bluuebunny/crossref_metadata_2025 huggingface dataset:
Global warming potentials of stemwood used for energy and materials in Southern Finland: differentiation of impacts based on type of harvest and product lifetime
Authors: Helin Tuomas , Salminen Hannu , Hynynen Jari , Soimakallio Sampo , Huuskonen Saija , Pingoud Kim
Published: January 2015

Wood harvesting in boreal forests typically consists of sequential harvesting operations within a rotation: a few thinnings and a final felling. The aim of this paper is to model differentiated relative global warming potential (GWP) coefficients for stemwood use from different thinnings and final fellings, and correction factors for long‐lived wood products, potentially applicable in life cycle assessment studies. All thinnings and final fellings influence the development of forest carbon stocks. The climate impact of a single harvesting operation is generated in comparison with no harvesting, thus encountering a methodological problem on how to handle the subsequent operations. The dynamic forest stand simulator MOTTI was applied in the modelling of evolution of forest carbon stocks at landscape level in Southern Finland. The landscape‐level approach for climate impact assessment gave results similar to some stand‐level approaches presented in previous literature that included the same forest C pools and also studied the impacts relative to the no‐harvest situation. The climate impacts of stemwood use decreased over time. For energy use, the impacts were higher or similar in the short term and 0–50% lower in the midterm in comparison with an identical amount of fossil CO2. The impacts were to some extent (approximately 20–40%) lower for wood from intermediate thinnings than for wood from final fellings or first thinnings. However, the study reveals that product lifetime has higher relative influence on the climate impacts of wood‐based value chains than whether the stemwood originates from thinnings or final fellings. Although the evolution of future C stocks in unmanaged boreal forests is uncertain, a sensitivity analysis suggests that landscape‐level model results for climate impacts would not be sensitive to the assumptions made on the future evolution of C stocks in unmanaged forest. Energy use of boreal stemwood seems to be far from climate neutral.
Evaluation of seedling emergence and relative DNA content under dry soil conditions of wild Festuca arundinacea populations collected in Iran
Authors: Rohollahi Iman , Khoshkholghsima Nayer Azam , Yamada Toshihiko , Kafi Mohsen , Hoshino Yoichiro , Liaghat Abdolmajid , Jafari Ali Ashraf
Published: January 2015

Tall fescue (Festuca arundinacea Schreb.) is an important forage and turf grass species adapted to cold, arid and semiarid environments. Germination and seedling establishment of F. arundinacea cultivars is constrained by the low soil moisture found in these regions. Genome size was found to positively correlate with latitude of origin, suggesting that structural changes in DNA may play a role in environmental adaptation. We investigated the effects of low soil moisture on the germination and early establishment and their correlation with relative DNA content using 14 wild F. arundinacea populations collected from various regions in Iran and two commercial turf cultivars. The populations were evaluated under 100% (−0.03 matric potential [MPa]), 80% (−0.2), 60% (−0.6) and 40% (−1.4) field capacity (FC) conditions. Seed germination and root and leaf growth decreased under reduced soil water content. Cluster analysis revealed that the populations fell into four groups. Populations in cluster I showed the greatest tolerance to low soil moisture and cluster IV was the least tolerant. ‘Isfahan’ and ‘Gonabad’ populations had the best final germination and longer leaf and root length at 40% FC. Studies to identify indices that were involved in drought resistance revealed that final germination, leaf length and seedling vigor index were most important evaluating indicators for F. arundinacea populations. Flow cytometric relative DNA content of the wild populations was negatively correlated with germination, leaf length and seedling vigor index. The drought tolerance populations in cluster I could be potentially useful germplasm for a breeding program to develop superior cultivars for arid and semiarid regions.
The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies
Authors: Marmura Michael J. , Silberstein Stephen D. , Schwedt Todd J.
Published: January 2015

The study aims to provide an updated assessment of the evidence for individual pharmacological therapies for acute migraine treatment. Pharmacological therapy is frequently required for acutely treating migraine attacks. The American Academy of Neurology Guidelines published in 2000 summarized the available evidence relating to the efficacy of acute migraine medications. This review, conducted by the members of the Guidelines Section of the American Headache Society, is an updated assessment of evidence for the migraine acute medications. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 2013. The American Academy of Neurology Guidelines Development procedures were followed. Two authors reviewed each abstract resulting from the search and determined whether the full manuscript qualified for review. Two reviewers studied each qualifying full manuscript for its level of evidence. Level A evidence requires at least 2 Class I studies, and Level B evidence requires 1 Class I or 2 Class II studies. The specific medications – triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan [oral, nasal spray, injectable, transcutaneous patch], zolmitriptan [oral and nasal spray]) and dihydroergotamine (nasal spray, inhaler) are effective (Level A). Ergotamine and other forms of dihydroergotamine are probably effective (Level B). Effective nonspecific medications include acetaminophen, nonsteroidal anti‐inflammatory drugs (aspirin, diclofenac, ibuprofen, and naproxen), opioids (butorphanol nasal spray), sumatriptan/naproxen, and the combination of acetaminophen/aspirin/caffeine (Level A). Ketoprofen, intravenous and intramuscular ketorolac, flurbiprofen, intravenous magnesium (in migraine with aura), and the combination of isometheptene compounds, codeine/acetaminophen and tramadol/acetaminophen are probably effective (Level B). The antiemetics prochlorperazine, droperidol, chlorpromazine, and metoclopramide are probably effective (Level B). There is inadequate evidence for butalbital and butalbital combinations, phenazone, intravenous tramadol, methadone, butorphanol or meperidine injections, intranasal lidocaine, and corticosteroids, including dexamethasone (Level C). Octreotide is probably not effective (Level B). There is inadequate evidence to refute the efficacy of ketorolac nasal spray, intravenous acetaminophen, chlorpromazine injection, and intravenous granisetron (Level C). There are many acute migraine treatments for which evidence supports efficacy. Clinicians must consider medication efficacy, potential side effects, and potential medication‐related adverse events when prescribing acute medications for migraine. Although opioids, such as butorphanol, codeine/acetaminophen, and tramadol/acetaminophen, are probably effective, they are not recommended for regular use.
Pathophysiology and management of hepatic encephalopathy 2014 update: Ammonia toxicity and hyponatremia
Authors: Iwasa Motoh , Takei Yoshiyuki
Published: January 2015

Hyperammonemia is a major factor involved in the pathogenesis of hepatic encephalopathy (HE). Ammonia elicits astrocyte swelling and causes brain edema. In addition, hyponatremia, a condition frequently observed in hepatic cirrhosis, also exacerbates brain edema, potentially becoming a factor that exacerbates HE. Therefore, as a treatment strategy for HE, alleviating ammonia toxicity is essential. In addition to restricting protein intake, synthetic disaccharides such as lactulose and lactitol, probiotics that improve gut flora, and rifaximin, an antibiotic with poor bioavailability, are also administrated. Additionally, branched‐chain amino acids and carnitine have also been administrated. Moreover, we investigated the current trend in the concomitant use of drugs with different mechanisms of action. In Japan, the V2 receptor antagonist tolvaptan can be administrated to hepatic cirrhosis patients with fluid retention. This drug is also useful as a countermeasure for hyponatremia in hepatic cirrhosis, and elucidating its effects in HE patients may therefore become an agenda in the future. These observations indicate that ammonia toxicity, gut flora control and low sodium control are major focuses in HE improvement and long‐term prognosis.
Seeing it through their eyes: a qualitative study of the pregnancy experiences of women with a body mass index of 30 or more
Authors: Lavender Tina , Smith Debbie M.
Published: January 2015

Background

Maternal obesity [body mass index (BMI) ≥ 30 kg/m2] is associated with numerous complications, but currently, little is known about the pregnancy experiences of these women.

Objective

To gain insight into the experience of pregnant women with BMI ≥ 30 kg/m2, when accessing maternity services and attending a community lifestyle programme.

Design

Qualitative methodology, utilizing focus groups and semi‐structured interviews with post‐natal women who had an antenatal BMI ≥ 30 kg/m2. The sample was obtained from a larger study.

Results

Thirty‐four women participated. Three main themes were identified using thematic analysis. Women described disappointment with their pregnancy. In particular, their informational expectations were not met; some health professionals appeared uninterested, insensitive or unconfident. Women described readiness to make a lifestyle change, but this was not encouraged during routine care. Attending the programme began the process of behavioural change. Women's beliefs that small changes make a big difference led to them being spurred on by success; driven by a desire to improve the health of their family.

Discussion and Conclusion

Pregnant women who are obese know this is the case and expect to be provided with information to assist them in making lifestyle changes. Health professionals should be aware of women's readiness for change and view pregnancy as an ideal time to communicate. Pregnant women with a BMI ≥ 30 kg/m2 should contribute to health professional training, to highlight the reality of the maternity system journey; first‐hand accounts may improve the way health professionals' approach these women. Lifestyle interventions should be developed with input from the intended target group.
Success of a smoking cessation programme in smoking behaviour of chronic periodontitis patients and identification of predictors of motivation for smoking cessation – a pilot study
Authors: Kropff B , Petersilka G , Flemmig T , Ehmke B , Heuft G , Schneider G
Published: January 2015

Background

The primary goal of this pilot study was to evaluate the success of a smoking cessation programme on smoking behaviour of patients with chronic periodontitis. Secondary goals were to identify the prevalence of smoking among them, predictors of motivation for smoking cessation and for successful nicotine abstinence.

Methods

Smokers suffering from chronic periodontitis were offered cognitive behavioural group therapy of 10 once‐weekly sessions. Smoking is reduced stepwise and complete cessation is to be achieved by the sixth session. Sociodemographic data, history of smoking and motivation for smoking cessation, subjective health status, and questionnaires on anxiety, depression, control beliefs and coping with stress were completed at study entry. Smoking behaviour was assessed at the end of the group programme and 3 months thereafter.

Results

Of 469 patients with periodontitis, 59 (12.6%) were smokers; 30 (50.6%) patients participated in the smoking cessation programme. Participants smoked more cigarettes/day (P = 0.03, 95% CI: −17.9/−0.89) and subjectively assessed their health as being worse than non‐participants (P = 0.09, 95% CI: −0.16/2.15). In SPQ, non‐participants showed more trivialization (P = 0.014, 95% CI: 0.59/4.94). Complete data were available for 15 group participants: six patients were smoke‐free after 10 weeks and five after 18 weeks (33.3%); two patients had reduced their cigarette consumption by half. At the start of the programme, less successful participants showed a tendency to higher depression in HADS (P = 0.085, 95% CI: −5.25/5.76) and were more inclined to seek substitute satisfaction (P = 0.034, 95% CI: 3.24/11.23).

Conclusion

The rate of success in this study was comparable with other studies. More research with larger samples is needed for confirming these observations.
Efficiency of professional tooth brushing before ultrasonic scaling
Authors: Kim MJ , Noh H , Oh HY
Published: January 2015

Objectives

This study aimed to examine the effect of dental plaque biofilm removal with a toothbrush, an interdental brush and dental floss by a dental hygienist prior to ultrasonic scaling on treatment times and client satisfaction.

Methods

This study was conducted among adults who received scaling after agreeing to participate in this study at a dental clinic in Seoul, Korea, from July to September 2012. Thirty‐seven subjects received modified scaling (M‐scaling) which is ultrasonic scaling after plaque control with a toothbrush and dental floss by a dental hygienist, and 37 subjects received routine ultrasonic scaling (R‐scaling). Univariate and multivariate analyses and chi‐squared and t‐tests were conducted using SAS. This study was approved by the Kangwon Institutional Review Board.

Results

Significant differences were found between the outcomes of M‐ and R‐scaling for both the ultrasonic scaling time (M‐scaling, 7.41 ± 6.18 min; R‐scaling, 23.22 ± 6.92 min) and the total tooth cleaning time (M‐scaling, 15.92 ± 7.70 min; R‐scaling, 23.22 ± 6.92 min) (P < 0.001). Subject satisfaction with the scaling process was not significantly different between M‐scaling (4.54 ± 0.80) and R‐scaling (4.84 ± 0.44).

Conclusions

These findings indicated that removing the dental plaque biofilm with a toothbrush and dental floss by a hygienist before scaling with an ultrasonic device was more effective in reducing the working time of the dental hygienist.
Randomized, double‐blind, controlled, comparative study on intralesional 10% and 15% hypertonic saline versus intralesional sodium stibogluconate in Leishmania donovani cutaneous leishmaniasis
Authors: Ranawaka Ranthilaka R. , Weerakoon Hema S. , de Silva S. H. Padmal
Published: January 2015

Background

Intralesional 7% hypertonic saline (HS) has been shown to be effective and safe against Leishmania donovani and Leishmania major cutaneous leishmaniasis (CL), with cure rates of 92% and 96%, respectively. This study was designed to assess the efficacy and safety of 10% and 15% HS in CL.

Methods

A total of 444 patients (643 lesions) were randomly allocated to sodium stibogluconate (SSG), 10% HS and 15% HS at a ratio of 2 : 2 : 1, taking into consideration any unwanted side effects that might arise with 15% HS. The follow‐up period was 18 months. Survival analysis using Cox proportional hazard regression was performed to assess the effectiveness of the three treatment modalities. The clinical trial was registered at the Sri Lanka Clinical Trial Registry (SLCTR/2013/024).

Results

Treatment with SSG resulted in a cure rate of 96.3% within one to seven injections (mean: 3.6 injections); the mean (median) duration of treatment was six weeks (6 weeks) per lesion. Treatment with 10% HS showed a cure rate of 93.0% within one to 10 injections (mean: 5.28 injections); the mean (median) duration of treatment was 9.3 weeks (9 weeks) per lesion. Treatment with 15% HS showed a cure rate of 93.6% within two to 10 injections (mean: 5.3 injections); the mean (median) duration of treatment was 11.3 weeks (10.0 weeks) per lesion. Treatment with 10% HS and 15% HS caused cutaneous necrosis in 3.1% and 30.6% of lesions, respectively. Despite continuous data collection for 14 months, we were unable to recruit a sample of sufficient size. Seventeen (3.8%) patients were lost to follow‐up, and 24 (5.4%) were partial or non‐responders.

Conclusions

This study found 10% HS to be an effective and safe alternative to SSG. Treatment with HS at concentrations of 15% or above was not safe as a result of cutaneous necrosis. Safety was not studied for concentrations of 11–14%, and these concentrations should be avoided pending further evidence. Hypertonic saline is very cheap (< US$1 per 100 ml, whereas SSG is priced at US$160 per 100 ml), is prepared locally and has no systemic side effects and minimal local side effects.
A retrospective audit of skin biopsies done in a tertiary care center in India
Authors: Balasubramanian Pradeep , Chandrashekar Laxmisha , Thappa Devinder Mohan , Jaisankar Telanseri Jayakar , Malathi Munisamy , Ganesh Rajesh Nachiappa , Singh Nidhi
Published: January 2015

Background

Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome.

Objectives

The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens.

Methods

We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance.

Results

The pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt.

Conclusion

Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases.
Antimicrobial efficacy of granulysin‐derived synthetic peptides in acne vulgaris
Authors: Lim Hee‐Sun , Chun Seung‐Min , Soung Min‐Gyu , Kim Jenny , Kim Seong‐Jin
Published: January 2015

Background

Antimicrobial peptides are considered as a potential alternative to antibiotic treatment in acne vulgaris because the development of a resistant strain of Propionibacterium acnes is problematic. Granulysin can be regarded as an ideal substance with which to treat acne because it has antimicrobial and anti‐inflammatory effects.

Objectives

This study was performed to explore the effectiveness of granulysin‐derived peptides (GDPs) in killing P. acnes in vitro under a standard microbiologic assay and to evaluate their potential use in a topical agent for the treatment of acne vulgaris.

Methods

Twenty different peptides based on the known sequence of a GDP were synthesized and tested in vitro for antimicrobial activity. Thirty patients with facial acne vulgaris were instructed to apply a topical formulation containing synthetic GDP to acne lesions twice per day for 12 weeks.

Results

A newly synthesized peptide in which aspartic acid was substituted with arginine, and methionine was substituted with cysteine, showed the highest antimicrobial activity against P. acnes. Moreover, it was effective against both Gram‐positive and Gram‐negative bacteria in vitro. After treatment with the topical formulation containing 50 ppm of synthetic peptide for 12 weeks, a significant reduction in the number of pustules was observed, regardless of the increase in the number of comedones. In addition, a significant reduction in the clinical grade of acne based on the Korean Acne Grading System (KAGS) was evident.

Conclusions

Synthesized GDP shows strong antimicrobial activity against P. acnes in vitro. The clinical improvement observed suggests a topical formulation containing the GDP has therapeutic potential for the improvement of inflammatory‐type acne vulgaris by its antimicrobial activity.
Functional properties of 8S globulin fractions from 15 mung bean (Vigna radiata (L.) Wilczek) cultivars
Authors: Liu Hong , Liu Hongkai , Yan Lei , Cheng Xuzhen , Kang Yufan
Published: January 2015

The functional properties including solubility, water absorption capacity, oil absorption capacity, foaming properties and emulsifying properties of 8S globulin fractions from 15 mung bean cultivars were investigated in this study. In addition, the effects of pH on solubility, foaming properties and emulsifying properties were studied. The functional properties of the 8S globulin fractions varied significantly among the different mung bean varieties and exhibited better performance in solubility and emulsion stability compared with soya bean 7S protein. A negative correlation was found between water absorption capacity and oil absorption capacity. Remarkable differences in polypeptides constituents were observed in 8S globulin fractions, and the ratio of 11S/8S globulins has a positive effect on water absorption capacity while a negative effect on oil absorption capacity. As a function of pH, the emulsifying activity indexes of the 8S globulin fractions were found to be distinctly dependent on the solubility, while no significant correlation was found between the emulsifying stability and solubility, nor between the foaming properties and solubility. The foaming capacity showed a strong correlation with foam stability.
Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction: Long‐term results
Authors: Nishi Morihiro , Tsuchida Mayumi , Ikeda Masaomi , Matsuda Daisuke , Iwamura Masatsugu
Published: January 2015

Objective

To evaluate the long‐term results of laparoscopic pyeloplasty in patients with secondary ureteropelvic junction obstruction after failed primary interventions.

Methods

Between August 2000 and October 2012, transperitoneal dismembered laparoscopic pyeloplasty was carried out in 13 patients with a surgical history of failed prior surgical interventions. Perioperative outcomes as well as long‐term results were assessed. These outcomes were compared with those of the same procedure carried out for primary ureteropelvic junction obstruction by a single surgeon during the same study period.

Results

Laparoscopic transperitoneal pyeloplasty was completed successfully in all cases without converting to open surgery or requiring blood transfusion. The preoperative symptoms in 12 of 13 patients all disappeared soon after the operation. Asymptomatic severe hydronephrosis found in a 2‐year‐old boy reduced in size postoperatively. When comparing the primary with the secondary laparoscopic pyeloplasty carried out by the same surgeon, the mean operative time was longer (183 vs 241 min, P = 0.002), estimated blood loss was larger (33 vs 66 mL, P = 0.03) and the complication rate was higher (8.8% vs 22.2%, P = 0.01) in the secondary group. Success rates were 97.9% and 100% (P = 0.41) at a mean follow up of 25.9 and 40.0 months (P = 0.14) for the primary and secondary groups, respectively.

Conclusions

Laparoscopic pyeloplasty is an excellent option for patients who failed previous surgical management. This approach provides durable long‐term outcomes comparable with those of primary treatment for ureteropelvic junction obstruction.
Functional significance of aberrantly expressed microRNAs in prostate cancer
Authors: Goto Yusuke , Kurozumi Akira , Enokida Hideki , Ichikawa Tomohiko , Seki Naohiko
Published: January 2015

microRNAs, a class of small non‐coding RNAs, regulate protein‐coding gene expression by repressing translation or cleaving RNA transcripts in a sequence‐specific manner. A growing body of evidence suggests that microRNAs contribute to prostate cancer development, progression and metastasis. Based on reports describing microRNA expression signatures, several differentially expressed microRNAs have been discovered. In the present review, eight genome‐wide microRNA expression signatures were used to select aberrantly expressed microRNAs (i.e. upregulated and downregulated microRNAs) in prostate cancer clinical specimens. Also, we mapped these selected microRNAs in the human genome. Interestingly, some clustered microRNAs, such as miR‐221/222, miR‐143/145, miR‐23b/27b/24‐1 and miR‐1/133a, are frequently downregulated in cancer tissues, and recent studies have shown that these clustered microRNAs function as tumor suppressors. We also discuss the functional significance of the differentially expressed microRNAs and the molecular pathways/targets regulated by these microRNAs. These recent findings of microRNAs in prostate cancer will facilitate the development of effective strategies for microRNA‐based therapeutics for the treatment of prostate cancer.
Optimization using simulation and response surface methodology with an application on subway train scheduling
Authors: Rahimi Mazrae Shahi Mohsen , Fallah Mehdipour Elnaz , Amiri Maghsoud
Published: January 2015

This paper presents a technique based on discrete‐event simulation and response surface methodology to model and then optimize the schedule of subway train travels. The aim of this study is to find appropriate headways—time intervals between the travels of two consecutive trains—at different hours in order to optimize average passenger travel time and rate of carriage fullness. For physical reasons and the observance of safety standards, an increase in the train speed in order to decrease average passenger travel time may not exceed some specified limits. One of the ways to decrease this average is to appropriately adjust headways of trains in the schedule. For this purpose, a metamodel of multinomial type is fitted to the data obtained from simulation tests to describe the relation between input variables (headways) and output variables (average passenger travel time in system and carriage fullness rate), and then optimal combinations of input variables are obtained using a weighed metric method and sequential quadratic programming.
We Have Come a Long Way with Device Therapy: Historical Perspectives on Antiarrhythmic Electrotherapy
Authors: LÜDERITZ BERNDT
Published: January 2015

Historical Perspectives on Antiarrhythmic Electrotherapy. The history of device therapies is long and fascinating. In the beginning, there is not simply the anatomy and physiology of the heart, but also analysis of the pulse, which indicates the activity of the heart. The analysis of the (peripheral) pulse as a mechanical expression of heart activity goes back several millennia. In China, in 280 BC, Wang Shu He wrote 10 books about the pulse. The Greeks called the pulse “sphygmos”; thus, sphygmology deals with a theory of this natural occurrence. In Roman times, Galen interpreted the various types of pulse according to the widespread presumption of the time that each organ in every disease has its own form of pulse. The growing clinical importance of electrical cardiac stimulation was recognized and renewed as Zoll in 1952 described a successful resuscitation in cardiac standstill by external stimulation. Meanwhile, millions of patients with cardiac arrhythmias worldwide have been treated with pacemakers in the last 40 years. The concept of a fully automatic implantable cardioverter defibrillator system for recognition and treatment of ventricular tachyarrhythmias was first suggested in 1970. The first implantation of the device in a human being was performed in February 1980. Further developments involved atrial and atrioventricular defibrillators, radiofrequency ablation, laser therapy, and advanced antiarrhythmic surgery. Since 1990, there has been a growing interest in using cardiac pacing as additional treatment in severe cardiac failure. Recent reports have suggested that intervention with left ventricular or biventricular pacing may be helpful for a subgroup of patients with congestive heart failure. Despite encouraging (preliminary) acute and short‐term results, pacing strategies for heart failure still are limited and currently regarded as investigational. Advances in the field of therapeutic application of pharmacologic and electrical tools as well as alternative methods will continue as rapidly as before and provide us further significant aid in taking care of patients.
Geographic Differences of Pacemaker Implant Rates in Europe
Authors: VARDAS PANOS E. , OVSYSCHER ELI I.
Published: January 2015

Pacemaker Implant Rates in Europe. Introduction: Pacemaker therapy, which has proved to be the only treatment for symptomatic bradyarrhythmias, exhibits great variation from country to country around the world. The aim of this study was to examine the variations in the number of first implants per calendar year in different European countries and to relate the differences to certain socioeconomic indices.

Methods and Results: Information concerning new pacemaker implants during the year 1999 was obtained from the European Pacemaker Registry, which is maintained by the Working Group of Cardiac Pacing of the European Society of Cardiology. Comparisons of pacemaker and econometric indices between western and eastern Europe were carried out using the t‐test. Correlations between selected pacemaker parameters and econometric indices were examined using univariate and multivariate regression analysis. Our findings reveal significant geographic differences in both the number of first implants and the types of pacemaker implanted. The gross domestic product is strongly related to the number of new pacemaker implants per year, as well as the number of pacing centers in individual countries.

Conclusion: Significant geographic variations exist within Europe as to the number of annual pacemaker implants and the types of pacemakers implanted. These variations are related to specific economic indices in the countries concerned.
Relevance of Atrial Fibrillation Classification in Clinical Practice
Authors: BRUGADA JOSEP
Published: January 2015

Atrial Fibrillation Classification. Use of different classifications for atrial fibrillation reflects the complexity of the arrhythmia and the difficulty in grouping its different aspects. Current classifications are based on clinical presentation, etiology, substrates, mechanisms, etc. From the clinical point of view, the most relevant probably should be one directed at classifying patients in terms of therapeutic options. In this article, a review of known classifications is given, together with an attempt at a new classification based on the possibility of offering a nonpharmacologic treatment to patients.
“Pills and Pulses”: Hybrid Therapy for Atrial Fibrillation
Authors: MURGATROYD FRANCIS D.
Published: January 2015

Hybrid Therapy for Atrial Fibrillation. Nonpharmacologic techniques are being increasingly applied to the treatment of atrial fibrillation (AF). None of these techniques (other than maze surgery) begins to approach 100% efficacy for long‐term elimination of arrhythmia. This review examines the evidence for “hybrid” therapy, using combinations of drug and nonpharmacologic treatments. The immediate success rate of electrical cardioversion can be increased with amiodarone or ibutilide, and a number of drugs reduce the risk of AF recurrence. Preventing or reversing electrical atrial remodeling is an attractive strategy for maintenance of sinus rhythm. However, the available evidence (relating to the use of verapamil) is limited and conflicting. Ablation of the cavotricuspid isthmus is effective when antiarrhythmic drugs given for AF give rise to typical flutter. Isthmus and other right atrial linear lesions are poor as a sole therapy for AF, but better when drugs are added. Better still is the combination of left atrial linear lesions with drugs. In patients with AF recurrence following focal ablation/pulmonary vein isolation procedures, drugs are an alternative to extensive linear ablation. Some studies indicate that pacing to prevent AF may be effective, but rarely without continued antiarrhythmic drug therapy. This may represent a specific effect or simply improved drug tolerance. Drugs also might assist pacemaker therapy by increasing the proportion of atrial arrhythmias that are highly organized and thus amenable to antitachycardia pacing. This and other forms of hybrid therapy will remain the subject of conjecture in the absence of controlled clinical trials, which are urgently needed.
Current Limitations in Treatment of Heart Failure: New Avenues and Treatment Options
Authors: DREXLER HELMUT , FUCHS MARTIN
Published: January 2015

Treatment of Heart Failure. Chronic heart failure is one of the main causes of death in western countries. Despite state‐of‐the‐art treatment including angiotensin‐converting enzyme inhibitors, beta‐blockers, and spironolactone, survival and relief from symptoms still are unacceptably poor in patients with chronic heart failure. The present article gives an overview of current limitations in the treatment of heart failure and points out possible treatment options in the future. It seems possible to reduce or at least delay progression of heart failure by adding drugs that interfere with novel pathophysiologic aspects in heart failure activation of the neuroendocrine system, including catecholamines, angiotensin II, cytokines, and endothelins, as well as alteration of calcium homeostasis and energy depletion.
Optimal Stimulation of the Left Ventricle
Authors: GRAS DANIEL , CEBRON JEAN‐PIERRE , BRUNEL PHILIPPE , LEURENT BERNARD , BANUS YVES
Published: January 2015

Optimal Stimulation of the Left Ventricle. Cardiac resynchronization therapy has been proposed to alleviate heart failure symptoms refractory to classic drug treatment. Potential benefits hinge on a number of key components, including judicious selection of patients likely to respond to the therapy and appropriate placement of the leads, particularly the lead responsible for left ventricular pacing. Evidence of ventricular asynchrony is an individual prerequisite for consideration of cardiac resynchronization therapy. Ventricular asynchrony can be diagnosed by recording a QRS duration > 150 msec or during echocardiography, with the goal of investigating the mechanical aspect of asynchrony. The optimal left ventricular pacing site can be defined by the latest segmental contraction, which is mainly the mid‐lateral wall. The first‐choice technique to initiate left ventricular pacing consists of a transvenous approach via the coronary sinus tributaries. In practice, the final left ventricular pacing location also depends on highly variant coronary sinus anatomy, acceptable electrical parameters, and lead stability. Procedure‐related complications, which consist mainly of coronary sinus perforation and phrenic nerve stimulation, remain low (<1%) and should decrease further with the use of new features specific to the procedure.
Patient Selection for Biventricular Pacing
Authors: LUNATI MAURIZIO , PAOLUCCI MARCO , OLIVA FABRIZIO , FRIGERIO MARIA , MAGENTA GIOVANNI , CATTAFI GIUSEPPE , VECCHI RITA , VICINI ILARIA , CAVAGLIÀ SERGIO
Published: January 2015

Biventricular Pacing. Introduction: Biventricular pacing improves functional status in the majority of patients with drug‐refractory heart failure, dilated cardiomyopathy, and interventricular conduction delay. The aim of this study was to analyze the baseline clinical and functional data of a cohort of patients implanted with a biventricular stimulation system in a single‐center experience, to verify if the pathophysiologic characteristics of patients affect outcome, and to determine if preliminary identification of the right candidates for the new therapy is possible with noninvasive parameters.

Methods and Results: Since March 1999, 52 patients with advanced heart failure (idiopathic cardiomyopathy 50%, ischemic cardiomyopathy 35%, other etiology 15%) and left bundle branch block underwent cardiac resynchronization and were followed prospectively. Paired analysis over mean (± SD) follow‐up of 348 ± 154 days showed an overall significant decrease of QRS width (baseline 194 ± 33.2 msec vs follow‐up 159.6 ± 20.1 msec), New York Heart Association (NYHA) functional class (baseline 3.2 ± 0.5 vs follow‐up 2.3 ± 0.5), quality‐of‐life score (baseline 54 ± 25 vs follow‐up 25 ± 16), and increase of maximal VO2 (baseline 12.6 ± 2.5 mL/kg/min vs follow‐up 15.0 ± 3.3 mL/kg/min). There were 80% responders (documented, persistent decrease ≥1 NYHA class) and 20% nonresponders (same NYHA class or decline of status; need for heart transplant; death due to progressive pump failure). No significant differences in baseline clinical and functional variables between the two subgroups were observed. In responders, there was a highly significant global improvement of all variables; in nonresponders, no parameters changed between baseline and follow‐up.

Conclusion: These data confirm the role of biventricular pacing in improving the functional status of the great majority of a selected patient population having advanced heart failure and left bundle branch block with wide QRS complex. Basal demographic, clinical, and functional characteristics are not helpful in preliminary selection of responders. Simple evaluation of NYHA class confirms favorable outcome (improvement of functional and hemodynamic status).
Evolution of Implantable Cardioverter Defibrillator Indications: Comparison of Guidelines in the United States and Europe
Authors: STEINBECK GERHARD
Published: January 2015

ICD Implantation Guidelines. Introduction: The rate of implantation of implantable cardioverter defibrillators (ICD) is growing much faster in the United States than in western Europe. Among several factors, education and awareness of the problem of sudden cardiac death might account for this discrepancy.

Methods and Results: Guidelines for ICD implantation developed in the United States and various European countries are compared, including the one recently published by the Working Groups on Arrhythmias and Cardiac Pacing of the European Society of Cardiology. Although all guidelines fully concur in their recommendations for patients after cardiac arrest due to ventricular fibrillation and ventricular tachycardia, small but noticeable differences in opinion can be traced for patients with sustained ventricular tachycardia or syncope, and for primary prevention. In general, European guidelines are more restrictive for the latter indications. Whereas U.S. guidelines were quickly updated over the years, this process took much longer in Europe, and several countries only recently adopted their first guidelines.

Conclusion: Although different in details, the recent release of ICD guidelines in major western European countries will undoubtedly lead to a pronounced increase of patients protected by this form of therapy in Europe in the coming years.
Geographic Differences in Implantable Cardioverter Defibrillator Usage
Authors: SEIDL KARLHEINZ , SENGES JOCHEN
Published: January 2015

Geographic Differences in ICD Usage. Despite the demonstrated efficacy of implantable cardioverter defibrillators (ICDs) in reducing sudden and total mortality in selected patients, their implantation rates vary greatly among countries. In the United States, the implantation rate is 185 implants per million inhabitants compared with only 31 implants per million in western Europe. The differences in ICD use may be explained by the following factors: manner in which sudden cardiac death is perceived by politicians and physicians (sudden cardiac death is perceived as a “nice way of dying”); differences in indications; physicians' information; prevalence of coronary artery disease; sudden cardiac death survival rates; perceived reliability of alternative treatment (namely, antiarrhythmics including amiodarone); economic backgrounds; and health care politics. Furthermore, the cost of this treatment strategy must be considered. This issue has been raised because generalization of ICD use in patients matching clinical characteristics of patients enrolled in the primary prevention trials may represent a significant economic burden to be added to the already overloaded health care system. This low acceptance may not be entirely related to budget constraint but also to the perceived efficacy of ICDs by physicians and health authorities.
Role of Implantable Cardioverter Defibrillators in Dilated Cardiomyopathy
Authors: CAPPATO RICCARDO , NEGRONI SILVIA , BENTIVEGNA STEFANO , BIANCHETTI FEDERICO , PECORA DOMENICO , MORANDI FRANCESCA , FURLANELLO FRANCESCO
Published: January 2015

ICDs in Dilated Cardiomyopathy. Idiopathic dilated cardiomyopathy (DCM) accounts for about 10,000 deaths per year in western countries. Of these deaths, 8% to 51% occur suddenly, with more than half of the events due to a ventricular arrhythmia. Improvement in diagnostic techniques and therapeutic strategies, together with changes in secular trends, have likely contributed to the reported trend toward improved survival in recent years. Identification of DCM patients at higher risk of sudden death is difficult. Poor left ventricular function is the strongest predictor of all‐cause death, whereas a history of sustained unstable ventricular arrhythmia or cardiac arrest identifies patients at high risk of sudden death. Recent data suggest that a history of syncope, regardless of inducibility at programmed electrical stimulation, may be a risk factor of sudden death. Despite the absence of controlled studies, use of implantable cardioverter defibrillator therapy for primary prevention can be considered in patients with unexplained syncope as well as subgroups of DCM patients awaiting transplantation. In patients who survive a cardiac arrest or an unstable ventricular tachycardia, use of implantable cardioverter defibrillator therapy is associated with improved survival during follow‐up and should be considered as a first‐line therapy.
Is There a Role for Implantable Cardioverter Defibrillators in Long QT Syndrome?
Authors: WILDE ARTHUR A.M.
Published: January 2015

ICDs in Long QT Syndrome. The congenital familial long QT syndrome (LQTS) is characterized by QT interval prolongation on ECG and potentially life‐threatening polymorphic ventricular arrhythmias. Antiadrenergic therapy, i.e., beta‐adrenoceptor blockade, left cardiac sympathetic denervation, and occasionally pacemaker therapy, sufficiently protects most LQTS patients. Implantable cardioverter defibrillator treatment, with some specific problems and setting requirements in LQTS patients, should at least be considered or implanted in patients with recurrent arrhythmias despite adequate antiadrenergic therapy. Some genetic subtypes, such as LQTS3, may not respond as well (or even adversely) to antiadrenergic therapy and, thus, benefit more from implantable cardioverter defibrillator therapy.
Echocardiographic Predictors of Survival in Patients Undergoing Radiofrequency Ablation of Postinfarct Clinical Ventricular Tachycardia
Authors: NABAR ASHISH , RODRIGUEZ LUZ‐MARIA , BATRA RAVINDER KUMAR , TIMMERMANS CARL , CHERIEX EMILE , WELLENS HEIN J.J.
Published: January 2015

Predictors of Survival in Postinfarct VT. Introduction: The aim of this study was to determine the predictive value of echocardiographic parameters of systolic left ventricular (LV) dysfunction for survival in a group of patients with “mappable” ventricular tachycardia (VT) after myocardial infarction who underwent radiofrequency ablation (RFA) of their clinical VT(s).

Methods and Results: RFA of at least one inducible, “mappable,” and clinical VT was attempted in 61 patients. In total, 63 (79%) of 80 target clinical VTs were ablated successfully, such that clinical VT(s) were noninducible in 49 (80%) of 61 patients. At the last recorded follow‐up (range 2 to 98 months; mean 21 ± 20), nonfatal VT recurrences were observed in 11 (22%) patients; 10 (16%) patients died. On univariate analysis, a higher LV end‐diastolic volume (LVEDV; P = 0.008) and, by multivariate analysis, applying backward selection of variables, older age (P = 0.03) with a higher LVEDV (P = 0.003) predicted patients more likely to die. When age and LV ejection fraction (LVEF) were excluded, LV end‐systolic diameter (LVESD; P = 0.007) was the most significant predictor of survival.

Conclusion: In our patient population with postinfarct VT who underwent RFA of mappable clinical VT(s), LVEF did not predict survival. In this group of patients with overall low mean LVEF (<35%), older age together with higher LVEDV and LVESD predicted patients who were more prone to die. LV size rather than LVEF correlated with survival.
Retraction: ‘Are European birds leaving traditional wintering grounds in the Mediterranean?’, by José Luis Tellería, Álvaro Ramírez and José Ignacio Aguirre
Authors: Tellería José Luis , Ramírez Álvaro , Aguirre José Ignacio
Published: January 2015

The above article, published online on 20 January 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editors in Chief, Thomas Alerstam and Jan‐Åke Nilsson, the Nordic Society Oikos and John Wiley and Sons Ltd.

The aim of this study was to answer the question, ‘Are European birds leaving traditional wintering grounds in the Mediterranean?’ Due to an analytical error the study only analysed EURING circumstance 20 ring records (see the EURING exchange code) which excludes birds hunted by shot and other ways, but not all hunted individuals. As a result, the effect of illegal hunting on ring recoveries was not controlled for in the analyses. This means that the data is affected by ring records from birds other than ‘alive and probably healthy and released by ringer’ (condition 8 in the EURING exchange code). The authors' intention always was to include both condition 8 and circumstance 20, but unfortunately this was not the case.

When the data was reanalysed including both condition 8 and circumstance 20 recoveries, there is no longer any support for the main conclusion of the paper and the authors can only conclude that winter ring recoveries in Spain of some common passerines (robin, chiffchaff and blackcap) do not decrease.

The authors apologise for this mistake and hope that the retraction will serve to prevent the spread of the unsound conclusions derived from this paper.