Feasibility and Utility of Routine Point-of-Care Gastric Ultrasonography in Patients Undergoing Upper Gastrointestinal Endoscopy Procedures: A Prospective Cohort Study.

OBJECTIVES: Previous studies have indicated that point-of-care ultrasonography (POCUS) of the gastric antrum can predict the adequacy of fasting before surgery and anesthesia. The aim of this study was to evaluate the utility of gastric POCUS in patients undergoing upper gastrointestinal (GI) endoscopy procedures. METHODS: We performed a single-center cohort study in patients undergoing upper GI endoscopy. Consenting patient's gastric antrum was scanned before anesthetic care for endoscopy to determine the cross-sectional area (CSA) and qualitatively determine safe and unsafe contents. Further, an estimate of residual gastric volume was determined using the formula and the nomogram methods. Subsequently, gastric secretions aspirated during endoscopy were quantified and further correlated with nomogram and formula-based assessments. No patient required a change in the primary anesthetic plan except for using rapid sequence induction in those with unsafe contents on POCUS scans. RESULTS: Qualitative ultrasound measurements consistently determined safe and unsafe gastric residual contents in 83 patients enrolled in the study. Unsafe contents were determined by qualitative scans in 4 out of 83 cases (5%) despite adequate fasting status. Quantitatively, only a moderate correlation was demonstrated between measured gastric volumes and nomogram (r = .40, 95% CI: 0.20, 0.57; P = .0002) or formula-based (r = .38, 95% CI: 0.17, 0.55; P = .0004) determinations of residual gastric volumes. CONCLUSION: In daily clinical practice, qualitative POCUS determination of residual gastric content is a feasible and useful technique to identify patients at risk of aspiration before upper GI endoscopy procedures.

Short-term daytime restricted feeding in rats with high salt impairs diurnal variation of Na+ excretion.

Night shift work increases risk of cardiovascular disease associated with an irregular eating schedule. Elevating this risk is the high level of salt intake observed in the typical Western diet. Renal Na+ excretion has a distinct diurnal pattern, independent of time of intake, yet the interactions between the time of intake and the amount of salt ingested are not clear. The hypothesis of the present study was that limiting food intake to the typically inactive period in addition to high-salt (HS) feeding will disrupt the diurnal rhythm of renal Na+ excretion. Male Sprague-Dawley rats were placed on either normal-salt (NS; 0.49% NaCl) or HS (4% NaCl) diets. Rats were housed in metabolic cages and allowed food ad libitum and then subjected to inactive period time-restricted feeding (iTRF) for 5 days. As expected, rats fed NS and allowed food ad libitum had a diurnal pattern of Na+ excretion. The diurnal pattern of Na+ excretion was not significantly different after 5 days of iTRF compared with ad libitum rats. In response to HS, the diurnal pattern of Na+ excretion was similar to NS-fed rats. However, this pattern was attenuated after 5 days of HS iTRF. The diurnal excretion pattern of urinary aldosterone was abolished in both NS iTRF and HS iTRF rats. These data support the hypothesis that HS intake combined with iTRF impairs circadian mechanisms associated with renal Na+ excretion.NEW & NOTEWORTHY Timing of food intake normally has little effect on the diurnal pattern of Na+ and water excretion. However, rats on a high-salt diet were unable to maintain this pattern, yet K+ excretion was more readily adjusted to match timing of intake. These data support the hypothesis that Na+ and water homeostasis are impacted by timing of high-salt diets.

Diurnal pattern in skin Na+ and water content is associated with salt-sensitive hypertension in ETB receptor-deficient rats.

Impairment in the ability of the skin to properly store Na+ nonosmotically (without water) has recently been hypothesized as contributing to salt-sensitive hypertension. Our laboratory has shown that endothelial production of endothelin-1 (ET-1) is crucial to skin Na+ handling. Furthermore, it is well established that loss of endothelin type B receptor (ETB) receptor function impairs Na+ excretion by the kidney. Thus we hypothesized that rats lacking functional ETB receptors (ETB-def) will have a reduced capacity of the skin to store Na+ during chronic high-salt (HS) intake. We observed that ETB-def rats exhibited salt-sensitive hypertension with an approximate doubling in the diurnal amplitude of mean arterial pressure compared with genetic control rats on a HS diet. Two weeks of HS diet significantly increased skin Na+ content relative to water; however, there was no significant difference between control and ETB-def rats. Interestingly, HS intake led to a 19% increase in skin Na+ and 16% increase in water content (relative to dry wt.) during the active phase (zeitgeber time 16) versus inactive phase (zeitgeber time 4, P < 0.05) in ETB-def rats. There was no significant circadian variation in total skin Na+ or water content of control rats fed normal or HS. These data indicate that ETB receptors have little influence on the ability to store Na+ nonosmotically in the skin during long-term HS intake but, rather, appear to regulate diurnal rhythms in skin Na+ content and circadian blood pressure rhythms associated with a HS diet.

Multi-detector computed tomography to analyze in-stent restenoses at different heart rates.

PURPOSE: This study was performed to evaluate the visualization of coronary in-stent restenosis by multi-detector computed tomography (MDCT). MATERIALS AND METHODS: A restenosis phantom with different stented stenoses was used. The phantom was placed into a dynamic heart phantom with heart rates from 40 to 120 bpm. MDCT was performed with two scan protocols: a standard and an ultra-high resolution scan protocol. RESULTS: Using the ultra-high resolution protocol, artifacts occurred at 0.6 mm around the stent struts (p < 0.001). Artifacts compromised the discrimination between no stenosis and low-grade stenosis. Approximately 73% of the central lumen diameter was able to be assessed without limiting artifacts allowing the discrimination of no or low vs. moderate and high-grade stenoses (p < 0.05). Using the standard protocol in the dynamic phantom, the image quality and visibility of stenoses decreased with an increasing heart rate (p < 0.0002 and p < 0.004). This was able to be compensated by analysis in an appropriate RR-interval. At the optimal RR-interval, an assessment of the grade of stenoses > 30% was feasible up to 120 bpm. CONCLUSION: Multi-detector computed tomography ultra-high resolution scans allowed the assessment of a wide range of degrees of in-stent restenoses. In this experimental setup, standard protocols allowed a discrimination of low, moderate and high-grade stenoses even at heart rates above 100 bpm.

[Quality of life following percutaneous coronary interventions in octogenarians]. / Perkutane Koronarinterventionen verbessern die Lebensqualität von Patienten nach dem 80. Lebensjahr.

BACKGROUND: Percutaneous coronary interventions (PCI) are increasingly performed in elderly patients. However, it is not known whether PCI leads to symptomatic relief comparable to that in younger patients. PATIENTS AND METHODS: 55 Patients aged 80 years or above with stable angina (82 +/- 2 years, 33 males, 22 females) were prospectively compared with younger patients (62 +/- 8 years) regarding their quality of life following PCI. For psychometric evaluation, the German version of the SF-36 Health Survey was used. RESULTS: Prior to angioplasty, there was significant physical pain, a perception of reduced general health and a significant limitation of physical activity in both groups. The number of diseased vessels was 2.7 +/- 0.6 in octogenarian patients vs. 2.6 +/- 0.7 in control patients; interventions were performed in 1.1 +/- 0.3 vs. 1.0 +/- 0.2 vessels and in 1.3 +/- 0.7 vs. 1.3 +/- 0.5 lesions. Frequency of stent implantation was 0.9 +/- 0.3 per lesion in both groups. Success rates were comparable in both groups (94 % vs. 97 %), as well as complication rates In both groups 6 months after angioplasty, bodily pain had decreased, the perception of general health and the ability to fulfill physical role expectations had improved. The effects on bodily pain and on the ability to fulfill physical role expectations were more pronounced in octogenarian patients. CONCLUSIONS: Our study shows that PCI improves quality of life in octogenarian patients with stable angina without excessive risk. The benefits of PCI were, in some aspects, even more pronounced than in younger patients.

Factors of patient satisfaction with medical services: the case of G.P. practices in the U.K.

This paper investigates whether factors previously identified in the literature are also important in the U.K. primary healthcare system. In a survey based on the SERVQUAL scale, 182 patients were personally interviewed. The analysis shows that the demographic variable age and gender are of little importance in determining satisfaction with G.P. services but the fundholding-non-fundholding divide is. For nearly every aspect of G.P. services the results clearly show that patients from fundholding surgeries are happier than patients from nonfundholding surgeries.

Precoating substrate and surface configuration determine adherence and spreading of seeded endothelial cells on polytetrafluoroethylene grafts.

Primary adherence and attachment area of seeded human endothelial cells (EC) were determined on differently coated polytetrafluoroethylene (PTFE) grafts. Cell counts and morphometric analyses were done immediately after 60 minutes of electronically controlled seeding of 3 x 10(4) EC/cm2, as well as after 3 hours of subsequent incubation. Cell adherence and cell spreading were distinctly superior on two surface-covering substrates: fibronectin-treated type I/III collagen and fibrinolytically inhibited fibrin glue. Uncovered, purely fibronectin- or laminin-coated PTFE or type IV collagen treated with the specifically binding glycoprotein laminin showed a far lower EC attachment rate and less pronounced cell spreading. It appears that not only a high surface content of fibronectin but also a smooth PTFE-covering matrix are prerequisites for optimal primary adherence and cell spreading. Because fibrin glue might be fibrinolytically degraded despite its plasmin-inhibiting epsilon-amino-caproic acid compound, type I/III collagen plus fibronectin could provide an optimal precoating substrate for EC lining of PTFE grafts.