bluuebunny/crossref_metadata_2025_split huggingface dataset:
Programmed versus Effective VV Delay during CRT Optimization: When What You See Is Not What You Get
Authors: BOGAARD MARGOT D. , MEINE MATHIAS , DOEVENDANS PIETER A. 
Published: January 2013

BackgroundIn cardiac resynchronization therapy (CRT) devices, the interventricular (VV) delay denotes the time interval between left (LV) and right ventricular (RV) pacing. This study aimed to determine the proportion of patients in whom the effective VV delay (VVeff, delay between LV and RV depolarization, being induced either by pacing or intrinsic conduction) is different from the programmed VV delay during a standard VV delay optimization procedure.MethodsThirty‐three patients with heart failure and left bundle branch block configuration without total atrioventricular (AV) block receiving CRT were prospectively included. VVeff was calculated from intrinsic AV intervals, programmed optimal AV delay, and programming system. Intrinsic AV intervals were measured on intracardiac electrograms. The optimal AV and VV delays were determined by highest increase in maximum rate of LV pressure rise (dP/dtmax). VV delays of 20–80 ms LV and RV preactivation were tested.ResultsCalculated maximum possible VVeff was shorter than 80 ms LV preactivation in up to 46% of patients and shorter than 40 ms LV preactivation in up to 3% of the patients. These proportions were 6% and 0% during 80 and 40 ms RV preactivation, respectively.ConclusionsIn CRT patients with left bundle branch block without total AV block, the effective VV delay is shorter than the programmed VV delay during a standard optimization procedure in approximately half of the patients and this phenomenon is encountered predominantly during LV preactivation by 40 ms or more. Calculation of the individual maximum VVeff in advance can shorten the VV delay optimization procedure.
Larger Interventricular Conduction Time Enhances Mechanical Response to Resynchronization Therapy
Authors: PADELETTI LUIGI , PIERAGNOLI PAOLO , RICCIARDI GIUSEPPE , PERROTTA LAURA , PERINI ALESSANDRO P. , GRIFONI GINO , RICCERI ILARIA , PADELETTI MARGHERITA , LIONETTI VINCENZO , VALSECCHI SERGIO 
Published: January 2013

BackgroundPrevious studies have reported that the left ventricular (LV) pacing site is a major determinant of the hemodynamic response to cardiac resynchronization therapy (CRT). However, lead positioning in a lateral or posterolateral cardiac vein may not be optimal for every patient. The objective of this study was to assess the relationship between the right ventricular (RV)‐to‐LV conduction time and the systolic function during CRT on the basis of changes to LV pressure‐volume loops.MethodsLeft ventricular pressure and volume data were determined using a conductance catheter during CRT device implantation in 10 patients. Four endocardial LV sites were systematically assessed at four atrioventricular delays. The RV‐to‐LV conduction time was measured as the time interval between spontaneous peak R waves, recorded through the RV lead and the LV catheter.ResultsThe optimal pacing site varied among patients. However, the pacing site associated with the maximum RV‐to‐LV conduction time resulted in a stroke volume improvement comparable to the pacing site identified through individual hemodynamic optimization (41 ± 17 mL vs 44 ± 18 mL, P = 0.266). Moreover, the RV‐to‐LV conduction time recorded at each endocardial pacing site correlated positively with the increase in stroke volume (r = 0.537; P < 0.001), stroke work (r = 0.642; P < 0.001), and the pressure‐derivative maximum (r = 0.646; P < 0.001) obtained with CRT.ConclusionsAn optimal acute response to CRT can be obtained by positioning the LV lead at the site associated with the maximum RV‐to‐LV conduction time. A significant correlation appears to exist between RV‐to‐LV conduction time and the improvement in systolic function with CRT.
Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization?
Authors: KREUZER JOERG , LENNERZ CARSTEN , DIETL JOSEF U. , BEIER THOMAS , STRAUCH ALEXEJ , SEMMLER VERENA , BADRAN HAITHAM , ZRENNER BERNHARD , KOLB CHRISTOF 
Published: January 2013

BackgroundAutomatic atrioventricular search hysteresis (AVSH) is designed to reduce the cumulative percentage of potentially deleterious right ventricular apical pacing (VP%) in dual‐chamber pacemakers. We investigated whether minimizing VP% by AVSH can, in turn, reduce ventricular wall stretching/stress, as assessed by plasma concentrations of the amino‐terminal fragment of the pro‐B‐type natriuretic peptide (NT‐proBNP).MethodsAfter dual‐chamber pacemaker implantation in 81 patients (age: 69 ± 11 years; males: 55.6%), the fixed atrioventricular delay of 225 ms was programmed and AVSH was turned off for 1 month. The patients were thereafter randomly assigned to standard AVSH for 1 month, followed by an enhanced AVSH for another month, or vice versa. At the 1‐, 2‐, and 3‐month follow‐ups, VP% values were retrieved from the pacemaker memory, and venous blood samples were taken for NT‐proBNP measurements.ResultsBoth standard and enhanced AVSH reduced the median VP% value from 38.5% (for the fixed atrioventricular delay) to 2.1% (P < 0.001). However, plasma NT‐proBNP concentrations for the fixed atrioventricular delay (median, 253 pg/mL), standard AVSH (225 pg/mL), and enhanced AVSH (276 pg/mL) did not differ significantly on the intrapatient basis (paired Wilcoxon tests) between any pair of these modalities.ConclusionMinimizing ventricular pacing by AVSH during 1 month had no influence on plasma NT‐proBNP levels (i.e., ventricular wall stretching/stress) compared with a constant, moderately prolonged atrioventricular delay.
Laser Lead Extraction in Congenital Heart Disease: A Case‐Controlled Study
Authors: McCANTA ANTHONY C. , KONG MELISSA H. , CARBONI MICHAEL P. , GREENFIELD RUTH A. , HRANITZKY PATRICK M. , KANTER RONALD J. 
Published: January 2013

IntroductionPatients with congenital heart disease (CHD) and implanted cardiac rhythm management devices have a high rate of endocardial lead issues requiring lead extraction. Laser lead extraction (LLE) is a promising modality for lead management though few studies have evaluated this technique in CHD.MethodsThis is a retrospective, case‐controlled (gender‐ and age‐matched, without CHD) analysis of all CHD patients from 2002–2010 at a single institution who underwent LLE as a primary extraction modality. The aim is to evaluate the utility of LLE in patients with CHD compared with controls without CHD. The primary outcome is LLE clinical success. Secondary outcomes include procedural success, complications, and factors related to LLE failure.ResultsTwenty‐two patients with CHD underwent 24 LLE procedures to extract 35 leads. These were compared with 22 patients without CHD who underwent 24 LLE procedures to extract 37 leads. LLE clinical success was achieved for 26 of 35 leads (74%) in patients with CHD versus 35 of 37 leads (92%) in patients without CHD [P = 0.02]. No factors within the CHD group predicted LLE failure. Six of the nine leads for which LLE was unsuccessful were extracted using other methods. No complications were observed in the CHD group.ConclusionsPatients with CHD are less likely to have successful LLE than gender‐ and age‐matched controls without CHD. LLE failures in CHD may be related to calcified adhesions. Mechanical‐rotational devices and the femoral snare technique are useful for LLE failures. LLE provides an effective first‐line approach for patients with CHD.
Early Repolarization Variant in Syncopal Patients Referred to Tilt Testing
Authors: BARTCZAK ANNA , LELONEK MALGORZATA 
Published: January 2013

BackgroundEarly repolarization variant (ERV) was recently described as an electrocardiogram (ECG) pattern associated with increased risk of sudden cardiac death (SCD) in some populations. We decided to establish the significance of ERV in syncopal patients referred to tilt testing due to suspected reflex syncope.MethodsFrom 160 consecutive patients (mean age 36.6 ± 15 years) history of syncopal episodes and resting ECG were collected. ERV was diagnosed if elevation of point J ≥0.1 mV was in ≥2 ECG leads II, III, aVF and/or I, aVL, V4–V6. Analysis was performed in regard to ERV and degree of J‐point elevation (JPE; ≥2 mV vs <2 mV). Patients were at 2 years follow‐up.ResultsERV was present in 31% of patients. The most frequent was the ascending ST elevation variant (84%) and lateral ECG locations (74%). The degree of JPE did not differentiate the studied patients. Male sex was associated with the higher risk of ERV (odds ratio [OR] = 2.84; P = 0.003). ERV in inferior ECG leads enhanced the risk of positive tilt testing (OR = 3.57; P = 0.048). There was no relationship between ERV and injuries or syncopal history. No deaths were observed in follow‐up.ConclusionsAmong middle‐aged people referred to tilt testing due to suspected reflex syncope the ascending ST elevation type was the most frequent variant of ERV and in midterm follow‐up there were no deaths. In this population ERV was frequent and associated with positive tilt testing. According to recently described higher risk of SCD among people with ERV, we need further studies and longer follow‐up to establish the clinical importance of ERV in patients with reflex syncope.
Threshold Currents of Platinum Electrodes used for Functional Electrical Stimulation of the Phrenic Nerves for Treatment of Central Apnea
Authors: HIRSCHFELD SVEN , VIEWEG HENDRYK , SCHULZ ARNDT P. , THIETJE ROLAND , BAER GERHARD A. 
Published: January 2013

BackgroundStability of threshold currents during long‐term use of phrenic nerve stimulation has been questioned.Methods and ResultsBetween January 5, 1988, and March 5, 2008, 49 patients with functional C2‐tetraplegia received an Atrostim PNS (Atrotech Ltd., Tampere, Finland) as treatment of their respiratory insufficiency; a follow‐up of 35 of such patients was carried out exclusively in our institution for 6.3 (4.44) 0.04–15.75 years (mean [standard deviation (SD)] range). The device employed four‐pole sequential nerve stimulation, which provided four threshold currents subsequently evaluated for each phrenic nerve. Stimulation data were prospectively recorded. The differences between threshold currents recorded 1 year after implantation and the last recorded values were 0.33–0.43 (0.44–0.63) 0–2.9 mA. After having excluded the data of eight patients with values >1 mA (= mean + SD), we registered the differences for the remaining patients of 0.15–0.24 (0.14–0.24) 0–0.95 mA, which is just twice the adjustment accuracy of the device. Out of the eight problem cases one had, and two were suspected to have, surgical trauma; all three nerves recovered. In two cases the values steadily increasing over years might have been caused by unspecific foreign body reaction. Two cases with values >1mA for different durations at different electrodes might be caused by biofilm, and one patient displaying steadily increasing values lived, unwilling to live, only 2 years after the implantation.ConclusionThus, there was no permanent nerve injury and in 77% of the presented cases threshold currents remained stable.
Propofol infusion syndrome or adrenoleukodystrophy?
Authors: Karaman Yucel , Goktay Aylin , Agin Hasan , Karaarslan Utku 
Published: January 2013

SummaryFollowing a propofol anesthetic, a 5‐year‐old girl with lower extremity spasticity seized and developed hypertriglyceridemia, hyperkalemia, and metabolic acidosis. A presumed diagnosis of propofol infusion syndrome (PRIS) was made, but further investigation revealed neonatal adrenoleukodystrophy. PRIS should be considered with this constellation of symptoms, but other neurometabolic disorders must always be ruled out.
Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study
Authors: Romlin Birgitta S. , Wåhlander Håkan , Synnergren Mats , Baghaei Fariba , Jeppsson Anders 
Published: January 2013

SummaryObjectiveEarlier detection of coagulopathy in pediatric cardiac surgery patients.AimTo determine whether thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post‐CPB results and whether analysis of clot firmness already after 10 min yields reliable results.BackgroundCardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures.Methods/MaterialFifty‐six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry (ROTEM®). The analyses were compared, and correlations and differences were calculated.ResultsHemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM‐CT and HEPTEM‐MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: −8.2 mm (−8.9 to −7.5); FIBTEM: −0.5 mm (−0.7 to −0.3).ConclusionThe results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.
An ATP synthase harboring an atypical γ–subunit is involved in ATP synthesis in tomato fruit chromoplasts
Authors: Pateraki Irini , Renato Marta , Azcón‐Bieto Joaquín , Boronat Albert 
Published: January 2013

SummaryChromoplasts are non‐photosynthetic plastids specialized in the synthesis and accumulation of carotenoids. During fruit ripening, chloroplasts differentiate into photosynthetically inactive chromoplasts in a process characterized by the degradation of the thylakoid membranes, and by the active synthesis and accumulation of carotenoids. This transition renders chromoplasts unable to photochemically synthesize ATP, and therefore these organelles need to obtain the ATP required for anabolic processes through alternative sources. It is widely accepted that the ATP used for biosynthetic processes in non‐photosynthetic plastids is imported from the cytosol or is obtained through glycolysis. In this work, however, we show that isolated tomato (Solanum lycopersicum) fruit chromoplasts are able to synthesize ATP de novo through a respiratory pathway using NADPH as an electron donor. We also report the involvement of a plastidial ATP synthase harboring an atypical γ–subunit induced during ripening, which lacks the regulatory dithiol domain present in plant and algae chloroplast γ–subunits. Silencing of this atypical γ–subunit during fruit ripening impairs the capacity of isolated chromoplast to synthesize ATP de novo. We propose that the replacement of the γ–subunit present in tomato leaf and green fruit chloroplasts by the atypical γ–subunit lacking the dithiol domain during fruit ripening reflects evolutionary changes, which allow the operation of chromoplast ATP synthase under the particular physiological conditions found in this organelle.
Quality Control and Substrate‐Dependent Downregulation of the Nutrient Transporter Fur4
Authors: Keener Justin M. , Babst Markus 
Published: January 2013

AbstractUpon exposure to stress conditions, unfolded cell‐surface nutrient transporters are rapidly internalized and degraded via the multivesicular body (MVB) pathway. Similarly, high concentrations of nutrients result in the downregulation of the corresponding transporters. Our studies using the yeast transporter Fur4 revealed that substrate‐induced downregulation and quality control utilize a common mechanism. This mechanism is based on a conformation‐sensing domain, termed LID (loop interaction domain), that regulates site‐specific ubiquitination (also known as degron). Conformational alterations in the transporter induced by unfolding or substrate binding are transmitted to the LID, rendering the degron accessible for ubiquitination by Rsp5. As a consequence, the transporter is rapidly degraded. We propose that the LID–degron system is a conserved, chaperone‐independent mechanism responsible for conformation‐induced downregulation of many cell‐surface transporters under physiological and pathological conditions.
Remote damage control resuscitation and the Solstrand Conference: defining the need, the language, and a way forward
Authors: Gerhardt Robert T. , Strandenes Geir , Cap Andrew P. , Rentas Francisco J. , Glassberg Elon , Mott Jeff , Dubick Michael A. , Spinella Philip C. ,   THOR Network and RemTORN Study Groups
Published: January 2013

Damage control resuscitation (DCR) is emerging as a standard practice in civilian and military trauma care. Primary objectives include resolution of immediate life threats followed by optimization of physiological status in the perioperative period. To accomplish this, DCR employs a unique hypotensive–hemostatic resuscitation strategy that avoids traditional crystalloid intravenous fluids in favor of early blood component use in ratios mimicking whole blood.The presence of uncontrolled major hemorrhage (UMH) coupled with a delay in access to hemostatic surgical intervention remains a primary contributor to preventable death in both combat and in many domestic settings, including rural areas and disaster sites. As a result, civilian and military emergency care leaders throughout the world have sought a means to project DCR principles forward of the traditional trauma resuscitation bay, into such remote environments as disaster scenes, rural health facilities, and the contemporary battlefield. After reflecting on experiences from past conflicts, defining current capability gaps, and examining available and potential solutions, a strategy for “remote damage control resuscitation” (RDCR) has been proposed.In order for RDCR to progress from concept to clinical strategy, it will be necessary to define existing gaps in knowledge and clinical capability; develop a lexicon so that investigators and operators may understand each other; establish coherent research and development agendas; and execute comprehensive investigations designed to predict, diagnose, and mitigate the consequences of hemorrhagic shock and acute traumatic coagulopathy before they become irreversible.This article seeks to introduce the concept of RDCR; to reinforce the importance of identifying and optimally managing UMH and the resulting shock state as part of a comprehensive approach to out‐of‐hospital stabilization and en route care; and to propose investigational strategies to enable the development and broad implementation of RDCR principles.
Prehospital detection of traumatic coagulopathy
Authors: Hagemo Jostein S. 
Published: January 2013

Increased focus on traumatic coagulopathy over the last decade has led to more aggressive use of hemostatic agents in resuscitation of the massively bleeding patient. Novel formulations of plasma factors and other therapeutics have opened for early intervention to prevent coagulopathy and may even be utilized in the prehospital setting. Careful selection of patients to receive hemostatic agents early during the resuscitation is of great importance due to the potential detrimental effects of this treatment.Several studies have identified coagulation parameters as reliable predictors of massive transfusion, even very early after trauma. Prothrombin time international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), fibrinogen concentration, and viscoelastic tests such as thrombelastography (TEG) and rotational thrombelastometry (RoTEM) have proved to be of value in predicting massive transfusion when performed in‐hospital. PT/INR appears to be slightly more accurate than the other parameters, with a reported sensitivity of 84.8% and an area under the receiver operating curve of 0.87. Comparison studies on PT/INR, aPTT, and viscoelastic assays do suggest that caution should be taken when point‐of‐care (POC) methods, as opposed to conventional laboratory analyses, are used. Novel techniques for POC measurement of fibrinogen levels are currently being developed, and preclinical data suggest acceptable agreement with conventional methods.A number of factors should be considered regarding the feasibility of POC tests in the prehospital environment. In addition to environmental factors such as temperature, altitude, and humidity, electromagnetic interference issues and operators' skills must be taken into account. Coagulation parameters appear to be a useful tool in identifying patients with increased risk of massive bleeding at an early stage. Further studies are needed to determine if prehospital intervention based on POC analyses improves outcome.
Risks of hemolysis due to anti‐A and anti‐B caused by the transfusion of blood or blood components containing ABO‐incompatible plasma
Authors: Berséus Olle , Boman Kjell , Nessen Shawn C. , Westerberg Lars A. 
Published: January 2013

BackgroundThe increasing use of fresh blood group O whole blood in acute trauma medicine makes it important to reevaluate the issue of hemolytic reactions related to the transfusion of ABO‐incompatible plasma.STUDY DESIGN AND METHODSThis review summarizes and evaluates published articles and case reports concerning hemolytic reactions in connection with the transfusion of group O whole blood or blood products to nongroup O recipients.ResultsIn 1945‐1986, 15 nonmilitary publications reported hemolytic transfusion reactions with group O blood/blood products. All patients recovered except for two fatalities. Late in World War II and during the Korean and Vietnam wars and onward in Iraq and Afghanistan only “low anti‐A, anti‐B titer” group O whole blood has been used as universal blood. In spite of a large number of units transfused, there are no reports of hemolytic reactions. Twenty‐five publications report hemolytic reactions after transfusion of group O platelets to nongroup O recipients. In all patients but one, the titer of the implicated A‐ or B‐antibody was >100 (saline) or >400 (antiglobulin) and all cases with an infused volume of incompatible plasma <200 mL were related to anti‐A or anti‐B antiglobulin titers >1000.ConclusionIn emergency lifesaving resuscitation, the risk of hemolytic transfusion reactions from transfusion of group O blood to nongroup O recipients constitutes risk that is outweighed by the benefits. A low titer of anti‐A/B will minimize the risk for a hemolytic reaction, particularly if the screening is repeated after an immunization episode, e.g., blood transfusion, vaccination, or pregnancy.
Lars von Trier’s Antichrist, the Bible, and Docetic Masculinity
Authors: Buch-Hansen Gitte 
Published: January 2013

Lars von Trier’s Antichrist (2009) has been criticised by feminists for its perceived misogyny. This interpretation ignores the long afterlife of the biblical figure of the Antichrist, which is more complex than its traces in contemporary popular culture would suggest. Reading the film into the reception history of the Antichrist, drawing on both contemporary scholars and Friedrich Nietzsche—whose virulent critique of Christianity, Der Antichrist, has long been on the director’s bedside table—I argue that von Trier uses the figure to paint a scathing, even shocking, critique of masculinity as inscribed in the creeds of the early Church. The three interrelated poles of my analysis—the biblical, the aesthetic and the Nietzschean—all point in the same direction: Antichrist is not a film about the dangerous female psyche, but about a masculinity that has gone astray—or, to borrow a term from theological discourse, become "docetic."