Cardiac Anatomy for the Interventional Arrhythmologist: I.Terminology and Fluoroscopic Projections

Cardiac anatomy is complex and its understanding is essential for the interventional arrhythmologist. The first difficulty is the terminology used to describe the location of sites of mapping and ablation. For many years, electrophysiologists have named these positions following the conventional electrocardiographical vocabulary, or the terminology used by surgeons performing arrhythmic surgery. This traditional nomenclature, however, failed to take note of the crucial principle of considering the location of the heart in the human body as viewed in its erect position. In other words, it had failed to use an attitudinally appropriate terminology. Almost 10 years ago, a new attitudinal nomenclature was proposed for the right and left atrioventricular junctions. In this first of a series of reviews of cardiac anatomy as seen by the interventional arrhythmologist, we discuss the role of attitudinally appropriate terminology, and relate this to the projections used for cardiac fluoroscopy, fluorography, and angiography. Throughout our series of reviews, we will illustrate the value of The Visible Human Slice and Surface Server in facilitating the understanding of the fluoroscopic anatomy. (PACE 2010; 497–507)     

A COMPARISON OF NSP-RETICULONS WITH CONVENTIONAL NEUROENDOCRINE MARKERS IN IMMUNOPHENOTYPING OF LUNG CANCERS

Neuroendocrine-specific protein (NSP)-reticulons are endoplasmic reticulum-associated protein complexes, which have been identified as markers for neuroendocrine differentiation. In this study, the expression of two members of the family of NSP-reticulons, NSP-A and NSP-C, have been investigated in different types of lung cancer and compared with the expression patterns of five conventional neuroendocrine markers, the neural cell adhesion molecule (NCAM), synaptophysin, chromogranin A, Leu-7, and neurofilament proteins. NSP-A and NSP-C antibodies were reactive with most carcinoid tumour and small cell lung carcinoma (SCLC) cases, while atypical carcinoid tumours showed a variable expression. In the total group of neuroendocrine tumours, a high concordance of expression was found between NSP-A and NSP-C, while their expression correlated well with NCAM and synaptophysin positivity. Chromogranin A, Leu-7, and neurofilament proteins were shown to be expressed to a limited extent in these neuroendocrine tumours. In a selected group of non-SCLCs known to exhibit neuroendocrine features, NSP-A expression was detected at much higher frequency than NSP-C. In virtually all NSP-A positive cases, this expression was associated with one or more of the other neuroendocine markers. NSP-A expression showed a stronger correlation with conventional neuroendocrine markers than NCAM. In detecting neuroendocrine differentiation in non-SCLC, NSP-A is more sensitive than synaptophysin, chromogranin A, Leu-7, and neurofilament proteins. It is concluded that NSP-reticulons are valuable markers in the diagnosis of neuroendocrine differentiation in non-SCLC and should be used in conjunction with NCAM. © 1997 John Wiley & Sons, Ltd.     

Pacing and Sensing: How Can One Electrode Fulfill Both Requirements?

Pacing and sensing are two different functions which can be accomplished by one and the same electrode. Optimal pacing requires a high tissue resistance in order to minimize the stimulation energy, making a small surface electrode highly desirable. For adequate sensing, however, the tissue resistance should be as low as possible which requires a larger electrode surface area. Decreasing the electrode surface area results in an increased polarization impedance. As this latter should he low for both pacing and sensing, an electrode with a large surface area should be used. How can these opposing needs be met by one electrode? The combination of a small geometrical surface and a large porous microstructure along with the choice of low polarizable materials meets both the requirements of pacing and sensing.     

The Action of Chelating Agents in Experimental Uranium Intoxication in Mice: Variations with Structure and Time of Administration

The determination of the relative abilities of 11 chelatingagents to enhance the urinary and fecal excretion of uraniumwhen administered 10 min after uranyl acetate dihydrate (UAD)in mice showed that the most effective of these were Tiron,desferrioxamine, and 1,2-dimethyl-3-hydroxypyrid-4-one. An increasein the interval between UAD administration and that of the chelatingagent drastically reduces the net mobilization of the uraniumby the chelating agents examined. When given shortly after UAD,Tiron produced the greatest reduction in renal and bone levelsof uranium. None of the chelating agents were able to affectthe bone levels of uranium when administered 24 hr or more afterthe administration of the UAD.     

A Th2-score in the tumor microenvironment as a predictive biomarker of response to Bacillus Calmette Guérin in patients with non-muscle invasive bladder carcinoma: A retrospective study

Intravesical Bacillus Calmette Guerin (BCG) is the gold standard therapy for intermediate/high-risk nonmuscle invasive bladder cancer (NMIBC). However, the response rate is ~60%, and 50% of non-responders will progress to muscle-invasive disease. BCG induces massive local infiltration of inflammatory cells (Th1) and ultimately cytotoxic tumor elimination. We searched for predictive biomarker of BCG response by analyzing tumor-infiltrating lymphocyte (TIL) polarization in the tumor microenvironment (TME) in pre-treatment biopsies. Pre-treatment biopsies from patients with NMIBC who received adequate intravesical instillation of BCG (n = 32) were evaluated retrospectively by immunohistochemistry. TME polarization was assessed by quantifying the T-Bet+ (Th1) and GATA-3+ (Th2) lymphocyte ratio (G/T), and the density and degranulation of EPX+ eosinophils. In addition, PD-1/ PD-L1 staining was quantified. The results correlated with BCG response. In most non-responders, Th1/Th2 markers were compared in pre-and post-BCG biopsies. ORR was 65.6% in the study population. BCG responders had a higher G/T ratio and a greater number of degranulated EPX+ cells. Variables combined into a Th2-score showed a significant association with higher scores in responders (p = 0.027). A Th2-score cut-off value >48.1 allowed discrimination of responders with 91% sensitivity but lower specificity. Relapse-free survival was significantly associated with the Th2-score (p = 0.007). In post-BCG biopsies from recurring patients, TILs increased Th2-polarization, probably reflecting BCG failure to induce a pro-inflammatory status and, thus, a lack of response. PD-L1/PD-1 expression was not associated with the response to BCG. Our results support the hypothesis that a preexisting Th2-polarized TME predicts a better response to BCG, assuming a reversion to Th1 polarization and antitumor activity.     

Oral manifestations as important symptoms for juvenile dermatomyositis early diagnosis: a case report

International Journal of Paediatric Dentistry 2011; 21: 77–80 Background. Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy of childhood and adolescence, characterized by symmetrical weakness of proximal muscles and classical cutaneous features. Literature reports rarely describe or focus on oral lesions that are associated with this disease. Case report. This case describes a 4‐year‐old girl in whom the oral lesions were the initial manifestations of JDM. Physical examination revealed characteristic skin manifestations, proximal muscle weakness, extensive calcinosis, necrotic ulceration, complicated erysipelas, and diffuse alopecia. The diagnosis was established based on the clinical, histological, electroneuromyography, and biochemical findings. Conclusion. Recognition of gingival telangiectases as an important diagnostic marker of JDM leads us to suggest that identifying oral manifestations, which may be carried out by a paediatric dentist, contributes in establishing an early diagnosis and an immediate treatment of this condition.     

Association between sleep duration and all‐cause mortality in old age: 9‐year follow‐up of the Bambuí Cohort Study,Brazil

This study investigates the association of sleep duration with risk of all‐cause mortality among elderly Brazilians using data from a 9‐year population‐based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox’s proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15 000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9 h or more per night were found to be at higher risk of mortality than those who slept 7 h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12–2.09]. Excluding those whose deaths occurred within 2 years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12–2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02–1.15) and following exclusion of those whose deaths occurred within 2 years after entry (HR: 1.13; 95% CI: 1.06–1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all‐cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.     

Malignancy: Case Report: Acute Promyelocytic Leukemia in Late Pregnancy. Successful Treatment with All-Trans-Retinoic Acid (ATRA) and Chemotherapy

The use of all-transretinoic acid (ATRA) in APL is a great advance in the treatment of acute leukemia, driving the maturation steps until adult form. The effect of this medication in pregnant women with APL is being a safe and effective treatment only after the first trimester of pregnancy. If used in the first three months, it can cause fetus malformations due to its potent teratogenicity. The two patients we reported here, gave birth to normal children, yet they received ATRA. After a week with ATRA treatment, fibrinogen level improved and "D" dimers decreased, so as observed slowly maturation of leukemic leucocytes. ATRA used at the same time with chemotherapy; such as Cytarabine and Idarrubicine seems highly useful for induction and long term control of disease. One short discussion about the findings and compare with those found in the literature are presented.