Interventional and Device-based Autonomic Modulation in Heart Failure

Heart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapy has sought to restore autonomic balance by neuromodulation. Results of preclinical animal studies and early clinical trials have demonstrated its safety and efficacy in heart failure. In this review article, we will discuss specific neuromodulatory treatment modalities individually—spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy and renal sympathetic nerve denervation

Estimation of LV End‐Diastolic Pressure Using Color‐TDI and Its Application to Noninvasive Quantification of Myocardial Wall Stress

Background: This study was undertaken to evaluate early-diastolic annular velocity (Ea) by color-TDI, combined with the early transmitral filling velocity (E) by pulsed Doppler echocardiographyfor estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasivequantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD)patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated inthe study. Methods: First linear regression analysis was performed to assess the relationships betweenE/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuringthe principal radii, the thickness of the LV segments, and the estimated LVEDP. The results werecompared to the wall stress that was calculated using catheter-measured LVEDP. Linear regressionanalysis was performed to assess the relationships between calculated wall stress using Doppler-estimated LVEDP (WSEP) and calculated wall stress using catheter-measured LVEDP (WSMP).Results: The results showed that LVEDP had a strong correlation to the lateral E/Ea (r = 0.85; P <0.001) and medial E/Ea ratios (r = 0.73; P < 0.001). No significant differences were found between theWSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) betweenthe WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate thatthe lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator ofLVEDP in CAD patients and provides pressure information required for noninvasive quantificationof LV myocardial wall stress with reasonable accuracy in diastole. (ECHOCARDIOGRAPHY, Volume26, April 2009

Of beasts, monsters and charming princes: A cultural look into the cinematographic adaptation of the tale of Beauty and the Beast

Esta investigación ofrecerá una reflexión sobre el uso de los cuentos de hadas como fuente para el historiador, mostrando de esa forma la aproximación que tiene el cuento de la Bella y la Bestia, con los conceptos de la belleza/fealdad y la civilización/barbarie.Así, el análisis se basará, en la relación que tienen las adaptaciones cinematográficas con dicho cuento; también, podemos observar aquella dicotomía con el lenguaje cinematográfico, donde Bella un personaje civilizador, intenta domar a aquel monstruo (La Bestia).No obstante, se tomará como base el cuento escrito por Jeanne- Marie LePrince de Beaumont, para mirar cuáles son las características de estas dos dualidades antes mencionadas y, de esa manera, analizar en las adaptaciones cinematográficas que se realizaron en Estados Unidos entre 1960 hasta el 1991, las transformaciones que ha tenido esta historia, para comprender la forma en que la sociedad destaca, en las representaciones de los personajes, las virtudes o los defectos.This research offers a reflection on the use of fairy tales as a source for historians, showing thus the approach to the tale of Beauty and the Beast with the concepts of beauty/ugliness and civilization/barbarism.Thus, the analysis is based on the relation between the cinematographic adaptations and the original tale. It also presents the cinematographic language dichotomy in which Beauty, a civilized character, tries to tame the monster (Beast).The study is based on the tale written by Jeanne-Marie Leprince de Beaumont and it is focused on identifying the characteristics of the aforementioned dualities. After identifying the characteristics, the article presents an analysis of the transformations suffered by the story in the cinematographic adaptations produced in the United States between 1960 and 1991 in order to understand the way in which the society highlights the virtues or the defects in the representations of the characters.Esta pesquisa vai se concentrar em oferecer uma reflexão sobre o uso de contos de fadas como uma fonte para o historiador; mostrando assim a abordagem que tem a história de A Bela é a Fera, com os conceitos de beleza/feiura e civilização/ barbárie.Assim, a análise é baseada na relação das adaptações para o cinema com essa história; também podemos ver esta dicotomia com a linguagem do filme, onde Bella um personagem civilizatório tenta domar esse monstro (a Fera).No entanto, o conto escrito por Jeanne-Marie Leprince de Beaumont, será a base para olhar as características dessas duas dualidades mencionadas e, portanto, analisados nas adaptações para o cinema que foram feitas nos EUA em 1960 até 1991, as mudanças que esta história, para entender como a sociedade representa nos personagens, as virtudes ou defeitos

ICD implantation in noncompaction of the left ventricular myocardium: a case report

Isolated noncompaction of the ventricular myocardium (INVM) is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with prominent trabecular meshwork and deep intertrabecular recesses, often associated with systolic dysfunction and ventricular dilatation. A 23-year-old man from Burkina Faso was referred to our operative unit with a diagnosis of INVM, made with echocardiogram and magnetic resonance imaging and nonsustained ventricular tachycardia. The literature reports the incidence of malignant ventricular arrhythmias in as many as 47% of the patients and sudden cardiac death in almost 50% of them and this supported our decision to perform implantable cardioverter-defibrillators implantatio

The Incomprehensible Gianni Rodari

Review of La poetica di Rodari: Utopia del folklore e nonsense. By Giulia Massini. Rome: Carocci, 2011. 159 pp. L’orecchio verde di Gianni Rodari. Edited by Stefano Panzarasa. Rome: Viterbo Stampa Alernativa/Nuovi Equilibri, 2011. 226 pp. Non solo filastrocche: Rodari e la letteratura del novecentro. By Mariarosa Rossitto. Rome: Bulzoni, 2011. 280 pp. Lamberto, Lamberto, Lamberto. By Gianni Rodari, Trans. Antony Shugar. Illustr. Federico Maggioni. Brooklyn, NY: Melville House, 2011. 208 pp

Breaking the Magic Spell: Radical Theories of Folk and Fairy Tales

This revised, expanded, and updated edition of the 1979 landmark Breaking the Magic Spell examines the enduring power of fairy tales and the ways they invade our subjective world. In seven provocative essays, Zipes discusses the importance of investigating oral folk tales in their socio-political context and traces their evolution into literary fairy tales, a metamorphosis that often diminished the ideology of the original narrative. Zipes also looks at how folk tales influence our popular beliefs and the ways they have been exploited by a corporate media network intent on regulating the mystical elements of the stories. He examines a range of authors, including the Brothers Grimm, Hans Christian Anderson, Ernst Bloch, Tolkien, Bettelheim, and J.K. Rowling to demonstrate the continuing symbiotic relationship between folklore and literature. A stimulating contribution to the critical literature of folk and fairy tales. -- Children’s Literature Association Quarterly The name Jack Zipes is synonymous with highly regarded and widely read anthologies and critiques of fairy tales. -- Choice All libraries should acquire this new edition of one of the most influential texts in the field. -- Choice Fairy Tales are a highly fashionable study today for literary scholars as well as folklorists, and another new book shows what a range of interest can be evoked by them. This time in Jack Zipes’ interesting and vigorous study. -- Encounter Zipes reveals the extraordinary breadth of his acquaintance with both recent and classic literature in the field of folk and fairytale research. -- Fabula Zipes manages the impressive trick of communicating both detail and overview without simplifying either. . . the serious folklorist should should defnitely have this on his bookshelf. -- Fortean Times Zipes ably demonstrates that moral, political, religious, and other ideologies have shaped these apparently innocent narratives. -- Lore and Language This problematic, provocative study will undoubtedly provide stimulating reading for many audiences. -- Romantic Movement Zipes has written a stimulating and important contribution to the sociology of popular literature. -- Sociological Review Places traditional tales in their socio-political, economic and cultural contexts. -- Teacher Librarian Folklorists, educators and historians will particularly find this resource to be valuable. But educators and parents will also find Zipes’s ideas intriguing. -- Elizabeth Herron -- Folks and Fairies in Action (resourcecenterblog.wordpress.com)https://uknowledge.uky.edu/upk_folklore/1014/thumbnail.jp

Walks4work: Rationale and study design to investigate walking at lunchtime in the workplace setting

Background: Following recruitment of a private sector company, an 8week lunchtime walking intervention was implemented to examine the effect of the intervention on modifiable cardiovascular disease risk factors, and further to see if walking environment had any further effect on the cardiovascular disease risk factors. Methods. For phase 1 of the study participants were divided into three groups, two lunchtime walking intervention groups to walk around either an urban or natural environment twice a week during their lunch break over an 8week period. The third group was a waiting-list control who would be invited to join the walking groups after phase 1. In phase 2 all participants were encouraged to walk during their lunch break on self-selecting routes. Health checks were completed at baseline, end of phase 1 and end of phase 2 in order to measure the impact of the intervention on cardiovascular disease risk. The primary outcome variables of heart rate and heart rate variability were measured to assess autonomic function associated with cardiovascular disease. Secondary outcome variables (Body mass index, blood pressure, fitness, autonomic response to a stressor) related to cardiovascular disease were also measured. The efficacy of the intervention in increasing physical activity was objectively monitored throughout the 8-weeks using an accelerometer device. Discussion. The results of this study will help in developing interventions with low researcher input with high participant output that may be implemented in the workplace. If effective, this study will highlight the contribution that natural environments can make in the reduction of modifiable cardiovascular disease risk factors within the workplace. © 2012 Brown et al.; licensee BioMed Central Ltd

Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Background This assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF). Objectives To assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions. Data sources Electronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers’ submissions to the National Institute for Health and Care Excellence. Review methods Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon. Results A total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY. Limitations Limitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups. Conclusions In people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony. Study registration This study is registered as PROSPERO number CRD42012002062. Funding The National Institute for Health Research Health Technology Assessment programme

Fantasy in the Anthropocene

“Fantasy in the Anthropocene” was inspired by the Fantasy Scholarship finalist from last year, edited by U of MN Prof. Marek Oziewicz, Prof. Brian Attebery and Prof. Teresa Dédinova, a unique collection of mini essays, stories, poetry and artwork. As its description puts it, “Fantasy and myth have long been humanity’s most advanced technologies for collective dreaming. Today they are helping us adopt a biocentric lens, re-kin us with other forms of life, and assist us in the transition to an ecological civilization.” With both Brian and Marek available for this discussion, joined by Prof. Jack Zipes, we want to hear where the future of fairy tales and fantasy might lead