Programmed stimulation in the evaluation of life-threatening or potentially life-threatening ventricular arrhythmias

Conclusion In conclusion, programmed stimulation is an excellent and appropriate method to guide thrapy for life-threatening and potentially life-threatening arrhythmias that occur infrequently and with unpredictable timing.The sensitivity and specificity of programmed stimulation is excellent in patients whose clinical presentation is by sustained uniform ventricular tachycardia and cardiac arrest. In contrast, such parameters are substantially less in patients with nonsustained ventricular tachycardia and in those who present wit syncope. The predictive accuracy of therapy guided by programmed electrical stimulation in cohorts with cardiac artest and sustained uniform ventricular tachycardia cohorts is reasonably well established and appears to be very good. Although no large randomized controlled comparative study of noninvasive versus PES-guided therapy has yet been completed, preliminary evidence suggests that there is a decreased incidence of arrhythmia recurrence and sudden cardiac death when therapy is guided by PES. In the minority of patients with syncope in whom sustained uniform ventricular tachycardia is induced during PES, therapy may be effectively guided by this modality. PES appears to be of benefit in managing patients with coronary artery disease who present with nonsustained ventricular tachycardia and depressed ejection fraction thereby defining a high risk subset for a subsequent arrhythmic event. However, we have not found electrophysiologic testing postmyocardial infarction to be prognostically useful.Dr. Josephson is the Robinette Foundation Professor of Medicine (Cardiovascular Diseases)Supported in part by grants from the American Heart Association, Southeastern Pennsylvania Chapter, Philadelphia, PA; and National Heart, Lung, and Blood Institute, Bethesda, MD (HL28093, HL07346, HL24278).     

Keeping the focus on public health: the struggles of a tobacco prevention task force.

This case study examines a nonlegislative task force as it struggled to reach internal consensus despite external political constraints. The study highlights the convergence of politics and science, revealing complex issues likely to be confronted by advocates and public health officials. Three themes capture participants' experiences: context, sizing up the opportunities and constraints; task force process, tacit strategy to operate outside the political context and play the science card; and aftermath, a glass half full. The task force took advantage of ambiguous parameters, crafting a comprehensive statewide plan to reduce tobacco use and breaking out of the common public health paradigm of allowing budget considerations to drive program design. These internal victories could not sustain a policy success in the legislature. However, the group's product sets science-based standards for future program development, and the task force's process provides valuable insights into other states developing tobacco prevention and control policies.     

In vitro packaging of the bacteriophage phi 6 ssRNA genomic precursors

Bacteriophage phi 6 contains three segments of double-stranded RNA within a nucleocapsid. Plasmids containing cDNA copies of the large genomic segment direct the synthesis of viral proteins that assemble into procapsids in Escherichia coli or Pseudomonas phaseolicola. These structures are dodecahedral assemblages of proteins P1, P2, P4, and P7. We report in this paper that these particles are capable of packaging viral single-stranded plus-sense RNA in vitro. The packaging reaction requires the presence of ATP or dATP. Synthesis of minus strands takes place within this filled procapsid in the presence of all four nucleoside triphosphates. Packaged ssRNA is found to be protected from added ribonuclease.     

The practice of forensic psychiatry in cases of homicide in Copenhagen, 1959 to 1983

During the years 1959 to 1983 a doubling in the rate of homicide took place in Copenhagen. This increase was exclusively due to an increasing number of male offenders. By comparing with another Danish material, the frequency of female homicide as well as that of homicide combined with suicide was found practically unchanged since 1946, indicating that both of these kinds of homicides seem to have a background different from those of other offences of fatal violence. During the years 1959 to 1983, the criteria of selection of the defendants for a psychiatric examination for the court were fairly consistent. Examinations were performed in practically all cases, where a charge of murder raised by the police was followed by a legal trial for homicide. Less and less of the defendants, however, were hospitalized for the examination, while more were examined in The Clinic of Forensic Psychiatry in Copenhagen.     

Identification and characterization of linear B-cell epitopes of beta-globulin, a major allergen of sesame seeds

BACKGROUND: The increased consumption of foods containing sesame seeds is paralleled by an increase in reported sesame-induced allergic reactions. OBJECTIVE: This study aimed at identifying and characterizing the linear B-cell epitopes of the 14-kd beta-globulin, the major allergen of sesame seed. METHODS: A peptide containing 71 amino acids (peptide B) was previously identified by us as the IgE-binding region on beta-globulin. To determine the amino acid sequence of the IgE-binding sites on peptide B, we synthesized overlapping peptides 20 and 10 amino acid residues long that span the entire length of peptide B, which were offset from each other by 10 and 2 amino acid residues, respectively. Sera from 20 subjects given diagnoses of allergy to sesame beta-globulin served to identify the epitopes by using the dot-blot test. RESULTS: At least 9 different IgE-recognition sites were identified on peptide B. Three of them, numbers 2, 3, and 13 (corresponding to amino acids 46-55, 48-57, and 76-86, respectively, in the beta-globulin sequence), appeared to be immunodominant IgE-binding epitopes. Also, these peptides were best recognized in terms of intensity of response. There was no obvious sequence motif shared by the 9 different IgE-binding epitopes of beta-globulin. However, approximately 60% of the amino acids represented in the epitopes are hydrophobic residues. CONCLUSION: Identification of the IgE-binding epitopes might provide a better understanding of the functional role the allergens play in the disease and might have implications for immunodiagnosis and probably immunotherapy.