Agreement and clinical utility of 2 techniques for measuring cardiac output in patients with low cardiac output

BACKGROUND: The reliability of cardiac output obtained with the bolus technique is a problem. OBJECTIVES: To compare measurements of cardiac output measured with bolus and continuous techniques in patients with low cardiac output and to determine if measurements obtained with the continuous technique increased the number of subsequent clinical decisions. METHODS: In 60 intensive care patients, a nurse recorded a single continuous cardiac output measurement and then obtained the mean of 3 consecutive bolus determinations. The medical records of these 60 patients (experimental group) for the next 48 hours and of 60 other patients with regular or mixed venous oximetry catheters (control group) were reviewed to assess the occurrence of cardiac output events and the frequency of clinical decisions based on the events. RESULTS: Mean cardiac output was 4.46 L/min by the continuous technique and 5.20 L/min by the bolus technique (P = .011) for the experimental group. Median bias between the 2 types of measurements was -0.10 L/min (P = .79). Twenty-three of the pairs (38%) had an absolute percent difference greater than 15%. Of these, 18 (78%) had a higher bolus reading. Treatment decisions per 48 hours were 9.9 for the experimental group and 8.6 for the control group (P = .014). Median length of stay was 2 days less in the experimental group (P = .02), and mean highest cardiac output was 0.81 L/min higher (P = .009). CONCLUSIONS: Measurements of cardiac output determined with the continuous technique may be more precise than measurements determined with the bolus technique. Continuous cardiac output information increases the number of treatment decisions and actions that may shorten hospital length of stay.     

Combined myofibrillar and mitochondrial creatine kinase deficiency impairs mouse diaphragm isotonic function

Creatine kinase (CK) is an enzyme central to cellular high-energy phosphate metabolism in muscle. To characterize the physiological role of CK in respiratory muscle during dynamic contractions, we compared the force-velocity relationships, power, and work output characteristics of the diaphragm (Dia) from mice with combined myofibrillar and sarcomeric mitochondrial CK deficiency (CK[-/-]) with CK-sufficient controls (Ctl). Maximum velocity of shortening was significantly lower in CK[-/-] Dia (14.1 +/- 0.9 Lo/s, where Lo is optimal fiber length) compared with Ctl Dia (17.5 +/- 1.1 Lo/s) (P < 0.01). Maximum power was obtained at 0.4-0.5 tetanic force in both groups; absolute maximum power (2,293 +/- 138 W/m2) and work (201 +/- 9 J/m2) were lower in CK[-/-] Dia compared with Ctl Dia (2,744 +/- 146 W/m2 and 284 +/- 26 J/m2, respectively) (P < 0.05). The ability of CK[-/-] Dia to sustain shortening during repetitive isotonic activation (75 Hz, 330-ms duration repeated each second at 0.4 tetanic force load) was markedly impaired, with CK[-/-] Dia power and work declining to zero by 37 +/- 4 s, compared with 61 +/- 5 s in Ctl Dia. We conclude that combined myofibrillar and sarcomeric mitochondrial CK deficiency profoundly impairs Dia power and work output, underscoring the functional importance of CK during dynamic contractions in skeletal muscle.     

Image-guided endoscopic surgery: results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system

Image-guided surgery has recently been described in the literature as a useful technology for improved functional endoscopic sinus surgery localization. Image-guided surgery yields accurate knowledge of the surgical field boundaries, allowing safer and more thorough sinus surgery. We have previously reviewed our initial experience with The InstaTrak System. This article presents a multicenter clinical study (n=55) that assesses the system's capability for localizing structures in critical surgical sites. The purpose of this paper is to present quantitative data on accuracy and performance. We describe several new advances including an automated registration technique that eliminates the redundant computed tomography scan, compensation for head movement, and the ability to use interchangeable instruments.     

Human gaze stabilization during natural activities: translation, rotation, magnification, and target distance effects

Stability of images on the retina was determined in 14 normal humans in response to rotational and translational perturbations during self-generated pitch and yaw, standing, walking, and running on a treadmill. The effects on image stability of target distance, vision, and spectacle magnification were examined. During locomotion the horizontal and vertical velocity of images on the retina was <4 degrees /s for a visible target located beyond 4 m. Image velocity significantly increased to >4 degrees /s during self-generated motion. For all conditions of standing and locomotion, angular vestibulo-ocular reflex (AVOR) gain was less than unity and varied significantly by activity, by target distance, and among subjects. There was no significant correlation(P > 0.05) between AVOR gain and image stability during standing and walking despite significant variation among subjects. This lack of correlation is likely due to translation of the orbit. The degree of orbital translation and rotation varied significantly with activity and viewing condition in a manner suggesting an active role in gaze stabilization. Orbital translation was consistently antiphase with rotation at predominant frequencies <4 Hz. When orbital translation was neglected in computing gaze, computed image velocities increased. The compensatory effect of orbital translation allows gaze stabilization despite subunity AVOR gain during natural activities. Orbital translation decreased during close target viewing, whereas orbital rotation decreased while wearing telescopic spectacles. As the earth fixed target was moved closer, image velocity on the retina significantly increased (P < 0.05) for all activities except standing. Latency of the AVOR increased slightly with decreasing target distance but remained <10 ms for even the closest target. This latency was similar in darkness or light, indicating that the visual pursuit tracking is probably not important in gaze stabilization. Trials with a distant target were repeated while subjects wore telescopic spectacles that magnified vision by 1.9 or 4 times. Gain of the AVOR was enhanced by magnified vision during all activities, but always to a value less than spectacle magnification. Gain enhancement was greatest during self-generated sinusoidal motion at 0.8 Hz and was less during standing, walking, and running. Image slip velocity on the retina increased with increasing magnification. During natural activities, slip velocity with telescopes increased most during running and least during standing. Latency of the visually enhanced AVOR significantly increased with magnification (P < 0.05), probably reflecting a contribution of the visual pursuit system. The oculomotor estimate of target distance was inferred by measuring binocular convergence, as well as from monocular parallax during head translation. In darkness, target distance estimates obtained by both techniques were less accurate than in light, consistently overestimating for near and underestimating for far targets.     

Studies on curcumin and curcuminoids XXI. Variation in the content of curcuminoids in Curcuma longa L. and Curcuma aromatica Salisb. from India during one season

Summary Three varieties ofCurcuma longa andC. aromatica were investigated during a growth period of 17 weeks with respect to the content of curcuminoids in the bulbs and fingers. A decrease in pigment production as a function of maturity of the rhizomes was observed. The total content of curcuminoids was equal inC. longa andC. aromatica, but with a slight difference in distribution between the fingers and bulbs in the two species. Taking the biomass into account, the fingers will be more beneficial for the isolation of curcuminoids than the respective bulbs.

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Studien über Curcumin und Curcuminoide XXI. Unterschiede des Gehaltes an Curcuminoiden bei Curcuma longa L. und Curcuma aromatica Salisb. aus Indien während einer Saison

Zusammenfassung Drei Typen vonCurcuma longa undC. aromatica wurden während einer Wachstumsperiode von 17 Wochen auf ihren Curcuminoidgehalt in den Knollen und im Wurzelstock untersucht. Eine Abnahme der Pigmentproduktion in Abhängigkeit von dem Entwicklungsstadium der Rhizome wurde festgestellt. Der Gesamtgehalt an Curcuminoiden beiC. longa undC. aromatica war der gleiche, doch bestand ein geringer Unterschied in der Verteilung dieser zwischen Knolle und Wurzelstock bei den beiden Spezies. Bei Betrachtung der Biomasse ist der Wurzelstock für die Isolation von Curcuminoiden besser geeignet als die Knollen.

     

Outbreak of adenovirus 35 pneumonia among adult residents and staff of a chronic care psychiatric facility

Outbreaks of acute respiratory disease caused by adenovirus are rarely documented in civilian populations, and adenovirus 35 is an uncommon serotype best recognized as a cause of serious disease in immunocompromised patients. An outbreak of adenovirus 35 pneumonia among residents and staff of a chronic care psychiatric facility was investigated. Fourteen (26%) of 53 residents and 4 (2%) of approximately 200 staff had radiographically confirmed pneumonia. Thirteen (93%) of 14 residents with pneumonia were hospitalized, 5 (36%) required mechanical ventilation, and 1 (7%) died. One staff member was hospitalized. Adenovirus infection was diagnosed in 17 (94%) persons with pneumonia by culture or serology and was confirmed as adenovirus 35 infection in 8 persons. Residents with pneumonia had resided at the facility longer than other residents. Chronic illness was not a risk factor for severe disease. Crowding and poor hygienic behaviors probably facilitated transmission among residents.     

Mutagenic and genotoxic activities of four pesticides: captan, foltaf, phosphamidon and furadan

The mutagenic and genotoxic potential of four pesticides viz. captan, foltaf, phosphamidon and furadan was evaluated by the Ames mutagenicity assay and their DNA damaging ability on radiation repair defective E. coli K-12 strains respectively. The mutagenic spectrum revealed captan to be most mutagenic in the absence of metabolic activation, while the presence of S9 mix led to an attenuated mutagenic response. Foltaf, phosphamidon and furadan were detected as relatively weaker mutagens. A significant decrease in the survival of SOS defective mutants, recA, lexA and pol- of E. coli was observed as compared to their wild-type counterparts in the presence of the pesticides. The role of SOS repair genes gains further support from the Salmonella strains triggering the error-prone SOS response.