Non-invasive haemodynamic assessments using Innocor™ during standard graded exercise tests

Cardiac output (Q) and stroke volume (V S) represent primary determinants of cardiovascular performance and should therefore be determined for performance diagnostics purposes. Since it is unknown, whether measurements of Q and V S can be performed by means of Innocor™ during standard graded exercise tests (GXTs), and whether current GXT stages are sufficiently long for the measurements to take place, we determined Q and V S at an early and late point in time on submaximal 2min GXT stages. 16 male cyclists (age 25.4±2.9years, body mass 71.2±5.0kg) performed three GXTs and we determined Q and V S after 46 and 103s at 69, 77, and 85% peak power. We found that the rebreathings could easily be incorporated into the GXTs and that Q and V S remained unchanged between the two points in time on the same GXT stage (69% peak power, Q: 18.1±2.1 vs. 18.2±2.3lmin−1, V S: 126±18 vs. 123±21ml; 77% peak power, Q: 20.7±2.6 vs. 21.0±2.3lmin−1, V S: 132±18 vs. 131±18ml; 85% peak power, Q: 21.6±2.4 vs. 21.8±2.7lmin−1, V S: 131±17 vs. 131±22ml). We conclude that Innocor™ may be a useful device for assessing Q and V S during GXTs, and that the adaptation of Q and V S to exercise-to-exercise transitions at moderate to high submaximal power outputs is fast enough for 1 and 2min GXT stage duration

Time to exhaustion at maximal lactate steady state is similar for cycling and running in moderately trained subjects

We compared time to exhaustion (t lim) at maximal lactate steady state (MLSS) between cycling and running, investigated if oxygen consumption, ventilation, blood lactate concentration, and perceived exertion differ between the exercise modes, and established whether MLSS can be determined for cycling and running using the same criteria. MLSS was determined in 15 moderately trained men (30±6years, 77±6kg) by several constant-load tests to exhaustion in cycling and running. Heart rate, oxygen consumption, and ventilation were recorded continuously. Blood lactate concentration and perceived exertion were measured every 5min. t lim (37.7±8.9 vs. 34.4±5.4min) and perceived exertion (7.2±1.7 vs. 7.2±1.5) were similar for cycling and running. Heart rate (165±8 vs. 175±10min−1; P<0.01), oxygen consumption (3.1±0.3 vs. 3.4±0.3lmin−1; P<0.001) and ventilation (93±12 vs. 103±16lmin−1; P<0.01) were lower for cycling compared to running, respectively, whereas blood lactate concentration (5.6±1.7 vs. 4.3±1.3mmoll−1; P<0.05) was higher for cycling. t lim at MLSS is similar for cycling and running, despite absolute differences in heart rate, ventilation, blood lactate concentration, and oxygen consumption. This may be explained by the relatively equal cardiorespiratory demand at MLSS. Additionally, the similar t lim for cycling and running allows the same criteria to be used for determining MLSS in both exercise mode

Cardiac output but not stroke volume is similar in a Wingate and V˙O2peak \dot{V}{\text{O}}_{{ 2 {\text{peak}}}} test in young men

Wingate test (WT) training programmes lasting 2-3weeks lead to improved peak oxygen consumption. If a single 30s WT was capable of significantly increasing stroke volume and cardiac output, the increase in peak oxygen consumption could possibly be explained by improved oxygen delivery. Thus, we investigated whether a single WT increases stroke volume and cardiac output to similar levels than those obtained at peak exercise during a graded cycling exercise test (GXT) to exhaustion. Fifteen healthy young men (peak oxygen consumption 45.0±5.3mlkg−1min−1) performed one WT and one GXT on separate days in randomised order. During the tests, we estimated cardiac output using inert gas rebreathing (nitrous oxide and sulphur hexafluoride) and subsequently calculated stroke volume. We found that cardiac output was similar (18.2±3.3 vs. 17.9±2.6lmin−1; P=0.744), stroke volume was higher (127±37 vs. 94±15ml; P<0.001), and heart rate was lower (149±26 vs. 190±12 beatsmin−1; P<0.001) at the end (27±2s) of a WT as compared to peak exercise during a GXT. Our results suggest that a single WT produces a haemodynamic response which is characterised by similar cardiac output, higher stroke volume and lower heart rate as compared to peak exercise during a GX

Treatment of inclusion body myositis: is low-dose intravenous immunoglobulin the solution?

Inclusion body myositis (IBM), the most common inflammatory myopathy in the elderly, is often resistant to various forms of therapy. Placebo-controlled treatment trials with high dose intravenous immunoglobulins (IVIG) have shown disease amelioration in some but not all patients. Here, we present the informative case of a 70-year-old woman with diagnosed inclusion body myositis that showed progressive muscle weakness without treatment and following immuno-suppressive treatment with corticosteroids and azathioprine. A trial with low-dose intravenous immunoglobulins was started at that time. The patient responded rapidly to low dose IVIG treatment with amelioration of muscle strength and normalization of CK serum activities. Our results demonstrate that IBM patients may respond to low-dose IVIG treatment which has important clinical and economic consequence

Cable Tree Wiring -- Benchmarking Solvers on a Real-World Scheduling Problem with a Variety of Precedence Constraints

Cable trees are used in industrial products to transmit energy and information between different product parts. To this date, they are mostly assembled by humans and only few automated manufacturing solutions exist using complex robotic machines. For these machines, the wiring plan has to be translated into a wiring sequence of cable plugging operations to be followed by the machine. In this paper, we study and formalize the problem of deriving the optimal wiring sequence for a given layout of a cable tree. We summarize our investigations to model this cable tree wiring Problem (CTW) as a traveling salesman problem with atomic, soft atomic, and disjunctive precedence constraints as well as tour-dependent edge costs such that it can be solved by state-of-the-art constraint programming (CP), Optimization Modulo Theories (OMT), and mixed-integer programming (MIP) solvers. It is further shown, how the CTW problem can be viewed as a soft version of the coupled tasks scheduling problem. We discuss various modeling variants for the problem, prove its NP-hardness, and empirically compare CP, OMT, and MIP solvers on a benchmark set of 278 instances. The complete benchmark set with all models and instance data is available on github and is accepted for inclusion in the MiniZinc challenge 2020

Pancreatic stone protein as a novel marker for neonatal sepsis

Purpose: Early-onset sepsis (EOS) is one of the main causes for the admission of newborns to the neonatal intensive care unit. However, traditional infection markers are poor diagnostic markers of EOS. Pancreatic stone protein (PSP) is a promising sepsis marker in adults. The aim of this study was to investigate whether determining PSP improves the diagnosis of EOS in comparison with other infection markers. Methods: This was a prospective multicentre study involving 137 infants with a gestational age of >34weeks who were admitted with suspected EOS. PSP, procalcitonin (PCT), soluble human triggering receptor expressed on myeloid cells-1 (sTREM-1), macrophage migration inhibitory factor (MIF) and C-reactive protein (CRP) were measured at admission. Receiver-operating characteristic (ROC) curve analysis was performed. Results: The level of PSP in infected infants was significantly higher than that in uninfected ones (median 11.3 vs. 7.5ng/ml, respectively; p=0.001). The ROC area under the curve was 0.69 [95% confidence interval (CI) 0.59-0.80; p9ng/ml) and PCT (>2ng/ml) was the best predictor of EOS (0.83; 95% CI 0.74-0.93; p<0.001) and resulted in a negative predictive value of 100% and a positive predictive value of 71%. Conclusions: In this prospective study, the diagnostic performance of PSP and PCT was superior to that of traditional markers and a combination bioscore improved the diagnosis of sepsis. Our findings suggest that PSP is a valuable biomarker in combination with PCT in EO

Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates

Abstract Backgrounds The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age. Methods Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making. Results In total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category ‘infection unlikely’ and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic. Conclusions Health care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category ‘infection unlikely,’ and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs

Static behaviour of earth block masonry: experimental testing and Finite Element Modelling

In this paper an extensive research campaign aimed to define the mechanical performance of earth block masonry panels is presented. Uniaxial compression and diagonal compression tests were performed. The test results confirmed the brittle behaviour of earth block masonry under uniaxial compressive load and showed that the failure of earth block masonry under shear load occurs by sliding of the earth blocks along the mortar joints after initial cracking in mortar joints and earth blocks. For diagonal compression test results showed that building technique practice is one of the key factors affecting the structural performances. Experimental behaviour was modelled with a non-linear model capable of describing cracking behaviour. Both micro-modelling and macro-modelling implementing isotropic or orthotropic material laws were used to assess the reliability of different modelling strategies. The model calibration was carried out by sensibility analysis of the input parameters to understand the influence of unit strength on the shear behaviour of masonry

Experimental testing and finite element modelling of earth block masonry

The current paper focuses on the determination of reliable numerical models of earth block masonry wallettes under different loading conditions. Uniaxial compression and diagonal compression tests were performed. Experimental behaviour was modelled with a non-linear model able to describe the cracking behaviour. The simplified approach based on macro-modelling shows a satisfactory accuracy and low computational costs. The results reproducing the uniaxial compression are in good correspondence with the post-elastic behaviour observed in the experimental campaign. The micro-modelling approach adopted to reproduce the shear behaviour, even with high computational cost, represents a suitable tool to predict the masonry collapse mechanism. (C) 2015 Elsevier Ltd. All rights reserved