Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices

BACKGROUND AND OBJECTIVES

Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs.

METHODS

This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated.

RESULTS

During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively).

CONCLUSIONS

A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.

"Elbow-Lock" Chest Compression Method in the Setting of Single Rescuer Pediatric Cardiopulmonary Resuscitation: A Crossover Simulation Study

BACKGROUND

We designed a new 1-handed chest compression method, the "elbow-lock" chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method.

METHODS

This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC.

RESULTS

Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001).

CONCLUSIONS

The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.Trial registration: Our research is simulation manikin study. So we do not need to "trial registration".

Prevalence and related factors of irregular menstrual cycles in Korean women: the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V, 2010-2012)

INTRODUCTION

There have been few population-based studies reporting medical, lifestyle and psychological factors associated with irregular menstrual cycles. This study aimed to elucidate the prevalence and related factors of irregular menstrual cycles in Korean women.

METHODS

Cross-sectional data from the 5th Korean National Health and Nutrition Examination Survey were used. Eligible women were 19-40 years old, not currently taking oral contraceptives or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal women were recruited in this study. The prevalence and related factors of irregular cycles were obtained using a general linear model and logistic regression analyses in a complex sampling design.

RESULTS

The prevalence of irregular cycles was 14.3%. Age and high-education level were associated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI) 0.87-0.96, and OR 0.58, 95% CI 0.38-0.88, respectively). The ORs of body mass index, perceived stress and depressive mood were 1.05 (95% CI 1.01-1.10), 1.46 (95% CI 1.11-1.92) and 2.07 (95% CI 1.18-3.63), respectively.

CONCLUSIONS

Age, perceived stress, body mass index, depressive mood and education level, rather than obstetric factors or metabolic diseases were significant factors associated with irregular menstrual cycles in Korean women. Of these factors, perceived stress is the most significant factor associated with increased irregular menstrual cycles.

Relationship between the activities of daily living, oral health-related quality of life and dementia

AIM

The aim of the present study was to investigate the association between the activities of daily living and the oral health-related quality of life and dementia in older adults.

METHODS

Over a period of 18 months, we visited 12 elderly care facilities and recruited 375 participants, 345 of whom were selected to undergo oral health examinations and oral health-related surveys. Each investigation was carried out face-to-face by a professional worker.

RESULTS

Cognitive ability was found to be good when the results of the activities of daily living and the oral health-related quality of life examinations were good. If the results of the activities of daily living examination were bad, the odds ratio of dementia was 2.66, and adjusted odds ratio for age, sex, residence type, education level and denture was 2.99, representing a significant difference (P < 0.05).

CONCLUSIONS

Most oral problems are not simply the outcome of aging, with oral hygiene management being the most important determining factor. Oral health problems can be prevented, and in order to improve the quality of life of older adults, attention must be paid to oral healthcare. Geriatr Gerontol Int 2018; 18: 943-949.

Antimicrobial activity of the chloroform fraction of Drynaria fortunei against oral pathogens

Drynaria fortunei (D. fortunei), widely used in traditional Korean medicine, is reportedly effective in treating inflammation, hyperlipidemia, bone fractures, oxidative damage, arteriosclerosis, rheumatism, and gynecological diseases. The objective of this study was to evaluate the antibacterial effects of the chloroform fraction of D. fortunei (DFCF) and assess the synergistic effects of DFCF with antibiotics against bacterial pathogens. This was carried out by calculating the minimal inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) and performing checkerboard dilution test and time-kill assays. The MICs/MBCs for DFCF, ampicillin, and gentamicin against all oral strains were >39-2,500/5,000 μg/mL, 0.25-64/0.25-64 µg/mL, and 0.5-256/1-512 µg/mL, respectively. DFCF exhibited the highest activity against the periodontic pathogens Prevotella intermedia and Porphylomonas gingivalis. DFCF in combination with ampicillin showed a strong synergistic effect against oral bacteria (fractional inhibitory concentration (FIC) index ≤0.5), whereas on combining with gentamicin, it reduced the on half-eighth times than used alone (FICI ≤ 0.5). DFCF combined with ampicillin or gentamicin killed 100% of most tested bacteria within 3-4 h. The results of this study demonstrate the antimicrobial and synergistic activity of DFCF and antibiotics against oral pathogens.

Physicochemical properties and antimicrobial activity of Roselle (Hibiscus sabdariffa L.)

BACKGROUND

The therapeutic action of a plant depends on its chemical constituents. In this study, experiments were carried out in order to evaluate the effect of extraction conditions on the antioxidative and antimicrobial activities of Roselle (Hibiscus sabdariffa L.).

RESULTS

Roselle was found to be rich in malic acid, anthocyanins, ascorbic acid and minerals, especially Ca and Fe, but low in glucose. More than 18 volatile compounds were identified by gas chromatography and gas chromatography-mass spectrometry. This herb, which is rich in phenolic compounds and displays DPPH radical scavenging activity, could be a good source of natural antioxidants. The antimicrobial activity of the Roselle water and ethanol extracts was tested with Bacillus subtilis (ATCC6633), Staphylococcus aureus (ATCC6538) and Escherichia coli (ATCC 8739). The inhibition of the Roselle ethanol extract against B. subtilis and S. aureus was slightly higher than that of water extract but this difference was not significant. However, E. coli was strongly inhibited by the Roselle water extract at concentrations of 25 and 50 mg mL(-1) as determined by a paper disc method.

CONCLUSION

The obtained results indicated that antioxidant and antimicrobial activity was related to different methods of extraction and Roselle extracts could be a source of therapeutically useful products.

Antibacterial activity of sophoraflavanone G isolated from the roots of Sophora flavescens against methicillin-resistant Staphylococcus aureus

In this study, sophoraflavanone G obtained from Sophora flavescens was evaluated against 10 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA), either alone or in combination with ampicillin or oxacillin, via checkerboard assay. At the end point of an optically clear well, the minimum inhibitory concentrations (MICs) ranged from 0.5 to 8 microg/ml for sophoraflavanone G, from 64 to 1024 microg/ml for ampicillin, and from 256 to 1024 microg/ml for oxacillin. The combination of sophoraflavanone G and ampicillin or oxacillin yielded a fractional inhibitory concentration index ranging from 0.188 to 0.375, thereby indicating a principally synergistic effect. The synergistic interaction was verified by time-kill studies using sophoraflavanone G and/or antibiotics. Thirty minutes of treatment with sophoraflavanone G with ampicillin or oxacillin resulted in an increase in the rate of killing in units of CFU/ml to a greater degree than was observed with Sophoraflavanone G alone. These findings indicated that the application of the tested sophoraflavanone G alone or in combination with antibiotics might prove useful in the control and treatment of MRSA infections.

Endoscopic treatment of difficult bile duct stones by using a double-lumen basket for laser lithotripsy--a case series

Laser lithotripsy is an effective and safe method for difficult common bile duct (CBD) stones. However, radiolucent laser fibers make accurate fragmentation difficult and require continuous visual control or an accessory for effective targeting. The newly developed double-lumen basket may promote effective laser lithotripsy after stone capture. We performed laser lithotripsy using a double-lumen basket in 14 patients with CBD stones refractive to conventional endoscopic treatment, and evaluated the feasibility and efficacy of this procedure. Stones were successfully fragmented in 13 of 14 patients, and 13 patients eventually became stone-free. Mechanical lithotripsy was applied in two patients with biliary strictures. Minor complications were noted in three patients, including transient hemobilia in one patient. For a selected group of patients with difficult CBD stones, laser lithotripsy using a double-lumen basket appears to be an effective and safe method. However, continuous development of basket protocols to increase the success rate of lithotripsy is needed.

Chemical composition and antibacterial activity of essential oil from Artemisia feddei

The chemical components of the essential oil from Artemisia feddei LEV. et VNT. were analyzed using GC-MS. Ninety-nine compounds, accounting for 96.23% of the extracted essential oil, were identified. The main oil compounds were 1,8-cineole (16.86%), chamazulene (9.04%), alpha-terpineol (8.18%), alpha-phellandrene (5.78%), alpha-thujone (5.51%), alpha-terpinyl acetate (5.07%), borneol (5.08%), beta- caryophyllene (4.71%), camphor (4.04%), and terpinen-4-ol (3.04%). The antimicrobial activity of the essential oil and some of its compounds was tested against 15 different genera of oral bacteria. The essential oil from A. feddei had a considerable inhibitory effect on all the obligate anaerobic bacteria tested (MICs, 0.025 to 0.05 mg/ml; MBCs, 0.025 to 0.1mg/ml), whereas the major compounds demonstrated different degrees of growth inhibition.

Synthesis and cytotoxic activities of 8-alkyl or 8-aryl-8,9-dihydro-7H-isoindolo[5,6-g]quinoxaline-7,9-diones

A series of 8-alkyl- and 8-aryl-8,9-dihydro-7H-isoindolo[5,6- g]quinoxaline-7,9-diones were synthesized using sultine chemistry as a key step in good yield. These compounds were evaluated for their in vitro cytotoxicity against six human cancer cell lines (HCT15, SK-OV-3, A549, SNB19, MCF7 and MCF7/ADR).

Inducible RGS2 is a cross-talk regulator for parathyroid hormone signaling in rat osteoblast-like UMR106 cells

Parathyroid hormone (PTH) activates dual signal transduction systems via Galphas and Galphaq proteins. We now report a novel mechanism by which "cross-talk" may occur between the Galphas and Galphaq signaling pathways. RGS2 (Regulator of G protein Signaling 2) mRNA was rapidly and transiently increased only by PTH analogs (PTH1-84, 1-34, 1-31, and PTHrP) that activated the Galphas-mediated cAMP/PKA signaling pathway, whereas activation of the Galphaq-mediated Ca(2+)/PKC signaling pathway by PTH3-34 had no effect on RGS2 expression. Treatment of UMR106 cells with nonPTH activators of the cAMP/PKA signaling pathway such as cholera toxin, forskolin, 8-Br-cAMP, and dibutyryl-cAMP also significantly elevated RGS2 mRNA levels, while activator of the Galphaq pathway PMA did not. Pretreatment using the Galphas signaling pathway inhibitors SQ22536 and H89 significantly blocked PTH-induced RGS2 expression, but the Galphaq signaling pathway inhibitor bisindolylmaleimide I had no effect. Therefore, RGS2 expression is governed solely by the Galphas signaling pathway. Additionally, we demonstrate for the first time that RGS2 binds to both Galphas and Galphaq subunits in their transition state (GDP/AlF(-4)-bound) forms, suggesting that RGS2 has the potential to act as a bridge between the cAMP/PKA and Ca(2+)/PKC pathways, and that it may act as a cross-talk regulator for these two PTH signaling pathways.

Fibrovascular polyp of the esophagus in infant

A five month female was referred complaining of intermittent vomiting with protrusion of a sausage-like mass through the oral cavity. Esophageal endoscopy and esophagogram revealed a mass in the upper esophagus, which was diagnosed as a fibrovascular polyp. Under general anesthesia, the mass was grasped through the oral cavity with a forcep and ligated and excised at the base, where a stump arose from the posterior wall of the cervical esophagus. The pathology was confirmed as a fibrovascular polyp, which is a rare benign esophageal lesion occurring mostly in adult males, and has not been reported in infancy.

Structural basis of human erythrocyte glucose transporter function in proteoliposome vesicles: circular dichroism measurements

The secondary structural compositions of the human erythrocyte glucose transporter in proteoliposome vesicles were assessed on the basis of circular dichroism (CD) spectra measured in the absence and in the presence of D-glucose or an inhibitor, cytochalasin B. We designed and used a scattered-light-collecting device, which corrects CD spectra for optical artifacts originating from light scattering. Relative contents of eight types of secondary structure were estimated by using basis spectra generated by the eigenvector method based on CD spectra of 15 proteins of known structure. Results indicate that the glucose transporter is composed of approximately 82% alpha-helices, 10% beta-turns, and 8% other random structure, with no beta-strands. In the presence of an excess of D-glucose, the alpha-helical content is reduced by more than 10% and there is a significant increase in the random structure content. Cytochalasin B does not appear to affect the secondary structural composition of the transporter to any significant degree.

Further characterization and chemical purity assessment of the human erythrocyte glucose transporter preparation

Chemical and functional purity of the human erythrocyte glucose transporter preparation obtained by DEAE column chromatography after octyl glucoside solubilization was assessed. The cytochalasin B binding capacity of the preparation indicates that the preparation is 60-85% functional glucose transporter. Gel filtration chromatography on TSK 250 column separates this preparation into at least three major peptide fractions, namely, P0, P1 and P2, with apparent Mr of approx. 80 000, 43 000 and 17 000, respectively. When the preparation is photolabelled with [3H]cytochalasin B prior to the separation only P0 and P1 are labelled. Exposure of the preparation to octyl glucoside or to ultraviolet light irradiation results in an increase in P0 in a time-dependent manner with a concomitant and proportional reduction in P1, without affecting P2 appreciably. For individual preparations, relative abundance of P0 and P1 vary widely in a reciprocal fashion, while that of P2 is practically fixed at approx. 10% of the total protein. The specific activity of cytochalasin B binding of each preparation correlates linearly with the relative abundance of P1 of the preparation, which gives a calculated specific binding activity of 22 nmol/mg protein for this fraction. These results indicate that P1 and P0 are native and denatured transporter, respectively, while P2 is contaminating protein impurities. These results demonstrate that the glucose transporter preparation contains approx. 10% of nontransporter protein impurities, with a varying amount (up to 30%) of denatured transporter, and that the transporter free of the chemical impurities and the denatured transporter can be obtained by a gel filtration chromatography of this preparation.

Structural basis of human erythrocyte glucose transporter function in reconstituted system. Hydrogen exchange

Hydrogen exchange kinetic behavior of human erythrocyte glucose transporter protein in vesicles was studied in the absence and in the presence of D-glucose or a well known inhibitor, cytochalasin B. This is to detect a proposed channel of water penetrating into the protein through which the sugar molecule passes and to monitor any conformational changes induced by the substrate or inhibitor. Analyses of the kinetic data revealed several classes of hydrogens which exchange with readily distinguishable rates. Of 660 hydrogens detected per transporter, approximately 30% exchanged with rates generally characterized as those of free amide hydrogens indicating they are interfaced to solvent water. Since the transporter is known to be embedded deep in the hydrophobic area of the membrane with minimum exposure to the outside of the membrane lipid bilayer, a significant portion of these free amide hydrogens must be at the purported channel rather than outside of the membrane. D-Glucose and cytochalasin B affected the exchange kinetics of these presumably channel-associated free amide hydrogens rather differently. D-Glucose reduced the apparent rate constants, but not the total number. Cytochalasin B on the other hand reduced the total number to one-half without significantly changing the apparent rate constants. The remaining 70% of the labeled hydrogens exchanged with much slower rates which vary 10-10,000-fold, indicating that they are internally structured peptide amide and side chain hydrogens. Both D-glucose and cytochalasin B further reduced the rates of these hydrogens, indicating a global stabilization of the protein structure.

Structural basis of human erythrocyte glucose transporter function in reconstituted vesicles

The transmembrane orientation of the human erythrocyte glucose transporter was assessed based on polarized Fourier transform infrared and ultraviolet circular dichroism spectroscopic data obtained from oriented multilamellar films of the reconstituted transporter vesicles. Infrared spectra revealed that there are distinct vibrations for alpha-helical structure while the vibrational frequencies specific to beta-structure are characteristically absent. Analysis of linear dichroism of the infrared spectra further indicated that these alpha-helices in the transporter are preferentially oriented perpendicular to the lipid bilayer plane forming an effective tilt of less than 38 degrees from the membrane normal. Such a preferential orientation was further supported by ultraviolet circular dichroism spectra which reveal that the 208 nm Moffit band found in the detergent-solubilized preparation is absent in the film preparation. Linear dichroism data further indicated that D-glucose, a typical substrate, further reduces this effective tilt angle slightly.