bluuebunny/crossref_metadata_2025 huggingface dataset:
Mandibular alveolar bone necrosis after trigeminal herpes zoster
Authors: Arikawa Junko , Mizushima Junichi , Higaki Yuko , Hoshino Junko , Kawashima Makoto
Published: February 2004

A 74‐year‐old Japanese man, who had pharyngeal cancer at the age of 53 years and had been treated with radiation therapy, was examined by his dentist for oral ulcers with severe pain for 2 days. He was referred to our hospital on the following day and admitted on March 7, 2000. Physical examination revealed vesicles and pustules on the right side of the lower lip, chin, cheek, and external ear. Ulceration was noted on the right side of the soft palate, buccal mucosa, and tongue. The mandibular soft tissue was markedly swollen. A diagnosis of trigeminal herpes zoster was made. The patient was treated with intravenous acyclovir, 750 mg daily for 7 days, and oral prednisolone, 20 mg daily for 2 days. The facial and mucosal lesions showed rapid improvement and the patient was discharged on March 16, 2000. Forty‐four days after the onset, the patient complained of a dull, throbbing pain in the right mandible. Panoramic tomography of the jaw revealed radiolucent areas without radio‐opacities on the mandibular bone (Fig. 1). These findings were not observed on the panoramic radiograph taken before admission. The mandibular right lateral incisor, canine, and left lateral incisor were markedly loose and periodontal attachment tissue was necrotic. Sequestrectomy of the necrotic bone was performed and the affected teeth were removed. Microscopic examination of the sequestered bone revealed eosinophilic, homogeneous bone tissue surrounded by degenerated connective tissue. The osteocytic lacunae were empty. Cavum dentis containing bone marrow had been replaced by necrotic tissue (Fig. 2). Although the change in lacunae could be an artifact of decalcification, these findings suggested that the bone tissue was necrotic. After sequestrectomy, the patient's mandibular pain ameliorated, but he developed post‐herpetic neuralgia.

Panoramic tomography of the jaw reveals radiolucent areas without radio‐opacities on the mandibular bone (arrow)

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Microscopic examination of the sequestered bone reveals eosinophilic, homogeneous bone tissue surrounded by degenerated connective tissue. The osteocytic lacunae are empty. Cavum dentis containing bone marrow has been replaced by necrotic tissue

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Localized cutaneous leishmaniasis imported into Paris: a review of 39 cases
Authors: El Hajj Lise , Thellier Marc , Carrière Jean , Bricaire François , Danis Martin , Caumes Eric
Published: February 2004

Background  Localized cutaneous leishmaniasis (LCL) is a common cause of dermatosis in travelers returning from the tropics. We describe the epidemiological, clinical, and biological aspects and therapeutic outcome of imported LCL.

Methods  A retrospective study of all cases of LCL observed from 1992 to 2000 in our tropical disease unit. Diagnosis was based on direct examination of skin smear and/or culture with identification of subsequent subspecies.

Results  Thirty‐nine cases (25 males, 14 females; median age: 38 years) were included: 35 French travelers and four foreign immigrants; 15 cases were acquired in the Old World and 24 cases in the New World. The patients presented to our department with a median of 60 days after return. Thirteen patients had already consulted general practitioners, and the diagnosis was missed in five cases (38%). Five clusters were identified. The median number of skin lesions was two per patient. Diagnosis was established by direct microscopic examination in 36 cases (92%). Thirty‐five patients were assessable for first‐line treatment with antimonials (intramuscularly in 18, intralesionally in nine), intramuscular pentamidine isethionate or oral ketoconazole (four patients each). Twenty‐five patients (71.4%) were cured. The remaining 10 patients were cured after one to three courses of other treatments. Overall adverse events occurred in 60% of the patients treated with antimonials and 37% of those treated with pentamidine.

Conclusion  Imported LCL is still unrecognized by Western physicians. Clusters may be observed in groups of travelers. The therapeutic outcome is impaired by numerous but minor side‐effects.
Zosteriform skin metastases
Authors: LeSueur Benjamin W. , Abraham Ryan J. , DiCaudo David J. , O'Connor William J.
Published: February 2004

A 66‐year‐old woman was referred for evaluation of a rash on the leg. She had a 1‐year history of stage IV bronchogenic adenocarcinoma with previous metastases to the right first metatarsal‐phalangeal (MTP) joint and a left supraclavicular lymph node. She underwent six cycles of chemotherapy with paclitaxel (Taxol; Bristol‐Myers Squibb Company, Princeton, NJ, USA) and carboplatin (Paraplatin; Bristol‐Myers Squibb Company, Princeton, NJ, USA) as well as palliative radiation therapy to the metastasis sites. One month after completing radiation therapy, the patient developed a nonpainful rash on the right thigh. This eruption was treated as a herpes zoster infection by her internist with 3 weeks of valcyclovir (Valtrex; Catalytica Pharmaceuticals, Greenville, NC, USA), but without improvement. One month later the leg became painful and swollen and the rash spread up the thigh to involve the groin and vulva. The patient was referred to the dermatology department. Physical examination revealed multiple red, indurated, crusted papules and nodules involving the medial, anterior, and lateral right thigh, labia majora, and suprapubic area. The lesions were grouped and arranged in a dermatomal zosteriform distribution (Fig. 1). There was a visible peau d’orange appearance of the right leg with pitting edema. A punch biopsy showed irregular islands of atypical glandular epithelial cells infiltrating the superficial and deep dermis, consistent with metastatic adenocarcinoma (Fig. 2a). Immunohistochemistry showed positive staining to thyroid transcription factor (TTF) and cytokeratin 7 (Fig. 2b and c). The tissue did not stain with progesterone receptor, estrogen receptor, or gross cystic disease fluid protein (BRST‐2). This immunostaining pattern was identical to previous biopsies of the right first MTP joint and left supraclavicular lymph node metastases and is consistent with adenocarcinoma of the lung.

Eruption on the right thigh with grouped papules and nodules arranged in a zosteriform pattern

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(a) Punch biopsy showing irregular islands of atypical glandular epithelial cells within the dermis (hematoxylin and eosin; original magnification × 100). (b) Positive staining with thyroid transcription factor (original magnification × 40). (c) Positive staining with cytokeratin 7 (original magnification × 40)

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Evaluating a new food selection guide
Authors: Hunt Paula , Strong Maureen , Poulter Jenny
Published: February 2004

In 2002, The British Meat Nutrition Education Service (BMNES) updated its food selection guide Getting the Balance Right. This was to reflect a wider array of foods now available and bring it in line with the nationally recognised model, the Food Standards Agency's (FSA) Balance of Good Health. Qualitative and quantitative research was conducted to gain insight into the distribution, use, relevance and perceived effectiveness of BMNES’ updated Getting the Balance Right model amongst nutrition educators and specialists in design/communication. The qualitative element was directed towards reaction to the content and execution of the guide. These methods typically involved a small number of participants, who were highly selected. The quantitative part focused on tracking the distribution and evaluating the effectiveness of the release of the tool to the target audience.

Overall the sample of users was extremely positive about the updated Getting the Balance Right, because of the model itself (based on the FSA version) and the way it was presented. The research identified key strengths and it was unanimously preferred to the FSA's Balance of Good Health plate model launched in 1994. However, some respondents had concerns over Getting the Balance Right, primarily because of its commercial origins and complexity of visual imagery, which in their view, may impact on its educational effectiveness.

Evidence from the first 6 months post‐launch suggests that BMNES’Getting the Balance  Right is  being  widely  used,  primarily  within  the  health  sector  specifically by dietitians and nurses. Its use is sometimes interactive (as intended) but also in a ‘stand alone’ manner and the educational context is likely to influence its effectiveness. The design/communication experts commented positively on the visual energy and business of the model though some felt this might distract from the overall central messages of proportion.

It is clear from this research that the current presentation of BMNES’Getting the Balance Right provides the basis for an extremely useful resource that seems likely to be an effective educational tool and is desperately needed within the field. The question of its true effectiveness will only be answered by systematic quantitative research to test the ability of consumers to understand and apply the information within the model.
Differences in perceptions of functional foods: UK public vs. nutritionists
Authors: McConnon A. , Fletcher P. L. , Cade J. E. , Greenwood D. C. , Pearman A. D.
Published: February 2004

As concepts in nutrition move towards emphasising the use of foods to promote better health and to help reduce the risk of disease, a new generation of functional food products has emerged. Nutritionists play a key role in educating the public on matters regarding diet and health. Therefore, they need to understand consumers’ attitudes to ensure their work is effective. This study aims to explore consumers’ and nutritionists’ perceptions of this relatively new area of nutrition using a psychometric questionnaire, adapted from Fife‐Schaw and Rowe (1996), to quantify attitudes towards five types of functional foods. The questionnaire was administered to 331 members of the British public (40% response rate) and a random sample of 199 members of the Nutrition Society (58% response rate). Perceptions held by the two groups were compared. Principal Components Analysis (PCA) was carried out to highlight underlying components revealed by the questionnaire. The most extreme differences in responses were evident on three issues: the ability to tell if functional foods were about to be consumed; who should take responsibility for informing consumers about the health effects; and understanding of functional foods. Nutritionists believed they had a greater understanding of functional foods and found it easier to tell if the foods they ate contained a functional component. Consumers had a stronger belief that it is the food manufacturers’ responsibility to provide information about functional foods. Using PCA to identify components of importance to each group confirmed differences in perceptions. For the consumer group worry and benefit were the most prominent components. For nutritionists, components relating to control and responsibility were most apparent. As consumers are more willing to look to food manufacturers than the government for information regarding these new foods, the importance of appropriate food labelling and legislation on health claims is of increasing importance. The differences in perceptions will be of interest to the different stakeholders involved in the provision of information to consumers, and should be used to ensure that appropriate messages and channels of communication are used in the development of this new branch of nutritional science.
The metabolic syndrome
Authors: P. Anne, Nugent
Published: February 2004

The metabolic syndrome has been described as a ‘clustering’ of several risk factors for cardiovascular disease, namely obesity (particularly abdominal obesity), dyslipidaemia, insulin resistance and hypertension. Globally, the incidence of this syndrome is rising at an alarming rate. Treatments involve pharmacological therapies and diet and lifestyle changes. In order to reduce the incidence of this disease, and to minimise costs to health services, increasing emphasis must be placed on prevention, and on the education of health professionals and the public regarding the importance of diet and exercise in preventing this disease. Research is urgently required to elucidate the molecular mechanisms underlying this syndrome, to evaluate prognostic biomarkers identifying this disease and to isolate and evaluate potential therapeutic agents. The OB‐AGE and LIPGENE projects are European Union funded research projects which aim to enhance our understanding of this syndrome (at a whole body, cellular and molecular level) and to evaluate the effectiveness of dietary fatty acids in preventing/ameliorating this disease.
The impact of shared practice learning on the quality of assessment carried out by social work and district nurse students
Authors: Torkington Claire , Lymbery Mark , Millward Andy , Murfin Maureen , Richell Barbara
Published: February 2004

It is evident from many recent government publications that health and social care agencies need to reduce the ‘gap’ between the various organizational and professional structures that exist. In the context of primary health and social care services, it has been suggested that this ‘gap’ exists at three levels – financial, organizational and professional. This article reports the findings from the Shared Practice Learning Project, which sought to reduce the ‘gap’ between social workers and district nurses by providing a shared practice learning experience for students undertaking their professional training in both disciplines. It identifies the key areas of learning that were generated by the project, focusing particularly on the commonalties and differences in assessment processes. It is suggested that the skills and orientation of social workers and district nurses are complementary and that there is much to be gained from more structured opportunities for students from both disciplines to share practice learning experiences.
The recognition of and response to dementia in the community: lessons for professional development
Authors: Iliffe Steve , Manthorpe Jill
Published: February 2004

Adult learning approaches require professionals to identify their learning needs. Learning about dementia syndromes is a complex task because of the insidious onset and variable course of the disease processes, the inexorability of cognitive and functional loss, and the emotional impact of neurodegenerative disorders on those experiencing them and on their family and professional carers. This report describes the ways in which learning tasks were understood and articulated by 774 community‐based professionals from different disciplines, working in nominal groups in 24 settings across the United Kingdom, and explores how these groups set about identifying their learning needs. These groups focused on being insufficiently skilled to carry out educational functions, on solving problems of limited resources and inflexible systems, and on carers rather than on people with dementia. The groups’ solution hinged on multidisciplinary learning being the best route to achieving system change, but such an approach to learning was dealt with uncritically. Three themes received scant attention: the impact of practitioners’ own emotional responses to dementia on their clinical or practical skills; the educational potential of voluntary organizations; and the value of learning from the person with dementia, as much as from their carers. Professional development should therefore widen the debate about recognition of dementia to improvement of timely responses. It should concentrate on developing capacities not only around diagnosis, but also around communication and support.
Dynamics of T‐U Wave in Patients with Idiopathic Ventricular Tachycardia Originating From the Right Ventricular Outflow Tract
Authors: NAKAGAWA MIKIKO , ITO MORIO , TAKAHASHI NAOHIKO , OOIE TATSUHIKO , SHIGEMATSU SAKUJI , HARA MASAHIDE , ICHINOSE MASASHI , NOBE SEIKI , YONEMOCHI HIDETOSHI , SAIKAWA TETSUNORI
Published: February 2004

Postextrasystolic U wave augmentation is observed in patients with long QT syndrome and those with organic heart disease. This phenomenon is considered a marker of increased risk of arrhythmia. However, the characteristics of the U wave have not been evaluated in patients with idiopathic VT originating from the right ventricular outflow tract (RVOT‐VT). The present study evaluated the dynamic change in the T‐U wave in patients with RVOT‐VT. Holter ECGs obtained from 14 patients with RVOT‐VT and 11 healthy control subjects were analyzed. The amplitude of T and U waves (Tamp and Uamp) and preceding RR intervals were measured during stable sinus rhythm (rate dependent change) and in the postextrasystolic sinus complex (pause dependent change). Uamp correlated negatively and significantly with the preceding RR interval in 13 (93%) RVOT‐VT patients but in only 2 (18%) control subjects. The average value of the slope of the Uamp/RR relationship was negative (−0.22 ± 0.10 mV/s) in the RVOT‐VT group, but was positive (0.04 ± 0.07 mV/s, P < 0.001) in the control group. Pause dependent U wave augmentation was observed in 12 (86%) of 14 patients. Increased frequency of consecutive preceding premature ventricular contractions (PVCs) was associated with a larger postextrasystolic Uamp. PVC or the first ventricular beat of VT arose from near the peak of augmented U waves. The dynamic changes in the T‐U wave were observed in patients with RVOT‐VT. Further investigations are required to elucidate the precise role of the U wave in arrhythmogenesis in those patients. (PACE 2004; 27:148–155)
Localization of Accessory Pathways by the Electrocardiogram:
Authors: KATSOURAS CHRISTOS S. , GREAKAS GEORGIOS F. , GOUDEVENOS JOHN A. , MICHALIS LAMPROS K. , KOLETTIS THEOFILOS , ECONOMIDES CONSTANTINOS , ARGYRI URANIA , PAPPAS SPIRIDON , SIDERIS DIMITRIS A.
Published: February 2004

We evaluated the extent of agreement among three algorithms used for the localization of accessory pathways in patients with overt preexcitation. By the use of one algorithm, three independent couples of observers localized the accessory pathway in 95 consecutive patients showing overt preexcitation in the 12‐lead surface electrocardiogram. We defined the following regions: Left atrioventricular ring (LAVR), Right atrioventricular ring (RAVR), Left lateral/left anterolateral (LL/LAL), Left posterior/left posterolateral (LP/LPL), Left posteroseptal (LPS), Right midseptal (RMS), Right posteroseptal (RPS), Right posterior/right posterolateral (RP/RPL), Right lateral/right anterolateral (RL/RAL), and Right anterior/right anteroseptal (RA/RAS). The extent of agreement in each region was evaluated and compared with the expected one, as calculated from the reported. The extent of agreement was as expected: (1) high in the regions LAVR, RAVR, LL/LPS and (2) limited in the regions LPS, RPS, and (3) clearly lower than expected in the regions LP/LPL, RA/RAS, RMS, RL/RAL. In cases with total or partial disagreement, the number of electrocardiograms with duration of QRS complex smaller than 120 ms was greater than in cases with total agreement (30/46 vs 22/50, P < 0.05). The observed agreement among algorithms is clearly lower than the expected one. Minimal preexcitation, limited number of patients, and arbitrarily defined regions were possibly the reasons for some unexpected results. (PACE 2004; 27:189–193)
Effects of Intravenous Nifekalant, A Class III Antiarrhythmic Drug, on Atrial Vulnerability Parameters in Patients with Paroxysmal Atrial Fibrillation
Authors: MINAMI TAKAKO , ISOMOTO SHOJIRO , NAKAO KOJIRO , KOMIYA NORIHIRO , FUKAE SATOKI , CENTURION OSMAR ANTONIO , YANO KATSUSUKE
Published: February 2004

Nifekalant, a class III antiarrhythmic drug, has been shown to suppress ventricular tachyarrhythmias, but its effects on AF are unclear. The aim of this study was to clarify the effects of nifekalant on the atrial vulnerability parameters in patients with paroxysmal AF. The study included 18 patients with paroxysmal AF who underwent electrophysiological study before and after intravenous infusion of nifekalant. The atrial electrophysiological parameters including the atrial effective refractory period (AERP), maximum intraatrial conduction delay, and wavelength index, calculated as the ratio of AERP to the maximum conduction delay, were quantitatively measured at baseline and during nifekalant infusion. The mean AERP was significantly prolonged from 214 ± 27 ms at baseline to 242 ± 39 ms after nifekalant (P < 0.001). Although earlier studies have shown that nifekalant does not affect the atrial conduction time, the mean maximum conduction delay of the study patients was significantly prolonged from 59 ± 19 ms at baseline to 72 ± 28 ms after nifekalant (P = 0.015). There was no significant difference in the wavelength index at baseline (4.1 ± 1.7) and after nifekalant (4.1 ± 2.5). However, when the differences of AERP and wavelength index were defined as each parameter during nifekalant infusion minus that at baseline, the difference of AERP showed a direct positive correlation with that of the wavelength index (P = 0.013). In conclusion, nifekalant may be effective in the prevention of AF due to prolongation of the AERP. However, in those patients who have a lesser degree of prolongation of the AERP by nifekalant, the wavelength index tended to be decreased, suggesting that the drug might augment the propensity for AF. (PACE 2004; 27:212–217)
Comparison of Step‐Down and Binary Search Algorithms for Determination of Defibrillation Threshold in Humans
Authors: SHOROFSKY STEPHEN R. , PETERS ROBERT W. , RASHBA ERIC J. , GOLD MICHAEL R.
Published: February 2004

Determination of DFT is an integral part of ICD implantation. Two commonly used methods of DFT determination, the step‐down method and the binary search method, were compared in 44 patients undergoing ICD testing for standard clinical indications. The step‐down protocol used an initial shock of 18 J. The binary search method began with a shock energy of 9 J and successive shock energies were increased or decreased depending on the success of the previous shock. The DFT was defined as the lowest energy that successfully terminated ventricular fibrillation. The binary search method has the advantage of requiring a predetermined number of shocks, but some have questioned its accuracy. The study found that (mean) DFT obtained by the step‐down method was 8.2 ± 5.0, whereas by the binary search method DFT was 8.1 ± 0.7 J, P = NS. DFT differed by no more than one step between methods in 32 (71%) of patients. The number of shocks required to determine DFT by the step‐down method was 4.6 ± 1.4, whereas by definition, the binary search method always required three shocks. In conclusion, the binary search method is preferable because it is of comparable efficacy and requires fewer shocks. (PACE 2004; 27:218–220)
Incidence of Antitachycardia Therapy Suspension Due to Magnet Reversion in Implantable Cardioverter Defibrillators
Authors: KOLB CHRISTOF , DEISENHOFER ISABEL , WEYERBROCK SONJA , SCHMIEDER SEBASTIAN , PLEWAN ANDREAS , ZRENNER BERNHARD , SCHMITT CLAUS
Published: February 2004

Electromagnetic interference may result in transient or persistent suspension of antitachycardia therapies in ICDs. The incidence of such events has not been assessed so far. Patient charts were retrospectively analyzed for the occurrence of temporary suspension of antitachycardia therapies as it is stored in the Holter of St. Jude Medical or Ventritex ICDs. Follow‐up data of 46 patients and 83.7‐patient years were analyzed. Overall, 43 episodes of transient ICD inactivation occurred. Twenty‐two of these episodes were related to intentional ICD inactivation in the emergency room or during surgery and 12 episodes were related to ICD follow‐up. In nine episodes an environmental source of electromagnetic interference is presumed. None of the interactions resulted in persistent ICD inactivation or reprogramming of the devices. The risk for temporary suspension of ICD therapies unrelated to surgery, intentional magnet application in the emergency room, or routine follow‐up is 11% per patient and year. Evaluation of its potential sources and the prevalence of ICD inhibition is warranted. (PACE 2004; 27:221–223)
Left Atrial Vein Pacing:
Authors: BIRNIE DAVID , CONNORS SEAN P. , VEINOT JOHN P. , GREEN MARTIN , STINSON WILLIAM A. , TANG ANTHONY S.L.
Published: February 2004

Biatrial pacing is a promising new therapy for drug refractory AF. This article reports two studies. First, an initial 14‐patient experience with a novel technique for biatrial pacing. The authors attempted to pace from the LA vein branches of the proximal CS for LA stimulation. LA vein pacing would potentially offer the advantages of greater interatrial synchronization and possibly greater reduction in AF burden and also of lesser far‐field R wave sensing and greater lead stability. Second, a postmortem series examining the number, size, and site of LA veins draining into the proximal CS is described. LA vein pacing was successful in 9 of 14 patients. LA vein electrode parameters have been stable during a median follow‐up of 580 days. There were three early lead dislodgments but no other complications. In the second study, a postmortem analysis of 43 human hearts was performed. The study found that 38 (88.4%) of 43 hearts had at least one LA vein draining into the proximal 5 cm of the CS. In addition, 81.2% (33/43) had at least one vein greater than 4 Fr caliber. Thus, pacing in a greater proportion of patients might be achieved by the development and use of smaller (3, 4, and 5 Fr) electrodes. Furthermore, these smaller leads would obviously allow deeper advancement into the LA veins with the potential advantages of greater interatrial synchronization and lead stability and lesser far‐field R wave sensing. (PACE 2004; 27:240–245)
Persistent Tachycardia Originating from the Superior Vena Cava as a Driver for Atrial Fibrillation
Authors: TADA HIROSHI , NAITO SHIGETO , MEGURO KENTARO , NOGAMI AKIHIKO , TANIGUCHI KOICHI
Published: February 2004

We describe a patient with drug‐resistant paroxysmal atrial fibrillation who underwent radiofrequency catheter ablation of tachycardia originating from the superior vena cava (SVC). A continuous and rapid tachycardia conducted to the atrium with evidence of exit block and drove atrial fibrillation (AF) and atrial tachycardia. Neither AF nor atrial tachycardia could be induced after SVC isolation, and nor were they observed during follow‐up. We conclude that continuous and rapid tachycardia originating from the SVC can act as a driver as well as an initiator of AF. (PACE 2004; 27:252–255)
Nonsurgical Transthoracic Epicardial Ablation for the Treatment of a Resistant Posteroseptal Accessory Pathway
Authors: DE PAOLA ANGELO A.V. , LEITE LUIZ R. , MESAS CÉZAR E.
Published: February 2004

A case of Wolff‐Parkinson‐White syndrome successfully treated by transcutaneous epicardial radiofrequency ablation is described in a patient with a posteroseptal accessory pathway who had failed prior attempts of conventional endocardial and coronary venous system approaches. Simultaneous endocardial and pericardial space mapping was performed and only ablation from the pericardial space was successful, suggesting an epicardial course of the accessory pathway. (PACE 2004; 27:259–261)
Dislodgment of an Atrial Screw‐In Pacing Lead 10 Years After Implantation
Authors: TOKANO TAKASHI , NAKAZATO YUJI , SASAKI AKITOSHI , YAMASHITA HARUYO , IIDA YOJI , KAWANO YASUNOBU , MINEDA YORIAKI , NAKAZATO KAORU , YASUDA MASAYUKI , SUMIYOSHI MASATAKA , NAKATA YASURO , DAIDA HIROYUKI
Published: February 2004

Dislodgment of an atrial screw‐in pacing lead is quite rare. This report describes a rare case of an atrial screw‐in lead dislodgment 10 years after implantation. Although it is an uncommon complication, very late dislodgment can occur postoperatively, and careful follow‐up is necessary. (PACE 2004; 27:264–265)
Cardiac Surgery for Arrhythmias
Authors: COX JAMES L.
Published: February 2004

Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff‐Parkinson‐White Syndrome. Subsequent surgical procedures included the left atrial isolation procedure and the right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentry tachycardia, the atrial transection procedure, corridor procedure and Maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the Maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25–30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an “esoteric” specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom on which better methods of treatment have been founded. One could hardly ask for a more rewarding experience. (PACE 2004; 27:266–282)
Biochemical and Proteomic Analysis of the Magnetosome Membrane in
Magnetospirillum gryphiswaldense
Authors: Grünberg Karen , Müller Eva-Christina , Otto Albrecht , Reszka Regina , Linder Dietmar , Kube Michael , Reinhardt Richard , Schüler Dirk
Published: February 2004

We analyzed the biochemical composition of the magnetosome membrane (MM) in
Magnetospirillum gryphiswaldense
. Isolated magnetosomes were associated with phospholipids and fatty acids which were similar to phospholipids and fatty acids from other subcellular compartments (i.e., outer and cytoplasmic membranes) but were present in different proportions. The binding characteristics of MM-associated proteins were studied by selective solubilization and limited proteolysis. The MM-associated proteins were further analyzed by various proteomic approaches, including one- and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by Edman and mass spectrometric (electrospray ionization-mass spectrometry-mass spectrometry) sequencing, as well as capillary liquid chromatography-mass spectrometry-mass spectrometry of total tryptic digests of the MM. At least 18 proteins were found to constitute the magnetosome subproteome, and most of these proteins are novel for
M. gryphiswaldense
. Except for MM22 and Mms16, all bona fide MM proteins (MMPs) were encoded by open reading frames in the
mamAB
,
mamDC
, and
mms6
clusters in the previously identified putative magnetosome island. Eight of the MMPs display homology to known families, and some of them occur in the MM in multiple homologues. Ten of the MMPs have no known homologues in nonmagnetic organisms and thus represent novel, magnetotactic bacterium-specific protein families. Several MMPs display repetitive or highly acidic sequence patterns, which are known from other biomineralizing systems and thus may have relevance for magnetite formation.
Spatial Variation in Frequency and Intensity of Antibiotic Interactions among Streptomycetes from Prairie Soil
Authors: Davelos Anita L. , Kinkel Linda L. , Samac Deborah A.
Published: February 2004

Antibiotic interactions are believed to be significant to microbial fitness in soil, yet little is known of the frequency, intensity, and diversity of antibiotic inhibition and resistance among indigenous microbes. To begin to address these issues, we studied the abilities of streptomycete isolates from prairie soil to inhibit growth and display resistance to antibiotics produced by a test collection of 10 streptomycete isolates. Wide variations in antibiotic inhibition and resistance for prairie isolates among three locations and four soil depths within a 1-m
2
plot were revealed. Fewer than 10% of 153 prairie isolates inhibited all 10 test isolates, while more than 40% of the isolates did not inhibit any of the test isolates. No field isolate was resistant to all of the test isolates, nor was any isolate susceptible to all of the test isolates. No correlation between inhibition and resistance phenotypes was found, suggesting that inhibition and resistance are under independent selection. The significant spatial variation in the frequency and intensity of antibiotic inhibition implies that the fitness benefits of antibiotic production are not the same among locations in soil. In contrast, the consistency of resistance over space indicates that its significance to fitness across locations is stable or the costs of maintaining resistance in the absence of selection are small or nonexistent. The spatial clustering of antibiotic inhibitory activity suggests a variable matrix of selection pressures and microbial responses across the soil landscape.
Fluorescent Amplified Fragment Length Polymorphism Analysis of
Bacillus anthracis
,
Bacillus cereus
, and
Bacillus thuringiensis
Isolates
Authors: Hill Karen K. , Ticknor Lawrence O. , Okinaka Richard T. , Asay Michelle , Blair Heather , Bliss Katherine A. , Laker Mariam , Pardington Paige E. , Richardson Amber P. , Tonks Melinda , Beecher Douglas J. , Kemp John D. , Kolstø Anne-Brit , Wong Amy C. Lee , Keim Paul , Jackson Paul J.
Published: February 2004

DNA from over 300
Bacillus thuringiensis
,
Bacillus cereus
, and
Bacillus anthracis
isolates was analyzed by fluorescent amplified fragment length polymorphism (AFLP).
B. thuringiensis
and
B. cereus
isolates were from diverse sources and locations, including soil, clinical isolates and food products causing diarrheal and emetic outbreaks, and type strains from the American Type Culture Collection, and over 200
B. thuringiensis
isolates representing 36 serovars or subspecies were from the U.S. Department of Agriculture collection. Twenty-four diverse
B. anthracis
isolates were also included. Phylogenetic analysis of AFLP data revealed extensive diversity within
B. thuringiensis
and
B. cereus
compared to the monomorphic nature of
B. anthracis
. All of the
B. anthracis
strains were more closely related to each other than to any other
Bacillus
isolate, while
B. cereus
and
B. thuringiensis
strains populated the entire tree. Ten distinct branches were defined, with many branches containing both
B. cereus
and
B. thuringiensis
isolates. A single branch contained all the
B. anthracis
isolates plus an unusual
B. thuringiensis
isolate that is pathogenic in mice. In contrast,
B. thuringiensis
subsp.
kurstaki
(ATCC 33679) and other isolates used to prepare insecticides mapped distal to the
B. anthracis
isolates. The interspersion of
B. cereus
and
B. thuringiensis
isolates within the phylogenetic tree suggests that phenotypic traits used to distinguish between these two species do not reflect the genomic content of the different isolates and that horizontal gene transfer plays an important role in establishing the phenotype of each of these microbes.
B. thuringiensis
isolates of a particular subspecies tended to cluster together.
Sourdough Bread Made from Wheat and Nontoxic Flours and Started with Selected Lactobacilli Is Tolerated in Celiac Sprue Patients
Authors: Di Cagno Raffaella , De Angelis Maria , Auricchio Salvatore , Greco Luigi , Clarke Charmaine , De Vincenzi Massimo , Giovannini Claudio , D'Archivio Massimo , Landolfo Francesca , Parrilli Giampaolo , Minervini Fabio , Arendt Elke , Gobbetti Marco
Published: February 2004

This work was aimed at producing a sourdough bread that is tolerated by celiac sprue (CS) patients. Selected sourdough lactobacilli had specialized peptidases capable of hydrolyzing Pro-rich peptides, including the 33-mer peptide, the most potent inducer of gut-derived human T-cell lines in CS patients. This epitope, the most important in CS, was hydrolyzed completely after treatment with cells and their cytoplasmic extracts (CE). A sourdough made from a mixture of wheat (30%) and nontoxic oat, millet, and buckwheat flours was started with lactobacilli. After 24 h of fermentation, wheat gliadins and low-molecular-mass, alcohol-soluble polypeptides were hydrolyzed almost totally. Proteins were extracted from sourdough and used to produce a peptic-tryptic digest for in vitro agglutination tests on K 562(S) subclone cells of human origin. The minimal agglutinating activity was ca. 250 times higher than that of doughs chemically acidified or started with baker's yeast. Two types of bread, containing ca. 2 g of gluten, were produced with baker's yeast or lactobacilli and CE and used for an in vivo double-blind acute challenge of CS patients. Thirteen of the 17 patients showed a marked alteration of intestinal permeability after ingestion of baker's yeast bread. When fed the sourdough bread, the same 13 patients had values for excreted rhamnose and lactulose that did not differ significantly from the baseline values. The other 4 of the 17 CS patients did not respond to gluten after ingesting the baker's yeast or sourdough bread. These results showed that a bread biotechnology that uses selected lactobacilli, nontoxic flours, and a long fermentation time is a novel tool for decreasing the level of gluten intolerance in humans.
Inactivation of
Escherichia coli
by Photochemical Reaction of Ferrioxalate at Slightly Acidic and Near-Neutral pHs
Authors: Cho Min , Lee Yunho , Chung Hyenmi , Yoon Jeyong
Published: February 2004

Fenton chemistry, which is known to play an effective role in degrading toxic chemicals, is difficult to apply to disinfection in water treatment, since its reaction is effective only at the acidic pH of 3. The presence of oxalate ions and UV-visible light, which is known as a photoferrioxalate system, allows the Fe(III) to be dissolved at slightly acidic and near-neutral pHs and maintains the catalytic reaction of iron. This study indicates that the main oxidizing species in the photoferrioxalate system responsible for microorganism inactivation is OH radical.
Escherichia coli
was used as an indicator microorganism. The
CT
value (OH radical concentration × contact time; used to indicate the effect of the combination of the concentration of the disinfectant and the contact time on inactivation) for a 2-log inactivation of
E. coli
was approximately 1.5 × 10
−5
mg/liter/min, which is approximately 2,700 times lower than that of ozone as estimated by the delayed Chick-Watson model. Since the light emitted by the black light blue lamp is similar to sunlight in the specific wavelength range of 300 to 420 nm, the photoferrioxalate system, which can have a dual function, treating water for both organic pollutants and microorganisms simultaneously, shows promise for the treatment of water or wastewater in remote or rural sites. However, the photoferrioxalate disinfection system is slower in inactivating microorganisms than conventional disinfectants are.
Dispersion and Transport ofCryptosporidiumOocysts from Fecal Pats under Simulated Rainfall Events
Authors: Davies Cheryl M. , Ferguson Christobel M. , Kaucner Christine , Krogh Martin , Altavilla Nanda , Deere Daniel A. , Ashbolt Nicholas J.
Published: February 2004

The dispersion and initial transport ofCryptosporidiumoocysts from fecal pats were investigated during artificial rainfall events on intact soil blocks (1,500 by 900 by 300 mm). Rainfall events of 55 mm h−1for 30 min and 25 mm h−1for 180 min were applied to soil plots with artificial fecal pats seeded with approximately 107oocysts. The soil plots were divided in two, with one side devoid of vegetation and the other left with natural vegetation cover. Each combination of event intensity and duration, vegetation status, and degree of slope (5° and 10°) was evaluated twice. Generally, a fivefold increase (P< 0.05) in runoff volume was generated on bare soil compared to vegetated soil, and significantly more infiltration, although highly variable, occurred through the vegetated soil blocks (P< 0.05). Runoff volume, event conditions (intensity and duration), vegetation status, degree of slope, and their interactions significantly affected the load of oocysts in the runoff. Surface runoff transported from 100.2oocysts from vegetated loam soil (25-mm h−1, 180-min event on 10° slope) to up to 104.5oocysts from unvegetated soil (55-mm h−1, 30-min event on 10° slope) over a 1-m distance. Surface soil samples downhill of the fecal pat contained significantly higher concentrations of oocysts on devegetated blocks than on vegetated blocks. Based on these results, there is a need to account for surface soil vegetation coverage as well as slope and rainfall runoff in future assessments ofCryptosporidiumtransport and when managing pathogen loads from stock grazing near streams within drinking water watersheds.
Integron Diversity in Heavy-Metal-Contaminated Mine Tailings and Inferences about Integron Evolution
Authors: Nemergut D. R. , Martin A. P. , Schmidt S. K.
Published: February 2004

Integrons are horizontal gene transfer (HGT) systems containing elements necessary for site-specific recombination and expression of foreign DNA. The overall phylogenetic distribution of integrons and range of genes that can be transferred by integrons are unknown. This report contains an exploration of integrons in an environmental microbial community and an investigation of integron evolution. First, using culture-independent techniques, we explored the diversity of integrons and integron-transferred genes in heavy-metal-contaminated mine tailings. Using degenerate primers, we amplified integron integrase genes from the tailings. We discovered 14 previously undescribed integrase genes, including six novel gene lineages. In addition, we found 11 novel gene cassettes in this sample. One of the gene cassettes that we sequenced is similar to a gene that codes for a step in a pathway for nitroaromatic catabolism, a group of compounds associated with mining activity. This suggests that integrons may be important for gene transfer in response to selective pressures other than the presence of antibiotics. We also investigated the evolution of integrons by statistically comparing the phylogenies of 16S rRNA and integrase genes from the same organisms, using sequences from GenBank and various sequencing projects. We found significant differences between the organismal (16S rRNA) and integrase trees, and we suggest that these differences may be due to HGT.
Colonization and Immunomodulation by
Lactobacillus reuteri
ATCC 55730 in the Human Gastrointestinal Tract
Authors: Valeur Nana , Engel Peter , Carbajal Noris , Connolly Eamonn , Ladefoged Karin
Published: February 2004

Lactobacillus reuteri
ATCC 55730 is a probiotic (health-promoting) bacterium widely used as a dietary supplement. This study was designed to examine local colonization of the human gastrointestinal mucosa after dietary supplementation with
L. reuteri
ATCC 55730 and to determine subsequent immune responses at the colonized sites. In this open clinical investigation, 10 healthy volunteers and 9 volunteers with ileostomy underwent gastroscopy or ileoscopy and biopsy samples were taken from the stomach, duodenum, or ileum before and after supplementation with 4 × 10
8
CFU of live
L. reuteri
ATCC 55730 lactobacilli per day for 28 days. Biopsy specimen colonization was analyzed using fluorescence in situ hybridization with a molecular beacon probe, and immune cell populations were determined by immunostaining. Endogenous
L. reuteri
was detected in the stomach of 1 subject and the duodenum of 3 subjects (out of 10 subjects). After
L. reuteri
ATCC 55730 supplementation, the stomachs of 8 and the duodenums of all 10 subjects were colonized. Three ileostomy subjects (of six tested) had endogenous
L. reuteri
at baseline, while all six displayed colonization after
L. reuteri
supplementation. Gastric mucosal histiocyte numbers were reduced and duodenal B-lymphocyte numbers were increased by
L. reuteri
ATCC 55730 administration. Furthermore,
L. reuteri
administration induced a significantly higher amount of CD4-positive T-lymphocytes in the ileal epithelium. Dietary supplementation with the probiotic
L. reuteri
ATCC 55730 induces significant colonization of the stomach, duodenum, and ileum of healthy humans, and this is associated with significant alterations of the immune response in the gastrointestinal mucosa. These responses may be key components of a mechanism by which
L. reuteri
ATCC 55730 exerts its well-documented probiotic effects in humans.
Two
Bacteria
Phylotypes Are Predominant in the Suiyo Seamount Hydrothermal Plume
Authors: Sunamura Michinari , Higashi Yowsuke , Miyako Chiwaka , Ishibashi Jun-ichiro , Maruyama Akihiko
Published: February 2004

Microbial diversity and populations in a hydrothermal plume that was present inside the caldera of the Suiyo Seamount, a submarine volcano on the Izu-Bonin Arc, were investigated by performing a phylogenetic analysis of the 16S rRNA gene and by using fluorescence in situ hybridization (FISH). Corresponding to transmissivity, an indicator of turbidity, the vertical total cell count as determined by 4′,6′-diamidino-2-phenylindole (DAPI) staining varied from 5.6 × 10
4
to 1.1 × 10
5
cells ml
−1
, and the apparent plume layer was assessed to be at a depth of 1,050 to 1,200 m inside the caldera and to contain 1.0 × 10
5
to 1.1 × 10
5
cells ml
−1
. From microbial samples collected in the plume by an in situ filtration system, the following two major phylogenetic groups, which were closely related to sulfur-oxidizing microbes, were obtained: the SUP05 group belonging to the gamma subclass of the
Proteobacteria
(13 of 20 clones) and the SUP01 group belonging to the epsilon subclass of the
Proteobacteria
(5 of 20 clones). Specific oligonucleotide probes for these groups (SUP05-187 and SUP01-63) were designed and were used with various water samples obtained from the Suiyo Seamount. In the apparent plume layer, up to 66% of the total counts of microbial cells were estimated to be
Bacteria
cells that hybridized to EUB338, and few cells were identified by the archaeal probe ARCH915. Almost all
Bacteria
cells were hard to identify with the known group-specific probes, such as ALF19, GAM42a, and CF319, while 88 to 90% of the
Bacteria
cells hybridized with SUP05-187 and >98% of them were considered members of the SUP05 and SUP01 populations. In a low-temperature vent fluid emitted from a bivalve-colonized mound, the SUP05 cells accounted for >99% of the
Bacteria
cells, suggesting that a portion of the plume cells originated on the surface of the seafloor at a depth of about 1,380 m. From further analysis of cell morphology (i.e., cell size and cell elongation index) we inferred that the SUP05 cells were active in the plume layer at a depth of 1,050 to 1,200 m compared to the activity in a near-bottom layer, while many elongated cells were found between these layers. These findings suggest that the morphology and distribution of SUP05 cells have complex relationships with hydrothermal activities and water circulation. Although growth and production rates remain to be defined, we concluded that this Suiyo Seamount caldera has functioned as a natural continuous incubator for these two phylotypes of
Bacteria
in an aphotic deep-sea environment.