bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamic Benefit of Multiple Programmable Pacing Configurations in Patients with Biventricular Pacemakers
Authors: BALASUNDARAM RAMPRAKASH , RAO HYGRIV B. , SRIDEVI C. , SOMARAJU B. , SINGH BALBIR , CALAMBUR NARASIMHAN 
Published: February 2009

Introduction: Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure. However, one‐third of the patients fail to improve with this therapy. Stimulation with different left ventricular stimulation (LVS) configurations has been used to prevent diaphragmatic capture and to decrease the capture thresholds. We evaluated the hemodynamic effects of different LVS configurations using echocardiography.
Methods: Recipients of CRT systems capable of multiple LVS configurations were studied. Biventricular capture was confirmed for each polarity and echocardiographic measurements were made. The atrioventricular and interventricular delays were optimized and kept constant during the study. The cardiac output (CO), myocardial performance index (MPI), and severity of mitral regurgitation (MR) were recorded for all LVS configurations and compared for the best and the worst configurations, determined by CO.
Results: We studied 10 men and four women, 55 ± 13 years of age on average. The CO and MPI changed significantly by changing the LVS configurations. The difference in CO ranged from 0.3 to 1.5 L, and seven patients (50%) showed ≥20% difference in CO between best and worst LVS configurations. Severity of MR decreased by ≥1 grade in nine patients, while in two patients MR worsened despite improvement in CO.
Conclusions: Changing the LVS configuration changes hemodynamic function in some CRT system recipients.
Predictors of Mortality and Hospitalization for Cardiac Causes in Patients with Heart Failure and Nonischemic Heart Disease: A Subanalysis of the ALPHA Study
Authors: ANSELMINO MATTEO , DE FERRARI GAETANO M. , MASSA RICCARDO , MANCA LORENZO , TRITTO MASSIMO , MOLON GIULIO , CURNIS ANTONIO , DEVECCHI PAOLO , BRAGA SIMONA SARZI , BARTESAGHI GIORGIO , KLERSY CATHERINE , ACCARDI FRANCESCO , SALERNO‐URIARTE JORGE A. ,   for the ALPHA Study Group Investigators
Published: February 2009

Background: Several studies have searched for predictors of clinical outcome in patients with heart failure (HF). However, since they were collected in clinical trials, most data were subject to selection biases and do not specifically apply to patients with nonischemic heart disease. This study examined the impact of several variables on combined all‐cause mortality and hospitalization for cardiac causes, in consecutive ambulatory patients with HF included in the ALPHA registry.
Methods and Results: This analysis included 446 patients with HF and nonischemic heart disease, in New York Heart Association functional class II or III, and a left ventricular (LV) ejection fraction below 40%. In 126 patients (73%) the disease was idiopathic dilated cardiomyopathy, in 72 (16%) hypertensive, in nine (2%) valvular, and in 39 (9%) of other etiologies. The median age was 61 years (range 51–69 years) and 349 (78%) patients were men. Over a median follow‐up of 31 months (range 23–40), 82 patients (18%) died or were hospitalized for cardiac causes. In a proportional hazard (Cox) regression model, maximal oxygen consumption (HR 0.9, P = 0.001), LV end‐diastolic diameter (HR 1.07, P < 0.001), resting systolic blood pressure (HR 0.97, P < 0.005), and hemoglobin (HR 0.86, P < 0.05) were independent predictors of the combined study endpoint.
Conclusions: In an unselected population of patients with HF and nonischemic heart disease, a reduced exercise capacity, large LV end‐diastolic diameter, low systolic blood pressure, and hemoglobin were correlated with long‐term all‐cause mortality or hospitalization for cardiac causes. These observations may help stratifying and tailoring the treatment of patients with HF and nonischemic heart disease.
Coronary Blood Flow Produced by Muscle Contractions Induced by Intracardiac Electrical CPR during Ventricular Fibrillation
Authors: WANG HAO , TANG WANCHUN , TSAI MIN‐SHAN , SUN SHIJIE , LI YONGQIN , GILMAN BYRON , KROLL MARK W. , GUAN JUN , BREWER JAMES E. , WEIL MAX H. 
Published: February 2009

It has been reported that transthoracic electrical cardiopulmonary resuscitation (ECPR) generates coronary perfusion pressures (CPP) similar to manual chest compressions (MCC). We hypothesized that intracardiac ECPR produces similar CPP.
Methods: ECPR pulse train protocols were applied for 20 seconds in a porcine model following 10 seconds of ventricular fibrillation (VF), using a defibrillator housing electrode and a right ventricular coil (IC‐ECPR). Each protocol consisted of 200‐ms electrical pulse trains applied at a rate of 100 pulse trains/min. The protocols were grouped in skeletal‐based versus cardiac‐based stimulation measurements. CPP was recorded and compared to historical MCC values generated by a similar experimental design. CPP > 15 mm Hg at 30 seconds of VF following the application of an IC‐ECPR protocol was defined as successful.
Results: Mean CPP for all intracardiac ECPR pulse train protocols at 30 seconds of VF was 14.8 ± 3.8 mm Hg (n = 39). Mean CPP in seven successful skeletal‐based IC‐ECPR protocols was 19.4 ± 3.2 mm Hg, and mean CPP in 10 successful cardiac‐based IC‐ECPR protocols was 17.4 ± 2.1 mm Hg. Reported CPP for 15 MCC experiments at 30 seconds of VF was 22.9 ± 9.4 mm Hg (P = 0.35 compared to skeletal‐based IC‐ECPR, P = 0.08 compared to cardiac‐based IC‐ECPR).
Conclusions: Intracardiac applied electrical CPR produced observable skeletal muscle contractions, measurable pressure pulses, and coronary perfusion pressures similar to MCC during a brief episode of untreated VF.
Exact Location of the Branching Bundle in the Living Heart
Authors: ADACHI MASAMITSU , IGAWA OSAMU , YANO AKIO , MIAKE JUNICHIRO , INOUE YOSHIAKI , OGURA KAZUYOSHI , KATO MASARU , IITSUKA KAZUHIKO , HISATOME ICHIRO 
Published: February 2009

Aims: The His bundle electrogram is believed to reflect the exact location of the His bundle. However, the distinction between distal His bundle potential and proximal right bundle branch potential is challenging. The aim of this study was to pinpoint the location of the branching point of the His bundle, and to compare that site with the site of recording of the largest His bundle electrogram (LH) during sinus rhythm.
Methods: We hypothesized that the site of earliest His activation (EH) during retrograde conduction via the left bundle branch is the branching point. We studied 15 nonconsecutive patients (mean age = 40 ± 22 years; eight men). We performed a programmed stimulation from right ventricular apex until retrograde right bundle branch block appeared. At that point we measured (1) the distance between antegrade LH site and retrograde EH site and (2) the atrial‐to‐ventricular amplitude ratio (A/V ratio) at both sites.
Results: EH was recorded at the proximal electrode of the His bundle catheter in all patients. Mean distance between EH and LH was 9.8 ± 2.5 mm. The mean A/V ratios at the EH site and the LH site were 1.01 ± 0.42 and 0.08 ± 0.06, respectively.
Discussion: This study showed that the EH site is located approximately 10‐mm proximal to the LH site. The mean A/V ratio at the EH site during sinus rhythm is approximately 1.0. These observations suggest that the majority of His potentials reflect proximal right bundle activation. Before delivering radiofrequency energy in the para‐Hisian area, attention should be paid to the presence of a His potential and to the A/V ratio, rather to the amplitude of the His electrogram.
Esophageal Acid Levels after Pulmonary Vein Isolation for Atrial Fibrillation
Authors: NÖLKER GEORG , RITSCHER GUIDO , GUTLEBEN KLAUS‐JÜRGEN , MARSCHANG HARALD , SCHMIDT MARTIN , RITTGER HARALD , MAYER DIRK , MARROUCHE NASSIR , BRACHMANN JOHANNES , SINHA ANIL‐MARTIN 
Published: February 2009

Background: Pulmonary vein antrum isolation (PVAI) is a potentially curative, nonpharmacologic treatment of atrial fibrillation (AF). Several procedural complications have been described, including esophageal wall lesions ranging from erythema and esophagitis, necrosis and ulcer, to atrio‐esophageal fistula. We prospectively studied changes in esophageal acid levels before and after PVAI.
Methods: We performed 24‐hour pH‐metry before and 1.3 ± 1.6 days after PVAI, in 25 patients (mean age = 62 ± 12 years, 17 men) with symptomatic AF. A 2‐mm transnasal probe was inserted into the inferior part of the esophagus and into the stomach to measure pH levels at fixed intervals. DeMeester scores, indicating acidic gastro‐esophageal reflux, were calculated.
Results: The mean number of reflux episodes increased from 89 ± 80 before to 107 ± 94 after PVAI. The mean percentage of time with esophageal pH < 4 was shorter after (108 ± 193 minutes) than before PVAI (159 ± 245 minutes). The mean DeMeester score decreased from 49 ± 68 before to 31 ± 41 after PVAI (P < 0.05). We observed erythema or esophagitis in five patients, necrosis or ulcer in seven, and atrio‐esophageal fistula in no patient.
Conclusions: Our hypothesis of increased acid levels caused by stimulation of the right vagal nerve during isolation of the right upper pulmonary vein was not verified.
Optimization of AV and VV Delays in the Real‐World CRT Patient Population: An International Survey on Current Clinical Practice
Authors: GRAS DANIEL , GUPTA MANISH S. , BOULOGNE ERIC , GUZZO LISA , ABRAHAM WILLIAM T. 
Published: February 2009

Background: Cardiac resynchronization therapy (CRT) is an effective treatment for patients suffering from advanced heart failure and electrical dyssynchrony. Limited data suggest that patients may benefit from routine optimization of the atrioventricular (AV) and interventricular (VV) delays; however, there is scarce information available on how and when optimization should be performed.
Objective: The objective of this survey was to characterize the current international standard of care for optimization of the AV and VV delays in CRT devices recipients.
Methods: Centers participating in the Frequent Optimization Survey Using the QuickOpt Method (FREEDOM) study completed surveys probing into their optimization of AV and VV delays procedures. Probes focused on the methods used to optimizing the delays, visits at which optimization of the delays was performed, percentage of patients that underwent optimization, and factors that limited centers from optimizing the CRT systems.
Results: Few of the 118 investigators from 16 countries who responded to the survey routinely optimized the delays in all patients. At follow‐up visits and during hospitalizations, a trend was observed to optimize the delays more often in nonresponders than in responders to CRT. Standard echocardiography was the most common method of optimization. Time availability and lack of qualified staff were the main factors limiting the optimization of CRT systems.
Conclusions: In real‐world practice, AV and VV optimization was not performed in a high proportion of patients. A less time‐consuming and easier optimization method might enable a more systematic optimization of the AV and VV delays at routine follow‐up visits in all recipients of CRT systems.
Recording of Peak Endocardial Acceleration in the Atrium
Authors: GRAS DANIEL , KUBLER LUC , RITTER PHILIPPE , ANSELME FRÉDÉRIC , DELNOY PIERRE PAUL , BORDACHAR PIERRE , RENESTO FABRIZIO , MABO PHILIPPE 
Published: February 2009

Background: The important role played by peak endocardial acceleration (PEA or sonR) in hemodynamic monitoring of cardiac resynchronization therapy (CRT) was recently highlighted in several studies with the sensor embedded in a right ventricular (RV) lead tip. This study examined the short‐ and long‐term reliability of a right atrial (RA) sonR sensor.
Methods: RA and RV sonR signals were measured from RA and RV leads respectively, at implant and up to 12 months of follow‐up, in 19 recipients of either single chamber pacemakers or CRT systems. At 1 month of follow up, RA sonR signals and heart rate were simultaneously recorded during exercise.
Results: A reliable RA sonR signal amplitude was measured at implant, proportional to the RV amplitude. We observed in both the right atrium and right ventricle (1) a similar signal noise ratio at implant, (2) a similar evolution of the sonR signal amplitude up to 12 months of follow‐up, and (3) a high correlation between heart rate and RA sonR signal amplitude during exercise.
Conclusions: The RA sonR signal was reliable and proportional to the RV signal on the short and long term, and reflected changes in activity. These observations suggest that the sonR sensor could be placed in the atrium for the hemodynamic monitoring of CRT system recipients.
Relationship between Amplitude and Timing of Heart Sounds and Endocardial Acceleration
Authors: TASSIN AUDE , KOBEISSI ADONIS , VITALI LUCA , ROULEAU FRÉDÉRIC , RITTER PHILIPPE , GAGGINI GUIDO , DUPUIS JEAN‐MARC 
Published: February 2009

Objective: To study the correlation between heart sounds and peak endocardial acceleration (PEA) amplitudes and timings, by modulation of paced atrioventricular (AV) delay in recipients of dual chamber pacemakers.
Methods: Ten recipients of dual chamber pacemakers implanted for high‐degree AV block were studied. Endocardial acceleration (EA) and phonocardiographic and electrocardiographic signals were recorded during performance of an AV delay scan in VDD and DDD modes.
Results: First PEA (PEA I) and first heart sound (S1) changed similarly with the AV delay. A close intrapatient correlation was observed between S1 and PEA I amplitudes in all patients (P < 0.0001). The interpatient normalized PEA I to S1 amplitudes correlation was r = 0.89 (P < 0.0001) in DDD mode, and r = 0.81 (P < 0.0001) in VDD mode. The mean cycle‐by‐cycle PEA I to S1 delay was −4.3 ± 22 ms and second PEA (PEA II) to second heart sound (S2) delay was −7.7 ± 15 ms.
Conclusions: A close correlation was observed between PEA I and S1 amplitudes and timings, and between PEA II and S2 timings. These observations support the hypothesis that PEA and heart sounds are manifestations of the same phenomena. EA might be a useful tool to monitor cardiac function.
Hand eczema in geriatric nurses in Germany – prevalence and risk factors
Authors: Skudlik Christoph , Dulon Madeleine , Wendeler Dana , John Swen M. , Nienhaus Albert 
Published: February 2009

Background and objectives:  The aim of this cross‐sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.
Sources of sensitization, cross‐reactions, and occupational sensitization to topical anaesthetics among general dermatology patients
Authors: Jussi Liippo , Kaija Lammintausta 
Published: February 2009

Background: Contact sensitization to local anaesthetics is often from topical medicaments. Occupational sensitization to topical anaesthetics may occur in certain occupations.Objectives: The aim of the study was to analyse the occurrence of contact sensitization to topical anaesthetics in general dermatology patients.Patients and Methods: Patch testing with topical anaesthetics was carried out in 620 patients. Possible sources of sensitization and the clinical histories of the patients are analysed.Results: Positive patch test reactions to one or more topical anaesthetics were seen in 25/620 patients. Dibucaine reactions were most common (20/25), and lidocaine sensitization was seen in two patients. Six patients had reactions to ester‐type and/or amide‐type anaesthetics concurrently. Local preparations for perianal conditions were the most common sensitizers. One patient had developed occupational sensitization to procaine with multiple cross‐reactions and with concurrent penicillin sensitization from procaine penicillin.Conclusions: Dibucaine‐containing perianal medicaments are the major source of contact sensitization to topical anaesthetics. Although sensitization to multiple anaesthetics can be seen, cross‐reactions are possible. Contact sensitization to lidocaine is not common, and possible cross‐reactions should be determined when reactions to lidocaine are seen. Occupational procaine sensitization from veterinary medicaments is a risk among animal workers.
Lethal pneumonia in a captive juvenile chimpanzee (Pan troglodytes) due to human‐transmitted human respiratory syncytial virus (HRSV) and infection with Streptococcus pneumoniae
Authors: Szentiks Claudia A. , Köndgen Sophie , Silinski Sandra , Speck Stephanie , Leendertz Fabian H. 
Published: February 2009

AbstractBackground  During an outbreak of respiratory disease in captive chimpanzees (Pan troglodytes), gorillas (Gorilla gorilla), Bornean orangutans (Pongo pygmaeus), and red‐capped mangabeys (Cercocebus torquatus) also staff members showed non‐specific upper respiratory signs. One infant female chimpanzee with severe respiratory symptoms died despite immediate medical treatment and was submitted for necropsy.Methods  Routine post mortem, histological and bacteriological examinations were conducted. Additionally lung tissue samples form the chimpanzee and swab samples from the staff members and the other primates were examined by PCR.Results  A severe catarrhal to purulent bronchopneumonia and an interstitial pneumonia were found and human respiratory syncytial virus (HRSV) as well as Streptococcus pneumoniae was detected in lung samples by PCR. Swab samples from one animal keeper revealed the same HRSV sequence as of the chimpanzee.Conclusions  Therefore, it is suggested that the outbreak of respiratory disease within a zoological institution was due to transmission of HRSV between both human and primates.
The effect of the novel partial alpha2‐adrenoceptor agonist naphthylmedetomidine on the basic cardiorespiratory parameters and behavior in rhesus monkeys
Authors: Votava Martin , Hess Ladislav , Schreiberová Jitka , Málek Jiří 
Published: February 2009

AbstractBackground  The aim of this study was to compare cardiorespiratory and behavioral profile of a new alpha 2‐adrenoceptor ligand naphthylmedetomidine with medetomidine in rhesus monkeys.Methods  Naphthylmedetomidine or medetomidine (50 μg/kg) together with ketamine (3 mg/kg) and hyaluronidase (150 IU/kg) i.m was administered to 35 rhesus monkeys. Behavioral changes were then observed together with blood pressure, heart rate and oxygen saturation of hemoglobin.Results  The onset of sedation, ataxia, and reduction of aggression was similar in both treatment groups. Immobilization was observed only in medetomidine treated animals, while in naphthylmedetomidine treated animals loss of aggressiveness was observed but the animals never completely lost mobility. Naphthylmedetomidine showed less prominent effects on cardiorespiratory functions compared with medetomidine.Conclusions  Our results suggest that naphthylmedetomidine can be used to induce sedation in primates and other small animals while avoiding the serious side effects observed after administration of the currently used full α2‐AR agonists.
Increased neonatal thyrotropin in Down syndrome
Authors: Myrelid Å , Jonsson B , Guthenberg C , Von Döbeln U , Annerén G , Gustafsson J 
Published: February 2009

AbstractAim: Down syndrome (DS) is frequently associated with thyroid dysfunction. The aim of this study was to investigate the blood concentration of thyrotropin (TSH) observed at neonatal screening of infants with DS and its possible association with development of hypothyroidism during childhood.Methods: TSH levels from neonatal screening of 73 children (34 F) with DS born in 1986–1996 were studied retrospectively and compared with those of controls. The DS children were followed up regarding thyroid function to the age of 10 years in this descriptive study.Results: The DS infants had a higher mean TSH level and a higher TSH standard deviation score (SDS) than controls (7.0 ± 7.45 mU/L vs. 3.9 ± 2.43 mU/L and 1.1 ± 2.67 vs. 0, respectively). The differences were mainly attributable to higher values in the male DS children. The TSH level at screening did not predict thyroid dysfunction during childhood.Conclusion: Infants with DS, especially boys, showed elevated levels of TSH at neonatal screening, indicating the occurrence of mild hypothyroidism already in early life. The TSH levels could not predict development of manifest thyroid disease later in childhood.
A functional analysis of large‐scale temporal shifts from 1970 to 2000 in weed assemblages of sunflower crops in France
Authors: Fried G. , Chauvel B. , Reboud X. 
Published: February 2009

AbstractQuestions: What are the relationships between weed species traits and their change in distribution over a 30‐year period? What does it tell us about factors that have driven shifts in the composition of weed communities?Location: France.Methods: We analysed the links between change in the status of weed species in sunflower crops (decreasing or increasing) and a set of 17 traits using data sets collected in the 1970s and the 2000s, respectively. We analysed the contribution of traits to explain changes in the status of species both individually and in a multivariate way by mean of a clustering of species into functional groups.Results: 69% of the most widespread species had significantly changed their frequency rank status over the last 30 years. Nearly two thirds of the increasing species belonged to a single functional group, out of the five groups identified in this analysis. Overall, the weed flora occurring in sunflower crops has specialised since the 1970s in favour of ‘sunflower mimicking’ functional groups: increasing species were more nitrophilous, more heliophilous, less sensitive to sunflower herbicides and shared a rapid summer life cycle.Conclusions: The individual trait approach gave some indication as to the environmental factors likely to have caused the shift in sunflower weed communities. The functional group approach seemed to outperform direct trait comparisons as it accounted for major traits combinations i.e. cases where a species has a number of favourable traits, but is severely disadvantaged by the possession of one or a few deleterious traits.