The elimination rate of 123I-heptadecanoic acid after intracoronary and intravenous administration

When calculating the elimination rate of radioactivity after the administration of radioiodinated heptadecanoic acid (¹²³I-HDA), background correction is necessary due to the high level of background activity. In the present study, the subtraction method of Freundlieb et al. was investigated on validity. This was done by comparing the half-time values of the elimination rate after intravenous (i.v.) and intracoronary (i.c.) injection. In the latter case, no background correction was necessary. Six patients underoging cardiac catheterization were studied. Scintigraphy was performed after the injection of ¹²³I-HDA into the left coronary artery and after i.v. injection. Half-time values were calculated from regions of interest drawn over myocardium perfused by the left-anterior descending branch (LAD) and the left circumflex artery (LCX). In the LAD region, the mean half-time value in the i.c. study was 22 min, while in the corrected i.v. study, the mean value was 27 min. In the LCX region, the half-time values were 24 and 33 min, respectively. The background-subtraction procedure proposed by Freundlieb et al. for i.v.-injected ¹²³I-HDA ss incomplete, as it resulted in half-time values that were higher than those of the i.c. study.     

Direct assessment of adherence and drug interactions in patients with hypertensive crisis—A cross‐sectional study in the Emergency Department

Though drug adherence is supposed to be low in hypertensive crisis (HTN‐C), there are no data available from direct adherence assessments. The aim of the present study was to evaluate adherence to prescribed antihypertensives and potential interactions of concomitant drugs and foods with prescribed antihypertensives in patients with HTN‐C by a direct evaluation via biochemical urine analysis. In the present cross‐sectional study, 100 patients with HTN‐C, admitted to the emergency department (ED), were included. A biochemical urine analysis using gas chromatography‐tandem mass spectrometry was performed. Out of 100 patients, 86 received antihypertensives. Urine analyses could be evaluated unambiguously in 62 patients. In 15 of these 62 patients (24%), a nonadherence could be demonstrated, and in 21 patients (34%), a partial nonadherence could be demonstrated. Patients with nonadherence or partial nonadherence showed a longer hypertension history (15[5‐22] vs 10[3‐15] years, P = 0.04) were prescribed more general medication (number 7.1 ± 3.4 vs 3.4 ± 1.8; P < 0.01) as well as antihypertensive drugs (number 2.8 ± 1.1 vs 1.5 ± 0.7, P < 0.01). A potential BP‐raising trigger by medications or food interaction was frequently detectable, predominantly with nonsteroidal anti‐inflammatory drugs (NSAIDs; n = 38), glucocorticoids (n = 8), antidepressants (n = 10), and licorice (n = 10). Nonadherence and partial nonadherence to prescribed antihypertensives might play a crucial role for the occurrence of HTN‐C. However, further case‐controlled studies are needed to confirm the present findings. Ingestion of concurrent over‐the‐counter drugs such as NSAIDs but also prescribed drugs as well as aliments may lead to critical BP elevation. In order to prevent HTN‐C, the present findings emphasize the importance for clinicians to pay attention to the issue of adherence and co‐medication.     

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery

Objective To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery.Design and setting A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.Patients and methods Patients (n = 67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.9% or the colloids gelatin 4%, hydroxyethyl starch 6% or albumin 5%. Biochemical variables and haemodynamics (transpulmonary thermodilution) were measured.Results An amount of 1800 (1300–1800) ml of saline or 1600 (750–1800) ml of colloid solution (P< 0.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P< 0.001). Plasma volume increased by 3.0% (–18 to 24) in the saline versus 19% (–11 to 50) in the colloid groups (P< 0.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P< 0.005). The rise in left ventricular stroke work index was greater in the colloid than in the saline groups. The different colloids were equally effective. The rise in cardiac index related to the rise in plasma volume and global end-diastolic volume, confirming plasma volume and preload augmentation by the fluid loading.Conclusion After cardiac or major vascular surgery, the pressure- and time-guided fluid response is dependent on the type of fluid used. Colloid fluid loading leads to a greater increase in preload-recruitable cardiac and left ventricular stroke work indices than that with saline, because of greater plasma volume expansion following an increase in plasma COP.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.     

Does neonatal morphine use affect neuropsychological outcomes at 8 to 9 years of age?

Morphine is widely used to treat severe pain in neonatal intensive care unit patients. Animal studies suggest adverse long-term side effects of neonatal morphine, but a follow-up study of 5-year-old children who participated in a morphine-placebo controlled trial as newborns found no such effects on the child’s general functioning. This study indicated that morphine may negatively affect response inhibition, a domain of executive functions. Therefore, we performed a second follow-up study in the same population at the age of 8 to 9 years, focused on the child’s general functioning in terms of intelligence, visual motor integration, and behavior and on executive functions. Children in the morphine group showed significantly less externalizing problems according to the parents but more internalizing behavior according to the teachers, but only after adjustment for intelligence quotient (IQ), potential confounders using a propensity score, and additional open-label morphine. Morphine-treated children showed significantly fewer problems with executive functions in daily life as rated by parents for the subscales inhibition and organization of materials and for planning/organizing as rated by the teachers. After adjustment for IQ and the propensity score, executive functioning as rated by the parents remained statistically significantly better in the morphine-treated group. The influence of the additional morphine given was not of a significant influence for any of the outcome variables. Overall, the present study demonstrates that continuous morphine infusion of 10 μg/kg/h during the neonatal period does not harm general functioning and may even have a positive influence on executive functions at 8 to 9 years.     

自体颞骨听骨链重建术对慢性中耳炎患者的听力重建效果及影响因素分析

目的:探讨采用自体颞骨听骨链重建术治疗慢性中耳炎患者的疗效,并对影响听力重建的因素进行分析。方法:2008年1月—2012年12月在复旦大学附属金山医院耳鼻咽喉科行开放式乳突根治并鼓室成形术联合应用自体耳后颞骨行听骨链重建的慢性中耳炎患者92例(92耳)。对患者手术前后进行纯音听力检查,比较5个频率(0.25、0.5、1、2、4 kHz)下手术前后气骨导差(airbone gaps,ABG)的变化,并分析影响听力重建效果的因素。结果:92例患者气导听阈从术前的(53.39±14.47)dB降至术后的(46.78±17.06)dB,听力明显改善(P<0.01);手术前后骨导听阈的平均值分别为(23.29±11.93)dB及(23.08±12.36)dB,未见显著改变(P>0.05);手术前后ABG由(30.10±8.54)dB减小为(23.71±9.67)dB,P<0.01。听力重建成功56例,重建成功率为60.7%(56/92)。将重建成功的患者定义为恢复良好组(56例),其余患者定义为恢复欠佳组(36例)。比较两组后发现,导致听力重建效果欠佳的因素有年龄大、术前气骨导差大、镫骨足板固定(P<0.05)。结论:采用自体颞骨进行听骨链重建可显著改善慢性中耳炎患者的听力,影响其听力重建最重要的因素是术耳病变情况。     

Evidence for a multistep mechanism for cell-cell fusion by herpes simplex virus with mutations in the syn 3 locus using heparin derivatives during fusion from within

Summary Stable neutralization and protection escape variants of a virulent strain (Trinidad Donkey) of the VEE virus were selected by monoclonal antibodies (MAbs). Determination of nucleotide sequences of nine variants revealed a clustering of single mutations in four regions of the E1 and E2 glycoproteins. Involvement of amino acid residues 206 (site E1-1), 57 and 59 (site E2-2), 180, 182, 213, 214 and 216 (site E2-6) and 232 (site E2-3) in protective epitopes was demonstrated.