Upward bias in estimates of pacemaker reliability: effect of unreported patient mortality

OBJECTIVES: This study attempted to determine the effect of unreported patient deaths on estimates of pacemaker reliability. BACKGROUND: The reliability of pacemakers is usually reported with reference to implant registration data and returned product analysis without censoring when follow-up data are missing. METHODS: We studied 73 patients (mean [+/- SD] age 77 +/- 8 years) undergoing implantation of a ventricular-inhibited (VVI) pacemaker who were subsequently found to be at increased risk of experiencing premature pacemaker failure. Survival curves for patients and pacemakers were constructed by the Kaplan-Meier method with appropriate censoring at the time of unrelated death or elective explantation of a normal device. To examine the effect of unreported loss of follow-up data, patient mortality was then ignored, and follow-up for pacemakers without known failure was assumed to continue to the date of analysis. RESULTS: There were 13 device failures, with a median pacemaker survival time of 37 months. Twenty-three patients died, all of causes unrelated to the pacemaker system; median patient survival time was only 44 months. Ignoring this attrition inflated follow-up time from 122 to 188 patient-years and reduced the apparent pacemaker failures at 30 months by almost half, from 37% to only 20%. Modeling the process shows that when the patient mortality rate is more than half the pacemaker failure rate, ignoring censoring inflates the device survival estimate by > or = 10% from the median survival onward. CONCLUSIONS: When medical device survival curves are generated by implant registration data and returned product analysis, they should be adjusted for unreported loss of follow-up.     

Antimicrobial action of rabbit leukocyte CAP18(106-137)

CAP18 is a cationic antimicrobial protein originally isolated from rabbit neutrophils, of which a 32-mer sequence from its C-terminal and (CAP18(106-137)) has been found to be the most active. The bactericidal action of this peptide has been characterized by conventional culture techniques and flow cytometry. Cultures of Escherichia coli NCTC10418 were exposed to the MBC (12 microM) of the peptide for up to 60 min and stained with a fluorochrome sensitive to changes in either membrane potential (bis-(1,3-dibutylbarbituric acid)trimethine oxonol [DiBAC4(3)), or membrane integrity (propidium iodide [PI]) before flow cytometric analysis. Addition of CAP18(106-137) to E. coli in broth culture resulted in immediate collapse of membrane potential [as determined by uptake of DiBAC4(3)] and loss of membrane integrity (as indicated by uptake of PI), with a corresponding 6- to 8-log decrease in viable counts as determined by colony formation on solid media. In identical experiments, the presence of Mg2+ (1 to 10 mM), K+ (50 to 250 mM), or EDTA (5 mM) or incubation in nutrient-free buffer or at 4 degrees C had no effect on peptide-induced dye uptake. In contrast, addition of Ca2+ (1 to 10 mM) or the respiratory chain poison carbonyl cyanide m-chlorophenylhydrazone (CCCP) (50 microM) inhibited the uptake of both dyes. These findings, however, did not relate to bacterial recovery on solid media, where (unless in the presence of K+ 150 to 250 mM) CAP18(106-137) at 12 microM fulfilled the MBC criteria (99.9% killing). We conclude that CAP18(106-137) exerts a rapid and profound action on E. coli cytoplasmic membranes and viability as measured by colony formation. The results suggest, however, that CAP18(106-137) may exert its action at sites additional to the cell membrane and that its activity profile is unique among cationic antimicrobial proteins.     

Design of a self-routing frequency division multiple access(SR-FDMA) network using an optical ring filter with or without gain as arouter

Self-routing frequency division multiple access (SR-FDMA) network with ASK coherent detection and dual ring topology is proposed. The router, which employs the optical ring filter, is used as a means for selecting the desired channel carrier and at the same time as a bypass of the other channel carriers. The channel capacity and the carrier-to-noise ratio are investigated with the consideration of cross talk and power budget penalty. We find that there exists an optimum coupling coefficient of the transceiver coupler and a trade-off in selecting channel number and data rate. The results show that the router with gain can suppress the cross talk, compensate the power budget penalty, and largely increase the channel number. Therefore, with this router, a self-routing, high-density FDMA network is feasible     

Characterization and mutual ligand-induced modulation of epidermal growth factor and interferon-alpha receptors on renal carcinoma cells in vitro

We have determined the binding of epidermal growth factor (EGF) and interferon (IFN)-alpha to their specific receptors on four renal carcinoma cell lines. CaKi-2, a-498 and ACHN cell lines express high numbers, and CaKi-1 expresses low number of EGF receptors (EGFRs). On all four renal carcinoma cell lines, we have also detected specific IFN-alpha binding sites. EGF and IFN-alpha binding to their receptors caused modulation of the other ligand's receptor binding. Scatchard analyses of binding data showed that IFN-alpha treatment leads to an increase of EGFR number in three out of four cell lines and to a decrease of EGFR number in one out of four (CaKi-1). No significant changes in EGF binding affinities were detected. EGF induced a reduction in IFN-alpha receptor number in all four cell lines without significant changes in IFN-alpha binding affinities. We hypothesize that presence of EGF in the microenvironment of renal cancer cells may modulate the biological effects of IFN and consequently decrease its antiproliferative activity.     

Non-metric multidimensional scaling in the analysis of neuroanatomical connection data and the organization of the primate cortical visual system

Neuroanatomists have established that the various gross structures of the brain are divided into a large number of different processing regions and have catalogued a large number of connections between these regions. The connectional data derived from neuroanatomical studies are complex, and reliable conclusions about the organization of brain systems cannot be drawn from considering them without some supporting analysis. Recognition of this problem has recently led to the application of a variety of techniques to the analysis of connection data. One of the techniques that we previously employed, non-metric multidimensional scaling (NMDS), appears to have revealed important aspects of the organization of the central nervous system, such as the gross organization of the whole cortical network in two species. We present here a detailed treatment of methodological aspects of the application of NMDS to connection data. We first examine in detail the particular properties of neuroanatomical connection data. Second, we consider the details of NMDS and discuss the propriety of different possible NMDS approaches. Third, we present results of the analyses of connection data from the primate visual system, and discuss their interpretation. Fourth, we study independent analyses of the organization of the visual system, and examine the relation between the results of these analyses and those from NMDS. Fifth, we investigate quantitatively the performance of a number of data transformation and conditioning procedures, as well as tied and untied NMDS analysis of untransformed low-level data, to determine how well NMDS can recover known metric parameters from artificial data. We then re-analyse real connectivity data with the most successful methods at removing the effects of sparsity, to ensure that this aspect of data structure does not obscure others. Finally, we summarize the evidence on the connectional organization of the primate visual system, and discuss the reliability of NMDS analyses of neuroanatomical connection data.     

Monobloc craniomaxillofacial distraction osteogenesis in a newborn with severe craniofacial synostosis: a preliminary report

Severe craniofacial synostosis can be a devastating problem for a newborn infant. Reasons for early surgical intervention include cranial stenosis, hydrocephalus, inadequate globe and corneal protection, compromised airway patency, and feeding problems. In this preliminary report, we describe the management of severe craniofacial synostosis in a newborn infant by means of cranial and midfacial distraction osteogenesis.