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.

Ablation of ischemic ventricular tachycardia: evidence, techniques, results, and future directions

PURPOSE OF REVIEW This article summarizes current understanding of the arrhythmia substrate and effect of catheter ablation for infarct-related ventricular tachycardia, focusing on recent findings. RECENT FINDINGS Clinical studies support the use of catheter ablation earlier in the course of ischemic disease with moderate success in reducing arrhythmia recurrence and shocks from implantable defibrillators, although mortality remains unchanged. Ablation can be lifesaving for patients presenting with electrical storm. Advanced mapping systems with image integration facilitate identification of potential substrate, and several different approaches to manage hemodynamically unstable ventricular tachycardia have emerged. Novel ablation techniques that allow deeper lesion formation are in development. SUMMARY Catheter ablation is an important therapeutic option for preventing or reducing episodes of ventricular tachycardia in patients with ischemic cardiomyopathy. Present technologies allow successful ablation in the majority of patients, even when the arrhythmia is hemodynamically unstable. Failure of the procedure is often because of anatomic challenges that will hopefully be addressed with technological progress.

Stable carbon isotope ratios of alkane of IODP Hole 302-M0004A

The Palaeocene/Eocene thermal maximum represents a period of rapid, extreme global warming approx ~55 million years ago, superimposed on an already warm world (Zachos et al., 2003, doi:10.1126/science.1090110; Bowen et al., 2004, doi:10.1038/nature03115; Thomas et al., 2002, doi:10.1130/0091-7613(2002)030<1067:WTFFTF>2.0.CO;2). This warming is associated with a severe shoaling of the ocean calcite compensation depth **4 and a >2.5 per mil negative carbon isotope excursion in marine and soil carbonates (Zachos et al., 2003, doi:10.1126/science.1090110; Bowen et al., 2004, doi:10.1038/nature03115; Thomas et al., 2002, doi:10.1130/0091-7613(2002)030<1067:WTFFTF>2.0.CO;2; Zachos et al., doi:10.1126/science.1109004). Together these observations indicate a massive release of 13C-depleted carbon (Zachos et al., doi:10.1126/science.1109004) and greenhouse-gas-induced warming. Recently, sediments were recovered from the central Arctic Ocean (Backman et al., 2006, doi:10.2204/iodp.proc.302.2006), providing the first opportunity to evaluate the environmental response at the North Pole at this time. Here we present stable hydrogen and carbon isotope measurements of terrestrial-plant- and aquatic-derived n-alkanes that record changes in hydrology, including surface water salinity and precipitation, and the global carbon cycle. Hydrogen isotope records are interpreted as documenting decreased rainout during moisture transport from lower latitudes and increased moisture delivery to the Arctic at the onset of the Palaeocene/Eocene thermal maximum, consistent with predictions of poleward storm track migrations during global warming (Backman et al., 2006, doi:10.2204/iodp.proc.302.2006). The terrestrial-plant carbon isotope excursion (about ~4.5 to ~6 per mil) is substantially larger than those of marine carbonates. Previously, this offset was explained by the physiological response of plants to increases in surface humidity (Bowen et al., 2004, doi:10.1038/nature03115). But this mechanism is not an effective explanation in this wet Arctic setting, leading us to hypothesize that the true magnitude of the excursion - and associated carbon input - was greater than originally surmised. Greater carbon release and strong hydrological cycle feedbacks may help explain the maintenance of this unprecedented warmth.of this unprecedented warmth.

Hydraulic conductivity and experiments of sediment beds

In marine environments, sediments from different sources are stirred and dispersed, generating beds that are composed of mixed and layered sediments of differing grain sizes. Traditional engineering formulations used to predict erosion thresholds are however, generally for unimodal sediment distributions, and so may be inadequate for commonly occurring coastal sediments. We tested the transport behavior of deposited and mixed sediment beds consisting of a simplified two-grain fraction (silt (D50 = 55 µm) and sand (D50 = 300 µm)) in a laboratory-based annular flume with the objective of investigating the parameters controlling the stability of a sediment bed. To mimic recent deposition of particles following large storm events and the longer-term result of the incorporation of fines in coarse sediment, we designed two suites of experiments: (1) "the layering experiment": in which a sandy bed was covered by a thin layer of silt of varying thickness (0.2 - 3 mm; 0.5 - 3.7 wt %, dry weight in a layer 10 cm deep); and (2) "the mixing experiment" where the bed was composed of sand homogeneously mixed with small amounts of silt (0.07 - 0.7 wt %, dry weight). To initiate erosion and to detect a possible stabilizing effect in both settings, we increased the flow speeds in increments up to 0.30 m/s. Results showed that the sediment bed (or the underlying sand bed in the case of the layering experiment) stabilized with increasing silt composition. The increasing sediment stability was defined by a shift of the initial threshold conditions towards higher flow speeds, combined with, in the case of the mixed bed, decreasing erosion rates. Our results show that even extremely low concentrations of silt play a stabilizing role (1.4% silt (wt %) on a layered sediment bed of 10 cm thickness). In the case of a mixed sediment bed, 0.18% silt (wt %, in a sample of 10 cm depth) stabilized the bed. Both cases show that the depositional history of the sediment fractions can change the erosion characteristics of the seabed. These observations are summarized in a conceptual model that suggests that, in addition to the effect on surface roughness, silt stabilizes the sand bed by pore-space plugging and reducing the inflow in the bed, and hence increases the bed stability. Measurements of hydraulic conductivity on similar bed assemblages qualitatively supported this conclusion by showing that silt could decrease the permeability by up to 22% in the case of a layered bed and by up to 70% in the case of a mixed bed.

Abundance of copepods during POLARSTERN cruise ANT-XXI/2 (BENDIX)

The main emphasis of this study was to analyse the short-term development of abundance, population structure and vertical distribution of the dominant calanoid copepods during a phytoplankton bloom in the coastal area of the eastern Weddell Sea in December 2003. Microcalanus pygmaeus was by far the most abundant calanoid species. Metridia gerlachei, Ctenocalanus citer, Calanoides acutus, Calanus propinquus and the ice-associated Stephos longipes were also present in considerable proportions. The observed changes in the population characteristics and parameters of these species are described in detail and discussed in the context of the spring phytoplankton bloom. A conspicuous event occurring during the final stage of the study was the development of a strong storm. While the results suggest that this storm did not have any considerable influence on the populations of all other investigated copepod species, it very likely caused pronounced changes in the S. longipes population present in the water column. Before the storm, S. longipes was found primarily in the upper 100 m of the water column, and its population was dominated by adults (mean proportion = 41%) and the copepodite stage I (mean proportion = 30%). After the storm, the abundance increased considerably, and the copepodite stage I contributed by far the largest proportion (53%) of the total population indicating that the early copepodite stages probably had been released from the sea ice into the under ice water layer due to ice break-up and ice melt processes caused by the storm.

Time-differentiated target temperature management after out-of-hospital cardiac arrest: a multicentre, randomised, parallel-group, assessor-blinded clinical trial (the TTH48 trial): study protocol for a randomised controlled trial

BACKGROUND The application of therapeutic hypothermia (TH) for 12 to 24 hours following out-of-hospital cardiac arrest (OHCA) has been associated with decreased mortality and improved neurological function. However, the optimal duration of cooling is not known. We aimed to investigate whether targeted temperature management (TTM) at 33 ± 1 °C for 48 hours compared to 24 hours results in a better long-term neurological outcome. METHODS The TTH48 trial is an investigator-initiated pragmatic international trial in which patients resuscitated from OHCA are randomised to TTM at 33 ± 1 °C for either 24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to treatment allocation and dichotomised to good (CPC 1-2) or poor (CPC 3-5) outcome. Secondary outcomes are: 6-month mortality, incidence of infection, bleeding and organ failure and CPC at hospital discharge, at day 28 and at day 90 following OHCA. Assuming that 50 % of the patients treated for 24 hours will have a poor outcome at 6 months, a study including 350 patients (175/arm) will have 80 % power (with a significance level of 5 %) to detect an absolute 15 % difference in primary outcome between treatment groups. A safety interim analysis was performed after the inclusion of 175 patients. DISCUSSION This is the first randomised trial to investigate the effect of the duration of TTM at 33 ± 1 °C in adult OHCA patients. We anticipate that the results of this trial will add significant knowledge regarding the management of cooling procedures in OHCA patients. TRIAL REGISTRATION NCT01689077.

Beach changes at Long Beach Island, New Jersey, 1962-73 /

Beach profile line data collected from 32 profile sites along Long Beach Island, New Jersey. A total of 2,158 profile line surveys were examined, using empirical eigenfunction analysis and other measures of beach variability. Most profile lines have shown an accretionary trend since 1962 with rates between 2.3 and 0.24 meter per year in spite of erosion estimates due to sea level rise on the order of 0.68 meter per year. A great deal of variability in profile line change takes place along the beach, increasing from north to south, due to the location of profile lines relative to structures and offshore linear shoals. Detailed closely spaced profile lines taken over a year in a groin field near the north end of the island indicate littoral transport directions shift from north to south. Evidence of a littoral transport node near the north end of the groin field has been found. Net transport of the node is toward the south, but the rate could not be established due to lack of adequate wave data. Profile line variability within groin cells shows that single profile lines are not sufficient to determine the net change within a cell. The design of future beach monitoring studies should consider coastal structures, offshore bathymetry, the method of analysis, and the scales of processes under study. A coastal storm in November 1968 moved the MSL back as much as 22 meters; however, the beach recovered without artificial measures. The offshore bathymetry shows a series of shoreface-connected linear shoals at several locations along the island. Limited data show that these have remained stable and that most beach variability takes place in water shallower than 3 meters.

Demonstration of nonpoint pollution abatement through improved street cleaning practices /

Mode of access: Internet.

Conventional and advanced sewer design concepts for dual purpose flood and pollution control : a preliminary case study, Elizabeth, New Jersey /

Mode of access: Internet.

Posthurricane survey of experimental dunes on Padre Island, Texas /

This report summarizes the impact of Hurricane Allen (August 1980) on dune configuration, sand accretion or erosion, and changes in the vegetation on north Padre Island. Four experimental foredunes, the result of grass plantings from 1969 to 1973, and an unplanted control section were monitored in 1975-1977 and also in 1981. The 1981 posthurricane data were compared where possilbe, with the previous studies. Foredune elevation surveys were completed in March 1981; accompanying vegetation transects were made in July 1981. Hurrican Allen causes erosion of the dune face of all the experimental dunes, but caused a breach in only one dune. The beach elevations had returned to approximately prehurricane heights by the time the area was resurveyed. The unplanted control dune provided little resistance to waves generated by the storm and a large quantity of sand was deposited inland.

Lawrence Avenue underflow sewer system : interim report, planning and construction /

"March 1980."

Water quality and biological effects of urban runoff on Coyote Creek : phase I, preliminary survey /

Mode of access: Internet.

Algemeene ophelderende verklaring van het oud letterschrift : in steenplaatdruk /

Pages 8-66 provide explanations about the plates.

Interlingua-English; a dictionary of the international language,

Mode of access: Internet.

The Germans on trial.

Mode of access: Internet.