Complex Fractionated Electrograms and AF Nests in Vagally Mediated Atrial Fibrillation

Background: Catheter ablation targeting of complex fractionated atrial electrograms (CFAEs) is one of the techniques used for atrial fibrillation (AF) ablation. The ablation of sites showing a high‐frequency spectral component (HFC) during sinus rhythm, known as AF nests, has been introduced as an adjunct to conventional ablation. Known locations of some AF nests are similar to CFAE sites. However, it has not been systematically evaluated whether these two targets represent the same foci. The purpose of this study was to compare the anatomical locations of these sites using an animal model of vagally mediated AF. Methods: Five anesthetized open‐chest dogs were evaluated. Atrial electrograms were obtained epicardially. AF was induced by burst atrial pacing with 20 Hz during vagal stimulation. A total of 15 sites (eight sites in right atrium and seven sites in left atrium) were evaluated in each animal. The CFAE was determined during AF according to the electrogram patterns. After sinus conversion, real‐time spectrum analysis was used for AF nest assessment at the same location. Results: The CFAE was observed at the high and mid sulcus terminalis areas, pulmonary vein antrum, and mid portion of the coronary sinus. Among them, only 60% of the CFAE sites showed HFC during sinus rhythm. In addition, some of the non‐CFAE sites (22%) showed HFC during sinus rhythm. Conclusion: The CFAE sites were not the same as the AF nests in this animal model of vagally mediated AF. Therefore, these two types of ablation methods appear to target different substrates of AF. (PACE 2010; 33:1497–1503)     

Association of weekly working hours with poor psychological well-being and moderation by employment status in Korean workers

We examined the association of weekly working hours with poor psychological well-being in Korean workers and the moderating effect of employment status. This secondary analysis examined data from the fifth Korean Working Conditions Survey (2017). There were 30,108 waged employees and 14,459 self-employed individuals. The two groups were compared using a moderated regression model with Hayes’ PROCESS macro for SPSS. The self-employed had a greater mean age than the waged employees. Higher percentages of the self-employed had short weekly working hours (<40), excessively long weekly working hours (≥60), and poor psychological well-being. After controlling for age, gender, education, monthly income, and occupational class, the interaction between weekly working hours and employment status on psychological well-being was significant (p<0.001). Among the self-employed, the well-being score was lowest in the short working hour group (<40 h/week), highest in the long working hour (48–59 h/week) groups, and intermediate in the excessively long working hours (≥60 h/week) group. For waged employees, psychological well-being was the greatest in the short working hour group and decreased continuously as the number of weekly working hours increased. In conclusion, employment status (employee vs. self-employed) moderated the relationship between weekly working hours and psychological well-being.     

Efficacy of a nicotine inhaler in smoking cessation: a double-blind, placebo-controlled trial

A non-combustible nicotine inhaler, administered orally, has been developed for treatment of smokers. The inhaler allows weaning from nicotine while maintaining partial reinforcement of the ritual/sensory phenomena of smoking. Subjects were randomly assigned to active (n=112) and placebo (n=111) groups. Some behavioral intervention occurred as a function of participation. Strict abstinence (primary outcome criterion) was defined by CO 8 ppm with no slips allowed at any time and cotinine values 14 at 1 year. Survival analysis showed active inhaler was superior to placebo (p0.01). Active vs. placebo success rates were: 63% vs. 47% (day 3), 46% vs. 28% (week 1), 36% vs. 19% (week 2), 33% vs. 16% (week 3), 29% vs. 14% (week 6), 24% vs. 10% (3 months), 17% vs. 9% (6 months) and 13% vs. 8% (1 year). chi2 analyses were significant through 3 months but not at 6 months (p0.08) or 1 year. Craving was relieved with active inhalers at day 3 and week 1. Subjects averaged six inhalers/day. Cotinine levels were 57-61% of smoking levels. Common side effects included throat/mouth irritation and coughing. Failure was predicted by early slips. The inhaler is clearly useful for short-term smoking cessation with potential for long-term efficacy. Extended access to the inhaler and relapse prevention training could improve success rates. Another promising approach would be to combine the inhaler with a nicotine patch.     

Endobronchial Malignant Lymphoma: Unusual Manifestations -- A Report of Two Cases --

Two unusual manifestations associated with endobronchial malignantlymphoma are reported. A 58-year-old white female was firstseen with massive hemoptysis requiring blood transfusion andpneumonectomy for histiocytic lymphoma (large cell type). Thesecond case was that of a 47-year-old black male treated previouslyfor poorly differentiated lymphocytic lymphoma (medium-sizedcell type) who had a relapse in the lungs. Increasingly copioussputum production led to respiratory distress which requiredextensive radiation therapy and chemotherapy for its control.     

Laser Photocoagulation Versus Ethanol Injection Therapy after Preinjection with Epinephrine in the Treatment of Bleeding Peptic Ulcers

Abstract: A prospective, randomized trial was performed to compare the efficacy of Nd: YAG laser photocoagulation (LP) and absolute ethanol injection therapy (AEIT) in the treatment of peptic ulcer bleeding. Of 396 patients who underwent endoscopy for acute gastrointestinal hemorrhage over a 18-month period, 185 were found to have peptic ulcers. The patients who had an ulcer with active bleeding (n = 25) or with a nonbleeding visible vessel (n = 35) were randomized to receive either LP (n = 29) or AEIT (n = 31). The two treatment groups were comparable in terms of age, severity of bleeding, site of ulcer, and endoscopic stigmata of recent hemorrhage. There were no significant differences between the LP and AEIT groups in terms of their transfusion requirements after treatment (0.6 ±1.0 vs. 0.5±0.9 unit), rate of initial hemostatic failure or rebleeding (13.8 vs. 9. 7%), emergency surgery (0 vs. O%), median hospital stay (6 us. 8 days), and mortality (0 us. 6.5%). All of the seven patients who rebled received a second session of endoscopic therapy with the other modality and bleeding was controlled. The cause of death in the two expired patients was not related to bleeding. We concluded that LP and AEIT are equally effective in the treatment of peptic ulcer bleeding but AEIT may be preferred over LP because of its simplicity and lower cost.     

Evaluation of Natural Change of Skin Function in Split-Thickness Skin Grafts by Noninvasive Bioengineering Methods

BACKGROUND: Autologous split-thickness skin grafts (STSGs) are considered the mainstay for the treatment of large full-thickness wounds. There have been few studies reporting the natural change of the skin function in STSGs after procedure, however. OBJECTIVE: The objective was to evaluate the natural change of the skin function in STSG using noninvasive bioengineering methods. METHODS: Eighteen patients were eligible for the study. The skin functions of the graft and the control site were evaluated by an evaporimeter, corneometer, mexameter, and cutometer at Postoperation Days 0.5, 1, 2, 3, 6, 9, and 12 months. RESULTS: Transepidermal water loss (TEWL) of the graft was maintained around that of the normal skin. The values of the skin hydration testing generally decreased during the follow-up period. Erythema was highly maintained for the whole period. For the pigmentation, the ratio tended to increase after 6 months. The skin pliability of the graft was abruptly decreased at 0.5 month, and it recovered from 3 to 12 months. The value did not reach that of the normal skin, however. CONCLUSION: Our results showed that the STSGs had changed within the frame of the skin function, including the TEWL, epidermal hydration, color, and pliability, throughout 1 year after surgery. The authors have indicated no significant interest with commercial supporters.