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PubMed1992

Ischaemic preconditioning and contractile function: studies with normothermic and hypothermic global ischaemia.

A significant reduction in the extent of cell necrosis or the incidence of reperfusion-induced arrhythmias can be achieved with ischaemic preconditioning. If preconditioning was also found to be effective in protecting against global ischaemia, then this may have significant implications for the preservation of the heart during cardiac surgery. We therefore investigated this phenomenon in relation to recovery of contractile function after global ischaemia in the isolated rat heart. Isolated working rat hearts (n = 6 per group) were perfused aerobically at 37 degrees C for 20 min and contractile function recorded. This was followed by 10 min of aerobic Langendorff perfusion (control hearts) or 5 min global ischaemia (37 degrees C) + 5 min Langendorff reperfusion (preconditioned hearts). The hearts were then subjected to 10, 15, 20 or 25 min of global ischaemia (37 degrees C) and reperfusion (15 min Langendorff + 20 min working) after which function was again assessed. Preconditioning improved functional recovery after all durations of ischaemia. Thus aortic flow after 10, 15, 20 and 25 min of ischaemia and 35 min of reperfusion recovered to 84, 58, 16 and 5%, respectively, in controls and 88, 74, 55 and 20%, respectively, in the preconditioned groups. To assess whether preconditioning was effective in a surgically relevant model of hypothermic ischaemia, the experiments were repeated with longer periods (45, 70, 90, 115, 135 and 160 min) of ischaemia at 20 degrees C. Under these conditions, normothermic preconditioning increase the post-ischaemic recovery of aortic flow after 115, 135 and 160 min of ischaemic (from 36, 20 and 10%, respectively, in controls to 57, 39 and 26%, respectively, in preconditioned hearts). There was no consistent correlation between tissue high energy phosphate content and enhanced post-ischaemic recovery. Thus, we have demonstrated that ischaemic preconditioning can improve contractile function after global ischaemia in the isolated rat heart, we have defined the duration of ischaemia for which it is operative, and we have shown that this protection is additive to that of hypothermia-induced protection during ischaemia. This may have clinical implications for cardiac surgery.

Adenosine↗
PubMed2003

Myocardial contrast echocardiography for the assessment of left ventricular function.

Assessment of regional and global left ventricular (LV) function is important in the management of patients with known or suspected cardiovascular disease. Echocardiography is widely used to provide vital parameters of LV function such as ejection fraction, wall motion score indices, LV volumes and regional wall motion assessment. Despite advances in image quality some images may still be inadequate for accurate assessment of LV function. The advent of intravenous contrast agents consisting of microbubbles have allowed improved endocardial definition leading to better assessment of global and regional function. This together with advances in low power imaging techniques allow less microbubble destruction and hence smaller doses of contrast agent. Improved endocardial definition has also lead to advances in techniques for the automated quantification of LV function. As a result contrast enhanced echocardiography may become the gold-standard in the assessment of wall motion and LV function.

Contrast Media↗
PubMed2003

Diagnostic value of routine clinical parameters in acute myocardial infarction: a comparison to delayed contrast enhanced magnetic resonance imaging. Delayed enhancement and routine clinical parameters after myocardial infarction.

AIMS: Contrast enhanced magnetic resonance imaging (ceMRI) has been shown to reliably identify irreversible myocardial injury. The aim of this study was to compare the findings on ceMRI with routine clinical markers of myocardial injury in patients with acute myocardial infarction (MI). METHODS AND RESULTS: Twenty-four patients with acute MI were investigated at 1.5 T. The global myocardial function was analysed with a standard cine MR protocol and a stack of short axis slices encompassing the entire left ventricle. Corresponding short axis slices were acquired for delayed ceMRI 15-20 min after the administration of 0.2 mmol gadolinium-DTPA/kg body weight. Mass of hyperenhancement and peak creatine kinase release (peak CK) was determined for each patient. The presenting 12-lead ECG was analysed for ST-elevation on admission and later development of Q-waves. Mass of hyperenhancement correlated moderately well to peak CK (r = 0.65, p < 0.01) and endsystolic volume index (r = 0.55, p < 0.01). Mass of hyperenhancement was inversely correlated to ejection fraction (r = -0.50, p = 0.02). Neither the presence of ST elevation on the admission ECG nor the later development of Q-waves did relate to the transmural extent of hyperenhancement and to the mass of hyperenhancement. CONCLUSION: Mass of hyperenhancement significantly correlates to global myocardial function and to peak CK. However, there is no relationship between the findings in ceMRI and 12-lead ECG abnormalities on admission suggesting an advantage of ceMRI in defining transmural extent and depicting small areas of necrosis.

Adult↗
PubMedDate not supplied

Quality of life in lung cancer patients: as an important prognostic factor.

Given that lung cancer is one of the common cancers world-wide, the implications of focusing on quality of life as well as survival require to be understood. We have carried out a study of the relationship between survival and quality of life in patients with lung cancer comparing patients those who lived with those who died within 3 months. The design of the study allowed every patient in a defined geographical area with a potential diagnosis of lung cancer to be studied from first outpatient consultation till after a definitive treatment has been given. Quality of life was measured using three standard questionnaires: the Nottingham Health Profile (NHP), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its lung cancer supplementary questionnaire (QLQ-LC13) in addition to a study specific questionnaire collecting data on demographic, social, clinical and performance status. The contribution of quality of life in relation to survival adjusted for known prognostic factors was determined using Cox's proportional hazard model. In all 129 lung cancer patients were interviewed, and 96 patients were alive at 3-months follow-up. Only 90 of 96 patients alive at 3-months follow-up were assessable. Descriptive analyses showed that those who were dead had more perceived health problems, greater level of symptoms and significant lower physical and role functioning and global quality of life at presentation. On the other hand, univariate analyses showed that patients' aggregate scores on the NHP, the functioning scores, and global quality of life scores alone were significant predictors of survival (P<0.03, P<0.04, P<0.04, respectively ). The multivariate analyses showed that pre-diagnosis global quality of life was the most significant predictor of the length of survival even after adjusting for known prognostic factors (age, P<0.04; extent of disease, P<0.03; global quality of life, P<0.02), while performance status, sex and weight loss were not. This study confirmed that pre-diagnosis quality of life was a significant predictor of survival. Indeed, pre-diagnosis quality of life should be considered as a clinical status which has to be established by physicians before treatment starts as it is such an important predictor of survival.

Adult↗
PubMed2002

Validity of the depression coping self-efficacy scale.

The purpose of this study was to examine construct validity of the Depression Coping Self-Efficacy Scale (DCSES) among patients receiving inpatient (n = 25) or partial hospital treatment (n = 25) for a depressive disorder. At time of treatment admission and discharge, patients completed the DCSES and Center for Epidemiologic Studies Depression (CES-D) Scale and researchers completed the Derogatis Psychiatric Rating Scale (DPRS) and Global Assessment of Functioning (GAF) Scale. The findings indicated depression coping self-efficacy levels to be related to levels of depressive symptoms and global functioning, particularly through and after treatment, and promise for the DCSES for measuring and targeting nursing interventions.

Adaptation, Psychological↗
PubMed1987

Global and regional right ventricular function after acute myocardial infarction: dependence upon site of left ventricular infarction.

The relation of global and regional right and left ventricular function during the acute phase after a first myocardial infarction was assessed by first pass radionuclide angiography in 20 patients (10 after anterior and 10 after inferior myocardial infarction). The right ventricular ejection fraction did not differ significantly between the groups, but left ventricular ejection fraction was significantly depressed after anterior myocardial infarction. There was evidence of right ventricular dilatation and impaired transit in the group with inferior infarction. Five patients with anterior infarction and six with inferior infarction had abnormal right ventricular ejection fractions. Right ventricular wall motion abnormalities affected the septal wall in the group with anterior infarction and the free wall in the group with inferior infarction. The relation between right and left ventricular ejection fractions was markedly different in the two groups. In the group with anterior infarction there was a significant linear relation between right and left ventricular ejection fraction, whereas in the group with inferior infarction there was not. Thus right ventricular dysfunction commonly occurs after both anterior and inferior myocardial infarction. Right and left ventricular impairment are related after anterior myocardial infarction, but are independent after inferior myocardial infarction. Finally, the different effects of anterior and inferior myocardial infarction on right ventricular function may be explained by differences in septal and free wall involvement.

Adult↗
PubMed2002

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus.

OBJECTIVE: To investigate the relationship between quantitative estimates of global brain damage based on magnetization transfer imaging (MTI) and cerebral functioning, as measured by neurologic, psychiatric, and cognitive assessments, as well as disease duration in patients with a history of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS: In a clinically heterogeneous group of 24 female patients (age range 19-65 years, mean age 35 years) with a history of NPSLE, the correlation values of several volumetric MTI measures and an estimate of cerebral atrophy, neurologic functioning (Kurtzke's Expanded Disability Status Scale [EDSS]), psychiatric functioning (the Hospital Anxiety and Depression Scale [HADS]), and cognitive functioning (cognitive impairment score [CIS] derived from the revised Wechsler Adult Intelligence Scale), as well as several measures of disease duration were assessed using Pearson's correlation coefficient. RESULTS: Quantitative volumetric estimates of global brain damage based on MTI and a measure of global brain atrophy correlated significantly with the EDSS, HADS, and CIS scores. No significant correlation was found between the quantitative estimates of global brain damage and the measures of disease duration. CONCLUSION: The results of this study demonstrate that volumetric MTI parameters and cerebral atrophy reflect functionally relevant brain damage in patients with NPSLE. Furthermore, the absence of a linear relationship between disease duration and results of volumetric MTI measures and atrophy suggests a complicated pattern of accumulating brain damage in patients with NPSLE.

Adult↗
PubMed2002

Anaerobic threshold and cardiovascular function.

The cardiopulmonary exercise test is a valuable method for quantifying global cardiovascular function. It is quantitative, cheap, safe and highly reproducible. Unfortunately, it is highly under-utilized in favor of less quantitative, more expensive and perhaps less safe and reproducible methods. But even if performed, the peak Vo2 is often the only measurement made, and the data for determining the patient's anaerobic threshold (AT) and other parameters are discarded by the examiner. The discarding of such valuable physiological data is likely due to the lack of recognition by the physician that these measurements, and the physiological parameters that could be calculated from them, reflect cardiovascular function. Furthermore, the information can be extracted without additional expense. The AT, as a marker of the severity of cardiovascular function, is particularly, under-utilized relative to its clinical usefulness. With the development of the V-slope method, the AT is easily measured in all patients whose exercise is limited by cardiovascular factors. While the AT is a very valuable measurement in all patients, it is especially valuable in patients who should not be maximally stressed, e.g., the elderly or post-myocardial infarction patients.

Adenosine Triphosphate↗
PubMed2006

ATP-loaded immunoliposomes specific for cardiac myosin provide improved protection of the mechanical functions of myocardium from global ischemia in an isolated rat heart model.

Earlier demonstrated cardio-protection by ATP-loaded liposomes (ATP-L) was further improved by attachment of cardiac myosin-specific monoclonal 2G4 antibody onto the surface of ATP-L. ATP-IL were infused for 1 min duration before starting the global ischemia for 25 min followed by reperfusion for 30 min in an isolated rat heart. The left ventricular developed pressure at the end of reperfusion in ATP-IL group significantly recovered to above 80% of the baseline compared to ca 25% in the Kreb's-Henseleit (KH) buffer, ca 60% in the IL, and ca 70% in the ATP-L treated groups. At the end of the reperfusion, left ventricular end diastolic pressure significantly reduced to 15 +/- 2 mmHg in ATP-IL group compared to 59 +/- 6 mmHg in the KH buffer, 31 +/- 4 mmHg in the IL and 23 +/- 3 mmHg in the ATP-L controls. The extent of preservation depended on the amount of the antibody present on the surface of the ATP-IL.

Adenosine Triphosphate↗
PubMed1986

Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction.

The effect of early myocardial reperfusion (within 4 hours after onset of symptoms) on regional left ventricular function in patients with acute myocardial infarction has been quantitated by analysis of segmental wall motion. Of 533 patients randomized either to conventional coronary care unit therapy or to a reperfusion strategy, in 332 high quality angiograms were obtained 2 to 8 weeks after the onset of myocardial infarction. In those assigned to thrombolytic therapy, angiographic data were also available after acute reperfusion. Analysis on an "intention to treat" basis revealed significant preservation of left ventricular function after thrombolytic therapy (ejection fraction 53%) compared with conventional treatment (ejection fraction 47%). In addition, wall motion analysis showed significant improvement of regional function in the infarct zone in both inferior and anterior infarction. In addition, significant changes occurred in regional function of the remote "noninfarct zone" in the acute as well as the chronic stage. It is concluded that improved regional and global left ventricular function can be achieved with early reperfusion and that this is the likely explanation for the reduction of early and late mortality after thrombolysis observed in this study.

Aged↗
PubMed2001

Gated blood pool tomography for the evaluation of global and regional left ventricular function in comparison to planar techniques and echocardiography.

BACKGROUND: Multigated radionuclide ventriculography (MUGA) is a simple and reliable tool for the assessment of global systolic and diastolic function and in several studies it is still considered a standard for the assessment of left ventricular ejection fraction. However the evaluation of regional wall motion by MUGA is critical due to two-dimensional imaging and its clinical use is progressively declining in favor of echocardiography. Tomographic MUGA (T-MUGA) is not widely adopted in clinical practice. The aim of this study was to compare T-MUGA to planar MUGA (P-MUGA) for the assessment of global ejection fraction and to transthoracic echocardiography for the evaluation of regional wall motion. METHODS: A 16-segment model was adopted for the comparison with echo regional wall motion. For each one of the 16 segments the normal range of T-MUGA ejection fraction was quantified and a normal data file was defined; the average value -2.5 SD was used as the lower threshold to identify abnormal segments. In addition, amplitude images from Fourier analysis were quantified and considered abnormal according to three different thresholds (25, 50 and 75% of the maximum). RESULTS: In a study group of 33 consecutive patients the ejection fraction values of T-MUGA highly correlated with those of P-MUGA (r = 0.93). The regional ejection fraction (according to the normal database) and the amplitude analysis (50% threshold) allowed for the correct identification of 203/226 and 167/226 asynergic segments by echocardiography, and of 269/302 and 244/302 normal segments, respectively. Therefore sensitivity, specificity and overall accuracy to detect regional wall motion abnormalities were 90, 89, 89% and 74, 81, 79% for regional ejection fraction and amplitude analysis, respectively. CONCLUSIONS: T-MUGA is a reliable tool for regional wall motion evaluation, well correlated with echocardiography, less subjective and able to provide quantitative data.

Echocardiography↗
PubMed1995

The regional effect of retrograde cardioplegia in areas of evolving ischemia.

Retrograde cardioplegia (RCP) is often used for myocardial protection during coronary bypass grafting, but the regional effect of RCP in areas of evolving ischemia is unknown. We examined the functional and metabolic indices of regional myocardial preservation following acute coronary occlusion with evolving ischemia in a canine model. Following the institution of 37 degrees C cardiopulmonary bypass in 14 dogs, the left anterior descending artery (LAD) was occluded for 15 min. The hearts were then subjected to 90 min of cardioplegic arrest (12 degrees C, 15 mL/kg every 30 min). Seven had antegrade cardioplegia (ACP) alone, while seven had ACP until arrest, then RCP. No topical cooling was used. The LAD occlusion was released after the first bolus of cardioplegia. Regional temperature and pH were measured in the LAD and circumflex (nonischemic) distributions. After 90 min of ischemia and 30 min of reperfusion, all dogs were weaned from bypass. Postischemic function was determined globally by the return of developed pressure (%dP/dt) and regionally by ultrasonic wall crystals. End-ischemic ATP preservation in the LAD distribution was assessed by HPLC (mm ATP/mg protein). Results show that regional functional and metabolic indices were better maintained with RCP in the ischemic LAD distribution. Although only moderate reduction of global function was seen with ACP, the severe reduction noted in LAD regional wall motion with ACP reflects poor regional protection that can be significantly improved in evolving ischemia with RCP.

Animals↗
PubMed1985

Quantitative assessment of global and regional left ventricular function with low-contrast dose digital subtraction ventriculography.

Few studies have compared the use of low-contrast dose digital subtraction ventriculography with conventional ventriculography for quantitative assessment of both global and regional left ventricular function. Accordingly, 34 patients underwent conventional ventriculography using 36 ml of ionic contrast material and digital ventriculography (mask-mode) using 10 ml of contrast diluted in 10 ml of saline and injected over two seconds. Data from two patients were excluded because of ectopy during cineventriculography and from one because of ectopy during both studies. End-diastolic and end-systolic volumes were calculated from both studies by an area-length method and used to calculate ejection fractions. Regional wall motion was quantitated by the centerline method. Results of linear regression analysis demonstrated high correlations for all parameters (end-diastolic volume, r = 0.85; end-systolic volume, r = 0.93; ejection fraction, r = 0.92; quantitative regional wall motion, r = 0.90). Thus, low-contrast dose digital subtraction ventriculography provides an accurate assessment of both global and regional ventricular function and minimizes the required dose and inherent risks of contrast media.

Adult↗
PubMed1985

Sensitivity of cross-sectional echocardiography in detection of impaired global and regional left ventricular function: prospective study.

In order to establish the sensitivity and specificity of cross-sectional echocardiography for detection of global and regional left ventricular function a prospective study was performed in 80 patients suspected of having coronary artery disease. Twenty four hours before heart catheterization, cross-sectional echocardiograms were recorded in the apical RAO-equivalent view and high quality echocardiograms were obtained in 71/80 patients (89%). M-mode echocardiograms of the left ventricle could be performed in 56/71 patients (79%). Based on normal values sensitivity and specificity of cross-sectional echocardiography were calculated in comparison to cineventriculography. For fractional shortening (normal value greater than 25%) sensitivity measured 46% and specificity 93%, and when the E-point septal separation was measured (normal value less than 7 mm), sensitivity increased to 73% and specificity was 84%. For detection of increased end-diastolic volume (less than 155 ml) sensitivity reached 84% and specificity 98% and for increased end-systolic (less than 70 ml) volume it was 86 and 97%, respectively. A depressed left ventricular ejection fraction (greater than 49%) was found with a sensitivity of 93% and specificity of 100%. Regional left ventricular wall motion, analyzed by an area method, revealed for anterior wall motion a sensitivity of 68% and a specificity of 94%, whereas for posterior wall motion sensitivity reached 80% and specificity 96%. Regression equation between the number of pathological segments and left ventricular ejection fraction for cineventriculography was given by Y = -4.06 X + 73.4, r = 0.93 and for cross-sectional echocardiography by Y = -3.69 X + 62.6, r = 0.85. We conclude that cross-sectional echocardiography can be used as a screening method to detect impaired left ventricular function. It is superior to M-mode echocardiography. Reduced regional function of the posterior wall can be found with high sensitivity, but depressed motion of the anterior wall may be overlooked.

Adult↗
PubMed2006

Acetaminophen for osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis. Published guidelines and expert opinion are divided over the relative role of acetaminophen (also called paracetamol or Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line pharmacologic therapy. The comparative safety of acetaminophen and NSAIDs is also important to consider. This update to the original 2003 review includes nine additional RCTs. OBJECTIVES: To assess the efficacy and safety of acetaminophen versus placebo and versus NSAIDs (ibuprofen, diclofenac, arthrotec, celecoxib, naproxen, rofecoxib) for treating OA. SEARCH STRATEGY: We searched MEDLINE (up to July 2005), EMBASE (2002-July 2005), Cochrane Central Register of Controlled Trials (CENTRAL), ACP Journal Club, DARE, Cochrane Database of Systematic Reviews (all from 1994 to July 2005). Reference lists of identified RCTs and pertinent review articles were also hand searched. SELECTION CRITERIA: Published randomized controlled trials (RCTs) evaluating the efficacy and safety of acetaminophen alone in OA were considered for inclusion. DATA COLLECTION AND ANALYSIS: Pain, physical function and global assessment outcomes were reported. Results for continuous outcome measures were expressed as standardized mean differences (SMD). Dichotomous outcome measures were pooled using relative risk (RR) and the number needed to treat (NNT) was calculated. MAIN RESULTS: Fifteen RCTs involving 5986 participants were included in this review. Seven RCTs compared acetaminophen to placebo and ten RCTs compared acetaminophen to NSAIDs. In the placebo-controlled RCTs, acetaminophen was superior to placebo in five of the seven RCTs and had a similar safety profile. Compared to placebo, a pooled analysis of five trials of overall pain using multiple methods demonstrated a statistically significant reduction in pain (SMD -0.13, 95% CI -0.22 to -0.04), which is of questionable clinical significance. The relative percent improvement from baseline was 5% with an absolute change of 4 points on a 0 to 100 scale. The NNT to achieve an improvement in pain ranged from 4 to 16. In the comparator-controlled RCTs, acetaminophen was less effective overall than NSAIDs in terms of pain reduction, global assessments and in terms of improvements in functional status. No significant difference was found overall between the safety of acetaminophen and NSAIDs, although patients taking traditional NSAIDS were more likely to experience an adverse GI event (RR 1.47, (95% CI 1.08 to 2.00). 19% of patients in the traditional NSAID group versus 13% in the acetaminophen group experienced an adverse GI event. However, the median trial duration was only 6 weeks and it is difficult to assess adverse outcomes in a relatively short time period. AUTHORS' CONCLUSIONS: The evidence to date suggests that NSAIDs are superior to acetaminophen for improving knee and hip pain in people with OA. The size of the treatment effect was modest, and the median trial duration was only six weeks, therefore, additional considerations need to be factored in when making the decision between using acetaminophen or NSAIDs. In OA subjects with moderate-to-severe levels of pain, NSAIDs appear to be more effective than acetaminophen.

Acetaminophen↗
PubMed1992

Global regulators of chromosome function in yeast.

In the yeast Saccharomyces cerevisiae, several abundant, sequence-specific DNA binding proteins are involved in multiple aspects of chromosome function. In addition to functioning as transcriptional activators of a large number of yeast genes, they are also involved in transcriptional silencing, the initiation of DNA replication, centromere function and regulation of telomere length. This review will consider each of these proteins, focusing on what is known about the mechanisms of their multiple functions.

Binding Sites↗
PubMed1993

Assessment of global and regional myocardial function using the Minnesota Q/QS codes. A comparison with clinical ECG interpretation.

The authors investigated 244 consecutive patients with suspected coronary artery disease by coronary angiography and quantitative left ventriculography to compare the Minnesota Q/QS code (MC) with clinical electrocardiographic (ECG) interpretation. Patients who were suspected to have wall motion abnormalities for reasons other than coronary artery disease for possible regional wall motion abnormalities were excluded. Out of 244 patients, 159 (65%) had wall motion abnormalities. The sensitivity for detecting wall motion abnormalities was 21% for MC 1.1 and 51% for MC 1.1-3, whereas clinical ECG interpretation showed a sensitivity of 73%. Specificity for MC 1.1 was 93% and for MC 1.1-3 it was 84%. Specificity of clinical ECG interpretation (84%) was comparable. Compared to the MC, clinical ECG interpretation showed a stronger association with left ventricular ejection fraction, number of segments with abnormal wall motion, and severity of wall motion abnormality. Anterior myocardial infarction presented more often with clinical ECG changes (71%) and with a Q/QS code (50%) than inferior myocardial infarction (61% and 41%, respectively). In summary, in contrast to clinical ECG criteria, the MC has high specificity at the expense of a low sensitivity.

Cineradiography↗