Non-destructive prediction of fertility and sex in chicken eggs using the short wave near-infrared region.

The objective of this study was to evaluate the ability of a handheld near-infrared device (900-1600 nm) to predict fertility and sex (male and female) traits in-ovo. The NIR reflectance spectra of the egg samples were collected on days 0, 7, 14 and 18 of incubation and the data was analysed using principal component analysis (PCA), linear discriminant analysis (LDA) and support vector machines classification (SVM). The overall classification rates for the prediction of fertile and infertile egg samples ranged from 73 % to 84 % and between 93 % to 95 % using LDA and SVM classification, respectively. The highest classification rate was obtained on day 7 of incubation. The classification between male and female embryos achieved lower classification rates, between 62 % and 68 % using LDA and SVM classification, respectively. Although the classification rates for in-ovo sexing obtained in this study are higher than those obtained by chance (50 %), the classification results are currently not sufficient for industrial in-ovo sexing of chicken eggs. These results demonstrated that short wavelengths in the NIR range may be useful to distinguish between fertile and infertile egg samples at days 7 and 14 during incubation.

Publisher Correction: Barcoding reveals complex clonal behavior in patient-derived xenografts of metastatic triple negative breast cancer.

The original version of this Article contained an error in Fig. 4. In the left histogram of the right panel of Fig. 4d, several data points were inadvertently deleted from the histogram during the production process. This error has been corrected in both the PDF and HTML versions of the Article. The original, incorrect version of Fig. 4 is presented in the accompanying Publisher Correction.

Barcoding reveals complex clonal behavior in patient-derived xenografts of metastatic triple negative breast cancer.

Primary triple negative breast cancers (TNBC) are prone to dissemination but sub-clonal relationships between tumors and resulting metastases are poorly understood. Here we use cellular barcoding of two treatment-naïve TNBC patient-derived xenografts (PDXs) to track the spatio-temporal fate of thousands of barcoded clones in primary tumors, and their metastases. Tumor resection had a major impact on reducing clonal diversity in secondary sites, indicating that most disseminated tumor cells lacked the capacity to 'seed', hence originated from 'shedders' that did not persist. The few clones that continued to grow after resection i.e. 'seeders', did not correlate in frequency with their parental clones in primary tumors. Cisplatin treatment of one BRCA1-mutated PDX model to non-palpable levels had a surprisingly minor impact on clonal diversity in the relapsed tumor yet purged 50% of distal clones. Therefore, clonal features of shedding, seeding and drug resistance are important factors to consider for the design of therapeutic strategies.

Towards establishing a rhinoceros-specific interferon-gamma (IFN-γ) assay for diagnosis of tuberculosis.

Mycobacterium bovis is the causal agent of bovine tuberculosis (BTB), with a diverse host range, extending from livestock to domestic and captive wild animals as well as free-ranging wildlife species. In South Africa, BTB is endemic in the Kruger National Park (KNP) and the Hluluwe iMfolozi National Park (HiP), where the high prevalence of M. bovis infections in buffalo herds has led to infection of a number of wildlife species. This has raised concerns about the spillover into the rhinoceros population, a species known to be susceptible to both M. bovis and Mycobacterium tuberculosis, jeopardizing breeding and relocation projects that serve to conserve and protect this species. In view of the advantages of the interferon-gamma (IFN-γ) assay in the diagnosis of BTB in a variety of species worldwide, such an assay has been developed for rhinoceroses by Morar and co-workers in 2007. In this study, this assay was optimized using recombinant eukaryotic rhinoceros IFN-γ and the lower detection limit was calculated to be 0.5 ng/ml. Subsequently, assessing the detection of native rhinoceros IFN-γ protein in whole-blood samples revealed stimulation with each of the mitogens: pokeweed (PWM), phytohaemagglutinin (PHA) & phorbol 12-myristate 13-acetate and calcium ionophore (PMA/CaI), though most prominently with the latter two. In addition, samples collected from 52 clinically healthy rhinoceroses, of presumed negative BTB status, from two different areas in South Africa were used to determine the cut-off value for a negative test result. This was calculated to be 0.10 (OD490 nm ) and as determined in this study is a preliminary recommendation based on IFN-γ responses observed in samples from BTB-free rhinoceroses only.

The elephant interferon gamma assay: a contribution to diagnosis of tuberculosis in elephants.

Mycobacterium tuberculosis (M. tb) has been shown to be the main causative agent of tuberculosis in elephants worldwide. M. tb may be transmitted from infected humans to other species including elephants and vice versa, in case of prolonged intensive contact. An accurate diagnostic approach covering all phases of the infection in elephants is required. As M. tb is an intracellular pathogen and cell-mediated immune (CMI) responses are elicited early after infection, the skin test is the CMI assay of choice in humans and cattle. However, this test is not applicable in elephants. The interferon gamma (IFN-γ) assay is considered a good alternative for the skin test in general, validated for use in cattle and humans. This study was aimed at development of an IFN-γ assay applicable for diagnosis of tuberculosis in elephants. Recombinant elephant IFN-γ (rEpIFN-γ) produced in eukaryotic cells was used to immunize mice and generate the monoclonal antibodies. Hybridomas were screened for IFN-γ-specific monoclonal antibody production and subcloned, and antibodies were isotyped and affinity purified. Western blot confirmed recognition of the rEpIFN-γ. The optimal combination of capture and detection antibodies selected was able to detect rEpIFN-γ in concentrations as low as 1 pg/ml. The assay was shown to be able to detect the native elephant IFN-γ, elicited in positive-control cultures (pokeweed mitogen (PWM), phorbol myristate acetate plus ionomycin (PMA/I)) of both Asian and African elephant whole-blood cultures (WBC). Preliminary data were generated using WBC from non-infected elephants, a M. tb infection-suspected elephant and a culture-confirmed M. tb-infected elephant. The latter showed measurable production of IFN-γ after stimulation with ESAT6/CFP10 PPDB and PPDA in concentration ranges as elicited in WBC by Mycobacterium tuberculosis complex (MTBC)-specific antigens in other species. Hence, the IFN-γ assay presented potential as a diagnostic tool for the detection of elephant tuberculosis. Validation of the assay will require its application in large populations of non-infected and infected elephants.

Characteristics of zero-absenteeism in hospital care.

BACKGROUND: Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence. AIMS: To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years. METHODS: A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbein's theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups. RESULTS: Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill. CONCLUSIONS: In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

Leadership effectiveness: a supervisor's approach to manage return to work.

PURPOSE: To investigate adaptive leadership in relation to personnel sickness absence (SA). In situational leadership, supervisors are effective if they adapt their leadership style appropriately to a given situation. METHODS: A managerial reorganization in a Dutch hospital with reassignment of supervisors provided the opportunity to compare SA in the same wards while under the leadership of different supervisors. Leadership effectiveness was measured with the Leader Effectiveness and Adaptability Description (LEAD). Personnel SA was retrieved from employer's records and cumulated at the individual level, distinguishing between short-term (1-7 day) and long-term (>7 days) SA. Cumulated SA days and mean SA lengths before and after managerial reorganization were compared at the individual level by using non-parametric paired statistical analyses. Employer's costs to compensate sick-listed employees' salaries before and after reorganization were cumulated and compared at ward level by using non-parametric statistics. RESULTS: 6 wards (N = 403) retained the same supervisor, 6 wards (N = 504) were assigned more effective supervisors, and 4 wards (N = 184) got less effective supervisors than the ones before reorganization. Cumulated short-term SA days and lengths did not change with leadership effectiveness. Employees who got more effective supervisors had fewer long-term SA days and shorter long-term SA lengths than before reorganization. More effective supervisors saved an average of 21,368 Euros per ward, particularly due to less long-term SA. CONCLUSIONS: Long-term SA was shorter after employees got more effective supervisors. Adaptive supervisors can facilitate return to work and save SA costs by providing the right type of support to sick-listed employees.

Development of a lion-specific interferon-gamma assay.

The ongoing spread of bovine tuberculosis (BTB) in African free-ranging lion populations, for example in the Kruger National Park, raises the need for diagnostic assays for BTB in lions. These, in addition, would be highly relevant for zoological gardens worldwide that want to determine the BTB status of their lions, e.g. for translocations. The present study concerns the development of a lion-specific IFN-γ assay, following the production and characterization of monoclonal antibodies specific for lion interferon-gamma (IFN-γ). Recombinant lion IFN-γ (rLIFN-γ) was produced in mammalian cells and used to immunize mice to establish hybridoma cell lines producing monoclonal antibodies. These were used to develop a sensitive, lion IFN-γ-specific capture ELISA, able to detect rLIFN-γ to the level of 160 pg/ml. Recognition of native lion IFN-γ was shown in an initial assessment of supernatants of mitogen stimulated whole blood cultures of 11 known BTB-negative lions. In conclusion, the capture ELISA shows potential as a diagnostic assay for bovine tuberculosis in lions. Preliminary results also indicate the possible use of the test for other (feline) species.

Self-rated coping styles and registered sickness absence among nurses working in hospital care: a prospective 1-year cohort study.

BACKGROUND: Sickness absence is an important problem in healthcare that affects the quality of care. Sickness absence has been related to coping strategies. Problem-focused coping was shown to be associated with low sickness absence and emotion-focused coping with high sickness absence among postal workers. OBJECTIVES: This study investigated the relationship between coping styles and sickness absence in healthcare. DESIGN: Prospective study linking self-rated coping styles at baseline with the number of episodes of sickness absence during one year of follow-up. SETTING: Somatic hospital employing 1,153 persons. PARTICIPANTS: Convenience sample of 566 female nurses working in the hospital's clinical wards and outpatient clinic. Of these, 386 (68%) nurses had complete data for analysis. METHODS: The nurses completed a questionnaire at baseline with items on health, work, and coping styles. Three styles of coping were defined: problem-solving coping (i.e., looking for opportunities to solve a problem), social coping (i.e., seeking social support in solving a problem), and palliative avoidant coping (i.e., seeking distraction and avoiding problems). Sickness absence data were retrieved from the hospital's register in the following year. The association between the coping styles and the number of both short (1-7 days) and long (>7 days) episodes of sickness absence was assessed by Poisson regression analyses with age, work hours per week, general health, mental health, and effort-reward [ER] ratio as covariates. RESULTS: Problem-solving coping was negatively associated with the number of long episodes of sickness absence (rate ratio [RR] = 0.78, 95% confidence interval [CI] = 0.64-0.95). Social coping was negatively associated with the number of both short episodes (RR = 0.88, 95% CI = 0.79-0.97) and long episodes (RR = 0.79, 95% CI = 0.64-0.97) of sickness absence. After adjustment for the ER-ratio, the associations of coping with short episodes of sickness absence strengthened and associations with long episodes weakened, however, significance was lost for both types of sickness absence. Palliative avoidant coping was not associated with sickness absence among female hospital nurses. CONCLUSION: Problem-solving coping and social coping styles were associated with less sickness absence among female nurses working in hospital care. Nurse managers may use this knowledge and reduce sickness absence and understaffing by stimulating problem-solving strategies and social support within nursing teams.

The history of registered sickness absence predicts future sickness absence.

BACKGROUND: The history of sickness absence has been found to predict future sickness absence. AIMS: To establish the review period of historical sickness absence data that is needed to predict future sickness absence. METHODS: The individual number of days and episodes of sickness absence were ascertained for 762 hospital employees from 2004 to 2008 inclusive. Past sickness absence was included stepwise in ordinal regression models. The explained variance of the ordinal regression models reflected the extent to which future sickness absence could be predicted and was expressed in percentages calculated as Nagelkerke's pseudo R(2) × 100%. RESULTS: A total of 551 employees (72%) had complete data and were eligible for regression analysis. Days of sickness absence in the past year predicted up to 15% of future days of sickness absence. Adding the sickness absence data of the past 2 or 3 years did not further increase the predictability of days of sickness absence. Episodes of sickness absence in the past year predicted up to 25% of future episodes of sickness absence. The predictability of episodes of sickness absence increased to 30% when the past 2 years of sickness absence were included in the regression model, but did not further increase when sickness absence of the past 3 years was included. CONCLUSIONS: Employees who are more likely to have an above average sickness absence can be identified from their history of sickness absence in the past 2 years.

An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery.

The bias, precision and tracking ability of five different pulse contour methods were evaluated by simultaneous comparison of cardiac output values from the conventional thermodilution technique (COtd). The five different pulse contour methods included in this study were: Wesseling's method (cZ); the Modelflow method; the LiDCO system; the PiCCO system and a recently developed Hemac method. We studied 24 cardiac surgery patients undergoing uncomplicated coronary artery bypass grafting. In each patient, the first series of COtd was used to calibrate the five pulse contour methods. In all, 199 series of measurements were accepted by all methods and included in the study. COtd ranged from 2.14 to 7.55 l.min(-1), with a mean of 4.81 l.min(-1). Bland-Altman analysis showed the following bias and limits of agreement: cZ, 0.23 and - 0.80 to 1.26 l.min(-1); Modelflow, 0.00 and - 0.74 to 0.74 l.min(-1); LiDCO, - 0.17 and - 1.55 to 1.20 l.min(-1); PiCCO, 0.14 and - 1.60 to 1.89 l.min(-1); and Hemac, 0.06 and - 0.81 to 0.93 l.min(-1). Changes in cardiac output larger than 0.5 l.min(-1) (10%) were correctly followed by the Modelflow and the Hemac method in 96% of cases. In this group of subjects, without congestive heart failure, with normal heart rhythm and reasonable peripheral circulation, the best results in absolute values as well as in tracking changes in cardiac output were measured using the Modelflow and Hemac pulse contour methods, based on non-linear three-element Windkessel models.

Less invasive determination of cardiac output from the arterial pressure by aortic diameter-calibrated pulse contour.

BACKGROUND: Cardiac output by modelflow pulse contour method can be monitored quantitatively and continuously only after an initial calibration, to adapt the model to an individual patient. The modelflow method computes beat-to-beat cardiac output (COmf) from the radial artery pressure, by simulating a three-element model of aortic impedance with post-mortem data from human aortas. METHODS: In our improved version of modelflow (COmfc) we adapted this model to a real time measure of the aortic cross-sectional area (CSA) of the descending aorta just above the diaphragm, measured by a new transoesophageal echo device (HemoSonic 100). COmf and COmfc were compared with thermodilution cardiac output (COtd) in 24 patients in the intensive care unit. Each thermodilution value was the mean of four measurements equally spread over the ventilatory cycle. RESULTS: Least squares regression of COtd vs COmf gave y=1.09x[95% confidence interval (CI) 0.96-1.22], R2=0.15, and of COtd vs COmfc resulted in y=1.02x(95% CI 0.96-1.08), R2=0.69. The limits of agreement of the un-calibrated COmf were -3.53 to 2.79, bias=0.37 litre min(-1) and of the diameter-calibrated method COmfc, -1.48 to 1.32, bias=-0.08 litre min(-1). The coefficient of variation for the difference between methods decreased from 28 (un-calibrated) to 12% after diameter-calibration. CONCLUSIONS: After diameter-calibration, the improved modelflow pulse contour method reliably estimates cardiac output without the need of a calibration with thermodilution, leading to a less invasive cardiac output monitoring method.

Mean cardiac output by thermodilution with a single controlled injection.

OBJECTIVE: A new method to estimate mean cardiac output by thermodilution with a single duration-controlled injection was evaluated in patients. DESIGN: Prospective criterion standard study. SETTING: University hospital cardiac surgical intensive care unit and cardiac operation room. PATIENTS: Of 33 patients, 24 underwent coronary bypass graft surgery, four had a valve replacement, and five were treated in the intensive care unit. INTERVENTIONS: Interventions consisted of thermodilution cardiac output measurements. One single duration-controlled injection of cold fluid was used to calculate cardiac output. This controlled injection was performed with a duration equal to one whole ventilation cycle of the ventilator. An algorithm adapted to this duration-controlled injection calculated cardiac output. Moreover, this algorithm has properties to reduce errors caused by artificial ventilation and thermal noise. MEASUREMENTS AND MAIN RESULTS: In 33 patients, the averaged values of four measurements equally spread over the ventilatory cycle (phase-controlled) were compared with the values of two single duration-controlled measurements. The measurements were performed during periods of stable respiration and circulation. No significant difference was observed between the mean of four phase-controlled measurements and the mean of the two duration-controlled measurements. The cardiac output values in the intensive care patients were significantly higher compared with the two other patient groups (p <.05). The difference between the two methods could not be subdivided for the three patient groups (p >.05). The coefficient of variation of the single duration-controlled thermodilution measurements was significantly lower than the single phase-controlled measurements, 3% vs. 6% (p <.01). CONCLUSIONS: One single duration-controlled injection thermodilution measurement is as accurate and repeatable as the mean of four phase-controlled measurements and is clinically feasible.

The volume-dependency of parallel conductance throughout the cardiac cycle and its consequence for volume estimation of the left ventricle in patients.

OBJECTIVE: To study the hypothesis that the electrical conductance of tissues and fluids (parallel conductance (G(p))) around the ventricle depends on left ventricular volume throughout the cardiac cycle. METHODS: We extended a recently developed method to determine G(p) throughout the cardiac cycle. First, we compared the estimates of parallel conductances obtained with the new method (G(a)(p)) with those of the conventional one (G(1)(p)), both averaged over the cardiac cycles. Secondly, G(a)(p) was determined throughout the cardiac cycle and its volume dependency was assessed. Thirdly, the factor alpha was calculated as the ratio between stroke volume, obtained by the conductance method using G(1)(p), and that obtained by a thermodilution method. Because the non-homogeneous field was indicated to be the reason for the dependency of G(p) on left ventricular volume as well as for the need for alpha, we tested whether the hypothesis implies that a correction with alpha is not needed if G(p) is determined throughout the cardiac cycle. RESULTS: We found a negative linear relation between G(p) and left ventricular volume. This relation appeared to be reproducible within each patient. Furthermore, we found that alpha deviates from 1 primarily due to the dependency of G(p) on left ventricular volume. CONCLUSION: To obtain stroke volume or to determine absolute left ventricular volume continuously within a cardiac cycle, G(p) should be determined throughout each cardiac cycle and if a constant G(p) throughout the cardiac cycle is used a correction with the factor alpha should be made to correct for a possible influence of electrical field heterogeneity.

A comparison of cardiac output derived from the arterial pressure wave against thermodilution in cardiac surgery patients.

In three clinical centres, we compared a new method for measuring cardiac output with conventional thermodilution. The new method computes beat-to-beat cardiac output from radial artery pressure by simulating a three-element model of aortic input impedance, and includes non-linear aortic mechanical properties and a self-adapting systemic vascular resistance. We compared cardiac output by continuous model simulation (MF) with thermodilution cardiac output (TD) in 54 patients (18 female, 36 male) undergoing coronary artery bypass surgery. We made three or four conventional thermodilution estimates spread equally over the ventilatory cycle. In 490 series of measurements, thermodilution cardiac output ranged from 2.1 to 9.3, mean 5.0 litre min(-1). MF differed +0.32 (1.0) litre min(-1) on average with limits of agreement of -1.68 and +2.32 litre min(-1). Differences decreased when the first series of measurements in a patient was used to calibrate the model. In 436 remaining series, the mean difference became -0.13 (0.47) litre min(-1) with limits of agreement of -1.05 and +0.79 litre min(-1). When consecutive measurements were made, the change was greater than 0.5 litre min(-1), on 204 occasions. The direction of change was the same with both methods in 199. The difference between the methods remained near zero during surgery suggesting that a single calibration per patient was adequate. Aortic model simulation with radial artery pressure as input reliably monitors changes in cardiac output in cardiac surgery patients. Before calibration, the model cannot replace thermodilution, but after calibration the model method can quantitatively replace further thermodilution estimates.

Computer control versus manual control of systemic hypertension during cardiac surgery.

BACKGROUND: We recently demonstrated the feasibility of computer controlled infusion of vasoactive drugs for the control of systemic hypertension during cardiac surgery. The objective of the current study was to investigate the effects of computer controlled blood pressures on hemodynamic stability when compared to conventional manual control. METHOD: Systemic artery blood pressures were managed either by computer (80 patients) or by a well-trained anesthesiologist (80 patients). The vasodilator drugs sodium nitroprusside and nitroglycerin were used. Hemodynamic stability was determined from the standard deviation of the mean arterial pressure samples and from the percentages of time that arterial pressure was hypertensive or hypotensive. RESULTS: The average standard deviation of the mean arterial pressure samples was smaller for the computer controlled than for the manually controlled group: 7.5+/-2.2 (mean+/-SD) versus 8.9+/-2.3 mmHg (P<0.0001). The systemic artery pressure was less hypertensive and less hypotensive in the computer controlled than in the manually controlled group: 9.4+/-5.7 versus 13.1+/-6.0% (P<0.0001) and 8.0+/-5.9 versus 11.8+/-7.4% (P<0.0001), respectively. CONCLUSION: We conclude that, compared with manual control, computer control of systemic hypertension significantly improved hemodynamic stability during cardiac surgery.

Acute and short-term effects of partial left ventriculectomy in dilated cardiomyopathy: assessment by pressure-volume loops.

OBJECTIVES: The aim of this study was to evaluate the short-term effects of partial left ventriculectomy (PLV) on left ventricular (LV) pressure-volume (P-V) loops, wall stress, and the synchrony of LV segmental volume motions in patients with dilated cardiomyopathy. BACKGROUND: Surgical LV volume reduction is under investigation as an alternative for, or bridge to, heart transplantation for patients with end-stage dilated cardiomyopathy. METHODS: We measured P-V loops in eight patients with dilated cardiomyopathy before, during and two to five days after PLV. The conductance catheter technique was used to measure LV volume instantaneously. RESULTS: The PLV reduced end-diastolic volume (EDV) acutely from 141+/-27 to 68+/-16 ml/m2 (p < 0.001) and to 65+/-6 ml/m2 (p < 0.001) at two to five days postoperation (post-op). Cardiac index (CI) increased from 1.5+/-0.5 to 2.6+/-0.6 l/min/m2 (p < 0.002) and was 1.8+/-0.3 l/min/m2 (NS) at two to five days post-op. The LV ejection fraction (EF) increased from 15+/-8% to 35+/-6% (p < 0.001) and to 26+/-3% (p < 0.003) at two to five days post-op. Tau decreased from 54+/-8 to 38+/-6 ms (p < 0.05) and was 38+/-5 ms (NS) at two to five days post-op. Peak wall stress decreased from 254+/-85 to 157+/-49 mm Hg (p < 0.001) and to 184+/-40 mm Hg (p < 0.003) two to five days post-op. The synchrony of LV segmental volume changes increased from 68+/-6% before PLV to 80+/-7% after surgery (p < 0.01) and was 73+/-4% (NS) at two to five days post-op. The LV synchrony index and CI showed a significant (p < 0.0001) correlation. CONCLUSIONS: The acute decrease in LV volume in heart-failure patients following PLV resulted at short-term in unchanged SV, increases in LVEF, and decreases in peak wall stress. The increase in LV synchrony with PLV suggests that the transition to a more uniform LV contraction and relaxation pattern might be a rationale of the working mechanism of PLV.

A new approach to determine parallel conductance for left ventricular volume measurements.

OBJECTIVES: To determine absolute ventricular volume with the conductance catheter technique, the electrical conductance of tissues and fluids (parallel conductance) around the ventricle should be determined precisely. METHODS: A new objective method to estimate parallel conductance based on analysis of the dilution curve of hypertonic saline was investigated. The parallel conductances obtained with the new method (G(a)(p)) were compared to those obtained with the conventional method (G(l)(p)). The study was performed in the left ventricle of 12 patients. RESULTS: G(a)(p) was not significantly different from G(l)(p). For the G(l)(p) method the average percentage difference between duplicate values, both taken as absolute values, was 15.06% and for the G(a)(p) method it was 4. 01%. Thus the reproducibility of the method is a factor four better than that of the method. This difference appeared to be significant. CONCLUSION: We conclude that a smaller number of injections will be required to obtain the same precision using our method.

Left ventricular wall stress normalization in chronic pressure-overloaded heart: a mathematical model study.

It is generally accepted that the left ventricle (LV) hypertrophies (LVH) to normalize systolic wall stress (sigma(s)) in chronic pressure overload. However, LV filling pressure (P(v)) may be elevated as well, supporting the alternative hypothesis of end-diastolic wall stress (sigma(d)) normalization in LVH. We used an LV time-varying elastance model coupled to an arterial four-element lumped-parameter model to study ventricular-arterial interaction in hypertension-induced LVH. We assessed model parameters for normotensive controls and applied arterial changes as observed in hypertensive patients with LVH (resistance +40%, compliance -25%) and assumed 1) no cardiac adaptation, 2) normalization of sigma(s) by LVH, and 3) normalization of sigma(s) by LVH and increase in P(v), such that sigma(d) is normalized as well. In patients, systolic and diastolic blood pressures increase by approximately 40%, cardiac output (CO) is constant, and wall thickness increases by 30-55%. In scenarios 1 and 2, blood pressure increased by only 10% while CO dropped by 20%. In scenario 2, LV wall thickness increased by only 10%. The predictions of scenario 3 were in qualitative and quantitative agreement with in vivo human data. LVH thus contributes to the elevated blood pressure in hypertension, and cardiac adaptations include an increase in P(v), normalization of sigma(s), and preservation of CO in the presence of an impaired diastolic function.