A detailed view on pacemaker lead parameters remotely transmitted after magnetic resonance.

BACKGROUND: The purpose of this study was to analyze potential influences of magnetic resonance (MR) on the course of automatically device-based assessed lead parameters remotely transmitted in patients who were implanted with MR-conditional permanent pacemakers (PMs) and who had nondiagnostic brain and lumbar spine MR (1.5T) within the ProMRI single center pilot study. METHODS: The ProMRI study evaluated the feasibility of the Evia PMs with Safio S leads (Biotronik SE&Co KG, Berlin, Germany) in the MR environment. All patients were equipped with remote monitoring on the day of MR. Atrial (RA) und ventricular (RV) lead parameters (sensing, pacing capture threshold [PCT], pacing impedance) were automatically assessed and remotely transmitted on a daily or event-triggered basis for 3 months post MR. Remotely transmitted data were normalized for potential differences between at-daytime (in-office) and at-night-time (remotely) assessed parameters using the 1-month follow-up data for each patient. Confidence intervals of continuous data were calculated day-wise with one sample t-tests of post-MR/pre-MR differences, respectively. RESULTS: A total of 2,428 data sets (mean 80 ± 20 per patient) were transmitted. Mean values for the different lead parameters were (RA/RV) 3.3 ± 2.0/14.4 ± 6.9 mV for sensing, 0.65 ± 0.17/0.78 ± 0.23 V/0.4 ms for PCT, and 516 ± 60/607 ± 47 Ω for pacing impedance. No significant differences were found compared with pre-MR measurements. No atrial PCT increases ≥0.5 V compared with pre-MR were observed, and in only one patient the ventricular PCT increased by ≥0.5 V from day 76 post-MR, presumably based on new antiarrhythmic therapy with amiodarone. CONCLUSION: Our analyses of automatically assessed and remotely transmitted PM lead parameters after MR show that sensing amplitudes, PCTs, and pacing impedances are not affected in a clinically relevant way by MR.

Monocenter feasibility study of the MRI compatibility of the Evia pacemaker in combination with Safio S pacemaker lead.

BACKGROUND: The purpose of this study was to evaluate the feasibility of the magnetic resonance (MR) conditional pacemaker (PM) system (Evia SR-T and DR-T with Safio S leads) under MR conditions. METHODS: Patients with standard PM indications and Evia PM were eligible for enrollment in this single center prospective non-randomized pilot study. Patients underwent MR of the brain and lower lumbar spine at 1.5 Tesla. Atrial (RA) und ventricular (RV) lead parameters (sensing, pacing threshold [PTH], pacing impedance) were assessed immediately before (baseline follow-up [FU]) and immediately after MRI (1st FU), after 1 month (2nd FU) and 3 months (3rd FU). The effect of MR on serious adverse device effect (SADE) free-rate, on atrial and ventricular sensing (AS/VS; mV) and atrial (RA) and ventricular (RV) pacing thresholds (PTH; V/0.4 ms) were investigated between baseline and 2nd FU. Continuous variables are expressed as mean ± SD and were compared using paired Student's t-test. A p < 0.05 was considered significant. RESULTS: Thirty-one patients were enrolled. One patient had to be excluded because of an enrollment violation. Therefore, data of 30 patients (female 12 [40%], age 73 ± 12 years, dual chamber PM 15 [50%]) were included in this analysis. No MR related SADE occurred. Lead measurements were not statistically different between the baseline FU and the 2nd FU (AS/VS at baseline 3.2 ± 2.1/15.0 ± 6.0, at 2nd FU 3.2 ± 2.1/14.9 ± 6.5; p = ns. RA-PTH/RV-PTH at baseline 0.68 ± 0.18/0.78 ± 0.22, at 2nd FU 0.71 ± 0.24/0.78 ± 0.22; p = ns). The presence of the permanent pacemakers led to MR imaging artifacts on diffusion weighted sequences of the brain, but did not affect other sequences (e.g. FLAIR and T2 weighted spin-echo images). CONCLUSION: The use of the MR conditional Evia PM in a MR environment under predefined conditions is feasible. No MR related SADEs nor clinically relevant changes in device functions occurred.

Abnormal findings in hallucal sesamoids on MR imaging-Associated with different pathologies of the forefoot? An observational study.

BACKGROUND: To evaluate the prevalence and localization of abnormalities in the hallucal sesamoids detectable by magnetic resonance (MR) imaging in patients with forefoot pain and to determine which pathologies of tarsus, metatarsus and phalanges are associated with these abnormalities. MATERIALS AND METHODS: The forefoot MRI examinations of 50 consecutive patients (32 females, 18 males; mean age 51 years, age range 20-86 years) were retrospectively analyzed by two musculoskeletal radiologists. A minimum of coronal and sagittal T1-weighted images and STIR images or T2-weighted images with fat saturation were performed on a 1.5-T scanner. Abnormal findings in the sesamoids were correlated with pathology in the I.MTP (metatarsal-phalangeal) joint, pathology in other parts of the forefoot and clinical information. RESULTS: Signal abnormalities of the sesamoids were found in 7 patients out of 50 (14%). Two patients presented a bone marrow edema (BME) in both sesamoids, in 1 patient only the lateral one was affected; all three associated with pathology and pain in the I.MTP joint. In four patients only the medial sesamoid was affected, not associated with pathology in the I.MTP joint but with pathology in other parts of the forefoot. CONCLUSION: The prevalence of signal abnormalities in hallucal sesamoids was 14%. BME of the lateral sesamoid or of both were predominantly associated with pathology in the I.MTP joint. In contrast, signal abnormalities of the medial sesamoid, without affection of the lateral one, were associated with pathology in other parts of the forefoot suggesting an overuse injury as a result of compensating posture.

Current-density maps as probes of aromaticity: global and Clar pi ring currents in totally resonant polycyclic aromatic hydrocarbons.

Calculation and visualisation of induced current density are important aids to the study of both aromaticity and observable molecular magnetic response properties. The ipsocentric method offers an accurate and economical approach to calculation of induced current density, and a physical interpretation in terms of occupied-orbital contributions. In monocyclic systems, these contributions allow rationalisation of the existence, sense, and strength of ring current using simple symmetry and node-counting arguments. Here we show maps computed with the model pseudo-pi version of the ipsocentric theory for large polycyclic aromatic hydrocarbons (PAH) of the Clar type. Maps are presented for D(6h)-symmetric systems with up to 438 carbon centres; a full ab initio calculation for an isomer of C114H30 confirms that the success of the pseudo-pi method for small PAH carries over to these larger systems. The computed maps follow a generic overall pattern that can be understood with a natural extension of the orbital arguments to a 'band theory' of totally resonant PAH. All show pi current densities that combine a Clar-sextet structure of localised benzenoid diatropic ring currents (contributed by just four HOMO electrons) with a global perimeter diatropic ring current contributed by the remaining pi electrons. Both currents are explained in the ipsocentric model: the localised currents arise from excitations from the HOMO; the perimeter current from excitations from the rest of the HOMO-band.

On the lack of ring-current aromaticity of (heteroatom) [N]radialenes and their dianions.

Current-density maps, calculated at the ab initio RHF//6-31G**/CTOCD-DZ level, show no significant pi ring current in planar equilateral geometries of neutral and dianionic [N]radialenes, oxocarbons and thiocarbons C(N)Y(N) (q-) (Y=CH(2), O, S; N=4, 5, 6; q=0 (1 a-12 a), 2 (1 b-12 b)). Only the N=3 deltate dianions C(3)Y(3) (2-) (Y=CH(2), O, S (1 b, 5 b and 9 b)) have discernible pi ring current, and then with at most 20-25 % of the strength of the standard benzene current. On the magnetic criterion, lack of current is definitive evidence against aromaticity. Pictorial molecular-orbital analysis within the ipsocentric approach shows this to be an inevitable consequence of the nodal structure of the pi and pi* orbitals of [N]radialene-like systems. On grounds of angular-momentum symmetry, spatial distribution, or both, the HOMO-LUMO excitation does not contribute a significant central diamagnetic ring current.

The shell structure of pi ring currents in the expanded porphyrin amethyrin.

Direct ab initio mapping of induced current density in the pi system of the expanded porphyrin amethyrin shows a picture at variance with the conventional 4npi ascription of antiaromaticity. The ipsocentric orbital model interprets the pattern of currents as a superposition of shell contributions: an intense paratropic ring current concentrated on the inner 20-site cycle, counteracted by a weaker diatropic circulation on a 24-site conjugation pathway and a combination of local 5-site diatropic circulations on the six pyrrolic rings.

Ring currents in the porphyrins: pi shielding, delocalisation pathways and the central cation.

It is shown that the ipsocentric orbital-based model explains how the charge of the central cation drives the delocalisation pathway in metalloporphyrins. A positive charge +Ze at the centre of the porphin ring gives rise to a two-way radial transfer of charge within the pi structure of the porphin macrocycle. This manifests itself in a change of pathway of the global pi current, as Z increases from Z = 0, from an inner- through a bifurcated- to an outer-pathway. Changes of pathway can be interpreted in terms of a specific pi shielding effect whereby electrons in high-lying pi orbitals are screened from the central charge by the electrons in lower-lying orbitals of the same symmetry. These changes in pi structure are essentially independent of accompanying changes in the sigma structure.

Audiological performance after cochlear implantation in children with inner ear malformations.

OBJECTIVES: To prove that cochlear implantation is a beneficial method of rehabilitation in deaf children with malformations of the inner ear. DESIGN: The evaluation of auditory responses to speech (EARS) test battery was performed on the children in this study after an average implant use of 3 years. RESULTS: Individual results of six children with inner ear anomalies receiving cochlear implants are presented in this study. Three of the patients showed an incomplete partition (Mondini dysplasia), one had a cochlear hypoplasia and two suffered from an intraoperative cerebrospinal fluid leak. The majority of the children in this study are successful implant users. Wherever possible, test scores are included and subjective case reports given. CONCLUSIONS: Results are similar to those in children with normal cochleas, therefore inner ear malformations found in as many as 20% of patients with congenital sensorineural hearing loss are no contraindication for cochlear implantation. Nevertheless, factors influencing the success of implantation are multiple, including a thorough preoperative radiological examination, a well-performed surgery and an individually tailored postoperative rehabilitation programme.

Diamagnetic and paramagnetic ring currents in expanded porphyrins.

Ipsocentric current density maps are computed at the coupled Hartree-Fock level in the 6-31G** basis set for the planar C(2v) B3LYP geometries of the expanded porphyrins, sapphyrin and orangarin. Both give clearly dominant global macrocyclic ring currents, but with opposite senses of circulation: in 22[small pi] sapphyrin, a diatropic current runs, with some bifurcation, around the conventional 22-centre delocalisation pathway; in 20[small pi] orangarin, a paratropic current runs around the inner 17-atom pathway. In agreement with the annulene analogy for these macrocycles, analysis of orbital contributions shows that in each case topology, energy and symmetry of the frontier orbitals together determine the macrocyclic ring current. In sapphryrin, 4-electron diamagnetism (aromaticity) arises from translationally allowed HOMO-LUMO excitations as in benzene itself; in orangarin, 2-electron paramagnetism (antiaromaticity) arises from rotationally allowed HOMO-LUMO excitations as in planarised cyclooctatetraene. The active orbitals invoked in the explanation of ring currents are those involved in the longstanding four-orbital model of porphyrin electronic spectra.

The four-electron diamagnetic ring current of porphycene.

Porphycene, an isomer that can replace porphin in chemical and biochemical contexts, is predicted by ab initio calculation to exhibit a global diatropic pi ring current with bifurcation across the four pyrrole units of the macrocycle. Analysis of the orbital contributions to the current density in porphycene reveals that the global current, with its bifurcation feature, is attributable to the four electrons of the near-degenerate HOMO levels, the same set of active electrons that feature in the well-known four-orbital model of the electronic spectra of porphyrins. Integration of the current density gives 1H, 13C and 15N NMR shieldings that are compatible with the observed low-field shifts of peripheral and bridge protons and high-field shift of the internal NH protons, assignment of the 13C NMR spectrum and the single average 15N chemical shift resulting from rapid NH tautomerism. Geometries were calculated with the DFT B3LYP functional, the current density maps were calculated with the ipsocentric coupled-Hartree-Fock CTOCD-DZ method, and the shieldings with the CTOCD-PZ2 variant, all in the same 6-31G** basis.

The diatropic sigma ring currents of [pi2s + pi2s + pi2s] pericyclic transition states.

Ab initio current-density maps for the (4n + 2)-electron transition states of two thermally allowed [pi2s + pi2s + pi2s] trimerisations, of ethyne to benzene (1), and of ethene to cyclohexane (2), show that both support sigma diatropic ring currents, dominated by four-electron sigma --> sigma* virtual excitation of HOMO electrons.

Control of the diatropic pi ring current in strained benzenes: effects of annelation with cyclopropa, cyclobuta, and cyclobutadieno clamping groups.

Direct visualization of the pi current density maps of highly strained annelated benzenes containing cyclopropa, cyclobuta, and cyclobutadieno clamps, alone and in combination, using a reliable distributed-origin, coupled Hartree-Fock method, shows the robustness of the classical benzene diatropic pi ring current. When only saturated clamps are used, the benzene ring current is essentially unchanged. In contrast, annelation with one or more cyclobutadieno clamps disrupts the benzene ring current. Analysis of orbital contributions to the current density maps gives a unified account of these observations in terms of the nature of the HOMO-LUMO transition.

Ring currents in a proposed system containing planar hexacoordinate carbon, CB(2-)(6).

Current-density maps at the coupled Hartree-Fock level calculated in the CTOCD (continuous transformation of origin of current density) approach demonstrate the magnetic response of the hypothetical planar hexacoordinate carbon species, CB(2-)(6). In contrast with the empty CB(2-)(6) framework, which supports paramagnetic currents, the carbon-containing species has a typical diamagnetic pi-ring current that circulates undisturbed by the central atom. In spite of the unconventional nature of the species, the properties of 6pi CB(2-)(6) and 4pi CB(2-)(6) can be rationalised with the same orbital model that accounts for the diamagnetic pi current of benzene and the paramagnetic pi current of planar cyclooctatetraene.

Counter-Rotating Ring Currents in Coronene and Corannulene.

Explicit ab initio current-density maps contradict the annulene-within-an-annulene model of [n]circulenes: in both coronene and corannulene the expected diamagnetic current on the perimeter is opposed by the central, paramagnetic ring current.