Artefacts in continuous ECG recordings--provoking and preventing manoeuvres

OBJECTIVES: A systematic estimation of the effects of some clinically important artefact provoking and artefact-preventing manoeuvres. DESIGN: A test protocol for the evaluation of technical modifications of continuous ECG recordings was tested in 17 patients. The programme comprised ECG recordings during five artefact-provoking manoeuvres (slight shaking of the ECG cables, rotating shoulders, slight electrode touching, washing, teeth-brushing) and two simple artefact-preventing manoeuvres (taping ECG cables and covering electrodes with paper cups). RESULTS: The artefact-provoking manoeuvres induced a substantial increase in artefactual ECG. The artefact-preventing manoeuvres only incompletely prevented this increase. CONCLUSION: There is a great need of technical improvements to reduce the distortion of ECG by artefacts. The test protocol developed by us exposes a broad spectrum of different categories of ECG qualities and is therefore suitable for evaluating technical improvements concerning artefactual ECG.     

Does diet matter for survival in long-lived cultures?

In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Ageing, in conjunction with the World Health Organization (WHO) global program for the elderly, embarked on the 'Food Habits in Later Life' (FHILL): a cross-cultural study to determine to what extent health, social and lifestyle variables, especially food intake, collectively predict survival amongst long-lived cultures. A total of 818 participants aged 70 years and over were recruited from five IUNS centres. Mortality data were collected after five to seven years. The cohorts included Swedes in Sweden (SWD), Greeks in Greece (GRS) and in Melbourne, Australia (GRM), Anglo-Celts in Australia (ACS) and Japanese in Japan (JPN). Information was obtained on health, lifestyle and diet at baseline. A Cox Proportional Hazard model containing ten potential predictors of survival, adjusted to age at enrollment and ethnicity/locality, was developed to analyse the survival data. Based on up to seven years survival data, it was found that being an elderly Greek in Australia conferred the lowest mortality risk and being an elderly Greek in Greece conferred the highest mortality risk. When the ten potential predictors of survival were entered into the Cox model, the memory score, the Mediterranean diet score, Activities of Daily Living (ADL) and general health status scores showed the greatest effects in significantly reducing mortality hazard ratios by 22%, 13%, 4% and 4%, respectively. For diet score, a one-unit change predicted a significant 13% difference in survival. Of the lifestyle (modifiable) variables entered in the multivariate model, exercise and social activity were not significant predictors of survival suggesting that diet is a more important predictor of survival than these variables. Another lifestyle variable, smoking, significantly increased mortality hazard ratios by 67%, making it a more important predictor of survival than diet. Being male (non-modifiable) also increased risk of death by 63%. Diet, particularly the Mediterranean Diet, operates irrespective and together with other factors as an appreciable contributor to survival, with a strength comparable to or greater than all other measured variables. The independence and strength of the predictiveness of food pattern for survival, and for this to be cross-cultural from Europe to Asia is a novel and important observation for food and health policy.     

Capillary permeability in ALS, determined through transcapillary escape rate of 125I-albumin

Since various macromolecules have experimentally been demonstrated to be taken up by the motor end-plates and subsequently transported through retrograde axoplasmic flow, noxious substances may gain entrance to the lower motorneurons through the same route. Consequently, the function of the capillary barrier in skeletal muscle is of interest in diseases of the lower motorneurons. The transcapillary escape of 125I-albumin was determined in six ALS patients. The values fell within the range earlier reported for normals.     

Reorganization and orientation of regenerating nerve fibres,perineurium, and epineurium in preformed mesothelial tubes – an experimental study on the sciatic nerve of rats

Regeneration of severed peripheral nerves is unfortunately often incomplete, due to loss of nerve fibers and neuroma formation. A new approach is presented with the intention of improving the conditions for nerve repair. In the first of the two stages, a pseudosynovial tube is formed around a silicone rubber rod, surrounded by a stainless steel spiral, which was placed in the backs of rats. This tube, in the second stage, is used as a free “tube graft” to bridge gaps of about 10–12-mm lengths in the severed sciatic nerve. The tube was kept open by the metal spiral. Regenerating nerve fibers with their sprouts grew into the initially open space in the tube. A new nerve trunk was formed, comprised of closely packed myelinated and unmyelinated axons, organized into fascicles. Demonstration by electron microscopy and by EMG recording of reinnervation of foot muscles supported successful long-term results. The fascicles were delimited by perineurial and epineurial sheaths and, furthermore, showed signs of maturation. It was also demonstrated that the nerve-fiber regeneration ceased after a few weeks if there was no distal nerve inserted into the tube. The importance of optimizing the interaction between local factors and regenerating nerve fibers for reestablishment of functionally valuable motor units is discussed.     

Adenosine A2A, but not A1, receptors mediate the arousal effect of caffeine

Caffeine, a component of tea, coffee and cola, induces wakefulness. It binds to adenosine A1 and A2A receptors as an antagonist, but the receptor subtype mediating caffeine-induced wakefulness remains unclear. Here we report that caffeine at 5, 10 and 15 mg kg(-1) increased wakefulness in both wild-type mice and A1 receptor knockout mice, but not in A2A receptor knockout mice. Thus, caffeine-induced wakefulness depends on adenosine A2A receptors.     

Group A streptococcus bacteraemia complicated by osteomyelitis in an immunocompetent adult

Osteomyelitis due to group A streptococcus is an unusual complication of varicellae in children. We report the first case of group A streptococcus bacteraemia complicated by multifocal osteomyelitis in an adult.     

Indium-111-labelled donor-lymphocyte infusion by way of hepatic artery and radio-frequency ablation against liver metastases of renal and colon carcinoma after allogeneic hematopoietic stem-cell transplantation

BACKGROUND: In patients with metastatic solid cancer, antitumor effects occur after allogeneic stem-cell transplantation (SCT). However, this treatment is not as effective in the liver as against pulmonary and lymph-node metastases. To intensify the effect of donor-lymphocyte infusions (DLI) against liver metastases, intra-arterial (IA) cell injection by way of the hepatic artery (HA) can be used. METHODS: To trace infused cells, three patients with colorectal, three with renal, and one with breast carcinoma were treated with Indium-111 (111-In)-oxinate-labeled lymphocytes. Four patients received the DLI IA, all after radio-frequency ablation (RFA) of liver metastases. Three patients with other metastases received 111-In DLI intravenously (IV). One of them had RFA before SCT. RESULTS: Localization of the IA 111-In DLI activity on scintigrams homed to the liver. After IA injection, the liver to sternum ratio of radioactivity was higher compared with IV injection. Cells (CD3+, 19+, and 56+) of donor origin in biopsies of liver metastasis in two patients treated with IA injection increased to 80% to 100%. Two of four patients treated using the IA DLI showed stable size and number of liver metastases for 5 and 21 months, respectively. Both are alive 18 and 34 months after SCT. Two of three patients receiving DLI IV are doing well, with a stable metastatic disease or still without metastases 21 and 20 months after cell infusions (26 and 34 months after SCT), respectively. Three patients died because of progressive disease. CONCLUSION: When infused by way of the HA, 111-In-labeled lymphocytes home to the liver and its metastases. The liver metastasis infiltrating cells of donor origin increased. DLI by way of the HA combined with RFA may be used to treat liver metastases after SCT.