bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery
Authors: Binder Jeffrey R. , Sabsevitz David S. , Swanson Sara J. , Hammeke Thomas A. , Raghavan Manoj , Mueller Wade M. 
Published: April 2008

Summary
Purpose: Verbal memory decline is a frequent complication of left anterior temporal lobectomy (L‐ATL). The goal of this study was to determine whether preoperative language mapping using functional magnetic resonance imaging (fMRI) is useful for predicting which patients are likely to experience verbal memory decline after L‐ATL.
Methods: Sixty L‐ATL patients underwent preoperative language mapping with fMRI, preoperative intracarotid amobarbital (Wada) testing for language and memory lateralization, and pre‐ and postoperative neuropsychological testing. Demographic, historical, neuropsychological, and imaging variables were examined for their ability to predict pre‐ to postoperative memory change.
Results: Verbal memory decline occurred in over 30% of patients. Good preoperative performance, late age at onset of epilepsy, left dominance on fMRI, and left dominance on the Wada test were each predictive of memory decline. Preoperative performance and age at onset together accounted for roughly 50% of the variance in memory outcome (p < 0.001), and fMRI explained an additional 10% of this variance (p ≤ 0.003). Neither Wada memory asymmetry nor Wada language asymmetry added additional predictive power beyond these noninvasive measures.
Discussion: Preoperative fMRI is useful for identifying patients at high risk for verbal memory decline prior to L‐ATL surgery. Lateralization of language is correlated with lateralization of verbal memory, whereas Wada memory testing is either insufficiently reliable or insufficiently material‐specific to accurately localize verbal memory processes.
Simultaneous EEG‐fMRI in drug‐naive children with newly diagnosed absence epilepsy
Authors: Moeller Friederike , Siebner Hartwig R. , Wolff Stephan , Muhle Hiltrud , Granert Oliver , Jansen Olav , Stephani Ulrich , Siniatchkin Michael 
Published: April 2008

Summary
Purpose: In patients with idiopathic generalized epilepsy (IGE), blood oxygen level dependent (BOLD) EEG during functional MRI (EEG‐fMRI) has been successfully used to link changes in regional neuronal activity to the occurrence of generalized spike‐and‐wave (GSW) discharges. Most EEG‐fMRI studies have been performed on adult patients with long‐standing epilepsy who were on antiepileptic medication. Here, we applied EEG‐fMRI to investigate BOLD signal changes during absence seizures in children with newly diagnosed childhood absence epilepsy (CAE).
Methods: Ten drug‐naive children with newly diagnosed CAE underwent simultaneous EEG‐fMRI. BOLD signal changes associated with ictal EEG activity (i.e., periods of three per second GSW) were analyzed in predefined regions‐of‐interests (ROIs), including the thalamus, the precuneus, and caudate nucleus.
Results: In 6 out of 10 children, EEG recordings showed periods of three per second GSW during fMRI. Three per second GSW were associated with regional BOLD signal decreases in parietal areas, precuneus, and caudate nucleus along with a bilateral increase in the BOLD signal in the medial thalamus. Taking into account the normal delay in the hemodynamic response, temporal analysis showed that the onset of BOLD signal changes coincided with the onset of GSW.
Discussion: In drug‐naive individuals with CAE, ictal three per second GSW are associated with BOLD signal changes in the same striato‐thalamo‐cortical network that changes its regional activity during primary and secondary generalized paroxysms in treated adults. No BOLD signal changes in the striato‐thalamo‐cortical network preceded the onset of three per second GSW in unmediated children with CAE.
Spread of ictal activity in focal epilepsy
Authors: Götz‐Trabert Katrin , Hauck Christoph , Wagner Kathrin , Fauser Susanne , Schulze‐Bonhage Andreas 
Published: April 2008

Summary
Purpose: Latencies between seizure onset, propagation of ictal activity, and initial clinical symptoms and signs are critically important for the successful implementation of detection‐based intervention systems in the treatment of epilepsy. This study analyzes intracranial EEG‐recordings for temporal characteristics of ictal spread and its dependence on focus localization.
Methods: Intracerebral EEG recordings of 215 seizures from 43 patients with pharmacoresistant focal epilepsy were evaluated based on site of first propagation, latencies between EEG seizure onset, early propagation, and clinical seizure onset. Seizure onset was mesial temporal in 15 patients, neocortical temporal in 15 patients, and frontal in 13 patients.
Results: Periods during which ictal activity remained confined to the seizure onset area showed significant differences between the patient groups. Median latencies between electrographic seizure onset and early propagation were significantly longer for patients with mesial temporal (5 s in seizure‐based analysis/10 s in patient‐based analysis) as compared to neocortical temporal (3 s/5 s) and frontal seizure focus (1 s/2 s; p < 0.01). Concordantly, median latencies to onset of clinical symptomatology were significantly longer for patients with mesial temporal (17 s/19 s) as compared to neocortical temporal (11 s/17 s) and frontal seizure focus (4 s in seizure‐based analysis and 6 s in patient‐based analysis; p < 0.01).
Conclusions: The speed of propagation of ictal activity and the latencies until initial clinical seizure symptoms differ significantly depending on focus localization. Extended spread often occurred within the time window during which current detection systems operate. This suggests that inclusion criteria of patients suitable for testing the efficacy of detection‐based seizure intervention strategies should be based on focus localization and patient‐individual propagation patterns.
Analysis of the Electrocardiographic Waveforms Produced by Right Ventricular Pacing: Relation to the Nonpaced Patterns
Authors: FRIEDMAN HOWARD S. 
Published: April 2008

Background: Ventricular aberrant conduction has a confounding effect on the known relationships between the electrocardiogram (ECG) and left ventricular (LV) mass. By relating the ECG of right ventricular pacing to LV mass and to nonpaced recordings, clarification of these effects might emerge.
Methods and Results: In 30 patients (age, 81 ± 7 years; 13 women) who had right ventricular paced ECGs and echocardiograms, 24 of who also had nonpaced ECGs, comparative analyses were performed. Although the nonpaced ECGs had strong correlations with various echocardiographic measurements, for paced ECGs, only QRS complex voltage and interventricular septal thickness (IVS) were significantly related. However, paced QRS complex voltage relationships correlated with those of nonpaced QRS complexes, ranging from an r = 0.54, P < 0.006, for the sum of the R in aVL and the S in V‐3 to r = 0.78, P < 0.001, for the sum of the R in I and the S in III. Paced ECGs had a QRS complex with a greater spatial amplitude, a longer duration, and a more superior position, and had more deeply inverted T waves than nonpaced ECGs. The differences between the voltages of paced and nonpaced QRS complexes, moreover, diminished as LV mass and/or IVS increased. When compared with nonpaced ECGs, paced ECGs showed the most similarity to nonpaced ECGs having a left bundle branch block (LBBB) pattern. Except for the presence of more superiorly directed QRS complexes, paced impulses were not significantly different (P < 0.008) from nonpaced impulses having a LBBB pattern. Also, the nonpaced ECG pattern had no discernable effect on ECG produced by right ventricular (RV) pacing.
Conclusions: Despite having weak relations with echocardiographic measurements, the QRS complex voltage of the paced ECG correlated with those of nonpaced ECGs, and the voltage differences between them were smaller as LV mass increased.
Intracardiac Echocardiography‐Guided His Bundle Pacing and Atrioventricular Nodal Ablation
Authors: YIN LIXUE , LASKE TIMOTHY G. , RAKOW NANCY , CAI LI , WILLIAMS TERRELL , LI CHUNMEI , ZHAO YONG , DENG YAN , CHEN LIJIAN , LI SHUANG , WANG SHAN , ZHENG CHANGQIONG , LI DEYU , WANG TIANFU , ZHENG YI 
Published: April 2008

Background: His bundle pacing (HBP) results in rapid synchronous ventricular activation, but has been associated with long procedure times and compromised pacing and sensing performance. This study sought to reduce procedure time and radiation exposure, and improve electrical performance through more accurate lead placement.
Methods: Intracardiac echocardiography (ICE) was used to guide ablation and lead implantation at the His bundle, right atrial appendage (RAA), and right ventricular apex (RVA), and to assess cardiac function. Custom bipolar screw‐in leads with steerable delivery sheaths and an ablation catheter were navigated using ICE (local detailed imaging) and fluoroscopy (global imaging) in anesthetized closed‐chest canines (N = 6).
Results: HBP (N = 1) or His + ventricular septal pacing (N = 5) was achieved in all canines. The QRS width was 59.7 ± 5.3 ms for canines in sinus rhythm (SR) and 82.8 ± 16.6 ms for canines with HBP (P = 0.0086). The QRS width for RVA pacing was 106.3 ± 18.4 ms (P = 0.042 vs HBP; P = 0.00013 vs SR). HBP thresholds were 3.0 ± 1.0 volts at 0.5 ms (N = 5 due to a late exit block in one canine). The average procedure duration for His lead placement was 40 ± 28 minutes (range of 3–81 minutes) and the total procedural X‐ray exposure was 12 ± 12 minutes (range of 2–30 minutes). Hemodynamic performance was similar for HBP and RAA pacing.
Conclusions: Feasibility of ICE guidance for His pacing and precision ablation of the atrioventricular (AV) node has been shown. This anatomic approach improved accuracy, limited X‐ray exposure, and might allow His pacing in patients with preexisting AV nodal block.
Lead‐Associated Endocarditis: The Important Role of Methicillin‐Resistant Staphylococcus aureus
Authors: GREENSPON ARNOLD J. , RHIM EUGENE S. , MARK GEORGE , DESIMONE JOSEPH , HO REGINALD T. 
Published: April 2008

Background: Infection is a potentially life‐threatening complication of cardiac device implantation. Lead‐associated endocarditis (LAE) may be the most serious complication since it is associated with a high mortality.
Methods: The medical records of patients referred to our institution for the treatment of LAE between 1999 and 2007 were reviewed.
Results: A total of 51 of 107 patients referred for device‐related infections met the criteria for LAE. Of these, 19 occurred within 6 months of their most recent procedure (early), while the remaining 32 occurred more than 6 months later (mean = 31.9 months post procedure). Devices included pacemakers in 33 patients and ICDs in 18 patients. The most common organism responsible for infection was Staphylococcus aureus (S. aureus) followed by coagulase‐negative staphylocci (22%) and streptococci (12%). Methicillin‐resistant S. aureus (MRSA) accounted for 67% of the S. aureus infections. Coagulase‐negative staphylococci were responsible for only 26% of early and 19% of late cases. A distant site of infection was common (26/51 = 51%), particularly in patients with MRSA LAE. The device and leads were removed percutaneously in all patients. Only one patient failed to respond to intravenous antibiotics.
Conclusions: Our data suggest that methicillin‐resistant S. aureus is an important pathogen in LAE. Since many infections occur months after the last device procedure, hematogenous spread of organisms from a distant site may be an important contributing factor. These data suggest that strategies to prevent hematogenous infection, particularly with S. aureus, are critical in patients with implantable cardiac devices.
Deactivating Implanted Cardiac Devices in Terminally Ill Patients: Practices and Attitudes
Authors: MUELLER PAUL S. , JENKINS SARAH M. , BRAMSTEDT KATRINA A. , HAYES DAVID L. 
Published: April 2008

Background:Clinicians may receive requests to deactivate pacemakers and implantable cardioverter‐defibrillators (ICDs) in terminally ill patients.Methods:We describe practices and attitudes regarding deactivation of pacemakers and ICDs in terminally ill patients among physicians, nurses, and others who manage treatment of patients with implanted cardiac devices and among field representatives of device manufacturers. A Web‐based survey was provided to Heart Rhythm Society members and to representatives of two manufacturers of implantable cardiac devices. Measurements were the answers of 787 respondents.Results:Of the respondents, 86.8% reported involvement in requests for ICD deactivation and 77.6% reported involvement in pacemaker deactivation (P < 0.001). Having cared for a terminally ill patient for whom the respondent or a physician had ordered device deactivation was common (95.4% for ICDs vs 84.8% for pacemakers; P < 0.001). Having personally deactivated a device was also common (92.4% for ICDs vs 76.6% for pacemakers; P < 0.001). More respondents said they were comfortable with personally deactivating an ICD than deactivating a pacemaker (56.7% for ICDs vs 34.4% for pacemakers; P < 0.001). Respondents reported that the industry representative is the individual who deactivates the device most of the time (59.3% for ICDs and 49.7% for pacemakers).Conclusions:Deactivation of implanted cardiac devices in terminally ill patients is common. Practices and attitudes associated with pacemaker deactivation differ significantly from those associated with ICD deactivation. Professional groups should develop guidelines for managing requests for implanted cardiac device deactivation and should clarify the role of device industry representatives in these deactivations.
Stimulation Rate and the Optimal Interventricular Interval during Cardiac Resynchronization Therapy in Patients with Chronic Atrial Fibrillation
Authors: VAN GELDER BERRY M. , MEIJER ALBERT , BRACKE FRANK A. 
Published: April 2008

Background: Optimization of cardiac resynchronization therapy (CRT) with respect to the interventricular (V‐V) interval is mainly limited to pacing at a resting heart rate. We studied the effect of higher stimulation rates with univentricular and biventricular (BiV) pacing modes including the effect of the V‐V interval optimization.
Methods: In 36 patients with heart failure and chronic atrial fibrillation (AF), the effects of right ventricular (RV), left ventricular (LV), simultaneous BiV, and optimized sequential BiV (BiVopt) pacing were measured. The effect of the pacing mode and the optimal V‐V interval was determined at stimulation rates of 70, 90, and 110 ppm using invasive measurement of the maximum rate of left ventricular pressure rise (LV dP/dtmax).
Results: The average LV dP/dt max for all pacing modalities at stimulation rates of 70, 90, and 110 ppm was 781 ± 176, 833 ± 197, and 884 ± 223 mmHg/s for RV pacing; 893 ± 178, 942 ± 186, and 981 ± 194 mmHg/s for LV pacing; 904 ± 179, 973 ± 187, and 1052 ± 206 mmHg/s for simultaneous BiV pacing; and 941 ± 186, 1010 ± 198, and 1081 ± 206 mmHg/s for BiVopt pacing, respectively. In BiVopt pacing, the corresponding optimal V‐V interval decreased from 34 ± 29, 28 ± 28, and
21 ± 27
ms at stimulation rates of 70, 90, and 110 ppm, respectively
. In two individuals, LV dP/dtmax decreased when the pacing rate was increased from 90 to 110 ppm.
Conclusion: In patients with AF and heart failure, LV dP/dtmax increases for all pacing modalities at increasing stimulation rates in most, but not all, patients. The rise in LV dP/dtmax with increasing stimulation rates is higher in biventricular (BiV and BiVopt) than in univentricular (LV and RV) pacing. The optimal V‐V interval at sequential biventricular pacing decreases with increasing stimulation rates.
Elevated Serum Creatinine at Baseline Predicts Poor Outcome in Patients Receiving Cardiac Resynchronization Therapy
Authors: SHALABY ALAA , El‐SAED AIMAN , VOIGT ANDREW , ALBANY CONSTANTINE , SABA SAMIR 
Published: April 2008

Background: Renal insufficiency is recognized as a predictor of mortality and poor outcome in heart failure patients. We sought to study the impact of baseline serum creatinine on subsequent outcome in cardiac resynchronization therapy (CRT) recipients.
Methods: We retrospectively reviewed hospital records of all CRT recipients at Pittsburgh Veterans Affairs (VA) Healthcare System (2003–2005) and University of Pittsburgh Medical Center (2004)
. We recorded clinical characteristics at the time of implantation including demographics, New York Heart Association (NYHA) functional class, ejection fraction, QRS duration, cardiomyopathy etiology, medical history, medication use, and serum creatinine. Mortality alone and mortality combined with heart failure hospitalization were the study endpoints.
Results: Out of the 330 patients studied, a total of 66 (20.0%) patients died over a mean follow‐up duration of 19.7 ± 9.0 months (range 1–44). The cohort was studied by three creatinine tertiles (0.6–1.0, 1.1–1.3, 1.4–3.0 mg/dL). Both study endpoints were observed more frequently in patients in the highest creatinine tertile compared to others (28.7% vs 14.0%, P = 0.008 for death and 41.6% vs 21.5%, P = 0.001 for the combined endpoint). High creatinine remained an independent predictor of mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.06–3.39, P = 0.032) and the combined endpoint (HR 1.94, 95% CI 1.20–3.13, P = 0.007) in multivariate adjusted models. Studied as a continuous variable, increase in creatinine level by 0.1 mg/dL was associated with an 11% increase in mortality risk and a 7% increase in the combined endpoint.
Conclusion: In an unselected cohort of CRT recipients, the baseline creatinine was found to predict worse survival and poor outcome over a modest follow‐up duration.
The Role of Tilt Training in Preventing Recurrent Syncope in Patients with Vasovagal Syncope: A Prospective and Randomized Study
Authors: DUYGU HAMZA , ZOGHI MEHDI , TURK UGUR , AKYUZ SERDAR , OZERKAN FILIZ , AKILLI AZEM , ERTURK UMIT , ONDER REMZI , AKIN MUSTAFA 
Published: April 2008

Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self‐training in preventing syncope in patients with recurrent VVS.
Methods: Eighty‐two consecutive patients (mean age 41 ± 4 years, 37 males) with recurrent VVS episodes and positive head‐up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end‐points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence.
Results: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 ± 2/year syncopal episodes prior to the HUT. The mean follow‐up after randomization was 12 ± 2 months. Spontaneous syncope recurrence during follow‐up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 ± 20 days vs 50 ± 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow‐up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 ± 1 vs 2 ± 1, P = 0.4).
Conclusions: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.
Ocular manifestations in liver transplant recipients with familial amyloid polyneuropathy
Authors: Sandgren Ola , Kjellgren Daniel , Suhr Ole B. 
Published: April 2008

Abstract.Purpose:  To evaluate postoperative ocular involvement in Swedish liver transplant (LT) recipients with familial amyloid polyneuropathy (FAP).Methods:  Routine ophthalmological examinations were performed in 48 LT recipients, with particular attention given to amyloid deposition in the anterior segment and the vitreous body. Medical records were scrutinized for information regarding neurological impairment at the time of the LT. The diagnosis was secured in all cases by examining for amyloid deposits in biopsy specimens and positive genetic testing for amyloidogenic transthyretin (ATTR) Val30Met mutation.Results:  Six patients (12.5%) developed vitreous opacities within the post‐LT observation period. The first opacities were seen 40 months after transplantation, 8 years after the onset of systemic disease. Four patients (8%) developed secondary glaucoma, the first of which was observed 18 months after the procedure and 6.5 years after the onset of disease. Sixteen patients (33%) developed deposits on the anterior surface of the lens. Scalloped pupillary margins were noted in 10 patients (21%).Conclusion:  The prevalence of eye complications increases with time after LT and regular follow‐up is necessary, especially to disclose the development of glaucoma – a complication with insidious symptoms of which patients are normally unaware.
Use of mental health services and complementary and alternative medicine in persons with common mental disorders
Authors: Wahlström M. , Sihvo S. , Haukkala A. , Kiviruusu O. , Pirkola S. , Isometsä E. 
Published: April 2008

Objective:  Few studies investigated the use of complementary and alternative medicine (CAM) by subjects with mental disorders. We examined the relationship between depressive, anxiety and alcohol‐use disorders and their comorbidity, as well as the relationship between use of CAM and use of mental health services.Method:  The Finnish adult (≥30 years) population‐based Health 2000 Study (n = 5987) collected information on use of CAM plus health and mental health care services.Results:  Generalised anxiety disorder and panic disorder were positively associated and alcohol abuse was negatively associated with use of CAM. The prevalence was highest in persons with comorbidity of anxiety and depressive disorders. The use or perceived usefulness of mental health services did not differ between CAM users and other participants.Conclusion:  The relationship between the use of CAM and mental disorders appears to vary depending on the type of mental disorder. Use of CAM seems unrelated to the use and the perceived usefulness of mental health services.