Automatic external defibrillators: importance of field testing to evaluate performance

A new automatic external defibrillator was tested first against a tape-recorded data base of rhythms and then during use by first-responding fire fighters in a tiered emergency system. The sensitivity for correctly classifying ventricular fibrillation and ventricular tachycardia was substantially less during clinical testing in 298 patients than would have been predicted from preclinical results: 52% of ventricular fibrillation analyses in patients were correctly classified versus 88% of episodes in the data base, and 22 versus 86%, respectively, for ventricular tachycardia (p less than 0.001). The detection algorithm was modified and evaluated further in another 322 patients. The modified detector performed substantially better than did the one that had been designed from prerecorded rhythms: with its use, 118 (94%) of 125 patients in ventricular fibrillation were counter-shocked compared with 91 (77%) of 118 similar patients with use of the initial algorithm (p less than 0.001). No inappropriate shocks were delivered. This improvement resulted in a shorter time to first shock (p less than 0.01) and more shocks being delivered for persistent or recurrent episodes of ventricular fibrillation (p less than 0.05). Of 620 patients treated with the automatic defibrillator, 243 (39%) had ventricular fibrillation; 57 (23%) of the 243 regained pulse and blood pressure before paramedics arrived, 141 (58%) were admitted to hospital and 71 (29%) were discharged.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term effects of exercise on psychological functioning in older men and women

The purpose of this study was to determine the psychological, behavioral, and cognitive changes associated with up to 14 months of aerobic exercise training. For the first 4 months of the study, 101 older (greater than 60 years) men and women were randomly assigned to one of three conditions: Aerobic exercise, Yoga, or a Waiting List control group. Before and following the intervention, all subjects completed a comprehensive assessment battery, including measures of mood and cognitive functioning. A semi-crossover design was employed such that, following completion of the second assessment, all subjects completed 4 months of aerobic exercise and underwent a third assessment. Subjects were given the option of participating in 6 additional months of supervised aerobic exercise (14 months total), and all subjects, regardless of their exercise status, completed a fourth assessment. Results indicated that subjects experienced a 10-15% improvement in aerobic capacity. In general, there were relatively few improvements in cognitive performance associated with aerobic exercise, although subjects who maintained their exercise participation for 14 months experienced improvements in some psychiatric symptoms. However, the healthy subjects in this study were functioning at a relatively high level to begin with, and exercise training may produce greater improvements among elderly with concomitant physical or emotional impairments.     

Ventricular fibrillation causes sudden death in Southeast Asian immigrants

Young, male, Southeast Asian immigrants living in the United States have a high incidence of unexplained, sudden, nocturnal death. We report the cases of three patients, two Laotians and one Filipino, who were resuscitated and subsequently studied extensively. Each patient was having ventricular fibrillation when first examined by paramedics outside the hospital, and episodes of fibrillation recurred in the early hospital course. Clinical evaluation found no significant coronary atherosclerosis or structural cardiac disease. One patient is asymptomatic after 2 years; the second patient died suddenly at 4 months; and the third is asymptomatic but had inducible ventricular tachycardia on electrophysiologic testing 6 months after resuscitation. The mechanism of sudden death in young Southeast Asian men appears to be ventricular fibrillation. The cause of the arrhythmia is unclear, although in our patients the arrhythmia was not an isolated event; underlying predispositions to further cardiac arrest persisted.     

Epidemiological standardization of a test for susceptibility to mumps

An enzyme-linked immunosorbent assay (ELISA) for antibody to mumps virus is described. It is standardized with sera from putatively susceptible and immune populations. The ranges for 49 susceptible and 19 immune children were an optical density of -0.020 to 0.028 and 0.133 to 0.640, respectively. When compared with the microneutralization assay for evaluating vaccine responses, the ELISA appeared to be more sensitive while retaining its specificity. The failure rate after mumps vaccination in 301 children was 1.7% (5 of 301) by the ELISA and 12% (36 of 301) or 7.6% (23 of 301) by the microneutralization assay, depending on whether a high (30-100 50% tissue culture infectious dose [TCID50]) or low (10-20 TCID50) dose of virus was used.     

Isolation and characterization of simian immunodeficiency viruses from two subspecies of African green monkeys

Cercopithecus aethiops (African Green monkey), a nonhuman primate species distributed throughout subsaharan Africa, has been shown to have high seroprevalence rates of antibodies to simian immunodeficiency virus (SIV), and therefore, has been proposed as a natural reservoir for immunodeficiency viruses. Our laboratories have isolated SIV-like viruses from two East African subspecies of C. aethiops designated grivet and vervet monkeys. Analysis of the structural proteins based on the molecular weights and immunologic cross-reactivity to the prototypic SIV(MAC), HIV-1, and HIV-2 isolates suggests that these viruses are distinctly different. Heterogeneity was observed in the molecular weights of the gag, pol, and env gene products between SIV isolates from vervets [SIV(AGM(VER))] and grivets [SIV(AGM(GRI))]. Phenotypically, SIV(AGM(VER)) isolates were distinguishable from SIV(AGM(GRI)) isolates by the apparent size difference of the major core antigen p24. All SIV(AGM(GRI)) and SIV(AGM(VER)) isolates were found to encode a transmembrane protein of approximately 40 kD (gp40) in contrast to gp32 of SIV(MAC). Furthermore, the transmembrane protein was shown to be encoded by the entire env open reading frame, unlike gp32 of SIC(MAC) or gp36 of SIV(AGM(TYO-1)). These data indicate that viruses from C. aethiops share common features with SIV(MAC) and HIV-1, but represent diverse SIV-like viruses which may vary according to subspecies and geographic location.     

Validation of multiple subject-specific finite element models of unicompartmental knee replacement

Accurate computer modelling of the fixation of unicompartmental knee replacements (UKRs) is a valuable design tool. However, models must be validated with in vitro mechanical tests to have confidence in the results. Ten fresh-frozen cadaveric knees with differing bone densities were CT-scanned to obtain geometry and bone density data, then implanted with cementless medial Oxford UKRs by an orthopaedic surgeon. Five strain gauge rosettes were attached to the tibia and femur of each knee and the bone constructs were mechanically tested. They were re-tested following implanting the cemented versions of the implants.Finite element models of four UKR tibiae and femora were developed. Sensitivity assessments and convergence studies were conducted to optimise modelling parameters. The cemented UKR pooled R² values for predicted versus measured bone strains were 0.85 and 0.92 for the tibia and femur respectively. The cementless UKR pooled R² values were slightly lower at 0.62 and 0.73 which may have been due to the irregularity of bone resections. The correlation of the results was attributed partly to the improved material property prediction method used in this project. This study is the first to validate multiple UKR tibiae and femora for bone strain across a range of specimen bone densities.     

Left ventricular ejection fraction after acute coronary occlusion in conscious dogs: relation to the extent and site of myocardial infarction

The change in left ventricular radionuclide ejection fraction after acute occlusion of the left anterior descending (LAD) or circumflex (LC) coronary artery was compared with the ultimate histologic extent of myocardial infarction in conscious dogs. The acute change in ejection fraction correlated with size of infarction in 14 dogs with occlusions of the LAD coronary artery (r = .89, y = 1.12x + 14.2) and in 27 dogs with occlusions of the LC coronary artery (r = .71, y = 0.73x + 7.9); the slope of the regression equation was greater (p less than .05) for those with LAD than for those with LC occlusions. Multivariate analysis revealed no independent contribution of left ventricular weight, the subendocardial extent of infarction, or change in heart rate to the acute change in ejection fraction. These data indicate that the decrease in ejection fraction after coronary occlusion is determined primarily by the size of the ischemic area, which also determines size of infarction. In dogs instrumented over a long term, infarcts in the LAD myocardial distribution result in greater decreases in ejection fraction than infarcts of comparable size in the LC distribution.