bluuebunny/crossref_metadata_2025_split huggingface dataset:
β2‐Adrenoceptors, NADPH oxidase, ROS and p38 MAPK: another ‘radical’ road to heart failure?
Authors: Di Lisa Fabio , Kaludercic Nina , Paolocci Nazareno 
Published: November 2010

Persistent activation of the cardiac β‐adrenergic system may contribute to the pathogenesis of congestive heart failure. Both β1‐ and β2‐adrenoceptors are known to mediate these noxious effects, yet the β1‐adrenoceptor‐PKA axis has received greater attention with less information available on β2‐adrenoceptor driven pathways. In the present issue, Xu and colleagues provide new evidence, showing that β2‐adrenoceptor over‐expression leads to increased reactive oxygen species (ROS) emission, mainly caused by up‐regulation of reduced nicotinamide adenine dinucleotide phosphate oxidase (Nox) 2 and 4. Increase in ROS levels is accompanied by p38 mitogen‐activated protein kinase activation, fibrosis, apoptosis and cardiac dysfunction. Both Nox inhibition and administration of the antioxidant N‐acetyl cysteine prevent these adverse effects. Interestingly, antioxidant treatment also prevents the increase in Nox expression, suggesting that β2‐adrenoceptor stimulation triggers a vicious cycle eventually amplified by both Nox isoforms. The possible existence of a circuitry to enhance ROS signalling and detrimental consequences on myocardial remodelling are also discussed, in light of the recent description of intracellular localization of Nox4.LINKED ARTICLE This article is a commentary on Xu et al., pp. 1012–1028 of this issue. To view this paper visit http://dx.doi.org/10.1111/j.1476‐5381.2010.01043.x
A Strain‐Based Flow‐Induced Hemolysis Prediction Model Calibrated by In Vitro Erythrocyte Deformation Measurements
Authors: Chen Yangsheng , Sharp M. Keith 
Published: November 2010

AbstractHemolysis is caused by fluid stresses in flows within hypodermic needles, blood pumps, artificial hearts, and other cardiovascular devices. Developers of cardiovascular devices may expend considerable time and effort in testing of prototypes, because there is currently insufficient understanding of how flow‐induced cell damage occurs to accurately predict hemolysis. The objective of this project was to measure cell deformation in response to a range of flow conditions, and to develop a constitutive model correlating cell damage to fluid stresses. An experimental system was constructed to create Poiseuille flow under a microscope with velocities up to 4 m/s, Reynolds number to 200, and fluid stresses to 5000 dyn/cm2. Pulsed laser illumination and a digital camera captured images of cells deformed by the flow. Equilibrium equations were developed to relate fluid stresses to cell membrane tension, and a viscoelastic membrane model was used to predict cell strain. Measurements of aspect ratio as a function of shear stress and duration of shear were used to calibrate the cell deformation model. Hemolysis prediction was incorporated with a threshold strain value for cell rupture. The new model provides an improved match to experimentally observed hemolytic stress thresholds, particularly at long exposure times, and may reduce the empiricism of hemolysis prediction.
Continuous Hemodiafiltration in Children After Cardiac Surgery
Authors: Watanabe Kenichi , Suzuki Yasuyuki , Goto Takeshi , Yamauchi Sanae , Daitoku Kazuyuki , Fukui Kozo , Fukuda Ikou 
Published: November 2010

AbstractAcute renal failure (ARF) after congenital cardiac surgery remains a serious complication and leading cause of morbidity and mortality. Continuous hemodiafiltration (CHDF) is presently accepted for pediatric applications. We retrospectively evaluated the effects of CHDF against ARF after congenital cardiac surgery at our hospital. We analyzed data from seven patients aged 23 days to 9 years and weighing 1.7–22.4 kg requiring dialysis therapy using CHDF after congenital cardiac surgery between April 2002 and January 2009. One patient who died could not be weaned from extracorporeal membrane oxygenation support and another died of multiple organ failure. Renal function recovered to normal in the other five (71%) patients. Treatment by CHDF lasted from 14 to 680 h and net ultrafiltration was 3.5 ± 1.4 mL/kg/h. Serum creatinine and urea concentrations were, respectively, 2.3 ± 1.6 and 43.7 ± 17.0 mg/dL before, and 0.5 ± 0.2 and 13.5 ± 8.1 mg/dL, after CHDF (P < 0.05). Thrombocytopenia developed in all patients, and platelet concentrates (0.76 ± 0.7 mL/kg/h) were infused during CHDF. Hypotension developed after changing the CHDF set in one patient. We suggest that CHDF is an effective alternative strategy for treating renal dysfunction after congenital cardiac surgery.
Albumin Dialysis Without Anticoagulation in High‐Risk Patients: An Observational Study
Authors: Tan Han K. , Yang Wen S. , Choong Hui L. , Wong Kok S. 
Published: November 2010

AbstractSevere liver failure causes coagulopathy and high bleeding risk. Albumin dialysis with Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden) is useful for treatment. However, anticoagulation during its use is of uncertain value. We omitted heparin‐saline priming and intradialytic heparin and examined its effects. Albumin dialysis was performed in critically ill patients with intermittent circuit saline flushes (2664 ± 2420 mL per treatment). A total of 12 patients (M : F = 10:2; age 49 ± 9 years) were thus treated: 6 for fulminant hepatic failure and 6 for acute‐on‐chronic liver failure. The overall hospitalization duration was 31 ± 30 days. A total of 44 treatment sessions were performed (average 8 ± 7 sessions per patient). Prescribed versus achieved MARS duration were 13 ± 3 versus 11 ± 4 h, P < 0.05. Twenty‐three percent (10/44) of MARS sessions clotted, 11% (5/44) of treatments were electively terminated, and 2% (1/44) developed vascular catheter occlusion. Spontaneous bleeding occurred in 9% (4/44). Pre‐ versus post‐MARS systemic and blood circuit transmembrane pressures (mm Hg), and albumin dialysate afferent and efferent pressures were all stable. Coagulation indices were (pre‐ vs. post‐MARS): (i) prothrombin time (seconds): 36 ± 30 versus 42 ± 33, P = 0.143; (ii) activated partial thromboplastin time (seconds): 78 ± 43 versus 88 ± 45, P = 0.117; and (iii) platelet count (×103/µL): 87 ± 40 versus 76 ± 48, P = 0.004. Systemic blood solute concentrations pre‐ versus post‐MARS were: (i) serum urea (mg/dL): 22.4 ± 19.6 versus 14.0 ± 8.4, P < 0.05; (ii) serum creatinine (mg/dL): 2.8 ± 2.3 versus 1.9 ± 1.5, P < 0.05; (iii) total bilirubin (mg/dL): 29.5 ± 8.8 versus 20.5 ± 5.1, P < 0.05; and (iv) plasma ammonia (µg/dL): 186 ± 85 versus 129 ± 66, P < 0.05. Anticoagulant‐free albumin dialysis remained effective despite frequent circuit clotting. This led to significant exacerbation of thrombocytopenia although bleeding risk remained low.
Air‐Handling Capabilities of Blood Cardioplegia Delivery Systems in a Simulated Pediatric Model
Authors: Palanzo David , Guan Yulong , Wan Caihong , Baer Larry , Kunselman Allen , Qiu Feng , Ündar Akif 
Published: November 2010

AbstractBlood cardioplegia delivery systems are employed in most pediatric open heart cases to arrest the heart and keep it preserved during aortic cross‐clamping. They are also used as part of a modified ultrafiltration system at the end of cardiopulmonary bypass. We evaluated and compared the air‐handling capabilities of different types of blood cardioplegia delivery devices. A simple circuit incorporating a cardiotomy reservoir, a roller pump, a cardioplegia test system, and two emboli detection and classification sensors were used to investigate the air‐handling capabilities of the following cardioplegia delivery systems: GISH Vision, Maquet Plegiox, Medtronic Trillium MYOtherm XP, Sorin Group BCD Vanguard, Sorin Group CSC14, and Terumo Sarns Conducer and Bubble Trap. The 0.25‐in. circuit was primed with 400 mL of Lactated Ringer's. Outdated packed red blood cells were added to obtain a hematocrit of 24–28%. System pressure was maintained at 50 mm Hg. Air (0.1, 0.3, 0.5 mL) was injected at a speed of 0.1 mL/s into the circuit just after the pump head. Gaseous microemboli (GME) were measured prior to the cardioplegia system and after the device to evaluate the air‐handling characteristics. The tests were run at 100, 200, and 400 mL/min blood flow for both 4 and 37°C. There were no significant differences among the groups when comparing precardioplegia delivery system GME, thus demonstrating that all devices received the same amount of injected air. When comparing the groups for postcardioplegia delivery system GME, significant differences were noted especially at the 400 mL/min blood flow rate. These results suggest that for the devices compared in this study, the Maquet Plegiox and the Medtronic Trillium MYOtherm XP eliminated GME the best.
Renin‐Angiotensin System Blocker Use May Be Associated with Suppression of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation
Authors: ISHIKAWA KIYOTAKE , YAMADA TAKUMI , YOSHIDA YUKIHIKO , TAKIGAWA MASATERU , AOYAMA YUTAKA , INOUE NATSUO , TATEMATSU YASUSHI , NANASATO MAMORU , KATO KAZUO , TSUBOI NAOYA , HIRAYAMA HARUO 
Published: November 2010

Introduction:

An additional approach may be essential to reduce recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We examined the efficacy of renin‐angiotensin system blockers (RAS‐B) in suppressing AF recurrences after PVI.
Methods and Results:

We retrospectively studied 264 consecutive patients (195 male, median age: 63 years) who underwent successful PVI of paroxysmal (n = 94) or persistent AF (n = 170). RAS‐B treatment was performed in 145 patients (angiotensin‐converting enzyme inhibitors; n = 13, angiotensin receptor blockers; n = 129, both; n = 3). Echocardiography was performed before and 3 months after the ablation to examine the occurrence of left atrial structural reverse remodeling (LA‐RR). After a median follow‐up of 195 (interquartile range: 95–316) days, AF recurred in 51 (19.3%) patients. A Cox regression analysis revealed that AF recurrence was significantly lower in the patients with RAS‐B than in those without (hazard ratio [HR] = 0.41 [95% confidence interval (CI): 0.23–0.71], P = 0.002). After a multivariate adjustment for potential confounders, the use of RAS‐B (HR = 0.39 [95% CI: 0.19–0.77], P = 0.007) and type of AF (HR = 0.30 [95% CI: 0.13–0.66], P = 0.003) were the independent predictors for AF recurrence during the entire follow‐up. Although effect of RAS‐B was not significant during the early follow‐up (<3 month), it was the only independent predictor during the late follow‐up (>3 months) (HR = 0.21 [95% CI: 0.08–0.53], P = 0.001). There were no significant differences in LA‐RR occurrence regarding RAS‐B medication. The use of RAS‐B was an independent predictor of late AF recurrences irrespective of an early LA‐RR occurrence.
Conclusions:

Treatment with RAS‐B significantly reduced the AF recurrence after PVI. This benefit became more prominent 3 months after the PVI. (PACE 2011; 34:296–303)
Evaluation of Patients with “Faint” in an American Teaching Hospital: A Dire Need for a Standardized Approach
Authors: BRIGNOLE MICHELE , MALASANA GANGADHAR , SHERWOOD RANDALL P. , DACCARETT MARCOS , JETTER TAWNI L. , HAMDAN MOHAMED H. 
Published: November 2010

Background:

Fainting is a major healthcare problem with significant morbidity, mortality, and healthcare cost. We sought to assess the appropriateness of current clinical practice when compared to a guideline‐based algorithm.
Methods:

The records of 100 consecutive patients who presented with faint and were referred to the University of Utah for further evaluation by specialists were reviewed. We analyzed the clinical characteristics, tests performed, diagnosis made, and number of admissions. In addition, we applied a guideline‐based algorithm to assess the appropriateness of these evaluations.
Results:

The mean age was 49 ± 21 years with 57% being female. One‐third presented with their first event. Structural heart disease was present in 22% of the cases. Twelve (36%) of 32 admissions were inappropriate. There was an underutilization of orthostatic testing, carotid sinus massage, and implantable loop recorder and overutilization of imaging studies and neurologic consultation. Specifically, active standing and tilt‐table testing were performed in only 24% and 7% of the cases, respectively, none of the patients had carotid sinus massage despite 26% of them being ≥65 years old, and only 3% of the patients received an implantable loop recorder. With the current practice, a final diagnosis was made in 45 cases with 17 (38%) of the 45 final diagnoses not being sufficiently supported by the completeness of the evaluation.
Conclusion:

With the current practice at a major university hospital, the cause of faint was unexplained in a high number of cases. Our findings highlight the need for a standardized approach to patients presenting with faint. (PACE 2011; 34:284–290)
Noncavotricuspid Isthmus‐Dependent Right Atrial Tachycardia after Paroxysmal Atrial Fibrillation Ablation
Authors: JU WEIZHU , YANG BING , CHEN HONGWU , ZHANG FENGXIANG , ZHAI LISHANG , CAO KEJIANG , CHEN MINGLONG 
Published: November 2010

Background:
Atrial tachycardia (AT) is commonly encountered after atrial fibrillation (AF) ablation. But no study exclusively on noncavotricuspid isthmus‐dependent right AT (NCTI‐RAT) post‐AF ablation has been reported. The present study aims to describe its prevalence, electrophysiological mechanisms, and ablation strategy and to further discuss its relationship with AF.
Methods:
From July 2006 to November 2009, 350 consecutive patients underwent catheter ablation for paroxysmal AF. A total of seven patients (2.0%) developed NCTI‐RAT after left atrium ablation for AF. In these highly selected patients (two male, mean age 54 ± 11 years, mean left atrium diameter of 34 ± 7 cm), all had circumferential pulmonary vein isolation in their initial procedures and three of them had additional complex fractionated electrograms ablation in the left atrium and the coronary sinus.
Results:
Totally, nine NCTI‐RATs were mapped and successfully ablated in the right atrium with a mean cycle length of 273 ± 64 ms in seven patients. Five ATs in three patients were electrophysiologically proved to be macroreentry and the remaining four were focal activation. All the ATs were successfully abolished by catheter ablation. After a mean follow‐up of 29 ± 15 months post‐AT ablation, all patients were free of AT and AF off antiarrhythmic drugs.
Conclusions:
NCTI‐RAT is relatively less common post‐AF ablation. Totally, 2.0% of paroxysmal AF patients were revealed to have NCTI‐RAT. (PACE 2011; 34:391–397)
Safety and Feasibility of Cephalic Venous Access for Cardiac Resynchronization Device Implantation
Authors: USSEN BASSEY , DHILLON PARAMDEEP S. , ANDERSON LISA , BEETON IAN , HICKMAN MIKE , GALLAGHER MARK M. 
Published: November 2010

Background:

Cardiac resynchronization therapy (CRT) devices are usually implanted using subclavian vein access, which is associated with the risk of pneumothorax. We examined whether cephalic venous access is an effective alternative to subclavian access by the Seldinger technique for CRT delivery.
Methods:

We retrospectively analyzed all CRT procedures performed over a 1‐year period at our center with respect to the access methods, primary success rate, safety, and efficiency.
Results:

We retrospectively analyzed 103 consecutive primary implantation procedures. The procedure was accomplished using cephalic access alone for 54 of 61 (89%) CRT implants attempted by this route. The overall success rate was 100% (61/61) with additional use of subclavian access. CRT implantation via subclavian vein access was successful in 37 of 42 (88%) (P < 0.05 vs cephalic group). The procedure duration was shorter for the cephalic group (118 ± 39 vs 147 ± 36 minutes, P < 0.0005) as were the screening times and radiation exposure (15 ± 9 vs 27 ± 18 minutes and 4.7 ± 5.8 vs 9.3 ± 9.1 Gcm2, both P < 0.01). In the cephalic group, procedure duration and radiation exposure diminished significantly with increasing experience of the technique. Complications occurred in two of 61 (3.3%) cases in the cephalic group and three of 42 (7.1%) in the subclavian group (P = NS).
Conclusion:

CRT devices can be implanted using cephalic access alone in a large majority of cases. This approach is safe and efficient. (PACE 2011; 34:365–369)
Interatrial Septum Pacing Decreases Atrial Dyssynchrony on Strain Rate Imaging Compared with Right Atrial Appendage Pacing
Authors: YASUOKA YOSHINORI , ABE HARUHIKO , UMEKAWA SEIKO , KATSUKI KEIKO , TANAKA NORIO , ARAKI RYO , IMANAKA TAKAHIRO , MATSUTERA RYO , MORISAWA DAISUKE , KITADA HIROKAZU , HATTORI SUSUMU , NODA YOSHIKI , ADACHI HIDENORI , SASAKI TATSUYA , MIYATAKE KUNIO 
Published: November 2010

Background:

Interatrial septum pacing (IAS‐P) decreases atrial conduction delay compared with right atrial appendage pacing (RAA‐P). We evaluate the atrial contraction with strain rate of tissue Doppler imaging (TDI) during sinus activation or with IAS‐P or RAA‐P.
Methods:

Fifty‐two patients with permanent pacemaker for sinus node disease were enrolled in the study. Twenty‐three subjects were with IAS‐P and 29 with RAA‐P. The time from end‐diastole to peak end‐diastolic strain rate was measured and corrected with RR interval on electrocardiogram. It was defined as the time from end‐diastole to peak end‐diastolic strain rate (TSRc), and the balance between maximum and minimum TSRc at three sites (ΔTSRc) was compared during sinus activation and with pacing rhythm in each group.
Results:

There were no significant differences observed in general characteristics and standard echocardiographic parameters except the duration of pacing P wave between the two groups. The duration was significantly shorter in the IAS‐P group compared with the RAA‐P group (95 ± 34 vs 138 ± 41; P = 0.001). TSRc was significantly different between sinus activation and pacing rhythm (36.3 ± 35.7 vs 61.6 ± 36.3; P = 0.003) in the RAA‐P group, whereas no significant differences were observed in the IAS‐P group (25.4 ± 12.1 vs 27.7 ± 14.7; NS). During the follow‐up (mean 2.4 ± 0.7 years), the incidence of paroxysmal atrial fibrillation (AF) conversion to permanent AF was not significantly different between the two groups.
Conclusions:

IAS‐P decreased the contraction delay on atrial TDI compared to RAA‐P; however, it did not contribute to the reduction of AF incidence in the present study. (PACE 2011; 34:370–376)
High‐Sensitivity C‐Reactive Protein as a Predictor of Atrial Fibrillation Recurrence after Primary Circumferential Pulmonary Vein Isolation
Authors: LIU JUN , FANG PI‐HUA , DIBS SAMER , HOU YU , LI XIAO‐FENG , ZHANG SHU 
Published: November 2010

Background: Atrial fibrillation (AF) recurrence after circumferential pulmonary vein isolation (CPVI) is difficult to predict. Inflammation is associated with the development of AF. Inflammatory markers, such as high sensitivity C‐reactive protein (hsCRP), are related to AF development via atrial remodeling. However, it is unknown whether plasma hsCRP concentration before CPVI can be used as a predictor for AF recurrence.
Methods: A total of 121 patients without structural heart disease who underwent primary CPVI by a single operator were included in the study (paroxysmal/persistent AF: 77/44). Left atrial diameter was measured by transesophageal echocardiography. Plasma hsCRP concentration was determined by enzyme‐linked immunosorbent assay. Based on the follow‐up outcomes, patients were divided into two groups, a recurrence group and a nonrecurrence group. AF recurrence was defined as AF or atrial flutter or atrial tachycardia episodes lasting for ≥30 s during regular follow‐up (>12 months).
Results: A total of 36 (29.8%) patients (paroxysmal/persistent AF: 19 [24.7%]/17 [38.6%]) had AF recurrence in a mean 23 (range, 12–44) month follow‐up period. The plasma hsCRP concentration in the recurrence group was significantly higher than that in the nonrecurrence group for all patients (median [quartile range] 2.22 [1.97] mg/L vs 0.89 [1.30] mg/L, P < 0.001), for patients with paroxysmal AF (2.12 [2.78] mg/L vs 0.84 [1.15] mg/L, P = 0.028), and for those with persistent AF (2.29 [1.08] mg/L vs 0.89 [1.53] mg/L, P = 0.005). Multiple logistic regression analyses showed that the higher level of the plasma hsCRP (P < 0.001) was a significant prognostic predictor of AF recurrence, both for patients with paroxysmal AF (P = 0.012) and those with persistent AF (P = 0.003).
Conclusion: Plasma hsCRP concentration before CPVI was associated with AF recurrence after primary CPVI procedure for both paroxysmal and persistent AF patients. Plasma hsCRP concentration could play a role in prediction of AF recurrence after primary CPVI. (PACE 2011; 34:398–406)
An Algorithm to Predict the Site of Origin of Focal Atrial Tachycardia
Authors: QIAN ZHI‐YONG , HOU XIAO‐FENG , XU DONG‐JIE , YANG BING , CHEN MING‐LONG , CHEN CHUN , ZHANG FENG‐XIANG , SHAN QI‐JUN , CAO KE‐JIANG , ZOU JIAN‐GANG 
Published: November 2010

Background: Only a few algorithms for predicting the site of origin of focal atrial tachycardia (AT) have been reported. We aimed to develop a new and more effective algorithm.
Methods: Surface 12‐lead electrocardiograms were collected during tachycardia and sinus rhythm in 61 patients who received successful radiofrequency ablation. P‐wave polarities, durations, and amplitudes were analyzed. Predictive values of the most significant parameters were determined. An algorithm was then developed and prospectively evaluated in 30 new consecutive AT patients.
Results: Thirty‐six percent (22/61) of the foci were located at the ostium of coronary sinus (CS). Other common foci included pulmonary veins (PVs, n = 15), right atrial appendage (RAA, n = 7), parahisian area (n = 7), and crista terminalis (CT, n = 3). Positive P waves in inferior leads (II, III, and aVF) and a negative P wave in lead aVR indicated high atrial origins (high CT, superior PVs, and RAA, defined as Area A), with a sensitivity of 95% and a specificity of 90%. Negative P waves in inferior leads and a positive P wave in lead aVR suggested right low septal origins (CS ostium and inferior tricuspid annulus, defined as Area B), with good sensitivity and specificity (88% and 89%, respectively). This new P‐wave diagnostic algorithm correctly identified the site of origin in 90% of AT cases.
Conclusion: Combination of data from multiple leads and regrouping of sites of origin provides a better predictive value. (PACE 2011; 34:414–421)
Seeing Dead People Not Known to Have Died: “Peak in Darien” Experiences
Authors: Greyson Bruce 
Published: November 2010

SUMMARYThe ubiquitous belief that, after death, our consciousness might persist in some discarnate form is fueled in part by phenomena like near‐death experiences (NDEs) and deathbed visions, mystical experiences reported on the threshold of death. Some NDEs, called “Peak in Darien” experiences, include visions of deceased people who are not known at the time to be dead. Cases of this kind provide some of the most persuasive evidence for the survival of consciousness after bodily death.
Understanding the Conundrum of Rebirth Experience of the Beaver, Gitxsan, and Witsuwit'en
Authors: Mills Antonia 
Published: November 2010

SUMMARYThe First Nations people of British Columbia experience reincarnation as a revitalization of their culture. This article documents the perseverance of reincarnation experiences among the Beaver, Witsuwit'en, and Gitxsan peoples of British Columbia, as well as my own growth in understanding such experiences. It recounts examples of rebirth cases. It explains what rebirth experiences mean to the First Nations people. It describes how these experiences are embedded in their perception of this world and embodied in their beliefs of spiritual realms, which include the interconnected and parallel worlds of fish and land animals, on this world and in spiritual dimensions. While the rebirth worldview contrasts with that of the Western scientific world, this is a worldview I have come to endorse.