123 research outputs found
A radiation hybrid framework map of bovine chromosome 13
In this paper we present a 5000-rad radiation hybrid framework map of bovine chromosome 13 (BTA13) containing 13 loci, including five conserved genes and eight polymorphic microsatellites. All framework markers are ordered with odds greater than 1000:1. Furthermore, we present a comprehensive map of BTA13 integrating 11 genes and 16 microsatellites. The proposed order is in general agreement with the recently published medium-density linkage maps. A model of five blocks of genes with conserved order between human, mouse and cattle is presente
Impact of the implantable cardioverter-defibrillator on rehospitalizations
Patients who survive out-of-hospital ventricular tachycardia or ventricular fibrillation are at risk of sudden cardiac death and often return to hospital after initial discharge. The frequency and duration of readmittance to hospital are not well known. Thus, the purpose of this study was to evaluate the impact of the implantable cardioverter defibrillator on frequency and duration of hospitalizations. Methods Between 1989 and 1993, 38 consecutive patients who had drug-refractory ventricular tachyarrhythmias were selected for the study. A total of 38 patients were implanted with the implantable cardioverter-defibrillator in accordance with the guidelines of the European Society of Cardiology. This analysis includes 35 of the 38 patients (92%). All hospitalizations which occurred one year before and one year after were studied. Clinical information for all patients was obtained by consulting medical records and by interviewing personal general practitioners. Results The annual number of hospitalizations before and after implantation of the implantable cardioverter defibrillator was, respectively, 3·28 ± 2 hospitalizations/patient/year and 0·88 ± 1·23 hospitalizations/patient/year (P<0·05). Before implantation of the implantable cardioverter-defibrillator, patients were hospitalized a mean of 32·94 plusmn; 24·18 days/patient/year and after, 9·31 ± 32·14 days/patient/year (P<0·05). The number of hospitalizations for cardiac reasons decreased by 90%. Before implantation, the most frequent cause was ventricular tachyarrhythmia (47 hospitalizations for ventricular tachycardia and eight for ventricular fibrillation), while after implantation, it was as a result of the shock from the implantable cardioverter defibrillator (II hospitalizations). The number of hospitalizations for non-cardiac reasons were similar in the two time periods. Of the 35 patients, 26 (74%) had at least one appropriate successful ventricular tachycardia interrupted by the implantable cardioverter-defibrillator, while 17 patients (49%) had their ventricular fibrillation terminated. There is a significant difference in the rate of hospitalizations to intensive care units (ICU) between the two periods. Before implantation, 30% of hospital days were spent in the ICU, with 3% after. Conclusions This study documents that the implantable cardioverter-defibrillator not only reduces the frequency and duration of hospital stays, but reduces admissions to the more expensive units in hospital. Taking into account the reduction in hospitalizations, the payback period for the implantation of an implantable cardioverter-defibrillator is 19 months. (Eur Heart J 1996; 17: 1565-1571
Impact of the implantable cardioverter-defibrillator on rehospitalizations
Patients who survive out-of-hospital ventricular tachycardia or ventricular fibrillation are at risk of sudden cardiac death and often return to hospital after initial discharge. The frequency and duration of readmittance to hospital are not well known. Thus, the purpose of this study was to evaluate the impact of the implantable cardioverter defibrillator on frequency and duration of hospitalizations. METHODS: Between 1989 and 1993, 38 consecutive patients who had drug-refractory ventricular tachyarrhythmias were selected for the study. A total of 38 patients were implanted with the implantable cardioverter-defibrillator in accordance with the guidelines of the European Society of Cardiology. This analysis includes 35 of the 38 patients (92%). All hospitalizations which occurred one year before and one year after were studied. Clinical information for all patients was obtained by consulting medical records and by interviewing personal general practitioners. RESULTS: The annual number of hospitalizations before and after implantation of the implantable cardioverter-defibrillator was, respectively, 3.28 +/- 2.38 hospitalizations/ patient/year and 0.88 +/- 1.23 hospitalizations/patient/year (P < 0.05). Before implantation of the implantable cardioverter-defibrillator, patients were hospitalized a mean of 32.94 +/- 24.18 days/patient/year and after, 9.31 +/- 32.14 days/patient/year (P < 0.05). The number of hospitalizations for cardiac reasons decreased by 90%. Before implantation, the most frequent cause was ventricular tachyarrhythmia (47 hospitalizations for ventricular tachycardia and eight for ventricular fibrillation), while after implantation, it was as a result of the shock from the implantable cardioverter-defibrillator (11 hospitalizations). The number of hospitalizations for non-cardiac reasons were similar in the two time periods. Of the 35 patients, 26 (74%) had at least one appropriate successful ventricular tachycardia interrupted by the implantable cardioverter-defibrillator, while 17 patients (49%) had their ventricular fibrillation terminated. There is a significant difference in the rate of hospitalizations to intensive care units (ICU) between the two periods. Before implantation, 30% of hospital days were spent in the ICU, with 3% after. CONCLUSIONS: This study documents that the implantable cardioverter-defibrillator not only reduces the frequency and duration of hospital stays, but reduces admissions to the more expensive units in hospital. Taking into account the reduction in hospitalizations, the payback period for the implantation of an implantable cardioverter-defibrillator is 19 months
Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants
Objective: Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs. Methods: We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination. Results: We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19–0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63–0.80). Conclusion: In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination
Bordetella pertussis Infection or Vaccination Substantially Protects Mice against B. bronchiseptica Infection
Although B. bronchiseptica efficiently infects a wide range of mammalian hosts and efficiently spreads among them, it is rarely observed in humans. In contrast to the many other hosts of B. bronchiseptica, humans are host to the apparently specialized pathogen B. pertussis, the great majority having immunity due to vaccination, infection or both. Here we explore whether immunity to B. pertussis protects against B. bronchiseptica infection. In a murine model, either infection or vaccination with B. pertussis induced antibodies that recognized antigens of B. bronchiseptica and protected the lower respiratory tract of mice against three phylogenetically disparate strains of B. bronchiseptica that efficiently infect naïve animals. Furthermore, vaccination with purified B. pertussis-derived pertactin, filamentous hemagglutinin or the human acellular vaccine, Adacel, conferred similar protection against B. bronchiseptica challenge. These data indicate that individual immunity to B. pertussis affects B. bronchiseptica infection, and suggest that the high levels of herd immunity against B. pertussis in humans could explain the lack of observed B. bronchiseptica transmission. This could also explain the apparent association of B. bronchiseptica infections with an immunocompromised state
Single and Combined Effects of Sympathetic and Parasympathetic Activity on Perceptual Sensitivity and Attention
Late clinical outcome after successful radiofrequency catheter ablation of accessory pathways
Late clinical outcome after successful radiofrequency catheter ablation of accessory pathways
AIMS: To evaluate the long-term clinical results of patients who underwent successful radiofrequency catheter ablation of a symptomatic drug-resistant accessory-pathway-mediated tachycardia. METHODS AND RESULTS: Clinical follow-up was done by direct contact with the patients and their physicians. One hundred and eighty consecutive patients (113 males, 67 females) were followed during a median period of 48.1 months. There were seven procedure related complications (4%). During the follow-up period, 79% of the patients remained asymptomatic; 14% complained of short bouts of palpitations due to isolated or short runs of atrial or ventricular premature beats; 7% had sustained palpitations due either to accessory pathway recurrence (4%) or supraventricular tachyarrhythmias not associated with an accessory pathway (3%). Symptoms due to accessory pathway recurrence appeared either in the first month following the ablation or at least later than 3 months when sustained supraventricular arrhythmias occurred related to another cause. CONCLUSIONS: Initially successful radiofrequency catheter ablation has a low, long-term recurrence rate (4%). Recurrence of accessory-pathway-mediated tachycardia is observed during the first month while later symptoms suggest supraventricular arrhythmias from another cause
Le diagnostic electrocardiographique d'hypertrophie ventriculaire gauche est-il possible en presence d'un hemibloc anterieur? [Is electrocardiographic diagnosis of left ventricular hypertrophy possible in the presence of an anterior hemiblock?]
The electrocardiographic diagnosis of left ventricular hypertrophy is often difficult because it is based on a large number of criteria which, even if taken on their own or as "scoring systems", have a poor sensitivity ranging from 10 to 60%. Some authors have shown that the diagnosis is easier--though at first sight this seems paradoxical--in the presence of altered ventricular depolarization. To verify this statement in the case of left anterior fascicular block, we tested the value of six different indices for the detection of left ventricular hypertrophy. We analyzed 100 patients with left anterior fascicular block and compared the six electrocardiographic indices with the echocardiographic reference method, using the formula of the Penn convention, to establish the left ventricular mass. The best index of the six was that of Gertsch: [S3+ (R+S) maximal precordial] greater than or equal to 30 mm. Its sensitivity was 74%, its specificity 69%, its positive predictive value 79% and its negative predictive value 63%. The other tested indices had a sensitivity of less than 45% with a specificity of more than 80%. Furthermore, Gertsch's index was of equal value in confirming the increased left ventricular mass due either to concentric hypertrophy or to dilated cardiomyopathy. This study therefore confirms that electrocardiographic diagnosis of left ventricular hypertrophy is even easier in the presence of left anterior fascicular block than in absence of altered ventricular depolarization. This result is of practical interest, the incidence of left anterior fascicular block being 1 to 5% in the general population and as high as 30% after the age of 80
- …