Self-efficacy expectancies versus outcome expectancies as determinants of performance deficits and depressive affect

To compare the depression etiologies specified by self-efficacy theory versus the revised learned helplessness theory, 108 male and female undergraduates were assigned randomly to either high, low, or no self response expectancy manipulations and high, low, or no response outcome expectancy manipulations. Expectancies were modified by combinations of easy or difficult anagrams and graphs showing that most or few students solved the anagrams. Males exhibited performance deficits and depressed affect following manipulations only if self response expectancy had been set low and other response expectancy had been set high. Contrary to revised learned helplessness theory, no performance deficit or depressive affect occurred when both self response and response outcome expectancies were low. Females' performance and affect were not changed by combined low self response and high response outcome manipulations. Repeated subject ratings of self response and response outcome expectancies during manipulations suggest that females set their self response expectancies low before manipulations to avoid depression. Expectancy ratings also showed that self response expectancies correlated more strongly with performance than did response outcome expectancies.We thank Katherine Acosta, Michael Davis, Larry McFarland, and Janine Tronolone for their assistance as experimenters.     

New aspects of pulmonary mechanics: ‘slowly” distensible compartments of the respiratory system,identified by a PEEP step maneuver

Objective The aims of the present study were 1) to evaluate a method for identification of slowly distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify slowly distensible rs-compartments in mechanically ventilated patients.Design Prospective studyon a physical lung model.Setting Intensive Care Unit, University Hospital, Tübingen.Patients and participants 19 patients with severe lung injury (acute respiratory distress syndrome, ARDS) and on 10 patients with mild lung injury.Measurements and results Positive end-expiratory pressure (PEEP)-increasing and-decreasing steps of about 5 cmH₂O were applied and the breath-by-breath differences of inspiratory and expiratory volumes (V) were measured. The sequence of Vs were analyzed in terms of volume change in the fast compartment (V_fast), the slow compartment (V_slow), total change in lung volume (VL) and mechanical time constant of the slow compartment (RC_slow). Thirty-eight measurements in a lung model revealed a good correlation between the preset V_slow/VL and V_slow/VL measured: r²=0.91 The V_slow/VL measured amounted to 0.94±0.15 of V_slow/VL in the lung model. RC_slow measured was 0.92±0.43 of the RC_slow reference. Starting from a PEEP level of 11 cmH₂O PEEP-increasing and PEEP-decreasing steps were applied to the mechanically ventilated patients. Three out of ten patients with mild lung injury (30%) and 7/19 patients with ARDS (36.8%) revealed slowly distensible rscompartments in a PEEP-increasing step, whereas 15/19 ARDS patients and 1/10 patients with mild lung injury showed slowly distensible rs-compartments in a PEEP-decreasing step (78.9% vs 10%,P<0.002, chi-square test).Conclusions The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the slow units to the total increase of lung volume following a PEEP step could be adequately assessed. Slowly distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed slow rs-compartments in PEEP-decreasing steps. The influence of slowly distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.The work was performed at the Klinik für Anaesthesiologie und Transfusionsmedizin der Universität Tübingen     

Left ventricular function after acute myocardial infarction

10 patients with their first AMI were studied within the first 48 hours and again after 3 weeks. Central and peripheral haemodynamics (CI, SV, SW, TPR) were examined, including indices of contractility (dp/dlmax) and wall stiffness (P/V, relation P/V to P) of the left ventricle.In the early phase CI and SW, as well as LV dp/dt_max were depressed in accordance with symptoms of LV failure. P/V was increased. Elevation of LVEDP correlated well with ventricular gallop rhythm, but less consistently with LV functional disturbance.During convalescence CI increased uniformly, both in digitalized and non-digitalized individuals. In contrast heart rate, aortic pressure, LVEDP and dp/dt_max remained unchanged. The increase of CI, SV and SW was accompanied by a fall of TPR and P/V. LV wall stiffness was still elevatedabove normal after 3 weeks. The improvement of cardiac pumping during infarct convalescence may have been effected through a fall of TPR and LV wall stiffness. Recovery of depressed contractile performance was generally not observed, and does therefore not seem to contribute to recuperation.Herrn Prof. Dr. med. P. Schölmerich zum 60. Geburtstag.     

Plantes et vieillissement, données actuelles*

Résumé: Le vieillissement résulte dune suite de mécanismes biologiques sacconpagnant de modifications physiologiques, anatomiques et psychologiques.Après avoir rappelé ses manifestations physiologiques (cérébrales, hormonales, cutanées, cardio-vasculaires, troubles de lappareil locomoteur), lauteur sélectionne, daprès des critères scientifiques, différentes plantes capables de contribuer à ralentir le processus de sénescence de lorganisme ou de combattre les effets du vieillissement. Ces végétaux ont fait lobjet de publications dans des revues scientifiques internationales principalement au cours de ces cinq dernières années. Dossier: Phytothérapie et vieillissement* Communication présentée lors du 5^e colloque de la revue Phytothérapie: les Avancées en Phytothérapie, janvier 2004.     

Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets

Objectives Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant.Design Randomized experimental trial.Setting Experimental laboratory of a University Department of Anesthesiology and Intensive Care.Animals Twelve anesthetised piglets.Interventions After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; IE was 11, and PEEP was set to 75% of the inflection point pressure level. The IE ratios of 1.51, 2.31, and 41 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP.Measurement and results Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF₆ tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the IE of 11, PaCO₂ was 8% lower, with IE 2.31 and 41 (p0.01) while PaO₂ remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased IE ratio. Stroke index and right ventricular ejection fraction were depressed at higher IE ratios (SI by 18% at 2.31, 20% at 41; RVEF by 10% at 2.31, 13% at 41;p0.05).Conclusion Under open lung conditions with an increased IE ratio, oxygenation remained unaffected while hemodynamics were impaired.This study was supported by the Swedish Medical Research Council (project 4252), the Swedish Heart-Lung Foundation, Stockholm, Sweden, and the Laerdal Foundation for Acute Medicine, Stavanger, Norway     

Phyto News

Phyto News est la revue commentée de communications dans le domaine de la plante médicinale (recherche pharmacologique et clinique), qui nous semble présenter un intérêt médical ou pharmaceutique tel quil puisse permettre de faire progresser dautres études qui aboutiront à une application thérapeutique. Il est cependant important davertir les lecteurs que dune découverte ou dune démonstration pharmacologique ne découle pas immédiatement la justification de lutilisation médicale.

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Phyto News is a commented review of papers about medicinal plant research all around the world. The papers must contain information leading to medicinal progress in phytotherapy practice or development in the pharmaceutical area. The reader is reminded that not all discoveries will have immediate use in medicine, but each may give ideas for further investigations.

     

Serum MIP-1α and IL-8 in septic patients

We studied blood MIP-1 and IL-8 in 38 septic patients and 5 healthy volunteers. Both chemokines were undetectable in the healthy volunteers. In sepsis, serum MIP-1 was detected in 45% of the patients and IL-8 in 84%. The levels of MIP-1, but not of IL-8, correlated with CRP, IL-6 and TNF levels. Complication, including various organ failures and mortality, showed no correlation with serum MIP-1 levels. In contrast, we found increased levels of serum IL-8 in septic patients with disseminated intravascular coagulation, central nervous system (CNS) dysfunction or renal failure, and the mortality rate was higher in the IL-8-detectable group than in the IL-8 undetectable group (50% vs 0%,p<0.05). In conclusion, the production of both MIP-1 and IL-8 was increased and initially detectable levels of circulating IL-8 predicted high mortality in sepsis.Objective To determine the significance of the C-C chemokine MIP-1 and the C-X-C chemokine IL-8 in sepsis.Design Prospective study.Setting Clinical investigation, emergency department and general intensive care unit of university hospital.Patients and participants 38 septic patients and 5 healthy volunteers were studied. Sepsis was diagnosed following the criteria formulated by ACCP/SCCM.Interventions 10–20 ml of blood was drawn from each patient at the time of initial diagnosis of sepsis.Measurements and results MIP-1 and IL-8 were determined by sand-wich ELISA. Both chemokines were undetectable in the healthy volunteers. In sepsis, serum MIP-1 was detected in 45% of the patients and IL-8 was detected in 84%. The levels of MIP-1, but not of IL-8, correlated with CRP, IL-6 and TNF levels. Complications, including various organ failures and mortality, showed no correlation with serum MIP-1 levels. In contrast, we found increased levels of serum IL-8 in patients with disseminated intravascular coagulation (DIC) (p<0.05), central nervous system (CNS) dysfunction (p<0.05), renal failure (p<0.01) and the mortality rates were higher in the IL-8 detectable group than in the IL-8 undetectable group (50% vs 0%,p<0.05).Conclusions The production of MIP-1 and IL-8 was increased in sepsis. Furthermore, an initially detectable level of circulating IL-8, but not MIP-1, predicted a high mortality in sepsis diagnosed according to the ACCP/SCCM criteria.This study was supported in part by a Grant-in-Aid from the Japanese Ministry of Education, Science and Culture, the Waxman Institute Research Fund and the Keio Fukuzawa Fund     

Positive end-expiratory pressure: Implications for tidal volume changes in anesthesia machine ventilation

In clinical practice, the addition of positive end-expiratory pressure (PEEP) into a standard anesthesia circle circuit decreases the delivered tidal volume (DTV) to a patient. We studied the magnitude of the DTV/PEEP relationship in two commonly used anesthesia systems. In addition, the magnitude of the DTV/PEEP relationship varies with both pulmonary compliance and volume of gas contained in the patient's breathing system between the ventilator and PEEP valve site, and this was also evaluated. Routine monitoring of expired tidal volume should be used whenever PEEP is added to an anesthesia circuit.     

Elevated serum bleomycin-detectable iron concentrations in patients with sepsis syndrome

Objective To determine serum bleomycin-detectable free iron in patients with septic shock and to relate these findings to both outcome and a marker of free radical damage.Design A prospective observational study.Setting A nine-bed intensive care unit in a university teaching hospital.Patients Sixteen consecutive patients with septic shock, defined as: (1) Clinical evidence of acute infection; (2) hypo- or hyperthermia (<35.6° or >38.3°C); (3) tachypnoea (>20 breaths/min or ventilated); (4) tachycardia (>90 beats min); (5) shock (systolic pressure <90 mmHg) or on inotropes. Fourteen patients also had secondary organ dysfunction.Measurements and results Bleomycin-detectable iron concentrations were elevated in all patients (37.2±11.0 mol/l vs 5.1±3.3 mol/l in healthy subjects,P<0.0001), but there was no difference between patients who died and those who survived (39.2±9.3 and 36.2±12.3 mol/l, respectively). Thiobarbituric acid reactive substances 9an index of lipid peroxidation) were higher in those who died (3.33±2.29 mol/l) than in the surviving patients (0.99±0.14 mol/l,P<0.01) or healthy subjects (0.92±0.39 mol/l,P<0.01). Free iron did not correlate with thiobarbituric acid-reactive substances. However, a significant correlation was found between lipid peroxidation and clinical severity (APACHE II) score (r=0.54,P<0.05).Conclusions The present study provides evidence of lipid peroxidation in patients who die with septic shock. The data suggest that ironcatalysed hydroxyl radical generation does not form an important contribution to this lipid peroxidation in patients with sepsis.     

Predictive value of tetrapolar body impedance measurements for hydration status in critically ill patients

Objective To design and evaluate a simple and rapid method to predict body hydration status in critically ill patients.Design Prospective, consecutive sample.Setting Medical intensive care unit of a university hospital.Patients 31 consecutive patients.Methods All patients were classified daily for hydration status by the attending physician based on clinical impression, weight changes and laboratory measurements. The hydration status was scored as dehydrated, euvolemic or edematous. The total body impedance was measured daily by a tetrapolar impedance technique.Results Resistances >700 were found in dehydrated subjects and resistances of <400 in edematous patients. Weight gain was observed in dehydrated and weight loss in edematous patients. A discriminant analysis was used to create a predictive model for hydration using the daily impedance and weight measurements. If a cutoff point of 60% for the predicted classification was used to categorize the patient's hydration as dehydrated, euvolemic and edematous, no false positive predictions were observed for the dehydrated or the edematous state.Conclusion Impedance measurements are in close agreement with the clinical impression of hydration of critically ill patients. Future investigations must elucidate the clinical importance.     

The patients’ perceptions of migraine and chronic daily headache: a qualitative study

This study aimed to gain insight into the management of migraine and chronic daily headache (CDH) from the patients perspective. This article outlines the patients perceptions of migraine and chronic daily headache. Thirteen semi–structured interviews were carried out with patients suffering from IHS migraine. Five patients, due to their headache frequency of more than 15 headache days per month, were classed as CDH patients. The data were transcribed verbatim and analysed in accordance with the grounded theory methodology. The main themes were: headaches, impact and headaches related to health issues. The theme headaches was sub-divided into their pain and symptoms, differentiating between their headaches and perceptions of headaches as barriers and facilitators to management. The patients perceptions of migraine and CDH were sometimes conflicting and influenced the patients management behaviours. The qualitative methodology may help to inform doctors, other healthcare professionals and headache researchers about the patients perspective and possibly develop future headache research, care and education.     

The sex killer

Thirteen sex killers were compared to 13 nonsex killers and 13 nonhomicidal sexually aggressive men on sexual history, substance abuse, history of violence, mental illness and personality, brain pathology and endocrine abnormalities. There were more similarities among the three groups than differences. Among the findings, the presence of transvestism and the early appearance of sadism differentiated the sex killers from the other two groups. Sex killers also killed by strangulation more often than nonsex killers and more often victimized a female stranger. The sex killer was more often diagnosed as antisocial personality and sadist than the other two groups. They were more often considered psychotic at the time of their offence and more often considered not guilty by reason of insanity. Directions for future research are noted.     

The effects of PEEP on arterial oxygenation

The effect of positive end expiratory pressure (PEEP) on arterial oxygenation depends on many factors. Two of the most important are the quality and the quantity of the physiological shunt. The quality depends on the mixed venous oxygen tension, and the quantity on the shunt fraction. Each of these factors may rise or fall with PEEP, depending on the pulmonary and circulatory state of the patient. Their ultimate balance influences the change in arterial oxygen tension.     

The activity of grepafloxacin in two murine models of <Emphasis Type="Italic">Mycobacterium avium</Emphasis> infection

The activity against Mycobacterium avium complex (MAC) of varying doses of grepafloxacin (GRE; 25mg/kg, 50mg/kg, 100mg/kg, and 200mg/kg) were compared to clarithromycin (CLA; 100mg/kg and 200mg/kg), ethambutol (EMB; 100mg/kg), and rifabutin (RBT; 10mg/kg) using an intranasal (IN) infection model compared to an intravenous (IV) infection model. Beige mice (C57BL6/J-Lyst bg J/+) were infected intranasally with about 10⁶ organisms and for the IV model about 10⁷ organisms. Treatment for both models was started 1 week postinfection and given by gavage 5 days/week for 4 weeks. At the initiation of therapy, an early control group was killed to determine the initial organism load. Three days following the completion of therapy, drug-treated groups of mice and the late control group were killed and the response to therapy measured. The most effective agents were CLA and RBT. GRE and EMB had modest activities in both the IN and the IV models. A matched comparison between IN and IV challenges for each of the agents used revealed greater suppression of MAC in the IN model compared to the IV model.     

Pharmacokinetics of panipenem/betamipron in patients with end-stage renal disease

Panipenem/betamipron (Carbenin), a parenteral carbapenem antibiotic, is used for the treatment of severe and intractable bacterial infections caused by gram-positive and gram-negative bacteria. Because 30% of panipenem and most of the betamipron are excreted in the urine in an unchanged form, renal function is the important determinant of the dosage regimen of panipenem/betamipron. In this study, the pharmacokinetics of panipenem/betamipron were investigated in patients with end-stage renal disease (ESRD) undergoing hemodialysis treatment to establish an appropriate dose regimen. We further attempted to predict the in vivo clearance in patients undergoing hemodialysis based on the in vitro dializability. The pharmacokinetics of panipenem/betamipron were investigated in eight patients after a 1-h intravenous infusion of panipenem/betamipron (500mg/500mg). The in vitro extraction ratios of panipenem/betamipron through a high-flux dialyzer were obtained, and compared with those obtained in vivo. The clearances of panipenem in patients were 9.53 ± 1.26l/h with hemodialysis, and 2.92 ± 0.238l/h without hemodialysis. In contrast, those of betamipron were 4.18 ± 0.643l/h and 0.615 ± 0.511l/h, respectively. The clearance of panipenem with hemodialysis were predicted well from in vitro extraction ratios, while that of betamipron was overestimated about 1.4-fold, probably due to high plasma protein binding and the binding difference between patients and healthy subjects. After comparing the pharmacokinetic behavior of panipenem in patients with ESRD and that of a surrogate marker of efficacy, we recommend that these patients be treated with 500mg/500mg of panipenem/betamipron once daily, which gives a similar clinical result in a patient with normal renal function.     

Learning about new anesthetics using a model driven,full human simulator

Objective.New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. Methods.Patients and clinical settings in which remifentanil might provide clinical advantages over existing anesthetics were identified. A simulator curriculum was developed to demonstrate the use of remifentanil in the sample cases. The simulation was designed to highlight the clinical advantages and potential side effects of remifentanil. A screen displaying the concentrations of remifentanil in plasma and in the hypothetical effector site was developed. A simulator was modified (addition of an infusion pump and a pharmacokinetic screen display) and transported to several cities in the U.S.A. An instructor guided small groups of anesthesiologists and anesthetists through a structured program that enabled participants to observe drug effects in simulated patients. Results.There were 836 participants in the remifentanil program, which was offered in 58 cities in the U.S.A. Surveys were completed by 574 anesthesiologists. There was a significant difference in comfort level for using remifentanil after the session compared to before (Chi-square, p< 0.001.) The statement: Clinical simulation experience is a means to learn about new agents like remifentanilwas rated as excellent by 81% and as good by 19% of participants. No participant found the experience to be not useful. Conclusions.Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.     

Impact of Kendall,Hollon, Beck,Hammen, and Ingram (1987) on treatment of the continuity issue in “depression” research

The article, Issues and Recommendations Regarding Use of the Beck Depression Inventory (Kendall, Hollon, Beck, Hammen, & Ingram, 1987), has had a major impact on depression research. A majority of studies using only the BDI in nonclinical samples now refer to the construct measured as dysphoria rather than depression. This word change, however, is not always accompanied by other changes in research design and interpretation that would seem warranted by the concerns that initially prompted the dysphoria recommendation, such as the nonspecificity of high BDI scores to major depression. Researchers typically continue to derive hypotheses from depression theory, use only the BDI to measure dysphoria rather than purer markers of negative affectivity, cite as a limitation of their findings the danger of assuming continuity between subclinical and clinical depression, and sometimes lapse into depression terminology. Alternative suggestions are made for considering how the particular goals of a study might lead to various ways of handling the continuity issue.We are grateful to Tony Ahrens, Diane Arnkoff, and anonymous reviewers for feedback on earlier drafts.     

Transbronchial regional electroplethysmography of the lungs

Objective. The objective of this study was to describe a method of transbronchial regional electroplethysmography of the lungs.Methods. The electrical resistance of a division of a lung, such as a segment or subsegment, as well as its pulsatile oscillation, were measured using a two-part process: A catheter-transducer was wedged into a small bronchus and the electrical resistance of a blood sample obtained from the same patient was measured. The electroplethysmograph (EPG) was developed for this purpose. The theory behind our method is based on a model of the lung as a three-component structure (blood-tissue-air). We performed experiments on isolated lung lobes of animals, using simultaneous electrometric and direct determination of physiologic indices for regional lung function.Results. Equations have been proposed to calculate blood volume, V_b (±10%); air volume, V_a (±11%); pulsatile increment of the blood volume, V (±10%); and regional stroke volume, RSV (±20%) per 100 cm³ of the lung. The proposed formulas yield an accuracy that is adequate for the clinical range of variations in V_b and V_a, as well as V and RSV. Experiments on lung lobes indicate that the conductivity of lung tissue (_t) is not large. This allows one to calculate the above indices without our having obtained accurate values for conductivity.Conclusions. The method of Transbronchial regional electroplethysmography of the lungs is described and cases in which this method was used for clinical investigation are presented.Glossary Resistivity of suspension - ₁ Resistivity of conducting medium - ₂ Resistivity of conducting spheres - Electroconductivity of the lung at diastole - ₁ Electroconductivity of the lung at systole - _b Electroconductivity of blood - _t Electroconductivity of tissue - _bt Electroconductivity of conducting medium (blood+tissue) - Pulsatile electroconductivity increment in the lung - _e Electrical equivalent of regional stroke volume - V Volume of lung - V_B Blood volume of lung - V_T Tissue volume of lung - V_A Air volume of lung - V_b Regional blood volume per lung volume unit - V_a Regional air volume per lung volume unit - V Regional pulsatile blood increment in the lungs - Ratio of the conducting medium (blood+tissue) volume to the lung volume unit - Ratio of the blood volume to the volume unit of the conducting medium - R Electrical resistance - R Electrical resistance increment - RSV Regional stroke volume per the organ volume unit - F Form-factor - l Cell length - S Cell cross-section area - K Empirical correction coefficient - K₁ Coefficient of electrode installation     

Combined effects of NO inhalation and intravenous PGF2α on pulmonary circulation and gas exchange in an ovine ARDS model

Objectives Inhalation of nitric oxide (NO) selectively dilates pulmonary vessels in well-ventilated regions. Prostaglandin F₂ (PGF₂) is a vasoconstrictor and is reported to enhance hypoxic pulmonary vasoconstriction. The objective of this study was to examine whether the combination of intravenous PGF₂ and inhaled NO in ARDS lungs has a beneficial effect on oxygenation.Design We investigated the effect of intravenous PGF₂ infusion (0.05–10.0 g/kg per min) with and without NO inhalation (60 ppm) on the hemodynamics and gas exchange in an ovine ARDS model, examining the pulmonary artery pressure versure the flow plot by varying cardiac output.Measurements and results After lung lavage, NO inhalation reduced the mean pulmonary arterial pressure (MPAP) by decreasing the zero-flow pressure intercept from 10.6±3.8 (mean±SD) to 8.5±3.8 mmHg (p<0.05) with no significant change in slope. NO inhalation improved PaO₂ from 56±12 to 84±38 mmHg (p<0.005) and reduced pulmonary shunt from 65±5 to 53±8% ( ) (p<0.001). The dose-dependent effects of PGF₂ infusion were: (1) increased MPAP attributed to an increased slope in pulmonary artery pressure-flow plot; (2) decreased cardiac index; (3) decreased with unchanged PaO₂. The dose-dependent decrease in after PGF₂ infusion was attributed to the decreased cardiac output.Conclusions It is suggested that inhalation of NO reduced the critical vascular pressure near alveoli without affecting upstream vessels, while infused PGF₂ constricted the larger upstream pulmonary artery vessels without appreciably affecting the critical pressure. Inhalation of NO into well-ventilated lung areas shifted perfusion to well-oxygenated areas, and there was no supplemental shift in blood flow by adding an infusion of PGF₂.This study was supported by USPHS grant HL 42391 to W.M.Z. and a Kitasato Research Foundation grant to H.K.