Inappropriate mode switching clarified by using a chest radiograph.

An 80-year-old woman with a history of paroxysmal atrial fibrillation and atrioventricular node disease status post-dual chamber pacemaker placement was noted to have abnormal pacing episodes during a percutaneous coronary intervention. Pacemaker interrogation revealed a high number of short duration mode switching episodes. Representative electrograms demonstrated high frequency nonphysiologic recordings predominantly in the atrial lead.

A Rare Association of Sinus Venosus-Type Atrial Septal Defect and Persistent Left Superior Vena Cava Detected by Transthoracic Echocardiography and Cardiac Magnetic Resonance Imaging.

Background: Association of persistent left superior vena cava (PLSVC) and sinus venosus-type atrial septal defect (SVASD) is rare. We describe a patient with dilated coronary sinus (CS) found to have PLSVC and SVASD.

Case Report: The patient is a 60-year-old man with history of stroke who underwent a transthoracic echocardiogram (TTE) for evaluation of shortness of breath.

The NFKB Inducing Kinase Modulates Hematopoiesis During Stress.

The genetic programs that maintain hematopoiesis during steady state in physiologic conditions are different from those activated during stress. Here, we show that hematopoietic stem cells (HSCs) with deficiencies in components of the alternative NFκB pathway (the NFκB inducing kinase, NIK, and the downstream molecule NFκB2) had a defect in response to stressors such as supraphysiological doses of cytokines, chemotherapy, and hematopoietic transplantation. NIK-deficient mice had peripheral blood and bone marrow leukocyte numbers within normal ranges (except for the already reported defects in B-cell maturation); however, HSCs showed significantly slower expansion capacity in in vitro cultures compared to wild-type HSCs.

Inadequate Blood Pressure Control in Hypertensive Patients Referred for Cardiac Stress Test.

The current study examined the degree of blood pressure (BP) control and incidence of myocardial ischemia in hypertensive patients (n=2039) referred for cardiac stress test. Patients were categorized into well-controlled (<140/90 mm Hg), poorly controlled (140-160/90-100 mm Hg), and very poorly controlled (>160/100 mm Hg) groups according to their resting BP. The mean age[±standard error of the mean] of the patients was 68±13 years, and 885 (43.

Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections.

Purpose: To evaluate the risk of cataract in the setting of AIDS.

Design: Prospective cohort study.

Participants: Subjects with AIDS free of ocular opportunistic infections throughout catamnesis.

Surgical management of gastrointestinal stromal tumors of the stomach.

Background: Laparoscopy has emerged as the "gold standard" procedure for many diseases that require surgical treatment. Our goal was to assess the outcomes of laparoscopic vs open partial gastrectomies for the management of gastrointestinal stromal tumors of the stomach (gGIST) using a national database.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2006-2009), we identified patients who underwent laparoscopic and open partial gastrectomy gGIST.

The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis.

Background: Patients with poor health literacy often lack the knowledge needed to manage their treatment.

Objective: The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.

Method: The study was completed in an urban, outpatient rheumatology setting.

Immediate complications related to anesthesia in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea.

Objectives/hypothesis: To analyze and assess the perioperative risks and complications in patients receiving general anesthesia undergoing surgery for obstructive sleep apnea (OSA).

Study Design: Retrospective chart review of patients with documented OSA who underwent uvulopalatopharyngoplasty (UPPP) with or without septoplasty for OSA between January 2009 and January 2010 at a specific institution. Anesthesia, operative, clinical, and postoperative/recovery nursing records were collected and reviewed for predetermined complications and risk factors.

5 points on hip resurfacing.

Hip resurfacing has enjoyed a resurgence in popularity as an alternative to total hip replacement (THR) for the treatment of end-stage arthritis in younger, active patients. However, technical difficulties in implant positioning have been realized, as the procedure has been introduced amongst surgeons new to the concept. Furthermore, as the follow-up interval increases beyond the short-term, it is evident that certain issues with the metal-on-metal bearing surface may lead to complications.

Neuromuscular disorders associated with hepatitis B virus infection.

Approximately 400 million worldwide are chronically infected with the hepatitis B virus (HBV). During the course of illness, approximately 20% of patients develop disease manifestations outside the liver. Neuropathy develops in approximately 5% of patients with chronic HBV infection and rarely during acute HBV infection.

Neuromuscular diseases associated with chronic hepatitis C virus infection.

Hepatitis C virus (HCV) infection is a growing international health problem, and more than 170 million people are chronic carriers. Up to 50% of HCV-positive patients develop at least one extrahepatic manifestation during the course of disease. To varying degrees of certainty, there is evidence of an association between chronic HCV infection and a variety of neuromuscular diseases.

Immune-mediated myelitis associated with hepatitis virus infections.

Virus-induced spinal cord damage results from a cytolytic effect on anterior horn cells or from predominantly cellular immune-mediated damage of long white matter tracts. Infection with the hepatitis virus group, most notably hepatitis C virus, has infrequently been associated with the occurrence of myelitis. The pathogenesis of hepatitis virus-associated myelitis has not been clarified: virus-induced autoimmunity (humoral or cell-mediated, possibly vasculitic) seems the most likely disease mechanism.

Assessment of social and economic influences on blood pressure of adolescents in public and private schools: an epidemiological study.

Introduction: The high prevalence of hypertension in high school students in Sorocaba, São Paulo, Brazil, has already been described. In this study, within a new sample of high school students from public and private schools, we evaluated if socioeconomic and lifestyle influence on blood pressure values.

Methods: This is an epidemiological study, which is part of the activities of a community-based work conducted by medical students.

Upper urinary tract pacemaker cells join the GLI club.

Mutations in GLI3, a component of the Sonic Hedgehog (Shh) signaling pathway, cause a variety of human developmental syndromes. In this issue of the JCI, Cain and colleagues show that tightly regulated GLI3 repressor activity is essential for Shh-dependent differentiation of upper urinary tract pacemaker cells and the efficient flow of urine from the kidney to the bladder. These results link defective pacemaker cell differentiation with hydronephrosis and provide a cellular basis for one of the abnormal renal defects observed in humans with the GLI3-linked disease Pallister-Hall syndrome.

An integrated approach to lower blepharoplasty.

Background: Limitations associated with traditional skin-muscle flaps and later with transconjunctival fat resection combined with carbon dioxide laser resurfacing have led to newer concepts in lower blepharoplasty that emphasize fat preservation, blending of the lid-cheek junction, simplified skin excision, and less morbid resurfacing techniques. Avoiding incision through the orbicularis muscle to preserve its innervation and reduce translamellar scarring is favored, as is a more liberal use of lateral canthal tightening procedures. This study investigates the use of a transconjunctival approach to resect and transpose fat combined with a skin flap technique that permits skin excision and simultaneous resurfacing with 30% trichloroacetic acid.

The advent of home parenteral nutrition support.

I review here some key developments of personal and professional interest, with special reference to total parenteral nutrition (TPN), an area in which I have been involved from 1937 until recently. As a result of basic and biomedical science advances achieved in university and industrial laboratories in numerous countries, many essential nutrients were identified, synthesized, produced, and provided to patients in safe and effective forms both enterally and parenterally. This period also saw important developments in analytic instrumentation.