bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Conduction Delays Induced by Right Ventricular Apical Pacing: Effect of Left Ventricular Dysfunction and Bundle Branch Block
Authors: VARMA NIRAJ
Published: October 2007

Background: RV apical pacing (RVP) may be deleterious, possibly by simulating LBBB, i.e., prolonging QRS duration (QRSd) and LV activation (LVAT). However, determinants of electrical delays are unknown.

Hypothesis: LV dysfunction (LVEF ≤ 40%, HF) and pre‐existing conduction system abnormalities may modulate RVP's effects, compared to LBBB.

Methods: RVP‐induced QRSd and LVAT were compared in normal LV to HF, with normal QRS (<120 ms), RBBB, or LBBB. LVAT was estimated by interval from QRS onset to basal inferolateral LV depolarization.

Results: During LBBB and RVP, LVAT/QRSd was ≥85%, i.e., LVAT indicated terminal LV depolarization. In normal LV, LVAT during intrinsic conduction (55 ± 18 ms) was delayed by RVP (129 ± 20 ms, n = 58, P < 0.001). RVP's effects were similar to LBBB (P = NS) and unaffected by baseline conduction disease. In HF overall, RVP‐induced delays (QRSd 209 ± 27, LVAT 186 ± 26 ms, n = 102) were greater than RVP in normal LV (P < 0.001). When baseline conduction system disease was present, RVP's effects were exaggerated (RVP wide QRS [>120 ms]: QRSd 216 ± 27, LVAT 191 ± 20 ms, [n = 72] vs RVP normal QRS: QRSd 193 ± 24, LVAT 169 ± 24 ms, n = 31, P < 0.001). In patients with LBBB (n = 41), delays during intrinsic conduction (QRSd 163 ± 29, LVAT 137 ± 33 ms, n = 41) were enhanced by RVP (QRSd 218 ± 28, LVAT 191 ± 22 ms, P < 0.001). RVP's effects were similar in patients with LBBB and RBBB (P = NS).

Conclusion: RVP simulated LBBB in normal LV. In HF, RVP induced greater conduction delays than LBBB, enhanced by accompanying conduction disease. These variations may contribute to RVP's mixed clinical effects.
A Novel Hybrid Transcatheter Ablation System That Combines Radiofrequency and Cryoenergy
Authors: KHAIRY PAUL , CARTIER CATHERINE , CHAUVET PATRICK , TANGUAY JEAN‐FRANÇOIS , SIMÉON BERTIN , LALONDE JEAN‐PIERRE , DUBUC MARC
Published: October 2007

Introduction: Radiofrequency (RF) and cryoenergy are largely considered independent modalities for the transcatheter ablation of cardiac arrhythmias. There are numerous theoretical advantages to engineering a system capable of delivering both energy forms.

Methods and Results: We designed a hybrid steerable catheter capable of delivering RF and cryoenergy independently, sequentially, and simultaneously. The novel catheter system was tested pre‐clinically by creating a total of 180 ablation lesions in 20 mongrel dogs. Right atrial and right and left ventricular sites were preselected by a randomized factorial design devised to compare sequential and simultaneous RF and cryoenergy applications to standard RF, irrigated RF, and standard cryoablation. A steerable 4‐mm electrode‐tip hybrid catheter (“Fire and Ice”) was created by modifying a 7 F cryocatheter (Freezor™, CryoCath Technologies, Montreal, Canada). RF energy was injected via a copper wire, thermocouples were isolated to reduce RF interference, and 100 KHz band pass filters and RF chokes were added. Sequential low‐dose RF (20 W, 60 seconds) preceding or following cryoablation resulted in larger lesions (P = 0.0010). The addition of RF energy did, however, produce more thrombus than cryoenergy alone, with clot detected on 82.4% versus 12.1% of ablation lesions, P < 0.0001. Simultaneously applying the two energy modalities (45 W, 10 or 30°C, 60 seconds) created more voluminous lesions than standard RF ablation (median 288.1 vs 126.1 mm3, P = 0.0333) of similar dimension to irrigated RF ablation.

Conclusion: A versatile catheter system was fashioned capable of creating standard cryoablation lesions, standard RF lesions, and simultaneous lesions of similar dimension to irrigated RF.
Association of Congenital, Diffuse Electrical Disease in Children with Normal Heart: Sick Sinus Syndrome, Intraventricular Conduction Block, and Monomorphic Ventricular Tachycardia
Authors: ITURRALDE‐TORRES PEDRO , NAVA‐TOWNSEND SANTIAGO , GÓMEZ‐FLORES JORGE , MEDEIROS‐DOMINGO ARGELIA , COLÍN‐LIZALDE LUIS , HERMOSILLO ANTONIO G. , VICTORIA DIANA , MÁRQUEZ MANLIO F.
Published: October 2007

Introduction: Rhythm disturbances in children with structurally normal hearts are usually associated with abnormalities in cardiac ion channels. The phenotypic expression of these abnormalities (“channelopathies”) includes: long and short QT syndromes, Brugada syndrome, congenital sick sinus syndrome, catecholaminergic polymorphic ventricular tachycardia, Lènegre‐Lev disease, and/or different degrees of cardiac conduction disease.

Methods: The study group consisted of three male patients with sick sinus syndrome, intraventricular conduction disease, and monomorphic sustained ventricular tachycardia. Clinical data and results of electrocardiography, Holter monitoring, electrophysiology, and echocardiography are described.

Results: In all patients, the ECG during sinus rhythm showed right bundle branch block and long QT intervals. First‐degree AV block was documented in two subjects, and J point elevation in one. A pacemaker was implanted in all cases due to symptomatic bradycardia (sick sinus syndrome). Atrial tachyarryhthmias were observed in two patients. The common characteristic ventricular arrhythmia was a monomorphic sustained ventricular tachycardia, inducible with ventricular stimulation and sensitive to lidocaine. In one patient, radiofrequency catheter ablation was successfully performed. No structural abnormalities were found in echocardiography in the study group.

Conclusion: Common clinical and ECG features suggest a common pathophysiology in this group of patients with congenital severe electrical disease.
ECG Clues for Diagnosing Ventricular Tachycardia Mechanism
Authors: RILEY MICHAEL P. , MARCHLINSKI FRANCIS E.
Published: October 2007

Three mechanisms underlie the initiation and maintenance of ventricular tachycardia: automaticity, triggered activity, and reentry. As straightforward as these mechanisms are, assessing which mechanism is operative in a particular patient's ventricular tachycardia can be difficult. The optimal treatment strategy for ventricular tachycardia in a given patient can be influenced by the mechanism underlying the ventricular tachycardia. Appropriately counseling patients, choosing the optimal pharmacologic agent that maximizes efficacy while minimizing undesirable side effects, risks, and toxicities, as well as recommending and timing ablative therapy all hinge on identifying the probable mechanism of ventricular tachycardia. Much has been published regarding invasive electrophysiologic maneuvers that allow for correct diagnosis of ventricular tachycardia mechanism. The aim of this clinical review is to provide insight into VT mechanisms based on ECG clues of spontaneous arrhythmia events and the response to pharmacologic manipulation prior to invasive electrophysiologic evaluation.
Finite Element Analysis of Stent Deployment: Understanding Stent Fracture in Percutaneous Pulmonary Valve Implantation
Authors: SCHIEVANO SILVIA , PETRINI LORENZA , MIGLIAVACCA FRANCESCO , COATS LOUISE , NORDMEYER JOHANNES , LURZ PHILIPP , KHAMBADKONE SACHIN , TAYLOR ANDREW M. , DUBINI GABRIELE , BONHOEFFER PHILIPP
Published: October 2007

Objectives: To analyze factors responsible for stent fracture in percutaneous pulmonary valve implantation (PPVI) by finite element method.

Background: PPVI is an interventional catheter‐based technique for treating significant pulmonary valve disease. Stent fracture is a recognized complication.

Methods: Three different stent models were created: (1) platinum–10% iridium alloy stent – resembles the first‐generation PPVI device; (2) same geometry, but with the addition of gold over the strut intersections – models the current stent; (3) same design as 1, but made of thinner wire. For Model 3, a stent‐in‐stent solution was applied. Numerical analyses of the deployment of these devices were performed to understand the stress distribution and hence stent fracture potential.

Results: Model 1: Highest stresses occurred at the strut intersections, suggesting that this location may be at highest risk of fracture. This concurs with the in vivo stent fracture data. Model 2: Numerical analyses indicate that the stresses are lower at the strut intersections, but redistributed to the end of the gold reinforcements. This suggests that fractures in this device may occur just distal to the gold. This is indeed the clinical experience. Model 3 was weakest at bolstering the implantation site; however, when two stents were coupled (stent‐in‐stent technique), better strength and lower stresses were seen compared with Model 1 alone.

Conclusions: Using finite element analysis of known stents, we were able to accurately predict stent fractures in the clinical situation. Furthermore, we have demonstrated that a stent‐in‐stent technique results in better device performance, which suggests a novel clinical strategy.
An Application of a Mixed‐Effects Location Scale Model for Analysis of Ecological Momentary Assessment (EMA) Data
Authors: Hedeker Donald , Mermelstein Robin J. , Demirtas Hakan
Published: October 2007

Summary For longitudinal data, mixed models include random subject effects to indicate how subjects influence their responses over repeated assessments. The error variance and the variance of the random effects are usually considered to be homogeneous. These variance terms characterize the within‐subjects (i.e., error variance) and between‐subjects (i.e., random‐effects variance) variation in the data. In studies using ecological momentary assessment (EMA), up to 30 or 40 observations are often obtained for each subject, and interest frequently centers around changes in the variances, both within and between subjects. In this article, we focus on an adolescent smoking study using EMA where interest is on characterizing changes in mood variation. We describe how covariates can influence the mood variances, and also extend the standard mixed model by adding a subject‐level random effect to the within‐subject variance specification. This permits subjects to have influence on the mean, or location, and variability, or (square of the) scale, of their mood responses. Additionally, we allow the location and scale random effects to be correlated. These mixed‐effects location scale models have useful applications in many research areas where interest centers on the joint modeling of the mean and variance structure.
Simple Sequential Boundaries for Treatment Selection in Multi‐Armed Randomized Clinical Trials with a Control
Authors: Cheung Ying Kuen
Published: October 2007

Summary In situations when many regimens are possible candidates for a large phase III study, but too few resources are available to evaluate each relative to the standard, conducting a multi‐armed randomized selection trial is a useful strategy to remove inferior treatments from further consideration. When the study has a relatively quick endpoint such as an imaging‐based lesion volume change in acute stroke patients, frequent interim monitoring of the trial is ethically and practically appealing to clinicians. In this article, I propose a class of sequential selection boundaries for multi‐armed clinical trials, in which the objective is to select a treatment with a clinically significant improvement upon the control group, or to declare futility if no such treatment exists. The proposed boundaries are easy to implement in a blinded fashion, and can be applied on a flexible monitoring schedule in terms of calendar time. Design calibration with respect to prespecified levels of confidence is simple, and can be accomplished when the response rate of the control group is known only up to an interval. One of the proposed methods is applied to redesign a selection trial with an imaging endpoint in acute stroke patients, and is compared to an optimal two‐stage design via simulations: The proposed method imposes smaller sample size on average than the two‐stage design; this advantage is substantial when there is in fact a superior treatment to the control group.
Influence of Paper Electrocardiogram Digitizing on T Wave and QRS Complex Morphology Parameters
Authors: Karsikas Mari , Huikuri Heikki , Perkiömäki Juha S. , Lehtola Lea , Seppänen Tapio
Published: October 2007

Backround:Many morphological parameters of the electrocardiogram (ECG) can be calculated from a digital ECG and paper prints of ECG after digitizing. However, the digitizing process, including printing, scanning, ECG contour extraction, and alignment, can produce changes to the signals, reducing the reliability of some sensitive parameters of QRS complex and T wave.

Methods:The influence of the digitizing process on the parameters of T wave and QRS complex morphology was studied by comparing systematically the values of the nine ECG morphology parameters, computed from the digital ECG and the corresponding paper ECG. The robustness of the parameters to the digitizing process and their discrimination ability between healthy subjects and postinfarction patients were investigated.

Results:The standard T wave parameters and all selected dipolar loop‐parameters retained their robustness and discrimination ability during the digitizing process of the paper ECGs. The non‐dipolar parameters distorted strongly, especially those of the QRS complex. The T wave‐based non‐dipolar parameters retained their discrimination ability during the digitizing process.

Conclusions:The selected standard T wave parameters and the dipolar loop‐parameters calculated from properly digitized ECG paper prints can be utilized in patient studies. Non‐dipolar parameters distort strongly but T wave‐based parameters retain discriminatory information.
Prevalence of Interatrial Block in a General Population of Elderly People
Authors: Ninios Ilias , Pliakos Christodoulos , Ninios Vlasios , Karvounis Haralampos , Louridas George
Published: October 2007

Background: Interatrial block (IAB: P wave ≥ 110 ms) is highly prevalent in people ≥65 years old living in a community.

Methods: We investigated 720 consecutive people age ≥65 years old, from the general population, with the intention of evaluating the prevalence of IAB in their electrocardiogram. After excluding 42 people with atrial fibrillation and atrial flutter (5%) or having a permanent pacemaker (0,83%), we evaluated the electrocardiograms of the remaining 678 people with sinus rhythm.

Results: We identified 400 (59%) persons with IAB with a similar distribution between men (58.5%) and women (59.4%). IAB was also identified in 347 from a total of 570 hypertensive people (60,9%) and only in 53 out of 108 (49.1%) nonhypertensive people (P = 0.015).

Conclusions: The surprisingly large prevalence of the IAB in the general older population emphasizes the importance of the early recognition of this abnormality from the surface 12‐lead electrocardiogram.
Detection of Proximal Coronary Occlusion in Acute Coronary Syndrome: A Feasibility Study Using Computerized Electrocardiographic Analysis
Authors: Eskola Markku J. , Nikus Kjell C. , Voipio‐Pulkki Liisa‐Maria , Huhtala Heini , Lund Juha , Ilva Tuomo , Niemelä Kari O. , Porela Pekka
Published: October 2007

Background: Rapid identification of a proximal occlusion site of a major coronary artery is of paramount importance in the care of myocardial infarction (MI). It is increasingly recognized that routine electrocardiogram (ECG) can be used for that purpose, provided that expert interpretation is available. Computer‐based signal analysis has potential to enhance early ECG interpretation but its performance must be validated against manual algorithms. We therefore set out to develop a computer‐assisted model to detect proximal occlusion of the left anterior descending coronary artery (LAD) in patients with suspected acute coronary syndrome (ACS).

Methods: Based on manual anatomical interpretation of the ECG, obtained from 216 consecutive patients who were admitted due to suspected ACS, an automatic computerized ECG model to detect LAD occlusion was constructed. Agreement between manual evaluation of the ECG by two cardiologists and a computerized ECG algorithm to detect occlusion of the LAD and the site of occlusion was determined.

Results: Using an expert electrocardiographer's anatomical interpretation as the gold standard, the computer model recognized patients fulfilling ECG criteria for any occlusion of the LAD with a specificity of 99% and a sensitivity of 67% (κ= 0.71). However, proximal LAD occlusion was detected with 100% specificity and 86% sensitivity (κ= 0.72). The computer program detected a distal occlusion in the LAD with a specificity of 99% and a sensitivity of 40% (κ= 0.72).

Conclusions: Computerized anatomical interpretation of the ECG is feasible and allows detection of a proximal LAD occlusion with excellent accuracy.
Analyses of Dynamic Beat‐to‐Beat QT–TQ Interval (ECG Restitution) Changes in Humans under Normal Sinus Rhythm and Prior to an Event of Torsades de Pointes during QT Prolongation Caused by Sotalol
Authors: Fossa Anthony A. , Wisialowski Todd , Crimin Kimberly , Wolfgang Eric , Couderc Jean‐Philippe , Hinterseer Martin , Kaab Stefan , Zareba Wojciech , Badilini Fabio , Sarapa Nenad
Published: October 2007

Background: Restitution through intracardiac pacing has been used to assess arrhythmia vulnerability. We examined whether analyses of sequential beat‐to‐beat QT and TQ interval measures can be used to quantify ECG restitution changes under normal sinus rhythm.

Methods: The QT, R‐R and TQ intervals were examined 22.5 hour Holter monitoring before and after oral sotalol in normal male and female volunteers. Additionally, comparisons were made to those observed in the time‐matched dataset prior to torsades de pointes in a heart diseased patient that received a single dose of sotalol.

Results: Sotalol increased QT, R‐R and TQ intervals 71, 101, and 125 ms after 160 mg (n = 38) and 194, 235, and 135 ms after 320 mg (n = 19) during maximum plasma concentrations, respectively. The percentage of beats with a QT/TQ ratio >1 was reduced 25% over the entire 22.5 hours after sotalol and the lower TQ interval boundary (5th quantile) was increased 22–30%. In contrast, 99% of the beats prior to torsades de pointes had a QT/TQ ratio > 1 and the median TQ interval was below the lower 98% confidence bounds of normals before and after sotalol.

Conclusions: ECG restitution changes are quantifiable under varying states (nocturnally, beta‐adrenergic blockade, QT prolongation) in healthy subjects.
Exercise‐Induced ST‐Segment Elevation in Patients with a Recent Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention
Authors: Infusino Fabio , Lanza Gaetano A. , Larosa Claudio , Sgueglia Gregory A. , Marinaccio Leonardo , Lamendola Priscilla , Mariani Luca , Santangeli Pasquale , Sestito Alfonso , Crea Filippo
Published: October 2007

Objectives: To get insight in the mechanism of exercise‐induced ST‐segment elevation (STE) in patients with Q/QS waves at the electrocardiogram (ECG).

Methods: We performed exercise stress test in 13 patients with anterior acute myocardial infarction treated by successful primary percutaneous coronary intervention (PCI).

Results: Compared to rest, an additional STE >1 mm in one or more precordial ECG leads during exercise occurred in nine patients (69%), in the absence of symptoms.

Conclusions: In acute myocardial infarction (MI) patients, treated by primary PCI and showing optimal coronary blood flow restoration at angiography, STE can still be induced by exercise in Q/QS wave ECG leads. This finding lends further support to the theory that exercise‐induced STE in this clinical context is unlikely to represent by itself transient myocardial ischemia or viability.
T‐Wave Morphology Parameters Based on Principal Component Analysis Reproducibility and Dependence on T−Offset Position
Authors: Extramiana Fabrice , Haggui Abdeddayem , Maison‐Blanche Pierre , Dubois Rémi , Takatsuki Seiji , Beaufils Philippe , Leenhardt Antoine
Published: October 2007

Background: T‐wave morphology parameters based on principal component analysis (PCA) are candidate to better understand the relation between QT prolongation and torsades de pointes. We aimed to assess the repeatability and to determine the influence of T‐end position on PCA parameters.

Methods: Digital ECGs recorded from 30 subjects were used to assess short term (5 minutes), circadian and long‐term (28 days) repeatability of PCA parameters. The T‐end cursor position was moved backward and forward (± 8 ms) from its optimal position. We calculated QRS‐T angle, PCA ratio, and T‐wave residuum (TWR).

Results: At long‐term evaluation, coefficients of variation were 11.3 ± 9.9%, 11.7 ± 7.1%, and 23.0 ± 22.0% for the QRS‐T angle, PCA ratio, TWR, respectively. After moving the T‐end cursor, repeatability was 0.42 ± 0.2%, 1.00 ± 1.04%, 4.0 ± 4.2% for the same PCA parameters.

Conclusions: T‐wave morphology parameters based on PCA are reproducible with the exception of TWR and QRS‐T angle. In addition, PCA is robust, showing only little dependence on T‐end cursor position. These data should be taken into account for safety pharmacology trials.
Brugada Syndrome Subject to Depolarization Abnormality of the Conduction System
Authors: Hosokawa Yusuke , Morita Norishige , Ogano Michio , Yokoyama Hiroyuki
Published: October 2007

We report a patient who first developed Brugada syndrome (BS) after the conduction in atrioventricular (AV) node and the ventricular conduction system was disturbed. A type‐1 Brugada ECG was unexpectedly unmasked after administration of a class IC antiarrhythmic agent for suppressing paroxysmal atrial fibrillation (paf), which had never been documented in the absence of such conduction disturbances, even after giving antiarrhythmic agents for paf. In addition, this patient was accompanied by sick sinus syndrome. This was an intriguing overlap syndrome case in that the development of BS might have been associated with the incidence of a conduction system disturbance.
Leached Layer Formation on Float Glass Surfaces in the Presence of Acid Interleave Coatings
Authors: Smith Nicholas J. , Pantano Carlo G.
Published: October 2007

Acid interleave coatings are routinely used in the float glass industry to inhibit corrosion during transport and storage in hot, humid environments. It is well recognized that acid interleave coatings neutralize surface alkalinity, and thereby delay the onset of etching, dissolution, and permanent staining (so‐called Stage II corrosion). However, the effect of acid interleave coatings on leached layer formation (so‐called Stage I corrosion) has not been reported. For many applications of float glass, the presence of a shallow leached layer may be of little consequence, but in other applications, there can be nanoscale effects on scratch resistance, optical properties, adsorption, adhesion, and interface stability. In this study, complementary techniques of X‐ray photoelectron spectroscopy (XPS) sputter depth profiling and infrared reflection spectroscopy were used to evaluate the thickness of leached layers in float glass samples weathered in a controlled manner, both with and without acid interleave coatings applied. The results reveal that acid interleave coatings do, in fact, enhance leaching during both cyclic and static weathering. This confirms that the acid not only neutralizes the alkaline reaction products of weathering but also reacts with the glass itself by ion exchange. The concentration of acid in the coating influences the thickness of the resultant leached layer, but this effect depends on the weathering conditions (cyclic versus static) and the duration of the exposure; boric acid and adipic acid coatings performed similarly. An excellent correlation was found between the more direct method of XPS depth profiling of the sodium leaching profile and the less direct, but perhaps more convenient, method of infrared reflection spectroscopy.
Assessing the outcome of community‐based psychiatric care: building a feedback loop from ‘real world’ health services research into clinical practice
Authors: Lasalvia A. , Ruggeri M.
Published: October 2007

Objective: To describe the main characteristics of the South‐Verona Outcome Project (SVOP) and to focus on its overall conceptual framework, with specific reference to the following perspectives: i) integrating evidence‐based and practice‐based approaches; ii) involving service professionals in routine outcome assessment; and iii) involving service users in mental health outcome assessment.

Method: A selective literature review of methodological and empirical papers addressing the relevance and usefulness of outcome research to routine clinical practice was performed.

Results: Reviewed literature shows the need to integrate evidence‐based and practice‐based approaches and to involve service professionals in routine outcome assessment, by adopting a multiple perspective paradigm. Studies conducted in ‘real world’ health services indicate that the outcome of care is multifaceted and it can be perceived differently when different perspectives are taken into account. Such a complex picture can provide more comprehensive information on the effectiveness of care provided, to feed back positively into clinical practice.

Conclusion: The SVOP design and its methodological background were demonstrated to be appropriate for a detailed and routine assessment of outcome in the ‘real world’ of mental health services.
Outcome of patients dropping out from community‐based mental health care: a 6‐year multiwave follow‐up study
Authors: Ruggeri M. , Salvi G. , Bonetto C. , Lasalvia A. , Allevi L. , Parabiaghi A. , Bertani M. , Tansella M.
Published: October 2007

Objective:  To test three hypotheses: i) is dropping out of community mental health care due to dissatisfaction? ii) Do those who appropriately interrupt mental health care need any more help? iii) Do those who need treatment continue to receive it?

Method:  A cohort from a Community Mental Health Service in Verona, Italy, was followed up for 6 years, interviewing patients at follow‐up who are both in contact and not in contact with the service.

Results:  The main reason for dropping out was service dissatisfaction. Patients still in contact with the service were more often psychotic. Many patients no longer in contact had mild‐to‐moderate problems, especially anxiety and depression and some social disability. Patients out of contact rarely sought help from other agencies.

Conclusion:  Comprehensive community mental health services seem to offer good continuity of mental health care to patients with psychosis, but dedicate less attention to patients with less severe problems. Some of these patients will go on experiencing a burden of symptoms and disability, over the years.
Applications and usefulness of routine measurement of patients’ satisfaction with community‐based mental health care
Authors: Ruggeri M. , Lasalvia A. , Salvi G. , Cristofalo D. , Bonetto C. , Tansella M.
Published: October 2007

Objective:  This study was conducted within the framework of the South‐Verona Outcome Project (SVOP) in a sample of patients, with the full spectrum of psychiatric diagnoses, who are attending the South‐Verona Community‐based Mental Health Service (CMHS). It aims to exemplify some applications of routine measurements of service satisfaction and specifically: i) identify strengths and weaknesses, in the patients’ perspectives, of a ‘real world’ service; ii) monitor whether this specific service provides satisfactory care over 3 years and iii) identify if there are any patients’ characteristics that might be associated with service dissatisfaction.

Method:  Service satisfaction was measured with the Verona Service Satisfaction Scale (VSSS) across three subsequent waves of the SVOP; frequency distributions of scores in the various VSSS domains were compared. The relationship between satisfaction with psychiatric care and a number of well‐established mental health indicators, including socio‐demographic, clinical and service intervention variables, was investigated using random‐effect models.

Results:  The organization of service and the behaviour and manners of the professionals were the main service strengths. Weaknesses were identified in the physical layout of facilities, in the lack of involvement of relatives and in the information provided. Overall satisfaction was medium‐high, while subjects with longer duration of service contact and higher disability were the most dissatisfied. The predictors we examined, however, explained only modest percentages of variance.

Conclusion:  Repeated, routine assessments of service satisfaction have provided a clear view of the South‐Verona CMHS’ strengths and weaknesses; this set of information was crucial for the continuous quality improvement process in the service.
Predictors of changes in caregiving burden in people with schizophrenia: a 3‐year follow‐up study in a community mental health service
Authors: Parabiaghi A. , Lasalvia A. , Bonetto C. , Cristofalo D. , Marrella G. , Tansella M. , Ruggeri M.
Published: October 2007

Objective:  The aims of this study were to measure changes over 3‐years in caregiving burden and emotional distress in relatives of people with schizophrenia and to identify factors predicting the levels of caregiving burden.

Method:  A cohort of 51 caregivers of patients with schizophrenia attending the South‐Verona Community Mental Health Service was assessed over 3‐years with the Involvement Evaluation Questionnaire, European Version. Predictors of caregiving burden included both caregivers’ and patients’ characteristics and patterns of carer–patient interaction.

Results:  Baseline levels of family burden were high in worrying and urging domains. Fifty‐one per cent of caregivers experienced significant emotional distress. Both overall burden and emotional distress improved. Higher patients’ psychopathology, higher numbers of patient‐rated needs, patients’ lower global functioning and patients’ poorer quality of life were found to be related to the severity of family burden. The only significant predictor of caregivers’ burden at follow‐up was the baseline level of caregivers’ burden itself.

Conclusion:  A policy addressing the caring burden of informal caregivers beyond patients’ symptoms reduction should be considered.
A prospective 6‐month analysis of the naturalistic use of aripiprazole – factors predicting favourable outcome
Authors: Taylor D. , Atkinson J. , Fischetti C. , Sparshatt A. , Jones S.
Published: October 2007

Objective:  To evaluate the effectiveness of aripiprazole in clinical practice.

Method:  Prospective follow‐up of patients consecutively prescribed aripiprazole in an acute mental health unit. Retrospective analysis of outcome from casenotes.

Results:  Data were available on 228 patients. Fifty‐one per cent discontinued aripiprazole over 6‐month follow‐up. Continuation with treatment was more likely in out‐patients [relative risk (RR) 1.50; 95% CI: 1.13–2.00], those never before considered for clozapine treatment (RR 1.61, 95% CI: 1.06–2.44) and older patients [RR 1.05, 95% CI: 1.01–1.09 (per 5‐year increase)]. The main reason for early discontinuation was the occurrence of minor adverse effects.

Conclusion:  Aripiprazole is effective in practice. Outcome is likely to be improved by careful patient selection and by attending to adverse effects experienced early in treatment.
Congruence between diagnosis of recurrent major depressive disorder and psychotropic treatment in the general population
Authors: Grolleau A. , Cougnard A. , Bégaud B. , Verdoux H.
Published: October 2007

Objective:  We explored in a sample representative of the French general population the congruence between lifetime use of psychotropic drugs and diagnosis of recurrent major depressive disorder (rMDD).

Method:  A total of 2111 (5.6%) subjects with rMDD were identified in the sample of 36 785 subjects assessed in the Mental Health survey in the General Population. A treatment congruent with a diagnosis of rMDD was defined as lifetime use of antidepressants or mood stabilizers.

Results:  Only one‐third of subjects with rMDD reported having ever used a congruent treatment. Female gender, higher income and presence of anxiety disorder were associated with a higher probability of having used a congruent treatment.

Conclusion:  Although these findings indicate that a large proportion of subjects with rMMD do not benefit from adequate treatment, community surveys not primarily designed to assess utilization and adequacy of psychotropic treatment in the community may overestimate the frequency of unmet need for care.
Immediate provisional restoration of XiVE® screw‐type implants in the posterior mandible
Authors: Payer Michael , Kirmeier Robert , Jakse Norbert , Wimmer Gernot , Wegscheider Walther , Lorenzoni Martin
Published: October 2007

Objectives: This prospective study evaluated the clinical outcome of immediately restored screw‐type implants for the replacement of mandibular (pre)molars. The results were based on survival, clinical stability and on changes of bone levels from implant placement to delivery of the definitive superstructure 6 months after insertion.

Material and methods: In this study, 24 patients were treated according to an immediate loading protocol. Forty XiVE® implants were placed in the mandibular (pre)molar regions for single‐tooth restoration and the treatment of free‐end situations. Radiographic bone levels in relation to implant margins were measured at the time of insertion and recorded. All implants were provided with a transfer coping and restored with provisional crowns within 7 days. After 6 months, the final restorations were fabricated. At this time, survival, Periotest® value and radiographic bone levels were assessed.

Results: A total of 40 XiVE® implants were placed with an insertion torque value of at least 45 N cm. The median Periotest® value 6 months post‐insertion was −5 (maximum −2, minimum −7). The mean radiographic coronal bone level at prosthetic delivery was 1.4 mm (SD±0.57) compared with 0.47 mm (SD±0.37) at the time of insertion. No implant failures were observed up to prosthetic restoration 6 months post‐insertion.

Conclusion: The present data of immediately loaded implants in the posterior mandible are comparable to results with conventional loaded implants. Additional long‐term data will be necessary to include this protocol as a standard procedure in our treatment concepts for the edentulous posterior mandible.
Prevalence and management of Schneiderian membrane perforations during sinus‐lift procedures
Authors: Hernández‐Alfaro Federico , Torradeflot Marta Marín , Marti Carlos
Published: October 2007

Abstract: This clinical study was undertaken to evaluate the prevalence of surgical complications of the sinus graft procedure and to set a protocol to repair sinus membrane perforations intraoperatively using a variety of techniques and materials. From January 2000 to May 2005, 338 patients were studied, on whom 474 sinus floor augmentation procedures were performed, and a total of 1166 dental implants were simultaneously placed. A total of 104 perforations of the sinus membrane were observed (19 were bilateral). In group number 1, sinus membrane perforations of <5 mm were observed in 56 sinus augmentation procedures (53.85%), 44 were treated using a resorbable collagen membrane and 12 were sutured with a resorbable material. In group number 2, 28 sinus membranes had a perforation size between 5 and 10 mm (26.92%) and were treated using lamellar bone combined with a resorbable membrane. Group number 3 consisted of 20 sinus membrane perforations>10 mm (19.23%), 10 were covered with lamellar bone combined with a buccal fat pad flap, six were treated with a mandibular block graft and four perforations were treated with only a lamellar bone sheet. Two‐hundred and seventy‐eight implants were placed under repaired membrane perforations and 247 implants survived. Interestingly enough, all the 25 implants that failed to integrate were placed under perforated and reconstructed membranes during the sinus lift procedure. Based on the results of this study, the survival rates of implants placed under reconstructed membranes correlate inversely with the size of the perforations.
A study of the sensitization rate to cocamidopropyl betaine in patients patch tested in a university hospital of Beijing
Authors: Li Lin‐feng
Published: October 2007

Background: The prevalence of sensitization to cocamidopropyl betaine (CAPB) in China has not been reported.

Objective: This study is to evaluate the prevalence of CAPB sensitization in patients patch tested in Peking University Third Hospital, Beijing.

Methods: 429 consecutive patients with suspected allergic contact dermatitis were patch tested with CAPB 1.0% aqueous, 3‐dimethylaminopropylamine (DMAPA) 1.0% aqueous as well as a modified European standard series of allergens from June 2005 to August 2006.

Results: 42 patients (9.8%) had a positive reaction to CAPB. 25 of them (59.5%) were considered relevant. Of those, 7 were head and/or neck dermatitis, 4 hand dermatitis, 1 cheilitis, and the other 13 patients were widespread dermatitis. 10 out of 429 (2.3%) patients reacted to DMAPA. Of those, 8 were relevant and 6 of them also reacted to CAPB.

Conclusion: The rate of CAPB sensitization in our study is higher than previously reported elsewhere. CAPB is a common cosmetic allergen in Beijing. Both CAPB and DMAPA should be tested in patients with suspected cosmetic dermatitis.
Etiology and prognosis of hand eczema in a dermatology clinic in China: a follow‐up study
Authors: Li Lin‐feng , Liu Guangren , Wang Jing
Published: October 2007

Background:  Prognosis of hand eczema (HE) has not been reported in China.

Objectives:  To investigate the etiology and outcome of HE in 655 consecutive patients patch tested with European standard series in Peking University Hospital in a 2‐year period.

Methods:  All patients were re‐examined at 1 year after patch testing, and prognosis of dermatitis was evaluated by the rate of clearance of skin symptoms for at least 3 months without relapse before the evaluation.

Results:  Of 599 patients examined, 82 (13.7%) were HE. Allergic, irritant, and unclassified HE accounted for 23.2%, 17.1%, and 51.3% of HE, respectively. The overall clearance rate of HE was much lower than that of eczema elsewhere (18.3% versus 29.6%, P < 0.05, chi‐squared test). 35.7% of patients with allergic HE and 26.3% with irritant HE cleared their lesions, of those with unclassified HE only 11.9% (P < 0.05, chi‐squared test). The lowest healing rate (5.7%) was found in unclassified HE patients with disease duration over 6 months.

Conclusions:  The outcome of HE was worse than eczema elsewhere. Allergic HE had a better prognosis than unclassified HE. Longer disease duration was the main risk factor for poor prognosis of unclassified HE.
Lack of evidence for allergenic properties of coumarin in a fragrance allergy mouse model
Authors: Vocanson Marc , Valeyrie Magalie , Rozières Aurore , Hennino Anca , Floc’h François , Gard Arielle , Nicolas Jean‐François
Published: October 2007

Background: There is controversy as to whether coumarin, an ingredient in cosmetics and fragrances, is a contact allergen involved in fragrance allergy. We recently showed that the purity of coumarin is a critical parameter for its allergenicity because coumarin preparations containing trace amounts of contaminants induced cell proliferation in the local lymph node (LN) assay whereas pure coumarin did not.

Objective/Method: In the present study, we analyzed the sensitizing properties of coumarin (purity > 99.9) and of dihydrocoumarin (DHC), in a recently developed model of fragrance allergy in mice.

Results: DHC was able to prime T cells in LNs draining the sensitization skin site and to induce a typical allergic contact dermatitis (ACD) reaction upon challenge, confirming that DHC is endowed with moderate sensitizing properties. In contrast, no T‐cell activation and no ACD responses were obtained following sensitization and challenge with coumarin.

Conclsuion: These results confirm that pure coumarin is endowed with very weak sensitizing capacities, if any, and suggest that the presence of contaminants in coumarin preparations may account for the previously reported allergenic properties of coumarin.
Central nervous system myelomatosis: review of the literature
Authors: Nieuwenhuizen Laurens , Biesma Douwe H.
Published: October 2007

Involvement of the central nervous system (CNS) in multiple myeloma (MM) is very uncommon; it has been observed in approximately 1% of the MM patients. This review summarizes the clinical and laboratory characteristics and treatment modalities of 109 patients with CNS myelomatosis (CNS MM) reported in the literature. CNS MM has a wide spectrum of neurological symptoms and signs. No guidelines for therapy of CNS MM are available, which has resulted in a large variation in the treatment schedules. Treatment options include intrathecal chemotherapy (IT), systemic chemotherapy (SC), cranial irradiation (CI) or a combination. The prognosis of CNS MM remains poor, with an overall median survival from the time of diagnosis to death of 2.0 months (range 0.1–25 months). Patients who were treated with CI had a significantly (P = 0.004) longer survival when compared with patients without CI.
The JAK2 V617F allele burden in essential thrombocythemia, polycythemia vera and primary myelofibrosis – impact on disease phenotype
Authors: Larsen Thomas Stauffer , Pallisgaard Niels , Møller Michael Boe , Hasselbalch Hans Carl
Published: October 2007

Background and objectives:  The JAK2 V617F tyrosine kinase mutation is present in the great majority of patients with polycythemia vera (PV), and approximately half of the patients with essential thrombocythemia (ET) and primary myelofibrosis (PMF). The three distinct disease entities may be considered as three phenotypic presentations of the same JAK2 V617F positive chronic myleoproliferative disorder. Together with physiological and genetic modifiers the phenotype may be determined by the JAK2 V617F allele burden. In the present study, we aimed to asses the JAK2 mutational load and its impact on phenotype.

Methods:  A highly sensitive real‐time quantitative PCR (qPCR) assay was used for quantification of the JAK2 V617F mutational load in 165 patients with Philadelphia chromosome negative chronic myeloproliferative disorders (ET = 40, PV = 95, PMF = 30).

Results:  We provide evidence of increasing JAK2 V617F allele burden from ET, over PV to PMF (P = 0.001 and P < 0.00001 respectively). The present data suggests the JAK2 V617F allele burden as a key determinant of the degree of myeloproliferation and myeloid metaplasia reflected by significantly higher levels of white blood cell counts (WBC) (P = 0.03), CD34 counts (P = 0.03), lactate dehydrogenase and Polycythemia Rubra Vera gene 1 levels (P = 0.03 and P < 0.00001 respectively), as well as lower platelet counts (P = 0.02) and more cases of splenomegaly (P = 0.001) in homozygous PV patients compared to their heterozygous counterparts.

Conclusion:  The present study support the concept of the JAK2 V617F positive chronic myeloproliferative disorders as a biological continuum with phenotypic presentation in part influenced by JAK2 V617F mutational load.
Effects of mobile phone electromagnetic fields at nonthermal SAR values on melatonin and body weight of Djungarian hamsters (Phodopus sungorus)
Authors: Lerchl Alexander , Krüger Heike , Niehaus Michael , Streckert Joachim R. , Bitz Andreas K. , Hansen Volkert
Published: October 2007

Abstract:  In three experiments, adult male Djungarian hamsters (Phodopus sungorus) were exposed 24 hr/day for 60 days to radio frequency electromagnetic fields (RF‐EMF) at 383, 900, and 1800 MHz, modulated according to the TETRA (383 MHz) and GSM standards (900 and 1800 MHz), respectively. A radial waveguide system ensured a well defined and uniform exposure at whole‐body averaged specific absorption rates of 80 mW/kg, which is equal to the upper limit of whole‐body exposure of the general population in Germany and other countries. For each experiment, using two identical waveguides, hamsters were exposed (n = 120) and sham‐exposed (n = 120) in a blind fashion. In all experiments, pineal and serum melatonin levels as well as the weights of testes, brain, kidneys, and liver were not affected. At 383 MHz, exposure resulted in a significant transient increase in body weight up to 4%, while at 900 MHz this body weight increase was more pronounced (up to 6%) and not transient. At 1800 MHz, no effect on body weight was seen. The results corroborate earlier findings which have shown no effects of RF‐EMF on melatonin levels in vivo and in vitro. The data are in accordance with the hypothesis that absorbed RF energy may result in metabolic changes which eventually cause body weight increases in exposed animals. The data support the notion that metabolic effects of RF‐EMFs need to be investigated in more detail in future studies.
Effect of melatonin on apoptosis, proliferation and differentiation of urothelial cells after cyclophosphamide treatment
Authors: Zupančič Daša , Jezernik Kristijan , Vidmar Gaj
Published: October 2007

Abstract:  Melatonin was recently shown to have protective effects against cyclophosphamide (CP)‐induced hemorrhagic cystitis (HC) by diminishing bladder oxidative stress. HC is accompanied by destruction of the bladder urothelium and followed by apoptosis and rapid regeneration via proliferation and differentiation of urothelial cells, reaching complete restoration of normal urothelium in three weeks. Therefore, the effect of melatonin on apoptosis, proliferation and differentiation of urothelial cells, during destruction and regeneration of the urothelium three‐weeks after a single dose CP treatment, was studied. F344 male rats were injected intraperitoneally with saline (control group) or melatonin (Mel group) or a single dose of CP (100 mg/kg; CP group) or melatonin (10 mg/kg) with CP (Mel + CP group). Melatonin co‐treatment with CP significantly reduced apoptosis and increased proliferation of urothelial cells at day 1 and thus prevented extensive loss of cells from the urothelium. However, proliferation indices at days 4 and 7 after melatonin and CP co‐treatment suddenly dropped and therefore the development of hyperplasia was prevented. Melatonin co‐treatment with CP also resulted in earlier differentiation of superficial urothelial cells. Melatonin seems to have protective effect against CP‐induced urothelial damage and a favorable impact on regeneration and restoration of normal urothelium, since it reduces the number of apoptotic and proliferating urothelial cells and results in their earlier differentiation.
Effects of Isomeric Fatty Acids on Reproductive Parameters in Mice
Authors: Veaute Carolina , Andreoli María Florencia , Racca Andrea , Bailat Alejandra , Scalerandi María Victoria , Bernal Claudio , Malan Borel Ileana
Published: October 2007

Problem  The aim of this study was to determine if dietary fatty acids (FA) level or isomeric FA type may affect reproductive parameters in mice.

Method of study  Mice were fed for 1 month diets differing in cisFA (cFA) content or type of isomeric FA. Resorption, number of fetuses and placental cytokine expression were determined and sperm acrosome reaction was evaluated after induction by calcium ionophore.

Results  Mice fed high fat diets showed increased fetal resorptions, a decrease in interleukin (IL)‐4 placental expression in the first generation and an increase of tumor necrosis factor‐α (TNF‐α) in the second generation. In this generation, conjugated linoleic acid (CLA) returned TNF‐α to normal levels and diminished IL‐4 and transforming growth factor‐β (TGF‐β) expressions; males fed transFA (tFA) and CLA showed a lower rate of induced acrosome reaction.

Conclusion  The amount and type of dietary FA may affect reproductive performance in mice by affecting sperm membrane functionality and placental cytokine production.