Diagnosis and treatment of interstitial lung disease related to systemic autoimmune myopathies: a narrative review.

Systemic autoimmune myopathies (SAMs) are rare diseases that lead to muscle inflammation and may be associated with a variety of systemic manifestations. Although there is great heterogeneity in the spectrum of extra-muscular involvement in SAMs, interstitial lung disease (ILD) is the most frequent lung manifestation. SAM-related ILD (SAM-ILD) presents significant variations according to geographic location and temporal trends and is associated with increased morbidity and mortality. Several myositis autoantibodies have been discovered over the last decades, including antibodies targeting aminoacyl-tRNA synthetase enzymes, which are associated with a variable risk of developing ILD and a myriad of other clinical features. In this review, the most relevant topics regarding clinical manifestations, risk factors, diagnostic tests, autoantibodies, treatment, and prognosis of SAM-ILD are highlighted. We searched PubMed for relevant articles published in English, Portuguese, or Spanish from January 2002 to September 2022. The most common SAM-ILD patterns are nonspecific interstitial pneumonia and organizing pneumonia. The combination of clinical, functional, laboratory, and tomographic features is usually sufficient for diagnostic confirmation, without the need for additional invasive methods. Glucocorticoids remain the first-line treatment for SAM-ILD, although other traditional immunosuppressants, such as azathioprine, mycophenolate, and cyclophosphamide have demonstrated some efficacy and, therefore, have an important role as steroid-sparing agents.

Left ventricular pseudoaneurysm associated with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is associated with several cardiac manifestations but, to our knowledge, there have been no previously published reports on left ventricular (LV) pseudoaneurysm in this disease. We describe a case of a 30-year-old woman with SLE who presented with a disease flare (acute and subacute cutaneous lupus, pericarditis, fever, leukopenia) associated with heart failure syndrome. The patient was diagnosed with a large LV pseudoaneurysm and a bovine pericardium patch closure was performed. Coronary arteries were angiographically normal, and cardiac magnetic resonance imaging did not exhibit detectable myocardial fibrosis or infarction. Trauma, previous cardiac surgery, Chagas disease, and antiphospholipid syndrome were excluded. Histopathology of the pericardium revealed lymphocytic arteriolitis raising the possibility of an autoimmune-mediated mechanism for this complication. The unequivocal concomitant diagnosis of lupus flare, the exclusion of other causes of pseudoaneurysm and the histopathological finding of arteriolitis in this patient reinforces the hypothesis of lupus-mediated lesion.

Detection of myocardial ischaemia by epicardial accelerometers in the pig.

BACKGROUND: We describe a novel technique for continuous real-time assessment of myocardial ischaemia using a three-axis accelerometer. METHODS: In 14 anaesthetized open-chest pigs, two accelerometers were sutured on the left ventricle (LV) surface in the perfusion areas of the left anterior descending (LAD) and circumflex (CX) arteries. Acceleration was measured in the longitudinal, circumferential, and radial directions, and the corresponding epicardial velocities were calculated. Regional LV dysfunction was induced by LAD occlusion for 60 s. Global LV function was altered by nitroprusside, epinephrine, esmolol, and fluid loading. Epicardial velocities were compared with strain by echocardiography during LAD occlusion and with aortic flow and LV dP/dt(max) during interventions on global LV function. RESULTS: LAD occlusion induced ischaemia, shown by lengthening in systolic strain in the LV apical anterior region (P<0.01) and concurrent changes in LAD accelerometer circumferential velocities during systole (P<0.01) and during the isovolumic relaxation phase (P<0.01). The changes in accelerometer circumferential velocities during LAD occlusion were greater compared with the changes during the interventions on global function (P<0.01). For the LAD accelerometer circumferential velocities, sensitivity was 94-100% and specificity was 92-94% in detecting ischaemia. CONCLUSIONS: Myocardial ischaemia can be detected with epicardial three-axis accelerometers. The accelerometer had the ability to distinguish ischaemia from interventions altering global myocardial function. This novel technique may be used for continuous real-time monitoring of myocardial ischaemia during and after cardiac surgery.

Acoustic properties of NC100100 and their relation with the microbubble size distribution.

RATIONALE AND OBJECTIVES: NC100100 is a contrast agent for medical imaging with ultrasonography consisting of stabilized gas microbubbles in an aqueous suspension. The objective of this article is to explore the acoustic properties of NC100100 and their relation with the microbubble size distribution. The results are used to motivate the choice of a suitable assay/dosage parameter for precise control of product efficacy. METHODS: The concentration and size distribution of microbubbles in > 50 preparations of NC100100 were determined by Coulter counting, and the acoustic attenuation and backscatter efficacy were determined for all samples. The in vivo efficacy of the product was investigated by harmonic imaging of the heart in a dog model. RESULTS: The results demonstrated that the attenuation and backscatter efficacy per microbubble volume vary strongly with size, showing distinct maxima with respect to microbubble diameter. Sizes for optimal attenuation per volume ranged from 2.6 to 5.8 microns, depending on ultrasound frequency. The contribution of the smaller end tail of the microbubble distribution was shown to be negligible. From the observed size dependency for the acoustic properties, the volume concentration of microbubbles was chosen as the assay/dosage parameter for NC100100. The accuracy of this parameter as a descriptor of product efficacy was demonstrated by precise, linear relations between volume, concentration, and attenuation/backscatter. In comparison, the correlation between the microbubble number and acoustic properties was not significant. Results from the in vivo study showed a precise, linear relation between injected microbubble volume and the observed in vivo efficacy. CONCLUSIONS: The acoustic properties of NC100100 are dependent on microbubble size. The observed batch-to-batch variance in the acoustic properties of the product may be fully explained by variation in concentration and size. Microbubble volume is a more precise predictor of in vitro/in vivo efficacy than microbubble number and consequently was chosen as the assay/dosage parameter for NC100100.

Effect of microsphere size distribution on the ultrasonographic contrast efficacy of air-filled albumin microspheres in the left ventricle of dog hearts.

RATIONALE AND OBJECTIVES: The in vitro ultrasonographic contrast efficacy of air-filled albumin microspheres has been found to depend on the size distribution of microspheres. The objective of the current study was to empirically describe the relationship between the size distribution of injected air-filled albumin microspheres and the in vivo contrast efficacy after lung capillary filtration in a dog model. METHODS: Twenty different air-filled microspheres with large and well-defined differences in size distribution were prepared from nine different batches of Albunex (Molecular Biosystems Inc.) and subsequently characterized by Coulter counting. The in vivo ultrasonographic contrast enhancement of these preparations was investigated with a VingMed CFM750 in closed chest model in six mongrel dogs. The observed contrast efficacy, measured as gray-level enhancement in the left ventricle (LV), was correlated to the microsphere size distribution, using both univariate and multivariate approaches. RESULTS: The results demonstrated a significant contribution to LV contrast efficacy from microspheres larger than approximately 7 microm, and a lack of contribution from microspheres smaller than approximately 7 microm. Linear relationships were found between LV contrast efficacy, and both the number concentration of microspheres between 8 to 12 microm and the total microsphere volume concentration. No significant covariance between in vivo contrast efficacy and the number concentration between 1 to 38 microm or 4 to 10 microm was observed. The multivariate model showed a significant contribution to the in vivo gray-level enhancement from microspheres in the size range 7 to 15 microm, with optimal efficacy per microsphere at approximately 13 microm. CONCLUSIONS: Large microspheres (> 7 microm), which had been expected to be trapped in the lung capillary bed, contribute most of the observed ultrasound contrast in the LV of the heart.

Automatic target detection and recognition in multiband imagery: a unified ML detection and estimation approach.

Multispectral or hyperspectral sensors can facilitate automatic target detection and recognition in clutter since natural clutter from vegetation is characterized by a grey body, and man-made objects, compared with blackbody radiators, emit radiation more strongly at some wavelengths. Various types of data fusion of the spectral-spatial features contained in multiband imagery developed for detecting and recognizing low-contrast targets in clutter appear to have a common framework. A generalized hypothesis test on the observed data is formulated by partitioning the received bands into two groups. In one group, targets exhibit substantial coloring in their signatures but behave either like grey bodies or emit negligible radiant energy in the other group. This general observation about the data generalizes the data models used previously. A unified framework for these problems, which utilizes a maximum likelihood ratio approach to detection, is presented. Within this framework, a performance evaluation and a comparison of the various types of multiband detectors are conducted by finding the gain of the SNR needed for detection as well as the gain required for separability between the target classes used for recognition. Certain multiband detectors become special cases in this framework. The incremental gains in SNR and separability obtained by using what are called target-feature bands plus clutter-reference bands are studied. Certain essential parameters are defined that effect the gains in SNR and target separability.

Oscillations of polymeric microbubbles: effect of the encapsulating shell

A model for the oscillation of gas bubbles encapsulated in a thin shell has been developed. The model depends on viscous and elastic properties of the shell, described by thickness, shear modulus, and shear viscosity. This theory was used to describe an experimental ultrasound contrast agent from Nycomed, composed of air bubbles encapsulated in a polymer shell. Theoretical calculations were compared with measurements of acoustic attenuation at amplitudes where bubble oscillations are linear. A good fit between measured and calculated results was obtained. The results were used to estimate the viscoelastic properties of the shell material. The shell shear modulus was estimated to between 10.6 and 12.9 MPa, the shell viscosity was estimated to between 0.39 and 0.49 Pas. The shell thickness was 5% of the particle radius. These results imply that the particles are around 20 times more rigid than free air bubbles, and that the oscillations are heavily damped, corresponding to Q-values around 1. We conclude that the shell strongly alters the acoustic behavior of the bubbles: The stiffness and viscosity of the particles are mainly determined by the encapsulating shell, not by the air inside.

Electrocortical activity characteristic of vitamin B6 deficiency in the rat.

Vitamin B6 deficiency is characterized by a variety of changes in the central nervous system. Weanling male white rats, fed different levels of pyridoxine for 60 days, showed consistent differences in both amplitude and frequency of their electrocortical activity. The more deficient animals displayed higher EEG voltages and a higher dominant frequency. These two effects were systematically related to pyridoxine intake and provided similar dose-response curves. The nutritional requirement for vitamin B6, as estimated from the EEG data, was in good agreement with that estimated from growth response data.

Effect of major nutrient substitutions on body weight gain, blood glucose and cholesterol levels, and the rate of drug metabolism in the liver.

Rats were fed diets resembling a normal human diet, except that, in a complete factorial fashion, safflower oil and/or mineral oil were substituted for part of the fat, while fructose, lactose and/or cellulose were substituted for carbohydrate, and zein was substituted for milk protein. Food intake and weight gain were not influenced by cellulose and mineral oil, but zein decreased both substantially. Plasma cholesterol was unchanged by safflower oil or mineral oil but was decreased by fructose. Plasma glucose was reduced as the starch-to-sugar ratio increased. The rate of aniline metabolism was increased by lactose and/or zein, but the rate of ethylmorphine metabolism was decreased by safflower oil or mineral oil.

Ultrasound scattering properties of Albunex microspheres.

Albunex is an ultrasound contrast agent used in echocardiography and in other areas, it consists of microspheres of which more than 95% have a diameter in the range 1-10 microns. The scattering properties of this agent as functions of ultrasound frequency and microsphere diameter and concentration are investigated. A model of the Albunex microspheres has been previously described, considering the individual microspheres as air bubbles surrounded by a thin elastic shell. In the present study this model is extended by including into it the internal friction in the shell when the microsphere vibrates. Acoustic scattering and transmission are measured in the frequency range from 700 kHz to 12.5 MHz. The measured transmitted power is used to estimate the two parameters in the theoretical model: the shell elasticity parameter, Sp and the shell friction, Sf. Introduction of the shell friction into the model improves the agreement between theory and measurements. For the scattered power, differences between measured and calculated values lie within 3 dB. It is concluded that for the frequencies 2.5 and 5 MHz, microspheres with a diameter between 5 and 12 microns are preferred as these deliver the most significant contribution to the total scattered power and cause relatively little attenuation.

Absorption and scatter of encapsulated gas filled microspheres: theoretical considerations and some measurements.

Albunex is an ultrasound contrast agent for use in echocardiology and other areas. It is capable of passing the lung circulation after intravenous injection. A theoretical model is developed for some acoustic properties, particularly the scatter and absorption, of this contrast agent, considering the individual microspheres as air bubbles surrounded by a thin shell. The attenuation, the sum of absorption and scatter, of this contrast medium is measured with five transducers to cover the frequency range from 700 kHz to 8.5 MHz. It is concluded that the model correlates well with these acoustic measurements. When Albunex is used intravenously the backscatter enhancement in the left ventricle is caused mainly by the microspheres with diameters between 5 and 8 microns.

Nursing curricula and violence issues.

This article presents the findings of a survey of Canadian schools of nursing (N = 155) that determined the extent to which violence-related content is addressed in nursing curricula. The study yielded a response rate of 88%. Theoretical content regarding violence against children and women of all ages, and suicide as a response to abuse formed part of the curriculum of all schools of nursing, if only in readings. Child abuse and suicide received the greatest number of hours of instruction, followed by woman abuse, sexual assault, and elder abuse. University schools of nursing provided the greatest number of hours of instruction when compared with other types of schools. Schools in Western and Atlantic Canada provided the greatest number of hours of instruction on woman abuse when compared with other regions of the country. The majority of university schools provided experiential instruction in the area of violence, with the other types of schools providing very little such instruction. Findings revealed a sensitivity to the importance of including content on violence in nursing curricula; however, the approach to this content is largely incidental and heavily dependent on individual faculty interests. Implications of this study point to the need for the systematic inclusion of violence-related content and the sharing of resources among schools of nursing.

Woman abuse in South Africa: an exploratory study.

PIP: This study aims to address the problem of woman abuse in South Africa as a basis for program development for survivors of violence. It also presents documentation for the expansion of social, health, and legal services for abused women and children. Ethnographic interviews were conducted on 37 South African women from various community settings and institutions in the Johannesburg region. Two focus groups discussed issues from the interview data. Two aspects of woman abused in South Africa were revealed in this study, namely, the endemic culture of violence, and the existence of cheap labor of domestic workers. It was observed that women abuse and sexual assault are rampant because of the endemic culture of violence and by customs, culture, and tradition which tends to objectify women and make them feel like male property. Regarding child and elderly abuse, it appears that more cases are being reported in South Africa. This study confirms the need for national survey data and in-depth research with abused women themselves in order to acquire a clearer picture of the personal, familial, and societal costs of violence against women. Furthermore, acknowledgement of domestic violence and its overall burden on community stability and health is vital in implementing reforms in South Africa.^ieng

The role of the innovation-based pharmaceutical industry in international drug information communication.

The ultimate responsibility and social contribution of the innovation-based pharmaceutical industry is to discover, develop, and provide products that contribute to improved health care. Achievement of this objective is dependent upon effective communication of accurate and comprehensive information about our products. This is a unique role which the research-based segment of the industry performs well and must be allowed to continue to perform. Although the ultimate objective of improved health care is a constant, the effective communication of product information is affected by a variety of factors which represent change or evolution. The discussion of drug information will review: the various forms that such information takes; the effects of differences in national health systems and objectives; and the implications of the fact that product data bases continue to develop after introductions. The systems and experience at the Upjohn Company, while not necessarily applicable for all companies, will be discussed briefly as useful examples of a working, effective process.

Battered women: understanding, identification, and assessment. A psychosociocultural perspective, Part 1.

The clinical implications of research with battered women and their families are discussed using the holistic framework of nursing and anthropology. Moving beyond superficial answers to "Why do battered women stay?," barriers to leaving that stem from the sociocultural roots of violence are examined. Understanding these obstacles and the characteristics of violent men is fundamental to sensitive interaction with abused women who frequently enter and leave health care systems with no direct attention given to their primary problem of abuse. Assessment techniques are suggested, and triage and comprehensive assessment protocols are presented to aid nurse practitioners and nurses in their response to this urgent public health problem.

Battered women: intervention and prevention. A psychosociocultural perspective, Part 2.

Building on the foundation of understanding and comprehensive assessment of battered women, this article addresses service planning and intervention. Strategies are approached within the framework of a Crisis Paradigm developed from field research with battered women and their families. They include mechanisms such as support groups which link crisis service to the long-term needs of battered women, and systematic approaches to removing the obstacles which keep women victimized. An Assessment and Service Planning Guide (ASPG) is proposed for inclusion in routine health care of abused women. The article concludes with strategies for preventing violence at interpersonal and societal levels.

Automated genetic analysis.

Automation of several new, non-traditional techniques for genetic analysis has now become possible. A new system is described that performs gel electrophoretic analysis of DNA including VNTRs, gene segments, and restriction enzyme digests. The instrument detects emitted fluorescence from labeled DNA segments in real-time as they electrophore through a gel matrix past a scanning laser beam. Molecular length determination and band quantification is accomplished by comparison to an in-lane standard. Since DNA segments can be labeled and detected with any of four different dyes, the simultaneous analysis of similar length segments from different reactions within a single lane is possible. PCR products are analyzed for research in the areas of human identification and genetic disease. These examples illustrate how automation will play key role in this new era of genetic analysis.

Healing the mind-body and nursing specialty splits. Conference regarding the "Blended" role in psychiatric/mental health nursing. June 5, 1998--University of Massachusetts, Lowell.

When the idea for this conference was born last year, our primary concern was for the graduates of our "blended" clinical specialist/nurse practitioner (CS/NP) program and the availability of a national examination credentialing them for this new advanced practice role. As we launched our new program and answered students' questions about credentialing, we were keenly aware of the American Nurses Credentialing Center (ANCC) position of waiting for at least 100 graduates nationally from programs like ours before developing an examination for "blended" role graduates. The purpose of this article is to share the outcomes of this conference and to inspire national collegial conversation about the serious issues we face as a specialty group in advanced practice nursing.

Bridging gaps between mind, body, & spirit. Healing the whole person.

Fifty percent of visits of primary care providers are for psychiatric problems making it desirable to screen for mental, addictive, or behavioral disorders at the level of primary care. Psychiatric/mental health nurses prepared at the master's level to practice in the blended clinical specialist/nurse practitioner role are well placed to treat or collaborate in the treatment of people who present with symptoms of physical or psychological problems. The role of the clinical specialist/nurse practitioner is evolving in response to changes in health demographics, epidemiology, scientific and technological advances, and changes in managed care. Advanced practice nursing education must continue to anticipate and meet on-going changes and challenges.

Bedrest after elective cardiac catheterisation.

Haematoma formation and bleeding at the femoral puncture site are the most common complications after cardiac catheterisation. Reducing the length of bedrest for patients after this procedure in one unit aimed to reduce discomfort and increase the number of patients treated. No significant clinical changes took place in the occurrence of haematoma formation or early bleeds as a result of shorter bedrest.