The Combined Transvenous Implantation of Cardioverter Defibrillators and Permanent Pacemakers

We developed criteria for implantation and programming of permanent endocardial pacemakers in patients with a nonthoracotomy ICD system. These criteria were prospectively used in 10 patients who recieved an ICD prior to (n = 5) or following (n = 5) implantation of a dual chamber (n = 6) or ventricular (n = 4) pacemaker with a unipolar (n = 4) or bipolar (n = 6) lead configuration. All patients were tested for interactions or malfunctions. Undersensing of ventricular fibrillation by the atrial sense amplifier and inadequate atrial pacing occurred in one patient with a unipolar dual chamber system programmed to AAIR but didn't impair ICD sensing. Transient or permanent loss of capture or sensing of the pacemaker was not observed after ICD shocks with the output programmed to double pulse width and voltage of stimulation threshold and the sensitivity to 50% of the detected R wave. One episode of transient reprogramming occurred without clinical consequences. One unipolar ventricular pacemaker lead had to be exchanged against a bipolar lead because of oversensing of the pacing artifact by the ICD. There was no failure of an ICD to detect ventricular arrhythmias due to inadequate pacemaker activity. During a follow-up period of 21 ± 11 months, a total of 78 ventricular arrhythmias were effectively treated in six patients. Thus, a combined use of transvenous ICD and pacemaker is possible despite the close vicinity of pacing and defibrillations leads. Optimized programming different to the common settings is required. As interactions occurred only in unipolar pacemaker leads bipolar systems should be used in these patients.     

Comparison of spontaneous and septally driven hippocampal theta field and theta-related cellular activity

Experiments were carried out for the purpose of comparing the electrophysiological properties of spontaneously occurring hippocampal theta field activity with those of theta-like field activity elicited by 5-Hz and 7-Hz electrical stimulation of the medial septum in urethane-anesthetized rats. Experiment 1 compared the amplitude and phase depth profiles for the three conditions of spontaneously occurring theta, theta elicited by 5-Hz medial septal stimulation, and theta elicited by 7-Hz medial septal stimulation. The results supported the conclusion that septally elicited theta field activity exhibited characteristics similar to those of spontaneously occurring theta field activity. Experiment 2 compared the discharge properties of hippocampal theta-related cellular discharges during spontaneous and septally elicited theta field activity. In contrast to the results of Experiment 1, the findings of Experiment 2 supported the conclusion that electrical stimulation of medial septal nuclei did not produce typical responses of hippocampal theta-related cellular activity. During spontaneously occurring field conditions, HPC theta-ON cells increased their discharge rates during spontaneous theta field activity, relative to LIA, and theta-OFF cells decreased (often to zero) their discharge rates during theta field activity relative to LIA. During septally elicited theta-like activity, phasic and tonic theta-ON cells decreased their discharge rates (some were totally inhibited), and most tonic theta-OFF cells increased their discharge rates (although two were totally inhibited). In addition, the discharges (albeit reduced) of the majority of both phasic and tonic theta-ON cells during septal driving became entrained to the stimulation pulses and thus exhibited rhythmicity and strong phase relations with the field activity. Furthermore, both cell types discharged near the positive peak of the septally elicited theta field activity during 5-Hz stimulation and near the negative peak during 7-Hz stimulation. The discharges of most tonic theta-OFF cells also became entrained to the stimulation pulses and exhibited similar phase relations to theta-ON cells during the 5-Hz and 7-Hz driving frequencies. Thus, based on cellular evidence, electrical stimulation of the medial septum activates the hippocampal neural circuitry involved in the generation of theta field activity in a nonphysiological manner. The findings of the present paper provide an explanation for why electrical stimulation of the medial septum in freely moving rats elicits a theta-like field activity that is dissociated from the normal behavioral correlates, in contrast to those elicited by stimulation of the posterior nucleus of the hypothalamus (Bland and Oddie. 2001. Behav Brain Res 127:119-136).     

COMPUTED TOMOGRAPHIC FINDINGS OF THE BRAIN IN CHILDREN WITH ACUTE LYMPHOCYTIC LEUKEMIA AFTER CENTRAL NERVOUS SYSTEM PROPHYLAXIS WITHOUT CRANIAL IRRADIATION

Abstract. Nineteen children in primary remission of acute lymphocytic leukemia (ALL) were investigated by computed tomographic (CT) scans of the brain 2 to 64 (mean 19) months after the central nervous system (CNS) prophylaxis was finished. The CNS prophylaxis consisted of high dose Methotrexate (HDM) intravenously combined with 6–8 doses of Methotrexate intrathecally. Two children received only Methotrexate intrathecally as CNS prophylaxis. In addition three children with ALL who had CNS leukemia were investigated by CT scans of the brain. Only one abnormal CT scan was found among the nineteen asymptomatic children, and one of the three patients with CNS relapse had slightly dilatated subarachnoidal spaces. These results compared with other reports in literature in which the CNS prophylaxis has consisted of intrathecal Methotrexate and cranial irradiation, suggest that there are fewer abnormal CT findings of the brain in patients not receiving cranial irradiation as part of CNS prophylaxis.     

Readiness to adopt a self-management approach to pain – Are profiles of subscale scores on the Pain Stages of Change Questionnaire useful?

The study evaluated the ability of the Pain Stages of Change Questionnaire (PSOCQ) to classify subjects into specific profiles of readiness to adopt a self‐management approach to pain. An analysis was made of whether the five earlier described PSOCQ‐profiles Precontemplation, Contemplation, Non‐contemplative Action, Participation and Ambivalent could be reproduced by two different methods, cluster analysis and visual analysis. The 184 included subjects completed the PSOCQ, the Hopkins Symptom Checklist (HSCL‐25), the Tampa scale of Kinesiophobia (TSK) and five self‐efficacy questions from the arthritis self‐efficacy questionnaire (ASES). Profiles were drawn based on the mean scores of the four subscales in PSOCQ. All the five predefined profiles were identified visually by two coders with an interrater agreement of Kappa 0.731. A 6‐cluster solution generated the four profiles Precontemplation, Contemplation, Non‐contemplative Action and Participation. Discriminant function analysis (DFA) on cluster analysis classified 83.5% of cases in the same group, and DFA on visual classification 72.1% of cases. Fifty‐three percent were classified in the same profile by cluster and visual analysis. The two profiles Precontemplation and Participation seem to identify distinct subgroups that differ in educational level, pain during activity and psychometric measures. Non‐contemplative Action share characteristics with Precontemplation, and the Contemplation group has scores in between. In conclusion, more research on the validity of the PSOCQ is needed. Outcome studies after pain treatment programmes could focus three main states that differ on measures for concurrent validity: Profiles that can be identified as Precontemplation or Non‐contemplative action, Contemplators, and subjects with Participation profiles.     

The etiology of prolonged thumb sucking

abstract – The purpose of the present investigation was to study the effect of reducing the pleasure derived from sucking in 23 children practicing a prolonged thumbsucking habit. For this purpose a 0.5 mm thick removable cover ("splint") was used, duplicating exact contour of teeth and palate. As a psychologic support the children were told that the sucking habit was just a pleasant occupation and that they were allowed to suck whenever they wished. Two control groups of 12 children were established, one having no splint but the same psychologic support, and one having neither splint nor psychologic support. Control after 6 months showed a significant decrease in sucking activity in the study group compared with the two control groups. Psychologic support without application of splint induced no decrease in sucking activity. The splint was worn willingly and cessation or reduction of the habit took place without any overt nervous reactions.     

ANATOM-2000型CT机中滤波核函数的分析

介绍X—CT滤波反投影重建算法中滤波核函数选择的简单原则，以及几种常用的滤波核函数，并对深圳安科公司ANOTOM—2000型CT重建算法中的滤波核函数进行了分析。