Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness

Background: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction.
Methods: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO^® monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (ΔVTI_LV) and right (ΔVTI_RV) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO.
Results: Receiver–operator characteristics (ROC) demonstrated the largest area under the curve for ΔVTI_RV [0.81 (0.70–0.93)] followed by PPV [0.76 (0.64–0.88)] [mean (and 95% CI)]. SPV, ΔVTI_LV and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC.
Conclusion: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.     

芹菜甲素保护脑细胞的作用

以每周定时im马桑内酯0.9～1.5mg/kg三个月为实验性癫痫慢性发作模型。ig芹菜甲素700mg/kg能明显降低大鼠癲痫发作的程度和次数,延长潜伏期。脑形态学结果表明,芹菜甲素对大脑顶叶皮层细胞、胶质细胞和小脑蚓部蒲肯野细胞有一定的保护作用。同时观察的安定1.5～5mg/kg则无此作用。     

U22, a Protocol to Quantify Symptoms Associated with Supraventricular Tachycardia

Background: The main indication for ablation of supraventricular tachyarrhythmias (SVTA) is symptomatic relief. Specific paroxysmal symptoms cannot be quantified with general measures of quality of life, such as with the SF-36 questionnaire. U22 is a new protocol which measures the effects of arrhythmia on well-being, the intensity of discomfort during an episode, the type and temporal characteristics of dominant symptoms, and the duration and frequency of episodes. Discrete 0–10 scales are used. Unlike SF-36, U22 can be used in individual patients.
Methods: U22 and SF-36 protocols were used in the symptomatic evaluation of 88 patients (mean age = 49.6 ± 16.4 years; 43 men), who underwent catheter ablation of SVTA.
Results: The U22 scores (SD) for (a) well-being (10 being best), (b) effects of arrhythmia on well-being (10 being worst), and (c) discomfort during arrhythmia (10 being worst) were 5.6 (2.7), 7.5 (2.8), and 8.0 (2.4), respectively. For comparison, the physical and mental component summaries of SF-36 were 45.3 (11.0) and 45.2 (12.1), respectively, slightly lower than the expected normal of 50. The intensity of dominant symptom scored by U22 was 9.7 (1.2), 10 being worst. In 29% of patients ≥4 symptoms were equally dominant. Multiple dominant symptoms in U22 were associated with a low general well-being in SF-36.
Conclusion: We found U22 useful to quantify symptoms associated with SVTA.     

Persistent SV5 virus infection in continuous cell cultures.

A continuous line of guinea pig kidney cells (CGPK/H) and a continuous line of mouse fibroblasts (L/H) spontaneously infected with parainfluenza virus SV5 were found. These cultures showed no enhanced cell degeneration or symplast formation, nor was haemagglutinin accumulation or infectious virus demonstrated in them. However, regular reproduction of ribonucleoprotein (RNP) characteristic of parainfluenza viruses, morphologically complete virions and antigens producing antibody to SV5 virus were found in the cells. Focal haemadsorption neutralized by antiserum to SV5 virus was also demonstrated. The infection persisted in the cell populations for over 2 years (the observation period) under standard conditions of cell dispersion and subcultivation.     

Population variability of serotype 3 adenoviruses circulating in the U.S.S.R

Composition analysis of natural populations of adenovirus serotype 3 (Ad 3) strains--based on samples selected out of 170 strains isolated in different regions of the U.S.S.R. from 1976 to 1981--has demonstrated their inhomogeneity with respect to cytopathogenicity and haemagglutination activity. The strains were classified into 3 groups: low, medium and highly cytopathic. The cytopathogenicity of the strains appeared to be a rather variable feature dependent on regional climate and on seasonal complexity. In summer low cytopathogenic viruses predominated. The epidemic activity of circulating adenoviruses (proportion of adenoviruses in the aetiology of acute respiratory disease) correlated with the level of their cytopathic activity.     

Differences in age at onset and familial aggregation between clinical types of idiopathic Parkinson's disease.

Idiopathic Parkinson's disease (PD) can be subdivided by its patterns of motor symptoms into tremor-dominant (TDT), akinetic-rigid (ART), and mixed type (MT). Our objective was to determine whether age at onset and family history are different in these three types. In total, 366 patients with PD were assigned in a standardized approach to one of the three subtypes. Age at onset and family history were obtained in all patients and all presumably affected family members were examined. Mean ages at disease onset were similar in all three groups, but distribution of age at onset was markedly different: monophasic in TDT with a peak around 60 years, biphasic in ART with two peaks, one in the middle of the sixth decade (earlier onset, ART-EO), another during the first half of the seventh decade (later onset, ART-LO), and increasing with age only in MT patients A positive family history was significantly associated only with TDT (odds ratio = 5.7) and ART-EO (odds ratio = 7.8), but not with MT or ART-LO patients. Segregation analysis suggested an autosomal recessive mode of transmission in ART-EO and an autosomal dominant mode of transmission in TDT.