Stable secondary arrhythmias late after intraoperative radiofrequency ablation of atrial fibrillation: incidence, mechanism, and treatment.

INTRODUCTION Intraoperative radiofrequency (RF) ablation is an effective treatment of atrial fibrillation (AF). However, secondary arrhythmias late after ablation may complicate the patient's course. We report on the incidence, mechanisms, and treatment of gap-related atrial flutter and other secondary arrhythmias during long-term follow-up. METHODS AND RESULTS In 129 patients who underwent intraoperative RF ablation with placement of left atrial linear lesions using minimally invasive surgical techniques, secondary arrhythmias were analyzed during long-term follow-up (20 +/- 6 months). Transient atrial arrhythmias during the first 3 postoperative months were excluded. In 8 (6.2%) of 129 patients, sustained stable secondary arrhythmias were documented. Left atrial, gap-related atrial flutter was observed in 4 patients (3.1%). The flutter was treated by percutaneous RF ablation in 3 patients (2.3%) and with drugs in 1 patient (0.8%). In 2 patients (1.6%), right atrial isthmus-dependent atrial flutter occurred and was treated successfully by percutaneous RF ablation. In 2 patients (1.6%), ectopic right atrial tachycardias occurred and were treated with percutaneous RF ablation. CONCLUSION Late after intraoperative RF ablation of atrial fibrillation, three types of stable secondary arrhythmias were observed in 6% of patients: left atrial gap-related atrial flutter, right atrial isthmus-dependent atrial flutter, and ectopic atrial tachycardia. Gaps after intraoperative RF ablation due to noncontinuous or nontransmural linear lesions may lead to stable left atrial macroreentrant tachycardias, requiring new interventional therapy.

Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease.

OBJECTIVES The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow. METHODS Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool). RESULTS Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 +/- 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 +/- 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 +/- 11) and mean power was lower (27 +/- 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 +/- 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation. CONCLUSIONS The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.

Dicer is required for female reproductive tract development and fertility in the mouse.

Dicer encodes a riboendonuclease required for microRNA biosynthesis. Dicer was inactivated in Müllerian duct mesenchyme-derived tissues of the reproductive tract of the mouse, using an Amhr2-Cre allele. Although Amhr2-Cre; Dicer conditional mutant males appeared normal and were fertile, mutant females were infertile. In adult mutant females, there was a reduction in the size of the oviducts and uterine horns. The oviducts were less coiled compared to controls and cysts formed at the isthmus near the uterotubal junction. Unfertilized, degenerate oocytes were commonly found within these cysts, indicating a defect in embryo transit. Beads transferred into the mutant oviduct failed to migrate into the uterus. In addition, blastocysts transferred directly into the mutant uterus did not result in pregnancy. Histological analysis demonstrated that the mutant uterus contained less glandular tissue and often the few glands that remained were found within the myometrium, an abnormal condition known as adenomyosis. In adult mutants, there was ectopic expression of Wnt4 and Wnt5a in the luminal epithelium (LE) and glandular epithelium (GE) of the uterus, and Wnt11 was ectopically expressed in GE. These results demonstrate that Dicer is necessary for postnatal differentiation of Müllerian duct mesenchyme-derived tissues of the female reproductive tract, suggesting that microRNAs are important regulators of female reproductive tract development and fertility.

Cerebral High-grade Oligodendroglioma with Sarcomatous Transdifferentiation ("Oligosarcoma") in a Boxer Dog.

A 9-year-old Boxer dog was referred to the Veterinary Teaching Hospital of the University of Bern for a history of chronic neck pain and gait problems, which rapidly progressed to a non-ambulatory status. Magnetic resonance imaging (MRI) examination of the head revealed a large intra-axial space-occupying lesion that was divided in two portions interconnected by a thin isthmus at the level of the cerebellar tentorium. Histopathology revealed a biphasic malignant neoplasm composed of neuroepithelial and mesenchymal elements. The former displayed characteristics of conventional anaplastic oligodendroglioma involving brisk mitotic activity and glomeruloid microvascular proliferation on a background of a fibrillary round cells with "honeycomb-like" perinuclear vacuolation. Conversely, the sarcomatous moiety exhibited haphazard fascicles of spindle cells amidst an intricate mesh of pericellular basal lamina and broad bands of collagen. Both tumor cell populations immunoreacted for Olig-2 and – to a lesser extent – GFAP. In addition, the sarcomatous areas focally expressed vimentin, muscular actin, and smooth muscle actin. "Oligosarcoma" - an exquisitely uncommon pattern of oligodendroglial malignancy in humans - has not previously been reported to affect dogs, although oligodendroglioma is a common CNS tumor in this species. Whether canine oligosarcoma shares with its human counterpart not only morphological aspects, but also molecular signatures, clinical behavior and responsiveness to therapy merits further investigation. In humans, oligodendroglial differentiation tends to confer significant clinical advantage with respect to prognosis and adjuvant treatment options. The awareness of such hallmarks and the investigation of their impact on prognosis are crucial for improved therapeutical strategies in dogs.

Comparative assessment of a canine-specific medium to support colony formation from canine hair follicular keratinocytes.

BACKGROUND Follicular stem cells and their progeny are responsible for the cyclical renewal of hair follicles and maintenance of the hair coat. The understanding of pathways involved in this process is essential to elucidate the pathogenetic mechanisms of primary alopecia. Stem cells and their direct descendants are located in the bulge region of the isthmus of hair follicles. Although these cells have been studied extensively in mice and humans, data for canine isthmic keratinocyte activation and proliferation are not available. HYPOTHESIS/OBJECTIVES The aim was to establish an accurate and reliable in vitro system to study the growth potential of canine isthmic keratinocytes. We assessed the colony-promoting capability of a commercially available canine-specific medium, CELLnTEC (CnT-09), compared with a well-established home-made medium, complete FAD (cFAD). The CnT-09 medium is specific for the growth of canine keratinocytes, while the cFAD medium can support growth and colony formation of keratinocytes from several species. ANIMALS Skin biopsies were obtained from 15 recently euthanized dogs of various breeds with no skin abnormalities. METHODS The isthmic region of compound hair follicles was isolated by microdissection and cell growth monitored using several parameters with colony-forming assays. RESULTS The CnT-09 and cFAD media provided similar growth as measured by the total number and size of colonies, as well as rate of cell differentiation. CONCLUSIONS The commercial canine-specific CnT-09 medium was comparable to the home-made cFAD medium in supporting the growth and proliferation of canine follicular keratinocytes in vitro. The CnT-09 medium should be a viable alternative growth medium for molecular studies of alopecic disorders in dogs.

Noninvasive pressure difference mapping derived from 4D flow MRI in patients with unrepaired and repaired aortic coarctation.

PURPOSE To develop a method for computing and visualizing pressure differences derived from time-resolved velocity-encoded three-dimensional phase-contrast magnetic resonance imaging (4D flow MRI) and to compare pressure difference maps of patients with unrepaired and repaired aortic coarctation to young healthy volunteers. METHODS 4D flow MRI data of four patients with aortic coarctation either before or after repair (mean age 17 years, age range 3-28, one female, three males) and four young healthy volunteers without history of cardiovascular disease (mean age 24 years, age range 20-27, one female, three males) was acquired using a 1.5-T clinical MR scanner. Image analysis was performed with in-house developed image processing software. Relative pressures were computed based on the Navier-Stokes equation. RESULTS A standardized method for intuitive visualization of pressure difference maps was developed and successfully applied to all included patients and volunteers. Young healthy volunteers exhibited smooth and regular distribution of relative pressures in the thoracic aorta at mid systole with very similar distribution in all analyzed volunteers. Patients demonstrated disturbed pressures compared to volunteers. Changes included a pressure drop at the aortic isthmus in all patients, increased relative pressures in the aortic arch in patients with residual narrowing after repair, and increased relative pressures in the descending aorta in a patient after patch aortoplasty. CONCLUSIONS Pressure difference maps derived from 4D flow MRI can depict alterations of spatial pressure distribution in patients with repaired and unrepaired aortic coarctation. The technique might allow identifying pathophysiological conditions underlying complications after aortic coarctation repair.

Spatial Distribution of Stem Cell-Like Keratinocytes in Dissected Compound Hair Follicles of the Dog

Hair cycle disturbances are common in dogs and comparable to some alopecic disorders in humans. A normal hair cycle is maintained by follicular stem cells which are predominately found in an area known as the bulge. Due to similar morphological characteristics of the bulge area in humans and dogs, the shared particularity of compound hair follicles as well as similarities in follicular biomarker expression, the dog is a promising model to study human hair cycle and stem cell disorders. To gain insight into the spatial distribution of follicular keratinocytes with stem cell potential in canine compound follicles, we microdissected hair follicles in anagen and telogen from skin samples of freshly euthanized dogs. The keratinocytes isolated from different locations were investigated for their colony forming efficiency, growth and differentiation potential as well as clonal growth. Our results indicate that i) compound and single hair follicles exhibit a comparable spatial distribution pattern with respect to cells with high growth potential and stem cell-like characteristics, ii) the lower isthmus (comprising the bulge) harbors most cells with high growth potential in both, the anagen and the telogen hair cycle stage, iii) unlike in other species, colonies with highest growth potential are rather small with an irregular perimeter and iv) the keratinocytes derived from the bulbar region exhibit characteristics of actively dividing transit amplifying cells. Our results now provide the basis to conduct comparative studies of normal dogs and those with hair cycle disorders with the possibility to extend relevant findings to human patients.

Neogene calcareous nannofossils in the Caribbean and the eastern equatorial Pacific

Principal components analysis of nannofossil assemblages in five ODP sites in the Caribbean and the eastern equatorial Pacific was used to monitor Neogene surface water circulation changes. In 15.83-10.71 Ma, floral distributions clearly show the existence of the Circum-tropical Current between the Caribbean and the eastern equatorial Pacific and no surface water communication between the northern and southern Caribbean. In 10.71-9.36 Ma, the Circum-tropical Current weakened and the northward intra-Caribbean current had been initiated. Northern and southern Caribbean surface waters again became separated in 8.35-3.65 Ma and the Circum-tropical Current was regenerated. After 2.76 Ma, the northward intra-Caribbean current has completely been established and the Circum-tropical Current disappeared. This suggests that a barrier to the Circum-tropical Current had formed, indicating the final closure of the Isthmus of Panama.

Stable isotope analysis and temperature reconstruction data from DSDP Hole 94-609B and ODP Hole 162-984B

The Greenland ice sheet is accepted as a key factor controlling the Quaternary glacial scenario. However, the origin and mechanisms of major Arctic glaciation starting at 3.15 Ma and culminating at 2.74 Ma are still controversial. For this phase of intense cooling Ravelo et al. proposed a complex gradual forcing mechanism. In contrast, our new submillennial-scale paleoceanographic records from the Pliocene North Atlantic suggest a far more precise timing and forcing for the initiation of northern hemisphere glaciation (NHG), since it was linked to a 2-3 °C surface water warming during warm stages from 2.95 to 2.82 Ma. These records support previous models, claiming that the final closure of the Panama Isthmus (3.0- ~2.5 Ma induced an increased poleward salt and heat transport. Associated strengthening of North Atlantic Thermohaline Circulation and in turn, an intensified moisture supply to northern high latitudes resulted in the build-up of NHG, finally culminating in the great, irreversible climate crash at marine isotope stage G6 (2.74 Ma). In summary, there was a two-step threshold mechanism that marked the onset of NHG with glacial-to-interglacial cycles quasi-persistent until today.

Mineralogy at DSDP Sites 68-502 and 68-503

Eighty-four sediment samples from four holes at Site 502 and 54 samples from three holes at Site 503 were analyzed for mineral content by semiquantitative X-ray diffraction methods. Site 502 is located in the Western Caribbean, whereas Site 503 lies in the Eastern Pacific (probably on the north flank of the Galapagos Spreading Center). Both sites were chosen to yield continuous core sections for investigations of late Neogene and Quaternary biostratigraphy and magnetostratigraphy and to study events such as the closing of the Isthmus of Panama. Our X-ray diffraction work should provide a framework for further investigations - for example, determination of climatic changes in relationship to clay mineral composition or the influx of terrigeneous sediment components from South America before and after development of the Panama landbridge.

Neogene calcareous nannofossil abundance and datums of ODP Site 186-1150 and 186-1151 sediments

Calcareous nannofossil assemblages were studied from Ocean Drilling Program Holes 1150A, 1150B, 1151A, 1151C, and 1151D in order to estimate the age of sediments drilled in the Japan Trench of the western Pacific Ocean. The abundance and species diversity of nannofossil flora are generally low but are sufficient to show that the sedimentary sequences range from Quaternary to Miocene in age (nannofossil Zones CN15-CN3). The abundance of Coccolithus pelagicus, a cold-water indicator, was studied from sediments younger than 3.83 Ma from both Holes 1150A and 1151A in order to elucidate past climate conditions. Between 3.83 and 2.82 Ma, the abundance of C. pelagicus was generally low, but abundance increased significantly after 2.82 Ma. In agreement with previous studies, this increase appears to be related to a change in the current system around the western Pacific Ocean and eastern Atlantic Ocean that occurred in response to the final elevation of the Isthmus of Panama.

Diversidad étnica e identidad en la llanura costera del istmo oaxaqueño

En este artículo se desarrollan una serie puntos para entender al istmo oaxaqueño como una zona de convergencia cultural diversa, múltiple y por lo tanto diferenciada tanto en el ámbito de la historia de los pueblos que en ella viven, como en el ámbito de la estructura económica que permite su reproducción no sólo como grupos étnicos, sino como comunidades. El autor plantea que las manifestaciones culturales de cada grupo se confunden, se entrelazan se influencian mutuamente y en una lógica asociada a la perdurabilidad de dichos procesos, terminan por imponerse. Para comprender las relaciones interétnicas no basta con dar cuenta de las características generales de estos grupos sino que es necesario actualizar la información que se ha obtenido de ellos, sobre todo ahora que nuevos procesos nacionales o internacionales están afectando de manera irreversible la composición y la estructura de estas culturas. Aspectos como la falta de vías de comercialización de productos agrícolas y pesqueros, la marginación sempiterna, la falta de empleo a escala regional, la migración, etc.. son entre otros, las aristas de una realidad que se revela en su irremediable avance frente a comunidades que ponen en funcionamiento estrategias de reproducción y de sobreviviencia para mantenerse como comunidad. Las manifestaciones de las relaciones interétnicas aquí se definen como asimétricas horizontales en virtud de una diferenciación entre etnias y las relaciones entre ellas, de tal forma que así como se ha analizado la relación grupos étnicos-sociedad nacional, en la que se constatan desigualdades flagrantes a nivel del acceso a la riqueza generada en el país, calidad de vida, educación, comunicación, y otras variables importantes, de la misma manera se constata que en los grupos étnicos hay unos que tienen una posición privilegiada en el acceso a vías de comunicación, redes comerciales e influencia política, entre otros aspectos, mientras que otros se encuentran excluidos de ellos, no sólo por su condición de indígenas, sino también como consecuencia de la dominación entre etnias que existe en la región. Finalmente, el autor enfatiza que en esta zona del estado de Oaxaca existe una gama considerable de recursos naturales cuya apropiación y explotación para beneficios económicos está en el centro de la discusión actual. En efecto, el sistema de lagunas del Golfo de Tehuantepec, las reservas de la biodiversidad como la selva de los Chimalapas, o la actividad ganadera agrícola en la zona mixe son, entre otras, no sólo zonas importantes de explotación económica, que han fortalecido a grupos de poder locales. También son espacios de control estratégico para el futuro desarrollo del país pues en el istmo oaxaqueño se ha ubicado una fuente importante de riqueza en agua, bosques, especies endémicas, etc... que puede tener un papel importante en la vida económica regional y nacional. La cuestión es saber qué dispositivos sociales o legales se han puesto en marcha para definir a los beneficiarios de esa riqueza natural.

Diversidad étnica e identidad en la llanura costera del istmo oaxaqueño

En este artículo se desarrollan una serie puntos para entender al istmo oaxaqueño como una zona de convergencia cultural diversa, múltiple y por lo tanto diferenciada tanto en el ámbito de la historia de los pueblos que en ella viven, como en el ámbito de la estructura económica que permite su reproducción no sólo como grupos étnicos, sino como comunidades. El autor plantea que las manifestaciones culturales de cada grupo se confunden, se entrelazan se influencian mutuamente y en una lógica asociada a la perdurabilidad de dichos procesos, terminan por imponerse. Para comprender las relaciones interétnicas no basta con dar cuenta de las características generales de estos grupos sino que es necesario actualizar la información que se ha obtenido de ellos, sobre todo ahora que nuevos procesos nacionales o internacionales están afectando de manera irreversible la composición y la estructura de estas culturas. Aspectos como la falta de vías de comercialización de productos agrícolas y pesqueros, la marginación sempiterna, la falta de empleo a escala regional, la migración, etc.. son entre otros, las aristas de una realidad que se revela en su irremediable avance frente a comunidades que ponen en funcionamiento estrategias de reproducción y de sobreviviencia para mantenerse como comunidad. Las manifestaciones de las relaciones interétnicas aquí se definen como asimétricas horizontales en virtud de una diferenciación entre etnias y las relaciones entre ellas, de tal forma que así como se ha analizado la relación grupos étnicos-sociedad nacional, en la que se constatan desigualdades flagrantes a nivel del acceso a la riqueza generada en el país, calidad de vida, educación, comunicación, y otras variables importantes, de la misma manera se constata que en los grupos étnicos hay unos que tienen una posición privilegiada en el acceso a vías de comunicación, redes comerciales e influencia política, entre otros aspectos, mientras que otros se encuentran excluidos de ellos, no sólo por su condición de indígenas, sino también como consecuencia de la dominación entre etnias que existe en la región. Finalmente, el autor enfatiza que en esta zona del estado de Oaxaca existe una gama considerable de recursos naturales cuya apropiación y explotación para beneficios económicos está en el centro de la discusión actual. En efecto, el sistema de lagunas del Golfo de Tehuantepec, las reservas de la biodiversidad como la selva de los Chimalapas, o la actividad ganadera agrícola en la zona mixe son, entre otras, no sólo zonas importantes de explotación económica, que han fortalecido a grupos de poder locales. También son espacios de control estratégico para el futuro desarrollo del país pues en el istmo oaxaqueño se ha ubicado una fuente importante de riqueza en agua, bosques, especies endémicas, etc... que puede tener un papel importante en la vida económica regional y nacional. La cuestión es saber qué dispositivos sociales o legales se han puesto en marcha para definir a los beneficiarios de esa riqueza natural.

Strontium and neodymium concentrations and isotope compositions in fossil fish teeth and pore waters at ODP Sites 130-807 and 125-786

We analyzed Nd and Sr isotopic compositions of Neogene fossil fish teeth from two sites in the Pacific in order to determine the effect of cleaning protocols and burial diagenesis on the preservation of seawater isotopic values. Sr is incorporated into the teeth at the time of growth; thus Sr isotopes are potentially valuable for chemostratigraphy. Nd isotopes are potential conservative tracers of paleocirculation; however, Nd is incorporated post-mortem, and may record diagenetic pore waters rather than seawater. We evaluated samples from two sites (Site 807A, Ontong Java Plateau and Site 786A, Izu-Bonin Arc) that were exposed to similar bottom waters, but have distinct lithologies and pore water chemistries. The Sr isotopic values of the fish teeth appear to accurately reflect contemporaneous seawater at both sites. The excellent correlation between the Nd isotopic values of teeth from the two sites suggests that the Nd is incorporated while the teeth are in chemical equilibrium with seawater, and that the signal is preserved over geologic timescales and subsequent burial. These data also corroborate paleoseawater Nd isotopic compositions derived from Pacific ferromanganese crusts that were recovered from similar water depths (Ling et al., 1997; doi:10.1016/S0012-821X(96)00224-5). This corroboration strongly suggests that both materials preserve seawater Nd isotope values. Variations in Pacific deepwater e-Nd values are consistent with predictions for the shoaling of the Isthmus of Panama and the subsequent initiation of nonradiogenic North Atlantic Deep Water that entered the Pacific via the Antarctic Circumpolar Current.

(Table 1) First and last occurrences of the menardellid clade in sediments of ODP Site 154-925

Biostratigraphic and isotopic studies of planktic foraminifera suggest that early to middle Pliocene closure of the Central American Seaway caused vicariant speciation among previously cosmopolitan menardellid foraminifera. New morphospecies were restricted to the tropical Atlantic. Isotopic data suggest that newly evolved Atlantic menardellids were adapted to more oligotrophic conditions, living higher in the water column than ancestral forms and perhaps harboring photosymbionts. In the late Pliocene, all but one menardellid morphospecies became extinct. These extinctions coincided with a progressive increase in the amplitude of periodic climatic change and the end of isolated tropical Atlantic surface circulation as Northern Hemisphere glaciation intensified.