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[Lead poisoning caused by lead-glazed ceramic household article, initially assumed to be of occupational origin].

The authors observed serious lead intoxication of a 18 year old female ceramic apprentice caused by tea with lemon stored in a glazed ceramic teapot made by the patient herself. The case history suggests: 1. the need of warning people to avoid the use of ceramic tablewares made by insufficient technology for alimentary purposes. 2. Patient with lead exposure can have also alimentary intoxication. 3. It seems advisable to perform screening tests of the ceramic apprentices who use lead glazes in order to detect the eventual increased absorption of lead in time.

Adolescent↗

Prenatal and postnatal blood lead level and head circumference in children to three years: preliminary results from the Mexico City Prospective Lead Study.

Multiple regression modeling was used to explore the relationship between prenatal and postnatal blood lead levels and child head circumference in the first three years of life. Maternal blood lead at 36 weeks of pregnancy and cord blood lead were found to be inversely related to 6 month and 18 month head circumference, respectively. Child 12 month blood lead was inversely related to 36 month head circumference. Limitations of the data set and the statistical techniques were discussed, as were the interpretations of the findings.

Adolescent↗

Ratio of ST-segment depression in lead V2 to ST-segment elevation in lead aVF in evolving inferior acute myocardial infarction: an aid to the early recognition of right ventricular ischemia.

The potential value of the ratio of precordial ST-segment depression to inferior ST-segment elevation as a sign of concomitant right ventricular (RV) ischemia was examined. The study group consisted of 68 patients, admitted within 3 hours of the onset of inferior acute myocardial infarction (AMI), in whom there was no evidence of prior AMI. In 27 of the 34 patients in whom inferior AMI was the result of right coronary artery occlusion proximal to the RV branch, the magnitude of ST-segment depression in lead V2 was 50% or less of the magnitude of ST-segment elevation in lead aVF, whereas in only 3 of the 34 patients in whom the site of occlusion was either distal to the RV branch (n = 23) or in the left circumflex artery (n = 11) was this ratio 50%; in no patient was it less than 50% (p less than 0.001). All 34 patients with occlusion of the right coronary artery proximal to the RV branch also had regional or global ischemic RV dysfunction by radionuclide ventriculography, with a mean RV ejection fraction of 30 +/- 10% compared with 42 +/- 6% in patients with occlusion distal to the RV branch or in the left circumflex artery (p less than 0.001). In conclusion, in patients with evolving inferior AMI, ST-segment depression in lead V2 of 50% or less of the magnitude of ST-segment elevation in lead aVF may be a useful sign (sensitivity 79%, specificity 91%, positive predictive value 90% and negative predictive value 82%) for identifying patients with concomitant RV ischemia.

Adult↗

Haematological parameters as predictors of blood lead and indicators of lead poisoning in the black duck (Anas rubripes).

The validity of various haematological parameters as indicators of blood lead concentration and lead poisoning in the black duck (Anas rubripes) is discussed. Elevated (> 40 microg dl(-1)) blood lead (PbB) levels were recorded in 41% of the 229 wild birds examined. No correlation was found between PbB concentration and haematocrit. Zinc protoporphyrin (ZPP) was positively correlated with PbB. Haemoglobin, delta-aminolevulinic acid dehydratase (ALA-d) activity and non-activated/activated ALA-d ratios were negatively correlated with PbB. The minimum PbB levels at which these parameters were affected varied greatly. ZPP and haemoglobin were relatively insensitive to PbB concentrations; whilst ALA-d activity and ALA-d ratio were influenced by PbB concentrations of < 5 microg dl(-1). Log(10) ALA-d ratio was more strongly correlated with PbB (r = -0.953) than log(10) ALA-d activity (r = -0.914) and the predictive validity (% false -ve and +ve predictions) of the ratio method was higher. The high individual variability in ALA-d activities at low PbB levels was greatly reduced by the use of the ALA-d ratio method. The ALA-d ratio method proved the most efficient for screening black duck for lead poisoning in the field.

Journal Article↗

Preparation and characterization of antibody to galactosyl(alpha 1 leads to 4)galactosyl(beta 1 leads to 4)glucosylceramide.

Antiserum against galactosyl(alpha 1 leads to 4)galactosyl(beta 1 leads to 4)glucosylceramide (globotriaosylceramide, Gb3) was raised in rabbits by the administration of four weekly intramuscular injections of 1.5 mg of the purified glycoplipid along with bovine serum albumin and Freund's complete adjuvant. AntiGb3 activity was quantitated initially by immunoprescipitation employing Gb3 mixed with 100-fold excess of lecithin and cholesterol (1 : 1 or 1 : 2, by wt.) as antigen. Subsequently, complement fixation tests done with antigen preparations containing Gb3/lecithin/cholesterol (1 :6 :20, by wt.) showed antiGb3 titres of up to 1 : 8192. Fractionation of the antiserum by BioGel A5m chromatography indicated the antibody was an IgM immunoglobulin. The partially purified antibody stimulated complement-dependent release of glucose from glucose-containing liposomes prepared with shingomyelin/cholesterol/dicetylphosphate/Gb3 (molar ratio, 100 : 75 :11 :1). The antibody crossreacted with the trisaccharide, Gal(alpha1 leads to 4)Gal(beta1 leads to 4)Glc, but not with galactosylerceramide, lactosylceramide, GM1 ganglioside, globotetraosylceramide, digalactosyldiglyceride or a number of low molecular weight saccharides.

Animals↗

Minimal invasive epicardial lead implantation: optimizing cardiac resynchronization with a new mapping device for epicardial lead placement.

To optimize resynchronization in biventricular pacing with epicardial leads, mapping to determine the best pacing site, is a prerequisite. A port access surgical mapping technique was developed that allowed multiple pace site selection and reproducible lead evaluation and implantation. Pressure-volume loops analysis was used for real time guidance in targeting epicardial lead placement. Even the smallest changes in lead position revealed significantly different functional results. Optimizing the pacing site with this technique allowed functional improvement up to 40% versus random pace site selection.

Cardiac Pacing, Artificial↗

Successful percutaneous extraction of pacemaker leads with a novel (VascoExtor) pacing lead removal system.

A new pacing lead extraction system (VascoExtor, VascoMed, Germany) with a universally applicable locking stylet was used over a period of 12 months to extract 25 permanent pacemaker leads (mean implantation time 3.9 +/- 3.8 years) in 16 patients who had pacemaker infection (n = 13), lead dysfunction (n = 2), or before an automatic defibrillator implant (n = 1). With use of this system, we were able to successfully and safely remove 24 of 25 chronic pacing leads (96%) in 15 of 16 patients (93%) with sole use of the locking stylet in 81%, and with use of an array of ancillary tools in the remaining 19% of patients.

Aged↗

Diagnostic accuracy of the conventional 12-lead and the orthogonal Frank-lead electrocardiograms in detection of myocardial infarctions with classifiers using continuous and Bernoulli features.

The performance of ECG classifiers using Bernoulli variables was evaluated in comparison with the same classifiers using an identical set of ECG features measured in continuum. A Bernoulli variable is permitted to take only two states depending on whether its value is below or above a given threshold. A new method was used for discretization threshold optimization. The branch-and-bound algorithm, the sequential forward selection and backward rejection procedures were used for selecting the best subsets of Bernoulli and continuous features out of the primary set of features measured from the conventional 12-lead and the orthogonal Frank-lead ECG. A linear discriminant function was used to estimate the classification accuracy of Bernoulli and continuous features in a test library composed of ECGs of 237 Subjects with old myocardial infarcts and 299 subjects without infarction. The results indicate that while Bernoulli variables perform as well as or better than continuous variables over a wide range of sensitivity and specificity, continuous features appear to yield a higher diagnostic accuracy when a high level of specificity is required. In comparison with the diagnostic accuracy of the Minnesota Code's criteria for myocardial infarction, decision-theoretic classifiers using continuous features yielded an overall improvement in sensitivity from 14 to 20% at a fixed level of specificity. The information content of the conventional 12-lead ECG appeared as good as or better than that of the orthogonal Frank-lead ECG regarding differential diagnosis between myocardial infarction and non-infarction groups when identical statistical procedures were used for the design of the classifiers.

Computers↗

Tribasic lead maleate and lead maleate: synthesis and structural and spectroscopic characterizations.

We report on the synthesis and structure of tribasic lead maleate hemihydrate ([Pb4O3]C2H2(CO2)2.(1/2)H2O, TRIMAL) and lead maleate (PbC2H2(CO2)2, PBMAL). The structure of [Pb4O3]C2H2(CO2)2.(1/2)H2O, solved ab initio from X-ray powder diffraction data, consists of infinite slabs of edge-sharing OPb4 tetrahedra, of composition [Pb4O3], running along the c axis and linked together into a three-dimensional network by tetradentate maleate anionic ligands. The structure of PbC2H2(CO2)2, solved from single crystal diffraction data, is lamellar and contains double layers of heptacoordinated lead atoms, bonded only to the oxygen atoms of the maleate ligands. In both compounds, lead is in the oxidation state 2+ and the coordination polyhedra around the Pb2+ exhibit a hemidirected geometry and are strongly distorted as a result of the lone pair of electrons. The absence of protons on the acidic portion of the maleate moieties was confirmed by Raman spectroscopy and by 1H MAS and 1H-13C CP MAS NMR experiments. The two compounds were further characterized using chemical and thermogravimetric analyses.

Journal Article↗

In silico drug discovery: solving the "target-rich and lead-poor" imbalance using the genome-to-drug-lead paradigm.

Advances in genomics, proteomics, and structural genomics have identified a large number of protein targets. Virtual screening has gained popularity in identifying drug leads by computationally screening large numbers of chemicals against experimentally determined protein targets. In that context, there continues to be a "target-rich and lead-poor" imbalance, reflecting an insufficiency of chemists pursuing drug discovery in academia, the challenge of engaging more chemists in this area of research, and a paucity of available protein target structures. This imbalance in manpower and structural information can be ameliorated, in part, by adapting a "genome-to-drug-lead" approach, in which chemicals can be virtually screened against computer-predicted protein targets, within the context of the US National Science Foundation's petascale computing initiative. This approach offers a solution to reduce manpower requirements for more chemists to experimentally search for drug leads, which represent one of the greatest limitations to drug discovery and better exploits the extensive availability of drug targets at the gene level, ultimately improving the success of moving discoveries from the laboratory to the patient.

Chemistry, Pharmaceutical↗

Follow-up X rays play a key role in detecting implantable cardioverter defibrillator lead fracture: a case of incessant inappropriate shocks due to lead fracture.

A patient with an implantable cardioverter defibrillator (ICD) received incessant inappropriate shocks due to a lead fracture 3 years after implantation. Routine lead measurements at 3-month intervals had shown no abnormal findings even at the most recent measurement performed 2 months prior to the event. In contrast, serial observation of chest X rays clearly disclosed progressive lead narrowing starting 11 months prior to the event. This case indicates the importance of the routine chest X rays in long-term follow-up of ICDs and sets a precedent for interpreting lead narrowing in such X rays.

Cardiomyopathy, Hypertrophic↗

Experimental model of lead nephropathy. III. Continuous low-level lead administration.

We sought to determine whether continuous low-level lead exposure (100 ppm lead acetate in drinking water) for periods of 1, 3, 6, 9, or 12 mo would produce adverse effects on kidney function or morphology in rats. Maximum blood lead levels in experimental animals were reached at 3 mo and averaged 29.4 +/- 4.1 micrograms/dl. Glomerular filtration rate, determined by single-injection 125I-iothalamate clearance, was found to be significantly increased above pair-fed controls at 1 and 3 mo, but it was normal at other time periods. Levels of urinary N-acetyl-beta-D-glucosaminidase exceeded levels found in controls at all time periods, except at 12 mo, when the normal increase with aging obscured differences between experimental animals and controls. In contrast, urinary ligandin (glutathione S transferase), a more specific marker of metal-associated proximal tubular injury, was normal at all time periods. Proximal tubular nuclear inclusion bodies were sparse and were observed only at 1 and 3 mo. There were no other pathological alterations in the kidneys, except at 12 mo, at which time mild tubular atrophy and interstitial fibrosis were seen. Therefore, low-level lead exposure in rats produced no significant changes in renal function and produced only mild alterations in renal morphology after 12 mo. The absence of changes in urinary ligandin accorded with the relative absence of morphological changes, whereas the observed increases in urinary N-acetyl-beta-D-glucosaminidase suggest that this enzyme may be an overly sensitive indicator of tubular injury.

Acetylglucosaminidase↗

Assessment of 1-lead and 2-lead electrode patterns in electrical impedance endotomography.

Electrical impedance endotomography (EIE) is a modality of impedance imaging where the electrodes are located on an insulating core placed at the centre of the region of interest. The absence of a physical limit to the medium surrounding the probe enables the use of remote electrodes. The present study compares the features of 2-lead measurements, where the two pairs of electrodes are located on the probe, to 1-lead measurements, where one of the two injection electrodes and one of the two sensing electrodes are located at a distance far away from the probe. The methodology was the characterization of the sensitivity matrix under the influence of electrode pattern, reconstruction radius and mesh construction. Three mesh constructions, three values of the reconstruction radius and five electrode patterns were compared. The study was carried out in 2D using calculated data. Measurement noise was simulated by an addition of 5% Gaussian white noise. The images were reconstructed using the Tikhonov method and L-curve technique. The results show that the reconstruction mesh and the radius of the reconstruction domain have less influence on the conditioning of the sensitivity matrix than the electrode pattern. Both 1-lead and 2-lead configurations enabled the reconstruction of images of relatively similar quality. Additional selection criteria are expected from hardware considerations.

Animals↗

Solubility of (1 leads to 3)-beta-D/(1 leads to 6)-beta-D-glucan in fungal walls: importance of presumed linkage between glucan and chitin.

In Saccharomyces cerevisiae, Neurospora crassa, Aspergillus nidulans and Coprinus cinereus most of the alkali-insoluble (1 leads to 3)-beta-D/(1 leads to 6)-beta-D-glucan of the wall can be extracted with dimethyl sulphoxide. The same fraction, and in Saccharomyces cerevisiae a small additional fraction, can be extracted by a destructive procedure involving 40% NaOH at 100 degrees C. The small fraction of the glucan which resists this treatment becomes soluble after a subsequent treatment with HNO2 indicating that it is covalently linked to chitin in the wall. In contrast, in Schizophyllum commune and Agaricus bisporus, nearly all the (1 leads to 3)-beta-D/(1 leads to 6)-beta-D-glucan appears to be held insoluble by linkage to chitin.

Agaricales↗

Clinical experience with 910 carbon tip leads: comparison with polished platinum leads.

Since 1980, we have implanted 910 carbon tip leads from three different manufacturers. The pacing thresholds from these leads were compared to those of standard polished platinum electrode configurations. Our major findings are that while acute voltage thresholds are not significantly different, two of the three carbon tip leads that we used in the study have statistically lower chronic thresholds then polished platinum leads (p less than or equal to 0.01).

Carbon↗

Clinical surveillance of an active fixation, bipolar, polyurethane insulated pacing lead, Part II: The ventricular lead.

Since 1989, 72 Telectronics 330-201 active fixation, polyurethane insulated ventricular leads (Accufix) have been implanted at the Mayo Clinic. There were four (5.6%) acute lead related complications (perforation, microdislodgment, and macrodislodgment), three of which led to early reoperation. Over a follow-up time of up to 2.7 years (median 9.4 months), there were six (8.3%) chronic lead related complications but no failures of lead material. Most of these complications developed during the first month, and half of them were transient, with documented improvement later. Two patients (2.8%) required reoperation for chronic complications. At follow-up examination of the pacing thresholds, usually performed about 3 months after implantation, 14.3% of the examined patients had high pacing thresholds necessitating high-output programming. The mechanisms and later evolution of this phenomenon should be further evaluated.

Adult↗

Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty.

The procedure of lead removal has recently matured into a definable, teachable art with its own specific tools and techniques. It is now time to recognize and formalize the practice of lead removal according to the current methods of medicine and the health care industry. In addition, since at this time the only prospective scientific study of lead extraction is the PLEXES trial, we suggest that studies relating to the techniques of and indications for lead extraction be designed. Recommendations for a common set of definitions, for a framework of training and reviewing physicians in the art, for general methods of reimbursement, and for consistency among clinical trials have been made. Implementation of these recommendations will require additional effort and cooperation from practicing physicians, medical societies, hospital administrations, and industry.

Cardiac Surgical Procedures↗

Initial results with left ventricular pacemaker lead implantation using a preformed "peel-away" guiding sheath and "side-wire" left ventricular pacing lead.

We report our preliminary experience with the use of preformed "peel-away" guiding sheaths and "side-wire" pacing leads for permanent biventricular pacemaker insertion in 13 patients with heart failure. Three of these patients were undergoing an upgrade of a preexistent VVIR pacing system after prior His ablation for medically refractory atrial fibrillation. Six of the patients had undergone attempted biventricular pacemaker insertion, but required left ventricular lead repositioning after total implantation failure or late displacement of the lead. The remaining patients were undergoing new system implantation. Target vessel cannulation was achieved in all patients. However, in one patient, diaphragmatic pacing throughout the target vessel length prevented successful implantation. All other implants were ultimately successful (92% success rate). We conclude that device implantation using a preformed sheath and side-wire pacing lead is feasible and may offer significant benefits over implantation with currently available technology.

Adult↗