The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs.

BACKGROUND: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. OBJECTIVES: We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. METHODS: We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. RESULTS: Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001). CONCLUSION: The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Microvascular ischemia in patients with successful percutaneous coronary intervention: effects of ranolazine and isosorbide-5-mononitrate.

OBJECTIVE: About one-third of patients undergoing percutaneous coronary interventions (PCIs) for flow-limiting coronary stenosis continue to develop signs of myocardial ischemia (MI) during exercise stress test [EST], despite successful coronary revascularization. Coronary microvascular dysfunction is a likely major cause of the persistence of EST-induced MI in these patients. PATIENTS AND METHODS: We studied 15 patients (14 men, age 67±5 years) fulfilling the following strict inclusion criteria: (1) recent PCI (<6 months), with drug-eluting stent, of coronary artery stenoses for stable angina, with evidence of full success (no residual stenosis >20% in any vessel); (2) persistence of ST-segment depression induction during EST. After a basal investigation, patients received either ranolazine (375 mg bid) or isosorbide-5-mononitrate (ISMN, 20 mg bid) for 3 weeks in a single-blind, randomized crossover study. Clinical assessment, symptom-limited EST, echocardiographic color-Doppler, with tissue-Doppler examination, and coronary microvascular dilator response to adenosine (CFR-ADO) and cold pressor test (CFR-CPT), assessed by transthoracic echo-Doppler, were obtained at baseline and the end of the 3-week therapy with each drug. RESULTS: Compared to both baseline and ISMN, ranolazine showed a longer time to 1 mm ST-segment depression (404±116 s vs. 317±98 and 322±70 s, respectively; p<0.01). No differences were observed in coronary microvascular function and diastolic left ventricular function between the 2 drugs and compared to baseline. CONCLUSIONS: Our data show that ranolazine, but not ISMN, improved time to ischemia during EST. This effect, however, was independent of any effects on coronary microvascular and diastolic function.

Upper-mantle dynamics revealed by helium isotope variations along the southeast Indian ridge.

Helium isotope variations in igneous rocks are important for relating isotopic heterogeneity to convective mixing in the Earth's mantle. High 3He/4He ratios at many ocean islands, along with lower and relatively uniform values in mid-ocean-ridge basalts (MORBs), are thought to result from a well mixed upper-mantle source for MORB and a distinct deeper-mantle source for ocean island basalts. At finer scales, 3He/4He variations along mid-ocean ridges have been related to underlying mantle heterogeneity, but relationships between the scales of geochemical segmentation and mantle convection remain enigmatic. Here we present helium isotope data for MORB glasses recovered along approximately 5,800 km of the southeast Indian ridge, and develop an approach to quantitatively relate spatial variations in geochemical and geophysical parameters at the Earth's surface. A point-to-point correlation analysis reveals structure in the helium isotope data at length scales of approximately 150 and approximately 400 km that appears to be related to secondary convection in the underlying mantle.

Verification of the onsager reciprocal relations in a molten silicate solution.

A key hypothesis in the generalized theory of nonequilibrium thermodynamics is the principle of microscopic time invariance as enunciated by Onsager in the 1930s. At the macroscopic level, Onsager's hypothesis is represented by a set of relations known as the Onsager reciprocal relations, which, when applied to isothermal, multicomponent diffusion, demand the symmetry of the phenomenological matrix that connects mass fluxes to chemical potential gradients. On the basis of experimentally determined diffusion coefficients and thermochemical data for the molten system CaO-Al(2)O(3)-SiO(2), the Onsager phenomenological coefficients have been computed, including an analysis of error. Within experimental uncertainty, the Onsager matrix is indeed symmetric.

[Toxocariasis (visceral larva migrans). A report of a case in an adopted child]. / Toxocariasi (visceral larva migrans). Descrizione di un caso in un bambino adottato.

A case of asymptomatic toxocariasis in a Brazilian adopted child with hypereosinophilia is described. The diagnosis is confirmed by measuring specific IgG antibodies anti-Toxocara and, in the light of growing adoptions of children coming from low standard of living extra-European countries, the authors note the importance of investigating also on those parasitosis until today rather infrequent in our country.

Thermal evolution of plutons: a parameterized approach.

A conservation-of-energy equation has been derived for the spatially averaged magma temperature in a spherical pluton undergoing simultaneous crystallization and both internal (magma) and external (hydrothermal fluid) thermal convection. The model accounts for the dependence of magma viscosity on crystallinity, temperature, and bulk composition; it includes latent heat effects and the effects of different initial water concentrations in the melt and quantitatively considers the role that large volumes of circulatory hydrothermal fluids play in dissipating heat. The nonlinear ordinary differential equation describing these processes has been solved for a variety of magma compositions, initial termperatures, initial crystallinities, volume ratios of hydrothermal fluid to magma, and pluton sizes. These calculations are graphically summarized in plots of the average magma temperature versus time after emplacement. Solidification times, defined as the time necessary for magma to cool from the initial emplacement temperature to the solidus temperature vary as R(1,3), where R is the pluton radius. The solidification time of a pluton with a radius of 1 kilometer is 5 x 10(4) years; for an otherwise identical pluton with a radius of 10 kilometers, the solidification time is approximately 10(6) years. The water content has a marked effect on the solidification time. A granodiorite pluton with a radius of 5 kilometers and either 0.5 or 4 percent (by weight) water cools in 3.3 x 10(5) or 5 x 10(4) years, respectively. Convection solidification times are usually but not always less than conduction cooling times.