Notes: Background: The implanted cardioverter-defibrillator (ICD) has been shown to improve survival in adult patients with high risk acquired cardiac disease, with a cost-effectiveness ratio in the range of $30,000 to $185,000 per quality-adjusted-life-year saved. However, data on the benefit and cost-effectiveness of device therapy in high-risk patients with inherited cardiac disorders are limited. Methods: We developed two separate computer-based analytical models to compare non-ICD with ICD therapy in patients (age range: 10–75 years) with long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM). In each disease entity patients were stratified into low-risk (no known risk factors); high-risk (known risk factors [primary prevention]); and very high-risk (prior near-fatal events [secondary prevention]). Net costs were defined as the difference between costs resulting from treatment of the disease and savings due to gained productivity attributable to prevention of sudden cardiac death. Outcome was defined as costs per quality-adjusted life-years saved. Results: In LQTS, defibrillator therapy was shown to be cost effective in high-risk male patients (incremental cost-effectiveness ratio [ICER]=$3328 per quality-adjusted-life-year saved), and cost saving in high-risk females (ICER =$7102 gained per quality-adjusted-life-year saved) and very high-risk males and females (ICER =$15,483 and 19,393 gained per quality-adjusted-life-year saved, respectively). In HCM, defibrillator therapy was cost saving in both male and female high-risk (ICER =$17,892 and $17,526 gained per quality-adjusted-life-year saved, respectively) and very high-risk (ICER =$22,944 and $22,329 gained per quality-adjusted-life-year saved, respectively) patients. Defibrillator therapy was not shown to be cost effective in low-risk patients with either LQTS or HCM (ICER in the range of $400,000 to $600,000 lost per quality-adjusted-life-year saved). Sensitivity analyses were consistent with the results in each risk group. Conclusions: In appropriately selected patients with inherited cardiac disorders, early intervention with ICD therapy is cost-effective to cost saving due to added years of gained productivity when the lifespan of an individual at risk is considered.

Notes: Introduction: Deaths secondary to low-energy impacts to the precordium in young individuals (commotio cordis) have been reported with increasing frequency. In a swine model, baseball impacts induce ventricular fibrillation when directed at the center of the left ventricle during the vulnerable portion of repolarization just prior to the T-wave peak. It has been hypothesized that activation of stretch-sensitive channels could be crucial for this electrophysiological phenomenon. In this study, a nonselective stretch-activated cation channel was pharmacologically blocked prior to chest blows to determine whether this channel represents a possible pathway by which commotio cordis events occur. Methods: In a randomized and blinded experiment, 12 swine (mean 17.1 ± 2.5 kg) received either 2-g streptomycin intramuscularly (mean serum concentration 115 ± 18 μM) or sterile water prior to chest impact. Each animal received six precordial impacts with a baseball propelled at 40 mph. Results: There was no significant difference in the frequency of induced VF in the animals administered streptomycin (10 of 19 impacts: 53%) compared to those control animals receiving only sterile water (10 of 31: 32%) (P = 0.15). However, the magnitude of ST segment elevation was less in the streptomycin-treated animals (19 ± 19 mV) versus controls (61 ± 46 mV) (P = 0.015). Conclusion: Streptomycin did not alter the frequency of ventricular fibrillation in our commotio cordis model, indicating that the stretch-activated channel is not implicated in the genesis of chest blow-induced cardiac arrest. However, streptomycin did reduce ST elevation following impact suggesting that the stretch-activated channel may play a role in ST segment elevation following chest wall blows.

Notes: Intermontane basins in the Trans-Pecos region of westernmost Texas and northern Chihuahua, Mexico, are target areas for disposal of interstate municipal sludge and have been identified as possible disposal sites for low-level radioactive waste. Understanding ground water movement within and between these basins is needed to assess potential contaminant fate and movement. Four associated basin aquifers are evaluated and classified; the Red Light Draw Aquifer, the Northwest Eagle Flat Aquifer, the Southeast Eagle Flat Aquifer, and the El Cuervo Aquifer. Encompassed on all but one side by mountains and local divides, the Red Light Draw Aquifer has the Rio Grande as an outlet for both surface drainage and ground water discharge. The river juxtaposed against its southern edge, the basin is classified as a topographically open, through-flowing basin. The Northwest Eagle Flat Aquifer is classified as a topographically closed and drained basin because surface drainage is to the interior of the basin and ground water discharge occurs by interbasin ground water flow. Mountains and ground water divides encompass this basin aquifer on all sides; yet, depth to ground water in the interior of the basin is commonly 〉500 feet. Negligible ground water discharge within the basin indicates that ground water discharges from the basin by vertical flow and underflow to a surrounding basin or basins. The most likely mode of discharge is by vertical, cross-formational flow to underlying Permian rocks that are more porous and permeable and subsequent flow along regional flowpaths beneath local ground water divides. The Southeast Eagle Flat Aquifer is classified as a topographically open and drained basin because surface drainage and ground water discharge are to the adjacent Wildhorse Flat area. Opposite the Eagle Flat and Red Light Draw aquifers is the El Cuervo Aquifer of northern Chihuahua, Mexico. The El Cuervo Aquifer has interior drainage to Laguna El Cuervo, which is a phreatic playa that also serves as a focal point of ground water discharge. Our evidence suggests that El Cuervo Aquifer may lose a smaller portion of its discharge by interbasin ground water flow to Indian Hot Springs, near the Rio Grande. Thus, El Cuervo Aquifer is a topographically closed basin that is either partially drained if a component of its ground water discharge reaches Indian Hot Springs or undrained if all its natural ground water discharge is to Laguna El Cuervo.

Notes: Animal models have been invaluable for studying aspects of food intake regulation that for various reasons cannot be observed in humans. The dairy cow is a unique animal model because of an unrivaled energy requirement; its great drive to eat results in feeding behavior responses to treatments within the physiological range. Cows' docile nature and large size make them ideal for measuring temporal treatment effects because digestion and absorption kinetics and responses in endocrine systems, gene expression, metabolite pools and fluxes, and feeding behavior can be measured simultaneously. Thus, cows are important models to investigate interactions of short-term signals regulating food intake. Furthermore, different physiological states throughout the lactation cycle provide powerful models to study how short- and long-term signals interact to affect long-term energy status. The use of the cow as a model can lead to breakthroughs in understanding the complex interactions of signals regulating food intake.

Notes: We investigated the potential function of the system formed by connections between the medial prefrontal cortex and the dorsomedial striatum in aspects of attentional function in the rat. It has been reported previously that disconnection of the same corticostriatal circuit produced marked deficits in performance of a serial, choice reaction-time task while sparing the acquisition of an appetitive Pavlovian approach behaviour in an autoshaping task (Christakou et al., 2001). Here, we hypothesized that unilateral disruption of the same circuit would lead to hemispatial inattention, contrasting with the global attention deficit following complete disconnection of the system. Combined unilateral lesions of the medial prefrontal cortex (mPFC) and the medial caudate–putamen (mCPu) within the same hemisphere produced a severe and long-lasting contralesional neglect syndrome while sparing the acquisition of autoshaping. These results provide further evidence for the involvement of the medial prefrontal-dorsomedial striatal circuit in aspects of attentional function, as well as insight into the nature of neglect deficits following lesions at different levels within corticostriatal circuitry.

Notes: Background.  Helicobacter pylori can be isolated from patients using the string test but contaminating oral and nasopharyngeal microflora need to be suppressed by rapid plating out onto selective culture media. Recently, use of this diagnostic method was enhanced by using a novel transport medium to collect specimens from subjects in a remote Australian clinic over 1300 km from the laboratory.Methods.  Retrieved string tests were transported to the laboratory in chilled polystyrene boxes in 5 ml screw-cap bottles with 3 ml of a brain heart infusion broth plus antibiotics. These were 20 g/ml vancomycin, 10 g/ml trimethoprim, 10 g/ml cefsulodin, and 10 g/ml amphotericin B. A comparison was made between subjects who gargled with a chlorhexidine mouthwash before swallowing the string test and those who did not.Results.  Forty-five urea breath test-positive subjects were tested and H. pylori was isolated from 34 of them. Successful culture was achieved from string tests that were in transit for up to 29 hours and where the maximum temperature in the transport box was 14 °C. The additional use of a mouthwash had a marked effect on the isolation rate. H. pylori was cultured from 75% of subjects who gargled but only from 39% who did not.Conclusions.  This methodology and transport medium can broaden the use of the string test to more remote geographic areas where endoscopy is not feasible so that H. pylori isolates may still be obtained for diagnostic and epidemiologic studies. The value of this promising methodology of collection and transport should be assessed in a controlled study.

Notes: 1. The lateral pericentral region of the cerebral cortex has been well documented in primates to be important in sensorimotor integration and control and in the learning of new motor skills.2. The present article provides, first, an overview of limb sensorimotor cortical mechanisms and, second, outlines recent evidence pointing to an important role for the face sensorimotor cortex in semi-automatic, as well as trained, orofacial motor behaviour and to its propensity for neuroplastic changes in association with orofacial motor skill acquisition or an altered oral environment.

Notes: Abstract  The distributions of lizards across habitat edges delimiting open-forest and regenerating sand-mined areas as a function of distance from the edge were studied at Tomago, New South Wales, Australia. Pitfall-trapping was used to survey lizards across the northern edges of four forest fragments, to determine if lizards displayed characteristic responses across the edge, and whether these could be explained by the different habitat conditions. At each site, 11 equally spaced drift fences (each parallel to the edge) were arranged in a transect running perpendicular to the edge, and stretching 50 m into each habitat type. Captures of Amphibolurus muricatus (Agamidae) decreased substantially across the edge from the mine-path to the forest so that it was identified as a mine-path specialist lizard species. Captures of two skink species decreased across the mine-path before reaching the edge, and were not caught (Ctenotus taeniolatus) or were seldom caught (Ctenotus robustus) in the forest, so they were identified as mine-path specialist, edge avoiding, lizard species. Captures of Lampropholis delicata (Scincidae) increased across edges into the forest, consistent with the expectation for a forest specialist. Regression analyses indicated the responses to edges of three lizard species (A. muricatus, C. robustus and C. taeniolatus) were negatively correlated with canopy cover (probably due to its influence on temperature, as captures of A. muricatus and C. robustus were also correlated positively with mean daily temperature). In addition, the response of C. robustus correlated negatively with a vegetation factor (dense, even vegetation in the first 50 cm from ground level). The response of L. delicata correlated positively with understorey height. We have identified edge response strategies for four species of lizards across edges delimiting temperate open-forest and mined areas, and identified habitat and microclimate variables that may have driven these responses.