SANS FLUORO Optimized: A Case Report of Pulmonary Vein Isolation in a Patient with Cardiac Resynchronization Therapy Defibrillator and the Optimizer™ III Device.

We offer the first reported case of a pulmonary vein isolation (PVI) procedure performed in a patient with two devices, specifically a cardiac resynchronization therapy defibrillator (CRT-D) and an Optimizer™ III device (Impulse Dynamics, Mount Laurel, NJ, USA), using the SANS FLUORO technique with zero fluoroscopy. In total, this patient had six leads traversing the right atrium, including two right atrial leads, three right ventricular leads-two associated with the Optimizer™ system and one implantable cardiac defibrillator lead-and a left ventricular lead.

Zero-fluoroscopy Radiofrequency Redo Ablation of Atrial Tachycardia Following Pulmonary Vein Isolation: A Tale of Two Systems.

Regular atrial tachycardia (AT) is one of the most important proarrhythmic complications that may occur following left atrial pulmonary vein isolation (PVI). These tachycardias that develop after atrial fibrillation ablation may lead to worse symptoms than those from the original arrhythmia existing prior to the index ablation procedure. Ablation of various types of supraventricular tachycardias without the use of fluoroscopy has been shown to be feasible in both children and adults using three-dimensional mapping systems. We describe the case of a 71-year-old woman who developed a focal AT after a successful PVI procedure. The initial ablation failed with one mapping system. Repeat electrophysiologic study despite antiarrhythmic medications revealed the same focal AT, which was successfully ablated with a different mapping system. Both ablations were performed without fluoroscopy.

SANS FLUORO Supersized: A case report of Fluoroless Ablation in a Super Morbidly Obese Patient.

We present the first ever reported case of a super morbidly obese patient (BMI > 70) with drug refractory, symptomatic atrial flutter who underwent a successful, uncomplicated ablation procedure using a zero fluoroscopy technique. This case demonstrates the following two critical points: (1) difficulties in the treatment of massively obese patients with arrhythmias; (2) increased use of fluoroless ablation techniques.

Engaging Community Providers to Create More Active After-School Environments: Results From the Ontario CATCH Kids Club Implementation Project.

BACKGROUND: This paper evaluates the impact of a large-scale, community agency-driven initiative to increase physical activity (PA) in after-school programs in Ontario. In 2008, the YMCA and Boys and Girls Club (BGC) introduced CATCH Kids Club (CKC) into 330 after-school program sites. METHODS: This study assessed the impact of the intervention on the quality and quantity of PA using a pretest/posttest quasi-experimental research design with a comparison non-CKC group. Data were collected at baseline (September 2008) and postintervention (May/June 2009) using the System for Observing Fitness Instruction Time (SOFIT). RESULTS: Nearly all sites, with the exception of the BGC baseline program (a sports program) achieved greater than 50% of time spent in MVPA. Significant differences were not found between levels of MVPA at CKC and comparison sites (59.3% vs. 64.2%), or at CKC sites at baseline versus postintervention (59.3% vs. 52.1%). BGC sites had significantly higher levels MVPA in CKC programs than in sports programs (70.8% vs. 35.2%). In postimplementation interviews, leaders reported general support but some mixed reactions related to how the program was received by participants. CONCLUSIONS: This paper offers support for PA programs that focus on inclusivity and enjoyment and emphasize the important role of staff competency.

Limited role for SREBP-1c in defective glucose-induced insulin secretion from Zucker diabetic fatty rat islets: a functional and gene profiling analysis.

Accumulation of intracellular lipid may contribute to defective insulin secretion in type 2 diabetes. Although Zucker diabetic fatty (ZDF; fa/fa) rat islets are fat-laden and overexpress the lipogenic master gene, sterol regulatory element binding protein 1c (SREBP-1c), the contribution of SREBP-1c to the secretory defects observed in this model remains unclear. Here we compare the gene expression profile of lean control (fa/+) and ZDF rat islets in the absence or presence of dominant-negative SREBP-1c (SREBP-1c DN). ZDF islets displayed elevated basal insulin secretion at 3 mmol/l glucose but a severely depressed response to 17 mmol/l glucose. While SREBP-1c DN reduced basal insulin secretion from ZDF islets, glucose-stimulated insulin secretion was not improved. Of 57 genes differentially regulated in ZDF islets and implicated in glucose metabolism, vesicle trafficking, ion fluxes, and/or exocytosis, 21 were upregulated and 5 were suppressed by SREBP-1c DN. Genes underrepresented in ZDF islets were either unaffected (Glut-2, Kir6.2, Rab3), stimulated (voltage-dependent Ca(2+) channel subunit alpha1D, CPT2, SUR2, rab9, syt13), or inhibited (syntaxin 7, secretogranin-2) by SREBP-1c inhibition. Correspondingly, SREBP-1c DN largely corrected decreases in the expression of the transcription factors Pdx-1 and MafA but did not affect the abnormalities in Pax6, Arx, hepatic nuclear factor-1alpha (HNF1alpha), HNF3beta/Forkhead box-a2 (Foxa2), inducible cyclic AMP early repressor (ICER), or transcription factor 7-like 2 (TCF7L2) expression observed in ZDF islets. We conclude that upregulation of SREBP-1c and mild increases in triglyceride content do not explain defective glucose-stimulated insulin secretion from ZDF rats. However, overexpression of SREBP-1c may contribute to enhanced basal insulin secretion in this model.