bluuebunny/crossref_metadata_2025_split huggingface dataset:
A reliability‐based data treatment system for actual load history
Authors: XIONG J. J. , SHENOI R. A. 
Published: September 2005

ABSTRACTThis paper seeks to establish an integrated and practical data treatment system for actual load history reliability analysis. A convergence–divergence counting procedure is presented to extract all load cycles from a load history of divergence–convergence waves. The lowest number of load history sampling is established on the basis of the damage‐based prediction criterion. A parameter estimation formula is proposed for hypothesis testing of the load distribution. The examples of its application for the data treatment of actual load history are given. The proposed data treatment system has been shown to have valid and practical characteristics in analysing reliability results.
Short crack growth and fatigue life in austenitic‐ferritic duplex stainless steel
Authors: POLÁK J. , ZEZULKA P. 
Published: September 2005

ABSTRACTThe kinetics of short crack growth has been studied in austenitic‐ferritic 2205 duplex stainless steel. Smooth cylindrical specimens and specimens with shallow notch were subjected to constant plastic strain amplitude loading. The crack growth was studied in notched specimens. The notch area has been mechanically and electrolytically polished to facilitate the observation of crack initiation and growth. The initiated cracks were observed in an SEM (scanning electron microscope). The crack growth was studied using long distance QUESTAR optical microscope equipped with high‐resolution camera. In constant plastic strain amplitude loading the microcracks were initiated and their growth kinetics has been studied. The characteristic features of the crack growth at different plastic strain amplitudes were recorded. Two approaches to analyse the crack growth rates were adopted. The comparison of the prediction of the fatigue life using the plastic‐strain‐dependent crack growth rate was compared with Manson–Coffin law and the relation between parameters of this law and parameters of the short crack growth law were established.
Anesthetic management in two siblings with glutaric aciduria type 1
Authors: HERNÁNDEZ‐PALAZÓN JOAQUÍN , SÁNCHEZ‐RÓDENAS LORENZO , MARTÍNEZ‐LAGE JUAN F. , COLLADO ISABEL CASTAÑO 
Published: September 2005

SummaryGlutaric aciduria type 1 (GA‐1) is an inborn error of metabolism that results from a deficiency of glutaryl‐CoA dehydrogenase. This disorder mainly manifests in early childhood and most patients with this condition develop a dystonic‐dyskinetic syndrome. We report the anesthetic management of two sisters with GA‐1, aged 30 and 17 months respectively at the time of surgery, who presented with macrocephaly and psychomotor delay. The children required CSF shunting procedures for hydrocephalus and subdural fluid collections, which were performed under total intravenous anesthesia with propofol and remifentanil.
Positioning for the Nuss procedure: avoiding brachial plexus injury
Authors: FOX MARY E. , BENSARD DENIS D. , BRENT ROATEN J. , HENDRICKSON RICHARD J. 
Published: September 2005

SummaryBackground:  In 1987, Nuss developed a minimally invasive technique for the treatment of pectus excavatum. The procedure has had excellent results with minimal complications. Anesthetic concerns include risks of cardiothoracic injuries, dysrythmias, pneumothorax, pleural effusions, and hemorrhage. In addition, we identified a risk of brachial plexus injury that can occur secondary to patient positioning. We report our experience with the Nuss procedure and modified patient positioning.Methods:  A retrospective chart review was performed on 95 children or adolescents who underwent a Nuss procedure at the Children's Hospital in Denver, CO, USA. The first group of patients (58) was positioned with their arms extended above their heads at a 90° angle at the shoulder. The second group of patients (37) was positioned in an arthroscopy sling in a neutral position utilizing a right angled suspension device attached to the operating room bed.Results:  In the first group of patients, three of 58 (5.2%) children had transient brachial plexus injuries. To date, in the second group of patients, there have been no brachial plexus injuries using the suspension device.Conclusions:  We found that patients are at risk of transient brachial plexus injury during the Nuss procedure due to positioning of the arms. A readily available device that permits the extremity to be maintained in a neutral position but also allows intraoperative manipulation during critical aspects of the Nuss procedure eliminates transient brachial plexus palsy.
A 15‐year review of children with Kawasaki's Syndrome having general anesthesia or deep sedation
Authors: MORRISON JOHN E. , ANDERSON MARSHA , CHAN KAK CHEN , PIETRA BIAGIO , ZUK JEANNIE , GNADINGER PHILIP 
Published: September 2005

SummaryBackground:  Children with Kawasaki's syndrome (KS), also known as Kawasaki's disease or ‘mucocutaneous lymph node syndrome’, have approximately 20–25% incidence of developing coronary artery aneurysms (CAA), stenosis or obliteration if not appropriately diagnosed and treated. In addition some children have myocarditis, pericardial effusions and/or cardiac arrhythmias during the acute phase of KS. Even with current treatment protocols, 2–4% will still be at risk of coronary artery pathology and the long‐term implications regarding future coronary artery disease are unknown. Many of these children present for surgical or diagnostic procedures requiring general anesthesia or deep sedation. Only sporadic case reports have been published on the anesthetic experiences of such patients.Methods:  With Institutional Review approval, we reviewed the medical records of all children with discharge diagnosis of KS from 1985 to 2000 for those receiving general anesthesia or deep sedation. Data abstracted from the medical records included information on any surgical procedures performed any time after onset of KS symptoms, type of anesthetic, perioperative monitoring and presence or absence of operative or perioperative complications.Results:  A total of 178 children with KS were identified of whom 47 (26.4%) received either general anesthesia (34) or deep sedation (13). There were no deaths; one child developed congestive heart failure in the immediate postoperative period associated with KS myocarditis. Five (15%) of those having general anesthesia initially were either not diagnosed as having KS or had no preoperative cardiac evaluations. None of the children having general anesthesia had ST segment analysis, invasive monitoring or troponin measurements perioperatively.Conclusions:  The high incidence of serious myocardial complications attributable to KS reported in the pediatric literature is rarely noted in the anesthesia literature. We feel there is a potential for more serious perioperative complications among KS children, although we can only speculate why complications are not more frequently encountered. Anesthetists involved in pediatric services are encouraged to consider KS in their diagnosis of children presenting with febrile illnesses with rashes and to consider the possibility of KS myocardial compromise if they encounter unexpected deterioration perioperatively. Preoperative ultrasound examination and perioperative monitoring (e.g. ST segment analysis and troponin measurements) for myocardial compromise are encouraged if KS is suspected.
On the relevance of mitochondrial fusions for the accumulation of mitochondrial deletion mutants: A modelling study
Authors: Kowald Axel , Jendrach Marina , Pohl Sandra , Bereiter‐Hahn Jürgen , Hammerstein Peter 
Published: September 2005

SummaryThe molecular mechanisms underlying the aging process are still unclear, but the clonal accumulation of mitochondrial deletion mutants is one of the prime candidates. An important question for the mitochondrial theory of aging is to discover how defective organelles might be selected at the expense of wild‐type mitochondria. We propose that mitochondrial fission and fusion events are of critical importance for resolving this apparent contradiction. We show that the occurrence of fusions removes the problems associated with the idea that smaller DNA molecules accumulate because they replicate in a shorter time – the survival of the tiny (SOT) hypothesis. Furthermore, stochastic simulations of mitochondrial replication, mutation and degradation show that two important experimental findings, namely the overall low mosaic pattern of oxidative phosphorylation (OXPHOS) impaired cells in old organisms and the distribution of deletion sizes, can be reproduced and explained by this hypothesis. Finally, we make predictions that can be tested experimentally to further verify our explanation for the age‐related accumulation of mitochondrial deletion mutants.
Validity of the SF‐36 Five‐Item Mental Health Index for Major Depression in Functionally Impaired, Community‐Dwelling Elderly Patients
Authors: Friedman Bruce , Heisel Marnin , Delavan Rachel 
Published: September 2005

Objectives:To examine criterion and construct validity of the five‐item Mental Health Index (MHI‐5) of the 36‐item Short Form health survey (SF‐36) in relation to the presence of major depression in functionally impaired, community‐dwelling elderly patients and of eight subsamples defined by cognitive functioning, levels of functional impairment, and proxy report versus self‐report.Design:Cross‐sectional observational.Setting:Nineteen counties in western New York, West Virginia, and Ohio.Participants:One thousand four hundred forty‐four functionally impaired, community‐dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Primary and Consumer‐Directed Care Demonstration.Measurements:MHI‐5, Mini‐International Neuropsychiatric Interview Major Depressive Episode (MINI‐MDE) module.Results:The MHI‐5 demonstrated sufficient criterion validity (area under the receiver operating characteristic curve=0.837; sensitivity=78.7% and specificity=72.1% using a cutpoint of 59/60) with respect to the presence of depression for the entire sample. A significant correlation between MHI‐5 scores and presence of major depression as identified using the MINI‐MDE (Spearman correlation=−0.426,P<.001), a strong correlation between the MHI‐5 and the SF‐36 role emotional scale (Spearman correlation=0.522) and a weak correlation with the SF‐36 physical functioning scale (Spearman correlation=0.133) provided evidence for construct validity. Additional evidence is provided by decline in mean MHI‐5 score as level of formal education and number of close friends and relatives decreased. All eight subsamples demonstrated similar criterion and construct validity. A Cronbach alpha of 0.794 demonstrated internal consistency reliability.Conclusion:This study provides evidence for adequate criterion and construct validity of the MHI‐5 in relation to the presence of major depression among functionally impaired, community‐dwelling elderly Medicare patients.
Significance of Inducible Ventricular Flutter‐Fibrillation After Myocardial Infarction
Authors: BREMBILLA‐PERROT BÉATRICE , SUTY‐SELTON CHRISTINE , CLAUDON OLIVIER , DE LA CHAISE ARNAUD TERRIER , LOUIS PIERRE , NIPPERT MARC , POPOVIC BATRIC , BLANGY HUGUES , KHALDI EMAD , BELHAKEM HADJ , BEURRIER DANIEL , HOURIEZ PIERRE 
Published: September 2005

Aim: The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF)
and its prognostic significance in post‐myocardial infarction.
Methods: Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients had an induced VFl/VF and were followed during 4 ± 2 years.
Results: VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 asymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) <40% versus 136/577 patients (22.5%) with LVEF >40% (NS). Cardiac mortality was 9%; LVEF was 33 ± 15% in patients who died, 43 ± 13% in alive patients (P < 0.004). In patients with LVEF <40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in asymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF >40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF <40% predicted sudden death.
Conclusion: Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF <40%, but did not increase sudden death. In patients with LVEF >40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope.
Radiation Doses to Patients and Cardiologists from Permanent Cardiac Pacemaker Implantation Procedures
Authors: TSALAFOUTAS IOANNIS A. , SPANODIMOS STAVROS G. , MANIATIS PETROS N. , FOURNARAKIS GEORGE M. , KOULENTIANOS ELIAS D. , TSIGAS DIMITRIOS L. 
Published: September 2005

Background: The purpose of this study was to determine the patient and cardiologist doses during the implantation of permanent cardiac pacemakers under fluoroscopic control.
Methods: For 55 procedures concerning three different types of pacemakers (DDD, VDD, and VVI), the dose‐area product (DAP) meter readings and fluoroscopy times were recorded. From these data, the dose to the operating cardiologist was estimated.
Results: The median values of DAP and fluoroscopy time for all the procedures monitored were 11.4 Gycm2 and 6.6 minute, respectively. For the 22 DDD, 21 VDD, and 12 VVI pacemakers implanted, the respective DAP median values were 14.7, 9.9, and 7.3 Gycm2 and the respective median fluoroscopy times were 8.4, 5, and 2.9 minutes. The median doses to the hands, chest, eyes, and legs of the cardiologist conducting the manipulations were estimated to 0.21, 0.06, 0.03, and 0.11 mGy, respectively, per procedure.
Conclusions: Compared to the existing literature, the median DAP value of this study is almost identical to the 11.2 Gycm2 reported from a sample of 627 patients in 17 different x‐ray rooms, whereas the fluoroscopy times are within the range of values reported by other authors. Concerning the cardiologist exposure, the estimated values indicate that the implantation of pacemakers is a procedure that does not involve a severe risk, especially if it is taken into account that lead aprons and collars are routinely used.
Complications of Implantable Cardioverter Defibrillator Therapy in 440 Consecutive Patients
Authors: ALTER PETER , WALDHANS STEFAN , PLACHTA EVELINE , MOOSDORF RAINER , GRIMM WOLFRAM 
Published: September 2005

Background: Although more than 150,000 implantable cardioverter defibrillators (ICDs) are implanted yearly worldwide, only few studies systematically examined complications of ICD therapy in large patient cohorts.
Methods: We prospectively analyzed ICD‐related complications in 440 consecutive patients who underwent first implantation of an ICD system for primary or secondary prevention of sudden cardiac death within the last 10 years at our institution. All study patients received pectoral nonthoracotomy ICD lead systems with the exception of one patient who had an artificial tricuspid valve.
Results: During 46 ± 37 months follow‐up, 136 of 440 patients (31%) experienced at least one complication including implant procedure‐related complications in 43 patients (10%), ICD generator‐related complications in 28 patients (6%), lead‐related complications in 52 patients (12%), and inappropriate shocks in 54 patients (12%). The most serious complications included one perioperative death due to heart failure (0.2%), two ICD system infections necessitating device removal (0.5%) and two perioperative cerebrovascular strokes (0.5%).
Conclusions: We conclude that more than one quarter of ICD patients experience complications during a mean follow‐up of almost 4 years, although serious complications such as intraoperative death or ICD system infections are rare in patients with nonthoracotomy ICD systems. Recognition of these complications is the prerequisite for advances in ICD technology and management strategies to avoid their recurrence.
Long‐Term Performance of Screw‐In Atrial Pacing Leads: A Randomized Comparison of J‐Shaped and Straight Leads
Authors: LURIA DAVID , BAR‐LEV DAVID , GUREVITZ OSNAT , GRANIT HAVA , ROTSTEIN ZEEV , ELDAR MICHAEL , GLIKSON MICHAEL 
Published: September 2005

Objective: In this prospective, randomized, control study we compared performance of J‐shaped (JL) and straight atrial leads (SL) with active (screw‐in) fixation mechanism, over a 5‐year follow‐up period.
Subjects and Methods: A total of 208 consecutive patients were randomized for implantation with a Medtronic 4568 JL model (n = 103) versus a Medtronic 4068 SL model (n = 105), and all lead‐related measurements and complications were recorded.
Results: Lead‐related complications occurred in JL and SL with similar frequency (6% and 9%, respectively, P = 0.45). Lead dislodgment occurred in 8 (7.8%) cases in SL versus none in JL (P = 0.004). Lead malfunction and excessive pacing thresholds without macrodislodgment occurred more frequently in JL (11; 10.7%) than in SL (4; 3.8%), P = 0.055. Lead material failure (insulation break) occurred only once in SL at the 5‐year checkup. Most complications occurred during the first year after implantation. Other events occurred in both leads with similar frequency and included: death in 39 and 35, loss of follow‐up in 8 and 6, and development of atrial fibrillation in 9 and 15 patients, respectively. Of those who completed follow‐up, lead impedance and pacing threshold increased significantly in both groups. P wave decreased in SL but not in JL.
Conclusion: More dislocations occurred in SL, but were counterbalanced by more lead malfunctions and excessive pacing thresholds in the JL group. Both leads demonstrated minor deterioration in electrical measurements during follow‐up, with only 1 case of lead material failure in SL. Overall, both groups demonstrated favorable lead performance throughout follow‐up.
Efficacy and Safety of Ibutilide for Cardioversion of Atrial Flutter and Fibrillation in Patients Receiving Amiodarone or Propafenone
Authors: FRAGAKIS NIKOLAOS , PAPADOPOULOS NIKOLAOS , PAPANASTASIOU SOULTANA , KOZIRAKIS MILTIADIS , MALIGKOS GEORGE , TSARITSANIOTIS EVANGELOS , KATSARIS GEORGE 
Published: September 2005

Aim: The effectiveness and safety of ibutilide (IB) use in patients receiving amiodarone or propafenone for atrial flutter (AFL) and atrial fibrillation (AF) were compared to IB alone.
Methods and Results: In 104 consecutive patients with AF (65%) or AFL (35%), receiving amiodarone (n = 46), propafenone (n = 30), or no specific antiarrhythmic drug (n = 28), IB was given for cardioversion. Fifteen patients in amiodarone group were loaded with 1.2 g intravenously before IB administration. The mean duration of arrhythmia episode was 23 ± 65 days, while 85% of patients had structural heart disease. The left ventricle ejection fraction was 57 ± 10% and the left atrium size was 4.2 ± 0.6 cm. The conversion efficacy did not differ among groups (62% for amiodarone vs 55% for propafenone vs 64% for IB alone). The QTc intervals were significantly prolonged, at 10 minutes and 30 minutes after IB administration, in amiodarone group (from 449 ± 88 to 496 ± 92 ms, 508 ± 52 ms; P = 0.001) and in the group where IB was used alone (from 434 ± 45 to 517 ± 74 ms, 492 ± 65 ms; P < 0.001), while it remained unchanged in propafenone group (from 464 ± 52 to 471 ± 80 ms, 489 ± 93 ms; P = 0.536). The only predictor of conversion was the presence of AFL (P = 0.009). Five patients developed ventricular tachycardias after IB administration (two in propafenone, one in amiodarone, and two in IB group).
Conclusions: The use of IB in patients receiving amiodarone or propafenone for AFL or AF is equally effective and safe as the use of IB alone. The presence of AFL is the stronger predictor factor for cardioversion.
Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation
Authors: UEDA MAREHIKO , TADA HIROSHI , KUROSAKI KENJI , ITOI KAZUHIRO , KOYAMA KEIKO , NAITO SHIGETO , ITO SACHIKO , KOMURO ISSEI , OSHIMA SHIGERU , TANIGUCHI KOICHI 
Published: September 2005

Background: The morphology of the pulmonary veins (PVs) before and after segmental isolation of the PVs has not been sufficiently characterized.
Methods and Results: Multi‐slice computed tomography was performed before and 3 ± 1 months after ablation in 30 patients with atrial fibrillation who underwent PV isolation. Before ablation, PV narrowing (≥25% luminal reduction) was found in nine (8%) PVs. After ablation, de novo PV narrowing was found in 24 PVs (26%) and was detected only in the supero‐inferior direction in 14 PVs (58%). The diameter reduction inside the PVs after ablation was greater in the supero‐inferior direction (14 ± 12%) than in the antero‐posterior direction (9 ± 13%; P < 0.0001). In the ablated PVs, the PV trunk was shorter than before ablation (P < 0.0001). The reduction in the diameters of both the PV ostium and the ablation site in the ablated PVs, as well as the diameter of the PV ostium in the nonablated PVs, correlated with the decrease in the left atrial diameter. Shortening of the PV trunk correlated with the severity of PV narrowing, but it was not related to the percent diameter reduction of the left atrium. PV narrowing before or after ablation did not result in any clinical consequences.
Conclusions: PV narrowing is present in about 10% of PVs before ablation. Asymmetric luminal reduction and longitudinal shrinkage of the PV trunk occur after ablation. Reverse remodeling of the PV and contraction of the PV wall may contribute to the reduction in the PV diameter. PV morphology should be assessed with multi‐directional views to avoid missing heterogeneous legions.
Do We Need a Reflex Tachycardia to Stand Up?
Authors: FORTRAT JACQUES‐OLIVIER , LEMARIE CATHERINE , BELLARD ELISABETH , VICTOR JACQUES 
Published: September 2005

Background: Sophisticated atrio‐ventricular pacing models are designed to integrate the pacemaker into cardiovascular autonomic control to react appropriately to the cardiovascular demands. Such an approach might be beneficial for patients with vasovagal responses to counterbalance the upright fall in arterial blood pressure by a pacing rate increase. We hypothesized that this approach would improve the cardiovascular response to standing in comparison with a regular pacing mode.
Methods: Two 5‐minute tilt tests were performed in a random order in 5 patients with a pacemaker (CLS‐INOS2) for sinus node disease and atrio‐ventricular block. One tilt test was performed in fixed pacing rate (DDD), the other one was performed in close loop stimulation (CLS), which allowed an upright rate‐rise pacing. Heart rate, systolic blood pressure, and cardiac output (modelflow) were recorded on a beat‐by‐beat basis.
Results: Changes of systolic blood pressure and cardiac output in response to upright posture were not significantly different between DDD and CLS modes (2.7 ± 13.2 vs 10.1 ± 12.9 mmHg and −0.8 ± 0.3 vs −1.1 ± 0.4 L/min, respectively).
But upright posture led to a tachycardia of more than 30 bpm in 3 patients in CLS mode and to a fall in systolic blood pressure greater than 20 mmHg in 3 patients in CLS mode and only in one patient in DDD mode.
Conclusion: Systolic blood pressure and cardiac output are not improved by the upright tachycardia and upright blood pressure response is actually worsened when an upright rate‐rise pacing is used. Thus, it appears that tachycardia alone cannot compensate for an upright fall in blood pressure.