Arrhythmia induction using isoproterenol or epinephrine during electrophysiology study for supraventricular tachycardia

Background Electrophysiology study (EPS) is an important part of the diagnosis and workup for supraventricular tachycardia (SVT). Provocative medications are used to induce arrhythmias, when they are not inducible at baseline. The most common medication is the β1‐specific agonist, isoproterenol, but recent price increases have resulted in a shift toward the nonspecific agonist, epinephrine. Objective We hypothesize that isoproterenol is a better induction agent for SVT during EPS than epinephrine. Methods We created a retrospective cohort of 131 patients, who underwent EPS and required medication infusion with either isoproterenol or epinephrine for SVT induction. The primary outcome was arrhythmia induction. Results Successful induction was achieved in 71% of isoproterenol cases and 53% of epinephrine cases (P = 0.020). Isoproterenol was significantly better than epinephrine for SVT induction during EPS (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.14‐4.85; P = 0.021). There was no difference in baseline variables or complications between the two groups. Other variables associated with successful arrhythmia induction included a longer procedure duration and atrioventricular nodal re‐entry tachycardia as the clinical arrhythmia. In a multivariable model, isoproterenol remained significantly associated with successful induction (OR, 2.57; 95% CI, 1.002‐6.59; P = 0.05). Conclusions Isoproterenol was significantly better than epinephrine for SVT arrhythmia induction. However, epinephrine was safe and successfully induced arrhythmias in the majority of patients who received it. Furthermore, when atropine was added in epinephrine‐refractory cases, in a post hoc analysis there was no difference in arrhythmia induction between medications. Cost savings could thus be significant without compromising safety

Structural abnormalities in cortical volume, thickness, and surface area in 22q11.2 microdeletion syndrome: Relationship with psychotic symptoms.

Introduction22q11.2 deletion syndrome (22q11DS) represents one of the largest known genetic risk factors for psychosis, yet the neurobiological mechanisms underlying symptom development are not well understood. Here we conducted a cross-sectional study of 22q11DS to decompose cortical volume into its constituent parts, cortical thickness (CT) and surface area (SA), which are believed to have distinct neurodevelopmental origins.MethodsHigh-resolution T1-weighted scans were collected on 65 participants (31 22q11DS, 34 demographically comparable typically developing controls, 10-25 years old). Measures of cortical volume, CT, and SA were extracted from regions of interest using the FreeSurfer image analysis suite. Group differences and age-related trajectories in these structures, as well as their association with psychotic symptomatology, were assessed.ResultsRelative to controls, 22q11DS participants showed bilateral volumetric reductions in the inferior temporal cortex, fusiform gyrus, anterior cingulate, superior parietal cortex, and cuneus, which were driven by decreased SA in these regions. 22q11DS participants also had increased volumes, driven by increased CT, in bilateral insula regions. 22q11DS youth had increased CT in frontal regions, particularly middle frontal and medial orbitofrontal cortices. A pattern of age-associated cortical thinning was observed in typically developing controls in brain regions associated with visual and sensory information-processing (i.e., left pericalcarine cortex and fusiform gyrus, right lingual and postcentral cortices). However, this relationship was disrupted in 22q11DS participants. Finally, correlational analyses revealed that increased CT in right medial orbitofrontal cortex was associated with increased positive symptom severity in 22q11DS.ConclusionDifferential disruptions of CT and SA in distinct cortical regions in 22q11DS may indicate abnormalities in distinct developmental neural processes. Further, neuroanatomic abnormalities in medial frontal brain structures disproportionately affected in idiopathic schizophrenia were associated with psychotic symptom severity in 22q11DS youth, suggesting that disrupted biological processes in these cortical regions may underlie development of psychotic symptoms, both in 22q11DS and in the broader population

Loss of Immunohistochemical Reactivity in Association With Handling-Induced Dark Neurons in Mouse Brains.

The handling-induced dark neuron is a histological artifact observed in brain samples handled before fixation with aldehydes. To explore associations between dark neurons and immunohistochemical alterations in mouse brains, we examined protein products encoded by Cav3 (neuronal perikarya/neurites), Rbbp4 (neuronal nuclei), Gfap (astroglia), and Aif1 (microglia) genes in adjacent tissue sections. Here, dark neurons were incidental findings from our prior project, studying the effects of age and high-fat diet on metabolic homeostasis in male C57BL/6N mice. Available were brains from 4 study groups: middle-aged/control diet, middle-aged/high-fat diet, old/control diet, and old/high-fat diet. Young/control diet mice were used as baseline. The hemibrains were immersion-fixed with paraformaldehyde and paraffin-embedded. In the hippocampal formation, we found negative correlations between dark neuron hyperbasophilia and immunoreactivity for CAV3, RBBP4, and glial fibrillary acidic protein (GFAP) using quantitative image analysis. There was no significant difference in dark neuron hyperbasophilia or immunoreactivity for any protein examined among all groups. In contrast, in the hippocampal fimbria, old age seemed to be associated with higher immunoreactivity for GFAP and allograft inflammatory factor-1. Our findings suggest that loss of immunohistochemical reactivity for CAV3, RBBP4, and GFAP in the hippocampal formation is an artifact associated with the occurrence of dark neurons. The unawareness of dark neurons may lead to misinterpretation of immunohistochemical reactivity alterations

A Course Correction for Homeland Security: Curbing Counterterrorism Abuses

In the wake of 9/11, Congress estab­lished a new cabinet agency with a singu­lar mission: to keep the coun­try safe from terror­ism. The Depart­ment of Home­land Secur­ity (DHS) brought together 22 agen­cies with dispar­ate func­tions under one roof. Two decades on, it struggles to carry out its work effect­ively and equit­ably.With the Home­land Secur­ity Act of 2002, Congress tasked the new depart­ment with keep­ing the coun­try safe from terror­ist attacks. DHS carved out a role for itself in two main areas: part­ner­ships with state, local, tribal, and territ­orial author­it­ies and screen­ing of trav­el­ers and immig­rants.Section I of this report iden­ti­fies the agency's coun­terter­ror­ism collab­or­a­tions with state and local author­it­ies and private firms. These programs have routinely surveilled Amer­ican Muslims, trau­mat­iz­ing entire communit­ies and cast­ing them as hotbeds of terror­ism. DHS agents have deployed these very tools against protest­ors, activ­ists, and journ­al­ists.Section II turns to travel and immig­ra­tion screen­ing programs. DHS has accu­mu­lated vast stores of inform­a­tion about people who travel into, out of, and over the United States. The Trans­port­a­tion Safety Admin­is­tra­tion (TSA) and Customs and Border Protec­tion (CBP), among other DHS compon­ents, use this data to draw infer­ences about them, docu­ment their move­ments, and subject them to warrant­less searches and inter­rog­a­tions. Agents do all of this without suspi­cion of poten­tial wrong­do­ing. Unsur­pris­ingly, reports of reli­gious or ethnic profil­ing are common.Section III analyzes DHS's over­sight infra­struc­ture. Three primary offices — the Privacy Office, the Office for Civil Rights and Civil Liber­ties (CRCL), and the Office of Inspector General (OIG) — have curbed some of the depart­ment's trans­gres­sions. But they have allowed many other civil rights and civil liber­ties viol­a­tions to continue.Finally, this report iden­ti­fies five aven­ues for reform: stronger safe­guards against profil­ing; better protec­tions for privacy and free expres­sion; rigor­ous eval­u­ations of program effic­acy; mean­ing­ful trans­par­ency about data hold­ings and the implic­a­tions DHS programs have for civil rights and civil liber­ties; and more robust internal over­sight. Forth­com­ing Bren­nan Center reports will delve into these recom­mend­a­tions in greater detail

Interstitial cell network volume is reduced in the terminal bowel of ageing mice

Ageing is associated with impaired neuromuscular function of the terminal gastrointestinal (GI) tract, which can result in chronic constipation, faecal impaction and incontinence. Interstitial cells of cajal (ICC) play an important role in regulation of intestinal smooth muscle contraction. However, changes in ICC volume with age in the terminal GI tract (the anal canal including the anal sphincter region and rectum)have not been studied. Here, the distribution, morphology and network volume of ICC in the terminal GI tract of 3‐to 4‐month‐old and 26‐to 28‐month‐old C57BL/6mice were investigated. ICC were identified by immunofluorescence labelling of wholemount preparations with an antibody against c‐Kit. ICC network volume was measured by software‐based 3D volume rendering of confocal Z stacks. A significant reduction in ICC network volume per unit volume of muscle was measured in aged animals. No age‐associated change in ICC morphology was detected. The thickness of the circular muscle layer of the anal sphincter region and rectum increased with age, while that in the distal colon decreased. These results suggest that ageing is associated with a reduction in the network volume of ICC in the terminal GI tract, which may influence the normal function of these regions

Putting Evidence into Practice: The PLoS Medicine Series on Global Mental Health Practice

The PLoS Medicine editors announce the launch of a new series on Global Mental Health Practice, and issue a call for papers

Finding and Combining Indicable Subgroups of Big Mapping Class Groups

We explicitly construct new subgroups of the mapping class groups of an uncountable collection of infinite-type surfaces, including, but not limited to, right-angled Artin groups, free groups, Baumslag-Solitar groups, mapping class groups of other surfaces, and a large collection of wreath products. For each such subgroup $H$ and surface $S$, we show that there are countably many non-conjugate embeddings of $H$ into $\text{Map}(S)$; in certain cases, there are uncountably many such embeddings. The images of each of these embeddings cannot lie in the isometry group of $S$ for any hyperbolic metric and are not contained in the closure of the compactly supported subgroup of $\text{Map}(S)$. In this sense, our construction is new and does not rely on previously known techniques for constructing subgroups of mapping class groups. Notably, our embeddings of $\text{Map}(S')$ into $\text{Map}(S)$ are not induced by embeddings of $S'$ into $S$. Our main tool for all of these constructions is the utilization of special homeomorphisms of $S$ called shift maps, and more generally, multipush maps.Comment: 31 pages, 19 figures. Results have been improved to show countably many non-conjugate embeddings of each subgroup we construc

Psychotic Symptoms in Kenya - Prevalence, Risk Factors, and Relationship with Common Mental Disorders

There have been few epidemiological surveys to establish prevalence and associated risk factors of psychosis in Sub-Saharan Africa. This paper reports a population- based epidemiological survey in rural Kenya of the prevalence of psychotic symptoms and their relationship with demographic, socio-economic and other risk factors. A random sample of 2% of all adults living in Maseno, Kisumu District of Nyanza province, Kenya (50,000 population) were studied, aiming for a sample size of 1,000 people. The psychosis screening questionnaire was used to assess the prevalence of psychotic symptoms in the preceding twelve months. The response rate was 87.6%. The prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms in this sample size. Psychotic symptoms were evenly distributed across this relatively poor rural population and were significantly associated with presence of common mental disorders, and to a lesser extent with poor physical health and housing type. We conclude that single psychotic symptoms are relatively common in rural Kenya and rates are elevated in those with CMD, poor physical health and poor housing