Direction of signal recording affects waveform characteristics of ventricular fibrillation in humans undergoing defibrillation testing during ICD implantation

INTRODUCTION: In cardiac arrest due to prolonged ventricular fibrillation (VF), defibrillation is more likely to result in a perfusing rhythm if chest compressions are performed first. Furthermore, the VF waveform can predict the shockability of VF and thus automated external defibrillators (AEDs) are being designed to analyze the VF waveform to direct therapies. However, it is unknown whether the VF waveform is dependent on recording direction, which could be altered by incorrect placement of AED patches. MATERIALS AND METHODS: VF was induced in 26 patients with ischemic cardiomyopathy and 19 patients with dilated cardiomyopathy and recorded in six limb leads. Frequency characteristics (mean, median, dominant frequency, and bandwidth) were computed as well as amplitude-based measures: amplitude spectral area (AMSA), slope, signal amplitude, and slope divide by signal amplitude (slope-amp). RESULTS: Frequency characteristics were similar in all leads. However, AMSA, slope, and signal amplitude were significantly affected (P<0.001) by lead. In particular, for ischemic cardiomyopathy patients, between leads I and II, AMSA varied from 29.4+/-3.2 to 49.3+/-4.6 mV Hz (mean+/-SEM, P<0.001) and slope varied from 1.5+/-0.2 to 2.4+/-0.3 mV/s (P<0.001). Slope-amp was similar in all leads. There were no significant differences between ischemic and dilated cardiomyopathy patients. CONCLUSIONS: Amplitude measures of VF are significantly affected by limb lead ECG recording direction. This work suggests that AED patches must be correctly and consistently placed if amplitude-based measures are used to decide whether to deliver a defibrillatory shock.     

Expanded instrument comparison of amplicon DNA melting analysis for mutation scanning and genotyping

BACKGROUND: Additional instruments have become available since instruments for DNA melting analysis of PCR products for genotyping and mutation scanning were compared. We assessed the performance of these new instruments for genotyping and scanning for mutations. METHODS: A 110-bp fragment of the beta-globin gene including the sickle cell anemia locus (HBB c. 20A>T) was amplified by PCR in the presence of LCGreen Plus or SYBR Green I. Amplicons of 4 different genotypes [wild-type, homozygous, and heterozygous HBB c. 20A>T and double-heterozygote HBB c. (9C>T; 20A>T)] were melted on 7 different instruments [Applied Biosystems 7300, Corbett Life Sciences Rotor-Gene 6500HRM, Eppendorf Mastercycler RealPlex4S, Idaho Technology LightScanner (384 well), Roche LightCycler 480 (96 and 384 well) and Stratagene Mx3005p] at a rate of 0.61 degrees C/s or when this was not possible, at 0.50 degrees C steps. We evaluated the ability of each instrument to genotype by melting temperature (Tm) and to scan for heterozygotes by curve shape. RESULTS: The ability of most instruments to accurately genotype single-base changes by amplicon melting was limited by spatial temperature variation across the plate (SD of Tm = 0.020 to 0.264 degrees C). Other variables such as data density, signal-to-noise ratio, and melting rate also affected heterozygote scanning. CONCLUSIONS: Different instruments vary widely in their ability to genotype homozygous variants and scan for heterozygotes by whole amplicon melting analysis. Instruments specifically designed for high-resolution melting, however, displayed the least variation, suggesting better genotyping accuracy and scanning sensitivity and specificity.     

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

Little evidence is available on how to treat incomplete atypical fractures of the femur. When surgery is chosen, intramedullary nailing is the most common invasive technique. However, this approach is adopted from the treatment of other types of ordinary femoral fracture and does not aim to prevent the impending complete fracture by interrupting the mechanism underlying the pathology. We suggest a different surgical approach that intends to counteract the underlying biomechanical conditions leading to a complete atypical fracture and thus could be better suited in selected cases. Here, we share an alternative surgical approach and present two cases treated accordingly.     

The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

Purpose

Biomechanical reports have advocated anatomic graft tunnel placement for reconstruction of the posterior cruciate ligament (PCL) to restore knee joint stability and facilitate optimal functional outcome. However, in vivo investigations that correlate tunnel position to functional results are lacking so far. This study evaluates the anatomic accuracy of femoral and tibial tunnel apertures on postoperative computed tomography (CT) scans and compares these findings to subjective and objective clinical outcome parameters.

Methods

After single-bundle PCL reconstruction, 29 patients were stratified into several subgroups according to the anatomic accuracy of femoral and tibial tunnel apertures measured on postoperative CT scans. A threshold value for the centres of the tunnel apertures was determined using a measurement grid system as a radiographic reference. To evaluate the functional and radiological results, visual analogue scale, International Knee Documentation Committee (IKDC), Tegner, Lysholm, Knee Injury and Osteoarthritis Outcome Score and osteoarthritis scores were obtained.

Results

Comparison between functional outcome and tunnel position yielded a statistically significant difference for subjective IKDC score and angle segment α and for objective stability and tunnel position P3 but no statistically significant difference with respect to intercondylar depth, intercondylar height and tibial tunnel position P2. No correlation was found between anatomic tunnel position and present or progressive osteoarthritis on follow-up. Of the patients, 72 % classified their result as excellent and good and 90 % would repeat surgical treatment.

Conclusions

Despite a small sample size and subject to the threshold values we used, our data indicate a potentially minor effect of anatomic tunnel placement on midterm functional outcome following PCL reconstruction.