Home About us Contact
|
Home About us Contact | ||
|
|
||
Bpm
Selected AbstractsNeuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2009Lambros Messinis Abstract Rationale Methadone and buprenorphine are among the most widely employed pharmacological treatments currently available for opioid addiction. Cognitive effects of buprenorphine in abstinent heroin abusers are nevertheless far from being understood. Methods Neuropsychological performance of 18 buprenorphine-maintained patients (BMP) was evaluated relative to that of 32 currently abstinent heroin abusers on naltrexone hydrochloride therapy (FHAN), and 34 non-drug dependent controls. The three groups were demographically balanced. Clinical groups reported histories of similar patterns of drug use and had increased periods of abstinence from any illicit substance use including heroin. Results The BMP group performed poorer than controls on the RAVLT (encoding and delayed recall of verbal information), CTT (conceptual flexibility, executive functions) and the RBANS figure copy (visual perception) and delayed recall of visual information. There were no significant differences in any of the cognitive measures between the BMP and FHAN groups or between the FHAN group and controls. Furthermore, the non-differing percentage of abnormal cases between the two patient groups led us to infer that treatment with either BPM or FHAN is not accompanied by qualitative differences in the cognitive profiles of these patients. Conclusion Overall, results suggest that treatment with naltrexone in abstinent heroin abusers may result in less impairment of cognitive functions compared to treatment with buprenorphine. These findings are relevant for improved prognosis and treatment strategies in opioid dependence. Copyright © 2009 John Wiley & Sons, Ltd. [source] Great Galway Goslings: Organizational Context of Managerial Accounting,ACCOUNTING PERSPECTIVES, Issue 3 2009Wagdy Abdallah ABSTRACT This case seeks to enhance student understanding of the relationship between accounting information and the order fulfllment and production activities of a manufacturing frm, Great Galway Goslings. Great Galway Goslings manufactures goose sculptures and has been suffering losses in recent years. Students draw on the skills they learned in financial accounting to analyze the company's order fulfllment activities, identify economic transactions, and prepare journal entries. The case provides a link to managerial accounting topics as students use segment financial statements to create contribution margin income statements, perform break-even analyses, and recommend whether Great Galway Goslings should keep its retail business segment. Students will become familiar with the key features of business process management (BPM) and the extensive, real-world activities that a manufacturing entity engages in to fll an order. Students will analyze the company's existing order fulfllment process and apply their knowledge of BPM to recommend process improvements for Great Galway. This case contributes to the accounting case literature by serving as a bridge from financial accounting to managerial accounting, intertwining many topics from managerial accounting into one cohesive case, and providing real-world business process knowledge. Student feedback indicates that, overall, the case met its stated learning objectives. Great Galway Goslings is appropriate for an undergraduate introductory managerial accounting course but can be adapted to the equivalent graduate-level course or an accounting information systems course. [source] Accurate model of InxGa1,xAsyP1,y/InP active waveguides for optimal design of switchesINTERNATIONAL JOURNAL OF NUMERICAL MODELLING: ELECTRONIC NETWORKS, DEVICES AND FIELDS, Issue 2 2003V. Petruzzelli Abstract Both the longitudinal and transverse charge diffusion terms in the rate equations as well as the spreading effect of the injected charge in the active layer are taken into account for a complete model of active twin ridge InGaAsP/InP-waveguides. A dedicated computer code, relying on an optimized beam propagation method (BPM) based on the method of lines (MoL,BPM), is written. The computer code is used for the optimal design of a travelling-wave switch and to simulate the bidirectional propagation for the design of a Fabry,Perot switch. This last switch version is more compact with respect to the travelling wave (TW) version because a reduction of the switch length of about 20% is gained. Copyright © 2003 John Wiley & Sons, Ltd. [source] Commentary on Chung BPM, Wong TKS, Suen ESB & Chung JWY (2005) SARS: caring for patients in Hong Kong.JOURNAL OF CLINICAL NURSING, Issue 11 2006Journal of Clinical Nursing 1 [source] Knowledge-oriented process portal with BPM approach to leverage NPD managementKNOWLEDGE AND PROCESS MANAGEMENT: THE JOURNAL OF CORPORATE TRANSFORMATION, Issue 3 2009Henrique Rozenfeld New product development (NPD) processes can be improved through change projects managed in a context of business process management (BPM). In order to fully characterize and implement NPD process change projects it is necessary to be able to identify and adequately describe "to-be" processes. These "to-be" processes should be based on best practices, which can be structured into NPD reference models and body of knowledge (BOK). Despite the availability of NPD BOKs today, they are not easily applicable to process improvement, since they are published in on- and off-line guidelines that are unsuitable for dynamic updating by a collaborative network such as a community of practice (CoP). A proposal is therefore put forward for the collaborative systematization of best practices through a two-level portal external and internal to an organization, enabling users to participate in creating generic and public NPD reference models and BOKs. The proposal allows for the selection of a specific reference model and an existing BOK as required. This paper presents the main concepts underlying the proposal and its methodology, which focuses on agile project management (APM). It also describes the portal vision and the main deliverables of this research, with emphasis on the concept of the knowledge-oriented process (KOP) portal. Three prototypes based on this concept are shown, which represent the evolutionary development of the KOP portal. Finally, the main results of the application are presented and discussed. Copyright © 2009 John Wiley & Sons, Ltd. [source] Spatially resolved defect studies on fatigued carbon steelPHYSICA STATUS SOLIDI (C) - CURRENT TOPICS IN SOLID STATE PHYSICS, Issue 10 2007P. Eich Abstract Several samples of the common ferritic tool steel AISI 1045 were fatigued in cyclic load tests. The local distribution of the Von-Mieses stress ,VM was simulated using the finite elements method (FEM). In the regions of interest, where ,VM reaches maximum values, the defect distribution was measured spatially resolved by Doppler-spectroscopy (DBAR) employing the Bonn Positron Microprobe (BPM). The lateral distribution of the S-parameter, which could be described by a simple model derived from linear fracture mechanics, corresponds well with the simulated Von-Mieses stress. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Support needs and acceptability of psychological and peer consultation: attitudes of 108 women who had undergone or were considering prophylactic mastectomyPSYCHO-ONCOLOGY, Issue 8 2008Andrea F. Patenaude Abstract Objective: Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America is low (0,27%) and 25,50% of women electing surgery report psychological distress and/or difficulty adapting following PM. Most women also report reduced cancer worry postoperatively. Psychological consultation to aid decision-making and post-surgical coping is not routinely offered. This retrospective, cross-sectional study explored interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery. Method: Qualitative interviews were conducted with 26 healthy women who had undergone prophylactic mastectomy of both (bilateral) breasts (BPM), 45 women who had undergone prophylactic mastectomy of one breast (unilateral contralateral) (UPM) after diagnosis of invasive breast cancer in the other breast or ductal carcinoma in situ (DCIS), and 37 women who were considering having PM surgery. Results: Of the women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable; nearly 2/3 thought post-surgical psychological consultation would be helpful. All women currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Strong support was reported in all groups for the emotional and informational value of speaking with a woman who had previously undergone PM. Conclusions: Narratives illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for integration of psychological services for women deciding about or adapting to PM. Copyright © 2008 John Wiley & Sons, Ltd. [source] Breast Reconstruction after Bilateral Prophylactic Mastectomy in Women at High Risk for Breast CancerTHE BREAST JOURNAL, Issue 2009Liron Eldor MD Abstract:, Several studies have shown the effectiveness of bilateral prophylactic mastectomies (BPM) at reducing the risk of developing breast cancer in women by more than 90%. A growing number of women at high risk for breast cancer are electing to undergo prophylactic mastectomy as part of a risk reduction strategy. This unique group of women frequently chooses to undergo reconstructive surgery as a part of their immediate treatment plan. Breast reconstruction after BPM has profound physiological and emotional impact on body image, sexuality, and quality of life. These factors should be taken into consideration and addressed when consulting the patient prior to BPM and reconstructive surgery. The timing of reconstructive surgery, the type of mastectomy performed, the reconstructive modalities available, and the possibility to preserve the nipple,areola complex, should all be discussed with the patient prior to surgery. In this article, we review our experience and the current existing literature on breast reconstruction for high-risk women after BPM. [source] Feed intake, growth and nutrient utilization in Atlantic halibut (Hippoglossus hippoglossus) fed diets containing a bacterial protein mealAQUACULTURE RESEARCH, Issue 4 2007Turid Synnøve Aas Abstract Triplicate groups of Atlantic halibut were fed diets containing 0%, 9% or 18% of a bacterial protein meal (BPM) produced from natural gas in a 9-week trial. Growth rates, relative feed intake, feed efficiency ratio and retention of all indispensable amino acids were significantly lower in fish fed the 18% BPM diets than in those fed the 0% and 9% BPM diets. There were no significant treatment effects on urea levels in plasma, liver or muscle, or in uric acid levels in plasma. The hepatosomatic index was lowest in fish fed the 18% BPM diet. Although the concentration of copper, an element abundant in BPM, increased in the liver as dietary BPM level increased, the total copper content in liver decreased. Fish fed the 0% and 9% BPM diets had a higher degree of supranuclear vacuolization of pyloric caeca and mid-intestine epithelia compared with fish fed the 18% BPM diet. In conclusion, the halibut fed the 9% BPM diet performed equally well as the control group regarding growth, feed intake and feed efficiency ratio, whereas performance was reduced in the fish fed the 18% BPM diet. [source] Operation of a municipal solid waste co-combustion pilot plantASIA-PACIFIC JOURNAL OF CHEMICAL ENGINEERING, Issue 6 2007V. K. C. Lee Abstract The co-combustion of municipal solid waste (MSW) is a novel and highly integrated design combining cement manufacturing, thermal processing of MSW and energy/electricity production (termed the Co-Co process). This novel design of the Co-Co process was developed in 2003,2004 and a pilot plant with a capacity of 40 tonnes per day was constructed and commissioned in 2005. The pilot plant was operated for a period of 10 weeks during 2005. Various feed protocols, namely, MSW as received and after removal of recyclables, were tested. Stack emissions were monitored either continuously (gas emission) or periodically (dioxins and heavy metal emissions). Solid residues including bottom ash and fly ash were also sampled and analysed for heavy metals and dioxins periodically. It was found that the levels of dioxins in the stack emissions and fly ash were below normal MSW thermal treatment processes, and government environmental and international limits (more than 1000 times less). Other gases, such CO, NOx, SOx and HCl, were also well below government environmental licence limits as defined by a best practical means (BPM). In addition, the materials recovery and recycling facility (MRRF) was tested. It demonstrated that different fractions, including metals, plastics and glass, of the MSW could be separated and recovered. The Co-Co process was successfully demonstrated and its emission levels were well below normal MSW thermal treatment processes. Copyright © 2007 Curtin University of Technology and John Wiley & Sons, Ltd. [source] Dynamic performance of the beam position monitor support at the SSRFJOURNAL OF SYNCHROTRON RADIATION, Issue 1 2009Xiao Wang Electron beam stability is very important for third-generation light sources, especially for the Shanghai Synchrotron Radiation Facility whose ground vibrations are much larger than those for other light sources. Beam position monitors (BPMs), used to monitor the position of the electron beam, require a greater stability than other mechanical structures. This paper concentrates on an investigation of the dynamic performance of the BPM support prototype. Modal and response analyses have been carried out by finite-element (FE) calculations and vibration measurements. Inconsistent results between calculation and measurement have motivated a change in the soft connections between the support and the ground from a ground bolt in the initial design to full grout. As a result the mechanical stability of the BPM support is greatly improved, showing an increase in the first eigenfrequency from 20.2,Hz to 50.2,Hz and a decrease in the ratio of the root-mean-square displacement (4,50,Hz) between the ground and the top of the support from 4.36 to 1.23 in the lateral direction. An example is given to show how FE analysis can guide the mechanical design and dynamic measurements (i.e. it is not just used as a verification method). Similar ideas can be applied to improve the stability of other mechanical structures. [source] Moxonidine improves glycaemic control in mildly hypertensive, overweight patients: a comparison with metforminDIABETES OBESITY & METABOLISM, Issue 4 2006Irina Chazova Aim:, To compare the effects of moxonidine and metformin on glycaemic control in patients with impaired glucose tolerance and signs of the metabolic syndrome. Methods:, A multicentre, prospective, randomized, open-label study design was adopted with blinded endpoint evaluation. Patients ,40 years old, with impaired glucose tolerance (or diabetes mellitus treated with diet alone) and a body mass index (BMI) of at least 27 kg/m2 were treated twice daily with moxonidine 0.2 mg or metformin 500 mg for 16 weeks. Oral glucose tolerance test (OGTT) was performed at baseline and end-of-study; plasma insulin and plasma glucose levels were measured at 0, 60, 120 and 180 min after administration. Results:, With regard to effects on insulin [mean area under the curve (AUC) for insulin], the primary efficacy endpoint of the study, both drugs did not show equivalence. On the contrary, in the per protocol (PP) population, moxonidine statistically significantly (p = 0.025) decreased the AUC for insulin from baseline in the PP population; for metformin, the treatment effect on insulin was a small, net increase resulting in a statistically significant between-group difference of 16.2% (95% CI = 0.1,35.0). The change in mean insulin AUC was most marked in the subgroup of patients with higher sympathetic activity (heart rate >80 bpm). Mean fasting plasma glucose (FPG) levels and HbA1c levels were largely unchanged by moxonidine treatment but significantly decreased by metformin treatment. The difference between the groups was 14.7% (p = 0.0523) in the intent-to-treat (ITT) sample. By study end, both treatments had significantly increased the Matsuda Insulin Sensitivity Index (ISI) from baseline to a comparable extent: moxonidine by reducing plasma insulin after a glucose challenge, metformin by reducing FPG. BMI fell significantly in both groups and blood pressure normalized; both drugs were well tolerated. Conclusions:, Moxonidine improved insulin sensitivity in response to glucose challenge in patients with evidence of metabolic syndrome. This improvement resulted from a reduction in plasma insulin levels and was most marked in patients with high sympathetic drive at baseline. By enhancing insulin sensitivity, moxonidine treatment may help prevent the development of diabetes and thereby ameliorate the risk for cardiovascular disease. [source] Cytotoxic Rhodium(III) Polypyridyl Complexes Containing the Tris(pyrazolyl)methane Coligand: Synthesis, DNA Binding Properties and Structure,Activity RelationshipsEUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 25 2009Ruth Bieda Abstract The RhIII complexes of the type [RhCl(pp)(tpm)]2+ [pp = bpy, bpm, phen, tap, dpq, dppz] 4,9 have been prepared by stepwise treatment of RhCl3·3H2O or mer,cis -[RhCl3(DMSO-,S)2(DMSO-,O)] with the appropriate polypyridyl ligand (pp) followed by the tripodal ligand tris(pyrazolyl)methane (tpm). Intermediates of the type [RhCl3(CH3OH)(pp)] 1,3 with pp = bpy, phen, dpq were also characterized but exhibit either low (3) or no (1, 2) cytotoxicity. X-ray structural analyses of [RhCl(bpy)(tpm)][PF6]24 and [RhCl(phen)(tpm)][PF6]26 were performed, and the interaction of complexes 4,9 with DNA was investigated by CD and UV/Vis spectroscopy and by gel electrophoresis. CD and viscosity studies confirm strong intercalation of dppz complex 9 into DNA. Complexes 8 and particularly 9 (IC50 = 0.43, 0.37 ,M) are potent cytotoxic agents towards the human cancer cell lines MCF-7 and HT-29, whereas respectively little (complex 6) or no activity (complexes 4, 5, 7) is observed for the other members of the series. Our findings indicate that the cytotoxicity is dependent on the hydrophobicity of both the polypyridyl and the facial coligand in these and other half-sandwich RhIII complexes. Irradiation of bpy compound 4 in the presence of plasmid pBR322 for 30 min at 311 nm at a molar ratio of r = 0.1 leads to total conversion of the supercoiled form into the nicked version. Although dppz complex 9 also functions as a photonuclease under these conditions, the degree of cleavage is much lower. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009) [source] Identification of the maximum acceptable frequencies of upper-extremity motions in the sagittal planeHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2009Ochae Kwon The present study examined the maximum acceptable frequencies (MAFs; motions/min) of upper-extremity motions in the sagittal plane at different forces. A dumbbell of 9.8 or 39.2 N was rotated by the arm about the shoulder, the forearm about the elbow, and the hand about the wrist; a dynamometer was pressed to 2.45 or 9.8 N by the index finger. Seventeen right-handed Korean men in their 20s without any history of musculoskeletal disorders received 1 hour of individual training and conducted each upper-extremity task for 30 minutes a day, assuming they were on an incentive basis. The participants determined their MAFs for 8 hours of work by the self-adjustment method, and work pulse (change in heart rate; beats per minute [bpm]) and rating of perceived exertion (RPE) were measured. For a limited set of conditions, the reproducibility of the MAF experimental protocol was found satisfactory (r = 0.97; interclass correlation coefficient > 0.95). The average MAFs of arm, forearm, hand, and index finger motions were 24, 45, 56, and 128 at their low force level and 9, 20, 30, and 66 at their high force level. The average work pulses of arm, forearm, and hand motions were 3.0, 2.1, and 1.5 times that of index finger motion (4.2 bpm at their low force level and 5.7 bpm at their high force level). The maximum average RPEs at the upper-extremity regions ranged from 2.1 (weak) to 3.1 (moderate) in Borg's CR-10 scale. © 2009 Wiley Periodicals, Inc. [source] Sex Differences in the Effect of Heart Rate on Mortality in the ElderlyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003Gila Perk MD Objectives:, To examine the association between heart rate and mortality risk in the elderly. Design:, Longitudinal cohort. Setting:, Outpatient. Participants: Four hundred twenty-two people, aged 70 upon entry, were surveyed and followed for 6 years. Measurements: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm. Results: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all-cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all-cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96,11.8). When women using beta-blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19,60.1). Conclusion: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men. [source] Relationship between stroke volume, cardiac output and filling of the heart during tiltACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009M. BUNDGAARD-NIELSEN Background: Cardiac function curves are widely accepted to apply to humans but are not established for the entire range of filling of the heart that can be elicited during head-up (HUT) and head-down tilt (HDT), taken to represent minimal and maximal physiological filling of the heart, respectively. With the supine resting position as a reference, we assessed stroke volume (SV), cardiac output (CO) and filling of the heart during graded tilt to evaluate whether SV and CO are maintained during an assumed maximal physiological filling of the heart elicited by 90° HDT in healthy resting humans. Methods: In 26 subjects, central blood volume was manipulated with graded tilt from 60° HUT to 90° HDT. We measured SV, CO (Finometer®) and cardiac filling by echocardiography of the left ventricular end-diastolic volume (LVEDV; n=12). Results: From supine rest to 60° HUT, SV and CO decreased 23 ml [confidence intervals (CI): 16,30; P<0.001; 23%] and 0.9 l/min (0.4,1.4; P<0.0001; 14%), respectively, but neither SV nor CO changed during HDT up to 70°. However, during 90° HDT, SV decreased 12 ml (CI: 6,19; P<0.0001; 12%), with an increase of 21 ml (9,33; P=0.002; 16%) in LVEDV because HR increased 3 bpm and CO decreased 0.5 l/min (ns). Conclusion: This study confirmed that SV and CO are maximal in resting, supine, healthy humans and decrease during HUT. However, 90° HDT was associated with increased LVEDV and induced a reduction in SV. [source] Temporary Epicardial Ventricular Stimulation in Patients with Atrial Fibrillation: Acute Effects of Ventricular Pacing Site on Bypass Graft FlowsJOURNAL OF CARDIAC SURGERY, Issue 4 2009Navid Madershahian M.D. This study aimed to evaluate the optimal epicardial ventricular pacing site in patients with AF following coronary artery bypass surgery (CABG). Methods: In 23 consecutive patients (mean age = 69.2 ± 1.9 years, gender = 62% male, ejection fraction [EF]= 50.4 ± 2.1%) monoventricular stimulations (VVI) were tested with a constant pacing rate of 100 bpm. The impact of ventricular pacing on bypass graft flow (transit-time flow probe) and pulsatility index (PI) were measured after lead placement on the mid paraseptal region of the right (RVPS) and the left (LVPS) ventricle, on the right inferior wall (RVIW), and on the right ventricular outflow tract (RVOT). In addition, hemodynamic parameters were measured. Patients served as their own control. Results: Comparison of all tested pacing locations revealed that RVOT stimulation provided the highest bypass grafts flows (59.9 ± 6.1 mL/min) and PI (2.2 ± 0.1) when compared with RVPS (51.3 ± 4.7 mL/min, PI = 2.6 ± 0.2), RVIW (54.0 ± 5.1 mL/m; PI = 2.4 ± 0.2), and LVPS (53.1 ± 4.5 mL/min; PI = 2.3 ± 0.1), respectively (p < 0.05). When analyzing patients according to their preoperative LV function (group I = EF > 50%; group II = EF < 50%), higher bypass graft flows were observed with RVOT pacing in patients with lower EF (p = n.s.). Conclusions: Temporary RVOT pacing facilitates optimal bypass graft flows when compared with other ventricular pacing sites and should be the preferred method of temporary pacing in cardiac surgery patients with AF. Especially in patients with low EF following CABG, RVOT pacing may improve myocardial oxygen conditions for the ischemic myocardium and enhance graft patency in the early postoperative period. [source] Safety of Deferring the Reimplantation of Pacing Systems After Their Removal for Infectious Complications in Selected Patients: A 1-Year Follow-Up StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2010ELOI MARIJON M.D. Introduction: Recent expert consensus guidelines mention that one of the principles for infected device replacement following removal is to "reevaluate carefully if there is a continued need for a new cardiac device replacement." This is a Class I recommendation, which nevertheless suffers from a very low level of evidence (level of evidence C), since no study has revisited the systematic practice of reimplanting the same device based on a meticulous clinical reassessment. In the present paper, we examined the safety of withholding the implantation of pacing systems in selected patients. Methods and Results: Between January 2005 and December 2007, 188 consecutive patients underwent extractions of infected pacing systems at 2 medical centers. "Low-risk" patients were identified by (1) a spontaneous heart rate >45 bpm, (2) no symptomatic asystole during monitoring, (3) QRS duration <120 ms when history of AV block was noted, (4) no high-degree AV block during continuous monitoring. They remained device-free, unless an adverse clinical event occurred mandating the reimplantation. The primary study endpoint was rate of sudden death and syncope after a 12-month follow-up. Among the 74 (39.4%) "low-risk" patients, a single patient suffered a bradycardia-related syncopal event corresponding to a 1.3% (95% CI, 0.0,3.9) rate of primary endpoint. Pacing systems were also reimplanted in 24 patients (32.4%) for syncope (n = 1), nonsevere bradycardia-reated symptoms (n = 17), cardiac resynchronization (n = 2), and for reassurance in 4 asymptomatic patients. Conclusion: After removal of infected pacing systems, these preliminary data demonstrated that a strategy of nonsystematic device reimplantation associated with close surveillance was safe in "low-risk" patients, allowing the administration of antimicrobials in a device-free state. (J Cardiovasc Electrophysiol, Vol. 21, pp. 540-544, May 2010) [source] Anatomy and Physiology of the Right Interganglionic Nerve: Implications for the Pathophysiology of Inappropriate Sinus TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008JING ZHOU M.D. Objective: To simulate inappropriate sinus tachycardia (IST) in experimental animals. Background: We recently found that epinephrine injected into the anterior right ganglionated plexi (ARGP) adjacent to the sinoatrial (SA) node induced an arrhythmia simulating IST. Methods: In 19 anesthetized dogs, via a right thoracotomy, the course of the interganglionic nerve (IGN) from the right stellate ganglion along the superior vena cava to the heart was delineated. High-frequency stimulation (HFS; 0.1 msec duration, 20 Hz, 4.5,9.3 V) was applied to IGN at the junction of innominate vein and SVC. Results: HFS of the IGN significantly increased the sinus rate (SR) (baseline: 156 ± 19 beats/minutes [bpm], 4.5 V: 191 ± 28 bpm*, 8.0 V: 207 ± 23 bpm*, 9.3 V: 216 ± 18 bpm*; *P < 0.01 compared to baseline) without significant changes in A-H interval or blood pressure. P-wave morphology, ice mapping, and noncontact mapping indicated that this tachycardia was sinus tachycardia. In 8 of 19 dogs, injecting hexamethonium (5 mg), a ganglionic blocker, into the ARGP attenuated the response elicited by IGN stimulation (baseline: 160 ± 21 bpm, 4.5 V: 172 ± 32 bpm, 8.0 V: 197 ± 32 bpm*, 9.3 V: 206 ± 26 bpm*; *P < 0.05 compared to baseline). In 19 of 19 animals, after formaldehyde injection into the ARGP, SR acceleration induced by IGN stimulation was markedly attenuated (baseline: 149 ± 17 bpm, 4.5 V: 151 ± 21 bpm, 8.0 V: 155 ± 23 bpm, 9.3 V: 167 ± 24 bpm*; *P < 0.05 compared to baseline). Conclusions: HFS of the IGN caused a selective and significant acceleration of the SR. A significant portion of IGN traverses the ARGP or synapses with the autonomic ganglia in the ARGP before en route to the SA node. Dysautonomia involving the IGN and/or ARGP may play an important role in IST. [source] Spontaneous Pulmonary Vein Firing in Man: Relationship to Tachycardia-Pause Early Afterdepolarizations and Triggered Arrhythmia in Canine Pulmonary Veins In VitroJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2007EUGENE PATTERSON Ph.D. Introduction: Rapid firing originating within pulmonary veins (PVs) initiates atrial fibrillation (AF). The following studies were performed to evaluate spontaneous PV firing in patients with AF to distinguish focal versus reentrant mechanisms. Methods: Intracardiac recordings were obtained in 18 patients demonstrating paroxysmal AF. Microelectrode (ME) recordings were obtained from superfused canine PV sleeves (N = 48). Results: Spontaneous PV firing (566 ± 16 bpm; 127 ± 6 ms cycle length) giving rise to AF (52 episodes) was observed. Tachycardia-pause initiation was present in 132 of 200 episodes of rapid PV firing and 34 of 52 AF episodes. The pause cycle length preceding PV firing was 1,039 ± 86 ms following tachycardia (420 ± 40 ms cycle length). The remaining episodes were initiated following a 702 ± 32 ms pause during sinus rhythm (588 ± 63 ms). Spontaneous firing recorded with a multipolar mapping catheter did not detect electrical activity bridging the diastolic interval between the initial ectopic and preceding post-pause sinus beat. Tachycardia-pause initiated PV firing (138 ± 7 ms coupling interval) in patients correlated with tachycardia-pause enhanced isometric force, early afterdepolarization (EAD) amplitude, and triggered firing within canine PVs. Rapid firing (1,172 ± 134 bpm; 51 ± 8 ms cycle length) following an abbreviated coupling interval (69 ± 12 ms) was initiated in 13 of 18 canine PVs following tachycardia-pause pacing during norepinephrine + acetylcholine superfusion. Stimulation selectively activating local autonomic nerve terminals facilitated tachycardia-pause triggered firing in canine PVs (5 of 15 vs 0 of 15; P < 0.05). Conclusions: The studies demonstrate (1) tachycardia-pause initiation of rapid, short-coupled PV firing in AF patients and (2) tachycardia-pause facilitation of isometric force, EAD formation, and autonomic-dependent triggered firing within canine PVs, suggestive of a common arrhythmia mechanism. [source] Bepridil Reverses Atrial Electrical Remodeling and L-Type Calcium Channel Downregulation in a Canine Model of Persistent Atrial TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2007KUNIHIRO NISHIDA M.D. Introduction: This study tested whether bepridil, a multichannel blocker, would reverse electrical remodeling induced by persistent atrial tachycardia. Methods and Results: Fourteen dogs were subjected to rapid atrial pacing at 400 bpm for 6 weeks after atrioventricular block was created to control the ventricular rate. During the study period, seven dogs were given placebo for 6 weeks (Control group), and seven were given placebo for 3 weeks, followed by 3 weeks of bepridil (10 mg/kg/day, Bepridil group). The atrial effective refractory period (ERP) and the inducibility and duration of atrial fibrillation (AF) were determined on a weekly basis. After 6 weeks, expression of L-type calcium channel ,1C messenger ribonucleic acid (mRNA) was quantified by real-time reverse transcription-polymerase chain reaction. In the Control group, ERP was shortened and the inducibility and duration of AF increased through the 6-week period. In the Bepridil group, the same changes occurred during the first 3 weeks, but were gradually reversed with bepridil. After 6 weeks, ERP was longer, AF inducibility was lower, and AF duration was shorter in Bepridil group than in the Control group. Expression of ,1C mRNA was decreased by 64% in the Control group (P < 0.05 vs sham), but in the Bepridil group, it was not different compared with the sham dogs. As a whole group of dogs, ERP was positively correlated with ,1C mRNA expression. Conclusion: Bepridil reverses the electrophysiological consequences of atrial remodeling to some extent and L-type calcium channel downregulation in a canine model of atrial tachycardia. [source] Incidence of Atrial Arrhythmias Detected by Permanent Pacemakers (PPM) Post-Pulmonary Vein Antrum Isolation (PVAI) for Atrial Fibrillation (AF): Correlation with Symptomatic RecurrenceJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007ATUL VERMA M.D. Background: Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known. Objective: To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence. Methods: Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range). Results: The patients (age 57 ± 8 years, EF 54 ± 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4,256] vs 401 [151,2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857,1,390]) and sustained (18 ± 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%). Conclusions: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon. [source] Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical ProsthesisJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007MAURO BIFFI M.D. Background. A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. Results. We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. Conclusion. Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis. [source] Long-Term Incidence of Malignant Ventricular Arrhythmia and Shock Therapy in Patients with Primary Defibrillator Implantation Does Not Differ from Event Rates in Patients Treated for Survived Cardiac ArrestJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2005ULRICH BACKENKÖHLER M.D. Introduction: Recent trials have demonstrated benefit of prophylactic defibrillator (ICD) implantation compared to conventional treatment in high-risk patients. However, many patients have rare or no sustained arrhythmias following implantation. Our study addresses the question, whether patients with prophylactic defibrillator implantation have a lower risk for life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) compared to sudden cardiac death (SCD) survivors. Methods and Results: Over 7 years we enrolled 245 patients. Occurrence of spontaneous sustained VT/VF resulting in adequate ICD treatment was the endpoint. Incidence, type, and treatment of sustained arrhythmia in 43 previously asymptomatic ICD recipients (group B) were compared to data of 202 survivors of imminent SCD (group A). All patients had severely impaired left ventricular ejection fraction (<45%). Group B patients had long runs (>6 cycles, <30 s) of VT during Holter monitoring and inducible sustained arrhythmia. Incidence of rapid VT and VF (cycle length <240 ms/heart rate >250 bpm) after 4 years (35% in both groups, P = ns) and adequate defibrillator therapies (57% vs 55%, P = ns) were similar in both groups after univariate and multivariate analysis. Cumulative mortality tended to be lower in group B compared to group A, but the difference was not statistically significant. Conclusion: During long-term follow-up, incidence of sustained rapid ventricular arrhythmia in prophylactically treated patients is as high as that of SCD survivors. Benefit from defibrillator implantation for primary prevention (group B) appears to be comparable to that for survived cardiac arrest (group A). [source] Cardiac disorders in farmed adult brown trout, Salmo trutta L.JOURNAL OF FISH DISEASES, Issue 4 2000C Mercier During summer in Brittany, France, sea farmed brown trout, Salmo trutta L., regularly experience a high mortality rate which is associated, at least in part, with cardiac disorders (aneurysms and infarcts). The present study is preliminary to a more extensive research programme, the objective of which is to determine to what extent the physiological performance of the cardiovascular system of brown trout is affected by the environmental conditions the fish experience in farm cages. We conducted a 2-week in situ experiment during which the heart rate of eight sea water acclimatized individuals was telemetered using acoustic tags. During the experimental period, water temperature ranged from 16.0 to 17.6 °C. Water oxygen saturation was above 80% at all times and salinity was very high (35.5,) but stable. Although they were unfed and not active, seven of out the eight tagged animals displayed near maximum heart beat frequencies, which ranged between 83 and 98 beats per minute (bpm). On the other hand, the eighth animal exhibited medium-range heart rates (50,70 bpm). Using phase delay maps, we established that the maximum heart rate of brown trout at 17 °C was in the range of 96,100 bpm. This result suggests that in our experimental conditions, the heart rate of most of our inactive fish was between 85 and 100% of maximum myocardial performance. We hypothesize that the cardiac failures observed in brown trout during summer are most likely a result of strenuous workloads imposed on the cardiovascular system by a combination of elevated temperature, high salinity and possibly season-related decreased hypo-osmoregulatory abilities. [source] GASTROENTEROLOGY: Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2010María Chaparro Abstract Background and Aim:, To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers. Methods:, Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out. Results:, A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure , 100 mmHg, heart rate , 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge. Conclusions:, Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients. [source] Fetal arrhythmia: Prenatal diagnosis and perinatal managementJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009Yasuki Maeno Abstract The importance of managing fetal arrhythmia has increased over the past three decades. Although most fetal arrhythmias are benign, some types cause fetal hydrops and can lead to fetal death. With the aim of improving the outcome in such cases, various studies for prenatal diagnosis and perinatal management have been published. Detailed analysis of the type of arrhythmia in utero is possible using M-mode and Doppler echocardiography. In particular, a simultaneous record of Doppler waveform at the superior venous cava and the ascending aorta has become an important and useful method of assessing the interval between atrial and ventricular contractions. Common causes of fetal tachycardia (ventricular heart rate faster than 180 bpm), are paroxysmal supraventricular tachycardia (SVT) with 1:1 atrioventricular (AV) relation and atrial flutter with 2:1 AV relation. Of fetal SVT, short ventriculo-atrial (VA) interval tachycardia due to atrioventricular reentrant tachycardia is more common than long VA interval. Most fetuses with tachycardia are successfully treated in utero by transplacental administration of antiarrhythmic drugs. Digoxin is widely accepted as a first-line antiarrhythmic drug. Sotalol, flecainide and amiodarone are used as second-line drugs when digoxin fails to achieve conversion to sinus rhythm. Fetal bradycardia is diagnosed when the fetal ventricular heart rate is slower than 100 bpm, mainly due to AV block. Approximately half of all cases are caused by associated congenital heart disease, and the remaining cases that have normal cardiac structure are often caused by maternal SS-A antibody. The efficacy of prenatal treatment for fetal AV block is limited compared with treatment for fetal tachycardia. Beta stimulants and steroids have been reported as effective transplacental treatments for fetal AV block. Perinatal management based on prospective clinical study protocol rather than individual experience is crucial for further improvement of outcome in fetuses with tachycardia and bradycardia. [source] Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significanceJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2004Houchang D. Modanlou Abstract Objectives: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology. Background: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh-sensitized and dying fetuses. This FHR pattern was called ,sinusoidal' because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death. Undulating FHR pattern: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre-mortem FHR pattern; (4) pseudo-SHR pattern; and (5) equivocal FHR patterns. Fetal conditions associated with SHR pattern: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth. Definition of true SHR pattern: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120,160 bpm; (b) amplitude of 5,15 bpm, rarely greater; (c) frequency of 2,5 cycles per minute; (d) fixed or flat short-term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity. Physiopathology: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology. Conclusion: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics. [source] Spontaneous resolution of hypothermia-induced atrial fibrillation in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2004Scott A. Campbell DVM Abstract Objective: To report a case of spontaneous resolution of atrial fibrillation secondary to hypothermia in a dog without detectable heart disease. Case summary: An 8-year-old female spayed mixed breed dog presented with a history of prolonged exposure to below freezing environmental temperatures. The dog presented hypothermic (<32°C or <90°F) and minimally responsive to stimuli. The heart rate was 80 beats per minute (bpm) and irregular. Atrial fibrillation was diagnosed. The dog had pale mucous membranes, absent femoral pulses, and no obtainable blood pressure via indirect Doppler technique. Resuscitation fluids were administered and active external warming was instituted. Peripheral edema was observed during the rewarming phase and the irregular heart rate was noted to increase. The atrial fibrillation spontaneously resolved with no specific anti-arrhythmic therapy. No underlying myocardial disease was found. The recovery of this dog was complete with a subsequent repeat of the echocardiogram and electrocardiogram (ECG) 8-months later found to be within normal limits. [source] Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990,2000)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2003Edward S. Cooper VMD Abstract Objective: This paper characterizes the clinical findings in 5 cats with feline asthma complicated by concurrent pneumothorax. Design: Retrospective study. Medical records of cats with concurrent diagnoses of asthma and pneumothorax that were presented to the Veterinary Hospital of the University of Pennsylvania from 1990 to 2000 were reviewed. Results: Of 421 cases of feline asthma, 5 cats fulfilled the inclusion criteria (1.2%). All 5 had respiratory distress at presentation. One cat was panting, and the other 4 cats had respiratory rates of 28, 52, 58 and 120 breaths per minute (bpm), respectively (mean RR 65±39 bpm). Historical findings included untreated chronic cough (n=3), previously treated asthma (n=1), and no previous illness (n=1). Thoracocentesis was performed in 4/5 cats, and 3 of those cats required thoracostomy tubes. Four cats required immediate oxygen supplementation, and 1 of those cats required ventilation. All 5 cats had evidence of pneumothorax on initial radiographs. Follow-up radiographs revealed partial or complete resolution of pneumothorax in 4 cats which were discharged alive with total hospitalization of 2,7 days, but were then lost to follow-up. One cat was euthanized because it could not be weaned off mechanical ventilation, and necropsy confirmed end-stage feline asthma and emphysema. Conclusion: Small airway obstruction can predispose asthma patients to increased alveolar pressure, emphysema, and spontaneous pneumothorax, which can lead to dyspnea in affected cats. The short-term outcome in these cats was good despite the severity of dyspnea at presentation. [source] | ||||||||||||||||||||||||||||||||||||||||||||||