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PubMed1988

Natural cooling of the brain during outdoor bicycling?

Tympanic membrane temperature (Ttymp) and deep esophageal temperature (Tes) were measured in 8 subjects during normal outdoor bicycling. Metabolic rate (VO2) was determined by the Douglas bag method. Heart rate was sampled continuously. Skin surface temperatures were measured at the forehead, chest and shoulder, and core temperatures in the deep esophagus and at the tympanic membrane using a radio telemetry system. For each outdoor experiment an indoor experiment in a climatic chamber, adjusted to the same air temperature but in still air, was performed. The subjects exercised at the same VO2 as in the outdoor trial on a stationary bicycle ergometer. Measurements were taken with the same equipment as in the outdoor experiments. O2-consumption (l.min-1) and heart rates (beats.min-1) were similar during outdoor and indoor bicycling, averaging 2.38 +/- 0.018 (SE) and 2.26 +/- 0.07, 141 +/- 7 and 147 +/- 8, respectively. During steady state Tes was the same during outdoor and indoor bicycling (37.95 degrees C), while Ttymp was significantly lower during outdoor bicycling. delta (Tes-Ttymp) was 1.25 degrees C during outdoor and 0.5 degrees C during indoor exercise. It is concluded that, if tympanic temperature is lowered by counter-current cooling of its arterial supply, then cooling of the brain may also take place in humans during physical activity under normal outdoor conditions with convective air movements. But the magnitude of a possible brain cooling cannot be deduced from the fall in tympanic temperature.

Adult↗

PubMed1994

A new respiratory valve system for measuring oxygen uptake during swimming.

We describe a new respiratory valve system with minimal dead space, which allows measurement of ventilation and oxygen uptake during swimming. The device offers considerable advantages in efficiency and accuracy over current equipment, and can be used in conjunction either with a miniaturized telemetry system for oxygen uptake measurement or with a conventional system. The valve has a low airflow resistance, a small dead space (15 ml), and an electrically operating, closed-circuit pump to remove excess water from the expiratory tube. The external form and the buoyancy of the valve have been hydrostatically and hydrodynamically designed to reduce drag and to ensure a correct mass in the water. To obtain this result a very sophisticated material, carbon fibre, has been utilized. Our studies showed that this respiratory system is ideal for obtaining valid and reliable values of oxygen uptake during swimming, even at high speed and in endurance swimming tests.

Air Pressure↗

PubMed1990

Spike voltage topography and equivalent dipole localization in complex partial epilepsy.

The EEG of 45 patients with complex partial epilepsy was recorded from standard and supplementary inferior temporal electrode sites for 2 or more days via cable telemetry onto video (VHS) tape (22-25 channels, common reference). Epochs with "temporal spikes" were read into a topographic EEG device where individual spikes were visually identified and averaged in sums of 8-32. Analysis of spike voltage topography revealed two distinct patterns - dipolar, Type 1 and non-dipolar, Type 2. One or the other spike type predominated in all but two patients. Application of source modeling techniques (3 shells, single dipole, 6 parameters) to the spike topography data revealed that both spike types had similar equivalent dipoles in terms of location and orientation, except for vector elevation. However, calculated dipoles for Type 1 spikes were more stable over the course of the spike peak. Correlations with clinical data and intracranial EEG suggest that Type 1 spikes originate in mesial temporal structures, while Type 2 spikes arise from temporal or frontal neocortex. Spike voltage topography and equivalent dipole localization appear to be useful in the presurgical evaluation of patients with focal epilepsy.

Action Potentials↗

PubMed1995

An audio-video system for automated data acquisition in the clinical environment. LOTAS Group.

OBJECTIVE: Our objective was to develop an audiovideo data acquisition system that facilitates studying the activities of anesthesia care providers in the clinical environment. METHOD: Ceiling-mounted miniature video cameras, vital sign monitors, and videocassette recorders (VCRs) were interfaced to digital computers in two patient admitting areas and two operating rooms of a trauma center. This video data acquisition system network (VASNET) is simple to operate. Insertion of a videotape activates the system and begins video overlay of updated vital signs onto the video image every 5 sec. Recorded data is passed via a local area network, allowing remote monitoring of the data acquisition process. To facilitate analysis of the video at a later time, the image, soundtrack, and vital signs data are stamped with the same time code. Each tape is initialized by recording the data file name and wall clock time for 30 sec at the start of taping. This initialization enables comparison of the video recordings with anesthesia, surgical, and nursing records. RESULTS: During 2 years of operation, VASNET was used to record over 100 cases of acute trauma management. Vital signs overlaid onto the video image identified when patient monitors were in use and providing data. Participants found videotape review useful in assessing their own performance. VASNET was nonintrusive and acquired data with minimum user interaction. In one operating room, separate from the trauma center, VASNET was installed to function as a remote monitor, with the option of videotaping. Although users were aware of when videotaping occurred, once patient management was underway, the activities of the anesthesia care providers did not appear to be influenced by the videocassette recording. Equipment maintenance was not excessive. The most frequent problems were changes to the VCR control settings and disconnection of the power supply or interface connections. CONCLUSIONS: Videotapes of the process of anesthetizing and resuscitating trauma patients provided a record of the activities of anesthesia care providers. Video vignettes may be useful training tools. Excerpts from real scenarios can be incorporated into anesthesia stimulators. The soundtrack and timing of real events from such video acquisition may be useful in the development of multimedia simulations of trauma patient resuscitation. The data collection may be useful for research into human performance, ergonomics, training techniques, quality assurance, and certification of anesthesia care providers in trauma patient management. Potential additional applications of VASNET include remote monitoring of patients in the operating room, in the intensive care unit, during transportation, in hazardous environments, and in the field. Such VASNET telemetry may facilitate the availability of expert opinions during medical and other consultations.

Anesthesia↗

PubMed1998

Magnesium deficiency in adult rats promotes the induction of ventricular tachycardia by the administration of epinephrine.

The effects of magnesium deficiency on epinephrine-induced ventricular tachyarrhythmia were investigated in adult rats. Forty-two adult Wistar rats were fed a magnesium-deficient diet while 30 rats were fed a standard diet for 20 days. The plasma magnesium concentration was lower in the magnesium-deficient rats (0.22+/-0.01 mmol/l) than in the control rats (0.76+/-0.03 mmol/l, P < 0.001). Using a telemetry system, electrocardiograms and arterial blood pressure were recorded on a polygraph in an unrestrained condition. Epinephrine was infused intravenously starting at 5 microg/kg per minute. The QT interval was prolonged to 50+/-1 ms in the magnesium-deficient rats compared with 44+/-1 ms in the control rats (P < 0.001). Before the administration of epinephrine, no ventricular tachyarrhythmias or seizures were found in either the control or the magnesium-deficient rats. The incidence of epinephrine-induced sustained ventricular tachycardia (VT) was higher in the magnesium-deficient rats (86%) than in the control rats (43%, P < 0.01). However, this VT did not result in sudden death. Seizures always preceded death in both the magnesium-deficient and control rats while the arrhythmias observed immediately before death were mainly bradyarrhythmias. The present study in an adult rat magnesium-deficient model revealed that magnesium deficiency enhances the susceptibility to epinephrine-induced ventricular tachyarrhythmias.

Animals↗

PubMed1981

[Medical aspects of stress measurement in the workplace].

To protect workers from overstress by occupational work, there are some methods to measure their working stress by recording different parameters continually during a period of several hours or days. The following physiological parameters are taken into consideration: heart rate, ECG, EMG, movement activities, breathing rate, oxygen consumption, body temperature, resistance of the skin and EEG. Periodically repeated measurements of the lactic acid in capillary blood as well of the catecholamines in the urine are also suitable. The heart rate is till now the most important parameter for practical use to estimate the physical and psychical strain. For values which can be registered by an electrical signal, three modern pickup systems are available: telemetry, magnetic tape recording, solid state memory. The most important advantage of the solid state memory used for the long time registration of bioelectrical signals (except those of high frequency) is actually evident. As the Laboratory of Occupational Medicine of the Federal Office for Industry and Labour is setting up a system to evaluate the individual psychical and physical stress, there has been developed a small memocardiometer which is able to record the heart rate during about 35 hours. The stored datas are transmitted via an interface to the computer HP-85, to be immediately available for calculations, tabulating and plotting.

Body Temperature↗

PubMed2000

Neostigmine: safe and effective treatment for acute colonic pseudo-obstruction.

BACKGROUND: Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a common and relatively dangerous condition. If left untreated, it may cause ischemic necrosis and colonic perforation, with a mortality rate as high as 50 percent. Neostigmine enhances excitatory parasympathetic activity by competing with acetylcholine for attachment to acetylcholinesterase at sites of cholinergic transmission and enhancing cholinergic action. We hypothesized that neostigmine would restore peristalsis in patients with acute colonic pseudo-obstruction. METHODS: Twenty-eight patients at Fletcher Allen Health Care and The Cleveland Clinic Foundation were treated for acute colonic pseudo-obstruction with neostigmine 2.5 mg IV over 3 minutes while being monitored with telemetry. Mechanical obstruction had been excluded. RESULTS: Complete clinical resolution of large bowel distention occurred in 26 of the 28 patients. Time to pass flatus varied from 30 seconds to 10 minutes after administration of neostigmine. No adverse effects or complications were noted. Of the two patients who did not resolve, one had a sigmoid cancer that required resection and one patient died from multiorgan failure. CONCLUSION: This study supports the theory that acute colonic pseudo-obstruction is the result of excessive parasympathetic suppression rather than sympathetic overactivity. We have shown that neostigmine is a safe and effective treatment for acute colonic pseudo-obstruction.

Acute Disease↗

PubMed1994

Modulation of ethanol reinforcement by conditioned hyperthermia.

The present study was designed to determine whether a signal for availability of self-administered ethanol would acquire the ability to elicit a conditioned thermal response and to alter ethanol self-administration. Non-deprived male albino rats (n = 8) were exposed to a differential conditioning procedure in which brief (30-min) periods of access to sweetened ethanol on a fixed-ratio operant schedule were either signalled (CS+trials) or unsignalled (Blank+trials). A different stimulus signalled trials on which barpressing was not reinforced (CS-trials). Body temperature was recorded continuously from implanted telemetry devices. As in previous studies involving experimenter-administered ethanol injections, the stimulus paired with self-administered ethanol (CS+) acquired the ability to elicit a conditioned increase in body temperature. Moreover, barpressing for ethanol was greater on signalled trials (CS+) than on unsignalled trials (Blank+), indicating that ethanol's reinforcing efficacy was altered by CS+. Ethanol self-administration was significantly correlated with the anticipatory increase in body temperature on CS+ trials (Pearson r = +0.77). When ethanol was removed, leaving sucrose alone as the reinforcer, the signal's effect on barpressing was eliminated. This finding suggests the signal's effect depended on ethanol's pharmacological properties. In general, these data are consistent with theories that attribute the signal's effect to conditioned changes in motivation to obtain ethanol or to an interaction between the conditioned response and ethanol's unconditioned effects. The specific pattern of results appears to support hypotheses linking ethanol's thermal and motivational effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗

PubMed1995

Alcohol, anxiolytics and social stress in rats.

The main objective was to compare the anxiolytic-like profiles of alcohol, diazepam and gepirone along the stress intensity gradient which characterizes consecutive phases of a social confrontation. The acute social stress situation consisted of initially placing the experimental rat as an intruder into the homecage of a resident while the resident was not present, termed the "anticipatory" phase, thereafter permitting brief physical agonistic interactions with the re-introduced resident until the intruder was forced into a submissive supine posture and emitted ultrasonic vocalizations (USV), and eventually exposing the intruder to the resident's threats for 1 h, while being shielded from potential injurious attacks. The hyperthermia, measured via telemetry, in the "anticipatory" phase prior to defeat and in reaction to threats, was decreased by alcohol, gepirone and diazepam; alcohol and gepirone were also effective in attenuating "anticipatory" tachycardia. Alcohol, like gepirone and diazepam, also decreased defensive responses and ultrasonic vocalizations in the "anticipatory" phase of the confrontation, but none of these drugs affected defensive reactions to threats which immediately followed defeat. Gepirone had no systematic sedative effects throughout the confrontation; infact, it dose-dependently reduced the stress-induced suppression of locomotor activity during the "anticipatory" phase. In contrast, at higher doses, alcohol as well as diazepam had marked sedative effects as evidenced by several behavioral parameters (i.e. lie, crouch, walk). The anxiolytic-like profile of hyperthermia, tachycardia, USV and defensive behavior in the "anticipatory" phase of the confrontation by alcohol, gepirone and diazepam contrasted with the lack thereof during the more intense reactive phase. This differential pattern of effects appears to be relevant to the clinical distinctions between anticipatory anxiety and other affective disturbances.

Animals↗

PubMed2003

Development and validation of implantable sensors for monitoring function of prosthetic heart valves: in vitro studies.

The development of a 'smart' heart valve prosthesis, with the intrinsic ability to monitor thrombus formation, mechanical failure and local haemodynamics and to relay this information externally, would be of significant help to clinicians. The first step towards such a valve is development of the sensors and examination of whether sensor output provides predictive information on function. Custom-made piezo-electric sensors were mounted onto the housing of mechanical valves with various layers of simulated thrombus and bioprosthetic valves with normal and stiffened leaflets. Sensor output was examined using joint time-frequency analysis. Sensors were able to detect leaflet opening and closing with high fidelity for all types of valve. The frequency content of the closing sounds for the mechanical valves contained several peaks between 100 Hz and 10 kHz, whereas closing sounds for the bioprosthetic valve contained energy in a lower frequency range (<1 kHz). A frequency peak of 47 +/- 15 Hz was seen for the normal bioprosthetic valve; this peak increased to 115 +/- 12 Hz for the valve with visibly stiffened leaflets. Total low-frequency (80-3500 Hz) energy content diminished predictably with increasing levels of thrombus for the mechanical valves. Lastly, closing sound intensity correlated well with closing pressure dynamics (dp/dt) (y = 190x - 443; r = 0.90), indicating that the sensors also provide information on haemodynamics. These studies provide initial evidence regarding the use of embedded sensors to detect prosthetic valve function. Efforts to encapsulate these sensors with telemetry into a custom valve are currently underway.

Bioprosthesis↗

PubMed1991

Method to evaluate the skill level in fast locomotion through myoelectric and kinetic signal analysis.

The paper describes a method aimed at providing objective diagnostic testing of skilled locomotor stereotypes. Bioelectric muscle activity indices and ground reaction force data are used to represent a movement structure, in a schematized way, using discrete states in time. Athletes were asked to perform one specific movement structure: a backward somersault from the standing position. Mathematical analyses of measured signals reveal the significance, for the skill level evaluation, of parameters reflecting the impulsive take-off force waveform and the symmetry in EMG activity of ankle extensor muscles, which therefore might be used as diagnostic criteria. Within technical limitations, this approach may also be applied to other locomotor patterns and possibly to monitor the progress in motorics in pathological locomotion. EMG telemetry could significantly enhance the method's scope.

Adult↗

PubMed1991

High-quality recording of bioelectric events. Part 2. Low-noise, low-power multichannel amplifier design.

A multichannel instrumentation amplifier, developed to be used in a miniature universal eight-channel amplifier module, is described. After discussing the specific properties of a bioelectric recording, the difficulties of meeting the demanded specifications with a design based on operational amplifiers are reviewed. Because it proved impossible to achieve the demanded combination of low noise and low power consumption using commercially available operational amplifiers, an amplifier equipped with an input stage with discrete transistors was developed. A new design concept was used to expand the design to a multichannel version with an equivalent input noise voltage of 0.35 microV RMS in a bandwidth of 0.1-100 Hz and a power consumption of 0.6 mW per channel. The results of this study are applied to miniature, universal, eight-channel amplifier modules, manufactured with thick-film production techniques. The modules can be coupled to satisfy the demand for a multiple of eight channels. The low power consumption enables the modules to be used in all kinds of portable and telemetry measurement systems and simplifies the power supply in stationary measurement systems.

Amplifiers, Electronic↗

PubMed1995

Implantable data logging system for heart rate and body temperature: its application to the estimation of field metabolic rates in Antarctic predators.

The metabolic rate of free-ranging animals is difficult to measure, but of great importance in understanding the interactions of a species with its environment. Heart rate can, if correctly validated and calibrated, give an estimate of metabolic rate, with both a fine time resolution and over long periods. The telemetry of heart rate is well documented, but is not appropriate over long ranges (possibly several thousands of kilometres) or for diving species. An implantable data logger has therefore been developed for the long term recording of heart rate and body temperature. The logger is built using hybrid and ASIC construction techniques, weighs 20 g and measures 55 x 24 x 6 mm. The device is programmable, and its solid-state memory holds over 70 days of data if, for example, heart rate is counted and stored every minute. Current consumption is 155 microA while logging, 50 microA during a programmable initial delay period, and less than 1 microA when the logger closes down after filling its memory. These loggers have been deployed for two field seasons in gentoo penguins, black-browed albatross and fur seals.

Animals↗

PubMed1995

Echocardiography in the evaluation of patients with syncope.

OBJECTIVE: Echocardiography is frequently used as a screening test for cardiac disease in patients with syncope despite the lack of published data describing its utility in this regard. The goal of the study was to examine the frequency with which echocardiography was used in the evaluation of patients admitted to one medical center because of syncope and to examine the diagnostic information, over and above that provided by the initial history, physical examination, and electrocardiography, contributed by the echocardiogram. DESIGN: A retrospective review was performed of all patients admitted to the study institution because of syncope over a seven-month period. SETTING: University teaching hospital in an urban setting of 2.5 million population. PATIENTS/PARTICIPANTS: One hundred twenty-eight patients were identified: 47 men and 81 women (average age 67 +/- 17 years). Patients for whom syncope was of a known cause, those with near-syncope or vertigo, those with clinically obvious seizure, or those referred for electrophysiologic testing were excluded, leaving 128 patients for analysis. Details from the admission history, physical examination, and electrocardiography for each patient were recorded. The results of all other diagnostic tests ordered to evaluate syncope were recorded along with any consultations obtained. The cause of syncope was assigned by examining all physicians' notes and test results and with the use of previously published diagnostic criteria as guidelines. MEASUREMENTS AND MAIN RESULTS: Ninety percent of the patients underwent cardiac testing other than routine electrocardiography and continuous telemetry monitoring while in the hospital. An echocardiogram was obtained for 64% of the patients and did not reveal an unsuspected cause for syncope in any case. The echocardiogram was normal for 52% of the patients undergoing the test. Echocardiograms of patients with syncope and no clinical evidence of heart disease by history, physical examination, or electrocardiography either were normal (63%) or provided no useful additional information for arriving at a diagnosis (37%). Nearly half (46%) of the patients undergoing echocardiography fit this clinical profile. Among the patients for whom cardiac disease was suspected after history, physical examination, or electrocardiography, the echocardiogram confirmed the suspected diagnosis for 48% and served to rule out a suspected diagnosis for the remaining 52%. In no instance did echocardiography provide an unsuspected cause for syncope. The history, physical examination, and initial electrocardiography provided sufficient information to permit a diagnosis to be made for 37 of the 48 patients (77%) for whom a cause of syncope was ultimately determined. CONCLUSION: Echocardiography was frequently used in the evaluation of patients admitted to the hospital because of syncope of unclear cause. For patients without suspected cardiac disease after history, physical examination, and electrocardiography, the echocardiogram did not appear to provide additional useful information, suggesting that syncope alone may not be an indication for echocardiography. For patients with suspected heart disease, echocardiography served to confirm or refute the suspicious in equal proportions. These data provide an objective basis to prospectively define the optimal role of echocardiography in the evaluation of patients with syncope.

Adult↗

PubMed1998

[Atrial defibrillator].

Atrial fibrillation (AF) is a frequent and costly health care problem representing the most common arrhythmia resulting in hospital admission. Total mortality and cardiovascular mortality are significantly increased in patients with AF compared to controls. In addition to symptoms of palpitations patients with AF have an increased risk of stroke and may also develop decreased exercise tolerance and left ventricular dysfunction. All of these problems may be reversed with restoration and maintenance of sinus rhythm. External electrical cardioversion has been a remarkably effective and safe method for termination of this arrhythmia. Originally described by Lown et al. in 1963, it has been a well accepted mode of acute therapy. However, this technique requires general anesthesia or heavy sedation. Internal atrial defibrillation has been evaluated as an alternative approach to the external technique for over 2 decades. Recent studies have shown that low-energy internal atrial defibrillation using biphasic shocks is an effective and safe means in restoring sinus rhythm in patients with AF and should be considered especially in patients in whom external cardioversion attempts have failed. IMPLANTABLE ATRIAL DEFIBRILLATOR: Recently, a stand alone IAD, the Metrix System (model 3000 and 3020), has entered clinical investigation. Atrial defibrillation is accomplished by a shock delivered between electrodes in the right atrium and the coronary sinus. The right atrium lead has an active fixation in the right atrium. The coronary sinus lead has a natural spiral configuration for retention in the coronary sinus, and can be straightened with a stylet. Both leads are 7 French in diameter and the defibrillation coils are each 6 cm in length. The electrodes may be placed using separate leads, or very soon by using a single bipolar lead. A separate bipolar right ventricular lead is used for R wave synchronization and post shock pacing. The Metrix defibrillator can be used to induce AF by using R wave synchronous shocks and can store intracardiac electrograms (EGMs) for up to 2 minutes from the most recent 6 AF episodes. The device can be programmed into one of the following operating modes: fully automatic, patient activated, monitor mode, bradycardia pacing only, and off. As AF is not life-threatening, in the automatic mode the device is only intermittently active in detecting and treating AF, and this "sleep wake-up" cycle interval is programmable. The device employs extensive processing both for detection and R wave synchronization. In April 1996, the phase I Metrix multicenter clinical trial was started. As of May 1997, a total of 51 Metrix systems had been implanted as part of the phase I multicenter clinical trial. Preliminary data suggest that both defibrillation thresholds and electrograms are stable over time (implant to 3 months). Detection accuracy has been excellent (100% specificity, 92.3% sensitivity) and there have been no errors of R wave selection for synchronization. No proarrhythmias have resulted from over 3700 shocks delivered. The device is effective in electrically converting 96% of the spontaneous episodes of AF. In 27% of episodes several shocks were required because of early recurrence of AF. In 5 patients, the atrial defibrillator was removed: 2 infections, 1 cardiac tamponade, 1 permanent loss of telemetry, 1 patient required His-Bundle ablation because of frequent episodes of drug refractory AF with rapid ventricular response. Initial clinical experience under controlled conditions with the Metrix system suggests that the implantable atrial defibrillator may offer a therapeutic alternative for a subgroup of patients with drug refractory, symptomatic, long lasting, and infrequent episodes of AF. Further efforts must be undertaken to reduce the patient discomfort associated with internal atrial defibrillation in an attempt to make this new therapy acceptable to a larger patient population with AF. (ABSTRACT TRUNCATED)

Atrial Fibrillation↗

PubMed1997

Daily rhythms of heart rate, temperature and locomotor activity are modified by anaesthetics in rats: a telemetric study.

The aim of this study was to evaluate the effect of anaesthesia (ether or ketamine) on daily rhythms of temperature (T), heart rate (H) and locomotor activity (A) in unrestrained rats by using implanted radio-telemetry transmitters. T, H and A were measured every 10 min, in Wistar male rats, and analysed using Cosinor. The mean +/- SEM days needed, after surgical implantation, to detect a daily rhythm in H, T and A were also assessed. Six rats were anaesthetized for about 50 min either by ketamine or ether in a 3 by 3 cross-over design. Mesors, amplitudes and acrophases of T, H and A were calculated three days before (D-3; D-2; D-1), the day of anaesthesia (D0) as well as the three following days (D1; D2; D3). ANOVA was performed in order to detect, firstly a possible effect due to the order of application of anaesthesia, secondly a significant difference between ether or ketamine-induced anaesthesia and finally a modification of the mesors, amplitudes and acrophases of T, H and A, induced by each anaesthesia, for D0, D1, D2 and D3 when compared to D-1. Our results indicate: (1) Alterations of the acrophases, mesors and amplitudes, except for the amplitude of A, of the daily rhythms of T, H and A on D0 of ketamine anaesthesia while regarding ether anaesthesia only amplitude of T and H and acrophase of A were modified on D0. Some of these modifications were still observed on the days following anaesthesia. A significant difference between ether and ketamine-induced anaesthesia was also observed. (2) A non-detection of T, H and A daily rhythms after surgical implantation, which was not observed after injection of either ether or ketamine alone. Almost 10 days were needed to detect a significant daily rhythm for T, H and A. The authors suggest that, the general anaesthetic agent was responsible for a perturbation of the mesors, amplitudes and acrophases of the daily rhythms of H, T and A while the non-detection of these rhythms after implantation was more due to the surgical aggression.

Anesthetics, General↗

PubMed2004

[Telemedicine in the maritime environment--hightech with a fine tradition].

Access to health care always has been one of the most critical issues for offshore crews. Therefore, telemedicine has a long and outstanding tradition in the maritime environment. Since 1931 Cuxhaven medical center (Medico Cuxhaven) operates as a hospital-based radio medical advice center (RMA) for ships worldwide providing one of the first routine telemedical services worldwide. For a long time this task was performed on a honorary basis by the hospital's physicians. In 1994 Germany accepted the IMO/ILO (International Maritime Organisation and International Labour Organisation) solution 164. Therefore, in 1998 a formal contract of the German Ministry of Transport officially installed Medico Cuxhaven as the TMAS Center for Germany. According to IMO/ILO solution 164, the RMA provides an expert level of care 24 h/day, 365 days/year. Cuxhaven hospital is a busy general hospital with departments of anesthesia and intensive care, internal medicine, surgery, gynecology and obstetrics, urology, pediatrics, ENT, radiology, and pain medicine. All physicians directly responding to TMAS calls have practical experience in maritime routine and emergency medicine. All incoming emergency calls are primarily handled by board-certified anesthesiologists, experienced in martime emergency medicine (e. g., staffing coastal SAR helicopters, working on rescue boats, carrying out repatriation services for sailors worldwide). If needed, other medical specialists are included. Today, Medico Cuxhaven takes an average workload of one to two emergency calls (response time < 20 s), two to three follow-up calls and approximately one informative call per day. Since 2000 transmission of digital photos has been used for routine RMA. Recently, a system for online and trenddata telemetry of twelve-lead ECG, NIBP (noninvasive blood pressure measurement), CO(2), SaO(2), pulse and respiration rates including the transmission of video images was developed. This system allows worldwide communications as it is capable of all possible means of telecommunication such as GSM, Inmarsat-ISDN or Iridium-Satellite-Transmission. So far, this system has been installed on board several German SAR rescue boats.However, radio telephone and the simple transmission of digital photography remain the basis of maritime radio medical advice service.

Adult↗

PubMed2006

Glycogen synthase kinase 3 inhibition improves insulin-stimulated glucose metabolism but not hypertension in high-fat-fed C57BL/6J mice.

AIMS/HYPOTHESIS: In the current study, the effect of a highly specific peptide inhibitor of glycogen synthase kinase 3 (GSK3) (L803-mts) on glucose metabolism and BP was examined in a high-fat (HF) fed mouse model of diabetes. METHODS: C57/BL6J mice were placed on an HF diet for 3 months and treated with L803-mts for 20 days, following which glucose metabolism was examined by euglycaemic-hyperinsulinaemic clamp studies. BP and heart rate were measured by radio-telemetry. RESULTS: The HF mice were obese, with impaired glucose tolerance and high plasma insulin and leptin levels. L803-mts treatment significantly reduced the insulin levels and doubled the glucose infusion rate required to maintain a euglycaemic condition in the HF+L803-mts group compared with the HF group. Insulin failed to suppress the endogenous glucose production rate in the HF group while decreasing it by 75% in the HF+L803-mts group, accompanied by increased liver glycogen synthase activity and net hepatic glycogen synthesis. GSK3 inhibition also reduced peripheral insulin resistance. Plasma glucose disappearance rate increased by 60% in the HF+L803-mts group compared with the HF group. In addition, glucose uptake in heart and gastrocnemius muscle was markedly improved. Although mean arterial pressure increased following the HF diet, it did not change significantly during the 12 days of L803-mts treatment. CONCLUSIONS/INTERPRETATION: These studies demonstrate that GSK3 inhibition improved hepatic and peripheral insulin resistance in a mouse model of HF-induced diabetes, but it failed to have an effect on BP. GSK3 may represent an important therapeutic target for insulin resistance.

Animals↗