Atrial function and geometry differences in transthyretin versus immunoglobulin light chain amyloidosis: a cardiac magnetic resonance study

To determine the differences in left atrial (LA) function and geometry assessed by cardiac magnetic resonance (CMR) between transthyretin (ATTR) and immunoglobulin light chain (AL) cardiac amyloidosis (CA). We performed a retrospective analysis of 54 consecutive patients (68.5% male, mean age 67 ± 11 years) with confirmed CA (24 ATTR, 30 AL) who underwent comprehensive CMR examinations. LA structural and functional assessment including LA volume, LA sphericity index, and LA strain parameters were compared between both subtypes. In addition, 15 age-matched controls were compared to all groups. Patients with ATTR-CA were older (73 ± 9 vs. 62 ± 10 years, p < 0.001) and more likely to be male (83.3% vs. 56.7%, p = 0.036) when compared to AL-CA. No significant difference existed in LA maximum volume and LA sphericity index between ATTR-CA and AL-CA. LA minimum volumes were larger in ATTR-CA when compared with AL-CA. There was a significant difference in LA function with worse strain values in ATTR vs AL: left atrial reservoir [7.4 (6.3–12.8) in ATTR vs. 13.8 (6.90–24.8) in AL, p = 0.017] and booster strains [3.6 (2.6–5.5) in ATTR vs. 5.2 (3.6–12.1) in AL, p = 0.039]. After adjusting for age, LA reservoir remained significantly lower in ATTR-CA compared to AL-CA (p = 0.03), but not LA booster (p = 0.16). We demonstrate novel differences in LA function between ATTR-CA and AL-CA despite similar LA geometry. Our findings of more impaired LA function in ATTR may offer insight into higher AF burden in these patients.

Descarte sanguíneo em sistema aberto de pressão arterial invasiva

Analisar o volume de solução a ser desprezado do cateter de pressão arterial invasiva a partir de quatro volumes mínimos para obtenção de amostra sanguínea com hemoconcentração eficaz para análise laboratorial. Estudo observacional transversal, com análise laboratorial, realizado em uma unidade de terapia intensiva no Estado do Rio de Janeiro. Os dados coletados foram armazenados no software Microsoft Excel® e analisados no SPSS Statistics®20.0, por análise estatística descritiva e de variância usando ANOVA e Tukey. Foram analisadas 157 amostra e percebeu-se que mesmo em comparações múltiplas não há diferença significativa entre os quatro volumes analisados, isto é, os volumes comparados não evidenciaram diferença dos resultados dos valores de hematócrito e hemoglobina. Concluiu-se que é possível recomendar o menor volume a ser desprezado do cateter de pressão arterial invasiva para uma amostra sanguínea eficaz, sendo este o volume de 1,5ml para cateteres arteriais radiais ou femorais.Descritores: Monitorização Hemodinâmica, Coleta de Amostras Sanguíneas, Cuidados Críticos. Blood disposal in an open invasive blood pressure systemAbstract: Analyze the volume of solution to be discarded from the invasive blood pressure catheter from four minimum volumes to obtain blood samples with effective hemoconcentration for laboratory analysis. Cross-sectional observational study, with laboratory analysis, carried out in an intensive care unit in the State of Rio de Janeiro. The collected data were stored in Microsoft Excel® software and analyzed using SPSS Statistics®20.0, using descriptive and variance statistical analysis using ANOVA and Tukey. 157 samples were analyzed and it was noticed that even in multiple comparisons there is no significant difference between the four volumes analyzed, that is, the volumes compared did not show any difference in the results of the hematocrit and hemoglobin values. It was concluded that it is possible to recommend the smallest volume to be discarded from the invasive blood pressure catheter for an effective blood sample, this being the volume of 1.5 ml for radial or femoral arterial catheters.Descriptors: Hemodynamic Monitoring, Blood Specimen Collection, Critical Care. Eliminación de sangre en un sistema abierto de presión arterial invasivaResumen: Analice el volumen de solución que se desechará del catéter invasivo de presión arterial a partir de cuatro volúmenes mínimos para obtener muestras de sangre con hemoconcentración efectiva para análisis de laboratorio. Estudio observacional transversal, con análisis de laboratorio, realizado en una unidad de cuidados intensivos en el estado de Río de Janeiro. Los datos recopilados se almacenaron en el software Microsoft Excel® y se analizaron usando SPSS Statistics®20.0, usando análisis estadísticos descriptivos y de varianza usando ANOVA y Tukey. Se analizaron 157 muestras y se observó que, incluso en comparaciones múltiples, no existe una diferencia significativa entre los cuatro volúmenes analizados, es decir, los volúmenes comparados no mostraron ninguna diferencia en los resultados de los valores de hematocrito y hemoglobina. Se concluyó que es posible recomendar que se descarte el volumen más pequeño del catéter invasivo de presión arterial para obtener una muestra de sangre efectiva, siendo este el volumen de 1,5 ml para catéteres arteriales radiales o femorales.Descriptores: Monitorización Hemodinâmica, Recolección de Muestras de Sangre, Cuidados Críticos.

EXPRESS: Reducing neonatal phlebotomy blood losses through the accurate calculation of minimum test volume requirements

Background: Repeated phlebotomy for laboratory diagnostic testing is a known cause of iatrogenic anaemia and in critically ill neonates often leads to blood transfusion being required. This study has developed a spreadsheet clinical decision support (CDS) tool to allow neonatal staff to determine the true minimum blood volume (MBV) required to analyse groups of blood tests and modelled its potential benefit compared to the existing system in use. Methods: The tool calculates the MBV accounting for novel factors including the current patient haematocrit for plasma/serum samples, instrument minimum test and dead volumes (including those where shared) and sharing of samples within/between laboratory departments. A year of neonatal unit laboratory requests were examined comparing the volumes and containers of blood recommended by the hospital information system (HIS) with both the amount actually collected by staff and that recommended by the tool. Results: 463 patients had 8,481 blood draws for 23,899 tests or test profiles over the year. The HIS recommended collecting 11,222mL of blood into 18,509 containers, while 17,734 containers were actually received (10,717mL if fully filled). The tool recommended collecting 4,915mL of blood into 15,549 containers. Conclusions: This tool allows NICU staff to objectively determine the MBV required for a combination of tests and is generalisable between laboratory instruments. Compared to the HIS, use of the MBV-CDS tool could maximally reduce the volume of blood collected from this neonatal unit by more than a half. NICU staff had apparently already gone some way to determining their own minimum volumes required.

Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function

Aims Atrial fibrillation (AF) is more common in athletes and may be associated with adverse left atrial (LA) remodelling. We compared LA structure and function in athletes and non-athletes with and without AF. Methods and results Individuals (144) were recruited from four groups (each n = 36): (i) endurance athletes with paroxysmal AF, (ii) endurance athletes without AF, (iii) non-athletes with paroxysmal AF, and (iv) non-athletic healthy controls. Detailed echocardiograms were performed. Athletes had 35% larger LA volumes and 51% larger left ventricular (LV) volumes vs. non-athletes. Non-athletes with AF had increased LA size compared with controls. LA/LV volume ratios were similar in both athlete groups and non-athlete controls, but LA volumes were differentially increased in non-athletes with AF. Diastolic function was impaired in non-athletes with AF vs. non-athletes without, while athletes with and without AF had normal diastolic function. Compared with non-AF athletes, athletes with AF had increased LA minimum volumes (22.6 ± 5.6 vs. 19.2 ± 6.7 mL/m2, P = 0.033), with reduced LA emptying fraction (0.49 ± 0.06 vs. 0.55 ± 0.12, P = 0.02), and LA expansion index (1.0 ± 0.3 vs. 1.2 ± 0.5, P = 0.03). LA reservoir and contractile strain were decreased in athletes and similar to non-athletes with AF. Conclusion Functional associations differed between athletes and non-athletes with AF, suggesting different pathophysiological mechanisms. Diastolic dysfunction and reduced strain defined non-athletes with AF. Athletes had low atrial strain and those with AF had enlarged LA volumes and reduced atrial emptying, but preserved LV diastolic parameters. Thus, AF in athletes may be triggered by an atrial myopathy from exercise-induced haemodynamic stretch consequent to increased cardiac output.

Qualification and Performance Evaluation of an Automated System for Compounding Injectable Cytotoxic Drugs

Background Use of automated systems for the production of chemotherapy will increase in answer to hospitals’ needs to rationalise production. The aim of the study was to evaluate the performance of a PharmaHelp® automated system for compounding chemotherapy. Methods Viable and non viable particles in air and liquid were measured by particle counter. Surface chemical contamination was simulated with a quinine solution. Microbiological contamination and aseptic processes were studied using media-fill tests. Dose accuracy was evaluated using a gravimetric method, in simulation studies and with real products in daily practice. Productivity was calculated by batch of ten IV-bags. Results No particles or microbiological contamination were detected. Filling was accurate for all the volumes of non-viscous solution studied (97–103 %). Minimum volumes which could be prepared accurately were 2 mL and 5 mL for the non-viscous and viscous solutions, respectively. For 2–5 mL volumes, the robot was less accurate than average, and 0–2 % of bags were rejected (deviation>10 %). Average fill deviations were from 0–3 % for 2–5 mL volumes and<1 % for volumes above 5 mL. Average production time for ten bags was 61±11 min. Conclusions The automated system was able to produce chemotherapy effectively, delivering appropriate quality with productivity comparable to manual preparations. These results confirmed that such automated systems have the potential to guarantee optimal safety for patients and technicians.

Analysis of break-even points of Polish regional airports

The problematic nature of the high costs of building terrestrial aviation infrastructure does not end after the planning phase and the construction of new airspace. After the infrastructure has been commissioned, the cost of its depreciation and maintenance over the years represents a significant contribution to the cost of operating the airport. The high share of fixed costs is a direct reason for strong leverage. As a result, it is imperative to provide external financing to young airports at an early stage of their development. Owners of companies managing the above-mentioned infrastructure should be vividly concerned about the earliest possible break-even point, and consequently, the burden of direct subsidizing aviation activities in the region. The purpose of this article is to analyze the profitability thresholds at Polish regional airports as a means to discuss possible minimum volumes and revenues that emerging airports need to achieve as they do not generate losses. The main research method is a tool based on regression functions.

Climate change alters the quantity and phenology of habitat for lake trout (Salvelinus namaycush) in small Boreal Shield lakes

We analyzed monitoring data (1970–2013) from small Boreal Shield lakes to understand how variations in air temperature and precipitation affect the phenology and amount of habitat for lake trout (Salvelinus namaycush). Annual air temperatures increased by ∼2 °C (significant in fall and winter). In response, ice cover was reduced by ∼19 days. Despite earlier ice-offs, springs became longer, allowing lake trout longer access to littoral regions when water temperatures were cool. Although summer surface water temperatures increased, the summer did not lengthen. Instead, later spring-warming and fall-cooling of lakes caused summer to shift later in the year, potentially delaying fall spawning. Complete loss of optimal oxythermal habitat volume occurred in all lakes and became more prevalent over time, more so in the darkest lakes. Although air temperatures did not become more variable, several habitat measures did, including mean summer surface water temperatures, duration of ice cover, timing of ice-off, and minimum volumes of optimal oxythermal habitat. Our results suggest that future warming will impose greater thermal stress on lake trout, but may be tempered by longer springs.