Prospective randomized study comparing permanent pacing with rate drop response and closed loop stimulation in patients with vasovagal syncope where permanent pacing is indicated and selected as the appropriate treatment option.

BACKGROUND: Pacing for vasovagal syncope is established. Two pacing algorithms are available. The rate-drop-response (RDR-Medtronic) is triggered by falling heart rate acting with modified rate-hysteresis. The closed loop stimulation or system (CLS-Biotronik) is triggered by impedance changes in the right ventricle reflecting falling volume and rising contractility. These are very different physiologically. Both algorithms carry favorable reports in clinical use. METHODS: A randomized-controlled superiority trial is proposed to compare the two algorithms for the control of vasovagal syncope in patients for whom pacing is indicated by current guidelines in North America and Europe. Available recent evidence may be seen as supporting superiority of CLS. No comparison between the two algorithms has been made. In this trial, patients will be centrally randomized to one or other algorithm on a 1:1 basis. Two-hundred-seventy-six patients in each group will be recruited. Sample size is determined using a confidence interval of 95%, a power of 90%, and a drop-out rate of 10% to detect an 11% difference between CLS and RDR. Recurrent symptom comparison will be made by an independent committee. The Co-primary endpoints will be recurrent syncope burden compared with that in 24-months preimplant, and occurrence of syncope in 24-months follow-up. Each outcome will be compared between the two algorithms. Secondary endpoints will be program and drug therapy changes over 24-months follow-up and quality of life by questionnaire at baseline,1 and 2 years. RESULTS AND CONCLUSIONS: These are anticipated to clarify the device algorithm choice and, therefore, to improve patient care.

Evaluation of oxidative stress-mediated cytotoxicity and genotoxicity of copper and flubendiamide: amelioration by antioxidants in vivo and in vitro.

Present study was designed to evaluate toxic effects of copper (Cu) (@ 33 mg/kg b.wt.) and flubendimide (Flb) (@ 200 mg/kg b.wt.) alone and/or in combination on blood-biochemical indices, oxidative stress, and drug metabolizing enzymes (DMEs) in vivo in male Wistar rats following oral exposure continuously for 90 days and their immunotoxic (cyto-genotoxic and apoptotic) potential in vitro on thymocytes. In in vivo study, ameliorative potential of α-tocopherol was assessed, whereas α-tocopherol, curcumin, resveratrol, and catechin were evaluated for protective effect in vitro. Significantly (P < 0.05) increased AST activity and increment in total bilirubin, uric acid, creatinine, and BUN levels; however, reduction in total protein, GSH content, reduced activities of SOD and GST, and increased lipid peroxidation and GPx activity with severe degenerative changes in histopathological examination of liver and kidney in group of Cu and Flb were observed. Treatment with α-tocopherol improved biochemical variables, redox status, and histoarchitecture of liver and kidney tissues. Reduced hepatic CYP450, CYPb5, APH, UGT, and GST activities observed in both Cu and α-tocopherol alone and their combination groups, whereas significant increment in Flb alone, while α-tocopherol in combination with xenobiotics improved the activities of hepatic DMEs. Primary cell culture of thymocytes (106 cells/ml) exposed to Cu and Flb each @ 40 µM increased TUNEL+ve cells, micronuclei induction, DNA shearing, and comet formation establishes their apoptotic and genotoxic potential, whereas treatment with antioxidants showed concentration-dependent significant reduction and their order of potency on equimolar concentration (10 µM) basis is: curcumin > resveratrol > catechin = α-tocopherol.

Coexisting BAG3 Variant and the Anomalous Origin of the Right Coronary Artery Presenting with Recurrent Ventricular Tachycardia.

A 49-year-old woman presented with recurrent palpitations and presyncope. Monitoring revealed recurrent non-sustained ventricular tachycardia (VT) episodes. Cardiac catheterization showed the right coronary artery originating from the left coronary cusp. Cardiac computerized tomography revealed the course between the aorta and the pulmonary artery. Despite surgical correction, VT persisted. Genetic testing revealed a rare BCL2-associated athanogene 3 (BAG3) variant associated with dilated cardiomyopathy.

Management of Adolescent Three-Part Lateral Triplane Ankle Fracture with Ipsilateral Shaft of Tibia Fracture and Intact Fibula in COVID Pandemic: A Case Report with Review of Literature.

INTRODUCTION: Triplane fracture of ankle is a rare adolescent injury. Its association with ipsilateral tibial shaft fracture is very uncommon in pediatric orthopedic traumatology and rarely reported in the literature till date. Timely diagnosis and management is required to optimize the outcome and avoid complications. CASE REPORT: This is a case of a 14-year-old male who sustained a twisting injury to his right leg during early phase of COVID-19 pandemic. He sustained a three-part lateral triplane fracture of the ankle with a concomitant displaced spiral fracture of the shaft of the right tibia. He underwent close reduction under fluoroscopy and above-knee casting for 10 weeks followed patellar tendon weight-bearing cast for 4 weeks. Both fractures healed uneventfully in 14 weeks with patient returning to full activities in 22 weeks. CONCLUSION: The ankle injury in adolescent age group (12-15 years) can easily be missed in the presence of the more obvious tibial fracture and therefore, we recommend ankle assessment of all patients with tibial shaft fractures in this age group both clinically and radiologically.

Salter-Harris Type 2 Injury of the Proximal Tibial Epiphysis in a 15-year-old Athlete: A Rare Case Report.

Background: Proximal tibial epiphyseal injuries in adolescents are uncommon accounting to 0.5 to 3 % of all epiphyseal injuries. Although rare, the proximity of popliteal artery puts this region at an increased risk of vascular injury and compartment syndrome. Also, premature closure of the growth plate can cause restrictions in growth and angular malformations. The fractures may often be missed on routine X-rays. Frequent monitoring and further testing should be done to better diagnose these injuries. Case History: We present a case of an adolescent football player (15 years old) who injured his left knee and was diagnosed to have Salter- Harris II proximal tibial epiphyseal injury. Routine radiographs revealed minimal widening in his epiphysis anteriorly when compared to his contralateral knee. Magnetic resonance imaging (MRI) findings revealed a fracture passing through the growth plate of proximal tibia exiting posteriorly into the tibial metaphysis. Management included closed manipulation and plaster cast immobilization with regular follow-ups. At the end of 1.5 years, the patient had full range of motion without any residual deformities. Conclusions: High clinical suspicion is required to diagnose these rare injuries. When in doubt, MRI is advocated to better delineate the fracture as the potential complications can be limb threatening. Anatomical reduction and adequate immobilization should be done to prevent deformities and good functional outcome in the long term.

Coronary vasospasm complicating atrial fibrillation ablation: a case report and review of the literature.

Radiofrequency ablation is one of the alternative treatment strategies in patients with atrial fibrillation. With the increasing number of such ablation procedures being performed it is important for the physicians to be aware of the associated complications. We present a very rare case of severe triple coronary vessel spasm during radiofrequency catheter ablation. The procedure was complicated by cardiac arrest secondary to ventricular fibrillation and cardiogenic shock requiring subsequent management with a temporary mechanical circulatory support device. Multi-vessel spasm is a rare and life-threatening complication leading to ventricular fibrillation and cardiac arrest. One should be extra vigilant in monitoring patients during extensive ablations and the procedure should be terminated at the earliest signs of ischemia in order to prevent this rare but fatal complication.

In vitro and in vivo effects of flubendiamide and copper on cyto-genotoxicity, oxidative stress and spleen histology of rats and its modulation by resveratrol, catechin, curcumin and α-tocopherol.

BACKGROUND: Living organisms are frequently exposed to more than one xenobiotic at a time either by ingestion of contaminated food/fodder or due to house-hold practices, occupational hazards or through environment. These xenobiotics interact individually or in combination with biological systems and act as carcinogen or produce other toxic effects including reproductive and degenerative diseases. Present study was aimed to investigate the cyto-genotoxic effects of flubendiamide and copper and ameliorative potential of certain natural phyotconstituent antioxidants. METHOD: In vitro cytogenotoxic effects were evaluated by employing battery of assays including Propidium iodide staining, Tunel assay, Micronuclei, DNA fragmentation and Comet assay on isolated splenocytes and their prevention by resveratrol (5 and 10 µM), catechin (10 and 20 µM), curcumin (5 and 10 µM) and α-tocopherol (5, 10 and 20 µM). In vivo study was also undertaken daily oral administration of flubendiamide (200 mg/kg) or copper (33 mg/kg) and both these in combination, and also all these concurrently with of α-tocopherol to Wistar rats for 90 days. RESULTS: Flubendiamide and copper produced concentration-dependent cytotoxic effects on splenocytes and at median lethal concentrations, flubendiamide (40 µM) and copper (40 µM) respectively produced 71 and 81% nonviable cells, higher number of Tunel+ve apoptotic cells, 7.86 and 9.16% micronucleus and 22.90 and 29.59 comets/100 cells and DNA fragmentation. In vivo study revealed significant (P < 0.05) increase in level of lipid peroxidation (LPO) and decrease in glutathione peroxidase (GPx), glutathione-S-transferase (GST) and superoxide dismutase (SOD) activities in groups exposed to flubendiamide or copper alone or both these in combination. Histopathological examination of rat spleens revealed depletion of lymphoid tissue, separation of splenocytes and rarification in splenic parenchyma of xenobiotic(s) treated groups. CONCLUSION: Flubendiamide and copper induce oxidative stress and produce cytogenotoxic effects along with histoarchitectural changes in spleen. All four tested natural antioxidants (resveratrol, catechin, curcumin and α-tocopherol) reduced flubendiamide and copper-induced cytotoxic effects in rat splenocytes. Rat splenocytes are very sensitive to flubendiamide and copper-induced cytogenotoxicity, therefore, these can be effectively employed for screening of compounds for their cytogenotoxic potential. α-tocopherol was effective in restoring alterations in oxidative stress biomarkers and preventing histoarchitectural lesions in spleen.

Mercury affects uterine myogenic activity even without producing any apparent toxicity in rats: Involvement of calcium-signaling cascades.

BACKGROUND: Mercury is an established environmental toxicant reported to cause reproductive disorders in women, however, its direct action on myometrial activity is yet to be understood. Earlier we have reported the underlying mechanism of mercury-induced myometrial contractions following in vitro exposure; however, no such information on the effect of mercury on myometrial activity following in vivo exposure is available, therefore, the present study was undertaken. OBJECTIVE: Present study was designed to evaluate the effect of mercury on myometrial activity following in vivo exposure of rats and unravel the possible underlying mechanism. METHODS: Female Wistar rats were orally exposed to mercury (5, 50 and 500 µg/L in drinking water) for 28 days to investigate the toxicodynamics of mercuric chloride (HgCl2)-induced alterations in myometrial activity. Response of the isolated myometrial strips to different spasmogens was recorded using polyphysiograph. Blood and uterine calcium, mercury, iron and zinc levels were estimated by atomic absorption spectrophotometry. Blood biochemicals and serum hormonal profiles (estradiol, progesterone) were also determined. RESULTS: No systemic toxicity of mercury was observed in any of the treatment groups (5, 50 and 500 µg/L) in terms of alterations in body weight, organ weights, blood biochemical parameters including hormonal profile. Interestingly, mercury at 5 µg/L concentration significantly increased the receptor-dependent (PGF2α-induced) and receptor-independent (CaCl2-induced and high K+-depolarizing solution-induced) myometrial contractions and it was coupled with corresponding increase in the uterine calcium levels. However, mercury at higher dose levels (50 and 500 µg/L) did not significantly alter the myometrial response. CONCLUSION: Our results evidently suggest that mercury at low level (5 µg/L) produced detrimental effect on myometrial activity by altering calcium entry into the smooth muscle and/or the release of calcium from intracellular stores without causing any apparent systemic toxicity in rats.

Calcium Channels, Rho-Kinase, Protein Kinase-C, and Phospholipase-C Pathways Mediate Mercury Chloride-Induced Myometrial Contractions in Rats.

Adverse effects of mercury on female reproduction are reported; however, its effect on myogenic activity of uterus and mechanism thereof is obscure. Present study was undertaken to unravel the mechanistic pathways of mercuric chloride (HgCl2)-induced myometrial contraction in rats. Isometric tension in myometrial strips of rats following in vitro exposure to HgCl2 was recorded using data acquisition system-based physiograph. HgCl2 produced concentration-dependent (10 nM-100 µM) uterotonic effect which was significantly (p < 0.05) reduced in Ca2+-free solution and inhibited in the presence of nifedipine (1 µM), a L-type Ca2+ channel blocker, thus suggesting the importance of extracellular Ca2+ and its entry through L-type calcium channels in HgCl2-induced myometrial contractions in rats. Cumulative concentration-response curve of HgCl2 was significantly (p < 0.05) shifted towards right in the presence of Y-27632 (10 µM), a Rho-kinase inhibitor, suggesting the involvement of Ca2+-sensitization pathway in mediating HgCl2-induced myometrial contraction. HgCl2-induced myometrial contraction was also significantly (p < 0.05) inhibited in the presence of methoctramine or para-fluoro-hexahydro-siladifenidol, a selective M2 and M3 receptor antagonists, respectively, which evidently suggest that mercury also interacts with M2 and M3 muscarinic receptors to produce myometrial contractions. U-73122 and GF-109203X, the respective inhibitors of PLC and PKC-dependent pathways, downstream to the receptor activation, also significantly (p < 0.05) attenuated the uterotonic effect of HgCl2 on rat uterus. Taken together, present study evidently reveals that HgCl2 interacts with muscarinic receptors and activates calcium signaling cascades involving calcium channels, Rho-kinase, protein kinase-C, and phospholipase-C pathways to exert uterotonic effect in rats. Graphical Abstract Graphical abstract depicting the mechanism of mercury-induced myometrial contraction in rats. M receptor: Muscarinic receptor; PIP2: phospho-inositol bisphosphate; PLC: phospholipase-C; DAG: diacyl glycerol; IP3: inositol triphosphate; IP3R: inositol triphosphate receptor; PKC; protein kinase-C; MLCP: myosin light chain phosphatise; MYPT: myosin phosphatase; SR: sarco-endoplasmic reticulum.

Effect of dietary supplementation of sea buckthorn and giloe leaf meal on the body weight gain, feed conversion ratio, biochemical attributes, and meat composition of turkey poults.

AIM: In the recent past, few studies have been carried out about sea buckthorn (SBT) and giloe in chicken as a part of the quest for suitable alternatives to antibiotics. However, studies in turkeys are lacking. Hence, the present study was conducted to evaluate the effects of SBT and giloe leaf meal by dietary feed supplementation in turkey poults. MATERIALS AND METHODS: A total of 1-day-old turkey poults (n=84) of small white variety were distributed into four dietary treatments having three replicates each with seven birds. The study was conducted in turkey poults during 0-8 weeks of age. During the experiment, the poults were fed basal ration (28% crude protein [CP], 2800 Kcal/kg ME) T1, T2-basal ration was supplemented with SBT leaf meal powder at 0.5%, T3-basal ration was supplemented with giloe leaf meal powder at 0.5%, and T4-basal ration was fed along with supplementation of both SBT at 0.5% and giloe leaf meal powder at 0.5%. RESULTS: T2 turkey poults had a significantly higher (p<0.01) body weight gain than T3 and T4 at 7th week of age. Weekly body weight gain was significantly higher (p<0.05) in T2 than T3 during 5th-8th week and 0-8th week of the growth phase. Feed conversion ratio (FCR) was significantly better (p<0.01) in T2 than other treatment groups during 4th-8th week phase of growth (2.09 vs. 2.36, 2.29 and 2.31). Further, FCR was significantly better (p<0.01) in T2 group as compared to other treatment groups during 0-8th week of growth phase (1.95 vs. 2.21, 2.21 and 2.12). Plasma uric acid was found significantly increased (p<0.05) in T1 than T3 and T4, and alkaline phosphatase value was significantly higher (p<0.05) in T1 and T3 than T2. Zinc content of breast (pectoralis major) muscles was significantly higher (p<0.05) in T2 and T4 as compared to T1, while ether extract (EE) in thigh (ilio tibialis) muscles was significantly higher (p<0.05) in T2 as compared to the other treatment groups. CONCLUSION: It may be concluded that supplementation of SBT leaf meal at 0.5% may improve production performance of turkey poults. Supplementation of 0.5% SBT leaf meal may result in higher levels of zinc and EE in the breast and thigh cuts of turkey poults.

Eucalyptus robusta leaves methanolic extract suppresses inflammatory mediators by specifically targeting TLR4/TLR9, MPO, COX2, iNOS and inflammatory cytokines in experimentally-induced endometritis in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Bacterial endometritis is one of the major causes of reproductive disorders including infertility in farm animals. Antibiotics are generally used for treatment of such disorders but now a days residues of antibiotics are of great public health concern, therefore, phytoremediation is being considered as an alternative to use of antibiotics. AIM OF THE STUDY: Present study was undertaken to investigate the efficacy of Eucalyptus robusta leaves methanolic extract against endometritis along with the possible mechanism of action especially targeting inflammatory biomarkers. MATERIALS AND METHODS: Bacterial endometritis was produced using clinical isolates of E. coli and Staphyloccocus aureus from bovines (cows and buffaloes) endometritis cases. After seven days of inoculation of the mixed bacterial culture, endometritis was confirmed based on the presence of visible pus and edema, thinning of endometrial lining and presence of large number of polymorphonuclear cells and bacterial load in uterine flushing. Female Wistar rats were divided in to five groups namely control, sham-operated, endometritis, endometritis plus Eucalyptus leaves extract and endometritis plus cefixime. Serum specific inflammatory biomarkers (interleukin-1ß, interleukin-10, tumor necrosis factor-α, intercellular adhesion molecule-1, serum amyloid A) and myleoperoxidase, toll like receptors-4 and -9, inducible nitric oxide synthase, nitric oxide, cyclooxygenase 1 and 2 were estimated in uterine tissues using ELISA kits. RESULTS: Interleukin-10, serum amyloid A, myleoperoxidase, toll like receptors-4 and-9, cyclooxygenase-2, inducible nitric oxide synthase and nitric oxide were significantly increased while non significant increase in interleukin-1ß, cycloxygenase-1 and intercellular adhesion molecule-1 were observed but level of tumor necrosis factor-α was found decreased in rats of endometritis group. Histopathological lesions in uterus showed efficient induction of endometritis by presence of inflammatory cells which are lessened effectively after treatment with Eucalyptus leaves extract. Eucalyptus robusta leaves extract produced curative and protective effect against endometritis and results were comparable to or even better than cefixime. CONCLUSIONS: Eucalyptus robusta leaves extract possess promising antibacterial activity and efficacy against experimental endometritis and, therefore, holds promising potential for development of effective formulation for treatment of endometritis in animals.

Ameliorative potential of α-tocopherol against flubendiamide and copper-induced testicular-insult in Wistar rats.

Study was undertaken to evaluate ameliorative potential of α-tocopherol against copper sulphate and flubendiamide alone and in combination-induced toxicity in rats following 90 days exposure. Absolute and relative organ weights did not differ between treatments groups. Increase of LPO in copper and flubendiamide intoxicated rats but modest increase in copper + flubendiamide group. GSH and activities of SOD, GPx and GST showed moderate decrease in intoxicated groups. Reduced CAT activity in alone exposed groups was observed. ACP, ALP and SDH remain unaltered. Increase in LDH, γ-GT, abnormal sperm and reduced 17ß-HSD, percent live and HOST +ve sperms and testosterone level was observed in all three exposed groups. Xenobiotics alone and in combination exhibited degenerative germinal epithelium, necrotic germ cells, loss of spermatozoa and spermatids. Treatment with α-tocopherol, reparative potential was observed as values of most of the parameters including testicular histoarchitecture were restored.

Environmental attributes to respiratory diseases of small ruminants.

Respiratory diseases are the major disease crisis in small ruminants. A number of pathogenic microorganisms have been implicated in the development of respiratory disease but the importance of environmental factors in the initiation and progress of disease can never be overemphasized. They irritate the respiratory tree producing stress in the microenvironment causing a decline in the immune status of the small ruminants and thereby assisting bacterial, viral, and parasitic infections to break down the tissue defense barriers. Environmental pollutants cause acute or chronic reactions as they deposit on the alveolar surface which are characterized by inflammation or fibrosis and the formation of transitory or persistent tissue manifestation. Some of the effects of exposures may be immediate, whereas others may not be evident for many decades. Although the disease development can be portrayed as three sets of two-way communications (pathogen-environment, host-environment, and host-pathogen), the interactions are highly variable. Moreover, the environmental scenario is never static; new compounds are introduced daily making a precise evaluation of the disease burden almost impossible. The present review presents a detailed overview of these interactions and the ultimate effect on the respiratory health of sheep and goat.

Proximate and elemental analyses of Tinospora cordifolia stem.

Tinospora cordifolia also known as Giloy or Guduchi, is an indigenous climber plant indigenous to tropical areas of India, Myanmar and Sri Lanka. Its stem is used for treatment of fever, jaundice, emaciation, skin ailments, diabetes, anaemia and various infectious diseases. The study was undertaken to evaluate the proximate and elemental analysis of the stems of Tinospora cordifolia. The proximate analyses were carried out using standard methods, while mineral elements were analyzed using Atomic Absorption Spectrophotometer, equipped with air acetylene flame. The proximate analysis of the stems of Tinospora cordifolia showed that it contained moisture 34.39%, ether extract 0.912%, crude protein 7.74%, crude fibre 56.42%, total ash 7.96%, nitrogen free extract 26.97%, cellulose 23.02% and hemicellulose 3.70%. The mineral analysis of the stems showed that they contain the following essential minerals: Calcium (102.23 ppm), phosphorous (24.81 ppm), iron (26.058 ppm), copper (3.733 ppm), zinc (7.342 ppm) and manganese (12.242 ppm). The study revealed that Tinospora cordifolia stems to be a potential source of nutrition and minerals for man as well as animals.

Differential modulation of xenobiotic-metabolizing enzymes in rats following single and concurrent exposure to chlorpyrifos, arsenic, and ascorbic acid.

The present study was undertaken to evaluate the subacute toxicity of arsenic (As) and chlorpyrifos (CPF) alone or in combination. In addition, the ameliorative effect of ascorbic acid on As and/or CPF-induced hepatic microsomal xenobiotic metabolizing enzymes in rats was examined. Rats were divided into 9 groups of 6 animals each: control (deionized water), vehicle control (groundnut oil), ascorbic acid (100 mg/kg body weight), As (40 ppm in water), CPF (5 mg/kg body weight), As (40 ppm) + CPF (5 mg/kg body weight), As + ascorbic acid, CPF + ascorbic acid, and As + CPF + ascorbic acid. After 28 d of exposure, rats were sacrificed and liver was extracted for isolation of hepatic microsomes. Exposure to As or CPF alone as well as both of these in combination significantly altered microsomal proteins and activity of phase I and phase II xenobiotic-metabolizing enzymes. Cytochrome P-450 and cytochrome b 5 levels and activities of aniline p-hydroxylase (APH) and uridine diphosphate glucuronosyltransferase (UGT) were significantly decreased in groups treated with As, CPF, and As plus CPF, while glutathione S-transferase (GST) was not markedly altered. Enzymatic activity of aminopyrine N-demethylase (ANDM) was also significantly reduced in As- and CPF-only groups. Co-administration of ascorbic acid effectively countered the As- and CPF-induced alterations in xenobiotic-metabolizing enzymes.

How feasible was a bed-height alert system?

This qualitative and descriptive study examined the feasibility of a bed-height alert system as a fall-prevention strategy. The alpha prototype was developed to measure and record bed height, and to remind staff to keep patient beds in the lowest position. This pilot project was conducted in a 52-bed adult acute surgical inpatient care unit of a Michigan community hospital. Qualitative and quantitative information was gathered during semistructured interviews of nursing staff (18 RNs and 13 PCAs; January-April 2011). Descriptive content analysis and descriptive analyses were performed. The overall response rate was 44.9%. The mean values of the feasibility questions are all favorable. Staff's comments also support the view that the alert system would promote patient safety and prevent falls. In short, this system was found to be somewhat useful, feasible, appropriate, and accurate. It has the potential to promote patient safety and prevent bed-associated injurious falls in inpatient care settings.

Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting.

High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses' awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls.

Keeping patient beds in a low position: an exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical inpatient care setting.

This descriptive study was intended to measure the percentage of the time that patient beds were kept in high position in an adult acute inpatient surgical unit with medical overflow in a community hospital in Michigan, United States. The percentage of the time was calculated for morning, evening, and night shifts. The results showed that overall, occupied beds were in a high position 5.6% of the time: 5.40% in the day shift, 6.88% in the evening shift, and 4.38% in the night shift. It is recognized that this study was unable to differentiate whether those times patient beds being kept in a high position were appropriate for an elevated bed height (e.g., staff were working with the patient). Further research is warranted. Falls committees may conduct high-bed prevalence surveys in a regular basis as a proxy to monitor staff members' behaviors in keeping beds in a high position.

Optimizing pacemaker longevity with pacing mode and settings programming: results from a pacemaker multicenter registry.

BACKGROUND: This study aimed to describe the influence on dual-chamber devices' expected longevity of devices' settings. METHODS: Data from patients implanted with dual chamber devices (Symphony™, SORIN CRM SAS, Clamart, France) from 2003 to 2006 were collected in registries. Programmer files were retrieved: device-estimated longevity, assessed through algorithm prediction, was analyzed according to device settings. RESULTS: One thousand sixty-eight recipients of dual chamber pacemaker in sinus rhythm (75.3±11.1 years, 54.5% male, ventricular block 30%, brady-tachy syndrome 21%, and sinus node dysfunction 49%) were followed up to 14.2±12.1 months (ranging from first quartile Q1: 2.9 months to fourth quartile Q4: 49.3 months) after implantation. DDD with automatic mode conversion and minimized ventricular pacing (SafeR) modes were programmed in 34.3%, 2.9%, and 62.8% of the patients, respectively. The mean total longevity estimated by the device was 134.1±31.5 months (11.2±2.6 years). Significant increase in longevity was observed in devices undergoing at least one reprogramming (134.4±31.4 months) versus device presenting no reprogramming (103.4±32.3 months, P=0.0005). The parameters associated with the major increase in mean longevity were the mode (mean longevity increase of +23.9 months in SafeR as compared to DDD mode, P<0.0001) and the atrial (A) and ventricular (V) amplitudes (mean longevity increase of +29.6 and +26.9 months for a decrease of less than 1V in A and V outputs respectively, P<0.0001). CONCLUSION: This study provides information on dual chamber pacemakers' longevity and highlights the impact of devices' reprogramming on expected longevities.