bluuebunny/crossref_metadata_2025 huggingface dataset:
Transforming growth factor beta‐1 level in pleural effusion
Authors: CEYHAN Berrin Bagci , DEMIRALP Emel , KARAKURT Zuha L. , KARAKURT Sait , SUNGUR Murat
Published: December 2004

Objective:  Transforming growth factor‐β1 is an important immunomodulator. The diagnostic role of TGF‐β1 has not been systematically investigated in pleural effusion.

Methodology:  A prospective clinical study of 45 patients (23 men, 22 women; mean age 49 ± 21 years) with pleural effusion was performed. Of these patients, 19 had malignant pleural effusion, 14 had tuberculous pleural effusion, seven had empyema/parapneumonic pleural effusion, and five had transudative pleural effusion due to congestive heart failure. The concentrations of TGF‐β1 were measured by ELISA in all pleural fluid samples and in serum samples only from patients with malignant and tuberculous pleural effusions.

Results:  The median TGF‐β1 levels of malignant, tuberculous and empyema/parapneumonic pleural effusions were 7.25 ng/mL, 7.81 ng/mL, and 9.75 ng/mL, respectively. There was no significant difference between them. The median TGF‐β1 level was 5.62 ng/mL in the transudate pleural effusion group and it was significantly lower than that in the empyema/parapneumonic group (P < 0.05). The pleural fluid TGF‐β1 levels did not correlate with cell profiles of the pleural fluid. The median serum TGF‐β1 levels in malignant and tuberculous pleural effusion groups were 7.38 ng/mL and 7.38 ng/mL, respectively. There was no significant difference between the levels of TGF‐β1 in paired samples of serum and pleural fluid.

Conclusions:  This study shows that TGF‐β1 concentrations in exudative pleural effusions are higher than those in transudative effusions secondary to congestive heart failure but TGF‐β1 concentrations do not assist in differentiating exudative effusions.
The loss of retinoic acid receptor α, β and alcohol dehydrogenase3 expression in non‐small cell lung cancer
Authors: INUI Naoki , SASAKI Shigekazu , SUDA Takafumi , CHIDA Kingo , NAKAMURA Hirotoshi
Published: December 2004

Objective:  The reason for unsuccessful retinoid chemoprevention of lung cancer is obscure. Therefore we examined the retinoid‐related receptor expression and the tissue distribution as well as the possible interaction between retinoid‐related receptor expression and cigarette smoke.

Methodology:  Using semiquantitative conventional reverse transcriptase polymerase chain reaction (RT‐PCR), quantitative real‐time RT‐PCR, in situ hybridization and immunostaining, we evaluated the expression and the distribution of retinoic acid receptor α, β, γ, retinoid X receptor α, β, γ, thyroid hormone receptor α, β, and alcohol dehydrogenase3 (a well‐characterized retinoic acid responsive gene) in malignant and non‐malignant tissues obtained from patients with non‐small cell lung cancer. We also assessed the response of the bronchial epithelial cell line, BEAS‐2B, following exposure to cigarette smoke extract.

Results:  Compared with non‐malignant tissues, malignant tissues had a 45% (P < 0.02) redution in retinoic acid receptor α and β expression, while other receptors were not affected. The expression of the alcohol dehydrogenase3 gene in malignant tissue was 50% of that observed in non‐malignant tissue (P < 0.05). There was a significant correlation between the retinoic acid receptor β‐mRNA level and the alcohol dehydrogenase3‐mRNA level (r = 0.52, P < 0.05). In situ hybridization and immunostaining demonstrated that retinoic acid receptor α and β were localized in the airway and alveolar epithelial cells and their expression was diminished to 30% in malignant tissues compared to non‐malignant tissues (P < 0.05). Interestingly, cigarette smoke extract decreased retinoic acid receptor β mRNA in BEAS‐2B cells (P < 0.05).

Conclusions:  The present findings suggest a possible association of the loss of retinoic acid receptor α, β and alcohol dehydrogenase3 with lung carcinogenesis.
Severe acute respiratory syndrome (SARS) in Hong Kong
Authors: TSANG Kenneth W. , MOK Thomas Y. , WONG Poon C. , OOI Gaik C.
Published: December 2004

Abstract:  Severe acute respiratory syndrome (SARS) is a recently recognized and highly contagious pneumonic illness, caused by a novel coronavirus. While developments in diagnostic, clinical and other aspects of SARS research are well underway, there is still great difficulty for frontline clinicians as validated rapid diagnostic tests or effective treatment regimens are lacking. This article attempts to summarize some of the recent developments in this newly recognized condition from the Asia Pacific perspective.
A novel approach for quality control of total lung capacity in the clinical pulmonary function laboratory: A study in a veteran population
Authors: SCHÜNEMANN Holger J. , DMOCHOWSKI Jacek , CAMPBELL Lucy A. , GRANT Brydon J. B.
Published: December 2004

Objective:  Quality control in the clinical pulmonary function laboratory has been well developed for spirometry and diffusing capacity but not for the measurement of TLC. The purpose of the present study was to test two approaches to this problem. First, we compared TLC by body plethysmography (TLCb) with a value predicted from TLC measured by multibreath helium dilution (TLCm). Concordance between the measured and predicted values would imply the validity of the measurements. Second, we measured the test–retest variability of TLCb, TLCm and TLC measured by single breath helium dilution (TLCs) to assess the consistency of the measurements.

Methodology:  We performed a prospective study of 815 veterans.

Results:  The prediction of TLCb from TLCm improved (r2 increased from 0.44 to 0.64) when FEV1/FVC and the difference between TLCm and TLCs were added to the model. The coefficient of variation for test–retest of TLCs, TLCm and TLCb were 8.9, 7.1 and 5.4%, respectively. Of all tests, 5.9% were inconsistent based on pathophysiology or measurement error and attributed mostly to TLCm.

Conclusions:  Prediction of TLCb from TLCm was not sufficiently accurate as to be useful for quality control. Comparison of TLCs, TLCm and TLCb may be useful for determining the internal data validity.
Breast‐feeding, a complex support system for the offspring
Authors: Hanson Lars Å , Korotkova Marina , Håversen LilIana , Mattsby‐Baltzer Inger , Hahn‐Zoric Mirjana , Silfverdal Sven‐Arne , Strandvik Birgitta , Telemo Esbjörn
Published: December 2004

The newborn has an immune system, very limited in size at birth and its postnatal expansion and maturation takes time. In the meantime the transplacental IgG antibodies from the mother play an important role for the protection of the infant. However, these antibodies act in tissues and induce inflammation and are energy‐consuming. In contrast, the milk secretory IgA antibodies stop microbes already on the mucosa preventing infection, tissue engagement and energy loss. In addition, the milk contains many protective factors such as lactoferrin and oligosacharides functioning as analogues for microbial receptors preventing mucosal attachment, the initial step of most infections. As a result, breast‐feeding significantly reduces the risk of neonatal septicemia, respiratory tract infections, otitis media, diarrhea, urinary tract infections, infection‐induced wheezing and necrotizing enterocolitis. Via several mechanisms it seems that human milk can actively stimulate the immune system of the breast‐fed infant. This reduces the risk of infections like otitis media, respiratory tract infections, diarrhea and infection‐induced wheezing for several years after the termination of breast‐feeding. Furthermore, it seems that breast‐feeding decreases the risk of attracting celiac disease and allergic diseases. The latter has been much debated, but a recent critical review of published reports gives good support for long‐term protection of allergic diseases, especially in high‐risk children.
Persistence of TEL‐AML1 transcript in acute lymphoblastic leukemia in long‐term remission
Authors: Endo Chie , Oda Megumi , Nishiuchi Ritsuo , Seino Yoshiki
Published: December 2004

Background
: It has recently been shown that t (12;21) (p13;q 22) is the most common molecular genetic abnormality in childhood acute lymphoblastic leukemia (ALL). We have analyzed this translocation in an attempt to evaluate its incidence and to monitor minimal residual disease (MRD) with t (12; 21) rearrangement by detection of TEL‐AML1 transcript in patients with childhood ALL.

Procedure
: All cryopreserved bone marrow samples were analyzed using a nested reverse transcription‐polymerase chain reaction (RT‐PCR) method. TEL‐AML1 transcripts were searched for in 34 ALL patients, including six in relapse consecutively diagnosed at our institution between 1991 and 1997.

Results
: TEL‐AML1 transcripts were found in five (19%) of 27 patients with B precursor ALL. The patients with BCR‐ABL, chromosome 11q23 rearrangement and T‐ALL patients did not express TEL‐AML1 transcripts. Moreover, MRD in five patients with TEL‐AML1 transcripts were analyzed in serial samples. Although TEL‐AML1 transcripts disappeared soon after the beginning of chemotherapy in three of the five patients, one patient continued to express them for up to 21 months without recurrence and remained in continuous complete remission for seven years after the cessation of chemotherapy. The remaining patient was admitted to our hospital after the second relapse but died following a failure to induce complete remission.

Conclusion
: For most patients, the presence of TEL‐AML1 transcripts suggests excellent chemosensitivity and a favorable prognosis, but some patients with these transcripts have a different outcome. The present study suggests the possibility that a persistence of MRD is not necessarily related to a relapse of ALL with TEL‐AML1 fusion. The prognostic significance of TEL‐AML1 transcript remains controversial. Further studies are needed to evaluate the relation between the TEL‐AML1 transcript and prognosis.
Effect of intramedullary gradual elongation of the shorter limb on gait patterns
Authors: Perttunen Jarmo R , Anttila Esa , Södergård Jerker , Merikanto Juhani , Komi Paavo V
Published: December 2004

Background
: Seven young patients were followed 52 weeks after intramedullary lengthening for limb length discrepancy (LLD). The mean LLD before surgery was 3.0 ± 1.1 cm and 1 year after surgery at the time of the nail‐removal it was 0.3 ± 0.3 cm.

Methods
: The plantar pressures and the ground reaction forces (GRF) were recorded simultaneously with electromyographic (EMG) activities at normal and fast walking speeds.

Results
: Bilateral comparison indicated that the uncorrected LLD resulted in asymmetrical gait patterns. The peak pressures were higher in the lateral heel and in the medial forefoot in the longer limb as compared to the shorter limb at normal walking speed. At fast walking speed, the peak pressures of the longer limb were higher in the forefoot area but lower in the central midfoot. One year after surgery, a clear improvement in the gait symmetry was observed compared to preoperative condition. Significantly, foot loading models were quite similar 52 weeks after surgery. However, during the follow‐up period of 52 weeks, the maximal isometric knee extensor torque still remained at lower levels on the operated side until week 52 postoperatively, but reached the same level with non‐operated side within 2 years.

Conclusions
: The improved walking symmetry obtained after surgical treatment may diminish possible pathologic loading of the lower extremity and may prevent the early appearance of arthritis in the lower extremities.
Three‐year follow up of term and near‐term infants treated with inhaled nitric oxide
Authors: Ichiba Hiroyuki , Matsunami Satoko , Itoh Fumihide , Ueda Toru , Ohsasa Yukinobu , Yamano Tsunekazu
Published: December 2004

AbstractBackground: The present study describes the outcome at 3 years in term and near‐term infants treated with inhaled nitric oxide (iNO) for persistent pulmonary hypertension of the newborn (PPHN).

Methods: The study population consisted of 18 infants delivered at  34 weeks by best obstetric estimate who were admitted to the neonatal intensive care units with a diagnosis of PPHN.

Results: Eighteen infants (mean gestational age 38.5 ± 2.6 weeks, mean birthweight 3015 ± 587 g) were treated with iNO. The mean oxygenation index before iNO was 27.2 ± 15.2. Responses to iNO were classified into three groups: (i) early response in eight infants; (ii) late response in two; and (iii) poor response in eight infants. Three infants died within seven postnatal days. Fifteen surviving infants were followed up to 3 years. The mean developmental scale was 98.4 ± 9.0. One infant was diagnosed with severe neurodevelopmental disability due to cerebral palsy. Another infant was diagnosed with mild neurodevelopmental disability because of a low developmental scale. No infant showed significant hearing loss. Five infants had reactive airway disease (RAD) at 18 months, these infants required a significantly longer duration of mechanical ventilation in their neonatal period than non‐RAD infants (P = 0.02). The frequency of survival with normal neurodevelopmental outcome was significantly higher in the early response group than the late or poor response groups (P = 0.03).

Conclusion: In iNO‐treated PPHN, mortality and neurodevelopmental outcome were associated with response to iNO, and pulmonary outcome was associated with duration of mechanical ventilation.
Diphtheria immunization rates and the effect of several sociodemographic factors on immunization of children in eastern Turkey
Authors: Adem ARİk , Tacettin Inandi , Sevin Altİnkaynak , Vildan Ertekin
Published: December 2004

Background
: One of the aims of the World Health Organization is to eliminate diphtheria in all countries. Thus, it is important to achieve a high level of childhood immunization. The present study was performed to determine the level of child immunization against diphtheria and the effect of several sociodemographic factors on immunization of children aged 0−6 years.

Methods
: Using the cluster‐sampling method, 767 healthy children were selected at random from three provinces in eastern Turkey. Children were categorized as completely vaccinated, incompletely vaccinated, unvaccinated or vaccination status unknown. If the child had no immunization card, he/she was categorized as vaccination status unknown.

Results
: Of the 767 children, 72.3% were completely vaccinated, 18.3% were incompletely vaccinated and 5.7% were not vaccinated. Vaccination status was unknown for 3.7% of children. As the age of the children increased, the proportion of completely vaccinated children increased and the proportion of non‐vaccinated and incompletely vaccinated children decreased. The vaccination rates increased in parallel with the education level of the parents. While the vaccination rate was significantly correlated with the socioeconomic level of the families, it was inversely correlated with sibling number.

Conclusions
: The results of the present study show that the immunization status necessary for the elimination of diphtheria has not yet been reached in eastern Turkey. In immunization programs for children in eastern Turkey, priority should be given to increasing primary immunization levels to 90−95% with three or more doses of diphtheria toxoid.
Spread of varicella‐zoster virus DNA to the environment from varicella patients who were treated with oral acyclovir
Authors: Suzuki Kyoko , Yoshikawa Tetsushi , Ihira Masaru , Ohashi Masahiro , Suga Sadao , Asano Yoshizo
Published: December 2004

Objective
: The purpose of the present study was to determine the degree of spread of varicella‐zoster virus to the environment (VZV) from varicella patients who received oral acyclovir treatment.

Methods
: Over a period of 8 months, seven healthy children (two girls and five boys, 23−64 months of age) with varicella who visited Fujita Health University School of Medicine were treated with routine doses of oral acyclovir (ACV) for 5 days, commencing within 24 h after onset of the disease. Swab samples from the throats of patients and their family members as well as from air purifier filters in their houses were collected for 7 days as frequently as possible after starting treatment for the disease. The VZV DNA in the samples was identified by a sensitive polymerase chain reaction amplification assay.

Results
: The VZV DNA was detected in 33−100% of throat swab samples from varicella patients by day 7 of the disease, in 17−32% of throat swab samples from family members by day 4 and in 29% of filters from air purifiers by day 3.

Conclusions
: The results suggest a broad spread of VZV, probably by the airborne route, from the patients with varicella even after the administration of oral ACV.
Risk factors of status epilepticus in children
Authors: KarasalİhoĞlu Serap , Öner Naci , ÇeLtik CoŞkun , Çelik Yahya , Biner Betül , Utku Ufuk
Published: December 2004

Abstract
Background
: Although there is abundant literature about the morbidity and mortality rates of status epilepticus (SE), little is known about the risk factors of this medical emergency. The aim of the present study is to assess the risk factors of SE in children.

Methods
: The authors reviewed the medical records of 83 patients admitted to the Pediatric Neurology Unit of Trakya University Hospital, Edirne, Turkey from January 1994 to December 2001 with the diagnosis of SE. Eighty‐three patients were compared with 166 controls who were admitted to the same unit due to non‐status epilepticus (non‐SE) seizure.

Results
: The univariate analysis demonstrated that SE episodes were significantly associated with a history of birth asphyxia, neonatal seizure, discontinuation of antiepileptic medication, epilepsy, partial seizure evolving to secondary generalized seizures, myoclonic seizure, generalized abnormalities in the neurological examination, neuromotor retardation, generalized background abnormalities on electroencephalogram (EEG), generalized abnormalities on neuroimaging and polypharmacy than non‐SE episodes. Logistic regression was used to test the independence of these parameters as predictors of SE risk. Four parameters emerged as significant independent predictors of SE in children in multiple logistic regression: polypharmacy (Odds ratio (OR) 5.17, P = 0.0004), discontinuation of antiepileptic medication (OR 4.04, P = 0.0095), neuromotor retardation (OR 4.03, P = 0.0016) and generalized background abnormalities on EEG (OR 2.48, P = 0.0419).

Conclusion
: Polypharmacy, discontinuation of antiepileptic medication, neuromotor retardation and generalized background abnormalities on EEG are indicators in children of a higher risk of SE.
Testicular sperm extraction with intracytoplasmic sperm injection for male infertility
Authors: Imamoto Takashi , Suzuki Hiroyoshi , Ichikawa Tomohiko , Ito Haruo , Kawana Yoko , Shiseki Yoshio , Akama Haruo , Naito Masafumi
Published: December 2004

Background and Aims: Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) is an effective procedure for the treatment of male infertility, obstructive and non‐obstructive azoospermia. We have reviewed our experience to investigate the correlation of TESE‐ICSI with morphological, biophysical and endocrine profiles in 27 men.

Results:  Testicular spermatozoa could be retrieved in 25 of 27 patients who underwent TESE. In two cases, testicular spermatozoa could not be recovered and their serum follicle‐stimulating hormone (FSH) levels were significantly higher than those of the former group. However, spermatozoa could be retrieved in sufficient numbers for ICSI, even in the patient with the highest FSH concentration. Johnsen scores evaluated by diagnostic pre‐TESE open biopsies were significantly higher in the cases with viable testicular spermatozoa than those in the cases without spermatozoa. However, even in the patient whose Johnsen score was 2.1, testicular spermatozoa could be retrieved with TESE, and pregnancy was achieved by ICSI.

Conclusions:  The serum FSH levels and the histological findings of the testes were strong predictors for successful TESE and provided useful information for consultation and making treatment decisions on an individual case. However, whether a patient has enough spermatozoa so that an IVF procedure with ICSI is possible can only be answered by a trial TESE. (Reprod Med Biol 2003; 2: 31–35)
Is the Left Ventricular Lateral Wall the Best Lead Implantation Site for Cardiac Resynchronization Therapy?
Authors: GASPARINI MAURIZIO , MANTICA MASSIMO , GALIMBERTI PAOLA , BOCCIOLONE MONICA , GENOVESE LUCA , MANGIAVACCHI MAURIZIO , LA MARCHESINA UGO , FALETRA FRANCESCO , KLERSY CATHERINE , COATES ROBERT , GRONDA EDOARDO
Published: December 2004

GASPARINI, M., et al.: Is the Left Ventricular Lateral Wall the Best Lead Implantation Site for Cardiac Resynchronization Therapy?
Short‐term hemodynamic studies consistently report greater effects of cardiac resynchronization therapy (CRT) in patients stimulated from a LV lateral coronary sinus tributary (CST) compared to a septal site. The aim of the study was to compare the long‐term efficacy of CRT when performed from different LV stimulation sites. From October 1999 to April 2002, 158 patients (mean age 65 years, mean LVEF 0.29, mean QRS width 174 ms) underwent successful CRT, from the anterior (A) CST in 21 patients, the anterolateral (AL) CST in 37 patients, the lateral (L) CST in 57 patients, the posterolateral (PL) CST in 40 patients, and the middle cardiac vein (MCV) CST in 3 patients. NYHA functional class, 6‐minute walk test, and echocardiographic measurements were examined at baseline, and at 3, 6, and 12 months. Comparisons were made among all pacing sites or between lateral and septal sites by grouping AL + L + PL CST as lateral site (134 patients, 85%) and A + MC CST as septal site (24 patients, 15%). In patients stimulated from lateral sites, LVEF increased from 0.30 to 0.39

(P < 0.0001)

, 6‐minute walk test from 323 to 458 m

(P < 0.0001)

, and the proportion of NYHA Class III–IV patients decreased from 82% to 10%

(P < 0.0001)

. In patients stimulated from septal sites, LVEF increased from 0.28 to 0.41

(P < 0.0001)

, 6‐minute walk test from 314 to 494 m

(P < 0.0001)

, and the proportion of NYHA Class III–IV patients decreased from 75% to 23%

(P < 0.0001)

. A significant improvement in cardiac function and increase in exercise capacity were observed over time regardless of the LV stimulation sites, either considered singly or grouped as lateral versus septal sites. (PACE 2003; 26[Pt. II]:162–168)
Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure
Authors: GASPARINI MAURIZIO , MANTICA MASSIMO , GALIMBERTI PAOLA , CERIOTTI CARLO , SIMONINI STEFANO , MANGIAVACCHI MAURIZIO , GRONDA EDOARDO
Published: December 2004

GASPARINI, M., et al.: Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure.
Since cardiac resynchronization therapy (CRT) improves LV function at the cost of low energetic expenditure, the authors hypothesized that it may increase the threshold of drug refractory angina in selected patients with CHF and CAD who are not amenable to myocardial revascularization. From October 1999 to April 2002, 75 patients with CHF and CAD were treated with CRT. Drug refractory angina occurred nearly daily in 8 of the 75 patients. The mean age of these eight men was 71 years, mean NYHA functional Class

3.4 ± 0.5

, mean QRS duration (QRSd)

168 ± 20  ms

, and mean left ventricular ejection fraction (LVEF)

0.29 ± 0.4

. Diffuse CAD not amenable to myocardial revascularization was confirmed on angiography. At baseline, no patient was able to complete a 6‐minute walk test because of angina. In the 6 months before CRT, the mean number of hospitalizations per patient for management of CHF or angina was

3.1 ± 0.3

. All patients underwent successful CRT. Mean QRSd decreased to

141 ± 16  ms
(P = 0.01vs baseline). After9 ± 6.1  months, LVEF increased to0.317 ± 0.028(P = 0.03vs baseline), while the NYHA class decreased to2.6 ± 0.5(P = 0.02vs baseline). All patients also experienced a marked decrease in angina episodes, from a mean of8.3 ± 11.6to0.6 ± 1.3episodes/week(P < 0.05), and completed a 6‐minute walk test, covering a mean distance of337 ± 68  m(vs237 ± 136  mat baseline,P = 0.007). No further hospitalization was necessary. The beneficial effects of CRT on overall cardiac function may include a better control of angina in severely symptomatic patients. (Pace 2003; 26[Pt. II]:181–184)
Programming Optimal Atrioventricular Delay in Dual Chamber Pacing Using Peak Endocardial Acceleration: Comparison with a Standard Echocardiographic Procedure
Authors: DUPUIS JEAN‐MARC , KOBEISSI ADONIS , VITALI LUCA , GAGGINI GUIDO , MERHEB MICHEL , ROULEAU FREDERIC , LEFTHERIOTIS GEORGES , RITTER PHILIPPE , VICTOR JACQUES
Published: December 2004

DUPUIS, J.‐M.,

et al

.: Programming Optimal Atrioventricular Delay in Dual Chamber Pacing Using Peak Endocardial Acceleration: Comparison with a Standard Echocardiographic Procedure.
Optimization of programmed atrioventricular delay in dual chamber pacing is essential to the hemodynamic efficiency of the heart. Automatic AV delay optimization in an implanted pacemaker is highly desirable. Variations of peak endocardial acceleration (PEA) with AV delay at rest correlate well with echocardiography derived observations, particularly with end‐diastolic filling and mitral valve closure timings. This suggests the possibility of devising a procedure for the automatic determination of the optimal AV delay. The aim of this study was to compare a proposed algorithm for optimal AV delay determination with an accepted echocardiographic method. Fifteen patients with high degree AV block received BEST‐Living pacing systems. Automatic AV delay scans were performed at rest (60–300 ms in 20‐ms steps with 60 beats per step) in DDD at 90 ppm, while simultaneously recording cycle‐by‐cycle PEA values, which were averaged for each AV delay to obtain a PEA versus AV delay curve. Nonlinear regression analysis based on a Boltzmann sigmoid curve was performed, and the optimal AV delay (OAVD) was chosen as the sigmoid inflection point of the regression curve. The OAVD was also evaluated for each patient using the Ritter echocardiographic method. Good sigmoid fit was obtained in 13 of 15 patients. The mean OAVD obtained by the PEA sigmoid algorithm was

146.9 ± 32.1  ms

, and the corresponding result obtained by echocardiography was

156.4 ± 34.3  ms

(range 31.8–39.7 ms). Correlation analysis yielded r = 0.79, P = 0.0012. In conclusion, OAVD estimates obtained by PEA analysis during automatic AV delay scanning are consistent with those obtained by echocardiography. The proposed algorithm can be used for automatic OAVD determination in an implanted pacemaker pulse generator. (PACE 2003; 26:[Pt. II]:210–213)
A New Algorithm for Closed‐Loop Stimulation: A Feasibility Study
Authors: PIERAGNOLI PAOLO , COLELLA ANDREA , MICHELUCCI ANTONIO , GIUSTI NICOLA , MILITELLO CARMELO , AUDOGLIO ROBERTO , PADELETTI LUIGI
Published: December 2004

PIERAGNOLI, P.,

et al

.: A New Algorithm for Closed‐Loop Stimulation: A Feasibility Study.
Closed‐loop stimulation (CLS) is a physiological system for adaptive rate pacing based on monitoring and processing of the intracardiac impedance. The “standard” CLS algorithm (SCLS) requires continuous ventricular pacing. A new, enhanced CLS algorithm (ECLS) provides rate modulation during sensed and paced ventricular depolarizations. The aim of this study was to validate ECLS and to compare its effectiveness with that of SCLS. Ten patients received Inos2+ CLS pulse generators. SCLS and ECLS were uploaded to the device and evaluated in a randomized, crossover fashion at 30 and 45 days after pacemaker implantation. At each follow‐up visit, ambulatory and posture tests were performed. Heart rate (HR) during daily activity was evaluated based on 24‐hour Holter recordings. During all phases of the ambulatory test, both algorithms provided physiologically appropriate rates in all patients. The proportion of sensed ventricular events was significantly higher in ECLS (93.9%) than in SCLS (0.7%). The proportion of paced ventricular events during 24 hours was substantially lower with ECLS (25.7%) than with SCLS (98.4%). Postural changes did not influence HR with either algorithm. The Holter recordings indicated prompt, safe, and effective rate modulation appropriate to patient activity. In conclusion, analysis of these clinical data demonstrated the safety and effectiveness of the ECLS algorithm. Moreover, with this algorithm the ventricle is paced only when required, which may be expected to retard battery depletion and retain the natural ventricular activation pattern whenever possible. (PACE 2003; 26[Pt. II]:229–232)
Atrial Evoked Response Integral for Automatic Capture Verification in Atrial Pacing
Authors: BORIANI GIUSEPPE , BIFFI MAURO , CAMERON DOUGLAS , DATTERI SERGIO , SNELL JEFF , HOLMSTRÖM NILS , PARK EULJOON , BORNZIN GENE A.
Published: December 2004

BORIANI, G.,

et al.:

Atrial Evoked Response Integral for Automatic Capture Verification in Atrial Pacing. Beat‐by‐beat Autocapture is currently limited to operation in the ventricle with bipolar leads. The authors investigated the integral of the negative‐going portion of the atrial evoked response integral (AERI) as a potential resource for verification of atrial capture. Intracardiac electrogram signals were collected from 59 patients (ages 67.8 ± 15.1 years) with bipolar, low polarization atrial leads. The signals were collected over a mean period of 6.1 months (minimum 4 days) after lead implantation. St. Jude Medical Affinity pulse generators were used to perform automatic capture threshold tests while the electrogram signals were recorded by a Model 3510 programming device. These signals were transferred to a personal computer in digital form for later analysis. The AERI was calculated at each programmable pacing voltage until capture was lost. The difference between the polarization integral at loss of capture and evoked response integral with successful capture was sufficient to justify enabling the atrial Autocapture feature in 53 of 59 patients in whom bipolar pacing and unipolar sensing was performed. The authors developed a calibration routine to identify automatically those patients in whom atrial Autocapture could be programmed On, based on the polarization integral at loss of capture, the estimated maximum polarization integral, and the AERI. Preliminary analysis indicated that the AERI is a practical resource for beat‐by‐beat atrial capture detection when used with low polarization leads. (PACE 2003; 26[Pt. II]:248–252)
The Influence of Concomitant Drug Therapy on the Efficacy of Atrial Overdrive Stimulation for Prevention of Atrial Tachyarrhythmias
Authors: KONZ KARL‐HEINZ , DANILOVIC DEJAN , BRACHMANN JOHANNES , ATTUEL PATRICK , ALLAF DIA EL , JOHN CORNELIA , MALINOWSKI KLAUS , BLANC ULRICH LE , SZENDEY ISTVAN , SCHIBGILLA VOLKER , MOTZKE THOMAS ,   on behalf of the“Suppression of Atrial Fibrillation by DDD+ Overdrive Pacing with Inos CLS Pacemakers”study investigators
Published: December 2004

KONZ, K.‐H.,

et al

.: The Influence of Concomitant Drug Therapy on the Efficacy of Atrial Overdrive Stimulation for Prevention of Atrial Tachyarrhythmias.
Data from the completed “Suppression of Atrial Fibrillation by DDD+ Overdrive Pacing with Inos2 CLS (closed‐loop system) Pacemakers” multicenter trial were retrospectively evaluated to examine the influence of concomitant antiarrhythmic drugs on the clinical success of conventional single site right atrial overdrive pacing compared with DDD pacing. The DDD+ overdrive algorithm provided >90% atrial pacing at a rate slightly above the intrinsic atrial rate. Seventy‐five patients with conventional pacing indications and paroxysmal, recurrent atrial tachyarrhythmia have completed the study. They were randomized to 6 months of DDD or DDD+ pacing, followed by mode crossover and an additional 6‐month follow‐up in the alternate mode. The incidence of atrial tachyarrhythmia during each period was compared using data on sustained (>60 s) mode switch episodes stored in the pacemaker memory. A stable antiarrhythmic drug regimen was allowed during the study. β‐Adrenergic blockers and Class III antiarrhythmics, prescribed to 54.7% and 40.0% of patients respectively, were linked to minimal or no benefit of overdrive pacing compared with DDD pacing. In contrast, patients untreated with β‐adrenergic blockers or Class III drugs had a significant reduction in atrial tachyarrhythmia burden of >5 hours/patient per week

(P < 0.05)

during overdrive. Changes with Class I and Class IV antiarrhythmic drugs, prescribed to 18.7% and 13.3% of patients, respectively, were insignificant. Our data indicate that clinical trials that prohibit the use of β‐adrenergic blockers may record more favorable outcomes with dynamic atrial overdrive algorithms versus conventional DDDR pacing, than studies allowing concomitant β‐adrenergic blockade. (PACE 2003; 26[Pt. II]:272–277)
Feasibility of Pulmonary Vein Ostia Radiofrequency Ablation in Patients with Atrial Fibrillation: A Multicenter Study (CACAF Pilot Study)
Authors: STABILE GIUSEPPE , BERTAGLIA EMANUELE , SENATORE GAETANO , SIMONE ANTONIO DE , ZERBO FRANCESCA , CARRERAS GIOVANNI , TURCO PIETRO , PASCOTTO PIETRO , FAZZARI MASSIMO
Published: December 2004

STABILE, G., et al.: Feasibility of Pulmonary Vein Ostia Radiofrequency Ablation in Patients with Atrial Fibrillation: A Multicenter Study (CACAF Pilot Study)
Radiofrequency (RF) catheter ablation has been proposed as a treatment of atrial fibrillation (AF). Several approaches have been reported and success rates have been dependent on procedural volume and operator's experience. This is the first report of a multicenter study of RF ablation of AF. We treated 44 men and 25 women with paroxysmal

(n = 40)

or persistent

(n = 29)
, drug refractory AF. Circular pulmonary vein (PV) ostial lesions were deployed transseptally, during sinus rhythm(n = 42)or AF(n = 26), under three‐dimensional electroanatomic guidance. Cavo‐tricuspid isthmus ablation was performed in 27 (40%) patients. The mean procedure time was215 ± 76minutes (93–530), mean fluoroscopic exposure32 ± 14minutes (12–79), and mean number of RF pulses per patient56 ± 29(18–166). The mean numbers of separate PV ostia mapped and isolated per patient were3.9 ± 0.5, and3.8 ± 0.7, respectively. Major complications were observed in 3 (4%) patients, including pericardial effusion, transient ischemic attack, and tamponade. At 1‐month follow‐up, 21 of 68 (31%) patients had had AF recurrences, of whom 8 required electrical cardioversion. After the first month, over a mean period of9 ± 3(5–14) months, 57 (84%) patients remained free of atrial arrhythmias. RF ablation of AF by circumferential PV ostial ablation is feasible with a high short‐term success rate. While the procedure and fluoroscopic exposure duration were short, the incidence of major cardiac complications was not negligible. (PACE 2003; 26[Pt. II]:284–287)
Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation
Authors: MACLE LAURENT , WEERASOORIYA RUKSHEN , JAIS PIERRE , SCAVEE CHRISTOPHE , RAYBAUD FLORENCE , CHOI KEE‐JOON , HOCINI MELEZE , CLEMENTY JACQUES , HAISSAGUERRE MICHEL
Published: December 2004

MACLE, L., et al.: Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation.
RF catheter ablation of paroxysmal atrial fibrillation (PAF) is associated with prolonged fluoroscopy. The procedural duration and fluoroscopic exposure to patients and medical staff were recorded and compared among 43 ablation procedures for PAF, 20 for common atrial flutter, and 16 for accessory pathways. Patient radiation exposure was measured by dosimeters placed over the xyphoid, while that of physicians and nurses was measured by dosimeters placed outside and inside the lead apron. The mean fluoroscopy time was

57 ± 30

minutes for PAF,

20 ± 10

minutes for common flutter, and

22 ± 21

minutes for accessory pathway ablation. The patient median radiation exposure was 1110μSv for PAF, compared with 500 μSv for common flutter and 560 μSv for accessory pathway ablation (P < 0.01). The median radiation exposure to physician and nurse inside the lead apron were, respectively, 2 μSv and 3 μSv for PAF, 1 μSv and 2 μSv for common flutter, and <0.5 μSv and 3 μSv for accessory pathway ablations. RF catheter ablation for PAF was associated with prolonged fluoroscopy times and a twofold higher radiation exposure to the patient and physician compared with other ablation procedures. Assuming 300 procedures/year, radiation exposure to the medical staff was below the upper recommended annual dose limit. (PACE 2003; 26[Pt. II]:288–291)
Prognostic Significance of Serial P Wave Signal‐Averaged Electrocardiograms Following External Electrical Cardioversion for Persistent Atrial Fibrillation: A Prospective Study
Authors: GUO XIAO HUA , GALLAGHER MARK MICHAEL , POLONIECKI JAN , YI GANG , CAMM A. JOHN
Published: December 2004

GUO, X.H., et al.: Prognostic Significance of Serial P Wave Signal‐Averaged Electrocardiograms Following External Electrical Cardioversion for Persistent Atrial Fibrillation: A Prospective Study.
The authors hypothesized that the persistence of abnormal atrial conduction detected by serial P wave signal‐averaged electrocardiograms (P‐SAECGs) can identify patients who are at high risk of recurrent atrial fibrillation (R‐AF) following electrical cardioversion (ECV). P‐SAECGs were recorded in 60 consecutive patients after ECV (53 men, age 66 ± 10 years) and repeated in those who had remained in sinus rhythm (SR) 1 week, and 1, 3, and 6 months later. Filtered P wave duration (PD), root mean square (RMS) voltage of the terminal 40, 30, 20 ms (RMS‐40, RMS‐30, RMS‐20) of the filtered P wave, RMS voltage of the entire filtered P wave (RMS‐p), and the integral of the voltages in the entire P wave (integral‐p) were analyzed. Thirty‐one (52%) patients returned to AF within 1 week, an additional 11 (18%) by 1 month, and a further 2 (3.3%) at each subsequent assessment (3 and 6 months). The patients with R‐AF had longer PD

(157 ± 24 vs 143 ± 17 ms, P < 0.0001)

and lower RMS‐40, RMS‐30, RMS‐20 (

5.3 ± 2.0

vs

6.1 ± 3.4 μV, P = 0.007; 4.3 ± 1.5

vs

5.7 ± 3.2 μV, P < 0.0001; 3.6 ± 1.4

vs

5.2 ± 3.0 μV, P < 0.0001

, respectively) than those who remained in SR. These measurements did not change significantly in either group. RMS‐p increased in SR patients

(P = 0.009)

but decreased in those who subsequently reverted to AF

(P = 0.032)

with a significant difference between the slopes of the RMS‐p change

(P = 0.006)

. Integral‐p decreased from the time of ECV in the R‐AF group only

(P = 0.0028)

and created a significant difference between the two slopes

(P = 0.0004)

. The evolution of P‐SAECG parameters after ECV differs in patients whose AF recurs versus patients who remain in SR. (PACE 2003; 26[Pt. II]:299–304)
Advanced Pacemaker Diagnostic Features in the Characterization of Atrial Fibrillation: Impact on Preventive Pacing Algorithms
Authors: YANG ALEXANDER , HOCHHÄUSLER MARC , SCHRICKEL JAN , BIELIK HELGA , SHLEVKOV NIKOLAY , SCHIMPF RAINER , OTTO SCHWAB JÖRG , ESMAILZADEH BAHMAN , SCHNEIDER CHRISTIAN , MELLERT FRITZ , WELZ ARMIN , SABOROWSKI FRIEDHELM , LÜDERITZ BERNDT , LEWALTER THORSTEN ,   on behalf of the VIP Study Group
Published: December 2004

YANG, A., et al.: Advanced Pacemaker Diagnostic Features in the Characterization of Atrial Fibrillation: Impact on Preventive Pacing Algorithms.
Pacing algorithms to prevent PAF are mainly based on the suppression of premature atrial complexes (PACs), which play an important role in its initiation. In contrast to 24‐hour ambulatory electrocardiograms, advanced pacemaker (PM) diagnostic features are capable of recording AF episodes during long follow‐up periods and of characterizing AF in a detailed fashion. For the specific use of these algorithms, a detailed characterization of AF was performed in 91 dual chamber PM recipients with histories of AF. Fifteen patients with episodes of oversensing due to far‐field signals or frequent episodes of “2:1‐undersensing” of atrial flutter were excluded. The remaining 76 patients had high recurrence rates of AF (median 0.8 episodes/day), however, the majority of episodes lasted <7 minutes. Despite frequent PACs (median 10.8/hour) during sinus rhythm, a median of 66.4% of the AF episodes were preceded by <2 PACs/min before onset. In conclusion, frequent, short‐lived AF episodes seem best suited for AF preventive pacing therapies. However, the small number of PACs preceding many AF episodes may limit the efficacy of PAC suppressing algorithms. (PACE 2003; 26[Pt. II]:310–313)
Catheter Ablation of Ventricular Tachycardia Following Myocardial Infarction Using Three‐Dimensional Electroanatomical Mapping
Authors: KAUTZNER JOSEF , ČIHÁK ROBERT , PEICHL PETR , VANČURA VLASTIMIL , BYTEŠNÍK JAN
Published: December 2004

KAUTZER, J., et al.: Catheter Ablation of Ventricular Tachycardia Following Myocardial Infarction Using Three‐Dimensional Electroanatomical Mapping.
One challenge encountered during catheter ablation of postinfarction ventricular tachycardia (VT) is the inducibility of multiple VT morphologies associated with variable hemodynamic instability. The clinical usefulness and safety of a three‐dimensional electroanatomical mapping in guiding radiofrequency (RF) catheter ablation of VT, used in parallel with a multichannel recording system, was studied in 28 men (mean age =

63.8 ± 10.6 years

, mean left ventricular ejection

fraction = 28%± 9%

). Three‐dimensional voltage maps of the left ventricle were obtained in sinus rhythm with annotation of areas of fractionated or late potentials, zones of slow conduction and/or dense scar with no pacing capture at 10 mA. RF lesions were created either in sinus rhythm or during hemodynamically stable VT within reconstructed critical zones of the circuit. A total of 82 VTs were induced

(mean = 2.9 ± 1.0/patient)

. Hemodynamically unstable clinical VTs were induced in 5 patients, and clinical or nonclinical unstable VT in 14. Clinical VT was rendered noninducible in 24/28 (85.7%) patients, and monomorphic VT was eliminated in 16/28 (57.1%) patients. The mean procedural time was

258 ± 82

minutes, and fluoroscopic exposure

13.5 ± 8.8 minutes

. During a mean follow‐up period of

10.6 ± 6.4 months

, catheter ablation was repeated in 6 patients for VT recurrences. No significant complications occurred except for a transient cerebral ischemic attack in one patient. In conclusion, electroanatomical mapping assisted the successful and safe catheter ablation of both mappable and nonmappable VTs in a significant proportion of patients after myocardial infarction. (PACE 2003; 26[Pt. II]:342–347)
Circadian Profile of QT Interval and QT Interval Variability in 172 Healthy Volunteers
Authors: BONNEMEIER HENDRIK , WIEGAND UWE K.H. , BRAASCH WIEBKE , BRANDES AXEL , RICHARDT GERT , POTRATZ JÜRGEN
Published: December 2004

BONNEMEIER, H., et al.: Circadian Profile of QT Interval and QT Interval Variability in 172 Healthy Volunteers.
The limited prognostic value of QT dispersion has been demonstrated in recent studies. However, longitudinal data on physiological variations of QT interval and the influence of aging and sex are few. This analysis included 172 healthy subjects (89 women, 83 men; mean age

38.7 ± 15

years). Beat‐to‐beat QT interval duration (QT, QTapex [QTa], Tend[Te]), variability (QTSD, QTaSD), and the mean R‐R interval were determined from 24‐hour ambulatory electrocardiograms after exclusion of artifacts and premature beats. All volunteers were fully active, awoke at approximately 7:00 am, and had 6–8 hours of sleep. QT and R‐R intervals revealed a characteristic day‐night‐pattern. Diurnal profiles of QT interval variability exhibited a significant increase in the morning hours (6–9 am; P < 0.01) and a consecutive decline to baseline levels. In female subjects the R‐R and Tend intervals were significantly lower at day‐ and nighttime. Aging was associated with an increase of QT interval mainly at daytime and a significant shift of the T wave apex towards the end of the T wave. The circadian profile of ventricular repolarization is strongly related to the mean R‐R interval, however, there are significant alterations mainly at daytime with normal aging. Furthermore, the diurnal course of the QT interval variability strongly suggests that it is related to cardiac sympathetic activity and to the reported diurnal pattern of malignant ventricular arrhythmias. (PACE 2003; 26[Pt. II]):377–382)
QT Dispersion Has No Prognostic Value in Patients with Symptomatic Heart Failure: An ELITE II Substudy
Authors: GANG YI , ONO TAKUYA , HNATKOVA KATERINA , HASHIMOTO KENICH , CAMM A. JOHN , PITT BERTRAM , POOLE‐WILSON PHILIP A. , MALIK MAREK ,   on behalf of the ELITE II investigators
Published: December 2004

GANG, Y., et al.: QT Dispersion Has No Prognostic Value in Patients with Symptomatic Heart Failure: An ELITE II Substudy.
This study prospectively investigated 3,118 standard 12‐lead ECGs recorded in 1,804 patients, who participated in the Losartan Heart Failure Survival Study—ELITE II clinical trial. After exclusion of patients with rhythms other than sinus, or atrioventricular block, or poor quality ECGs, 986 (703 men, mean age 71 ± 7 years) with baseline ECGs were retained, of whom 615 patients had follow‐up ECGs 4 months after randomization. QT intervals were manually measured with a digitizing board. Heart rate, QRS duration, maximum QT and JT intervals, QT and JT dispersion (the interval ranges across all measurable ECG leads) were analyzed. In the overall population, there were 140 (14%) deaths from all causes, including 119 (12%) cardiac and 59 (6%) sudden deaths during a follow‐up of

540 ± 153 days

. The mean heart rate was significantly faster in nonsurvivors than in survivors (

77 ± 16

vs 74 ± 14 beats/min, P = 0.006), and in patients who died of cardiac death (

76 ± 16 beats/min, P = 0.04

vs survivors). Mean QRS duration was significantly longer in nonsurvivors

(107 ± 25 ms)

, and in the subgroups who died of cardiac

(107 ± 24 ms)

or sudden death

(112 ± 23 ms)

than in survivors (

99 ± 24 ms, P < 0.01

for all). The maximum and corrected (QTc) QT intervals were similar for nonsurvivors, regardless of cause of death, and in survivors (

P = NS

for all comparisons). Significantly shorter maximum and corrected (JTc) JT intervals were observed in victims of any mode of death compared to survivors (P < 0.05 for all). There was no significant difference in QT or JT dispersion between patients with any mode of death and survivors (

P > 0.1

for all). Neither losartan nor captopril significantly modified QT or JT dispersion. In conclusion, increased QT dispersion is not associated with increased mortality in patients with heart failure, and is not suitable to examine drug efficacy in these patients. (PACE 2003; 26[Pt. II]:394–400)