Abstract Heart failure (HF) affects 5.7 million in the U.S., and despite well-established pharmacologic therapy, the 5-year mortality rate remains near 50%. Furthermore, the mortality rate for HF has ...not declined in years, highlighting the need for new therapeutic options. Omega-3 polyunsaturated fatty acids (ω3-PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are important regulators of cardiovascular health. However, questions of efficacy and mechanism of action have made the use of ω3-PUFAs in all cardiovascular disease (CVD) controversial. Here, we review recent studies in animal models of HF indicating that ω3-PUFAs, particularly EPA, are cardioprotective, with the results indicating a threshold for efficacy. We also examine clinical studies suggesting that ω3-PUFAs improve outcomes in patients with HF. Due to the relatively small number of clinical studies of ω3-PUFAs in HF, we discuss EPA concentration-dependency on outcomes in clinical trials of CVD to gain insight into the perceived questionable efficacy of ω3-PUFAs clinically, with the results again indicating a threshold for efficacy. Ultimately, we suggest that the main failing of ω3-PUFAs in clinical trials might be a failure to reach a therapeutically effective concentration. We also examine mechanistic studies suggesting that ω3-PUFAs signal through free fatty acid receptor 4 (Ffar4), a G-protein coupled receptor (GPR) for long-chain fatty acids (FA), thereby identifying an entirely novel mechanism of action for ω3-PUFA mediated cardioprotection. Finally, based on mechanistic animal studies suggesting that EPA prevents interstitial fibrosis and diastolic dysfunction, we speculate about a potential benefit for EPA-Ffar4 signaling in heart failure preserved with ejection fraction.
Pulse transit time (PTT) represents a potential approach for cuff-less blood pressure (BP) monitoring. Conventionally, PTT is determined by (1) measuring (a) ECG and ear, finger, or toe PPG waveforms ...or (b) two of these PPG waveforms and (2) detecting the time delay between the waveforms. The conventional PTTs (cPTTs) were compared in terms of correlation with BP in humans. Thirty-two volunteers 50% female; 52 (17) (mean (SD)) years; 25% hypertensive were studied. The four waveforms and manual cuff BP were recorded before and after slow breathing, mental arithmetic, cold pressor, and sublingual nitroglycerin. Six cPTTs were detected as the time delays between the ECG R-wave and ear PPG foot, R-wave and finger PPG foot finger pulse arrival time (PAT), R-wave and toe PPG foot (toe PAT), ear and finger PPG feet, ear and toe PPG feet, and finger and toe PPG feet. These time delays were also detected via PPG peaks. The best correlation by a substantial extent was between toe PAT via the PPG foot and systolic BP - 0.63 ± 0.05 (mean ± SE); p < 0.001 via one-way ANOVA. Toe PAT is superior to other cPTTs including the popular finger PAT as a marker of changes in BP and systolic BP in particular.
Reportedly, clinicians of all kinds are experiencing alarming rates of burnout, and its prevalence among anesthesia providers is high. We examined burnout in a large academic anesthesia department ...with a commonly used questionnaire, the Oldenburg Burnout Inventory, which provides scores on two scales, “exhaustion” and “disengagement.” We examined differences in scores between exhaustion and disengagement and their prevalences. All N = 415 staff members of the department were requested to complete the Oldenburg Burnout Inventory and N = 130 (31%) did so. The mean ± standard deviation was 2.52 ± 0.51 (range, 1.13 to 3.75) for exhaustion and 2.27 ± 0.52 (range, 1.13 to 3.63) for disengagement. The mean for exhaustion exceeded that for disengagement by 0.25 ± 0.42 (range, −1.25 to 1.25), t(129)=6.68, p < 0.0001 by paired t test. Mean ratings exceeded the midpoint (2.5) between the “burned out” and “not burned out” ends of the rating scale for 49% of respondents for exhaustion, but only 30% for disengagement. More respondents (N = 87, 67%) had a higher mean for exhaustion than disengagement than the opposite pattern (N = 28, 22%), M = 29.5, p < 0.0001 by sign test. Thus, burnout symptoms were common but reflected more in exhaustion than disengagement. Literature review suggested that the difference between the exhaustion and disengagement means that we found was larger than typical, but not unusual, for health-care-related groups, and typical for other groups. Future studies should clarify circumstances under which exhaustion exceeds disengagement and vice versa, both in anesthesia and other fields.
Objective: Photoplethysmography (PPG) waveform analysis is being increasingly investigated for continuous, non-invasive, and cuff-less blood pressure (BP) measurement. However, the efficacy of this ...approach and the useful features and models remain largely unclear. The objectives were to develop easy-to-understand models relating PPG waveform features to BP changes (after a cuff calibration) and to determine their value in BP measurement accuracy. Methods: The study data comprised finger, toe, and ear PPG waveforms, an ECG waveform, and reference manual cuff BP measurements from 32 human subjects (25% hypertensive) before and after slow breathing, mental arithmetic, cold pressor, and nitroglycerin administration. Stepwise linear regression was employed to create parsimonious models for predicting the intervention-induced BP changes from popular PPG waveform features, pulse arrival time (PAT, time delay between ECG R-wave and PPG foot), and subject demographics. Leave-one-subject-out cross validation was applied to compare the BP change prediction root-mean-squared-errors (RMSEs) of the resulting models to reference models in which PPG waveform features were excluded. Results: Finger b-time (PPG foot to minimum second derivative time interval) and ear "STT" (PPG amplitude divided by maximum derivative), when combined with PAT, reduced the systolic BP change prediction RMSE of reference models by 6-7% (p<inline-formula><tex-math notation="LaTeX">\,<\, </tex-math></inline-formula>0.022). Ear STT together with pulse width reduced the diastolic BP change prediction RMSE of the reference model by 13% (p = 0.003). Conclusion: The two PPG fast upstroke time intervals can offer some added value in cuff-less BP trending. Significance: This study offers important information towards achieving non-invasive and passive BP monitoring without a cuff.
It is uncertain how different academic medical departments differ in academic productivity as assessed by commonly used bibliometric measures, eg, the h-index (the maximum value of h such that an ...author has published h papers that have each been cited at least h times).
This project examined whether departments in the University of Iowa's Carver College of Medicine differed in h-indices of tenured faculty members.
Based on 2020 data obtained from the College (and other University sources), the author compiled three data sets of Scopus h-indices of tenured faculty members identified by department, varying in size due to slightly different inclusion criteria (N's=334, 341, and 354). Analyses compared h-indices between ranks and among departments.
In the basic data set (N=334), h-indices of the 230 (69%) full and 104 (31%) associate professors differed based on a t-test, means (standard deviations)=37 (17) and 20 (7), respectively, p<0.0001. For both full and associate professors separately, departments differed in h-indices based on analyses of variance, p=0.04 and p=0.02, respectively. In the expanded data sets, departmental differences were significant for full and associate professors (with N=341) and full professors (with N=354).
Departments differed in academic productivity of tenured faculty members as assessed by h-indices. This was not a powerful, monolithic effect, ie, relative departmental standings for full and associate professors were not consistent, and departmental differences for associate professors were nonsignificant in the largest (N=354) data set. Multiple factors probably contributed to departmental differences and should be further investigated.
Awareness during anesthesia is uncommon. The number of cases that are found in one single study are insufficient to identify and estimate the risks, causal factors and sequelae. One method of ...studying a large number of cases is to analyze reports of cases of awareness that have been published in scientific journals.
We conducted an electronic search of the literature in the National Library of Medicine's PubMed database for case reports on "Awareness" and "Anesthesia" for the time period between 1950 through August, 2005. We also manually searched references cited in these reports and in other articles on awareness. We used two surgical control groups for comparative purposes. The first group in a study by Sebel et al. consisted of patients who did not experience awareness. The second group, from the 1996 data from the National Survey of Ambulatory Surgery included patients who received general anesthesia. We also used data from the National Center for Health Statistics to compare weight and Body Mass Index.
We compared the data of 271 cases of awareness with 19,504 patients who did not suffer it. Aware patients were more likely to be females (P < 0.05), younger (P < 0.001) and to have cardiac and obstetrics operations (P < 0.0001). Only 35% reported the awareness episode during the stay in the recovery room. They received fewer anesthetic drugs (P < 0.0001), and were more likely to exhibit episodes of tachycardia and hypertension during surgery (P < 0.0001). A much larger percentage of these patients (52%, P < 0.0001) voiced postoperative complaints related to awareness. Inability to move and feelings such as helplessness, sensation of weakness, and hearing noises and voices were related to the persistence of complaints such as sleep disturbances and fear about future anesthetics (P < 0.041-0.0003). Twenty-two percent of the patients suffered late psychological symptoms.
Our review suggested light anesthesia and a history of awareness as risk factors. Obesity and avoidance of nitrous oxide use did not seem to increase the risk. Light anesthesia was the most common cause. Our findings suggest preventive procedures that may lead to a decrease in the incidence of awareness.
Knowledge of lipoprotein(a) measurement in community practice is limited. The objective of this study is to evaluate the frequency of Lp(a) screening across the University of Rochester Medical Center ...(URMC). Descriptive data were collected for all URMC patients >= 18 years old who have had at least one Lp(a) measurement from January 2011 to August 2022 from the URMC electronic health record (EHR). Cardiovascular diagnoses were queried to define yearly frequency and demographic information. We identified 2,698 patients with at least one Lp(a) result. An increasing number of patients were tested per year. There were more women than men, and about 11% having more than one Lp(a) measured with the majority having a level <30 mg/dL (the normal-range in the UMRC lab). The majority do not have a listed diagnosis of cerebral infarction, peripheral vascular disease, myocardial infarction, coronary artery disease, or aortic stenosis. Across URMC, there has been a steady increase of Lp(a) measurements in the past several years.
Objective: Early-onset cannabis use has been associated with later use/abuse, mental health problems (psychosis, depression), and abnormal development of cognition and brain function. During ...adolescence, ongoing neurodevelopmental maturation and experience shape the neural circuitry underlying complex cognitive functions such as memory and executive control. Prefrontal and temporal regions are critically involved in these functions. Maturational processes leave these brain areas prone to the potentially harmful effects of cannabis use. Method: We performed a two-site (United States and the Netherlands; pooled data) functional magnetic resonance imaging (MRI) study with a cross-sectional design, investigating the effects of adolescent cannabis use on working memory (WM) and associative memory (AM) brain function in 21 abstinent but frequent cannabis-using boys (13-19) years of age and compared them with 24 nonusing peers. Brain activity during WM was assessed before and after rule-based learning (automatization). AM was assessed using a pictorial hippocampal-dependent memory task. Results: Cannabis users performed normally on both memory tasks. During WM assessment, cannabis users showed excessive activity in prefrontal regions when a task was novel, whereas automatization of the task reduced activity to the same level in users and controls. No effect of cannabis use on AM-related brain function was found. Conclusions: In adolescent cannabis users, the WM system was overactive during a novel task, suggesting functional compensation. Inefficient WM recruitment was not related to a failure in automatization but became evident when processing continuously changing information. The results seem to confirm the vulnerability of still developing frontal lobe functioning for early-onset cannabis use. (Contains 9 figures and 3 tables.)
Shaken baby syndrome is a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children. Although the term is well known and has been used for a ...number of decades, advances in the understanding of the mechanisms and clinical spectrum of injury associated with abusive head trauma compel us to modify our terminology to keep pace with our understanding of pathologic mechanisms. Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well. Spinal cord injury and secondary hypoxic ischemic injury can contribute to poor outcomes of victims. The use of broad medical terminology that is inclusive of all mechanisms of injury, including shaking, is required. The American Academy of Pediatrics recommends that pediatricians develop skills in the recognition of signs and symptoms of abusive head injury, including those caused by both shaking and blunt impact, consult with pediatric subspecialists when necessary, and embrace a less mechanistic term, abusive head trauma, when describing an inflicted injury to the head and its contents.
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