In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.

The heavy chains of both botulinum neurotoxin type B and tetanus toxin form channels in planar bilayer membranes. These channels have pH-dependent and voltagedependent properties that are remarkably similar to those previously described for diphtheria toxin. Selectivity experiments with anions and cations show that the channels formed by the heavy chains of all three toxins are large; thus, these channels could serve as "tunnel proteins" for translocation of active peptide fragments. These findings support the hypothesis that the active fragments of botulinum neurotoxin and tetanus toxin, like that of diphtheria toxin, are translocated across the membranes of acidic vesicles.Diphtheria toxin (1), botulinum neurotoxin (2), and tetanus toxin (3) are proteins that are similar in origin and macrostructure. All three toxins are synthesized by bacteria (Corynebacterium diphtheriae, Clostridium botulinum, and Clostridium tetani) as single polypeptide chains (diphtheria toxin, "'60 kDa; clostridial neurotoxins, ==150 kDa). When exposed to trypsin or trypsin-like enzymes, they are cleaved to yield two-chain molecules in which a heavy-chain polypeptide is linked by a disulfide bond to a light-chain polypeptide. The two-chain structure is the active form of the three toxins.Various techniques have been used to generate polypeptide fragments from the toxins. The most straightforward of these is disulfide-bond reduction, which releases the heavy chain from the light chain. Alternatively, the clostridial neurotoxins have been exposed to limited proteolysis (e.g., with papain) to generate a fragment B and fragment C. Finally, traditional techniques have been used to select mutant organisms that synthesize incomplete toxins, such as the CRM45 fragment of diphtheria toxin, from which the B45 fragment can be formed. The various toxins and their fragments are illustrated in Fig. 1 Previous studies have shown that the amino terminus of the heavy chain from diphtheria toxin (18) and whole diphtheria toxin (19) form channels in lipid bilayers, and it has been proposed (18) that these channels provide the pathway for the light chain to cross membranes. Here we report that the heavy chains of both botulinum neurotoxin type B and tetanus toxin also form channels in lipid bilayers. Furthermore, for all three toxins, channel formation is maximal when the protein-containing (cis) side of the artificial membrane is at low pH (-4.0) and the opposite (trans) side is at pH -7.0, a pH gradient comparable to that across the membranes of acidic vesicles in cells. The channels for all three toxins are very large, as determined by selectivity experiments with large anions and cations, and this finding is compatible with the idea that the channels function as "tunnel proteins" for translocation of fully extended active fragments. In addition, tetanus toxin channels display a voltage dependence similar to that of diphtheria toxin channels, opening when positive voltages are applied to the cis side of artificial membranes and closing when nega...

This report stresses the importance of an additional defibrillator being readily available during electrophysiologic testing. This technique of rapid, double sequential external shocks may have general applicability, providing a simple and potentially lifesaving approach to refractory ventricular fibrillation.

Hematocrit (HCT) and hemoglobin (Hb) concentration were measured in four chromosomal species and some peripherally semi-isolated and isolated populations of the mole rat superspecies Spalax ehrenbergi in Israel. HCT was 52.0, 51.4, 50.9, and 47.8%, and Hb was 16.0, 16.6, 16.3, and 14.7 g/100 ml for 2n = 52, 58, 54, and 60, respectively. The species 2n = 60, which lives in arid habitats, had lower HCT and Hb than the other three species. HCT decreased as aridity increased between the species and within the species 2n = 60. Changes in HCT probably reflect clinal changes in both soil permeability to gases and ambient temperature.

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We reviewed CTA and transesophageal echocardiographic images obtained in 861 consecutive patients with a history of AF undergoing same-day CTA and transesophageal echocardiogram (TEE) before AF ablation at a single hospital (2006-2013). CTA findings of LAA filling defects from acquisitions without electrocardiogram gating were compared to TEE features of LAA stasis (grade 0-4) and thrombus. Stasis grade 0 or 1 by TEE in the absence of thrombus was defined as a negative result. In addition, LAA peak flow velocity was assessed by TEE. Average age was 61 ± 10 years and 75% were male. On CTA, 161 patients (19%) had LAA filling defects on CTA and 21 had ≥grade 2 stasis on TEE, including two with thrombus, resulting in a positive predictive value of only 13%. However, among 670 CTA-negative patients, 669 (99%) were negative for thrombus or stasis by TEE with one false-negative CTA in a patient with grade 2 stasis by TEE but no thrombus, yielding a negative predictive value of 99.9%. Slow LAA Doppler flow velocity was the most important determinant of false-positive CTA results in multivariate analysis (P < 0.0001) CONCLUSION: LAA filling defects on CT are associated with slow LAA flow velocity. AF patients without LAA filing defects on CT are free of significant stasis and thrombus on TEE. It may be possible to eliminate TEE in up to 80% of AF ablation patients based on negative CTA findings.

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