Discordance between microneurographic and heart-rate spectral indices of sympathetic activity in pulmonary arterial hypertension.

OBJECTIVES: To determine, in patients with pulmonary arterial hypertension (PAH), whether there is a relationship: (1) between sympathetic nerve firing rate and spectral indices of sympathetic neural heart rate modulation; and (2) between heart rate variability (HRV) and right atrial pressure, a stimulus to sinoatrial node stretch. DESIGN: Characterisation of patients and healthy controls. SETTING: Teaching hospital-based study. PATIENTS: 9 PAH patients without elevated pulmonary capillary wedge pressure and nine age-matched control subjects. INTERVENTIONS: Heart rate (HR) and muscle sympathetic nerve activity (MSNA) were recorded during 10 min of supine rest in both PAH patients studied after right heart catheterisation, and healthy volunteers. Coarse-graining spectral analysis determined HR spectral power. MAIN OUTCOME MEASURES: (1) Low-frequency (PL) spectral component of HRV; (2) MSNA burst frequency; and in PAH patients: (3) right atrial pressure. RESULTS: MSNA burst frequency was higher in PAH patients (48 (24) and 29 (11) bursts/min, respectively; mean (SD); p = 0.05), whereas total power (p = 0.01), its fractal (p<0.01) and harmonic (p = 0.04) components, and PL (p = 0.01) were all reduced. PL related inversely to both MSNA burst frequency (r = -0.86, p = 0.005) and right atrial systolic pressure (r = -0.77, p = 0.04). CONCLUSIONS: Thus, in PAH (as in patients with left ventricular systolic dysfunction) loss of PL relates inversely to gain in MSNA burst frequency. Diminished sympathetic neural heart rate modulation and increased right atrial stretch may combine to attenuate HRV, an adverse prognostic marker.

The effectiveness of selected microbial and chemical indicators to detect sewer leakage impacts on urban groundwater quality.

Sewer and stormwater pipe leakage can lead to the degradation of urban groundwater quality. This groundwater may be subsequently used for public water supply and so the resulting water treatment and public health consequences can be serious. To understand the impact of sewer exfiltration on groundwater quality, suitable indicators need to be sampled and analysed for. This study examined potential sewer-derived inorganic and microbial parameters in the U.K. city of Doncaster. Sulphite reducing clostridia, faecal streptococci and boron were all detected in groundwater with reductions compared with sewer values ranging from 1 to 6 orders of magnitude for the former two, to 1 to 2 orders of magnitude decrease for boron. The correlation between these two different indicator types suggests that groundwater quality is being adversely affected by sewer leakage in the study area. The employment of several and varied indicators can better demonstrate the effect than use of single parameters.

Alteration of baroreflex control of forearm vascular resistance by dietary fatty acids.

The effects of dietary safflower (control, n = 10), borage (n = 9), and fish oil (n = 10), as sources of linoleic, gamma-linolenic, and eicosapentaenoic acid, respectively, at a dose of 4.5 ml/day for 4 wk, on cardiovascular responses to lower body negative pressure (LBNP) were studied in normotensive humans in a randomized, double-blind design. Pre- and postsupplementation, subjects were exposed to 5 min of -10 and -40 mmHg LBNP. Blood pressure (BP), heart rate (HR), forearm blood flow (FBF), forearm vascular resistance (FVR), and plasma norepinephrine (PNE) were measured at each level. Subjects were then exposed to a cold-pressor test, isometric handgrip, and forearm ischemia. At pretest, LBNP reduced BP and FBF and increased HR and FVR in all groups. After diets, the PNE and vasoconstrictor responses to -40 mmHg LBNP, as well as the reflex vasodilation on its cessation, were significantly augmented by borage oil. No diet differences were observed in the HR responses to LBNP or in the responses to the other tasks, with the exception that fish oil increased FBF after forearm ischemia. These data indicate that borage oil augments the arterial baroreflex control of vascular resistance. The vasodilatory effects of fish oil may be mediated via local mechanisms.

Desipramine blocks augmented neurogenic vasoconstrictor responses to epinephrine.

The forearm vasoconstrictor response to lower body negative pressure (LBNP), a reflex stimulus to norepinephrine release, can be augmented by a prior brachial artery infusion of epinephrine. We wished to determine whether this sustained aftereffect of epinephrine could be replicated by systemic infusion and, if so, whether it could be prevented by prior uptake-1 blockade with desipramine. Eight normal men (mean age 30 years) were studied on two separate study days at least 1 week apart, 2.5 hours after taking, at random, either desipramine (125 mg p.o.) or placebo. Forearm vascular resistance was measured at rest and at the end of 6 minutes of LBNP at -40 mm Hg. This was done both before and 30 minutes after a 60-minute infusion of epinephrine (1.5 micrograms/min i.v.). From similar baselines, the forearm vasoconstrictor response to LBNP was significantly augmented 30 minutes after epinephrine on the placebo day (+17 +/- 4 vs. +12 +/- 3 resistance units, mean +/- SEM, p less than 0.01) but not on the desipramine day (+14 +/- 2 vs. +16 +/- 3 resistance units). The heart rate response to LBNP was also greater after epinephrine on the placebo day (+20 +/- 3 vs. +16 +/- 2 beats/min, p less than 0.05). Mean arterial pressure was higher after epinephrine infusion on the placebo (p less than 0.01) but not on the desipramine day.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical nurse specialists in transition.

Much attention is given to the development of the clinical nurse specialist role in an institution. This article is written for the seasoned Clinical Nurse Specialist who experiences a change in nursing administration. It describes dilemmas, identifies dynamics, and offers practical suggestions for surviving and thriving during a transition period.

Quantitation of herpes simplex virus type 1 shed in preocular tear film of rabbits treated with acyclovir.

The quantity and duration of herpes simplex virus type 1 shedding in the preocular tear film of rabbits were measured before, during, and after administration of acyclovir topically, intravenously, and by these routes. Topical administration reduced shedding significantly, Intravenous administration was without effect and in the combination regimen added nothing to the effectiveness of local application. The effects of acyclovir were temporary because there were significant increase in preocular tear film virus shedding after cessation of treatment.