Heart failure (HF) as a syndrome which is normally associated with significant reduction of cardiac output has evolved to include conditions such those of moderate and preserved ejection fraction. While the prevalence of HF in the population is increasing, it is not HF with reduced ejection fraction that is driving the trajectory upward for mortality. There is some evidence to suggest that a better understanding of the pathophysiology, novel pharmacological strategies, devices, as well as remote monitoring of the hemodynamics seem to account for a reduction in the cardiovascular mortality and re-hospitalization in some cohorts with HF. However, the all-cause mortality associated with HF has not been reduced significantly by the current interventions. To explore the potential approaches needed for the strategies and avenues to reduce all-cause mortality in patients with HF, it would be helpful to evaluate the evidence in the literature directed at the care of patients with chronic/acute decompensated HF. It is evident that ambulatory measurements of pressures and volume are pivotal in a better management of HF but unless the interventions extend to an improvement in the renal function, the chances of reducing all-cause mortality seems modest. Therefore, future directions of interventions must not only be directed at close monitoring of pressures and volume simultaneously in HF patients but also at improving renal function. Moreover, it is clear that venous congestion plays a detrimental role in the deterioration of renal function and until measures are in place to reduce it, all-cause mortality will not decrease.

Pro-and anti-inflammatory cytokines mediate the inflammatory response in sepsis. Therefore, regulation of cytokines with medications in risky situations may protect the patients from sepsis. Hydroxychloroquine and artemisinin are antimalarial drugs with immunomodulatory properties. In this study, we intended to investigate the effects of artemisinin and hydroxychloroquine on the cytokines released during sepsis in the rat model. Twenty-four rats were randomized into four groups. The control group received oral saline, the sepsis group received oral saline and intraperitoneal lipopolysaccharide toxin (LPS), the artemisinin-treated sepsis group received oral 33.33 mg/kg of artemisinin, and the hydroxychloroquinetreated sepsis group received oral 33.33 mg/kg of hydroxychloroquine before LPS injection. Three hours later, serum cytokines were measured. An increase was detected in TNF-a, IL-1, and IL-6 levels in the sepsis group compared to the control (p<0.01). Oral pretreatment with artemisinin resulted in significant downregulation only of IL-1 levels (p<0.01). Cytokines IL-1 and IL-6 were significantly downregulated in the serum of LPS-induced rats pretreated with oral hydroxychloroquine than rats with sepsis (p<0.01). Decreases observed in TNF-a and IL-10 levels were insignificant. These results demonstrated that both artemisinin and hydroxychloroquine attenuate the release of pro-inflammatory cytokines three hours after LPS-induced sepsis in rats. A significant decrease was observed in serum IL-1 and IL-6 levels with hydroxychloroquine and IL-1 levels with artemisinin. Based on our findings, we suggest that the therapeutic potential of artemisinin and hydroxychloroquine may be beneficial in preventing cytokine storm during sepsis, and further research is needed to determine the optimal timing of administration.

Background: Of the three common central access sites, subclavian vein catheterization has the lowest risk of infection but the highest risk of pneumothorax. The main disadvantage of the short-axis ultrasound guided approach is difficult needle-tip visualization. We describe use of the hydrolocation technique to improve needle-tip localization.Case: Two females, an 81-year-old and a 72-year-old, presented for coronary artery bypass grafting requiring central vein cannulation. To confirm that the needle tip was visualized and not the shaft, needle advancement was paused and 1 ml of saline injected. The appearance of a small anechoic pocket superficial to the subclavian vein helped to visualize the needle tip. Negative aspiration was then re-applied and slight advancement resulted in aspiration of blood and successful subclavian vein puncture. Conclusions The use of hydrolocation for subclavian vein access was easily implemented, required little modification in setup and technique, and provided improved localization of the needle tip.

Background: Noise-induced hearing loss is a well-known occupational disease that affects many fish harvesters from many fisheries worldwide, whose risk factor is prolonged exposure to hazardous noise levels. To date, academic research activities and regulatory bodies have not provided any comparative analysis among the existing methods to assess noise exposure levels of fish harvesters. This paper provides a comparison of four relevant assessment methods of noise exposure, examining the results of a measurement campaign performed onboard small fishing vessels from Newfoundland and Labrador. Methods: We traveled onboard 11 vessels engaged in multiple fisheries from Newfoundland and Labrador and performed extensive noise exposure surveys using the simplified International Maritime Organization method, the full-day measurement method, and the two methods provided by ISO 9612:2009, the task-based method and job-based method (JBM). Results: The results showed that the four methods yield similar values when the noise components are dominated by the engine and auxiliaries (steady-state sources); when noise components are dominated by the fishing gear, task-based method and the simplified International Maritime Organization method estimates are less accurate than JBM, using full-day measurements as baseline. Conclusion The JBM better assesses noise exposure in small-scale fisheries, where noise exposure has significant variance and uncertainties on the exposure levels are higher.

Background: Noise-induced hearing loss is a well-known occupational disease that affects many fish harvesters from many fisheries worldwide, whose risk factor is prolonged exposure to hazardous noise levels. To date, academic research activities and regulatory bodies have not provided any comparative analysis among the existing methods to assess noise exposure levels of fish harvesters. This paper provides a comparison of four relevant assessment methods of noise exposure, examining the results of a measurement campaign performed onboard small fishing vessels from Newfoundland and Labrador. Methods: We traveled onboard 11 vessels engaged in multiple fisheries from Newfoundland and Labrador and performed extensive noise exposure surveys using the simplified International Maritime Organization method, the full-day measurement method, and the two methods provided by ISO 9612:2009, the task-based method and job-based method (JBM). Results: The results showed that the four methods yield similar values when the noise components are dominated by the engine and auxiliaries (steady-state sources); when noise components are dominated by the fishing gear, task-based method and the simplified International Maritime Organization method estimates are less accurate than JBM, using full-day measurements as baseline. Conclusion The JBM better assesses noise exposure in small-scale fisheries, where noise exposure has significant variance and uncertainties on the exposure levels are higher.

A once-daily formulation of tacrolimus, Advagraf®, is increasingly being used in place of twice-daily tacrolimus, Prograf®, as a standard immunosuppressive agent for transplant patients. In this study, the clinical safety and efficacy of Advagraf® were compared with Prograf®, among multi-ethnic Malaysian renal transplanted population.

The concept of autonomic regulation (aR) reflects the relevance of the function of different autonomic systems for health. aR can be captured by questionnaires. We differentiate between a trait or constitutional aR questionnaire version including 12 (short-version) or 18 items, respectively, with three subscales (orthostatic-circulatory, rest/activity and digestive regulation), and an 18-item state aR questionnaire on the preceding week with four subscales (rest/activity, orthostatic-circulatory, thermo- and digestive regulation). The validated questionnaires show satisfying to good reliability and robust validity with clear construct validity. In this article, we summarized the actually available literature on aR and the use of aR questionnaires in clinical and observational studies. We described the relationship of high aR with health and in case of low aR or loss of regulation with disease and functional disorder in the three (four) different subscales and functional systems, such as rest/activity, orthostatic-circulatory or digestive regulation (thermoregulation) with the consecutive therapeutic need. Finally, we gave perspectives of its further application in clinical research.

No abstract available.
Cohort Studies* ; Ectodermal Dysplasia 1, Anhidrotic* ; Hispanic Americans* ; Humans

OBJECTlVE To investigate the association between CYP3A5 genotypes and the early efficacy of tacrolimus ( Tac) and cyclosporin A ( CsA) in renal transplantation recipients, and provide a basis for individualized treatment. METHODS Seventy-four kidney transplantation recipients were en-rolled in this study between August 2012 and April 2013. Thirty-one patients were treated with the combi-nation of CsA, MMF and methylprednisolone while the rest were treated with Tac, MMF and methylpred-nisolone. The genotype CYP3A5 was detected by sequence specific primer-polymerase chain reaction ( SSP-PCR) before transplantation. The levels of Tac and CsA were detected by ELlSA and chemilumi-nescence, respectively, to monitor the blood concentration/dose of drugs ( c/D) at 2 weeks, 1 month, 2 months, 3 months and 6 months after transplantation. Simultaneously, the concentrations of blood glu-cose, creatinine, urea nitrogen and uric acid were determined with hexokinase method, creatininase method, urease method and uricolase method, respectively. RESULTS Among the 74 recipients, 9.5%carried CYP3A5?1/?1, 48.6%carried CYP3A5?1/?3 and 41.9%carried CYP3A5?3/?3. According to the phenotype of CYP3A5, the patients were divided into CYP3A5 expression group ( including CYP3A5?1/?1 and CYP3A5?1/?3) and non-expression group ( including CYP3A5?3/?3) , which accounted for 58.1%and 41.9%of the cases, respectively. Among the patients taking Tac, the median value of c/D at 2 weeks, 1 month, 2 months, 3 months and 6 months was 25.49, 49.64, 53.72, 51.9 and 44.5 in CYP3A5 expression group, and 65.48,100.84,99.54,123.01 and 133.21 in non-expression group. The c/D ratio of CYP3A5 non-expressers was higher than among CYP3A5 expressers at each time point ( P<0.05) . The initial dose of Tac 0.1 mg·kg-1 was high for CYP3A5 non-expressers, and the kidney function recovered more slowly than among CYP3A5 expressers and kidney damage occurred. However, there was no association between CYP3A5 genotype and the early efficacy of CsA. The levels of blood glucose, creatinine, urea nitrogen and uric acid were not significantly different between CYP3A5 expression and non-expression groups. CONCLUSlON CYP3A5 non-expression recipients whose starting amount of Tac was 0.1 mg·kg-1 have drug overdoses. CYP3A5 genotype is one of the factors affecting the efficacy of Tac. CYP3A5 genotype has no association with the efficacy of CsA in renal transplantation recipients.