Efficiency and Safety of Prolonged Levosimendan Infusion in Patients with Acute Heart Failure

Background. Levosimendan is an inotropic drug with unique pharmacological advantages in patients with acute heart failure. Scope of this study is to determine whether longer infusion patterns without the hypotension-inducing loading dose could justify an effective and safe alternative approach. Methods. 70 patients admitted to the emergencies with decompensated chronic heart failure received intravenously levosimendan without a loading dose up to 72 hours. Clinical parameters, BNP (Brain Natriuretic Peptide) and signal-averaged-ECG data (SAECG) were recorded up to 72 hours. Results. The 48-hour group demonstrated a statistically significant BNP decrease (P < .001) after 48 hours, which also maintained after 72 hours. The 72-hour group demonstrated a bordeline decrease of BNP after 48 hours (P = .039), necessitating an additional 24-hour infusion to achieve significant reduction after 72 hours (P < .004). SAECG data demonstrated a statistically significant decrease after 72 hours (P < .04). Apart from two deaths due to advanced heart failure, no major complications were observed. Conclusion. Prolonged infusion of levosimendan without a loading dose is associated with an acceptable clinical and neurohumoral response

Development and evaluation on a wireless multi-gas-sensors system for improving traceability and transparency of table grape cold chain

There is increasing requirement to improve traceability and transparency of table grapes cold chain. Key traceability indicators including temperature, humidity and gas microenvironments (e.g., CO2, O2, and SO2) based on table grape cold chain management need to be monitored and controlled. This paper presents a Wireless Multi-Gas-Sensors System (WGS2) as an effective real-time cold chain monitoring system, which consists of three units: (1) the WMN which applies the 433 MHz as the radio frequency to increase the transmission performance and forms a wireless sensor network; (2) the WAN which serves as the intermediary to connect the users and the sensor nodes to keep the sensor data without delay by the GPRS remote transmission module; (3) the signal processing unit which contains embedded software to drive the hardware to normal operation and shelf life prediction for table grapes. Then the study evaluates the WGS2 in a cold chain scenario and analyses the monitoring data. The results show that the WGS2 is effective in monitoring quality, and improving transparency and traceability of table grape cold chains. Its deploy ability and efficiency in implantation can enable the establishment of a more efficient, transparent and traceable table grape supply chain.N/

Study of the newer echorrheological indicators in patients with heart failure treated by newer inotropic agents or biventricular pacing

The aim of this clinical study was to examine and compare the efficacy of two intravenously administered inotropic agents, levosimendan and milrinone in acute heart failure vs biventricular implantation measured by hemodynamic parameters and simple markers of cardiac function. The unique aspect of this study is the comparison between the two agents in humans while it has been an effort to provide the possible advantage by using the newer echorrheological indicators, (Tei-index, Z-Ratio, PWLvot x HR). Hemodynamic data are correlated to other measured parameters like BNP and data derived from the Signal Averaged Electrocardiogram. Participants were patients of the Second Department of Cardiology of the Aristotle University of Thessaloniki admitted to the emergency room for acute heart failure, class III or IV according to NYHA classification, without congestion but refractory clinical course with the highest dose of diuretics. They are divided into two main investigational groups: The first group received in addition to the evidence based conventional therapy for acute heart failure, infusion of levosimendan for 48 and up to 72 hours. Simple echocardiographic measurements and data from the Signal Averaged Electrocardiogram were performed at the index point, 48 hours and 72 hours after infusion, respectively. The end-points were divided into primary and secondary: The main primary end-point was defined as the hemodynamic response of each inotrope infusion after 48 or 72 hours according to echocardiographic measurements and the clinical response between the two agents. For the patients with biventricular pacing the same were calculated before implantation, after a month, three months, after six months and after a year. BNP response was not correlated to hemodynamic response. Results derived confirmed the following conclusive points: Infusion of levosimendan or milrinone without a loading dose over 24 up to 72 hours is safe and efficient for immediate clinical improvement. Both levosimendan and milrinone improved haemodynamic response as documented by means of echocardiographic parameters with a supremacy of levosimendan. In acute heart failure, the evaluation of response to the infusion of inotropic agents by means of echocardiographic parameters, is efficient safe and unreplaceble. The application of the newer echorrheological indicators in patients with biventricular pacemaker-defibrilator it was rendered awkward with low reliability. Indexes who estimates the ventricular function globally (PWLvot και PWLvot XHR), provides reliability easyness and reproducibility, estimating the total cardiac performance being able to applicate easily in this particular patients category.Σκοπός της κλινικής μελέτης είναι η εξέταση και σύγκριση της αποτελεσματικότητας των ενδοφλέβιων ινότροπων φαρμάκων λεβοσιμενδάνη και μιλρινόνη στην οξεία καρδιακή ανεπάρκεια, μετρούμενη με κλασσικές υπερηχορρεομετρικές παραμέτρους και τη συνεκτίμηση με αδρούς και νεώτερους δείκτες προσδιοριζόμενους υπερηχογραφικά. Το ίδιο εφαρμόσθηκε και σε ασθενείς φέροντες αμφικοιλιακό βηματοδότη – απινιδωτή. Η πρωτοτυπία της εργασίας έγκειται στο ότι συγκρίνονται τα δύο συγκεκριμένα φάρμακα με αιμοδυναμικά κριτήρια στον άνθρωπο ενώ γίνεται προσπάθεια ανάδειξης των ενδεχόμενων πλεονεκτημάτων από την εφαρμογή των νεώτερων υπερηχορρεομετρικών δεικτών, (Tei-index, Z-Ratio,PWLvot x HR). Στη μελέτη έλαβαν μέρος ασθενείς της B΄ Kαρδιολογικής κλινικής Α.Π.Θ. με οξεία καρδιακή ανεπάρκεια, κλάσης ΙΙΙ ή IV κατά NYHA που δεν ανταποκρίνονταν επαρκώς σε αυξημένες δόσεις διουρητικών. Καταρτίστηκαν δύο ομάδες μελέτης: Η πρώτη έλαβε εκτός της ενδεδειγμένης συμβατικής θεραπείας για καρδιακή ανεπάρκεια και λεβοσιμενδάνη, για 48 ή 72 ώρες. Στα τελικά σημεία περιλαμβάνονταν η αιμοδυναμική ανταπόκριση μετά από 24 ή 48 ώρες χορήγησης έκαστου ινότροπου φαρμάκου, όπως αυτή προσδιορίζεται από τις υπερηχοκαρδιογραφικές μετρήσεις και την κλινική ανταπόκριση. Για τους ασθενείς με αμφικοιλιακό βηματοδότη προσδιορίσθηκαν οι ίδιες μεταβλητές και η αιμοδυναμική ανταπόκριση εντός μηνός, τριμήνου, εξαμήνου και έτους από της εμφυτεύσεως. Εκ των αποτελεσμάτων της μελέτης για τους φαρμακευτικούς παράγοντες συνάγονται τα εξής συμπεράσματα: Η χορήγηση λεβοσιμενδάνης ή μιλρινόνης χωρίς δόση εφόδου για περισσότερες από 24 και μέχρι 48 ώρες είναι ασφαλής και αποτελεσματική ως προς την άμεση κλινική βελτίωση. Τόσο η λεβοσιμενδάνη όσο και η μιλρινόνη βελτίωσαν νωρίς (24 ώρες) τις υπερηχογραφικές παραμέτρους αιμοδυναμικής απάντησης με υπεροχή της λεβοσιμενδάνης. Η παρακολούθηση με υπερηχογραφικές παραμέτρους κατά τη χορήγηση ινοτρόπων φαρμάκων σε οξεία καρδιακή ανεπάρκεια με την αξιοποίηση και των νεώτερων αυτών, αποτελεί μία αναντικατάστατη, ασφαλή, αναπαραγώγιμη και αποτελεσματική μέθοδο παρακολούθησης της θεραπείας. Η εφαρμογή των νεώτερων υπερηχορρεομετρικών δεικτών σε ασθενείς με αμφικοιλιακό βηματοδότη – απινιδωτή κατέστη δυσχερής, με χαμηλή αξιοπιστία, ενώ δείκτες που εκτιμούν συνολικά την κοιλιακή λειτουργικότητα (PWLvot kai PWLvot XHR) παρέχουν ευκολία αξιοπιστία και αναπαραγωγιμότητα, εκτιμώντας το σύνολο της κοιλιακής απόδοσης δυνάμενοι να εφαρμοσθούν ευχερώς σε αυτή την κατηγορία ασθενών

Influences of packaging attributes on consumer purchase decisions for fresh produce, Appetite 59

a b s t r a c t Packaging attributes are considered to have an influence on consumer purchase decisions for food and, as a consequence, also on its consumption. To improve the current minimal understanding of these influences for fresh produce, a survey instrument in the form of an online questionnaire has been developed and launched in the US. The first part of the questionnaire covers consumers&apos; preferences for packaging convenience features, characteristics, materials, disposal method, and others for fresh produces in general, and the second focuses on attributes like price, container size, produce shelf life for a specific fresh produce, sweet cherries, to allow us to supply specific values for these factors to the participants. Cluster and conjoint analyses of responses from 292 participants reveal that specific packaging and produce attributes affect consumer purchase decisions of fresh produce in general and of sweet cherries in particular (P 6 0.05) and that some are population segment dependent (P 6 0.05). For produce packaging in general, &apos;extend the &apos;&apos;best by&apos;&apos; date&apos; was ranked as the top convenience feature, the type of packaging material was considered to affect the food product quality (92.7%) and containers made from bio-based materials were highly appealing (3.52 out of 5.00). The most important attributes that affect the purchasing decisions of consumers regarding a specific fresh produce like sweet cherries are price (25%), shelf life (19%) and container size (17.2%)