Magnitude Of Fall Research Articles

Effects of intravenous clonidine or dexmedetomidine on haemodynamic responses to laryngoscopy and endotracheal intubation and sedation: A randomised double-blind clinical efficacy study

Background: Laryngoscopy and tracheal intubation (LTI) is associated with undesirable haemodynamic (HD) responses. Both clonidine and dexmedetomidine have been tried to attenuate this HD response. The present study was to assess whether single pre-induction dose of intravenous clonidine (2 μg/Kg) or dexmedetomidine (1 μg/Kg) is more efficient to attenuate the HD response to LTI. Methods: Sixty patients belonging to American Society of Anesthesiologists Grade I and II were randomly divided into two groups: group C (clonidine 2 μg/Kg) and Group D (dexmedetomidine 1 μg/Kg). Study drug was given as an infusion over 10 Min before induction of anaesthesia followed by standardised anaesthetic technique. Heart rate (HR) and blood pressure (BP) were studied at baseline, before study drug infusion (BSD), after study drug infusion, before LTI and at 1, 2, 3, 5 and 10 m in after intubation. Sedation score was analysed BSD, after study drug infusion and at the end of surgery Results: This study revealed suppression of HR and BP at all time points in both the groups without any significant difference in suppression of HR between the groups. The magnitude of fall in BP in the clonidine group is more compared to the dexmedetomidine group before LTI and at 3, 5, and 10 min after tracheal intubation. The patients in the dexmedetomidine group were more sedated than in the clonidine group at the end of the study drug infusion. Conclusions: Both clonidine and dexmedetomidine were effective in attenuating HD response to LTI. Dexmedetomidine appears to be superior to clonidine in maintaining stable HD.

Pharmacodynamic Response to Anti-thyroid Drugs in Graves' Hyperthyroidism.

Objective: Graves' disease is the commonest cause of hyperthyroidism in populations with sufficient dietary iodine intake. Anti-thyroid drugs (ATD) are often used as the initial treatment for Graves' hyperthyroidism, however there is a paucity of data relating the dose of ATD therapy to the effect on thyroid hormone levels, increasing the risk of both over- and under-treatment. We aimed to determine the pharmacodynamic response to the ATD carbimazole.Design: Retrospective cohort study.Methods: Participants were patients (n = 441) diagnosed with Graves' disease at Imperial College Healthcare NHS Trust between 2009 and 2018. The main outcome measure was change in thyroid hormone levels in response to ATD.Results: Baseline thyroid hormone levels were positively associated with TSH receptor antibody titres (P < 0.0001). Baseline free triiodothyronine (fT3) were linearly related to free thyroxine (fT4) levels in the hyperthyroid state (fT3 = fT4*0.97–11), and fell proportionately with carbimazole. The percentage falls in fT4 and fT3 per day were associated with carbimazole dose (P < 0.0001). The magnitude of fall in thyroid hormones after the same dose of carbimazole was lower during follow up than at the initiation visit. The fall in thyroid hormone levels approximated to a linear response if assessed at least 3 weeks after commencement of carbimazole. Following withdrawal of antithyroid drug treatment, the risk of relapse was greater in patients with higher initial fT4, initial TSH receptor antibody titre, males, smokers, and British Caucasian ethnicity.Conclusion: We identify a dose-response relationship for fall in thyroid hormones in response to carbimazole to aid in the selection of dose for Graves' hyperthyroidism.

Development of Phonetic Contrasts in Cantonese Tone Acquisition.

Purpose Previous studies showed both early and late acquisition of Cantonese tones based on transcription data using different criteria, but very little acoustic data were reported. Our study examined Cantonese tone acquisition using both transcription and acoustic data, illustrating the early and protracted aspects of Cantonese tone acquisition. Method One hundred fifty-nine Cantonese-speaking children aged between 2;1 and 6;0 (years;months) and 10 reference speakers participated in a tone production experiment based on picture naming. Natural production materials with 30 monosyllabic words were transcribed by two native judges. Acoustic measurements included overall tonal dispersion and specific contrasts between similar tone pairs: ratios of average fundamental frequency height for the level tones (T1, T3, T6), magnitude of rise and inflection point for the rising tones (T2, T5), magnitude of fall, H1*-H2*, and harmonic-to-noise ratio for the low tones (T4, T6). Auditory assessment of creakiness for T4 was also included. Results Children in the eldest group (aged 5;7-6;0) were still not completely adultlike in production accuracy, although two thirds of them had production accuracy over 90%. Children in all age groups had production accuracy significantly higher than chance level, and they could produce the major acoustic contrasts between specific tone pairs similarly as reference speakers. Fine phonetic detail of the inflection point and creakiness was more challenging for children. Conclusion Our findings illustrated the multifaceted aspects (both early and late) of Cantonese tone acquisition and called for a wider perspective on how to define successful phonological acquisition. Supplemental Material https://doi.org/10.23641/asha.11594853.

920. A Sharp Fall in Antibiotic Use in Infants Is Correlated With a Population-Wide Reduction in Asthma Incidence for Children Under 5

BackgroundAntibiotic use in infants <1 is associated with increased relative risk (~1.5) for childhood asthma in cohort studies. This may be mediated by removal from the infant microbiome of organisms shown to protect against asthma, a hypothesis supported by experiment. We launched this study to see whether reductions in antibiotic use at population level are associated with benefit by way of asthma reduction.MethodsWe obtained antibiotic prescribing data from BC PharmaNet, a population-based database that captures all outpatient prescribing for British Columbia, Canada (n = 4.7 million). We focused on prescriptions in children <1 and calculated prescription rate per 1,000 population per year. We obtained asthma incidence data from the BC Ministry of Health Chronic Disease Registry. Asthma case identification uses a standard case definition making use of community and hospital diagnostic codes as well as asthma drug data from BC’s universal physician billing, hospital and drug databases. We focused on age-stratified asthma incidence for children aged 1–4. The correlation between antibiotic prescription rate in children < 1 and asthma incidence in the following year was estimated using the Spearman test.ResultsAntibiotic prescribing for all age groups fell 9.5% between 1999 and 2013. The rate for infants <1 dropped 58% from 1,014 to 427 prescriptions per 1,000 population/year. Between 2000 and 2014, asthma incidence (ages 1–4) fell 26% from 27.3 (95% CI: 26.5–28.0) to 20.2 (95% CI: 19.5–20.8) per 1,000 population/year. These trends were strongly correlated: Spearman’s rho = 0.81 (P = 0.0002). The magnitude of fall in asthma incidence is slightly greater than that predicted based on calculated population attributable risk for antibiotic exposure.ConclusionThe population health benefit from antibiotic stewardship in infants may not be confined to slowing the emergence of resistance and could include a reduced risk of asthma. As this is a population-based ecological study, a reduction in other risk factors may also have contributed to the fall in asthma incidence. This promising trend should be further studied at individual level within a large cohort study. Disclosures All authors: No reported disclosures.

Intraabdominal Surgery and Anesthesia Management.

The purpose of this study was to determine if the pattern of ventilation, by itself, influences oxygenation during anesthesia and surgery and examine the hypothesis that progressive pulmonary atelectasis may occur during constant ventilation whenever periodic hyperventilation is lacking, but is reversible by passive hyperinflation of the lungs. Eighteen surgical patients, ranging in age from 24 to 87 yr, without known pulmonary disease, were studied during intraabdominal procedures and one radical mastectomy. Although ventilation remained constant, changes occurred in arterial oxygen tension and in total pulmonary compliance, with an average fall of 22% in oxygen tension and 15% in total pulmonary compliance. This fall in oxygen tension supports the hypothesis that progressive mechanical atelectasis may lead to increased venous admixture to arterial blood. The influence of the ventilator pattern on atelectasis and shunting is further illustrated by the reversibility of the fall in oxygen tension that follows hyperinflation. A relation between the degree of ventilation and the magnitude of fall in arterial oxygen tension was found, where large tidal volumes appear to protect against falls in oxygen tension, while shallow tidal volumes lead to atelectasis and increased shunting with impaired oxygenation.

Effect of co-administration of different doses of phenylephrine with oxytocin on the prevention of oxytocin-induced hypotension in caesarean section under spinal anaesthesia: A randomised comparative study.

Introduction:Co-administration of phenylephrine prevents oxytocin-induced hypotension during caesarean section under spinal anaesthesia (SA), but higher doses cause reflex bradycardia. This study compares the effects of co-administration of two different doses of phenylephrine on oxytocin-induced hypotension during caesarean section under SA.Methods:In this prospective, double-blind study, 90 parturients belonging to the American Society of Anesthesiologists' physical status 1 or 2, undergoing caesarean section under SA were randomised into Group A: oxytocin 3U and phenylephrine 50 μg, Group B: oxytocin 3U and phenylephrine 75 μg, Group C: oxytocin 3U and normal saline, administered intravenously over 5 min after baby extraction. The incidence of hypotension (the primary outcome), rescue vasopressor requirement and side effects were recorded. Statistical analyses were with analysis of variance, Kruskal-Wallis, chi-square and Fisher's exact tests.Results:Demographic parameters such as age, height, weight, level of sensory block at 20 min and duration of surgery were comparable in all the groups. The incidence of hypotension (Group A – 90%, Group B – 10%, Group C – 98%, P = 0.001), magnitude of fall in mean arterial pressure (Group A-15.03 ± 6.12 mm of Hg, Group B – 6.63 ± 4.49 mm of Hg and Group C-13.03 ± 3.39 mm of Hg, P < 0.001) and rescue vasopressor requirement (Group A-45 ± 15.25 mg, Group B-5 ± 15.25, Group C-91.66 ± 26.53, P < 0.001) were significantly lower in Group B compared to A and C.Conclusion:Co-administration of phenylephrine 75 μg with oxytocin 3U reduces the incidence of oxytocin-induced hypotension compared to phenylephrine 50 μg with oxytocin 3U during caesarean section under spinal anaesthesia.

Reductions in tyrosine levels are associated with thyroid hormone and catecholamine disturbances in sepsis

The magnitude of fall in thyroid hormone and rise in catecholamine levels are prognostic in critical illness (1, 2). These may be linked, as the amino acid tyrosine is converted by tyrosine hydroxylase to L-DOPA, and thence to dopamine, norepinephrine and epinephrine, whereas thyroxine (T4) and tri-iodothyronine (T3) are formed by the iodination of tyrosine residues in thyroglobulin. We used our well-characterized 72 h fluid-resuscitated rat model of faecal peritonitis, where accurate prognostication can be made as early as 6 h (3), to explore any relationship.

Renal nerves: time for reassessment of their role in hypertension?

Renal nerves: time for reassessment of their role in hypertension?

Transfusion after Intramedullary Nailing of Hip Fractures

Introduction: Patients with unstable multi-fragmentary trochanteric fractures in comparison to those with simple intra-capsular and inter-trochanteric fractures have a larger amount of fractured metaphyseal bone from which bleeding can occur at the time of injury. A detailed analysis was performed comparing haemoglobin (Hb) in the pre and postoperative periods between patients requiring transfusion and those not. This was to determine if pre-operative blood loss caused a greater magnitude of fall in Hb concentration compared to post-operative blood loss, demonstrating if bleeding from the fracture as opposed to the surgery that patients had undergone was associated with the need for transfusion. Methods: Retrospective review of patients undergoing third generation Gamma Nail (Stryker Trauma, Switzerland) fixation for unstable peritrochanteric fractures. Fracture type was classified according to the MUller AO/ OTA classification. Patients were excluded if they had prophylactic nailing for metastatic disease; had sustained a diaphyseal fracture; or if they had been on warfarin, had any previous documented anaemia or acute gastrointestinal haemorrhage. The pre and post-operative Hb was recorded, timing and volume of transfusion. The Hb levels were analysed using a repeated measures regression model. The mean arterial blood pressure (MAP), level of fitness prior to surgery according to the American Society Anaesthesiologists (ASA) grading and fracture type was defined for each patient. Results: There were 51 patients with a mean age of 78 years after exclusions. 23 patients received a transfusion and 28 did not. The mean pre-operative Hb in the non-transfused group was 118.4 g/L, higher than the Hb in the transfused group, 95.9 g/L (p < 0.00). In comparison, in the 48 hour period after their operation, the mean Hb concentrations were comparable in both groups (p=0.358). Conclusions: There was a significant difference in the starting Hb level between groups: in the group requiring transfusion patients were anaemic before surgery. The association of pre-operative anaemia with an unstable multifragmentary trochanteric fracture should alert clinicians that these patients are likely to require blood replacement.

Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy: a randomized clinical trial.

Hypertensive crisis is an important cause of maternal and perinatal morbidity and mortality. To compare the efficacy of oral nifedipine and intravenous labetalol. One hundred women with hypertensive crisis were randomized to receive either oral nifedipine 10 mg or intravenous labetalol 20 mg. Oral nifedipine was given 10 mg stat followed by 10 mg every 30 minutes up to a maximum of 50 mg. Intravenous labetalol was given 20 mg stat followed by 40 mg 30 minutes later then two more doses of 80 mg every 30 minutes up to a maximum of 220 mg. The primary outcome was the number of doses required to achieve target blood pressure (BP) and time required to reduce the mean arterial pressure by 25%. Secondary outcomes analysed included additional drugs required, resurgence of hypertensive crisis. Data were analysed using repeated measures analysis of variance (ANOVA), mixed ANOVA, unpaired t-test and chi square test and P value ≤0.05 was considered significant. Systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) were lower than baseline at all time points of follow-up in both nifedipine and labetalol groups (P < 0.01). P < 0.05 by repeated measures ANOVA for overall trend of changes in SBP, DBP and MAP for within-group effects in both nifedipine and labetalol groups and P < 0.05 by mixed ANOVA for between-group effects during entire observation period. The magnitude of fall in SBP, DBP and MAP was greater in the labetalol group compared with the nifedipine group (P < 0.05). Target BP was achieved in 90% in the nifedipine group and 92% in the labetalol group. Maternal and fetal adverse effects were infrequent. Both oral nifedipine and intravenous labetalol are effective in the treatment of hypertensive crisis. Intravenous labetalol may have benefits because it is more effective in reducing the SBP, DBP and MAP to target levels with a lower number of doses.

Can the fall in serum FSH during coasting in IVF/ICSI predict clinical outcomes?

This retrospective cohort study determined whether the total falls in serum FSH and oestradiol concentrations from start to end of coasting in IVF/intracytoplasmic sperm injection could predict clinical outcomes. Ninety-nine cycles, with gonadotrophin-releasing hormone-agonist down-regulation where coasting with serial serum oestradiol and FSH monitoring was adopted due to risk of severe ovarian hyperstimulation syndrome, were consecutively included. The primary clinical outcome was live-birth rate (LBR); other outcomes measured were number of oocytes retrieved and fertilization, implantation and clinical pregnancy rates. LBR for FSH fall>10IU/l compared with 5–10 and<5IU/l were 45.4% versus 22.0% and 25.0%, respectively. Mean serum FSH fall was similar with and without live birth (8.4±6.2 versus 7.3±5.0IU/l) as were mean oestradiol and FSH concentrations on HCG administration, oestradiol fall, percentage fall in FSH/oestradiol and duration of coasting. None of the variables efficiently predicted live birth on regression analysis. The AUC of FSH fall was 0.53 at 11.0IU/l. Basal FSH, starting and total gonadotrophin dose and duration of coasting were positively correlated with FSH fall. A potentially clinically important association between live birth and FSH fall during coasting was apparent, which requires further evaluation.The purpose of this retrospective cohort study was to determine whether the magnitude of fall in the serum FSH and oestradiol concentrations from start to end of coasting in IVF/intracytoplasmic sperm injection cycles could predict the clinical outcomes. Gonadotrophin-releasing hormone-agonist down-regulated cycles (n=99), where coasting with serial serum oestradiol and FSH monitoring was adopted due to risk of ovarian hyperstimulation, were consecutively included. Live birth was the primary clinical outcome measured; number of oocytes retrieved and fertilization, implantation and clinical pregnancy rates were the other outcomes examined. Live-birth rate tended to be high when FSH fall was >10IU/l, compared with 5–10IU/l and <5IU/l, although not statistically significantly. Mean serum FSH fall were similar in live-birth and no-live-birth cycles (8.4±6.2 versus 7.3±5.0) as were mean oestradiol and FSH concentrations on hCG administration, oestradiol fall, percentage fall in FSH and oestradiol and duration of coasting. None of the variables efficiently predicted live birth. The area under the curve of FSH fall was 0.53. FSH fall of <11.0IU/l was found to be more likely to predict negative outcome (specificity 84.72%) than predicting positive outcome when FSH fall was >11IU/l (sensitivity 34.48%). Women’s basal FSH, starting and total gonadotrophin dose of ovarian stimulation and duration of coasting had direct positive correlation with the magnitude of FSH fall. A potentially clinically important rise in live birth in association with greater FSH fall during coasting was apparent, which requires further evaluation.

Early iron supplementation in very low birth weight infants – a randomized controlled trial

To evaluate if supplementing iron at 2 weeks of age improves serum ferritin and/or haematological parameters at 2 months of life in very low birth weight (VLBW) infants. Preterm VLBW infants who received at least 100 mL/kg/day of oral feeds by day 14 of life were randomized to either 'early iron' (3-4 mg/kg/day orally from 2 weeks) or 'control' (no iron until 60 days) groups. Infants were followed up fortnightly and all morbidities were prospectively recorded. Serum ferritin was measured at 60 days by enzyme immunoassay method. Forty-six infants were included in the study; primary outcome was available for 42 infants.There was no difference in either serum ferritin (mean: 50.8 vs. 45.3 microg/L; adjusted difference in means: 5.8, 95% CI: -3.0, 14.6; p = 0.19) or haematocrit (32.5 +/- 5.3 vs. 30.8 +/- 6.3%; p = 0.35)at 60 days between the early iron and control groups. The magnitude of fall in serum ferritin from baseline to the end of study period was also not different between the groups (4.9 vs. 13.8 microg/L; difference in means: 8.8; 95% CI: -0.3, 17.9; p = 0.06). The requirement of blood transfusions (9.5 vs. 13%; p = 0.63) and a composite outcome of common neonatal morbidities (19% vs. 21.7%; p = 0.55) were also not different between the two groups. Supplementing iron at 2 weeks of age in preterm VLBW infants did not improve either serum ferritin or the haematological parameters at 2 months when compared to the standard practice of starting iron from 8 weeks of age.

Cerebrovascular Responses To Incremental Exercise During Hypobaric Hypoxia: Effect Of Oxygenation On Maximal Performance

PURPOSE: We sought to describe cerebrovascular responses to incremental exercise and test the hypothesis that changes in cerebral oxygenation influence maximal performance. METHODS: Eleven men cycled in three conditions: 1) sea level (SL); 2) acute hypoxia (AH: hypobaric chamber, Pbar 460 mmHg); and 3) chronic hypoxia (CH: 4,300 m, Pbar 460 mmHg). At maximal work rate (Wmax), FIO2 was surreptitiously increased to 0.60 while subjects were encouraged to continue pedaling. Changes in cerebral (frontal lobe) and muscle (vastus lateralis) oxygenation (COX, MOX; near infrared spectroscopy), middle cerebral artery blood flow velocity (CBFv; transcranial Doppler) and end-tidal CO2 (PETCO2) were analyzed across %Wmax and condition (α=0.05). RESULTS: At SL, PETCO2, CBFv and COX fell as work rate rose from 75 to 100% Wmax. During AH, PETCO2 and CBFv declined from 50 to 100% Wmax while COX fell from rest. With CH, PETCO2 and COX dropped throughout exercise, while CBFv fell only from 75 to 100% Wmax. MOX fell from rest to 75% Wmax at SL and AH, and throughout exercise in CH. Of note, the magnitude of fall in COX, but not MOX, was different between conditions (CH>AH>SL). FIO2 0.60 at Wmax did not prolong exercise at SL, yet allowed subjects to continue for 96±18 s in AH and 162±27 s in CH. During FIO2 0.60,COX and PETCO2 rose, CBFv fell and MOX remained constant as work rate increased. CONCLUSIONS: Changes in cerebral oxygenation influence maximal exercise performance during hypobaric hypoxia, but are only weakly correlated with PETCO2 and CBFv. Funding provided by US Army Medical Research Materiel Command ATO IV.MD.2006.01. Authors' views; not official U.S. Army or DoD policy.

Cerebrovascular responses to incremental exercise during hypobaric hypoxia: effect of oxygenation on maximal performance

We sought to describe cerebrovascular responses to incremental exercise and test the hypothesis that changes in cerebral oxygenation influence maximal performance. Eleven men cycled in three conditions: 1) sea level (SL); 2) acute hypoxia [AH; hypobaric chamber, inspired Po(2) (Pi(O(2))) 86 Torr]; and 3) chronic hypoxia [CH; 4,300 m, Pi(O(2)) 86 Torr]. At maximal work rate (W(max)), fraction of inspired oxygen (Fi(O(2))) was surreptitiously increased to 0.60, while subjects were encouraged to continue pedaling. Changes in cerebral (frontal lobe) (C(OX)) and muscle (vastus lateralis) oxygenation (M(OX)) (near infrared spectroscopy), middle cerebral artery blood flow velocity (MCA V(mean); transcranial Doppler), and end-tidal Pco(2) (Pet(CO(2))) were analyzed across %W(max) (significance at P < 0.05). At SL, Pet(CO(2)), MCA V(mean), and C(OX) fell as work rate rose from 75 to 100% W(max). During AH, Pet(CO(2)) and MCA V(mean) declined from 50 to 100% W(max), while C(OX) fell from rest. With CH, Pet(CO(2)) and C(OX) dropped throughout exercise, while MCA V(mean) fell only from 75 to 100% W(max). M(OX) fell from rest to 75% W(max) at SL and AH and throughout exercise in CH. The magnitude of fall in C(OX), but not M(OX), was different between conditions (CH > AH > SL). Fi(O(2)) 0.60 at W(max) did not prolong exercise at SL, yet allowed subjects to continue for 96 +/- 61 s in AH and 162 +/- 90 s in CH. During Fi(O(2)) 0.60, C(OX) rose and M(OX) remained constant as work rate increased. Thus cerebral hypoxia appeared to impose a limit to maximal exercise during hypobaric hypoxia (Pi(O(2)) 86 Torr), since its reversal was associated with improved performance.

Impact of Diabetes on Microvascular PO2 and Tension in Rat Extensor Digitorum Longus (EDL) Muscle

Microvascular PO (PO m) on-kinetics are accelerated in the spinotrapezius muscle of diabetic rats (Am J Physiol 283: H926, 2002). The faster PO2m on-kinetics in diabetic skeletal muscle appear to be associated with the structural and functional changes in the microcirculation, however direct correlations to muscle tension development have not been performed. PURPOSE: To test the hypotheses that; (1) the faster PO2m on-kinetics in diabetic rat skeletal muscle are associated with greater oxygen utilization due to greater tension development, and (2) that insulin therapy will ameliorate the changes in PO2m on-kinetics and tension development. METHODS: Female Sprague-Dawley rats were divided into control (C, n=9; blood glucose, 105 ± 13 mg/dL) and diabetic groups (n=17, 50 mg/kg STZ). Diabetics were subdivided into untreated (D, n=9; glucose, 435 ± 37 mg/dL), and insulin treated diabetic (I, n=8; 4 units insulin glargine/day; glucose, 355 ± 31 mg/dL) groups. Experiments were performed 8–10 wks later. PO2m (phosphorescence quenching) was measured at rest and during electrically stimulated muscle contractions (1 Hz, 6.5 V, 2 ms duration). The distal tendon of the EDL was attached to a force transducer and muscle tension analyzer. Significance at P<0.05. RESULTS: D rats had lower body weight (C, 302 ± 8; D, 225 ± 17; I, 289 ± 5 g) and EDL weight (C, 168 ± 8; D, 90 ± 11; I, 150 ± 4 mg) compared to C and I. Mean arterial pressure (C, 131 ± 10; D, 128 ±7; I, 125 ± 6 mmHg) and arterial PO2 (C, 85 ± 2; D, 76 ± 4; I, 72 ± 2 mmHg) were similar. Resting PO2m was not different among groups (C, 32 ± 3; D, 30 ± 2; I, 25 ± 2 mmHg), however the fall in PO2m during steady-state contractions was less in D and I (C, −20 ± 2; D, −11 ± 2; I, −13 ± 1 mmHg) compared to C. At the onset of contractions, the time delay was similar (C, 5 ± 1; D, 6 ± 1; I, 5 ± 1 s), but the time constant was less in D and I rats (C, 21 ± 3; D, 14 ± 2; I, 12 ± 1 s). Absolute peak twitch tension (g) was less in D rats, however, due to marked atrophy in D, peak tension per muscle mass was not different (C, 165 ± 19; D, 226 ± 18; I, 180 ±17g/g) CONCLUSION: Insulin treatment prevented the diabetes-induced decreases in body weight and muscle atrophy, but did not restore the PO2m on-kinetics, or magnitude of fall in PO2m. Average peak tension development per g EDL was not different among C, D and I, suggesting that oxygen consumption was similar. These data imply there is a slower increase in oxygen delivery relative to consumption at the onset of contractions in D and I, but that steady-state oxygen delivery is greater, as reflected in a reduced fall in PO m. (Supported by KCOM Graduate Program Committee and the American Heart Association, Heartland Affiliate.)

Safety of Sputum Induction in Moderate-to-Severe Smoking-Related Chronic Obstructive Pulmonary Disease

Background. Investigation of the safety of sputum induction in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) has been limited. Objective. to evaluate this issue in 100 patients with a mean FEV1 of 1.2 (0.4) L. After 200 μg inhaled salbutamol, sputum induction was performed with inhaled saline in increasing and tailored concentrations (0.9% to 5%) until an adequate sample of sputum was obtained or the FEV1 fell by > 20%. Main Findings. Sputum induction was successful in 92% of occasions. The mean (SD) fall in FEV1 was 13.5 (8.6)%. Five patients had a fall > 20% but all recovered to 10% of baseline after inhaled salbutamol. The magnitude of fall in FEV1 correlated weakly with salbutamol reversibility (r = 0.37, p < 0.001), baseline FEV1/VC (r = −0.32, p = 0.001) and baseline FEV1% predicted (r = −0.36, p = 0.003) but not with age, smoking history or post-Salbutamol FEV1. Principle conclusion. Sputum induction can be performed safely using a patient-tailored approach in patients with moderate-to-severe COPD, supporting its use in research and clinical practice.

Soluble syndecan‐1 level at diagnosis is an independent prognostic factor in multiple myeloma and the extent of fall from diagnosis to plateau predicts for overall survival

Syndecan-1 (CD138) is a heparin sulphate proteoglycan that is over expressed on the surface of both normal and malignant plasma cells and actively shed from the cell surface (soluble syndecan-1). Soluble syndecan-1 has been shown to be an independent prognostic factor in myeloma but its role in prognostic classification requires further investigation. We have retrospectively measured soluble syndecan-1 in 324 presentation samples and 154 plateau phase samples from the UK Medical Research Council Myeloma VIth trial. Log-rank analysis showed that the presentation value of soluble syndecan-1 is a highly significant prognostic factor when assessing survival from entry (chi2=14.92, P<0.0001) and remains an important independent prognostic factor when considered in Cox regression models (P<or=0.02) with known independent factors. The magnitude of fall in soluble syndecan-1 from presentation to plateau also had prognostic value when assessing overall survival from plateau (chi2=3.79, P=0.05). In conclusion, this large study confirms that soluble syndecan-1 level is a powerful independent prognostic factor both at diagnosis and at plateau phase.

Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions

Background: Carotid sinus syndrome (CSS) is a common cause of syncope in older persons. There appears to be a high prevalence of carotid sinus hypersensitivity (CSH) in patients with dementia...

Has India Inc Failed in Playing the Leadership Role?

A large number of higher rung companies have not been able to contribute effectively to correct India's balance of trade. In fact, a large proportion (over 50%) is involved in aggravating it. The performance of lower rung corporates is comparatively more satisfactory. The contribution by the higher rung corporates to the globalization of Indian business is even more unsatisfactory. With a few honourable exceptions, they are globalizing more actively inwards than outwards. Most of the corporates are not contributing to increasing the global competitiveness of India through technological capability building. There is increasing technological dependence of these companies, perhaps strategic dependence, on foreign companies as manifested by accelerated pace of foreign collaboration by corporate leaders in every field. Corporates are not able to withstand global competition. The performance of over 50 per cent of pre-reform corporate leaders has gone down both in terms of their sales rank and profit position. The performance of the neo-leader companies (entering the fray after 1992) is even worse. This downturn has started affecting the national economy and society. The deteriorating performance of corporate leaders has blocked a huge amount of country's savings in unutilized/underutilized fixed assets and created sizeable non- performing assets. A majority of corporates are still not considering internationalization of their business leaving the task to small companies, especially the software ventures, which are vulnerable to host country protests as well as increasing share of the MNCs in business process outsourcing. Considering all these factors, it is time the corporates realized that they also have a role to play in ensuring sound health of their industry and Indian economy without which their own survival may be at stake in the long run. The magnitude of fall in their performance suggests that the issue has to be taken up as a strategic challenge and new models and approaches for arresting the fall need to be developed. This study analyses the policy implications of this phenomenon and comes up with the following suggestions: The policy-makers need to critically evaluate the export-import and other policies and examine what policy support is needed to make more Indian corporates assume responsibility for increasing the net exports and for internationalization of Indian business. The creation of a large amount of non-performing assets due to failed expansion and diversification moves would entail major ongoing restructuring of the underutilized assets in the form of acquisitions, mergers, and divestitures. There is a need for proactive policies for facilitating such strategies with concern for protecting the interests of larger section of the society. The policy-makers also have to think and consciously decide as to what level of “exit” is to be tolerated as a price to be paid for better quality and increased supply of goods and services. Corporate leaders are not paying enough attention to develop and/or scale up native products that are embedded in the natural endowment and socio-cultural context of the country which could be leveraged as a strategic tool for meeting global competition on local strengths. New/additional policy measures seem to be neces- sary for the purpose. There is a need for large-scale, coordinated research by mobilizing and unifying the national efforts with active industry involvement at various stages of research.

Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects

Postprandial hypotension occurs frequently in older people and may lead to syncope and falls. Some recent studies suggest that the magnitude of the postprandial fall in blood pressure (BP) is influenced by the rate of gastric emptying. The aim of this study was, therefore, to determine whether the fall in blood pressure induced by intraduodenal glucose is influenced by the rate of nutrient delivery into the small intestine, bypassing the effects of gastric emptying. Eight healthy elderly subjects (four male and four female, age 70.3 +/- 3.4 years) were studied on two separate days, in double-blind, randomised order. Glucose was infused intraduodenally at a rate of either 1 or 3 kcal min(-1), for 60 min, (0-60 min) followed by 0.9 % saline for a further 60 min (60-120 min). Blood pressure and heart rate were recorded at baseline and every 3 min during the study. Blood glucose and plasma insulin were also determined. Only the 3 kcal min(-1) infusion caused a significant fall in systolic (P < 0.001) and diastolic (P < 0.0001) blood pressure and an increase in the heart rate (P < 0.0001). The rises in blood glucose (P < 0.01) and plasma insulin (P < 0.05) concentrations were greater during the 3 kcal min(-1) infusion. We conclude that in healthy older subjects, the magnitude of the fall in blood pressure and increase in heart rate induced by intraduodenal glucose infusion is dependent on the rate of nutrient delivery into the small intestine. These results may have relevance to the treatment of postprandial hypotension.