A hybrid approach for quantification of aortic valve stenosis using cardiac magnetic resonance imaging and echocardiography.

BACKGROUND: Doppler-derived calculation of aortic valve area (AVA) using the continuity equation can be difficult at times, e.g. due to poor acoustic windows, heavy calcification of the aortic valve, or significant flow acceleration in the left ventricular outflow tract. The aim of this study was to compare AVA as assessed by means of transthoracic echocardiography (TTE) with a hybrid approach, where the Doppler-derived numerator in the continuity equation was replaced by cardiovascular magnetic resonance (CMR) determination of stroke volume. METHODS: Twenty consecutive patients admitted for evaluation of aortic stenosis underwent transthoracic echocardiography and CMR determination of stroke volume within a time period of 3 weeks. Additionally, continuous-wave Doppler spectra of the aortic valve were acquired immediately after the CMR examination. RESULTS: There was no statistically significant difference for mean AVA between the two methods (0.88 +/- 0.23 cm2 by the standard continuity equation versus 0.86 +/- 0.23 cm2 by the hybrid approach, p = 0.55; r = 0.73, p < 0.01). The mean difference was 0.02 cm2 and the limits of agreement were -0.32 to 0.36. Only 2 patients were classified differently by the two methods. Intraobserver and interobserver variability and reproducibility were superior for the hybrid approach. CONCLUSION: The hybrid method for determination of AVA is an excellent alternative to the standard approach by TTE.     

Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

The widespread use of complementary products poses a challenge to clinicians in the perioperative period and may increase perioperative risk. Because dietary supplements are regulated differently from traditional pharmaceuticals and guidance is often lacking, the Society for Perioperative Assessment and Quality Improvement convened a group of experts to review available literature and create a set of consensus recommendations for the perioperative management of these supplements. Using a modified Delphi method, the authors developed recommendations for perioperative management of 83 dietary supplements. We have made our recommendations to discontinue or continue a dietary supplement based on the principle that without a demonstrated benefit, or with a demonstrated lack of harm, there is little downside in temporarily discontinuing an herbal supplement before surgery. Discussion with patients in the preoperative visit is a crucial time to educate patients as well as gather vital information. Patients should be specifically asked about use of dietary supplements and cannabinoids, as many will not volunteer this information. The preoperative clinic visit provides the best opportunity to educate patients about the perioperative management of various supplements as this visit is typically scheduled at least 2 weeks before the planned procedure.     

Reduced heart rate variability in chronic severe traumatic brain injury: Association with impaired emotional and social functioning,and potential for treatment using biofeedback

Heart rate variability (HRV) may provide an index of capacity for social functioning and may be remediated by HRV biofeedback. Given reductions in HRV are found following traumatic brain injury (TBI), the present study aimed to determine whether lower HRV in TBI is associated with social function, and whether HRV biofeedback might be a useful remediation technique in this population. Resting state HRV and measures of social and emotional processing were collected in 30 individuals with severe TBI (3–34?years post-injury) and 30 controls. This was followed by a single session of HRV biofeedback. HRV was positively associated with social cognition and empathy, and negatively associated with alexithymia for the TBI group. Both TBI and control groups showed significantly increased HRV on both time-domain (i.e., SDNN, rMSSD) and frequency-domain measures (LF, HF, LF:HF ratio) during biofeedback compared to baseline. These results suggest that decreased HRV is linked to social and emotional function following severe TBI, and may be a novel target for therapy using HRV biofeedback techniques.     

Innominate artery compression of the trachea: an unusual cause of apnea in a 12-year-old boy

Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. Obstructive respiratory symptoms occur in only a fraction of such cases, and symptomatic patients are most commonly detected in the first year of life. We present a case of a 12-year-old boy with a chief complaint of progressive stridor and apnea who was diagnosed with symptomatic innominate artery compression of the trachea. We reviewed the literature regarding the pathology, diagnosis, and treatment of this condition.     

Dual use of electronic cigarettes and tobacco in New Zealand from a nationally representative sample

Objective : There is strong interest in the use of electronic cigarettes (e‐cigarettes) globally. Not much is known about the dual use of e‐cigarettes and combustible tobacco cigarettes, or if there are demographic differences among dual users and e‐cigarette only users. This paper reports on the demographics of dual users and e‐cigarette only users in New Zealand in a nationally representative sample. Methods : The Health and Lifestyles Survey (HLS) is a biennial face‐to‐face in‐house survey of New Zealand adults aged 15 years or over. The HLS was completed by 3,854 participants in 2016. Results : There is clear evidence of significant dual use in the current sample: most current e‐cigarette users (63.9%) were dual users. Respondents 45 years and older were twice as likely to be dual users as those aged 15 to 34 years. Conclusion : The current study found evidence for substantial dual use of e‐cigarettes and combustible tobacco cigarettes among adult e‐cigarette users, particularly among users aged 45 years and over. Implications for public health : Public health initiatives should provide clear advice that e‐cigarettes should be used as a smoking cessation tool and not as a way to allow the consumption of combustible tobacco to continue.     

The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

Background  

During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery.     

Investigation of calcium-stimulated adenylyl cyclases 1 and 8 on toluene and ethanol neurobehavioral actions

The abused inhalant toluene has potent behavioral effects, but only recently has progress been made in understanding the molecular pathways that mediate the action of toluene in the brain. Toluene and ethanol induce similar behavioral effects and share some targets including NMDA and GABA receptors. In studies examining neuronal actions of ethanol, mice lacking the calcium-stimulated adenylyl cyclases (ACs), AC1 and AC8 (DKO), show increased sedation durations and impaired protein kinase A (PKA) phosphorylation following acute ethanol treatment. Therefore, using DKO mice, we compared the neurobehavioral responses following toluene exposure to that of ethanol exposure to determine if these abused substances share molecular mechanisms of action. In the present study, acute sensitivity to toluene- or ethanol-induced changes in locomotor activity was evaluated in DKO and wild type (WT) mice. Mice were exposed to toluene vapor (0, 500, 1000, 2000, 6000, or 8000ppm) for 30min in static exposure chambers equipped with activity monitors. Both WT and DKO mice demonstrated increased ambulatory distance during exposure to a 2000-ppm concentration of toluene compared to respective air-exposed (0ppm) controls. Significant increases in locomotor activity were also observed during an air-only recovery period following toluene exposure in WT and DKO mice that had been exposed to 2000ppm of toluene compared to respective air controls. Sedative effects of toluene were equivalent in WT and DKO mice, both during exposure and afterwards during recovery. Although no significant differences in locomotor activity were detected in DKO compared to WT mice at individual doses tested, a significant main effect of toluene was achieved, with DKO mice demonstrating a generalized reduction in locomotor activity during the post-toluene recovery period compared to WT mice (when analyzing all doses collectively). For comparison to toluene, additional WT and DKO mice were treated with 1.0 or 2.0g/kg ethanol (i.p.) and monitored for locomotor activation. In WT mice, both doses of ethanol increased distance traveled compared to saline controls. Conversely, DKO mice demonstrated no increase in locomotor activation at 1.0g/kg, with significantly reduced distances traveled at both doses compared to ethanol-treated WT mice. These behavioral activity results suggest that acute effects of ethanol and toluene are distinct in the mechanisms by which they induce acute sedating effects with respect to AC1 and AC8 activity, but may be similar in the mechanisms subserving locomotor stimulation.