Responses of canine endocardium to stimulation of the upper thoracic roots

In each of 10 mongrel dogs anesthetized with alpha chloralose, strain-gauge arches were sutured to five epicardial and three endocardial locations. Comparisons of contractile force responses during stimulation of the left and right roots of the same segmental level revealed several differences dependent upon the particular myocardial area observed. Of the three left ventricular endocardial areas studied, the interventricular septum was the most responsive, particularly during stimulation of the right roots. The basal free wall and posterior papillary muscle were more responsive to left-root than to right-root stimulations. Epicardial responses were consistent with those previously reported. Generally, all areas responded to the greatest degree during stimulation of the second roots with the third and first next in order of effectiveness. Although stimulation of each level of preganglionic outflow activated all epicardial and endocardial segments of the myocardium, the magnitude of the changes in contractile force were highly variable dependent upon the specific level of preganglionic outflow and the location of the strain-gauge arch.     

Undernutrition is associated with mortality,exacerbation, and poorer quality of life in patients with chronic obstructive pulmonary disease: A systematic review with meta-analysis of observational studies

Impaired nutrition status is recognized as a risk factor for worse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate how undernutrition is diagnosed, its prevalence, and whether there is an association between this condition and clinical outcomes in patients with COPD. The search for this systematic review of observational studies (PROSPERO: CRD42020191888) was performed in the PubMed, Embase, and Scopus databases, with no date or language restrictions. The studies had to report data on the diagnosis of undernutrition and its association with mortality, exacerbation, length of hospital stay, or quality of life in adult patients with COPD. A meta-analysis with a random-effects model was performed to combine data. Forty-nine studies were included (20 of them classified as having a low risk of bias), and the most common diagnostic method of undernutrition was body mass index (BMI) (n = 36). The pooled prevalence of undernutrition was equal to 20% (95% CI, 0.15–0.25; I² = 100%), and it was associated with mortality (risk ratio = 1.97; 95% CI, 1.55–2.50; I² = 98%), exacerbation (risk ratio = 1.73; 95% CI, 1.03–2.91; I² = 96%), and poorer quality of life (mean difference = 8.25; 95% CI, 5.40–11.10; I² = 79%). For all outcomes, the certainty of evidence was very low. In conclusion, undernutrition is prevalent and is associated with poorer outcomes in patients with COPD. However, undernutrition is mainly diagnosed by BMI, which underreports its prevalence, and the certainty of the evidence is very low.