[Qualitative and quantitative changes of circulating in blood endotheliocyte precursor cells in patients with hypercholesterolemia].

Aim of this study was elucidation of diagnostic value of qualitative and quantitative parameters of circulating endotheliocyte precursor cells (EPC), in the state of apoptosis (apoptotic endotheliocytes A AE), as well as effect of main risk factors on the studied parameters in patients with coronary atherosclerosis and hypercholesterolemia. We examined 24 patients with ischemic heart disease (14 men, 10 women, mean age 58.4 +/- 2.3 years) with stenoses >75% in coronary arteries according to angiography data and hypercholesterolemia (main group). Control group comprised 15 healthy volunteers. Circulating EPC in peripheral blood were evaluated by cytofluorimetry. Functional parameters of isolated EPC were assessed after cultivation in human fibronectin. Adhesive properties were studied in cell culture by immunehistochemical method after 7 days of incubation. Proliferation capacity was assessed by number of EPC in 1 mm3 of medium at day 7 of incubation. Determination and counting of AE was carried out using cytofluorimetry with immunostaining of cells by anexin B and CDA31 after preliminary treatment of endotheliocyte culture with H2O2 and comparing the results with control culture of endotheliocytes. Number of circulating EPC in patients with IHD was 58.% less than in healthy persons. Adhesive capacity of EPC in patients with IHD was lowered by 43%. Number of EPC surviving in cell culture was 80.9% less than in control group. At the same time number of circulating AE in patients with IHD was 2.5 times greater. Reduction of number of EDC, adhesive capacity, and rise of number of AE correlated significantly with number of involved coronary arteries, presence of diabetes, and smoking status. Presence of arterial hypertension and blood cholesterol level did not correlate with quantitative and qualitative parameters of EPC. Thus qualitative and qualitative parameters of circulating EPC and apoptotic cells can be considered as markers of dysfunction of endothelium and predictors of atherosclerotic vascular lesions in patients with hypercholesterolemia.

[Some special characteristics of vascular reactivity in heart failure].

We determined parameters of elasticity of peripheral arteries in patients with heart failure (HF) including those with pulmonary arterial hypertension. We also investigated pulmonary artery responses to vasoconstricting factors in vitro. Reactivity of the aorta and carotid artery was studied on the model of experimental HF. Lowering of elasticity of small arteries progressed with worsening of HF functional class and increase of pulmonary arterial hypertension. In the genesis of pulmonary hypertension definite role played elevated constrictor response of pulmonary artery to endothelin 1 at the background of dysfunction of endothelial ETB receptors. Endothelial dependent reactivity of the aorta and carotid artery was impaired and their constrictor effect augmented.

[Changes of activity of the endothelial system in experimental heart failure].

Despite obvious participation of endothelins in pathogenesis of heart failure therapeutic approaches to the use of endothelin receptor antagonists remain to be elucidated. Experimental heart failure caused by prolonged infusion of norepinephrine is associated with diminished endothelin induced coronary constricting effect of stimulation of ET(A) receptors and inversion of coronary dilating effect of stimulation of these receptors. The latter effect is mediated by smooth muscle ET(B)-receptors and is indicative of functional derangement of vascular control by endothelial cells. The use of selective ET(A)-antagonist is effective on early stages of heart failure while on later stages administration of nonselective ET(AB)-antagonist produces more pronounced effect.

CT of intracranial cryptococcosis.

CT scans of 35 patients with intracranial cryptococcal infection were reviewed retrospectively. Studies were normal in 43% of the patients. Positive findings in others included diffuse atrophy in 34%, mass lesions (cryptococcoma) in 11%, hydrocephalus in 9%, and diffuse cerebral edema in 3%. Two unusual types of cryptococcoma were encountered, namely gelatinous pseudocysts and an intraventricular cryptococcal cyst. All findings were nonspecific for CNS cryptococcosis. The results suggest that CNS cryptococcosis should be considered in all patients at risk for the disease who have these abnormal CT findings, no matter what their initial clinical presentation. In addition, MR demonstration of gelatinous pseudocysts in one patient indicates that this technique may be helpful in locating cryptococcal mass lesions not visualized on CT.

Myocardial alterations induced by prolonged noradrenaline administration in various doses.

Prolonged noradrenaline administration to rats in steadily increasing dosages for a period of one to four weeks (cumulative doses 25-35 mg/kg) resulted in the development of focal necrotic areas with abundant collagen fibers and marked hypertrophy of cardiomyocytes. Cellular diameter was higher by 37-44% and extracellular space area by 70-100%. A combination of overcontracted and overdistended sarcomeres in some cardiomyocytes and a twofold rise in serum creatine kinase presumably reflected cellular calcium overload. Myocardial high energy phosphate content was depleted to 50-62% of the control level. The extent of this depletion positively correlated with a decrease in heart rate and cardiac output of the isolated heart. The latter may be attributed to limited left ventricular filling caused by elevated LV diastolic pressure and stiffness. Minimal metabolic and functional changes were observed after lowest noradrenaline dose (5 mg/kg for nine days) that was followed by only moderate depletion of myocardial phosphocreatine content and moderate rise in LV diastolic stiffness. Results suggest that energy-deficient increase in myofibrillar stiffness may form the basis for decreased myocardial distensibility and cardiac pump failure.

The impact of do-not-resuscitate orders on nursing workload in an ICU.

BACKGROUND: The meaning of do-not-resuscitate orders and their impact on nursing care have been a source of confusion, and the results of the few studies that have examined nursing care of ICU patients with these orders have been conflicting. OBJECTIVES: To assess nursing workload associated with caring for patients with do-not-resuscitate orders and to better understand the patients and selected events associated with these orders. METHOD: Sixty patients from medical, surgical, and neuroscience ICUs met the criteria for the study. The Medicus Systems Corporation InterAct 2000 Workload and Productivity System was used to classify patients by type; the results reflected the number of hours of nursing care required per 24 hours. Data on patient type for 1 day before and 1 day after do-not-resuscitate orders were written were available for 31 of the 60 patients. These data were analyzed. RESULTS: The number of hours of nursing care required 1 day before and 1 day after a do-not-resuscitate order did not change. The amount of nursing care remained the same or increased for 74% (23/31) of the patients after the order was written. Patients were classified as types IV (n = 8), V (n = 20), and VI (n = 3) after the order was written. CONCLUSIONS: A high level of nursing care was required for this group of critically ill patients, and the do-not-resuscitate order did not alter the number of hours of nursing care required after the order was written.

Use of Q methodology for hospital strategic planning: a case study.

This study was designed to illustrate how Q Methodology can be used as a tool for strategic planning. Potential plans for the future of a small Indiana hospital were formulated and Q sorted to determine support or resistance by key leaders from within hospital management, the board, and the medical staff. The hospital was able to identify stakeholder perceptions that resulted in strong consensus that integration should be a priority for the hospital. This exercise provided a list of objectives for hospital leadership and the results were also used to justify the cessation of several programs that the hospital leadership had been pursuing.

[Contractile function of the isolated heart in chronic adriamycin-induced myocardial lesions]. / Sokratitel'naia funktsiía izolirovannogo serdtsa pri khronicheskom porazhenii miokarda adriamitsinom.

Adriamycin, administered to rats for 4 weeks, caused insufficiency of isolated heart contractility with a twofold reduction of cardiac output in surviving animals. The same cumulative dose of adriamycin, administered to rats over 10 weeks, was not associated with any significant reduction of the heart's pumping function. However, heart rate increase by atrial electrostimulation that shortened the diastolic pause to a control level, also reduced the minute and stroke volumes by 38%, as compared to the controls. All animals showed increased diastolic stiffness of the left ventricle that must have interfered with its filling, particularly so in case of low inflow pressure, and disturbed atrial automaticity, as reflected in bradicardia in rats and supraventricular arrhythmia in guinea pigs.

[Plasma renin activity and aldosterone concentration of patients with congestive cardiomyopathy]. / Aktivnost' renina i kontsentratsiia al'dosterona v plazme bol'nykh zastoinoi kardiomiopatiei.

Blood plasma aldosterone concentration and renin plasma activity were studied in 30 patients with congestive cardiomyopathy and in 41 patients with congestive heart failure resulting from CHD or valvular heart disease using a radio-immunoassay. In congestive cardiomyopathy as well as in congestive heart failure of another etiology an increase in plasma renin activity was noted in single cases in stages IIA and IIB and in most patients with stage III congestive heart failure. Changes in plasma aldosterone concentration with relation to stages of congestive heart failure were unidirectional in both groups of examinees. There was no correlation between plasma renin activity and aldosterone concentration. The study has shown that in congestive cardiomyopathy shifts in the renin-angiotensin-aldosterone system are of the same nature as in patients with congestive heart failure of another etiology.

[Antioxidants, lipid peroxidation, and receptor-dependent increase in Ca2+ concentration in human platelets]. / Antioksidanty, perekisnoe okislenie lipidov i retseptorzavisimoe uvelichenie kontsentratsii Ca2+ v trombotsitakh cheloveka.

Content of tocopherol and total antiradical activity of hydrophobic antioxidants were estimated in human blood platelets. Two hydrophobic antioxidants--tocopherol and ubiquinone were detected in hexane extracts of thrombocytes using thin-layer chromatography. After incubation of thrombocytes with N-ethyl maleimide content of malonyl dialdehyde was increased and of tocopherol--decreased, receptor-dependent increase of Ca2+ concentration in cytoplasm was potentiated, while the Ca(2+)-blocking effect of nitroglycerol was decreased. Nitroglycerol did not inhibit the N-ethyl maleimide effect on content of malonyl dialdehyde in blood platelets. Addition of exogenous vitamin E to thrombocytes did not affect the receptor-dependent increase of Ca2+ concentration. Ascorbic acid inhibited the receptor-dependent increase of Ca2+ concentration. The data obtained suggest that nitrates may be used more rationally in combination with antioxidants and/or inhibitors of cyclooxygenase.

[Norepinephrine-induced heart failure and the protective effect of taurine]. / Porazhenie serdtsa, vyzyvaemoe noradrenalinom, i zashchitnyi éffekt taurina.

The prolonged noradrenaline treatment of rats (total dosage from 1 week--25 mg/kg), results in greatly reduced cardiac pump function and heart rate with a pronounced increase in left ventricular diastolic stiffness. These functional changes are associated with a deficiency of energy supply, especially depletion of phosphocreatine content. The taurine administration (100 mg/kg prior to 20 min noradrenaline injection) is accompanied by reliably less essential cardiac insufficiency. Moreover, the ATP, ADP level is normal and phosphocreatine content enhances by 15%.

[Changes in the peripheral nerves in traction injuries]. / Izmeneniia perifericheskikh nervov pri ikh traktsionnoi travme.

The functional and structural changes in a nerve with various degree of stretching were studied by complex examination of 126 animals by means of neurophysiological and neurohistological methods. The character of changes in a nerve in traction trauma was found to be dependent on the degree of its stretching and the individual features of its external and intertruncal structure. A correlation between the type of changes and the size of nerve distraction was encountered.

[Clinical value of determining potassium level in erythrocytes of operated-on patients]. / Klinicheskoe znachenie opredeleniia kaliia v éritrotsitakh operirovannykh.

Since potassium ions are very important in surgical pathology and the course of the postoperative period, the authors determined erythrocyte potassium in 211 patients (37 in the control group and in 174 in the pathological group). The statistically evaluated results were compared for both groups and the correlations of serum and red cell potassium with the acid-base status were studied. The authors used a Marongiu's modified method of potassium determination in a erythrocyte hemolysate with a flame photometer. The mean values for both the control and pathological groups were 84.61 (SD 5.24) and 85.98 (SD 9.10), respectively. The correlation of serum and erythrocyte potassium is subject to many influences and occurs only in the limited pH and HCO3 intervals (pH 7.4 +/- 0.5 and HCO3 21 +/- 2.0) so that it is insignificant even for the control group. If a concentration exceeding two standard deviations is considered abnormal and a deficit percentage is calculated, it is possible to approximate the total body deficit from the expected values of 50-55 mM/kg and to start proper replacement. In evaluating the results, precise laboratory work must be performed and the clinical condition must be taken into account. Therefore, the method of erythrocyte potassium determination is not suitable for routine work and is used only in case of serum potassium excess values and during prolonged postoperative parenteral treatment.

The Joint Commission's ORYX initiative.

Home care organizations and hospices increasingly need to have objective, quantifiable information about their own performance that they can use externally to demonstrate accountability. The ORYX initiative will help organizations meet this need.

[Functional and morphological changes in the nerves following injury due to traction mechanism (experimental and morphological studies)]. / Funktsional'nye i morfologicheskie izmeneniia nerva pri traktsionnom mekhanizme ego povrezhdeniia. (Eksperimental'noe-morfologicheskoe issledovanie).

In acute and chronic experiments on 52 animals (rabbits and dogs), carried out by means of neurophysiologic and neurohistologic methods, the authors have studied functional and histologic changes in the nerves following a one-step forced traction. Traction injuries have been found to cause early trophic disorders, persistent and long-lasting alterations of the nerve conductability and excitability. Some considerable retrograde changes in the nerves and related segments of the spinal cord have been noted together with the delay of the resorption of the decay products of the axons and the myelin sheath in the peripheral nerve fragment. The severity degree of the alterations depends on the degree of the traction.

Managing patients whose family members are physicians.

The ethical complexities involving physicians who treat their own family members are well known and it is generally accepted that such practice should not occur. We present three anonymous cases in which patient family members who worked as physicians complicated the medical care of their hospitalized relatives. When a health care worker's family member becomes a hospital patient, the situation can be emotionally charged due to the medical insight the multiple parties have, as well as the desire of relatives to be protective of their family members. Clinician-relatives need to allow the medical team to assume the role of caretaker when their family members are hospitalized. Teams may need to employ limit setting in order to ensure fair and consistent care for all patients on the ward, and to prevent escalation of emotionally charged situations.

The economic burden of Clostridium difficile.

Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient's primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease.