Atrial peptides, ANP(1-98) and ANP(99-126) in health and disease in an elderly population

Circulating immunoreactive atrial natriuretic peptide, Ir ANP(99-126)and the N-terminal fragment of the prohormone, Ir ANP(1–98)were measured in two population samples from the general populationof Gothenburg, Sweden. A group of 85-year olds (974 subjects)and a group of 40-year olds (191 subjects) were investigatedin respect of cardiovascular, renal and metabolic disease. Ir ANP(99-126) and Ir ANP(1-98) were significantly higher inthe 85-year olds compared to tile 40-year olds, and were significantlyincreased in subjects with congestive heart failure, ischaemicheart disease, atrial fibrillation and renal dysfunction butnot in subjects with hypertension. Eighty-five-year-old subjectswho were on treatment with digitalis, ß-adrenergic-blockers,nitrates and diuretics had significantly increased Ir ANP(99-126)and Ir ANP(1-98). In multivariate analysis Ir ANP(99-126) concentrationswere predictive for congestive heart failure, ischaemic heartdisease, atrial fibrillation and treatment with ß-blockersand anti-depressant drugs. Ir ANP(1–98) was predictivefor congestive heart failure, ischaemic heart disease, atrialfibrillation, diabetes mellitus, renal failure and drug treatmentwith ß-blockers and neuroleptics. We conclude that measurements of circulating concentrationsof Ir ANP(99-126) and/or Ir ANP(1-98) may add valuable informationin the diagnosis of congestive heart failure and ischaemic heartdisease in an elderly population. It remains to be determinedwhether routine measurements of circulating Ir ANP(99–126)and Ir ANP(1–98) may be of value in predicting currentcardiovascular disease for the individual patient.     

Hypnotic depth and the incidence of emergence agitation and negative postoperative behavioral changes

Background:  Emergence agitation (EA) and negative postoperative behavioral changes (NPOBC) are common in children, although the etiology remains unclear. We investigated whether longer times under deep hypnosis as measured by Bispectral Index™ (BIS) monitoring would positively correlate with a greater incidence of EA in the PACU and a greater occurrence of NPOBC in children after discharge.
Methods:  We enrolled 400 children, 1–12 years old, scheduled for dental procedures under general anesthesia. All children were induced with high concentration sevoflurane, and BIS monitoring was continuous from induction through recovery in the PACU. A BIS reading <45 was considered deep hypnosis. The presence of EA was assessed in the PACU using the Pediatric Anesthesia Emergence Delirium scale. NPOBC were assessed using the Post-Hospital Behavior Questionnaire, completed by parents 3–5 days postoperatively. Data were analyzed using logistic regression, with a P  < 0.05 considered statistically significant.
Results:  The incidence of EA was 27% (99/369), and the incidence of NPOBC was 8.8% (28/318). No significant differences in the incidence of EA or NPOBC were seen with respect to length of time under deep hypnosis as measured by a BIS value of <45.
Conclusion:  Our data revealed no significant correlation between the length of time under deep hypnosis (BIS < 45) and the incidence of EA or NPOBC. Within this population, these behavioral disturbances do not appear to be related to the length of time under a deep hypnotic state as measured by the BIS.     

Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy

The Pediatric Motor Activity Log (PMAL) is a parent-report measure of the use, by children with hemiplegic cerebral palsy (CP), of their affected upper limb in everyday activities. The aim of this study was to examine the psychometric properties of both scales of the PMAL ('How Often' and 'How Well' scales) using Rasch measurement modelling. Sixty-one parents of children with hemiplegic CP completed the PMAL and 31 completed it again 3 weeks later. The mean age of children was 4 years 6 months (SD 1y 9mo); 35 males, 26 females. Children were at Gross Motor Function Classification System (GMFCS) levels I (83%) and II (17%), and Manual Ability Classification System levels I (35%), II (52%), and III (14%). The original scales were found to have disordered rating scale structure. Further Rasch modelling with collapsed rating scale structures resulted in both scales conforming to the expectations of the Rasch model, yielding strong evidence for construct validity and reliability. One item from the How Often scale failed to conform to Rasch expectations and was deleted in subsequent analyses. Test–retest reliability of both scales was high (the intraclass correlation coefficient for the How Often scale was 0.94, and for the How Well scale 0.93). The revised scales possess good psychometric properties, specifically a logical item hierarchy, evidence of unidimensionality, adequate rating scale structure, and good test–retest reliability. We conclude that the revised PMAL has the capacity to yield valid and reliable scores except for children at the extremes of upper limb ability.