bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Mechanical Dyssynchrony in Heart Failure Patients with Different QRS Durations
Authors: HAGHJOO MAJID , BAGHERZADEH ATAALLAH , FAZELIFAR AMIR FARJAM , HAGHIGHI ZAHRA OJAGHI , ESMAIELZADEH MARYAM , ALIZADEH ABOLFATH , EMKANJOO ZAHRA , SADEGHPOUR ANITA , SAMIEI NILOOFAR , FARAHANI MARYAM MOSHKANI , SADR‐AMELI MOHAMMAD ALI , MALEKI MAJID , NOOHI FEREIDOUN
Published: May 2007

Background:

Cardiac resynchronization therapy (CRT) has emerged as an established therapy for congestive heart failure. However, up to 30% of patients fail to respond to CRT despite prolonged QRS.

Objectives:

This study aimed at defining the prevalence of interventricular and intraventricular dyssynchrony in heart failure patients with different QRS durations.

Methods:

A total of 123 consecutive patients with severe heart failure (LVEF < 35% and NYHA class III–IV) were prospectively evaluated using 12‐lead electrocardiogram and complete echocardiographic examination including tissue Doppler imaging.

Results:

According to the QRS duration, 56 patients had a QRS duration ≤120 ms (Group 1), 33 patients had a QRS duration between 120 and 150 ms (Group 2), and 34 patients had a QRS duration ≥150 ms (Group 3). Intraventricular dyssynchrony was present in 36% of Group 1 patients, in 58% of Group 2 patients, and in 79% of Group 3 patients (P < 0.000). Linear regression demonstrated a weak relation between QRS and intraventricular dyssynchrony. A greater proportion of patients with interventricular dyssynchrony was observed in Group 3 or Group 2 compared to patients with normal QRS duration (32% in Group 1 vs. 51.5% in Group 2 vs. 76.5% in Group 3, P < 0.000). Linear regression demonstrated a significant relation between QRS duration and interventricular mechanical delay.

Conclusions:

Although both interventricular and intraventricular dyssynchrony increased with the increasing QRS duration, the correlation between intraventricular mechanical and electrical dyssynchrony was weak. The lack of intraventricular dyssynchrony in a fraction of patients with standard CRT indication by QRS duration may provide us insight into the nonresponders rates.
Investigation of Various Types of Neurocardiogenic Response to Head‐Up Tilting by Extended Hemodynamic and Neurohumoral Monitoring
Authors: NOWAK LORENZ , NOWAK FRANZ G. , JANKO SABINE , DORWARTH UWE , HOFFMANN ELLEN , BOTZENHARDT FLORIAN
Published: May 2007

Background:

The pathophysiology of neurocardiogenic syncope is heterogeneous. This study aim was to analyze whether extended monitoring during tilt‐table testing provided additional information on the hemodynamic and vegetative state prior to neurocardiogenic syncope.

Methods:

This retrospective analysis is based on data of head‐up tilt‐table testing of 40 unselected consecutive patients with a history of unexplained syncope. For optimized characterization of the type of syncope, monitoring included electrocardiogram (ECG), blood pressure measurements and cardiac output, peripheral vascular resistance and contractility index measurements by impedance cardiography, as well as epinephrine and norepinephrine plasma levels in supine position and every 5 min during tilting.

Results:

Seven of 40 patients were unsuitable for analysis because of incomplete data sets. Tilt‐table was positive in 26 patients, negative in 7. Groups did not differ in hemodynamic and catecholaminergic parameters at baseline. Responses to tilting were VASIS 1 (mix of cardioinhibitory and vasodepressor) in 5 patients, VASIS 2B (cardioinhibitory with asystole >3sec) in 3, VASIS 3 (vasodepressor) in 16, orthostatic dysregulation in 2. In VASIS 1, the catecholamine measurement 4 min before syncope showed a proportionally larger increase of the epinephrine level than of norepinephrine. This disproportion was not observed in VASIS 2B and 3. In VASIS 2B, strong vasoconstriction and negative inotropy were evident in the presyncopal period. In VASIS 3, vascular resistance decreased continuously before syncope, while contractility index increased inadequately. Presyncopal epinephrine surge or norepinephrine loss was not observed in this group, suspecting other vasodilating factors.

Conclusions:

Extended monitoring by impedance cardiography and plasma catecholamine measurements during tilt‐table testing gave further insight into different hemodynamic and neurohumoral presyncopal patterns among the various types of neurocardiogenic syncope and may thereby help to develop individualized therapeutic concepts.
Effects of Intracoronary Low‐Dose Enalaprilat on Ventricular Repolarization Dynamics After Direct Percutaneous Intervention for Acute Myocardial Infarction
Authors: BONNEMEIER HENDRIK , SCHÄFER ULRICH , KURZ THOMAS , ORTAK JASMIN , HARTMANN FRANZ , KATUS HUGO A. , RICHARDT GERT , SCHUNKERT HERIBERT
Published: May 2007

Background:

Data from animal models suggest that inhibition of angiotensin converting enzymes result in an increased ventricular electrical stability after reperfusion in acute myocardial infarction (MI). As electrical stability is largely dependent on ventricular repolarization, we sought to determine the impact of low‐dose intracoronary (ic.) application of enalaprilat (EN) as an adjunct to direct primary coronary intervention (PCI) on QT dynamics in the acute phase of MI.

Methods:

Twenty‐two consecutive patients with a first acute MI who underwent successful direct PCI (TIMI 3 flow) were randomized to ic. EN (50 μg) or placebo/saline (PL), given immediately after reopening of the infarct vessel. On hospital admission, a 24‐hour‐Holter‐electrocardiogram (ECG) was initiated. Slopes of the linear QT/RR regression were determined for the time intervals before reperfusion and after reperfusion.

Results:

A total of 7 patients in the EN group and 8 patients in the PL group had valid ECG recordings for beat‐to‐beat QT analysis. Mean RR interval and mean QT interval were not significantly different between the EN and the PL groups both before and after PCI. There were also no significant differences regarding QT/RR slopes between EN and PL groups before PCI. After PCI, QT/RR slopes significantly decreased in the EN group (0.169 ± 0.04 to 0.121 ± 0.03; P < 0.01), whereas there were no significant alterations in the PL group (0.175 ± 0.04 to 0.171 ± 0.03; P = ns).

Conclusions:

Intracoronary EN therapy as an adjunct to direct PCI significantly decreases QT/RR slopes, suggesting a normalization of the coupling between heart rate and repolarization by improving electrical restitution. Thus, our findings offer new insights into possible beneficial effects of ACE inhibition on cardiac electrical stability in acute MI.
Is Home Orthostatic Self‐Training Effective in Preventing Neurally Mediated Syncope?
Authors: ON YOUNG KEUN , PARK JUNGWAE , HUH JUNE , SOO KIM JUNE
Published: May 2007

Background:

Repeated orthostatic stress may prove to be of benefit in the regulation of neurally mediated syncope. But the role of home orthostatic self‐training is not established to prevent symptoms in patients with neurally mediated syncope. We performed a prospective and randomized study to evaluate the effectiveness of repeated home orthostatic self‐training in preventing tilt‐induced neurally mediated syncope.

Methods and Results:

Fourty‐two consecutive patients (24 males and 18 females, mean age 39 years, 16–68 years) with recurrent neurally mediated syncope were randomized into the tilt training and control groups. The home orthostatic self‐training program consisted of daily sessions for 7 days a week for 4 weeks. In order to determine the effects of home orthostatic self‐training, we repeated the head‐up tilt test in both groups 4 weeks later. Among the tilt‐training group, 9 of 16 patients (56%) had a positive response on follow‐up head‐up tilt test. Among the untreated control group, 9 of 17 patients (53%) had a positive response on follow‐up head‐up tilt test. In subgroup analyses according to the number of tilt‐training sessions or the classified type, we found no differences in the follow‐up head‐up tilt test responses. Spontaneous syncope or presyncope over mean follow‐up of 16.9 months were observed in 42.9% versus 47.1% in the tilt‐training and control group, respectively.

Conclusions:

Home orthostatic self‐training was ineffective in reducing the positive response rate of head‐up tilt test in patients with recurrent neurally mediated syncope.
Determinants of Lesion Sizes and Tissue Temperatures During Catheter Cryoablation
Authors: WOOD MARK A. , PARVEZ BABAR , ELLENBOGEN AMY L. , SHAFFER KATHERINE M. , GOLDBERG SCOTT M. , GASPAR MICHAEL P. , ARIEF ISTI , SCHUBERT CHRISTINE M.
Published: May 2007

Background:

Factors which influence lesion size from catheter‐based cryoablation have not been well described. This study describes factors which influence lesion size during catheter cryoablation.

Methods and Results:

Cryoablation was delivered to porcine left ventricular myocardium in a saline bath using 4‐ or 8‐mm electrode catheters. Ablation was delivered with the electrodes either vertical or horizontal to the tissue and both with and without superfusate flow over the electrode. The effect of electrode contact pressure was tested. Lesion dimensions were measured. All experiments were duplicated to measure tissue temperatures at 1‐, 2‐, 3‐, and 5‐mm deep to the ablation electrode. The 8‐mm electrode produced lower tissue temperatures and larger lesion volumes when compared with the 4‐mm electrode (all P < 0.05). Superfusate flow slowed the rate of tissue cooling, markedly warmed tissue temperatures, and reduced lesion volume when compared with no flow conditions. By linear regression modeling, lesion sizes and tissue temperatures were related to the presence of superfusate flow, electrode orientation, contact pressure and electrode size, or catheter refrigerant flow rate (r2 for models = 0.90–0.96, all P < 0.001). Electrode temperature predicted lesion size or tissue temperatures only when analyzed independent of electrode size or refrigerant flow rate.

Conclusions:

Lesion sizes and tissue temperatures during catheter cryoablation are related to convective warming, electrode orientation, electrode contact pressure, and any of the following: electrode size, catheter refrigerant flow rate or electrode temperature. However, electrode temperature may be a poor predictor of lesion size and tissue temperature for a given catheter size.
Incidence and Initial Characteristics of Pilsicainide‐Induced Ventricular Arrhythmias in Patients With Brugada Syndrome
Authors: CHINUSHI MASAOMI , KOMURA SATORU , IZUMI DAISUKE , FURUSHIMA HIROSHI , TANABE YASUTAKA , WASHIZUKA TAKASHI , AIZAWA YOSHIFUSA
Published: May 2007

Background: In patients with Brugada syndrome, class I antiarrhythmic drugs can trigger ventricular arrhythmias (VA). The incidence and initial characteristics of VA that developed after pilsicainide was examined in 28 patients with Brugada‐type electrocardiographic (ECG) abnormalities and with a positive response in the pilsicainide test. The clinical outcome was also compared between patients with and without pilsicainide‐induced VA.

Methods and Results: In all patients, pilsicainide increased ST segment elevation and accentuated type 1 ECG changes. Ventricular tachycardia (VT) developed in 3 patients and premature ventricular complexes (PVC) in 2 other patients. These 5 patients (group I) had higher ST segment elevation in lead V2 on the ECG at baseline and after pilsicainide and showed a longer QTc interval after pilsicainide than the other 23 patients (group II). However, there was no difference between the 2 groups regarding incidence of prior cardiac events, results of signal‐averaged ECG, HV interval, inducibility of ventricular fibrillation by programmed electrical stimulation, or QRS duration. In 1 patient, PVC originated from 3 sites, 2 of which triggered polymorphic VT. The right ventricular (RV) outflow tract was the origin of 2 types of PVC, and other RV sites of 5 other types. During a 45 ± 37 months follow‐up, polymorphic VT recurred in 2 patients in group II.

Conclusions: Pilsicainide induced VA in some patients with Brugada syndrome, but this result may not be used as a parameter of the risk stratification of Brugada syndrome. Multiple PVC induced by pilsicainide and triggering polymorphic VT originated from several RV sites is an important factor when considering patients for treatment with catheter ablation.
The Dilemma of ICD Implant Testing
Authors: SWERDLOW CHARLES D. , RUSSO ANDREA M. , DEGROOT PAUL J.
Published: May 2007

Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self‐evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high‐output ICDs, the probability of passing a 10 J safety margin is ∼95%, the probability that a maximum output shock will defibrillate is ∼99%, and the incidence of system revision based on testing is ≤ 5%. Bayes' Theorem predicts that implant testing identifies ≤ 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first‐shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1–0.2%. Overall, VF should be induced to assess sensing in ∼ 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20–40% of recipients who can be identified as having a higher‐than‐usual probability of an inadequate defibrillation safety margin based on patient‐specific factors. However, implant testing is too risky in ∼5% of recipients and may not be worth the risks in 10–30%. In 25–50% of ICD recipients, testing cannot be identified as either critical or contraindicated.
Early Pacemaker Battery Depletion Caused by a Current Leak in the Output Circuitry: Rectification not Exchange
Authors: ROOS MARKUS , KOBZA RICHARD , ERNE PAUL
Published: May 2007

Malfunction of a dual chamber system pacemaker due to a current leak in the output circuitry leading to a rapid decline in battery longevity is described. Serial pulse amplitude alterations in defined device configurations enabled location of the defect in the 2.5‐V output voltage level; the current leak disappeared in the 5‐V output voltage level, and recurred in the 7.5‐V output voltage level which combines both 2.5‐V and 5‐V output circuitries. Reprogramming of pulse amplitudes rectified device malfunction. Circuitry reprogramming of pacemakers with faulty unexplained high battery current can circumvent early replacement in management of device malfunction.
Brugada Pattern Electrocardiogram Associated with Supratherapeutic Phenytoin Levels and the Risk of Sudden Death
Authors: ALOUL BASEL AL , ADABAG A. SELCUK , HOUGHLAND MARK A. , THOLAKANAHALLI VENKATAKRISHNA
Published: May 2007

The emergence of Brugada pattern on electrocardiogram in response to class IA or IC antiarrhythmic agents is widely utilized to diagnose concealed Brugada syndrome and recognized as a risk factor for sudden death. Phenytoin, a class IB antiarrhythmic agent, has not been reported to induce Brugada pattern. We report a patient who presented with Brugada electrocardiogram at supratherapeutic phenytoin level. Considering that patients with syncope may falsely be labeled to have seizures and some epilepsy patients are at increased risk of sudden death, all patients with supratherapeutic phenytoin level should be evaluated with an electrocardiogram for emergence of Brugada pattern.
Runaway Implantable Defibrillator—A Rare Complication of Radiation Therapy
Authors: NˇEMEC JAN
Published: May 2007

A case of a patient with runaway implantable cardioverter defibrillator (ICD) due to radiation therapy of a lung cancer is reported. This manifested as poorly tolerated wide complex tachycardia due to inappropriate rapid ventricular pacing, The event terminated with polymorphic VT, which inhibited pacing and ceased spontaneously before ICD discharge. The likely cause was corruption of device random access memory by ionizing radiation.
An Unusual Case of the Cephalic Vein with a Supraclavicular Course
Authors: LAU ERNEST W. , LIEW REGINALD , HARRIS STUART
Published: May 2007

While the subclavian or axillary vein can be safely and successfully punctured in the majority of cases, some device implanters still prefer cut down to the cephalic vein as the initial approach to venous access for transvenous placement of pacemaker or defibrillator leads out of concern for the risk of pneumothorax, subclavian crush, and other possible complications. However, very occasionally, the cephalic vein crosses superficial to the clavicle to join the external jugular vein, making it rather unappealing for this purpose. Relying on a guide wire introduced through the cephalic vein to guide puncture of the subclavian vein is unlikely to be successful in such a situation and may cause accidental damage to the vital structures in the thoracic inlet region. Device implanters need to be aware of this anatomical anomaly because of the implications for transvenous lead placement.
Feasibility of Percutaneous Coronary Interventions in Early Postcoronary Artery Bypass Graft Occlusion or Stenosis
Authors: ABDULMALIK AMEEN , ARABI ABDULRAHMAN , ALROAINI ABDULWAHHAB , ROSMAN HOWARD , LALONDE THOMAS
Published: May 2007

Background: With continuing technical advances in percutaneous coronary interventions (PCI) for coronary artery disease (CAD), patients undergoing coronary artery bypass surgery (CABG) often have complex coronary anatomy that is not ideal for PCI. Because of the complex anatomy, these patients have a higher risk of early graft occlusion. The feasibility of PCI in the treatment of early graft occlusion is not well established.

Methods: A retrospective chart review was performed of patients presenting with recurrent ischemia within three months post‐CABG and at one‐year follow‐up.

Results: Forty‐six patients with 156 grafts were identified. Three presented with STEMI, 21 with NSTEMI, 21 with unstable angina, and one with congestive heart failure. Sixty‐three grafts were occluded or stenosed (>70%). Twenty‐seven grafts (43%) in 17 patients were not amenable to PCI. The other 34 grafts (54%) in 23 patients underwent successful PCI. PCI was performed upon native vessels and occluded grafts with equal frequency. Six patients had patent grafts. At one‐year follow‐up, six of 23 patients in the PCI group were readmitted with ischemia; five vessels (14%) in four patients had restenosed. There were no deaths. In the group with no PCI, 11 of 23 patients were readmitted with ischemia with one death.

Conclusion: PCI for early post‐CABG occlusion was safely performed in slightly more than half of target vessels. PCI was performed upon native vessels and occluded grafts with equal frequency. After initial PCI success, the clinical target vessel restenosis rate was 14% at one‐year follow‐up.
Na‐Modified Cubic Zirconia—Link Between Sodium Zirconate and Zirconia in the Na2O–ZrO2 Phase Diagram
Authors: Näfe H. , Karpukhina N.
Published: May 2007

Solid‐state electrochemical and XRD studies reveal that the phase relation between Na2ZrO3(s) and ZrO2(s) is governed by the existence of non‐stoichiometric Na‐modified cubic ZrO2. It leads to the splitting of the nominal Na2ZrO3/ZrO2 (NZO) equilibrium system into two systems:
. The causes extended single‐phase region in between the thermodynamic stability in the temperature interval 400°–600°C to change steadily upon varying the composition of the phase mixture. As a consequence, previous data on the thermodynamic stability of the NZO system have to be considered with caution.
Spatial clustering of Diabrotica virgifera virgifera and Agriotes ustulatus in small‐scale maize fields without topographic relief drift
Authors: Toepfer Stefan , Ellsbury Michael M. , Eschen René , Kuhlmann Ulrich
Published: May 2007

The soil‐living larvae of Diabrotica virgifera virgifera LeConte (Coleoptera: Chrysomelidae) and Agriotes ustulatus Schaller (Coleoptera: Elateridae) can cause economic damage to maize roots, Zea mays L. (Poaceae). This study investigated the spatial clustering of both pests in four small‐scale maize fields in southern Hungary, where clustering had been observed but not expected due to the lack of topographic relief drifts and soil structuring. Between 2000 and 2002, numbers of D. v. virgifera larvae and adults and of A. ustulatus larvae were determined at four randomly chosen georeferenced maize plants in each of 24 plots per field. Soil moisture, soil bulk density, and vegetational characteristics were assessed. Moran's I test for spatial autocorrelations, semivariogram analyses, and interpolated mapping revealed that D. v. virgifera larvae and adults were spatially clustered in 67 and 50% of cases, respectively. Larvae of A. ustulatus were clustered in 75% of cases. Diabrotica virgifera virgifera larval distributions were mainly determined by increasing weed density (negative correlation), in particular with high densities of Cirsium arvense (L.) (Asteraceae), as well as by increasing soil moisture (negative correlation). Adult distributions of D. v. virgifera were mainly determined by the density distribution of flowering maize. They were moreover correlated with larval distribution and with the adult distribution of the previous year. The density distributions of male adults differed from those of females. Female density was additionally correlated with higher soil moisture and Poaceae density, e.g., with Sorghum halepense (L.) Pers. No relation was found between the larvae of A. ustulatus and D. v. virgifera. Agriotes ustulatus larval distributions were mainly determined by vegetational cover (correlation with less cover). Conclusively, male and female D. v. virgifera adults, larvae of D. v. virgifera, and larvae of A. ustulatus will display different spatial clustering even within ostensibly homogeneous habitats of flat small‐scale maize fields.
First field evidence that parasitoids use upwind anemotaxis for host‐habitat location
Authors: Williams Ingrid H. , Frearson David J.T. , Barari Hassan , McCartney Alastair
Published: May 2007

The direction of flight of natural populations of Phradis interstitialis (Thomson), Tersilochus obscurator Aubert (both Hymenoptera: Ichneumonidae), and Platygaster subuliformis (Kieffer) (Hymenoptera: Platygastridae), parasitoids of three crucifer‐specialist herbivores, to and from their hosts’ host plant [oilseed rape, Brassica napus L. (Brassicaceae)] was studied in the field within a heterogeneous arable environment. Double‐sided Malaise traps encircling a plot of winter oilseed rape (cultivar Lutin) were used to sample the parasitoids as they flew towards and away from the plot during spring and summer. Daily trap catch of parasitoids and trap air flow were compared using Spearman's rank correlation. For all 14 insect days analysed, and for each species, the correlations between daily catch of parasitoids into distal halves of traps (relative to the plot) and wind direction were negative, significantly so on half the days analysed. This confirmed that flights towards the plot were by upwind anemotaxis. In contrast, the correlations between daily catch of parasitoids into proximal halves of traps (relative to the plot) and wind direction were most often crosswind; they were never strongly nor significantly either negative or positive. Implications of the results for integrated pest management strategies incorporating biological control with these parasitoids are discussed.
Anti‐inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide versus prednisolone acetate 1% eyedrops after pars plana vitrectomy
Authors: Paccola Letícia , Jorge Rodrigo , Barbosa José C. , Costa Rogério A. , Scott Ingrid U.
Published: May 2007

Purpose:  To compare the safety and anti‐inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide (TA) with prednisolone acetate 1% eyedrops after pars plana vitrectomy (PPV).

Methods:  The study included 40 consecutive phakic eyes of 40 patients undergoing PPV for non‐clearing vitreous haemorrhage with attached retina (verified by echography), epiretinal membrane or macular hole. At the end of the surgical procedure, eyes were randomized to receive either a single posterior subtenon injection of TA (40 mg in 1 ml) plus sham eyedrops (prednisolone acetate 1% vehicle) postoperatively (group TA), or a posterior subtenon sham injection (1 ml balanced salt solution) plus prednisolone acetate 1% eyedrops postoperatively (group ED).

Results:  There was no difference in the severity of anterior chamber cell and flare between the two groups at any time‐point during the study period (p > 0.05). Separate within‐group analysis revealed a significant decrease in anterior chamber cell and flare from postoperative day 1 to postoperative days 7, 14 and 28 in both groups (p < 0.05). There was no difference in pain, photophobia, conjunctival erythema, ciliary flush or chemosis scores between the two groups at any time‐point during the study period (p > 0.05). Steroid‐induced intraocular hypertension was not observed in either group.

Conclusions:  A single posterior subtenon injection of TA can be as effective and safe as a 4‐week regimen of prednisolone acetate 1% eyedrops in controlling intraocular inflammation after PPV.
Full‐thickness macular hole in a patient with diabetic cystoid macular oedema treated by intravitreal triamcinolone injections
Authors: Lecleire‐Collet Amélie , Offret Olivier , Gaucher David , Audren François , Haouchine Belkacem , Massin Pascale
Published: May 2007

Purpose:  Full‐thickness macular hole associated with diabetic macular oedema is a rare feature and its pathogenesis remains incompletely elucidated. We report the occurrence of a full‐thickness macular hole, documented with optical coherence tomography (OCT), in a patient with diabetic cystoid macular oedema treated by intravitreal triamcinolone injections.

Case Report:  A 48‐year‐old woman with refractory diabetic cystoid macular oedema underwent successive intravitreal triamcinolone injections, which were followed by a progressive thinning of the neurosensory retina at the fovea, and then by a full‐thickness macular hole, associated with a perifoveal posterior hyaloid detachment, visible on OCT. During pars plana vitrectomy, a thin epiretinal macular membrane was diagnosed and removed.

Discussion:  Pathogenesis of the present full‐thickness macular hole associated with diabetic macular oedema is different from that of idiopathic macular holes because anteroposterior vitreous tractions were not involved in its formation. Recurrent intravitreal triamcinolone injections may have had an indirect role in the development of the macular hole, by favouring the rupture of distended Muller cells and intraretinal pseudocysts.
Entry‐site‐related retinal detachment after pars plana vitrectomy
Authors: Wimpissinger Barbara , Binder Susanne
Published: May 2007

Purpose:  Today, pars plana vitrectomy represents a standard surgical procedure for a number of retinal diseases that were previously considered inoperable. The aim of the present study is to investigate the entry site of pars plana vitrectomy as a possible source of retinal detachment.

Methods:  We reviewed retrospectively all cases of uncomplicated pars plana vitectomies because of macular hole, macular pucker and diabetic macular oedema performed in our department between 1 January 2001 and 7 July 2004.

Results:  Over 3.5 years, 244 pars plana vitrectomies because of macular disease were performed. Sclerotomy‐related retinal detachment was observed in 11 (4.5%) cases. These retinal detachments occurred at a mean of 37 (2–100) days after surgery. They appeared within the first 4 weeks in 55% of the cases.

Conclusion:  Iatrogenic retinal breaks and detachment continue to be a severe complication of pars plana vitrectomy, despite improvements in instrumentation and surgical techniques. A 4.5% incidence of sclerotomy‐related retinal detachment after simple vitrectomy calls for action. Current approaches to reduce this complication – such as circular peripheral cryoretinopexy, scleral buckling or 360° laser treatment – are invasive. We recommend extended vitreous base cleaning with scleral indentation and examination of the entry sites, performed with a three‐mirror lens or via careful indirect ophthalmoscopy into the periphery, 4 weeks after surgery.
Incidence of endophthalmitis after cataract surgery in Japan
Authors: Oshika Tetsuro , Hatano Hiroshi , Kuwayama Yasuaki , Ogura Yuichiro , Ohashi Yuichi , Oki Kotaro , Uno Toshihiko , Usui Norio , Yoshitomi Fumiaki
Published: May 2007

Purpose:  To estimate the incidence rate of endophthalmitis after cataract surgery performed by Japanese surgeons.

Methods:  A sample of 20% of members of the Japanese Society of Ophthalmic Surgeons was randomly selected. Each member was sent a postal survey asking for information on the number of cataract surgeries performed in 2003 and the number of postsurgery cases of endophthalmitis.

Results:  Replies were received from 78.7% (513/652) of survey recipients. The total number of cataract surgeries was 100 539, among which 52 cases of endophthalmitis occurred, resulting in an overall incidence rate of 0.052%. Incidence rates were 0.049% (38/78 170) for scleral incision phacoemulsification and 0.043% (9/20 894) for clear corneal incision phacoemulsification, with no significant difference between groups. The average annual volumes of surgery were 210 and 280 cases for surgeons who preferred scleral incision and clear corneal incision, respectively. There was a significant difference between volumes (Student's t‐test, p < 0.01). The incidence of endophthalmitis was significantly lower with high‐volume (> 300 cases/year) surgeons than with low‐volume (≤ 300 cases/year) surgeons (0.040% versus 0.066%, chi‐square test, p < 0.05).

Conclusions:  The incidence of endophthalmitis after cataract surgery in Japan as estimated by a postal survey was low (0.052%) and consistent with rates reported previously. Surgeons who preferred clear corneal incision performed significantly more surgeries annually, but the incidence of endophthalmitis was similar between scleral and clear corneal incision phacoemulsification surgery.
Foot shock stress prolongs the telogen stage of the spontaneous hair cycle in a non‐depilated mouse model
Authors: Katayama Mirei , Aoki Eri , Suzuki Hidenori , Kawana Seiji
Published: May 2007

Abstract:  Background:  There is an increasing evidence to indicate that stress can influence skin disease and cutaneous functions. Previous studies have shown that stress alters the murine hair cycle; however, these studies have been carried out by using mouse models in which the hair cycle is forcibly synchronized after depilation.

Objective:  To examine whether foot shock stress (FS) changes the spontaneous hair cycle in a non‐depilated animal model, and to evaluate the role of mast cells and substance P (SP) in the influence of stress on the hair cycle.

Methods:  Changes in the spontaneous hair cycle and the inhibitory effects of a specific SP NK1 receptor antagonist were examined in non‐depilated mice during 3–4 weeks of FS.

Results:  Foot shock stress prolonged the telogen stage of the hair cycle and delayed the induction of the subsequent anagen stage in the animal model. FS caused an increase in the ratio of de‐granulated mast cells in the skin, an increase in the number of TUNEL‐positive cells, and a decrease in the number of Ki67‐positive cells. The NK1 receptor antagonist, WIN 62577, inhibited these stress responses.

Conclusion:  Our results strongly support previous work, demonstrating that stress alters active hair‐cycling in vivo through the action of SP.
The association between endothelin‐1 gene polymorphisms and susceptibility to vitiligo in a Korean population
Authors: Kim Hyun‐Jin , Choi Chun‐Pill , Uhm Yoon Kyung , Kim Young Il , Lee Jin‐Woo , Yoon Seo Hyun , Chung Joo‐Ho , Lee Mu‐Hyoung
Published: May 2007

Abstract:  Background:  Vitiligo is a skin disorder affected by genetic, environmental, local and endocrine factors. Endothelin‐1, which is expressed by keratinocytes, has paracrine effects on melanocytes, influencing their homeostasis, proliferation and pigmentation. It is thought to play a role in the skin response to 311‐nm, narrow‐band ultraviolet irradiation.

Objective:  To investigate the association of endothelin‐1 gene (EDN1) polymorphisms with vitiligo in a Korean population.

Methods:  To evaluate the expression of endothelin‐1 in cultured human keratinocytes after irradiation with narrow‐band ultraviolet B (NBUVB), we performed RT‐PCR and ELISA. In addition, we genotyped 312 vitiligo patients and 313 matched‐healthy controls, and compared the genotype, allele and haplotype frequencies of EDN1 polymorphisms (intron 4 G/A, rs2071942 and exon 5 G/T, rs5370) between the two groups, using PCR‐restriction fragment length polymorphism. The effects of sex, onset age, the presence of autoimmune diseases, family history and clinical type were analysed statistically.

Results:  NBUVB induced the expression of endothelin‐1 in cultured human keratinocytes. The genotype distributions and allele frequencies of EDN1 polymorphisms did not differ significantly between vitiligo patients and healthy controls. Moreover, the results were not related to sex, onset age, the presence of autoimmune diseases or family history. Interestingly, the haplotype frequencies of EDN1 polymorphisms differed significantly between vitiligo patients and healthy controls. When analysed according to clinical type, the haplotype frequencies in the focal and segmental clinical types differed significantly from healthy controls.

Conclusion:  This study suggests that EDN1 is related to the development of vitiligo in the Korean population.
Inhibitory effect of cranberry polyphenol on biofilm formation and cysteine proteases of Porphyromonas gingivalis
Authors: Yamanaka A. , Kouchi T. , Kasai K. , Kato T. , Ishihara K. , Okuda K.
Published: May 2007

Background and Objective:  The purpose of this study was to investigate the effects of cranberry polyphenol fraction on biofilm formation and activities of Arg‐gingipain and Lys‐gingipain in Porphyromonas gingivalis.

Material and Methods:  The polyphenol fraction was prepared by using a glass column packed with Amberlite XAD 7HP and 70% aqueous ethanol as an elution solvent.

Results:  Synergistic biofilm formation by P. gingivalis and Fusobacterium nucleatum was significantly inhibited by the polyphenol fraction at a concentration of 250 µg/mL compared with untreated controls (p < 0.01). Arg‐gingipain and Lys‐gingipain activities in P. gingivalis ATCC 33277 and FDC 381 were inhibited significantly at a polyphenol fraction concentration of ≥ 1 µg/mL (p < 0.05).

Conclusion:  These findings indicate that the polyphenol fraction inhibits biofilm formation and the Arg‐gingipain and Lys‐gingipain activities of P. gingivalis.
Focal adhesion kinase mediates human leukocyte histocompatibility antigen class II‐induced signaling in gingival fibroblasts
Authors: Yoshizawa S. , Meguro M. , Ohyama H. , Takeuchi‐Hatanaka K. , Matsushita S. , Takashiba S. , Nishimura F.
Published: May 2007

Background and Objective:  The role of human leukocyte antigen class II molecules on nonantigen‐presenting cells has been a matter of controversy. We previously reported that human leukocyte antigen class II molecules on human gingival fibroblasts do not present antigens, but transduce signals into the cells by making a complex with antigenic peptide T‐cell receptor or by stimulating cell surface human leukocyte antigen‐DR molecules with human leukocyte antigen‐DR antibody (L243), which mimics the formation of the human leukocyte antigen class II–antigenic peptide T‐cell receptor complex, resulting in the expression of several cytokines. The aim of this study was to detect human leukocyte antigen class II‐associated molecules mediating human leukocyte antigen class II‐induced signals into the cells.

Material and Methods:  Antibody‐based protein‐microarray analysis was performed to detect activated signaling molecules in gingival fibroblasts stimulated via human leukocyte antigen class II molecules. Then, we examined if these molecules structurally associate with human leukocyte antigen class II and actually transduce signals into the cells.

Results:  Stimulation of human leukocyte antigen class II on gingival fibroblasts by L243 resulted in enhanced phosphorylation of focal adhesion kinase. Focal adhesion kinase was co‐immunoprecipitated with human leukocyte antigen‐DR by L243. Stimulation of gingival fibroblasts with L243 induced phosphorylation of focal adhesion kinase. Luteolin, a putative focal adhesion kinase inhibitor, suppressed phosphorylation of focal adhesion kinase and dose dependently inhibited human leukocyte antigen class II‐induced cytokine production.

Conclusion:  Focal adhesion kinase is structurally associated with human leukocyte antigen‐DR and mediates human leukocyte antigen class II‐induced signals in gingival fibroblasts.
Gingival fibroblasts grown from cyclosporin‐treated patients show a reduced production of matrix metalloproteinase‐1 (MMP‐1) compared with normal gingival fibroblasts, and cyclosporin down‐regulates the production of MMP‐1 stimulated by pro‐inflammatory cytokines
Authors: Sukkar T. Z. , Thomason J. M. , Cawston T. E. , Lakey R. , Jones D. , Catterall J. , Seymour R. A.
Published: May 2007

Background and Objective:  Cyclosporin‐induced gingival overgrowth arises from an alteration in collagen homeostasis and is enhanced by inflammatory changes in the gingival tissues. The aim of this study was to investigate the interaction among interleukin‐1, oncostatin M, cyclosporin and nifedipine in promoting the up‐regulation of matrix metalloproteinase‐1 (MMP‐1) and tissue inhibitor of metalloproteinase by gingival fibroblasts.

Material and Methods:  Fibroblast cultures (n = 5) were obtained from healthy controls and from patients with cyclosporin‐induced gingival overgrowth, and cells were harvested between the fourth and ninth passages. Cells were stimulated with interleukin‐1 and oncostatin M, alone or in combination, and with different concentrations of cyclosporin (0–2000 ng/mL) and nifedipine (0–200 ng/mL). MMP‐1 and tissue inhibitor of metalloproteinase‐1 production was determined using an enzyme‐linked immunosorbent assay technique. A CyQuant cell proliferation assay was used to determine the DNA concentration in the sample.

Results:  Fibroblasts obtained from patients with cyclosporin‐induced gingival overgrowth produced significantly lower levels of MMP‐1 than control fibroblasts (p < 0.001); tissue inhibitor of metalloproteinase‐1 levels were significantly lower (p < 0.05), and the ratio of MMP‐1 to tissue inhibitor of metalloproteinase‐1 was reduced, in the conditioned medium of patients with cyclosporin‐induced gingival overgrowth compared with controls. Interleukin‐1 and oncostatin M produced a significant increase in the up‐regulation of MMP‐1, which was reversed when cyclosporin and nifedipine were added to the cell cultures (p < 0.05).

Conclusion:  Pro‐inflammatory cytokines significantly up‐regulate MMP‐1 in cultured gingival fibroblasts. Up‐regulation is attenuated by both cyclosporin and nifedipine. The interaction may account for the synergism between inflammation and cyclosporin‐induced gingival overgrowth.
Melatonin inhibits MPP+‐induced caspase‐mediated death pathway and DNA fragmentation factor‐45 cleavage in SK‐N‐SH cultured cells
Authors: Chetsawang Jirapa , Govitrapong Piyarat , Chetsawang Banthit
Published: May 2007

Abstract:  Neurodegenerative diseases such as Parkinson's disease are illnesses associated with high morbidity and mortality with few, or no effective, options available for their treatment. In addition, the direct cause of selective dopaminergic cell loss in Parkinson's disease has not been clearly understood. Taken together, several studies have demonstrated that melatonin has a neuroprotective effect both in vivo and in vitro. Accordingly, the effects of melatonin on 1‐methyl, 4‐phenyl, pyridinium ion (MPP+)‐treated cultured human neuroblastoma SK‐N‐SH cell lines were investigated in the present study. The results showed that MPP+ significantly decreased cell viability. By contrast, an induction of phosphorylation of c‐Jun, activation of caspase‐3 enzyme activity, cleavage of DNA fragmentation factors 45 and DNA fragmentation were observed in MPP+‐treated cells. These changes were diminished by melatonin. These results demonstrate the cellular mechanisms of neuronal cell degeneration induced via c‐Jun‐N‐terminal kinases and caspase‐dependent signaling, and the potential role of melatonin on protection of neuronal cell death induced by this neurotoxin.
Melatonin inhibits lipopolysaccharide‐induced CC chemokine subfamily gene expression in human peripheral blood mononuclear cells in a microarray analysis
Authors: Park Hae Jeong , Kim Hak Jae , Ra Jehyun , Hong Seung‐Jae , Baik Hyung Hwan , Park Hun‐Kuk , Yim Sung Vin , Nah Seong‐Su , Cho Jeong Je , Chung Joo‐Ho
Published: May 2007

Abstract:  Melatonin possesses a number of important biologic activities including oncostatic, anti‐oxidant, and immunostimulatory actions. This study was designed to assess the effects of melatonin on inflammation‐related gene expression in lipopolysaccharide (LPS)‐stimulated human peripheral blood mononuclear cells (PBMCs), using CombiMatrix 2K Human Inflammation chip. After pretreatment with melatonin (100 μm) for 4 hr, cells were incubated with LPS (1 μg/mL) for 24 hr. We compared gene expression profiles between LPS‐treated, melatonin‐treated, LSP/melatonin‐treated, and control groups. LPS induced the upregulation of 95 genes, compared with controls. Melatonin pretreatment in LPS‐stimulated PBMCs suppressed the expression of 23 genes more than twofold. Interestingly, melatonin showed a suppressive effect on the expression of CC chemokine subfamily genes, including CCL2/MCP1, CCL3/MIP1α, CCL4/MIP1β, CCL5/RANTES, CCL8/MCP2, CCL20/MDC, and CCL22/MIP3α, in LPS‐stimulated PBMCs. This result was confirmed by reverse transcriptase polymerase chain reaction. Among the CC chemokine subfamily genes, particularly, the expression of CCL2 and CCL5 was markedly downregulated by melatonin in LPS‐stimulated PBMCs. The secretion levels of CCL2 and CCL5 were measured using enzyme‐linked immunosorbent assay. Stimulation of PBMCs by LPS induced the secretion of CCL2 (2334.3 ± 161.4 pg/mL, mean ± S.E.M.), whereas melatonin pretreatment (153.0 ± 3.8 pg/mL) inhibited the LPS‐induced secretion of CCL2. Melatonin pretreatment (2696.2 ± 385.3 pg/mL) also inhibited the LPS‐induced secretion of CCL5 (4679.6 ± 107.5 pg/mL). Taken together, these results suggest that melatonin may have a suppressive effect on LPS‐induced expression of CC chemokine genes, especially CCL2 and CCL5, which may explain its beneficial effects in the treatment of various inflammatory conditions.
Multiple protective effects of melatonin against maternal cholestasis‐induced oxidative stress and apoptosis in the rat fetal liver–placenta–maternal liver trio
Authors: Perez Maria J. , Castaño Beatriz , Gonzalez‐Buitrago Jose M. , Marin Jose J. G.
Published: May 2007

Abstract: Maternal cholestasis is usually a benign condition for the mother but induces profound placental damage and may be lethal for the fetus. The aim of this study was to investigate the protective effects in rat maternal and fetal livers as also the placenta of melatonin or silymarin against the oxidative stress and apoptosis induced by maternal obstructive cholestasis during the last third of pregnancy (OCP). Melatonin or silymarin administration (i.e. 5 mg/100 g bw/day after ligation of the maternal common bile duct on day 14 of pregnancy) reduced OCP‐induced lipid peroxidation, and prevented decreases in total glutathione levels. However, the protective effect on OCP‐induced impairment in the GSH/GSSG ratio was mild in the placenta and fetal liver, while absent in maternal liver. Melatonin or silymarin also reduced OCP‐induced signs of apoptosis (increased caspase‐3 activity and Bax‐αupregulation) in all the organs assayed. Moreover, melatonin (but not silymarin) upregulated several proteins involved in the cellular protection against the oxidative stress in rats with OCP. These included, biliverdin‐IXαreductase and the sodium‐dependent vitamin C transport proteins SVCT1 and SVCT2, whose expression levels were enhanced in maternal and fetal liver by melatonin treatment. In contrast, in placenta only biliverdin‐IXαreductase and SVCT2 were upregulated. These results indicate that whereas the treatment of cholestatic pregnant rats with melatonin or silymarin affords a direct protective antioxidant activity, only melatonin has dual beneficial effects against OCP‐induced oxidative challenge in that it stimulates the expression of some components of the endogenous cellular antioxidant defense.
Melatonin antagonizes apoptosis via receptor interaction in U937 monocytic cells
Authors: Radogna Flavia , Paternoster Laura , Albertini Maria Cristina , Cerella Claudia , Accorsi Augusto , Bucchini Anahi , Spadoni Gilberto , Diamantini Giuseppe , Tarzia Giorgio , Nicola Milena De , D'Alessio Maria , Ghibelli Lina
Published: May 2007

Abstract:  Among the non‐neurological functions of melatonin, much attention is being directed to the ability of melatonin to modulate the immune system, whose cells possess melatonin‐specific receptors and biosynthetic enzymes. Melatonin controls cell behaviour by eliciting specific signal transduction actions after its interaction with plasma membrane receptors (MT1, MT2); additionally, melatonin potently neutralizes free radicals. Melatonin regulates immune cell loss by antagonizing apoptosis. A major unsolved question is whether this is due to receptor involvement, or to radical scavenging considering that apoptosis is often dependent on oxidative alterations. Here, we provide evidence that on U937 monocytic cells, apoptosis is antagonized by melatonin by receptor interaction rather than by radical scavenging. First, melatonin and a set of synthetic analogues prevented apoptosis in a manner that is proportional to their affinity for plasma membrane receptors but not to their antioxidant ability. Secondly, melatonin's antiapoptotic effect required key signal transduction events including G protein, phospholipase C and Ca2+ influx and, more important, it is sensitive to the specific melatonin receptor antagonist luzindole.