Migotanie przedsionków z szybką czynnością komór w czasie przełomu tarczycowego

We present the case of an unconscious 81 year-old woman admitted to the Emergency Department with fever and significant tachycardia up to 210 bpm. The patient was referred by the general physician to the neurology department with suspected stroke. Atrial fibrillation (AF) with rapid ventricular rate was found. The causes of significant tachycardia, in this case, were complex and associated with dehydration, fever, infection and thyroid storm. It could be assumed that the deterioration of the patient’s general condition and a decreased fluid intake had caused hypertonic dehydration which could have led to further acceleration of the heart rhythm and loss of consciousness.  Thyroid function tests are indicated in all cases of paroxysmal AF. In the presented case, the suspicion of thyroid storm was based on the results of analysis and it was confirmed later by the results of free traction of thyroid hormones’ levels. The very fast ventricular rate was related to metabolic disorders and the influence of thyroid hormones on the electrophysiological properties of the atrioventricular junction. In order to stabilise the condition of the patient, passive oxygen therapy, an antipyretic drug, the correction of water and electrolyte disturbances, and digoxin were administered. This treatment improved the patient’s general condition and state of consciousness, resulting in slowing heart rate and respiratory rate. W pracy przedstawiono przypadek nieprzytomnej 81-letniej kobiety przywiezionej na szpitalny oddział ratunkowy z gorączką i znaczną tachykardią do 210/min skierowanej przez lekarza rodzinnego na neurologię z podejrzeniem udaru mózgu. W zapisie elektrokardiograficznym stwierdzono migotanie przedsionków (AF) z szybką czynnością komór. Przyczyny wystąpienia znacznej tachykardii w tym przypadku były złożone i związane z odwodnieniem, gorączką, infekcją oraz przełomem tarczycowym. Pogorszenie stanu pacjentki i zmniejszone przyjmowanie płynów prowadziło do odwodnienia hipertonicznego, co mogło prowadzić do dalszego przyspieszenia rytmu serca i utraty przytomności.  Badanie czynności tarczycy jest wskazane u wszystkich pacjentów z napadowym AF. W prezentowanym przypadku pozwoliło ono podejrzewać przełom tarczycowy, potwierdzony następnie w badaniu stężeń wolnych frakcji hormonów tarczycy. Bardzo szybka częstość komór w tym wypadku wiązała się z zaburzeniami metabolicznymi oraz wpływem hormonów tarczycy na właściwości elektrofizjologiczne łącza przedsionkowo-komorowego. W celu wstępnej stabilizacji stanu pacjentki zastosowano nawadnianie, tlenoterapię bierną, podano lek przeciwgorączkowy, uzupełniano niedobór elektrolitów i podano digoksynę, co pozwoliło na poprawę stanu ogólnego pacjentki i jej stanu świadomości, zwolnienie czynności serca i częstotliwości oddychania.

Quantifying fat replacement of muscle by quantitative MRI in muscular dystrophy

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

The effect of noise and lipid signals on determination of Gaussian and non-Gaussian diffusion parameters in skeletal muscle

This work characterizes the effect of lipid and noise signals on muscle diffusion parameter estimation in several conventional and non-Gaussian models, the ultimate objectives being to characterize popular fat suppression approaches for human muscle diffusion studies, to provide simulations to inform experimental work and to report normative non-Gaussian parameter values. The models investigated in this work were the Gaussian monoexponential and intravoxel incoherent motion (IVIM) models, and the non-Gaussian kurtosis and stretched exponential models. These were evaluated via simulations, and in vitro and in vivo experiments. Simulations were performed using literature input values, modeling fat contamination as an additive baseline to data, whereas phantom studies used a phantom containing aliphatic and olefinic fats and muscle-like gel. Human imaging was performed in the hamstring muscles of 10 volunteers. Diffusion-weighted imaging was applied with spectral attenuated inversion recovery (SPAIR), slice-select gradient reversal and water-specific excitation fat suppression, alone and in combination. Measurement bias (accuracy) and dispersion (precision) were evaluated, together with intra- and inter-scan repeatability. Simulations indicated that noise in magnitude images resulted in <6% bias in diffusion coefficients and non-Gaussian parameters (α, K), whereas baseline fitting minimized fat bias for all models, except IVIM. In vivo, popular SPAIR fat suppression proved inadequate for accurate parameter estimation, producing non-physiological parameter estimates without baseline fitting and large biases when it was used. Combining all three fat suppression techniques and fitting data with a baseline offset gave the best results of all the methods studied for both Gaussian diffusion and, overall, for non-Gaussian diffusion. It produced consistent parameter estimates for all models, except IVIM, and highlighted non-Gaussian behavior perpendicular to muscle fibers (α ~ 0.95, K ~ 3.1). These results show that effective fat suppression is crucial for accurate measurement of non-Gaussian diffusion parameters, and will be an essential component of quantitative studies of human muscle quality

Preserved thenar muscles in non-ambulant Duchenne muscular dystrophy patients

Background Clinical trials in Duchenne muscular dystrophy (DMD) focus primarily on ambulant patients. Results cannot be extrapolated to later disease stages due to a decline in targeted muscle tissue. In non-ambulant DMD patients, hand function is relatively preserved and crucial for daily-life activities. We used quantitative MRI (qMRI) to establish whether the thenar muscles could be valuable to monitor treatment effects in non-ambulant DMD patients.Methods Seventeen non-ambulant DMD patients (range 10.2-24.1 years) and 13 healthy controls (range 9.5-25.4 years) underwent qMRI of the right hand at 3 T at baseline. Thenar fat fraction (FF), total volume (TV), and contractile volume (CV) were determined using 4-point Dixon, and T2(water) was determined using multiecho spin-echo. Clinical assessments at baseline (n = 17) and 12 months (n = 13) included pinch strength (kg), performance of the upper limb (PUL) 2.0, DMD upper limb patient reported outcome measure (PROM), and playing a video game for 10 min using a game controller. Group differences and correlations were assessed with non-parametric tests.Results Total volume was lower in patients compared with healthy controls (6.9 cm(3), 5.3-9.0 cm(3) vs. 13.0 cm(3), 7.6-15.8 cm(3), P = 0.010). CV was also lower in patients (6.3 cm(3), 4.6-8.3 cm(3) vs. 11.9 cm(3), 6.9-14.6 cm(3), P = 0.010). FF was slightly elevated (9.7%, 7.3-11.4% vs. 7.7%, 6.6-8.4%, P = 0.043), while T2(water) was higher (31.5 ms, 30.0-32.6 ms vs. 28.1 ms, 27.8-29.4 ms, P < 0.001). Pinch strength and PUL decreased over 12 months (2.857 kg, 2.137-4.010 to 2.243 kg, 1.930-3.339 kg, and 29 points, 20-36 to 23 points, 17-30, both P < 0.001), while PROM did not (49 points, 36-57 to 44 points, 30-54, P = 0.041). All patients were able to play for 10 min at baseline or follow-up, but some did not comply with the study procedures regarding this endpoint. Pinch strength correlated with TV and CV in patients (rho = 0.72 and rho = 0.68) and controls (both rho = 0.89). PUL correlated with TV, CV, and T2(water) (rho = 0.57, rho = 0.51, and rho = -0.59).Conclusions Low thenar FF, increased T2(water), correlation of muscle size with strength and function, and the decrease in strength and function over 1 year indicate that the thenar muscles are a valuable and quantifiable target for therapy in later stages of DMD. Further studies are needed to relate these data to the loss of a clinically meaningful milestone.Neuro Imaging Researc

The effect of mirabegron on energy expenditure and brown adipose tissue in healthy lean South Asian and Europid men

Aim: To compare the effects of cold exposure and the β3-adrenergic receptor agonist mirabegron on plasma lipids, energy expenditure and brown adipose tissue (BAT) activity in South Asians versus Europids. Materials and Methods: Ten lean Dutch South Asian (aged 18-30 years; body mass index [BMI] 18-25 kg/m2 ) and 10 age- and BMI-matched Europid men participated in a randomized, double-blinded, cross-over study consisting of three interventions: short-term (~ 2 hours) cold exposure, mirabegron (200 mg one dose p.o.) and placebo. Before and after each intervention, we performed lipidomic analysis in serum, assessed resting energy expenditure (REE) and skin temperature, and measured BAT fat fraction by magnetic resonance imaging. Results: In both ethnicities, cold exposure increased the levels of several serum lipid species, whereas mirabegron only increased free fatty acids. Cold exposure increased lipid oxidation in both ethnicities, while mirabegron increased lipid oxidation in Europids only. Cold exposure and mirabegron enhanced supraclavicular skin temperature in both ethnicities. Cold exposure decreased BAT fat fraction in both ethnicities. After the combination of data from both ethnicities, mirabegron decreased BAT fat fraction compared with placebo. Conclusions: In South Asians and Europids, cold exposure and mirabegron induced beneficial metabolic effects. When combining both ethnicities, cold exposure and mirabegron increased REE and lipid oxidation, coinciding with a higher supraclavicular skin temperature and lower BAT fat fraction.Diabetes Research Foundation Fellowship 2015.81.1808Netherlands CardioVascular Research Initiative: 'the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organisation for Health Research and Development and the Royal Netherlands Academy of Sciences' CVON2014-02 ENERGISE CVON2017-20 GENIUS-IIEuropean Union (EU) 602485European Research Council (NOMA-MRI) PCNR is an Established Investigator of the Netherlands Heart Foundation 2009T03

Effect of pressure after casting on high strength fibre reinforced mortar

This study investigates the effects of applying pressure after casting on the flexural response of high strength fibre reinforced mortar in which up to 5% fibres by volume were premixed. High mortar strength was achieved by reducing mix porosity (low water-cement ratio), adding fly ash and using superplasticisers. Variables included eigth different types of fibre, their volume fraction in the mix, two mortar matrices, two values of pressure after casting, and the casting orientation. It is found that pressure improves the proportional limit and the flexural strength of the composite but may lead to a deterioration in its postcracking response and toughness. Composite moduli of rupture of more than 5000 psi (37 MPa) are observed with steel fibres while highest toughness indices of up to 90 are reported with polypropylene fibres. It is concluded that the application of pressure after casting to improve composite properties is not economically justifiable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26082/1/0000158.pd

Novel Muscle Imaging in Inflammatory Rheumatic Diseases—A Focus on Ultrasound Shear Wave Elastography and Quantitative MRI

In recent years, imaging has played an increasing role in the clinical management of patients with rheumatic diseases with respect to aiding diagnosis, guiding therapy and monitoring disease progression. These roles have been underpinned by research which has enhanced our understanding of disease pathogenesis and pathophysiology of rheumatology conditions, in addition to their key role in outcome measurement in clinical trials. However, compared to joints, imaging research of muscles is less established, despite the fact that muscle symptoms are very common and debilitating in many rheumatic diseases. Recently, it has been shown that even though patients with rheumatoid arthritis may achieve clinical remission, defined by asymptomatic joints, many remain affected by lingering constitutional systemic symptoms like fatigue, tiredness, weakness and myalgia, which may be attributed to changes in the muscles. Recent improvements in imaging technology, coupled with an increasing clinical interest, has started to ignite new interest in the area. This perspective discusses the rationale for using imaging, particularly ultrasound and MRI, for investigating muscle pathology involved in common inflammatory rheumatic diseases. The muscles associated with rheumatic diseases can be affected in many ways, including myositis—an inflammatory muscle condition, and myopathy secondary to medications, such as glucocorticoids. In addition to non-invasive visual assessment of muscles in these conditions, novel imaging techniques like shear wave elastography and quantitative MRI can provide further useful information regarding the physiological and biomechanical status of the muscle

Nielegalne postępowanie z zużytym sprzętem elektrycznym I elektronicznym — zagrożeniem dla życia I zdrowia człowieka

Przedmiotem rozważań niniejszego artykułu jest zużyty sprzęt elektryczny i elektroniczny. W artykule przedstawiono międzynarodową, europejską oraz krajową definicję odpadów, sprzętu elektrycznego i elektronicznego, jak również odpadów niebezpiecznych. Wyjaśniono, na czym polega gospodarka odpadami, gospodarowanie odpadami oraz zaprezentowano hierarchię postępowania z odpadami. W niniejszym opracowaniu poruszono zasady postępowania z zużytym sprzętem elektrycznym i elektronicznym. Wskazano sankcje karne za nieodpowiednie postępowanie z odpadami. Wyeksponowano szkodliwe substancje znajdujące się w zużytych sprzętach elektrycznych i elektronicznych i ich wpływ na środowisko, zdrowie i życie ludzi oraz uwidoczniono skutki nielegalnego postępowania z odpadami