Components of heart rate variability have attracted considerable attention in psychology and medicine and have become important dependent measures in psychophysiology and behavioral medicine. Quantification and interpretation of heart rate variability, however, remain complex issues and are fraught with pitfalls. The present report (a) examines the physiological origins and mechanisms of heart rate variability, (b) considers quantitative approaches to measurement, and (c) highlights important caveats in the interpretation of heart rate variability. Summary guidelines for research in this area are outlined, and suggestions and prospects for future developments are considered.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8986.1997.tb02140.x

Heart rate variability: Origins, methods, and interpretive caveats

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Acute myocardial infarction (MI) is a major cause of death and disability worldwide. In patients with MI, the treatment of choice for reducing acute myocardial ischemic injury and limiting MI size is timely and effective myocardial reperfusion using either thombolytic therapy or primary percutaneous coronary intervention (PPCI). However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is still no effective therapy. A number of new therapeutic strategies currently under investigation for preventing myocardial reperfusion injury have the potential to improve clinical outcomes in patients with acute MI treated with PPCI.

https://dm5migu4zj3pb.cloudfront.net/manuscripts/62000/62874/JCI62874.v1.pdf

Myocardial ischemia-reperfusion injury: a neglected therapeutic target

The recommendations in this 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are based on an extensive evidence review process that was begun by the International Liaison Committee on Resuscitation (ILCOR) after the publication of the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 1,2 and was completed in February 2015.3,4

In this in-depth evidence review process, ILCOR examined topics and then generated a prioritized list of questions for systematic review. Questions were first formulated in PICO (population, intervention, comparator, outcome) format,5 and then search strategies and inclusion and exclusion criteria were defined and a search for relevant articles was performed. The evidence was evaluated by the ILCOR task forces by using the standardized methodological approach proposed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group.6

The quality of the evidence was categorized based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). Then, where possible, consensus-based treatment recommendations were created.

To create this 2015 Guidelines Update, the AHA formed 15 writing groups, with careful attention to manage conflicts of interest, to assess the ILCOR treatment recommendations and to write AHA treatment recommendations by using the AHA Class of Recommendation (COR) and Level of Evidence (LOE) system. The recommendations made in the Guidelines are informed by the ILCOR recommendations and GRADE classification, in the context of the delivery of medical care in North America. The AHA writing group made new recommendations only on topics specifically reviewed by ILCOR in 2015. This chapter delineates instances where the AHA writing group developed recommendations that are significantly stronger or weaker than the ILCOR statements. In the online …

Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care

Recording electrocardiograms can be dangerous.

Patients with bronchial hyperreactivity are at increased risk for bronchospasm particularly during airway instrumentation such as with intubation, extubation, or bronchoscopy. Pretreatment with either lidocaine or salbutamol is suggested, since application of lidocaine intravenously or salbutamol as an aerosol has been shown to be similarly effective in increasing the (2,2 resp. 2,6 fold) threshold for histamine evoked bronchoconstriction. Furthermore, combined salbutamol and lidocaine pretreatment has an additive effect and increases 4,8 fold the histamine-threshold. Thus, lidocaine treatment can be applied to patients with airway disease treated with β 2 -mimetics also. Inhaled and injected lidocaine is equally effective in decreasing histamine threshold although at different plasma concentrations, i.e., lidocaine is effective at approx. 0,7 μg/ml after inhalation but at up to 2 μg/ml after injection. While inhaled lidocaine results in lower plasma concentrations it can evoke an initial bronchoconstriction. Furthermore, local anesthesia of pharynx and larynx associated with inhalation may not be tolerable in some patients. Intravenous lidocaine, in contrast, results in higher plasma concentrations and side-effects are seen more often. While several case reports have described beneficial effects of lidocaine in the treatment of bronchospasm no clinical studies have been performed. Overall, both inhaled and injected local anesthetics are effective in mitigating reflex mediated bronchoconstriction.

Lokalanästhetika und bronchiale Hyperreagibilität

Introduction: The ubiquitin-proteasome system is involved in the development and progression of atherosclerosis. We tested the release of local and systemic proteasome in patients with advanced coronary artery disease. Material and methods: Thirty-nine symptomatic male patients (68 ±1 years) with a flow-limiting stenosis (63 ±1% diameter reduction) in their saphenous vein aortocoronary bypass graft (SVG) underwent stent implantation under protection with a distal balloon device, which permits aspiration of the plaque- derived particulate debris and fluid; the 20S proteasome concentration was measured in the venous plasma of 28 healthy controls and of these 39 patients as well as in the soluble and particulate fraction of the aspirate before and after stenting, using an enzyme-linked immunosorbent assay. Results: The peripheral venous 20S proteasome plasma concentration was higher in patients undergoing SVG stenting (1327 ±102 ng/ml) than in healthy subjects (447 ±29 ng/ml, p median of 1335 ng/ml: 40 ±9% diameter reduction within 6.0 ±0.4 months, n = 20 stenoses vs. ≤ 1335 ng/ml: 17 ±3% diameter reduction within 6.4 ±0.5 months, n = 21 stenoses, p = 0.0059). 20S proteasome concentration in the particulate debris fraction averaged 7010 ±890 ng/ml. However, the plaque-derived 20S proteasome concentration during intervention was less in patients with high (> 1335 ng/ml) venous 20S proteasome concentration (5846 ±993 ng/ml, n = 21 stenoses) than in those with lower (≤ 1335 ng/ml) concentration (8538 ±1548 ng/ml, n = 22 stenoses, p = 0.0308). Conclusions: We propose that release of 20S proteasome from an atherosclerotic lesion may reflect progression of coronary atherosclerosis and could possibly serve as a biomarker.

/pdf/local-and-systemic-20s-proteasome-release-in-patients-with-29u3o2bv9v.pdf

Local and systemic 20S proteasome release in patients with stenting of stenotic saphenous vein bypass grafts – a pilot study

Pretreatment Intravenous Lidocaine for Intubation of the Asthmatic Patient More Data Are Needed

The ubiquitin-proteasome system is the major intracellular pathway for protein degradation in eukaryotes, and it also generates oligopeptides for antigen presentation. However, the 20S proteasome is also associated with the cell's outer membrane, and observations indicate its physiologic presence and biological activity in the extracellular alveolar space (i.e., in the epithelial lining fluid). Furthermore, its concentration is increased in the adult respiratory distress syndrome, acute lung injury, and other inflammatory lung disease. While its cellular origin, potential extracellular biological role, and mechanisms for extracellular transport are hitherto unclear, extracellular alveolar proteasomes could have a role in protein clearance, digestion of alveolar debris, modification or activation of secreted precursor proteins, and/or antigen processing, both in health and lung disease. This article summarizes available information on the extracellular alveolar proteasome and its possible role in alveolar ...

https://www.atsjournals.org/doi/pdf/10.1513/pats.200906-035JS

Jürgen Peters

Papers

Recording electrocardiograms can be dangerous.

Lokalanästhetika und bronchiale Hyperreagibilität

Local and systemic 20S proteasome release in patients with stenting of stenotic saphenous vein bypass grafts – a pilot study

Pretreatment Intravenous Lidocaine for Intubation of the Asthmatic Patient More Data Are Needed

Extracellular Alveolar Proteasome