Glucose Control in the ICU: Is There a Time for More Ambitious Targets Again?

During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.     

Myrica rubra leaves as a potential source of a dual 5-LOX/COX inhibitor

Myrica rubra Sieb. et Zucc. is a valuable fruit tree that is used in Chinese, Japanese and Taiwanese traditional medicine. We investigated the anti-inflammatory activity of M. rubra leaves extracted with four different solvents. Total phenolics were determined using the Folin–Ciocalteu method. Extracts were investigated for their inhibitory activity toward the pro-inflammatory enzymes cyclooxygenase-1 and -2 (COX-1, COX-2) and 5-lipoxygenase (5-LOX). The ethanol extract of M. rubra leaves demonstrated a strong inhibition of prostaglandin E₂ (PGE₂) biosynthesis catalyzed by both COX-1 (93.42%) and COX-2 (75.71%) and leukotriene B₄ (LTB₄) formation catalyzed by 5-LOX (82.72%). Further we identified selective COX-1 inhibition by the n-butanol and aqueous fractions of the ethanol extract (with an IC₅₀ for COX-1 inhibition of 1.07 and 0.71?µg?mL^?1 _, respectively) and dual 5-LOX/COX inhibition by the ethyl acetate fraction (with an IC₅₀ of 3.29 for COX-1, 2.54 for COX-2 and 8.30?µg?mL^?1 for 5-LOX).     

Protracted neurocardiogenic reaction

Vasovagal reactions following catheterization procedures are relatively common complications, mostly in their milder forms. We present a case report of a young male undergoing selective coronarography with a dramatic postprocedural course including haemodynamic instability, and especially very late normalization of the neurological status.     

Reproducibility of tissue Doppler parameters of asynchrony in patients with advanced LV dysfunction.

AIMS: To assess the reproducibility of tissue Doppler myocardial velocities in patients with dilated ventricles and markedly reduced systolic function (ejection fraction <35%). METHODS AND RESULTS: Forty-one patients referred for cardiac resynchronization therapy (CRT) were evaluated using tissue Doppler echocardiography. The inter and intra-individual reproducibility of peak systolic myocardial velocities and the intra-ventricular delay in three apical projections was assessed by repeated evaluation of each registered data set. Variability (measured by the coefficient of variation) ranged between 18 and 56% for the peak systolic velocities and between 32 and 117% for the time intervals. CONCLUSION: The reproducibility of the tissue Doppler echocardiography parameters (peak systolic myocardial velocity and intra-ventricular delay) was poor in our set of patients with dilated left ventricles and low ejection fraction. The most probable causes of our poor results are discussed including the missing standardization of the TDI measurements.