Evaluation of cardiac function using heart-lung interactions.

Heart lung interactions can be used clinically to assist in the evaluation of cardiac function. Application of these interactions and understanding of the physiology underlying them has formed a focus of research over a number of years. The changes in preload induced by changes in intrathoracic pressure (ITP) with the respiratory cycle, have been applied to form dynamic tests of fluid responsiveness. Pulse pressure variation (PPV), stroke volume variation (SVV), end expiratory occlusion test, pleth variability index (PVI) and use of echocardiography are all clinical assessments that can be made at the bedside. However, there are limitations and pitfalls to each that restrict their use to specific situations. The haemodynamic response to treatment with continuous positive airway pressure (CPAP) in left ventricular failure is explained by the presence of heart lung interactions, and works predominately through afterload reduction. Similarly, in other disease states such as acute respiratory distress syndrome (ARDS), the effects of a change in ventilation can provide information about both the cardiac and respiratory system. This review aims to summarise how assessment of cardiac function using heart lung interactions can be performed. It introduces the underlying physiology and some of the clinical applications that are further explored in other articles within the series

Superconductivity in undoped T' cuprates with Tc over 30 K

Undoped cuprates have long been considered to be antiferromagnetic insulators. In this article, however, we report that superconductivity is achieved in undoped T'-RE2CuO4 (RE = Pr, Nd, Sm, Eu, and Gd). Our discovery was performed by using metal-organic decomposition (MOD), an inexpensive and easy-to-implement thin-film process. The keys to prepare the superconducting films are firing with low partial-pressure of oxygen and reduction at low temperatures. The highest Tc of undoped T'-RE2CuO4 is over 30 K, substantially higher than "electron-doped" analogs. Remarkably, Gd2CuO4, even the derivatives of which have not shown superconductivity so far, gets superconducting with Tconset as high as ~ 20 K. The implication of our discovery is briefly discussed.Comment: 22 pages, 5 figures, submitted to Physical Review Letter

New biocompatible hydroxy double salts and their drug delivery properties

Two biocompatible hydroxy double salts (HDSs) were synthesised for the first time and loaded with active pharmaceutical ingredients. Drug release was studied from these intercalates, and sustained release observed. The HDS–drug composites were further formulated into tablets which were found to comply with pharmacopeia requirements for delayed and extended release dosage forms

Pharmacodynamic Analysis of a Fluid Challenge.

OBJECTIVE: This study aims to describe the pharmacodynamics of a fluid challenge over a 10-minute period in postoperative patients. DESIGN: Prospective observational study. SETTING: General and cardiothoracic ICU, tertiary hospital. PATIENTS: Twenty-six postoperative patients. INTERVENTION: Two hundred and fifty-milliliter fluid challenge performed over 5 minutes. Data were recorded over 10 minutes after the end of fluid infusion MEASUREMENTS AND MAIN RESULTS:: Cardiac output was measured with a calibrated LiDCOplus (LiDCO, Cambridge, United Kingdom) and Navigator (Applied Physiology, Sydney, Australia) to obtain the Pmsf analogue (Pmsa). Pharmacodynamics outcomes were modeled using a Bayesian inferential approach and Markov chain Monte Carlo estimation methods. Parameter estimates were summarized as the means of their posterior distributions, and their uncertainty was assessed by the 95% credible intervals. Bayesian probabilities for groups' effect were also derived. The predicted maximal effect on cardiac output was observed at 1.2 minutes (95% credible interval, -0.6 to 2.8 min) in responders. The probability that the estimated area under the curve of central venous pressure was smaller in nonresponders was 0.12. (estimated difference, -4.91 mm Hg·min [95% credible interval, -13.45 to 3.3 mm Hg min]). After 10 minutes, there is no evidence of a difference between groups for any hemodynamic variable. CONCLUSIONS: The maximal change in cardiac output should be assessed 1 minute after the end of the fluid infusion. The global effect of the fluid challenge on central venous pressure is greater in nonresponders, but not the change observed 10 minutes after the fluid infusion. The effect of a fluid challenge on hemodynamics is dissipated in 10 minutes similarly in both groups

Cress Seed (Lepidium sativum) Role in the healthy Processed Spread Cheese and Its Anti-Diabetic Activity

The present study dealt with utilization of cress seeds (Lepidium sativum) in the manufacture of processed spread cheese, instead of emulsifying salt. Cress seed have also health promoting properties especially lowering glucose ratios. Cress seeds powder were prepared and added with the ingredients during manufacture of processed spread cheese at levels of six ratios (0.05, 1.5, 2.5, 3.5, 4.5 and 5.5%) compared with control (3% commercial emulsifying salt). The chemical, physical, microbiology and organoleptic properties of resultant samples were evaluated. Data revealed that processed spread cheese sample fortified with 3.5% cress seeds was the best either when fresh or during storage (8±2ºC for 3 months) and they had acceptable properties. Microstructure of processed cheese spread samples were also conducted. From nutritional view, processed cheese spread samples fortified with 3.5% cress seeds were used for feeding Adult male albino rats to study their effect on plasma glucose level. Obtained data indicated that the glucose level in plasma was significantly decreased (

Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16) years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes) and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study.

OBJECTIVE: The objectives of this study are to determine what is the minimal volume required to perform an effective fluid challenge and to investigate how different doses of IV fluids in an fluid challenge affect the changes in cardiac output and the proportion of responders and nonresponders. DESIGN: Quasi-randomized controlled trial. SETTING: Cardiothoracic ICU, tertiary university hospital. PATIENTS: Eighty postcardiac surgery patients. INTERVENTION: IV infusion of 1, 2, 3, or 4 mL/Kg (body weight) of crystalloid over 5 minutes. MEASUREMENTS AND MAIN RESULTS: Mean systemic filling pressure measured using the transient stop-flow arm arterial-venous equilibrium pressure, arterial and central venous pressure, cardiac output (LiDCOplus; LiDCO, Cambridge, United Kingdom), and heart rate. The groups were well matched with respect to demographic and baseline physiologic variables. The proportion of responders increased from 20% in the group of 1 mL/kg to 65% in the group of 4 mL/kg (p = 0.04). The predicted minimal volume required for an fluid challenge was between 321 and 509 mL. Only 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure beyond the limits of precision and was significantly associated with a positive response (odds ratio, 7.73; 95% CI, 1.78-31.04). CONCLUSION: The doses of fluids used for an fluid challenge modify the proportions of responders in postoperative patients. A dose of 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure and reliably detects responders and nonresponders

Applying System Dynamics Approach to the Fast Fashion Supply Chain: Case Study of an SME in Indonesia

The fashion industry is the biggest contributor among the 14 creative industries in Indonesia. Nowadays many apparel companies are shifting toward the vertical integration. Since speed is everything to be successful in the apparel industry, fast fashion retailers must quickly respond to the market demand. This papers aims to develop a model of the supply chain of a small and medium scale enterprise (SME) of an apparel company in Indonesia and to propose a decision support system using System Dynamics (SD) and helps the management to identify the best business strategy. Simulated scenarios can help the management to identify the most appropriate policy to be applied in the future. Case study method was used in this research where data were collected from a typical fast fashion firm in Indonesia that produces its own wares ranging from raw materials to be ready-to-wear clothes, has three stores, a warehouse and is running online sales system. We analyses the result of many simulations in a fashion company from an operational point of view and from them we derive suggestions about the future business strategy in a small and medium fashion company in Indonesia