Cosmetic outcomes and quality of life in children with cardiac implantable electronic devices

BackgroundAxillary implant location is an alternative implant location in patients for cardiac implantable electronic devices (CIEDs) for the purposes of improved cosmetic outcome. The impact from the patient’s perspective is unknown. The purpose of this study was to compare scar perception scores and quality of life (QOL) in pediatric patients with axillary CIED implant location versus the standard infraclavicular approach.MethodsThis is a multicenter prospective study conducted at eight pediatric centers and it includes patients aged from 8 to 18 years with a CIED. Patients with prior sternotomy were excluded. Scar perception and QOL outcomes were compared between the infraclavicular and axillary implant locations.ResultsA total of 141 patients (83 implantable cardioverter defibrillator [ICD]/58 pacemakers) were included, 55 with an axillary device and 86 with an infraclavicular device. Patients with an ICD in the axillary position had better perception of scar appearance and consciousness. Patients in the axillary group reported, on average, a total Pediatric QOL Inventory score that was 6 (1, 11) units higher than the infraclavicular group, after adjusting for sex and race (P = 0.02).ConclusionsQOL is significantly improved in axillary in comparison to the infraclavicular CIED position, regardless of device type. Scar perception is improved in patients with ICD in the axillary position.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147032/1/pace13522.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147032/2/pace13522_am.pd

Friends-of-Friends Groups and Clusters in the 2SLAQ Catalogue

We present a catalogue of galaxy groups and clusters selected using a friends-of-friends algorithm with a dynamic linking length from the 2dF-SDSS and QSO (2SLAQ) luminous red galaxy survey. The linking parameters for the code are chosen through an analysis of simulated 2SLAQ haloes. The resulting catalogue includes 313 clusters containing 1,152 galaxies. The galaxy groups and clusters have an average velocity dispersion of sigma_v = 467.97 km/s and an average size of R_clt = 0.78 Mpc/h. Galaxies from regions of one square degree and centred on the galaxy clusters were downloaded from the Sloan Digital Sky Survey Data Release 6 (SDSS DR6). Investigating the photometric redshifts and cluster red-sequence of these galaxies shows that the galaxy clusters detected with the FoF algorithm are reliable out to z~0.6. We estimate masses for the clusters using their velocity dispersions. These mass estimates are shown to be consistent with 2SLAQ mock halo masses. Further analysis of the simulation haloes shows that clipping out low richness groups with large radii improves the purity of catalogue from 52% to 88%, while retaining a completeness of 94%. Finally, we test the two-point correlation function of our cluster catalogue. We find a best-fitting power law model with parameters r0 = 24\pm4 Mpc/h and gamma = -2.1\pm 0.2, which are in agreement with other low redshift cluster samples and consistent with a {\Lambda}CDM universe.Comment: 17 pages, 14 figure

The Recent Evolution of the Dwarf Starburst Galaxy NGC 625 from Hubble Space Telescope Imaging

New HST/WFPC2 imaging of the dwarf starburst galaxy NGC 625 is presented. These data, 80% complete to V and I magnitudes of 26.0 and 25.3, respectively, allow us to study the recent star formation history of NGC 625. We derive a tip of the red giant branch (TRGB) distance modulus of 27.95+/-0.07, corresponding to a distance of 3.89+/-0.22 Mpc, and a location on the far side of the Sculptor Group. NGC 625 has a well-defined radial stellar population gradient, evidenced by a central concentration of young MS stars and an RGB/AGB ratio that increases with galactocentric distance. The prominent AGB is very red, and RGB stars are detected far from the central star forming regions. Using H Alpha and H Beta narrow band imaging and previous optical spectroscopy we identify substantial and varying internal extinction (A_V = 0.0 to 0.6 mag) associated with the central active star formation regions. To better understand the effects of internal extinction on the analysis of young stellar populations, synthetic models are presented which, for the first time, examine and account for this effect. Using the luminous blue helium burning stars, we construct a simple model of the recent (< 100 Myr) star formation in which an elevated but declining star formation rate has been present over this entire period. This is at odds with the presence of spectroscopic W-R features in the major star formation region which imply a short duration (<= 5 Myr) for the recent starburst. This suggests that starbursts displaying W-R features are not necessarily all of a short duration. Finally, we speculate on the possible causes of the present burst of star formation in this apparently isolated galaxy, and compare it to other nearby, well-studied dwarf starburst systems.Comment: 56 pages, including 15 figures (2 in color). Scheduled to appear in AJ, December, 2003. Full-resolution version may be obtained at http://www.astro.umn.edu/~Cannon/n625.p

Quantitative estimates of unique continuation for parabolic equations, determination of unknown time-varying boundaries and optimal stability estimates

In this paper we will review the main results concerning the issue of stability for the determination unknown boundary portion of a thermic conducting body from Cauchy data for parabolic equations. We give detailed and selfcontained proofs. We prove that such problems are severely ill-posed in the sense that under a priori regularity assumptions on the unknown boundaries, up to any finite order of differentiability, the continuous dependence of unknown boundary from the measured data is, at best, of logarithmic type

Reply to: New Meta- and Mega-analyses of Magnetic Resonance Imaging Findings in Schizophrenia: Do They Really Increase Our Knowledge About the Nature of the Disease Process?

This work was supported by National Institute of Biomedical Imaging and Bioengineering Grant No. U54EB020403 (to the ENIGMA consortium)

Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC). Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS).

AbstractIn view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients

Inducible Costimulator Expression Regulates the Magnitude of Th2-Mediated Airway Inflammation by Regulating the Number of Th2 Cells

Inducible Costimulator (ICOS) is an important regulator of Th2 lymphocyte function and a potential immunotherapeutic target for allergy and asthma. A SNP in the ICOS 5' promoter in humans is associated with increased atopy and serum IgE in a founder population and increased ICOS surface expression and Th2 cytokine production from peripheral blood mononuclear cells. However, it is unknown if increased ICOS expression contributes to disease progression or is a result of disease pathology.We developed a mouse model in which ICOS surface expression levels are genetically predetermined to test our hypothesis that genetic regulation of ICOS expression controls the severity of Th2 responses in vivo. Using ICOS+/+ and ICOS+/- mice in a Th2 model of airway inflammation, we found that T cells from the ICOS+/- mice had reduced ICOS expression and decreased Th2-mediated inflammation in vivo. Although the activation status of the T cells did not differ, T cells isolated from the lungs and draining lymph nodes of ICOS+/- mice at the peak of inflammation produced less Th2 cytokines upon stimulation ex vivo. Using 4get mice, which express GFP upon IL-4 transcription, we determined that the decreased Th2 cytokines in ICOS+/- is due to reduced percentage of Th2 cells and not a defect in their ability to produce IL-4.These data suggest that in both mice and humans, the level of ICOS surface expression regulates the magnitude of the in vivo Th2 response, perhaps by influencing Th2 differentiation

Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter.

Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations

Protective Effector Memory CD4 T Cells Depend on ICOS for Survival

Memory CD4 T cells play a vital role in protection against re-infection by pathogens as diverse as helminthes or influenza viruses. Inducible costimulator (ICOS) is highly expressed on memory CD4 T cells and has been shown to augment proliferation and survival of activated CD4 T cells. However, the role of ICOS costimulation on the development and maintenance of memory CD4 T cells remains controversial. Herein, we describe a significant defect in the number of effector memory (EM) phenotype cells in ICOS−/− and ICOSL−/− mice that becomes progressively more dramatic as the mice age. This decrease was not due to a defect in the homeostatic proliferation of EM phenotype CD4 T cells in ICOS−/− or ICOSL−/− mice. To determine whether ICOS regulated the development or survival of EM CD4 T cells, we utilized an adoptive transfer model. We found no defect in development of EM CD4 T cells, but long-term survival of ICOS−/− EM CD4 T cells was significantly compromised compared to wild-type cells. The defect in survival was specific to EM cells as the central memory (CM) ICOS−/− CD4 T cells persisted as well as wild type cells. To determine the physiological consequences of a specific defect in EM CD4 T cells, wild-type and ICOS−/− mice were infected with influenza virus. ICOS−/− mice developed significantly fewer influenza-specific EM CD4 T cells and were more susceptible to re-infection than wild-type mice. Collectively, our findings demonstrate a role for ICOS costimulation in the maintenance of EM but not CM CD4 T cells