bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and Experimental Aspects of Olmesartan Medoxomil, a New Angiotensin II Receptor Antagonist
Authors: Yoshida Kazunori , Kohzuki Masahiro 
Published: August 2010

ABSTRACTOlmesartan medoxomil is a new orally active angiotensin II (Ang II) type 1 receptor antagonist. It is a prodrug and is rapidly de‐esterified during absorption to form olmesartan, the active metabolite. Olmesartan is a potent, competitive and selective Ang II type 1 receptor antagonist. Olmesartan is not metabolized by the cytochrome P‐450 and has a dual route of elimination, by kidneys and liver.In patients with essential hypertension olmesartan medoxomil administered once daily at doses of 10–80 mg dose‐dependently reduced diastolic blood pressure (DBP). Troughto‐peak ratios for both DBP and systolic blood pressure (SBP) were above 50%. At the recommended once‐daily starting doses, olmesartan medoxomil (20 mg) was more effective than losartan (50 mg), valsartan (80 mg) or irbesartan (150 mg) in reducing cuff DBP in patients with essential hypertension. The results of cuff SBP and mean 24‐h DBP and SBP were similar to those of cuff DBP measurement. In mild‐to‐moderate hypertensive patients the recommended starting dose of olmesartan medoxomil was as effective as that of amlodipine besylate (5 mg/day) in reducing both cuff and 24‐h blood pressure. In lowering DBP olmesartan medoxomil, at 10–20 mg/day, was as effective as atenolol at 50–100 mg/day. In mild‐to‐moderate hypertensive patients, olmesartan medoxomil, at 5–20 mg once daily, was more effective than captopril at 12.5–50 mg twice daily. At 20–40 mg once daily olmesartan medoxomil was as effective as felodipine, at 5–10 mg once daily. Olmesartan medoxomil has minimal adverse effects with no clinically important drug interactions.Animal studies have shown that olmesartan medoxomil provides a wide range of organ protection. Olmesartan medoxomil ameliorated atherosclerosis in hyperlipidemic animals and ameliorated cardiac remodeling and improved survival in rats with myocardial infarction. Olmesartan medoxomil has renoprotective effects in a remnant kidney model and type 2 diabetes models. Future investigation should reveal whether these beneficial effects of olmesartan medoxomil are applicable to human diseases.
Therapeutic Potential of Monteplase in Acute Myocardial Infarction as a Powerful Thrombolytic Agent for Pretreatment of Coronary Intervention
Authors: Inoue Teruo , Nishiki Ryoichi , Kageyama Manabu , Node Koichi 
Published: August 2010

ABSTRACTThrombolysis with conventional thrombolytic agents followed by percutaneous coronary intervention (PCI) had no impact on the treatment of acute myocardial infarction (AMI). However, the development of mutant type plasminogen activator (mt‐PA) has prompted us to reassess the combination of thrombolysis and PCI. Monteplase (Eisai, Co. Ltd., Tokyo, Japan) is a newly developed mt‐PA that can be administrated as a single intravenous bolus injection. We initiated a clinical trial [Combining Monteplase with Angioplasty (COMA)] to evaluate the effectiveness of monteplase followed by PCI. The AMI patients were randomly assigned to receive PCI following pretreatment with a single bolus intravenous injection of monteplase or direct PCI without monteplase. The initial coronary angiography prior to PCI showed that 36.2% of patients in the monteplase group achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow in the infarct‐related artery, compared with in only 7.9% of patients in the direct PCI group (P < 0.0001). During 24 months following PCI, major cardiac events occurred in 27.7% of patients in the monteplase + PCI group, and in 46.7% of patients in the direct PCI group without monteplase (P < 0.05). Thus, the ideal strategy for the treatment of AMI is the administration of monteplase upon arrival at a community hospital with a prompt transfer to a tertiary center for PCI.
Serofendic Acid, a Substance Extracted from Fetal Calf Serum, as a Novel Drug for Cardioprotection
Authors: Akao Masaharu , Takeda Toshihiro , Kita Toru , Kume Toshiaki , Akaike Akinori 
Published: August 2010

ABSTRACTWe previously identified a novel endogenous substance, serofendic acid, from a lipophilic extract of fetal calf serum. The compound, a low‐molecular‐weight sulfur‐containing atisane‐type diterpenoid, exhibited potent protective action against neurotoxicity induced by glutamate, nitric oxide, and oxidant stress. We investigated whether this substance has a cardioprotective effect. Primary cultures of neonatal rat cardiac myocytes were exposed to oxidant stress (H2O2) to induce cell death. Pretreatment with serofendic acid significantly suppressed cell death induced by H2O2, and the cytoprotective effect was closely associated with the preservation of mitochondrial function. Serofendic acid inhibited H2O2‐induced loss of mitochondrial membrane potential in a concentration‐dependent manner (with saturation by 100 μM), by attenuating matrix calcium overload and intracellular accumulation of reactive oxygen species. The protective effect of serofendic acid was comparable to that of a mitochondrial ATP‐sensitive potassium (mitoKATP) channel opener, diazoxide. Furthermore, mitoKATP channel blocker, 5‐hydroxydecanoate, abolished the protective effect of serofendic acid. Serofendic acid and diazoxide, administered together, at 100 μM each, had no additive effects. Thus, serofendic acid inhibited the oxidant‐induced mitochondrial death pathway, presumably through activation of the mitoKATP channel. In conclusion, serofendic acid appears to protect cardiac myocytes from oxidant‐induced cell death by preserving the functional integrity of mitochondria. Our findings suggest that serofendic acid may represent a novel candidate for cardioprotective therapy in ischemia/reperfusion injury.
Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre‐post analysis within a multihospital health care system
Authors: Baer Vickie L. , Henry Erick , Lambert Diane K. , Stoddard Ronald A. , Wiedmeier Susan E. , Eggert Larry D. , Ilstrup Sarah , Christensen Robert D. 
Published: August 2010

BACKGROUND: We previously reported that in the year 2006, approximately 35% of the transfusions administered in the Intermountain Healthcare neonatal intensive care units (NICU) were noncompliant with our transfusion guidelines. In January 2009 we instituted an electronic NICU transfusion ordering and monitoring system as part of a new program to improve compliance with transfusion guidelines.STUDY DESIGN AND METHODS: In the four largest NICUs of Intermountain Healthcare, we performed a pre‐post analysis of compliance with transfusion guidelines and transfusion usage.RESULTS: After beginning the new transfusion compliance program all four NICUs had an increase in compliance from 65% to 90%. Accompanying the improved compliance, all four NICUs had a reduction in transfusions administered. Specifically, compared with 2007 and 2008, there were 984 fewer NICU transfusions given in 2009. This included 554 fewer red blood cell (RBC) transfusions, 174 fewer platelet transfusions, and 256 fewer frozen plasma infusions. We calculate that in 2009, a total of 200 NICU patients who in previous years would have received one or more transfusions instead received none. Applying specific Intermountain Healthcare billing data to the observed transfusion reductions, this new program resulted in an annual decrease of $780,074 in blood bank charges (blood administration charges were not included). During the 3‐year period, January 2007 through December 2009, we detected no change in NICU demographics, major morbidities, length of hospital stay, or mortality rate.CONCLUSION: Implementing a systemwide NICU program to improve compliance with already‐established transfusion guidelines increased compliance from 65% to 90%. Improved compliance with transfusion guidelines was accompanied by a significant reduction in transfusions given, with no increase in NICU length of stay or mortality rate.
Unexpected Discharge from an Implanted Automatic Defibrillator
Authors: CRITELLI GIUSEPPE , GRECO CESARE , AMBROSINI MARIA , SINATRA RICCARDO , MARINO BENEDETTO , REALE ATTILIO 
Published: August 2010

The occurrence of inappropriate discharge from an implanted cardioverter‐defibrillator is reported. The device was triggered by an episode of induced nonsustained ventricular tachycardia, and the shock was delivered 10 sec after spontaneous termination of the arrhythmia.This observation demonstrates that unexpected discharges from an implanted cardiaverter/defibrillator can occur while the patient is asymptomatic. In order to avoid such an adverse effect, improvement of the detection system of the device is advisable.
Effect of Procainamide, Mexiletine, and Propranolol on Ventricular Activation Time Recorded at Cardiac Mapping in Chronic Canine Myocardial Infarction
Authors: DENNISS A. ROBERT , ROSS DAVID L. , WAYWOOD JUDITH A. , COOPER MARK J. , UTHER JOHN B. 
Published: August 2010

Delayed potentials detected during sinus rhythm appear to be markers for ventricular tachyarrhyth mias associated with ch ronic myocardial infarction. This study investigated whether intravenous Class I and Class II antiarrhythmic drugs could affect delayed potentials detected at cardiac mapping in dogs studied 1–2 weeks after anterior myocardial infarction.Procainamide at therapeutic serum levels (17–34 μmol/L) caused prolongation of delayed potentials (first degree block), the mean change in duration of ventricular activation being + 19.4 ± 5.0 msec (n = 4, p <0.05). At serum levels above the therapeutic range, procainamide caused first degree block in delayed potentials in three of six animals tested (50%), second degree block (Wenckebach, 2:1 or 3:1 block) in another two animals, and third degree block (complete abolition of delayed potentials) in the remaining animal.Mexiletine at therapeutic serum levels (3.5–9.0 μmol/L, caused no significant change in delayed potential duration (+3.1 ± 5.7 msec, n = 4). At serum levels above the therapeutic range, first degree block occurred in four of five animals tested (80%), there being no change in the fifth animal. After propranolol (0.2 mg/kg), there was no significant change in delayed potential duration (−2.5 ± 2.5 msec, n = 4).In conclusion: (1) at standard doses, mexiletine and propranolol have no effect on delayed potentials, but procainamide causes first degree block; (2) at serum levels above the therapeutic range, mexiletine typically causes first degree block, while procainamide causes either first degree or high grade block; (3) ventricular tachyarrhythmias may still be inducible after drugs if delayed potentials persist unchanged or with first degree block.
Immediate Termination of Fibrillation at 50% Probability of Overall Success Correlates with Defibrillation Dose‐Response Curve Width
Authors: TOVAR OSCAR H. , SNYDER DAVID E. , JONES JANICE L. 
Published: August 2010

Introduction: Issues in transthoracic defibrillation, including waveform shape, fixed versus escalating dose protocol, and low‐ versus high‐energy shocks, can be addressed by examining the defibrillation dose‐response curve. We tested the hypothesis that, for commonly used defibrillation waveforms, the steepness of the overall defibrillation dose‐response curve, measured as normalized curve width, correlates with the probability of a successful defibrillation being immediate at the shock intensity producing 50% success. Methods and Results: We used 16 isolated rabbit hearts to determine probability of overall success as a function of shock intensity and probability that a successful defibrillation is immediate rather than progressive (followed by several extrasystoles) at the shock intensity producing 50% overall defibrillation success. Two waveform pairs were tested—a monophasic damped sine versus a biphasic truncated exponential waveform commonly used for transthoracic defibrillation, and a monophasic/biphasic truncated exponential waveform pair similar to those used in internal cardioverter defibrillators. There was a close correlation between probability of a successful defibrillation being immediate at I50 and normalized curve width for the defibrillation dose‐response curve. Conclusion: Our findings suggest that a high probability of successful defibrillation being immediate at low shock intensities is correlated with a narrow normalized curve width for the defibrillation dose‐response curve.
Paced Electrogram Fractionation Analysis of Arrhythmogenic Tendency in ΔKPQ Scn5a Mice
Authors: HEAD CATHERINE E. , BALASUBRAMANIAM RICHARD , THOMAS GLYN , GODDARD CATHARINE A. , LEI MING , COLLEDGE WILLIAM H. , GRACE ANDREW A. , HUANG CHRISTOPHER L‐H. 
Published: August 2010

Introduction: Gain‐of‐function mutations within Scn5a, including the ΔKPQ 1505‐1507 deletion in the inactivation domain compromising myocardial repolarization, are implicated in human long QT 3 syndrome (LQT3), associated with ventricular arrhythmogenesis and sudden death. Methods and Results: Patch clamp studies on isolated ventricular Scn5a+/Δ myocytes from ΔKPQ mice produced by homologous recombination in embryonic stem (ES) cells confirmed such altered electrophysiological properties of the mutant channel. Programmed electrical stimulation (PES) with decremental pacing from the basal right ventricular epicardial surface and paced electrogram fractionation analysis (PEFA) of electrograms recorded from the basal left ventricular epicardial surface of Langendorff‐perfused whole heart preparations demonstrated ventricular tachycardia (VT) in 8 of 9 Scn5a+/Δ mutant (but no Scn5a+/+ (wild‐type (WT)) controls; n = 17), with increased electrogram durations (EGD) and more dispersed conduction curves. Isoproterenol (100 nM) was without effect on tachycardic Scn5a+/Δ hearts (n = 9) yet propranolol (1 μM) prevented VT in all isoproterenol‐infused WT control (n = 4) but no Scn5a+/Δ hearts (n = 4). Furthermore propranolol itself increased EGD and dispersion in Scn5a+/Δ hearts. In contrast, mexiletine (10 μM) suppressed VTs in 4 of 5 Scn5a+/Δ hearts without altering EGD or dispersion. Conclusion:β‐adrenoreceptor blockade does not confer an antiarrhythmic effect and may even enhance arrhythmogenesis by increasing reentrant substrate in Scn5a+/Δ hearts while mexiletine protects against VT without modifying conduction characteristics. Together these findings permit a scheme where VT in LQT3 is initiated by triggered mechanisms but propagated by reentry.
Comparison Between Anatomical and Integrated Approaches to Atrial Fibrillation Ablation: Adjunctive Role of Electrical Pulmonary Vein Disconnection
Authors: MANTOVAN ROBERTO , VERLATO ROBERTO , CALZOLARI VITTORIO , BACCILLIERI STELLA , DE LEO ALESSANDRO , TURRINI PIETRO , PASTORE GIOVANNI , CROSATO MARTINO , RAMONDO ANGELO , STRITONI PAOLO 
Published: August 2010

Introduction: The aim of this study was to compare the outcome of anatomical pulmonary vein (PV) radiofrequency (RF) ablation with that of an integrated approach (anatomical with electrophysiological confirmation of PV disconnection). Methods: Sixty consecutive patients affected by drug‐refractory paroxysmal (39), persistent (13), and permanent (8) atrial fibrillation (AF) were assigned to an anatomical (group A: 30 patients; 25 male, 5 female, mean age: 55 ± 7 years) or integrated approach (group B: 30 patients; 26 male, 4 female, mean age: 52 ± 9 years). In all cases, RF ablation was performed by means of the Carto system in order to anatomically create circumferential lines around PVs. In group B, the persistence of PV potentials was then assessed with a multipolar circular catheter. If PV potentials persisted, RF pulses targeting the electrophysiological breakthroughs were delivered to disconnect PVs. Results: Total procedure duration, fluoroscopy time, and RF delivery time were similar in both groups: 227 ± 43, 50 ± 23, and 43 ± 16 minutes (group A); 232 ± 32, 55 ± 15, and 42 ± 10 minutes (group B), respectively (ns). One asymptomatic PV stenosis and one pericardial effusion occurred in group A and B, respectively. After 15.4 ± 7.4 months, 17 (57%) group A patients and 25 (83%) group B patients were in stable sinus rhythm (P = 0.02) (RR 1.78; 95% CI: 1.7–2.9). Conclusions: PV ablation by means of an integrated anatomical and electrophysiological approach seems more effective than a purely anatomical RF ablation approach. Electrophysiological confirmation of PV disconnection could be a useful marker of successful RF treatment of AF.
Value of Different Follow‐Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial Fibrillation
Authors: PIORKOWSKI CHRISTOPHER , KOTTKAMP HANS , TANNER HILDEGARD , KOBZA RICHARD , NIELSEN JENS COSEDIS , ARYA ARASH , HINDRICKS GERHARD 
Published: August 2010

Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7‐day Holter as two methods of follow‐up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow‐up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow‐up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow‐up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7‐day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan‐Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow‐up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7‐day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30–40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom‐only‐based follow‐up; using serial 7‐day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7‐day Holter were equally effective to objectively determine long‐term success and to detect asymptomatic patients.
Delayed Defibrillation Testing in Patients Implanted with Biventricular ICD (CRT‐D): A Reliable and Safe Approach
Authors: GASPARINI MAURIZIO , GALIMBERTI PAOLA , REGOLI FRANÇOIS , CERIOTTI CARLO , BONADIES MARIKA 
Published: August 2010

Background: Defibrillation testing (DT) at the end of the implantation of cardiac resynchronization pacemaker with a defibrillator (CRT‐D) exposes heart failure (HF) patients to increased procedural risks. However, until now, delayed DT has not been assessed as a possible option in HF patients implanted with CRT‐D. Objective: Aim of the present study is to assess safety and feasibility of delayed DT in HF patients treated with CRT‐D. Material and Methods: Two hundred and eleven consecutive patients (mean age: 65 years, mean NYHA class 3.0, mean EF: 29.3%) underwent CRT‐D implantation from October 1999 to December 2004. In the first 17 patients, DT was performed at the end of CRT‐D implantation. In the other 194 consecutive patients, DT was performed at 2 months after CRT‐D implantation. Outcome of DT, as well as “acute” LV lead dislodgment rate were evaluated in the latter group of 194 patients undergoing a delayed DT. Also, ICD function was assessed through device telemetry analysis at 2 months. Results: At delayed DT, first shock was effective in 187 of 194 patients (96%), ineffective VF interruption at maximum energy occurred only in one patient (0.5%), and acute LV lead dislodgment was 1%. No ICD therapy failure occurred in the 2‐month untested period. Conclusion: DT performed 2 months after CRT‐D implantation is safe and feasible; this is possibly related to the improvement of clinical conditions and hemodynamic status as well as greater lead stability 2 months after CRT‐D.
Systematic Review of Educational Interventions for Improving Advance Directive Completion
Authors: Durbin Christine R. , Fish Anne F. , Bachman Jean A. , Smith Katharine V. 
Published: August 2010

Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.