Reliability intra-and inter-examiner of the head postural assessment by computerized photogrammetry

Scientific articles about reliability of photogrammetry for cervical spine posture evaluation are infrequent. The aim of the present investigation is to verify intra-and inter-examiner reliability of the computerized photogrammetry method for head postural evaluation in lateral view. Twenty-five young women, between 20 and 30 years old, were positioned seated in an upright position and photographed in lateral view. The photographs were imported to Corel Draw X13 program for postural evaluation by computerized photogrammetry. Analyses of intra-and inter-examiner reliability were performed for the angles: condyle-acromion (ACA), menton-sternum (AME) and Frankfurt (AF). The photogrammetry was performed by two examiners: EA and EB. For intra-examiner analyses, EA assessed the pictures twice (A1 and A2) for the same angles within 3 months. For the inter-examiner analyses, EB performed the photogrammetry for the same angles (B1) in order to compare with the data from EA. Using the interclass correlation coefficient (ICC) we observed an excellent correlation in the intra-examiner analysis (A1 and A2) for the angles: ACA and AME (both with ICC=1.0); and AF (ICC=0.78). For the inter-examiner analyses between A1 and B1, it was observed: ACA (ICC=0.24), AME (ICC=0.26) and AF (ICC=0.00). For the comparison between A2 and B1, the ICC values were: 0.23; 0.27 and 0.00, respectively for ACA, AME and AF, classified as weak correlations. In conclusion, the photogrammetry is reliable when performed by the same examiner. The inter-examiner assess showed low reliability, what could have been compromised by the reduced experience of the EB in applying the method

Anesthesia advanced circulatory life support

The constellation of advanced cardiac life support (ACLS) events, such as gas embolism, local anesthetic overdose, and spinal bradycardia, in the perioperative setting differs from events in the pre-hospital arena. As a result, modification of traditional ACLS protocols allows for more specific etiology-based resuscitation. Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology. When the health care provider identifies the probable cause of arrest, the practitioner has the ability to initiate medical management rapidly. Recommendations for management must be predicated on expert opinion and physiological understanding rather than on the standards currently being used in the generation of ACLS protocols in the community. Adapting ACLS algorithms and considering the differential diagnoses of these perioperative events may prevent cardiac arrest

Protein kinase C and cardiac dysfunction: a review

Heart failure (HF) is a physiological state in which cardiac output is insufficient to meet the needs of the body. It is a clinical syndrome characterized by impaired ability of the left ventricle to either fill or eject blood efficiently. HF is a disease of multiple aetiologies leading to progressive cardiac dysfunction and it is the leading cause of deaths in both developed and developing countries. HF is responsible for about 73,000 deaths in the UK each year. In the USA, HF affects 5.8 million people and 550,000 new cases are diagnosed annually. Cardiac remodelling (CD), which plays an important role in pathogenesis of HF, is viewed as stress response to an index event such as myocardial ischaemia or imposition of mechanical load leading to a series of structural and functional changes in the viable myocardium. Protein kinase C (PKC) isozymes are a family of serine/threonine kinases. PKC is a central enzyme in the regulation of growth, hypertrophy, and mediators of signal transduction pathways. In response to circulating hormones, activation of PKC triggers a multitude of intracellular events influencing multiple physiological processes in the heart, including heart rate, contraction, and relaxation. Recent research implicates PKC activation in the pathophysiology of a number of cardiovascular disease states. Few reports are available that examine PKC in normal and diseased human hearts. This review describes the structure, functions, and distribution of PKCs in the healthy and diseased heart with emphasis on the human heart and, also importantly, their regulation in heart failure