary‐care clinical sample, these data suggest that children with IOLE, are at risk for lower intellectual performance, poor scholastic achievement and psychiatric disorders, as well as for specific deficits in the visuoperceptual domain, probably due to dysfunction of the occipitotemporal circuitries most often involved in seizure spread in epilepsies originating in the posterior brain.
Nonidiopathic Focal Epilepsies: Methodological Problems for a Comprehensive Neuropsychological Evaluation
Authors: Arzimanoglou Alexis , Laurent Agathe , De Schonen Scania
Published: November 2006

Summary: In aiming to define better practice parameters for neuropsychological assessment in patients with nonidiopathic partial epilepsies, particularly in children, we discuss the reasons for the current lack of clear answers. The relevant factors include the epilepsy itself, the complexity of the issues related to cognitive function/dysfunction and the underlying developmental processes. Another factor is the lack of availability and high cost of neuropsychological testing, even in industrialized societies. Because of these factors, the need for neuropsychological testing must be considered on an individual basis in the initial evaluation of every child with focal epilepsy; it should be left to the clinician and parents to decide which children will actually be referred. Systematic presurgical and postsurgical testing is important for surgical candidates. Comprehensive research protocols should be designed on a collaborative basis between large epilepsy centers, covering all the essential parameters to be evaluated. Children with focal epilepsies should be included in these protocols from the onset of the epilepsy.
Cognitive Outcomes in Patients with Chronic Temporal Lobe Epilepsy
Authors: Helmstaedter Christoph , Kockelmann Edgar
Published: November 2006

Summary:  Cognitive impairment is frequent in temporal lobe epilepsy (TLE). In particular, specific deficits in temporal lobe related functions occur, but deficits in extratemporal lobe functions and global intelligence are also found. The degree and type of the impairment are first determined by structural damage and functionally dynamic factors. Most cognitive problems in TLE are already detectable at, or even before, the onset of the epilepsy. Accumulation of damage during the course of chronic epilepsy may add to this. This additional damage may be caused directly by severe seizures, head trauma, intoxication etc., or indirectly by interference of the epilepsy with mental development. Surgical treatment of TLE may also affect the cognitive outcome of patients with chronic TLE, with a risk of additional impairments on the one hand and functional recovery due to seizure control on the other hand. With regard to patient‐associated factors, better baseline performance, younger age, cerebral plasticity, and good mental reserve capacities are associated with a better outcome. With regard to treatment‐associated factors, prevention of additional brain dysfunction/damage and successful seizure control are important.
Epileptic Amnesic Syndrome: An Update and Further Considerations
Authors: Gallassi Roberto
Published: November 2006

Summary:  We describe 30 patients with “epileptic amnesic syndrome” (EAS) with adult‐senile onset of a severe memory complaint that started before or at the same time as stereotyped seizures with only short loss of contact and automatisms. Because the seizures were not obvious or disturbing, they remained undiagnosed for a long time. Twenty‐three patients also had attacks of transient anteroretrograde amnesia after the seizures: “epileptic amnesic attacks” (EAA). These are similar to attacks of transient global amnesia but are more frequent, shorter, accompanied by clear‐cut clinical epileptic manifestations, and respond favorably to antiepileptic drug (AED) therapy. Interictal neuropsychological investigation ruled out global mental deterioration, showing only selective memory impairment in a few long‐term tasks, and subjective and objective improvement after AED. Bilateral deep discharges involving the hippocampal‐mesial temporal lobe regions may explain EAA, which is probably a postictal phenomenon. The interictal memory problems may be due to subclinical discharges causing difficulty in codification or consolidation of the amnesic trace. EAS patients having uniform anamnestic, clinical and neuropsychological features represent a particular type of temporal lobe epilepsy. We propose a definition of EAS, according to which cases can be classified as definite, probable or possible forms.
Idiopathic Generalized Epilepsies of Adolescence
Authors: Beghi Massimiliano , Beghi Ettore , Cornaggia Cesare Maria , Gobbi Giuseppe
Published: November 2006

Summary:  The prevalence of idiopathic generalized epilepsies (IGEs) has been assessed as being 15–20% of all epilepsies. The seizure types in IGEs are typical absences, myoclonic jerks, and generalized tonic–clonic seizures (TCS), alone or in varying combinations and with variable severity. The seizures tend to be more frequent on awakening and with sleep deprivation. This group of clinical conditions includes among others, age‐related epilepsy syndromes of adolescence such as juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with generalized TCS or epilepsy with grand mal on awakening (EGMA). The classification of IGEs follows two schools of thought; one maintains that IGEs are a group of different and separate syndromes while the other suggests that IGEs are one biological continuum. Patients with IGEs may have mild impairment of cognitive functions, especially verbal memory and other frontal lobe functions, despite a normal IQ, and some seem to have characteristic personality traits, although further studies are needed to support this theory. They appear to lack a degree of self‐control, to neglect their physical needs, and are poorly compliant with therapy. Some patients become obstinate and are impressionable. The cognitive and behavioral aspects of these patients suggest an involvement of frontal lobes.
Eye‐Closure–Triggered Paroxysmal Activity and Cognitive Impairment: A Case Report
Authors: Termine Cristiano , Rubboli Guido , Veggiotti Pierangelo
Published: November 2006

Summary:  Purpose: To study the neuropsychological status of an epileptic patient presenting with epileptic activity triggered by eye closure in a 14‐year follow‐up period.

Methods: The patient was studied at 12 and 26 years of age; during this period he underwent periodical clinical evaluations and EEG investigations; brain magnetic resonance imaging (MRI) was performed at 12 years of age. A neuropsychological assessment was carried out both at 12 years of age (T0) and at 26 years of age. At T0 and T1, neuropsychological tests (digits and words span, graphoestesia, reactions time to auditory stimuli, sentences repetition, words repetition, digital gnosis, backward counting [i.e.,100–0]) were performed during video‐EEG monitoring either with eyes closed or with eyes open, to evaluate possible transitory effects related to ongoing epileptic activity. Moreover, at T0 the patient underwent Wechsler Intelligence Scale for Children‐Revised, and at T1 to Wechsler Adult Intelligence Scale‐Revised.

Results: EEG recordings showed continuous epileptic activity triggered by eye closure, disappearing only with eyes opening, both at T0 and T1 (in this latter case, anteriorly predominant). The results of neuropsychological assessment during eyes closed as compared to performances with eyes open did not show significant differences, at T0 as well as at T1. Wechsler Intelligence scales showed a deterioration of performances at T1 with respect to T0; in addition, at T1, attention and short‐term memory abnormalities, impairment in facial recognition and block design, and defective results in Continuous Performance Test and Wisconsin Card Sorting Test were observed.

Conclusions: Lack of differences between the results of neuropsychological tests performed with eyes closed as compared to the eyes open condition suggests that in our patient epileptic activity did not cause transitory cognitive abnormalities. Deterioration of Wechsler Intelligence Scales in the follow‐up period might be interpreted as the result of a disruption of cognitive processes possibly related to the persistence of a continuous epileptic activity during eye closure over the years. We speculate whether a dysfunction in posterior cortical areas involved in visual processing might be related to the impairment in face recognition and block design tests as well to eye closure sensitivity.
Cognitive and Behavioral Outcomes of Epileptic Syndromes: Implications for Education and Clinical Practice
Authors: Besag Frank M. C.
Published: November 2006

Summary: The educational and social progress of a child with epilepsy depends not only on seizure control but also on cognitive and behavioral factors. The various epilepsy syndromes of childhood and adolescence differ greatly in terms of cognitive and behavioral outcome. A high proportion of babies who have West syndrome and children who have Dravet syndrome (severe myoclonic epilepsy in infancy) will have long‐term cognitive and behavioral problems. The Lennox‐Gastaut syndrome also often has a poor prognosis in this regard. Children with the Landau‐Kleffner syndrome have a variable prognosis, some regain speech and others have permanent speech impairment. Benign childhood epilepsy with centrotemporal spikes is now recognised as lying on a spectrum with the Landau‐Kleffner syndrome: mild cases have few if any cognitive or behavioral problems but others may have quite severe difficulties. People with juvenile myoclonic epilepsy may have characteristics suggesting frontal lobe impairment. The educational and social impairments associated with the epilepsy syndromes of childhood and adolescence are of major importance but they have been the subject of remarkably few well‐performed studies. The impairments are not always necessarily permanent and it seems highly likely that the cognitive and behavioural outcome of at least some of these syndromes can be influenced greatly by early effective treatment with either antiepileptic medication or surgery.
History of Articulators: Henry L. “Harry” Page and the Transograph
Authors: Engelmeier Robert L. , Starcke Edgar N.
Published: November 2006

The intention of this article is to introduce the reader to the Transograph from a historical perspective. The technical data presented are intended to help the reader understand the design of this unique instrument and how it was programmed, but will not provide the reader a thorough understanding of this philosophy. The article seeks neither to defend nor criticize the principles of Transographics.
Nasal Width as a Guide for the Selection of Maxillary Complete Denture Anterior Teeth in Four Racial Groups
Authors: Varjão Fabiana Mansur , Nogueira Sergio Sualdini
Published: November 2006

Purpose: Selecting artificial teeth for edentulous patients is difficult when pre‐extraction records are not available. Various guidelines have been suggested for determining the width of the maxillary anterior denture teeth. This study was undertaken to evaluate the use of the nasal width as a guide for the selection of proper width maxillary anterior denture teeth in four racial groups of the Brazilian population.

Materials and Methods: One hundred and sixty subjects (40 Whites, 40 Mulattos, 40 Blacks, and 40 Asians) were selected. Using a sliding caliper, the nasal width and the intercanine distance were measured. The Pearson product‐moment correlation coefficient was used to determine the relationship between the above measurements. A prediction was made of the percentage of subjects of the White, Mulatto, Black, and Asian populations in which the selection error due to the clinical application of the method of the nasal width would be within 0 to 2 mm, within 2 to 4 mm, and greater than 4 mm.

Results
: The four racial groups showed a weak correlation between the intercanine distance and the nasal width. In 39.7% of the White, 55.7% of the Mulatto, 81.9% of the Black, and 48.2% of the Asian populations, errors greater than 4 mm would be present with the use of the nasal width.

Conclusions: The correlation found between the intercanine distance and the nasal width was not high enough to be used as a predictive factor. The relationship between natural tooth width and artificial tooth width as predicted by the nasal width showed that the nasal width method is not accurate for all the studied groups.
Fixed Rehabilitation of an ACP PDI Class III Patient
Authors: Michalakis Konstantinos X.
Published: November 2006

This clinical report documents the treatment of a 63‐year‐old Caucasian female Prosthodontic Diagnostic Index Class III patient using dental implants and a fixed prosthetic reconstruction. The treatment involved the fabrication of single crowns and fixed partial dentures retained by natural teeth in the maxillary arch. The posterior segments of the mandibular arch were rehabilitated with fixed partial dentures retained by endosseous implants.
Evaluation of Atrial Thrombus Formation and Atrial Appendage Function in Patients with Pacemaker by Transesophageal Echocardiography
Authors: ALIZADEH ABOLFATH , MALEKI MAJID , BASSIRI HOSSIENALI , ALASTI MOHAMMAD , EMKANJOO ZAHRA , HAGHJOO MAJID , ARYA ARASH , BAGHERZADEH ATALLAH , FAZELIFAR AMIRFARJAM , SADR‐AMELI MOHAMMAD A.
Published: November 2006

Background: Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation.

Methods: We conducted a cross‐sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity

Results: A total 72 patients (mean age, 65 ± 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean ± SD; %) was 53.3 ± 6.2% in ventricular pacing mode and 52.2 ± 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA‐FV) was significantly higher among the patients with AV sequential pacing mode (49.44 ± 18 cm/s vs 40.94 ± 19.4 cm/s, P value = 0.02). LAA‐FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 ± 2.3 mm vs 37.79 ± 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA‐FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage.

Conclusion: Long‐term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm.
The Magnitude of Sinus Cycle Length Change During Ventricular Tachycardia is Predictive of Successful Antitachycardia Pacing
Authors: MACGREGOR JOHN F. , WASMUND STEPHEN L. , PAI RAKESH K. , ABEDIN MOEEN , AKOUM NAZEM , SEGERSON NATHAN M. , FREEDMAN ROGER A. , KLEIN RICHARD C. , WALL T. SCOTT , RAWLING DAVID A. , SHEN SHUYING , HAMDAN MOHAMED H.
Published: November 2006

Background: Despite the wide use of antitachycardia pacing (ATP) in patients with implantable cardioverter defibrillators (ICDs), predictors of ATP success remain poorly understood. We hypothesize that the degree of sympathoexcitation, as measured by the sinus cycle length (SCL) shortening during ventricular tachycardia (VT), is a predictor of ATP success.

Methods and Results: The charts of 462 patients with dual‐chamber ICDs were reviewed. A total of 88 events in 26 patients met the inclusion criteria and were analyzed. The mean SCL during the 4 seconds preceding the VT onset (SCL‐baseline), and during the 4 seconds prior to ATP delivery (SCL‐VT) was measured. The percent shortening in SCL was calculated as ((SCL‐baseline) – (SCL‐VT))/(SCL‐baseline) × 100. Patients were classified into the ATP‐success and ATP‐failure groups depending on the VT(s) response to ATP. Using a t‐test analogue for clustered data, patients in the ATP‐success group exhibited a greater shortening in SCL when compared with the ATP‐Failure group (5.8% compared to 4.7%, P = 0.007). The successful ATP events displayed an average SCL shortening of 6.0% compared to 1.8% in the unsuccessful ATP events (P = 0.029). When the events were analyzed, the sensitivity and specificity of a shortening in SCL of >10% in predicting ATP success were 0.29 and 1.

Conclusion: We have shown that the SCL change during VT, a marker of the autonomic changes that accompany a tachycardia, is useful in predicting ATP success. Our findings suggest that analysis of the SCL during VT might play a role in future programming of ATP in patients with ICDs.
Comparison of a Standard versus Accelerated Dosing Regimen for d,l‐Sotalol for the Treatment of Atrial and Ventricular Dysrhythmias
Authors: KIM ROBERT J. , JURIANSZ G. JEREMY , JONES D. RANDY , GERLING BARBARA R. , HOLZBERGER PETER T. , GREENBERG MARK L.
Published: November 2006

Background: The current recommended starting dose of sotalol is 80 mg orally twice per day, followed by a judicious increase in dosage every 3 days under continuous telemetry monitoring. We hypothesized that sotalol administered at a higher starting dose (120 or 160 mg twice daily) would allow a more rapid attainment of therapeutic response with an acceptable safety and comparable efficacy profile.

Methods: Two hundred nine inpatients with various atrial and ventricular dysrhythmias were begun on either a standard starting dose (80 mg b.i.d.) or an accelerated dose (120 or 160 mg b.i.d.) of sotalol. In‐hospital occurrences of drug‐related adverse effects (proarrhythmic and others), drug efficacy, and length of hospitalization were retrospectively compared between the two groups.

Results: Ten patients (9.3%) in the 80 mg b.i.d. starting dose group experienced a cardiac adverse effect of sotalol as compared to 15 patients (14.9%) in the accelerated dose group (P = 0.286). The mean amount of corrected QT (QTc) prolongation over baseline was not significantly different between the two groups at hospital discharge (22.5 ms vs 21.6 ms, P = 0.898). There was a trend toward more noncardiac side effects of sotalol in the accelerated dose group: 2 (1.9%) versus 7(6.9%), P = 0.092. The average length of hospital stay was similar in the two groups (6.8 days vs 7.4 days, P = 0.558).

Conclusion: Initiating sotalol at 120–160 mg orally twice per day marginally increases the risk of cardiac and non‐cardiac side effects compared to the standard starting regimen of 80 mg b.i.d. Such an accelerated dosing regimen neither shortened hospitalization nor had any effect on treatment efficacy in this retrospective analysis.
Implantation of Left Ventricular Leads Using a Telescopic Catheter System
Authors: ZANON FRANCESCO , BARACCA ENRICO , PASTORE GIANNI , AGGIO SILVIO , RIGATELLI GIANLUCA , DONDINA CRISTINA , MARRAS GILLA , BRAGGION GABRIELE , BOARETTO GRAZIANO , CARDAIOLI PAOLO , GALASSO MARIAPAOLA , ZONZIN PIETRO , BAROLD S. SERGE
Published: November 2006

Background: Implantation procedures for cardiac resynchronization therapy (CRT) remain challenging with regard to coronary sinus (CS) cannulation and left ventricular (LV) lead positioning. Technologic advances in catheter design may facilitate CS cannulation and LV lead placement.

Aims: To evaluate two different telescoping dual‐catheter systems, RAPIDO Guiding Catheter System (Group R) and RAPIDO ADVANCE Guiding Catheter System (Group A) (Guidant Inc., St. Paul, MN, USA), during implantation of a CRT device.

Methods: Seventy‐four consecutive patients randomly received a CRT device using the R or A system.

Results: An LV lead was successfully implanted in 74 patients (100%). (1) Median times for CS cannulation in groups R and A were 0.3 minutes (range from 0.05 to 14 minutes) and 0.5 minutes (range from 0.05 to 9 minutes), respectively (P = NS). (2) Median times for LV lead placement were 8 minutes (range from 0.8 to 100 minutes) and 3.5 minutes (range from 0.25 to 30 minutes), respectively, for groups R and A (P = 0.032). (3) Median total fluoroscopy times were 12.33 minutes (range from 5 to 70 minutes) and 14.33 minutes (range from 6 to 53 minutes) for groups R and A, respectively (P = NS). (4) Median procedural times for CRT implantation were 80 minutes (range from 40 to 200 minutes) and 75 minutes (range from 45 to 180 minutes) (P = NS) in groups R and A, respectively. There were no major complications.

Conclusion: CS cannulation and LV lead placement with a telescopic dual‐catheter system is a safe and feasible approach that may reduce fluoroscopy and overall CRT implantation times. Our observations suggest that the RAPIDO ADVANCE System is faster than the RAPIDO System in terms of median time for LV lead positioning.
Myopotentials Leading to Ventricular Fibrillation Detection After Advisory Defibrillator Generator Replacement
Authors: ECKART ROBERT E. , HRUCZKOWSKI TOMASZ W , STEVENSON WILLIAM G. , EPSTEIN LAURENCE M.
Published: November 2006

We present an unusual source of oversensing following an internal cardioverter‐defibrillator generator change. The early appearance of reproducible myopotentials in the defibrillator sensing channel is usually due to a technical complication at the time of device implantation. Clues such as abrupt impedance change or reproduction with mechanical stimulation can help to localize a problem. Frequently the complication requires reoperation to examine the system. What do you do when everything seems to be working fine?
Precision of QT Interval Measurement by Advanced Electrocardiographic Equipment
Authors: HNATKOVA KATERINA , GANG YI , BATCHVAROV VELISLAV N. , MALIK MAREK
Published: November 2006

The costs of clinical investigations of drug‐induced QT interval prolongation are mainly related to manual processing of electrocardiographic (ECG) recordings. Potentially, however, these costs can be decreased by automatic ECG measurement. To investigate the improvements in measurement accuracy of the modern ECG equipment, this study investigated QT interval measurement by the “old” and “new” versions of the 12SL ECG algorithm by GE Healthcare (Milwaukee, WI, USA) and compared the results to carefully validated and reconciled manual measurements. The investigation used two sets (A and B) of ECG recordings that originated from large clinical studies. Sets A and B consisted of 15,194, and 29,866 10‐second ECG recordings, respectively. All the recordings were obtained with GE Healthcare recorders and were available in digital format compatible with ECG processing software by GE Healthcare. The two sets of recordings differed significantly in ECG quality with set B being substantially more noise polluted. Compared to careful manual QT interval readings in recording set A, the errors of the automatic QT interval measurement were (mean ± SD) +3.95 ± 5.50 ms, and +0.51 ± 12.41 ms for the “new” and “old” 12SL algorithm, respectively. In recording set B, these numbers were +2.41 ± 9.47 ms, and –0.17 ± 14.89 ms, respectively (both differences were highly statistically significant, P < 0.000001). In recording set A, 95.9% and 76.6% of ECGs were measured automatically within 10 ms of the manual measurement by the “new” and “old” versions of the 12SL algorithm, In recording set B, these numbers were 83.9% and 59.5%. The errors made by the “new” and “old” version of 12SL algorithm were practically independent each of the other (correlation coefficients of 0.031 and 0.281 in recording sets A and B, respectively). The study shows that (a) compared to the “old” version of the 12SL algorithm, the QT interval measurement by the “new” version implemented in the most recent ECG equipment by GE Healthcare is significantly better, and (b) the precision of automatic measurement by the 12SL algorithm is substantially dependent on the quality of processed ECG recordings. The improved accuracy of the “new” 12SL algorithm makes it feasible to use modern ECG equipment without any manual intervention in selected parts of drug‐development program.
RF Catheter Ablation: Lessons on Lesions
Authors: WITTKAMPF FRED H.M. , NAKAGAWA HIROSHI
Published: November 2006

The present treatment of atrial fibrillation by radiofrequency catheter ablation requires long continuous lesions in the thin walled left atrium where side effects may lead to serious complications. Better understanding of the physical processes that take place during ablation may help to improve the quality, safety, and outcome of these procedures. These processes include the distribution of power between blood, tissue, and patient; the mechanisms of tissue heating and coagulum formation; the relation between tissue and electrode temperatures; and the effects of increased electrode size and internal and external electrode cooling.

With normal electrode‐tissue contact, only a fraction of all power is effectively delivered to the tissue. Due to the variability of blood flow cooling, applied power and electrode temperature rise are poor indicators of lesion formation. With a longer electrode, the efficiency of tissue heating is decreased and the greater variation in tissue contact caused by electrode orientation makes lesion formation even more unpredictable. The absence of impedance rise during ablation does not guarantee the absence of blood clot formation on the tissue contact site. Blood clots may unnoticeably be created on the lesion surface and are caused by thermal denaturization of blood proteins, independent of heparinization. Irrigated ablation with external flush may prevent blood clot formation. Irrigation minimally affects lesion size by cooling the tissue surface. Larger lesions may only be created by the application of higher power levels. Electrode cooling, however, impedes electrode temperature feed back and blinds the operator for excessive tissue heating. External cooling alone with preservation of temperature feed back is a promising concept that may lead to improved procedural safety and success.
Repetitive Intermittent Left Bundle Branch Block
Authors: ARIAS MIGUEL A. , SÁNCHEZ ANA M. , LÓPEZ JUANA M.
Published: November 2006

A 32‐year‐old woman with no structural heart disease was referred for evaluation due to daily occasional palpitations and documented left bundle branch block (LBBB) on surface electrocardiogram (EKG). Continuous 24‐hour Holter monitoring revealed a broad range of repetitive intermittent LBBB grades with a rate‐dependent pattern that was also associated with circadian variations.
Photoluminescence Characteristics of Sol–Gel Materials Prepared from Bimetallic Erbium Alkoxides Coordinated by Al or Ti
Authors: Lim Mi Ae , Seok Sang Il , Athar Taimur , Ju Jung‐Jin , Lee Myung‐Hyun , Hong Seok In
Published: November 2006

Er3+‐doped Al2O3–SiO2 and TiO2–SiO2 powders were prepared by the sol–gel process using bimetallic erbium isopropoxides coordinated with Al or Ti. The local environment surrounding Er3+ ions was controlled orderly at the precursor stage. The phase development of two different systems as a function of temperature was characterized by XRD, and the amount of OH groups remaining within the samples was investigated by a Fourier‐transformed infrared spectrometer with increasing annealing temperatures. The photoluminescence spectra and lifetimes of two systems annealed at different temperatures were measured and discussed. The strong emission and long lifetime were observed in Er3+‐doped Al2O3–SiO2 system, ascribed to the homogeneous distribution of Er3+ ion.
Effect of Slag Impregnation on Thermal Degradations in Refractories
Authors: Blond Eric , Schmitt Nicolas , Hild François , Blumenfeld Philippe , Poirier Jacques
Published: November 2006

Degradation in bauxite refractory linings used in steel plants is localized in the slag‐impregnated zone of refractories. It is proposed to estimate the contribution of the pressure of the impregnated liquid on the degradation of refractories. The study of the gradient of chemical composition allows for the evaluation of the liquid content, the oxide content in the liquid phase, and the “slag” viscosity. The thermomechanical analysis of a porous refractory impregnated by slag enables us to propose analytical expressions for a rapid estimate of the maximum “slag pressure” and its location as well as the level of thermoelastic stresses.
Migration of Half Partial Dislocations in the Planar Fault Plane of Hexagonal Barium Titanate
Authors: Wu Yu‐Chuan , Wang Sea‐Fue , Lu Hong‐Yang
Published: November 2006

The prism plane half partials with Burgers vector bPr= 1/3 ×〈0110〉 dissociated from the perfect basal dislocations with bB= 1/3〈1210〉 embedded in an α‐type extended planar stacking fault of hexagonal (h‐)BaTiO3 have been analyzed by transmission electron microscopy. It is found that the dissociation of a series of basal dislocations occurred by glide in the fault plane (0002). However, migrating of the pair partials trailing behind in the fault plane was impeded by the leading pair. Under the applied stress in hot pressing, these partials were gradually piled up with successively decreasing separation between each pair. That has consequently led to partial separations ranging between ∼195 and 56 nm. One partial dislocation (p1) belonging initially to the leading pair partials has moved to another plane by a mixed mechanism of glide in (0002) and climb down in (0110) by 1/2[0001] (i.e., (1/2)c). The climbing partial has become an obstacle hindering dislocation migration in the fault plane. Determining the secondary pyramidal plane (0112) connecting the leading half partial allows us to propose that the p1 partial migrating by glide and climb has arrived at another planar fault plane (0005) during hot pressing. The stages of how half partials were created, separated in fault plane, and arrived gradually at the present configuration are proposed and schematically illustrated. The significance of climb‐controlled dislocation glide mechanism in the hot pressing of h‐BaTiO3 is discussed.
In Vitro Bioactive Characteristics of Borate‐Based Glasses with Controllable Degradation Behavior
Authors: Yao Aihua , Wang Deping , Huang Wenhai , Fu Qiang , Rahaman Mohamed N. , Day Delbert E.
Published: November 2006

Silicate‐based bioactive glasses undergo incomplete conversion to a calcium phosphate material after in vivo implantation, which severely limits their biomedical application. In this communication, novel borate‐based glasses with controllable degradation behavior were developed and their bioactive potential was investigated in vitro. When immersed in a 0.02M K2HPO4 solution at 37°C, these glasses reacted to form a carbonate‐substituted hydroxyapatite (c‐HA) on their surfaces, indicating their bioactive potential. The conversion rate to c‐HA was controlled by adjusting the B2O3/SiO2 ratio in the glass composition. The results indicate the potential application of the borate‐based bioactive glass as scaffold materials for bone tissue engineering.
Tm3+‐Doped Gallium–Germanium–Bismuth–Lead Glasses as 1.47 μm Fiber Amplifier Materials
Authors: Yang Gangfeng , Zhang Qinyuan , Shi Dongmei , Jiang Zhonghong
Published: November 2006

We report the spectroscopic properties of Tm3+‐doped and Tm3+/Ho3+‐codoped [Ga2O3–GeO2–Bi2O3–PbO (PbF2)] glasses for S‐band optical amplifications. The Judd–Ofelt intensity parameters have been determined based on the measured absorption spectra. It is found that PbF2‐modified glasses exhibit a lower Ω2 value, and the addition of PbF2 caused the chemical bond associated with Tm3+ ions to be more ionic. The PbF2‐free glasses have large peak emission cross‐sections in the range of 2.15–2.18 × 10−21 cm2. Meanwhile, the studied glasses exhibit broad 1.47 μm emission with the full width at half‐maximum of 119–126 nm. The results indicate that these glasses are useful host material for broadband S‐band fiber amplifiers.
Synthesis of Tetragonal Barium Titanate Nanoparticles Via Alkoxide–Hydroxide Sol‐Precipitation: Effect of Water Addition
Authors: Yoon Songhak , Baik Sunggi , Kim Min Gyu , Shin Namsoo , Kim Insung
Published: November 2006

Barium titanate (BaTiO3) nanoparticles are synthesized under N2 atmosphere by the hydrolysis and condensation of barium hydroxide octahydrate and titanium (IV) isopropoxide with controlled water addition. With increasing the amount of water addition, the primary nanoparticles tend to grow from 7.5 to 68.5 nm in average diameter and to agglomerate to form spherical secondary particles of 0.5–3 μm in diameter. The influence of water content on the crystal size and structure was studied by X‐ray diffraction via synchrotron radiation. As the amounts of added water increased, Rietveld analysis revealed that the lattice volume shrinks along the c‐axis changing the crystal structure of BaTiO3 nanoparticles gradually from tetragonal to cubic. FT‐IR spectra also indicated that the concentration of hydroxyl ions in BaTiO3 nanoparticles decreases with increasing water contents. It is thus concluded that adding sufficient amount of water is effective in reducing the concentration of protons in the oxygen sublattice during synthesis of BaTiO3 nanoparticles via alkoxide–hydroxide sol‐precipitation process.
Development and usefulness of an instrument for the standard description and comparison of services for disabilities (DESDE)
Authors: Salvador‐Carulla L. , Poole M. , Gonzalez‐Caballero J. L. , Romero C. , Salinas J. A. , Lagares‐Franco C. M. ,   for RIRAG/PSICOST Group and DESDE Consensus Panel
Published: November 2006

Objective:  Mental health research has made significant progress in international comparison and instrument development. This study reports the adaptation of the European Service Mapping Schedule (ESMS) to the assessment of services for persons with disabilities.

Method:  Qualitative groups were used to develop the Description and Evaluation of Services for Disabilities in Europe (DESDE). The psychometric analysis of DESDE covered: feasibility, inter‐rater reliability, descriptive validity and internal validity. A demonstration study was also carried out.

Results:  Compared to the original ESMS, a new main branch and several sub‐branches were added. We identified 826 services for persons with disabilities, which provided 1284 main types of care. The feasibility and reliability was good for the majority of codes. Only 6% of services were not properly classified. The Boolean factor analysis supported the internal validity of DESDE.

Conclusion:  DESDE is a useful and reliable instrument for the assessment of services for persons with disabilities.
Cost‐effectiveness of different clinical interventions for reducing the burden of schizophrenia in Spain
Authors: Gutierrez‐Recacha P. , Chisholm D. , Haro J. M. , Salvador‐Carulla L. , Ayuso‐Mateos J. L.
Published: November 2006

Objective:  To estimate the cost‐effectiveness of interventions for reducing the burden of schizophrenia in Spain.

Method:  The study examined the cost‐effectiveness of seven different types of clinical interventions at the level of Spanish population: i) current situation; ii) older antipsychotics alone; iii) new antipsychotics alone (risperidone); iv) older antipsychotics plus psychosocial treatment; v) new antipsychotics plus psychosocial treatment; vi) older antipsychotics plus case management and psychosocial treatment; vii) new antipsychotics plus case management and psychosocial treatment.

Results:  Interventions based on the combination of haloperidol with psychosocial treatment or psychosocial treatment plus case management proved to be the most efficient strategies.

Conclusion:  The relatively modest additional cost of concurrent psychosocial treatment has significant health gains, thereby making such a combined strategy for schizophrenia more cost‐effective than pharmacology alone.