Risk Factors for Composite Failure of Hip Dysplasia Treated With Periacetabular Osteotomy: A Minimum 10-Year Follow-up.

Introduction: Periacetabular osteotomy (PAO) is a common surgical treatment of prearthritic hip dysplasia in young adults, but there are few long-term studies of clinical outcomes. The purpose of this investigation was to report a minimum 10-year clinical follow-up of hip dysplasia treated with PAO and identify risk factors for composite failure.

Methods: We identified 151 patients (198 hips) who underwent PAO to treat hip dysplasia at a single institution.

Neuromodulatory Approaches for Atrial Fibrillation Ablation.

In this review, the authors describe evolving alternative strategies for the management of AF, focusing on non-invasive and percutaneous autonomic modulation. This modulation can be achieved - among other approaches - via tragus stimulation, renal denervation, cardiac afferent denervation, alcohol injection in the vein of Marshall, baroreceptor activation therapy and endocardial ganglionated plexi ablation. Although promising, these therapies are currently under investigation but could play a role in the treatment of AF in combination with conventional pulmonary vein isolation in the near future.

Coronary vein defibrillator coil placement in patients with high defibrillation thresholds.

Background: Elevated defibrillation threshold (DFT) occurs in 2%-6% of patients undergoing implantable cardioverter defibrillator (ICD) implantation. Adding a defibrillation coil in the coronary sinus (CS) or its branches can result in substantial reductions in the mean DFT. However, data regarding acute success and long-term stability remain lacking.

Clinical impact of ethanol infusion into the vein of Marshall on the mitral isthmus area evaluated by atrial electrograms recorded inside the coronary sinus.

Background: The left atrial myocardium (LAM) and coronary sinus (CS) musculature (CSM) generate atrial electrograms recorded inside the CS (AECSs). The vein of Marshall (VOM) courses the mitral isthmus (MI), and ethanol infusion into the VOM (EI-VOM) is useful to ablate it. However, its detailed effect on the MI, which contains the LAM, CSM, and those connections, is unknown.

Human Semaphorin-4A drives Th2 responses by binding to receptor ILT-4.

Semaphorin-4A (Sema4A) has been implicated in the co-stimulation of T cells and drives Th1 immune responses by binding to the receptor T-cell immunoglobulin and mucin domain protein 2 (Tim-2) in mice. Here we show that human, but not murine, Sema4A is preferentially expressed on antigen-presenting cells, and co-stimulates CD4 T-cell proliferation and drives Th2 responses. By employing two independent cloning strategies, we demonstrate that Immunoglobulin-like transcript 4 (ILT-4) is a receptor for human SEMA4A (hSEMA4A) on activated CD4 T cells.

Long-Term Follow-Up of Autonomic and Enteric Measures in Patients Undergoing Vertical Banded Gastroplasty for Morbid Obesity.

Background: A multi-component model of autonomic and enteric factors may correlate with ultimate weight loss or gain after restrictive obesity surgery. This study aimed to determine relevant parameters to predict successful long-term weight loss.

Methods: Thirty-nine patients (four males and 35 females) with a mean age of 37.

The Cost Effectiveness of LAA Exclusion.

Left atrial appendage (LAA) exclusion strategies are increasingly utilized for stroke prevention in lieu of oral anticoagulants. Reductions in bleeding risk and long-term compliance issues bundled with comparable stroke prevention benefits have made these interventions increasingly attractive. Unfortunately, healthcare funding remains limited.

Combination of Hansen Robotic system with cryocatheter in a challenging parahisian accessory pathway ablation.

A perceived distinctive feature of cryoablation is the stability (cryoadherence) of the catheter tip during cold temperatures at the desired location, even during tachycardia. We report the case report of a young patient with a parahisian accessory pathway where stability of the ablation catheter was not achieved despite using the cryocatheter with a steerable sheath. Ultimately, stability at the desired location was achieved robotically by means of Hansen system (Hansen Medical, Mountain View, CA, USA).

Clinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics.

The autonomic nervous system regulates all aspects of normal cardiac function, and is recognized to play a critical role in the pathophysiology of many cardiovascular diseases. As such, the value of neuroscience-based cardiovascular therapeutics is increasingly evident. This White Paper reviews the current state of understanding of human cardiac neuroanatomy, neurophysiology, pathophysiology in specific disease conditions, autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases.

Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia.

Background: Radiofrequency (RF) ablation can alleviate drug-refractory inappropriate sinus tachycardia (IST). However, phrenic nerve (PN) injury and other complications limit its use.

Objective: The purpose of this study was to characterize the maneuvers used to avoid PN injury and the long-term clinical outcomes.

Atrioventricular Junction Ablation In Atrial Fibrillation: Choosing The Right Patient And Pacing Device.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is not possible in a large proportion of AF patients, who therefore are subject to a rate control strategy only. Nonetheless, in some of these patients pharmacological rate control may be ineffective, often leaving the patient highly symptomatic and at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF). Catheter ablation of the atrioventricular junction (AVJ) with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved.

Ethanol infusion in the vein of Marshall leads to parasympathetic denervation of the human left atrium: implications for atrial fibrillation.

Objectives: This study sought to determine whether ethanol infusion in the vein of Marshall (VOM) can ablate intrinsic cardiac nerves (ICN).

Background: ICN cluster around the left atrial epicardium and are implicated in the genesis of atrial fibrillation (AF).

Methods: Patients undergoing catheter AF ablation underwent adjunctive ethanol injection in the VOM.

A comparison of still point induction to massage therapy in reducing pain and increasing comfort in chronic pain.

A quantitative study was completed to determine whether complementary techniques provide pain relief and comfort in patients with chronic pain. Subjects participated in sessions including aromatherapy and music therapy. Massage or cranial still point induction was randomly assigned.

IL-9 and Th9 cells: progress and challenges.

T(h)9 cells are a new subset of helper T cells, and the signature cytokine for T(h)9 cells is IL-9. Both T(h)9 cells and T(h)9 products are implicated in multiple disease settings. Thus, a clear understanding of how T(h)9 cells are induced and controlled is an important and clinically relevant issue.

Effect of Age on Outcomes of Catheter Ablation of Atrial Fibrillation.

Age has a great impact in the development of atrial fibrillation, which is the most common arrhythmia found in the elderly. The higher risk of stroke, heart failure and mortality associated with atrial fibrillation highlights the need for successful therapeutic interventions that can translate in better outcomes in this population. The introduction of catheter ablation has revolutionized the management of atrial fibrillation over the past decades with an undeniable impact in morbidity, mortality and quality of life.

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access.

We describe a novel arteriovenous graft configuration in the abdominal wall for hemodialysis in a 51-year-old woman with sickle cell disease. Upper extremity access sites were exhausted, and intrathoracic central veins occluded. Because of diminished quality of the left groin due to scar tissue from previous infected access, inadequate vasculature, and the presence of functional femoral catheter in the right groin with common iliac vein stenosis, we decided to create an arteriovenous graft from the left common iliac artery to the inferior vena cava.

Role of the vein of Marshall in atrial fibrillation recurrences after catheter ablation: therapeutic effect of ethanol infusion.

Unlabelled: Vein of Marshall Ethanol in Recurrent AF.

Introduction: Atrial fibrillation (AF) or flutter can recur after pulmonary vein (PV) antral isolation (PVAI). The vein of Marshall (VOM) has been linked to the genesis of AF.

Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation.

Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI.

Objective: To test whether VOM ethanol infusion could help achieve MI block.

Robotic catheter ablation of left ventricular tachycardia: initial experience.

Background: Catheter ablation of ventricular tachycardia (VT) can be technically challenging due to difficulty with catheter positioning in the left ventricle (LV) and achieving stable contact. The Hansen Sensei Robotic system (HRS) has been used in atrial fibrillation but its utility in VT is unclear.

Objective: The purpose of this study was to test the technical feasibility of robotic catheter ablation of LV ventricular tachycardia (VT) using the HRS.

Ross root dilation in adult patients: is preoperative aortic insufficiency associated with increased late autograft reoperation?

Background: The Ross aortic valve replacement (AVR) offers excellent hemodynamic and clinical outcomes in most patients undergoing aortic root replacement. Because of ongoing debate regarding the durability of this procedure, long-term follow-up in a large adult Ross experience might be of interest.

Methods: Between 1994 and 2010, 230 adult patients underwent modified Ross root procedures.

A task analysis of emergency physician activities in academic and community settings.

Study Objective: We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error.

Methods: This was an observational, time-motion study.

Combination of niacin extended-release and simvastatin results in a less atherogenic lipid profile than atorvastatin monotherapy.

Objective: To compare the effects of combination niacin extended-release + simvastatin (NER/S) versus atorvastatin alone on apolipoproteins and lipid fractions in a post hoc analysis from SUPREME, a study which compared the lipid effects of niacin extended-release + simvastatin and atorvastatin in patients with hyperlipidemia or mixed dyslipidemia.

Patients And Methods: Patients (n = 137) with dyslipidemia (not previously receiving statin therapy or having discontinued any lipid-altering treatment 4-5 weeks prior to the study) received NER/S (1000/40 mg/day for four weeks, then 2000/40 mg/day for eight weeks) or atorvastatin 40 mg/day for 12 weeks. Median percent changes in apolipoprotein (apo) A-1, apo B, and the apo B:A-I ratio, and nuclear magnetic resonance lipoprotein subclasses from baseline to week 12 were compared using the Wilcoxon rank-sum test and Fisher's exact test.

Lyso-phosphatidylcholine induces osteogenic gene expression and phenotype in vascular smooth muscle cells.

Objective: Calcifying vascular cells in human atherosclerotic plaques actively contribute to ectopic vascular mineralization. Lyso-phosphatidylcholine (LPC), a product of oxidized phosphatidylcholine hydrolysis, is found at concentrations of 1-12 microg/g tissue throughout the atheroma. The objective of this study was to determine if LPC induces an osteogenic phenotype in vascular smooth muscle cells.