Significant Differences In Rest Research Articles

Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty: A Systematic Review and Meta-analysis.

Ultrasound-guided pericapsular nerve group (PENG) block is an emerging regional anesthesia technique that may provide analgesia for patients undergoing total hip arthroplasties (THA). There are clinical studies comparing this fascial plane block to other established methods; however, evidence on the actual efficacy of this block for THA continues to evolve. Available clinical studies conducted over the past 4 years were reviewed to evaluate the analgesic efficacy and effectiveness of PENG block in patients undergoing THAs. A meta-analysis of randomized controlled trials (RCTs) in patients undergoing THA, where PENG block was compared to no block, placebo/sham block (injection with saline), or other analgesic techniques including suprainguinal fascia iliaca block (FIB), or periarticular infiltration (PAI) was performed. Our primary outcome was opioid consumption during the first 24 hours. Secondary outcomes were postoperative rest and dynamic pain scores at 6-12, 24 and 48 hours, block performance time, sensory-motor assessment, quadriceps weakness, the incidence of postoperative falls, first analgesic request, block and opioid-related complications, surgical complications, patient satisfaction scores, postanesthesia care unit length of stay, hospital length of stay, and functional and quality of life outcomes. We included 12 RCTs with a total of 705 patients. Data showed that PENG block decreased 24-hour oral morphine milligram equivalent consumption by a mean difference (MD) of 3.75mg (95% CI: -5.96,-1.54; P =0.0009). No statistically significant differences in rest or dynamic pain were found, except for a modest MD reduction in dynamic pain score of 0.55 points (95% CI: -0.98, -0.12; P =0.01), measured 24 hours after surgery in favor of PENG block. Our systematic review and meta-analysis suggest that PENG block provides better analgesia, measured as MME use, in the first 24 hours after THA, with no real impact on postoperative VAS scores. Despite statistical significance, the high heterogeneity across RCTs implies that PENG's benefits may not surpass the minimal clinically important difference threshold for us to recommend PENG as best practice in THA.

NCS 교육 요구에 대한 인식 차이 분석 연구: P사 사례

The purpose of this study is to find the differences in training needs and perceptions on NCS education. The subject of this study is 220 managers and employees at a domestic company case P. t-test was used as the research method to find the differences. The study results are as follows. First, out of 10 domains of NCS, only the resource management ability had significant gender difference. There were no significant differences in rest of the domains. Second, out of 10 domains of NCS, only the communication skills had significant difference based on working years. There were no significant differences in rest of the domains. Third, there were several significant differences in domains based on working position. Especially, communication skills, numeracy, interpersonal skills, information ability, and professional ethics had shown significant differences.

Abstract 53: Body Mass Index Is A Predictor Of Mortality And Adverse Cardiorespiratory Outcomes In Patients Hospitalized For SARS-COV-2 Infection

Objectives: We aimed to evaluate the association of body mass index (BMI) with in-hospital mortality and cardiorespiratory outcomes in patients admitted with COVID-19 infection. Methods: This data was collected from an academic tertiary referral center in upstate New York. Retrospective cohort analysis was conducted on patients admitted with COVID-19 infection (n=194). BMI was calculated and patients were stratified into two categories: ‘healthy’ (BMI=18.5-24.5) and ‘overweight’ (BMI>25). Cardiorespiratory outcomes were classified as in-hospital mortality, need for vasopressors, mechanical ventilation, and hemodialysis. Transthoracic echocardiography was performed to evaluate for left ventricular (LV) ejection fraction, right ventricular (RV) systolic function and RV dilation. Cardiovascular (CV) risk factors such as history of COPD, Diabetes, HTN, CAD and cigarette smoking were analyzed. LDH, troponin, CRP and ferritin levels were also noted. Results: Out of 194 patients, 68% were overweight with a mean BMI of 29.8 +/- 9.5 kg/m2 and a mean age of 66 +/- 16, 75% of females and 63% of males were overweight. Mortality rate was 31% in overweight patients compared to 17% in healthy subset (p<0.04). The rate of need for mechanical ventilation was higher in overweight group as well (34% vs. 17%, p<0.02). There was no significant difference between the cohorts in terms of vasopressor and hemodialysis requirement (p=0.09 and 0.2 respectively). RV systolic function was depressed in 21% of overweight cohort vs. 8% of healthy patients (p<0.02) while RV dilatation was seen in 15% of overweight patients compared with 5% of healthy patients (p<0.03). There was no significant difference in LV ejection fraction between the groups. LDH was more frequently elevated in overweight cohort with a mean level of 346 +/- 185 IU/L (p<0.01). No significant difference in rest of the laboratory analysis or CV risk factors were found. Conclusion: Elevated BMI (>25) is associated with a statistically significant increase in in-hospital mortality, need for mechanical ventilation, right ventricular abnormalities, and LDH levels in patients hospitalized with COVID-19 infection.

Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study

BackgroundVarious truncal block techniques with ultrasonography (USG) are becoming widespread to reduce postoperative pain and opioid requirements in video-assisted thoracoscopic surgery (VATS). The primary aim of our study was to determine whether the USG-guided serratus anterior plane block (SAPB) is as effective as the thoracic paravertebral block (TPVB) in VATS. Our secondary aim was to evaluate patient and surgeon satisfaction, block application time, first analgesic time, and length of hospital stay.MethodsPatients in Group SAPB received 0.4 mL/kg bupivacaine with a USG-guided SAPB, and patients in Group TPVB received 0.4 mL/kg bupivacaine with a USG-guided TPVB. We recorded the pain scores, the timing of the first analgesic requirement, the amount of tramadol consumption, and postoperative complications for 24 hours. We also recorded the block application time and length of hospital stay.ResultsA total of 62 patients, with 31 in each group (Group SAPB and Group TPVB) completed the study. Between the two groups, there were no significant differences in rest and dynamic pain visual analog scale scores at 0, 1, 6, 12, and 24 hours after surgery. The total consumption of tramadol was significantly lower in the TPVB group (P = 0.026). The block application time was significantly shorter in Group SAPB (P < 0.001).ConclusionsAn SAPB that is applied safely and rapidly as a part of multimodal analgesia in patients who undergo VATS is not inferior to the TPVB and can be an alternative to it.

Postoperative Pain Management and the Incidence of Ipsilateral Shoulder Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A Prospective Audit

Ipsilateral shoulder pain (ISP) is a common but variably occurring(42%-85%) complication after thoracic surgery. Multiple potential treatments, including upper limb blocks, intrapleural local anaesthetic infiltration, and systemic opioids, have undergone trials, with limited efficacy. Phrenic nerve infiltration is a potential intervention that may prevent ISP. The aim of this study was to assess the incidence and severity of ISP after thoracic surgery at the authors' institution, where phrenic nerve infiltration is commonly used. Observational cohort study. A single- center study in a tertiary referral center in Brisbane, Australia. This study comprised all adult patients undergoing thoracic surgery at a tertiary- care referral center from May to July 2018. Surgical procedures were divided into open thoracotomy, video-assisted thoracic surgery (VATS) and VATS-guided mini-thoracotomy. The primary outcome was a comparison of incidence of ISP among the 3 types of surgical procedures. Data were analyzed using Stata (StataCorp), with significance testing by Kruskal-Wallis equality of populations rank test. A p value of < 0.05 was deemed significant. Sixty thoracic surgeries were performed during the audit period. Nineteen patients had thoracotomies performed for lobectomy or pneumonectomy, all of whom received phrenic nerve infiltration. The incidence of moderate-to-severe ipsilateral shoulder pain among the thoracoctomy cohort was 15.8% (3/19). Of the 36 VATS procedures audited, 7 patients (19.4%) received infiltration of their phrenic nerve, none of whom reported postoperative ISP. Of the remaining twenty-nine patients who did not receive phrenic nerve infiltration, there were 4 cases of moderate-to-severe ipsilateral shoulder pain (11.1%). Four of the 5 patients (80%) who underwent VATS-guided mini-thoracotomies received phrenic nerve infiltration intraoperatively. Three patients reported moderate-to-severe ISP and of these 3 patients, 2 patients had phrenic nerve infiltration, and 1 patient did not receive infiltration. Overall, there were no statistically significant differences in rest or dynamic pain scores across the surgical groups at any time point. Mann-Whitney test revealed that the participants with ISP were significantly older than those without ISP (p = 0.006). However, there were no significant differences in sex or body mass index between those with and without ISP. The authors observed a lower (15.8%) incidence of moderate-to-severe ISP among their thoracotomy patients than reported in prior literature. Injection of local anesthetic into the phrenic nerve fat pad at the level of the diaphragm appeared to be an effective and safe surgical intervention that may eliminate a significant cause of ISP. None of the VATS patients who received phrenic nerve infiltration experienced ISP. Postoperative pain in VATS is expected to be reduced by avoiding the use of a rib spreader, severing of the intercostal nerves, and division of muscle tissue, which may account for the lower observed rates of ISP in the VATS cohort who did not receive phrenic nerve infiltration. Further randomized controlled trials are warranted to establish if patients undergoing various VATS procedures benefit from this intervention.

CALCA and TRPV1 genes polymorphisms are related to a good outcome in female chronic migraine patients treated with OnabotulinumtoxinA

BackgroundSome variables have been proposed as predictors of efficacy of OnabotulinumtoxinA in chronic migraine patients, but data available are inconclusive. We aimed to analyse the influence of single nucleotide polymorphisms in the response to OnabotulinumtoxinA.MethodsWe included 156 female patients treated with OnabotulinumtoxinA accordingly to PREEMPT paradigm in three headache units. OnabotulinumtoxinA was offered to patients that had not responded to topiramate and at least one other preventative. Age at first procedure was 43.7 ± 11.8 years (16–74). Patients with a reduction of at least 50% in the number of migraine days after two OnabotulinumtoxinA procedures were considered as responders. We analysed 25 polymorphisms selected for their relevance regarding migraine pathophysiology and their association with migraine according to previously published genome-wide association studies. Genotyping was performed using KASP probes and a LightCycler-480 (Roche-Diagnostics). Allelic, genotypic frequencies and dominance/recesivity hypothesis of the allelic variants were compared between responders and non-responders by Fisher’s exact test.ResultsResponse to treatment with OnabotulinumtoxinA was achieved in 120 patients (76,9%). Two polymorphisms showed differences: CALCA rs3781719, where allele C represents 26.9% in responders and 40.9% in non-responders (p = 0.007, OR = 3.11 (1.33–7.26)); and TRPV1 rs222749, where allele A represents 4.17% in responders and 12.5% in non-responders (p = 0.013, OR = 3.29 (1.28–8.43)). No significant differences in rest of polymorphisms or clinical or demographic variables were found.ConclusionsPolymorphic variations of CALCA and TRPV1 genes might play a role as prognostic markers of efficacy of OnabotulinumtoxinA in chronic migraine female patients in our population.

Comparison of photodynamic therapy and navigated microsecond laser for chronic central serous chorioretinopathy.

To compare the visual and anatomical outcomes after photodynamic therapy (PDT) and navigated microsecond laser (nMSL) for chronic central serous chorioretinopathy (CSCR). This retrospective study included eyes with chronic CSCR who underwent either PDT or nMSL with a minimum of 6 months' follow-up. Eyes with a history of treatment with any other modalities in the past or during 6 months post PDT or microsecond laser follow-up were excluded. Primary outcome measures included change in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome measures included changes in subretinal fluid, hyper-reflective foci, cystic spaces, subfoveal choroidal thickness, and outer retinal structure integrity. Forty-five eyes of 39 subjects (PDT group-23 eyes, nMSL group-22 eyes) with chronic CSCR were analyzed. At 6 months' follow-up, the nMSL group had significantly higher improvement in visual acuity compared to the PDT group (0.12 ± 0.24 vs -0.02 ± 0.20 (p = 0.039)). Reduction in central macular thickness was significantly higher in nMSL group compared to the PDT (85.5 ± 93.26 vs 24.47 ± 73.18 microns (p = 0.02)). Thirteen (59%) eyes in nMSL group had complete resolution of the SRF at 6 months compared to 5 (21.7%) eyes in PDT group. There was no significant difference in rest of the anatomical features between the groups. nMSL seems to be superior over PDT in improving visual and anatomical outcomes at 6 months and can be considered as a cheap alternative to PDT in treatment of CSCR.

Effects of Superficial and Deep Dry Needling on Pain and Muscle Thickness in Subject with Upper Trapezius Muscle Myofascial Pain Syndrome

Background: Dry needling is one of the main therapeutic approaches in patients with Myofascial pain syndrome. Few studies have been compared the superficial and deep dry needling methods in these patients. Objective: To evaluate the effects of superficial and deep dry needling on pain and muscle thickness in subjects with upper trapezius myofascial pain syndrome. Design: A randomized quasi-experimental double-blinded trial. Methods: 50 subjects with upper trapezius myofascial pain syndrome (age=26/08 ± 4/62, weight=63/88 ± 8/71 kg, height=167/7 ± 4/82 cm, pain duration=9/75 ± 7/05 m) randomly assigned to the superficial (n=25) and deep (n=25) dry needling groups. The pain and maximum thickness of upper trapezius muscle in rest, fair and normal contractions were measured by visual analogue scale (VAS) and an ultrasound device respectively before and after the intervention as well as 7 and 15 days follow-up. Results: The mixed-model ANOVAs revealed a significant group-by-time interaction (F=44.03, p<0.001) for pain and muscle thickness in rest (F=67.00, p<0.001), fair (F=108.73, p<0.001) and normal contraction (F=17.73, p<0.001). The main effects of group and time were statistically significant for pain, rest, fair and normal muscle thickness (p<0.001). There were not any significant differences in rest, fair and normal muscle thickness after intervention as well as 7 and 15 days follow-up. Conclusion: Both superficial and deep dry needling techniques induced significant short-term changes in the VAS. Muscle thickness in rest, fair and normal contractions did not show any significant changes between the groups.

The Impact of Flood Disaster on Daily Activities and Quality of Life amongst Women Flood Disaster Survivors

Flood disaster disrupted routine and performance in daily activities. Disengagement from performing daily activities have a negative impact on health leading to decrease the quality of life. Women were tied with the social norms of having to take care of others, which proves to be harder to juggle in times of disaster. The objective of this study was to identify the most affected occupations among the sandwich generation of women flood survivors. One hundred and thirty-one participants participated in this cross-sectional study. The results indicated that there is a significant difference in rest and sleep among the sandwich generation of women flood survivors.

A case control association study of COMT gene polymorphism (I/D) with type 2 diabetes and its related factors in Pakistani Punjabi population.

BackgroundThe Catechol-O-Methyl Transferase (COMT) gene polymorphism (I/D of C nucleotide at base position 900) has been previously implicated in the development of type 2 diabetes (T2D) and kidney disease. So, aim of this study was to find association of I/D polymorphism with T2D, and its associated factors like family history and nephropathy (End Stage Renal Disease, ESRD) patients in a cohort of Pakistani Punjabis.MethodsGenomic DNA was extracted from human subjects divided as four study groups: controls (n = 46), diabetics (n = 46), diabetics with nephropathy/ESRD (n = 53), and non-diabetics without nephropathy/ESRD (n = 43). The 900 I/D C polymorphism in the COMT gene was tested by PCR-RFLP method. Genotype and allele frequencies as well as Odds Ratios were calculated for these groups. Groups were compared statistically for the analysis of genotypes, alleles, biochemical parameters as well as disease status.ResultsIn comparison with control group (non-diabetic, non-nephropathy), there was no significant difference in rest of the three groups for allele or genotype frequencies of COMT gene. However, Chi square (χ2) analysis identified a significant (p = 0.02) correlation of the 900 I/D C polymorphism with family history of diabetes, as it was found that greater number (74%) of patients having I allele had a positive family history of T2D.ConclusionsA significant correlation of the COMT polymorphism (900 I/D C) with the family history of T2D has been observed, which has not been previously reported in Pakistani Punjabi population, however, this preliminary finding requires further validation studies.

MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI John Patrick Selph, Mustafa Bashir, Shubham Gupta, Michael J. Belsante, Timothy Brand, Timothy Tausch, Jessica Lloyd, Zachariah Goldsmith, and Andrew Peterson John Patrick SelphJohn Patrick Selph More articles by this author , Mustafa BashirMustafa Bashir More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Michael J. BelsanteMichael J. Belsante More articles by this author , Timothy BrandTimothy Brand More articles by this author , Timothy TauschTimothy Tausch More articles by this author , Jessica LloydJessica Lloyd More articles by this author , Zachariah GoldsmithZachariah Goldsmith More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The precise mechanism by which the AdVance(TM) transobturator sling (TOS) improves continence is unknown. Postulated mechanisms of action include changes in urethral mobility or an increase in functional membranous urethral length (FUL). Using dynamic MRI, we sought to determine how anatomic and functional relationships change in the male urethra after TOS surgery. METHODS We conducted a prospective study of males undergoing TOS from 2010 to 2014. Males with SUI after radical prostatectomy (RP) who were scheduled for TOS were enrolled. Patients underwent pad weight testing, voiding diary, urodynamics, and cystoscopy preoperatively. Dynamic MRI was performed before and after TOS. On matched pre- and post-operative sagittal T2 weighted images using a 3T MR system, the following measurements were obtained both at rest (R) and Valsalva (V): 1) distance from bladder neck BN to pubic symphysis (termed AP); 2) distance from BN to urethra at the pubococcygeal line (termed CC); and 3) distance from BN to urethra at the penile bulb (termed FUL). A group of patients who underwent RP with no SUI on pad weight testing underwent MRI post-RP and served as controls. RESULTS A total of 34 (20 cases, 14 controls) patients were enrolled in the study. All patients who underwent TOS had improvement in continence (12 used zero pads, 5 used 1 pad/day). Prior to TOS, there was a significant difference in rest and Valsalva CC but not AP distance when compared to non-leaking controls (mean case CC R 0.42cm and V 0.32cm vs. control CC R 1.06cm and V 1.09cm, resp, p < 0.05). Post-TOS, neither R and V AP nor R and V CC were different when compared to non-leaking controls. When comparing post-TOS to pre-TOS among the cases, there was a trend towards a difference in mean CC distance at rest and Valsalva (R pre 0.42cm vs post 0.63cm, p = 0.09; V pre 0.32cm vs post 0.54cm, p = 0.13). To assess urethral mobility, we looked at the rest to Valsalva change in AP and CC distance before and after TOS, and there was no significant difference in either measurement (mean difference in R-to-V AP pre 0.21cm vs post 0.3cm, mean difference in R-to-V CC pre 0.1cm vs post 0.09cm). However, the pre-sling cases had a shorter rest FUL when compared to controls (1.27 vs 1.92cm, p <0.05) and the post-TOS FUL increased significantly (1.27 vs 1.53 cm, p <0.05) and approximated the FUL found in dry controls. CONCLUSIONS The mechanism of action of the male TOS appears to be via an increase in functional urethral length rather than changes in urethral mobility. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1094 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Patrick Selph More articles by this author Mustafa Bashir More articles by this author Shubham Gupta More articles by this author Michael J. Belsante More articles by this author Timothy Brand More articles by this author Timothy Tausch More articles by this author Jessica Lloyd More articles by this author Zachariah Goldsmith More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

湖北石首麋鹿昼间活动时间分配

为探讨性别、年龄和季节对麋鹿(<em>Elaphurus davidianus</em>)行为的影响,2006年9月-2007年10月,作者采用焦点取样法和瞬时记录法,将麋鹿昼间活动归为采食、饮水、运动、休息、警觉、其他行为等六大类型,每月 6-8 d 对湖北石首麋鹿国家级自然保护区麋鹿种群的昼间活动时间分配进行了跟踪观察。 结果表明:麋鹿有晨、昏两个采食高峰和一个午间休息期,各种行为类型所占比例依次是:休息 53.40% (± 5.59%)、采食 22.36 (± 8.34%)、运动 11.23% (± 0.63%)、警觉 5.03% (± 1.76%)、其他行为 4.42% (± 2.06%), 饮水 2.65%(± 0.74%)。不同季节, 时间分配变化明显。非参数 Kruskal Wallis <em>H</em> 检验结果显示(n=120),季节、年龄和性别显著影响麋鹿的活动时间分配。除运动行为 (χ² =16.856, <em>d_f</em>=3, <em>P</em>>0.05)和饮水行为 (χ²=7.667, <em>d_f</em>=3, <em>P</em> >0.05)无显著差异外, 采食 (χ² =15.657, <em>d_f</em> =3, <em>P</em> <0.01)、休息 (χ² =13.173, <em>d_f</em>=3, <em>P</em> <0.01)、警觉 (χ²=13.887, <em>d_f</em>=3, <em>P</em> <0.01)和其他行为 (χ²=16.317, <em>d_f</em>=3, <em>P</em><0.01) 在不同季节所占时间百分比均有极显著差异。对不同性别年龄组的活动时间分配采用两个独立样本的 Mann-Whitney <em>U</em> 检验, 各性别-年龄组间的运动行为所占时间比例有极显著差异 (<em>P</em><0.01), 雄鹿与雌鹿之间的警觉行为有极显著差异 (<em>P</em><0.01), 雄鹿花较多时间用于警觉。幼鹿与成年鹿及亚成年鹿之间的采食行为时间有极显著差异 (<em>P</em><0.01)。不同性别、年龄组在不同季节的昼间活动时间分配的差异采用方差(ANOVA)分析后发现:所有年龄组,夏季与冬季饮水、春季与夏季警觉均存在显著性差异(<em>P</em><0.01);成体和亚成体麋鹿,春季与冬季警觉、夏季与冬季运动均存在显著性差异 (<em>P</em> <0.01)。;To probe how sex, age and season influence the behavior of Père David's deer (<em>Elaphurus davidianus</em>), we studied the diurnal activity time budget of the Père David's deer in Hubei Shishou Milu National Nature Reserve, by using a focus sampling and instantaneous recording methods. We conducted observation for six to ten days each month from Sept. 2006 to Oct. 2007. The result showed that Père David's deer have crescent activity pattern: foraged mainly at dawn and dusk and took a break at noon. They spent the most of their time resting (53.40%), followed by feeding (22.36%), moving (11.23%), alertness (5.03%), drinking (2.65%), and others (4.42%). Season and age-sex classes significantly influenced the activity time budgets. A greater proportion of time was spent resting in summer (58%) and autumn (58%). Significant difference were found in feeding, rest, alert and other activities (<em>P</em><0.01) except in drinking and moving (<em>P</em>>0.05) among seasons. Only moving behavior showed an extremely significant difference (<em>P</em><0.01) and had no significant difference in rest (<em>P</em>>0.05) among age-sex classes. There was an extremely significant difference between the male deer and the female deer in alert behavior (<em>P</em><0.01) while the adult males spent more time on alert than the adult females. Adults and the sub-adults spent more time feeding and rest, while calves spent more time moving, and less time feeding and rest. According to the results of ANOVA analysis on the diurnal activity time budget of sex-age classes at different seasons, for all age classes, extremely significant difference were found in drinking both summer and winter, in alertness both spring and summer (<em>P</em><0.01). Moreover, for adult and subadult groups, there were extremely significant difference in alertness both spring and winter, in moving both summer and winter (<em>P</em><0.01).

Hypoxic ventilatory response, ventilation, gas exchange, and fluid balance in acute mountain sickness.

To examine whether sea-level hypoxic ventilatory responses (HVR) predict acute mountain sickness (AMS) and document temporal changes in ventilation, HVR, gas exchange, and fluid balance, we measured these parameters at low altitude (100 m) and daily during 3 days at high altitude (4559 m). At low altitude, there were no significant differences in rest or exercise isocapnic HVR, poikilocapnic HVR at rest, and hypercapnic ventilatory response between 12 subjects without significant AMS and 11 subjects who fell sick. No low altitude ventilatory responses correlated with AMS or fluid balance at high altitude. On day 1, isocapnic HVR was significantly lower in the AMS group [0.86 +/- 0.43 (SD) vs. 1.43 +/- 0.63 L/min/% Sa(O2), p < 0.05). AMS was associated with higher AaD(O2), lower Pa(O2), and Sa(O2), while Pa(CO2) was not different between subjects with and without AMS. Both groups showed equivalent reductions in urine volume, sodium output, and gain in body weight on day 1 while climbing to 4559 m, but on day 2 only subjects without AMS had diuresis, natriuresis, and weight loss. We conclude that (1) susceptibility to AMS, fluid balance, and ventilation at high altitude cannot be predicted by low altitude HVR testing and (2) that the failure to increase HVR on arrival at high altitude and impaired gas exchange, possibly due to interstitial edema, may account for the more severe hypoxemia in AMS.

Exercise hemodynamics and oxygen delivery in human hypertension. Response to verapamil.

To characterize the hemodynamic response to exercise and the effects of calcium channel antagonism in hypertensive subjects, invasive exercise hemodynamics were performed in the baseline state after intravenous infusion of verapamil and after 5 to 7 days of oral verapamil in 10 subjects with moderate to severe hypertension. We also assessed oxygen delivery and use and the response of the sympathetic nervous system by measuring plasma norepinephrine levels at rest and during exercise. Both routes of administration were associated with significant reductions of mean arterial pressure and systemic vascular resistance at rest and peak exercise (p less than 0.05). Changes in heart rate were not statistically significant. Following oral administration of verapamil, stroke volume increased significantly in both the resting and exercise states. Pulmonary wedge pressure did not increase; in fact, the Frank-Starling relationship of cardiac performance actually was improved. Oxygen delivery and use were unchanged with both routes of administration. There was no significant difference in rest and exercise plasma norepinephrine levels following verapamil therapy. Thus, verapamil resulted in a significant reduction of mean arterial pressure, mediated by a significant reduction of systemic vascular resistance, following both intravenous and short-term oral administration. This reduction occurred without expression of left ventricular dysfunction and was not at the expense of increased oxygen use or enhanced sympathetic nervous systemic activity.

Reproducibility of equilibrium radionuclide ventriculography in patients with coronary artery disease: Response of left ventricular ejection fraction and regional wall motion to supine bicycle exercise

To evaluate the reproducibility of ejection fraction (EF) and regional wall motion (RWM) analyses by rest and exercise equilibrium radionuclide ventriculography (RNV) in the presence of coronary artery disease (CAD), 18 patients underwent two maximum, multistage supine bicycle exercise studies separated by an interval of 2 weeks. There were no significant differences in EF between the two studies, both at rest (56.0 ± 13.8% vs 58.2 ± 11.7%, p = NS) and with exercise (51.1 ± 17.6% vs 54.3 ± 17.6%, p = NS) and a highly significant correlation was shown between the two groups of values (rest r = 0.90, exercise r = 0.93, p < 0.001). There was no significant difference in the change from rest to exercise (−4.9 ± 12.0% vs −3.8 ± 11.5%, p = NS) between the two studies and the correlation was highly significant ( r = 0.69, p < 0.01). The interstudy variabilities were 2.2 ± 6.1% and 1.2 ± 7.3% for rest and exercise, respectively, and 2.0 ± 9.2% for the change from rest to exercise. Ninety-four percent of both rest and exercise regions had similar RWM. Eighty-one percent of the abnormally contracting regions were common to both exercise studies. Utilizing conventional criteria for the diagnosis of CAD, 11 patients had abnormal EF response and nine had abnormal RWM response to exercise on both studies. Combining EF and RWM criteria resulted in the diagnosis of CAD in 15 patients in both studies. We conclude that: (1) there were no significant differences in rest and exercise radionuclide EF and RWM between two supine bicycle exercise studies performed 2 weeks apart in patients with stable CAD and there were significant correlations between the two studies; (2) despite these correlations, the interstudy variabilities emphasize the need for the inclusion of reproducibility studies in all evaluations of interventions by exercise radionuclide ventriculography; and (3) the variations in EF and RWM response to exercise result in a lack of uniformity between the two studies regarding the diagnosis of CAD based on conventional RNV criteria.