The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival

Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention). In both groups, the ICD showed overall and cardiac mortality reduction. The device now can more accurately detect VT-VF and differentiate these from other arrhythmias through a series of algorithms and direct-chamber sensing. Therapy options include painless antitachycardia pacing, low-energy cardioversion, and high-energy defibrillation. The technique implant is now simple as a pacemaker with one lead attached to an active (hot) can functioning as the other electrode. Among other improvements is its weight, volume, multiprogrammability, and storage of information,dual-chamber pacing and sensing, dual-chamber defibrillation, and addition of biventricular pacing for cardiac synchronization. It is anticipated that further improvement in ICD technology will take place and the list of indications will grow.     

Children grow and horses race: is the adiposity rebound a critical period for later obesity?

Background  

The adiposity rebound is the second rise in body mass index that occurs between 3 and 7 years. An early age at adiposity rebound is known to be a risk factor for later obesity. The aim here is to clarify the connection between the age at rebound and the corresponding pattern of body mass index change, in centile terms, so as to better understand its ability to predict later fatness.     

Short-Term Toxicity and Binding of Platinum to Freshwater Periphyton Communities

The release of platinum (Pt) from automobiles equipped with exhaust catalysts has resulted in increasing concentrations of this normally rare metal in the urban and roadside environment. Although concentrations are increasing, little is known about the environmental effects of Pt and its potential toxicity. This study was an investigation of Pt toxicity to naturally grown periphyton communities. Periphyton communities were exposed to Pt(II) and Pt(IV) in reference and stream waters. Uptake increased linearly with Pt concentration for both reference- and stream-water exposure. However, decreased photosynthetic activity was observed only for reference-water exposure. This difference was related to uptake by biotic components in reference water and binding to abiotic components in stream water.     

Expression of progesterone receptors A and B and insulin-like growth factor-I in human myometrium and fibroids after treatment with a gonadotropin-releasing hormone analogue

OBJECTIVE: To determine mRNA and protein expression of the progesterone receptor (PR) and insulin-like growth factor-I (IGF-I) in myometrium and fibroids. DESIGN: Retrospective clinical study.SETTING: Hospital-based and university-affiliated research laboratories. PATIENT(S): Twelve women in the proliferative phase and six women treated with GnRH analogue (GnRH-a). INTERVENTION(S): Blood sampling and collection of myometrium and fibroids. MAIN OUTCOME MEASURE(S): PR and IGF-I mRNA levels in fibroids and myometrium were analyzed by solution hybridization and in situ hybridization whereas the proteins were localized by immunohistochemistry. RESULT(S): Fibroids and myometrium from women in the proliferative phase showed significantly higher PR mRNA than the corresponding tissues from GnRH-a-treated women. The amount of cells positively stained for PR-AB and PR-B in fibroids and myometrium decreased after GnRH-a treatment compared with in the proliferative phase. The IGF-I mRNA in both fibroids and myometrium in the proliferative phase was significantly higher than those after GnRH-a treatment. The immunostaining of IGF-I showed no difference between the two tissues. There was weaker immunostaining in the GnRH-a-treated group compared with in the proliferative phase group. CONCLUSION(S): The shrinkage of fibroids after steroid deprivation is associated with alterations in PR and IGF-I expression.     

Variability in zinc tolerance,measured as incorporation of radio-labeled carbon dioxide and thymidine,in periphyton communities sampled from 15 European river stretches

Fifteen European rivers and streams belonging to watersheds in Sweden, the Netherlands, and Spain respectively, were sampled by allowing periphyton to colonize submerged glass substrata. Their zinc tolerances were quantified in short-term laboratory tests, where inhibition of photosynthesis in microalgae and thymidine incorporation in bacterial DNA was measured, and expressed as EC50 values. The variability in zinc tolerances was high reaching 1.5–2.5 orders of magnitude, ranging from 25–8145 μM for photosynthesis and 15–467 μM for thymidine assays. Based on the observed variability, uncertainty factors were estimated for the extrapolation of zinc toxicity data from river to river, both regionally and interregionally. Under the assumption to protect 95% of the observed communities the regional uncertainty factors were 1.7–4.3 and the interregional 2.4–8.6. The sampling sites were characterized in terms of biotope physiography, water chemistry, periphyton biomass, trace element content, and species composition. Multivariate analysis of the data using PLS (Projection to Latent Structure), was used to generate hypotheses about the relation between periphyton zinc tolerance and the 123 so-called predictor variables. Zinc contamination, phosphate, nitrogen nutrients, pH, calcium, bicarbonate, dissolved organic carbon, and various diatom species are important predictors for zinc tolerance in the entire data set representing all 15 river stretches. Regional models suggested that very different factors determined the zinc tolerance in the Swedish and Dutch periphyton. The results are interpreted in terms of Pollution-Induced Community Tolerance (PICT) and the bioavailability of zinc. Received: 16 December 2001/Accepted: 24 July 2002     

Pulmonary function in asthmatic children during thalassotherapy.

In 39 asthmatic children, 5-14 years of age, sent to the Kinderkurheim Satteldüne for a 6 week course of thalassotherapy, the following pulmonary function studies were tested serially: Vital capacity (VC), one-second forced expiratory volume (FEV1), maximal mid-expiratory flow rate (MMFR) and peak flow rate (PFR). Results expressed as mean values per week of the group as a whole, showed subnormal results at initial testing in all 4 parameters measured. Improvement followed rapidly with the final level generally achieved during week 2. However, statistical analysis showed the differences between the initial and each of the subsequent values to be insignificant with one exception in the FEV1 values. Thus the clinical improvement observed in most patients during thalassotherapy could not be substantiated by pulmonary function tests.     

13Carbon mixed triglyceride breath test and pancreatic enzyme supplementation in cystic fibrosis

Children with cystic fibrosis have variable degrees of exocrine pancreatic insufficiency which, if untreated, is the main cause of fat malabsorption. The impact of pancreatic enzyme supplementation on fat digestion was measured in 41 children with cystic fibrosis, 11 healthy controls, and five children with mucosal diseases by a non-invasive test of intraluminal lipolysis using 13carbon (13C) labelled mixed triglyceride (1,3-distearyl, 2[13C] octanoyl glycerol). The children with cystic fibrosis without pancreatic supplements had a median (range) 13C cumulative percentage dose recovered over six hours (cPDR) of 3.1% (0-31.7), the controls 31.0% (21.8-41.1), and the subjects with mucosal disease 27.8% (19.7-32.5). In 23 subjects with cystic fibrosis the usual dose of pancreatic enzyme supplements increased the cPDR to a median of 23.9% (0-45.6), and twice the usual dose of enteric coated microspheres increased the cPDR to 31.1% (11.1-47.8). There was no significant difference between the median cPDR of normal controls and children with mucosal disease, but there was a highly significant difference between these groups and children with untreated cystic fibrosis. Thirteen children with cystic fibrosis had no 13C recovery in their breath without enzymes and 10 showed marked increases with regular enzymes. In eight children doubling the dose of enzymes caused no or minimal improvement. The mixed triglyceride breath test offers a simple, non-invasive way of assessing the need for pancreatic enzyme supplementation in children with cystic fibrosis and could be used to optimise treatment.