Reference Values for Peak Exercise Cardiac Output in Healthy Individuals

BACKGROUND: Cardiac output (Q\u2d9) is a key parameter in the assessment of cardiac function, its measurement being crucial for the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, Q\u2d9 determination at peak exercise has been possible through invasive methods, so that normal values were obtained in studies based on small populations. METHODS: Nowadays, peak Q\u2d9 can be measured noninvasively by means of the inert gas rebreathing (IGR) technique. The present study was undertaken to provide reference values for peak Q\u2d9 in the normal general population and to obtain a formula able to estimate peak exercise Q\u2d9 from measured peak oxygen uptake (V\u2d9o2). RESULTS: We studied 500 normal subjects (age, 44.9 \ub1 1.5 years; range, 18-77 years; 260 men, 240 women) who underwent a maximal cardiopulmonary exercise test with peak Q\u2d9 measurement by IGR. In the overall study sample, peak Q\u2d9 was 13.2 \ub1 3.5 L/min (men, 15.3 \ub1 3.3 L/min; women, 11.0 \ub1 2.0 L/min; P < .001) and peak V\u2d9o2 was 95% \ub1 18% of the maximum predicted value (men, 95% \ub1 19%; women, 95% \ub1 18%). Peak V\u2d9o2 and peak Q\u2d9 progressively decreased with age (R2, 0.082; P < .001; and R2, 0.144; P < .001, respectively). The V\u2d9o2-derived formula to measure Q\u2d9 at peak exercise was (4.4 7 peak V\u2d9o2) + 4.3 in the overall study cohort, (4.3 7 peak V\u2d9o2) + 4.5 in men, and (4.9 7 peak V\u2d9o2) + 3.6 in women. CONCLUSIONS: The simultaneous measurement of Q\u2d9 and V\u2d9o2 at peak exercise in a large sample of healthy subjects provided an equation to predict peak Q\u2d9 from peak V\u2d9o2 values

Hes3 regulates cell number in cultures from glioblastoma multiforme with stem cell characteristics

Tumors exhibit complex organization and contain a variety of cell populations. The realization that the regenerative properties of a tumor may be largely confined to a cell subpopulation (cancer stem cell) is driving a new era of anti-cancer research. Cancer stem cells from Glioblastoma Multiforme tumors express markers that are also expressed in non-cancerous neural stem cells, including nestin and Sox2. We previously showed that the transcription factor Hes3 is a marker of neural stem cells, and that its expression is inhibited by JAK activity. Here we show that Hes3 is also expressed in cultures from glioblastoma multiforme which express neural stem cell markers, can differentiate into neurons and glia, and can recapitulate the tumor of origin when transplanted into immunocompromised mice. Similar to observations in neural stem cells, JAK inhibits Hes3 expression. Hes3 RNA interference reduces the number of cultured glioblastoma cells suggesting a novel therapeutic strategy

Multicenter survey on emergency nurses’ perception of Numerical Rating Scale reliability at triage time in adult Emergency Department patients

Since pain perception is highly subjective and culturally mediated, its objective evaluation remains difficult. Nevertheless, pain measurement should ideally be a part of the assessment of patients in order to plan adequate pain relief. Several scales have been proposed for pain measurement, being the numerical rating scale (NRS) the most widely used, often at triage time. NRS have demonstrated acceptable reliability and validity, in post-operative medicine and in oncologic pain, but data in the Emergency Departments (EDs) are poor. The aim of this study is to evaluate the Emergency Nurses’ (ENs) perception about the reliability of NRS in the triage process. A questionnaire based on 11 items was designed and subsequently administered to a large number of ENs in several EDs in Northern and Central Italy. 301 questionnaires were filled out and returned. The majority declares using NRS scale to measure pain (item 2, mode = 4, mean = 3.8), and attributing priority code based on NRS value (item 3, mode = 4, mean = 3.4). In general, triage nurses believe that NRS is only indicative and that their judgement matters (item 4, mode = 4, mean = 3.2). The vast majority of triage nurses do believe that the patients will indicate a fake higher NRS value with the aim to get a more urgent code (item 5, mode = 5, mean = 4), while only a small minority expects that patients would underestimate their NRS for fear of penalizing more urgent patients. Very few believe that such scale underestimates the patients’ condition, while the majority is ambivalent about whether such scale overestimates it. In conclusion, NRS confirms to be a potentially valuable tool for pain evaluation at triage time, but many nurses express some doubts on its reliability, and will attribute the triage code mainly basing on their own judgement

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG