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2,332,800 | Fractal cardiovascular dynamics and baroreflex sensitivity after stellate ganglion block. | It has been shown that stellate ganglion block can attenuate baroreflex sensitivity. Our primary purpose in this study was to determine whether fractal dynamics (dynamic change of self-similar fluctuation patterns) of not only heart rate but also systolic blood pressure variability are involved in attenuation of baroreflex sensitivity after stellate ganglion block.</AbstractText>Sixteen young, healthy volunteers entered the study. Spectral analysis of heart rate and systolic blood pressure variability was performed before and 30, 60, 90, and 120 min after either right or left stellate ganglion block, separated by a 1 to 1(1/2)-mo interval, with 6 mL of 1% mepivacaine. Shortly after each spectral analysis, baroreflex sensitivity was assessed with the head-up tilt test.</AbstractText>Baroreflex sensitivity, assessed by the head-up tilt test, was significantly attenuated at 30 min after either right or left stellate ganglion block (1.26 +/- 0.18 to 0.46 +/- 0.08 bpm/mm Hg, P < 0.05 and 1.17 +/- 0.35 to 0.51 +/- 0.13 bpm/min, P < 0.01, respectively). Fractal slopes reflecting the degree of self-similarity of fluctuations were significantly increased at 30 min after either right or left stellate ganglion block (right stellate ganglion block--heart rate; -1.08 +/- 0.30 to -1.62 +/- 0.22, P < 0.01; right stellate ganglion block--systolic blood pressure; -1.30 +/- 0.80 to -2.40 +/- 0.80, P < 0.05; left stellate ganglion block--systolic blood pressure; -1.20 +/- 0.40 to -2.13 +/- 0.50, P < 0.05). Fractal slope did not change after left stellate ganglion block with heart rate variability analysis.</AbstractText>Loss of complexity (status of being complex behavior) of both heart rate and systolic blood pressure variability, indicated by increased fractal slopes, is one mechanism in attenuating baroreflex sensitivity after stellate ganglion block.</AbstractText> |
2,332,801 | Cryo-Imaging of Fluorescently-Labeled Single Cells in a Mouse. | We developed a cryo-imaging system to provide single-cell detection of fluorescently labeled cells in mouse, with particular applicability to stem cells and metastatic cancer. The Case cryo-imaging system consists of a fluorescence microscope, robotic imaging positioner, customized cryostat, PC-based control system, and visualization/analysis software. The system alternates between sectioning (10-40 μm) and imaging, collecting color brightfield and fluorescent block-face image volumes >60GB. In mouse experiments, we imaged quantum-dot labeled stem cells, GFP-labeled cancer and stem cells, and cell-size fluorescent microspheres. To remove subsurface fluorescence, we used a simplified model of light-tissue interaction whereby the next image was scaled, blurred, and subtracted from the current image. We estimated scaling and blurring parameters by minimizing entropy of subtracted images. Tissue specific attenuation parameters were found [u(T) : heart (267 ± 47.6 μm), liver (218 ± 27.1 μm), brain (161 ± 27.4 μm)] to be within the range of estimates in the literature. "Next image" processing removed subsurface fluorescence equally well across multiple tissues (brain, kidney, liver, adipose tissue, etc.), and analysis of 200 microsphere images in the brain gave 97±2% reduction of subsurface fluorescence. Fluorescent signals were determined to arise from single cells based upon geometric and integrated intensity measurements. Next image processing greatly improved axial resolution, enabled high quality 3D volume renderings, and improved enumeration of single cells with connected component analysis by up to 24%. Analysis of image volumes identified metastatic cancer sites, found homing of stem cells to injury sites, and showed microsphere distribution correlated with blood flow patterns.We developed and evaluated cryo-imaging to provide single-cell detection of fluorescently labeled cells in mouse. Our cryo-imaging system provides extreme (>60GB), micron-scale, fluorescence, and bright field image data. Here we describe our image pre-processing, analysis, and visualization techniques. Processing improves axial resolution, reduces subsurface fluorescence by 97%, and enables single cell detection and counting. High quality 3D volume renderings enable us to evaluate cell distribution patterns. Applications include the myriad of biomedical experiments using fluorescent reporter gene and exogenous fluorophore labeling of cells in applications such as stem cell regenerative medicine, cancer, tissue engineering, etc. |
2,332,802 | Biphasic myopathic phenotype of mouse DUX, an ORF within conserved FSHD-related repeats. | Facioscapulohumeral muscular dystrophy (FSHD) is caused by contractions of D4Z4 repeats at 4q35.2 thought to induce misregulation of nearby genes, one of which, DUX4, is actually localized within each repeat. A conserved ORF (mDUX), embedded within D4Z4-like repeats, encoding a double-homeodomain protein, was recently identified on mouse chromosome 10. We show here that high level mDUX expression induces myoblast death, while low non-toxic levels block myogenic differentiation by down-regulating MyoD and Myf5. Toxicity and MyoD/Myf5 expression changes were competitively reversed by overexpression of Pax3 or Pax7, implying mechanistic similarities with the anti-myogenic activity of human DUX4. We tested the effect of mDUX expression on Xenopus development, and found that global overexpression led to abnormalities in gastrulation. When targeted unilaterally into blastomeres fated to become tail muscle in 16-cell embryos, mDUX caused markedly reduced tail myogenesis on the injected side. These novel cell and animal models highlight the myopathic nature of sequences within the FSHD-related repeat array. |
2,332,803 | Safety and effectiveness of coadministration of intrathecal sufentanil and morphine in hyperbaric bupivacaine-based spinal anesthesia for cesarean section. | Subarachnoid block is a widely used technique for cesarean section. Opioids adding to the local anesthetics can improve its quality. In this prospective, randomized, double blind, controlled trial, we compared the effects of coadministration of intrathecal sufentanil and morphine with intrathecal sufentanil and a single administration of subcutaneous morphine. Sixty-four pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned to two groups according to the way of administration of morphine: intrathecal sufentanil (5 microg) plus intrathecal morphine (150 microg) (ITM group), and intrathecal sufentanil (5 microg) plus single administration of 10 mg subcutaneous morphine (SCM group). In both groups, the local anesthetic used was hyperbaric bupivacaine 0.5 percent (10 mg). Both groups received 1 g acetaminophen every 6 hours. In the postoperative period, pain was recorded on a 0-100 visual analog scale (VAS) and intravenous tramadol (100 mg) was administered if VAS score was >40 mm. Collateral effects, such as nausea, itching, respiratory depression, and sedation were assessed. VAS scores at rest and on coughing were significantly higher in the SCM group than in the ITM group between 3 and 24 hours. The mean titrated dose of tramadol consumed was also significantly greater in the SCM group than in the ITM group (p < 0.05). The time to first administration of tramadol was lower in the SCM group versus the ITM group (p < 0.05). The incidence of nausea was significantly lower in the SCM group than in the ITM group (p < 0.05). There was no significant group difference in the incidence of pruritus (p > 0.05). In conclusion, coadministration of sufentanil and morphine into the subarachnoid space was effective and provided longer pain relief than intrathecal sufentanil plus a single injection of subcutaneous morphine, despite a higher incidence of side effects such as nausea and vomiting. |
2,332,804 | [Efficacy of sugammadex in the reversal of neuromuscular blockade induced by rocuronium in long-duration surgery: under inhaled vs. intravenous anesthesia]. | Sugammadex reverses neuromuscular blockade induced by aminosteroid agents by encapsulating these agents. The objective of this study was to compare the efficacy and safety of sugammadex to reverse a rocuronium-induced neuromuscular blockade in long-duration surgery in association with inhaled or intravenous anesthesia.</AbstractText>We performed a randomized, double-blind, multicenter trial of 20 ASA 1-3 patients aged between 18 and 69 years and scheduled for elective surgery lasting at least 120 minutes. Anesthesia was induced with remifentanil and rocuronium at a dosage of 0.6 mg x kg(-1), and neuromuscular function was monitored by means of acceleromyography. After randomization, anesthesia was maintained with sevoflurane or with propofol for total intravenous anesthesia. Patients in both groups also received an infusion of remifentanil for analgesia and rocuronium to maintain a block of greater than 90%. After surgery, sugammadex was administered at a dosage of 2 mg x kg(-1) on reappearance of the second train-of-four (TOF) twitch (T2) and the times until recovery of T4/T1 ratios of 0.7, 0.8, and 0.9 (main endpoints). Mean arterial pressure and heart rate were recorded at baseline and after 2, 5, 10, and 30 minutes (secondary outcome measures).</AbstractText>Although less rocuronium was consumed in the sevoflurane group than in the propofol group and the time between the start of sugammadex administration until recovery of a TOF ratio of 0.9 was shorter for the sevoflurane group than for propofol group (mean [SD], 1.46 [0.30] minutes and 1.89 [0.62] minutes, respectively), these differences were not significant. No signs of recurarization or associated adverse effects were observed.</AbstractText>Sugammadex effectively and safely reverses a rocuronium-induced neuromuscular blockade in less than 2 minutes in long-duration surgery performed under both inhaled and intravenous anesthesia. The interaction of neuromuscular blocking agents with sevoflurane appears not to affect the reversal time of sugammadex in such operations.</AbstractText> |
2,332,805 | Irrigated radiofrequency-biophysics and application to surgical ablation. | Surgical ablation has become a routine procedure in many institutions and is a nearing standard of care for certain conditions. A variety of energy sources are available to the surgeon to induce cell death and create a line of conduction block. This article provides a brief review of the biophysics of irrigated radiofrequency and its application to monopolar and bipolar ablation. |
2,332,806 | Comparison of sub-Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery. | Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery.</AbstractText>In a randomized, observer-blinded trial, after obtaining institutional ethical committee approval and parental consent, 200 ASA grade I-II children aged 5-16 yr were allocated to receive either a sub-Tenon's block (Group SB) or 2 microg kg(-1) i.v. fentanyl (Group F) after induction of anaesthesia and topical anaesthesia of the conjunctiva with proparacaine 0.5% drops. Patients in Group F received fentanyl 0.5 microg kg(-1) and those in Group SB were given a corresponding volume of normal saline i.v. every hour from preloaded syringes. Increases in heart rate or mean arterial pressure by more than 20% of baseline were treated with additional 0.5 microg kg(-1) i.v. fentanyl boluses in both groups. The incidence of oculocardiac reflex (OCR), need for additional analgesics, postoperative pain, and PONV were recorded for the first 24 h after surgery.</AbstractText>More patients in Group F (47.96%) had moderate to severe pain in the first 24 h when compared with Group SB (31.36%) (P=0.023). The need for postoperative ibuprofen was higher in Group F (66.3%) compared with Group SB (47.95%) (P=0.012). The incidence of OCR was significantly higher in Group F (31.6%) compared with Group SB (5.1%) (P<0.001). The incidence of PONV was similar in both groups.</AbstractText>Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.</AbstractText> |
2,332,807 | The effects of intrathecal levobupivacaine and bupivacaine in the elderly. | The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 microg) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side-effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients. |
2,332,808 | Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section? | Spinal anesthesia for cesarean section is associated with a high incidence of maternal hypotension. The aim of this study was to assess the efficacy of low-dose bupivacaine with fentanyl to reduce the incidence of hypotension in spinal anesthesia for cesarean section.</AbstractText>Forty pregnant women undergoing elective cesarean section were randomly allocated to two groups; those receiving 10 mg bupivacaine to group B (n = 20) and those receiving 4 mg bupivacaine plus 25 microg fentanyl to group BF (n = 20); the agents were given intrathecally with patients in the sitting position, with a combined spinal-epidural technique.</AbstractText>Sensory block was adequate for surgery in all patients. Hypotension occurred in all patients in group B (100%) and in 15 patients in group BF (75%). The incidence of hypotension, number of ephedrine treatments, and need for ephedrine were significantly greater in group B than group BF. Three patients in group BF required i.v. fentanyl supplementation after delivery. In 1 of these patients, i.v. fentanyl was not adequate, and epidural supplementation of 1% lidocaine was required.</AbstractText>The development of hypotension after spinal block in subjects undergoing cesarean section was not prevented despite low-dose (4 mg) bupivacaine plus 25 microg fentanyl, but the severity of maternal hypotension, and the number of ephedrine treatments and the total dose of ephedrine were decreased.</AbstractText> |
2,332,809 | Exercise-induced vasculitis associated with autoimmune disease. | Exercised-induced vasculitis (EIV) is an underreported and frequently misdiagnosed condition that occurs on the lower extremities shortly after exercise. Most reported cases have presented in healthy-appearing individuals, but some cases have been linked to other disease processes. A case report is presented of recurring EIV in a 65-year-old woman with a history of dermatitis herpetiformis; chronic, mildly elevated liver transaminases of unknown cause; microscopic colitis; celiac disease; multiple miscarriages; and heart block who was found to have autoimmune hepatitis upon workup of her rash. Both EIV and autoimmune hepatitis were misdiagnosed over many years by several clinicians in various specialties. Her family history was remarkable for 2 sisters with systemic lupus erythematosus and similar recurring exercise-induced rashes of the lower extremities, suggesting a familial link for this condition. Clinicians should recognize EIV and consider the possibility that this disorder may be the presenting sign of subclinical connective-tissue diseases. |
2,332,810 | Performance and subjective effects of diazepam and d-amphetamine in high and low sensation seekers. | Although sensation-seeking status is associated with age of initiation and amount of drug use among adolescents, and sensitivity to the behavioral and reinforcing effects of drugs among young adults, it is unclear whether sensation-seeking status among adolescents is predictive of sensitivity to the pharmacological effects of drugs (i.e. abuse potential) as adults. This study examined the acute behavioral effects of oral diazepam and d-amphetamine in young adults, ages 18-21 years, who had consistently scored in the highest or lowest third of their grade-based cohort on a modified Sensation Seeking Scale that was completed annually between ages 10 and 14 years. Healthy participants completed 16 7.5-h test days, with test days separated by a minimum of 48 h. Each day, assessments consisting of computer task performance, verbal report of drug effects, and cardiovascular measures were completed 0, 50, 110, 170, 230, and 290 min after drug administration. Placebo and three active doses of diazepam and d-amphetamine (2.5, 5.0 and 10.0 mg/70 kg) were tested under double-blind conditions according to a randomized-block design. Typical stimulant and sedative effects were obtained with d-amphetamine and diazepam, respectively. Drug effects varied as a function of sensation-seeking status, with magnitude of effects on cardiovascular function, task performance, and report of positive drug effects being greater among high sensation seekers, and report of negative drug effects being greater among low sensation seekers. Adolescents who report high levels of sensation seeking on a consistent basis are more sensitive to pharmacological effects of stimulant and sedative drugs that are associated with abuse potential as young adults. |
2,332,811 | Congenital heart block associated with Sjögren syndrome: case report. | Congenital heart block is a rare complication of pregnancy associated with Sjögren Syndrome that may result in the death of the foetus or infant, or the need for pacing in the newborn or at a later stage.</AbstractText>The case is presented of a 64-year-old patient with primary Sjögren Syndrome and a history of having given birth to two sons with congenital heart block, both of whom required pacing several years later.</AbstractText>The literature relating to this association is discussed including the suggested mechanism, long-term outcome of mothers of children with congenital heart block and preventive treatment strategies.</AbstractText> |
2,332,812 | Diagnosing cardiac sarcoidosis clinically without tissue confirmation. | A 52-year-old woman is described in whom cardiac sarcoidosis was diagnosed clinically on the basis of high-grade heart block, recurring ventricular tachyarrhythmias, and acute cardiac decompensation. Confirmation of sarcoidosis was not determined until necropsy. When it causes cardiac dysfunction, sarcoidosis rarely causes dysfunction of another body organ, although small sarcoid granulomas may also be present in noncardiac organs or tissues. In the present patient, neurosarcoidosis accompanied the cardiac sarcoidosis, but it was the latter that produced the life-threatening symptoms and was fatal. |
2,332,813 | Development of a human immunodeficiency virus type 1-based lentiviral vector that allows efficient transduction of both human and rhesus blood cells. | Human immunodeficiency virus type 1 (HIV-1) vectors transduce rhesus blood cells poorly due to a species-specific block by TRIM5alpha and APOBEC3G, which target HIV-1 capsid and viral infectivity factor (Vif), respectively. We sought to develop a lentiviral vector capable of transducing both human and rhesus blood cells by combining components of both HIV-1 and simian immunodeficiency virus (SIV), including SIV capsid (sCA) and SIV Vif. A chimeric HIV-1 vector including sCA (chiHIV) was superior to the conventional SIV in transducing a human blood cell line and superior to the conventional HIV-1 vector in transducing a rhesus blood cell line. Among human CD34(+) hematopoietic stem cells (HSCs), the chiHIV and HIV-1 vectors showed similar transduction efficiencies; in rhesus CD34(+) HSCs, the chiHIV vector yielded superior transduction rates. In in vivo competitive repopulation experiments with two rhesus macaques, the chiHIV vector demonstrated superior marking levels over the conventional HIV-1 vector in all blood lineages (first rhesus, 15 to 30% versus 1 to 5%; second rhesus, 7 to 15% versus 0.5 to 2%, respectively) 3 to 7 months postinfusion. In summary, we have developed an HIV-1-based lentiviral vector system that should allow comprehensive preclinical testing of HIV-1-based therapeutic vectors in the rhesus macaque model with eventual clinical application. |
2,332,814 | Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients. | Spontaneous intracranial hypotension (SIH) is a potentially serious pathological syndrome consisting of specific symptoms and neuroradiological signs that can sometimes be used to assess the efficacy of the treatment. In this paper the authors report a series of 28 patients with this syndrome who were all treated with an epidural blood patch at the authors' institution. The authors propose a novel physiopathological theory of SIH based on some anatomical considerations about the spinal venous drainage system.</AbstractText>Between January 1993 and January 2007, the authors treated 28 patients in whom SIH had been diagnosed. Twenty-seven of the 28 patients presented with the typical findings of SIH on brain MR imaging (dural enhancement and thickening subdural collections, caudal displacement of cerebellar tonsils, and reduction in height of suprachiasmatic cisterns). The sites of the patients' neuroradiologically suspected CSF leakage were different, but the blood patch procedure was performed at the lumbar level in all patients. The patients were then assessed at 3-month and 1- and 3-year follow-up visits. At the last visit (although only available for 11 patients) 83.3% of patients were completely free from clinical symptoms and 8.3% complained of sporadic orthostatic headache.</AbstractText>The authors think that in the so-called SIH syndrome, the dural leak, even in those cases in which it can be clearly identified on neuroradiological examinations, is not the cause of the disease but the effect of the epidural hypotension maintained by the inferior cava vein outflow to the heart. The goal of their blood patch procedure (a sort of epidural block obtained using autologous blood and fibrin glue at the L1-2 level) is not to seal CSF leaks, but instead to help in reversing the CSF-blood gradient within the epidural space along the entire cord.</AbstractText>The authors' procedure seems to lead to good and long-lasting clinical results.</AbstractText> |
2,332,815 | Novel strategies for the prevention of dementia from Alzheimer's disease. | As the world's population continues to age, Alzheimer's disease presents a looming public health crisis that, left unchecked, threatens to overwhelm health care systems throughout the developed world. In order to significantly tackle the most catastrophic and devastating symptom of Alzheimer's disease (AD)--dementia--we must be able to detect the disease prior to the onset of clinical symptoms, and be able to offer patients preventative treatments that block or significantly slow disease progression. This review summarizes a variety of the most promising early detection methods for Alzheimer's disease (AD) and mild cognitive impairment (MCI) that could be used to identify those at high risk of developing the disease and used for monitoring disease progression and response to investigational treatments. In addition, treatment research programs that could be developed into disease-modifying treatments that significantly delay the development of dementia are highlighted. These potential treatments target many different pathways, and may one day be dosed in combination to increase efficacy and prevent cognitive deterioration in patients with AD. While we still face numerous challenges, AD researchers have made great progress in understanding disease mechanisms. As we have seen in the treatment of heart disease, even modest preventative treatments can have hugely significant clinical outcomes and drastically reduce disease prevalence on a population scale. Therefore, there is hope that the development of prophylactic treatments, combined with improved early detection methods, will provide dramatic relief for millions of aging individuals threatened by the specter of Alzheimer's disease.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shineman</LastName><ForeName>Diana W</ForeName><Initials>DW</Initials><AffiliationInfo><Affiliation>The Alzheimer's Drug Discovery Foundation, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fillit</LastName><ForeName>Howard M</ForeName><Initials>HM</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Dialogues Clin Neurosci</MedlineTA><NlmUniqueID>101238198</NlmUniqueID><ISSNLinking>1294-8322</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D016229">Amyloid beta-Peptides</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D053327">Apolipoprotein E4</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015415">Biomarkers</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D010446">Peptide Fragments</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C075222">amyloid beta-protein (1-42)</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000544" MajorTopicYN="N">Alzheimer Disease</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016229" MajorTopicYN="N">Amyloid beta-Peptides</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="N">cerebrospinal fluid</QualifierName><QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D053327" MajorTopicYN="N">Apolipoprotein E4</DescriptorName><QualifierName UI="Q000235" MajorTopicYN="N">genetics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015415" MajorTopicYN="N">Biomarkers</DescriptorName><QualifierName UI="Q000032" MajorTopicYN="N">analysis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001921" MajorTopicYN="N">Brain</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003072" MajorTopicYN="N">Cognition Disorders</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D042241" MajorTopicYN="N">Early Diagnosis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010446" MajorTopicYN="N">Peptide Fragments</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="N">cerebrospinal fluid</QualifierName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="spa">Ya que la población mundial sigue envejeciendo, la Enfermedad de Alzheimer presenta una crisis inminente para la salud pública, que si se descuida, amenazará con sobrecargar los sistemas de atención de salud en el mundo desarrollado. Para abordar significativamente el síntoma más catastrófico y devastador de la Enfermedad de Alzheimer (EA), la dementia, debemos ser capaces de detectar la enfermedad antes de que aparezcan los síntomas clínicos, y ofrecer a los pacientes tratamientos preventivos que bloqueen o retrasen significativamente la progresión de la enfermedad. Esta revisión resume varios de los métodos más prometedores de detección precoz para la EA y el deterioro cognitivo leve (DCL) que podrían ser utilizados para identificar a los pacientes con alto riesgo de desarrollar la enfermedad y para monitorear la progresión de ésta y la respuesta a tratamientos en investigatión. Además, se destacan algunos de los programas de tratamiento en investigatión que podrían llegar a constituir terapias modificadoras de la enfermedad, que retrasen significativamente el desarrollo de la dementia. Estos potentiates tratamientos están dirigidos a muy diversas vías, y un día podrán ser administrados en combinación para aumentar la eficatia y prévenir el deterioro cognitivo en patientes con EA. Aunque todavía se enfrentan numerosos desafíos, los investigadores de la EA han realizado grandes progresos para la comprensión de los mecanismes de la enfermedad. Como se ha observado en el tratamiento de la enfermedad cardíaca, incluso modestos tratamientos preventives pueden tener un gran impacto en la evolutión clínica y reducir drásticamente la prevalentia de la enfermedad en un subgrupo de la población. Por lo tanto, hay esperanzas en que el desarrollo de tratamientos profilácticos combinado con una mejoría en los métodos de detectión precoz, proveerá un dramático alivio para millones de individuos que están envejeciendo amenazados por el espectro de la Enfermedad de Alzheimer.</OtherAbstract><OtherAbstract Type="Publisher" Language="fre">Alors que la population mondiale vieillit, la maladie d'Alzheimer présente un problème imminent de santé publique qui, non maîtrisé, menace de submerger les systèmes de santé des pays développés. Afin de lutter signi ficativement contre le symptôme le plus catastrophique et le plus terrible de la maladie d'Alzheimer (MA), la démence, nous devons être capables de dépister la maladie avant l'apparition des symptômes cliniques et d'offrir aux patients des traitements préventifs pour arrêter ou ralentir significativement la progression de la maladie. Cet article résume les différentes méthodes les plus prometteuses de détection précoce de la MA et du déficit cognitif léger (DCL) qui pourraient permettre d'identifier les patients à haut risque de développer la maladie et qui permettraient de surveiller la progression du trouble et la réponse aux traitements étudiés. Il met de plus en lumière certains des programmes de recherche thérapeutique comme des traitements modifiant la maladie qui ralentissent significativement l'évolution de la démence. Ces traitements potentiels ciblent beaucoup de voies différentes et pourraient un jour être prescrits ensemble pour augmenter l'efficacité et prévenir la détérioration cognitive chez les patients atteints de MA, De nombreux défis nous attendent encore mais les chercheurs sur la MA ont beaucoup progressé dans la compréhension des mécanismes de la maladie. Comme nous l'avons vu avec le traitement de la maladie cardiaque, des traitements préventifs même modestes peuvent avoir de grands effets cliniques et réduire de façon importante la prévalence de la maladie à l'échelle d'une population, il y a donc un espoir que des traitements préventifs associés aux méthodes améliorées de détection précoce, apportent à des millions de sujets âgés menacés par ie spectre de la MA un soulagement remarquable. |
2,332,816 | Interleukin 7 receptor alpha as a potential therapeutic target in transplantation. | Drugs targeting memory lymphocytes may allow for a better control of rejection in transplantation, particularly in immunized patients. In this article the rationale of targeting interleukin 7 receptor alpha (IL-7Ralpha), a molecule expressed by both memory and naive T cells, is reviewed in the context of transplantation. Whereas naive T cells are partly responsible for acute rejection and are targeted by current immunosuppressive drugs that block costimulatory signals (cyclosporine A, anti-CD3 antibody, anti-CD52 antibody, anti-thymocyte globulin, etc.), memory T cells are resistant to costimulation blockade. As such, memory cells are an obstacle to experimental tolerance induction and may be involved in chronic rejection. There is thus much scientific interest in developing molecules able to target these cells. The role of the IL-7/IL-7Ralpha pathway in transplantation rejection has been suggested by the effect of an anti-IL-7 monoclonal antibody which, when associated with costimulation blockade, prolonged heart allograft survival in mice. Here the hypothesis that targeting IL-7Ralpha would preserve effector T cells that are less dependent on IL-7 for survival while sparing regulatory CD4+ CD25high IL-7Ralpha(low) T cells is discussed. An anti-IL-7Ralpha antibody could also help achieve allograft tolerance by reducing alloreactive cells. |
2,332,817 | Freezing reaction in panic disorder patients associated with anticipatory anxiety. | Anticipatory anxiety can be described as a conditioned response with a defensive posture of freezing and autonomic activation. The purpose of this study was to assess the postural control analysis and autonomic activation in panic disorder (PD) patients presented with visual stimuli.</AbstractText>PD patients (n=29) and healthy controls (n=27) stood on a force platform while viewing a series of anxiogenic, mutilation, and neutral pictures. Skin conductance responses and the displacements of the center of pressure were measured.</AbstractText>Overall, the PD patients demonstrated significantly reduced body sway, increased mean power frequency, and increased skin conductance compared to control group throughout the experiment (P<.05). PD patients also showed a negative correlation between anticipatory anxiety and mean sway area throughout the experiment. However, there was no significant difference in body sway velocity compared to healthy controls while viewing the anxiogenic block of pictures or the neutral block.</AbstractText>Our data shows that PD patients experiencing anticipatory anxiety may present with lower mobility, consistent with the freezing behavior of the defense cascade. The data also shows that PD patients do not have a postural instability when confronted with specific anxiogenic context. The importance of this study is that it objectively demonstrates freezing-like behavior in PD patients.</AbstractText> |
2,332,818 | Effect of scalp infiltration with Bupivacaine on early hemodynamic responses during craniotomy under general anesthesia. | The present study was conducted to evaluate the effect of scalp infiltration with Bupivacaine on hemodynamic responses during early stimulation in craniotomy under general anesthesia. Thirty six patients were prospectively randomized to receive Bupivacaine scalp infiltration (B group) or a saline control (S group) as an adjuvant to general anesthesia using isoflurane in 50% N2O-O2. Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded as base line, after scalp incision or pin insertion and then every 3 min until 12 min. The measurements were repeated every 5 min till dura was opened. The mean difference between the two groups for HR during scalp incision or pin insertion was significant (p = 0.03). The mean MAP throughout the time intervals of preincision or pin insertion to 12 min postincision and then to dural opening were statistically different between the two groups (p = 0.001). No complications related to the technique of block or drugs were recorded. Scalp infiltration with Bupivacaine as an adjuvant to general anesthesia can provide more stable hemodynamics, as measured by HR and MAP changes during early stimulation in craniotomy. |
2,332,819 | First episode psychosis and the trail to secondary care: help-seeking and health-system delays. | People experience delays in receiving effective treatment for many illnesses including psychosis. These delays have adverse consequences in heart disease and cancer, and their causes have been the subject of much research but only in recent years have pathways to care in psychosis received such attention. We sought to establish if, when and where people seek help in the early phase of psychosis in a representative sample.</AbstractText>One hundred and sixty-five people with first episode psychosis, referred from community-based psychiatric services and a private psychiatric facility to an early intervention service over 18 months, were interviewed with the Structured Clinical Interview for DSM-IV diagnoses. Symptoms were measured using the Schedule for the Assessment of Positive Symptoms, Schedule for the Assessment of Negative Symptoms and the Calgary Scale. Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were established using the Beiser Scale. Pathways to mental health services were systematically detailed through interviews with patients and their families.</AbstractText>The final sample consisted of 142 (88M, 54F) cases after those with psychosis due to a general medical condition and those without pathway and DUP data were excluded. Less than half of participants initiated help seeking themselves. Of those who did seek help (n = 57) 25% did so during the DUI. Those who had a positive family history of mental illness and poorer premorbid adjustment were significantly less likely to seek help for themselves and those who did not seek help were more likely to require hospitalisation. Families were involved in help seeking for 50% of cases and in 1/3 of cases did so without the affected individual participating in the contact. Being younger and having more negative symptoms were associated with having one's family involved in help seeking. Delays to effective treatment from the onset of psychosis were evenly split between "help-seeking delays" and "health-system delays". Having a family member involved in help seeking and better premorbid adjustment were independently associated with shorter help-seeking delays when measured from the onset of psychosis. Being female, having better premorbid adjustment and fewer negative symptoms were associated with shorter help-seeking delays from the onset of illness. Those with a non-affective psychosis had significantly longer system delays.</AbstractText>Many people with first episode psychosis do not initiate help-seeking for themselves particularly those with a relative affected by mental illness. Those with poor premorbid adjustment are at particular risk of longer delays. Poor premorbid adjustment compounded by long delays to effective treatment reduces the likelihood of a good outcome. Families play a vital role in hastening receipt of effective treatment.</AbstractText> |
2,332,820 | Tbx2 misexpression impairs deployment of second heart field derived progenitor cells to the arterial pole of the embryonic heart. | Tbx2 is a member of the T-box family of transcription factors that play important roles during heart development. In the embryonic heart tube, Tbx2 is expressed in non-chamber myocardium (outflow tract and interventricular canal) and has been shown to block chamber formation. We have developed a genetic system to conditionally misexpress Tbx2 in the embryonic mouse heart at early stages of development. We show that Tbx2 expression throughout the myocardium of the heart tube both represses proliferation and impairs secondary heart field (SHF) progenitor cell deployment into the outflow tract (OFT). Repression of proliferation is accompanied by the upregulation of Ndrg2 and downregulation of Ndrg4 expression, both genes believed to be involved in cell growth and proliferation. Impaired deployment of SHF cells from the pharyngeal mesoderm is accompanied by downregulation of the cell adhesion molecules Alcam and N-cadherin in the anterior part of the embryonic heart. Tbx2 misexpression also results in downregulation of Tbx20 within the OFT, indicating complex and region-specific transcriptional cross-regulation between the two T-box genes. |
2,332,821 | Cutaneous absorption of Oleander: Fact or fiction. | Cardiac conduction disorders following oral ingestion of Oleander plant materials were documented earlier. Transcutaneous absorption of yellow oleander (Thevetia peruviana) leaf extract applied over non intact skin (raw wound) resulting in reversible cardiac conduction disorder observed in four healthy males who were free from any other systemic or electrolyte or metabolic disorders or exposure to pesticide or toxins is reported for the first time. Their hematological, biochemical, clinical, and echocardiogram status were within normal limits and free of any abnormalities. One among the four, presented for weakness and breathlessness (class II). He had bradycardia with Mobitz II block and hypotension without any other demonstrable localizing signs. The other three were identified in the community and without any symptoms. However, their ECG revealed bradycardia with Mobitz I block in two and complete heart block in the other. All of the four recovered well without any untoward events. Hence, it is suggested that physicians and practitioners have to elicit history and route of administration of unconventional therapy, whenever they are confronted with clinical challenges and during medical emergencies before embarking final decision. |
2,332,822 | Strategic, political, and cultural aspects of IT implementation: improving the efficacy of an IT system in a large hospital.<Pagination><StartPage>191</StartPage><EndPage>207</EndPage><MedlinePgn>191-206; discussion 206-7</MedlinePgn></Pagination><Abstract><AbstractText>Healthcare spending will exceed $4 trillion by 2017, a trend that is leading executives to implement information technology (IT) systems to contain these rising costs. Studies show that numerous factors determine the outcome and net benefits of IT in healthcare. However, what happens when a newly implemented IT system results in negative outcomes? We explore this question by examining a newly implemented IT system in a large hospital that was yielding none of the benefits for which its designers had hoped. Using an expanded set of analytic lenses, our in-depth study found that political issues were a major stumbling block to the implementation of this IT system, as the interests of IT managers were different from those of the system's users. In addition, cultural values among these stakeholders were not aligned. The new IT system carried very different meanings for these two key groups. These political and cultural issues, which reflect a broader set of factors than is commonly applied in IT or in management, led to specific recommendations designed to improve the system's viability and benefits. In a follow-up analysis we found that these alternative lenses helped increase the intended usage of the IT system by 16 percent in the first year, yielding a 20 percent improvement in performance. By better understanding the cultural and political significance of IT implementation, managers may thus improve the effectiveness of new information technologies for containing costs in hospitals.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wurster</LastName><ForeName>Christina J</ForeName><Initials>CJ</Initials><AffiliationInfo><Affiliation>Heart Rhythm Society, Washington, DC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lichtenstein</LastName><ForeName>Benyamin B</ForeName><Initials>BB</Initials></Author><Author ValidYN="Y"><LastName>Hogeboom</LastName><ForeName>Tasha</ForeName><Initials>T</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Healthc Manag</MedlineTA><NlmUniqueID>9803529</NlmUniqueID><ISSNLinking>1096-9012</ISSNLinking></MedlineJournalInfo><MeshHeadingList><MeshHeading><DescriptorName UI="D003258" MajorTopicYN="N">Consumer Behavior</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017598" MajorTopicYN="Y">Efficiency, Organizational</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006284" MajorTopicYN="N">Health Plan Implementation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006751" MajorTopicYN="N">Hospital Information Systems</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006784" MajorTopicYN="N">Hospitals, Teaching</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="N">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009511" MajorTopicYN="N" Type="Geographic">New England</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015279" MajorTopicYN="N">Organizational Culture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009936" MajorTopicYN="N">Organizational Innovation</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>6</Month><Day>27</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>6</Month><Day>27</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>12</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19554799</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19553905</PMID><DateCompleted><Year>2009</Year><Month>08</Month><Day>07</Day></DateCompleted><DateRevised><Year>2021</Year><Month>10</Month><Day>20</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1940-087X</ISSN><JournalIssue CitedMedium="Internet"><Issue>28</Issue><PubDate><Year>2009</Year><Month>Jun</Month><Day>24</Day></PubDate></JournalIssue><Title>Journal of visualized experiments : JoVE</Title><ISOAbbreviation>J Vis Exp</ISOAbbreviation></Journal>Implantation of engineered tissue in the rat heart. | Healthcare spending will exceed $4 trillion by 2017, a trend that is leading executives to implement information technology (IT) systems to contain these rising costs. Studies show that numerous factors determine the outcome and net benefits of IT in healthcare. However, what happens when a newly implemented IT system results in negative outcomes? We explore this question by examining a newly implemented IT system in a large hospital that was yielding none of the benefits for which its designers had hoped. Using an expanded set of analytic lenses, our in-depth study found that political issues were a major stumbling block to the implementation of this IT system, as the interests of IT managers were different from those of the system's users. In addition, cultural values among these stakeholders were not aligned. The new IT system carried very different meanings for these two key groups. These political and cultural issues, which reflect a broader set of factors than is commonly applied in IT or in management, led to specific recommendations designed to improve the system's viability and benefits. In a follow-up analysis we found that these alternative lenses helped increase the intended usage of the IT system by 16 percent in the first year, yielding a 20 percent improvement in performance. By better understanding the cultural and political significance of IT implementation, managers may thus improve the effectiveness of new information technologies for containing costs in hospitals.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wurster</LastName><ForeName>Christina J</ForeName><Initials>CJ</Initials><AffiliationInfo><Affiliation>Heart Rhythm Society, Washington, DC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lichtenstein</LastName><ForeName>Benyamin B</ForeName><Initials>BB</Initials></Author><Author ValidYN="Y"><LastName>Hogeboom</LastName><ForeName>Tasha</ForeName><Initials>T</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Healthc Manag</MedlineTA><NlmUniqueID>9803529</NlmUniqueID><ISSNLinking>1096-9012</ISSNLinking></MedlineJournalInfo><MeshHeadingList><MeshHeading><DescriptorName UI="D003258" MajorTopicYN="N">Consumer Behavior</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017598" MajorTopicYN="Y">Efficiency, Organizational</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006284" MajorTopicYN="N">Health Plan Implementation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006751" MajorTopicYN="N">Hospital Information Systems</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006784" MajorTopicYN="N">Hospitals, Teaching</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="N">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009511" MajorTopicYN="N" Type="Geographic">New England</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015279" MajorTopicYN="N">Organizational Culture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009936" MajorTopicYN="N">Organizational Innovation</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>6</Month><Day>27</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>6</Month><Day>27</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>12</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19554799</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19553905</PMID><DateCompleted><Year>2009</Year><Month>08</Month><Day>07</Day></DateCompleted><DateRevised><Year>2021</Year><Month>10</Month><Day>20</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1940-087X</ISSN><JournalIssue CitedMedium="Internet"><Issue>28</Issue><PubDate><Year>2009</Year><Month>Jun</Month><Day>24</Day></PubDate></JournalIssue><Title>Journal of visualized experiments : JoVE</Title><ISOAbbreviation>J Vis Exp</ISOAbbreviation></Journal><ArticleTitle>Implantation of engineered tissue in the rat heart.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">1139</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.3791/1139</ELocationID><Abstract>Rodent surgery is often an important component in assessing the utility of engineered tissues. A wide variety of surgical procedures can be performed in common laboratory rats or mice and these quite frequently serve as an intermediate step between bench-top experiments and large animal testing or human trials. Given that rodents provide an established, cost-effective, and physiologically-relevant model system in which to test novel combinations of scaffolding materials and cells, they are particularly well-suited for cardiovascular tissue engineering studies. Presently, we describe an open-heart surgical procedure to implant engineered tissue containing myogenic progenitor cells in the atrioventricular (AV) groove of a rat heart. These implants are intended to create an electrical conduit between the right atrium and right ventricle with the ultimate goal of providing an alternative treatment to conventional pacemaker implantation in pediatric patients with complete heart block. The engineered tissue is implanted in the AV-groove by means of a thoracotomy. For our purposes, Lewis rats are anesthetized and invasively ventilated to maintain positive airway pressure during the sterile surgical procedure. The approach to the heart is performed by a right thoracotomy through an antero-lateral incision at the 5(th) intercostal space. The tissue construct is fixed in the AV groove using a single 7-0 Prolene suture and positioned between the right ventricle and atrium at the ventral portion of the heart. The epicardium is partially removed to allow direct contact between the recipient myocardial cells and those contained in the engineered tissue. Following implantation, the chest wall is closed in layers, any pneumothorax is evacuated, and the animal is extubated and treated with analgesic. |
2,332,823 | Traffic particles and occurrence of acute myocardial infarction: a case-control analysis. | We modelled exposure to traffic particles using a latent variable approach and investigated whether long-term exposure to traffic particles is associated with an increase in the occurrence of acute myocardial infarction (AMI) using data from a population-based coronary disease registry.</AbstractText>Cases of individually validated AMI were identified between 1995 and 2003 as part of the Worcester Heart Attack Study. Population controls were selected from Massachusetts, USA, resident lists. NO(2) and PM(2.5) filter absorbance were measured at 36 locations throughout the study area. The air pollution data were used to estimate exposure to traffic particles using a semiparametric latent variable regression model. Conditional logistic models were used to estimate the association between exposure to traffic particles and occurrence of AMI.</AbstractText>Modelled exposure to traffic particles was highest near the city of Worcester. Cases of AMI were more exposed to traffic and traffic particles compared to controls. An interquartile range increase in modelled traffic particles was associated with a 10% (95% CI 4% to 16%) increase in the odds of AMI. Accounting for spatial dependence at the census tract, but not block group, scale substantially attenuated this association.</AbstractText>These results provide some support for an association between long-term exposure to traffic particles and risk of AMI. The results were sensitive to the scale selected for the analysis of spatial dependence, an issue that requires further investigation. The latent variable model captured variation in exposure, although on a relatively large spatial scale.</AbstractText> |
2,332,824 | Continuous spinal anesthesia. | Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia. |
2,332,825 | Clinical conditions associated with environmental exposures: an epidemiologic study in two communities in Juana Díaz, Puerto Rico. | A population-based cross-sectional design was used to compare the prevalence of respiratory and general symptoms and of respiratory and heart diseases in two communities of Juana Díaz, Puerto Rico: Guayabal, exposed to particulate matter from quarries and diesel exhaust; and Río Cañas Abajo, which has no such exposure.</AbstractText>A probabilistic sampling design was used to obtain a representative sample of households and 288 residents of the selected households were interviewed. Adjusted PORs were estimated to assess the relationship between diseases/symptoms and place of residence using logistic regression models. To estimate the parameters of this model, a multilevel approach was used in order to control for potential correlation among residents of the same block.</AbstractText>A higher prevalence of general and respiratory symptoms and of respiratory diseases was observed for residents of Guayabal when compared to Río Cañas Abajo (p < 0.05). Residents of Guayabal were more likely to have bronchitis (adjusted POR = 5.5; p-value < 0.05), nasal allergies (adjusted POR = 4.2; p-value = 0.01), nasal congestion (adjusted POR = 2.9; p-value = 0.02), and nausea and vomiting (adjusted POR = 8.7; p-value < 0.01).</AbstractText>The perception of the community of Guayabal of a higher prevalence of symptoms and health conditions was supported by the present findings. This study provides statistical evidence for the design of an analytical epidemiologic study aimed at evaluating the potential effect of quarrying on adverse health outcomes in the community of Guayabal.</AbstractText> |
2,332,826 | Removal of out-of-plane fluorescence for single cell visualization and quantification in cryo-imaging. | We developed a cryo-imaging system, which alternates between sectioning (10-40 microm) and imaging bright field and fluorescence block-face image volumes with micron-scale-resolution. For applications requiring single-cell detection of fluorescently labeled cells anywhere in a mouse, we are developing software for reduction of out-of-plane fluorescence. In mouse experiments, we imaged GFP-labeled cancer and stem cells, and cell-sized fluorescent microspheres. To remove out-of-plane fluorescence, we used a simplified model of light-tissue interaction whereby the next-image was scaled, blurred, and subtracted from the current image. We estimated scaling and blurring parameters by minimizing an objective function on subtracted images. Tissue-specific attenuation parameters [micro(T): heart (267 +/- 47.6 cm(-1)), liver (218 +/- 27.1 cm(-1)), brain (161 +/- 27.4 cm(-1))] were found to be within the range of estimates in the literature. "Next-image" processing removed out-of-plane fluorescence equally well across multiple tissues (brain, kidney, liver, etc.), and analysis of 200 microsphere images gave 97 +/- 2% reduction of out-of-plane fluorescence. Next-image processing greatly improved axial-resolution, enabled high quality 3D volume renderings, and improved automated enumeration of single cells by up to 24%. The method has been used to identify metastatic cancer sites, determine homing of stem cells to injury sites, and show microsphere distribution correlated with blood flow patterns. |
2,332,827 | Mitochondrial permeability transition pore opening as a promising therapeutic target in cardiac diseases. | In addition to their central role in ATP synthesis, mitochondria play a critical role in cell death. Oxidative stress accompanied by calcium overload, ATP depletion, and elevated phosphate levels induces mitochondrial permeability transition (MPT) with formation of nonspecific MPT pores (MPTP) in the inner mitochondrial membrane. Pore opening results in mitochondrial dysfunction with uncoupled oxidative phosphorylation and ATP hydrolysis, ultimately leading to cell death. For the past 20 years, three proteins have been accepted as key structural components of the MPTP: adenine nucleotide translocase (ANT) in the inner membrane, cyclophilin D (CyP-D) in the matrix, and the voltage-dependent anion channel (VDAC) in the outer membrane. However, most recent studies have questioned the molecular identity of the pores. Genetic studies have eliminated the VDAC as an essential component of MPTP and attributed a regulatory (rather than structural) role to ANT. Currently, the phosphate carrier appears to play a crucial role in MPTP formation. MPTP opening has been examined extensively in cardiac pathological conditions, including ischemia/reperfusion as well as heart failure. Accordingly, MPTP is accepted as a therapeutic target for both pharmacological and conditional strategies to block pore formation by direct interaction with MPTP components or indirectly by decreasing MPTP inducers. Inhibition of MPTP opening by reduction of CyP-D activity by nonimmunosuppressive analogs of cyclosporine A or sanglifehrin A, as well as attenuation of reactive oxygen species accumulation through mitochondria-targeted antioxidants, is the most promising. This review outlines our current knowledge of the structure and function of the MPTP and describes possible approaches for cardioprotection. |
2,332,828 | [Epidural analgesia in latent phase of labor: effects on length of labor and mode of delivery]. | To compare the outcome of ropivacaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor.</AbstractText>360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 microg/ml sufentanil and active group (cervix dilation > or = 3 cm) receive 0.15% ropivacaine with 0.5 microg/ml sufentanil, both followed by an infusion of 0.1% ropivacaine with 0.5 microg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed.</AbstractText>Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups.</AbstractText>Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.</AbstractText> |
2,332,829 | The relationships of impulsivity and cardiovascular responses: the role of gender and task type. | The present study was conducted to assess the relationships of impulsivity with both baseline cardiovascular levels and reactivity during two laboratory stressors in both female and male young adults. Heart rate (HR), blood pressure (BP), and heart rate variability (HRV) were measured at rest and during a reaction time and speech task in one hundred and one undergraduate students. Impulsivity was measured using the Barratt Impulsiveness Scale-11 and Block's Ego-Undercontrol Scale. Males and females responded similarly to both laboratory tasks and also did not differ on the impulsivity scales. For males, higher scores on impulsivity were associated with higher systolic BP levels at rest but decreased systolic BP and HR reactivity during the preparation of the speech task; females showed no relationships of resting cardiovascular levels with impulsivity, but more impulsive females did show decreased HR response during speech preparation. No significant relationships were found between impulsivity and either HRV levels or reactivity. It is speculated that tasks involving a degree of planning may be important to find relationships between impulsivity and cardiovascular reactivity, especially in males. |
2,332,830 | Reversed drift in heart rate but increased oxygen uptake at fixed work rate during 24 h ultra-endurance exercise. | In this paper we report a reversed drift in heart rate (HR) but increased oxygen uptake (VO(2)) during ultra-endurance exercise. Nine well-trained male athletes performed 24-h exercise in a controlled laboratory setting, with alternating blocks of kayaking, running and cycling. Each block included 110 min of exercise and 10 min of rest, with an average work intensity of approximately 55% of respective VO(2peak). Blood samples were taken and HR and VO(2) measured every 6th hour during steady-state cycling at fixed work rate. As assumed HR was increased at 6 h by 15 +/- 6 beats/min compared with initial level (0 h). Thereafter the drift did not progress continuously, but instead unexpectedly returned toward initial values, although the plasma levels of catecholamines increased continuously during exercise. VO(2) was increased by 0.22 +/- 0.15 L/min (10%) at 6 h and 0.37 +/- 0.18 L/min (17%) at 12 h compared with 0 h, and thereafter remained stable. This implies an increased oxygen pulse (VO(2)/HR) by approximately 10% at the last half of the 24-h exercise compared with 0 h. Consequently, sole use of HR would give inaccurate estimates of exercise intensity and energy expenditure during endurance exercise lasting more than 6 h, and different patterns of cardiovascular drift need to be taken into account. |
2,332,831 | Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor. | To compare two neuraxial block techniques during labor for maternal and fetal effects.</AbstractText>Women in labor at term with cephalic singleton fetuses were randomized (nonblinded) to receive either labor epidural (EPI) or combined spinal-epidural (CSE) analgesia. Primary outcome was prolonged deceleration (PD) of fetal heart rate. Outcomes also included hypotension, mode of delivery, and efficacy of analgesia by visual analog pain scale (VAPS) before and after block placement.</AbstractText>Randomization occurred in 127 patients: 63 received EPI, 64 received CSE. There was no difference in the rate of PD in the EPI group compared with the CSE group (3.2% vs 6.2% respectively; P=0.43, RR 2.0; 95% CI 0.4-9.3), rate of cesarean delivery, or mean epidural duration. VAPS ratings were significantly lower in the CSE group.</AbstractText>There were no differences in the rate of PD or other adverse outcomes. Hypotension occurred more frequently with CSE during labor at term. The study supports both EPI and CSE during labor as safe and effective techniques for neuraxial analgesia.</AbstractText> |
2,332,832 | Post-ischemic infusion of atrial natriuretic peptide attenuates warm ischemia-reperfusion injury in rat lung. | The serious shortage of organs for transplantation, especially lungs, has drawn increasing attention to donation after cardiac death and protection of organs against warm ischemic injury. Atrial natriuretic peptide (ANP) activates guanylate cyclase receptors and increases cyclic guanosine monophosphate (cGMP) levels, which decrease in the lung during ischemia. In this study we investigated the effect on lung ischemia-reperfusion injury of administering synthetic ANP (carperitide) at the onset of reperfusion after warm ischemia.</AbstractText>An isolated rat lung perfusion model was used. The rats were allocated into three groups: the control group; the ANP group; and the sham group. In the control and ANP groups, the heart-lung block was exposed to 60 minutes of ischemia at 37 degrees C, and subsequently reperfused for 60 minutes. At the onset of reperfusion, either saline or ANP was added to the perfusate. In the sham group, lungs were continuously perfused without ischemia and only saline was added to the perfusate.</AbstractText>ANP significantly reduced pulmonary vascular resistance and pulmonary edema, and improved oxygenation. It also significantly increased cGMP levels in reperfused lungs. Histologically, lungs in the ANP group showed significantly fewer signs of injury and fewer cells demonstrated apoptotic changes or single-stranded DNA than lungs in the control group.</AbstractText>Our results indicate that ANP administered at the onset of reperfusion increases cGMP in lung tissue and attenuates warm ischemia-reperfusion injury in isolated perfused rat lung.</AbstractText> |
2,332,833 | A comparison of the efficacy and cardiorespiratory effects of four medetomidine-based anaesthetic protocols in the red fox (Vulpes vulpes). | To evaluate the anaesthetic and cardiorespiratory effects of four anaesthetic protocols in red foxes (Vulpes vulpes).</AbstractText>Prospective, blinded and randomized complete block design.</AbstractText>Ten adult captive red foxes.</AbstractText>Foxes were anaesthetized by intramuscular (IM) injection using four protocols in random order: medetomidine 40 microg kg(-1), midazolam 0.3 mg kg(-1) and butorphanol 0.1 mg kg(-1) (MMiB), medetomidine 40 microg kg(-1) and ketamine 4 mg kg(-1) (MK40/4), medetomidine 60 microg kg(-1) and ketamine 4 mg kg(-1) (MK60/4), medetomidine 40 microg kg(-1) and tiletamine/zolazepam 2 mg kg(-1) (MTZ). Time to lateral recumbency, induction time and time to recovery following IM administration of atipamezole 0.2 mg kg(-1) were recorded. Heart rate (HR), respiratory rate ((f)R) and rhythm, blood pressure, rectal temperature, end-tidal CO(2) tension (Pe'Co(2)), functional oxygen saturation and presence/absence of interdigital, palpebral and ear reflexes were recorded every 10 minutes, and following administration of atipamezole. Data were analysed using two-way repeated-measures anova with Bonferroni post tests; p < 0.05 was considered significant.</AbstractText>All protocols produced profound sedation with good muscle relaxation. Only the MMiB protocol diverged significantly from the others. Induction of anaesthesia and recovery time following atipamezole were significantly longer, and f(R) and initial HR significantly lower with MMiB than with the other protocols. With all protocols, mean arterial blood pressure (MAP) was initially relatively high (140-156 mmHg), and decreased significantly over time. With all protocols, the administration of atipamezole resulted in a rapid, significant decrease in MAP and an increase in HR.</AbstractText>All four protocols provided anaesthetic conditions suitable for minor procedures and allowed endotracheal intubation. The cyclohexanone protocols provided quicker and more reliable inductions and recoveries than the MMiB protocol.</AbstractText> |
2,332,834 | [Continuous epidural anaesthesia vs paravertebral block for lung surgery--a comparative study]. | This prospective randomized study compared the effects of two techniques--thoracic epidural analgesia (TEA), and thoracic paravertebral analgesia (TPVA), on pain control and haemodynamics after thoracotomy.</AbstractText>Sixty adult ASA 1 and 2 patients were randomly assigned to two equal groups to receive either: (I) 10 mL of 0.5% bupivacaine before and at the end of surgery via a thoracic epidural catheter; or (II) 30 mL of 0.5% bupivacaine before, and 15 mL at the end of surgery, via a thoracic paravertebral catheter. During the postoperative period, patients of both groups received continuous infusion of 0.1 mL kg(-1) h(-1) into the respective spaces. This technique was supplemented by patient-controlled intravenous infusion of fentanyl (bolus 0.02 mg; lock-out time 12 min).</AbstractText>The average dose of fentanyl administered intraoperatively in both groups was similar. Blood pressure and heart rate were significantly lower in the TEA group. Pain intensity, assessed using the NRS and PHHPS scales, was similar in both groups. PCA fentanyl consumption was higher in theTPVA group.</AbstractText>(1) Thoracic paravertebral anaesthesia can be regarded as a satisfactory alternative to epidural anaesthesia for control of post-thoracotomy pain. (2) The effect of paravertebral anaesthesia on blood pressure and heart rate is minimal, therefore this technique may be recommended for patients with coexisting circulatory disease. (3) The frequency of use of the PCA system cannot be regarded as an objective method of pain assessment.</AbstractText> |
2,332,835 | Mobile Block Hessian Approach with Adjoined Blocks: An Efficient Approach for the Calculation of Frequencies in Macromolecules. | In an earlier work, the authors developed a new method, the mobile block Hessian (MBH) approach, to accurately calculate vibrational modes for partially optimized molecular structures [ J. Chem. Phys. 2007 , 126 ( 22 ), 224102. ]. It is based on the introduction of blocks, consisting of groups of atoms, that can move as rigid bodies. The internal geometry of the blocks need not correspond to an overall optimization state of the total molecular structure. The standard MBH approach considers free blocks with six degrees of freedom. In the extended MBH approach introduced herein, the blocks can be connected by one or two adjoining atoms, which further reduces the number of degrees of freedom. The new approach paves the way for the normal-mode analysis of biomolecules such as proteins. It rests on the hypothesis that low-frequency modes of proteins can be described as pure rigid-body motions of blocks of consecutive amino acid residues. The method is validated for a series of small molecules and further applied to alanine dipeptide as a prototype to describe vibrational interactions between two peptide units; to crambin, a small protein with 46 amino acid residues; and to ICE/caspase-1, which contains 518 amino acid residues. |
2,332,836 | Identification of coagulation factor (F)X binding sites on the adenovirus serotype 5 hexon: effect of mutagenesis on FX interactions and gene transfer. | Recent studies have demonstrated the importance of coagulation factor X (FX) in adenovirus (Ad) serotype 5-mediated liver transduction in vivo. FX binds to the adenovirus hexon hypervariable regions (HVRs). Here, we perform a systematic analysis of FX binding to Ad5 HVRs 5 and 7, identifying domains and amino acids critical for this interaction. We constructed a model of the Ad5-FX interaction using crystallographic and cryo-electron microscopic data to identify contact points. Exchanging Ad5 HVR5 or HVR7 from Ad5 to Ad26 (which does not bind FX) diminished FX binding as analyzed by surface plasmon resonance, gene delivery in vitro, and liver transduction in vivo. Exchanging Ad5-HVR5 for Ad26-HVR5 produced deficient virus maturation. Importantly, defined mutagenesis of just 2 amino acids in Ad5-HVR5 circumvented this and was sufficient to block liver gene transfer. In addition, mutation of 4 amino acids in Ad5-HVR7 or a single mutation at position 451 also blocked FX-mediated effects in vitro and in vivo. We therefore define the regions and amino acids on the Ad5 hexon that bind with high affinity to FX thereby better defining adenovirus infectivity pathways. These vectors may be useful for gene therapy applications where evasion of liver transduction is a prerequisite. |
2,332,837 | Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for caesarean section. | Prophylactic infusion of phenylephrine to prevent hypotension at Caesarean section has been shown to decrease the rostral spread of intrathecal plain levobupivacaine and intrathecal hyperbaric bupivacaine by a median of two dermatomes compared with ephedrine. The aim of this study was to determine the median effective dose (ED50) of intrathecal bupivacaine required to achieve a block to touch at the xiphisternum in patients undergoing Caesarean section when phenylephrine or ephedrine are used to prevent hypotension.</AbstractText>Seventy women were randomized in two groups to receive either phenylephrine at a rate of 16.6 microg min(-1) (concentration 1microg ml(-1)) or ephedrine at a rate of 1.5 mg min(-1) (concentration 90 microg ml(-1)). Patients received varying doses of hyperbaric bupivacaine with fentanyl 25 microg using a double-blinded, up-down sequential allocation design. Effective doses were defined as anaesthesia to touch with ethyl chloride spray to the xiphisternum within 20 min.</AbstractText>The ED50 estimates of bupivacaine were similar in the two groups: 7.8 mg [95% confidence interval (CI) 6.7-8.9] with phenylephrine and 7.6 mg (95% CI 6.8-8.4) with ephedrine. Systolic blood pressure control was similar (P=0.18) with vasopressors but heart rate was higher with ephedrine (P=0.0014).</AbstractText>Under the conditions of this study, we have shown that when phenylephrine or ephedrine were used to prevent post-spinal hypotension, the dosing requirement of hyperbaric bupivacaine was similar for intrathecal anaesthesia.</AbstractText> |
2,332,838 | Loss of cerebrovascular Shaker-type K(+) channels: a shared vasodilator defect of genetic and renal hypertensive rats. | The cerebral arteries of hypertensive rats are depolarized and highly myogenic, suggesting a loss of K(+) channels in the vascular smooth muscle cells (VSMCs). The present study evaluated whether the dilator function of the prominent Shaker-type voltage-gated K(+) (K(V)1) channels is attenuated in middle cerebral arteries from two rat models of hypertension. Block of K(V)1 channels by correolide (1 micromol/l) or psora-4 (100 nmol/l) reduced the resting diameter of pressurized (80 mmHg) cerebral arteries from normotensive rats by an average of 28 +/- 3% or 26 +/- 3%, respectively. In contrast, arteries from spontaneously hypertensive rats (SHR) and aortic-banded (Ao-B) rats with chronic hypertension showed enhanced Ca(2+)-dependent tone and failed to significantly constrict to correolide or psora-4, implying a loss of K(V)1 channel-mediated vasodilation. Patch-clamp studies in the VSMCs of SHR confirmed that the peak K(+) current density attributed to K(V)1 channels averaged only 5.47 +/- 1.03 pA/pF, compared with 9.58 +/- 0.82 pA/pF in VSMCs of control Wistar-Kyoto rats. Subsequently, Western blots revealed a 49 +/- 7% to 66 +/- 7% loss of the pore-forming alpha(1.2)- and alpha(1.5)-subunits that compose K(V)1 channels in cerebral arteries of SHR and Ao-B rats compared with control animals. In each case, the deficiency of K(V)1 channels was associated with reduced mRNA levels encoding either or both alpha-subunits. Collectively, these findings demonstrate that a deficit of alpha(1.2)- and alpha(1.5)-subunits results in a reduced contribution of K(V)1 channels to the resting diameters of cerebral arteries from two rat models of hypertension that originate from different etiologies. |
2,332,839 | Air pollution exposure and self-reported cardiovascular disease. | Studies suggest that increases of fine particle concentrations (PM2.5) could be linked with a rise in cardiovascular disease. With approximately 25% of American adults aged 30 and older reporting having either heart disease or hypertension it is possible that exposure to air pollution could have significant public health consequences. This study examined the relationship between PM2.5 and the prevalence of self-reported hypertension and heart disease using data from a large nation-wide survey.</AbstractText>Adults, 30 years of age or older, who participated in the National Health Interview Survey (NHIS) from 1999 to 2005 were linked to annual PM2.5 data from the US Environmental Protection Agency (N = 132,224). Annual air quality estimates were averaged from monitors within 20 miles of the respondent's residential block group. Respondents who reported being told they had hypertension by a health professional on two or more separate occasions were defined as hypertensive. Heart disease was defined as answering, "yes" to one or more of three NHIS questions on heart disease.</AbstractText>A 10 microg/m3 increase in PM2.5 exposure was associated with a small elevated risk of hypertension (adjusted odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00-1.10) risk of heart disease (1.08 95% CI 1.00-1.16). The association between PM2.5 and hypertension was found in non-Hispanic white adults (OR 1.10 95% CI 1.04-1.17) but not in non-Hispanic black or Hispanic adults.</AbstractText>Findings from this study complement those from other studies and indicate that PM2.5 adversely affects cardiovascular health. Our results are consistent with other studies in showing a small association between exposure to PM2.5 and cardiovascular outcomes.</AbstractText> |
2,332,840 | Adverse drug reactions to local anaesthetics: a review of the French pharmacovigilance database. | Some evidence of significant patient morbidity or mortality has been reported with the use of local anaesthetics (LAs). The most common adverse drug reactions (ADRs) to LAs are neurological (seizures) and cardiac (conduction disorders, cardiac arrests). However, little is known about other adverse drug reactions (ADRs).</AbstractText>The aim of this study was to characterize the safety profile of the LAs lidocaine, bupivacaine, mepivacaine, ropivacaine and levobupivacaine.</AbstractText>We studied ADRs occurring between 1995 and 2006 reported to the French Pharmacovigilance System.</AbstractText>For each ADR, we noted type of LA, type of ADR, its seriousness and the causality assessment score.</AbstractText>We identified 727 reports (corresponding to 0.3% of patients in the database) in which LA was suspected as the cause of 1157 different ADRs. Sixty-one patients (8.7%) were children aged<18 years. Lidocaine (36.0%) and bupivacaine (35.4%) were the LAs most often involved. The most frequently reported ADRs were failure of the block (27.7%), followed by neurological (22.1%), allergic (19.4%) and cardiovascular (15.3%) complications. Eight patients died. Spinal anaesthesia performed with bupivacaine represented 90% of failed blocks. Seizures were the most frequent neurological complications, leading to death in four cases. Twenty-two of 111 cardiovascular complications were cardiac arrest (three of which were fatal).</AbstractText>To our knowledge, this is the first analysis of safety profiles of LAs in a non-selected population, using data collected in a pharmacovigilance database. The present study confirmed the frequency and seriousness of both neurological and cardiovascular complications. Other less well documented ADRs were identified, such as spinal anaesthesia failures with bupivacaine and allergic reactions following LA injections.</AbstractText> |
2,332,841 | Lixivaptan: a novel vasopressin receptor antagonist. | Arginine vasopressin, also known as antidiuretic hormone, is a neuropeptide that functions in the maintenance of body water homeostasis. Inappropriate secretion of vasopressin has been implicated in the pathophysiology of multiple diseases, including polycystic kidney disease, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and the hyponatremia commonly associated with cirrhosis and congestive heart failure. Vasopressin receptor antagonists are novel agents that block the physiologic actions of vasopressin. Lixivaptan is a vasopressin receptor antagonist with high V2 receptor affinity and is now undergoing Phase III clinical trials. Studies so far have demonstrated that lixivaptan is efficacious in the correction of hyponatremia in SIADH, heart failure and liver cirrhosis with ascites, and few adverse effects have been noted. Thus, lixivaptan remains a promising therapeutic modality for the treatment of multiple diseases and prevention of the associated morbidity and mortality associated with hyponatremia. |
2,332,842 | Preoperative intravenous clonidine in the surgical treatment of cataract: evaluation of the clinical benefits. | Clonidine has been used in anesthesia for its sedative and analgesic properties, and to achieve greater hemodynamic stability with reduction in intra-ocular pressure. This study evaluated the clinical effects of intravenous clonidine (2.5 microg.kg(-1)) on the intra-ocular pressure (IOP), hemodynamic parameters, and post-anesthetic recovery in the surgical treatment of cataract.</AbstractText>This is a randomized, double-blind, placebo-controlled study that included patients undergoing cataract surgery under peribulbar block. After placement of monitoring devices, baseline (M0) values of IOP, mean arterial pressure (MAP), heart rate (HR), SpO2, and the degree of sedation (Ramsay) were determined. Afterwards, placebo (Group P) or clonidine (Group C) was administered intravenously. After 30 minutes, at Moment 1 (M1), measurements were repeated, and once again at the end of the surgery, at Moment 2 (M2).</AbstractText>The change in IOP between M0 and M1 was different for both groups, 14.5% in Group C and 5.25% in Group P (p = 0.01), and the means remained reduced until M2. Mean arterial pressure in Group C showed a 17% reduction from M0 to M1 and increased 3.5% in Group P (p < 0.001) and in Group C it showed a recovery at M2 (p = 0.17). The heart rate decreased 6.4% in Group C and 1% in Group P (p = 0.1) from M0 to M1. There was a greater sedation in Group C when compared with Group P (p < 0.001) but there was no cases of respiratory depression. The relative risk of intraoperative hypertension was 0.657 (CI 95% 0.517 to 0.835) in Group C, p < 0.01. Differences in the incidence of tachycardia, hypoxemia, hypotension, and increased hospital staying were not observed between both groups.</AbstractText>Clonidine, under the conditions of the present study, showed to be a safe drug and decreased IOP and the intraoperative risk of hypertension without delaying hospital discharge.</AbstractText> |
2,332,843 | A lateral percutaneous technique for stellate ganglion blockade in rats. | In the present study, we describe and show the efficacy of a lateral approach to stellate ganglion block (SGB) in rats.</AbstractText>Twenty-one rats were randomized into three groups: the posterior technique group (n = 7), the lateral technique group (n = 7), and the control group (n = 7). Thiopental was administered intraperitonally as 5 mg per 100 g of each rat's weight for sedation during the procedure. In the posterior technique group, SGB was performed by a posterior percutaneous approach as described previously. In the lateral technique and control groups, the cervical vertebrae was fixed between the left first and third fingers of the physician's left hand while palpating the C7 process with the second finger. The study drug was 0.2 mL 0.25% plain bupivacaine for the two percutaneous treatment groups, and 0.2 mL saline in the controls.</AbstractText>Two animals in the posterior technique group died immediately after local anesthetic injection (P < 0.01). There were no deaths in the new technique group or in the controls. Ptosis appeared at 300 +/- 120 s in the posterior group, whereas it was seen almost immediately after withdrawing the needle in the lateral technique group (6 +/- 4 s) (P < 0.001). Ptosis did not occur in the control group. There was no statistically significant difference in heart rate among groups (P > 0.069).</AbstractText>The lateral approach to SGB does not require the induction of general anesthesia. The approach is associated with early development of ptosis and may be associated with a lower mortality rate compared to the conventional posterior approach.</AbstractText> |
2,332,844 | [Grand mal convulsion after an interscalene block with ropivacaine]. | We report a case of grand mal convulsion due to inadvertent intravascular injection of ropivacaine. An 83-year-old woman was scheduled for upper limb surgery. The interscalene block was performed with neurostimulator and 0.5% ropivacaine 30 ml was injected after careful negative aspiration. Approximately 3 min after the injection, the patient lost consciousness and developed generalized convulsion, which was repeated 7 times. The seizures stopped after administration of diazepam 10 mg and thiamylal 250 mg i.v. Trachea was intubated and lungs were mechanically ventilated. During the seizure, arterial blood pressure increased from 180/110 mmHg to 190/120 mmHg and heart rate changed from 90 beats x min(-1) to 88 beats x min(-1). Ventricular premature beats were observed sporadically but stopped spontaneously. After the episode, the operation was performed under general anesthesia (nitrous oxide 50% and sevoflurane 1.5-2% in oxygen 50%). The patient recovered uneventfully after the operation. Although careful aspiration was done before the injection of ropivacaine, inadvertent intravenous injection could have occurred during the administration. Intermittent aspiration should be indispensable during the administration, because a large dose of local anesthetic is necessary for interscalene block. In this case, the only cardiovascular manifestation was ventricular premature beats indicating that ropivacaine has less cardiotoxicity. |
2,332,845 | Pharmacological profile of the inhibition by dihydroergotamine and methysergide on the cardioaccelerator sympathetic outflow in pithed rats. | The present study set out to analyse the pharmacological profile of the inhibitory responses induced by the antimigraine agents dihydroergotamine (DHE) and methysergide on the tachycardic responses to preganglionic sympathetic stimulation in pithed rats. For this purpose, 132 male Wistar normotensive rats were pithed and prepared to: (i) selectively stimulate the preganglionic (C(7)-T(1)) cardiac sympathetic outflow; or (ii) receive intravenous (i.v.) bolus injections of exogenous noradrenaline. Electrical sympathetic stimulation or exogenous noradrenaline produced, respectively, frequency-dependent and dose-dependent tachycardic responses. Moreover, i.v. continuous infusions of DHE (1.8, 3.1 and 5.6 microg/kg x min) or methysergide (100, 300 and 1000 microg/kg x min) dose-dependently inhibited the tachycardic responses to sympathetic stimulation, but not those to exogenous noradrenaline. Using physiological saline or antagonists (given as i.v. bolus injections), the cardiac sympatho-inhibition induced by either DHE (3.1 microg/kg x min) or methysergide (300 microg/kg x min) was: (1) unaffected by saline (1 ml/kg); (2) partially blocked by the antagonists rauwolscine (300 microg/kg; alpha(2)) or N-[4-methoxy-3-(4-methyl-1-piperazinyl) phenyl]-2'-methyl-4'-(5-methyl-1,2,4-oxadiazol-3-yl) [1,1,-biphenyl]-4-carboxamide hydrochloride monohydrate (GR127935, 300 microg/kg; 5-HT(1B/1D)); and (3) completely antagonised by the combination rauwolscine plus GR127935. These antagonists, at doses high enough to completely block their respective receptors, failed to modify the sympathetically-induced tachycardic responses per se. The above results, taken together, suggest that the cardiac sympatho-inhibition induced by DHE (3.1 microg/kg x min) and methysergide (300 microg/kg x min) may be mainly mediated by stimulation of both alpha(2)-adrenoceptors and 5-HT(1B/1D) receptors. |
2,332,846 | Images in cardiovascular medicine. Cannon a wave.<Pagination><StartPage>e381</StartPage><EndPage>e383</EndPage><MedlinePgn>e381-3</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1161/CIRCULATIONAHA.108.833095</ELocationID><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Dalong</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pai</LastName><ForeName>Pei-Ying</ForeName><Initials>PY</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Circulation</MedlineTA><NlmUniqueID>0147763</NlmUniqueID><ISSNLinking>0009-7322</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054537" MajorTopicYN="N">Atrioventricular Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003937" MajorTopicYN="N">Diagnosis, Differential</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="Y">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007601" MajorTopicYN="N">Jugular Veins</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014261" MajorTopicYN="N">Tricuspid Valve</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014264" MajorTopicYN="N">Tricuspid Valve Stenosis</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>4</Month><Day>8</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>4</Month><Day>8</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>5</Month><Day>1</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19349328</ArticleId><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.108.833095</ArticleId><ArticleId IdType="pii">119/13/e381</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19349019</PMID><DateCompleted><Year>2009</Year><Month>07</Month><Day>29</Day></DateCompleted><DateRevised><Year>2009</Year><Month>04</Month><Day>07</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1092-9126</ISSN><JournalIssue CitedMedium="Print"><PubDate><Year>2009</Year></PubDate></JournalIssue><Title>Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual</Title><ISOAbbreviation>Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu</ISOAbbreviation></Journal>Aortic stenosis and aortic insufficiency in children: impact of valvuloplasty and modified Ross-Konno procedure. | Aortic stenosis and aortic insufficiency in young children present multiple challenges to the patient, family, and surgeon. Mechanical valves require anticoagulation therapy, which is a poor option in active youngsters and noncompliant adolescents. Aortic valvuloplasty and the various forms of the Ross/Ross-Konno operations appear to be good solutions in this patient population due to valve preservation for the former and autograft growth for the latter. However, valvuloplasty failure and autograft dilatation have developed in some patients. In addition, heart block remains a problem in those patients who require an annular enlarging operation. We review our experience with the various forms of valvuloplasty, Ross operation, Konno operation, Ross-Konno operation, and the modified Ross-Konno operation, which we have used to eliminate heart block in patients who require an annular enlarging operation. |
2,332,847 | A histomorphometric study on collagen-apatite composite as a graft material: the influence of gap size at the titanium-bone interface in animal model. | The purpose of this study was to evaluate the healing process of collagen-apatite composite (CAC) at the titanium-bone interface in animal model. Small gaps (0.5 or 1.0 mm-sized wells) were prepared in the epoxy-resin block implants coated with pure titanium. The gaps were filled with CAC or demineralized freeze-dried bone (DFDB). The titanium-coated epoxy-resin block implants were inserted in the tibia of rabbit for 4 weeks or 8 weeks. The microscopic features of bony healing process in the grafted gaps were examined and analyzed. In the histomorphometric analysis, CAC group showed higher fraction of newly-formed bone than DFDB group in both 0.5 and 1.0 mm gap subgroup at 4-week specimen (P < 0.05). In the transmission electron microscopic examinations, osteoblasts of the newly-formed bone of CAC group showed more cellular activity than that of DFDB group. From the results, it was expected that CAC had more beneficial property on early bony healing process than DFDB at the titanium-bone interface. |
2,332,848 | Development of bronchus-associated lymphoid tissue hyperplasia following lipopolysaccharide-induced lung inflammation in rats. | Gram-negative bacterial endotoxin lipopolysaccharide (LPS) administration has been used as an animal model of sepsis-related acute lung injury and adult respiratory distress syndrome (ALI/ARDS). This paper describes the lung histology following lung injury induced by the intraperitoneal (i.p.) administration of endotoxin to rats, in comparison with earlier findings. ALI was induced by the i.p. administration of Esherichia coli LPS 2 (n = 8) or 3 (n = 5) mg/kg, whereas physiological saline was administered to the control animals (n = 5). Eighteen hours after the LPS injections, the animals were euthanized. The lungs and heart were removed in one block for histological study (hematoxylin and eosin [H&E], periodic acid-Schiff [PAS], Mason's trichrome; light microscopy). The lung tissue injury (bronchial wall, vessels, alveoli, interstitium) was graded via a scoring system (0 to 3+). The control animals showed intact lung tissue. Ten of the 13 LPS group had bronchus-associated lymphoid tissue (BALT) hyperplasia. Pathological signs of ALI/ARDS, diffuse alveolar damage (DAD) and emphysema, were observed in 5 and 8 cases, respectively. LPS injection induces primarily BALT hyperplasia and also the less characteristic DAD. This rat model is suitable for the investigation not only of ALI/ARDS but also of BALT hyperplasia occurring as a consequence of chronic pulmonary inflammatory processes. |
2,332,849 | Optimal dose of sufentanil in children for intubation after sevoflurane induction without neuromuscular block. | We studied 63 ASA I children (age 2-8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block.</AbstractText>Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (e'(sevo)) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep e'(sevo) at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an 'up and down' design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist.</AbstractText>The ED(50) [effective dose for 50% of subjects; mean (sd)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED(95)) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31-1.74] microg kg(-1), 0.58 (95% CI 0.17-0.99) microg kg(-1), or 0.28 (95% CI 0.04-0.52) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively.</AbstractText>Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.</AbstractText> |
2,332,850 | 'Muscle-sparing' statins: preclinical profiles and future clinical use. | Coronary heart disease (CHD) is a leading cause of death in the US, and hypercholesterolemia is a key risk factor for this disease. The current standard of care for treating hypercholesterolemia is the use of HMG-CoA reductase inhibitors, also known as statins, which block the rate-limiting step of cholesterol biosynthesis. In widespread clinical use, statins have proven safe and effective for both primary prevention of CHD and secondary prevention of coronary events. Results from several recent clinical trials have demonstrated that increasingly aggressive cholesterol-lowering therapy might offer additional protection against CHD compared with less aggressive treatment standards. While higher doses of current statin therapies are capable of achieving these more aggressive treatment goals, in certain cases statin-induced myalgia, the muscle pain or weakness that sometimes accompanies high-dose statin therapy, limits patient compliance with a treatment regimen. To address this limitation, efforts have been undertaken to develop highly hepatoselective statins that are capable of delivering best-in-class efficacy with minimized risk of dose-limiting myalgia. In this review, the preclinical and early clinical data for these next generation statins are discussed. |
2,332,851 | Transient loss of consciousness 1: causes and impact of misdiagnosis. | Part 1 of this two-part unit outlines the various possible causes of transient loss of consciousness (blackouts), the importance of accurate diagnosis and the impact of misdiagnosis. It also discusses the establishment of specialist clinics in order to help with diagnosis and management. |
2,332,852 | Critical analysis of autoregressive and fast Fourier transform markers of cardiovascular variability in rats and humans. | The autonomic nervous system plays an important role in physiological and pathological conditions, and has been extensively evaluated by parametric and non-parametric spectral analysis. To compare the results obtained with fast Fourier transform (FFT) and the autoregressive (AR) method, we performed a comprehensive comparative study using data from humans and rats during pharmacological blockade (in rats), a postural test (in humans), and in the hypertensive state (in both humans and rats). Although postural hypotension in humans induced an increase in normalized low-frequency (LFnu) of systolic blood pressure, the increase in the ratio was detected only by AR. In rats, AR and FFT analysis did not agree for LFnu and high frequency (HFnu) under basal conditions and after vagal blockade. The increase in the LF/HF ratio of the pulse interval, induced by methylatropine, was detected only by FFT. In hypertensive patients, changes in LF and HF for systolic blood pressure were observed only by AR; FFT was able to detect the reduction in both blood pressure variance and total power. In hypertensive rats, AR presented different values of variance and total power for systolic blood pressure. Moreover, AR and FFT presented discordant results for LF, LFnu, HF, LF/HF ratio, and total power for pulse interval. We provide evidence for disagreement in 23% of the indices of blood pressure and heart rate variability in humans and 67% discordance in rats when these variables are evaluated by AR and FFT under physiological and pathological conditions. The overall disagreement between AR and FFT in this study was 43%. |
2,332,853 | Comparison of fentanyl and sufentanil as adjuncts to bupivacaine for labor epidural analgesia. | To compare the clinical efficacy of theoretically equipotent doses of fentanyl and sufentanil, each in combination with bupivacaine, for patient-controlled epidural analgesia (PCEA) for labor.</AbstractText>Single-blinded, randomized study.</AbstractText>University hospital.</AbstractText>48 ASA physical status I and II term parturients in active labor, with cervical dilatation equal to or less than 5 cm, and requesting epidural analgesia.</AbstractText>Patients received a loading dose of 10 mL of 0.125% bupivacaine with either 30 microg of fentanyl or 5 microg of sufentanil. PCEA was maintained with 0.0625% bupivacaine with either fentanyl two microg/mL or sufentanil 0.35 microg/mL. The PCEA settings were: bolus 5 mL, lockout 10 minutes, infusion 10 mL/hr, and maximum dose 40 mL/hr. Standardized rescue doses of bupivacaine were administered as necessary.</AbstractText>The bupivacaine requirement in mg/hr was calculated from the time of initiation of the epidural until the patient had had 4 to 6 hours of PCEA. The hourly pain score, sensory and motor block, and side effects were documented. Overall patient satisfaction was assessed at the end of the study.</AbstractText>The mean (standard deviation) bupivacaine requirement was 12.4 mg/hr (3.2) and 11.0 mg/hr (2.4) for the fentanyl and sufentanil groups, respectively (P = 0.08). There was evidence of higher maternal satisfaction (P = 0.01), and weak evidence of lower pain scores (P = 0.10) in the sufentanil group. The side effects were similar in both groups.</AbstractText>At the assumed equipotent sufentanil to fentanyl ratio of 6:1, there is some evidence that sufentanil is clinically superior to fentanyl as an adjunct to bupivacaine in labor epidurals, although the advantages are subtle.</AbstractText> |
2,332,854 | [Study on the use of a smart pillbox to improve treatment compliance]. | To assess the usefulness of the Practidose individualised dispensing and dosing pillbox system in improving treatment compliance (TC).</AbstractText>Open-labelled, randomised, clinical trial.</AbstractText>Cordoba province from April to September 2005.</AbstractText>A total of 220 patients 70 years diagnosed with ineffective management of treatment regime, polymedicated with no cognitive deterioration or limited mobility. Enrolment was carried out by block random assignment. Each district linking nurse was assigned 10 interviews, 5 from the intervention group and 5 from a control group.</AbstractText>To give a smart pillbox with instructions. MEASUREMENTS AND PRIMARY OUTCOMES: The response variable was the TC measured using the Morisky-Green questionnaire at the beginning and at 2 months. The independent variables were: age, sex, education level, number of people living in the home and mean age, diabetes, hypertension, heart disease, COPD, number of medications, number of daily and weekly doses self-medication, and interest in the patient information leaflet. A descriptive analysis and a multiple logistic regression were performed on the data. A total of 182 patients finished the study. The TC improved by 6.74% in the intervention group and by 2.15% in the control group. To look after the medications and suffer from COPD lead to better TC, and was less so when there was interest in the patient information leaflet.</AbstractText>The improvement in treatment compliance with the Practidose Pillbox was not statistically significant, although a positive tendency was observed.</AbstractText> |
2,332,855 | Music may reduce anxiety during invasive procedures in adolescents and adults. | A block randomised controlled trial was conducted.</AbstractText>Patients in the music (test) group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects wore headphones but without the music.</AbstractText>Anxiety was measured before the study and at the end of the treatment procedure. Patients' heart rate, blood pressure and finger temperature were measured before the study and every 10 min until the end of the root canal treatment procedure.</AbstractText>The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. The subjects in the music group, however, showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14, respectively.</AbstractText>Relaxing music administered through headphones to subjects during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect blood pressure and heart rate over the procedure.</AbstractText> |
2,332,856 | The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. | High body temperature in the first 12-24 h after stroke onset is associated with poor functional outcome. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial aimed to assess whether early treatment with paracetamol improves functional outcome in patients with acute stroke by reducing body temperature and preventing fever.</AbstractText>In a multicentre, randomised, double-blind, placebo-controlled trial, patients with ischaemic stroke or intracerebral haemorrhage and body temperature between 36 degrees C and 39 degrees C were randomly assigned treatment with paracetamol (6 g daily) or placebo within 12 h from symptom onset. Treatment allocation was based on a computer-generated list of random numbers with varying block size. The primary outcome was improvement beyond expectation on the modified Rankin scale at 3 months, according to the sliding dichotomy approach. This trial is registered, number ISRCTN74418480.</AbstractText>Between March, 2003, and May, 2008, 1400 patients were randomly allocated treatment. 260 (37%) of 697 patients receiving paracetamol and 232 (33%) of 703 receiving placebo improved beyond expectation (adjusted odds ratio [OR] 1.20, 95% CI 0.96-1.50). In a post-hoc analysis of patients with baseline body temperature 37-39 degrees C, treatment with paracetamol was associated with improved outcome (1.43, 1.02-1.97). There were 55 serious adverse events in the paracetamol group (8%) and 70 in the placebo group (10%).</AbstractText>These results do not support routine use of high-dose paracetamol in patients with acute stroke. Paracetamol might have a beneficial effect on functional outcome in patients admitted with a body temperature 37-39 degrees C, but this post-hoc finding needs further study.</AbstractText>Netherlands Heart Foundation.</AbstractText> |
2,332,857 | The endothelial glycocalyx mediates shear-induced changes in hydraulic conductivity. | Recent in vitro and in vivo studies have reported fluid shear stress-induced increases in endothelial layer hydraulic conductivity (L(p)) that are mediated by an increased production of nitric oxide (NO). Other recent studies have shown that NO induction by shear stress is mediated by the glycocalyx that decorates the surface of endothelial cells. Here we find that a selective depletion of the major components of the glycocalyx with enzymes can block the shear stress-induced response of L(p). Heparinase and hyaluronidase block shear-induced increases in L(p), which is consistent with their effects on NO production. But chondroitinase, which does not suppress shear-induced NO production, also inhibits shear-induced L(p). A further surprise is that treatment with the general proteolytic enzyme pronase does not suppress the shear L(p) response. We also find that heparinase does not alter baseline L(p) significantly, whereas chondroitinase, hyaluronidase, and pronase increase it significantly. |
2,332,858 | Casein haplotypes and their association with milk production traits in Norwegian Red cattle. | A high resolution SNP map was constructed for the bovine casein region to identify haplotype structures and study associations with milk traits in Norwegian Red cattle. Our analyses suggest separation of the casein cluster into two haplotype blocks, one consisting of the CSN1S1, CSN2 and CSN1S2 genes and another one consisting of the CSN3 gene. Highly significant associations with both protein and milk yield were found for both single SNPs and haplotypes within the CSN1S1-CSN2-CSN1S2 haplotype block. In contrast, no significant association was found for single SNPs or haplotypes within the CSN3 block. Our results point towards CSN2 and CSN1S2 as the most likely loci harbouring the underlying causative DNA variation. In our study, the most significant results were found for the SNP CSN2_67 with the C allele consistently associated with both higher protein and milk yields. CSN2_67 calls a C to an A substitution at codon 67 in beta-casein gene resulting in histidine replacing proline in the amino acid sequence. This polymorphism determines the protein variants A1/B (CSN2_67 A allele) versus A2/A3 (CSN2_67 C allele). Other studies have suggested that a high consumption of A1/B milk may affect human health by increasing the risk of diabetes and heart diseases. Altogether these results argue for an increase in the frequency of the CSN2_67 C allele or haplotypes containing this allele in the Norwegian Red cattle population by selective breeding. |
2,332,859 | Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. | To determine risk factors for developing hypotension after spinal anesthesia for cesarean section to prevent obstetric patients from hypotensive episodes potentially resulting in intrauterine malperfusion and endangering the child.</AbstractText>The data from 503 women, having received spinal anesthesia for cesarean sections were investigated using online gathered vital signs and specially checked manual entries employing an anesthesia information management system. Blood pressure, heart rate, and oxygen saturation were measured throughout and hypotension was defined as either a drop in mean arterial blood pressure of >20% from baseline value or readings of <90 mmHg systolic arterial blood pressure. Thirty-two variables were studied for association with hypotensive episodes using univariate analysis and logistic regression employing a forward stepwise algorithm to identify independent variables (P < 0.05).</AbstractText>Hypotension was found in 284 cases (56.5%). The univariate analysis identified the neonate's weight, mother's age, body mass index, and peak sensory block height associated with hypotension. Body mass index, age and sensory block height were detected as independent factors for hypotension (odds-ratio: 1.61 each).</AbstractText>Knowledge of these risk factors should increase the anesthesiologist's attention to decide for the necessity to employ prophylactic or therapeutic techniques or drugs to prevent the neonate from any risk resulting of hypotension of the mother.</AbstractText> |
2,332,860 | The analgesic effects of ropivacaine in ilioinguinal-iliohypogastric nerve block in children--concentration or volume? | The aim of the present study was to compare the analgesic effects of ripovacaine when used as high concentration/small volume, versus its use as high volume/low concentration, in ilioinguinal-iliohypogastric nerve block in children.</AbstractText>This is a prospective single-blind randomized study consisting of 72 children ASA I & II, 3-9 years of age, scheduled for outpatient elective surgery. Children were randomly assigned into two equal groups (36 each), to receive ropivacaine 0.8 mg.kg(-1), for ilioinguinal-iliohypogastsric block, either as: 1 mg.ml(-1) (0.8 ml.kg(-1)) G1 group, or 2 mg.ml(-1) (0.4 ml.kg(-1)) G2 group. The postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), at the end of surgery (H0), at one (H1), tow (H2), four (H4) and six (H6) postoperative hours. Parents were requested to record their child's pain every 6 hours during the first 24 postoperative hours, using the postoperative pain measurement for Parent Scale.</AbstractText>CHEOPS score H0 was significantly lower in G2 as compared to G1 group (p = 0.03). Only 2 children in G2 as compared to 8 children in G1 group, required i.v. paracetamol administration after surgery (p = 0.04). In group G1, two children required paracetamol at home and three developed a postoperative transitory femoral nerve block (p = 0.23).</AbstractText>Ropivacaine when used with high concentration/small volume is more efficient than when used a high volume/low concentration, for ilioinguinal-iliohypogastric nerve block in children.</AbstractText> |
2,332,861 | The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy. | The insertion of skull pins into the periosteum induces not only a haemodynamic response but also an increase in stress hormones. We compared the effects of scalp-nerve block, infiltration anaesthesia, and routine anaesthesia during skull-pin insertion on haemodynamic and stress responses to craniotomy.</AbstractText>Forty-five ASA I or II patients, scheduled for elective craniotomies, were enrolled in this prospective, randomized, placebo-controlled study. Anaesthesia was induced with thiopental (5 mg kg(-1)), fentanyl (2 microg kg(-1)) and vecuronium (0.1 mg kg(-1)), and was maintained with 50% N2O in oxygen and 1% isoflurane. Five minutes before head pinning, 0.5% bupivacaine was infiltrated at each pin-insertion site in group L. In group S, scalp block was performed by blocking the supraorbital, supratrochlear, auriculotemporal, occipital, and postauricular branches of the greater auricular nerves using 20 ml 0.5% bupivacaine. Opioids were used to control haemodynamic responses in group C (the control group). Heart rate and mean arterial pressure were recorded at regular intervals before and for 1 h after induction. Blood samples were collected for cortisol and adrenocorticotropic hormone analysis 5 min before induction and 5 and 60 min after pin-holder insertion.</AbstractText>There were significant increases in heart rate and mean arterial pressure during head pinning in groups L and C compared with group S and also at the 1st, 2nd and 3rd minutes after pinning (P < 0.05). In group S, the reduced plasma cortisol and adrenocorticotropic hormone levels measured at the 5th and 60th minutes after pinning were significantly lower than those in groups L and C (P < 0.05).</AbstractText>We conclude that scalp block using 0.5% bupivacaine blunts the haemodynamic and stress responses to head pinning better than routine anaesthesia or scalp infiltration with bupivacaine and should be considered in conjunction with general anaesthesia for craniotomy.</AbstractText> |
2,332,862 | A comparison of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery. | This randomized, double-blinded, prospective study was performed to compare the intraoperative hemodynamic variables and the patient-reported outcomes, such as intra- and postoperative analgesia and patient satisfaction, of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery under monitored anesthesia care.</AbstractText>Eighty-one patients, ASA physical status I-III, undergoing elective cataract surgery under monitored anesthesia care, aged between 43 and 78 years, were randomly assigned to three groups: retrobulbar block (group R), sub-Tenon block (group S), or topical anesthesia (group T). Three minutes after the start of monitored anesthesia care with lidocaine-propofol-remifentanil mixture, an ophthalmologist performed regional anesthesia. Intraoperative hemodynamics, pain score, and patients' satisfaction with the anesthetic experiences were recorded by a study-blinded anesthesiologist.</AbstractText>Mean arterial pressure and heart rate in group R were significantly higher than those in groups S and T during and just after the regional block (p<0.05). Group R required smaller dosage of patient controlled sedation and fewer supplemental bolus doses than groups S and T (p<0.05). On the other hand, group S showed the highest satisfaction scores among the three groups (p<0.05).</AbstractText>Sub-Tenon block seems to be better than retrobulbar block and topical anesthesia in patient satisfaction though adequate analgesia was achieved after retrobulbar block during cataract surgery under monitored anesthesia care.</AbstractText> |
2,332,863 | Spinal anesthesia with 3.75 mg of 0.25% hyperbaric bupivacaine for diabetic foot surgery. | Spinal anesthesia in the sitting position with low-dose local anesthetics usually provides satisfactory anesthesia for diabetic foot surgery because most operations do not require tourniquet application. This study was designed to investigate the influence of different sitting periods after subarachnoid injection of low dose bupivacaine on the spread of analgesia.</AbstractText>In this randomized, controlled clinical trial, 60 patients undergoing diabetic foot surgery under spinal anesthesia without a tourniquet were randomized to three groups. Patients remained sitting for 2 (Group D2, n = 20), 5 (Group D5, n = 20), or 10 (Group D10, n = 20) min after the completion of subarachnoid administration of 3.75 mg of 0.25% hyperbaric bupivacaine solution. They were then placed in the supine position. Analgesia levels were assessed bilaterally using pinpricks. Blood pressure and heart rate were also recorded.</AbstractText>The maximal sensory block level [median (range)] was higher in Group D2 [L3 (L2-L3)] compared with Group D10 [L4 (L3-L4)] (P = 0.002). The highest sensory block levels were T12, T11, and L2 in Group D2, 5 and 10, respectively. There were no hemodynamic differences among the three groups and none of the patients showed hemodynamic instability except for one patient in Group D10.</AbstractText>Although spinal anesthesia using a minimal dose of 0.25% hyperbaric bupivacaine provides adequate anesthesia for diabetic foot surgery without profound hypotension, regardless of the time spent in the sitting position, maintaining the position for 10 min required to confine the sensory blockade on the lower level.</AbstractText> |
2,332,864 | 'Reverberation time', dreaming and the capacity to dream. | In this paper the author suggests that understanding the roots of the subjective sense of time can throw light on the disturbances in psychic time which are found in particular in the more severe pathologies. She introduces the argument that the roots of the development of the sense of time rest on a primitive sense of time she calls 'reverberation time'. By this notion she refers to the particular quality of the earliest 'back and forth' internalized exchange with the mother in which the auditory dimension plays a significant part. Referring to a wide range of literature and clinical examples, the author thus suggests that the subjective sense of time is created by the reverberation between mother and infant. Disturbances in this area will be reflected in the pathological 'arresting' of time which is observed in the different pathologies and, in particular, around the negotiation of the depressive position and the oedipal situation.Extending this argument, the author goes on to suggest that it is the internalization of this experience of 'reverberation' which lies at the heart of the experience of dreaming; she considers that dreaming understood as an internal dialogue points both to its roots in the relationship to the maternal object and to its fundamental role in psychic life. The author concludes that 'reverberation time' is also the building block of a psychoanalysis, leading to 'unfreezing' psychic time and enabling the reconnection of 'here and now' with 'there and then' in a flexible way which promotes open possibilities, and that this takes place via the analyst's reverie, or time of reverberation. |
2,332,865 | Treatment of persistent sinus bradycardia with intermittent symptoms: are guidelines clear? | There is uncertainty in the aetiology of syncope in subjects with persistent sinus bradycardia (SB) (sick sinus syndrome). The results of pathophysiological studies suggest a reflex origin of syncope in the vast majority of subjects with SB. From a nosological point of view, 'syndrome' is defined as the association of signs and symptoms that have a pathophysiological correlation. Since in most cases the causal relationship between syncope and persistent SB appears very weak, 'reflex syncope with associated SB' appears to be the most appropriate diagnosis. |
2,332,866 | Urocortin induces interleukin-6 release from rat cardiomyocytes through p38 MAP kinase, ERK and NF-kappaB activation. | CRH and its structurally related peptide urocortin (Ucn) are released under stress. Ucn is a potent agonist for CRH-receptor 2 (CRH-R2), which is strongly expressed in rodent heart. Stress induces Ucn mRNA expression in the heart, where it may be cardioprotective. However, increasing evidence indicates that Ucn may also have pro-inflammatory actions. Here, we show that neonatal rat cardiomyocytes express CRH-R2 by western blot analysis and Ucn induces interleukin-6 (IL-6) release in a time- and dose-dependent fashion. Ucn stimulates activation of ERK and p38 MAP kinases, while both MEK1 and p38 inhibitor block Ucn-induced IL-6 release. Ucn also activates nuclear factor kappa B (NF-kappaB) and a NF-kappaB inhibitor blocks Ucn-induced IL-6 release. Finally, the CRH-R antagonists alpha-helical (9-41) CRH and astressin-2B completely inhibit Ucn-induced IL-6 release, as well as activation of ERK, p38, and NF-kappaB. These findings indicate that Ucn induces IL-6 synthesis and release from neonatal rat cardiomyocytes. Our findings suggest that even though Ucn may confirm some protection on cardiomyocyte survival, it can also release IL-6, which is an independent risk factor for acute coronary syndrome. The precise role of cardiac Ucn in vivo remains to be elucidated. |
2,332,867 | Antibody reactivity to alpha-enolase in mothers of children with congenital heart block. | To evaluate the frequency of anti-alpha-enolase antibodies in the sera of mothers whose children have congenital heart block (CHB), given provocative results in which alpha-enolase, a membrane protein, was recognized by monoclonal antibodies reactive with the peptide p200 of 52 kDa Ro/SSA in a neonatal rat heart library.</AbstractText>An ELISA using a recombinant alpha-enolase protein was developed. Sera from 100 anti-Ro52+ CHB mothers in the Research Registry for Neonatal Lupus, 50 patients with systemic lupus erythematosus (SLE; 7 anti-Ro52+), and 48 healthy controls were tested for anti-alpha-enolase reactivity.</AbstractText>There were no significant differences in the median values obtained from CHB mothers, patients with SLE, or controls at each of the dilutions tested. Only 7 (7%) at 1:100 dilution and 2 (2%) at 1:1000 dilution of 100 CHB sera were 3 standard deviations above the mean value obtained for controls. Preincubation with recombinant Ro52 did not inhibit anti-alpha-enolase reactivity.</AbstractText>The low frequency of anti-alpha-enolase antibodies in the sera of CHB mothers and the absence of apparent cross-reactivity with Ro52 suggest that antibodies to Ro52 are not likely to mediate CHB via binding to alpha-enolase.</AbstractText> |
2,332,868 | Is it Williams syndrome? GTF2IRD1 implicated in visual-spatial construction and GTF2I in sociability revealed by high resolution arrays. | Genetic contributions to human cognition and behavior are clear but difficult to define. Williams syndrome (WS) provides a unique model for relating single genes to visual-spatial cognition and social behavior. We defined a approximately 1.5 Mb region of approximately 25 genes deleted in >98% of typical WS and then rare small deletions, showing that visual-spatial construction (VSC) in WS was associated with the genes GTF2IRD1 and GTF2I. To distinguish the roles of GTF2IRD1 and GTF2I in VSC and social behavior, we utilized multiple genomic methods (custom high resolution oligonucleotide microarray, multicolor FISH and somatic cell hybrids analyzed by PCR) to identify individuals deleted for either gene but not both. We analyzed genetic, cognitive and social behavior in a unique individual with WS features (heart defects, small size, facies), but with an atypical deletion of a set of genes that includes GTF2IRD1, but not GTF2I. The centromeric breakpoint localized to the region 72.32-72.38 Mb and the telomeric breakpoint to 72.66 Mb, 10 kb downstream of GTF2IRD1. Cognitive testing (WPPSI-R, K-BIT, and PLS-3) demonstrated striking deficits in VSC (Block Design, Object Assembly) but overall performance 1.5-3 SD above WS means. We have now integrated the genetic, clinical and cognitive data with previous reports of social behavior in this subject. These results combine with previous data from small deletions to suggest the gene GTF2IRD1 is associated with WS facies and VSC, and that GTF2I may contribute to WS social behaviors including increased gaze and attention to strangers. |
2,332,869 | Comparison of glutathione peroxidase 1 and iodothyronine deiodinase 1 mRNA expression in murine liver after feeding selenite or selenized yeast. | The experiment was conducted to compare the effect of different selenium sources on the expression of glutathione peroxidase 1 (GPx1) and iodothyronine deiodinase 1 (Dio1) mRNA in mice by quantitative real-time PCR. A total of 60 male Kunming mice at average body weight of 20 g were allotted to three groups in a randomized complete block design, namely two treatments and one control. Mice in Group 1 were fed a basal diet as control, while mice in Groups 2 and 3 were fed the basal diet supplemented with 0.1mg/kg selenium as sodium selenite or selenized yeast, respectively. Whole feeding experiment lasted for 30 d. At the end of the feeding trial, liver mRNA levels of GPx1 and Dio1 were determined by quantitative real-time PCR, as well as growth performance, body composition, blood and GPx activity were determined. The results showed that no significant differences in overall growth performance and body composition, including body weight, body length, heart weight, kidney weight and liver weight, were found between the experimental groups (P>0.05). Blood GPx activity increased in all of the selenium supplemented groups compared with control group (P<0.01). However, blood GPx activity in selenized yeast group was higher than that in sodium selenite group (P<0.05). Liver mRNA levels of GPx1 and Dio1 also increased in the two selenium supplemented groups compared with the control group (P<0.05), while there was no significant difference between the sodium selenite and selenized yeast groups (P>0.05). In conclusion, selenium increased the mRNA expression of GPx1 and Dio1 genes in murine liver, and there was no significant difference between the organic or inorganic form of selenium used. |
2,332,870 | A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. | Emergency department visits and rehospitalization are common after hospital discharge.</AbstractText>To test the effects of an intervention designed to minimize hospital utilization after discharge.</AbstractText>Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card.</AbstractText>General medical service at an urban, academic, safety-net hospital.</AbstractText>749 English-speaking hospitalized adults (mean age, 49.9 years).</AbstractText>A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment.</AbstractText>Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment.</AbstractText>Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed.</AbstractText>This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.</AbstractText>A package of discharge services reduced hospital utilization within 30 days of discharge.</AbstractText>Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.</AbstractText> |
2,332,871 | ETA receptor blockade with atrasentan prevents hypertension with the multitargeted tyrosine kinase inhibitor ABT-869 in telemetry-instrumented rats. | ABT-869 is a novel multitargeted inhibitor of vascular endothelial growth factor and platelet-derived growth factor receptor tyrosine kinases (RTKs) with potent antiangiogenic properties that slow tumor progression. Vascular endothelial growth factor receptor blockade has been shown to produce hypertension. Atrasentan is a potent and selective endothelin (ETA) receptor antagonist that lowers blood pressure and affects tumor growth. To assess the utility of ETA receptor blockade in controlling hypertension with RTK inhibition, we evaluated the ability of atrasentan to block hypertension with ABT-869 in conscious, telemetry-instrumented rats. Changes in mean arterial pressure (MAP) and heart rate (HR) were evaluated using mean values and the area under the curve (AUC). Atrasentan (0.5, 1.5, and 5.0 mg kg(-1) d(-1) for 5 days) elicited dose-dependent decreases in MAP-AUC (-16.7 +/- 1.3, -20.94 +/- 3.68, and -30.12 +/- 3.57 mm Hg x day, respectively) compared with vehicle. ABT-869 (1, 3, 10, 30 mg kg(-1) d(-1) for 5 days) increased MAP compared with vehicle (MAP-AUC values of -5.52 +/- 3.75, 12.7 +/- 8.4, 37.5 +/- 4.4, and 63.8 +/- 3.3 mm Hg x day, respectively). Pretreatment with atrasentan (5 mg/kg for 5 days) prevented and abolished the hypertensive effects of ABT-869. Thus, ETA receptor blockade effectively alleviated hypertension with RTK inhibition and may serve a dual therapeutic role by preventing hypertension and slowing tumor progression. |
2,332,872 | Unilateral phrenic nerve block guided by ultrasonography and nerve stimulator for the treatment of hiccup developed after tongue cancer operation: A case report. | Hiccups are common benign and usually transient phenomenon that occur in nearly everyone. However, persistent or intractable hiccups can cause multiple problems including malnutrition, weight loss, fatigue, dehydration, insomnia, and wound dehiscence. We have experienced a case of postoperative persistent hiccup. The patient was formerly diagnosed tongue cancer and developed persistent hiccup after partial glossectomy with modified radical neck dissection and a radial forearm free-flap operation. He was unsuccessfully managed using pharmacologic methods, and then we tried phrenic nerve block guided by ultrasonography and a nerve stimulator because the surface anatomy of neck was deformed by the previous operation. Thirty minutes after the block, the hiccups disappeared. |
2,332,873 | China makes an impressive breakthrough in avian influenza virus research - Discovering the "heart" of avian infl uenza virus. | The successive appearance of strains of epizootic avian influenza A virus with the subtype H5N1 in China has attracted considerable concern from the public and Chinese authorities. According to the latest WHO estimates as of February 2, 2009, the number of H5N1 virus deaths in China totaled 25, second only to Indonesia and Viet Nam (http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_02_02/en/index.html). The H5N1 virus is highly contagious among birds and is fatal when transmitted to humans, though the means by which this occurs is still unknown. Owing to the possible variation of the H5N1 prototype virus, together with the fact that it has the propensity to exchange genes with influenza viruses from other species, humans have no natural immunity to the virus. Despite years of efforts, the exact pathogenesis of H5N1 transmission to humans is still not completely clear, nor is potential human-tohuman transmission as could lead to an epidemic or even worldwide pandemic (Enserink M. Science. 2009; 323:324). Unfortunately, current antiviral treatment and therapeutic measures cannot effectively overcome this virulent virus that causes highly pathogenic avian influenza (HPAI). Researchers from around the world are working to study the virology of influenza viruses, including their methods of infiltration, replication, and transcription, to elucidate the mechanisms of unremitting viral infection in terms of aspects such as the virus, host, and environment. These researchers are also working to identify potential molecular targets related to H5N1 for anti-influenza drug intervention. A recent H5N1-related study from China provides encouraging information. According to the People's Daily (Renmin Ribao), a newspaper out of Beijing, professor Liu Yingfang, academician Rao Zihe, and fellow researchers from more than 6 research centers, including the Institute of Biophysics Chinese Academy of Sciences, Nankai University, and Tsinghua University, have achieved exciting results in providing a detailed understanding of the mechanisms of action of the RNA polymerase PA subunit, the "heart" of the avian influenza virus, at the atomic level. They hope to provide clues to potential avian influenza therapy targets and a new platform for new drug discovery (http://202.123.110.5/jrzg/2009-02/06/content_1222973.htm, available as of February 6, 2009). According to Liu et al., influenza viruses are enveloped, negatively stranded RNA viruses with a segmented genome (consisting of 8 RNA segments) that can encode 11 kinds of viral proteins. Among these proteins, the complex of influenza polymerase, consisting of PB1, PB2, and PA subunits, is regarded to be what gives life to influenza viruses because of its essential catalytic role in viral RNA replication and mRNA transcription in the nucleus of infected cells. Notwithstanding earlier virology studies on the influenza virus that elucidated the functions of PB1 and PB2, the exact function of PA is still not completely clear. The group resolved the crystal structure of the carboxyl-terminus of PA in complex with the aminoterminus of PB1 peptides for the first time. This structure mode provides details for the interactions of PA and PB1, as well as the binding sites of PA and RNA. Results of the research, entitled the "Crystal structure of the polymerase PA(c)-CPB1(N) complex from an avian influenza H5N1 virus," were published in the August 28th issue of the respected international scientific journal Nature (He X, Zhou J, Bartlam M, et al. Nature. 2008; 454:1123-1126). Further efforts by the group served to indicate the fine three-dimensional structure of the N-terminal of PA protein. They revealed that the PA subunit holds an endonuclease active site and that it, rather than the PB1 subunit as was previously, plays a critical role in the endonuclease activity of influenza virus polymerase. In addition, PA's characteristics of being highly conserved and having little mutations make it an attractive target for anti-influenza therapeutics. Specifically, endonuclease can block the mRNA of host cells cached by the complex of polymerase, resulting in mRNA transcription. Results of the group's most recent research have been published in a recent February 4th issue of Nature (Yuan P, Bartlam M, Lou Z, et al. Nature. 2009; Epub ahead of print). |
2,332,874 | Blind identification of evoked human brain activity with independent component analysis of optical data. | Diffuse optical tomography (DOT) methods observe hemodynamics in the brain by measuring light transmission through the scalp, skull, and brain. Thus, separating signals due to heart pulsations, breathing movements, and systemic blood flow fluctuations from the desired brain functional responses is critical to the fidelity of the derived maps. Herein, we applied independent component analysis (ICA) to temporal signals obtained from a high-density DOT system used for functional mapping of the visual cortex. DOT measurements were taken over the occipital cortex of human adult subjects while they viewed stimuli designed to activate two spatially distinct areas of the visual cortex. ICA was able to extract clean functional hemodynamic signals and separate brain activity sources from hemodynamic fluctuations related to heart and breathing without knowledge of the stimulus paradigm. Furthermore, independent components were found defining distinct functional responses to each stimulus type. Images generated from single ICA components were comparable, with regard to spatial extent and resolution, to images from block averaging (with knowledge of the block stimulus paradigm). Both images and estimated time-series signals demonstrated that ICA was superior to principal component analysis in extracting the true event-evoked response signals. Our results suggest that ICA can extract the time courses and the corresponding spatial extent of functional responses in DOT imaging. |
2,332,875 | The successful use of peripheral nerve blocks for femoral amputation. | We present a case report of four patients with severe cardiac insufficiency where peripheral nerve blocks guided by either nerve stimulation or ultrasonography were the sole anaesthetic for above-knee amputation. The patients were breathing spontaneously and remained haemodynamically stable during surgery. Thus, use of peripheral nerve blocks for femoral amputation in high-risk patients seems to be the technique of choice that can lower perioperative risk. |
2,332,876 | The impact of meloxicam on postsurgical stress associated with cautery dehorning. | The objectives were to determine the duration of the stress response associated with cautery dehorning and to assess the effectiveness of the nonsteroidal anti-inflammatory drug meloxicam (Metacam, 20 mg/mL solution for injection) for reducing that response. Sixty Holstein heifer calves were blocked by age and randomly assigned to receive an i.m. injection of meloxicam or a placebo (0.5 mg/kg). All calves were given a lidocaine cornual nerve block delivered 5 mL per side 10 min before dehorning. To establish baseline values, calves were sham dehorned 24 h before actual dehorning. Blood samples were taken via indwelling jugular catheters at 0, 0.5, 1, 1.5, 2, 4, 6, and 24 h after the procedure. Heart and respiratory rates were also taken at these times. Data were analyzed using PROC MIXED in SAS. Analysis of covariance was employed to assess the difference between sham and dehorning at each time period. Dehorning was associated with elevated serum cortisol (d -1: 33.9 +/- 1.26; d 0: 46.2 +/- 2.33 nmol/L) and heart rate (d -1: 108 +/- 1.8; d 0: 109.4 +/- 2.4 beats per minute) in both groups for 24 h, and elevated respiratory rate (sham: 42.2 +/- 1.95 vs. dehorning: 45.1 +/- 2.19 respirations per minute) in both groups for 6 h. A treatment x time interaction was found for cortisol, with meloxicam calves having lower serum cortisol than controls until 6 h after dehorning (meloxicam: 49.7 +/- 4.37 vs. control: 63.0 +/- 6.94 nmol/L). There was no difference between the treatment groups at 24 h (meloxicam: 35.2 +/- 2.74 and control: 34.8 +/- 3.64 nmol/L of cortisol). Overall, the changes in heart rates (increase meloxicam: 3.74 +/- 0.96 vs. control: 4.70 +/- 1.87) and respiratory rates (increase meloxicam: 2 +/- 0.1 vs. control: 4 +/- 0.2) were greater in the control group compared with the meloxicam group. These results indicate that meloxicam reduced the physiological stress response to dehorning. |
2,332,877 | FPGA-core defibrillator using wavelet-fuzzy ECG arrhythmia classification. | An electrocardiogram (ECG) feature extraction and classification system has been developed and evaluated using Quartus II 7.1 belong to Altera Ltd. In wavelet domain QRS complexes were detected and each complex was used to locate the peaks of the individual waves. Then, fuzzy classifier block used these features to classify ECG beats. Three types of arrhythmias and abnormalities were detected using the procedure. The completed algorithm was embedded into Field Programmable Gate Array (FPGA). The completed prototype was tested through software-generated signals, in which test scenarios covering several kinds of ECG signals on MIT-BIH Database. For the purpose of feeding signals into the FPGA, a software was designed to read signal files and import them to the LPT port of computer that was connected to FPGA. From the results, it was achieved that the proposed prototype could do real time monitoring of ECG signal for arrhythmia detection. We also implemented algorithm in a sequential structure device like AVR microcontroller with 16 MHZ clock for the same purpose. External clock of FPGA is 50 MHZ and by utilizing of Phase Lock Loop (PLL) component inside device, it was possible to increase the clock up to 1.2 GHZ in internal blocks. Final results compare speed and cost of resource usage in both devices. It shows that in cost of more resource usage, FPGA provides higher speed of computation; because FPGA makes the algorithm able to compute most parts in parallel manner. |
2,332,878 | Block circulant quasi-band matrix property for the SENSE unfolding in k-space and justification for GRAPPA. | The k-space unfolding matrix for parallel imaging in MRI was examined and was found to have the structure of block circulant quasi-band, providing a rigorous mathematical justification for the interpolation kernel in the commonly used GRAPPA method. The optimal GRAPPA kernel size and dimension were closely related to sensitivity spectrum. |
2,332,879 | Comparison of analysis techniques of diabetic cardiac action potential propagation. | Diabetes is known to cause a variety of cardiovascular complications. One of the effects of the diabetic state is that the conduction velocity of the action potential front may be delayed in the myocardium. Current methods of measuring this effect have included optical mapping methods, from which the time required for activation of the ventricular surface can be measured. It has been proposed that the same information could be obtained from the ECG. This paper examines whether the current optical methods correlate with the proposed ECG-based method. To do this, an ECG measurement algorithm was written and results compared to those of the optical method. The data suggest that the new ECG method is correlated with the existing optical methods. However, the data also suggest that this correlation is highest when the measurement is made during sinus rhythm, rather than in response to a pacing stimulus. |
2,332,880 | An attempt to prevent senescence: a mitochondrial approach. | Antioxidants specifically addressed to mitochondria have been studied to determine if they can decelerate senescence of organisms. For this purpose, a project has been established with participation of several research groups from Russia and some other countries. This paper summarizes the first results of the project. A new type of compounds (SkQs) comprising plastoquinone (an antioxidant moiety), a penetrating cation, and a decane or pentane linker has been synthesized. Using planar bilayer phospholipid membrane (BLM), we selected SkQ derivatives with the highest permeability, namely plastoquinonyl-decyl-triphenylphosphonium (SkQ1), plastoquinonyl-decyl-rhodamine 19 (SkQR1), and methylplastoquinonyldecyltriphenylphosphonium (SkQ3). Anti- and prooxidant properties of these substances and also of ubiquinonyl-decyl-triphenylphosphonium (MitoQ) were tested in aqueous solution, detergent micelles, liposomes, BLM, isolated mitochondria, and cell cultures. In mitochondria, micromolar cationic quinone derivatives were found to be prooxidants, but at lower (sub-micromolar) concentrations they displayed antioxidant activity that decreases in the series SkQ1=SkQR1>SkQ3>MitoQ. SkQ1 was reduced by mitochondrial respiratory chain, i.e. it is a rechargeable antioxidant. Nanomolar SkQ1 specifically prevented oxidation of mitochondrial cardiolipin. In cell cultures, SkQR1, a fluorescent SkQ derivative, stained only one type of organelles, namely mitochondria. Extremely low concentrations of SkQ1 or SkQR1 arrested H(2)O(2)-induced apoptosis in human fibroblasts and HeLa cells. Higher concentrations of SkQ are required to block necrosis initiated by reactive oxygen species (ROS). In the fungus Podospora anserina, the crustacean Ceriodaphnia affinis, Drosophila, and mice, SkQ1 prolonged lifespan, being especially effective at early and middle stages of aging. In mammals, the effect of SkQs on aging was accompanied by inhibition of development of such age-related diseases and traits as cataract, retinopathy, glaucoma, balding, canities, osteoporosis, involution of the thymus, hypothermia, torpor, peroxidation of lipids and proteins, etc. SkQ1 manifested a strong therapeutic action on some already pronounced retinopathies, in particular, congenital retinal dysplasia. With drops containing 250 nM SkQ1, vision was restored to 67 of 89 animals (dogs, cats, and horses) that became blind because of a retinopathy. Instillation of SkQ1-containing drops prevented the loss of sight in rabbits with experimental uveitis and restored vision to animals that had already become blind. A favorable effect of the same drops was also achieved in experimental glaucoma in rabbits. Moreover, the SkQ1 pretreatment of rats significantly decreased the H(2)O(2) or ischemia-induced arrhythmia of the isolated heart. SkQs strongly reduced the damaged area in myocardial infarction or stroke and prevented the death of animals from kidney ischemia. In p53(-/-) mice, 5 nmol/kgxday SkQ1 decreased the ROS level in the spleen and inhibited appearance of lymphomas to the same degree as million-fold higher concentration of conventional antioxidant NAC. Thus, SkQs look promising as potential tools for treatment of senescence and age-related diseases. |
2,332,881 | Comparison of the effect of sevoflurane and halothane anesthesia on the fall in heart rate as a predictor of successful single shot caudal epidural in children. | To investigate the effect of sevoflurane anesthesia on heart rate HR fall with the injection of the initial drug in caudal space to confirm the correct needle placement.</AbstractText>After the ethical approval was obtained from the hospital's ethics committee, a prospective, randomized, clinical study was designed in Yeditepe University Hospital, in 2007. Children aged 1-12 years, scheduled for infraumbilical surgery under general anesthesia, and caudal block were included in the study. Anesthesia was induced, and maintained by sevoflurane in group S (n=85), and by halothane in group H (n=82). Baseline HR was recorded before the caudal block was performed. The HR changes during the initial dose, and total drug injection were recorded followed by 2 more HR recordings taken 5, and 10 minutes after caudal injection. The success of the block was recorded by a blind observer.</AbstractText>There were 167 children included in the study. Caudal block success was 96.5% in group S, and 97.6% in group H. Basal HR was 110.9 +/- 10.9 in group S, and 105.9 +/- 10.1 in group H. Following the initial drug injection, mean HR was 109.8 +/- 10.9 in group S, and 102.9 +/- 9.9 in group H. It was significantly lower than the baseline in group H. The only significant decrease in the HR of the patients in group S was at the tenth minute following caudal injection.</AbstractText>The decrease in HR with drug injection has no value to predict the success of caudal block under sevoflurane anesthesia.</AbstractText> |
2,332,882 | A method for the analysis of domain movements in large biomolecular complexes. | A new method for the analysis of domain movements in large, multichain, biomolecular complexes is presented. The method is applicable to any molecule for which two atomic structures are available that represent a conformational change indicating a possible domain movement. The method is blind to atomic bonding and atom type and can, therefore, be applied to biomolecular complexes containing different constituent molecules such as protein, RNA, or DNA. At the heart of the method is the use of blocks located at grid points spanning the whole molecule. The rotation vector for the rotation of atoms from each block between the two conformations is calculated. Treating components of these vectors as coordinates means that each block is associated with a point in a "rotation space" and that blocks with atoms that rotate together, perhaps as part of the same rigid domain, will have colocated points. Thus a domain can be identified from the clustering of points from blocks that span it. Domain pairs are accepted for analysis of their relative movements in terms of screw axes based upon a set of reasonable criteria. Here, we report on the application of the method to biomolecules covering a considerable size range: hemoglobin, liver alcohol dehydrogenase, S-Adenosylhomocysteine hydrolase, aspartate transcarbamylase, and the 70S ribosome. The results provide a depiction of the conformational change within each molecule that is easily understood, giving a perspective that is expected to lead to new insights. Of particular interest is the allosteric mechanism in some of these molecules. Results indicate that common boundaries between subunits and domains are good regions to focus on as movement in one subunit can be transmitted to another subunit through such interfaces. |
2,332,883 | Effects of iron oxide nanoparticles on cardiac differentiation of embryonic stem cells. | The therapeutic potential of transplantation of embryonic stem cells (ESCs) in animal model of myocardial infarction has been consistently demonstrated. The development of superparamagnetic iron oxide (SPIO) nanoparticles labeling and cardiac magnetic resonance imaging (MRI) have been increasingly used to track the migration of transplanted cells in vivo allowing cell fate determination. However, the impact of SPIO- labeling on cell phenotype and cardiac differentiation capacity of ESCs remains unclear. In this study, we demonstrated that ESCs labeled with SPIO compared to their unlabeled counterparts had similar cardiogenic capacity, and SPIO-labeling did not affect calcium-handling property of ESC-derived cardiomyocytes. Moreover, transplantation of SPIO-labeled ESCs via direct intra-myocardial injection to infarct myocardium resulted in significant improvement in heart function. These findings demonstrated the feasibility of in vivo ESC tracking using SPIO-labeling and cardiac MRI without affecting the cardiac differentiation potential and functional properties of ESCs. |
2,332,884 | Differential protein expression in heart in UT-B null mice with cardiac conduction defects. | Cardiac conduction defects were found in transgenic mice deficient in urea transporter UT-B. To investigate the molecular mechanisms of the conduction defects caused by UT-B deletion, we studied the protein expression profiles of heart tissue (comprising most conduction system) in wild-type versus UT-B null mice at different ages. By two-dimensional electrophoresis-based comparative analysis, we found that more than dozen proteins were modulated (>two-fold) in the myocardium of UT-B null mice. Out of these modulated proteins, troponin T (TNNT2) presented significant changes in UT-B null mice at early stage prior to the development of P-R interval elongation, while the change of atrial natriuretic peptide (ANP) occurred only at late stage in UT-B null mice that had the AV block. These data indicate that UT-B deletion caused the dynamic expression regulation of TNNT2 and ANP, and these proteins may provide new clues to investigate the molecular events involved in cardiac conduction. |
2,332,885 | The cardioprotective effect of postconditioning is mediated by ARC through inhibiting mitochondrial apoptotic pathway. | Postconditioning protects the heart against ischemia/reperfusion injury by inhibiting cardiomyocyte apoptosis. However, the molecular mechanism by which postconditioning suppresses apoptosis remains to be fully understood. Apoptosis repressor with caspase recruitment domain (ARC) has been demonstrated to possess the ability to protect cardiomyocytes from apoptosis induced by ischemia/reperfusion. It is not yet clear as to whether ARC contributes to the inhibitory effect of postconditioning against cardiomyocyte apoptosis.</AbstractText>The cultured cardiomyocytes from 1-day old male Sprague-Dawley rats were exposed to 3 h hypoxia followed by 3 h of reoxygenation. Cells were postconditioned by three cycles each of 5 min reoxygenation and 5 min hypoxia before 3 h of reoxygenation.</AbstractText>Hypoxia/reoxygenation led to a decrease of endogenous ARC protein levels. In contrast, postconditioning could block the reduction of endogenous ARC protein levels. Interestingly, inhibition of endogenous ARC expression by ARC antisense oligodeoxynucleotides reduced the inhibitory effect of postconditioning against apoptosis. Furthermore, our data showed that postconditioning suppressed the loss of mitochondrial membrane potential, Bax activation and the release of mitochondrial cytochrome c to cytosol. However, these inhibitory effects of postconditioning disappeared upon knockdown of endogenous ARC.</AbstractText>Our data for the first time demonstrate that ARC plays an essential role in mediating the cardioprotective effect of postconditioning against apoptosis initiated by the mitochondrial pathway.</AbstractText> |
2,332,886 | A case of an acquired high-degree AV block in a pregnant woman. | Acquired heart block during pregnancy is rare. We describe the case of a 29-year-old pregnant female with fatigue due to an unexplained high-degree AV conduction disorder. She was treated with a dual chamber pacing system. Further pregnancy and delivery were without complications. The sparse literature on this topic is reviewed. (Neth Heart J 2008;16:419-21.). |
2,332,887 | [The lived experience of struggling against illness for patients with amyotrophic lateral sclerosis]. | The purpose of this study was to identify and describe phenomenological structures of the lived experience of struggling against an illness for patients with Amyotrophic Lateral Sclerosis (ALS).</AbstractText>The participants were 7 patients with ALS recruited by snowball sampling who agreed to participate in this research and could verbally communicated with the researcher. Data were collected by long term-repeated interviews with participants in their own homes. Data were analyzed using Colaizzi's method of phenomenology.</AbstractText>Four categories were extracted as follows: 'Being seized with fear of death', 'Living a marginal life', 'Accepting hard fate', and 'Clinging to faint life'. Seven theme clusters were identified as: 'Wandering to find a healing method with ominous signs in the body', 'Having a diagnosis of ALS is like a bolt from the blue and struggling against illness with faint hope', 'Being forced out to the edge of life with anguish', 'Filling one's heart with hatred and longing toward becoming estranged from the world', 'Living with stigma as a stumbling block with bitter grief in one's heart', 'Accepting every things as one's fate with self controlled fear of death', and 'Attaching to desire to live'.</AbstractText>The results of this study can be used to develop the programs to support patients with ALS and their family.</AbstractText> |
2,332,888 | Activation of cytosolic phospholipase A2-{alpha} as a novel mechanism regulating endothelial cell cycle progression and angiogenesis. | Release of endothelial cells from contact-inhibition and cell cycle re-entry is required for the induction of new blood vessel formation by angiogenesis. Using a combination of chemical inhibition, loss of function, and gain of function approaches, we demonstrate that endothelial cell cycle re-entry, S phase progression, and subsequent angiogenic tubule formation are dependent upon the activity of cytosolic phospholipase A(2)-alpha (cPLA(2)alpha). Inhibition of cPLA(2)alpha activity and small interfering RNA (siRNA)-mediated knockdown of endogenous cPLA(2)alpha reduced endothelial cell proliferation. In the absence of cPLA(2)alpha activity, endothelial cells exhibited retarded progression from G(1) through S phase, displayed reduced cyclin A/cdk2 expression, and generated less arachidonic acid. In quiescent endothelial cells, cPLA(2)alpha is inactivated upon its sequestration at the Golgi apparatus. Upon the stimulation of endothelial cell proliferation, activation of cPLA(2)alpha by release from the Golgi apparatus was critical to the induction of cyclin A expression and efficient cell cycle progression. Consequently, inhibition of cPLA(2)alpha was sufficient to block angiogenic tubule formation in vitro. Furthermore, the siRNA-mediated retardation of endothelial cell cycle re-entry and proliferation was reversed upon overexpression of an siRNA-resistant form of cPLA(2)alpha. Thus, activation of cPLA(2)alpha acts as a novel mechanism for the regulation of endothelial cell cycle re-entry, cell cycle progression, and angiogenesis. |
2,332,889 | Postoperative patient-controlled thoracic epidural analgesia: importance of dose compared to volume or concentration. | This randomised and blinded study evaluated the quality of analgesia and the incidence of side-effects of two concentrations of levobupivacaine (0.15% and 0.5%) given as an equal mg-bolus-dose (5 mg) via patient-controlled epidural analgesia after lower abdominal surgery. The patients were randomly assigned into two groups to receive either 0.15% levobupivacaine as a 3.3 ml bolus on demand, with a lockout interval of 30 minutes (n=30), or 0.5% levobupivacaine as a 1 ml bolus on demand, with a similar lockout interval (n=30). For both groups we combined the bolus on demand with a background infusion of 5 mg/hour levobupivacaine, i.e. 3.3 ml/hour 0.15% or 1 ml/hour 0.5% of levobupivacaine. The epidural catheters were inserted in a lower thoracic intervertebral space before induction of general anaesthesia. The following variables were registered in the 48 hours after surgery: upper and lower sensory block, pain scores at rest and after coughing, rescue morphine consumption, motor blockade, haemodynamic (arterial blood pressure and heart rate), nausea and vomiting, and patient satisfaction ratings. The two groups had similar sensory block, quality of analgesia, rescue morphine consumption requirement, motor blockade and side-effects, and both had a high satisfaction rate. These findings indicate that administering the same dose of levobupivacaine in either a low or high concentration via the patient-controlled epidural analgesia mode, combined with a background infusion, provides an equal quality of analgesia for low thoracic level epidurals with no difference in the incidence of side-effects. |
2,332,890 | Implantation of lumenless pacing leads at the inter-atrial septum and right ventricular outflow tract with deflectable catheter-sheath. | Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class I indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French (Fr) lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath (Medtronic Inc., USA) were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results (mean atrial pacing threshold: 0.87 V; mean P wave amplitude: 2.28 mV; mean ventricular pacing threshold: 0.53V; mean R wave amplitude: 8.75 mV) were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible. |
2,332,891 | Physiologic and cardiac roles of beta-arrestins.<Pagination><StartPage>300</StartPage><EndPage>308</EndPage><MedlinePgn>300-8</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.yjmcc.2008.11.015</ELocationID><Abstract><AbstractText>Beta-arrestin1 and beta-arrestin2 were initially identified by sequence homology to visual arrestins and by their ability to bind to and inactivate signaling of the beta-2-adrenergic receptor in a process known as desensitization. While the role of beta-arrestins in desensitization has been known for some time, more recent evidence has revealed that beta-arrestins are multifunctional scaffolding proteins that are involved in numerous aspects of G protein-coupled receptor (GPCR) signaling. Interestingly, exciting new data shows that beta-arrestins can mediate signaling in their own right independent of classical second messenger mediated signaling, and that this beta-arrestin-mediated signaling may be cardioprotective. Identifying novel ligands for GPCRs that can block G protein-mediated signaling while simultaneously promoting beta-arrestin-mediated signaling could provide powerful new therapies for cardiac disease.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Patel</LastName><ForeName>Priyesh A</ForeName><Initials>PA</Initials><AffiliationInfo><Affiliation>Duke University School of Medicine, Durham, North Carolina 27710, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tilley</LastName><ForeName>Douglas G</ForeName><Initials>DG</Initials></Author><Author ValidYN="Y"><LastName>Rockman</LastName><ForeName>Howard A</ForeName><Initials>HA</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2008</Year><Month>12</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Mol Cell Cardiol</MedlineTA><NlmUniqueID>0262322</NlmUniqueID><ISSNLinking>0022-2828</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D058666">Adrenergic beta-2 Receptor Agonists</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019390">Arrestins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D002316">Cardiotonic Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D018343">Receptors, Adrenergic, beta-2</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000071557">beta-Arrestins</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D058666" MajorTopicYN="N">Adrenergic beta-2 Receptor Agonists</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000818" MajorTopicYN="N">Animals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019390" MajorTopicYN="N">Arrestins</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002316" MajorTopicYN="N">Cardiotonic Agents</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006331" MajorTopicYN="N">Heart Diseases</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009206" MajorTopicYN="N">Myocardium</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011173" MajorTopicYN="N">Portraits as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018343" MajorTopicYN="N">Receptors, Adrenergic, beta-2</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015290" MajorTopicYN="Y">Second Messenger Systems</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000071557" MajorTopicYN="N">beta-Arrestins</DescriptorName></MeshHeading></MeshHeadingList><NumberOfReferences>102</NumberOfReferences></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2008</Year><Month>8</Month><Day>13</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2008</Year><Month>11</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2008</Year><Month>11</Month><Day>12</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2008</Year><Month>12</Month><Day>24</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2008</Year><Month>12</Month><Day>24</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>6</Month><Day>9</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19103204</ArticleId><ArticleId IdType="doi">10.1016/j.yjmcc.2008.11.015</ArticleId><ArticleId IdType="pii">S0022-2828(08)01408-9</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19102237</PMID><DateCompleted><Year>2009</Year><Month>01</Month><Day>26</Day></DateCompleted><DateRevised><Year>2008</Year><Month>12</Month><Day>23</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0201-7563</ISSN><JournalIssue CitedMedium="Print"><Issue>5</Issue><PubDate><Year>2008</Year><Season>Sep-Oct</Season></PubDate></JournalIssue><Title>Anesteziologiia i reanimatologiia</Title><ISOAbbreviation>Anesteziol Reanimatol</ISOAbbreviation></Journal>[Central hemodynamics under conditions of combined anesthesia on the basis of a thoracic epidural block]. | Beta-arrestin1 and beta-arrestin2 were initially identified by sequence homology to visual arrestins and by their ability to bind to and inactivate signaling of the beta-2-adrenergic receptor in a process known as desensitization. While the role of beta-arrestins in desensitization has been known for some time, more recent evidence has revealed that beta-arrestins are multifunctional scaffolding proteins that are involved in numerous aspects of G protein-coupled receptor (GPCR) signaling. Interestingly, exciting new data shows that beta-arrestins can mediate signaling in their own right independent of classical second messenger mediated signaling, and that this beta-arrestin-mediated signaling may be cardioprotective. Identifying novel ligands for GPCRs that can block G protein-mediated signaling while simultaneously promoting beta-arrestin-mediated signaling could provide powerful new therapies for cardiac disease.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Patel</LastName><ForeName>Priyesh A</ForeName><Initials>PA</Initials><AffiliationInfo><Affiliation>Duke University School of Medicine, Durham, North Carolina 27710, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tilley</LastName><ForeName>Douglas G</ForeName><Initials>DG</Initials></Author><Author ValidYN="Y"><LastName>Rockman</LastName><ForeName>Howard A</ForeName><Initials>HA</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2008</Year><Month>12</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Mol Cell Cardiol</MedlineTA><NlmUniqueID>0262322</NlmUniqueID><ISSNLinking>0022-2828</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D058666">Adrenergic beta-2 Receptor Agonists</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019390">Arrestins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D002316">Cardiotonic Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D018343">Receptors, Adrenergic, beta-2</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000071557">beta-Arrestins</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D058666" MajorTopicYN="N">Adrenergic beta-2 Receptor Agonists</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000818" MajorTopicYN="N">Animals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019390" MajorTopicYN="N">Arrestins</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002316" MajorTopicYN="N">Cardiotonic Agents</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006331" MajorTopicYN="N">Heart Diseases</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009206" MajorTopicYN="N">Myocardium</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011173" MajorTopicYN="N">Portraits as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018343" MajorTopicYN="N">Receptors, Adrenergic, beta-2</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015290" MajorTopicYN="Y">Second Messenger Systems</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000071557" MajorTopicYN="N">beta-Arrestins</DescriptorName></MeshHeading></MeshHeadingList><NumberOfReferences>102</NumberOfReferences></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2008</Year><Month>8</Month><Day>13</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2008</Year><Month>11</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2008</Year><Month>11</Month><Day>12</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2008</Year><Month>12</Month><Day>24</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2008</Year><Month>12</Month><Day>24</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>6</Month><Day>9</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19103204</ArticleId><ArticleId IdType="doi">10.1016/j.yjmcc.2008.11.015</ArticleId><ArticleId IdType="pii">S0022-2828(08)01408-9</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19102237</PMID><DateCompleted><Year>2009</Year><Month>01</Month><Day>26</Day></DateCompleted><DateRevised><Year>2008</Year><Month>12</Month><Day>23</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0201-7563</ISSN><JournalIssue CitedMedium="Print"><Issue>5</Issue><PubDate><Year>2008</Year><Season>Sep-Oct</Season></PubDate></JournalIssue><Title>Anesteziologiia i reanimatologiia</Title><ISOAbbreviation>Anesteziol Reanimatol</ISOAbbreviation></Journal><ArticleTitle>[Central hemodynamics under conditions of combined anesthesia on the basis of a thoracic epidural block].</ArticleTitle><Pagination><StartPage>76</StartPage><EndPage>79</EndPage><MedlinePgn>76-9</MedlinePgn></Pagination><Abstract>The authors set themselves a task of assessing systemic hemodynamic parameters under combined general anesthesia on the basis of a thoracic epidural block (TEB) versus combined general anesthesia during thoracoabdominal interventions. Thirty patients were examined. Their physical status was in ASA Class II-IV. The preoperative examination was as follows: electrocardiography (ECG) (at rest), ECG (during exercise), and 24-hour ECG monitoring. Hemodynamic parameters, such as systolic blood pressure (BP), diastolic BP, mean BP, and heart rate), were intraoperatively measured by invasive and noninvasive techniques. By using the measurements of cardiac output (extrasternal Doppler study), the authors calculated cardiac index, specific peripheral vascular resistance (SPVS), and stroke index (SI). They made 24-hour ECG monitoring intra- and postoperatively (on days 1 and 5, respectively). The findings suggest that inclusion of TEB in a complex of anesthetic maintenance of thoracoabdominal operations along with combined or total intravenous anesthesia shows better hemodynamic changes, as indicated by a 31% increase in SI and a 32.6% decrease in double product with the stable values of mean BP and heart rate, which was not noted in the control group. The dose of narcotic analgesics was decreased by 2.6 times. |
2,332,892 | Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young Black and White women. | The prevalence of hypertension and its contribution to cardiovascular disease risk makes it imperative to identify factors that may help prevent this disorder. Extensive biological and biochemical data suggest that plasma ascorbic acid may be such a factor. In this study we examined the association between plasma ascorbic acid concentration and blood pressure (BP) in young-adult women.</AbstractText>Participants were 242 Black and White women aged 18-21 yr from the Richmond, CA, cohort of the National Heart, Lung and Blood Institute Growth and Health Study. We examined the associations of plasma ascorbic acid with BP at follow-up year 10, and with change in BP during the previous year.</AbstractText>In cross-sectional analysis, plasma ascorbic acid at year 10 was inversely associated with systolic BP and diastolic BP after adjusting for race, body mass index, education, and dietary intake of fat and sodium. Persons in the highest one-fourth of the plasma ascorbic acid distribution had 4.66 mmHg lower systolic BP (95% CI 1.10 to 8.22 mmHg, p = 0.005) and 6.04 mmHg lower diastolic BP (95% CI 2.70 to 9.38 mmHg, p = 0.0002) than those in the lowest one-fourth of the distribution. In analysis of the change in BP, plasma ascorbic acid was also inversely associated with change in systolic BP and diastolic BP during the previous year. While diastolic blood pressure among persons in the lowest quartile of plasma ascorbic acid increased by 5.97 mmHg (95% CI 3.82 to 8.13 mmHg) from year 9 to year 10, those in the highest quartile of plasma vitamin C increased by only 0.23 mmHg (95% CI -1.90 to +2.36 mmHg) (test for linear trend: p < 0.0001). A similar effect was seen for change in systolic BP, p = 0.005.</AbstractText>Plasma ascorbic acid was found to be inversely associated with BP and change in BP during the prior year. The findings suggest the possibility that vitamin C may influence BP in healthy young adults. Since lower BP in young adulthood may lead to lower BP and decreased incidence of age-associated vascular events in older adults, further investigation of treatment effects of vitamin C on BP regulation in young adults is warranted.</AbstractText> |
2,332,893 | The optimum concentration of levobupivacaine for intra-operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate. | Probit analysis was used to predict the median effective concentration (EC(50)) and the 95% effective concentration (EC(95)) values of levobupivacaine for caudal analgesia in children at equal volumes of injectate. Sixty children scheduled for inguinal herniorrhaphy were recruited. Anaesthesia was induced with sevofurane and nitrous oxide. Then caudal block (total volume of local anaesthetic 1 ml.kg(-1)) was performed. Patients randomly received one of six concentrations (0.08%, 0.10%, 0.12%, 0.14%, 0.16% or 0.18%) of levobupivacaine. Thereafter, inhalational anaesthetics were discontinued and intravenous midazolam 0.1 mg.kg(-1) was administered to maintain sedation. The effective caudal analgesia was defined as an absence of gross movements and a haemodynamic (heart rate or blood pressure) reaction < 20% compared with baseline in response to surgical incision. Our data indicated that the EC(50) and EC(95) values of levobupivacaine for caudal analgesia were 0.109% (95% confidence intervals 0.098-0.120%) and 0.151% (95% confidence intervals 0.135-0.193%) when using the same volume (1 ml.kg(-1)), respectively. |
2,332,894 | Calcium and vitamin D intakes may be positively associated with brain lesions in depressed and nondepressed elders. | Studies indicate that diet and vascular calcification may be related to the occurrence of brain lesions, although the importance of dietary calcium and vitamin D has not been investigated. The objective of this study was to test the hypothesis that calcium and vitamin D intakes would be positively associated with brain lesion volumes in elderly individuals with and without late-life depression. A cross-sectional study was performed as part of a longitudinal clinical study of late-life depression. Calcium and vitamin D intakes were assessed in 232 elderly subjects (95 with current or prior depression, 137 without depression) using a Block 1998 food frequency questionnaire. Calcium, vitamin D, and kilojoule intake were determined. Brain lesion volumes were calculated from magnetic resonance imaging scan. Subjects were 60 years or older. Calcium and vitamin D intakes were significantly and positively correlated with brain lesion volume (P < .05 and P < .001, respectively). In 2 separate multivariable models, controlling for age, hypertension, diabetes, heart disease, group (depression/comparison), lesion load (high/low), and total kilocalories, these positive associations remained significant (P < .05 for calcium; P < .001 for vitamin D). In conclusion, calcium and vitamin D consumption were associated with brain lesions in elderly subjects even after controlling for potentially explanatory variables. These associations may be due to vascular calcification or other mechanism. The possibility of adverse effects of high intakes of calcium and vitamin D needs to be further explored in longitudinal studies of elderly subjects. |
2,332,895 | [Comparison of lumbar plexus block and epidural block for elderly patients undergoing intertrochanteric femoral fracture surgery]. | To compare the anesthesia efficacy, hemodynamics, recovery of passage of gas by anus and bladder function in elderly patients with operation of intertrochanteric femoral fracture with epidural or lumbar plexus block.</AbstractText>Sixty patients with intertrochanteric femoral fracture, aged 65-97, were randomly divided into 3 equal groups: lumbar plexus group (Group A, undergoing posterior lumbar plexus block) and epidural group (Group B, undergoing epidural block at L(1-2) interspace). The block onset time, anesthesia efficacy, transfusion amount during operation, blood pressure and heart rate change 1 h after anesthesia, and recovery after anesthesia were observed.</AbstractText>The block onset time on femoral nerve, lateral cutaneous nerve of thigh, obturator nerve, and saphenous nerve of Group A were (2.7 +/- 2.0) min, (3.1 +/- 3.4) min, (3.5 +/- 3.3) min, and (3.7 +/- 3.1) min respectively, all significantly shorter than those of Group B [(13.5 +/- 2.1) min, (13.5 +/- 2.1) min, (13.5 +/- 2.1) min, and (13.5 +/- 2.1) min respectively, all P < 0.01]. The duration of postoperative analgesia of Group A was (420 +/- 152) min, significantly longer than that of Group B [(204 +/- 44) min, P < 0.05]. There were no significant differences in the change of blood pressure and heart rate between these 2 groups. The blood pressure decreased significantly 10 - 60 min after anesthesia in Group B, and remained stable in Group A. The transfusion amount of Group A was (773 +/- 353) ml, significantly fewer than that in Group B [(1483 +/- 444) ml, P < 0.01]. Passage of gas by anus started (1.1 +/- 0.6) h after operation in Group A, a time significantly shorter than that in Group B (5.9 +/- 1.2) h, P < 0.01). Urinary retention was seen in 8 patients of Group B, however, no patient in Group A showed incidence of urinary retention (P < 0.01). Forty-eight patients, 20 in Group A and 28 in Group B got excellent anesthesia effect, and 12 of them, 10 in Group A and 2 in Group B, got relatively good anesthesia (P < 0.05).</AbstractText>Both lumbar plexus block and epidural block provide satisfactory anesthetic efficacy for operation of intertrochanteric femoral fracture in elderly patients. Epidural block provide better efficacy, and lumbar plexus block shows faster recovery of digestive system and urinary system after operation.</AbstractText> |
2,332,896 | Effect of some acute and prophylactic antimigraine drugs on the vasodepressor sensory CGRPergic outflow in pithed rats. | This study analyzed in pithed rats the effect of several acute and prophylactic antimigraine drugs on the CGRPergic vasodepressor sensory outflow, in an attempt to investigate systemic cardiovascular effects in a model unrelated to migraine.</AbstractText>Male Wistar pithed rats were pretreated with continuous i.v. infusions of hexamethonium (2 microg/kg.min; to block autonomic outflow) and methoxamine (15-20 microg/kg.min; to maintain diastolic blood pressure at around 130 mmHg). Under these conditions, the effect of both electrical stimulation (0.56-5.6 Hz; 50 V and 2 ms) of the spinal cord (T(9)-T(12)) or i.v. bolus injections of exogenous alpha-CGRP (0.1-1 microg/kg) were studied in animals pretreated with continuous i.v. infusions of sumatriptan (1-100 microg/kg.min), ergotamine (0.18-0.56 microg/kg.min), dihydroergotamine (1-10 microg/kg.min), magnesium valproate (1000-1800 microg/kg.min), propranolol (100-300 microg/kg.min) or their respective vehicles.</AbstractText>Electrical stimulation of the spinal cord and i.v. bolus injections of exogenous alpha-CGRP resulted in, respectively, frequency- and dose-dependent decreases in diastolic blood pressure without affecting heart rate. Moreover, the infusions of sumatriptan, ergotamine and dihydroergotamine, but not of magnesium valproate, propranolol or their respective vehicles, dose-dependently inhibited the vasodepressor responses to electrical stimulation. In contrast, sumatriptan (10 microg/kg.min), ergotamine (0.31 microg/kg.min) and dihydroergotamine (3 microg/kg.min) failed to inhibit the vasodepressor responses to exogenous alpha-CGRP.</AbstractText>The above findings suggest that the acute (rather than the prophylactic) antimigraine drugs attenuate the vasodepressor sensory outflow mainly by prejunctional mechanisms. This may be of particular relevance when considering potential cardiovascular adverse effects by acute antimigraine drugs.</AbstractText> |
2,332,897 | Thoracic epidural analgesia with low concentration of bupivacaine induces thoracic and lumbar sympathetic block: a randomized, double-blind clinical trial. | Clinical benefits of thoracic epidural anesthesia (TEA) are partly ascribed to thoracic sympathetic block. However, data regarding sympathetic activity during TEA are scarce and contradictory. This prospective, randomized, double-blind study evaluated the segmental propagation of sympathetic block after low-concentration, high-volume TEA using digital thermography.</AbstractText>Twenty-four patients were included in the study. Thoracic epidural catheters were placed at a median insertion level of T8-T9. Patients were accommodated for 20 min to the room temperature of 23 degrees +/- 0.3 degrees C. Skin temperature was recorded by digital thermography. After baseline measurement of heart rate, arterial pressure, and core body and skin temperature, 10 ml saline (control group) or 10 ml bupivacaine, 0.25% (TEA group), respectively, was administered epidurally. Five minutes (t5) and 20 min (t20) after baseline measurements, hemodynamic parameters and core body temperature were again measured, and sensory block was identified by loss of cold-warm discrimination. In the thumb, the toe, and each thoracic dermatome, difference from baseline temperature was calculated at t5 and t20. Data were analyzed by Mann-Whitney U test.</AbstractText>Baseline characteristics did not differ among groups. Median spread of sensory block at t20 was T5-L5. At both t5 and t20, skin temperature decreased more in the control group than in the TEA group in all thoracic dermatomes (P < 0.05). Toe temperature increased in the TEA group compared with the control group (P < 0.05), whereas thumb temperature remained unchanged.</AbstractText>TEA with 10 ml bupivacaine, 0.25%, induced thoracic and lumbar sympathetic block that precedes and exceeds sensory block. Caudal limit of sympathetic block could not be demonstrated in this study.</AbstractText> |
2,332,898 | Cardioprotection by postconditioning is lost in WOKW rats with metabolic syndrome: role of glycogen synthase kinase 3beta. | Postconditioning by repetitive I/R cycles immediately after onset of reperfusion protects the heart. Metabolic disorders undermine the protection of preconditioning. The present study tested whether postconditioning protects hearts from rats with established metabolic syndrome [Wistar-Ottawa-Karlsburg W rats (WOKW)].</AbstractText>After 28 weeks of age, WOKW rats were much heavier than DA (Dark Agouti) and Wistar control rats and showed the pattern of the metabolic syndrome. Postconditioning was performed by 3 30-second cycles of reperfusion/ischemia immediately after the regional ischemia (30 minutes). Infarct size was comparable in all control hearts from DA, Wistar, and WOKW rats (58 +/- 2%, 49 +/- 3%; 49 +/- 2%, respectively). Postconditioning significantly reduced the infarct size in DA rats (39 +/- 5%) and Wistar rats (29 +/- 3%). In WOKW rats, the infarct sparing effect of postconditioning was lost (43 +/- 4%).GSK-3beta and Erk are involved in the signaling of postconditioning. Therefore, the phosphorylation of these proteins was determined by Western blot analysis. Postconditioning significantly increased the phosphorylation of GSK-3beta in DA and Wistar rats (1.6-fold in DA rats, 2.3-fold in Wistar rats, P < 0.05) but failed to do so in WOKW rats. Similarly, a trend for an increased phosphorylation of Erk was found in DA rats but not in WOKW rats. Thus the inefficacy of postconditioning in reducing infarct size in rats with metabolic syndrome is paralleled by a lack of phosphorylation of GSK-3beta and Erk.</AbstractText>The metabolic syndrome, as shown in this animal model, completely abrogates the postconditioning. This blockade involves the phosphorylation of GSK-3beta. Further studies have to evaluate whether this block of postconditioning makes patients with a metabolic syndrome more susceptible to myocardial damage after infarction.</AbstractText> |
2,332,899 | [Complete heart block and myocardial ischaemia during a severe anaphylactic reaction]. | An 83-year-old man had to be operated under general anaesthesia for a head skin tumor. The preanaesthetic exam of the cardiovascular function was reassuring but a cardiac arrest with a complete heart block occurred a few minutes after induction of anaesthesia. Resuscitation managing was successful but a myocardial ischaemia appeared. Biological tests confirmed severe anaphylactic reaction. The electrocardiographic expression, pathophysiology and management of cardiac anaphylaxis are discussed. |
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