Impact of mapping points in high-density mapping of the left atrium.

PURPOSE: Currently, high-density mapping techniques are being discussed for more precise voltage mapping, lesion validation after pulmonary vein isolation (PVI) and superior left atrial tachycardia (LAT) mapping. However, the quality of high-density maps varies according to different mapping systems, multipolar catheter (MPC) types and numbers of mapping points. The aim of this study was to evaluate the impact of different numbers of mapping points in high-density mapping on validity. METHODS: From February 2016 to August 2018, 154 patients with previous PVI ablation and recurrent atrial fibrillation (AF) or left atrial tachycardia (LAT) were mapped by Orion™ multipolar catheter and Rhythmia HDx™ mapping system at our centre. Of those, 90 maps from 25 patients [11 male patients/14 female patients; age 76 ± 12 years] with 8000 to 16,000 mapping points in the primary map were collected. All maps were evaluated offline by two independent and blinded electrophysiologists regarding the following issues: (1) Is PVI observable in all veins? (2) Does voltage map cover the whole left atrium? (3) Does activation map display one or more isthmuses? The 90 maps consist of 30 maps with deactivated 24 of 64 electrodes of MPC with < 1000 mapping points (A), 30 maps with deactivated 16 of 64 electrodes of MPC and 2000 to 6000 mapping points (B) and 30 primary maps with 8000 to 16,000 mapping points (C). RESULTS: For (A), only in one map (3.3%), for (B) in 20 maps (66.7%, p < 0.05) and for (C) in 24 maps (80%) both investigators agreed with evaluable PVI in all veins. Investigators were able to assess whether the voltage map covered the whole left atrium and the same low voltage areas in (A) in 0 maps, in (B) in 16 maps (53%, p < 0.05) and in (C) in 23 maps (77%, p < 0.05). Also, investigators were able to locate the same critical isthmuses in the activation maps in (A) in 0 maps, in (B) in 2 maps (7%) and in (C) in 20 maps (67%, p < 0.05). CONCLUSIONS: In order to achieve comparable high-density maps which are verified by independent investigators, a minimum of 2000 to 6000 mapping points are required in the majority of voltage maps to evaluate PVI and low voltage areas. To define the critical isthmuses in activations maps, 8000 mapping points or more might be necessary. High-density maps with more than 8000 points increase the interrater reliability.

[Cardiogenic shock]. / Kardiogener Schock.

Cardiogenic shock is most commonly a complication of acute myocardial infarction. The ischemic loss of functional myocardium triggers distinct cardiovascular responses which can deteriorate to global pump failure with a mortality rate of more than 50%. Causes of cardiogenic shock beyond myocardial ischemia are very diverse. Decisive management with rapid evaluation, identification of the underlying disease and urgent initiation of supportive measures as well as definitive therapy is of prognostic value. Causal treatment of the cardiac disease is crucial but has to be weighed against the specific surgical circumstances of perioperative patients, particularly concerning anticoagulation, platelet inhibition and bleeding risks. Hemodynamic stabilization is achieved by pharmacological support of myocardial function, control of arrhythmia and volume load. Prevention and intensive care of shock-related multiorgan failure is of pivotal importance in the successful management of cardiogenic shock.

Readmission to the intensive care unit after cardiac surgery: a single-center experience with 7105 patients.

AIM: Identification of patients at high risk for readmission to the Intensive Care Unit (ICU) after cardiac surgery is paramount. We evaluated the clinical characteristics of readmitted patients and identified perioperative prognostic variables for ICU readmission. METHODS: A total of 7105 patients who underwent cardiac surgery between 2007 and 2010 and discharged after a primary stay in the ICU were reviewed retrospectively. Of these, 7.8% (554) patients were readmitted. The reasons for readmission and postoperative course were analyzed. Perioperative risk factors for readmission were determined by multivariate regression analysis. RESULTS: Mortality of patients after readmission was 13.6% compared with 0.2% without recidivism (P<0.0001). Mean length of stay in hospital of patients requiring readmission was 24.9 ± 19.1 days and significantly longer compared to all other patients 12.3±8.4 days (P<0.0001). The main reasons for readmission were respiratory failure (39.0%) and cardiovascular instability (26.2%). Complex cardiac surgery, aortic surgery and extended stay in the ICU were the most powerful variables to predict ICU readmission. CONCLUSION: ICU readmission was related to complex surgery and associated with impaired outcome. Respiratory complications were the most common reasons for readmission. Predictive renal and pulmonary risk factors indicate the need of preoperative preconditioning and patient selection.

[Cardiogenic shock]. / Kardiogener Schock.

Cardiogenic shock is most commonly a complication of acute myocardial infarction. The ischemic loss of functional myocardium triggers distinct cardiovascular responses which can deteriorate to global pump failure with a mortality rate of more than 50%. Causes of cardiogenic shock beyond myocardial ischemia are very diverse. Decisive management with rapid evaluation, identification of the underlying disease and urgent initiation of supportive measures as well as definitive therapy is of prognostic value. Causal treatment of the cardiac disease is crucial but has to be weighed against the specific surgical circumstances of perioperative patients, particularly concerning anticoagulation, platelet inhibition and bleeding risks. Hemodynamic stabilization is achieved by pharmacological support of myocardial function, control of arrhythmia and volume load. Prevention and intensive care of shock-related multiorgan failure is of pivotal importance in the successful management of cardiogenic shock.

Tip-enhanced near-field optical microscopy of carbon nanotubes.

We review recent experimental studies on single-walled carbon nanotubes on substrates using tip-enhanced near-field optical microscopy (TENOM). High-resolution optical and topographic imaging with sub 15 nm spatial resolution is shown to provide novel insights into the spectroscopic properties of these nanoscale materials. In the case of semiconducting nanotubes, the simultaneous observation of Raman scattering and photoluminescence (PL) is possible, enabling a direct correlation between vibrational and electronic properties on the nanoscale. So far, applications of TENOM have focused on the spectroscopy of localized phonon modes, local band energy renormalizations induced by charge carrier doping, the environmental sensitivity of nanotube PL, and inter-nanotube energy transfer. At the end of this review we discuss the remaining limitations and challenges in this field.

Raman spectroscopy of graphene edges.

Graphene edges are of particular interest since their orientation determines the electronic properties. Here we present a detailed Raman investigation of graphene flakes with edges oriented at different crystallographic directions. We also develop a real space theory for Raman scattering to analyze the general case of disordered edges. The position, width, and intensity of G and D peaks are studied as a function of the incident light polarization. The D-band is strongest for polarization parallel to the edge and minimum for perpendicular. Raman mapping shows that the D peak is localized in proximity of the edge. For ideal edges, the D peak is zero for zigzag orientation and large for armchair, allowing in principle the use of Raman spectroscopy as a sensitive tool for edge orientation. However, for real samples, the D to G ratio does not always show a significant dependence on edge orientation. Thus, even though edges can appear macroscopically smooth and oriented at well-defined angles, they are not necessarily microscopically ordered.

[Added caries prevention by means of topical fluoride application in children of a district with fluoridation]. / Additive Karieshemmung durch lokale Fluoridapplikation bei Kindern eines Wohngebietes mit fluoridangereichertem Trinkwasser.

The effects of weekly mouth-rinsings with a 0.5% sodium fluoride solution were clinically and radiologically investigated in 58 children (age 13.6 years) from a town with water fluoridation (Karl-Marx-Stadt, 1.0 +/- 0.1 p.p.m.F) by means of a longitudinal study on the premolars and canines. As compared to an untreated control group (48 subjects), a 42% inhibition of fissure caries increment (DF/S index) was stated after 57-fold application (over 24 months).

Effect of maltose on glucoamylase formation by Aspergillus niger.

Low levels of glucoamylase are produced when Aspergillus niger is grown on sorbitol, but substitution of the latter by glucose, maltose, or starch results in greater formation of glucoamylase as measured by enzymatic activity. Both glucoamylase I and glucoamylase II are formed in a yeast extract medium; however, glucoamylase I appears to be the only form produced when ammonium chloride is the nitrogen source. Maltose or isomaltose (1.4 x 10(-4)m), but no other disaccharides or monosaccharides, dextrins, dextrans, or starches, stimulated glucoamylase formation when added to mycelia pregrown on sorbitol-ammonium salts. The induction of glucoamylase by maltose was independent of sulfate concentration but showed a dependency on low pH and the absence of utilizable carbon sources.

Transfer of infectious drug resistance in microbially defined mice.

Germ-free mice were intentionally associated with drug-resistant donor strains of Escherichia coli known to carry R factors and with drug-sensitive recipient strains. In vivo transfer of R factors was observed in all experiments, involving five different donor-recipient combinations. The number of converted recipients varied, depending upon the donor-recipient combination, but in all cases it was restricted by limiting numbers of either recipient or donor strains in the digestive tract of the microbially defined mice. Converted recipients were detected in fecal material as early as 5.5 hr after mice were associated with donor and recipient bacteria. Donors, recipients, and converted recipients were detectable in the stomach, small intestine, cecum, and large intestine of the microbially defined mice and their suckling young.

Transferable drug resistance among Enterobacteriaceae isolated from human urinary tract infections.

Fifteen sulfonamide-resistant cultures isolated from urinary tract infections in eastern Nebraska were screened for transferable drug resistance by three methods. Seven of the 15 resistant cultures could transfer resistance of varying levels to two or more chemotherapeutic agents. Transfer of drug resistance occurred without accompanying transfer of chromosomal traits and required cell to cell contact. In mixed culture, the number of drug-resistant recipients increased exponentially, reaching a plateau 2 hr after mixing. Spontaneous or artificial elimination of resistance was found to be a rare event. In addition, several drug-sensitive isolates from urinary tract infections were shown to be competent recipients of drug resistance determinants. From these data, it appears that the transferable drug resistance observed was mediated by R factors.

Phospholipids from Bacillus stearothermophilus.

The lipids of Bacillus stearothermophilus strain 2184 were extracted with chloroform-methanol and separated into neutral lipid and three phospholipid fractions by chromatography on silicic acid columns. The phospholipids were identified by specific staining reactions on silicic acid-impregnated paper, by chromatography of alkaline and acid hydrolysis products, and by determination of acyl ester:glycerol:nitrogen:phosphorus molar ratios. The total extractable lipid was 8% of the dry weight of whole cells and consisted of 30 to 40% neutral lipid and 60 to 70% phospholipid. The phospholipid consisted of diphosphatidyl glycerol (23 to 42%), phosphatidyl glycerol (22 to 39%), and phosphatidyl ethanolamine (21 to 32%). The concentrations of diphosphatidyl glycerol and phosphatidyl glycerol were lower in 2-hr cells than in 4- and 8-hr cells. Whole cells were fractionated by sonic treatment and differential centrifugation. The total lipid content, expressed in per cent of dry weight of each fraction was: whole protoplasts, 10%; membrane fraction, 18%; 30,000 x g particulate fraction, 22%; and 105,000 x g particulate fraction, 26%. The relative phospholipid concentrations in each fraction were about the same. As had been previously reported, none of the phospholipid was stable to alkaline hydrolysis.