Natriuretic peptide-directed medical therapy: a systematic review

Abstract Natriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcome was to determine whether NP-directed medical therapy is effective in reducing NP levels within 6 months, compared to standard of care. The secondary outcome was to determine whether reducing NP levels is associated with decreased mortality. Full texts of 18 trials were reviewed. NP-directed medical therapy showed no significant difference compared to standard care in decreasing NP levels (standardized mean difference − 0.04 (− 0.16, 0.07)), but was associated with a 6-month (relative risk (RR) 0.82 (95% confidence interval (CI) 0.68–0.99)) reduction in mortality

Management of HIV-associated cryptococcal disease in South Africa

In routine-care settings, the 10-week mortality associated with cryptococcal meningitis (CM) is high, even with prompt, appropriate antifungal treatment and correctly timed initiation of antiretroviral therapy (ART). While early diagnosis of HIV infection and initiation of ART prior to the development of AIDS is the most important way to reduce the incidence of CM, a cryptococcal antigenaemiascreen-and-treat intervention has the potential to reduce mortality by identifying patients prior to onset of CM. Antifungal treatment for HIV-associated CM is divided into three phases over a minimum period of 1 year: (i) a 2-week induction phase, including intravenous amphotericin B deoxycholate as a backbone; (ii) an 8-week consolidation phase with fluconazole 400 mg daily; and (iii) a maintenance phase with fluconazole 200 mg daily. Amphotericin B should be paired with another antifungal agent to maximise cerebrospinal fluid fungal clearance. World Health Organization guidelines emphasise that patients receiving amphotericin B-containing regimens should have access to a ‘minimum package of toxicity prevention, monitoring and management to minimise the serious amphotericin B-related toxicities particularly hypokalaemia and nephrotoxicity’. Raised intracranial pressure is a serious and often fatal complication of CM, which requires good pressure management with repeat lumbar punctures. ART should be initiated 4 - 6 weeks after starting antifungal therapy. In many cases, relapse CM among South African patients occurs because of suboptimal adherence to secondary prophylaxis with fluconazoleand/or the antifungal not being prescribed

A causal model of radiating stellar collapse

We find a simple exact model of radiating stellar collapse, with a shear-free and non-accelerating interior matched to a Vaidya exterior. The heat flux is subject to causal thermodynamics, leading to self-consistent determination of the temperature $T$. We solve for $T$ exactly when the mean collision time $\tau_{c}$ is constant, and perturbatively in a more realistic case of variable $\tau_{c}$. Causal thermodynamics predicts temperature behaviour that can differ significantly from the predictions of non-causal theory. In particular, the causal theory gives a higher central temperature and greater temperature gradient.Comment: Latex [ioplppt style] 9 pages; to appear Class. Quantum Gra

The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review

Abstract Exercise is recommended in patients with cardiac failure. In the perioperative patient, exercise is also gaining popularity as a form of prehabilitation. In this meta-analysis, we examine if exercise is able to reduce natriuretic peptide levels. Natriuretic peptide (NP) has strong prognostic ability in identifying patients who will develop adverse postoperative cardiovascular outcomes. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcomes were to determine whether exercise therapy was effective in reducing NP levels as compared to control group, the shortest time period required to reduce NP levels after exercise therapy, and whether reducing NP levels decreased morbidity and mortality. Full texts of 16 trials were retrieved for this review. Exercise therapy showed a significant reduction in natriuretic peptide levels between the intervention and control groups (SMD − 0.45, 95% CI − 0.88 to − 0.03) with significant heterogeneity between the included trials. This was also shown in the within a 12-week period

Mass and Charge in Brane-World and Non-Compact Kaluza-Klein Theories in 5 Dim

In classical Kaluza-Klein theory, with compactified extra dimensions and without scalar field, the rest mass as well as the electric charge of test particles are constants of motion. We show that in the case of a large extra dimension this is no longer so. We propose the Hamilton-Jacobi formalism, instead of the geodesic equation, for the study of test particles moving in a five-dimensional background metric. This formalism has a number of advantages: (i) it provides a clear and invariant definition of rest mass, without the ambiguities associated with the choice of the parameters used along the motion in 5D and 4D, (ii) the electromagnetic field can be easily incorporated in the discussion, and (iii) we avoid the difficulties associated with the "splitting" of the geodesic equation. For particles moving in a general 5D metric, we show how the effective rest mass, as measured by an observer in 4D, varies as a consequence of the large extra dimension. Also, the fifth component of the momentum changes along the motion. This component can be identified with the electric charge of test particles. With this interpretation, both the rest mass and the charge vary along the trajectory. The constant of motion is now a combination of these quantities. We study the cosmological variations of charge and rest mass in a five-dimensional bulk metric which is used to embed the standard k = 0 FRW universes. The time variations in the fine structure "constant" and the Thomson cross section are also discussed.Comment: V2: References added, discussion extended. V3 is identical to V2, references updated. To appear in General Relativity and Gravitatio

Neurophysiologic, phenomenological, cultural, social and spiritual correlates of empathy experiences: integral psychological and person centered perspectives

The main objective of this research was to explore neurophysiologic, phenomenological, cultural and social correlates of recipients’ experiences of empathy within the context of Wilber’s Integral approach and Person Centered theory and practice. Thirteen psychologists participated as co-researchers in a triangulated, within subjects’ post-test experimental design in which empathy data were compared with data from control conditions of factual information processing and rest. A consistent pattern emerged from data gathered. Empathy experiences were associated with an unexpected, statistically significant increase in alpha activity, with some associated increasing trends in theta and beta activity. Expected findings were significant decreases in delta activity accompanied by decreasing  trends in gamma wave activity, muscle tension, heart and respiration rate. Individual experiences generally reflected an affective, interpersonal,  cultural, social and spiritual state of normal waking consciousness. Participant consensus was that the neurophysiologic and other correlates corresponded truthfully with typical empathic moments, insights and/or peak experiences, which are associated with effective therapeutic change in traditional and contemporary healing contexts.Key words: Neurophysiologic, phenomenological, cultural, social, spiritual, correlates, empathy experiences, integral psychology, person centered psychotherap