Clinical training stress and autonomic nervous function in female medical technology students : analysis of heart rate variability and 1/f fluctuation

To evaluate the level of stress induced by clinical training, ambulatory electrocardiograms from 12 healthy female medical technology students were recorded and the spectral components of heart rate variability (HRV) were analyzed as an index of autonomic nervous function. The HF power reflecting parasympathetic tone was significantly decreased at awakening, compared with that before clinical training (p 0.01). The LF/HF ratio reflecting sympathetic activity also significantly increased during, compared with before clinical training (p 0.01). The slope of the spectral density also changed before and during the clinical training from -1.20 0.04 to -1.09 0.03 (p 0.05). The 1/f fluctuation of HRV appeared comfortable, and tension was apparently adequate while undergoing clinical training. None of these HRV indices statistically changed while asleep. Thus, the students perceived the stress as a comfortable level of tension and analyzing spectral components and 1/f fluctuation of HRV might be a useful method for evaluating study stress

Noncommutative Burgers Equation

We present a noncommutative version of the Burgers equation which possesses the Lax representation and discuss the integrability in detail. We find a noncommutative version of the Cole-Hopf transformation and succeed in the linearization of it. The linearized equation is the (noncommutative) diffusion equation and exactly solved. We also discuss the properties of some exact solutions. The result shows that the noncommutative Burgers equation is completely integrable even though it contains infinite number of time derivatives. Furthermore, we derive the noncommutative Burgers equation from the noncommutative (anti-)self-dual Yang-Mills equation by reduction, which is an evidence for the noncommutative Ward conjecture. Finally, we present a noncommutative version of the Burgers hierarchy by both the Lax-pair generating technique and the Sato's approach.Comment: 24 pages, LaTeX, 1 figure; v2: discussions on Ward conjecture, Sato theory and the integrability added, references added, version to appear in J. Phys.

Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma

The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general surgeons. Surgery is reserved for complications of the disease, refractory disease, or rare causes of ulcer disease such as gastrinoma and Zollinger–Ellison syndrome. In this report, we describe a case of intractable peptic ulcer disease that progressed to gastric outlet obstruction despite maximal medical therapy. We review the diagnostic studies utilized to evaluate the potential etiologies of peptic ulcer disease and the difficulty in diagnosing gastrinoma and Zollinger–Ellison in the setting of potent medical acid suppression therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44437/1/10620_2005_Article_2999.pd

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None