In Vitro Model of Myocardial CeU Contractile Performance
A modification® of a previously described in vitro myocardial cell contractility system- was used to assay for MDS activity. Briefly, spontaneously beating newborn rat heart cell cultures were established as follows. Hearts from two-day-old rats were pooled and minced into small blocks of tissue. The cells were disaggregated with 0.05 percent trypsin in modified Hanks solution without Ca+ + or Mg+ + . Read the rest of this entry »

A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Radionuclide CineangiographyRadionuclide Cineangiography
Initial and serial ECG-gated radionuclide cineangiographic studies were performed on all patients at the bedside using techniques that have been described in detail previously. Patients received an injection of stannous pyrophosphate, and 30 min later they each received 0.3 mCi/kg ®®mTc to accomplish in vivo labeling of erythrocytes. These radionuclide scans were obtained using a portable Picker camera according to the following previously described protocol. The initial scan was performed within the first 24 to 48 h of patient entry into the septic shock protocol. A follow-up scan was obtained at two to four days after entry into the study. Read the rest of this entry »

“Possible” septic shock was defined as fever (38°C or higher) and hypotension (mean arterial pressure 60 mm Hg or less). The diagnosis of septic shock was confirmed in 34 of these 50 patients. “Confirmed” septic shock was defined using one of two sets of criteria: (1) fever, hypotension, and positive blood cultures (21 patients); or (2) fever, hypotension, and a localized culture-positive infection, but negative blood cultures, attributed either to the transient nature of bacteremia or to concomitant broad-spectrum antibiotic therapy (13 patients). The remaining 16 patients proved to be critically ill but did not have sepsis or septic shock. All subjects gave informed consent and the study protocol was approved by the institutional committee on human research. Read the rest of this entry »

A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral HypoperfusionReversible myocardial depression has been demonstrated in human and canine septic shock. This myocardial depression occurs within the first several days of shock and is characterized by left ventricular (LV) dilatation and a decrease in LV efection fraction (EF). In survivors, these profound changes are transient, and the EF usually returns to normal in seven to ten days. comments
The pathogenetic mechanism of this early, transient LV dilatation and decrease in EF is not known. This decrease in EF is not associated with a global reduction in coronary blood flow nor with an elevated myocardial lactic acid production in humans, so myocardial ischemia cannot be implicated as the cause of the myocardial depression. Read the rest of this entry »

Dillard et al have shown that maximal exercise ventilation in patients with CAO correlates with peak inspiratory flow rate as well as the FEV. It is not clear why the training induced decrease of H/rtot in our study was not translated into improved exercise performance. Possibly threshold pressure breathing is just not specific enough with regard to exercise ventilation to induce a useful training effect. www.help-at-diabetes.com
It may be that inspiratory muscle fatigue was not a significant limitation in our patients. Pardy et al concluded that specific training of the inspiratory muscles is usually associated with improved exercise performance only in those who demonstrate electromyographic changes heralding inspiratory muscle fatigue during exercise. Read the rest of this entry »

Threshold Pressure Training, Breathing Pattern, and Exercise Performance in Chronic Airflow Obstruction: OutcomeNot only did Ti/Ttot decrease during the course of threshold breathing training, but this training led to substantial improvements in maximum inspiratory pressure, training pressure, and the work and pressure-time integral of threshold breathing. These improvements leave little doubt that IMT did train the inspiratory muscles of our patients.
We cannot exclude the possibility of improvement in inspiratory muscle performance being due to placebo effects of the training device or frequent contact with a physiotherapist. Read the rest of this entry »

Sonne and Davis found that resistive inspiratory training led to improved maximal exercise ventilation, oxygen uptake and work rate on a cycle ergometer, with no change in a sham training group. Jones et al, using a very similar program, with the addition of a third group who undertook simple physical exercises, found that all three groups improved equally. add comment
Many of these studies used inspiratory muscle training methods which left it open to the subjects to adopt an altered breathing strategy, and thereby avoid doing increased respiratory muscle work. The predictable performance of our threshold pressure valve allowed the prescription of a known inspiratory pressure. Read the rest of this entry »

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