Avoiding sports-related sudden cardiac death in children with congenital channelopathy : Recommendations for sports activities.

For the past few years, children affected by an inherited channelopathy have been counseled to avoid (recreational) sports activities and all competitive sports so as to prevent exercise-induced arrhythmia and sudden cardiac death. An increased understanding of the pathophysiological mechanisms, better anti-arrhythmic strategies, and, in particular, more epidemiological data on exercise-induced arrhythmia in active athletes with channelopathies have changed the universal recommendation of "no sports," leading to revised, less strict, and more differentiated guidelines (published by the American Heart Association/American College of Cardiology in 2015). In this review, we outline the disease- and genotype-specific mechanisms of exercise-induced arrhythmia; give an overview of trigger-, symptom-, and genotype-dependent guidance in sports activities for children with long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), or short QT syndrome (SQTS); and highlight the novelties in the current guidelines compared with previous versions. While it is still recommended for patients with LQT1 and CPVT (even when asymptomatic) and all symptomatic LQTS patients (independent of genotype) to avoid any competitive and high-intensity sports, other LQTS patients successfully treated with anti-arrhythmic therapies and phenotype-negative genotype-positive patients may be allowed to perform sports at different activity levels - provided they undergo regular, sophisticated evaluations to detect any changes in arrhythmogenic risk.

[Heavy tamponade in complicated inferior retinal detachment]. / Schwere Tamponade bei komplizierten inferioren Netzhautablösungen.

BACKGROUND: Retinal detachment with inferior proliferative vitreoretinopathy is a difficult to treat problem. The aim of our study was to assess the safety and efficacy of Densiron in the clinical management of complicated retinal detachment. HISTORY AND SIGNS: 6 eyes of 6 consecutive patients presenting with a retinal detachment with inferior proliferative vitreoretinopathy grade 3 were treated with pars plana vitrectomy and injection of Densiron. The mean age of the patients was 61 years. 3 patients had a previous unsuccessful vitreoretinal surgery and 3 patients had Densiron as a first procedure. The extent of detachment was at least 2 or more quadrants with macular involvement in 3 cases. Preoperatively the mean visual acuity was 29.2 letters with ETDRS. THERAPY AND OUTCOME: Densiron was removed after an average of 58 days. 5 patients achieved retinal re-attachment without further tamponade, and 1 patient after additional injection of conventional silicon oil. 4 - 6 weeks after removal of Densiron the mean visual acuity was 50.2 letters with ETDRS. The most common complication was an elevated intraocular pressure during endotamponade, which resolved following removal of the agent. CONCLUSIONS: Densiron improves inferior tamponade, and in clinical practice may be considered to increase the anatomic success rate in selected cases of complicated retinal detachment with inferior proliferative vitreoretinopathy.

Feasibility of polymer gel-based measurements of radiation isocenter accuracy in magnetic fields.

For conventional irradiation devices, the radiation isocenter accuracy is determined by star shot measurements on films. In magnetic resonance (MR)-guided radiotherapy devices, the results of this test may be altered by the magnetic field and the need to align the radiation and imaging isocenter may require a modification of measurement procedures. Polymer dosimetry gels (PG) may offer a way to perform both, the radiation and imaging isocenter test, however, first it has to be shown that PG reveal results comparable to the conventionally applied films. Therefore, star shot measurements were performed at a linear accelerator using PG as well as radiochromic films. PG were evaluated using MR imaging and the isocircle radius and the distance between the isocircle center and the room isocenter were determined. Two different types of experiments were performed: i) a standard star-shot isocenter test and (ii) a star shot, where the detectors were placed between the pole shoes of an experimental electro magnet operated either at 0 T or 1 T. For the standard star shot, PG evaluation was independent of the time delay after irradiation (1 h, 24 h, 48 h and 216 h) and the results were comparable to those of film measurements. Within the electro magnet, the isocircle radius increased from 0.39 ± 0.01 mm to 1.37 ± 0.01 mm for the film and from 0.44 ± 0.02 mm to 0.97 ± 0.02 mm for the PG-measurements, respectively. The isocenter distance was essentially dependent on the alignment of the magnet to the isocenter and was between 0.12 ± 0.02 mm and 0.82 ± 0.02 mm. The study demonstrates that evaluation of the PG directly after irradiation is feasible, if only geometrical parameters are of interest. This allows using PG for star shot measurements to evaluate the radiation isocenter accuracy with comparable accuracy as with radiochromic films.

Taste in dementing diseases and parkinsonism.

Like with many sensory abilities a reduction of taste and smell occurs during aging. Since there are hints to an additional reduction in dementing diseases, we assessed 52 patients, 26 women and 26 men, who were presented to a memory clinic, using the Sniffin' Sticks, Whole Mouth and Taste Strip Tests. While smoking, alcohol consumption, intake of drugs and sex exerted only minor impact, age and the severity of cognitive impairment were of major importance. There was a moderate but significant correlation between the severity of dementia, taste and smell, even if the age effect was partialled out. Notably, patients with Parkinson syndrome showed worse taste and smell abilities than those without. Here the differences were indeed marked enough to play a possible role in making the diagnosis. This exploratory study confirms a mild reduction of gustatory function in dementing diseases over and beyond that of normal aging which--in addition to a reduction of smell--seems to be especially marked in Parkinson syndromes.

Oral stereotypy induced by amphetamine microinjection into striatum: an anatomical mapping study.

The ventrolateral striatum has been shown to specifically contribute to expression of psychostimulant-induced orofacial stereotypies. Adult male Sprague-Dawley rats were implanted with bilateral cannulae directed at one of eight striatal subareas, and were injected with saline or amphetamine (20 micrograms/0.5 microliter/side) in a counterbalanced order. Behaviors were observed and scored using a time-sampling procedure. In the middle ventrolateral striatum, amphetamine injections produced intense stereotypy, primarily consisting of bar biting, non-injurious self-biting and repetitive paw-to-mouth movements, while having no effect on locomotion or rearing. Amphetamine injections 2 mm medial or 1 mm dorsal produced no oral stereotypy, while injections 1 mm rostral or caudal to the effective site produced only low levels of stereotypy. Injections into the surrounding sites, particularly in the ventromedial region, also had stimulatory effects on locomotion and rearing. In a separate experiment, animals were given either unilateral or bilateral injection of amphetamine into the ventrolateral striatum. The unilateral injection produced stereotypy half as intense as that observed with bilateral injections. These results suggest that the ventrolateral striatum is a discrete neuroanatomical region which is primarily responsible for expression of psychostimulant-induced orofacial stereotypies, and which is likely to be the striatal region controlling normal oral motor function. Further investigation of this area may provide valuable insights concerning the etiology and treatment of orofacial dyskinesias associated with basal ganglia dysfunction.

Cholinergic stimulation of the ventrolateral striatum elicits mouth movements in rats: pharmacological and regional specificity.

Cholinomimetic drugs are known to induce changes in perioral behavior in rodents, characterized primarily by "purposeless" chewing movements, but little is known about their central sites of action. Using observational methods, the effects of direct microinfusion of a mixture of physostigmine and acetylcholine (PS/Ach, 0, 0.5, 2.5, 5.0 micrograms of each in 0.5 microliter saline) into the ventrolateral striatum (VLS) were assessed. Cholinergic stimulation of this region produced a dose-dependent induction of mouth movements, characterized by chewing movements, jaw opening and closing, tongue protrusions and jaw tremors. These movements were not directed toward any stimulus. In some rats, cholinergic stimulation of the VLS also induced stereotyped self-biting, although this effect was less prominent and of shorter duration. Induction of mouth movements by cholinergic stimulation of the VLS was blocked by prior administration of atropine, either systemically (50 mg/kg) or directly into the VLS (10 micrograms). Systemic administration of methylatropine (50 mg/kg) did not block the mouth movements. Pretreatment with haloperidol (2.5 micrograms into VLS) had no effect on PS/Ach-induced mouth movements. Infusion of PS/Ach (0, 2.5, 5.0 micrograms) into the dorsolateral or ventromedial striatum did not produce significant changes in oral behavior, although the level of mouth movements was somewhat higher at the medial site. The three sites studied were also differentiated with respect to spontaneous motor behaviors (locomotion and rearing) following direct cholinergic stimulation. These findings are considered as further evidence for the role of the ventrolateral striatum in oral motor behavior.

Depletion of rat liver glucocorticoid receptor hormone-binding and its mRNA in sepsis.

Glucocorticoid receptor (GR) hormone-binding activity, its physical characteristics, and GR mRNA levels were studied in the liver, brain and muscle of normal (saline-injected) and hypermetabolic septic rats 24 h after the subcutaneous injections of E. coli. The GR levels (hormone-binding activity) declined by about 40%, 56%, and 40% in septic liver, brain, and muscle cytosol, respectively. The mechanism of the decrease in the GR levels in sepsis was studied in liver. The GR levels remained low (45% of control hormone-binding) even after 48 h of E. coli administration. The decrease in the liver GR occurred in the 9S untransformed GR. The 9S GR from septic liver transformed to the 4S form in proportions comparable to the control liver GR. In addition, the 4S GR from control and septic liver was capable of binding to DNA-cellulose to a similar extent. The GR mRNA level in septic liver declined by about 30%. Thus, a decrease in GR hormone-binding activity in sepsis appears to be due to a decline in the steady-state GR mRNA level and not from a change in the qualitative properties of the GR protein.

Skin exposure to I blocks thyroid uptake of 131I.

Radioisotopes of I pose an important health risk to man in nuclear accidents associated with electric power generation due to their uptake by the thyroid glands. Topical application of tincture of I or povidone-iodine to the skin of rats has been found to be as effective as oral administration of potassium iodide in blocking thyroid uptake of parenterally administered 131I. If the same effectiveness can be demonstrated in humans, this may be an attractive alternative method of mass protection from radioisotopes of I following nuclear accidents.

The effects of topical povidone I solution on serum iodide levels and thyroid uptake of 131I in dogs.

Topical application of povidone I solution in dogs has been found to be effective in producing significant elevations in serum iodide concentrations within 2 h after application. Among dogs treated with this preparation 2 h before oral administration of 131I, significant thyroid blocking persisted for at least 72 h.

[Recurrent selective bronchial intubation in laparoscopic cholecystectomy]. / Intubation bronchique sélective à répétition au cours d'une cholécystectomie coelioscopique.

Selective endobronchial intubation occurred three times in a 38-year-old female patient undergoing laparoscopic cholecystectomy. She weighed 58 kg and was 165 cm tall. Anaesthesia was obtained with propofol, fentanyl and vecuronium. Endotracheal intubation was carried out with a Mallinckrodt tube, size 7.5. It was attached to the cheeks with the 22 cm marking at the teeth. The diagnosis of endobronchial intubation was made when he SpO2 fell abruptly to 79, 87 and 93% respectively. Simultaneously, the peak inspiratory pressure increased and PetCO2 decreased. The third time, both lung fields were auscultated; no breath sounds were found on the left side. The first two incidents were cured by exsufflating the artificial pneumoperitoneum. Pulling out the tube 4 cm definitely solved the problem. These endobronchial intubations were due to the tube being too close to the carina. During insufflation of the pneumoperitoneum, the carina is pushed upwards with the corresponding part of the mediastinum.

Specific Lactobacillus/Mutans Streptococcus co-aggregation.

Selective interaction of mutans streptococci with benign bacteria could present an opportunity for their removal from the mouth without disruption of other oral flora. This study was conducted to find probiotic lactobacilli that could specifically co-aggregate in vitro with mutans streptococci, but not with other plaque commensals. A search of 624 lactobacilli among a large culture library revealed 6 strains, all classifiable as L. paracasei or L. rhamnosus, which met this criterion. Such novel, specific co-aggregation, however, was not a general characteristic of these species or the genus Lactobacillus. The co-aggregation by these specific lactobacilli was characterized as heat treatment (autoclaving)- and protease-resistant, lectin-independent, not inactivated by sugar substitutes, operational over a wide pH range, unaffected by whole saliva, but calcium-dependent. It is thus seen to present a potential strategy for in vivo alteration of plaque biofilm and caries.

Caries inhibition by and safety of Lactobacillus paracasei DSMZ16671.

Lactobacillus paracasei DSMZ16671, even if heat-killed, sensitively co-aggregates mutans streptococci specifically. Mutans streptococci are strongly implicated in caries induction in humans and rodents. We hypothesized: (1) that S. mutans recoveries from rats' teeth in vivo will decrease, with an associated decrease in caries, if these lactobacilli are fed to rats in an established caries model; and (2) that toxicological assays of these lactobacilli will show them to be benign. Four groups of specific-pathogen-free rats were formed: S. mutans 10449S-inoculated/16671-supplemented diet; un-inoculated/16671-supplemented diet; S. mutans 10449S-inoculated/placebo diet; and un-inoculated/placebo diet. Standard tests of toxicity and mutagenicity of heat-killed DSMZ16671 were performed. S. mutans recoveries were significantly reduced both in mid-experiment and at termination, as were caries lesion scores for the rats inoculated by S. mutans and fed the DSMZ16671 supplement, by comparison with controls. Neither toxicity nor mutagenicity of DSMZ16671 was detected. Use of heat-killed DSMZ16671 is efficacious in rats and appears safe.

[Three-dimensional recording of changes in infant jaws with bilateral lip-maxilla-palate clefts with special reference to the results of preoperative orthodontic therapy]. / Dreidimensionale Erfassung der Veränderungen an Säuglingskiefern mit doppelseitigen Lippen-Kiefer-Gaumen-Spalten unter besonderer Berücksichtigung der Ergebnisse der präoperativen kieferorthopädischen Therapie.

Bilateral clefts are more difficult to treat than unilateral ones. The most important step during the orthopedic therapy is the retrusion of the premaxilla between the lateral segments of the maxilla. Thus the anterior cleft width, as opposed to the medial and posterior cleft width, did not become smaller. The position of premaxilla is mainly shown in the sagittal measurement values. The values of slope also changed in this sample. The maxilla became more flat. The preoperative orthodontic therapy can also be seen as advantageous in the case of bilateral clefts.

[3-dimensional recording of changes in the infant jaw with unilateral cheilognathopalatoschisis with special reference to the results of preoperative orthodontic therapy]. / Dreidimensionale Erfassung der Veränderungen an Säuglingskiefern mit einseitigen Lippen-Kiefer-Gaumen-Spalten unter besonderer Berücksichtigung der Ergebnisse der präoperativen kieferorthopädischen Therapie.

The changes of jaws of cleft palate children were examined from birth until after the operative lip closure by the aid of a method of coordinate measurement technique. The examination resulted in a significant reduction of the anterior, medial and posterior cleft width during the preoperative treatment period. The anterior and posterior width of alveolar crest arch remained nearly constant in the examination period. The translation of the anterior poles of the palate segments in the case of the unilateral clefts were more distinct in the transversal direction than in sagittal direction. Values of slope were constant or became little smaller after the orthopedic treatment. After the lip closure we found end-to-end relation resulting from guided growth of the segments having constant arch dimensions. A collapse of the segments could not be observed. Altogether we can say the preoperative orthopedic therapy would give the cleft palate good suppositions for the further development.

[The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation]. / Spontane und induzierte neuromuskuläre Erholung nach gleich langer Relaxierung mit Rapacuronium und Mivacurium.

This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O2 (2/1). Endotracheal intubation was performed when maximum blockade was achieved and scored by a blinded intubator. Neuromuscular block was monitored using the train-of-four response to supramaximal stimuli at the ulnar nerve every 15 seconds using acceleromyography (TOF Watch SX). Onset time, clinical duration (reappearance of the third twitch of a TOF-stimulation) and recovery to T4/T1 > 0.9 were recorded. Speed of recovery was evaluated by the time difference between reappearance of the third twitch and T4/T1 > 0.9. The intubating conditions at the time of maximum block revealed no statistically significant differences between the three groups. Changes in blood pressure, heart rate and airway pressure were not significant. Onset time in subjects who received Rapacuronium (99 +/- 29 s) was faster compared to the onset time in those who received Mivacurium (157 +/- 36 s). Also clinical duration was significantly shorter following Rapacuronium without reversal (12 +/- 4 min) as well as with reversal (9 +/- 1 min) compared with Mivacurium (21 +/- 5 min)). Patients treated with Rapacuronium and reversal recovered faster (14 +/- 8 min)) compared to the other two groups (Mivacurium: 20 +/- 6 min, Rapacuronium without reversal: 31 +/- 9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51 %) when compared with Rapacuronium/Neostigmine (43 %) and Rapacuronium (28 %).

Rapid transbilayer movement of fluorescent phospholipid analogues in the plasma membrane of endocytosis-deficient yeast cells does not require the Drs2 protein.

Evidence is presented that endocytosis-deficient Saccharomyces cerevisiae end4 yeast cells rapidly internalize the fluorescent phospholipid analogues 1-palmitoyl-2-{6-[7-nitro-2,1, 3-benzoxadiazol-4-yl(NBD)amino] caproyl}phosphatidylcholine (P-C6-NBD-PtdCho) and P-C6-NBD-phosphatidylserine (P-C6-NBD-PtdSer). Both analogues redistributed between the exoplasmic and cytoplasmic leaflet with a half-time of < 15 min at 0 degrees C. The plateau of internalized analogues was about 70%. Transbilayer movement is probably protein-mediated, as the flip-flop of both analogues was very slow in liposomes composed of plasma-membrane lipids. Rapid analogue internalization was not abolished on depletion of intracellular ATP by about 90%. For P-C6-NBD-PtdCho only was a moderate decrease in the plateau of internalized analogues of about 20% observed, while that of P-C6-NBD-PtdSer was not affected. The Drs2 protein plays only a minor role, if any, in the rapid transbilayer movement of analogues in S. cerevisiae end4 cells. In S. cerevisiae end4 Deltadrs2 cells harbouring both an end4 allele and a drs2 null allele, about 60% and 50% of P-C6-NBD-PtdCho and P-C6-NBD-PtdSer, respectively, became internalized within 15 min at 0 degrees C. The preferential orientation of P-C6-NBD-PtdSer to the cytoplasmic leaflet is in qualitative agreement with the sequestering of endogenous phosphatidylserine to the cytoplasmic leaflet, as assessed by binding of annexin V. Virtually no binding of annexin V to spheroplasts of the parent wild-type strain or the mutant strains was observed. Likewise, no difference in the exposure of endogenous aminophospholipids to the exoplasmic leaflet between these strains was found by labelling with trinitrobenzenesulfonic acid. Thus, lipid asymmetry, at least of aminophospholipids, was preserved in S. cerevisiae end4 cells independently of the presence of the Drs2 protein.

Comparison of the effects of five adjuvants on the antibody response to influenza virus antigen in guinea pigs.

Five adjuvants were tested for their effect on the immune response in guinea pigs to the hemagglutinin antigen of influenza virus strain B/Panama. Vaccines containing 924 micrograms of hemagglutinin antigen/ml were prepared at high and low doses of Freund's complete and incomplete adjuvants, Syntex adjuvant, RIBI's adjuvant, TiterMax adjuvant, and aluminum phosphate adjuvant. Responses to these vaccines were compared with those to a control vaccine containing influenza virus B/Panama hemagglutinin antigen and saline. On day 28, vaccines containing the following adjuvant doses had significantly higher titers than the titer for the control: Freund adjuvants at high and low doses, RIBI at high dose, TiterMax at high and low doses, and aluminum phosphate at high dose. On day 42, vaccines containing the following adjuvant doses had significantly higher titers than that for the control: Freund adjuvants at high and low doses, RIBI at high dose, TiterMax at high dose, and aluminum phosphate at high dose. Freund adjuvants at high and low doses, RIBI adjuvant at high dose, and aluminum phosphate at high dose caused significantly greater swelling at the inoculation site than did the control vaccine. TiterMax adjuvant at high and low doses, and aluminum phosphate at low dose caused minor swelling at the inoculation site, but it was not significantly different from the swelling caused by the control vaccine. Syntex adjuvant at high and low doses, RIBI at low dose, and control (saline/antigen) at high and low doses caused no swelling after inoculation. Overall, the high dose of adjuvants caused greater tissue swelling than did the low dose of adjuvants.(ABSTRACT TRUNCATED AT 250 WORDS)