bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eplerenone might affect atrial fibrosis in patients with hypertension
Authors: Kawasaki Masato , Yamada Takahisa , Okuyama Yuji , Morita Takashi , Furukawa Yoshio , Tamaki Shunsuke , Iwasaki Yusuke , Kikuchi Atsushi , Sakata Yasushi , Fukunami Masatake 
Published: August 2017

AbstractBackgroundEplerenone is reported to reduce the development of atrial fibrillation (AF). The aim of this study was to clarify the mechanism of eplerenone for AF prevention from the viewpoint of P wave morphology, which is reported to correlate with atrial fibrosis.MethodsThirty‐five patients with hypertension, who were randomized to receive eplerenone (n = 16) or amlodipine (n = 19) for 1 year, were evaluated. P wave signal‐averaged electrocardiography was recorded at baseline and 1 year after entry, and P wave duration (Ad) and P wave dispersion (P‐disp) were obtained. Serum levels of intact procollagen type I N‐terminal propeptide (PINP) and N‐terminal procollagen‐III peptide (PIIIP) were also measured.ResultsThere were no significant differences in baseline clinical characteristics including Ad, P‐disp, and the decrease in blood pressure at 1‐year follow‐up between the two groups. Ad and P‐disp (mean ± standard deviation) significantly increased in patients on amlodipine after 1 year (140 ± 21 ms to 139 ± 19 ms vs 132 ± 10 ms to 136 ± 12 ms, P < 0.01 and 14 ± 7 ms to 9 ± 4 ms vs 12 ± 5 to 16 ± 8, P < 0.01, respectively). PINP was significantly more decreased in patients with eplerenone than amlodipine (56.6 ± 30.4 μg/mL to 46.6 ± 19.4 μg/mL vs 41.5 ± 16.2 μg/L to 48.7 ± 21.3 μg/L, P < 0.01). Percent changes of Ad, P‐disp, PINP, and PIIIP were significantly smaller in patients with eplerenone than amlodipine (0.0 ± 4.7% vs 3.2 ± 4.4%, P < 0.05, − 28.6 ± 31.0% vs 46.3 ± 73.0%, P < 0.01, − 5.6 ± 38.1% vs 22.7 ± 42.7%, P < 0.05, and − 9.2 ± 25.1% vs 7.4 ± 19.0%, P < 0.05, respectively).ConclusionsEplerenone reduced the increase of Ad and P‐disp with a decrease of PINP and PIIIP, which might translate into reduction of atrial fibrosis. This study showed that eplerenone may be useful as upstream therapy for AF in patients with hypertension.
Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters
Authors: Rubín José Manuel , Calvo David , Pérez Diego , Fidalgo Ana , de la Hera Jesús María , Martínez Lidia , Capín Esmeralda , Arrizabalaga Haritz , Carballeira Lidia , García Daniel , Morís Cesar 
Published: August 2017

AbstractIntroductionOur aim was to characterize a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter in a prospective, noncrossover randomized study.MethodsOne hundred and fifty patients referred for cavotricuspid isthmus (CTI)‐dependent atrial flutter ablation were randomized to undergo an ablation with an 8‐mm‐tip catheter (group 1), a 3.5‐mm open irrigation‐tip catheter (group 2), and a 3.5‐mm open irrigation porous‐tip catheter (group 3). A stepwise approach was performed, changing the ablation site from medial to septal aspects of the CTI, in case it was not effective without crossover between catheters.ResultsCTI block was achieved in all the patients using only one catheter. There was a 68% efficacy in group 1, 40% in group 2, and 28% in group 3 to achieve CTI block within 10 minutes (P = 0.001) and 96%, 70%, and 70% in groups 1, 2, and 3, respectively, within 20 minutes (P = 0.002) of radiofrequency ablation. The 8‐mm catheter was also faster in fluoroscopy time and CTI block time. There were no differences in efficiency in the both irrigated catheters. There were no significant differences in complications among three catheters.ConclusionsWith this stepwise approach, it is possible to achieve CTI block in all cases, using a single catheter without crossover, with good times of procedure and with a low complication rate. The 8‐mm solid catheter is faster than the other irrigated‐tip catheters. The 3.5‐mm open irrigation porous‐tip catheter is as effective and safe as the conventional irrigated‐tip catheter.
Venipuncture procedure affects heart rate variability and chronotropic response
Authors: Kliszczewicz Brian , Esco Michael R. , E. Bechke Emily , Feito Yuri , M. Williamson Cassie , Brown Danielle , Price Brandi 
Published: August 2017

AbstractBackgroundHeart rate variability (HRV) has been shown to be influenced by several factors such as noise, sleep status, light, and emotional arousal; however, little evidence is available concerning autonomic responses to a venipuncture. The purpose of this study was to investigate changes of HRV indexes and heart rate (HR) during and following a venipuncture procedure among healthy individuals.Methods33 healthy individuals (22.8 ± 0.56 years, 167 ± 1.56 cm, 69.5 ± 2.61 kg) participated. Testing included 10‐minute HRV analysis prior to the venipuncture, a 1‐minute venipuncture procedure followed by a 10‐minute analysis of HRV, and a total recording of 21 minutes. The first 5 minutes of the 21‐minute recordings were discarded, and the remaining 5 minutes of the resting segment was analyzed (PRE), and the last 5 minutes of the 21‐minute recording (POST). The log transformation of the time domain root mean squared of successive differences (lnRMSSD) and the frequency domains of high frequency (lnHF) and low frequency (lnLF) and LF/HF ratio (lnLF/HF) were used to quantify autonomic activity. HR was measured in 1‐minute segments at 2 minutes prior (PRE), venipuncture (STICK), and post (P1‐5).ResultsHR significantly increased at STICK (P = 0.002), and fell below resting at P‐5 (P < 0.001). lnRMSSD and lnHF increased significantly by POST (P < 0.001, P = 0.005). lnLF/HF ratio significantly decreased at POST (P = 0.047), while no significant changes occurred for lnLF (P = 0.590).ConclusionsHRV and HR are influenced for 10 minutes following the venipuncture procedure. Practitioners and researchers who are interested in collecting blood and measuring HRV need to account for the influence of the venipuncture.
Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience
Authors: Ruzieh Mohammed , Sirianni Natalie , Ammari Zaid , Dasa Osama , Alhazmi Luai , Karabin Beverly , Grubb Blair 
Published: August 2017

AbstractBackgroundIvabradine is a selective If channel blocker that reduces heart rate without affecting other cardiovascular functions. In case reports and case series, it was shown to improve symptoms in patients with postural tachycardia syndrome (POTS).Methodology and resultsThis retrospective study examined patients who were diagnosed with POTS and received ivabradine as part of their treatment. Forty‐nine patients (47 females, 95.9%) received ivabradine. The average age was 35.1 ± 10.35 years. The most common symptoms were palpitations and lightheadedness and both improved significantly, 88.4% and 76.1% response rate, respectively. A total of 38 patients reported improvement in their symptoms. In addition, ivabradine resulted in an objective decrease in sitting and standing heart rate (78.1 ± 10.7 vs 72.5 ± 7.6, P‐value: 0.01) and (107.4 ± 14.1 vs 95.1 ± 13.7, P‐value: < 0.001), respectively, with no significant change in blood pressure. The most common reported side effect was luminous phenomena/visual brightness occurring in nine patients. However, none of the patients stopped ivabradine due to side effects.ConclusionOur study shows that ivabradine is likely to be effective in treating patients with POTS. Nearly 78% of our cohort reported a significant improvement in symptoms with no major adverse effects reported. A future randomized, placebo‐controlled trial is warranted.
International survey of knowledge, attitudes, and practices of cardiologists regarding prevention and management of cardiac implantable electronic device infections
Authors: DeSimone Daniel C. , Chahal Anwar A. , DeSimone Christopher V. , Asirvatham Samuel J. , Friedman Paul A. , Baddour Larry M. , Sohail M. Rizwan 
Published: August 2017

AbstractBackgroundCardiovascular implantable electronic devices (CIEDs) can be life‐saving. However, complications from CIED infection can be life‐threatening, often requiring device removal. Despite publication of CIED infection management guidelines, there remains marked variation in clinical practice.ObjectiveTo better understand and quantify these differences, we conducted a multinational survey of practitioners of CIED management.MethodsAn electronic survey was sent to Heart Rhythm Society members, spanning 70 countries across six continents. All responses were collected anonymously.Results227 out of 3,600 (6.3%) responded to the survey. The majority of surveys were completed by practitioners from the United States (168; 68.3%) and 53.8% of these practiced in academic medical centers. The large majority (92.7%) of sites had protocols to ensure appropriate timing of prophylactic antibiotics. Superficial (incisional) site infections were treated with antibiotics alone 52.5% of the time (consistent with guidelines); in contrast, deep pocket infections were treated with antibiotics (with device removal) in accordance to guidelines only 37.4% of the time. Almost all providers (98.7%) were inclined to perform complete hardware removal in cases of CIED‐related endocarditis. In contrast, 82.2% of survey participants suggested complete CIED system removal in patients with an occult Gram‐positive bacteremia, 65.5% with occult Gram‐negative bacteremia, and 59.3% with prolonged bacteremia due to a source other than CIED.ConclusionsThese data suggest wide variability in clinical practice in managing CIED infection with significant deviations from published guidelines. There is critical need to increase awareness and develop institutional protocols to ensure adherence with evidence‐based guidelines to optimize outcomes.
Ablation of the vanishing PVC, facilitated by quantitative morphology‐matching software
Authors: Moak Jeffrey P. , Sumihara Kohei , Swink Jonathan , Hanumanthaiah Sridhar , Berul Charles I. 
Published: August 2017

AbstractBackgroundAblation of cardiac arrhythmias in children and teenagers often necessitates the use of anesthesia, which can suppress ventricular arrhythmias (VAs), making it difficult to map the site of origin using activation time (AT). Pace mapping, a technique employed to assist with VA origin localization, depends on subjective comparison of paced and targeted QRS morphology. We assessed the utility of a quantitative approach to paced QRS to VA morphology matching using the PaSo software (Carto 3, Biosense Webster), to localize the VA site of origin.MethodsTwenty‐four patients underwent 26 procedures for frequent VAs, 29 for targeted VA. If AT mapping was precluded due to infrequent VA, pace mapping was executed using the PaSo software, after regionalization based on targeted VA QRS morphology.ResultsSubjects were aged 1–32 (mean 14 ± 6) years; 10 were male. Heart disease was present in six patients. PVC frequency prior to onset of anesthesia was 15 ± 16/min, decreasing to 0–1 PVC/min in 17 cases prior to ablation. Arrhythmia localization was performed by AT mapping + PaSo (12) or PaSo only (17). Pace mapping exhibited an intraventricular gradient of percent QRS morphology match. Highest achieved QRS match averaged 96 ± 2%. Successful ablation (> 1‐month follow‐up) was achieved in 24/29 targeted VAs, 11/12 ablated using AT and pace mapping, and 13/17 VA ablated using pace mapping only, P = 0.29.Conclusions(1) Spontaneous VA frequency was markedly reduced following anesthesia, despite catecholamine administration. (2) Notwithstanding the ability to perform AT mapping, successful ablation can still be performed using pace mapping only, facilitated by the PaSo software.
Paroxysmal atrioventricular block: Electrophysiological mechanism of phase 4 conduction block in the His‐Purkinje system: A comparison with phase 3 block
Authors: Shenasa Mohammad , Josephson Mark E. , Wit Andrew L. 
Published: August 2017

AbstractBackgroundParoxysmal atrioventricular (A‐V) block is relatively rare, and due to its transient nature, it is often under recognized. It is often triggered by atrial, junctional, or ventricular premature beats, and occurs in the presence of a diseased His‐Purkinje system (HPS). Here, we present a 45‐year‐old white male who was admitted for observation due to recurrent syncope and near‐syncope, who had paroxysmal A‐V block. The likely cellular electrophysiological mechanisms(s) of paroxysmal A‐V block and its differential diagnosis and management are discussed.MethodsContinuous electrocardiographic monitoring was done while the patient was in the cardiac unit.ResultsMultiple episodes of paroxysmal A‐V block were documented in this case. All episodes were initiated and terminated with atrial/junctional premature beats. The patient underwent permanent pacemaker implantation and has remained asymptomatic since then.ConclusionsParoxysmal A‐V block is rare and often causes syncope or near‐syncope. Permanent pacemaker implantation is indicated according to the current guidelines. Paroxysmal A‐V block occurs in the setting of diseased HPS and is bradycardia‐dependent. The detailed electrophysiological mechanisms, which involve phase 4 diastolic depolarization, and differential diagnosis are discussed.
Lower airway dimensions in pediatric patients—A computed tomography study
Authors: Szelloe Patricia , Weiss Markus , Schraner Thomas , Dave Mital H. 
Published: August 2017

SummaryBackgroundThe aim of this study was to obtain lower airway dimensions in children by means of computed tomography (CT).MethodsChest CT scans from 195 pediatric patients (118 boys/77 girls) aged 0.04‐15.99 years were analyzed. Tracheal and bronchial lengths, anterior‐posterior and lateral diameters, as well as cross‐sectional area were assessed at the following levels: mid trachea, right proximal and distal bronchus, proximal bronchus intermedius, and left proximal and distal bronchus. Mediastinal angles of tracheal bifurcation were measured. Data were analyzed by means of linear and polynomial regression plots.ResultsThe strongest correlations were found between tracheal and bronchial diameters and age as well as between tracheal and bronchial lengths and body length. All measured airway parameters correlated poorly to body weight. Bronchial angles revealed no association with patient's age, body length, or weight.ConclusionThis comprehensive anatomical database of lower airway dimensions demonstrates that tracheal and bronchial diameters correlate better to age, and that tracheal and bronchial length correlate better to body length. All measured airway parameters correlated poorly to body weight.
Ethical issues in pediatric face transplantation
Authors: Benghiac Ana‐Gabriela , Garrett Jeremy R. , Carter Brian S. 
Published: August 2017

AbstractFacial transplantation has become a reality in adult medicine. Children are subject to congenital craniofacial differences, disease‐related, traumatic, or thermochemical craniofacial changes and might be suitable for face transplantation. This manuscript addresses unique ethical issues in considering potential pediatric face transplant. These challenges are operant at the individual, technologic, and psychosocial level for clinicians, investigators, and society.
Safety of hematopoietic cell infusion in children with malignant and non‐malignant diseases
Authors: Heneghan Chelsea , Smilow Elana , Tanhehco Yvette , Jin Zhezhen , Cofnas Paige , Schwartz Sharon , Patel Nita , Carberry Deborah , Silverman Justin , Huynh Paul , Hagan Brittany , Tobin Kim , Bhatia Monica , George Diane , Garvin James , Satwani Prakash 
Published: August 2017

AbstractHPC infusions have been associated with a variety of adverse events related to either patient or HPC product‐related factors. Studies documenting infusion‐related AEs in children are limited. We reviewed HPC infusion records in 354 children. Infusion‐related adverse events were classified as follows: grade 0—absent, grade I—mild, grade II—moderate, grade III—severe, grade IV—life‐threatening, and grade V—death. The percentage of patients with grade 0, I, and II‐IV AEs was as follows: 0 = 67%, I = 23.4%, and II‐V = 9.6% (one patient had fatal anaphylactic reaction to dimethyl sulfoxide). The incidence of grade II‐IV hypertension was 7.1%. There was a higher incidence of AEs with infusion of allogeneic bone marrow versus allogeneic PBSCs (47.4% vs 25.3%, P = .001). Cryopreserved products had a lower incidence of infusion‐associated AEs compared with fresh HPC products (24% vs 39.4%, P = .003). Allogeneic HPC infusion volume (>100 mL) was a significant risk factor for infusion‐associated AEs (P < .001). Patients >10 years who received autologous HPC infusions had higher risk of AEs when compared to patients <10 years (P = .01). Our study demonstrated that despite a high incidence of infusion‐associated hypertension, HPC infusion is relatively safe in children. Investigating strategies to optimize management of hypertension in the setting of HPC infusion is warranted.
T cell replete–haploidentical second hematopoietic stem cell transplantation for primary graft failure in pediatric patients with hematologic malignancies
Authors: Mochizuki Kazuhiro , Sano Hideki , Akaihata Mitsuko , Kobayashi Shogo , Waragai Tomoko , Ohara Yoshihiro , Takahashi Nobuhisa , Ito Masaki , Ikeda Kazuhiko , Ohto Hitoshi , Kikuta Atsushi 
Published: August 2017

AbstractGF is one of the fatal complications of allogeneic HSCT. To rescue patients with primary GF, a second HSCT should be conducted as soon as possible, but the optimal donor source and technique have yet to be established. In this study, we retrospectively analyzed six children with hematologic malignancies who received TCR‐haploidentical second HSCT for primary GF. The median interval between the prior HSCT and the second HSCT was 37.5 days. All patients received fludarabine and ATG containing reduced‐intensity re‐conditioning before the second HSCT. All patients, except one who died early, achieved both neutrophil and Plt engraftment at a median time of 15 and 33 days, respectively. Chimerism analysis showed that all engrafted patients achieved complete donor chimerism within 3 weeks. Four patients developed acute GVHD, and three patients developed chronic GVHD. TRM occurred in two patients. Median follow‐up of the four survivors was 6.8 years, and all remained in sustained remission until the last follow‐up. These results suggested that a TCR‐haploidentical second HSCT for pediatric patients is feasible, and this approach may provide a potent option for children with primary GF.
Parent‐child coregulation of parasympathetic processes varies by social context and risk for psychopathology
Authors: Lunkenheimer Erika , Tiberio Stacey S. , Skoranski Amanda M. , Buss Kristin A. , Cole Pamela M. 
Published: August 2017

AbstractThe parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent‐child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent‐child interactions showed overall dynamic, positive concordance in mother‐child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother‐child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent‐child physiological coregulation are discussed.
Pathophysiology of exercise intolerance in pulmonary arterial hypertension
Authors: Tran Derek L. , Lau Edmund M.T. , Celermajer David S. , Davis Glen M. , Cordina Rachael 
Published: August 2017

ABSTRACTPulmonary arterial hypertension (PAH) is a chronic disease with poor prognosis and important exercise limitation despite the proliferation of treatment options in the last decade. Chronically increased right ventricular (RV) afterload results in right heart failure and without treatment, rapid clinical deterioration is common. Exercise intolerance is the cardinal feature of the disease impacting upon quality of life and clinical outcome. The pathophysiological mechanisms that lead to reduced exercise capacity in this population are complex with ventriculoarterial uncoupling likely to be the predominant feature. The relative contributions of additional factors that contribute to exercise limitation beyond ventriculoarterial uncoupling have not been characterized. This review addresses these factors with a focus on recent developments and uncertainties. RV maladaptation and the intricate interplay between the heart, abnormal pulmonary vascular bed and peripheral factors such as dysfunction of the respiratory and peripheral muscles are discussed in detail.
Treatment of idiopathic pulmonary fibrosis in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia
Authors: Jo Helen E. , Troy Lauren K. , Keir Gregory , Chambers Daniel C. , Holland Anne , Goh Nicole , Wilsher Margaret , de Boer Sally , Moodley Yuben , Grainge Christopher , Whitford Helen , Chapman Sally , Reynolds Paul N. , Glaspole Ian , Beatson David , Jones Leonie , Hopkins Peter , Corte Tamera J. 
Published: August 2017

ABSTRACTIdiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial lung disease (ILD) of unknown aetiology with a median survival of only 2–5 years. It is characterized by progressive dyspnoea and worsening lung function, ultimately resulting in death.Until recently, there were no effective therapies for IPF; however, with the publication of two landmark clinical trials in 2014, the anti‐fibrotic therapies, nintedanib and pirfenidone, have gained widespread approval.This position paper aims to highlight the current evidence for the treatment of IPF, with particular application to the Australian and New Zealand population. We also consider areas in which evidence is currently lacking, especially with regard to the broader IPF severity spectrum and treatment of co‐morbid conditions. The utility of non‐pharmacological therapies including pulmonary rehabilitation, oxygen as well as symptom management thought to be important in the holistic care of IPF patients are also discussed.