Background-Some current pacing systems can automatically detect and record atrial tachyarrhythmias that may be asymptomatic. We prospectively studied a 312-patient (pt) subgroup of MOST (MOde Selection Trial), a 2010-patient, 6-year randomized trial of DDDR versus VVIR pacing in sinus node dysfunction (SND). The purpose of the study was to correlate atrial high rate events (AHREs) detected by pacemaker diagnostics with clinical outcomes. Methods and Results-Pacemakers were programmed to log an AHRE when the atrial rate was Ͼ220 bpm for 10 consecutive beats. Analysis was confined to patients with at least 1 AHRE duration exceeding 5 minutes. The 312 patients were median age 74 years, 55% female, and 60% had a history of SVT. 160 of 312 (51.3%) patients enrolled had at least 1 AHRE Ͼ5 minutes duration over median follow-up of 27 months. Cox proportional hazards analysis assessed the relationship of AHREs with clinical events, adjusting for prognostic variables and baseline covariates. The presence of any AHRE was an independent predictor of the following: total mortality (hazard ratio AHRE versus no AHRE and 95% confidence intervalsϭ2.

Herein we report a new microwave-assisted synthetic strategy to rapidly prepare hybrid zeolitic–imidazolate frameworks (ZIFs): ZIFs with mixed metal centers and/or mixed linkers.

Objective: To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).Methods: This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score $4 and assessed by multivariable logistic regression.Results: There were 229 patients with an average age of 55 6 15 years. Higher REE was associated with younger age (p 5 0.02), male sex (p , 0.001), higher Hunt Hess grade (p 5 0.001), and higher modified Fisher score (p 5 0.01). Negative NBAL was associated with lower caloric intake (p , 0.001), higher body mass index (p , 0.001), aneurysm clipping (p 5 0.03), and higher CRP:TTR ratio (p 5 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 6 3. Older age (p 5 0.002), higher Hunt Hess (p , 0.001), lower caloric intake (p 5 0.001), and negative NBAL (p 5 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p , 0.001), older age (p , 0.001), negative NBAL (p 5 0.01), HAI (p 5 0.03), higher CRP:TTR ratio (p 5 0.04), higher body mass index (p 5 0.03), and delayed cerebral ischemia (p 5 0.04).Conclusions: Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH. Neurology ® 2015;84:680-687 GLOSSARY CRP 5 C-reactive protein; DCI 5 delayed cerebral ischemia; HAI 5 hospital-acquired infection; ICU 5 intensive care unit; IDC 5 indirect calorimetry; mRS 5 modified Rankin Scale; NBAL 5 nitrogen balance; PBD 5 postbleed day; REE 5 resting energy expenditure; SAH 5 subarachnoid hemorrhage; SHOP 5 SAH outcomes project; TTR 5 transthyretin; UUN 5 urine urea nitrogen.Aneurysmal subarachnoid hemorrhage (SAH) is a significant contributor to all stroke-related potential years of life lost before age 65 years.1 Much of this is attributed to delayed cerebral ischemia (DCI).2 However, recent studies have found that both medical and infectious complications are significant independent contributors to morbidity and mortality after SAH.3-5 We previously found an association between poor nutritional status and infectious complications acutely after SAH. 6 Malnutrition has been associated with impaired immunologic function leading to increased rates of infection. 7 An assessment of nutritional profiles measured by indirect calorimetry (IDC) found SAH patients to have average resting energy expenditure (REE) rates ...

Aim To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. Materials and Methods This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. Results Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30–1.99, p < 0.001) and type II (OR = 1.4, 95% CI 1.22–1.67, p < 0.001), hypertension (OR = 1.2, 95% CI 1.10–1.37, p < 0.001), hypercholesterolaemia (OR = 1.2, 95% CI 1.07–1.38, p = 0.004), hyperlipidaemia (OR = 1.2, 95% CI 1.06–1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth (OR = 2.9, 95% CI: 1.32–7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia (OR = 1.5, 95% CI 1.05–2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. Conclusions This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records.

Familial hypercholesterolemia (FH) is severely underdiagnosed in the USA. Primary care providers are well-positioned to identify FH cases; however, universal FH screening is not routinely implemented in practice. The aim of the present study was to identify perceived barriers to FH screening among primary care physicians in Minnesota. A questionnaire assessed FH screening practices, knowledge, and perceived barriers to FH screening. The questionnaire, sent electronically to internal and family medicine physicians in Minnesota (N = 1932) yielded a conservative estimated response rate of 9% (N = 173). Although 92% of participants reported themselves responsible for identifying individuals with FH, 30% did not routinely perform screening in practice. Only 50% of participants were able to correctly identify the risk of FH to first-degree relatives of individuals with FH. Challenges incorporating lipid and family history data was the most frequently endorsed barrier to FH screening (34%). A majority of participants endorsed a clinical decision support system that flags individuals at high risk for FH (62%) and an algorithm with cholesterol levels and lipid disorders (56%) as means of facilitating FH screening. Although the generalizability of the findings is unknown, the results underscore the need for increased provider education regarding FH and suggest an FH screening strategy incorporating a clinical decision support system, screening algorithm, and support from other healthcare providers.

No abstract

Amniotic fluid embolism (AFE, also known as anaphylactoid syndrome of pregnancy) at the time of surgery for placenta percreta has been previously reported. We report here a case in which AFE and associated cardiac arrest occurred following a hysterectomy for placenta percreta. In this case, subhepatic manual aortic compression during the cardiac arrest and chest compressions followed by infrarenal aortic cross-clamping during volume infusion and reversal of the coagulopathy were associated with a successful resuscitation and good maternal outcome.

This case report is about two patients with two different types of ICDs who underwent electrical muscle stimulation (EMS) therapy. In one patient with an ICD that has epicardial screw-in bipolar sensing leads, electromagnetic interference (EMI) from the EMS device caused the delivery of an inappropriate ICD discharge. In a second patient with an ICD with endocardial true bipolar sensing, there was no evidence of EMI during the EMS therapy despite all of our attempts to reproduce it. The sensing circuits in the two different ICDs are compared.