Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation.

Aims: To describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients. Methods and results: Consecutive patients who underwent a bipolar voltage map guided AF ablation, were enrolled. Voltage maps were conducted for each patient using 3-dimensional electroanatomical mapping system and LVZ were defined as areas of bipolar voltage < 0.5 mV. A total of 539 patients (309 male, age 65 ± 10 years) were included. Low voltage zones was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P < 0.001). The area of LVZ was larger in patients with persistent as compare to paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1 cm2 (IQR 3.6-28.5), P = 0.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1.05-1.10, P < 0.001), female gender (OR 2.18, 95%CI 1.38-3.43, P = 0.001), sinoatrial node dysfunction (OR 3.90, 95%CI 1.24-12.21, P = 0.020), larger surface area of left atrium pr. cm2 (OR 1.01, 95%CI 1.00-1.02, P = 0.016), and persistent AF (OR 5.03, 95%CI 3.20-7.90, P<0.001) were associated with presence of LVZ. Conclusion: In a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ was associated with higher age, female gender, larger LA surface area, and sinoatrial node dysfunction.

Fatal ulcerative enteritis of the small intestine in a patient with ulcerative colitis treated with vedolizumab.

Vedolizumab (VDZ) inhibits α4ß7 integrins and is used to target intestinal immune responses in patients with inflammatory bowel disease, which is considered to be relatively safe. Here we report on a fatal complication following VDZ administration. A 64-year-old female patient with ulcerative colitis (UC) refractory to tumor necrosis factor inhibitors was treated with VDZ. One week after the second VDZ infusion, she was admitted to hospital with severe diarrhea and systemic inflammatory response syndrome (SIRS). Blood stream infections were ruled out, and endoscopy revealed extensive ulcerations of the small intestine covered with pseudomembranes, reminiscent of invasive candidiasis or mesenteric ischemia. Histology confirmed subtotal destruction of small intestinal epithelia and colonization with Candida. Moreover, small mesenteric vessels were occluded by hyaline thrombi, likely as a result of SIRS, while perfusion of large mesenteric vessels was not compromised. Beta-D-glucan concentrations were highly elevated, and antimycotic therapy was initiated for suspected invasive candidiasis but did not result in any clinical benefit. Given the non-responsiveness to anti-infective therapies, an autoimmune phenomenon was suspected and immunosuppressive therapy was escalated. However, the patient eventually died from multi-organ failure. This case should raise the awareness for rare but severe complications related to immunosuppressive therapy, particularly in high risk patients.

Biofunctional surfaces based on dendronized cellulose.

Biofunctionalized surfaces based on dendronized cellulose were prepared either by embedding 6-deoxy-6-(1,2,3-triazolo)-4-polyamidoamine (PAMAM) cellulose (degree of substitution, DS 0.25), obtained by homogeneous conversion of 6-deoxy-6-azido cellulose with propargyl-PAMAM dendron via the copper-catalyzed Huisgen reaction, in a cellulose acetate (DS 2.50) matrix or by the heterogeneous functionalization of deoxy-azido cellulose film with the dendron. The amount of amino groups provided by the solid supports was determined and the covalent attachment of enzyme was proven with glucose oxidase as model enzyme after activation with glutardialdehyde. The quality of glucose oxidase immobilization was defined by determining of the specific enzyme activity, coupling efficiency, storage stability, and reproducibility. Although the heterogeneous functionalization of the deoxy-azido film yields a product that binds more enzyme compared to the blend of dendronized cellulose derivative with cellulose acetate, the coupling efficiency is comparatively small. Nevertheless, the different approaches for the preparation of biofunctionalized surfaces based on dendronized cellulose provide an excellent reproducibility and good storage stability.

Novel bulky esters of cellulose.

Novel bulky esters of cellulose were synthesized homogeneously, applying the solvent systems DMA/LiCl or DMSO/TBAF, by conversion of the biopolymer with aryl polyester dendrons. The carboxylic acid moieties were efficiently activated in situ with CDI or the acid chloride was applied. Cellulose esters with DS values of up to 0.7 were obtained. The functionalization pattern was analyzed by different NMR spectroscopic techniques indicating that not only position 6 (primary hydroxyl group) but also the secondary one at position 2 was included in the reaction.

Odontogenic sinusitis maxillaris: A retrospective study of 121 cases with surgical intervention.

PURPOSE: Otolaryngologists, dentists and maxilla-facial surgeons see patients suffering from odontogenic maxillary sinusitis on a daily routine. The study was performed to investigate the different origins of the odontogenic maxillary sinusitis ranging from periodontitis to augmentative implant surgery. Furthermore, the microbial flora of purulent odontogenic maxillary sinusitis was analyzed in order to present a proper antibiotic treatment in addition to a surgical approach. MATERIALS AND METHODS: A retrospective study was performed, analyzing the clinical trials of 121 patients suffering from odontogenic maxillary sinusitis who undergone surgery. Harvested bacteria were tested for susceptibility on a routine base, surgical reports of removed foreign material or dental focus were reviewed as well as preoperative CBCT. RESULTS: Patients mean age was 56.62 (±16 SD) with a slight female gender dominance. Allergic profile to ß-lactam antibiotics had no influence on patients' length of in-hospital stay. 69 out of 121 cases of OMS occurred after dental surgery (extractions, augmentation or implant surgery). Maxillary molars were the teeth mostly hold accountable for an onset without surgery in recent history. 22.3% of the patients possessed a dislocated foreign body in the maxillary sinus. Pseudomonas aeruginosa infection was significantly associated with misplaced foreign bodies (root filling, augmentative dental material e.g. p < 0.05). We protocoled an anaerobic dominance with 45 anaerobes versus 19 aerobes. Ampicillin/Sulbactam (80%) and Piperacillin/Tazobactam (93.3%) present sufficient susceptibly rates to the harvested bacteria. Likewise showed Moxifloxacin (86.3%) equal results, whereas Clindamycin had a poor outcome with merely 50% of the tested bacteria being susceptible to Clindamycin. CONCLUSION: If OMS is diagnosed dental focus should be treated, misplaced bodies should be removed and purulent exacerbation has to be additionally treated with a calculated antibiotic therapy according to the pathogens resistance patterns.

Intermediate microRNA expression profile in Graves' disease falls between that of normal thyroid tissue and papillary thyroid carcinoma.

AIMS: Many studies have previously reported a higher prevalence of papillary thyroid carcinomas (PTC) in patients with Graves' disease (GD). MicroRNAs (miRNAs) are small, non-coding RNAs that are upregulated in PTC compared with benign thyroid tissue. The objective of the study was to examine the miRNA expression of selected miRNAs that are known to be upregulated in PTC in patients with GD. METHODS: Paraffin embedded thyroid tissue from 159 patients with GD was screened for expression of the miRNAs 146b, 181b, 21, 221 and 222 by RT-PCR. The expression profiles of four normal thyroids, 50 PTCs without concomitant GD and 11 patients with untreated GD served as the controls. RESULTS: The expression pattern of these miRNAs in patients with GD is intermediate between that of benign thyroid tissue (p<0.001) and PTC (in three out of five miRNAs, p<0.001). This corresponds to a 15-fold change for GD versus PTC, and a 31-fold change for GD versus normal thyroid tissue. The miRNA expression in 11 papillary microcarcinomas found in our study (a prevalence of 0.07) was not different from that in PTC samples from patients without GD for four of five miRNA types. Furthermore, we found a significant difference in the expression of miRNA 221/222 between treated and untreated GD tissue. CONCLUSIONS: In conclusion, we found an intermediate expression of specific miRNAs in thyroid tissue from patients with GD that fell between the expression levels found in normal thyroid glands and PTC, which suggests a possible influence of certain miRNAs on developing PTC in patients with GD.

Current rare indications and future directions for implantable loop recorders.

The scope of application for implantable loop recorders has shifted away from the evaluation of unclear palpitations and syncope episodes to more complex conditions. This article focuses on rare indications of growing importance such as rhythm monitoring after ablation of atrial fibrillation or after cryptogenic stroke. Furthermore, forthcoming applications in various clinical settings are described, e. g., arrhythmia detection after myocardial infarction, after catheter-based valve interventions, in heart failure, and in cardiomyopathies. Enhancement of the capabilities of implantable loop recorders could broaden their fields of use.

Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study.

OBJECTIVE: We explored whether the use of a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation. METHODS: Eighty patients (44 men (55%); mean age 63 ± 10 years) who underwent catheter ablation due to paroxysmal AF were recruited consecutively in the present study. Patients were randomized (1:1) into 2 arms for AF ablation: one using a conventional 3-dimensional electroanatomical mapping (EAM) system and the other using the F-EAM system. RESULTS: Fluoroscopy time (10:42 [interquartile range {IQR} 8:45-12:46] minutes:seconds vs 1:45 [IQR 1:05-2:22] minutes:seconds; P < .001) and radiation doses (2440 [IQR 1593-3091] cGy·cm(2) vs 652 [IQR 326-1489] cGy·cm(2); P < .001) in the EAM group were significantly greater than those in the F-EAM group. The majority of reduction of radiation exposure was achieved after transseptal puncture, which was near-zero fluoroscopic exposure. In total, approximately 84% of fluoroscopy time and 73% of radiation doses have been reduced during the AF ablation procedure using the F-EAM system compared to using the conventional EAM system. However, procedure time did not differ significantly (1:39 [IQR 1:18-2:10] hours:minutes vs 1:37 [IQR 1:17-1:50] hours:minutes; P = .362). During follow-up (5.9 ± 1.3 months), 61 patients (76.3%) had no recurrence of atrial arrhythmias. The recurrence rate between the 2 groups did not differ. CONCLUSION: AF catheter ablation using the F-EAM system was safe and resulted in a significant reduction of radiation exposure to patients and staff without complicating the workflow of the procedure. A near-zero fluoroscopic catheter ablation procedure could be performed without compromising acute/mid-term efficacy and safety.

Polyoxoanion-Supported Organometallic Complexes: Carbonyls of Rhenium(I), Iridium(I), and Rhodium(I) That Are Soluble Analogs of Solid-Oxide-Supported M(CO)(n)()(+) and That Exhibit Novel M(CO)(n)()(+) Mobility.

The Dawson-type P(2)W(15)Nb(3)O(62)(9)(-) polyoxoanion-supported Re(CO)(3)(+) complex, [Re(CO)(3).P(2)W(15)Nb(3)O(62)](8)(-) (1), has been synthesized and characterized in two different counter-cation compositions. The [(n-C(4)H(9))(4)N](8)(8+) complex provides a highly soluble compound which exists as a single isomer in solution. The carbonyl stretching infrared frequencies suggest that the P(2)W(15)Nb(3)O(62)(9)(-) ligand serves as a strong electron donor to the Re(CO)(3)(+) fragment. The P(2)W(15)Nb(3)O(62)(9)(-) polyoxoanion-supported Ir(CO)(2)(+) complex [Ir(CO)(2).P(2)W(15)Nb(3)O(62)](8)(-) (2) has also been synthesized and characterized as its octakis(tetrabutylammonium), [(n-C(4)H(9))(4)N](8)(8+), salt. This compound was characterized by NMR and IR, results which demonstrate that 2 also exists as a single isomer in solution. The [Ir(CO)(2).P(2)W(15)Nb(3)O(62)](8)(-) complex is stable in the absence of water, but decomposes quickly in the presence of even 1 equiv of water. Attempted preparation of the analogous P(2)W(15)Nb(3)O(62)(9)(-) -supported Rh(CO)(2)(+) complex (3), while monitoring by (31)P NMR, revealed that this compound is unstable in solution at room temperature. In addition, we have discovered that added Na(+) can induce the formation of non-C(3)(v)() symmetry isomers of supported Re(CO)(3)(+) and Ir(CO)(2)(+) and, by inference, supported Ir(1,5-COD)(+). When Na(+) is removed from these systems by addition of Kryptofix[2.2.2], the non-C(3)(v)() isomers convert back to the single, C(3)(v)() isomer with heating, thereby providing a model system for the little studied mobility of M(CO)(n)()(+) cations across a soluble-oxide surface. When [Rh(CO)(2).P(2)W(15)Nb(3)O(62)](8)(-) is irradiated in the presence of hydrogen and cyclohexene a novel polyoxoanion-stabilized Rh(0)(n)() nanocluster is formed, results that bear a strong analogy to Yates' work studying atomically-dispersed Rh(CO)(2)(+) on solid Al(2)O(3).(10e) Yates and co-workers observe that Rh(CO)(+).Al(2)O(3) loses a CO upon photolysis, and that the resultant Rh(CO)(1)(+).Al(2)O(3) is reduced under H(2) to form Rh(0), which in turn yields Rh(0)(n)() clusters on Al(2)O(3)-a process that, intriguingly, is largely reversible if CO is readded. Also briefly discussed is other relevant literature of solid-oxide-supported Re(CO)(3)(+) and M(CO)(2)(+) (M = Ir, Rh), literature that makes apparent the potential significance of these complexes as EXAFS and other spectroscopic models of solid-oxide-supported M(CO)(n)()(+).