Interlead Distance and Left Ventricular Lead Electrical Delay Predict Reverse Remodeling During Cardiac Resynchronization Therapy

Background: Both anatomic interlead separation and left ventricle lead electrical delay (LVLED) have been associated with outcomes following cardiac resynchronization therapy (CRT). However, the relationship between interlead distance and electrical delay in predicting CRT outcomes has not been defined. Methods: We studied 61 consecutive patients undergoing CRT for standard clinical indications. All patients underwent intraprocedural measurement of LVLED. Interlead distances in the horizontal (HD), vertical (VD), and direct (DD) dimensions were measured from postprocedure chest radiographs (CXR). Remodeling indices [percent change in left ventricle (LV) ejection fraction, end‐diastolic, end‐systolic dimensions] were assessed by transthoracic echocardiogram. Results: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.361, P = 0.004) and a negative correlation between LVLED and VD on posteroanterior (PA) CXR (r =?0.281, P = 0.028). To account for this inverse relationship, we developed a composite anatomic distance (defined as: lateral HD—PA VD), which correlated most closely with LVLED (r = 0.404, P = 0.001). Follow‐up was available for 48 patients. At a mean of 4.1 ± 3.2 months, patients with optimal values for both corrected LVLED (≥75%) and composite anatomic distance (≥15 cm) demonstrated greater reverse LV remodeling than patients with either one or neither of these optimized values. Conclusions: We identified a significant correlation between LV–right ventricular interlead distance and LVLED; additionally, both parameters act synergistically in predicting LV anatomic reverse remodeling. Efforts to optimize both interlead distance and electrical delay may improve CRT outcomes. (PACE 2010; 575–582)     

Effects of Anti-CD 18 and LPS on CD 14 Expression on Human Monocytes

In this study we show that the cytokine stimulatory effect of LPS on human monocytes is enhanced by addition of monoclonal antibodies against CD18 (aCD18 MoAbs). Incubation of monocytes with αCD18 MoAbs overnight increased the CD 14 expression as detected by Leu-M3, but not with My-4. These results indicate that CD18 participates in LPS-induced TNF-o production as well as in regulating CD14 expression on monocytes. Addition of LPS to monocytes resulted in a reduction in the CD14 expression after 1/2, 1, 2 and 4h, but increased CD 14 expression was seen after LPS stimulation overnight. By doing double labelling of the monocyte population for CD 14 and CD16 it was found that the reduction in CD 14 expression occurred in the CD14⁺/CD16⁺ sub-population, while the increase in CD14 expression was seen in both the CD14⁺/CD16⁺ and the CD14⁺/CD16⁺ cells. αCDU MoAbs that were able to inhibit LPS-induced cytokine production from monocytes (3C10 and My-4) were considerably less able to detect the increase in CD14 expression after LPS stimulation than aCD14 MoAbs that did not inhibit LPS-induced cytokine production (Leu-M3 and αCD14_serva)- Our data indicate that My-4 and Leu-M3 define two populations of CD14⁺ cells on LPS stimulated human monocytes.     

All for one and one for all: team building and nursing

Nursing care provision has become increasingly complex with the growth of health care systems in recent years. This has resulted in a greater emphasis upon the use of team approaches to providing care. This paper explores the nature of teams within nursing and how they can be developed. The membership of nursing teams and the differences between the type of teams is also examined. The process of team building in nursing teams and the way that induction programmes can play a part in this team building process is also discussed.     

Darier''s disease: an immunohistochemical study using antibodies to proteases

The expression of plasminogen activators, plasminogen and fibrinogen was investigated in 10 specimens of normal skin and in the involved skin of seven males with Darier's disease, using immunohistochemical techniques. Changes in the localization of proteases were found in the involved skin of Darier's disease, plasminogen being expressed by suprabasal cells and fibrinogen being detected in the keratotic plug.     

The Involvement of CD 14 in Stimulation of TNF Production from Peripheral Mononuclear Cells Isolated from PNH Patients†

Peripheral blood mononuclear ceils (PBMC) from six patients with paroxysmal nocturnal haemoglobinuria (PNH) were analysed by flow cytometry for expression of CD14 and for ability to respond to bacterial lipopolysaccharide and β 1–4 linked polymannuronic acid by TNF secretion. Expression of cell surface CD 14 could not be detected on cells from the PNH patients, whereas the levels of expression of other monocyte antigens, e. g. CD33 and CD13, were comparable to that of cells from healthy subjects. The cells from the patients with PNH responded with secretion of significantly less TNF after stimulation with LPS and polymannuronic acid than mononuclear cells from healthy subjects, suggesting an impaired ability in PNH to respond to bacterial infection by TNF secretion from monocytes. Soluble CD 14 appeared to be involved in the residual activation of CD14 negative PBMC, and the sera of these patients contained normal or slightly elevated levels of soluble CD 14. After allogeneic bone marrow transplantation in one patient the monocytes expressed CD 14 at normal levels and responded normally with respect to their ability to generate TNF upon stimulation.