Search

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or “on waking,” appeared more relevant to disease activity than asking about symptom severity “now” (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients’ lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.

Background.Noninvasive imaging techniques would be highly desirable to differentiate oncotic from apoptotic cell death. Indium 111 antimyosin and technetium 99m glucaric acid were used to assess whether apoptotic and oncotic myocardial cell death can be differentiated. Methods and Results.Cultured H9C2 rat embryonic cardiocytes and CD1 rats were treated with doxorubicin to induce myocardial apoptosis. Acute myocardial oncosis was induced by heat or subcutaneous isoproterenol administration. Scanning electron microscopy, DNA laddering, TUNEL staining, In-111 antimyosin antibody, and Tc-99m glucaric acid were used to demonstrate in vitro and in vivo doxorubicin-induced apoptosis or isoproterenol-induced myocardial oncosis. Scanning electron microscopy, DNA laddering, and TUNEL staining of H9C2 cardiocytes treated with doxorubicin all showed cell death by apoptosis. Rat hearts treated with doxorubicin (10 and 20 mg/kg) were DNA ladder–positive and localized significantly greater In-111 antimyosin antibody (mean ± SD, 0.1942 ± 0.0150 percent injected dose per gram [%ID/g] and 0.1825 ± 0.0238 %ID/g, respectively) than normal hearts (0.1154 ± 0.0270 %ID/g, P< .05). No increase in myocardial Tc-99m glucaric acid activity was observed in rat hearts after 6, 12, and 24 hours of doxorubicin injection (0.0311 ± 0.0066 %ID/g, 0.0356 ± 0.007 %ID/g, and 0.0368 ± 0.0047 %ID/g, respectively; control hearts, 0.0352 ± 0.0099 %ID/g; P= not significant). Tc-99m glucaric acid uptake was significantly greater in isoproterenol-induced oncotic hearts (0.1256 ± 0.1023 %ID/g) than in controls (P< .0001). Conclusions.Tc-99m glucaric acid is avid only for the oncotic myocardium. Antimyosin, on the other hand, is positive for both oncotic and apoptotic myocardium. (J Nucl Cardiol 2002;9:471-81)

Pilot injection timing is a very important parameter at the start of ignition which will affect engine performance and emissions on diesel dual-fuel engines, especially at high loads. This research was carried out on the Diamond DI 800 diesel engine, a single-cylinder that was modified into a dual fuel engine with the aim to determine the effect of advancing the pilot injection timing (PIT) on engine performance, combustion and emissions under high loads with variation pilot injection timing (110, 130, 150, 170 and 190 BTDC). The cylinder pressure, heat release rate (HRR), combustion duration, ignition delay, power, SFC and brake thermal efficiency (BTE), as well as carbon monoxide (CO), hydrocarbon (HC) and particulate matter emissions, were analyzed. The results showed that advancing the pilot injection timing increased the maximum cylinder pressure by 69.52 bar; the heat release rate was 117.79 kJ/m3/0CA, brake thermal efficiency was 25.17% and significantly reduced HC, CO and PM emissions at the pilot injection timing 17deg BTDC. Improved combustion performance occurs when the combustion duration is reduced even though the ignition delay period occurs by adding pilot injection timing under high load.

The use of CNG on dual fuel diesel engines causes a decrease in engine performance, combustion and increased emissions, especially at low loads, which is affected by the addition of ignition delay period so that the maximum of peak combustion away from the top dead center (TDC). Pilot injection timing acts as an ignition delay controller. This research was carried out using an experimental method on diesel/CNG dual fuel engine a single-cylinder to determine the engine performance, combustion process and emissions characteristics with a variation of pilot injection timing from 110 to 190 BTDC with an interval of 20. The results showed an increase in thermal efficiency of 3.006%, maximum cylinder pressure up to 4.78 MPa, maximum heat release rate of up to 52.05 kJ/m3/0CA, and decrease hydrocarbons (HC), carbon dioxide (CO) and particulate matter (PM) emissions at pilot injection timing 170 BTDC under low load. Likewise, combustion performance has increased marked by a reduction in combustion duration and maximum of peak combustion approaching TDC by advancing the pilot injection timing on diesel/CNGdual fuel engine.