School stress is one of the most important stressors in adolescents around the world. This study tested the impact of region, age, gender, family structure, and school achievement on adolescents’ stress perception. In a cross-sectional design, 12.172 adolescents from 21 countries participated in the study. Adolescents from Central European and North American countries had generally quite low levels of school stress. Adolescents from Southern Europe exhibited the highest stress levels, but also adolescents from Latin America, the Middle East and Asian countries reported quite high levels of school-related stress. Rank 1 in many countries was the pressure to get the best marks. Additionally, the fear that differences in opinion with the teacher may result in bad marks and that the leaning material is too difficult or too boring were also important stressors, whereas rivalries among pupils seemed not to be a major problem. Adolescents from single-parent families experienced higher school-related stress than adolescents from two-parent families. The findings were discussed with respect to overall globalization and future insecurities, leading to universal stressors of adolescents in different parts of the world.
{"title":"School-related stressors in adolescents from 21 countries: What is universal?","authors":"I. Seiffge-Krenke","doi":"10.18103/IMR.V7I1.907","DOIUrl":"https://doi.org/10.18103/IMR.V7I1.907","url":null,"abstract":"School stress is one of the most important stressors in adolescents around the world. This study tested the impact of region, age, gender, family structure, and school achievement on adolescents’ stress perception. In a cross-sectional design, 12.172 adolescents from 21 countries participated in the study. Adolescents from Central European and North American countries had generally quite low levels of school stress. Adolescents from Southern Europe exhibited the highest stress levels, but also adolescents from Latin America, the Middle East and Asian countries reported quite high levels of school-related stress. Rank 1 in many countries was the pressure to get the best marks. Additionally, the fear that differences in opinion with the teacher may result in bad marks and that the leaning material is too difficult or too boring were also important stressors, whereas rivalries among pupils seemed not to be a major problem. Adolescents from single-parent families experienced higher school-related stress than adolescents from two-parent families. The findings were discussed with respect to overall globalization and future insecurities, leading to universal stressors of adolescents in different parts of the world.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81437541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More and more people practice mindfulness to reduce stress and improve their wellbeing. In this regards, technology-based interventions such as smartphone apps provide an interesting potential. Our study explores effects on users' perceived wellbeing and stress on the example of the mindfulness-based app My Blossom. Forty-four new users answered four online questionnaires in one-week intervals, containing established multi-item wellbeing and stress scales for as well as single-item direct explicit questions about perceived changes in wellbeing and stress. In combination, these two forms of assessment provided insights to what degree users are conscious of a possible change and whether these perceptions are in parallel to the more indirect measures. Paired t tests show significant improvements in positive and negative affect, mood and stress in both scales and overall ratings after three weeks of mindfulness-training with My Blossom compared to the pre-intervention baseline. These findings suggest mindfulness-training in form of an app as an interesting alternative to mindfulness-trainings under instructions of a physically present trainer and the power to increase wellbeing and decrease stress. Future research should concentrate on the specific mechanisms and possible design factors of app-based mindfulness-trainings (e.g., variety of training offers, degree of guidance, reminder functions) as well as long term effects.
{"title":"Effects of technology-based mindfulness training on wellbeing and stress","authors":"Tatjana Schauer, S. Diefenbach","doi":"10.18103/IMR.V7I1.901","DOIUrl":"https://doi.org/10.18103/IMR.V7I1.901","url":null,"abstract":"More and more people practice mindfulness to reduce stress and improve their wellbeing. In this regards, technology-based interventions such as smartphone apps provide an interesting potential. Our study explores effects on users' perceived wellbeing and stress on the example of the mindfulness-based app My Blossom. Forty-four new users answered four online questionnaires in one-week intervals, containing established multi-item wellbeing and stress scales for as well as single-item direct explicit questions about perceived changes in wellbeing and stress. In combination, these two forms of assessment provided insights to what degree users are conscious of a possible change and whether these perceptions are in parallel to the more indirect measures. Paired t tests show significant improvements in positive and negative affect, mood and stress in both scales and overall ratings after three weeks of mindfulness-training with My Blossom compared to the pre-intervention baseline. These findings suggest mindfulness-training in form of an app as an interesting alternative to mindfulness-trainings under instructions of a physically present trainer and the power to increase wellbeing and decrease stress. Future research should concentrate on the specific mechanisms and possible design factors of app-based mindfulness-trainings (e.g., variety of training offers, degree of guidance, reminder functions) as well as long term effects.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90554510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hippocampus plays an important role in processing episodic memory. The different patterns of multi-unit activity (MUA) of CA1 neurons in hippocampus corresponds to the different high order functions of the brain such as memory, association, planning, action decision, etc. In this paper, a deep learning model, which is a composition of convolutional neural network (CNN) and support vector machine (SVM), is adopted to classify 4 kinds of episodic memories of a male rat: restraint stress (restraint), contact with a female rat (female), contact with a male rat (male), and contact with a novel object (object). In addition, the characteristic patterns of the different events occurred in CA1 neurons are specified by the feature explanation of CNN using Grad-CAM. As the result, this study suggests that it is available to recognize episodic memories by MUA signals and vice versa.
{"title":"Episodic memory recognition of the hippocampus using a deep learning method","authors":"T. Kuremoto","doi":"10.18103/IMR.V7I1.915","DOIUrl":"https://doi.org/10.18103/IMR.V7I1.915","url":null,"abstract":"Hippocampus plays an important role in processing episodic memory. The different patterns of multi-unit activity (MUA) of CA1 neurons in hippocampus corresponds to the different high order functions of the brain such as memory, association, planning, action decision, etc. In this paper, a deep learning model, which is a composition of convolutional neural network (CNN) and support vector machine (SVM), is adopted to classify 4 kinds of episodic memories of a male rat: restraint stress (restraint), contact with a female rat (female), contact with a male rat (male), and contact with a novel object (object). In addition, the characteristic patterns of the different events occurred in CA1 neurons are specified by the feature explanation of CNN using Grad-CAM. As the result, this study suggests that it is available to recognize episodic memories by MUA signals and vice versa.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84974602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We have developed the world's first novel type of artificial retina, OUReP (Okayama University Retinal Prosthesis), in which a photoelectric dye that converts light energy into electric potential is covalently bonded to the surface of a polyethylene thin film as an insulator. The receptor that absorbs light and the output device that generates displacement current to stimulate nearby neurons are integrated in a sheet of thin film. It has become possible to measure the surface potential of the artificial retina OUReP using a Kelvin probe that measures the surface potential of semiconductors. When light is turned on and off to the artificial retina OUReP, the surface potential changes rapidly. As the light intensity is increased, the potential change on the surface of the artificial retina becomes larger. As for safety, the artificial retina OUReP was not toxic in all tests for biological evaluation of medical devices. As for efficacy, the artificial retina OUReP was implanted under the retina by vitreous surgery in monkey eyes which had chemically-induced macular degeneration with photoreceptor cell loss. Over the next 6 months, retinal detachment did not occur during the course, and the artificial retina was in contact with the retinal tissue. The amplitude of the visual evoked potential attenuated by macular degeneration recovered 1 month after implantation of the artificial retina, and the recovery of amplitude was maintained until 6 months after the implantation. By using multielectrode array-mounted dish recording system, it has been proved that action potential spikes are induced when the artificial retina is placed on degenerative retinal tissue of retinal dystrophic rats or mice and exposed to light, which is used as an index of the effectiveness of the artificial retina. We have established manufacturing and quality control of the device in a clean room facility, proved the safety and efficacy, and are preparing for first-in-human investigator-initiated clinical trials.
{"title":"Photoelectric dye-based retinal prosthesis (OUReP) as a novel type of artificial retina","authors":"T. Matsuo, Tetsuya Uchida","doi":"10.18103/IMR.V7I1.916","DOIUrl":"https://doi.org/10.18103/IMR.V7I1.916","url":null,"abstract":"We have developed the world's first novel type of artificial retina, OUReP (Okayama University Retinal Prosthesis), in which a photoelectric dye that converts light energy into electric potential is covalently bonded to the surface of a polyethylene thin film as an insulator. The receptor that absorbs light and the output device that generates displacement current to stimulate nearby neurons are integrated in a sheet of thin film. It has become possible to measure the surface potential of the artificial retina OUReP using a Kelvin probe that measures the surface potential of semiconductors. When light is turned on and off to the artificial retina OUReP, the surface potential changes rapidly. As the light intensity is increased, the potential change on the surface of the artificial retina becomes larger. As for safety, the artificial retina OUReP was not toxic in all tests for biological evaluation of medical devices. As for efficacy, the artificial retina OUReP was implanted under the retina by vitreous surgery in monkey eyes which had chemically-induced macular degeneration with photoreceptor cell loss. Over the next 6 months, retinal detachment did not occur during the course, and the artificial retina was in contact with the retinal tissue. The amplitude of the visual evoked potential attenuated by macular degeneration recovered 1 month after implantation of the artificial retina, and the recovery of amplitude was maintained until 6 months after the implantation. By using multielectrode array-mounted dish recording system, it has been proved that action potential spikes are induced when the artificial retina is placed on degenerative retinal tissue of retinal dystrophic rats or mice and exposed to light, which is used as an index of the effectiveness of the artificial retina. We have established manufacturing and quality control of the device in a clean room facility, proved the safety and efficacy, and are preparing for first-in-human investigator-initiated clinical trials.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86883240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole J Topilow, Ann Q Tran, Eubee B Koo, Chrisfouad R Alabiad
Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.
{"title":"Etiologies of Proptosis: A review.","authors":"Nicole J Topilow, Ann Q Tran, Eubee B Koo, Chrisfouad R Alabiad","doi":"10.18103/imr.v6i3.852","DOIUrl":"10.18103/imr.v6i3.852","url":null,"abstract":"Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"6 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204542/pdf/nihms-1580247.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37913024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nirmal Shah, M. Sabia, R. Mathur, M. Goldberg, I. Wainer, M. Torjman
{"title":"The Multifaceted Role of Low Dose IV Ketamine to Control Debilitating Neuropathic Pain Conditions","authors":"Nirmal Shah, M. Sabia, R. Mathur, M. Goldberg, I. Wainer, M. Torjman","doi":"10.18103/imr.v6i3.853","DOIUrl":"https://doi.org/10.18103/imr.v6i3.853","url":null,"abstract":"","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85904839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yellow nail syndrome (YNS) is a rare, but relatively well characterized triad of slow growing yellow nails, lymphedema of the distal portions of the upper and lower limbs as well as chronic infection of the respiratory tract and/or pleural effusion. The most characteristic features of this syndrome are the nail changes that allow the diagnosis to be made even if the triad is not complete. Yellow discoloration of the nails is nonspecific and often seen in onychomycosis, nail psoriasis, a variety of other conditions that are associated with onycholysis. Distal limb edema may not be very pronounced. In addition to the bronchopulmonary disorders, malignancies, chronic heart conditions and gastrointestinal diseases may occur. Treatment after exclusion of non-YNS conditions is aimed at finding the underlying systemic disorder, which usually requires a very long therapy and a lot of patience both from the patient as well as the treating physician.
{"title":"Yellow Nail Syndrome – Diagnosis, Differential Diagnosis, Treatment Options","authors":"E. Haneke","doi":"10.18103/imr.v6i5.891","DOIUrl":"https://doi.org/10.18103/imr.v6i5.891","url":null,"abstract":"Yellow nail syndrome (YNS) is a rare, but relatively well characterized triad of slow growing yellow nails, lymphedema of the distal portions of the upper and lower limbs as well as chronic infection of the respiratory tract and/or pleural effusion. The most characteristic features of this syndrome are the nail changes that allow the diagnosis to be made even if the triad is not complete. Yellow discoloration of the nails is nonspecific and often seen in onychomycosis, nail psoriasis, a variety of other conditions that are associated with onycholysis. Distal limb edema may not be very pronounced. In addition to the bronchopulmonary disorders, malignancies, chronic heart conditions and gastrointestinal diseases may occur. Treatment after exclusion of non-YNS conditions is aimed at finding the underlying systemic disorder, which usually requires a very long therapy and a lot of patience both from the patient as well as the treating physician.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72812183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaw Watanabe, Tetsurou Yamamoto, T. Enomoto, Muneaki Iizuka, Hideyo Yamaguchi
Hay fever is an increasing disease in Japan, and the prevalence of cedar pollinosis exceeds 20% nationwide. More than 50 kinds of pollen have been reported so far in Japan. Pollinosis often complicated other allergic conditions. Since patients with allergic diseases have lower s-IgA levels than healthy subjects, patients with hay fever have less weak mucosal immunity so that it would affect the efficacy of the influenza vaccine. Eight thousand three hundred thirty-seven (3885 men and 4452 women) participated in this survey to clarify the relationship between allergic diseases and the influenza vaccine's efficacy. In the no hay fever group, the effective vaccine rate against influenza disease was 0.2%, and in the hay fever group, it was 0.21%. No effect of the influenza vaccine was present in this population. Rather, vaccination seemed to increase influenza incidence in people with hay fever. The basic presence of allergic condition influenza vaccination increased susceptibility to influenza infection. (12.9% vs. 13.89%) (p<0.001). A tailor-made strategy for these patients should be necessary for preventing influenza.
花粉热在日本是一种日益严重的疾病，雪松授粉病在全国的患病率超过20%。到目前为止，日本已经报道了50多种花粉。花粉症常常并发其他过敏症状。由于过敏性疾病患者s-IgA水平低于健康人，花粉热患者黏膜免疫较弱，影响流感疫苗的效果。88337人(3885名男性和4452名女性)参加了这项调查，以澄清过敏性疾病与流感疫苗疗效之间的关系。在无花粉热组中，流感有效疫苗接种率为0.2%，在花粉热组中为0.21%。流感疫苗在这一人群中没有效果。相反，疫苗接种似乎增加了花粉热患者的流感发病率。流感疫苗接种增加了对流感感染的易感性。(12.9% vs. 13.89%) (p<0.001)。为预防流感，有必要为这些患者制定量身定制的策略。
{"title":"Hay fever and the effect of influenza vaccines","authors":"Shaw Watanabe, Tetsurou Yamamoto, T. Enomoto, Muneaki Iizuka, Hideyo Yamaguchi","doi":"10.18103/imr.v6i5.888","DOIUrl":"https://doi.org/10.18103/imr.v6i5.888","url":null,"abstract":"Hay fever is an increasing disease in Japan, and the prevalence of cedar pollinosis exceeds 20% nationwide. More than 50 kinds of pollen have been reported so far in Japan. Pollinosis often complicated other allergic conditions. Since patients with allergic diseases have lower s-IgA levels than healthy subjects, patients with hay fever have less weak mucosal immunity so that it would affect the efficacy of the influenza vaccine. Eight thousand three hundred thirty-seven (3885 men and 4452 women) participated in this survey to clarify the relationship between allergic diseases and the influenza vaccine's efficacy. In the no hay fever group, the effective vaccine rate against influenza disease was 0.2%, and in the hay fever group, it was 0.21%. No effect of the influenza vaccine was present in this population. Rather, vaccination seemed to increase influenza incidence in people with hay fever. The basic presence of allergic condition influenza vaccination increased susceptibility to influenza infection. (12.9% vs. 13.89%) (p<0.001). A tailor-made strategy for these patients should be necessary for preventing influenza.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82406649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alan Patrício da Silva, Andréia Zarzour Abou Hala Corrêa, Marjorie Heloise Masuchi, B. Daboin, F. Leitão, Leticia Pacheco, Adilson Monteiro, R. Raimundo, Í. M. Bezerra, L. C. Abreu
{"title":"ACCESS TO ASSISTIVE TECHNOLOGY DEVICES IN INDIVIDUALS WITH CEREBRAL PALSY AND COMMUNICATION LIMITATIONS","authors":"Alan Patrício da Silva, Andréia Zarzour Abou Hala Corrêa, Marjorie Heloise Masuchi, B. Daboin, F. Leitão, Leticia Pacheco, Adilson Monteiro, R. Raimundo, Í. M. Bezerra, L. C. Abreu","doi":"10.18103/imr.v6i4.873","DOIUrl":"https://doi.org/10.18103/imr.v6i4.873","url":null,"abstract":"","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82827774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sudden cardiac death accounts for approximately 360,000 annually in the United States and is the cause of half of all cardiovascular deaths. Ischemic heart disease is the major cause of death in the general adult population. Sudden cardiac death can be due to arrhythmic or non-arrhythmic cardiac causes, for example, myocardial rupture. Arrhythmic sudden cardiac death may be caused by ventricular tachyarrhythmia (ventricular tachycardia/ventricular fibrillation) or pulseless electrical activity/asystole. The majority of research in risk stratification centers on ventricular tachyarrhythmias simply because of the availability of a successful management strategy, the implantable cardioverter/ defibrillator. Currently the main criterion of primary defibrillator prophylaxis is the presence of organic heart disease and depressed left ventricular systolic function assessed as left ventricular ejection fraction. However, only one third of eligible patients benefit from the implantable defibrillator, resulting in significant redundancy in the use of the device. The cost to the health care system of sustaining this approach is substantial. Further, the current low implantation rate among eligible population probably reflects a perceived low benefit-to-cost ratio of the device. Therefore, attempts to optimize the selection process for primary implantable defibrillator prophylaxis are paramount. The present report will review the most recent pathophysiology and risk stratification strategies for sudden cardiac death beyond the single criterion of depressed ejection fraction. Emphasis will be placed on electrophysiological surrogates of conduction disorder, dispersion of repolarization, and autonomic imbalance, which represent our current understanding of the electrophysiological mechanisms that underlie the initiation of ventricular tachyarrhythmias. Further, factors that modify arrhythmic death, including noninvasive risk variables, biomarkers, and genomics will be addressed. These factors may have great utility in predicting sudden cardiac arrhythmic death in the general public.
{"title":"Pathophysiology and Risk Stratification of Sudden Cardiac Death in Ischemic Heart Disease","authors":"N. El-Sherif, M. Boutjdir, G. Turitto","doi":"10.18103/imr.v6i5.892","DOIUrl":"https://doi.org/10.18103/imr.v6i5.892","url":null,"abstract":"Sudden cardiac death accounts for approximately 360,000 annually in the United States and is the cause of half of all cardiovascular deaths. Ischemic heart disease is the major cause of death in the general adult population. Sudden cardiac death can be due to arrhythmic or non-arrhythmic cardiac causes, for example, myocardial rupture. Arrhythmic sudden cardiac death may be caused by ventricular tachyarrhythmia (ventricular tachycardia/ventricular fibrillation) or pulseless electrical activity/asystole. The majority of research in risk stratification centers on ventricular tachyarrhythmias simply because of the availability of a successful management strategy, the implantable cardioverter/ defibrillator. Currently the main criterion of primary defibrillator prophylaxis is the presence of organic heart disease and depressed left ventricular systolic function assessed as left ventricular ejection fraction. However, only one third of eligible patients benefit from the implantable defibrillator, resulting in significant redundancy in the use of the device. The cost to the health care system of sustaining this approach is substantial. Further, the current low implantation rate among eligible population probably reflects a perceived low benefit-to-cost ratio of the device. Therefore, attempts to optimize the selection process for primary implantable defibrillator prophylaxis are paramount. The present report will review the most recent pathophysiology and risk stratification strategies for sudden cardiac death beyond the single criterion of depressed ejection fraction. Emphasis will be placed on electrophysiological surrogates of conduction disorder, dispersion of repolarization, and autonomic imbalance, which represent our current understanding of the electrophysiological mechanisms that underlie the initiation of ventricular tachyarrhythmias. Further, factors that modify arrhythmic death, including noninvasive risk variables, biomarkers, and genomics will be addressed. These factors may have great utility in predicting sudden cardiac arrhythmic death in the general public.","PeriodicalId":91699,"journal":{"name":"Internal medicine review (Washington, D.C. : Online)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88674035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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