Beneficial hemodynamic effects of intravenous and oral diltiazem in severe congestive heart failure

Concern persists about the potential negative inotropic effects of calcium channel blockers in patients with severely depressed myocardial function. Therefore, intravenous diltiazem (100 to 200 ltg/kg per min infusion) was administered for 40 minutes followed by oral diltiazem (90 to 120 mg/8 hours) for 24 hours to patients with advanced congestive heart failure (New York Heart Association class III to IV, mean ejection fraction 26 ± 4 [SD]). Intravenous diltiazem (eight patients) increased cardiac index 20% (2.05 ± 0.8 to 2.47 ± 0.8 liters/min per MZ, p < 0.01), stroke volume index 50% (22 ± 9 to 33 ± 12 MI/M2, p < 0.001) and stroke work index 27% (19 ± 10 to 24 ± 10 g-m/MZ, p < 0.05); while reducing heart rate 23% (97 ± 18 to 75 ± 11 beats/min, p < 0.01), mean arterial pressure 18% (95 ± 13 to 78 ± 7 mm Hg) and pulmonary wedge pressure 34% (29 ± 9 to 19 ± 7 mm Hg), without altering maximal first derivative of left ventricular pressure (dP/dtmax). Oral diltiazem (seven patients) produced equivalent hemodynamic effects. Transient junctional arrhythmias were observed in three of eight patients with intravenous diltiazem and one of seven patients with oral diltiazem.It is concluded that intravenous and short-term oral diltiazem improve left ventricular performance and reduce myocardial oxygen demand by heart rate and afterload reduction without significantly depressing contractile function in severe congestive heart failure. Caution should be exercised to avoid potential adverse, druginduced electrophysiologic effects in such patients

Systemic NK cell ablation attenuates intra‐abdominal adipose tissue macrophage infiltration in murine obesity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108606/1/oby20823.pd

Effect of increasing the time between slurry application and first rainfall event on phosphorus concentrations in runoff

Publication history: Accepted - 26 May 2021; Published online - 12 August 2021.Minimizing slurry phosphorus (P) losses in runoff requires careful management in the context of both soil P surpluses and changing patterns in rainfall. Increasing the time interval between slurry application and the first rainstorm event is known to reduce P loss in runoff although the risk period for elevated P concentrations in runoff can extend for weeks. This study investigated the impact of increasing the time interval between slurry application and first rainstorm event on P concentrations in runoff. Simulated rainfall (40 mm h−1) was applied at 2, 4, 10, 18, 30 and 49 days after dairy slurry was surface-applied to a grassland sward in Ireland. Increasing time to runoff resulted in a decrease in dissolved reactive P concentrations from 5.0 to 1.0 mg P L−1 and a P signal in runoff for 18 days. Beyond 18 days, elevated P concentrations were observed in runoff collected from natural rainfall that preceded the day 49 rainstorm event. A published surface phosphorus and runoff model (SurPhos) was used to understand the slurry P dynamics controlling P interactions with runoff. Dissolved reactive P in runoff was predicted with accuracy by SurPhos, R2 = .89. The SurPhos model implied thatslurry P mineralization occurred during the experimental period that resulted in a small spike in P concentrations beyond the defined risk period. This study shows that the experimental data have the potential to be extrapolated to different weather scenarios using SurPhos and could test when and where slurry P could be most safely spread.Open access funding provided by IReL. WOA Institution: University College Dublin Blended DEAL: IReL

Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study

Objective: Type 2 diabetic patients have an increased arterial stiffness and a very high risk of cardiovascular death. The present study investigated the relationship between pulse pressure, an indicator of vascular stiffness, and risk of cardiovascular mortality among type 2 diabetic and non-diabetic individuals. Second, we determined the relationship between pulse pressure and its main determinant (i.e. age), and the influence of diabetes and mean arterial pressure on this relationship. Design and methods: We studied a cohort of 2484 individuals including 208 type 2 diabetic patients. Mean age and median follow-up for non-diabetic and diabetic individuals, respectively, were 61 and 66 years, and 8.8 and 8.6 years. One-hundred and sixteen non-diabetic and 34 diabetic individuals died of cardiovascular causes. Relative risks of cardiovascular mortality were estimated by Cox proportional hazards regression adjusted for age, gender and mean arterial pressure. Results: Pulse pressure was associated with cardiovascular mortality among the diabetic, but not among the non-diabetic individuals [adjusted relative risk (95% confidence interval) per 10 mmHg increase, 1.27 (1.00-1.61) and 0.98 (0.85-1.13), P interaction = 0.07]. Further adjustment for other risk factors gave similar results. The association, at baseline, between age and pulse pressure was dependent on the presence of diabetes (P interaction = 0.03) and on the mean arterial pressure (P interaction < 0.001) (i.e. there was a stronger association when diabetes was present and when mean arterial pressure was higher). Conclusions: We conclude that, in type 2 diabetes, pulse pressure is positively associated with cardiovascular mortality. The association between age and pulse pressure is influenced by the presence of type 2 diabetes and by the height of the mean arterial pressure. These findings support the concept of accelerated vascular aging in type 2 diabetes. © 2002 Lippincott Williams & Wilkins

Variability in Surgical Treatment of Spondylolisthesis Among Spine Surgeons

Background There are a multitude of treatments for low-grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach. Objective To identify the surgical treatment patterns for spondylolisthesis among United States spine surgeons. Methods 445 spine surgeons in the United States completed a survey of clinical/radiographic case scenarios on patients with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or without (S−BP) associated mechanical back pain. Treatment options included decompression, laminectomy with posterolateral fusion, posterior lumbar interbody fusion, or none of the above. The primary outcome measure was the probability of 2 randomly chosen surgeons disagreeing on the treatment method. Results There was 64% disagreement (36% agreement) among surgeons for treatment of spondylolisthesis with mechanical back pain (S+BP) and 71% disagreement (29% agreement) for spondylolisthesis without mechanical back pain (S−BP). For S+BP, disagreement was 52% for those practicing 5 to 10 years versus 70% among those practicing more than 20 years. Orthopedic surgeons had greater disagreement than did neurosurgeons (76% vs. 56%) for S+BP. Greater clinical equipoise was seen for S−BP than for S+BP regardless of surgeon characteristics. For spondylolisthesis without mechanical back pain, neurosurgeons were significantly more likely to select decompression-only than were orthopedic surgeons, who more commonly selected fusion. Conclusions Clinical equipoise exists for the treatment of spondylolisthesis. Differences are greater when the patient presents without associated back pain. Surgeon case volume, practice duration, and specialty training influence operative decisions for a given pathologic condition. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost-effective treatment paradigms

Just use it! Linguistic conversion and identities of resistance amongst Galician new speakers

In recent years there has been a focus in language policy research on understanding how national policies are interpreted and negotiated by social actors on the ground. This paper looks at the interplay between government and grassroots initiatives to create Galician-speaking spaces in predominantly Spanish-speaking urban settings. While official language policies in Galicia since the 1980s have increased the potential for language use through bilingual educational policies, these policies have failed to convert the large pool of potential speakers amongst a younger generation of Galicians into active language users. Drawing on ethnographic fieldwork and in-depth interviews with Galician neofalantes (new speakers) this paper looks at instances where such policies seem to have worked and where the linguistic capacity created through the education system has been converted into active language use. The article examines how such speakers rationalise their practice of linguistic conversion not as success stories of language policy but as reactions to and dissatisfaction with what is perceived as ‘top-down’ governmentality through a reflexive process in which existing power structures are brought into question. The article looks specifically as the ideologies underpinning their decisions to become active speakers and the role they play as language planners in contemporary Galicia

Volcanic and Tectonic Constraints on the Evolution of Venus

Surface geologic features form a detailed record of Venus’ evolution. Venus displays a profusion of volcanic and tectonics features, including both familiar and exotic forms. One challenge to assessing the role of these features in Venus’ evolution is that there are too few impact craters to permit age dates for specific features or regions. Similarly, without surface water, erosion is limited and cannot be used to evaluate age. These same observations indicate Venus has, on average, a very young surface (150–1000 Ma), with the most recent surface deformation and volcanism largely preserved on the surface except where covered by limited impact ejecta. In contrast, most geologic activity on Mars, the Moon, and Mercury occurred in the 1st billion years. Earth’s geologic processes are almost all a result of plate tectonics. Venus’ lacks such a network of connected, large scale plates, leaving the nature of Venus’ dominant geodynamic process up for debate. In this review article, we describe Venus’ key volcanic and tectonic features, models for their origin, and possible links to evolution. We also present current knowledge of the composition and thickness of the crust, lithospheric thickness, and heat flow given their critical role in shaping surface geology and interior evolution. Given Venus’ hot lithosphere, abundant activity and potential analogues of continents, roll-back subduction, and microplates, it may provide insights into early Earth, prior to the onset of true plate tectonics. We explore similarities and differences between Venus and the Proterozoic or Archean Earth. Finally, we describe the future measurements needed to advance our understanding of volcanism, tectonism, and the evolution of Venus

Acute and Chronic Impact of Dynamic Exercise on Arterial Stiffness in Older Hypertensives

Arterial stiffness increases with ageing and hypertension. Regular physical activity has been recommended as an important management component of hypertension. The purpose of this study was to examine the acute impact of maximal dynamic exercise and the effect of 20 weeks of aerobic exercise on arterial stiffness of the carotid and brachial arteries in older hypertensives. Nine previously sedentary and treated older hypertensives (2 men and 7 women, age 68.2 ± 5.4 yrs) performed maximal treadmill exercise to volitional fatigue while arterial stiffness indices (arterial distensibility and β stiffness index) were measured prior to, immediately (about 10 min) following, and 24 h following maximal exercise. These measurements were repeated following 20 weeks of moderate intensity aerobic exercise training. Maximal exercise had no impact on arterial stiffness indices immediately and 24 h following exercise intervention. Following 20 weeks of training, arterial stiffness indices remained unchanged at rest and following maximal exercise. These data show that, in older hypertensives, 1) acute maximal dynamic exercise had no impact on arterial stiffness of the carotid and brachial arteries, and 2) 20 weeks of moderate intensity aerobic exercise training failed to modify arterial stiffness