Brady-tachy syndrome: rapid atrial pacing efficacy in preventing atrial fibrillation recurrence assessed by reliable electrograms: the prefib pilot study.

AIMS: Recent studies have tested different atrial pacing rates, modes, and sites for preventing atrial fibrillation (AF) recurrence. Present generation pacemakers offer reliable electrograms (EGMs) storage for optimizing the arrhythmia diagnosis. Based on these EGMs, the study objective was to assess the rate of AF recurrence at two different pacing rates. METHODS: Thirty patients suffering exclusively from symptomatic brady-tachy syndrome (BTS) resistant to > or =2 drugs, were implanted with a DDDR pacemaker. After a 5-days observation period, the DDD pacing rate was randomly programmed at 60 bpm (-15 bpm hysteresis) or at 80 bpm for 12 weeks. The two sequences were crossed over at the end of this fixed period or when earlier symptomatic AF recurred. Antiarrhythmics were maintained. Stored EGMs of > or =4 s duration identified all AF recurrence. RESULTS: Thirty patients (17 males, 77.2 +/- 8.1 years old) were included. One patient withdrew prematurely for severe heart failure associated with AF recurrence and rapid ventricular response. For the remainder of the 29 patients, fast atrial pacing neither provoked symptoms nor haemodynamic change. AF recurred in 16 patients paced at 60 (-15) bpm (mean time: 29 days; range 1-61) and in 9 patients paced at 80 bpm (mean time: 55 days; range 5-83) (P < 0.05). AF recurrence was asymptomatic in 50% of patients. CONCLUSIONS: These results confirm that rapid atrial pacing is 1) significantly effective for preventing AF recurrence in symptomatic BTS patients, and 2) haemodynamically well tolerated.     

In vivo protection against scorpion toxins by liposomal immunization

The possibility of raising a humoral immune response able to induce protection from the lethal effects of scorpion toxins was evaluated in the mouse model. A toxic fraction from the venom of the scorpion Tityus serrulatus was entrapped in sphingomyelin-cholesterol liposomes which yielded a conveniently detoxified immunogen. After three injections of this immunogen, all but three of a group of 18 mice developed an IgG response which was shown to be both specific and of good affinity for the toxic antigen. In vitro neutralization assays indicated that pre-incubation of a lethal dose of the toxic fraction with immune sera strongly diminished its toxicity. In vivo protection assays showed that mice with the highest levels of circulating anti-toxin antibodies could resist the challenge by double the normal LD₅₀ of the toxic fraction, which killed all control non-immune mice. The protection was, however, found to be limited both in its duration and its effectiveness against higher amounts of toxin.     

Failure of ES 52, a highly potent enkephalinase inhibitor, to affect nociceptive transmission by rat dorsal horn convergent neurones

The effects of ES 52, a highly potent derivative of the enkephalinase (enkephalin-dipeptidylcarboxypeptidase) inhibitor thiorphan, were studied on nociceptive activities of dorsal horn convergent neurones in the anaesthetized rat. Neither the C-fibre component of the responses elicited by supramaximal electrical stimulation of the hindpaw excitatory receptive fields nor diffuse noxious inhibitory controls triggered by immersion of the tail in 46-48 degrees C waterbaths, were affected by ES 52. Thus we conclude that, in our experimental conditions, modulations of the transmission of nociceptive messages at the spinal level are not greatly modified by specifically blocking the degradation of enkephalins. If a major role for enkephalinase (vs aminopeptidase) in the catabolism of enkephalins at the spinal level can be confirmed, then comparison of the present data with our previous results obtained using the opioid antagonist naloxone, might suggest a predominant role for proenkephalin B products (i.e. dynorphins and/or alpha-neo-endorphin) in modulating nociceptive transmission in the spinal cord.     

Occurrence of Adverse Events in Long-Term Intrathecal Baclofen Infusion: A 1-Year Follow-Up Study of 158 Adults

Objective

To assess the frequency and types of adverse events (AEs) related to intrathecal baclofen (ITB) therapy in adults, and associated risk factors.

Design

A prospective, observational cohort study of adults followed up from January 1 to December 31, 2010.

Setting

A neurologic rehabilitation department in a university hospital.

Participants

All consecutive adult subjects (N=158) receiving ITB via a pump, either implanted or followed up during the study period.

Intervention

Not applicable.

Main Outcome Measures

Frequency and type of AEs.

Results

In 2010, 158 subjects were followed up for ITB therapy, of whom 128 were implanted before 2010 (nonsurgical subjects), and 30 underwent implantation in 2010 (surgical subjects). Of these 30 subjects, 20 were “newly implanted” and 10 were “replacements.” The most frequent pathologic disorders were spinal cord injury (42%) and multiple sclerosis (28%). Twenty-eight subjects (18%) experienced a total of 38 AEs. The rate of AEs was .023 per month of ITB treatment. AEs were related to the surgical procedure in 53% of cases, to the device in 29% (predominantly catheter dysfunctions), and to adverse effects of baclofen in 18%. AEs related to the surgical incision (scar complications and collections) were more frequent in replacement than newly implanted subjects (P=.009). No significant association between occurrence of an AE and subject characteristics (age, gait capacity, spinal vs cerebral spasticity, duration of ITB therapy follow-up) was found. Nearly half of the AEs were serious, extending admission time by a mean of 16 days. No AE induced long-term morbidity or death.

Conclusions

The AE rate was relatively low in this cohort. This has to be balanced against the clinical, functional, and quality-of-life improvements, which are expected from ITB therapy.     

Self-rehabilitation combined with botulinum toxin to improve arm function in people with chronic stroke. A randomized controlled trial

BackgroundBotulinum toxin injection (BTI) reduces muscle hyperactivity, but its effect on active upper-limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation.ObjectivesThe aim of this randomized controlled trial was to determine the effect of a self-rehabilitation program combined with BTI on upper-limb function in individuals with chronic hemiparesis.MethodsIn total, 33 outpatients were randomly allocated to receive BTI + self-rehabilitation (R group: n = 17) or BTI alone (C group: n = 16). Outcomes evaluated just before the BTI and 4 weeks later included the Wolf Motor Function Test (WMFT time: primary outcome), Action Research Arm Test, fatigue and quality of life.ResultsChange in WMFT did not differ between groups at 4 weeks (WMFT time: ?14% for R group, ?4% for C group. WFMT score: +12% for R group, 0% in C group). WFMT time and score improved significantly in the R group only (?14%, P = 0.01, and +12%, P = 0.02). In addition, the proportion of patients with improved WMFT time and score was higher in the R than C group (R group: 71% improved score, 77% improved time; C group: 43% improved score, 50% improved time). Also, passive range of shoulder flexion (P = 0.03) and wrist extension (P = 0.01) improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed.ConclusionsThe addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone; however, movement quality and speed improved only in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, which suggests that they found the program worthwhile. These clinically relevant findings justify larger-scale studies of the effects of self-rehabilitation to enhance the effects of BTI. Clinical trial: NCT02699762.     

Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix

The objective of our retrospective study was to determine the MDCT-enteroclysis appearance of the appendix in patients with Crohn’s disease and to correlate this appearance with the status of the disease. We reviewed the MDCT-enteroclysis examinations of 76 patients with Crohn’s disease. Images were analyzed for visualization of the appendix, largest axial diameter of the appendix and degrees of enhancement. Findings were correlated with the status of the disease (active vs. nonactive) and compared with those observed in a control group. Among the various variables, hyperenhancement of the appendiceal wall was found in 18.9% of patients with active disease and in no patients with inactive disease nor in the control group (P = 0.0023). This sign had a specificity of 100% for differentiating between active and inactive Crohn’s disease. We conclude that increased appendiceal wall enhancement is, at a statistically significant level, more frequently observed in patients with active Crohn’s disease by comparison with patients with inactive disease and control subjects. This result suggests that this finding may be used as an additional MDCT-enteroclysis finding to determine the activity of the disease.     

Herbalists and wild medicinal plants in M'Sila (North Algeria): An ethnopharmacology survey

Ethnopharmacological relevance

The main aim of this study was to identify, catalogue and document the large number of wild medicinal plants used in the M'Sila region (northern Algeria) for the treatment of several human pathologies. Another more ambitious aim is to contribute to overcoming the limits of an orally transmitted pharmacopoeia, attempting to exploit the large ethnopharmacology patrimony of the region for further pharmacological purposes.

Materials and methods

Our field study was carried out over a period of three years (2008–2010). During this period, herbalists were interviewed using semi-structured questionnaires investigating the herbalist as a holder of information (gender, age and educational level) and about wild medicinal plants (local name, uses and part used). In addition, the relative importance value of the species was determined and informant consensus factor (ICF) was calculated for the medicinal plants included in the study.

Results

A total of 83 herbalists were interviewed; men dominate the practice of traditional medicine in the region. About 41% of them are between 31 and 40 years, and about a third (34%) are illiterate. The traditional herbal knowledge is passed from generation to generation in the verbal form, a writing tradition being almost totally absent. The interviewed herbalists identified and recorded 58 plants species and 50 genera belonging to 27 plant families. Lamiaceae and Asteraceae were the most represented plant families. The aerial parts were the most commonly used plant part, while infusion and decoction were the most common method of traditional drug preparation.

Conclusions

The survey provides a veritable source of information on the herbalists and wild medicinal plants. Plants which are used in different parts of the world for the treatment of similar diseases may be deemed to be effective in pharmacological terms. These medicinal plants may be incorporated into the healthcare delivery system of the country.