Is It Time to Beta Block the Septic Patient?

Beta blockers are some of the most studied drugs in the pharmacopoeia. They are already widely used in medicine for treating hypertension, chronic heart failure, tachyarrhythmias, and tremor. Whilst their use in the immediate perioperative patient has been questioned, the use of esmolol in the patients with established septic shock has been recently reported to have favourable outcomes. In this paper, we review the role of the adrenergic system in sepsis and the evidence for the use of beta stimulation and beta blockers from animal models to critically ill patients

Reproducibility of measurement techniques used for creatine kinase, interleukin-6 and high-sensitivity C-reactive protein determination over a 48 h period in males and females

To examine the reproducibility of three measurement techniques used to determine creatine kinase, interleukin-6 and high-sensitivity C-reactive protein, 50 participants had blood samples taken on two occasions. Fingertip plasma samples were analysed using the Reflotron for CK determination. Venous blood samples collected into serum separator tubes were used for IL-6 and hs-CRP analyses. IL-6 was measured using an enzyme linked immune assay development kit. The hs-CRP was measured by an in-house ELISA method. Dependent t-tests showed no systematic bias between samples. The interdian CV was 20.0% for CK, 15.3% for IL-6 and 44.2% for hs-CRP. The intraclass correlation coefficient was 0.90 for CK, 0.98 for IL-6 and 0.70 for hs-CRP. The 95% limits of agreement were ?69.7 to 63.5 IU/L for CK, ?1.48 to 1.80?pg/ml for IL-6 and ?1.10 to 0.91??g/L for hs-CRP. The results demonstrate low absolute reproducibility, which may obscure a true experimental effect. ? 2018, ? 2018 Taylor & Francis.Association of Anaesthetists of Great Britain and Ireland, University of Western Sydney, Aspetar Orthopaedic and Sports Medicine Hospital, Central Manchester University Hospitals NHS Foundation Trust, Loughborough University, College of Arts and Sciences, Boston University, University of Hul

Inbreeding depression across the lifespan in a wild mammal population

Inbreeding depression is of major concern for the conservation of threatened species, and inbreeding avoidance is thought to be a key driver in the evolution of mating systems. However, the estimation of individual inbreeding coefficients in natural populations has been challenging, and, consequently, the full effect of inbreeding on fitness remains unclear. Genomic inbreeding coefficients may resolve the long-standing paucity of data on inbreeding depression in adult traits and total fitness. Here we investigate inbreeding depression in a range of life history traits and fitness in a wild population of red deer (Cervus elaphus) in Scotland using individual inbreeding coefficients derived from dense Single-Nucleotide Polymorphism (SNP) data (Fgrm). We find associations between Fgrm and annual breeding success in both sexes, and between maternal inbreeding coefficient and offspring survival. We also confirm previous findings of inbreeding depression in birth weight and juvenile survival. In contrast, inbreeding coefficients calculated from a deep and comparatively complete pedigree detected inbreeding depression in juvenile survival, but not in any adult fitness component. The total effect of inbreeding on lifetime breeding success (LBS) was substantial in both sexes: for Fgrm =0.125, a value resulting from a half-sib mating, LBS declined by 72% for females and 95% for males. Our results demonstrate that SNP-based estimates of inbreeding provide a powerful tool for evaluating inbreeding depression in natural populations, and suggest that, to date, the prevalence of inbreeding depression in adult traits may have been underestimated

Analisis Biaya Diferensial Sebagai Dasar Pengambilan Keputusan Menerima Atau Menolak Pesanan Khusus (Studi Kasus Pada Perusahaan Kecap Cap “Kuda” Tulungagung Tahun 2013)

This research aims to describe analysis ofdifferential cost fordecision making acceptor rejectspecial order in KetchupCompanystamp of"Kuda". The research method used in this research is descriptive case study approach. The focus ofthis researchare thesales data, production data, cost production data, dataof non-costs production, and income report of"Kuda" KetchupCompanyin 2013. The collecting data technique usedin this research is documentation. The sourceof data for this research isthe secondarydata source. The result of this research are: the company will receive additional profits of Rp 2.748.258,96 if the company received special order from UD. Jiar; the company will receive additional profits of Rp 2.392.904,17 if the company received special order from UD. Sumber Rejeki.Based on this research, then the companysuggested to receive the special order from UD. Jiar and UD. Sumber Rejeki, because receive the special order make the company get additional profits

Is It Time to Beta Block the Septic Patient?

Beta blockers are some of the most studied drugs in the pharmacopoeia. They are already widely used in medicine for treating hypertension, chronic heart failure, tachyarrhythmias, and tremor. Whilst their use in the immediate perioperative patient has been questioned, the use of esmolol in the patients with established septic shock has been recently reported to have favourable outcomes. In this paper, we review the role of the adrenergic system in sepsis and the evidence for the use of beta stimulation and beta blockers from animal models to critically ill patients.Peer Reviewe

Reproducibility of creatine kinase: how useful is this measurement tool?

Establishing the reproducibility of a measurement is essential for repeated testing to ensure that any systematic change is a result of an external influence (i.e. intervention), as oppossed to normal random variation. Although some degree of error is inherent in any measure, a measurement tool should yield consistent results that do not fluctuate to an unacceptable degree from one test to another. Creatine kinase (CK) is consistently measured in the blood as a marker of exercise induced muscle damage (EIMD). However, its usefulness as a predictive tool to examine the temporal pattern, and magnitude of muscle damage has been questioned. PURPOSE:The main aim of the present study was to employ a variety of reproducibility statistics in order to examine the typical level of measurement error for CK. METHODS: Fifty (36 male, 14 female), apparently healthy participants completed three trials on three separate occasions with each trial separated by 48 - 72 h. The initial trial served as a familiarisation. During trials 2 and 3 (48 h), CK measures were obtained using standard fingerprick technique, and analysed in duplicate immediatley using a colorimetric assay procedure. Each participant completed their trials at the same time of day, following identical pre-test procedures. RESULTS: The intra-test coefficient of variation (CV) within our laboratory was 9%. Dependent t-tests indicated there was no systematic bias between trials (p = 0.82). The interdian CV displayed low reproducibility (20%). Furthermore, the 95% limits of agreement (LoA) were -69.7 to 63.5 iµ/L. However, the intraclass correlation coefficient (ICC) was 0.90, which can be clasified as displaying ‘high’ reproducibility. CONCLUSION: The interdian CV demonstrates that under identical resting conditions (48 h apart), CK displays inherent low absoulte reproducibility, which may obscure a true experimental effect. However, interpretation of the ICC, suggests that CK has high relative reproducibility. The high range of observed CK values is thought to have increased the size of the correlation. Subsequently, an indivdual change in CK following EIMD may not be indicative of the magnitude of damage, and may simply be a result of the inherent variation (e.g. biological). Therefore, it is advised that caution should be taken when using CK within experimental research, and as an indication of when an athlete has recovered, and is able to recommence training

Inbreeding depression by environment interactions in a free-living mammal population

Experimental studies often find that inbreeding depression is more severe in harsh environments, but the few studies of in situ wild populations available to date rarely find strong support for this effect. We investigated evidence for inbreeding depression by environment interactions in nine traits in the individually monitored Soay sheep population of St Kilda, using genomic inbreeding coefficients based on 37 037 single-nucleotide polymorphism loci, and population density as an axis of environmental variation. All traits showed variation with population density and all traits showed some evidence for depression because of either an individual's own inbreeding or maternal inbreeding. However, only six traits showed evidence for an interaction in the expected direction, and only two interactions were statistically significant. We identify three possible reasons why wild population studies may generally fail to find strong support for interactions between inbreeding depression and environmental variation compared with experimental studies. First, for species with biparental inbreeding only, the amount of observed inbreeding in natural populations is generally low compared with that used in experimental studies. Second, it is possible that experimental studies sometimes actually impose higher levels of stress than organisms experience in the wild. Third, some purging of the deleterious recessive alleles that underpin interaction effects may occur in the wild

A conceptual framework for evaluating cooking systems

PUBLISHED 7 March 2022Tami C Bond, Christian L, Orange, Paul R Medwell, George Sizoomu, Samer Abdelnour, Verena Brinkmann, Philip Lloyd and Crispin Pemberton-Pigot

The effect of atorvastatin (and subsequent metformin) on adipose tissue acylation-stimulatory-protein concentration and inflammatory biomarkers in overweight/obese women with polycystic ovary syndrome

Copyright © 2019 Sathyapalan, Hobkirk, Javed, Carroll, Coady, Pemberton, Smith, Cianflone and Atkin. Background: Atorvastatin has been shown to improve cardiovascular risk (CVR) indices in women with polycystic ovary syndrome (PCOS). Low-grade chronic inflammation of adipose tissue may link PCOS and adverse CVR. In pro-inflammatory states such as PCOS, spontaneous activation of the alternative pathway of complement results in increased generation of acylation stimulating protein (ASP) from adipocytes irrespective of body mass index. Methods: The objective of this study was to determine the effect of atorvastatin on markers of adipose tissue dysfunction and inflammation; acylation-stimulating-protein (ASP), interleukin-6 (IL-6), and monocyte-chemoattractant-protein-1 (MCP-1) in PCOS. This was a randomized, double-blind, placebo-controlled study where 40 medication-naive women with PCOS and biochemical hyperandrogenaemia were randomized to either atorvastatin 20 mg daily or placebo for 12 weeks. Following the 12 week randomization; both group of women with PCOS were subsequently started on metformin 1,500 mg daily for further 12 weeks to assess whether pre-treatment with atorvastatin potentiates the effects of metformin on markers of adipose tissue function We conducted a post-hoc review to detect plasma ASP and the pro-inflammatory cytokines IL6 and MCP-1 before and after 12 and 24 weeks of treatment. Results: There was significant reduction in ASP (156.7 ± 16.2 vs. 124.4 ± 14.8 ng/ml

Biomarkers of oxidant stress, insulin sensitivity and endothelial activation in rheumatoid arthritis: a cross-sectional study of their association with accelerated atherosclerosis

<p>Abstract</p> <p>Background</p> <p>Women with rheumatoid arthritis (RA) have increased morbidity and mortality due to coronary heart disease. Chronic systemic inflammation is known to accelerate atherosclerosis and increase arterial stiffness in patients, but other mechanisms may also be involved. Biomarkers of oxidant stress, inflammation, insulinaemia and endothelial dysfunction were measured in blood and urine from 46 RA patients and 48 age-matched controls. Plaque formation and intima-medial thickness (IMT) were measured using B-mode carotid Doppler scan.</p> <p>Findings</p> <p>The prevalence of plaque was increased (p = 0.042) in RA patients between 50–59 years old compared to the same age group in controls. 8-isoprostane (p = 0.004), C-reactive protein (p < 0.001), interleukin-6 (p < 0.001), insulin (p = 0.035), adiponectin (p = 0.012), vascular cell adhesion molecule (VCAM) (p = 0.029) and E-selectin (p < 0.001) were all increased while selenium (p = 0.003) and LDL-cholesterol (p = 0.025) were both decreased in all RA patients. 8-isoprostane correlated with 10 year cardiac risk (r = 0.55, p < 0.001), VCAM with IMT (r = 0.37, p = 0.012) and E-selectin with rheumatoid factor titre (r = 0.43, p = 0.003) in RA patients. In the control group, age, carotid IMT, VCAM, systolic blood pressure and smoking status were all associated with plaque development whereas in RA patients only age was associated with plaque.</p> <p>Conclusion</p> <p>The burden of atherosclerosis is particularly increased in middle-aged women with RA. Patients with RA have increased levels of oxidant stress, inflammation, insulin and soluble adhesion molecules. As the association between classical risk factors was much weaker in RA patients compared to controls, these additional factors may be more important in the accelerated development of atheroma in RA.</p