Guidelines on the management of stable angina pectoris.

We read with great interest the recently published guidelineson the management of     

Associations between renal function, volume status and endotoxaemia in chronic kidney disease patients.

Inflammation is an important predictor of increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD), but the mechanisms behind the chronic activation of the immune system are not clearly understood. CKD patients develop fluid overload, which has been proposed to be a stimulus for inflammatory activation due to the translocation of macromolecules from the gut. We hypothesize that fluid overload is associated with signs of systemic inflammation and endotoxaemia in stages 1-5 CKD patients. The aim of this prospective study was to evaluate the associations between renal function, fluid status [evaluated by the inferior vena cava diameter (IVCD) and the collapsibility index (CI)], systemic inflammation [plasma levels of C-reactive protein (CRP), fibrinogen and albumin] and endotoxaemia (through the Limulus amebocyte lysate enzymatic assay) in a group of CKD patients in our out-patient clinic. The population consisted of 74 (mean of 57; range 23-83 years of age; 47% males) CKD patients with glomerular filtration rate (based on the mean of urea and creatinine clearances) of 34 ml/min. Both albumin (Rho = 0.25; P = 0.05) and fibrinogen (Rho= - 0.48; P < 0.0001) were significantly correlated to glomerular filtration rate (GFR). According to the IVCD, 84% of the patients were fluid overloaded, while 83% were considered overloaded by the CI. Signs of endotoxaemia were detected in all patients. Endotoxin levels were higher in patients with signs of fluid overload (0.85 +/- 0.11ng/l) when compared with patients with normal values of IVCD (0.61 +/- 0.05 ng/l; P < 0.05). Endotoxin levels correlated to both IVCD (Rho=0.33, P < 0.005) and CI (Rho = -0.25, P < 0.05). There was no correlation between endotoxin levels and GFR, CRP or fibrinogen. In summary, although most CKD patients presented signs of fluid overload that was associated with endotoxaemia, there was no association between endotoxaemia and systemic inflammation, suggesting the endotoxaemia may not be the main determinant of the inflammatory status in this group of patients.     

The pattern of metabolism of 2-acetylaminofluorene in carcinogen-induced hepatocyte nodules in comparison to normal liver

This study was designed to test further the hypothesis thatthe special biochemical pattern seen in hepatocyte nodules duringliver carcinogenesis could be of fundamental importance in theirselective metabolism of one carcinogenic xenobiotk, 2-AAF, asrelated to their resistance to xenobiotics. Nodules of a certainstage were induced using the resistant hepatocyte model. Themetabolism of a single small dose of 2-AAF in hepatocyte nodulesin comparison to normal liver was studied at different timeintervals up to 30 h. The levels of free 2-AAF in nodules andin normal liver were approximately the same over the whole timeperiod. However, the nodules showed a large decrease in thebinding of 2-AAF to DNA, RNA and proteins as well as in themetabolic conversion to hydroxylated forms, both free and conjugatedwith glucuronic acid. The patterns of metabolic conversion tometabolites and of conjugation of the metabolites are in harmonywith the known biochemical patterns in nodules, a decrease inphase I components involved in the metabolism of carcinogensand other xenobiotics and an increase in most phase II componentsinvolved in conjugation and detoxification.     

Source monitoring deficits in hallucinating compared to non-hallucinating patients with schizophrenia.

In two source memory tests, hallucinating patients with schizophrenia (N=30), compared to non-hallucinating (N=31), are impaired in recognizing internal self-generated items and misattribute them to an external event. They are not impaired in recognizing events from two internal sources. Results support a selective source-monitoring deficit in the occurrence of auditory hallucinations.     

Bariatric Surgery and Multiple Personality Disorder: Complexities and Nuances of Care

Background: Multiple personality disorder (MPD) can occur in patients with morbid obesity in need of bariatric surgery, though few reports noting this association exist in the literature. Herein we address MPD in morbid obesity, in the context of a patient presenting to us seeking surgical treatment of her morbid obesity. Methods: A 31-year-old morbidly obese (BMI 49 kg/m²) Hispanic female presented in early 1994 requesting bariatric surgery. She had been a victim of violent sexual abuse as a young girl. Subsequently, she developed at least three personalities, including one male personality. Results: Although she has lost nearly 45 kg after gastroplasty, her care has been complicated by her named multiple personalities. While MPD are infrequent and unfamiliar to most care providers, successful outcomes can be promoted with a proper approach. Conclusions: This patient's care illustrates that: (1) all personalities must agree to proposed operative intervention; (2) consent must be obtained from the ‘true’ patient; and (3) postoperative care and follow-up must address all personalities for an optimal outcome.     

Technical aspects of an impact acceleration traumatic brain injury rat model with potential suitability for both microdialysis and PtiO2 monitoring

This report describes technical adaptations of a traumatic brain injury (TBI) model—largely inspired by Marmarou—in order to monitor microdialysis data and P_tiO₂ (brain tissue oxygen) before, during and after injury. We particularly focalize on our model requirements which allows us to re-create some drastic pathological characteristics experienced by severely head-injured patients: impact on a closed skull, no ventilation immediately after impact, presence of diffuse axonal injuries and secondary brain insults from systemic origin… We notably give priority to minimize anaesthesia duration in order to tend to banish any neuroprotection.Our new model will henceforth allow a better understanding of neurochemical and biochemical alterations resulting from traumatic brain injury, using microdialysis and P_tiO₂ techniques already monitored in our Intensive Care Unit. Studies on efficiency and therapeutic window of neuroprotective pharmacological molecules are now conceivable to ameliorate severe head-injury treatment.     

Reduction in injection pain using buffered lidocaine as a local anesthetic before cardiac catheterization

Previous reports have suggested that pain associated with the injection of lidocaine is related to the acidic pH of the solution. To determine if the addition of a buffering solution to adjust the pH of lidocaine into the physiologic range would reduce pain during injection, we performed a blinded randomized study in patients undergoing cardiac catheterization. Twenty patients were asked to quantify the severity of pain after receiving standard lidocaine in one femoral area and buffered lidocaine in the opposite femoral area. The mean pain score for buffered lidocaine was significantly lower than the mean score for standard lidocaine (2.7 +/- 1.9 vs. 3.8 +/- 2.2, P = 0.03). The pH adjustment of standard lidocaine can be accomplished easily in the catheterization laboratory before injection and results in a reduction of the pain occurring during the infiltration of tissues.     

Detailed model of spot-welded joints to simulate the failure of car assemblies

This paper presents the construction and the validation of a volumic crash detailed model of different spotwelded coupons using the finite element method. The goal of this detailed model is to provide input data for the validation of a simplified model, which will be later on implemented in the complete car model. First, by studying a weld’s cross section, three different areas (spot weld, heat affected zone and basis material) have been identified and characterized using the Vickers hardness test. Moreover, the geometry of the specimen has been carefully analyzed to construct an accurate FE-model. To reflect the different mechanical properties of each zone, a simple method based on the extrapolation of the tensile strength from the Vickers hardness has been used. To compute the damage and the rupture inside the specimen, the Gurson material model implemented in the explicit time integration method “LS-DYNA3D” has been used. The global accuracy of the detailed model is checked by comparing the simulated and experimental force/displacement curves and the weld’s rupture mode under a quasi-static load case of 10 mm/min. This study shows that detailed models of shear-tension, lap-shear and coach-peel specimens are validated for a mild steel.