bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcranial Magnetic Stimulation and Sleep Deprivation as Experimental Tools: When Sleep Deprivation is Too Exciting
Authors: Fountain Nathan B. 
Published: October 2007

Sleep Deprivation Increases Cortical Excitability in Epilepsy: Syndrome-Specific Effects. Badawy RA, Curatolo JM, Newton M, Berkovic SF, Macdonell RA. Neurology 2006;67(6):1018–1022. OBJECTIVE: To use transcranial magnetic stimulation (TMS) to investigate the hypothesis that sleep deprivation increases cortical excitability in people with epilepsy. METHODS: We performed paired pulse TMS stimulation, using a number of interstimulus intervals (ISIs) on each hemisphere of 30 patients with untreated newly diagnosed epilepsy (15 idiopathic generalized epilepsy [IGE] and 15 focal epilepsy) and on the dominant hemisphere of 13 healthy control subjects, before and after sleep deprivation. RESULTS: Both hemispheres in patients with IGE and the hemisphere ipsilateral to the EEG seizure focus in those with focal epilepsy showed an increase in cortical excitability following sleep deprivation at a number of ISIs. This change in excitability was most prominent in the patients with IGE. Although there were minor changes after sleep deprivation in control subjects and the contralateral hemisphere in the focal epilepsy group seen at the 250-millisecond ISI, it was less than that in the other groups. CONCLUSIONS: Sleep deprivation increases cortical excitability in epilepsy; the pattern of change is syndrome dependent. Effects of Sleep Deprivation on Cortical Excitability in Patients Affected by Juvenile Myoclonic Epilepsy: A Combined Transcranial Magnetic Stimulation and EEG Study. Manganotti P, Bongiovanni LG, Fuggetta G, Zanette G, Fiaschi A. J Neurol Neurosurg Psychiatry 2006;77(1):56–60. OBJECTIVE: To investigate the effect of sleep deprivation on corticospinal excitability in patients affected by juvenile myoclonic epilepsy (JME) using different transcranial magnetic stimulation (TMS) parameters. METHODS: Ten patients with JME and 10 normal subjects underwent partial sleep deprivation. Motor threshold (MT), motor evoked potential amplitude (MEP), and silent period (SP) were recorded from the thenar eminence (TE) muscles. Short latency intracortical inhibition (SICI) and short latency intracortical facilitation (SICF) were studied using paired magnetic stimulation. TMS was performed before and after sleep deprivation; EEG and TMS were performed simultaneously. RESULTS: In patients with JME, sleep deprivation induced a significant decrease in SICI and an increase in SICF, which was associated with increased paroxysmal activity. A significant decrease in the MT was observed. No significant changes in any TMS parameters were noted in normal subjects after sleep deprivation. The F wave was unchanged by sleep deprivation in both control subjects and in patients with JME. CONCLUSIONS: In patients with JME, sleep deprivation produces increases in corticospinal excitability in motor areas as measured by different TMS parameters.
Effects of Simultaneous and Optimized Sequential Cardiac Resynchronization Therapy on Myocardial Oxidative Metabolism and Efficiency
Authors: CHRISTENSON STUART D. , CHAREONTHAITAWEE PANITHAYA , BURNES JOHN E. , HILL MICHAEL R.S. , KEMP BRAD J. , KHANDHERIA BIJOY K. , HAYES DAVID L. , GIBBONS RAYMOND J. 
Published: October 2007

Introduction: Cardiac resynchronization therapy (CRT) can improve left ventricular (LV) hemodynamics and function. Recent data suggest the energy cost of such improvement is favorable. The effects of sequential CRT on myocardial oxidative metabolism (MVO2) and efficiency have not been previously assessed. Methods and Results: Eight patients with NYHA class III heart failure were studied 196 ± 180 days after CRT implant. Dynamic [11C]acetate positron emission tomography (PET) and echocardiography were performed after 1 hour of: 1) AAI pacing, 2) simultaneous CRT, and 3) sequential CRT. MVO2 was calculated using the monoexponential clearance rate of [11C]acetate (kmono). Myocardial efficiency was expressed in terms of the work metabolic index (WMI). P values represent overall significance from repeated measures analysis. Global LV and right ventricular (RV) MVO2 were not significantly different between pacing modes, but the septal/lateral MVO2 ratio differed significantly with the change in pacing mode (AAI pacing = 0.696 ± 0.094 min−1, simultaneous CRT = 0.975 ± 0.143 min−1, and sequential CRT = 0.938 ± 0.189 min−1; overall P = 0.001). Stroke volume index (SVI) (AAI pacing = 26.7 ± 10.4 mL/m2, simultaneous CRT = 30.6 ± 11.2 mL/m2, sequential CRT = 33.5 ± 12.2 mL/m2; overall P < 0.001) and WMI (AAI pacing = 3.29 ± 1.34 mmHg*mL/m2*106, simultaneous CRT = 4.29 ± 1.72 mmHg*mL/m2*106, sequential CRT = 4.79 ± 1.92 mmHg*mL/m2*106; overall P = 0.002) also differed between pacing modes. Compared with simultaneous CRT, additional changes in septal/lateral MVO2, SVI, and WMI with sequential CRT were not statistically significant on post hoc analysis. Conclusion: In this small selected population, CRT increases LV SVI without increasing MVO2, resulting in improved myocardial efficiency. Additional improvements in LV work, oxidative metabolism, and efficiency from simultaneous to sequential CRT were not significant.
Dual‐Dye Optical Mapping after Myocardial Infarction: Does the Site of Ventricular Stimulation Alter the Properties of Electrical Propagation?
Authors: SABA SAMIR , MATHIER MICHAEL A. , MEHDI HAIDER , LIU TONG , CHOI BUM‐RAK , LONDON BARRY , SALAMA GUY 
Published: October 2007

Introduction: Myocardial infarction (MI) disrupts electrical conduction in affected ventricular areas. We investigated the effect of MI on the regional voltage and calcium (Ca) signals and their propagation properties, with special attention to the effect of the site of ventricular pacing on these properties. Methods: New Zealand White rabbits were divided into four study groups: sham‐operated (C, n = 6), MI with no pacing (MI, n = 7), MI with right ventricular pacing (MI + RV, n = 6), and MI with BIV pacing (MI + BIV, n = 7). At 4 weeks, hearts were excised, perfused, and optically mapped. As previously shown, systolic and diastolic dilation of the LV were prevented by BIV pacing, as was the reduction in LV fractional shortening. Results: Four weeks after MI, optical mapping revealed markedly reduced action potential amplitudes and conduction velocities (CV) in MI zones, and these increased gradually in the border zone and normal myocardial areas. Also, Ca transients were absent in the infarcted areas and increased gradually 3–5 mm from the border of the normal zone. Neither BIV nor RV pacing affected these findings in any of the MI, border, or normal zones. Conclusions: MI has profound effects on the regional electrical and Ca signals and on their propagation properties in this rabbit model. The absence of differences in these parameters by study group suggests that altering the properties of myocardial electrical conduction and Ca signaling are unlikely mechanisms by which BIV pacing confers its benefits. Further studies into the regional, cellular, and molecular benefits of BIV pacing are therefore warranted.
Correlation Between Atrial ZnT‐1 Expression and Atrial Fibrillation in Humans: A Pilot Study
Authors: ETZION YORAM , GANIEL AMIR , BEHARIER OFER , SHALEV ARYEH , NOVACK VICTOR , VOLVICH LIOBOV , ABRAHAMOV DAN , MATSA MENACHEM , SAHAR GIDEON , MORAN ARIE , KATZ AMOS 
Published: October 2007

Background: Until recently, the membrane protein ZnT‐1 was studied mainly in the context of zinc homeostasis. However, new findings indicate that it acts as an inhibitor of L‐type calcium channels. We recently found that acute rapid pacing of the rat atria in vivo augments the expression of ZnT‐1, while knockdown of ZnT‐1 in culture can oppose the inhibition of L‐type calcium channels following rapid pacing. This pilot study, the first to assess cardiac ZnT‐1 in humans, was designed to look for possible correlation between the atrial expression of ZnT‐1 and atrial fibrillation. Methods: Right atrial appendage tissue was collected from 39 patients (27 with sinus rhythm and 12 with atrial fibrillation; 6‐permanent, 6‐ paroxysmal or persistent) undergoing open‐heart surgery. The expression of ZnT‐1 was analyzed by Western blot utilizing β‐actin as an internal loading control and a standard rat heart sample (STD) for inter‐blot comparison. Results: Overall atrial fibrillation patients (n = 12) had median ZnT‐1/β‐actin of 1.80 STD (inter‐quartile range 1.26 to 2.85) versus 0.73 STD (0.24 to 1.64) in the sinus rhythm group (P = 0.002). No association was found between ZnT‐1 level and most other clinical parameters tested. Multivariate analysis determined that atrial fibrillation and increased body mass index were the only independent variables clearly associated with higher ZnT‐1 levels (Standardized coefficients Beta = 0.62, 0.31; P = 0.002, P = 0.04, respectively). Conclusions: This pilot study provides evidence for increased ZnT‐1 expression in the atria of patients with atrial fibrillation.
Improvement in Endothelium Dysfunction in Diabetics Treated with Statins: A Randomized Comparison of Atorvastatin 20 mg versus Rosuvastatin 10 mg
Authors: BRUNETTI NATALE DANIELE , MAULUCCI GUGLIELMO , CASAVECCHIA GRAZIA PIA , DISTASO CARLO , DE GENNARO LUISA , LUIGI PELLEGRINO PIER , DI BIASE MATTEO 
Published: October 2007

Aim: To investigate the effect a 3‐month treatment with atorvastatin 20 mg compared with rosuvastatin 10 mg on endothelium dysfunction in subjects with diabetes.
Methods: A total of 22 consecutive subjects with diabetes who were not receiving statins were enrolled in the study. Endothelium function was assessed before treatment (T0), after 1 month (T1), and after 3 months of treatment (T2) with statins with brachial echo‐Doppler test. Patients were randomized to receive atorvastatin 20 mg or rosuvastatin 10 mg. Blood samples were drawn in the meantime in order to evaluate C‐reactive protein (CRP) plasmatic concentrations.
Results: A total of 82% of patients enrolled showed endothelium dysfunction (hyperemic reserve <5%). Treatment with statins significantly improved endothelium function in diabetics. Subjects with endothelium dysfunction decreased from 82% (T0) to 44% (T2): mean hyperemic reserve values increased from 2.64% (T0) to 3.23% (T1) and 4% (T2) in patients treated with rosuvastatin (ANOVA P < 0.01), and from 2.74% (T0) to 2.75% (T1) and 4.40% (T2) in those treated with atorvastatin (ANOVA P < 0.01); differences were significant only comparing T2 with T0. Relative increase in endothelium reserve was 51.51% with rosuvastatin versus 60.58% with atorvastatin (P N.S.). Both statins significantly reduced plasmatic levels of CRP (3.18 ± 2.43 mg/dL [T0] vs. 1.31 ± 1.67 mg/dL [T2] with rosuvastatin [P < 0.01], 7.53 ± 7.46 mg/dL [T0] vs. 2.92 ± 2.06 mg/dL [T2] with atorvastatin [P < 0.01]). Relative reduction of CRP levels was −50.57% with rosuvastatin versus −36.28% with atorvastatin (P N.S.).
Conclusion: A 3‐month treatment with either atorvastatin 20 mg or rosuvastatin 10 mg is effective in improving endothelium dysfunction in subjects with diabetes.
Augmentation of ECG QRS Complexes after Fluid Removal via a Mechanical Ultrafiltration Pump in Patients with Congestive Heart Failure
Authors: Madias John E. , Guglin Maya E. 
Published: October 2007

Background: Augmentation of the amplitude of ECG QRS complexes, correlating with loss of weight or fluid volume removed, has been documented in patients with congestive heart failure (CHF). Methods: We investigated the effect of an ultrafiltration (UF) pump on the fluid removal and the amplitude of ECG QRS complexes in patients with CHF. Nine patients aged 48.3 ± 10.4 years with CHF were treated with an UF system, and weights, fluid removed, and sums of the amplitude of QRS complexes (ΣQRS), were inter‐correlated. Results: UF resulted in removal of 4.62 ± 1.82 L of fluid, 5.0 ± 2.9% decrease in the weights (P = 0.002) and 18.1 ± 16.8% increase in the ΣQRS (P = 0.012). There was a moderate correlation of % increase in the ΣQRS and net fluid volume losses (UF + urine − oral intake), (r = 0.67, P = 0.0471, and a poor correlation between % increase in the ΣQRS and % decrease in weights (r = 0.11, P = 0.77). Correlations of the change in weights after UF with the fluid removed by UF, or with the volume of total fluid loss (including insensible losses) were moderate but barely statistically significant (r = 0.65, P = 0.0559), and (r = 0.65, P = 0.0577), correspondingly. Conclusion: Augmentation of the amplitude of QRS complexes correlates well with net fluid loss in response to UF in patients with CHF, and can be employed as an index of effectiveness of therapy. Also, a model of fluid losses in patients treated for CHF is being proposed.
Automatic P Wave Analysis Over 24 Hours in Patients with Paroxysmal or Persistent Atrial Fibrillation
Authors: Bitzen Alexander , Sternickel Karsten , Lewalter Thorsten , Schwab Jörg Otto , Yang Alexander , Schrickel Jan Wilko , Linhart Markus , Wolpert Christian , Jung Werner , David Peter , Lüderitz Berndt , Nickenig Georg , Lickfett Lars 
Published: October 2007

Background: Patients with atrial fibrillation (AF) often exhibit abnormalities of P wave morphology during sinus rhythm. We examined a novel method for automatic P wave analysis in the 24‐hour‐Holter‐ECG of 60 patients with paroxysmal or persistent AF and 12 healthy subjects. Methods: Recorded ECG signals were transferred to the analysis program where 5–10 P and R waves were manually marked. A wavelet transform performed a time‐frequency decomposition to train neural networks. Afterwards, the detected P waves were described using a Gauss function optimized to fit the individual morphology and providing amplitude and duration at half P wave height. Results: >96% of P waves were detected, 47.4 ± 20.7% successfully analyzed afterwards. In the patient population, the mean amplitude was 0.073 ± 0.028 mV (mean variance 0.020 ± 0.008 mV2), the mean duration at half height 23.5 ± 2.7 ms (mean variance 4.2 ± 1.6 ms2). In the control group, the mean amplitude (0.105 ± 0.020 ms) was significantly higher (P < 0.0005), the mean variance of duration at half height (2.9 ± 0.6 ms2) significantly lower (P < 0.0085). Conclusions: This method shows promise for identification of triggering factors of AF.
Acoustic Cardiography Augments Prolonged QRS Duration for Detecting Left Ventricular Dysfunction
Authors: Zuber Michel , Attenhofer Jost Christine H. , Kipfer Peter , Collins Sean P. , Michota Frank , Frank Peacock W. 
Published: October 2007

Background: Prolonged QRS duration has been used as a marker for left ventricular (LV) systolic dysfunction (SD) and is used in the evaluation of patients presenting with known or suspected heart failure. The goal of this study was to compare the abilities of QRS duration and simultaneous digital ECG and heart sounds, that is acoustic cardiographic, parameters to identify patients with LV dysfunction. Methods: Our learning population consisted of 171 patients with possible chronic compensated or mildly decompensated heart failure who presented to an ambulatory cardiology clinic for echocardiographic examination. We defined LVSD as a LV ejection fraction < 50%, and estimated LV filling pressures from diastolic measurements. These patients also had acoustic cardiographic recordings from which we obtained a variety of individual ECG and acoustic cardiographic parameters. We used the product of four of these parameters to obtain a diagnostic score for LV dysfunction. We then compared the diagnostic performances of QRS duration and the score on a test population of patients who presented to an emergency department with possible heart failure. Results: In the learning population, the sensitivities/specificities of QRS duration ≥120 ms and the score for prediction of LVSD were 51%/92% and 77%/90%, respectively. In the test population, the score remained superior to QRS duration for detecting LVSD as well as acute decompensated heart failure. Conclusions: Improved identification of LVSD and clinical heart failure can be achieved with a cost‐effective bedside screening tool with the simple combination of simultaneously acquired digital ECG and heart sound data.
Noninvasive Assessment of Atrial Substrate Change after Wide Area Circumferential Ablation: A Comparison with Segmental Pulmonary Vein Isolation
Authors: Redfearn Damian P. , Skanes Allan C. , Gula Lorne J. , Griffith Michael J. , Marshall Howard J. , Stafford Peter J. , Krahn Andrew D. , Yee Raymond , Klein George J. 
Published: October 2007

Background: The wide area circumferential ablation (WACA) approach to atrial fibrillation is thought to result in ‘substrate modification’ perhaps related to autonomic denervation. We examined this prospectively by comparing WACA and segmental pulmonary vein isolation (PVI) using noninvasive surrogate markers. Methods: Heart rate variability (HRV) and signal averaged P wave (SAPW) data were derived from high‐resolution (HR) recordings (‘SpiderView’ ELA Medical) made in sinus rhythm immediately before and 24 hours after ablation. Results: Forty patients recruited (20 WACA; 20 PVI); cohorts were comparable. WACA caused marked SAPW change: P wave duration (PWD) (149[4.6] ms to 160[5.9] ms; P = 0.003), root mean square (RMS) (4.4[0.4]μV to 2.8[0.4]; P = 0.001) and energy content (30–150 Hz; 20.4 [3.6]μV2/s to 13.7[2.4]; P = 0.001). No significant change was seen after PVI. Heart rate increased after WACA and PVI (61.4 to 73.5 [P = 0.001]; 69.5 to 75.0 [P = 0.07], respectively). HRV was significantly influenced after WACA: low frequency power (LF) 5.7(0.4) to 3.6(0.4); P = 0.001), high‐frequency power (HF) 4.6(0.4)–3.4(0.3); P = 0.024, and after PVI: LF 5.4(0.3) to 4.3(0.3); P = 0.024. HF: 4.4(0.4) to3.0(0.4); P = 0.018). Conclusions: HR recordings exhibit change in HRV after WACA and PVI. Marked change in both HRV and SAPW is observed after WACA. SAPW variables provide a measure of atrial substrate change after WACA unrelated to autonomic denervation.
Polymorphism in the Cholesteryl Ester Transfer Protein Gene and the Risk of Early Onset Myocardial Infarction among Cigarette Smokers
Authors: Goldenberg Ilan , Moss Arthur J. , Block Robert , Ryan Daniel , Corsetti James P. , McNitt Scott , Eberly Shirley W. , Zareba Wojciech 
Published: October 2007

Background: Cigarette smoking and the common B1 allele of the TaqIB polymorphism have both been reported to be associated with increased cholesteryl ester transfer protein (CETP) activity and altered lipoprotein levels. Thus, it is possible that the combined presence of these two respective environmental and genetic factors may enhance cardiovascular risk. We hypothesized that susceptibility to early onset myocardial infarction (MI) among cigarette smokers may be related to the presence of TaqIB polymorphism in the CETP gene. Methods: The age at onset of a first MI among current (n = 199), past (n = 345), and never (n = 270) smokers was related to the presence of the TaqIB1 and B2 alleles in a cohort of 814 first MI patients. Results: Multivariate regression analysis demonstrated that cigarette smoking was associated with a significant increase in the risk for early onset MI only among carriers of the TaqIB1 allele: current smokers with the B1B1 and B1B2 genotypes displayed a respective 9.4 (P < 0.001) and 8.4 (P < 0.001) year reduction in the age at onset of a first MI compared with never smokers, and past smokers with these genotypes exhibited a respective 3.8 (P = 0.003) and 3.7 (P = 0.01) year reduction. By contrast, current and past smoking was not associated with a significant increase in the risk for early onset MI among B2B2 homozygotes (3.0 [P = 0.28] and 0.2 [P = 0.93] year reduction, respectively). The smoking x genotype interaction was statistically significant (P = 0.04). Conclusions: The current findings suggest that genetic factors may modify susceptibility to early onset MI among cigarette smokers.
Predicting clinical and social outcome of patients attending ‘real world’ mental health services: a 6‐year multi‐wave follow‐up study
Authors: Lasalvia A. , Bonetto C. , Cristofalo D. , Tansella M. , Ruggeri M. 
Published: October 2007

Objective:  The aims of this study were: i) to determine changes in symptoms and social disability, and ii) to explore predictors of clinical and social outcome in patients receiving community‐based mental health care.Method:  A total of 354 patients treated in the South‐Verona Community Mental Health Service were followed up over 6 years (with assessments made at baseline, 2 and 6 years) by using a set of standardized measures exploring psychopathology (Brief Psychiatric Rating Scale) and social disability (Disability Assessment Schedule). Generalized linear latent and mixed models were used to explore longitudinal predictors of clinical and social outcome.Results:  Psychotic patients displayed clinical and social outcome characterized by complex patterns of exacerbation and remission over time; however, a clear trend towards a deteriorating course was not found, thus challenging the notion that psychotics are fatally prone to a destiny of chronicity. Non‐psychotics reported a significant reduction in the core symptom of depression and in the observable physical and motor manifestations of tension and agitation, and a parallel increase in complaints about their physical health. Clinical and social dimensions of outcome are influenced by specific and different set of predictors.Conclusion:  The results of this study confirm the need to implement naturalistic outcome studies conducted in the ‘real world’ services to inform decisions and strategies to be adopted in routine clinical practice.
Predictors of changes in needs for care in patients receiving community psychiatric treatment: a 4‐year follow‐up study
Authors: Lasalvia A. , Bonetto C. , Salvi G. , Bissoli S. , Tansella M. , Ruggeri M. 
Published: October 2007

Objective:  This study aimed to investigate changes and predictors of change in needs for care, as assessed by both patients and mental health professionals, in a sample of subjects receiving community‐based psychiatric care.Method:  The study was conducted using a 4‐year prospective longitudinal design. A cohort of patients from the South‐Verona Community Mental Health Service (CMHS) was assessed at baseline and follow‐up using the Camberwell Assessment of Need, both staff and patient versions. Predictors of changes in needs were explored using block‐stratified multiple regression analyses.Results:  An overall stability for both patient‐rated and staff‐rated needs was found over time; however, significant changes in some specific need domains were found, such as self‐rated health needs (improvement), self‐rated social needs (deterioration) and staff‐rated health needs (deterioration). Changes over time in self‐rated and staff‐rated needs are influenced by different and specific set of predictors, thus indicating that the two measures are not overlapping and convey different types of information.Conclusion:  Our data support the adoption of a negotiated approach in which both staff and users’ views should be given equal weight when planning and providing needs‐led mental health care.