Propafenone for the treatment of refractory complex ventricular ectopic activity

The results of therapy with propafenone were evaluated in 45 patients with complex ventricular ectopic activity that had been refractory to a mean of 3.8 antiarrhythmic drugs. The cardiac diagnoses were ischemic heart disease (in 16 patients), cardiomyopathy (in 7), mitral valve prolapse (in 7), mitral valve prolapse (in 7), idiopathic ventricular ectopic beats (in 6), valvular heart disease (in 5), and hypertension (in 4). The frequency of ventricular ectopic beats was established after therapy with antiarrhythmic agents had been discontinued. Patients then received propafenone during a dose-ranging protocol. An effective response was defined as a reduction in total ventricular ectopic beats of 80% or more. During dose ranging, therapy failed in four patients because of side effects, in eight because of a reduction in ventricular ectopic beats of less than 80%, and in three because of an aggravation of the arrhythmia. Thirty patients had a reduction in total ventricular ectopic beats of 80% or more. During a mean follow-up of 12.4 months, therapy failed in 1 patient because of sustained ventricular tachycardia and in 7 because of intolerable side effects; 22 patients continued to receive propafenone. PR and QRS intervals were significantly prolonged (P = 0.001), but the corrected QT interval and the heart rate were unchanged. The mean trough plasma level of propafenone associated with an effective response was 756 ng/ml, and that associated with intolerable side effects was 920 ng/ml. Thus, in patients with refractory complex ventricular ectopic beats, propafenone was effective and well tolerated initially in 67% of patients and during long-term administration in 49%, and toxicity was minor in most patients.     

Public Disaster Communication and Child and Family Disaster Mental Health: a Review of Theoretical Frameworks and Empirical Evidence

Children have been identified as particularly vulnerable to psychological and behavioral difficulties following disaster. Public child and family disaster communication is one public health tool that can be utilized to promote coping/resilience and ameliorate maladaptive child reactions following an event. We conducted a review of the public disaster communication literature and identified three main functions of child and family disaster communication: fostering preparedness, providing psychoeducation, and conducting outreach. Our review also indicates that schools are a promising system for child and family disaster communication. We complete our review with three conclusions. First, theoretically, there appears to be a great opportunity for public disaster communication focused on child disaster reactions. Second, empirical research assessing the effects of public child and family disaster communication is essentially nonexistent. Third, despite the lack of empirical evidence in this area, there is opportunity for public child and family disaster communication efforts that address new domains.     

Role of prolactin versus growth hormone on islet B-cell proliferation in vitro: implications for pregnancy

This study investigated the effects of homologous rat PRL (rPRL) and rat GH (rGH) on islet growth as indicated by modifications in insulin secretion, islet cell proliferation, and islet volume with neonatal and adult rat islets in vitro. The number of proliferating cells was determined by immunocytochemical staining for 5-bromo-2'-deoxyuridine (BrdU) incorporated into replicating DNA during the final 24 h of culture. When neonatal rat islets were examined by laser scanning confocal microscopy, more than 90% of the BrdU-labeled nuclei were observed in B-cells with insulin immunoreactivity. In neonatal rat islets, rPRL was much more effective than rGH in increasing insulin secretion (3.7-fold vs. 1.4-fold) during the 10 days of culture. The number of BrdU-labeled nuclei per islet was increased from 2.9 +/- 0.4 (n = 77) in control islets to 47.3 +/- 2.7 (n = 95) with rPRL (16.3-fold) and 9.7 +/- 0.8 (n = 84) with rGH (3.3-fold). The effects of rPRL and rGH on both insulin secretion and BrdU labeling were approximately additive. After 10 days, an increased average islet volume was only observed with rPRL. When followed for 36 days, the total amount of islet tissue was unchanged for control islets (1.1-fold), more than doubled with rPRL (2.5-fold), and only slightly increased with rGH (1.4-fold). From the observed rates of islet cell proliferation and increases in islet volumes, doubling times of 23-24 days for rPRL and 89-91 days for rGH can be estimated. Of other proposed islet growth factors, cholecystokinin, epidermal growth factor, platelet-derived growth factor, and 2-aminoisobutyric acid, an increase in insulin secretion and islet cell proliferation was only observed with cholecystokinin in neonatal rat islets. However, both effects were less than 20% of those observed with rPRL. In adult rat islets, rPRL was also more effective than rGH in increasing insulin secretion (1.6-fold vs. 1.2-fold) during the 9 days of culture. The number of BrdU-labeled nuclei per islet was increased from 2.7 +/- 0.5 (n = 96) in control islets to 9.5 +/- 0.6 (n = 175) with rPRL (3.5-fold). In contrast to the neonatal islets, rGH had no effect on the number of BrdU-labeled nuclei per islet in adult rat islets (2.4 +/- 0.3, n = 194).(ABSTRACT TRUNCATED AT 400 WORDS)     

The melanocortin pathway: effects of voluntary exercise on the melanocortin-4 receptor knockout mice and ACTH(1-24) ligand structure activity relationships at the melanocortin-2 receptor

The melanocortin pathway consists of endogenous agonists, antagonists, G-protein coupled receptors, and ancillary proteins that mediate the function of the endogenous antagonists. The melanocortin-4 receptor (MC4R) is involved in the regulation of obesity and the melanocortin-2 receptor (MC2R) is involved in the regulation of steroidogenesis. Herein, we present the effects of voluntary exercise on the MC4R knockout mice in terms of bypassing the morbid obesity and hyperphagia phenotypes associated with this genetic obesity model. Additionally, a systematic truncation study of the adrenocorticotropin hormone (ACTH 1-24) has been performed and characterized at the cloned MC2R.     

Calendar of events

We compared serum creatine kinase (CK) levels between spinobulbar muscular atrophy (SBMA) and amyotrophic lateral sclerosis (ALS) and reviewed available histochemical studies of frozen sections of muscle biopsies. CK levels and the frequency of patients with elevated CK levels were significantly higher in the SBMA group when compared with the ALS group. CK levels occasionally approached values up to 8 times the upper limit of normal in the SBMA group. In addition to the chronic neurogenic changes in the muscle biopsy, all SBMA patients showed one or more myopathic changes. Increased numbers of markedly hypertrophic fibers were consistently seen in all patients. It is not clear whether the elevated CK level is directly related to the increased number of hypertrophic fibers or to other myopathic features. Based on these findings, we recommend genetic testing for SBMA in cases of male patients with motor neuron disease who present with a significantly elevated serum creatine kinase level, even when other characteristic clinical features of SBMA are absent. Muscle Nerve 40: 126–129, 2009     

Brain magnetic resonance imaging abnormalities in patients with heart failure

BACKGROUND: Although heart failure (HF) is a common cardiovascular disorder, to date little research has been conducted into possible associations between HF and structural abnormalities of the brain. AIMS: To determine the frequency and pattern of magnetic resonance imaging (MRI) abnormalities in outpatients with chronic HF, and to identify any demographic and clinical correlates. METHODS: Brain MRI scans were compared between a sample of 58 HF patients, 48 controls diagnosed with cardiovascular disease uncomplicated by HF (cardiac controls) and 42 healthy controls. Deep, periventricular and total white matter hyperintensities (WMH), lacunar and cortical infarcts, global and medial temporal lobe atrophy (MTA) were investigated. RESULTS: Compared to cardiac and healthy controls, HF patients had significantly more WMH, lacunar infarcts and MTA, whereas cardiac controls only had more MTA, compared to healthy controls. Age and left ventricular ejection fraction (LVEF) were independently associated with total WMH. Age and systolic hypotension were associated with MTA in HF patients and cardiac controls. CONCLUSION: Our results suggest that cardiac dysfunction contributes independently to the development of cerebral MRI abnormalities in patients with HF. Age and low LVEF are the principal predictors of cerebral WMH in patients with HF and in cardiac controls.     

Effect of referral bias on assessing survival in ALS

We assessed the effect of referral bias on patients with ALS treated at our medical center. A total of 132 subjects were treated by our center over the past 3 years. The referral population had a median survival of 29 months compared to 18 months for the local population (p = 0.007). Referral bias should be addressed when assessing the efficacy of self-selected therapies in the setting of a tertiary ALS clinic.     

Microvascular dysfunction in left apical ballooning syndrome: Primary cause or secondary phenomenon?

We read with great interest the recent report from Meimoun etal.¹ indicating the time course of transthoracic coronary flowreserve in the left anterior descending artery in a patientwho suffered a transient left apical ballooning syndrome. Theauthors conclude that serial non-invasive measurements of coronaryflow reserve in