Effects of Gender on the Incidence of Cardiac Tamponade Following Catheter Ablation of Atrial Fibrillation: Results from a Worldwide Survey in 34,943 AF Ablation Procedures.

BACKGROUND -Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. METHODS AND RESULTS -A systematic Medline search was used to locate academic electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high volume centers. Three cases of tamponade (1%) culminated in death. CONCLUSIONS -Tamponade during AF ablation procedures is relatively rare. Women have an almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.

Third party assessments in trust problems with conflict of interest: An experiment on the effects of promisesm

Is it possible to elicit reliable assessment from an assessor having a conflict of interest (e.g. a professor that writes a recommendation letter for a formal PhD student)? We propose an experimental test and show that compared to a not-incentivized assessment, a promise to give a truthful assessment reduces misreporting to the same extent as an incentivized assessment (i.e. when the assessor gains higher payoff if the assessment is correct).

A practical approach to designing syndromic surveillance systems for livestock and poultry

The field of animal syndromic surveillance (SyS) is growing, with many systems being developed worldwide. Now is an appropriate time to share ideas and lessons learned from early SyS design and implementation. Based on our practical experience in animal health SyS, with additions from the public health and animal health SyS literature, we put forward for discussion a 6-step approach to designing SyS systems for livestock and poultry. The first step is to formalise policy and surveillance goals which are considerate of stakeholder expectations and reflect priority issues (1). Next, it is important to find consensus on national priority diseases and identify current surveillance gaps. The geographic, demographic, and temporal coverage of the system must be carefully assessed (2). A minimum dataset for SyS that includes the essential data to achieve all surveillance objectives while minimizing the amount of data collected should be defined. One can then compile an inventory of the data sources available and evaluate each using the criteria developed (3). A list of syndromes should then be produced for all data sources. Cases can be classified into syndrome classes and the data can be converted into time series (4). Based on the characteristics of the syndrome-time series, the length of historic data available and the type of outbreaks the system must detect, different aberration detection algorithms can be tested (5). Finally, it is essential to develop a minimally acceptable response protocol for each statistical signal produced (6). Important outcomes of this pre-operational phase should be building of a national network of experts and collective action and evaluation plans. While some of the more applied steps (4 and 5) are currently receiving consideration, more emphasis should be put on earlier conceptual steps by decision makers and surveillance developers (1-3).

Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure.

Membrane Lipid Integrity Relies on a Threshold of ATP Production Rate in Potato Cell Cultures Submitted to Anoxia

In this paper we report on our study of the changes in biomass, lipid composition, and fermentation end products, as well as in the ATP level and synthesis rate in cultivated potato (Solanum tuberosum) cells submitted to anoxia stress. During the first phase of about 12 h, cells coped with the reduced energy supply brought about by fermentation and their membrane lipids remained intact. The second phase (12–24 h), during which the energy supply dropped down to 1% to 2% of its maximal theoretical normoxic value, was characterized by an extensive hydrolysis of membrane lipids to free fatty acids. This autolytic process was ascribed to the activation of a lipolytic acyl hydrolase. Cells were also treated under normoxia with inhibitors known to interfere with energy metabolism. Carbonyl-cyanide-4-trifluoromethoxyphenylhydrazone did not induce lipid hydrolysis, which was also the case when sodium azide or salicylhydroxamic acid were fed separately. However, the simultaneous use of sodium azide plus salicylhydroxamic acid or 2-deoxy-D-glucose plus iodoacetate with normoxic cells promoted a lipid hydrolysis pattern similar to that seen in anoxic cells. Therefore, a threshold exists in the rate of ATP synthesis (approximately 10 μmol g−1 fresh weight h−1), below which the integrity of the membranes in anoxic potato cells cannot be preserved.

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 705 - Anmerkungen zum Umzug von Arthur Schopenhauer von Mannheim nach Frankfurt am Main

abgedruckt in: Schopenhauer-Jahrbuch 57 (1976), S 119-120

Benthic foraminifera in Lower Cretaceous sediments from various DSDP samples

From the DSDP Legs 1, 11, 13, 17, 25, 27, 32, 36, 41, 43, 44, 50, and 62 the Lower Cretaceous foraminifers have been investigated for biostratigraphical, taxonomical, and palaeoecological purposes. An overview of the cored Lower Cretaceous sections of Leg 1-80 is given. In the Northern Atlantic Ocean characteristic foraminiferal faunas are missing from the Upper Tithonian to the Valanginian due to a marked regression which caused hiatuses. In areas without black shale conditions Valanginian to Barremian medium rich to poor microfaunas with Praedorothia ouachensis (Sigal) of the Praedorothia ouachensis Zone (Valanginian-Hauterivian). The Hauterivian-Aptian interval is characterized by zones of Gavelinella barrerniana, Gaudryina dividens, and Conorotalites aptiensis. During the Albian a world-wide fauna consisting of agglutinated and calcareous foraminifers of the Pseudoclavulina gaultina Zone is established in areas lacking the wide-spread black-shale conditions. The Upper Albian and the Cenomanian are represented by the Gavelinella eenomanica Zone. Some ornamented species of the nodosariids (Citharina, Lenticulina), Gavelinella, Conorotatites, Pleurostomella, Vatvulineria, and Osangularia are of some importance for the biostratigraphy of the Berriasian-Albian interval. The Berriasian to Albian zones introduced for the Tethys and the DSDP by Moullade (1984) could only be of some local importance due to the long stratigraphical range of the foraminiferal species used. In the Indian Ocean an exact stratigraphical age cannot be assigned to the few Neocomian foraminiferal faunas of a cooler sea water (Site 261). These faunas mainly contain primitive agglutinated foraminifers, because in most cases the calcareous tests are dissolved or redeposited. In the Pacific Ocean most of the Berriasian to Aptian microfaunas are of minor biostratigraphical and palaeoecological importance for reasons of poor core recoveries, contaminations or original foraminiferal poverty (black shales). Since the Albian there are somewhat higher-diverse faunas of calcareous and agglutinated foraminifers with index species of the Pseudoclavulina gaultina Zone. As a rule, the boundary Albian/Cenomanian is set by means of planktonic foraminifers because no other foraminifer has its first appearance datum during this interval, except Gavelinella cenornanica. During the Albian very uniform, world-wide foraminiferal faunas without a marked provincialism are obvious.