Physiologic Mode Research Articles

Ex Situ Left Ventricular Pressure-Volume Loop Analyses for Donor Hearts: Proof of Concept in an Ovine Experimental Model.

Ex situ heart perfusion (ESHP) has emerged as an important strategy to preserve donation after brain death (DBD) and donation after circulatory death (DCD) donor hearts. Clinically, both DBD and DCD hearts are successfully preserved using ESHP. Viability assessment is currently based on biochemical values, while a reliable method for graft function assessment in a physiologic working mode is unavailable. As functional assessment during ESHP has demonstrated the highest predictive value of outcome post-transplantation, this is an important area for improvement. In this study, a novel method for ex situ assessment of left ventricular function with pressure-volume loop analyses is evaluated. Ovine hearts were functionally evaluated during normothermic ESHP with the novel pressure-volume loop system. This system provides an afterload and adjustable preload to the left ventricle. By increasing the preload and measuring end-systolic elastance, the system could successfully assess the left ventricular function. End-systolic elastance at 60min and 120min was 2.8 ± 1.8mmHg/mL and 2.7 ± 0.7mmHg/mL, respectively. In this study we show a novel method for functional graft assessment with ex situ pressure-loop analyses during ESHP. When further validated, this method for pressure-volume assessments, could be used for better graft selection in both DBD and DCD donor hearts.

Healthy Lifestyle, Coping, and Adaptation of Public Health Nurses Amidst COVID-19 Pandemic in Selected Municipalities of Isabela Basis for Wellness Intervention Program

Considering the struggles with this kind of situation, the COVID-19 pandemic restored the appreciation for healthy lifestyle behaviors as well as the coping and adaption techniques of Public Health Nurses (PHNs). The study assessed the PHNs' coping, adaptation, and healthy lifestyle practices; the significant relationship between their healthy lifestyle practices and coping and adaptation styles based on their profile; and the possible need to intervene based on the results of the study through a wellness intervention program. Descriptive-correlational study was conducted in the adopted municipalities from the southern part of Isabela namely Echague and Alicia, through a survey method. The study's findings suggest that PHNs' healthy lifestyle behaviors, as well as their coping and adapting techniques, were effective throughout the onset of COVID-19. Furthermore, the findings revealed that older respondents (36-50 years old) are more likely to follow healthy lifestyle practices in the domain of nutrition (M = 4.15), whereas married respondents (M = 3.66) are more likely to engage in physical activity on a regular basis than their younger counterparts. In comparison to contractual employees, permanent employees with an average of (M = 4.19) are more conscious of their role function as part of their coping and adapting to the COVID-19 pandemic. Finally, the association between respondents' healthy lifestyle, coping, and adaption approaches demonstrates a substantial positive relationship, particularly in terms of nutrition and physiologic adaptation with an r-value of 0.745 at a 0.001 p-value, physical activity and physiologic mode with an r-value of 0.669 at a 0.001 p-value, and physiologic mode and stress management with an r-value of 0.655 at a 0.001 p-value. Moreover, the domains of stress management and self-concept mode also show a strong positive relationship with an r-value of 0.698 at a 0.001 p-value.

Bariatrik Cerrahi Sonrası Geri Kilo Alımı Olan Bireyin Roy Adaptasyon Modeline Göre Hemşirelik Bakım Süreci

Bariatrik cerrahi sonrası geri kilo alımı bireyin yaşam tarzında önemli değişikliklere neden olmakla beraber bireyin hayatını fizyolojik, psikolojik, emosyonel ve sosyal alanlarda etkilemektedir. Bu çalışmada, bariatrik cerrahi sonrası geri kilo alımı olan bir olgu değerlendirilmiştir. Bu olguda birey her hafta Roy Adaptasyon Modeli’nin dört uyum alanına göre değerlendirilmiştir. Bireye Roy Adaptasyon Modeli’nin uyum alanlarına yönelik hemşirelik girişimleri uygulanmış olup, gereksinimi doğrultusunda haftada 1 kez ortalama 1 saat sürecek şekilde 9 hafta boyunca eğitim verilerek değişen yaşam tarzına uyumu desteklenmiştir. Fizyolojik uyum alanda; beden gereksiniminden fazla beslenme, benlik uyum alanda; düşük benlik saygısı, rol fonksiyon uyum alanında; etkisiz rol performansı, karşılıklı bağlılık uyum alanında; sosyal iletişimde bozulma hemşirelik tanısı ele alınmış ve bu tanılara yönelik hemşirelik girişimleri uygulanmıştır. Bireye gereksinimi halinde belirlenen görüşme programı dışında telefon ile de danışmanlık sağlanmıştır. Bireyden yazılı ve sözlü olarak bilgilendirilmiş olur alınmıştır. Çalışma sonucuna göre, bu olguya yönelik planlanan ve uygulanan hemşirelik süreci ile bireyin bariatrik cerrahi sonrası değişen yaşam tarzına optimum uyumu tekrar sağlanmıştır. Bu doğrultuda Roy Adaptasyon Modeli’nin bariatrik cerrahi sonrası geri kilo alımı olan bireylerde kullanımının uygun olduğu ve bu çalışmanın rehber niteliği taşıyacağı sonucuna varılmıştır.

Assessment of the Difficulties Experienced by Individuals with Intestinal Stomas: A Qualitative Study.

The aim of this study was to assess the difficulties faced by individuals with intestinal stomas. The authors used a qualitative descriptive phenomenologic design. The study population comprised individuals with intestinal stoma living in Eskişehir who were 18 years or older and did not have any mental, physical, and communication disorders. Criterion sampling and snowball sampling methods were used. Data were collected from June to September 2019 through a questionnaire of personal characteristics as well as a semistructured interview. Data on personal characteristics were analyzed in numbers and percentages, and qualitative data were analyzed using the MAXQDA 2020 program (VERBI Software, Berlin, Germany). The study data were evaluated under two headings: (1) themes created using the Roy's Adaptation Model and (2) other themes. In the themes created using the Roy's Adaptation Model, difficulties related to the physiologic adaptation mode and interdependence adaptation mode were observed, whereas among other themes, difficulties due to lack of information and economic worries were commonly reported. Most individuals experienced sleep pattern disturbances; faced issues in their relationships with family and friends due to physiologic and psychological distress; received no training for stoma care, diet, or sexual life; could not cope with issues related to the stoma; and faced financial difficulties in procuring stoma bags and care products.

Abstract 11706: His Bundle Pacing and Atrioventricular Nodal Ablation in the Management of Refractory Atrial Fibrillation, a Systematic Review and Meta-Analysis

Introduction: Ventricular rate control is critical in management of atrial fibrillation (AF). When pharmacologic therapy fails in controlling the ventricular rate, atrioventricular nodal ablation (AVNA) and pacing is considered an effective therapy for symptomatic management. His bundle pacing (HBP) is considered a physiologic mode of pacing with AVNA ensuring synchronized activation of right and left ventricles preserving ventricular functioning. Hypothesis: HBP and AVNA are feasible, safe, and effective for management of refractory AF. Methods: We identified 218 studies after literature review of EMBASE, Medline, and Cochrane databases. Our analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results: Six studies (two randomized controlled trials, four observational cohorts) were included in the final meta-analyses. A total of 275 patients underwent attempted permanent HBP and AVNA. The mean age of patients was 70.74 (SD 4.38; 95% CI 62.15-79.32). Mean implant success rate for acute HBP was 94.5% (SD 10.12; 95% CI 74.70, 100.00). Selective HBP was noted in 44.7% (95% CI 12.5-76.9), while Non-selective-HBP was noted at rate of 42.2% (95% CI 10.2-74.2). The mean follow-up duration was 21.71 months (SD 3.77; 95% CI 14.32-29.11). All-cause mortality had a pooled proportion of 0.107 (SD 0.110, 95% CI -0.109-0.323); hospitalization proportion was 0.078 (SD 0.072; 95% CI -0.063-0.219). We noted a significant improvement in left ventricular ejection fraction (LVEF) (Baseline [BL] 41.84%, Follow-up [FU] 53.63%, Standardized mean difference [SMD] 0.646, p 0.028), NYHA class (BL 2.77, FU 1.55, SMD -2.542, p <0.001) and LV end diastolic volume (SMD -0.495, 95% CI -0.721, -0.269, p <0.001). We found a significant rise of threshold potential (BL 1.12 V, FU 1.49 V, SMD 0.393, p <0.001 and an increase between baseline and follow up QRS duration (BL 102.21 ms, FU 106.90 ms, SMD 0.646, p 0.028). Conclusion: HBP and AVNA are feasible, safe, effective and has high success rate for management of refractory AF. Further studies are needed to evaluate its role in comparison to left bundle branch area pacing and cardiac resynchronization therapy to evaluate comparative efficacy in refractory AF.

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

The sacroiliac joint (SIJ) is a well-known source of low back pain, with increasing interest for both conservative and surgical treatment. Alterations in pelvis kinematics are hypothesized as a contributor to SIJ pain and pelvic orthoses one treatment option, but their effects on the pelvis are poorly understood. Alterations in movement patterns induced by the application of pelvic orthoses were determined in five human cadaveric pelvises. Deformations were obtained from the lumbosacral transition and the bilateral SIJ, using digital image correlation and a customized routine to compute the movements within the pelvis. Significant alterations were found for the movements at the SIJ, in particular a vast increase in axial (x-axis) rotation, accompanied by increased inferior (y-) translation of the sacrum relative to the ilium. Movement patterns at the lumbosacral transition changed, causing increases in axial rotation and decreased inferior translation of L5 relative to S1. Using a physiologic mode of load application gives novel insights into the potential effects of pelvic orthoses. The results of these in-vitro experiments vary markedly from previous experiments with loading limited to two or less axes. Furthermore, the influence of pelvic orthoses on the lumbosacral transition warrants further investigation.

The testicular transcriptome associated with spermatogonia differentiation initiated by gonadotrophin stimulation in the juvenile rhesus monkey (Macaca mulatta).

What is the genetic landscape within the testis of the juvenile rhesus monkey (Macaca mulatta) that underlies the decision of undifferentiated spermatogonia to commit to a pathway of differentiation when puberty is induced prematurely by exogenous LH and FSH stimulation? Forty-eight hours of gonadotrophin stimulation of the juvenile monkey testis resulted in the appearance of differentiating B spermatogonia and the emergence of 1362 up-regulated and 225 down-regulated testicular mRNAs encoding a complex network of proteins ranging from enzymes regulating Leydig cell steroidogenesis to membrane receptors, and from juxtacrine and paracrine factors to transcriptional factors governing spermatogonial stem cell fate. Our understanding of the cell and molecular biology underlying the fate of undifferentiated spermatogonia is based largely on studies of rodents, particularly of mice, but in the case of primates very little is known. The present study represents the first attempt to comprehensively address this question in a highly evolved primate. Global gene expression in the testis from juvenile rhesus monkeys that had been stimulated with recombinant monkey LH and FSH for 48 h (N = 3) or 96 h (N = 4) was compared to that from vehicle treated animals (N = 3). Testicular cell types and testosterone secretion were also monitored. Precocious testicular puberty was initiated in juvenile rhesus monkeys, 14-24 months of age, using a physiologic mode of intermittent stimulation with i.v. recombinant monkey LH and FSH that within 48 h produced 'adult' levels of circulating LH, FSH and testosterone. Mitotic activity was monitored by immunohistochemical assays of 5-bromo-2'-deoxyuridine and 5-ethynyl-2'-deoxyuridine incorporation. Animals were bilaterally castrated and RNA was extracted from the right testis. Global gene expression was determined using RNA-Seq. Differentially expressed genes (DEGs) were identified and evaluated by pathway analysis. mRNAs of particular interest were also quantitated using quantitative RT-PCR. Fractions of the left testis were used for histochemistry or immunoflouresence. Differentiating type B spematogonia were observed after both 48 and 96 h of gonadotrophin stimulation. Pathway analysis identified five super categories of over-represented DEGs. Repression of GFRA1 (glial cell line-derived neurotrophic factor family receptor alpha 1) and NANOS2 (nanos C2HC-type zinc finger 2) that favor spermatogonial stem cell renewal was noted after 48 and 96 h of LH and FSH stimulation. Additionally, changes in expression of numerous genes involved in regulating the Notch pathway, cell adhesion, structural plasticity and modulating the immune system were observed. Induction of genes associated with the differentiation of spermatogonia stem cells (SOHLH1(spermatogenesis- and oogenesis-specific basic helix-loop-helix 1), SOHLH2 and KIT (V-Kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog)) was not observed. Expression of the gene encoding STRA8 (stimulated by retinoic acid 8), a protein generally considered to mark activation of retinoic acid signaling, was below our limit of detection. The entire mRNA data set for vehicle and gonadotrophin treated animals (N = 10) has been deposited in the GEO-NCBI repository (GSE97786). The limited number of monkeys per group and the dilution of low abundance germ cell transcripts by mRNAs contributed from somatic cells likely resulted in an underestimation of the number of differentially expressed germ cell genes. The findings that expression of GDNF (a major promoter of spermatogonial stem cell renewal) was not detected in the control juvenile testes, expression of SOHLH1, SOHLH2 and KIT, promoters of spermatogonial differentiation in mice, were not up-regulated in association with the gonadotrophin-induced generation of differentiating spermatogonia, and that robust activation of the retinoic acid signaling pathway was not observed, could not have been predicted. These unexpected results underline the importance of non-human primate models in translating data derived from animal research to the human situation. The work described was funded by NIH grant R01 HD072189 to T.M.P. P.A. was supported by an Endocrine Society Summer Research Fellowship Award and CONICET (Argentine Research Council), S.N. by a grant from Vali-e-Asr Reproductive Health Research Center of Tehran University of Medical Sciences (grant #24335-39-92) to Dr Batool Hosseini Rashidi, and M.P.H. by grants from the National Health and Medical Research Council of Australia, and the Victorian State Government's Operational Infrastructure Support Program. The authors have nothing to disclose.

(490) - Identification of Hypoxic Cells in Lung Grafts for Future Cell Targeted Therapy for Obliterans Bronchiolitis

Purpose: Ex vivo heart perfusion (EVHP) has been proposed as a means improving heart preservation and expanding the donor pool. Current clinical EVHP protocols involve preservation in an unloaded and non-working state; however, the impact of this approach on the preservation of donor heart function is unknown. We sought to determine if myocardial load during EVHP impacts the preservation of donor heart function. Methods: Donor porcine hearts were perfused ex vivo in a beating state for 12 hours. Loaded hearts (N= 4) were perfused in a working mode (left atrial pressure= 6 mmHg, heart rate= 100 beats/minute) for the entire EVHP interval. Unloaded hearts (N= 4) were briefly transitioned into a working mode at hours 1 (T1), 5 (T5), and 11 (T11) for metabolic and functional assessments, but were otherwise perfused in a resting mode (left atrial pressure= 0 mmHg). Results: Myocardial function (T11 cardiac index (mL/minute/gram): loaded= 6.9±1.0 vs. unloaded= 2.0±1.2, p= 0.02) and mechanical efficiency (T11: loaded= 11±1 vs. unloaded= 2±1 %, p< 0.01) were better preserved in loaded hearts. Myocardial injury (T11 troponin I (ng/mL): loaded= 11.6±0.4 vs. unloaded= 12.1±0.3, p= 0.39) and edema formation (% weight gain: loaded= 14±8 vs. unloaded= 24±3 %, p= 0.15) did not account for these differences. Free fatty acids were rapidly depleted in both groups; however, triglycerides were continually consumed by loaded hearts and secreted by unloaded heats (Figure 1). Conclusion: EVHP in a loaded state improves the preservation of myocardial function. Uncoupling of fatty acid oxidation may contribute to the decline in myocardial function observed in unloaded hearts; however, further research is required to elucidate the mechanism underlying these observations. These results highlight the need for an EVHP device capable of preserving the donor heart in a physiologic working mode.

AV WENCKEBACH POINT AS A LONG-TERM PREDICTOR OF RIGHT VENTRICULAR PACING DEPENDENCE

Patients presenting symptomatic sick sinus syndrome with preserved AV node function with indication for permanent pacemaker implantation theoretically benefit form single chamber device (AAI) as it represents a more physiologic pacing mode and it reduces complication rates. The incidence of high degree AV block in patients with sick sinus syndrome was reported to be between 0.6 and 3 % annually. We hypothesized that the baseline AV wenckebach point (WP) at the time of AAI pacemaker implantation represent a valid predictor of the futur need for a ventricular lead implantation. We retrospectively analyzed 211 patients who underwent double chamber pacemaker (DDD) implantation who had more than one AV WP measure over a follow-up of up to 7 years. The primary outcome was the percentage of right ventricular pacing at follow-up stratified for the baseline WP. Secondary outcomes included the evolution of the mean WP and right ventricular pacing percentage over time. There is a linear relationship between baseline WP and right ventricular pacing at follow-up (correlation coefficient -0.68) With a baseline value greater than 120 bpm, patients have 9% RV pacing burden at follow-up while an initial value ≤ 100 bpm will result in a 54% RV pacing burden at follow-up. Also, there was no significant difference in the mean WP and percentage of right ventricular pacing at 6 years of follow-up. Routine measurement of the WP should be part of the assessment of patients with sick sinus syndrome in order to better determine if they are candidate for single chamber AAI pacemaker implantation. If the WB is > than 120 bpm, implantation of an AAI pacemaker seems reasonable as suggested by a low burden of ventricular pacing at follow-up and a stable WP measure over time.

Assessment of donor heart viability during ex vivo heart perfusion.

Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min(-1)·g(-1)). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R(2) = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R(2) = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R(2) = 0.74, sensitivity = 1.00, specificity = 0.54; tau: R(2) = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R(2) = 0.28; coronary vascular resistance: R(2) = 0.20; lactate concentration: R(2) = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.

(591) - Preoperative and Postoperative Renal Dysfunction Is an Important Predictor of Survival After LVAD Implantation

s S221 system (Berlin Heart) is a third generation axial continuous flow pump with active magnetic levitation, thus avoiding the potential downsides of mechanical bearings. Implemented software algorithms allow for a more physiologic operation mode including pulsatility. Methods: The aim of this study was to review the Italian experience with the INCOR LVAD and to determine the prevalence of GI bleeding and pump thrombosis. All patients implanted from January 2006 to May 2012, in centers with at least 5 implants were considered eligible. All AE, meeting the INTERMACS classification, were evaluated. Results: The total population consisted of 42 patients. LVAD indication was BTT in 36 (86%) patients and DT in 6 (14%) patients. 31 patients (74%) were in class 1 or 2 INTERMACS at time of implantation, among them 22 (52%) requiring inotropic therapy and 10 (24%) extracorporeal membrane oxygenation support. The mean support time was 525 ± 570 days, median 372 days (5 to 2704) days. The 30-day post-operative mortality was 7 %. The 1-year and 2-year survival rates were 74% and 60%, respectively. At last follow-up (July 2014), 17 (41%) of the 42 patients were transplanted, one (2%) patient regained myocardial function and had the device removed, 5 (12%) are still on support , 19 (45%) of the 42 patients died . The most frequently observed AE was driveline infection in 19 patients (0.33 events PPY). Stroke with consequence occurred in 10 patients (0.17 events PPY), followed by sepsis in 4 patients (0.07 events PPY), right heart failure in 3 patients (0.05 events PPY), and device malfunction in 2 patients (0.03 events PPY). No episodes of pump thrombosis or GI bleeding were observed during the long term follow-up. Conclusion: In this cohort of mainly high-risk HF patients INCOR LVAD seems to be effective in support patients. Moreover, absence of GI bleeding and pump thrombosis seem to demonstrate a favorable device characteristic. Further prospective studies are needed to confirm these data.

(593) - Multidisciplinary Treatment for Acute Fulminant and Nonfulminant Myocarditis

s S221 system (Berlin Heart) is a third generation axial continuous flow pump with active magnetic levitation, thus avoiding the potential downsides of mechanical bearings. Implemented software algorithms allow for a more physiologic operation mode including pulsatility. Methods: The aim of this study was to review the Italian experience with the INCOR LVAD and to determine the prevalence of GI bleeding and pump thrombosis. All patients implanted from January 2006 to May 2012, in centers with at least 5 implants were considered eligible. All AE, meeting the INTERMACS classification, were evaluated. Results: The total population consisted of 42 patients. LVAD indication was BTT in 36 (86%) patients and DT in 6 (14%) patients. 31 patients (74%) were in class 1 or 2 INTERMACS at time of implantation, among them 22 (52%) requiring inotropic therapy and 10 (24%) extracorporeal membrane oxygenation support. The mean support time was 525 ± 570 days, median 372 days (5 to 2704) days. The 30-day post-operative mortality was 7 %. The 1-year and 2-year survival rates were 74% and 60%, respectively. At last follow-up (July 2014), 17 (41%) of the 42 patients were transplanted, one (2%) patient regained myocardial function and had the device removed, 5 (12%) are still on support , 19 (45%) of the 42 patients died . The most frequently observed AE was driveline infection in 19 patients (0.33 events PPY). Stroke with consequence occurred in 10 patients (0.17 events PPY), followed by sepsis in 4 patients (0.07 events PPY), right heart failure in 3 patients (0.05 events PPY), and device malfunction in 2 patients (0.03 events PPY). No episodes of pump thrombosis or GI bleeding were observed during the long term follow-up. Conclusion: In this cohort of mainly high-risk HF patients INCOR LVAD seems to be effective in support patients. Moreover, absence of GI bleeding and pump thrombosis seem to demonstrate a favorable device characteristic. Further prospective studies are needed to confirm these data.

EVALUATION THE STATUS OF SLEEP QUALITY IN ELDERLY PEOPLE IN KERMANSHAH CITY

Background and Aim: Sleeping is composed of two physiologic mode of slow and fast eye movement. Sleeping disorder in elderly people can cause different side effects such as falling, depression, mind disorders, irritability, tiredness, concentration problems, and so on. Current study was done with the aim of determining sleep quality among elderly people in Kermanshah. Materials and Methods: This current survey is a cross-sectional descriptive study which was performed among 100 elderly people in Kermanshah in 1392.The sample was selected according to the simple random sampling among the elderly people settling in Mehregan Sanatorium of elderly. The tools used for data collection were a questionnaire consisted of two demographic information parts and a questionnaire of Pittsburgh sleep standards, which were completed after interviewing the participants. Data was analyzed using SPSS16 software. Results: Mean age of participants was 66.7% ±2.7% years old. Most of the participants (67%), were undereducated. Half of them were women and the other half were men. 77.6% of participants were married and the others were single, widow, or got divorce. 10.2% reported having mental disorders history. 4.1% of participants in this study had used drugs before according to the achieved information from questionnaire. 39.8% of participants had moderate and 24.5% of them had severe sleep quality problems. Conclusion: The findings show that prevalence of improper sleep quality among elderly people is increasing which can cause serious problems. So, identifying effective factors in sleep quality in elderly people and designing proper intervention based on those factors in the direction of improving the quality of elderly people are suggested. Key Words: Elderly people, sleep quality , Kermanshah.

Heated Humified High Flow Nasal Cannulae (HHHFNC), in The Beginning it was the Flow!

Then at 1971, Gregory described use of Use of continuous positive airway pressure (CPAP) for respiratory distress syndrome (RDS), opening the door for the new era of non invasive ventilation [3]. CPAP have proved to be a more physiologic mode of assisted ventilation, with less parameters to be adjusted and less complications [4]. CPAP parameters included the flow together with FiO2 and PEEP as the adjustable CPAP parameters [5].

Nursing Approach Based on Roy Adaptation Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer.

The use of models in nursing provides nurses to focus on the role of nursing and its applications rather than medical practice. In addition, it helps patient care to be systematic, purposeful, controlled and effective. One of the commonly used models in nursing is Roy Adaptation Model. According to Roy adaptation model, the aim of nursing is to increase compliance and life expectancy. Roy Adaptation Model evaluates the patient in physiologic mode, self-concept mode, role function mode and interdependence mode aiming to provide holistic care. This article describes the use of Roy Adaptation Model in the care of a patient who has been diagnosed with breast cancer and had breast-conserving surgery. Patient data was evaluated in the four modes of Roy adaptation model (physiologic, self-concept, role function, and interdependence modes) and the nursing process was applied.

Roy's adaptation model‐guided education for adaptation to chronic obstructive pulmonary disease

This article is a report of the effects of Roy's adaptation model-based patient education on physical and psychosocial adaptation of patients with chronic obstructive pulmonary disease. Patients with chronic obstructive pulmonary disease abound in Turkey, as they do worldwide. Patient education could help in the adaptation of patients with chronic obstructive pulmonary disease to the disease, as it has with other long-term diseases. The study adapted a quasi-experimental design, with a comparison between an intervention group and a control group. Sixty-five patients with obstructive pulmonary disease participated in this study. The data were collected between December 2008-January 2010. The data collection tool comprised an adaptation of a Roy's adaptation model-based evaluation form and perceived social support from family and friends scale. The intervention group received oral and written education based on Roy's adaptation model, while the control group received a routine follow-up. Data were analysed with paired t-test and analysis of covariance (ancova). The results indicate that education given according to Roy's adaptation model increases adaptation to disease in three modes (physiologic, self-concept and role-function mode). In addition, taking into account interdependence mode as Roy's adaptation model's fourth mode, a statistically significant increase was observed in social support from friends but not from family. The more intervention for improving interpersonal support - especially perceived as coming from family - the more using Roy's adaptation model to educate patients with chronic obstructive pulmonary disease could benefit them to increase adaptation to the disease.

Retraction: Blood B-Type Natriuretic Peptide Changes in Different Periods and Different Cardiac Pacing Modes

To observe blood B-type natriuretic peptide (BNP) level changes and the clinical implications in different periods and different cardiac pacing modes, the BNP levels of 105 patients with permanent cardiac pacing were assayed before pacemaker implantation and 1 day, 1 week, 1 month, 3 months, 6 months, and 9 months postoperatively. BNP level changes were compared in different periods and during different pacing modes. DDD(R) pacing mode was performed in 32 patients for 9 months and then changed to AAI(R) and VVI(R) pacing modes for 2 months, respectively. BNP levels were assayed during three different pacing modes. BNP levels did not change at any time with any pacing mode in patients with New York Heart Association (NYHA) heart functional class I to II before pacemaker implantation, however, BNP levels did change significantly with physiologic pacing mode and nonphysiologic pacing mode in patients with NYHA heart functional class III to IV before pacemaker implantation. BNP levels during physiologic pacing mode decreased significantly while it increased during nonphysiologic pacing mode. BNP levels were the lowest in AAI(R) pacing and the highest in VVI(R) pacing among the three pacing modes. The BNP level in DDD(R) pacing was between that for AAI(R) pacing and VVI(R) pacing. The results indicate that physiologic pacing should first be chosen in patients with bradycardia and congestive heart failure (CHF), and that AAI(R) was the best pacing mode if atrioventricular conduction function was normal.

Essential function of Chk1 can be uncoupled from DNA damage checkpoint and replication control

Chk1 is widely known as a DNA damage checkpoint signaling protein. Unlike many other checkpoint proteins, Chk1 also plays an essential but poorly defined role in the proliferation of unperturbed cells. Activation of Chk1 after DNA damage is known to require the phosphorylation of several C-terminal residues, including the highly conserved S317 and S345 sites. To evaluate the respective roles of these individual sites and assess their contribution to the functions of Chk1, we used a gene targeting approach to introduce point mutations into the endogenous human CHK1 locus. We report that the essential and nonessential functions of Chk1 are regulated through distinct phosphorylation events and can be genetically uncoupled. The DNA damage response function of Chk1 was nonessential. Targeted mutation of S317 abrogated G(2)/M checkpoint activation, prevented subsequent phosphorylation of Chk1, impaired efficient progression of DNA replication forks, and increased fork stalling, but did not impact viability. Thus, the nonessential DNA damage response function of Chk1 could be unambiguously linked to its role in DNA replication control. In contrast, a CHK1 allele with mutated S345 did not support viability, indicating an essential role for this residue during the unperturbed cell cycle. A distinct, physiologic mode of S345 phosphorylation, initiated at the centrosome during unperturbed mitosis was independent of codon 317 status and mechanistically distinct from the ordered and sequential phosphorylation of serine residues on Chk1 induced by DNA damage. Our findings suggest an essential regulatory role for Chk1 phosphorylation during mitotic progression.

Economic and health consequences of managing bradycardia with dual-chamber compared to single-chamber ventricular pacemakers in Italy

This study sought to estimate the economic implications of managing bradycardia due to sinoatrial node disease or atrioventricular block with dual compared to single-chamber ventricular pacemakers from an Italian government perspective. Dual-chamber pacemakers lower the risk of developing atrial fibrillation and pacemaker syndrome. A discrete event simulation of a patient's course for 5 years following pacemaker implantation. Each patient may experience the following: complications, pacemaker syndrome, atrial fibrillation, stroke, or death. Risk functions were based on published data from the Canadian Trial of Physiologic Pacing and Mode Selection Trial in Sinus-Node Dysfunction. Identical patients were simulated after receiving a single or dual-chamber pacemaker. Quality-adjusted life-years (QALYs) and direct medical costs were estimated (2004 Euros). Benefits and costs were discounted at 3%. The model predicts that implanting the dual-chamber device in 1000 patients will prevent 36 patients from developing atrial fibrillation, 168 from developing severe pacemaker syndrome, but will lead to 13 additional hospitalizations with complications over 5 years. Health benefits are achieved at an incremental cost of 23 euros per patient, and 0.09 QALY, yielding an incremental cost-effectiveness ratio of euro 260 euros/QALY. Sensitivity analysis shows that device replacement rates due to pacemaker syndrome have the biggest impact on the final results. In the long term, higher initial costs of the dual-chamber device may be offset by a reduction in costs associated with reoperations and atrial fibrillation.

Evaluation of Atrial Thrombus Formation and Atrial Appendage Function in Patients with Pacemaker by Transesophageal Echocardiography

Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation. We conducted a cross-sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity. A total 72 patients (mean age, 65 +/- 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean +/- SD; %) was 53.3 +/- 6.2% in ventricular pacing mode and 52.2 +/- 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA-FV) was significantly higher among the patients with AV sequential pacing mode (49.44 +/- 18 cm/s vs 40.94 +/- 19.4 cm/s, P value = 0.02). LAA-FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 +/- 2.3 mm vs 37.79 +/- 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA-FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage. Long-term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm.