Land-based birds as potential disseminators of avian mammalian reassortant influenza A viruses

Chickens, quail, and other land-based birds are extensively farmed around the world. They have been recently implicated in zoonotic outbreaks of avian influenza in Hong Kong. The possibility that land-based birds could act as mixing vessels or disseminators of avian/mammalian reassortant influenza A viruses with pandemic potential has not been evaluated. In this report, we investigated whether chickens and Japanese quail are susceptible to a mammalian influenza virus (A/swine/Texas/4199-2/98 [H3N2]). This virus did not grow in chickens and replicated to low levels in Japanese quail but did not transmit. Replacing the H3 gene of this virus for one of the avian H9 viruses resulted in transmission of the avian/swine reassortant virus among quail but not among chickens. Our findings demonstrated that Japanese quail could provide an environment in which viruses like the A/swine/Texas/4199-2/98 [H3N2] virus could further reassort and generate influenza viruses with pandemic potential.

[Sacroiliac fixation: a new technique after pelvic trauma]

We propose a new technique for sacroiliac fixation for the treatment of pelvic fracture with vertical and horizontal instability (Tile class C). This fixation technique allows control of vertical displacement while allowing, if needed, a certain degree of movement in the horizontal plane to facilitate reduction of anterior lesions. The technique involves insertion of two sacral screws, one in S1 and one in S2, and two iliac screws. The iliac screws are inserted in the posterior iliac crest through two sacroiliac connectors placed on a rod linking the two sacral screws. Vertical displacement is controlled by blocking the screw heads on the connecting rod. If needed, a certain degree of horizontal mobility of the half pelvis can be allowed by loosening the connectors on the rods. This technique was used for 4 patients. Anatomic reduction was achieved and no secondary movement of the osteosynthesis material nor secondary displacement were observed. The quality of the fixation allowed rapid weight bearing in the standing position and early walking without crutches. This type of fixation can only be used for type C12 fractures in the Tile classification.

[15-year-old patient with decompensated heart failure and tachycardia with negative P-waves in inferior ECG recordings. An indication for heart transplantation?]

A 15-year-old girl was admitted with signs of severe cardiac failure. There were no symptoms of cardiac insufficiency 4 weeks before hospital admission. She presented with permanent supraventricular tachycardia with negative P-waves in leads II, III and aVF, the heart rate was 150 beats per minute. The electrophysiological examination showed a permanent junctional reentry tachycardia. A postero-septal accessory pathway could be eliminated successfully by radiofrequency catheter ablation. Immediately after the procedure cardiac function deteriorated with slight decrease of the strongly reduced cardiac output. Intensive care and application of dobutamine led to clinical stability. During a follow-up of two years the young patient showed permanent sinus rhythm and an age related physical strain. This case report documents the rapid and severe manifestation of cardiac failure owing to permanent junctional reentry tachycardia in a 15-year-old girl. She was referred for consideration of heart transplantation. Invasive electrophysiological treatment led to permanent sinus rhythm with improvement of left ventricular function.

Effects of two Gbetagamma-binding proteins--N-terminally truncated phosducin and beta-adrenergic receptor kinase C terminus (betaARKct)--in heart failure

Myocardial overexpression of the C-terminus of beta-adrenergic receptor kinase (betaARKct) has been shown to result in a positive inotropic effect or an improvement of survival in heart failure. However, it is not clear whether this beneficial effect is mainly because of dominant-negative inhibition of betaARK1, and a consecutive resensitization of beta-adrenergic receptors (betaAR), or rather due to inhibition of other Gbetagamma-mediated effects. In this study, we tested whether overexpression of N-terminally truncated phosducin (nt-del-phosducin), another Gbetagamma-binding protein that does not resensitize betaARs owing to simultaneous inhibition of GDP release from Galpha subunits, shows the same effects as betaARKct. Adenoviral gene transfer was used to express nt-del-phosducin and betaARKct in isolated ventricular cardiomyocytes and in myocardium of rabbits, which suffered from heart failure because of rapid ventricular pacing. BetaAR-stimulated cAMP formation was increased by betaARKct, but not by nt-del-phosducin, whereas both proteins inhibited Gbetagamma-mediated effects. Both transgenes also increased contractility of normal and failing isolated cardiomyocytes and improved contractility in rabbits with heart failure after gene transfer in vivo. In conclusion, overexpression of nt-del-phosducin enhances the contractility of cardiomyocytes to the same extent as betaARKct, suggesting that the effects of betaARKct might be owing to inhibition of Gbetagamma rather than to betaAR resensitization.

Chylothorax nach Anlage eines zentralvenösen Katheters

The authors report on a chylothorax, a rare, although classical complication of left internal jugular vein cannulation. The anatomy of major lymphatic vessels including variations is illustrated. The mechanisms of central venous catheter associated chylothorax are discussed. Likewise described are pathophysiology, signs, clinical features, and differential diagnosis with special consideration of the triglyceride content as well as treatment options.

Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter

AIMS

Catheter ablation of the inferior vena cava-tricuspid annulus isthmus and continuation of antiarrhythmic drug therapy have been shown to be an effective hybrid therapy for atrial flutter which results from antiarrhythmic drug treatment of atrial fibrillation. The aim of this study was to determine the risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter.

METHODS AND RESULTS

90 patients with paroxysmal (n=46) or persistent atrial fibrillation (n=44) developed atrial flutter due to the administration of amiodarone (n=48), flecainide (n=22), propafenone (n=14) or sotalol (n=6). Recurrence of atrial fibrillation after ablation was assessed during follow-up on continued antiarrhythmic drug therapy and during long-term follow-up, irrespective of the initial antiarrhythmic medication. During the follow-up on continued antiarrhythmic drug therapy (16+/-13 months), recurrence of atrial fibrillation was documented in 24 of 90 patients (27%). The presence of accompanying pre-ablation episodes of atrial fibrillation on antiarrhythmic treatment (Odds ratio 7.1, 95% confidence interval 2.3 to 25, p=0.001) and decreased left ventricular ejection fraction (Odds ratio 3.7, 95% confidence interval 1.01 to 12.5, p=0.048) were significant and independent predictors of post-ablation atrial fibrillation. Antiarrhythmic medication was discontinued during long-term follow-up due to adverse drug effects (amiodarone, n=12; flecainide, n=1) in 13 patients (14%). During the long-term follow-up, irrespective of the initial antiarrhythmic medication (21+/-15 months), stable sinus rhythm was maintained in 60 of 90 patients (67%). CONCLUSION Hybrid therapy can be considered as the first line therapy for patients with antiarrhythmic drug-induced atrial flutter but patients should be carefully evaluated for accompanying pre-ablation episodes of atrial fibrillation and possible adverse drug effects before initiation of hybrid therapy.

Application of LA-ICP-MS in polar ice core studies

The direct determination of element signatures in polar ice core samples from Greenland by laser ablation with subsequent inductively coupled plasma mass spectrometry analysis has been investigated. A cryogenic sample chamber enables the element determination in ice directly from the solid (frozen) state. A procedure was developed to analyse up to 38 elements (traces: Mg, Al, Fe, Zn, Cd, Pb and rare earth elements; minor constituents: Na) in ice samples from Greenland with a previously unachievable spatial resolution of 4 mm along the core axis. This resolution is helpful to detect seasonal variations of element concentration in thin annual layers of deep ice. We report operating conditions and analytical performance of the experimental set up, the improvement of signal stability by (17)OH internal standardisation and application of a desolvation unit. Calibration of the system was performed with frozen multielement standard solutions along a special preparation procedure. Detection limits for the tracers Na, Mg (sea salt), Al (mineral dust) and Zn (anthropogenic source) are 0.1-1 microg kg(-1). Best detection limits in the range of 0.001-0.01 microg kg(-1 )were reached for Co, Pb and all rare earth elements. To validate the method, frozen standard reference materials were measured. The recovery is about +/-10%. Greenland ice core samples from different ages were analysed with the new technique. The results obtained by laser ablation were compared with values from solution analysis, available published data and the particle content. Most elements have shown good correlation with the particle content in the Greenland samples; however, differences could be seen between the values obtained by laser ablation and solution bulk analysis after a tri-acid digestion. The influence of particles is discussed. The high spatially resolved 2D mapping of element concentrations shows strong inhomogeneities along the core axis most probably due to seasonal variations of element deposition.

Haemorheological pattern in young adults with acute myocardial infarction

Acute myocardial infarction (AMI) in young people has recently received great attention. Its main characteristics include a typical risk factor profile and a good prognosis. We studied the haemorheological pattern (whole blood viscosity at high and low shear rates, plasma and serum viscosity, whole-blood filtration and erythrocyte aggregation) in 64 subjects, aged <46 years, with recent AMI. We observed marked alterations in blood, plasma and serum viscosity and whole-blood filtration. Subdividing the AMI subjects in accordance with the number of cardiovascular risk factors or the extent of coronary lesions, we did not observe any significative influence of these aspects on the haemorheological determinants, with the exception of low shear rate blood viscosity. The latter was in fact higher than in control subjects only in AMI subgroups with respectively more risk factors and more stenosed coronary vessels. Thirty-three AMI subjects were re-examined after three months and showed, on this occasion, a haemorheological pattern not significantly different from that of the first evaluation. These results demonstrate that in young subjects with AMI there is a hyperviscosity syndrome that persists during subsequent months, despite a good clinical course. Haemorheological impairment may unfavourably influence the long-term prognosis of AMI in young subjects and therefore, in our opinion, management should take into account the monitoring of the haemorheological pattern.

Control of Cl- transport in the operculum epithelium of Fundulus heteroclitus: long- and short-term salinity adaptation

The eurohaline fish, Fundulus heteroclitus, adapts rapidly to enhanced salinity by increasing the ion secretion by gill chloride cells. An increase of approximately 70 mOsm in plasma osmolarity was previously found during the transition. To mimic this in vitro, isolated opercular epithelia of seawater-adapted Fundulus mounted in a modified Ussing chamber were exposed to an increase in NaCl and/or osmolarity on the basolateral side, which immediately increased I(SC). Various Cl(-) channel blockers as well as the K(+) channel blocker Ba(2+) added to the basolateral side all inhibited the steady-state as well as the hypertonic stimulation of I(SC). The exists -agonist isoproterenol stimulates I(SC) in standard Ringer solutions. In contrast, when cell volume was kept at the larger value by simultaneous addition of water, the stimulation with isoproterenol was abolished, suggesting that the key process for activation of the Na(+), K(+), 2Cl(-) cotransporter is cell shrinkage. The protein kinase C (PKC) inhibitor chelerythrine and the myosin light chain kinase (MLCK) inhibitor ML-7 had strong inhibitory effects on the mannitol activation of I(SC), thus both MLCK and PKC are involved. The two specific protein kinase A (PKA) inhibitors H-89 and KT 5720 had no effect after mannitol addition whereas isoproterenol stimulation was completely blocked by H-89. This indicates that PKA is involved in the activation of the apical Cl(-) channel via c-AMP whereas the shrinkage activation of the Na(+), K(+), 2Cl(-) cotransporter is independent of PKA activation. The steady-state Cl(-) secretion was stimulated by an inhibitor of serine/threonine phosphatases of the PP-1 and PP-2A type and inhibited by a PKC inhibitor but not by a PKA inhibitor. Thus, it seems to be determined by continuous phosphorylation and dephosphorylation involving PKC but not PKA. The steady-state Cl(-) secretion and the maximal obtainable Cl(-) secretion were measured in freshwater-adapted fish and in fish retransferred to saltwater. No I(SC) could be measured in freshwater-adapted fish or in the fish within the first 18 h after transfer to saltwater. As evidenced from Western blot analysis using antiserine-antibodies, a heavily serine phosphorylated protein of about 190 kDa was consistently observed in the saltwater-acclimated fish, but was only weakly present in freshwater-acclimated fish. This observation indicates that acclimatization to saltwater stimulates the expression of this 190-kDa protein and/or a serine/threonine kinase, which subsequently phosphorylates the protein.

Evaluation of aluminum-silicate polymer composite as a coagulant for water treatment

Aluminum-silicate polymer composite (PASiC), a new kind of inorganic coagulant, was produced by two approaches: (1) hydroxylation of the mixture of AlCl3 and fresh polysilicate (PASiCc); (2) hydroxylated polyaluminum-chloride (PAC) combined with fresh polysilicate (PASiCm). The PASiC products had the following properties: Al2O3 content = 6.40-7.30%, SiO2 content = 0.40-0.82%, Al/Si ratios = 10-20, basicity (OH/Al molar ratio, denoted B) = 1.2-2.0. The coagulation behaviour of PASiC and PAC under conditions typical for coagulation and flocculation in water treatment were investigated by studying the rate of floc size development, the variety of streaming current value, the efficiency of turbidity removal and the effect of pH on the turbidity removal efficiency, and the stability of PASiC. The results detailed in this study suggest that, compared with PAC, PASiC may enhance aggregating efficiency and give better coagulating effects, but weaken charge effectiveness in coagulation process or become unstable when stored for longer time, especially at higher B value and lower Al/Si ratio. The coagulating effect of PASiC is closely linked to the preparation procedure. With the increase of B value and the decrease of Al/Si ratio, the coagulation efficiency of PASiC increases, and at the same B value and Al/Si ratio, PASiCc seems to give a little better coagulation effect than PASiCm but less stability. The Al/Si ratio should not be too low or the B value should not be too high, otherwise, the PASiC products tend to become cloudy or partly gelatinous, which will make them loss some coagulation efficiency.

Operativer und interventioneller Einsatz von Radiofrequenzstrom: gibt es Interferenzen mit implantierbaren Cardioverter/Defibrillatoren?

BACKGROUND

During surgical and interventional procedures, interactions between implantable cardioverter defibrillators (ICD) and electrical cautery, respectively, application of radiofrequency (RF) energy may occur. Induction of inadequate shock therapies or device malfunction may result and represent a potential perioperative hazard for the patient.

METHODS

Hence, we analyzed the intraoperative interactions in 23 consecutive ICD patients with regard to different surgical and interventional procedures. Sixteen surgical operations (general surgery n = 7, urologic n = 5, abdominal n = 2, gynecological n = 1, thoracic n = 1) and 7 interventional therapies (RF catheter ablation n = 5, endoscopic papillotomy n = 2) were performed. The ICD devices were all located in the left pectoral position and consisted of 15 single and 8 dual chamber defibrillators. During the procedure tachyarrhythmia detection (VF 295 +/- 21 ms, VT 370 +/- 55 ms) of the devices was maintained active (monitoring mode); only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right mid femoral position n = 18, thoracic spine area n = 5). After the procedure, the ICD memory was checked for detections, respectively, for changes of the programming.

RESULT

There was no misdetection or reprogramming of the ICD caused by electrical cautery or RF energy.

CONCLUSIONS

Despite the lack of undesired interactions ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation be ineffective or not manageable, electromagnetic interference is highly unlikely.

In vitro folding, functional characterization, and disulfide pattern of the extracellular domain of human GLP-1 receptor

The N-terminal, extracellular domain of the receptor for glucagon-like peptide 1 (GLP-1 receptor) was expressed at a high level in E. coli and isolated as inclusion bodies. Renaturation with concomitant disulfide bond formation was achieved from guanidinium-solubilized material. A soluble and active fraction of the protein was isolated by ion exchange chromatography and gel filtration. Complex formation with GLP-1 was shown by cross-linking experiments, surface plasmon resonance measurements, and isothermal titration calorimetry. The existence of disulfide bridges in the N-terminal receptor fragment was proven after digestion of the protein with pepsin. Further analysis revealed a disulfide-binding pattern with links between cysteines 46 and 71, 62 and 104, and between 85 and 126.

Complexity of biomedical data models in cardiology: the Intranet-based AF registry

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with major complications. Ongoing research is focused on new pacing devices for alternative treatment of this disease. The objective of an AF registry is to store prospectively all relevant data covering clinical information, quality of life and device parameters and by this means provide a platform for long-term follow-up. For statistical analysis, categorical and numerical items are required, thus a high-granular data structure must be defined and implemented in the clinical setting. Facing the limits of formalization, we developed an XML-based documentation scheme consisting of 619 items in eight tables and implemented it with state-of-the-art Intranet technology. At present detailed information on 88 patients is recorded. The pacing device generates per patient and follow-up visit a file consisting of approximately 400-500 parameters provided on a floppy disk, which are transferred by means of a specific interface into the database. Success factors for integration of a complex research database into the routine workflow of a busy university hospital are interfaces between data sources to enable non-redundant data entry, intensive fine tuning by iterative software engineering and benefit for the clinical users in form of clinical reports and patient-specific summaries. Data quality must be assured by plausibility checks. To get an overview of this complex dataset we developed a dedicated visualization tool. Due to the high number of items a large patient collective must be recruited for statistical evaluation. Interinstitutional cooperation is required for a consensus on common minimal documentation schemes to enable pooling of data.

The effect of carbonate on the precipitation of calcium phosphate

In order to facilitate the recovery of phosphorus from wastewater, the effect of carbonate on the precipitation of calcium phosphate has been studied. The effect of carbonate concentrations up to 5.00 millimoles per liter on the precipitation of 20 milligrammes phosphorus per liter phosphate was studied. At pH 8.00 the precipitation rate of phosphate was greatly retarded by carbonate and the corresponding precipitation efficiency also decreased, but at pH values > or = 9.00 the effect of carbonate on the precipitation of phosphate was very small. This indicates that carbonate may decrease the precipitation rate and efficiency of calcium phosphate, but the solution pH value is still a key factor influencing the precipitation process. The effect of carbonate on the precipitation of phosphate was attributed to the formation of ion pairs between carbonate and calcium and the decrease of free calcium ions. This resulted in the decrease of the thermodynamic driving force for the precipitation of calcium phosphate, so the effect of carbonate on the precipitation of phosphate was in fact a competing one, although this competing effect was not so obvious at pH > or = 9.00. Carbonate may be coprecipitated with phosphate from solution, especially at pH 9.00-11.00, and this will decrease the relative phosphorus content of the precipitate. The increases in solution pH value and initial Ca/P ratio are two approaches to overcome the influence of carbonate on the precipitation of phosphate, but the solution pH values should be lower than 10.00 and the initial Ca/P ratios should not exceed 5.00.

An in vivo pilot study characterizing the new CYP2A6*7, *8, and *10 alleles

We developed genotyping assays for CYP2A6*7 (Ile471Thr) and CYP2A6*8 (Arg485Leu). We found higher allelic frequencies in Japanese and Chinese versus Caucasians and identified an allele in which both substitutions occur together (CYP2A6*10). We created a homology model for predicting the impact of allelic variants on enzymatic activity and subsequently tested this in vivo in a pilot kinetic study. Consistent with our homology model predictions, we found (i) that CYP2A6*7 produces an enzyme that has decreased (not inactive) activity for metabolizing nicotine and coumarin; (ii) that CYP2A6*8 is unlikely to affect catalytic activity in vivo; and (iii) that having both substitutions together on an allele (CYP2A6*10) dramatically reduces function and may be fully inactive for some substrates. In conclusion, this study identifies, at relatively high frequency in Asians, an allele with decreased activity (may be substrate selective), a fully functional allele, and an allele containing both substitutions in which function is dramatically reduced.

[Mechanisms of initiation in atrial fibrillation]

Atrial fibrillation is the most relevant arrhythmia in daily clinical practice. The pathophysiology is determined by multiple independent reentrant wavelets in both atria. Repetitive triggers and an underlying substrate may favor the initiation and maintenance of atrial fibrillation. Mapping studies in patients with drug-refractory paroxysmal atrial fibrillation identified potentials from the ostia of pulmonary veins as a main source of triggers that initiate atrial fibrillation. In ongoing clinical trials, catheter ablation of pulmonary vein foci is used to eliminate atrial premature beats and thereby prevent the initiation of atrial fibrillation. The autonomic modulation of the heart rate and the occurrence of other supraventricular tachycardias that degenerate into atrial fibrillation are also considered as triggering mechanisms of atrial fibrillation. Since symptomatic bradycardia is associated with an increased incidence of atrial fibrillation, atrial pacing therapies for prevention of atrial fibrillation are another concept. Ongoing clinical trials evaluating the efficacy of pacing in patients with and without a primary pacemaker indication are currently under investigation. To date, data to which extent anatomical and electrophysiological characteristics of the atria influence the initiation and maintenance of atrial fibrillation are still missing. The myocardial adaptation to atrial fibrillation, the so-called "atrial remodeling", includes shortening of the atrial refractory period, slowing of atrial conduction, shortening of the atrial action potential, a progressive reduction of L-type calcium channel expression and microfibrosis of the myocardial tissue. New drug developments target atrial remodeling by modulating ion channel function and receptors of the angiotensin metabolism.

Molecular evolution of H6 influenza viruses from poultry in Southeastern China: prevalence of H6N1 influenza viruses possessing seven A/Hong Kong/156/97 (H5N1)-like genes in poultry

The A/teal/Hong Kong/W312/97 (H6N1) influenza virus and the human H5N1 and H9N2 influenza viruses possess similar genes encoding internal proteins, suggesting that H6N1 viruses could become novel human pathogens. The molecular epidemiology and evolution of H6 influenza viruses were characterized by antigenic and genetic analyses of 29 H6 influenza viruses isolated from 1975 to 1981 and 1997 to 2000. Two distinct groups were identified on the basis of their antigenic characteristics. Phylogenetic analysis revealed that all H6N1 viruses isolated from terrestrial poultry in 1999 and 2000 are closely related to A/teal/Hong Kong/W312/97 (H6N1), and the nucleotide sequences of these viruses and of A/Hong Kong/156/97 (H5N1) were more than 96% homologous. The hemagglutinin (HA) of the 1999 and 2000 terrestrial viruses does not have multiple basic amino acids at the site of cleavage of HA1 to HA2; however, a unique insertion of aspartic acid in HA1 between positions 144 and 145 (H3 numbering) was found. The neuraminidase of these terrestrial H6N1 viruses has a deletion of 19 amino acids characteristic of A/Hong Kong/156/97 (H5N1). Evolutionary analysis suggested that these H6N1 viruses coevolved with A/quail/Hong Kong/G1/97-like H9N2 viruses and became more adapted to terrestrial poultry. These terrestrial 1999 and 2000 A/teal/Hong Kong/W312/97 (H6N1)-like viruses, along with the H9N2 viruses, could have been involved in the genesis of the pathogenic H5N1 influenza viruses of 1997. The presence of H6N1 viruses in poultry markets in Hong Kong that possess seven of the eight genes of the A/Hong Kong/156/97 (H5N1) virus raises the following fundamental questions relevant to influenza pandemic preparedness: could the pathogenic H5N1 virus reemerge and could the H6N1 viruses directly cross the species barrier to mammals?

Universal primer set for the full-length amplification of all influenza A viruses

To systematically identify and analyze the 15 HA and 9 NA subtypes of influenza A virus, we need reliable, simple methods that not only characterize partial sequences but analyze the entire influenza A genome. We designed primers based on the fact that the 15 and 21 terminal segment specific nucleotides of the genomic viral RNA are conserved between all influenza A viruses and unique for each segment. The primers designed for each segment contain influenza virus specific nucleotides at their 3'-end and non-influenza virus nucleotides at the 5'-end. With this set of primers, we were able to amplify all eight segments of N1, N2, N4, N5, and N8 subtypes. For N3, N6, N7, and N9 subtypes, the segment specific sequences of the neuraminidase genes are different. Therefore, we optimized the primer design to allow the amplification of those neuraminidase genes as well. The resultant primer set is suitable for all influenza A viruses to generate full-length cDNAs, to subtype viruses, to sequence their DNA, and to construct expression plasmids for reverse genetics systems.

Harmonisation of rat fetal skeletal terminology and classification. Report of the Third Workshop on the Terminology in Developmental Toxicology. Berlin, 14-16 September 2000

The initial efforts of the Federal Institute for Health Protection of Consumers and Veterinary Medicine (BgVV) and the Free University of Berlin to standardise terminology in the field of developmental toxicology began in 1995. Procedures were undertaken to harmonise the terminology used by the International Federation of Teratology Societies (IFTS) and the International Programme on Chemical Safety (IPCS). This article reflects these activities and is a report on the Third Workshop on the Terminology in Developmental Toxicology held in September 2000. This Workshop served as a forum to discuss the results of a survey on the classification of skeletal anomalies that had been previously sent to scientists active in the field. Although high agreement was reached among the evaluators for several terms, the use of a number of terms was rather variable. Therefore, the discussions at the workshop among the experts from research institutions, regulatory agencies, and industry were mainly focussed on those terms for which there was disagreement and/or uncertainties and the possible reasons. Pictures provided by the participants for the illustration of "grey zone" anomalies constituted the basis for detailed discussions. In many of the cases with lower agreement, decisions were facilitated by the provision of the corresponding picture. The main reasons for lower agreement were imprecise terms, insufficient knowledge on postnatal consequences, theoretical terms that are unlikely to occur in isolation, and the possibility of observing a range of severity that might be decisive for the classification of either a malformation or variation. The attendees concluded that "grey-zone" anomalies will never disappear completely and that for the assessment, the grade of severity and/or the frequency of the observation can be decisive for the terminology chosen. A Joint IPCS/IFTS Project was proposed to further consensus of terminology and classification and to link these anomalies to pictures at different skeletal sites. In order to support the harmonisation of regulatory decisions, it was proposed to establish a "Clearinghouse" System under the umbrella of the IPCS. The Clearinghouse could be contacted either by the regulatory authorities or by any company to clarify their queries, particularly with regard to registration or authorisation processes. Finally, it was recommended to also carry out a similar survey on "soft tissue anomalies" and "external findings." The results of this survey will be discussed at a Joint IPCS/IFTS Workshop in Berlin in 2002.

Identification of pharmaceutical glasses by laser ablation ICP-MS

The chemical composition of pharmaceutical glasses (ampoules, infusion bottles, plunger) has been determined by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). A Nd:YAG laser with 10 Hz repetition rate in the Q-switch mode at its fundamental wavelength (1064 nm) was used to identify common types of pharmaceutical glasses. The following isotopes were used for measurements: 7Li, 11B, 23Na, 24Mg, 27Al, 28Si, 29Si, 30Si, 39K, 42Ca, 47Ti, 57Fe, 90Zr, 121Sb, 137Ba. Each analysis included the measurement of 12 craters. Relative standard deviations between 1.8% and 8.0% of the quantitative results were obtained. 29Si was used as internal standard. Standard reference materials (soda-lime-, lead- and borosilicate glasses) were used for external calibration of laser sampling. Linear calibration functions for each isotope were found. All samples and standard materials were digested in a two-step-procedure by nitric/fluoric acid, then measured and externally calibrated by ICP-MS with multi-elemental standard solutions using 45Sc as internal standard. Digestion and laser ablation results agree within 8% (confidential interval 95%) with the certified values. Intensity ratios of most isotopes also agree sufficiently with the corresponding theoretical values (+/- 18%). The developed method allows to distinguish different types of pharmaceutical glasses.

Early reinitiation of atrial fibrillation following external electrical cardioversion in amiodarone-treated patients

Early reinitiation of atrial fibrillation (ERAF) following external or internal electrical cardioversion is one of the factors determining unsuccessful electrical cardioversion. Prevention of ERAF has not been studied systematically in patients on amiodarone therapy.

METHODS AND RESULTS

22 patients had ERAF within 1 min after external electrical cardioversion of atrial fibrillation. 11 patients were on amiodarone therapy and 11 patients had no antiarrhythmic medication. The effect of atropine, post-shock atrial pacing and intravenous ajmaline on ERAF was consecutively tested in these patients. Administration of atropine before repeated defibrillation or post-shock atrial pacing prevented ERAF in 9 of the 11 patients (82%) on amiodarone therapy but in only 3 of 11 patients (27%) without amiodarone (p<0.05). In the remaining patients, intravenous ajmaline was effective in the suppression of ERAF in 5 patients without amiodarone and in 1 patient with amiodarone. The PP interval preceding the atrial premature beat reinitiating atrial fibrillation was nonsignificantly longer in amiodarone-treated patients (1127+/-419 ms) in comparison to patients without amiodarone (896+/-271ms). 27% of patients without amiodarone at the time of electrical cardioversion and 55% of patients with amiodarone remained in sinus rhythm during the follow-up of 29+/-14 and 30+/-14 months, respectively.

CONCLUSIONS

ERAF in patients on amiodarone can be treated by atropine or atrial pacing to prevent bradycardia-dependent ERAF. ERAF in amiodarone-treated patients does not apparently predict late recurrence of atrial fibrillation on continued amiodarone therapy.

Laser ablation inductively coupled plasma mass spectrometry: a new tool for trace element analysis in ice cores

A new method for the detection of trace elements in polar ice cores using laser ablation with subsequent inductively coupled plasma mass spectrometry analysis is described. To enable direct analysis of frozen ice samples a special laser ablation chamber was constructed. Direct analysis reduces the risk of contamination. The defined removal of material from the ice surface by means of a laser beam leads to higher spatial resolution (300-1000 microm) in comparison to investigations with molten ice samples. This is helpful for the detection of element signatures in annual layers of ice cores. The method was applied to the successful determination of traces for the elements Mg, Al, Fe, Zn, Cd, Pb, some rare-earth elements (REE) and minor constituents such as Ca and Na in ice cores. These selected elements serve as tracer elements for certain sources and their element signatures detected in polar ice cores can give hints to climate changes in the past. We report results from measurements of frozen ice samples, the achievable signal intensities, standard deviations and calibration graphs as well as the first signal progression of 205Pb in an 8,000-year-old ice core sample from Greenland. In addition, the first picture of a crater on an ice surface burnt by an IR laser made by cryogenic scanning electron microscopy is presented.

Persistent hypercapnia in children after treatment of obstructive sleep apnea syndrome by adenotonsillectomy

Obstructive sleep apnea syndrome (OSAS) in childhood is frequently in part a consequence of enlarged adenoids and/or tonsils and may lead to hypoxemia and hypercapnia during sleep. Whereas long-term blood gas alterations are well documented in adults, only few polygraphic data are available for children. It was the aim of this study to document blood gas alterations before and after treatment in this population. 9 children with OSAS (6 male, 3 female, median age 5.9 years, range 1.1-13.5 years) were investigated by polysomnography before and after adenotonsillectomy. Prior to intervention most children presented with moderate hypercapnia (ETCO2 mean 44.3 +/- 3.8 mm Hg, ETCO2 maximum 53.2 +/- 5.2) and hypoxemic episodes (oxygen saturation mean 93.2 +/- 3.2%, minimum 74.4 +/- 16.5%). Following adenotonsillectomy subsequent polygraphic investigations displayed normalisation of oxygen saturation (saturation mean 96.1 +/- 0.8%, minimum 90.1 +/- 3.1%). In contrast, moderate hypercapnia in several patients persisted up to five months after treatment (ETCO2 mean 44.9 +/- 2.8 mm Hg, ETCO2 maximum 51.2 +/- 3.6). Persistent hypercapnia most likely reflects an adaptation process of chemosensitivity and respiratory control due to preceding long-term hypercapnia.

Gene transfer of heterologous G protein-coupled receptors to cardiomyocytes: differential effects on contractility

In heart failure, reduced cardiac contractility is accompanied by blunted cAMP responses to beta-adrenergic stimulation. Parathyroid hormone (PTH)-related peptide and arginine vasopressin are released from the myocardium in response to increased wall stress but do not stimulate contractility or adenylyl cyclase at physiological concentrations. To bypass the defective beta-adrenergic signaling cascade, recombinant P1 PTH/PTH-related peptide receptors (rPTH1-Rs) and V(2) vasopressin receptors (rV(2)-Rs), which are normally not expressed in the myocardium and which are both strongly coupled to adenylyl cyclase, and recombinant beta(2)-adrenergic receptors (rbeta(2)-ARs) were overexpressed in cardiomyocytes by viral gene transfer. The capacity of endogenous hormones to increase contractility via the heterologous, recombinant receptors was compared. Whereas V(2)-Rs are uniquely coupled to Gs, PTH1-Rs and beta(2)-ARs are also coupled to other G proteins. Gene transfer of rPTH1-Rs or rbeta(2)-ARs to adult cardiomyocytes resulted in maximally increased basal contractility, which could not be further stimulated by adding receptor agonists. Agonists at rPTH1-Rs induced increased cAMP formation and phospholipase C activity. In contrast, healthy or failing rV(2)-R-expressing cardiomyocytes showed unaltered basal contractility. Their contractility and cAMP formation increased only at agonist exposure, which did not activate phospholipase C. In summary, we found that gene transfer of PTH1-Rs to cardiomyocytes results in constitutive activity of the transgene, as does that of beta(2)-ARS: In the absence of receptor agonists, rPTH1-Rs and rbeta(2)-ARs increase basal contractility, coupling to 2 G proteins simultaneously. In contrast, rV(2)-Rs are uniquely coupled to Gs and are not constitutively active, retaining their property to be activated exclusively on agonist stimulation. Therefore, gene transfer of V(2)-Rs might be more suited to test the effects of cAMP-stimulating receptors in heart failure than that of PTH1-Rs or beta(2)-ARS:

Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias

AIMS

Incisional atrial tachycardias in patients following surgery for congenital heart disease are based on complex structural abnormalities in these hearts. The aim of this study was to evaluate the use of the electroanatomical mapping system, CARTO, in consecutive patients with different forms of incisional atrial tachycardia.

METHODS AND RESULTS

The electroanatomical mapping system combines electrophysiological and spatial information and allows visualization of atrial activation in a three-dimensional anatomical reconstruction of the atria. Electroanatomical mapping of right atrial activation was performed in 10 patients after surgery for congenital heart disease, surgery for Wolff-Parkinson-White syndrome, or heart transplantation presenting with 13 incisional atrial tachycardias. The three-dimensional mapping allowed a rapid distinction between focal (n=3) and reentrant mechanisms (n=10) and visualization of the activation wavefronts along anatomical and surgically created barriers. Electroanatomical activation maps (mean right atrial activation time 213+/-107 ms) were constructed with 89+/-60 catheter positions during an average mapping time of 48+/-33 min. Reentrant tachycardias propagating through the tricuspid annulus-vena cava inferior isthmus (n=6) or along periatriotomy loops (n=4) were identified in eight patients. Ectopic atrial foci near surgical scars could be localized in three patients. Catheter ablation by creation of a lesion in a critical isthmus of conduction or by targeting the arrhythmogenic focus eliminated 11 of 13 incisional atrial tachycardias.

CONCLUSION

Visualization of atrial activation in a three-dimensional reconstruction of the right atrium using the electroanatomical mapping system CARTO facilitates understanding of the mechanism and defines the reentrant circuits of incisional atrial tachycardias. This new method may improve the success rate of electrophysiologically guided and anatomically guided catheter ablation of incisional atrial tachycardias.

XML-based visual data mining in medicine

Medical databases in general are characterized by a high degree of complexity in terms of quantity of items, number of parameter values and data types (free text, categorical, numerical and other). Substantial domain knowledge is required for adequate formalization of medical entities. In this context we developed medical database plot (mdplot), a data mining tool to visualize both structure and quality of data in medical databases to identify items suitable for evaluation. Data models are provided in XML format. Missing data is identified to enable targeted efforts to improve data quality prior to analysis. Database items are classified as 1:1- related to the patient (i.e. variables are collected once per patient) and 1:n related. mdplot provides a list of all classes contained in a database, the number of records each and a condensed bar chart for semi-quantitative description of completeness according to four types of items: categorical, numerical, text and other. All items in a category are grouped from left to right, the height of each bar represents the proportion of non-missing values with respect to the total number of records in the class; thus the amount of content in a specific class is visualized. By selection of a specific class, a detailed description of it is provided including mean completeness in each item category as well as number of values per item. The new methodology was applied to a cardiological research database consisting of 619 items on 88 patients.

Efficient expression of the tumor-associated antigen MAGE-3 in human dendritic cells, using an avian influenza virus vector

Dendritic cells (DCs) are the most potent inducers of immune reactions. Genetically modified DCs, which express tumor-associated antigens (TAA), can efficiently induce antitumor immunity and thus have a high potential as tools in cancer therapy. The gene delivery is most efficiently achieved by viral vectors. Here, we explored the capacity of influenza virus vectors to transduce TAA genes. These viruses abortively infect DCs without interfering with their antigen-presenting capacity. In contrast to other viruses used for DC transduction, influenza viruses can be efficiently controlled by antiviral pharmaceuticals, lack the ability to integrate into host chromosomes, and fail to establish persistent infections. Genes encoding a melanoma-derived TAA (MAGE-3), or the green fluorescence protein (GFP), were introduced into a high-expression avian influenza virus vector. Monocyte-derived mature DCs infected by these recombinants efficiently produced GFP or MAGE-3. More than 90% of the infected DCs can express a transduced gene. Importantly, these transduced DCs retained their characteristic phenotype and their potent allogeneic T cell stimulatory capacity, and were able to stimulate MAGE-3-specific CD8(+) cytotoxic T cells. Thus influenza virus vectors provide a highly efficient gene delivery system in order to transduce human DCs with TAA, which consequently stimulate TAA-specific T cells.

Duplications and defects in the CYP2A6 gene: identification, genotyping, and in vivo effects on smoking

In humans, 80% of nicotine is metabolized to the inactive metabolite cotinine by the enzyme CYP2A6, which can also activate tobacco smoke procarcinogens (e.g., 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone). Previously, we demonstrated that individuals who are nicotine-dependent and have defective CYP2A6 alleles (*2, *3) smoked fewer cigarettes; however, we recognize that the genotyping method used for the CYP2A6*3 allele gave a high false-positive rate. In the current study we used improved genotyping methods to examine the effects of the defective CYP2A6*2 and CYP2A6*4 alleles on smoking behavior. We found that those with the defective alleles (N = 14) smoked fewer cigarettes per day than those homozygous (N = 277) for wild-type alleles (19 versus 28 cigarettes per day, P <.001). In addition, we identified a duplicated form of the CYP2A6 gene, corresponding to the gene deletion CYP2A6*4 allele, developed a genotyping assay, assessed the gene copy number, and examined its prevalence in Caucasian smokers (N = 296). We observed an ascending rank order for plasma cotinine and breath carbon monoxide levels (an index of smoke inhalation) in individuals with null (CYP2A6*2 and CYP2A6*4) alleles (N = 14), those homozygous for wild-type (CYP2A6*1/*1) alleles (N = 277), and those with our newly identified CYP2A6 gene duplication (N = 5). The phenotype, as determined by plasma nicotine/cotinine ratios, had a descending rank order for these three genotype groups that did not reach significance. Although further characterization is required for the duplication gene variant, these results extend our previous findings and suggest a substantial influence of CYP2A6 genotype and phenotype on smoking behavior.

Spatial determination of elements in green leaves of oak trees (Quercus robur) by laser ablation-ICP-MS

Laser ablation inductively coupled plasma mass spectrometry (laser ablation-ICP-MS) has been applied to the spatially resolved determination of the elements Mg, Ca, Cu, Ni, Ba, Al, Pb, Sr and Mn in green leaves of oak trees. Instrument operating parameters such as the laser wavelength and the pulse energy have been optimized to provide the sensitivity and reproducibility required for the analysis. The method provides spatial resolution down to 300 microm with the use of the 355 nm wavelength (3rd harmonic of the 1,064 nm Nd:YAG laser wavelength) and the pulse energy of 50 mJ. Plant standards and cellulose, doped with multi element solution standards, dried and pressed to pellets were used as calibration samples. To compensate for signal fluctuations caused by the variation of the ablated sample mass 13C was used as a "natural" internal standard. The accuracy of the calibration was verified with selected samples analyzed by ICP-MS (high pressure digestion, 170 degrees C, 10(7) Pa, HNO3, 2 h) and by laser ablation-ICP-MS. Recovery rates between 93% (Cu) and 108% (Mn) were obtained. Leaves taken from oak trees (Quercus robur) were analyzed.

Characterization of the influenza A virus gene pool in avian species in southern China: was H6N1 a derivative or a precursor of H5N1?

In 1997, an H5N1 influenza virus outbreak occurred in chickens in Hong Kong, and the virus was transmitted directly to humans. Because there is limited information about the avian influenza virus reservoir in that region, we genetically characterized virus strains isolated in Hong Kong during the 1997 outbreak. We sequenced the gene segments of a heterogeneous group of viruses of seven different serotypes (H3N8, H4N8, H6N1, H6N9, H11N1, H11N9, and H11N8) isolated from various bird species. The phylogenetic relationships divided these viruses into several subgroups. An H6N1 virus isolated from teal (A/teal/Hong Kong/W312/97 [H6N1]) showed very high (>98%) nucleotide homology to the human influenza virus A/Hong Kong/156/97 (H5N1) in the six internal genes. The N1 neuraminidase sequence showed 97% nucleotide homology to that of the human H5N1 virus, and the N1 protein of both viruses had the same 19-amino-acid deletion in the stalk region. The deduced hemagglutinin amino acid sequence of the H6N1 virus was most similar to that of A/shearwater/Australia/1/72 (H6N5). The H6N1 virus is the first known isolate with seven H5N1-like segments and may have been the donor of the neuraminidase and the internal genes of the H5N1 viruses. The high homology between the internal genes of H9N2, H6N1, and the H5N1 isolates indicates that these subtypes are able to exchange their internal genes and are therefore a potential source of new pathogenic influenza virus strains. Our analysis suggests that surveillance for influenza A viruses should be conducted for wild aquatic birds as well as for poultry, pigs, and humans and that H6 isolates should be further characterized.

Regional and cellular induction of nicotine-metabolizing CYP2B1 in rat brain by chronic nicotine treatment

In the rat, nicotine is metabolized to cotinine primarily by hepatic cytochrome P450 (CYP) 2B1. This enzyme is also found in other organs such as the lung and the brain. Hepatic nicotine metabolism is unaltered after nicotine exposure; however, nicotine may regulate CYP2B1 in other tissues. We hypothesized that nicotine induces its own metabolism in brain by increasing CYP2B1. Male rats were treated with nicotine (0.0, 0.1, 0.3, or 1.0 mg base/kg in saline) s.c. daily for 7 days. CYP2B1 mRNA and protein were assayed in the brain and liver by reverse transcriptase-polymerase chain reaction (RT-PCR), immunoblotting, and immunocytochemistry. In control rats, CYP2B1 mRNA and protein expression were brain region- and cell-specific. CYP2B1 was not induced in the liver, but CYP2B1 mRNA and protein showed dose-dependent, region- and cell-specific patterns of induction across brain regions. At 1.0 mg nicotine/kg, the largest increase in protein was in the brain stem (5.8-fold, P < 0.05) with a corresponding increase in CYP2B1 mRNA (7.6-fold, P < 0.05). Induction of CYP2B1 was also observed in the frontal cortex, striatum, and olfactory tubercle. Immunocytochemistry showed that induction was restricted principally to neurons. These data indicate that nicotine may alter its own metabolism in the brain through transcriptional regulation, perhaps contributing to central tolerance to the effects of nicotine. CYP2B1 and its human homologue CYP2B6 also activate tobacco smoke procarcinogens such as NNK [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone]. Highly localized increases in CYP2B could result in increased mutagenesis. These data suggest roles for nicotine-induced CYP2B in central metabolic tolerance, nicotine-induced neurotoxicity, neuroplasticity, and carcinogenesis.

[The coronary circulation and myocardial ischemia]

In this review concerning the relationship between coronary circulation and myocardial ischemia, the authors focus on the factors influencing myocardial oxygen demand and supply, through the evaluation of the determinants of myocardial oxygen consumption and coronary flow regulation. The concepts of coronary flow reserve and endothelial control, the latter being probably a link among vasoconstriction, thrombosis and inflammation in the genesis of acute ischemic syndromes, have been particularly investigated. Moreover, the hemodynamic effects of coronary artery stenoses have been shortly mentioned. The complex mechanisms involved in the regulation of coronary artery tone and flow and the evolution of atherosclerotic plaques are clinically expressed in the so-called "ischemic cascade" leading from local ischemia to chest pain.

Effects of intra-accumbens injection of 2-methylthio ATP: a combined open field and electroencephalographic study in rats

RATIONALE

Previous experiments have shown that P2 receptor activation increases the release of dopamine in the mesolimbic mesocortical system.

OBJECTIVE

In order to investigate the functional correlates of dopaminergic stimulation, EEG and behavioural responses to injection of the P2 receptor agonist 2-methylthio ATP (2-MeSATP) into the nucleus accumbens (NAc) of rats were investigated.

METHODS

EEG electrodes were positioned into the NAc together with the guide cannula for intracerebral injection. Behavioural analysis was performed in an open field cage and was evaluated by a video activity measurement system. Rats were assigned to separate groups that were given artificial cerebrospinal fluid (aCSF) or drug treatment.

RESULTS

2-MeSATP significantly extended the period of locomotor activity in the novel environment. The quantitative EEG was characterized by an elevation of the power in the alpha-range and a decrease in power in the delta range. The P2 receptor antagonists reactive blue 2 but not pyridoxalphosphate-6-azophenyl-2'4'-disulphonic acid (PPADS) also enhanced locomotion when given alone, and elevated the alpha-1 and beta-2 bands. Both antagonists abolished the locomotor and EEG responses to 2-MeSATP. The dopamine D1 receptor antagonist SCH 23390 and the D2/D3 receptor antagonist sulpiride did not alter locomotor activity when given either alone or in combination. Only sulpiride and especially sulpiride in combination with SCH 23390 prevented the effect of 2-MeSATP. Sulpiride produced a selective increase in the alpha-1 band of the power spectrum whereas SCH 23390 elevated the power of the alpha-1, alpha-2 and beta-1 activities. Neither antagonist inhibited the effect of 2-MeSATP on the EEG when applied separately; however, the co-administration of SCH 23390 and sulpiride abolished the 2-MeSATP-induced alteration of power distribution. After a 6-hydroxydopamine (6-OHDA)-induced lesion of the accumbal dopaminergic terminals, 2-MeSATP failed to enhance the locomotor activity and to induce the characteristic EEG changes.

CONCLUSIONS

The observed alterations in open field behaviour and quantitative EEG after injection of 2-MeSATP into the NAc may be mostly due to P2 receptor-mediated dopamine release and subsequent receptor activation.

Heart rate dynamics at the onset of ventricular tachyarrhythmias as retrieved from implantable cardioverter-defibrillators in patients with coronary artery disease

BACKGROUND

The recent availability of implantable cardioverter-defibrillators (ICDs) that record 1024 R-R intervals preceding a ventricular tachyarrhythmia (VTA) provides a unique opportunity to analyze heart rate variability (HRV) before the onset of VTA.

METHODS AND RESULTS

Fifty-eight post-myocardial infarction patients with an implanted ICD for recurrent VTA provided 2 sets of 98 heart rate recordings in sinus rhythm: (1) before a VTA and (2) during control conditions. Three subgroups were considered according to the antiarrhythmic (AA) drug regimen. A state of sympathoexcitation was suggested by the significant reduction in HRV before VTA onset compared with control conditions. beta-Blockers and dl-sotalol enhanced HRV in control recordings; nevertheless, HRV declined before VTA independent of AA drugs. A gradual increase in heart rate and decrease in sinus arrhythmia at VTA onset were specific findings of patients who received dl-sotalol.

CONCLUSIONS

The peculiar heart rate dynamics observed before VTA onset are suggestive of a state of sympathoexcitation that is independent of AA drugs.

A DNA transfection system for generation of influenza A virus from eight plasmids

We have developed an eight-plasmid DNA transfection system for the rescue of infectious influenza A virus from cloned cDNA. In this plasmid-based expression system, viral cDNA is inserted between the RNA polymerase I (pol I) promoter and terminator sequences. This entire pol I transcription unit is flanked by an RNA polymerase II (pol II) promoter and a polyadenylation site. The orientation of the two transcription units allows the synthesis of negative-sense viral RNA and positive-sense mRNA from one viral cDNA template. This pol I-pol II system starts with the initiation of transcription of the two cellular RNA polymerase enzymes from their own promoters, presumably in different compartments of the nucleus. The interaction of all molecules derived from the cellular and viral transcription and translation machinery results in the generation of infectious influenza A virus. The utility of this system is proved by the recovery of the two influenza A viruses: A/WSN/33 (H1N1) and A/Teal/HK/W312/97 (H6N1). Seventy-two hours after the transfection of eight expression plasmids into cocultured 293T and MDCK cells, the virus yield in the supernatant of the transfected cells was between 2 x 10(5) and 2 x 10(7) infectious viruses per milliliter. We also used this eight-plasmid system for the generation of single and quadruple reassortant viruses between A/Teal/HK/W312/97 (H6N1) and A/WSN/33 (H1N1). Because the pol I-pol II system facilitates the design and recovery of both recombinant and reassortant influenza A viruses, it may also be applicable to the recovery of other RNA viruses entirely from cloned cDNA.

[Mental disorders in prisons--view of prison governors]

This article reports on experiences with prisoners with mental diseases. Due to the multitude of drug supply of all kind in Frankfurt, several addicted humans are living in this area. Their way of life is frequently accompanied by arrest and imprisonment. It is demonstrated what we experienced with these prisoners and what kind of problems has occurred. The employees of a penal institution are not prepared enough to deal with such problems. Such demands are demonstrated.

Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation

AIMS

Antiarrhythmic drug treatment for atrial fibrillation can cause atrial flutter-like arrhythmias. The aim of this study was to clarify the effect of catheter ablation of the tricuspid annulus-vena cava inferior isthmus on amiodarone-induced atrial flutter and to determine the incidence of atrial fibrillation after catheter ablation of amiodarone-induced atrial flutter in comparison to regular typical flutter.

METHODS AND RESULTS

Among 92 consecutive patients with typical atrial flutter who underwent isthmus ablation 28 patients had atrial flutter without a history of previous atrial fibrillation (group I), 10 patients had atrial flutter following the initiation of amiodarone therapy for paroxysmal atrial fibrillation (group II) and 54 patients had atrial flutter and atrial fibrillation (group III). Atrial cycle length during atrial flutter in amiodarone-treated patients (group II) (277+/-24 ms) was significantly longer as compared to the cycle length of atrial flutter in group I (247+/-33 ms) and group III patients (235+/-28 ms). The rate of successful transient entrainment and overdrive stimulation to sinus rhythm was not different between patients with (60%) or without amiodarone therapy (group I: 71%, group III: 53%). Successful isthmus ablation with bidirectional conduction block eliminating right atrial flutter was achieved in 90% of amiodarone-treated patients and 93% of patients without amiodarone therapy. In the amiodarone-treated patient group atrial conduction times during pacing in sinus rhythm were significantly prolonged by 20-30% before and after ablation in all regions of the reentrant circuit. During a mean follow-up of 8+/-3 months post-ablation, atrial fibrillation recurred in two of 10 patients on continued amiodarone therapy after successful isthmus ablation. Thus, successful catheter ablation of atrial flutter due to amiodarone therapy was associated with a markedly lower recurrence rate of paroxysmal atrial fibrillation (20%) as compared to patients with atrial flutter plus preexisting paroxysmal atrial fibrillation (76%) and was similar to the outcome of patients with successful atrial flutter ablation without preexisting atrial fibrillation (25%).

CONCLUSION

These data suggest that isthmus ablation with bidirectional block and continuation of amiodarone therapy is an effective therapy for the treatment of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation.

[Variable late potentials in long-term ECG of the post-infarct patient at risk for ventricular fibrillation]

BACKGROUND

Ventricular late potentials are found more readily in post-infarction patients who had sustained ventricular tachycardia than in those who survived ventricular fibrillation. Hypothetically, a daytime variability of late potentials might be responsible for this finding.

METHOD

Therefore a conventional late potential analysis only performed once a day was compared to a late potential analysis in time and frequency domain repeatedly performed every hour in the Holter-ECG of 160 post-infarction patients (50 patients (= VT-group) with documented, sustained ventricular tachycardia (cycle-length > 230 ms), 50 patients (= VF-group) who survived, documented ventricular fibrillation and 60 patient, without ventricular arrhythmias (= O VT/VF-group)).

RESULTS

The conventional analysis showed late potentials in time domain in 72% of the patients in the VT-group, in 40% of patients in the VF-group and in 20% of the patients in the O VT/VF-group. The Holter-ECG showed late potentials to be permanently present in frequency domain in 66% of the patients in the VT-group, in only 6% in the patients in the VF-group and in no patient in the O VT/VF-group. However, in at least one analysis we detected late potentials in 84% of patients of the VF-group, in 90% of patients in the VT-group and in 18% of patients in the O VT/VF-group. Transiently detectable late potentials in patients of the VF-group were predominantly seen at heart rate accelerations in the morning hours, ST-segment shifts or transitory decreased heart rate variability.

CONCLUSIONS

Post-infarction patients with sustained ventricular tachycardia predominantly have constantly detectable late potentials over 24 hours. In these patients conventional late potential is successful for post-infarction risk stratification at any time of the day. However, in post-infarction patients who survived ventricular fibrillation, late potentials are found to be transitory and only detectable by Holter-ECG. Thus, late potential analysis performed in the Holter-ECG might improve post-infarction risk stratification in patients prone to sudden cardiac death.

"Ambisense" approach for the generation of influenza A virus: vRNA and mRNA synthesis from one template

We present a system for creating influenza virus by generating viral RNA (vRNA) and mRNA from one template. Recently, a system for the generation of influenza A virus entirely from cloned cDNAs was established (Neumann et al., 1999, Proc. Natl. Acad. Sci. USA 96, 9345-9350). Cells were transfected with plasmids for RNA polymerase I-driven intracellular synthesis of all eight viral RNAs, and with protein expression plasmids for the synthesis of viral structural proteins. Although this system is highly efficient in virus generation, the construction and cotransfection of 17 plasmids is cumbersome and may limit the use of this system to cell lines that can be transfected with high efficiencies. Synthesizing both vRNA and mRNA from one template would reduce the number of plasmids required for virus generation. Therefore, we generated a bidirectional transcription construct that contains cDNA encoding PB1 flanked by an RNA polymerase I (pol I) promoter for vRNA synthesis and an RNA polymerase II (pol II) promoter for mRNA synthesis. The utility of this approach is proved by the generation of virus after transfecting the pol I/pol II-promoter-PB1 construct together with vRNA- and protein-expression constructs for the remaining seven segments. Because this approach reduces the number of plasmids required for virus generation, it also reduces the work necessary for cloning, probably enhances the efficiency of virus generation, and expands the use of the reverse-genetics system to cell lines for which efficient cotransfection of 17 plasmids cannot be achieved.

New mapping technology for atrial tachycardias

Prerequisite for succesful radiofrequency catheter ablation of tachycardias is the exact mapping during the electrophysiological study. The new mapping system CARTO allows a three-dimensional color-coded electroanatomic map of impulse propagation using electromagnetic technology. The aim of this study was to determine the feasibility and safety of the new electromagnetic mapping technology CARTO for atrial tachycardias.

RESULTS

Electrophysiologic study and CARTO mapping was performed in 38 atrial tachycardias. The mapping procedure took 26 +/- 23 min. We created 33 maps within the right atrium and 5 maps within the left atrium with a mean of 74 +/- 38 different catheter positions. The mechanism was determined as reentrant in 9, junctional in 1 and focal in 28 tachycardias. In focal tachycardias the tachycardia cycle length (CL) and the total atrial activation time (AT) were clearly different (352 +/- 98 ms vs 99 +/- 25 ms). Reentrant tachycardias had a comparable CL and AT (236 +/- 44 ms vs 240 +/- 56 ms). In 83% of the focal tachycardias and in 67% of the reentrant tachycardias, ablation was performed successfully. No complications occured.

CONCLUSION

The electroanatomic mapping system allows high resolution visualization of electrical activity and may therefore improve precision and simplify the determination of the arrhythmogenic substrate during tachycardias for successful catheter ablation.