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- Chockalingam, Priya, et al.
(author)
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Not all beta-blockers are equal in the management of Long QT Syndrome types 1 and 2 : higher recurrence of events under metoprolol
- 2012
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In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 60:20, s. 2092-2099
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Journal article (peer-reviewed)abstract
- Objectives The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equally effective.Methods Electrocardiographic and clinical parameters of 382 LQT1/LQT2 patients initiated on propranolol (n = 134), metoprolol (n = 147), and nadolol (n = 101) were analyzed, excluding patients <1 year of age at beta-blocker initiation. Symptoms before therapy and the first breakthrough cardiac events (BCEs) were documented.Results Patients (56% female, 27% symptomatic, heart rate 76 +/- 16 beats/min, QTc 472 +/- 46 ms) were started on beta-blocker therapy at a median age of 14 years (interquartile range: 8 to 32 years). The QTc shortening with propranolol was significantly greater than with other beta-blockers in the total cohort and in the subset with QTc >480 ms. None of the asymptomatic patients had BCEs. Among symptomatic patients (n = 101), 15 had BCEs (all syncopes). The QTc shortening was significantly less pronounced among patients with BCEs. There was a greater risk of BCEs for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, 95% confidence interval: 1.2 to 13.1, p = 0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol.Conclusions Propranolol has a significantly better QTc shortening effect compared to metoprolol and nadolol, especially in patients with prolonged QTc. Propranolol and nadolol are equally effective, whereas symptomatic patients started on metoprolol are at a significantly higher risk for BCEs. Metoprolol should not be used for symptomatic LQT1 and LQT2 patients.(J Am Coll Cardiol 2012;60:2092-9) (C) 2012 by the American College of Cardiology Foundation
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| 2. |
- Christensson, Niklas, et al.
(author)
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Electronic Double-Quantum Coherences and Their Impact on Ultrafast Spectroscopy: The Example of beta-Carotene
- 2010
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In: The Journal of Physical Chemistry Letters. - : American Chemical Society (ACS). - 1948-7185. ; 1:23, s. 3366-3370
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Journal article (peer-reviewed)abstract
- The energy level structure and dynamics of biomolecules are important for understanding their photoinduced function. In particular, the role of carotenoids in light-harvesting is heavily studied, yet not fully understood. The conventional approach to investigate these processes involves analysis of the third-order optical polarization in one spectral dimension. Here, we record two-dimensional correlation spectra for different time-orderings to characterize all components of the transient molecular polarization and the optical signal. Single- and double-quantum two-dimensional experiments provide insight into the energy level structure as well as the ultrafast dynamics of solvated beta-carotene. By analysis of the lineshapes, we obtain the transition energy and characterize the potential energy, surfaces of the involved states. We obtain direct experimental proof for an excited state absorption transition in the visible (S-2 -> S-n2). The signatures of this transition in pump-probe transients are shown to lead to strongly damped oscillations with characteristic pump and probe frequency dependence.
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| 3. |
- Nemeth, Alexandra, et al.
(author)
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Double-quantum two-dimensional electronic spectroscopy of a three-level system: Experiments and simulations
- 2010
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In: Journal of Chemical Physics. - : AIP Publishing. - 0021-9606 .- 1089-7690. ; 133:9
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Journal article (peer-reviewed)abstract
- Double-quantum coherence two-dimensional (2Q2D) electronic spectroscopy is utilized to probe the dynamic fluctuations of electronic states in a solvated molecule at approximately twice the energy of the ground state bleach transition. The 2Q2D spectrum gives insight into the energetic position and spectral fluctuations (system-bath interaction) of the probed excited states. Combining it with single-quantum two-dimensional (1Q2D) electronic spectroscopy enables one to determine the strength of the excited state absorption transition and the relative detuning of electronic states, as well as the dynamics of the single-quantum coherence. To investigate the correlation of spectral fluctuations in different electronically excited states, we have carried out experiments on a solvated dye (Rhodamine 6G) with 23 fs pulses centered at the maximum of the linear absorption spectrum. The 2Q2D spectrum reveals three peaks of alternating signs with the major negative peak located at higher frequencies along the emission axis compared to the single positive peak. The 1Q2D spectrum, on the other hand, shows a negative peak stemming from excited state absorption at lower frequencies along the emission axis. Analysis of the signal in the homogeneous limit fails to account for this observation as well as the number of peaks in the 2Q2D spectrum. Employing a three-level model in which all time correlations of the third-order response function are accounted for via second-order cumulant expansion gives good agreement with both the 1Q2D and 2Q2D data. Furthermore, the analysis shows that the fluctuations of the probed electronic states are highly correlated, reflecting the modulation by a common nuclear bath and similarities in the nature of the electronic transitions. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3474995]
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| 4. |
- Thor, Maria, et al.
(author)
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Introducing multiple treatment plan-based comparison to investigate the performance of gantry angle optimisation (GAO) in IMRT for head and neck cancer
- 2012
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In: Acta Oncologica. - 1651-226X. ; 51:6, s. 743-751
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Journal article (peer-reviewed)abstract
- Background and purpose. The purpose of this study was to evaluate the performance of gantry angle optimisation (GAO) compared to equidistant beam geometry for two inverse treatment planning systems (TPSs) by utilising the information obtained from a range of treatment plans. Material and methods. The comparison was based on treatment plans generated for four different head and neck (H&N) cancer cases using two inverse treatment planning systems (TPSs); Varian Eclipse (TM) representing dynamic MLC intensity modulated radiotherapy (IMRT) and Oncentra (R) Masterplan representing segmented MLC-based IMRT. The patient cases were selected on the criterion of representing different degrees of overlap between the planning target volume (PTV) and the investigated organ at risk, the ipsilateral parotid gland. For each case, a number of 'Pareto optimal' plans were generated in order to investigate the trade-off between the under-dosage to the PTV (V-PTV,V-D (< 95%)) or the decrease in dose homogeneity (D-5-D-95) to the PTV as a function of the mean absorbed dose to the ipsilateral parotid gland (< D >(parotid gland)). Results. For the Eclipse system, GAO had a clear advantage for the cases with smallest overlap (Cases 1 and 2). The set of data points, representing the underlying trade-offs, generated with and without using GAO were, however, not as clearly separated for the cases with larger overlap (Cases 3 and 4). With the OMP system, the difference was less pronounced for all cases. The Eclipse GAO displays the most favourable trade-off for all H&N cases. Conclusions. We have found differences in the effectiveness of GAO as compared to equidistant beam geometry, in terms of handling conflicting trade-offs for two commercial inverse TPSs. A comparison, based on a range of treatment plans, as developed in this study, is likely to improve the understanding of conflicting trade-offs and might apply to other thorough comparison techniques.
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