Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation?

OBJECTIVE: Transthoracic impedance (TTI) is a factor determining the magnitude of the transmyocardial current during external defibrillation. Minimising TTI increases the chances of successful defibrillation. Most external defibrillation paddles are rectangular in shape and can, therefore, be placed in a transverse or longitudinal orientation. The apical paddle is often placed in a transverse orientation. This may theoretically result in a higher TTI than a longitudinal orientation because of poorer contact at the lateral paddle edges. We compared TTI with the apical paddle in both a transverse and longitudinal orientation. MATERIALS AND METHODS: Twenty sequential anaesthetised patients were studied. A pair of defibrillator paddles were instrumented to measure paddle force. TTI was recorded pre-operatively at end-expiration with the apical paddle in both longitudinal and transverse orientations. The sternal paddle was placed in a longitudinal orientation for all measurements. RESULTS: TTI decreased in both transverse and longitudinal orientations as paddle force increased. Transverse paddle orientation resulted in a significantly (P<0.01) higher TTI than longitudinal orientation at all paddle forces below 12 kg force. CONCLUSION: The longitudinal orientation of a rectangular defibrillation paddle provides a lower TTI than orientation horizontally.     

Clinical study of the changes in homeostasis during the course of acute poisoning in patients treated with hemoperfusion北大核心CSCD

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning. Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed. The clinical data included blood pH, PvCO2, PvO2, blood lactate, potassium, free-calcium, bicarbonate and blood glucose assayed and recorded at 0 min, 30 min and 120 min after hemoperfusion. The statistical software SPSS 18. 0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion. Results At the beginning of hemoperfusion therapy, levels of homeostasis indicators were pH (7. 36 ± 0. 05), PvCO2 (41. 0 ± 8. 8) mmHg, PvO2 (37. 0 ± 11. 8) mmHg, lactate (1.35 ± 1.00) mmol/L, potassium (3.1 ±0.5) mmol/L, sodium (136.3 ± 4.8) mmol/L, free-calcium (0.95 ±0.11) mmol/L, blood glucose (7.90 ±3.47) mmol/L, bicarbonate (22. 8 ± 3. 3) mmol/L. At 30 min, the levels of those were (7. 36 ± 0. 04), (40. 0 ± 5. 7) mmHg, (41.0±7.5) mmHg, (1.11±0.57) mmol/L, (3.1 ±0.4) mmol/L, (137.3±5.4) mmol/L, (0. 94 ±0. 12) mmol/L, (6. 20 ± 1. 55) mmol/L, (22. 2 ±2. 3) mmol/L, respectively. At 120 min, the levels of those were (7. 35 ± 0. 06), (38. 0 ± 6. 7) mmHg, (46. 0 ± 7. 9) mmHg, (0. 69 ± 0. 52) mmol/L, (3.0±0.4) mmol/L, (137.3±5.0) mmol/L, (0.97±0.10) mmol/L, (5.88±1.43) mmoL/L, (22. 0±2. 2) mmol/L, respectively. Apparently, there were significant statistical difference in PvO2 lactate and blood glucose (P < 0. 05) among three different intervals, and no significant statistical differences in other indicators (P > 0.05). Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.     

What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome?

[Purpose] The aim of the study was to investigate the ability of Semmes-Weinstein Monofilament testing to detect carpal tunnel syndrome, as well as moderate-to-severe carpal tunnel syndrome using varying thresholds and methods. [Subjects] Clinical and electrophysiological data of 62 patients (124 hands) with a mean age of 49.09±10.5 years were evaluated in this study. [Methods] Sensitivity and specificity were calculated according to two threshold values (2.83 and 3.22) and two methods, a conventional method and an internal comparison method. A threshold value of 3.22 was also used to determine sensitivity and specificity in the diagnosis of electrophysiologically moderate-to-severe carpal tunnel syndrome. Data of the first three digits were averaged to reveal the mean strength value of the monofilaments for each hand. [Results] The criteria of 2.83-conventional method yielded a sensitivity of 98% and a specificity of 17% in the diagnosis of carpal tunnel syndrome. The threshold value of 3.22 using a conventional method was found to detect moderate-to-severe carpal tunnel syndrome with high sensitivity (80%) and excellent specificity (93%). A statistically significant difference was observed in the mean strength values of the monofilaments in moderate-to-severe carpal tunnel syndrome hands and hands without carpal tunnel syndrome. [Conclusion] The current study demonstrated that Semmes-Weinstein monofilament testing might be a valuable quantitative method for detecting moderate-to-severe carpal tunnel syndrome.Key words: Semmes-Weinstein monofilaments, Sensitivity and specificity, Carpal tunnel syndrome     

Palonosetron and prednisolone for the prevention of nausea and emesis during fractionated radiotherapy and 5 cycles of concomitant weekly cisplatin—a phase II study

Purpose

Recommendations for antiemetic prophylaxis supportive to radiotherapy and concomitant chemotherapy are not evidence-based. The purpose of this study was to evaluate the efficacy of the antiemetic regimen concurrent to fractionated radiotherapy and concomitant weekly cisplatin in two Danish departments of oncology.

Methods

Patients with gynecological cancer scheduled to receive fractionated radiotherapy and concomitant weekly cisplatin (40 mg/m²) were asked to complete a study diary in order to assess episodes of emesis, grade of nausea, and use of rescue antiemetic treatment daily during 5 weeks of treatment. Antiemetic treatment consisted of palonosetron and prednisolone. A patient had completed the study if emesis occurred or if 5 weeks of treatment were accomplished without emesis. The primary endpoint was sustained no emesis during 5 weeks of treatment.

Results

A total of 48 patients completed 155 weekly cycles of radiotherapy, concomitant weekly cisplatin, and antiemetic prophylaxis. The probability of completing 5 cycles without emesis (sustained no emesis) was 57 %. During cycle 1, 42 % of the patients were free from nausea. After 5 cycles, only 23 % of patients were continuously free from nausea. One half of the patients used rescue antiemetic treatment at least once during the 5 cycles.

Conclusion

The present study demonstrates that an antiemetic prophylaxis consisting of palonosetron and prednisolone is insufficient for the prevention of nausea and vomiting induced by radiotherapy and weekly cisplatin in patients treated for gynecological cancer. The addition of a neurokinin-1 receptor antagonist should be investigated in a randomized, double-blind study in this setting.     

Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study

OBJECTIVE: The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. DESIGN: Prospective, observational study. SETTING: Medical-surgical intensive care unit of a teaching hospital. PATIENTS AND PARTICIPANTS: Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12h of admission (Day0), after stabilization of hemodynamics by fluid loading (median volume: 4.9l [lower and upper quartiles: 3.7-9.6l]) and vasopressor therapy, and after vasopressors were stopped (Dayn). MEASUREMENTS AND RESULTS: Thirty-five patients were studied (median age: 60 years [range 44-68]; SAPS II: 53 [46-62]; SOFA score: 9 [8-11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day0 and Dayn (7 days [range 6-9]), mean left ventricular (LV) ejection fraction (EF) increased (47 +/- 20 vs. 57 +/- 14%: p < 0.05), whereas mean LV end-diastolic volume decreased (97 +/- 25 vs. 75 +/- 20ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day0, 12 had normal LVEF on Dayn and 4 patients fully recovered by Day28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148ml) on Day0, but none on Dayn. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day0 (3 with normal LVEF), which resolved on Dayn. CONCLUSIONS: This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. DESCRIPTORS: Shock: clinical studies (38), Cardiovascular monitoring (34).     

A study of the prevalence and severity of retinopathy of prematurity in East of Iran during 2015–2017: A descriptive cross-sectional study

IntroductionRetinopathy of prematurity (ROP) is a retinal vascular disease in preterm infants, which can cause partial defects in visual acuity or lead to serious defects including retinal detachment and blindness. In most cases, ROP can be prevented and treated if detected early. In this study, the prevalence of ROP and some factors affecting the severity of this disease have been examined.MethodThis cross-sectional study was implemented on 253 premature infants referred to Khatam-Al-Anbia hospital in Mashhad in 2015–2017 period for ROP screening. The sampling was performed using census method. The data-gathering tool was a demographic questionnaire and a checklist for recording the stage of the disease, follow-up and treatment of the patients.ResultsThe sample consisted of 104 female infants (41.1%) and 149 male infants (58.9%). The mean gestational age of infants was 32.1 ± 2.9 weeks and the mean birth weight was 1697.2 ± 566.5 g. Of the sample, 112 (44.3%) had some degrees of ROP and only 1.98% were in need of treatment. In the first examination, the severity of retinopathy in both eyes of infants was the highest in infants with gestational age of less than 32 weeks, and the lowest in infants older than 34 weeks (P < 0.001). There was a significant correlation between ROP severity and gestational age (p ≥ 0.001). The severity of retinopathy in natural pregnancy was also lower than assisted reproduction techniques (P < 0.001). In this study, there was no significant relationship between ROP severity and gender (p ≥ 0.10).ConclusionIn general, the prevalence of ROP in our sample was relatively high. Considering that the severity of ROP was found to be related to the gestational age of infants, and since early diagnosis is the key to ROP treatment, it is suggested to administer ROP screening for all infants with a gestational age of less than 34 weeks or premature infants born by assisted reproduction techniques.     

Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis – a CMR study

Background

Myocardial edema is a substantial feature of the inflammatory response in human myocarditis. The relation between myocardial edema and myocardial mass in the course of healing myocarditis has not been systematically investigated. We hypothesised that the resolution of myocardial edema as visualised by T2-weighted cardiovascular magnetic resonance (CMR) is associated with a decrease of myocardial mass in steady state free precession (SSFP)-cine imaging.

Methods

21 patients with acute myocarditis underwent CMR shortly after onset of symptoms and 1 year later. For visualization of edema, a T2-weighted breath-hold black-blood triple-inversion fast spin echo technique was applied and the ratio of signal intensity of myocardium/skeletal muscle was assessed. Left ventricular (LV) mass, volumes and function were quantified from biplane cine steady state free precession images.11 healthy volunteers served as a control group for interstudy reproducibility of LV mass.

Results

In patients with myocarditis, a significant decrease in LV mass was observed during follow-up compared to the acute phase (156.7 ± 30.6 g vs. 140.3 ± 28.3 g, p < 0.0001). The reduction of LV mass paralleled the normalization of initially increased myocardial signal intensity on T2-weighted images (2.4 ± 0.4 vs. 1.68 ± 0.3, p < 0.0001).In controls, the interstudy difference of LV mass was lower than in patients (5.1 ± 2.9 g vs. 16.3 ± 14.2 g, p = 0.02) resulting in a lower coefficient of variability (2.1 vs 8.9%, p = 0.04).

Conclusion

Reversible abnormalities in T2-weighted CMR are paralleled by a transient increase in left ventricular mass during the course of myocarditis. Myocardial edema may be a common pathway explaining these findings.     

Homœopathy—A pilot study of the attitudes and awareness of pharmacy staff in the Stoke-on-Trent area

The survey was designed to study the attitudes of a sample of pharmacists, technicians and unqualified staff towards homœopathy, and their understanding of the principles involved.The most significant findings were that the majority of those who expressed a view (i.e. excluding the don't knows) were favourable to homœopathy, but there was little understanding of the subject. Most pharmacists thought that homœopathic medicines worked ‘by faith’. An urgent need for an education programme was demonstrated.     

Early changes of a novel APC-dependent thrombin generation assay during chemotherapy independently predict venous thromboembolism in cancer patients—a pilot study

Purpose

Identifying cancer patients who are most at risk for venous thromboembolism (VTE) is essential to improve timely delivery of chemotherapy. Several studies have been performed to identify novel candidate biomarkers, but no agreement has yet been reached. In this light, we sought to analyze whether a dynamic evaluation of early changes of activated protein C (APC) function during chemotherapy could be predictive of a first VTE episode in cancer outpatients, thus improving risk stratification.

Methods

A retrospective single-center pilot study was conducted to investigate the adequacy of a dynamic evaluation of a novel APC-dependent thrombin generation assay (HemosIL ThromboPath (ThP)) in predicting VTE in 208 ambulatory cancer patients, enrolled on the basis of tight inclusion criteria, prior to start and before the second cycle of a new chemotherapy regimen.

Results

Retrospective analysis of samples showed the occurrence of an acquired APC resistance during chemotherapy, which was predictive of VTE. Univariate Cox proportional hazards survival analysis showed that early ThP changes predicted VTE (stable vs. decreasing ThP: hazard ratio (HR) 0.21; 95% CI 0.10–0.19; p?p?. decreasing ThP assay results in an intermediate risk group.

Conclusions

We may thus conclude that early changes of ThP assay in patients on active chemotherapy enhance VTE risk stratification, helping in identifying a population of cancer patients who might benefit from thromboprophylaxis.     

Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain – a diagnostic case-control study

Objectives: To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions.

Methods: Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38).

Results: Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004).

Discussion: Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON.

Level of Evidence: 3b.