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Objectives The aim of the study was to investigate if pleurocentesis in patients with pleural effusion would lead to changes in systolic and diastolic function of the left ventricle. Design The study was descriptive, and patients were their own controls. Setting The setting was a single-center university hospital. Participants Patients with pleural effusion requiring pleurocentesis were eligible for inclusion. Interventions The participants who had pleurocentesis performed were available for analysis. Measurements and Main Results Prior to pleurocentesis and approximately 1 hour after, patients were examined primarily with transthoracic echocardiography. The examination included measurements of left ventricular volumes and measures of diastolic function assessed by Doppler echocardiography. Thirty-five patients were included, and 11 later were excluded, yielding a study population of 24. Preload, expressed as left ventricular end-diastolic volume, increased significantly from before to after pleurocentesis (p = 0.014). None of the diastolic parameters showed significant results. Significant changes were observed for heart rate, supplementary O 2 , respiratory frequency, and saturation. Conclusions Pleurocentesis increased left ventricular preload and improved respiratory function. [ABSTRACT FROM AUTHOR]

Objective: The authors hypothesized that preoperative N-terminal probrain natriuretic peptide (NT-proBNP) correlates well with longitudinal strain measurements and with Doppler measurements of diastolic function. Design: Prospective observational study. Setting: University teaching hospital. Participants: Forty patients undergoing elective cardiac surgery. Interventions: Aortic valve replacement, coronary artery bypass grafting, or a combination of these procedures. Measurements and Main Results: Plasma NT-proBNP concentration was obtained by analyzing blood samples with a commercially available kit. Left ventricular systolic function was assessed by speckle tracking ultrasound strain measurements and left ventricular diastolic function was assessed by 2 Doppler methods: E/A ratio and E/E′ ratio. Tissue Doppler imaging velocities (E′ and A′) were measured in the basal septum (annular) and pulse-wave Doppler was used to measure mitral in-flow profile (E and A). The correlation between global strain data from the speckle tracking ultrasound measurement and NT-proBNP levels was ρ = 0.35 (p = 0.026). With a cutoff value of −15% in global strain measurements, there was a significant difference in NT-proBNP levels (117 v 57 pg/mL, p = 0.048). E/E′ values correlated with NT-proBNP levels (ρ = 0.46, p = 0.011). With a cutoff of 15 in E/E′ values, there were significant differences in corresponding NT-proBNP levels (33 v 113 pg/mL, p = 0.004). Conclusions: A correlation was found between plasma levels of NT-proBNP and speckle tracking ultrasound strain measurements by an easily employed method applicable in the anesthesia and preoperative settings. In addition, the well-established marker of diastolic function, E/E′, correlated well with NT-proBNP, whereas the E/A ratio failed to show any association. [ABSTRACT FROM AUTHOR]

Abstract: This study tested the effects of two instructional aids in a complex, dynamic environment, specifically, a business simulation. Participants studied (1) a “causal map,” which depicted key variables in an interconnected network, (2) a textual outline of the same relationships, or (3) no-aid. With the relevant aid still available, the participants ran the simulation three times. Then, the aid was removed, and the participants ran another three simulations. Both when the aid was available and later when removed, the group receiving the causal map gained a greater market share than the other two groups, which failed to differ. With respect to profits, however, a cross-over interaction appeared. When the aid was available, the causal map group showed lower profits than the other two groups, but, without the aid, the causal map group showed greater profits. The results are discussed in the context of information processing theories of instructional design. [Copyright &y& Elsevier]

Abstract: Reduced diurnal blood pressure (BP) variation (“non-dipping”) is associated with both micro- and macrovascular complications in patients with type 2 diabetes. The relation between endothelial perturbation and diurnal BP variation in diabetic subjects has not previously been studied. Seventy-six subjects, stratified to 4 gender-, age-, and duration-matched groups of 19 subjects each, were studied (group A: non-diabetic subjects; group B to D, type 2 diabetic subjects; group B: no retinopathy; group C: minimal background retinopathy; group D: diabetic maculopathy). All subjects underwent a 24-hour ambulatory BP monitoring. von Willebrand factor (vWF), fibrinogen, E-selectin, and intercellular adhesion molecule-1 were measured in plasma. Systolic night/day BP ratio increased gradually in groups A to D: 85.2 ± 5%, 85.7 ± 7%, 88.5 ± 6%, and 90.5 ± 7%, respectively, P < .05. Among diabetic patients, non-dippers had significantly higher plasma levels of vWF and fibrinogen than dippers (median/interquartile range 1.7/1.4 to 2.1 vs. 1.2/0.9 to 1.5 U/mL, P < .01 and 3.6/3.6 to 3.7 vs. 2.9/2.5 to 3.6 g/L, P = .01). Non-dipping is associated with elevated plasma levels of proteins related to endothelial cell activation as well as with retinopathy in subjects with type 2 diabetes. This finding suggests a possible mechanism linking non-dipping with microvascular complications in these subjects. [Copyright &y& Elsevier]

Abstract: Background: Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on central hemodynamics and predicts fluid responsiveness during positive pressure ventilation. In spontaneously breathing patients, the correlations between IVC dynamics and the hemodynamic response to volume shifts remain to be described. Objectives: We aimed to describe the correlation between IVC dynamics and the changes in cardiac output (CO) caused by controlled hemorrhage. Methods: Healthy donors from the blood bank were eligible for inclusion. Measurements of the IVC and CO were performed before and immediately after blood donation using ultrasound methods. A control group served to evaluate the effect of resting. Results: Thirty-seven participants completed the study. IVC collapsibility index (IVC-CI) and IVC end expiratory diameter (IVCe) both changed significantly after blood donation (p < 0.001). The baseline IVC-CI and IVCe did not correlate with the change in CO (p-values ≥ 0.40). The alterations in IVC-CI and IVCe induced by blood donation also did not correlate with the change in CO (p ≥ 0.71). The sensitivities of IVC-CI or IVCe, defined as an increase in IVC-CI and a decrease in IVCe, for picking up any decrease in CO were 81.3% and 84.4%, respectively. In the control group, no effect was seen between measurements. Conclusion: IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting early blood loss. [Copyright &y& Elsevier]