Recommendations for occupational radiation protection in interventional cardiology

The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging‐chain geometry; collimating; avoiding high‐scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.© 2013 Wiley Periodicals, Inc.     

Self‐Reported Adherence to Nonpharmacological Treatment and Association with Mortality over 6 Years: Population‐Based Study in Older Persons with Hypercholesterolemia

OBJECTIVES: To determine the prevalence of self‐reported adherence of older persons with hypercholesterolemia to nonpharmacological treatment prescribed by a physician and to describe its association with mortality. DESIGN: Population‐based prospective study. SETTING: Home interview and physical examination at baseline. PARTICIPANTS: Four thousand eight persons representative of the noninstitutionalized Spanish population aged 60 and older. MEASUREMENTS: Primary exposure variable was self‐reported adherence to nonpharmacological treatment (weight control or loss, increased physical activity, and reduced saturated fat or cholesterol intake) in the 918 persons with known hypercholesterolemia in 2001. The outcome variable was mortality from all causes between 2001 and 2007. The association between self‐reported adherence to nonpharmacological treatment and total mortality was studied using Cox models adjusted for main confounders. RESULTS: Most (83.8%) persons with known hypercholesterolemia reported adherence to at least one nonpharmacological measure, and 29.5% adhered to three measures. Those who reported increasing their physical activity had less mortality than those who did not (hazard ratio (HR)=0.68, 95% confidence interval (CI)=0.46–0.99; P<.05). Persons with hypercholesterolemia who reported adherence to one, two, or all three nonpharmacological measures had lower mortality than those who reported adherence to none of the measures (49%, 41%, and 60%, respectively, P for linear trend .002). No independent association with mortality was found for weight control or loss or dietary measures. CONCLUSION: Most of this population with known hypercholesterolemia reported adherence to at least one physician‐prescribed nonpharmacological measure. Reported adherence to all three measures was associated with the lowest mortality.     

El salbutamol mejora la contractilidad diafragmática en la obstrucción crónica de la vía aérea

Introduction

Chronic airflow obstruction in conditions such as chronic obstructive pulmonary disease is associated with respiratory muscle dysfunction. Our aim was to study the effects of salbutamol—a β-adrenergic agonist known to improve muscle strength in physiologic and pathologic conditions—on diaphragm contractility in an animal model of chronic airway obstruction achieved by tracheal banding.

Materials and Methods

Twenty-four Sprague-Dawley rats were randomized into a control group and 3 tracheal banding groups, 1 that received acute salbutamol treatment, 1 that received chronic salbutamol treatment, and 1 that received nothing. Arterial blood gases, acid-base balance, and in vitro diaphragmatic contractility were evaluated by measuring peak twitch tension, contraction time, contraction velocity, half-relaxation time, relaxation velocity, and force-frequency curves.

Results

The 3 study groups had significantly reduced arterial pH and increased PaCO₂ and bicarbonate levels compared to the control group (P<.05). The untreated tracheal banding group had significantly reduced peak twitch tension and contraction velocity, and a significantly lower force-frequency curve in comparison with the other groups (P<.05). The chronic treatment group had a higher relaxation velocity than the untreated study group (P<.05). The mean (SE) peak twitch tension values were 6.46 (0.90) N/cm² for the control group, 3.28 (0.55) N/cm² for the untreated tracheal banding group, 6.18 (0.71) N/cm² for the acute treatment group, and 7.09 (0.59) N/cm² for the chronic treatment group.

Conclusions

Diaphragmatic dysfunction associated with chronic airflow obstruction improves with both the acute and chronic administration of salbutamol. The mechanisms involved in respiratory muscle dysfunction warrant further study.     

Cardiovascular disease prevention in women: A rapidly evolving scenario

The past decade has witnessed a long overdue recognition of the importance of CVD in women, accompanied by an increasing awareness of gender differences in risk factors, natural history, preventive strategies, treatment, and prognosis of CVD. Reflecting the disease burden and the specific aspects of CVD in women, the American Heart Association has developed women-specific evidence-based guidelines and consensus documents for CVD prevention. The most recent update of these guidelines, published in 2011, is a milestone in the field and shows the rapidly evolving scenario of CVD prevention in women. We discuss some novel aspects of the 2011 update. The new guidelines change the focus from evidence-based to effectiveness-based, with consideration of both benefits and harms/costs of preventive interventions. The guidelines also introduce “ideal cardiovascular health” as the lowest category of risk, which implies the need of communitywide preventive, educational and policy initiatives to promote healthy lifestyles in the general population. Furthermore, the guidelines emphasize long-term overall CVD risk rather than short-term coronary risk. We also address several barriers and open questions in the evaluation and implementation of these guidelines, including how to increase the small proportion of women with ideal cardiovascular health; how to increase implementation and compliance with the recommendations; how to provide effectiveness-based recommendations for lifetime prevention goals based on short-term trials; how to obtain the best possible evidence in women; how to identify subgroups of women with different cardiovascular risk profiles or who may require tailored preventive strategies; and how to adapt current guidelines to international settings, particularly to low- and middle-income countries.     

Adult immunization in university-based primary care and specialty practices

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6-7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2-8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.     

Regulation of glycogen content in rat pineal gland by norepinephrine

In the rat pineal gland the glycogen stores were cytochemically localized in astrocytes and pinealocytes. Moreover, it was found that norepinephrine (NE) induced a time- and concentration-dependent reduction in pineal glycogen content and yielded lactic acid. The NE effect was prevented by blocking ₁- but not ₂ or β-adrenoceptors. Activation of ₂-adrenoceptors induced a small decrease in glycogen levels that could have pre- and postsynaptic components. Activation of β-adrenoceptors with 10⁻¹²–10⁻³ M isoproterenol (ISO) induced a bell shape concentration-response curve, presumably due to desensitization, since the response induced by 10⁻⁴ M ISO was greater with shorter period of stimulation. On the other hand, activation of ₁-adrenoceptors with 10⁻¹²–10⁻³ M phenylephrine (PHN) induced a hyperbolic concentration-response curve with a maximum at concentrations above 10⁻⁸ M. Moreover, treatment with ISO drastically reduced the response induced by PHN concentrations lower but not higher than 10⁻⁶ M, favoring a concentration-dependent response between 10⁻⁶ and 10⁻⁴ M PHN, similar to that induced by equimolar NE concentrations. Thus, the NE-induced reduction in glycogen content of the rat pineal gland is mainly mediated by ₁-adrenoceptors and modulated by intracellular mechanisms activated by β-adrenoceptors.     

A method for controlling for a high placebo response rate in a comparison of venlafaxine XR and diazepam in the short-term treatment of patients with generalised anxiety disorder.

This randomised, double-blind, placebo-controlled study compared the efficacy of venlafaxine XR (75 or 150 mg/d) with diazepam (15 mg/d) over an 8-week treatment period in 540 non-depressed outpatients with generalised anxiety disorder (GAD). At week 8, significant improvements from baseline were observed in the venlafaxine XR, diazepam and placebo groups. Although these improvements were higher in the first two groups than in the placebo group for each of the primary efficacy variables (Hamilton Rating Scale for Anxiety (HAM-A) total, HAM-A psychic anxiety factor, Hospital Anxiety and Depression Scale (HAD) anxiety sub-scale and Clinical Global Impression (CGI) improvement), there were no statistically significant differences between groups. These non-positive results were thought to be due to the very high placebo response observed in some centres. To understand the variability of the study, a secondary preplanned analysis was performed. This involved sub-dividing the study centres according to their ability to detect a two-point mean difference between diazepam and placebo at week 8 on the HAM-A total score. Centres able to show such a difference were termed verum-sensitive. Improvements from baseline to week 8 in venlafaxine XR-treated patients from verum-sensitive centres were significantly greater than in placebo on each of the primary efficacy measures (P 相似文献   

Idiopathic stabbing headache in the juvenile population: a clinical study and review of the literature

Idiopathic stabbing headache is a not well known type of pain, and few reports have described the disorder in juvenile age. We report a sample of 30 juvenile patients with clinical features of stabbing headache after having excluded other pain disorders. We observed the presence of psychological features and the lack of association with migraine, unlike in the adult form. Some patients needed pharmacological treatment but the prognosis was good. Further studies are needed to better understand the mechanisms of pain and possible triggering factors. Received: 6 November 2001 / Accepted in revised form: 14 January 2002     

Nocturnal prolactin and growth hormone levels in children with complex partial and generalized tonic-clonic seizures

This study measures whether there is a rise in the secretion of nocturnal prolactin and growth hormone (GH), during the delta phase of the first sleep cycle in children who are suffering from either complex partial or generalized tonic-clonic seizures. The findings are compared with those obtained in the control group of patients which is made up who suffer from pseudoseizures. There is a moderate but significant rise in the nocturnal prolactin plasma level in both types of infantile seizures. No significant difference was found in the GH.