The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc. Delayed blood pressure (BP) and heart rate (HR) decline at recovery post‐exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non‐CAD patients (374 normotensive) were followed for new‐onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow‐up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New‐onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28–2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08–2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03–4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14–4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.     

Quality assessment of robot assisted thoracic surgical resection of non-small cell lung cancer: nodal upstaging and mediastinal recurrence

BackgroundRobot assisted thoracic surgery (RATS) is the minimally invasive surgical technique of choice for treatment of patients with non-small cell lung cancer (NSCLC), at the Isala Hospital. The aim of this study is to compare clinical and pathological staging results and mediastinal recurrence after RATS for anatomical resections of lung cancer as surrogate markers for quality of mediastinal lymph node dissection (MLND).MethodsThis single institute retrospective study was conducted in patients who underwent RATS for NSCLC. Excluded were patients with a history of concurrent malignant disease, with other previous neoplasms, with small cell lung cancer (SCLC) and patients in whom the robotic technique was converted to thoracotomy, prior to lymph node dissection. Data were obtained from the hospital database. The difference between clinical and pathological staging was expressed as upstaging and downstaging. Computed Tomography scanning was used for follow-up, and diagnosis of mediastinal recurrence.ResultsFrom November 2011 to May 2016, 227 patients underwent RATS at Isala Hospital Zwolle, the Netherlands. Of those, 130 (mean age, 69.5±9.3 years) met the eligibility criteria. Preoperative mediastinal lymph node staging was done by endoscopic ultrasound/endobronchial ultrasound, by positron emission tomography (PET) or mediastinoscopy. In 14 patients (10.8%) unforeseen N2 disease was found, 6 patients (4.6%) were upstaged from cN0 to pN2 and 8 patients (6.2%) were upstaged from cN1 to pN2. Mediastinal recurrence was detected in 7 patients (5.4%) during a median follow-up of 54 months (range, 1.5–102 months).ConclusionsIn patients with NSCLC, who underwent anatomical resection by means of RATS, an unforeseen N2 disease rate of 10.8% was demonstrated and a mediastinal recurrence rate of 5.4%. It is concluded that robotic surgery provides an accurate lymph node dissection.     

Thyroid hormone synthesis and secretion in humans after 80 milligrams of iodine for 15 days and subsequent withdrawal

CONTEXT: In animals, acute iodine administration results in acute intrathyroidal inhibition of iodinations followed by escape of the inhibition if the excessive iodine intake continues. In humans, the intrathyroidal nonhormonal and hormonal iodine concentration after exposure to large doses of iodine for a relatively long period of time is not known. OBJECTIVE: To determine whether, in human thyroid, administration of large doses of iodine for a relatively long time results in alterations of intrathyroidal hormonal (HI) T4 and T3 and total iodine (TI) content, as well as whether changes in serum concentration of thyroid hormones and TSH would occur after iodine administration or discontinuation. DESIGN: In 33 euthyroid patients with single thyroid nodule or hyperparathyroidism, Lugol solution (80 mg iodine) was administered for 15 d before operation. Groups of six to eight patients underwent operation 0, 5, 10, and 15 d after iodine withdrawal. TI, HI in a sample of thyroid tissue, and serum concentration of T4, T3, and TSH were measured. In 21 normal euthyroid subjects who did not undergo operation, a similar protocol was used and serial blood measurements were taken. MAIN OUTCOME MEASURE: Intrathyroidal TI, HI, and serum thyroid hormone and TSH measurements were the main outcome measure. RESULTS: Intrathyroidal HI content and serum T4 and T3 were unchanged during and after iodine discontinuation. TI was increased during iodine administration and returned to control values 5 d after discontinuation of iodine. The ratio of HI/TI was decreased and returned to control values 15 d after the iodine was discontinued. Serum TSH was increased during iodine administration and returned to control values 10 d after iodine withdrawal. CONCLUSIONS: In humans, administration of iodine for a relatively long period of time was accompanied by increased intrathyroidal TI, but no changes in HI or demonstrable increases of serum T4 and T3 were observed. It is hypothesized that the maintenance of normal intrathyroidal HI is the result of the combined inhibitory effect of iodine on thyroid hormone synthesis and on the release of T4 and T3 from the thyroid.     

Endotoxin-induced suppression of erythropoiesis: the role of erythropoietin and a heme synthesis stimulating factor

The regulation of erythropoiesis is primarily controlled by erythropoietin (Ep). Recently, however, other factors that both stimulate and inhibit erythropoiesis have been reported. Using an in vitro liquid culture of bone marrow cells, a factor in normal mouse serum was demonstrated that markedly stimulated heme synthesis by marrow erythroid cells. In this study, the role of this heme synthesis stimulating factor (HSF) and Ep in the erythropoietic suppression caused by endotoxin administration to mice was examined. Although HSF levels did not alter appreciably after endotoxin injection, marrow erythroid cells from these animals became unresponsive to the factor. This could be reversed if Ep was added to the culture in vitro or if the hormone was injected into the mice 18 hr prior to harvesting the marrow. This marrow erythroid cell response is identical to that seen in animals in whom Ep levels are markedly reduced, such as that found in exhypoxic polycythemia, and suggest a decrease in the hormone following endotoxin administration. Additional studies demonstrated that when Ep was injected into mice 6 hr after endotoxin administration, an increase in femoral erythroid colony-forming units (CFU-E), proerythroblast number, and 59 Fe incorporation into femoral marrow cells could be demonstrated. These findings, together with the marrow erythroid cell response to the hormone, suggest that the mechanism for suppression of erythropoiesis after endotoxin injection is a reduction in the level of circulating Ep.     

眼部用药对老年人的全身影响

老年人使用眼药的情况是很普遍的,这些药物可能具有严重的全身影响,特别是在老年病人。这在医源性疾病的鉴别诊断中应予以考虑。文献报道的这个问题并非仅限于老龄人群,尽管大多数病人属于老年。眼药滴入球结膜囊中,除少量流出或吞下外,大部分均经由结膜毛细血管、鼻粘膜及咽部直接进入血液循环,其吸收量之大可足以产生副作用。由于老年人常常使用多种药物,因而与其他药物产生药物相互作用的可能性亦是存在的。现根据眼部用药的不良反应所涉及的主要     

Accuracy of velocity and shear rate measurements using pulsed Doppler ultrasound: a comparison of signal analysis techniques.

An experimental investigation was instituted to evaluate the performance of Doppler ultrasound signal processing techniques for measuring fluid velocity under well-defined flow conditions using a 10-MHz multigated pulsed ultrasound instrument. Conditions of fully developed flow in a rigid, circular tube were varied over a Reynolds number range between 500 and 8000. The velocity across the tube was determined using analog and digital zero crossing detectors and three digital spectrum estimators. Determination of the Doppler frequency from analog or digital zero crossing detectors gave accurate velocity values for laminar and moderately turbulent flow away from the wall (0.969 less than or equal to r less than or equal to 0.986). Three digital spectrum estimators, Fast Fourier Transform, Burg autoregressive method, and minimum variance method, were slightly more accurate than the zero crossing detector (0.984 less than or equal to r less than or equal to 0.994), especially at points close to the walls and with higher levels of turbulence. Steep velocity gradients and transit-time-effects from high velocities produced significantly larger errors in velocity measurement. Wall shear rate estimates were most precise when calculated using the position of the wall and two velocity points. The calculated wall shears were within 20%-30% of theoretically predicted values.     

Suction–curettage with combination of two different cannulae in the treatment of axillary osmidrosis and hyperhidrosis

Objective  To investigate the efficacy and safety of suction–curettage with a combination of two different cannulae for treatment of axillary osmidrosis and hyperhidrosis.
Design  Retrospective analysis of patients who underwent surgery from September 2004 to September 2006.
Setting  Outpatient clinic for hyperhidrosis at a university-affiliated hospital.
Subjects  Sixty-five patients who were treated for axillary malodor and hyperhidrosis.
Interventions  Patients were sequentially treated with Fatemi and Cassio cannulae.
Main outcome measures  Demographic data, severity data (assessment of malodor), degree of satisfaction, sweating, hair growth, scarring, recurrence and complications.
Results  Sixty of the 65 patients (96.9%) had excellent to fair results, and only 2 patients (3.1%) had poor results. Complications occurred in 4 patients (6.2%). Recurrence occurred in 3 patients (4.6%).
Conclusions  This simplified and inexpensive method resulted in a high success rate with low complications and high satisfaction with minimal scarring and rapid recovery.