bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of muscular exercise on plasma C‐peptide and insulin in obese non‐diabetics and diabetics, Type II
Authors: Krotkiewski M. , Górski J.
Published: September 2010

Summary. The levels of plasma insulin and C‐peptide during exercise and subsequent recovery have been determined in obese non‐diabetics, obese diabetics Type II and middle‐aged female controls. It has been found that exercise reduces levels of peptides both in the control and in the obese non‐diabetic group. This effect of acute exercise was found blunted in the obese diabetic group. Non‐diabetic obese subjects pretreated with phentolamine showed no reduction either in plasma insulin or C‐peptide levels during exercise. During the recovery, the level of plasma insulin returned promptly to the pre‐exercise value in the control group but increased above the resting value in obese subjects, both non‐diabetic and diabetic.

In controls and non‐diabetic obeses the increment of C‐peptide: insulin molar ratio occurred early after the onset of exercise and then returned to the resting value despite the exercise being continued. The plasma C‐peptide:insulin molar ratios were reduced during the first 15 min of recovery period in obese non‐diabetic subjects and returned to normal in the next 15 min. The latter may suggest that reduced insulin removal could also contribute to the increase in plasma insulin values in the obeses during recovery.
Comparison of two methods to assess the tissue/blood partition coefficient for xenon in subcutaneous adipose tissue in man
Authors: Jansson P.‐A. , Lönnroth P.
Published: September 2010

Summary. A new method to calculate the tissue/blood partition coefficient (Λ) for xenon in studies on the subcutaneous adipose tissue blood flow was compared with a previously reported method based on local skinfold thickness (ΛLSt). The former method included needle biopsies from the abdominal and femoral subcutaneous adipose tissue, and the mean fat cell diameter was measured (ΛECT)‐ The extracellular tissue fraction in subcutaneous tissue was then estimated from a diagram. The tissue lipid content was approximated to equal the relative intracellular volume and Ostwald's solubility coefficients for 133Xe, based on the distribution of xenon in lipid, albumin and 0.9% saline were applied. Estimated Λ‐values based on needle biopsies from the abdominal site were: 8.6±0.1 versus 9.9±0.4 ml g‐1 (meanæ) (P<0.05) and from the femoral site: 9.1±0.1 versus 9.6±0.2 in lean (n=10) and obese subjects (n=10), respectively. The corresponding Λ‐values obtained from skinfold measurements were: 6.2±0.5 versus 11.0±0.4 (P<0.001) and 6.9±03 versus 11.4±0.4 (P<0.001) in lean and obese subjects, respectively.

Pooled ΛLsT‐values correlated positively with estimated adipose tissue blood flow (ATBF) (r: 0.34, P<0.05, n=40) whereas no such correlation was found for ΛECT‐values.

In conclusion, a new method is presented which may allow an accurate determination of, and which may lead to reliable data on, subcutaneous ATBF in both lean and obese subjects. Comparative studies indicate that the widely used Λ‐value of 10.0 in subcutaneous adipose tissue may be used as a rough estimate for subcutaneous blood flow studies in these patient groups.
Spirometric and anthropometric determinants of forced expiratory time in a general population
Authors: Kainu Annette , Lindqvist Ari , Sarna Seppo , Sovijärvi Anssi
Published: September 2010

Background:  Forced expiratory time (FET) has gained new interest in the joint recommendation of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) for the assessment of spirometry. Interpretation of FET is, however, difficult as limited information is available on spirometric and anthropometric determinants of FET in populations.

Methods:  We studied a non‐selected population sample including healthy non‐smokers with a structured interview and flow‐volume spirometry. Regular medication, if any, was continued. Spirometry of 603 individuals (248 men, 355 women) fulfilled predefined quality criteria based on modified ATS recommendations. FET from the flow‐volume curve with the largest sum of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) was used in analyses.

Results:  The mean FET in the population sample was 10·7 (95% CI 10·4–11·1) s and in healthy non‐smokers 9·8 (9·2–10·4) s. Men had on average longer FET (11·3 s versus 10·3 s), but the gender difference was not significant when FEV1/FVC was used as a covariate. FEV1/FVC (r = −0·613, P<0·01) and maximal mid‐expiratory flow (MMEF) correlated negatively and age (r = 0·279, P<0·01), body mass index (BMI) and smoking pack‐years positively with FET.

Conclusions:  The findings indicate that mean FET is around 11 s in a non‐selected adult population and around 10 s in healthy non‐smokers. FET increases slightly with age and BMI, suggesting age‐ and weight‐related changes in pulmonary mechanics. The negative correlation of FET with FEV1/FVC and MMEF even in healthy non‐smokers indicates that airflow limitation, either pathological or physiological, tends to prolong FET.
Physical Activity and Hypertensive Complications During Pregnancy: Findings from 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System
Authors: Martin Chantel L. , Brunner Huber Larissa R.
Published: September 2010

Abstract:  Background:  Hypertensive complications during pregnancy occur in nearly 8 percent of pregnancies and account for 15 percent of all maternal mortalities in the United States. The purpose of this study was to investigate further the association between physical activity and hypertensive complications during pregnancy using data from a population‐based surveillance system.

Methods:  This study included 3,348 participants from the 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System. Hypertensive complications during pregnancy were assessed using birth certificate data, and physical activity levels before pregnancy and during pregnancy were self‐reported on questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders.

Results:  Although no strong association was found between physical activity before pregnancy and hypertensive complications during pregnancy, a dose–response relationship emerged for the physical activity during pregnancy‐hypertensive complications association after adjustment for prepregnancy body mass index (physical activity for 1–4 days per week: OR = 0.63, 95% CI: 0.45–0.90; physical activity for 5+ days per week: OR = 0.46, 95% CI: 0.20–1.02). When levels of physical activity before and during pregnancy were combined, a statistically significant protective effect was seen only for women who indicated that they were physically active both before and during pregnancy (adjusted OR = 0.65, 95% CI: 0.44–0.96).

Conclusions:  In this population‐based study, physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy. During a healthy pregnancy, health care practitioners may recommend that women engage in physical activity as one way to potentially prevent the development of this critical condition. (BIRTH 37:3 September 2010)
Roundtable Discussion: “No One Can Condemn You to a C‐Section!”
Authors: Feldman Perle , Cymbalist Rivka , Vedam Saraswathi , Kotaska Andrew
Published: September 2010

Abstract:  The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician. (BIRTH 37:3 September 2010)
Symptom Profile of Nasopharyngeal Cancer Patients during Radiation Therapy
Authors: Huang Hsiu‐Ying , Wilkie Diana J. , Schubert Mark M. , Ting Lai‐Lei
Published: September 2010

Purpose: This prospective, longitudinal study was aimed to describe the prevalence, severity, and pattern of symptoms over the course of radiation therapy in persons with nasopharyngeal carcinoma and to explore symptom severity by treatment modality.

description of Study: Thirty‐seven patients completed this study, and 46% received chemotherapy before radiation therapy. A self‐reported radiation symptom checklist and an objective mucositis assessment tool were used weekly to document oropharyngeal, skin, nose or ear, or more general side effects, and mucositis.

Results: Oropharyngeal problems were the most severe complaints during radiation therapy. All patients experienced dry mouth, taste change, difficulty in swallowing, difficulty in opening their mouths, hoarseness, sore throat, and observable mucositis. Most reported moderate‐to‐severe dry mouth, difficulty in swallowing, and sore throat from weeks 3 through 7. Skin problems were not prominent until week 4. Patients also lost an average of 3.9 kg during the therapy. Sequential chemotherapy and radiation therapy was associated with more severe oropharyngeal problems than radiation therapy alone, but no significant differences in other problems were found.

clinical Implications: Despite recognition of the oropharyngeal side effects associated with irradiation, effective management protocols for such symptoms have not been implemented in the studied institution. The frequency and intensity of the symptoms reported indicate an urgent need for increased vigilance about radiation‐related side effects and pain management. As well, patient education about expected side effects may help mitigate the anxiety that patients experience when these symptoms occur.
Physical Functioning and Depression Among Older Persons with Cancer
Authors: Kurtz Margot E. , Kurtz J. C. , Stommel Manfred , Given Charles W. , Given Barbara
Published: September 2010

Purpose: The purpose of this study was to help identify factors to assess which elderly patients are likely to experience problems with physical and psychological functioning in association with cancer or its treatment.

description of Study: A study was undertaken with a sample of 420 patients with cancer who were between the ages of 65 and 98 years and had received an incident diagnosis of breast, colon, lung, or prostate cancer. An analysis of covariance technique was used to determine how cancer site, treatment type, stage of disease, gender, age, comorbidity, symptom severity, and prediagnosis levels of physical functioning were related to physical functioning deficit, and how all of these in turn influenced patient depressive symptomatology.

Results: Prediagnosis physical functioning, symptom severity, and days since surgery were significant predictors of physical functioning deficit. Patients who had been treated only with surgery experienced greater physical functioning deficits than did patients who had received both surgery and adjuvant therapy. This apparent anomaly was partly explained by the time interval from surgery to interview. Higher levels of symptom severity, lower levels of prior physical functioning, and greater physical functioning deficits all predicted higher levels of depressive symptomatology.

clinical Implications: In the care of elderly patients with cancer, it is important for healthcare providers to consider the prediagnosis levels of physical functioning of patients with cancer to understand and anticipate the physical and psychological consequences of cancer and its treatment. Equally important is the proper management of patient symptoms in maximizing both the physical and psychological quality of life.
Lake Superior Rural Cancer Care Project
Authors: Elliott Thomas E. , Elliott Barbara A. , Regal Ronald R. , Renier Colleen M. , Crouse Byron J. , Gangeness David E. , Witrak Martha T. , Jensen Patricia B.
Published: September 2010

Purpose: To date, effective cancer care and control intervention studies have been carried out largely in urban and suburban populations. This study was conducted to test innovative interventions, using experimental designs, to improve the care and outcomes of patients with cancer in rural settings.

Description of Study: The Lake Superior Rural Cancer Care Project (LSRCCP) tested an innovative, multimodal, multidisciplinary intervention that involved rural healthcare providers and their healthcare system. An experimental design was used, with the rural community as the unit of randomization. Outcomes were measured at three levels: rural providers' knowledge of cancer management, providers' practice performance, and patient outcomes. This 5‐year study was conducted in rural areas of northern Minnesota, Wisconsin, and the western part of the Upper Peninsula of Michigan.

Results: Baseline data from the study are provided, and details of the design and methods are presented. The study outcomes are reported in part in “Lake Superior Rural Cancer Care Project Part II” in this issue and will be reported further in future issues.

Clinical Implications: This article describes the hypotheses, design, and methods of the LSRCCP. The design and methods as well as the results of this study may be useful to cancer researchers and clinicians in rural areas across the United States.
Unanswered Questions about Public Service Motivation: Designing Research to Address Key Issues of Emergence and Effects
Authors: Wright Bradley E. , Grant Adam M.
Published: September 2010

As public service motivation research gains momentum, important questions emerge regarding its origins and consequences that are not addressed by existing research. The authors identify some fundamental public service motivation assumptions, including critical gaps in our current understanding of its basic tenets. The authors then discuss specific research studies that, by virtue of their findings and designs, may fill in and inform such apparent gaps. Their aim is to chart new concrete directions for scholarship that complements and advances existing public service motivation research.
Beyond Bureaucracy—Public Administration as Political Integrator and Non‐Weberian Thought in Germany
Authors: Seibel Wolfgang
Published: September 2010

The political role of public administration holds an ambiguous status in public administration theory. The dominant paradigms of the discipline offer more or less negative perspectives. Max Weber’s notion of bureaucracy conceives public administration as the apolitical tool of government, while the public choice school conceives it as the realm of individual selfishness and rent seeking at taxpayers’ expense. In this unfavorable epistemological environment, positive concepts of what makes public administration “political” can hardly flourish. However, as public authorities may organize clientele participation and consequently co‐opt stakeholders, they provide for symbolic sense making and create patterns of identity. Public administration thus works as a political integrator in its own right. Unfortunately, this subject is not prominent within contemporary scholarly research. German political integration through administration is analyzed here in order to address these and related theoretical questions.
Analytics and Beliefs: Competing Explanations for Defining Problems and Choosing Allies and Opponents in Collaborative Environmental Management
Authors: Weible Christopher M. , Moore Richard H.
Published: September 2010

The rationale for collaborative environmental management often hinges on two factors: first, specialized training creates biased analytics that require multidisciplinary approaches to solve policy problems; second, normative beliefs among competing actors must be included in policy making to give the process legitimacy and to decide trans‐scientific problems. These two factors are tested as drivers of conflict in an analysis of 76 watershed partnerships. The authors find that analytical bias is a secondary factor to normative beliefs; that depicting the primary driver of conflict in collaborative environmental management as between experts and nonexperts is inaccurate; that compared to the “life” and “physical” sciences, the social sciences and liberal arts have a stronger impact on beliefs and choice of allies and opponents; and that multiple measures are needed to capture the effect of analytical biases. The essay offers lessons for public administrators and highlights the limitations and generalizations of other governing approaches.
Public Trust in Government in Japan and South Korea: Does the Rise of Critical Citizens Matter?
Authors: Kim Soonhee
Published: September 2010

Based on the Asia Barometer Survey of 2003, 2004, and 2006, government performance, citizen empowerment, and citizen satisfaction with self‐expression values are associated with public trust in government in Japan and South Korea. This study finds, first, that government performance on the economy, controlling political corruption, the quality of public services, crime, and attention to citizen input are significantly associated with broad public trust in government in both Japan and South Korea. Likewise, citizens’ satisfaction with their right to gather and demonstrate and to criticize the government is closely connected to trust in central and local governments in Japan. In South Korea, citizens’ satisfaction with their right to gather and demonstrate is intimately linked to trust in local government. Implications for government leadership to enhance performance, transparency, citizen participation, and public trust in government are analyzed and elaborated upon in this insightful study.
Confidence Intervals for Uncommon but Dramatic Responses to Treatment
Authors: Rosenbaum Paul R.
Published: September 2010

Summary A small literature discusses locally most powerful rank tests when only a fraction of treated subjects respond to treatment. The ranks used in these tests are very different from conventional ranks, being relatively flat for low responses and then rising steeply, and the associated tests are much more powerful than conventional rank tests when, indeed, only a small fraction of treated subjects exhibit dramatic responses. Because the tests are derived from considerations of local power, they do not yield a plausible family of models for effect, and therefore they do not yield confidence intervals for the magnitude of effect formed by inverting the tests. There is a similarity between these tests and another family of tests, originally motivated by different considerations involving peak performance in small subsets. Exploiting this similarity, a method for obtaining confidence statements is proposed. In the case of observational studies, sensitivity to unobserved bias from nonrandom assignment of treatments is also examined. Two examples are used as illustrations: (i) a study of smoking during pregnancy and its effects on birth weight, in which smokers are matched to six controls, and (ii) a matched pair study of damage to DNA among workers at aluminum production plants.
Comparison of Distributions of Ventricular Periods During Paroxysmal Atrial Fibrillation and Sinus Rhythm
Authors: Hnatkova Katerina , Murgatroyd Francis D. , Alferness Clif A. , Camm A. John , Malik Marek
Published: September 2010

Background: The mean ventricular rate is known to be, on average, higher during episodes of paroxysmal atrial fibrillation (AF) than during the sinus rhythm. The data on other statistical parameters of ventricular periods are less known, especially in the respect of atrial premature beats, which are frequent in paroxysmal AF patients while in sinus rhythm.

Methods: This study investigated distinction between paroxysmal AF and sinus rhythm based on statistical parameters of 60‐second segments of RR interval series from paroxysmal AF and sinus rhythm episodes. The data of the study were taken from 54 long‐term Holter recordings of 31 paroxysmal AF patients. For each segment, the mean, standard deviation, skewness, and kurtosis of RR intervals were computed. The values obtained from segments of paroxysmal AF and sinus rhythm were used in attempts to distinguish both rhythms. The distinction was evaluated using: (1) statistical comparison of each parameter in each tape; and (2) receiver operator characteristics (ROCs) (dependency of specificity on sensitivity) computed in each tape for each individual parameter as well as for multivariate combinations of all four parameters.

Results: The comparison found the mean RR to be the most powerful discriminator of all statistical parameters used in the distinction of paroxysmal AF and sinus rhythm. The standard deviation of RR intervals differentiated significantly the segments of sinus rhythm and paroxysmal AF in pool data. However, when applied to individual Holter recordings, the distinction between paroxysmal AF and sinus rhythm based on standard deviation of RR intervals (assessed with ROC) was the worst among all investigated parameters.

Conclusions: The study suggests that an automatic distinction between paroxysmal AF and sinus rhythm episodes is highly problematic, mainly because of the frequent atrial premature beats that pollute sinus rhythm episodes in patients with paroxysmal AF.
Restoring Sinus Rhythm in Atrial Fibrillation: Electrical or Pharmacological Cardioversion
Authors: Lévy Samuel
Published: September 2010

Restoration of sinus rhythm represents a desirable endpoint in patients with persistent (nonselfterminating) episode of paroxysmal atrial fibrillation (AF) and in selected patients with chronic AF. The decision whether to cardiovert AF pharmacologically or electrically is unresolved. Pharmacological cardioversion with oral quinidine first used to terminate recent onset AF is no longer used in Europe because its safety has been questioned. Other oral antiarrhythmic agents were used orally in this indication including procaînamide, disopyramide, and oral amiodarone. More recently, oral flecaînide and oral propafenone have been used in recent onset AF. Success rates ranging between 67% and 95% were reported in placebo‐controlled studies. Pharmacological cardioversion can also routinely be obtained in hospital practice using intravenous injection of an antiarrhythmic agent. Intravenous digoxin, although commonly used, has shown in controlled studies to be no better than placebo. Intravenous amiodarone in open studies was associated with high success rates. Intravenous flecaînide, intravenous propafenone, and intravenous cibenzoline have been reported to be sucessful in recent onset AF. It is important to keep in mind that pharmacological cardioversion carries the risk of flutter with 1:1 conduction and ventricular proarrhythmia. The safety of pharmacological cardioversion using oral agents should be assessed in a hospital environment before allowing outpatient use. External (transthoracic) electrical cardioversion remains the technique of choice for restoring sinus rhythm in chronic AF. The success rates range from 65% to 90%. A technique of high energy electrical DC (200J or 300J) internal cardioversion has been shown to be useful in patients who failed external conversion. Recently, a technique for low‐energy (> 6J) cardioversion of AF using biphasic shocks, electrode catheters positioned in the right atrium (cathode), and the coronary sinus (anode), was found to restore sinus rhythm in 70%‐88% of patients. Internal cardioversion is emerging as a therapeutic alternative in selected groups of AF patients, particularly in those who failed external cardioversion.
The Diagnostic Value of ST Segment Analysis in Ambulatory ECG Monitoring Evaluated Using Bayes' Theorem in Patients Screened for Coronary Artery Disease
Authors: Piotrowicz Ryszard , Dabrowski Andrzej , Kwiatkowski Wojciech
Published: September 2010

Background: The diagnostic value of ambulatory ECG monitoring in screening for coronary artery disease has been studied in diverse and usually small groups of patients. There are no studies evaluating the diagnostic value of Holter recorded ST depression using the Bayes' theorem of probability, which accounts for the prevalence of the disease in prespecified populations.

Purpose: Applying the Bayes' theorem, this study aimed to examine the diagnostic value of Holterrecorded 1‐mm ST depression in patients screened for coronary artery disease (CAD) and to identify groups of patients who may benefit from diagnostic ST segment monitoring in ambulatory ECG recordings.

Methods: The ST segment analysis was performed in 24‐hour ambulatory ECG monitoring of 460 subjects (375 males; aged 35–65, mean 48.6 years), who were screened for CAD and had coronary angiography. The Bayes' formulae were used to calculate the predictive value of ST segment monitoring (posttest likelihood of CAD) in comparison to pretest likelihood of the disease based on age, gender, and symptoms.

Results: The 1‐mm ST depression was identified in the ambulatory ECG monitoring in 203 (44%) patients. CAD was angiographically confirmed in 279 (61%) patients. The 1‐mm ST depression had 54% sensitivity, 71% specificity, 74% positive predictive value, and 50% negative predictive value for CAD. The Bayes' theorem analysis with adjustment for pretest likelihood of the disease in relation to age, gender, and symptoms showed that 1‐mm ST segment depression is significant diagnostically in patients with pretest likelihood of the disease exceeding 75%, i.e., in males aged 35–45 years and females aged 56–65 years, both with typical angina. In other groups of patients regardless of the symptoms, age, and gender, detection of ST segment depression does not improve the diagnostic process. A negative result (absence of ST segment depression) can be helpful, confirming the absence of CAD in patients with 15%–25% pretest likelihood of the disease, i.e., in females aged 35–45 years with atypical angina pains and in males aged 46–55 years with nonanginal chest pains.

Conclusions: Based on our observations, the 1‐mm ST segment depression detected on 24‐hour ambulatory ECG monitoring indicates a high likelihood of CAD in patients with < 75% pretest likelihood of the disease. ST segment analysis in other age and gender relative groups of patients, regardless of the nature of their symptoms, does not significantly improve diagnosis process.
Microvolt T‐Wave Alternans for Risk Stratification in Athletes with Ventricular Arrhythmias: Correlation with Programmed Ventricular Stimulation
Authors: Inama Giuseppe , Pedrinazzi Claudio , Durin Ornella , Nanetti Massimiliano , Donato Giorgio , Pizzi Rita , Assanelli Deodato
Published: September 2010

Background: Aim of our study is to evaluate the role of T‐wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results.

Methods: We studied 85 Ath with VA (61 M, mean age 32 ± 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow‐up of 30 ± 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT).

Results: TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow‐up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS.

Conclusion: TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.
Sodium Channel Blockers Enhance the Temporal QT Interval Variability in the Right Precordial Leads in Brugada Syndrome
Authors: Kanemori Tetsuzou , Shimizu Hiroki , Oka Katsumi , Furukawa Yoshio , Hiromoto Kenji , Mine Takanao , Masuyama Tohru , Ohyanagi Mitsumasa
Published: September 2010

Background: Temporal QT interval variability is associated with sudden cardiac death. The purpose of this study was to evaluate temporal QT interval variability in Brugada syndrome (BS).

Methods: We measured QT and RR intervals in precordial leads (V1–V6) based on 12‐beat resting ECG recordings from 16 BS patients (B group) with spontaneous ST elevation in right precordial leads (V1–V2) and from 10 patients with normal hearts (C group). We measured the response in B group before and after administration of pilsicainide (1 mg/kg). The standard deviation (QT‐SD, RR‐SD) of the time domain and total frequency power (QT‐TP, RR‐TP) were calculated for all precordial leads, and the latter was to analyze the frequency domain.

Results: The right precordial leads in BS exhibited an additional and prominent ST elevation (coved‐type) after pilsicainide administration. Both QT‐SD and QT‐TP values were significantly more increased in B, than in C (5.1 ± 1.2 vs 3.6 ± 0.2 and 23.4 ± 2.9 vs 12.3 ± 1.7 msec2, P < 0.01, respectively) and after pilsicainide administration in B. (5.1 ± 0.4 vs 3.9 ± 0.3, 25.8 ± 3.4 vs 16.3 ± 2.6 msec2, P < 0.01, respectively) However, QT‐SD and QT‐TP did not significantly change in any of other leads (V3–V6) and RR‐SD and RR‐TP were similar for both groups, as well as after intravenous pilsicainide administration in B.

Conclusions: The temporal QT interval variability was identified in BS. Moreover, sodium channel blocker induced temporal fluctuation in QT interval and it may possibly provide a substrate for ventricular arrhythmia in BS patients.
Variable Morphology Wide Complex Rhythm: What Is the Etiology?
Authors: Silver Eric S. , Starc Thomas J. , Pass Robert H. , Liberman Leonardo
Published: September 2010

We report a case of an infant who developed transient complete heart block following aortic and mitral valve surgery. In the course of his recovery, he developed a variable morphology wide complex rhythm with intermittent narrow complex beats. Review of his initial postoperative electrocardiogram (ECG), which demonstrated a right bundle branch block, helped to clarify the rhythm.
The Impact of the Distance between the Atrial Electrode and the Atrial Wall on Atrial Undersensing in Patients with VDD Pacemakers: Long‐Term Follow‐Up
Authors: Altin Timucin , Guldal Muharrem , Candemir Basar , Polat Cegerhun , Ozdemir Aydan O. , Tulunay Cansin , Ozdol Cagdas , Akyurek Omer , Karaoguz Remzi , Erol Cetin
Published: September 2010

Aim: Atrial undersensing (AUS) in single‐lead VDD pacemakers may be due to diminished P‐wave amplitude secondary to local inflammation beneath the electrodes closer to atrial wall. The aim of this study was to assess the potential effect of distance between atrial electrode and atrial wall on immediate and long‐term atrial sensing stability in VDD systems.

Methods: A total of 275 patients with normal sinus node function who received VDD pacemakers were enrolled into the study and were followed up for a median duration of 33 months. During each control visit, a standard 12‐lead electrocardiogram (ECG) was obtained and standard pacemaker function assessment was performed including testing for pacing threshold and atrioventricular synchrony. The distance between atrial electrode and atrial wall was measured from chest X‐ray.

Results: Of the 275 patients, AUS was detected in 59 patients. Univariate predictors of AUS were use of closely spaced bipolar ring atrial electrode (CSBR) (P = 0.01), wider atrial ring‐spacing (P = 0.03), and atrial sensitivity programmed to a higher level (P = 0.001). Use of CSBR (P = 0.04) and atrial sensitivity ≥0.3 mV (P = 0.02) were observed to be the independent predictors for AUS. When the distance between atrial electrode and atrial wall was <7 mm, AUS was less with diagonally arranged bipolar ring electrodes (DABR) than it was with CSBRs (P = 0.02).

Conclusions: The distance between atrial electrode and atrial wall does not appear to affect AUS incidence in VDD pacemakers. For VDD electrodes closer to atrial wall, AUS was significantly less likely in DABR‐type electrodes.
Postextrasystolic Changes in the Complexity of the QRS Complex and T Wave
Authors: Batchvarov Velislav N. , Camm A. John
Published: September 2010

We tested the hypothesis that ventricular repolarization of the first sinus beat following a ventricular premature beat (VPB) can be modulated in the absence of clearly discernible T‐wave changes. We applied principal component analysis (PCA) to assess QRS and T‐wave complexity of sinus beats preceding and following VPBs in multiple 10‐second resting 12‐lead electrocardiograms of two subjects with frequent VPBs and no apparent heart disease. In both subjects, T‐wave complexity of the first post‐VPB beat was significantly increased compared to the beats preceding the VPB.
T‐Wave Alternans: Reviewing the Clinical Performance, Understanding Limitations, Characterizing Methodologies
Authors: Garcia Euler de Vilhena
Published: September 2010

Accurate recognition of individuals at higher immediate risk of sudden cardiac death (SCD) is still an open question. The fortuitous nature of acute cardiovascular events just does not seem to fit the well‐known model of ventricular tachycardia/fibrillation induction in a static arrhythmogenic substrate by a synchronous trigger. On the mechanism of SCD, a dynamical electrical instability would better explain the rarity of the simultaneous association of a correct trigger and an appropriate cardiac substrate. Several studies have been conducted trying to measure this cardiac electrical instability (or any valid surrogate) in an ECG beat stream. Among the current possible candidates we can number QT prolongation, QT dispersion, late potentials, T‐wave alternans (TWA), and heart rate turbulence. This article reviews the particular role of TWA in the current cardiac risk stratification scenario. TWA findings are still heterogeneous, ranging from very good to nearly null prognostic performance depending on the clinical population observed and clinical protocol in use. To fill the current gaps in the TWA base of knowledge, practitioners, and researchers should better explore the technical features of the several technologies available for TWA evaluation and pay greater attention to the fact that TWA values are responsive to several factors other than medications. Information about the cellular and subcellular mechanisms of TWA is outside the scope of this article, but the reader is referred to some of the good papers available on this topic whenever this extra information could help the understanding of the concepts and facts covered herein.
An On‐Line Study of Japanese Nesting Complexity
Authors: Nakatani Kentaro , Gibson Edward
Published: September 2010

This paper reports the results of a self‐paced reading experiment in Japanese in which the materials consisted of four versions of successively more nested syntactic structures. It was found that (1) people read the more nested materials slower than the less nested materials; and (2) the locus of the relative slowdown occurred early in the nested structures. There was no corresponding slowdown when processing the verbs at the end of each clause. The results are therefore not predicted by retrieval‐based integration accounts of syntactic complexity. Rather, the results support expectation‐based accounts of syntactic complexity for these materials.
Tissue response to poly‐L‐lactide acid‐polyglycolic acid absorbable screws in autogenous bone grafts: a histologic morphological analysis
Authors: Matsumoto Mariza Akemi , Filho Hugo Nary , Padovan Luís Eduardo Marques , Kawakami Roberto Yoshio , De Assis Taveira Luís Antônio
Published: September 2010

Objectives: To evaluate the local bone condition of autogenous chin grafts in contact with resorbable polymers fixation devices.

Material and methods: Seven patients presenting severe maxillary and mandibular atrophy underwent alveolar ridge reconstruction with autogenous chin grafts fixed with conventional metallic screws, who received poly l‐lactide acid–polyglycolic acid and titanium test screws for histological evaluation after 4 months of implantation.

Results: Viable bone tissue could be seen in the specimens related to titanium test screws, with no signs of bone resorption or inflammation. A thick layer of fibrous connective tissue was observed between the resorbable test screws and bone tissue, which presented a few areas of resorption.

Conclusion: There are no contraindications of both materials for use as fixation devices in autogenous bone grafts. However, care must be taken when using absorbable screws in a period of 4 months, which can interfere with the sequence of the treatment with endosseous dental implants.
Surgical navigation for implant placement using transtomography
Authors: Bousquet Frederic , Joyard Marion
Published: September 2010

Objectives: To present a new guidance technique using transtomography in the operating room and to test the accuracy of this surgical protocol.

Material: A new concept of operating room, integrating when necessary this imagery to secure flapless procedures by intraoperative control, is described. This operating room concept, including X ray protection of the operators, is explained in addition to the transport system of the panoramic machine for its transfer to the patient who remains seated on his surgical chair.

Methods: Twenty‐five single‐tooth edentulous patients were treated by implant placement with a flapless or a minimally invasive procedure using transtomographic navigation. The surgical protocol is explained: after the first limited drill through mucosa and bone, intraoperative transtomography is performed with a custom‐made titanium guide inserted into the bone. Images show the drilling axis in three dimensions. This form of navigation allows rectifying the drill axis. We explain how this protocol respects asepsis.

Results: The mean angular deviation was 2.04° in the mesiodistal direction (range: 0°–4.8°, variance: 2.88) and 2.71° in the buccal or the palatolingual direction (range: 0°–5.4°; variance: 2.63). Implant tip deviation was calculated: the mean mesiodistal tip deviation was 0.42 mm, and the mean buccal or palatolingual tip deviation was 0.5 mm. The maximum tip mesiodistal deviation was 1.08 mm and the maximum vestibular or palatolingual tip deviation was 1.22 mm.

Conclusion: This protocol appears to be as accurate as other guided or navigation systems. The advantages and limitations of this technique are explained, followed by future prospects with the new 3D cone beam computed tomography developed with the same panoramic machine.
ECSI ‐ A new index for evaluating caries progression
Authors: Wagg B. J.
Published: September 2010

abstract ECSI (Extrapolated Carious Surface Increment Index) is a caries progression index which takes into account the enlargement of existing lesions as well as the initiation of new ones. It differs in principle from previously described progression indices in that it is de‐fined as an interval scale which allows expression of the increment as a single figure. It is also unique in that it relates fillings and extractions to their preceding caries state. Detailed analysis of data from caries clinical trials shows that different populations which are apparently similar as judged on the basis of conventional DMF indices can in fact be shown to be grossly different as a result of different denial treatment patterns. Furthermore, the fundamental assumption of the DMFS index that an extracted tooth is equivalent to four or five‐carious surfaces is demonstrably false; the true figure obtained from the data studied is nearer 2.25. These shortcomings have been corrected in the ECSI logic.
Timing of permanent tooth emergence in Danish children
Authors: Helm Sven , Seidler Bjorn
Published: September 2010

abstract Mean times of emergence of the permanent teeth, except the third molars, and mean times of onset of specific dental stages were studied cross‐sectionally in nearly 8,000 Danish children. In both sexes, a tendency for grouped emergence was observed, the teeth within a group showing similar mean times of emergence. The following groups were distinguishable: (1) the first molar in each jaw and the mandibular central incisor, (2) the maxillary central and mandibular lateral incisor, (3) the mandibular canine and the first premolar in each jaw, and (4) the maxillary canine and the second premolar in each jaw. The sex difference in emergence timing ranged from 2–11 months. In Denmark, the first visit to the Child Dental Services usually takes place when the children enter school in the year they attain the age of 7 years. The present findings indicate that, in order to include the initial phase of permanent tooth emergence, organized dental care should be introduced at least 1 year earlier.
Geographic variations in dental services provided to older adults in Ontario, Canada
Authors: Locker D. , Clarke M.
Published: September 2010

Abstract– In an initial study, Leake et al. (J Public Health Dent 1996; 52: 182–90) found that older Ontarians living in metropolitan communities received almost twice the amount of dental care than older Ontarians living in non‐metropolitan communities. Since data were collected for the 2 years prior to the enrolment of subjects in a longitudinal study, factors responsible for this variation could not be explored. This paper extends thesendings by examining the volume of dental services received by these subjects in the 3 years between the baseline and follow‐up phases of the longitudinal study. During this 3‐year period, geographic variations in the volume of services provided were also observed. In a regression analysis, geographic location remained a significant predictor of the number of services received after controlling for six other explanatory variables: insurance coverage, number of teeth, restorative treatment need, self‐rated oral health, regular dental visits and use of specialist services. Together, these explained only 24% of the variance in service provision. Since patient‐reported outcomes were better in the communities with higher volumes of provision, further research concerning the patient and dentist factors inuencing treatment provision is warranted.
Quantifying the diffused benefit from water fluoridation in the United States
Authors: Griffin Susan O. , Gooch Barbara F. , Lockwood Stuart A. , Tomar Scott L.
Published: September 2010

Abstract – Objective: To estimate the total contribution of water fluoridation to caries reduction by including the benefit from the diffusion of fluoride from fluoridated communities to surrounding nonfluoridated communities via the export of bottled beverages and processed foods. Methods: We analyzed data from the 1986–87 NIDR Children's Survey for 18 507 school children aged 6–17 years who had at least one permanent tooth and for whom a complete fluoride exposure history could be created. To measure water fluoridation exposure, we generated continuous and categorical exposure variables. Years of fluoridation exposure (YFE‐continuous) measured the number of years the child lived at residences receiving fluoridated water. Lifetime fluoridation exposure (LFE‐categorical) was high if the child lived at residences receiving fluoridated water more than 50% of his life and low, otherwise. We summed the proportion of state population receiving fluoridated water times the number of years the child had lived in each state and then divided this value by the child's age to measure diffusion exposure (DE). We grouped DE into three levels: low (DE<=0.25), medium (0.25<DE<0.55), and high (DE>=0.55). For each level of DE, we compared the age‐adjusted mean DMFS for high and low LFE. In addition we used linear regression to measure the association between DMFS and YFE while controlling for DE, age, exposures to other fluoride sources, and sociodemographic variables. Reported results are significant at P<0.05. Results: Comparison of mean DMFS scores found that the direct benefit of water fluoridation (DMFSLFE=low– DMFSLFE=high) was 1.44 surfaces among low DE children and 0 among high DE children. The diffused benefit (DMFSLFE=low, DE=low– DMFSLFE=low, DE=high) was 1.23 surfaces. The regression results were similar and indicated that the direct benefit would be 1.44 fewer DMFS for low DE children and the indirect benefit would be 1.09 fewer DMFS for high DE children. Conclusion: Failure to account for the diffusion effect may result in an underestimation of the total benefit of water fluoridation, especially in high diffusion exposure regions.
Development of molecular immunoassay system for probiotics via toll‐like receptors based on food immunology
Authors: KITAZAWA Haruki , TOHNO Masanori , SHIMOSATO Takeshi , SAITO Tadao
Published: September 2010

Recent interest has focused on the importance of intestinal immunity for the host defense, but to date, not much is known about the underlying mechanisms. The toll‐like receptor (TLR) family plays an important role in host defense through recognizing bacterial pathogen‐associated molecular patterns. Our recent research on the physiological function of food products has investigated the immunoregulatory effects of probiotic lactic acid bacteria (LAB) via TLR. Studies of swine, which often substitute for a human model, have demonstrated intestinal immunoregulation by the probiotic LAB mediated by TLR in the gut. On the basis of our study, efforts have also been made to develop a molecular immunoassay system for probiotic LAB and find novel immunostimulatory DNA sequences from probiotics and high potential immunobiotic LAB strains via TLR signaling. These findings may provide important clues at the molecular level on TLR signal transduction pathways and recognition mechanisms for the ligands. They also provide impetus to further delineate the activation mechanism of the innate immune response. In addition to identifying immunoregulatory factor immunogenics from LAB, a better understanding of intestinal immune regulation through cytokine networks holds out promise for basic food immunology research and the development of immunobiotic foods to prevent specific diseases.