Novel approach to discriminate left bundle branch block from nonspecific intraventricular conduction delay using pacing-induced functional left bundle branch block

Purpose

Left bundle branch block (LBBB) has a predictive value for response to cardiac resynchronization therapy as reported by Zareba et al. (Circulation 123(10):1061–1072, 2011). However, based on ECG criteria, the discrimination between complete LBBB and nonspecific intraventricular conduction delay is challenging. We tested the hypothesis that discrimination can be performed using standard electrophysiological catheters and a simple stimulation protocol.

Methods

Fifty-nine patients were analyzed retrospectively. Patients were divided into groups of narrow QRS (n?=?20), wide QRS of right bundle branch block (RBBB) morphology (n?=?14), and wide QRS of LBBB morphology (n?=?25). Using a diagnostic catheter placed in the coronary sinus, left ventricular activation was assessed during intrinsic conduction as well as during right ventricular (RV) stimulation.

Results

In patients with narrow QRS and RBBB, the Q-LV/QRS ratio was 0.43?±?0.013 (n?=?20) and 0.41?±?0.026 (n?=?14), respectively. In patients with LBBB morphology, the Q-LV/QRS split up into a group of patients with normal (0.43?±?0.022, n?=?7) and a group with delayed left ventricular activation (0.75?±?0.016, n?=?18). By direct comparison of the Q-LV/QRS ratio during intrinsic conduction with the Q-LV/QRS ratio during RV pacing leading to a functional LBBB, a clear distinction between a group of “true LBBB” and another group of “apparent LBBB”/nonspecific intraventricular conduction delay (NICD) could be generated.

Conclusions

We present a novel and practical method that might facilitate discrimination between patients with apparent LBBB and true LBBB by comparing Q-LV/QRS ratios during intrinsic activation and during RV stimulation. Although this method can already be directly applied, validation by 3D electrical mapping and prospective correlation to cardiac resynchronization therapy (CRT) response will be required for further translation into clinical practice.

     

Onabotulinumtoxin type A improves lower urinary tract symptoms and quality of life in patients with human T cell lymphotropic virus type 1 associated overactive bladder

Aim

To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL).

Autologous canine immunotherapy: short-time generated dendritic cells loaded with canine transmissible venereal tumor-whole lysate

Abstract

Objective: The aim of the present study was to evaluate the therapeutic potential of autologous DCs loaded with whole tumor cell lysate of CTVT generated under a simplified and rapid procedure in vitro production process, in a vulvar submucosal model of CTVT in dogs.

Materials and methods: We generated a model of intravulvar CTVT in dogs. A CTVT lysate antigen was prepared according to the method of 1-butanol and after administered with complete Freund's adjuvant via subcutaneous in female healthy dogs and challenge with CTVT cells to corroborate the immunogenicity. Short-time generated dendritic cell pulsed with CTVT whole-lysate was performed, and analyzed by FITC-dextran uptake assay and characterized using anti-canine monoclonal antibodies CD14, CD80, CD83, and DLAII by flow cytometry. Dendritic cell therapy was administered in a frequency of three times every 2 weeks when the CTVT had 4 months of growth and 89?±?5 cm diameter. The CD3⁺, CD4⁺ and CD8⁺ lymphocytes were determined by flow cytometry, and IFN-γ by ELISA assay.

Results and discussion: The administration of CTVT whole-lysate resulted in tumor prevention. The short-time generated dendritic cell pulsed with CTVT whole-lysate administration resulted in an efficient reduction and elimination of CTVT, probably due to the increase in lymphocyte populations (CD3⁺, CD4⁺, and CD8⁺), IFN-γ production and tumor infiltrating lymphocytes.

Conclusion: In conclusion, this study demonstrates the efficacy of immunotherapy based in short-time generated dendritic cell pulsed with CTVT whole-lysate for the treatment of CTVT, and offer veterinary oncologists new alternative therapies to treat this and another malignancy.     

Influenza vaccination status in multiple sclerosis patients from Latin America

Journal of NeuroVirology - The objective of the present study was to identify the frequency of MS patients in Latin America (LATAM) that received the influenza vaccine during the most recent season...     

Dealing with Difficult Patients: Do Customer Service Initiatives Improve Patient Satisfaction at an Interdisciplinary Pain Center?

Chronic pain patients can be difficult to manage due to complicated medical and psychiatric comorbidities. This study focused on strategies designed to improve patient treatment satisfaction within a tertiary urban hospital‐based pain management center. Information was obtained of monthly patient satisfaction and Press Ganey scores in 2009 based on patient perceptions of staff and telephone access, frequency of returned phone calls, staff empathy and responsiveness, and overall patient experience with their pain treatment. Information was also obtained of the number of formal complaints made to the Patient Relations Department of the hospital. A customer service program designed to target patient's phone access, response to phone calls, improved patient experiences, and service friendliness was initiated in March 2010. Six hundred eleven patients (n = 611) were randomly surveyed 3 months after their treatment between 2009 and 2012 and rates of formal patient complaints were monitored. Thirty‐three (n = 33) staff members were encouraged to attend monthly 1.5‐hour customer service meetings and participate in specialized work teams between March 2010 and December 2012. Patient satisfaction scores rose from a low of 80.3 (average of 83.5%) in 2009 to a high of 91.2 (average 88.9%) in 2012. Annual formal complaints to Patient Relations decreased by 40.5% over 4 years (112 in 2009 to 30 in 2012). Phone abandonment rates also decreased by 20% and the center scored 12% higher than average total practice scores in patient satisfaction based on secret shopper ratings. This study demonstrates that customer service initiatives that engage staff participation and that are designed to target specific improvements in patient satisfaction can effectively change the way pain patients perceive treatment at an interdisciplinary anesthesia‐based pain center.     

Synergistic potential of 1α,25-dihydroxyvitamin D3 and calcium–aluminate–chitosan scaffolds with dental pulp cells

Clinical Oral Investigations - This study aimed to develop a porous chitosan–calcium–aluminate scaffold (CH-AlCa) in combination with a bioactive dosage of 1α,25-dihydroxyvitamin...     

On the Similarity Between the tRNAs of Organelles and Prokaryotes

Fluorescence studies with organelle transfer RNAs separated from their cytoplasmic counterparts revealed that phenylalanine tRNA from Euglena chloroplasts or Neurospora mitochondria does not contain a fluorescent "base Y." In contrast, cytoplasmic phenylalanine tRNA from Euglena and cytoplasmic tRNA from Neurospora were found to contain fluorescent bases. The fluorescence-emission spectra of Neurospora cytoplasmic tRNAs and those of the related ascomycete Saccharomyces cerevisiue were observed to be quite different. The results support the generalization that eukaryotic tRNAs contain a fluorescent base, but indicate that their respective organelle tRNAs do not. They also indicate a striking parallelism between organelle and prokaryotic tRNAs.