Cardiac pacing in the 1980s: Treatment and techniques in transition

AbstractThe pacemaker of the 1980s is designed to maintain atrioventricular synchrony through dual-chamber pacing. This pacemaker is multiprogrammable and capable of telemetric transmission of biologic, electronic and electrophysiologic data. Several developments have made this therapeutic modality possible: 1) the cumulative survival rate of many lithium-battery pacemakers exceeds 95% at 5 years; 2) lead and connector problems are rare; 3) atrial and ventricular electrode malfunctions occur in less than 2% of implants; and 4) new introducer techniques have simplified implantation (mortality and major morbidity rates are 0.5 and 0.4%, respectively). With multiprogrammability, pacemaker function can be optimized for the patient's needs, and about 20% of reoperations can be avoided.Ninety-six dual-chamber (DDD) pacemakers, 55 of which have been followed up for more than 3 months, have provided trouble-free performance and have yielded salutary clinical results, particularly when implanted to replace previous ventricular inhibited units. Problems with these pacemakers have included unusual pacing electrocardiograms, pacemaker eccentricities, programmer maintenance, pacing and follow-up complexities and costs.In the 1980s, effort will be required to find a balance between rapidly evolving technology and the clinical need for complex pacing systems. From 1978 to 1981, the rate of pacemaker implantation grew from 309 to 513 implants per million population per year, and there are now approximately 500,000 patients with implanted pacemakers living in the United States. Indications for pacing are ill-defined, because in many cases the assessment of clinical response to pacing is largely subjective, lacking satisfactory quantitative indexes. This decade will be a time of reappraisal of the extent of clinical applicability of new techniques, particularly the multi-programmable dual-chamber system which, after 3 years of clinical trial, shows promise of being the predominant pacemaker of the immediate future

The 1981 United States survey of cardiac pacing practices

A survey of physicians implanting pacemakers was conducted to obtain a profile of permanent cardiac pacing practices in the United States during 1981. Questionnaires were mailed to 5,832 implanters with 765 responses (13%) received and 680 analyzed. It was estimated that there were approximately 5,600 physicians, 66% surgeons and 34% nonsurgeons, implanting pacemakers at 3,670 centers. About 118,000 new primary implants were performed, or 518 per million population. Only 17% of implantation procedures in 1981 were replacements compared with 31% in 1978. Roughly half the respondents worked in teams, most implanting from 46 to 55 pacemakers annually.The chief indications for permanent pacing were sick sinus syndrome (48%) and impairment of conduction in the atrioventricular node and His-Purkinje system (42%). Ninety-five percent of pacing leads were implanted transvenously. Seventy percent of the respondents had had experience with atrial and dual-chamber pacemakers, used largely to increase cardiac output. The use of ventricular demand (VVI) pacing decreased accordingly from 91% in 1975 to 84% in 1981. Although approximately 90% of primary pacemakers were programmable to some degree, almost half were not reprogrammed within the first 3 months after implantation and 30% were never reprogrammed. Most patients (85%) were followed up by transtelephonic electrocardiographic monitoring, 68% in conjunction with private office visits. The respondents estimated that dual-chamber pacing, accounting for 10% of implants in 1981, would increase to 37% by 1985.Early electrode malfunctions were less frequent when implantation was performed by high volume and solo implanters, and in public and community hospitals. It is concluded that periodic surveys of this type disclose important trends in the practice of cardiac pacing

Heparinase Immobilization Characterization and Optimization a

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73755/1/j.1749-6632.1988.tb25880.x.pd

Classification of finite dimensional irreducible modules over W-algebras

Finite W-algebras are certain associative algebras arising in Lie theory. Each W-algebra is constructed from a pair of a semisimple Lie algebra g (our base field is algebraically closed and of characteristic 0) and its nilpotent element e. In this paper we classify finite dimensional irreducible modules with integral central character over W-algebras. In more detail, in a previous paper the first author proved that the component group A(e) of the centralizer of the nilpotent element under consideration acts on the set of finite dimensional irreducible modules over the W-algebra and the quotient set is naturally identified with the set of primitive ideals in U(g) whose associated variety is the closure of the adjoint orbit of e. In this paper for a given primitive ideal with integral central character we compute the corresponding A(e)-orbit. The answer is that the stabilizer of that orbit is basically a subgroup of A(e) introduced by G. Lusztig. In the proof we use a variety of different ingredients: the structure theory of primitive ideals and Harish-Chandra bimodules of semisimple Lie algebras, the representation theory of W-algebras, the structure theory of cells and Springer representations, and multi-fusion monoidal categories.Comment: 52 pages, preliminarly version, comments welcome; v2 53 pages, small correction

1-(4-Meth­oxy­phen­yl)-2-(1H-1,2,4-triazol-1-yl)ethanone

In the title compound, C11H11N3O2, the dihedral angle between the central ethanone fragment and the 4-meth­oxy­phenyl group is 2.9 (2)°, while that between the ethanone fragment and the triazole ring is 83.4 (2)°. The dihedral angle between the planes of the triazole and benzene rings is 81.7 (1)°. The 4-meth­oxy­phenyl group is cis with respect to the ethanone fragment O atom across the exocyclic C—C bond. In the crystal, mol­ecules are linked by C—H⋯N inter­actions into C(9) chains along [001]

Raloxifene for women with Alzheimer disease: A randomized controlled pilot trial

OBJECTIVE: To determine whether raloxifene, a selective estrogen receptor modulator, improves cognitive function compared with placebo in women with Alzheimer disease (AD) and to provide an estimate of cognitive effect. METHODS: This pilot study was conducted as a randomized, double-blind, placebo-controlled trial, with a planned treatment of 12 months. Women with late-onset AD of mild to moderate severity were randomly allocated to high-dose (120 mg) oral raloxifene or identical placebo provided once daily. The primary outcome compared between treatment groups at 12 months was change in the Alzheimer's Disease Assessment Scale, cognitive subscale (ADAS-cog). RESULTS: Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses (mean age 76 years, range 68-84), and 39 women contributed 12-month outcomes. ADAS-cog change scores at 12 months did not differ significantly between treatment groups (standardized difference 0.03, 95% confidence interval -0.39 to 0.44, 2-tailed p = 0.89). Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score. Caregiver burden and caregiver distress were similar in both groups. CONCLUSIONS: Results on the primary outcome showed no cognitive benefits in the raloxifene-treated group. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for women with AD, raloxifene does not have a significant cognitive effect. The study lacked the precision to exclude a small effect

Терапия болезней периодонта с использованием шинирующих волоконных систем

периодонта болезн