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Surgical ablation of ventricular tachycardia is generally guided by the results of pre- and intraoperative cardiac mapping. However, in certain situations intraoperative cardiac mapping may not be possible and, therefore, surgery has to be based on information obtained preoperatively. This raises the question whether intraoperative mapping is necessary for the success of this approach. We describe our experience with encircling endocardial cryoablation for ischemic VT and examine the contribution of intraoperative mapping for this procedure. Thirty-three patients with inducible VT refractory to medical therapy and a well defined anatomic scar were considered for surgery. All patients underwent baseline electrophysiology study and intraoperative mapping was attempted during normothermic cardiopulmonary bypass. In 14 patients, VT was inducible intraoperatively (Group 1) and surgical ablation was guided by this information, whereas in 19 patients, VT could not be mapped for various reasons (Group 2). Reasons for failure to obtain intraoperative map included noninducibility (3), nonsustained VT (8), polymorphic VT (4), VF (3), and incessant VT with hemodynamic collapse and cardiac arrest (1). The two groups did not differ with respect to age, location of myocardial infarction, or preoperative left ventricular ejection fraction. The operative procedures were similar in the two groups with respect to aortic cross clamp time, cardiopulmonary bypass time, number of cryoablation lesions, concomitant revascularization, aneurysmectomy, and ICD implantation. Encircling endocardial cryoablation was performed in 32 patients and one patient underwent partial right ventricular free wall disconnection (RV infarct). Thirteen patients underwent concomitant coronary artery bypass grafting (5 in Group 1 and 8 in group 2). One patient had prophylactic ICD patches (Group 1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intraoperative mapping is not necessary for VT surgery. 784 35

In patients with IDCM and sustained VT, every effort should be made to exclude bundle branch reentrant tachycardia. We strongly believe that this mechanism of VT remains underdiagnosed despite electrophysiologic evaluation. In appropriate candidates with cardiomyopathies and "nonbundle branch reentrant VT," ICD implantation is frequently the treatment of choice, especially if the clinical presentation is that of hemodynamic collapse, or there is significant left ventricular systolic dysfunction. The role of amiodarone versus ICD, especially for patients with well-tolerated VT and milder forms of cardiomyopathies, is yet to be defined.
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PMID:Therapy of ventricular tachycardia in patients with nonischemic cardiomyopathies. 880 12

A 21-year-old patient with repaired double-outlet right ventricle and normal ventricular function underwent internal cardioverter defibrillator implantation for primary prevention of sudden death. First occurrence of spontaneous ventricular tachycardia resulted in hemodynamic collapse and syncope but the internal cardioverter defibrillator rescued the patient. ICD implantation for primary prevention may be an appropriate goal in adults with repaired congenital heart disease, even in the setting or normal ventricular function.
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PMID:Defibrillator for primary prevention in congenital heart disease. 1530 72

After binding, central nervous system (CNS) myelin-derived axon growth inhibitory ligands, the Nogo-66 receptor (NgR), complexes with LINGO-1 and either the low-affinity neurotrophin receptor (p75(NTR)) or TROY to initiate growth cone collapse via a Rho-A inhibitory signaling pathway and/or Ca(2+)-dependent activation of epidermal growth factor receptor (EGFR) through an unknown signaling pathway. We have shown that axon growth through CNS myelin is disinhibited after neurotrophic factor administration by 1) initiating intramembranous proteolysis (RIP) of p75(NTR), leading to cleavage of the extracellular (p75(ECD)) and intracellular domains (p75(ICD)) by alpha- and gamma-secretase, respectively, thereby paralyzing inhibitory signaling; 2) shedding of soluble NgR(ECD), which acts as a competitive antagonist to NgR for binding of inhibitory ligands; and 3) antagonizing NgR/p75(NTR) clustering by competitive p75(ECD)/NgR interaction. Here, we report that TNF-alpha converting enzyme (TACE) (a disintegrin and metalloproteinase 17, ADAM17) induces disinhibition of FGF2-stimulated neurite outgrowth of dorsal root ganglion neurons (DRGN) cultured in the presence of a predetermined concentration of inhibitory CNS myelin-derived ligands. After addition of TACE (which has alpha-secretase activity) to mitotically arrested adult rat mixed DRG cultures, we demonstrate 1) NgR(ECD) shedding; 2) release of p75(ECD) and p75(ICD) by RIP of p75(NTR); 3) blockade of Rho-A activation; 4) reduced EGFR phosphorylation; and 5) increased FGF2-stimulated DRGN neurite outgrowth and branching in the presence of CNS myelin-derived inhibitory ligands. Thus, TACE-induced cleavage of NgR and RIP of p75(NTR) abrogates axon growth inhibitory signaling, thereby disinhibiting CNS axon/neurite growth.
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PMID:TACE-induced cleavage of NgR and p75NTR in dorsal root ganglion cultures disinhibits outgrowth and promotes branching of neurites in the presence of inhibitory CNS myelin. 1684 93

Injury classification systems are generally used in sports medicine (1) to accurately classify diagnoses for summary studies, permitting easy grouping into parent categories for tabulation and (2) to create a database from which cases can be extracted for research on specific injuries. Clarity is most important for the first purpose, whereas diagnostic detail is particularly important for the second. An ideal classification system is versatile and appropriate for all sports and all data collection scenarios. The Orchard Sports Injury Classification System (OSICS) was developed in 1992 primarily for the first purpose, a specific study examining the incidence of injury at the elite level of football in Australia. As usage of the OSICS expanded into different sports, limitations were noted and therefore many revisions have been made. A recent study found the OSICS-8, whilst superior to the International Classification of Diseases Australian Modification (ICD-10-AM) in both speed of use and 3-coder agreement, still achieved a lower level of agreement than expected. The study also revealed weaknesses in the OSICS-8 that needed to be addressed. A recent major revision resulted in the development of the new 4-character OSICS-10. This revision attempts to improve interuser agreement, partly by including more diagnoses encountered in a sports medicine setting. The OSICS-10 should provide far greater depth in classifications for the benefit of those looking to maintain diagnostic information. It is also structured to easily collapse down into parent classifications for those wanting to preserve basic information only. For those researchers wanting information collected under broader injury headings, particularly those not using fully computerized systems, the simplicity of the OSICS-8 system may still suffice.
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PMID:The Orchard Sports Injury Classification System (OSICS) version 10. 1751 12

Signaling by the p75 neurotrophin receptor (p75) has been implicated in diverse neuronal responses, including the control of neuronal survival versus death and axonal regeneration and growth cone collapse, involving p75 in different neuropathological conditions. There are different levels of complexity regulating p75-mediated signaling. First, p75 can interact with different ligands and co-receptors in the plasma membrane, forming tripartite complexes, whose activation result in different cellular outcomes. Moreover, it was recently described that trafficking capacities of p75 in neurons are regulating, in addition to p75 downstream interactions, also the sequential cleavage of p75. The proteolytical processing of p75 involves, first, a shedding event that releases a membrane-bound carboxiterminal fragment (p75-CTF), followed by a gamma-secretase mediated cleavage, generating a soluble intracellular domain (p75-ICD) with signaling capabilities. The first shedding event, generating a p75-CTF, is the key step to regulating the production of p75-ICD, and although the generation of p75-ICD is important for both p75-mediated control of neuronal survival and the control of neurite outgrowth, little is known how both cleavage events are regulated. In this review, we argue that both sheddases and gamma-secretase are key membrane components regulating p75-mediated signaling transduction; therefore, further attention should be paid to their roles as p75 signaling regulators.
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PMID:Metalloproteases and gamma-secretase: new membrane partners regulating p75 neurotrophin receptor signaling? 1798 44

Drastic losses on the stock markets within short periods have been the subject of numerous investigations in view of the fact that they are often irrational. Stock exchanges around the world suffered dramatic losses on Monday 21 January 2008, and again recently on Monday 17 March 2008. Regardless of cultural affiliation, public reporting of the global collapse in stock prices on Monday was striking in its almost unified mood of panic, anxiety and general fear of further partially arbitrary trading losses. These partly irrational mechanisms of an international financial crisis seem to fulfil several criteria of typical panic disorders according to classification systems like ICD-10 or DSM-IV. The new phenomenon affects international stock markets in the sense of a global panic disorder (GPD).
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PMID:Black Monday on stock markets throughout the world - a new phenomenon of collective panic disorder? A psychiatric approach. 1870 Dec 21

As a potential cathode material for the ICD lithium battery, one advantage of Ag(6)Mo(2)O(7)F(3)Cl (SMOFC) is its enhanced gravimetric capacity of ca. 133 mAh/g above 3 V (vs Li(+)/Li) delivered by two biphasic transitions at 3.46 and 3.39 V (vs Li(+)/Li). The unique crystal structure of SMOFC enables a high silver ion conduction: sigma( perpendicular[001]) = 3.10(-2) S/cm (+/-2.10(-2) S/cm) and sigma(//[001]) = 4.10(-3) S/cm (+/-2.10(-3) S/cm) and, hence, an excellent discharge rate capability. Lithium insertion has been monitored by in situ XRD measurements with HRTEM investigations. There is a linear isotropic collapse of the structure leading to a fully amorphous structure beyond four inserted lithiums.
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PMID:Ag(6)Mo(2)O(7)F(3)Cl: a new silver cathode material for enhanced ICD primary lithium batteries. 2054 6

An excimer laser sheath has recently been used for extraction of pacing and ICD leads. By using this technique, leads are removed more easily and it has to take a shorter time to extract leads. Although lead extraction with this method can cause fatal complications such as large vessel injury, little has been reported regarding anesthetic management during the lead extraction. We experienced two cases of pacing lead extraction using an excimer laser sheath under general anesthesia. The procedures were mainly performed by cardiologists in the operating theater. A wide area was prepared with sterile drapes as for cardiac surgery with cardiovascular surgeons standing by. Vascular access catheters were placed in the right femoral artery as well as vein, and in the right internal jugular vein so that immediate PCPS introduction could be performed in case of sudden hemodynamic collapse by massive bleeding. In the first case, lead extraction was completed without any complication, but in the second case sternotomy was performed by cardiac surgeons for safe separation of leads from vessels. There were also no bleeding episodes in the second case. Preparation for bleeding and cooperation among cardiologists, cardiovascular surgeons, medical engineers and anesthesiologists are necessary from the safety point of view of this procedure under general anesthesia.
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PMID:[Pacing lead extraction using an excimer laser sheath under general anesthesia]. 2323 39

Emergency hospital admissions for patients with ill-defined conditions International Classification of Diseases-10 R codes (ICD-10 R codes) are rising. Policy literature has suggested that they are attributable to 'social' problems and could potentially be avoided yet there is no research evidence to support this view. Therefore, this study sought to describe patients with ill-defined conditions and determine clinical and demographic factors predicting assignment of such codes. Patients aged over 70 admitted to a hospital acute admissions unit with collapse or falls were recruited in one hospital. Measures of functional status, frailty, depression, routine blood tests, demographic and service use data were collected. 80 patients were recruited, 35 were discharged with ill-defined conditions codes. Functional limitations were common in patients with ill-defined conditions and 77% had frailty. Blood profiles did not indicate acute medical problems. Deprivation was the only significant independent predictor of assignment of ill-defined conditions codes at discharge (OR 0.64, 95% CI: 0.45-0.93). Whilst our data confirm policy suppositions that patients with ill-defined conditions have functional impairment and frailty, it is the social and organisational factors that are important in determining risk of ill-defined conditions rather than clinical indicators.
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PMID:Reducing avoidable hospital admission in older people: health status, frailty and predicting risk of ill-defined conditions diagnoses in older people admitted with collapse. 2357 Nov 28


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