Viennese SIDS prevention campaign-- a quality management project

At the 4th Austrian SIDS Consensus Meeting (1998), consultation was the focus of attention. Secure sleep, the Vienna SIDS prevention campaign, is an information campaign in cooperation with the children's hospitals of Vienna with the aim of reducing the incidence of SIDS in and around Vienna. The campaign was intended to spread awareness concerning care measures to reduce SIDS as well as to reduce SIDS related anxiety (SRA) among anxious parents. The Vienna SIDS prevention campaign is a quality management project, the core of which is consultation. Demands upon the structural quality of a SIDS consultation office include the expertise, communication skills and psychological competence of the consulting team. This can be achieved through interdisciplinary continuing education, international networking and training in communication skills. Priority is given to supporting care for the client by an interdisciplinary team headed by a case manager with the required communication skills. The qualitative outcome is defined by a primary objective medical goal (reduction of SIDS mortality) and a secondary subjective psychological goal (reduction of SRA). It also includes raising effectiveness and efficiency through optimal consultation and, finally, reducing costs by saving expenditure for monitors. The quality of SIDS consultation can be measured by evaluating satisfaction in patients as well as among co-workers.     

Ein Cylindrom des Meckelschen Divertikels

Resümee Ein Cylindrom am Ende eines freien Meckelschen Divertikels, ein Tumor, der am Darm erst einmal, am Meckelschen Divertikel noch nicht beobachtet wurde, hat durch Abknickung des Darmanhanges zu Diverticulitis, Perforation und sog. gedoppelter Invagination des Ileum geführt.     

The Prognostic Accuracy of Different QT Interval Measures

Background: The QT intervals accuracy for predicting arrhvthmic death varies between studies, possibly due to differences in the selection of the lead used for measurement of the QT interval. The purpose of this study was to analyze the prognostic accuracy of all known ways to select the lead. Methods and Results: Three institutions that used different methods for measuring QT intervals provided their QT databases. They included more than 3500 twelve‐lead surface ECGs. The data represented low‐ and high‐risk patients of the normal population (survivors vs dead from cardiovascular causes), acute myocardial infarction (survivors versus death from all causes) and remote myocardial infarction (with vs without a history of ventricular arrhythmia). The prognostic accuracy was defined as the area under the Receiver Operator Curve (ROC‐area). The most accurate standard leads were I and aVL and the least accurate was AVR. The most accurate precordial lead was V₄. The prognostic accuracy of the longest QT interval was higher than for any standard lead. The prognostic accuracv of the mean of the three longest QT intervals was equal to or slightly lower than for the longest QT interval. Conclusions: The highest prognostic accuracy is obtained with the longest QT interval. The accuracies of the lead selection methods are so different that it can explain a substantial part of the differences between otherwise similar studies in the literature. We recommend the use of the mean value of the three longest QT intervals. A.N.E. 2002;7(1):10–16     

Changing patterns of radiosensitivity of hematopoietic progenitors from chronically irradiated dogs prone either to aplastic anemia or to myeloproliferative disease

Hematopoietic patterns have been assessed in chronic 60Co gamma irradiated dogs during preclinical phases of evolving aplastic anemia (AA) or myeloproliferative disease (MPD), principally myeloid leukemia. Within the AA-prone dog, a singular phase of progressive decline in blood levels of granulocytes and monocytes was noted along with a similar reduction in marrow progenitors committed to granulocyte/monocyte differentiation (CFU-GM). Measured radioresistance of the preAA CFU-GM in vitro, relative to control CFU-GM from nonirradiated animals, revealed only slightly increased resistance to gamma rays, but significantly increased resistance to fission neutrons. Within the MPD-prone dogs, four preclinical phases (i.e. suppression, partial recovery, accommodation, and preleukemic transition) preceding development of overt MPD were evidenced by the monitored change in blood granulocyte/monocyte counts and marrow progenitor levels. Analysis of radioresistance of preMPD CFU-GM revealed marked changes with time of exposure and, in turn, with preclinical phase transitions. Gamma ray resistance increased in the initial phases of exposure, with maximal levels occurring during the middle phase of exposure (accommodation, phase III) followed by a tailing off of resistance at later times. Resistance to fission neutrons by preMPD CFU-GM was observed as well, but somewhat later in the exposure course and at a much lower, more consistent level. These differential patterns of radioresistance expressed by marrow CFU-GM of chronically irradiated MPD-prone dogs to gamma rays and fission neutrons gave rise to preclinical phase-specific 'relative biological effectiveness' (RBE) values. From these observations, we conclude that: (i) CFU-GM of MPD-prone dogs acquire and maintain marked radioresistance to low linear energy transfer (LET) gamma rays, but only marginally elevated radioresistance to high-LET fission neutrons during the course of chronic gamma ray exposure; and (ii) CFU-GM of the AA-prone dog, in contrast, acquire little change in resistance to gamma rays, but, surprisingly, marked resistance to neutrons relative to progenitors from nonirradiated controls. These results support the concept that acquired radioresistance of vital granulocyte/monocyte lineage-committed hematopoietic progenitors is temporally, perhaps causally, linked to the processes mediating hematopoietic recovery and accommodation under chronic irradiation, and in turn to preclinical events of evolving MPD. In addition, the marked differential responses of progenitors to gamma and neutron irradiation in vitro might suggest differences in the nature of cellular lesions elicited by chronic gamma irradiation, in vivo.     

Postprandial increase of cardiac output in patients with acute myocardial infarction

The influence on the hemodynamics of oral and intravenous nourishment containing the same amount of calories in comparison to isotonic solution of sodium chloride was studied in 14 patients with acute myocardial infarction. Forty minutes after administration of nourishment, a 34% increase in cardiac index, rising from 2.61 +/- 0.43 to 3.49 +/- 0.68 l/min/m2 was measured in the oral group, P less than 0.001. The increase was 22% (from 2.75 +/- 0.54 to 3.36 +/- 0.83 l/min/m2) in the intravenous group, P less than 0.025. Stroke index rose by 26% (from 33.4 +/- 7.8 to 42.1 +/- 10.6 ml/m2) in the oral group, P less than 0.025; and by 13% (from 32.7 +/- 8.3 to 37.0 +/- 9.7 ml/m2) in the intravenous group, P less than 0.05. No increases were seen in heart rate, mean blood pressure and pulmonary arterial diastolic pressure. The systemic vascular resistance decreased significantly in both groups. Thus, changes that mimic those seen during treatment with positive inotropic or vasodilating drugs were found. These effects have to be taken into account when assessing hemodynamic changes following cardiovascular medication.     

Effects of statins,fibrates, rosuvastatin,and ezetimibe beyond cholesterol: The modulation of LDL size and subclasses in high-risk patients

Increasing evidence suggests that the quality-rather than just the quantity-of low-density lipoproteins (LDLs) exerts a great influence on cardiovascular risk. LDLs comprise multiple subclasses with discrete size and density, and different physicochemical composition, metabolic behaviors, and atherogenicity. Individuals generally cluster into 2 broad subgroups. Most have a predominance of large LDLs, and some have a higher proportion of small particles. Small, dense LDLs are good predictors of cardiovascular events and progression of coronary artery disease. Their predominance has been accepted as an emerging cardiovascular risk factor by the National Cholesterol Education Program Adult Treatment Panel III. Several studies have shown that therapeutic modulation of LDL size and subclass is of great benefit in reducing the risk of cardiovascular events. This seems particularly true for statins and fibrates when they are administered to higher-risk patients, such as those with type 2 diabetes or vascular disease. Data reporting outcomes with the use of rosuvastatin, the latest statin molecule introduced to the market, and ezetimibe, a cholesterol absorption inhibitor, are promising.     

Contact‐free monitoring of vessel graft stiffness – proof of concept as a tool for vascular tissue engineering

Tissue‐engineered vessel grafts have to mimic the biomechanical properties of native blood vessels. Manufacturing processes often condition grafts to adapt them to the target flow conditions. Graft stiffness is influenced by material properties and dimensions and determines graft compliance. This proof‐of‐concept study evaluated a contact‐free method to monitor biomechanical properties without compromising sterility. Forced vibration response analysis was performed on human umbilical vein (HUV) segments mounted in a buffer‐filled tubing system. A linear motor and a dynamic signal analyser were used to excite the fluid by white noise (0–200 Hz). Vein responses were read out by laser triangulation and analysed by fast Fourier transformation. Modal analysis was performed by monitoring multiple positions of the vessel surface. As an inverse model of graft stiffening during conditioning, HUV were digested proteolytically, and the course of natural frequencies (NFs) was monitored over 120 min. Human umbilical vein showed up to five modes with NFs in the range of 5–100 Hz. The first natural frequencies of HUV did not alter over time while incubated in buffer (p = 0.555), whereas both collagenase (?35%, p = 0.0061) and elastase (?45%, p < 0.001) treatments caused significant decreases of NF within 120 min. Decellularized HUV showed similar results, indicating that changes of the extracellular matrix were responsible for the observed shift in NF. Performing vibration response analysis on vessel grafts is feasible without compromising sterility or integrity of the samples. This technique allows direct measurement of stiffness as an important biomechanical property, obviating the need to monitor surrogate parameters. Copyright © 2016 John Wiley & Sons, Ltd.     

Secretin deficiency causes impairment in survival of neural progenitor cells in mice

Hippocampal neurogenesis is the lifelong production of new neurons in the central nervous system (CNS), and affects many physiological and pathophysiological conditions, including neurobehavioral disorders. The early postnatal stage is the most prominent neurogenesis period; however, the functional role of neurogenesis in this developing stage has not been well characterized. To understand the role of hippocampal neurogenesis in the postnatal developing period, we analyzed secretin, a neuropeptide, which is expressed significantly higher in the development stage. Secretin is a pleiotropic neuropeptide hormone that belongs to the secretin/VIP/glucagon peptide family. Although secretin was originally isolated in the gastrointestinal system, it has been found that secretin itself acts as a neuropeptide in the CNS. Here, we report a new function of secretin as a survival factor for neural progenitor cells in the hippocampus. We found that secretin-deficient mice exhibit decreased numbers of BrdU-labeled new neurons and dramatically increased apoptosis of doublecortin-positive neural progenitor cells in the subgranular zone of the dentate gyrus (DG) during the early postnatal period. Furthermore, we found that reduced survival of neural progenitor cells leads to decreased volume of DG, reduced long-term potentiation and impaired spatial learning ability in adults. Our studies demonstrate that secretin has important implications for neurogenesis in postnatal development, and affects neurobehavioral function in the adult mouse.     

Electrophysiologic assessment of sciatic nerve regeneration in the rat: surrounding limb muscles feature strongly in recordings from the gastrocnemius muscle

Striking inconsistencies between the results of morphometric and electrophysiologic examinations of the regenerating nerve were observed in a previous study featuring the bridging of a 14 mm gap in the rat sciatic nerve. To shed light on this dichotomy, seven further rats were subjected to permanent sciatic nerve transection and assessed electrophysiologically, histologically and by retrograde axonal tracing at various postoperative intervals (1 h to 8 weeks). The results of the histological examinations and retrograde tracing revealed that in spite of the fact that compound muscle action potentials could be recorded in the gastrocnemius muscle, no reinnervation of the gastrocnemius muscle, either physiological or aberrant, had actually taken place. Furthermore, it was established that the electrical activity recorded in the gastrocnemius muscle after stimulation of the proximal or distal stump is generated by surrounding hind limb muscles unaffected by denervation. These are stimulated either directly, or indirectly due to spreading of the impulse. It is therefore strongly recommended that caution should be exercised when interpreting recordings from the gastrocnemius muscle after stimulation of a regenerating sciatic nerve in laboratory rodents.