The Plumber Versus Electrician Dilemma: To Bypass or to Defibrillate?

We present a unique case of an 80-year-old male who presented to our emergency department following cardiac defibrillation when he was found to be in polymorphic ventricular tachycardia (VT) after a syncopal event while at cardiac rehabilitation. He had known coronary artery disease and had a four-vessel coronary artery bypass graft (CABG) 20 years prior to presentation. He underwent left heart catheterization (LHC) two months prior to the syncopal event for worsening shortness of breath and the decision at that time was to proceed with medical management and intervene with redo-CABG if shortness of breath did not improve or progressively worsened.

Imperfect replacement of native species by non-native species as pollinators of endemic Hawaiian plants.

Native plant species that have lost their mutualist partners may require non-native pollinators or seed dispersers to maintain reproduction. When natives are highly specialized, however, it appears doubtful that introduced generalists will partner effectively with them. We used visitation observations and pollination treatments (experimental manipulations of pollen transfer) to examine relationships between the introduced, generalist Japanese White-eye (Zosterops japonicus) and 3 endemic Hawaiian plant species (Clermontia parviflora, C.

Cardiovascular implantable electronic device implantation with uninterrupted dabigatran: comparison to uninterrupted warfarin.

Background: While continuation of oral anticoagulation (OAC) with warfarin may be preferable to interruption and bridging with heparin for patients undergoing cardiovascular implantable electronic device (CIED) implantation, it is uncertain whether the same strategy can be safely used with dabigatran.

Objective And Methods: To determine the risk of bleeding and thromboembolic complications associated with uninterrupted OAC during CIED implantation, replacement, or revision, the outcomes of patients receiving uninterrupted dabigatran (D) were compared to those receiving warfarin (W).

Results: D was administered the day of CIED implant in 48 patients (age 66 ± 12.

Climate-associated population declines reverse recovery and threaten future of an iconic high-elevation plant.

Although climate change is predicted to place mountain-top and other narrowly endemic species at severe risk of extinction, the ecological processes involved in such extinctions are still poorly resolved. In addition, much of this biodiversity loss will likely go unobserved, and therefore largely unappreciated. The Haleakalā silversword is restricted to a single volcano summit in Hawai'i, but is a highly charismatic giant rosette plant that is viewed by 1-2 million visitors annually.

Effect of chest compressions on ventricular activation.

External mechanical forces can cause ventricular capture and fibrillation (i.e., commotio cordis).

Periods of highly synchronous, non-reentrant endocardial activation cycles occur during long-duration ventricular fibrillation.

Unlabelled: Periods of Highly Organized Activation During VF.

Background: Little is known about long-duration ventricular fibrillation (LDVF), lasting 1-10 minutes when resuscitation is still possible.

Methods And Results: To determine global left ventricle (LV) endocardial activation during LDVF, 6 canines (9.

Purkinje activation precedes myocardial activation following defibrillation after long-duration ventricular fibrillation.

Background: While reentry within the ventricular myocardium (VM) is responsible for the maintenance of short-duration ventricular fibrillation (SDVF; VF duration <1 minute), Purkinje fibers (PFs) are important in the maintenance of long-duration ventricular fibrillation (LDVF; VF duration >1 minute).

Objective: The purpose of this study was to test the hypothesis that the mechanisms of defibrillation may also be different for SDVF and LDVF.

Methods: A multielectrode basket catheter was deployed in the left ventricle of eight beagles.

In a swine model, chest compressions cause ventricular capture and, by means of a long-short sequence, ventricular fibrillation.

Background: During resuscitation, fibrillation often recurs. In swine, we studied refibrillation after long-duration ventricular fibrillation, investigating an association with chest compressions (CCs).

Methods And Results: In protocol A, 47 episodes of long-duration ventricular fibrillation lasting at least 2.

Patterns of nucleotide variation in homoeologous regulatory genes in the allotetraploid Hawaiian silversword alliance (Asteraceae).

Genome-wide duplication (polyploidization) is prevalent in a large number of eukaryotic organisms and is particularly widespread in flowering plants. Polyploid species appear to vary from their diploid progenitors in a variety of ecologically important traits, suggesting that genome duplications provide a mechanism for ecological diversification. Studies of nucleotide variation at duplicate genes that arise via polyploidization allow us to infer the evolutionary forces that act on these polyploid loci.

Tissue elastic properties of eight Hawaiian Dubautia species that differ in habitat and diploid chromosome number.

Eight Hawaiian Dubautia species grow in habitats as varied as exposed lava, dry scrub, mesic forest, wet forest, and bog. These species also differ in diploid chromosome number, with four species having 13 pairs of chromosomes and four species having 14 pairs. This ecological and chromosomal variation is paralleled by significant interspecific variation in tissue elastic properties.

Variation in the tissue water relations of two sympatric Hawaiian Dubautia species and their natural hybrid.

At one site of sympatry on the Island of Hawaii, Dubautia ciliolata and D. scabra are restricted to different lava flows, even though individuals of the two species may be found growing within a few meters of one another. Associated with this habitat difference is a difference in the tissue water deficits experienced by these two species.

Photosynthetic responses of C and C species from cool shaded habitats in Hawaii.

The C species, Euphorbia forbesii, and the C species, Claoxylon sandwicense, occupy cool, shaded habitats in Hawaii. Both of these species exhibit the photosynthetic characteristics of typical shade plants: low light-saturated photosynthetic rates, low dark respiration rates, low light levels for saturation of photosynthesis, and low light compensation points. In addition, the quantum yields of the two species are similar at leaf temperatures near 22°C, reflecting a significant increase in the quantum yield of E.

Environmental characteristics, field water relations, and photosynthetic responses of C Hawaiian Euphorbia species from contrasting habitats.

Four endemic Hawaiian Euphorbia species range in habitat from open arid coastal strand to shaded mesic forest and in growth-form from small prostrate shrubs to trees. As shown in the present study, these large differences in habitat and growth-form are paralleled by equally large differences in maximal photosynthetic rate (13.7 to 37.