Role of alternative interventional procedures when endo- and epicardial catheter ablation attempts for ventricular arrhythmias fail.

BACKGROUND Ventricular tachycardia (VT) refractory to antiarrhythmic drugs and standard percutaneous catheter ablation techniques portends a poor prognosis. We characterized the reasons for ablation failure and describe alternative interventional procedures in this high-risk group. METHODS AND RESULTS Sixty-seven patients with VT refractory to 4±2 antiarrhythmic drugs and 2±1 previous endocardial/epicardial catheter ablation attempts underwent transcoronary ethanol ablation, surgical epicardial window (Epi-window), or surgical cryoablation (OR-Cryo; age, 62±11 years; VT storm in 52%). Failure of endo/epicardial ablation attempts was because of VT of intramural origin (35 patients), nonendocardial origin with prohibitive epicardial access because of pericardial adhesions (16), and anatomic barriers to ablation (8). In 8 patients, VT was of nonendocardial origin with a coexisting condition also requiring cardiac surgery. Transcoronary ethanol ablation alone was attempted in 37 patients, OR-Cryo alone in 21 patients, and a combination of transcoronary ethanol ablation and OR-Cryo (5 patients), or transcoronary ethanol ablation and Epi-window (4 patients), in the remainder. Overall, alternative interventional procedures abolished ≥1 inducible VT and terminated storm in 69% and 74% of patients, respectively, although 25% of patients had at least 1 complication. By 6 months post procedures, there was a significant reduction in defibrillator shocks (from a median of 8 per month to 1; P<0.001) and antiarrhythmic drug requirement although 55% of patients had at least 1 VT recurrence, and mortality was 17%. CONCLUSIONS A collaborative strategy of alternative interventional procedures offers the possibility of achieving arrhythmia control in high-risk patients with VT that is otherwise uncontrollable with antiarrhythmic drugs and standard percutaneous catheter ablation techniques.

Radiomic Texture Analysis Mapping Predicts Areas of True Functional MRI Activity.

Individual analysis of functional Magnetic Resonance Imaging (fMRI) scans requires user-adjustment of the statistical threshold in order to maximize true functional activity and eliminate false positives. In this study, we propose a novel technique that uses radiomic texture analysis (TA) features associated with heterogeneity to predict areas of true functional activity. Scans of 15 right-handed healthy volunteers were analyzed using SPM8. The resulting functional maps were thresholded to optimize visualization of language areas, resulting in 116 regions of interests (ROIs). A board-certified neuroradiologist classified different ROIs into Expected (E) and Non-Expected (NE) based on their anatomical locations. TA was performed using the mean Echo-Planner Imaging (EPI) volume, and 20 rotation-invariant texture features were obtained for each ROI. Using forward stepwise logistic regression, we built a predictive model that discriminated between E and NE areas of functional activity, with a cross-validation AUC and success rate of 79.84% and 80.19% respectively (specificity/sensitivity of 78.34%/82.61%). This study found that radiomic TA of fMRI scans may allow for determination of areas of true functional activity, and thus eliminate clinician bias.

Chemical composition of volcanic ash layers from ODP Leg 134 sites

Volcanic ash layers (1-3 cm thick) are abundant in the North Aoba Basin drill sites but less common at forearc sites. Ash deposited on the forearc slopes is liable to be redistributed as turbidites. In addition, the westerly upper winds also minimize ash-fall on the western (forearc) side of the New Hebrides Island Arc. Crystalline components in the ashes are primarily plagioclase (An90-An44), clinopyroxene (Ca46Mg49Fe5-Ca43Mg33Fe24), olivine (Fo87-Fo62), and titanomagnetite. There are also small amounts of orthopyroxene, magnetite, apatite, and quartz. Glass shards occur in most of the ashes and range in composition from basalt to rhyolite. There is often a variety of glass compositions within a single ash layer. One explanation for this is that the rate of accumulation of ash from several different eruptions or eruptive phases exceeded the background sedimentation rate: there may also have been a certain amount of reworking. The high-K and low-K trends previously recognized in volcanic rocks from the New Hebrides Island Arc are clearly represented in the Leg 134 glasses. All of the ashes investigated here are thought to have originated from the Central Chain volcanoes. The source of the high-K group was probably the Central Basin volcanoes of Santa Maria, Aoba, and Ambrym. The lower-K series includes a distinctive group of dacites and is likely to have originated from the Epi-Tongoa-Tongariki sector of the arc where major pyroclastic eruptions, associated with caldera collapse, have occurred during the Holocene, perhaps as recently as 400 yr ago.

Virtual car accidents of epilepsy patients, interictal epileptic activity, and medication.

OBJECTIVE To investigate effects of interictal epileptic activity (IEA) and antiepileptic drugs (AEDs) on reactivity and aspects of the fitness to drive for epilepsy patients. METHODS Forty-six adult patients with demonstration of focal or generalized bursts of IEA in electroencephalography (EEG) readings within 1 year prior to inclusion irrespective of medication performed a car driving computer test or a single light flash test (39 patients performed both). Reaction times (RTs), virtual crashes, or lapses (RT ≥ 1 s in the car or flash test) were measured in an IEA burst-triggered fashion during IEA and compared with RT-measurements during unremarkable EEG findings in the same session. RESULTS IEA prolonged RTs both in the flash and car test (p < 0.001) in individual patients up to 200 ms. Generalized IEA with spike/waves (s/w) had the largest effect on RT prolongation (p < 0.001, both tests), whereas mean RT during normal EEG, age, gender, and number of AEDs had no effect. The car test was better than the flash test in detecting RT prolongations (p = 0.030). IEA increased crashes/lapses >26% in sessions with generalized IEA with s/w. The frequency of IEA-associated RT >1 s exceeded predictions (p < 0.001) based on simple RT shift, suggesting functional impairment beyond progressive RT prolongation by IEA. The number of AEDs correlated with prolonged RTs during normal EEG (p < 0.021) but not with IEA-associated RT prolongation or crashes/lapses. SIGNIFICANCE IEA prolonged RTs to varying extents, dependent on IEA type. IEA-associated RTs >1 s were more frequent than predicted, suggesting beginning cerebral decompensation of visual stimulus processing. AEDs somewhat reduced psychomotor speed, but it was mainly the IEA that contributed to an excess of virtual accidents.

Cuentos.

Author's pseud., Silverio Lanza, at head of title.

Ekklēsiai vyzantinai exakrivoumenai (kyriōs hē Theotokos tou kyriou) : symplērōma tou vyzantinou heortologiou /

Includes bibliographical references.

uvres de m. de Lamartine.

t.1. Janin, J. Sur cette nouvelle e dition. Premie res me ditations poe tiques. La mort de Socrate. Epitres et poe sies diverses.--t.2. Nouvelles me ditations poe tiques. Le dernier chant du pe lerinage d'Harold.--t.3-4. Harmonies poe tiques et religieuses. Le chant du sacre. Epi tres et poe sies diverses. Discours a l'Acade mie franc aise, etc.

El factor geográfico en la política sudamericana,

At head of title: Real Academia de jurisprudencia y legislacion.

Oeuvres diverses de Grécourt.

Vol. 4 has title: Supplement de Grécourt, ou collection de differentes piéces, dont partie, ci-devant confondues dans toutes les editions de ce poëte, sont redonnées ici plus correctes; & partie publiées pour la premiere fois.

Sophoclis tragoediae septem /

Includes indexes.

Birth defects and other adverse pregnancy outcomes in Illinois, 1998-2002 : a report on county-specific incidence.

" ... supported by grant/cooperative agreement number U50/CCU523303 from the U.S. Centers for Disease Control and Prevention."--Page ii.

Pentalogia, sive Tragoediarum graecarum delectus.

Vocabulary: [32] p. at end.

Epidemiology of Opisthorchis viverrini

Opisthorchis viverrini is a food home trematode, important because of the sheer numbers of people infected and its serious morbidities such as hepatobiliary diseases and cholangiocarcinoma (CHCA). Although infections are identified throughout Southeast Asia, the epi-center is northeast Thailand, where high prevalence coexists with a high incidence of CHCA. In this review, we present the basic population features and the factors influencing transmission between the different hosts. (C) 2003 Elsevier B.V. All rights reserved.

Sofrimento psíquico em trabalhadores do lixo: um olhar da psicodinâmica do trabalho

O número de catadores, caminhoneiros e trabalhadores informais que utilizam o trabalho com o lixo como forma de sobrevivência cresce em todo país. Sabe-se que esse tipo de trabalho oferece vários riscos à saúde física: no entanto, há poucos estudos sobre os efeitos que pode ocasionar na saúde mental. Diante disso, o presente estudo, de caráter exploratório, teve como objetivo compreender o sofrimento psíquico decorrente do trabalho de manuseio e triagem de resíduos sólidos recicláveis em trabalhadores de uma corporativa de reciclagem da região metropolitana de São Paulo. O referencial teórico utilizado foi a Psicodinâmica do Trabalho, disciplina clínica e teórica que se sustenta na descrição e no conhecimento das relações entre trabalho e saúde mental. Utilizou-se também o método específico da Psicodinâmica do Trabalho, regido pelos princípios da pesquisa-ação, que liga a intervenção à pesquisa. A coleta de dados se deu através da criação de um grupo de expressão, em que foram abordadas questões ligadas às vivências e experiências dos trabalhadores que manuseiam resíduos sólidos recicláveis. A análise dos dados mostra que a organização do trabalho neste caso torna-se pano de fundo para a problemática do sofrimento psíquico, uma vez que, na cooperativa, os trabalhadores têm certo controle sobre a realização da tarefa, podendo interferir no processo de trabalho. Constatou-se ainda que o sofrimento psíquico decorrente do trabalho assume diversas formas: a negação do risco à saúde física decorrente da precariedade e insalubridade do trabalho, que se concretiza pela não-utilização dos equipamentos de segurança (EPI) e por maus hábitos de higiene: a negação da dificuldade em manusear o lixo, pela busca de vantagens na atividade realizada que ajudem a suportar o contato com o que é sujo e desvalorizado e pela luta para manter-se no trabalho, que proporciona a cooperação entre os sujeitos - sendo a solidariedade e a cooperação as características mais marcantes nas relações entre esses trabalhadores. Entende-se que o trabalho realizado tem grande importância social, mas é preciso atentar para o fato de que o problema da destinação do lixo não pode superar a problemática dos efeitos sobre a saúde dos trabalhadores. Esse quadro só poderá ser alterado com melhores condições de trabalho e, principalmente, com o reconhecimento da atividade como algo fundamental para a sociedade e que, como tal, deve ser valorizado.(AU)