Cardiorespiratory control: an Integrated view H.-P. Koepchen in memoriam

SUMMARY  H.-P. Koepchen's presence at this symposium on cardiocirculatory function during sleep would have given us an inspiring impetus. His death has meant a severe loss for all of us. Koepchen's integrated view on cardiorespiratory control and rhythmicity has been the content of his late work. His considerations as documented in various papers are used for this contribution. They are based on earlier experimental studies of spontaneous coordinations of rhythmic activities in anaesthetized dogs, conscious men, and microelectrode recordings and local cooling experiments in the brain stem of anaesthetized dogs and cats, which he had worked on together with his students.     

Immunogenicity in rabbits and monkeys of influenza ISCOMs conjugated with repeated sequences of the Plasmodium falciparum antigen Pf155/RESA

Rabbits and monkeys were immunized with two fusion proteins, ZZ-M3 and ZZ-M5, coupled to pre-formed influenza virus membrane glycoprotein ISCOMs. The fusion proteins comprise two IgG-binding domains from staphylococcal protein A (ZZ) and repeated amino acid sequences from the C-terminal (M3) or central (M5) repeat regions of the Plasmodium falciparum antigen Pf155/RESA. The induced antibody responses were of long duration, could be efficiently boosted and were comparable to those obtained with Freund's Adjuvant. The produced antibodies reacted with M3, M5, protein A and the influenza glycoprotein, recognized Pf155/RESA and inhibited merozoite invasion in vitro. These results suggest that coupling of immunogens to pre-formed ISCOMs may be a basis for construction of multivalent subunit vaccines.     

Coronary Thrombolysis

Myocardial infarction (MI) size is the major determinant of the function of the left ventricle and thus of the prognosis of the patient. Attempts to limit infarct size therefore constitute an important goal in modern coronary care. There is evidence that intravenous thrombolytic therapy can lyse coronary artery thrombi, restore antegrade coronary blood flow, preserve myocardial viability and function and improve survival. The time interval from onset of infarction, the extent of remaining ischemic myocardium and the rate at which myocardial necrosis is progressing are factors influencing the extent of myocardial salvage in reperfusion.     

Ring 14 chromosome presenting as early-onset isolated partial epilepsy

We report four infants (two males, two females) with ring 14 chromosome presenting with early-onset partial epilepsy. The first seizure occurred between 3 and 6 months (3, 3, 4, and 6mo respectively). In all four cases, diagnosis was based on early focal seizures, rather than on psychomotor retardation or morphological features, which were not prominent at seizure onset. Moreover, despite the young age of the patients and the high frequency of seizures, neither epileptic spasms nor progression to 'epileptic encephalopathy', such as hypsarrhythmia, were observed. Epilepsy remained partial in these patients. At the most recent follow-up, all four children had slight or mild psychomotor delay, and two of them had moderate non-specific dysmorphic traits. Data from the literature about epilepsy in ring 14 chromosome syndrome were also reviewed. Ring 14 chromosome syndrome may be revealed by isolated, early-onset focal epilepsy suggestive of focal lesions with only mild mental retardation and morphological features at the time of diagnosis. The characteristics of these observations differ from classic ring 14 syndrome, and may enlarge this clinical spectrum. Many unanswered questions remain concerning phenotype–genotype correlation and identification of the potential genes and molecular mechanisms responsible for epilepsy in patients with ring 14 syndrome.     

Evaluation of a Bifurcation Drug‐Eluting Stent System versus Provisional T‐Stenting in a Perfused Synthetic Coronary Artery Model

Background: Provisional T‐stenting is a widely used strategy for the treatment of coronary artery bifurcation lesions. However, the use of conventional stents in this setting is limited by multiple factors; this includes technical considerations such as wire wrap when accessing the involved vessel, and stent overlap at or near the carina of the lesion. In addition, current slotted tube stent technology tends to be associated with gaps in the coverage of the side branch ostium, which may result in restenosis in that segment of the lesion. The Pathfinder device, now more commonly referred to as the Xience Side Branch Access System (Xience SBA) is a drug‐eluting stent (DES) designed specifically to assist in the treatment of bifurcation lesions by allowing wire access into the side branch, irrespective of the treatment strategy to be employed. Methods: The Xience SBA drug‐eluting stent was compared with the standard Vision coronary stent system using a provisional T‐stenting strategy in a perfused synthetic model of the coronary vasculature with side branch angulations of 30°, 50°, 70°, and 90°. Stent delivery was performed under fluoroscopic guidance. Following the procedure, high‐resolution 2D Faxitron imaging was used to evaluate deployment accuracy of the side branch stent relative to the main branch stent. Results: Deployment of the Xience SBA was accomplished in the same total time as the standard stents in a provisional T‐stenting approach (14.9 vs. 14.6 minutes). However, the time required to achieve stent deployment in the main branch was less with the Xience SBA (4.0 vs. 6.6 minutes), and as a result, total contrast usage (49.4 vs. 69.4 cm³) and fluoroscopy time (5.1 vs. 6.2 minutes) was lower. Additionally, the Xience SBA had a lower incidence of wire wrap (22% vs. 89%) and less distal protrusion of the side branch stent into the main branch (0.54 vs. 1.21 mm). Significant gaps in ostial side branch coverage were not seen in either group. Conclusions: The Xience Side Branch Access DES is a viable device for consistently accessing coronary bifurcation lesions; it allows for easy wire access into the side branch. This may assist the operator in overcoming those well‐recognized limitations associated with use of standard one‐ or two‐stent strategies. In this perfused synthetic coronary model, Xience SBA deployment required less contrast usage and shorter fluoroscopy times. Further testing of this device is warranted.     

Psychometric testing of the Leadership and Management Inventory: a tool to measure the skills and abilities of first‐line nurse managers

Aim To estimate the validity and reliability of the Leadership and Management Inventory, a tool to measure the skills and abilities of first‐line nurse managers. Background The decision to develop an inventory reflects the need for an instrument that can measure the various skills and abilities first‐line nurse managers should possess. Method Factor analysis was conducted and internal consistency initially estimated on data from 149 registered nurses; a second sample of 197 health care personnel was used to test these results. Results Principal component analysis of the first sample resulted in a preferred three‐factor solution that explained 65.8% of the variance; Cronbach’s alpha coefficient varied between 0.90 and 0.95. Analysis of the second sample also resulted in a three‐factor solution that explained 64.2% of the variance; Cronbach’s alpha coefficient varied from 0.88 to 0.96. For both samples, the factors were labelled ‘interpersonal skills and group management’, ‘achievement orientation’ and ‘overall organizational view and political savvy’. Conclusion Results indicate that estimates of validity and reliability for the Leadership and Management Inventory can be considered acceptable. Implications for nursing management The Leadership and Management Inventory can be used when first‐line nurse managers’ leadership and management skills and abilities are to be measured.     

Blood-brain barrier permeability during shortlasting intravascular hyperosmolality

Blood-brain barrier permeability for 24Na+ and 36Cl- ions and for 3HOH was studied during isoosmolality and during shortlasting intravascular hyperosmolality in twenty-five patients using the double indicatir single injection method. Hyperosmolality was induced by a rapid injection into the internal carotid artery of 8 ml of one of the following hypertonic solutions: 5% saline, 25% mannitol or a contrast medium of the metrizoat group (Isopaque-amine 280). The extractions of the small sodium and chloride ions remained unchanged and essentially zero indicating that 'opening' of the blood-brain barrier did not occur. The blood-brain barrier permeability to water remained unchanged during hyperosmolality, but the extraction of 3HOH increased when mannitol and especially when Isopaque-amine 280 was used as hypertonic agent corresponding to the lower water concentration in these solutions.     

Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults: Feasibility,Safety, and Efficacy

Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults Background: Catheter ablations are traditionally performed using fluoroscopic guidance, exposing both patients and medical staff to the risks of radiation. Nonfluoroscopic catheter ablation has been used successfully to treat limited types of arrhythmias in children, but whether this approach has broad application in adults is uncertain. The purpose of this study was to evaluate the feasibility, safety, and efficacy of fluoroless catheter ablation in adults being treated for a range of arrhythmias. Methods and Results: Retrospective analysis was performed in 2 patient groups (both n = 60): (1) the nonfluoroscopy (NF) group consisting of consecutive adult patients, in which catheter positioning was accomplished exclusively with intracardiac electrograms (IE), electroanatomic mapping (EAM), and intracardiac echocardiography (ICE); and (2) the fluoroscopy (F) group, in which catheter positioning was additionally guided by fluoroscopy. The patients in the F group were selected to match the types of arrhythmias in the NF group. All ablation procedures were performed by one operator. The total procedure time did not differ between groups for any specific type of arrhythmia ablated. Acute procedural success was similar in both groups (NF, 59/60 [98%] and F, 60/60 [100%]). The complications were limited to a groin pseudoaneurysm in the NF group, and pericardial effusion and groin hematoma in the F group. Conclusion: Catheter ablations were efficiently and effectively performed in adults with a variety of arrhythmias using only IE, EAM, and ICE for catheter guidance. This nonfluoroscopic technique was feasible, posed no additional safety concerns, and should be readily implementable in most electrophysiology laboratories. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1078‐1086, October 2012)