A premature infant with fetal myocardial and abdominal calcifications and factor V Leiden homozygosity

We present a premature male neonate with confirmed factor V Leiden deficiency diagnosed prenatally with cardiac and abdominal calcifications. Our patient's findings suggest that clinicians consider thromboembolic conditions when multiple fetal calcifications are visualized.

Congenital long-QT syndromes: a clinical and genetic update from infancy through adulthood

Long-QT syndromes (LQTSs) have been described in all ages and are a significant cause of cardiovascular mortality, especially in structurally normal hearts. Abnormalities in transmembrane ion conduction channels and structural proteins produce these clinical syndromes, labeled LQT1-LQT12; however, genotype-positive patients still represent only about 70% of LQTSs. Future research will determine the etiology of the remaining cases, further risk-stratify the known genetic defects, improve current treatment options for these syndromes, and uncover novel therapies.

Digital music players cause interference with interrogation telemetry for pacemakers and implantable cardioverter-defibrillators without affecting device function

BACKGROUND

Concern exists regarding the potential electromagnetic interaction between pacemakers, implantable cardioverter-defibrillators (ICDs) and digital music players (DMPs). A preliminary study reported interference in 50% of patients whose devices were interrogated near Apple iPods.

OBJECTIVE

Given the high prevalence of DMP use among young patients, we sought to define the nature of interference from iPods and evaluate other DMPs.

METHODS

Four DMPs (Apple Nano, Apple Video, SanDisk Sansa and Microsoft Zune) were evaluated against pacemakers and ICDs (PM/ICD). Along with continuous monitoring, we recorded a baseline ECG strip, sensing parameters and lead impedance at baseline and for each device.

RESULTS

Among 51 patients evaluated (age 6 to 60 years, median 22), there was no interference with intrinsic device function. Interference with the programmer occurred in 41% of the patients. All four DMPs caused programmer interference, including disabled communication between the PM/ICD and programmer, noise in the ECG channel, and lost marker channel indicators. Sensing parameters and lead impedances exhibited no more than baseline variability. When the DMPs were removed six inches, there were no further programmer telemetry interactions.

CONCLUSIONS

Contrary to a prior report, we did not identify any evidence for electromagnetic interference between a selection of DMPs and intrinsic function of PM/ICDs. The DMPs did sometimes interfere with device-programmer communication, but not in a way that compromised device function. Therefore, we recommend that DMPs not be used during device interrogation, but suggest that there is reassuring counterevidence to mitigate the current high level of concern for interactions between DMPs and implantable cardiac rhythm devices.

Impact of transvenous ventricular pacing leads on tricuspid regurgitation in pediatric and congenital heart disease patients

INTRODUCTION

Transvenous ventricular pacing leads across the tricuspid valve may cause or exacerbate tricuspid regurgitation (TR). The literature in adults is inconclusive and no studies have investigated the association between pacing leads and TR in children or congenital heart disease patients.

METHODS AND RESULTS

A retrospective chart review was conducted at a large children's hospital, yielding 123 patients with initial placement of a transvenous lead across their tricuspid valve that had adequate echocardiographic data for review. The median age was 16 years (range 2-52) at time of lead placement. The pre-procedure echo was compared both to the first echo after lead placement and the most recent echo. Median time was 242 days from implant to first echo, and 827 days to most recent echo. There was no difference in TR between the pre-procedure echo and first follow-up echo (p = NS). However, TR was more likely to progress mildly between the pre-procedure echo and the most recent echo (p < 0.02) with a mean increase from 1.54 to 1.69 on a 0 to 4 ordinal scale. There were 76 pts (62%) with CHD. Mean pre-procedure TR was 1.82 in right-sided valvular CHD (e.g., tetralogy of Fallot, repaired AV canal) vs. 1.43 without right-sided CHD (p < 0.01).

CONCLUSIONS

In patients with transvenous ventricular leads across the tricuspid valve, echocardiography demonstrates a small, but statistically significant change in TR. The detected change is minimal, suggesting that there is little impact of transvenous leads on TR, even in growing children or patients with right-sided structural heart disease.

Composition of Acridid gut bacterial communities as revealed by 16S rRNA gene analysis

The gut bacterial community from four species of feral locusts and grasshoppers was determined by denaturing gradient gel electrophoresis (DGGE) analysis of bacterial 16S rRNA gene fragments. The study revealed an effect of phase polymorphism on gut bacterial diversity in brown locusts from South Africa. A single bacterial phylotype, consistent with Citrobacter sp. dominated the gut microbiota of two sympatric populations of Moroccan and Italian locusts in Spain. There was evidence for Wollbachia sp. in the meadow grasshopper caught locally in the UK. Sequence analysis of DGGE products did not reveal evidence for unculturable bacteria and homologies suggested that bacterial species were principally Gammaproteobacteria from the family Enterobacteriaceae similar to those recorded previously in laboratory reared locusts.

Bacterial community structure, compartmentalization and activity in a microbial fuel cell

AIMS

To characterize bacterial populations and their activities within a microbial fuel cell (MFC), using cultivation-independent and cultivation approaches.

METHODS AND RESULTS

Electron microscopic observations showed that the fuel cell electrode had a microbial biofilm attached to its surface with loosely associated microbial clumps. Bacterial 16S rRNA gene libraries were constructed and analysed from each of four compartments within the fuel cell: the planktonic community; the membrane biofilm; bacterial clumps (BC) and the anode biofilm. Results showed that the bacterial community structure varied significantly between these compartments. It was observed that Gammaproteobacteria phylotypes were present at higher numbers within libraries from the BC and electrode biofilm compared with other parts of the fuel cell. Community structure of the MFC determined by analyses of bacterial 16S rRNA gene libraries and anaerobic cultivation showed excellent agreement with community profiles from denaturing gradient gel electrophoresis (DGGE) analysis.

CONCLUSIONS

Members of the family Enterobacteriaceae, such as Klebsiella sp. and Enterobacter sp. and other Gammaproteobacteria with Fe(III)-reducing and electrochemical activity had a significant potential for energy generation in this system.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has shown that electrochemically active bacteria can be enriched using an electrochemical fuel cell.

Assessment of dermal ethanol emission sensors: experimental design

This paper discusses methods that will be used to experimentally determine the limitations of transdermal ethanol alcohol sensors when used on human subjects. Transdermal ethanol sensors are used to measure the concentration of ethanol emitted by the surface of the skin. The maximum concentration of ethanol in the skin is proportional to the concentration of ethanol in the blood stream but is offset temporally because of the diffusion delay intrinsic to body tissue. Methods to evaluate different model ethanol sensors are discussed as well as the development and function of a portable, transdermal ethanol sensing device suitable for measuring ethanol concentration on the palm of a test subject's hand. In addition, the designs of several experiments are described to test the functional limitations of transdermal ethanol sensors in practical use settings. These experiments include tests to correlate a subject's peak blood and skin ethanol concentrations and experimental determination of different false positive sources.

Comparison of the epidemiology and co-morbidities of heart failure in the pediatric and adult populations: a retrospective, cross-sectional study

Background

Heart failure is a clinical syndrome that is associated with a significant number of interventional procedures and has received a large amount of scrutiny in the adult literature; however, the epidemiology in children is less well described.

Methods

We analyzed two large, commercially available inpatient datasets collected in 1997 by the Agency for Healthcare Research and Quality: the Kids' Inpatient Database and the National Inpatient Study, accounting for 50% of the U.S. pediatric discharges and 20% of the U.S. adult discharges in 1997.

Results

The database contained 5,610 children and 732,752 adults with a diagnosis of HF. When compared with the adult sample, the pediatric sample showed a higher proportion with cardiac procedures (61.4% vs. 0.28%, p < 0.01), a higher prevalence of congenital heart disease (61% versus 0.3%, p < 0.01), a higher percentage of male patients (50% pediatric vs. 44% adult, p < 0.01), and a lower percentage of white patients (40.9% vs. 65.6%, p < 0.01). Children had a significantly different spectrum of co-morbidities compared with adults. There was no difference in mortality rate between children and adults (7.5% vs. 7.9%, p = NS).

Conclusion

There are significant differences in the epidemiological profile of children and adults with heart failure. Children suffer from different types of co-morbidities and require different procedures in the hospital setting. As such, children with heart failure who are hospitalized may require significantly different facilities, management and therapeutic intervention than adults with similar symptoms.

Air pollution and daily hospitalization rates for cardiovascular and respiratory diseases in London, Ontario

In this paper, we examine the role that ambient air pollution plays in exacerbating cardiovascular and respiratory disease hospitalization in London, Ontario from 1 November 1995 to 31 December 2000. The number of daily cardiac and respiratory admissions was linked to concentrations of air pollutants (sulphur dioxide, nitrogen dioxide, ozone, carbon monoxide, coefficient of haze, PM(10)) and weather variables (maximum and minimum of temperature and humidity). Results showed that current day carbon monoxide and coefficient of haze produced significant percentage increase in daily cardiac admissions of 8.0% (95% CI: 1.5-11.5%) and 5.7% (95% CI: 0.9-10.8%) for people < 65 years old. PM(10) was found to be significantly associated with asthma admission in the > 65 group, with percentage increase in cardiac admission of 25% (95% CI: 2.8-52.3%) and 26.0% (95% CI: 5.3-50.9%) for current day and 2-day means, respectively.