2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

http://www.botonimarco.it/files/chamberquantification.pdf

Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

The secretion of glucocorticoids (GCs) is a classic endocrine response to stress. Despite that, it remains controversial as to what purpose GCs serve at such times. One view, stretching back to the time of Hans Selye, posits that GCs help mediate the ongoing or pending stress response, either via basal levels of GCs permitting other facets of the stress response to emerge efficaciously, and/or by stress levels of GCs actively stimulating the stress response. In contrast, a revisionist viewpoint posits that GCs suppress the stress response, preventing it from being pathologically overactivated. In this review, we consider recent findings regarding GC action and, based on them, generate criteria for determining whether a particular GC action permits, stimulates, or suppresses an ongoing stressresponse or, as an additional category, is preparative for a subsequent stressor. We apply these GC actions to the realms of cardiovascular function, fluid volume and hemorrhage, immunity and inflammation, metabolism, neurobiology, and reproductive physiology. We find that GC actions fall into markedly different categories, depending on the physiological endpoint in question, with evidence for mediating effects in some cases, and suppressive or preparative in others. We then attempt to assimilate these heterogeneous GC actions into a physiological whole. (Endocrine Reviews 21: 55‐ 89, 2000)

/pdf/how-do-glucocorticoids-influence-stress-responses-4egr3fa2k0.pdf

How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions.

Behavioral scientists routinely publish broad claims about human psychology and behavior in the world's top journals based on samples drawn entirely from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Researchers - often implicitly - assume that either there is little variation across human populations, or that these "standard subjects" are as representative of the species as any other population. Are these assumptions justified? Here, our review of the comparative database from across the behavioral sciences suggests both that there is substantial variability in experimental results across populations and that WEIRD subjects are particularly unusual compared with the rest of the species - frequent outliers. The domains reviewed include visual perception, fairness, cooperation, spatial reasoning, categorization and inferential induction, moral reasoning, reasoning styles, self-concepts and related motivations, and the heritability of IQ. The findings suggest that members of WEIRD societies, including young children, are among the least representative populations one could find for generalizing about humans. Many of these findings involve domains that are associated with fundamental aspects of psychology, motivation, and behavior - hence, there are no obvious a priori grounds for claiming that a particular behavioral phenomenon is universal based on sampling from a single subpopulation. Overall, these empirical patterns suggests that we need to be less cavalier in addressing questions of human nature on the basis of data drawn from this particularly thin, and rather unusual, slice of humanity. We close by proposing ways to structurally re-organize the behavioral sciences to best tackle these challenges.

/pdf/the-weirdest-people-in-the-world-480wr4m3kb.pdf

The WEIRDest People in the World

In Reply.— The apparent complexity of quantitative buffy coat analysis that Fischer and Addison refer to in their letter was certainly true in our prototype instrumentation and methodology. A system is currently being manufactured that can be easily operated by personnel who have no laboratory training. The instrument incorporates a microprocessor that uses the described algorithms instantly to display results after the measurements are made. Results are available in less than 12 minutes, with about one minute of actualhands-ontime. We polled five senior hematology technologists, and they stated that the same tests, when performed by their most skilled technologists using the methods described by Fischer and Addison, would take at least 25 minutes,the majority of that being hands-on time. In our article, the data were taken in a manner that would show theworst caseperformance of the system. Data were gathered over a period of weeks,

Quantitative Buffy Coat Analysis-Reply

Of the several public dialogues currently being carried on in the United States, the controversy over military strength and disarmament may be both the most important and the most confusing. Its importance is obvious; it is an interesting commentary on the vital nature of armament-disarmament policy that the literature in the field is burgeoning almost as fast as the literature about the Civil War on its 100th anniversary. But, if the importance is obvious, the confusion is becoming equally so.

Facts and Morals in the Arms Debate

Clinical use of mixed venous oxygen saturation (SVO2) is limited for the required invasive procedure. With Fick’s equation, expired gas analysis, echocardiography, simple blood tests, and percutane...

https://journals.physiology.org/doi/pdf/10.1152/ajpheart.00429.2020

Novel noninvasive estimation of mixed venous oxygen saturation by echocardiography and expired gas analysis.

In order to provide for a sharply defined line of demarcation between red cells and granulocytes in a centrifuged blood sample, the blood sample is drawn into a capillary tube. The bottom of the capillary tube is capped and the blood sample is centrifuged for a time sufficient to layer the blood sample in its constituent blood cell types. The capillary tube is then removed from the centrifuge and the top of the capillary tube is capped. The tube is then placed in the centrifuge inverted from its original orientation whereupon the sample is centrifuged again. Abnormally light red cells are thus trapped towards the bottom of the red cell column whereupon they cannot float up into the granulocyte band.

Method of enhancing separation of abnormally light red cells from granulocytes in a centrifuged blood sample

The mitral valve (MV) is often perceived to be a static fibrous tissue flap— a fixed sized door that closes against a rigid frame. Nothing could be further from the evidence. Human and experimental findings without doubt support a dynamic cellular MV tissue environment that actively adapts to superimposed stresses. Why is this important? Harnessing leaflet adaptation in a remodeling ventricle with leaflet-targeted therapies has the potential to restore optimal leaflet-to-mitral annular area ratio while maintaining leaflet flexibility to reduce postinfarction mitral regurgitation (MR). Nishino et al,1 in this issue of Circulation: Cardiovascular Imaging, provide further evidence and important insights into intrinsic MV changes associated with ischemic MR in patients with acute myocardial infarction (MI) treated with percutaneous revascularization (PCI) and followed over time. Physiological MV adaptation occurs during fetal to adult growth, with leaflets enlarging 20-fold to match the growing left ventricle (LV) and mitral annulus.2 This maintains an optimal leaflet-to-mitral annular area ratio of ≈2:1 which maintains proper coaptation and prevents MR.3 Leaflet growth is tightly regulated by developmental processes: overshooting MV leaflet growth can result in prolapse or LV outflow obstruction due to MV systolic anterior motion; inadequate MV leaflet adaptation relative to LV size may result in MR due to insufficient leaflet surface area for proper coaptation. Acute and chronic disease states that imbalance the spatial and temporal 3-dimensional interplay of the MV apparatus can prompt leaflet adaptation responses. Experimental data have confirmed that MV adaptation occurs over time after MI and in cardiomyopathy.4,5 Infarction and myopathy cause leaflet tethering that adaptively increases MV area by reactivating the developmental process of endothelial mesenchymal transformation (EndMT6), as shown in MV leaflets mechanically tethered without MI for 2 months.7 Adding MI to mechanical tethering compounds leaflet area growth but also induces exuberant EndMT as the substrate for counterproductive interstitial collagen deposition and limitation of valve area expansion.8 Treatment with the angiotensin II receptor antagonist Losartan that also inhibits profibrotic TGF (transforming growth factor)-β modulates the excessive EndMT and collagen response while preserving adaptive leaflet area growth.9 In humans, Chaput et al10 found MV leaflets were ≈35% larger in patients with dilated ischemic and nonischemic cardiomyopathy compared with normal subjects. Less MR corresponded to sufficient leaflet growth in relation to leaflet tethering and mitral annulus size.10 Subsequent MV adaptation studies in similar patient populations by Saito et al11 and Debonnaire et al12 support these findings. Beaudoin evaluated © 2020 American Heart Association, Inc. Circulation: Cardiovascular Imaging

Robert A. Levine

Papers

Quantitative Buffy Coat Analysis-Reply

Facts and Morals in the Arms Debate

Novel noninvasive estimation of mixed venous oxygen saturation by echocardiography and expired gas analysis.

Method of enhancing separation of abnormally light red cells from granulocytes in a centrifuged blood sample

Mitral Regurgitation Postinfarction: The Mitral Valve Adapts to the Times.