PubMed · 13987828
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C C SELTZER. 1963-06-29. Morphologic constitution and smoking.. https://doi.org/10.1001/jama.1963.03700260084023
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Previous clinical studies have shown that impedance measurements using right ventricular (RV) leads can monitor congestion due to heart failure. We previously reported on a three-fold advantage of bipolar left ventricular (LV) leads, which are near the lung, over RV leads in detecting pulmonary edema with impedance. A combined system of internal and external electrodes is now investigated using computer models, for use with conventional cardiac resynchronization (CRT) systems with unipolar LV leads. The system uses the normal LV pacing pulse as current source, and the resultant voltage at two skin electrodes to obtain a lung edema impedance (Z) measurement. Using gated MRIs, thoracic computer models of 3.8 million control volumes were constructed. Changes of Z with edema were simulated with a conventional totally implanted system, as well as with combined implanted-external systems. Right atrial (RA), RV, RV defibrillator coil and LV leads were used. Per cent Z responses to edema were compared. The all implanted responses were RA: 11.8%, RV: 8.6%, RVcoil: 11.3%, LV: 23.8%. The combined system responses were LV-ext: 21.45%, RA-ext: 10.13%, LV-arm leg: 26.08%. The computer models suggest that combined internal-external systems can be as sensitive as the totally implanted ones. Lung edema may be monitored at follow up or home for LV paced patients with only two external electrodes. Using very low impedance configurations optimized by computer can greatly maximize the response, with a cost of poor stability.
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OBJECTIVE: Maternal obesity is likely a risk factor for neural tube defects (NTDs). By late 1997, it became mandatory in Canada that all refined wheat flour be fortified with folic acid. Because overweight women may consume greater quantities of refined wheat flour, we questioned whether their risk of NTD changed after flour fortification. METHODS: A retrospective population-based study was conducted between 1994 and late 2000. We included all Ontarian women who underwent antenatal maternal screening at 15 to 20 weeks of gestation. Self-declared maternal date of birth, ethnicity, current weight, and the presence of pregestational diabetes mellitus were recorded in a standardized fashion on the maternal screening requisition sheet. The presence of NTDs was systematically detected both antenatally and postnatally. The risk of open NTD was evaluated across maternal weight quartiles and deciles, and an interaction between greater maternal weight and the presence of flour fortification was tested using multiple logistic regression analysis. RESULTS: A total of 292 open NTDs were detected among 420,362 women. The adjusted odds ratio (OR) for NTD was 1.2 (95% confidence interval [CI] 1.1-1.3) per 10-kg incremental rise in maternal weight. Comparing the highest with the lowest quartile of maternal weight, the adjusted OR for NTD was 2.6 (95% CI 1.8-4.0). A similar finding was observed for the highest compared with lowest weight deciles (adjusted OR 3.3, 95% CI 1.7-6.2). The interaction between elevated maternal weight and the presence of folic acid flour fortification was of borderline significance (P = .09). Before fortification, greater maternal weight was associated with a modestly increased risk of NTD (adjusted OR 1.4, 95% CI 1.0-1.8); after flour fortification, this effect was more pronounced (adjusted OR 2.8, 95% CI 1.2-6.6). CONCLUSION: These data emphasize the higher risk of NTD associated with increased maternal weight, even after universal folic acid flour fortification. Beyond periconceptional folic acid use, consideration should be given to testing whether prepregnancy weight reduction is an independent means of preventing NTD. LEVEL OF EVIDENCE: II-2.