ICD Shock, Not Ventricular Fibrillation, Causes Elevation of High Sensitive Troponin T after Defibrillation Threshold Testing-The Prospective, Randomized, Multicentre TropShock-Trial

Background The placement of an implantable cardioverter defibrillator (ICD) has become routine practice to protect high risk patients from sudden cardiac death. However, implantation-related myocardial micro-damage and its relation to different implantation strategies are poorly characterized. Methods A total of 194 ICD recipients (64 +/- 12 years, 83% male, 95% primary prevention of sudden cardiac death, 35% cardiac resynchronization therapy) were randomly assigned to one of three implantation strategies: (1) ICD implantation without any defibrillation threshold (DFT) testing,(2) estimation of the DFT without arrhythmia induction (modified "upper limit of vulnerability (ULV) testing") or (3) traditional safety margin testing including ventricular arrhythmia induction. High-sensitive Troponin T (hsTnT) levels were determined prior to the implantation and 6 hours after. Results All three groups showed a postoperative increase of hsTnT. The mean delta was 0.031 +/- 0.032 ng/ml for patients without DFT testing, 0.080 +/- 0.067 ng/ml for the modified ULV-testing and 0.064 +/- 0.056 ng/ml for patients with traditional safety margin testing. Delta hsTnT was significantly larger in both of the groups with intraoperative ICD testing compared to the non-testing strategy (p<0.001 each). There was no statistical difference in delta hsTnT between the two groups with intraoperative ICD testing (p = 0.179). Conclusion High-sensitive Troponin T release during ICD implantation is significantly higher in patients with intraoperative ICD testing using shock applications compared to those without testing. Shock applications, with or without arrhythmia induction, did not result in a significantly different delta hsTnT. Hence, the ICD shock itself and not ventricular fibrillation seems to cause myocardial micro-damage

Use of an Atrial Lead with Very Short Tip-To-Ring Spacing Avoids Oversensing of Far-Field R-Wave

The AVOID-FFS (Avoidance of Far-Field R-wave Sensing) study aimed to investigate whether an atrial lead with a very short tip-to-ring spacing without optimization of pacemaker settings shows equally low incidence of far-field R-wave sensing (FFS) when compared to a conventional atrial lead in combination with optimization of the programming.Patients receiving a dual chamber pacemaker were randomly assigned to receive an atrial lead with a tip-to-ring spacing of 1.1 mm or a lead with a conventional tip-to-ring spacing of 10 mm. Postventricular atrial blanking (PVAB) was programmed to the shortest possible value of 60 ms in the study group, and to an individually determined optimized value in the control group. Atrial sensing threshold was programmed to 0.3 mV in both groups. False positive mode switch caused by FFS was evaluated at one and three months post implantation.A total of 204 patients (121 male; age 73±10 years) were included in the study. False positive mode switch caused by FFS was detected in one (1%) patient of the study group and two (2%) patients of the control group (p = 0.62).The use of an atrial electrode with a very short tip-to-ring spacing avoids inappropriate mode switch caused by FFS without the need for individual PVAB optimization.ClinicalTrials.gov NCT00512915

Comparison of German and Japanese student teachers’ views on creativity in chemistry class

Abstract in Japanese 理科教育においては、新しい科学的な発見や技術的な革新を生み出すという意味においても、また、日常生活や職業生活において創意工夫ができるという意味においても、子ども達の創造性を育成することは重要と考えられている。これまで、アメリカなどの欧米諸国、中国や韓国などのアジア諸国の一部では、現職教師や教職課程の学生を対象として、科学および科学教育における創造性に関する認識が調べられてきた。しかしながら、創造性教育の伝統のあるドイツや国際学力調査で上位の日本の教師や子どもの創造性に関する認識・態度は調べられていない。そこで本研究では、ドイツと日本の教職課程の化学(理科)の学生を対象として、化学(理科)および化学授業(理科授業)における創造性に対する態度を調査した。ドイツの教職課程の第2段階に相当する修士課程の学生16名を、日本の教職課程の第1〜2学年の学生14名を対象とした。いずれの学生であっても、理科教育に関する専門的な学習をはじめた段階にあった。学生の化学授業(理科授業)における創造性についての態度は、「化学授業(理科授業)における創造性」を中心語とするコンセプトマップとそれを補足する選択式・記述式の質問紙によって探った。学生は、創造性に関連するラベルの有無がある2種類のコンセプトマップを作成した。得られたデータは、コンセプトマップの構造とラベルおよびラベル間の関係に見られる意味内容に着目して分析した。その結果として、化学授業(理科授業)における創造性について、その促進には教師の役割が大きいという認識がドイツと日本の学生に共通して見られた。ドイツの学生のコンセプトマップには、創造性を特徴付けるラベルがより多く見られ、それが構造化されていた。それに対して、日本の学生のコンセプトマップには、必ずしも創造性に関連しているとは言えないラベルも見られ、むしろ化学授業(理科授業)に関するラベルを多く記述する傾向が見られた。今回の調査に限って言えば、日本の教職課程の学生に比べて、ドイツの学生は、化学授業(理科授業)における創造性としての特質などを意識化しており、構造的に捉えられていると言える。ドイツや日本の社会的・文化的な側面での共通点や相違点を視野に入れつつ、理科授業に関する信念や教授行動の実際を含めたさらなる検討が必要である。

Die Volkszählungen 1850 und 1860 des Kantons für Basel-Stadt

Im Rahmen des Bürgerforschungsprojekts Basel-Spitalfriedhof wurden in drei-jähriger Arbeit die Volkszählungen 1850 und 1860 in zwei Datenbanken erfasst. Über 70`000 Personendaten stehen nun erstmalig der Öffentlichkeit kostenfrei zur Verfügung: https://ipna.unibas.ch/bbs/grundlagen.htm. Damit liegen nun alle Informationen zur wenig bekannten Volkszählung von 1850 und ebenso zu 1860 vor. 70`000 Personendaten aus der durch eine hohe Mobilität geprägten Zeit der Jahre 1850 und 1860 liefern der genealogischen Forschung wertvolle Hinweise und können der Nachverfolgung von Lebenslauf-daten historischer Personen dienen. Diese auf Freiwilligenarbeit basierende Datenerschliessung nützt aber nicht nur der genealogischen Forschung, sondern soll einerseits helfen, die zahlreichen Forschungslücken in der Basler Stadt- und Sozialgeschichte teilweise zu schlies-sen. Verschiedene Abschlussarbeiten an den Universitäten Basel und Freiburg im Breisgau geben Einblicke in die Sozial-, Spital- und Wirtschaftsgeschichte der Stadt Basel in den Jahren 1840 bis 1868, einer Zeit die durch eine grosse Bevöl-kerungszuwanderung und Armut geprägt war. Die Abschlussarbeiten helfen andererseits, die Ergebnisse der anthropologischen Forschungen zu den identi-fizierten Skeletten des Spitalfriedhofs in einen historischen Zusammenhang zu stellen. Es waren gerade die frühen anthropologischen Forschungen an den Skeletten, die uns zur Einsicht brachten, dass die bestehenden Forschungslücken in der Basler Stadt- und Sozialgeschichte nur durch eine umfassende Datenerschliessung der historischen Quellen gemildert werden könnte. Dies führte uns zur über Jahre andauernden digitalen Erfassung der Volkszählungen und zahlreicher anderer Quellen, die hier gar nicht erwähnt werden sollen. Wie die nun vorliegenden Abschlussarbeiten zeigen, hat sich diese Strategie bewährt. Darum möchten wir diese Quellen und die Abschlussarbeiten der genealogischen Gemeinschaft zugänglich machen. Die Abschlussarbeiten können ebenfalls als PDF von der Website heruntergeladen werden

Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation

Atrial fibrillation (AF) is a relevant comorbidity in recipients of implantable cardioverter-defibrillators (ICD). Latest generation single-chamber ICD allow the additional sensing of atrial tachyarrhythmias and, therefore, contribute to the early detection and treatment of AF, potentially preventing AF-related stroke. The present study aimed to measure the impact on patient-related costs of this new ICD compared to conventional ICD. A Markov model was developed to simulate the long-term incidence of stroke in patients treated with a single-chamber ICD with or without atrial sensing capabilities. The median annual cost per patient and its difference, the number of strokes avoided, and the cost per stroke avoided were estimated. During a 9-year horizon, the costs for the ICD and stroke treatment were €570 per patient-year for an ICD with atrial sensing capabilities and €491 per patient-year for a conventional ICD. Per 1,000 patients, 4.6 strokes per year are assumed to be avoided by the new device. Higher CHA2DS2-VASc scores are associated with higher numbers of avoided strokes and larger potential for cost savings. Apart from clinical advantages, the use of ICD with atrial sensing capabilities may reduce the incidence of stroke and, in high-risk patients, may also contribute to reduce overall health care costs

Pulmonary vein isolation using new technologies to improve ablation lesion formation: Initial results comparing enhanced catheter tip irrigation (Surround Flow®) with contact force measurement (Smarttouch®)

Introduction: Pulmonary vein reconnection after pulmonary vein isolation (PVI) is a significant problem in the treatment of paroxysmal atrial fibrillation (AF). We report about patients who underwent contact force (CF) guided PVI using CF catheter and compared them to patients with PVI using an ablation catheter with enhanced tip irrigation. Methods: A total of 59 patients were included in the analysis. In 30 patients circumferential PVI was performed using the Thermocool Smarttouch® ablation catheter (ST) whereas in 29 patients circumferential PVI using the Thermocool Surround Flow SF® ablation catheter (SF) was performed. Patients were compared in regard to procedure time, fluoroscopy time/dose as well as RF-application duration and completeness of PVI. Adverse events (pericardial effusion, PV stenosis, stroke, death) were evaluated. The presence of sinus rhythm off antiarrhythmic medication was assessed during 6 months follow-up using multiple 7 day Holter-ECGs. Results: In both groups, all PVs were isolated without serious adverse events. Procedure time was 2.15 ± 0.5 h (ST) vs. 2.37 ± 1.13 h (SF) (p = 0.19). Duration of RF-applications was 46.6 ± 18 min (ST) and 49.8 ± 19 min (SF) (p = 0.52). Fluoroscopy time was 25.2 ± 13 min (ST) vs. 29 ± 18 min (SF), fluoroscopy dose 2675.6 ± 1658 versus 3038.3 ± 1997 cGym2 (p = 0.36 and 0.46 respectively). Sinus rhythm off antiarrhythmic medication validated with 7 day Holter ECGs was present in both groups in 72% of patients after 6 months of follow up. Conclusion: PVI using the new contact force catheter is safe and effective in patients with paroxysmal AF

Forces Applied during Transvenous Implantable Cardioverter Defibrillator Lead Removal

Methods. 17 physicians, experienced in transvenous lead removal, performed a lead extraction manoeuvre of an ICD lead on a torso phantom. They were advised to stop traction only when further traction would be considered as harmful to the patient or when—based on their experience—a change in the extraction strategy was indicated. Traction forces were recorded with a digital precision gauge. Results. Median traction forces on the endocardium were 10.9 N (range from 3.0 N to 24.7 N and interquartile range from 7.9 to 15.3). Forces applied to the proximal end were estimated to be 10% higher than those measured at the tip of the lead due to a friction loss. Conclusion. A traction force of around 11 N is typically exerted during standard transvenous extraction of ICD leads. A traction threshold for a safe procedure derived from a pool of experienced extractionists may be helpful for the development of required adequate simulator trainings