Esophageal Endoscopy Results After Pulmonary Vein Isolation Using the Single Big Cryoballoon Technique

Esophageal Effects of Single Big Cryoballoon PVI. Introduction: Reversible esophageal thermal lesions after cryoballoon pulmonary vein isolation (CB‐PVI) have been reported when using variable balloon sizes. The aim of this study was to investigate (1) the incidence of esophageal thermal lesions, and (2) esophageal temperature changes associated with CB‐PVI using the single big cryoballoon technique. Methods and Results: Thirty‐eight patients with atrial fibrillation underwent successful CB‐PVI using only the 28 mm cryoballoon. Luminal esophageal temperature (LET) was continuously monitored by 3 thermocouples. Fluoroscopic distance from cryoballoon to esophagus probe was retrospectively evaluated in RAO 30° and LAO 40° projections. All patients underwent postprocedural esophageal endoscopy. Average minimal LET was lower during freezing at inferior PVs, when compared to superior PVs: 35.4 ± 0.9 (range: 32.6 to 37.4; RSPV); 31.5 ± 7.5 (2.5 to 37.6; RIPV); 32.9 ± 5.2 (8.5 to 36.5; LSPV); and 30.3 ± 8.4°C (?6 to 36.7°C; LIPV); P = 0.001. We found steep temperature gradients over distance (1) from the cryoballoon center (LETs < 10°C confined to a distance of < 15 mm in both RAO 30° and LAO 40° projections), and (2) along the esophagus long axis, underscoring the need for multiple measurement sites. None of the patients showed esophageal thermal lesions at endoscopy after 3 ± 1 (range 1–7) days. No AEF occurred during a follow‐up of 125 ± 78 days. Conclusion: In a cohort of AF patients treated by the single big cryoballoon technique, CB‐PVI was not associated with thermal esophageal lesions. (J Cardiovasc Electrophysiol, Vol. 21, pp. 869‐874, August 2010)     

Monopolar Radiofrequency Treatment of the Eyelids: A Safety Evaluation

BACKGROUND Monopolar radiofrequency (RF) energy has been used to successfully accomplish noninvasive skin tightening of the face, abdomen, and extremities. Owing to concerns about injury to the eye itself, monopolar RF treatment of the eyelids has not been feasible.
OBJECTIVE The objective was to evaluate the safety of a novel 0.25-cm²"shallow" treatment tip for noninvasive tightening of eyelid skin.
METHODS AND MATERIALS This was a tripartite study that began with an animal model to evaluate soft tissue effects and temperature change at the ocular surface. Findings were then extrapolated to ex vivo evaluation of human eyelids and ultimately to an in vivo human eyelid safety study.
RESULTS The animal studies demonstrated that the 0.25-cm² treatment tip could be used safely on eyelids in conjunction with appropriate ocular protection. The ex vivo human eyelid studies confirmed that, at typical treatment settings, the shallow treatment tip did not produce frank eyelid injury. The in vivo human studies confirmed that, at the tested settings, the novel treatment tip did not injure the eyelids or eyes.
CONCLUSION If used properly, the 0.25-cm² treatment tip can be safely used on human eyelids.     

REQUIREMENTS FOR PROTEIN AND ESSENTIAL AMINO ACIDS IN EARLY INFANCY1Studies with a Soy-Isolate Formula

Thirteen normal female infants were observed from 8 through 111 days of age while receiving a diet providing 1.62 g of protein per 100 kcal, almost entirely from soy-isolate. Clinical observations, growth rates and serum concentrations of albumin were similar to those of female infants fed milk-based formulas providing greater intakes of protein. On the basis of these findings, it is assumed that the requirements for protein and essential amino acids of these infants were no greater than the amounts consumed. Reasons for preferring to express requirements for proteins and amino acids per unit of calorie intake rather than per unit of body weight are presented. The preliminary estimates of requirements presented here are believed applicable when the diet is adequate in total calories and non-nitrogenous essential nutrients, nitrogen is provided primarily in the form of whole proteins, and protein intakes do not greatly exceed the requirement. For reasons discussed, the approach is likely to yield estimates of requirements for some amino acids that are substantially greater than the true requirements. Nevertheless, our estimates of requirements for isoleucine and methionine are distinctly less than those reported by Holt & Snyderman. We conclude that the estimates of Holt & Snyderman from studies of infants fed mixtures of amino acids are less relevant than our estimates to circumstances in which whole proteins are fed in amounts that do not greatly exceed the requirement for protein.     

D2 DOPAMINE RECEPTOR TaqI ALLELES IN MEDICALLY ILL ALCOHOLIC AND NONALCOHOLIC PATIENTS

The prevalence of TaqI A alleles of the D₂ dopamine receptor(DRD2) gene was examined in two subgroups of medically ill nonalcoholics(more prevalent and less prevalent substance users, MPSU andLPSU, respectively) and in two subgroups of medically ill alcoholics(more severe and less severe alcoholics, MSA and LSA, respectively).The prevalence of the Al allele in the 80 nonalcoholic and 73alcoholic patients was 30.0% and 52.1%, respectively (P = 0.009).In the four subgroups of these patients, the prevalence of thisallele was: LPSU = 18.2%, MPSU = 34.5%, LSA = 44.4% and MSA= 58.3%. Linear trend analysis showed that as the use of substancesand severity of alcoholism increase, so does Al prevalence (P= 0.001). Specific, subgroup comparisons showed Al prevalencein MSA to be about 3-fold (P = 0.007) and 1.5-fold (P = 0.04)higher than in LPSU and MPSU subgroups, respectively. Similarly,in a combined analysis of independent studies, Al prevalencein MSA was higher when compared to LSA (P < 5 x 10^–3),MPSU (P < l0^–4 and LPSU (P < l0^–8) subgroups.There was virtually no difference in the prevalence of the Alallele between LSA and MPSU subgroups. None of the specificmedical or neuropsychiatric complications of alcoholism wasassociated with the Al allele. In conclusion, the severity ofalcohol dependence in alcoholics and of substance use behaviorsin controls are important variables in DRD2 allelic association.The present report and converging lines of evidence suggestthat the DRD2 locus could represent a prominent gene risk factorfor susceptibility to severe alcoholism. However, other genesand environmental factors, when combined, still play the largerrole.     

Pharmacological characterization of four related substance P antagonist

The purpose of this pharmacological study was to further characterize 4 related substance P (SP) analogues, namely (D-Pro², D-Phe⁷, D-Trp⁹)-SP (I), (D-Pro², D-Trp^7.9)-SP (II), (D-Arg¹, D-Pro², D-Phe⁷, D-Trp⁹)-SP (III) and (D-Arg¹, D-Pro², D-Trp^7.9)-SP (IV). At a concentration of 10^-4 M they were found to have little or no smooth muscle-contracting effect on the guinea-pig ileum, analogues I and II having substantially less agonist activity than III and IV. Pretreatment with the analogues inhibited the contractile responses to SP, but not to histamine or acetylcholine. Of the 4 analogues, II was found to be the most potent SP antagonist. The contractile responses to physalaemin and eledoisin were also inhibited by analogue II. The concentration-response curves for SP were shifted in parallel to higher concentrations in the presence of the analogues. The pA₂-values derived from Schild plots were 4.61 for (I), 5.43 for (II), 4.69 for (III) and 5.11 for (IV). Except for (I) the slopes of the regression lines of the Schild plots were close to unity. The data are consistent with simple competitive antagonism over the concentration ranges investigated. Without being secretagogues per se, the analogues inhibited SP-stimulated salivary secretion in the rat. Physalaemin-stimulated secretion was inhibited by analogue II. The inhibitory effect of sequences with D-Arg¹ instead of L-Arg¹ seemed to be of longer duration. Not one of these analogues blocked the blood pressure-lowering effect of SP, which indicates the existence of more than one type of SP receptor. This study has shown that 4 related SP analogues specifically inhibit the actions of SP and structurally related peptides physalaemin and eledoisin, both in vitro and in vivo. Analogues II-IV seem to inhibit in a simple competitive manner. (D-Pro², D-Trp^7.9)-SP was the most potent of the 4 SP antagonists.     

Comparison of health inequalities between East and West Germany

Background: The major objective of the study was to assess whetherthe extent of health inequalities varies between East and WestGermany and whether differences in social Inequalities betweenboth parts of Germany are associated with differences in healthinequalities. Methods: Data were available from a representativesample of 5,311 persons from West Germany and 2,414 personsfrom East Germany in the same age group (25–69 years).The study protocol was nearly identical in both studies. Socioeconomicstatus (SES) was assessed by household equivalent income andby educational level. Health status was assessed by perceivedgeneral health and by the number of chronic conditions. Absolutedifferences as well as relative differences (odds ratios) inthe morbidity rates between low and high SES groups were calculated.All analyses were performed separately for men and women. Results:Income inequalities are larger in West Germany as compared withEast Germany, but there are minor differences between East andWest Germany concerning educational inequalities and morbidityrates. Just about all measures indicated that health inequalitiesfavouring the upper socioeconomic groups exist in East Germanyas well as in West Germany and that there are no significantdifferences in the extent of health inequalities between bothparts of Germany. Conclusion: Using two data sets which wereraised with nearly identical study protocols, it can be concludedthat health inequalities are very stabile as they do not seemto differ substantially despite the fact that both parts ofGermany have experienced different social systems during thepast 45 years.     

EXPRESSION OF THE LAMININ γ2 CHAIN IN PANCREATIC ADENOCARCINOMA

Forty-two pancreatic adenocarcinomas were investigated immunohistochemically and by in situ hybridization for the expression of the laminin γ 2 chain. In 41 cases, intracytoplasmic immunoreactivity for the γ2 chain was seen. Positive tumour cells were located especially at the epithelial–stromal interface of the tumour cell islands. In 22 cases, diffuse laminin γ2 chain immunoreactivity could also be seen in stroma and in seven cases, occasional positivity was detected in the neoplastic basement membranes. Signals for laminin γ2 chain mRNA in tumour cells displayed a distribution similar to that observed on immunohistochemistry. There were significantly more cases with less than 20 per cent of laminin γ2 chain-positive tumour cells in tumours extending to peripancreatic tissues and/or tumours with regional or distant metastases ( P =0·029). A corresponding statistical significance could also be noted in the mRNA level ( P =0·025). The results show that pancreatic adenocarcinomas display a high activity of laminin γ 2 chain synthesis. Tumours with a strong laminin γ2 chain synthesis show a lower invasive and metastatic potential than tumours with a weak or moderate laminin γ2 chain expression.