HUMAN HEART 1. could be re-evaluated in the light of data obtained. on the human heart in vivo. of digitalis lanata which can be given intravenously.

Size: px
Start display at page:

Download "HUMAN HEART 1. could be re-evaluated in the light of data obtained. on the human heart in vivo. of digitalis lanata which can be given intravenously."

Transcription

1 STUDES ON MYOCRDL METBOLSM V THE EFFECTS OF LNTOSDE-C ON THE METBOLSM OF THE HUMN HERT 1 By J M BLN, E E EDDLEMN, SEGEL, ND R J BNG (Frm the Departments f Experimental Medicine and Clinical Physilgy, The Medical Cllege f labama, Birmingham, labama, and the Veterans' dministratin Hspital, Birmingham, la) (Submitted fr publicatin Septenber 6, 1955; accepted Nvember 16, 1955) Since 1785 when Withering undertk the first systemic study f the effects f digitalis, a large amunt f data has been accumulated describing its pharmaclgical effects Despite intensive study, the underlying mechanism respnsible fr the beneficial results in patients with heart failure remains bscure lthugh digitalis in small dses may affect the heart rate thrugh its vagal effect, it is agreed that the predminant actin f this drug is n the heart muscle directly (1) n additin, the cardiac glycsides als influence the inic gradient between the muscle cell and the surrunding medium (2-8) ts effect n xygen cnsumptin and fdstuff utilizatin f the heart has been repeatedly investigated in the heart-lung preparatin, in tissue slices and in tissue hmgenates (9) The reader is here referred t the review article f Wllenberger (1) Hwever, the abundance f cnflicting results suggests that cardiac glycsides may exhibit different metablic defects dependent n the experimental cnditin t appears likely that ne limiting factr in elucidating the mechanism f actin f the glycside has been the lack f means fr direct study f the metablic respnses f the heart beating in a mre physilgical envirnment By the technique f crnary sinus intubatin, a direct study f patients treated with therapeutic dses f a rapid acting cardiac glycside is pssible Simultaneus sampling f arterial and crnary venus bld, tgether with measurement f the crnary flw, permits the determinatin f the net mycardial gain r lss f fdstuffs, gases r ther metablites (11-13) While prviding n infrmatin regarding intermediary reactins, data btained by 1 Wrk supprted by the U S Public Health Service Grant N H-1129 (C3), The Life nsurance Medical Research Fund, the merican Heart ssciatin, and Sandz Pharmaceuticals 314 this methd shuld aid in elucidating the metablic pathways within the heart muscle; thus reactins determined by mre precise in vitr methds culd be re-evaluated in the light f data btained n the human heart in viv The varius cardiac glycsides differ in time f nset and persistence f actin Lanatside-C, the preparatin used in this study, is a purified derivative f digitalis lanata which can be given intravenusly The nset f actin depends n the dsage used; with average digitalizing dses f 12 t 16 mgm, the s-called "vagal effect" usually appears within 15 t 2 minutes, reaching a maximum in abut 4 minutes Weisberger and Feil (14), fr example, reprted their results in treating 17 cases f resistant parxysmal auricular tachycardia Sixteen cases reverted t nrmal sinus rhythm within 4 minutes, with an average respnse f 176 minutes Barrw (15), in a series f 26 patients, fund the average time fr reversin t be 19 minutes Nichlsn (16) administered 16 mgm f Cedilanidg t 22 subjects with auricular fibrillatin whse rates were stabilized at 12 beats per minute n all patients there was a drp f frm 15 t 8 beats within 15 minutes, with an average decrease in heart rate f 24 beats Stead, Warren, and Brannn (17) administered 16 mgm f lanatside-c intravenusly t 22 patients with cngestive failure The first effect nticed was a fall in venus pressure which began in 5 t 1 minutes and cntinued fr 3 t 6 minutes Cardiac utput, measured 6 t 7 minutes after the injectin, shwed an average rise f 16 liters per minute This effect was nted regardless f the cardiac rhythm r the initial strke vlume The present paper reprts n the actin f lanatside-c n the mycardial metablism f glucse, pyruvate, lactate, amin acids, ketnes and

2 EFFECTS OF LNTOSDE-C ON CRDC METBOLSM fatty acids subsequent reprt will deal with the effect f this glycside n the sdium and ptassium balance f the human heart PROCEDURE Twelve undigitalized adult patients were selected fr the study (Table ) Seven f these had heart disease with evidence f left ventricular hypertrphy but had n symptms f cngestive failure ther than decreased exercise tlerance Five f these seven were hypertensive (J B J, G G, E E, W H, and M T), ne had rheumatic heart disease (D T) and ne had artic insufficiency due t syphilis (F M) Cngestive heart failure was present in fur patients Heart failure in these individuals resulted frm rheumatic valvular disease (L W), hypertensin (W B) and frm cngenital malfrmatin f the heart (E F) n the furth patient the cause f the failure was unknwn (J R) One f the subjects in the series had n evidence f heart disease (J W) ll patients were studied in the pst adsrptive state n three f the subjects (W B, E F, and J R) with cngestive failure preliminary treatment with bed rest, diuretics and salt restrictin was necessary befre the studies culd be perfrmed Small dses f merperidine r pentbarbital were given n the mrning f the study t thse individuals wh seemed unduly apprehensive The majrity received n premedicatin Cardiac catheterizatin was perfrmed in the usual manner (12, 13) f diagnstic prcedures were indicated, these were cmpleted first Cardiac utput was measured by the methd f Fick (18), the mixed venus sample being btained frm the mst distal cardiac chamber entered Expired air was cllected in a Duglas bag r Tisst spirmeter Oxygen and carbn dixide in expired air was determined by the methd f Schlander (19) The crnary sinus was intubated accrding t previusly described methds (2) Simultaneus bld samples were cllected frm the crnary sinus and right femral artery fr determinatins f xygen, carbn dixide, glucse, pyruvate, lactate, fatty acids, amin acids and ketnes n mst cases duplicate samples were drawn and the results f the tw analyses averaged Crnary flw was measured 3 t 4 minutes fllwing the ingestin f the glycside Crnary flw was nt determined prir t the injectin f lanatside-c, since this wuld have unduly prlnged the prcedure; als it had been previusly fund that digitalis in therapeutic dses des nt influence the rate f crnary bld flw (21) Lanatside-C was administered intravenusly in dses f 2 t 3 mgm per 1il bdy weight, and crnary bld flw was measured using the nitrus xide desaturatin methd (22, 23) Thirty t frty minutes later, r as sn as definite electrcardigraphic changes appeared (slwing f heart rate, depressin f ST segment r premature ventricular cntractins), bld samples fr metablic determinatins were again btained frm the femral artery and crnary sinus Oxygen and carbn dixide cntents f bld were 315 determined by the manmetric methd f Van Slyke and Neill (24) Bld glucse was measured by the methd f Hagedrn and Jensen, using Smgyi's methd t prepare the filtrates (25, 26) Pyruvate was determined accrding t the methd f Friedemann and Haugen (27), using a triclracetic acid filtrate, and lactate by the methd f Barker and Summersn (28) Fr the determinatin f fatty acids the methd f Man and Gildea was used (29) This is essentially a mdificatin f the prcedure f Stddard and Drury's vlumetric analysis (3) min acids were estimated accrding t the methd f lbanese and rby (31) and ketnes by a mdificatin f the micrmethd f Greenberg and Lester (32) Frm the analysis f the bld samples the mycardial extractin (crnary arterivenus difference) f xygen, carbn dixide and individual metablites was determined The mycardial usage f 1 grams f left ventricle was calculated as the prduct f the mycardial extractin times the crnary flw The xygen extractin rati was determined by multiplying the mycardial extractin by the xygen equivalent f the particular metablite divided by the mycardial xygen extractin This rati represents the percentage f xygen extracted by the heart which culd be accunted fr by cmplete catablism f fdstuff t carbn dixide and water Because f the temprary strage f metablites and their cnversin within the metablic pl, the sum f the individual xygen extractin ratis at any ne mment need nt ttal 1 per cent The percentage mycardial extractin represents the percentage f the arterial cncentratin f a metablite which is remved frm crnary bld during its passage thrugh heart muscle; it is calculated by the frmula: -V X 1, where and V represent the respective arterial and crnary venus cncentratins f the metablites t has previusly been shwn that extractin f a substrate by the human heart varies in prprtin t the arterial cncentratin (11) Since the percentage mycardial extractin takes int cnsideratin the fluctuatins in arterial level, this calculatin prvides a mre accurate means f cmparing changes in uptake f carbhydrates, fats and prteins by the mycardium than des the arterivenus difference alne Evidence f Cedilanid effect was btained frm cmparisns f electrcardigrams taken befre and at intervals f five t ten minates fllwing the injectin f the glycside The earliest and mst cnsistent change bserved was slwing f the ventricular rate, which was present in nine subjects by the end f thirty minutes and was mst marked in the tw patients with auricular fibrillatin (L W and E F) n seven subjects with nrmal sinus rhythm the average decrease amunted t 1 beats per minute Other electrcardigraphic changes included depressin f the S-T segment in three patients, flattening f the T-waves in five patients, and the nset f frequent ventricular extrasystles after digitalis administratin in ne individual N electrcardigraphic alteratins were present in ne patient, and the tracings f ne subject were lst Hwever, the develdment f

3 316 J M BLN, E E EDDLEMN, SEGEL, ND R J BNG 14 a) 8 >1 1 ) <C a ) 4 <CO 4i COd U*> C CO -- t ^ 4O O W) _NON -- O N - O) N'c S- - t) c c ~' N c c c ) 'N nt - V- c ' d -)N N) C j~ ' N e g n t- N - "in N N N V Ut ) Y) W,-eN 14 ' _c_ eeol NN ) _ N VW W N ci Y)rN c - O %t Nl ') --7 G a t N N4_ W i S _t et V V ~~~~~~ 6 V ' NN _ "28 e Zt in in i _ C )C UO4 UO )U Lt * S r-c + as ' +C14 s) V) CK t- ffi b u) e N et O t ' V t) U 4 e m in inco b + V) ~~~~ N ~~~~~~ r -- C - _ ES s t) V Vt( ~~~~~~~ V - ~ "O i tu t t )t Nt - v~ _r- ~) O _-_ t) N " ) - t O'7 8N ctzn ' _ W VN 4 _-d _;;l_ 'NO' UW) )UW) - in '' t' ci(i - c c - -M' fli 1 cjv s '' Ntr)v N_ - \ n O t c ( N * _ C N U ' V c 'S 8 ) *t c Vt) V ' t C t -4 _ V - <~~~~~~~~~~~~ -q 4 ' N't '- ~ NO -i C)" C N c 1 v, R'C rl n - ' - t) t) te t) -t) N O t) t) ) ) ) ) ) ) c 1 4 ) b & a ) 1 c c 1: m u m u m 4u umu c > CO CO CO CO CO~~~~~~~~~~~C > > > 3> C c_ s U U U c 6 > a c )C 4 4 ) C) t ; 2 )) Uu ' t a g _ m!u ) W 4i 4i _ C ucd N t ) CO _~ r1 ; -

4 EFFECTS OF LNTOSDE-C ON CRDC METBOLSM 317 -C,- 't t t e _ W ~6c ;!' $) 1 V), 4)'V > 1 : U ) Cq e * W~ _ t N v 4 G z -i g ; -ic; 9" - d~~~~~~~~~~~~~ %% "Ct'~~~~~~~~~~ O1 ~~ d W) CD W N_ O C _4 &- _* _ ck cff U M >b t 4 16 K 2 9O U 4,s -* 8,4 li li tl " N'5 4 c 4 ic -, m s e ; cav fs ; b 8 6%6 a N CS O 4U - i; -4 C' 4 4, t l U 1 - i -4 W) 4 if) 4 e - G 4 Wv q ",^ c c U 'C -- ~ *) 'U t- 4* 4 _4 4~ >^t bb"n e4 4 9 * il * c ( M ; ' U ' '1' 4'4' G) 44 ' W C C' a c q 'l W 4 ee e * _- - _ t- in v 4% C a,if (4 1 l 1 %% uz 4 Gs b' 4% C' c m W) 4 %4' + Um 'i "i C O44 r el el! 2 vx ) uz 4 C f) t4 - ' C; - an 1c UOl 'en c t- r- "-4 if)4- t' t- - c 4 qzt (-1 _S 8 > ': g E " >b E t Xa > c" t- " inue) 4 g c t- W-) rō W) t- g4 eg4 T, a OR 44 U 4U% ) C) as DW) NO t 1, '44' 44 1 c - 8 ) 'O4' Nt e _ e W V n " n m m 118 Ch t- i v <" ** + a c 4 44 a &_V i ;C;dc;C ' * v _ O;O %' _R _W *' 'C - a W) Uc'C '4' g m b C) * e VZ UUC v C; 4 * n Ost 4 ~C& - 44' -" t- r4 C l - US C % U & a ~ U C'; C * C ~4 4 X C: cc ~ OD c E _- c c 2 a X~~~C a c - OD J, E'X v ai = c % N 4 14c dc z 4 ' (4 YC - a % c: in U cd z~ (4

5 318 J M BLN, E E EDDLEMN, SEGEL, ND R J BNG nausea and vmiting frty minutes after the administratin f Cedilanid* (ten minutes after bld samples were taken) prbably cnstitutes adequate evidence f drug effect in this persn The individual bservatins befre and after CedilanidO administratin are shwn in Table Differences bserved after injectin f the glycside were subjected t statistical analysis, each patient serving as his wn cntrl Changes were cnsidered significant nly if there was less than ne chance in twenty that the effect culd have been due t chance alne (p < 5) RESULTS N significant changes in the respiratry qutient f the heart culd be attributed t the actin f Cedilanid Of the ten bservatins available befre and after treatment, the respiratry qutient decreased in seven and increased in three (Table ) The mycardial xygen extractin fr the grup shwed a mean increment f 37 vlumes per cent, increasing in eight subjects and decreasing in tw The difference was nt statistically significant (p > 2) Since digitalis causes n significant alteratin in crnary flw, it can be assumed that mycardial xygen usage likewise remained unchanged (21) Observatins f the arterial cncentratin and crnary arterivenus glucse difference were available in eleven subjects The arterial glucse cncentratin decreased in eight and increased in three patients, while the mycardial extractin de- PERCENTGE MYOCRDL GLUCOSE EXTRCTON J=~lX 9 PTENT FG 1 LLUSTRTES THE PERCENTGE MYOCRDL GLUcOSE EXTRCTON N THE ELEVEN PTENTS STUDED This rati increased in all but tw patients (1 and 11); these had the highest initial percentage f glucse extractin creased in tw subjects and increased in nine Fr the grup as a whle, there was an average fall f 19 mgm per 1 cc in the arterial level f glucse and an average rise f 6 mgm per 1 cc in its mycardial extractin Neither f these changes was statistically significant Because f the lwer arterial level, the percentage glucse extractin by the heart shwed a mre cnspicuus gain, increasing frm 37 per cent t 45 per cent lthugh the p value was > 1, slightly abve the level accepted as significant in this study, it can be seen in Figure 1 that the percentage extractin increased in all subjects except the tw wh initially had the highest percentages f glucse extractin (W H and E F) Mycardial pyruvate extractin shwed small fluctuatins in bth directins, but n cnsistent changes ccurred which culd be ascribed t the drug There was a slight gain frm 164 per cent t 192 per cent in the mean percentage pyruvate extractin Hwever, in fur individual bservatins this rati declined lteratins in arterial lactate level and mycardial lactate extractin were similarly incnsistent s in the case f glucse and pyruvate the mean percentage extractin advanced slightly, rising frm a cntrl level f 24 per cent t 29 per cent after the administratin f Cedilanid@ Data f fatty acid metablism were available in ten subjects The arterial cncentratin f fatty acids decreased in seven and increased in three individuals with a mean increase f 31 meq per 1 cc (p > 1) Changes in fatty acid extractin and percentage extractin were mre variable and did nt apprach statistical significance The average percentage extractin by the heart increased frm 12 per cent t 17 per cent Despite the small percentage f available fatty acids extracted, their imprtance as a ptential surce f energy t the heart muscle is demnstrated by their high xygen extractin ratis n several instances the quantity f fatty acids remved frm the crnary circulatin culd accunt fr mre than 1 per cent f the simultaneus xygen extractin if it is assumed that they are cmpletely metablized t carbn dixide and water Similar findings have been described in previus publicatins (11, 13) n eight f nine patients n whm data were available the amin acid extractin by the heart

6 EFFECTS OF LNTOSDE-C ON CRDC METBOLSM declined n ne subject mycardial extractin f amin acids was zer befre and after injectin f Cedilanid, and in fur thers the extractin fell t zer t shuld be nted, hwever, that the arterial amin acid cncentratin als declined in six f the patients, s that the decrease in percentage extractin was nt as marked as was the crnary arterivenus difference The mean percentage extractin befre and after therapy was 25 per cent and 11 per cent, respectively The mycardial metablism f ketnes was nt altered by digitalis DSCUSSON The mass f cnflicting data in the literature makes it likely that the difference in metablic effects f digitalis n heart muscle may be the result f varius cncentratins f drug emplyed and the differences in the kind f substrates and the techniques used in the studies (1, 33, 34) Hwever, even with identical techniques and cncentratins f drugs the results have been cntradictry Fr example, varius bservers have nted that Ouabain increased the xygen cnsumptin f cardiac muscle slices respiring in the Warburg apparatus, while thers have reprted a decreased xygen uptake with the same cncentratin f glycsides (1, 33) Using human auricular appendages btained at peratin, Burdette (35) fund that the additin f lanatside-c tripled the rate f respiratin David (36) n the ther hand, fund that after an initial increase Ouabain caused a diminutin in the respiratin f the islated frg's auricle Studies n the heart-lung preparatin have yielded equally variable results Evans (37) reprted that while digitalis increased cardiac utput and efficiency, the xygen cnsumptin f the heart diminished Peters and Visscher (9) fund that digitalis increases bth xygen cnsumptin and efficiency f the perfused heart Hwever, the increase in efficiency n a percentile basis was fur t five times as great as the increase in mycardial xygen cnsumptin (9) The bulk f evidence suggests that in the varius types f experimental "failure" digitalis increases the wrk perfrmance f the heart ut f prprtin t the changes in xygen cnsumptin, thereby increasing mycardial efficiency n patients with cngestive failure cardiac glycsides increase car- 319 diac utput and efficiency withut causing significant changes in xygen cnsumptin (21) The results f the present study demnstrate that digitalis in therapeutic dsage prduces nly minimal changes in the extractin f fdstuffs by the heart Since there is sme rise in the mean extractin percentage f pyruvate and lactate, the lwer amin acid extractin after digitalis may be due t the "prtein sparing" effect f carbhydrates The negative effect f Cedilanid@ n carbhydrate metablism in the intact human heart cntrasts with results f Wllenberger (34) This investigatr fund, in studying the actin f Ouabain n the respiratin f heart slices in the Warburg apparatus, that the glycside accelerates the xidatin f glucse and lactate This actin accunts fr the simultaneus increase in respiratry activity, with the acceleratin f glucse xidatin exceeding, in prprtin, that f the xygen uptake The results reprted in this paper demnstrate nly a slight elevatin in percentage glucse extractin withut any change in mycardial xygen utilizatin Since mycardial lactate utilizatin remains unchanged, a digitalis-induced shift frm a glyclytic t a largely respiratry metablism f carbhydrates as suggested by Wllenberger is unlikely in the human heart under these cnditins The finding that the cardiac glycside prduces n significant changes in mycardial xygen cnsumptin r in ttal fdstuff utilizatin suggests that the imprvement in wrk capacity f the failing heart induced by these glycsides must be the result f their actin n energy liberatin, r mre specifically, n the cntractile prteins f failing heart muscle directly Digitalis can accelerate the spiraling f mysin threads (38) Mallv and Rbb (39) reprted that actmysin threads prepared frm beef hearts shwed increased spiraling and shrtening when digitxin was added n a later reprt the same authrs, using prtein surface films, fund that Ouabain increased the wrk perfrmance f actmysin prepared in this manner (4) Digitalis als influences the plymerizatin f actin (41) Furthermre, digitxin des nt cmbine with sarcsmes f heart muscle, in which the enzymes cncerned with energy prductin are cncentrated (42) dditinal evidence that cardiac glycsides d nt influence energy

7 32 J M BLN, E E EDDLEXN, SEGEL, ND R J BNG prductin is available frm the findings f Wllenberger (43) that Ouabain r Digxin in therapeutic dsages causes n change in the cncentratin f high-energy phsphate carriers and phsphcreatine Similar cnclusins can be drawn frm the wrk f Rthlin, Taeschler, and Cerletti (44) These investigatrs induced heart failure in the heart-lung preparatin with dinitrphenl, a drug which increased mycardial xygen cnsumptin Lanatside-C restred the initial wrk perfrmance f the heart withut further influencing mycardial xygen cnsumptin SUMMRY The effects f therapeutic dses f Cedilanid n the metablism f glucse, pyruvate, lactate, amin acids, fatty acids and ketne bdies f the human heart have been investigated The studies were carried ut n patients using intubatin f the crnary sinus Only minimal changes in the extractin f metablites by the heart were bserved The findings suggest that the imprvement in wrk capacity f the failing heart induced by the glycside is the result f its actin n energy liberatin REFERENCES 1 Lwn, B, and Levine, S, Current cncepts in digitalis therapy New England J Med, 1954, 25, Stutz, H, Feigelsn, E, Emersn, J, and Bing, R J, The effect f digitalis (Cedilanid) n the mechanical and electrical activity f extracted and nnextracted heart muscle preparatins Circulatin Res, 1954, 2, Hellems, H K, Regan, T J, and Talmers, F N, nfluence f acetyl strphanthidin n mycardial electrlyte exchange J Clin nvest, 1955, 34, Wedd, M, The influence f digxin n the ptassium cntent f heart muscle J Pharmacl & Exper Therap, 1939, 65, Wd, E H, and Me, G K, Electrlyte and water cntent f the ventricular musculature f the heart-lung preparatin with specific reference t the effects f cardiac glycsides m J Physil, 1942, 136, Hagen, P S, The effects f digilanid C in varying dsage upn the ptassium and water cntent f rabbit heart muscle J Pharmacl & Exper Therap, 1939, 67, 5 7 Calhun, J, and Harrisn, T R, Studies in cngestive heart failure X The effect f digitalis n the ptassium cntent f the cardiac muscle f dgs J Clin nvest, 1931, 1, Byer, P K, and Pindexter, C, The influence f digitalis n the electrlyte and water balance f heart muscle m Heart J, 194, 2, Peters, H C, and Visscher, M B, The energy metablism f the heart in failure and the influence f drugs upn it m Heart J, 1936, 11, Wllenberger,, The energy metablism f the failing heart and the metablic actin f the cardiac glycsides Pharmacl Rev, 1949, 1, Bing, R J, The metablism f the heart Harvey Lecture Series (n Press) 12 Bing, R J, Siegel,, Vitale, G, Balbni, F, Sparks, E, Taeschler, M, Klapper, M, and Edwards, S, Metablic studies n the human heart in viv Studies n carbhydrate metablism f the human heart m J Med, 1953, 15, Bing, R J, Siegel,, Ungar,, and Gilbert, M, Metablism f the human heart Studies n fat, ketne and amin acid metablism m J Med, 1954, 16, Weisberger, S, and Feil, H, Lanatside C in the treatment f persistent parxysmal auricular tachycardia m Heart J, 1947, 34, Barrw, J G, Treatment f parxysmal supraventricular tachycardia with Lanatside C nn nt Med, 195, 32, Nichlsn, J, The intravenus use f lanatside C New England J Med, 1943, 229, Stead, E, Jr, Warren, J V, and Brannn, E S, Effect f lanatside C n the circulatin f patients with cngestive failure study using catheterizatin f the right side f the heart rch nt Med, 1948, 81, Fick,, Ueber die Messung des Blutquantums in den Herzventrickeln Verhandlungen Sitzungsbericht, phys med Gesell zu Wurzburg, NF 2, Jul 187, p XV 19 Schlander, P F, nalyzer fr accurate estimatin f respiratry gases in ne-half cubic centimeter samples J Bil Chem, 1947, 167, Bing, R J, Vandam, L D, Gregire, F, Handelsman, J C, Gdale, W T, and Eckenhff, J E, Catheterizatin f the crnary sinus and the middle cardiac vein in man Prc Sc Exper Bil & Med, 1947, 66, Bing, R J, Maraist, F M, Dammann, J F, Jr, Draper,, Jr, Heimbecker, R, Daley, R, Gerard, R, and Calazel, P, Effect f strphanthus n crnary bld flw and cardiac xygen cnsumptin f nrmal and failing human hearts Circulatin, 195, 2, Spencer, F C, Merrill, D L, Pwers, S K, and Bing, R J, Crnary bld flw and cardiac xygen cnsumptin in unanesthetized dgs m J Physil, 195, 16, Gdale, W T, and Hackel, D B, Measurement f crnary bld flw in dgs and man frm rate f mycardial nitrus xide desaturatin Circulatin Res, 1953, 1, 52

8 EFFECTS OF LNTOSDE-C ON CRDC METBOLSM Van Slyke, D D, and Neill, J M, The determinatin f gases in bld and ther slutins by vacuum extractin and manmetric measurement J Bil Chem, 1924, 61, Hagedrn, H C, and Jensen, B N, Zur Mikrbestimmung des Blutzuckers mittels Ferricyanid Bichem Ztschr, 1923, 135, Smgyi, M, Methd fr the preparatin f bld filtrates fr the determinatin f sugar J Bil Chem, 193, 86, Friedemann, T E, and Haugen, G E, Pyruvic acid The determinatin f ket acids in bld and urine J Bil Chem, 1943, 147, Barker, S B, and Summersn, W H, The clrimetric determinatin f lactic acid in bilgical -material J Bil Chem, 1941, 138, Man, E B, and Gildea, E F, mdificatin f the Stddard and Drury titrimetric methd fr the determinatin f the fatty acids in bld serum J Bil Chem, 1932, 99, 43 3 Stddard, J L, and Drury, P E, titratin methd fr bld fat J Bil Chem, 1929, 84, lbanese,, and rby, V, Determinatin f amin nitrgen f bld filtrates by the cpper methd J Lab & Clin Med, 1945, 3, Greenberg, L, and Lester, D, Micrmethd fr the determinatin f acetne and ketne bdies J BiL Chem, 1944, 154, Olsn, R E, and Schwartz, W B, Mycardial metablism in cngestive heart failure Medicine, 1951, 3, Wllenberger,, Metablic actin f the cardiac glycsides nfluence f uabain n the utilizatin f C-14 labeled glucse, lactate, and pyruvate by dg heart slices rch f exper Path u Pharnakl, 1953, 219, Burdette, W J, ncrease in xygen cnsumptin f human cardiac muscle incubated with lanatside C J Lab & Clin Med, 1952, 4, David, J C, The actin f drugs n the xygen cnsumptin f the frg's islated auricle J Pharmacl & Exper Therap, 193, 4, Evans, C L, Metablism f the heart Edinburgh M J, 1939, 46, Bwen, W J, Effects f digxin upn rate f shrtening f mysin B threads Federatin Prc, 1952, 11, Mallv, S, and Rbb, J S, Behavir f actmysin threads Federatin Prc, 1949, 8, 14 4 Rbb, J S, and Mallv, S, Effect f uabain n actmysin threads J Pharmacl & Exper Therap, 1953, 18, Hrvath,, Kiraly, C, and Szerb, J, ctin f cardiac glycsides n the plymerizatin f actin Nature, 1949, 164, Friedman, M, and St Gerge, S, The cardiac and hepatic intracellular fate f digitxin J Clin nvest, 1953, 32, Wllenberger,, Metablic actin f the cardiac glycsides Effect f uabain and digxin n the energy-rich phsphate cntent f the heart J Pharmacl & Exper Therap, 1951, 13, Rthlin, E, Taeschler, M, and Cerletti,, ctin f dinitrphenl and lanatside C n the canine heartlung preparatin Circulatin Res, 1955, 3, 32

A Plasma Humoral Factor of Extrarenal Origin Causing Release of Reninlike Activity in Hypotensive Dogs

A Plasma Humoral Factor of Extrarenal Origin Causing Release of Reninlike Activity in Hypotensive Dogs A Plasma Humral Factr f Extrarenal Origin Causing Release f Reninlike Activity in Hyptensive Dgs By E. De Vit, C. Wilsn, R. E. Shipley, R. P. Miller, and B. L. Mrtx ABSTRACT Plasma reninlike activity significantly

More information

Integrity of Energy Stores in Cat Papillary Muscle

Integrity of Energy Stores in Cat Papillary Muscle Integrity f Energy Stres in Cat Papillary Muscle EFFECT OF CHANGES IN TEMPERATURE AND FREQUENCY OF NTRACTION ON HIGH ENERGY PHOSPHATE STORES By Peter E. Pl, M.D., Brian M. Chandler, M.D., Edmund H. Snnenblick,

More information

PHYLLIS FOSSHAGE. rabbit auricle (12). Dock and Lewis established. that thyroid feeding to rats increased the total

PHYLLIS FOSSHAGE. rabbit auricle (12). Dock and Lewis established. that thyroid feeding to rats increased the total THE HEMODYNAMICS OF THYROTOXICOSIS IN MAN WITH SPECIAL REFERENCE TO CORONARY BLOOD FLOW AND MYOCARDIAL OXYGEN METABOLISM1 By GEORGE G. ROWE, JOHN H. HUSTON,2 ARVIN B. WEINSTEIN, HERMAN TUCHMAN,. JOHN F.

More information

Monensin and Extruded Urea-Grain for Range Beef Cows

Monensin and Extruded Urea-Grain for Range Beef Cows Mnensin and Extruded Urea-Grain fr Range Beef Cws R. P. Lemenager, F. N. Owens, w. E. Sharp, Merwin Cmptn and Rbert Ttusek Stry in Brief Tw trials were cnducted t evaluate the supplemental value f mnensin

More information

M.R.C.Path. causes to the raised plasma urea in patients admitted

M.R.C.Path. causes to the raised plasma urea in patients admitted Pstgradcuate Medical Jurnal (January 1979) 55, 1-14 The cause f the raised plasma urea f acute heart failure R D THOMAS MRCP D B MORGAN MRCPath ALISON NWILL AIMLS Departments f Cardilgy and Chemical Pathlgy,

More information

M.J. Guthriel, D.G. Wagner2

M.J. Guthriel, D.G. Wagner2 EFFECT OF SUPPLEMENTAL PROTEIN OR GRAIN ON INTAKE AND UTILIZATION OF MEDIUM QUALITY PRAIRIE HAY BY STEERS M.J. Guthriel, D.G. Wagner2 and D.C. Weakley3 Stry in Brief Sixteen 1,053 lb tw-year-ld Herefrd

More information

Ketone-Body Utilization by Adult and Suckling Rat Brain in vivo

Ketone-Body Utilization by Adult and Suckling Rat Brain in vivo Bichem. J. (1971) 122, 13-18 13 Printed in Great Britain Ketne-Bdy Utilizatin by Adult and Suckling Rat Brain in viv By R. A. HAWKINS, D. H. WILLIAMSN AND H. A. KREBS Metablic Research Labratry, Nuffield

More information

The demonstration of lysosomes by the controlled temperature freezing-sectioning method By LUCILLE BITENSKY

The demonstration of lysosomes by the controlled temperature freezing-sectioning method By LUCILLE BITENSKY 205 The demnstratin f lyssmes by the cntrlled temperature freezing-sectining methd By LUCILLE BITESKY (Frm the Department f Pathlgy, Ryal Cllege f Surgens f England, Lincln's Inn Fields, Lndn, W.C. 2)

More information

disease at the time of study. The age range was from 23 to 49 years. All observations were made with the

disease at the time of study. The age range was from 23 to 49 years. All observations were made with the OBSERVATIONS ON THE EARLY ELEVATION OF SERUM POTASSIUM DURING RESPIRATORY ALKALOSIS 1 By JOHN B. HICKAM, WILLIAM P. WILSON, AND REGINA FRAYSER (Frm The Departments f Medicine and Psychiatry, Duke University

More information

METHYL TESTOSTERONE IN PREMATURE INFANTS

METHYL TESTOSTERONE IN PREMATURE INFANTS METHYL TESTOSTERONE IN PREMATURE INFANTS BY URSULA JAMES and B. L. COLES Frm the General Lying-In and Annie McCall Hspitals, Lndn (RECE:IVED FOR PUBLICATiN crber 18. 195 1) It is an established fact that

More information

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder? updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

CONDITIONS characterized by the presence

CONDITIONS characterized by the presence Cardiac Functin in Experimental Mitral Stensis By F..1. HADDY, M.D., A. L. FERRIN, M.D., D. W. HANNON, M.D., J. F. ALDEN, M.D., W. L. ADAMS, M.D., AND I. D. BARONOFSKY, M.D., PH.D. The results f S5 cmbined

More information

Resistance in Humans Not Undergoing Surgery

Resistance in Humans Not Undergoing Surgery Studies f Hemdynamic hanges in Humans Fllwing Inductin f Lw and High Spinal Anesthesia II. The hanges in Splanchnic Bld Flw, Oxygen Extractin and nsumptin, and Splanchnic Vascular Resistance in Humans

More information

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synpsis fr Public Disclsure This clinical study synpsis is prvided in line with Behringer Ingelheim s Plicy n Transparency and Publicatin f Clinical Study Data. The synpsis which is

More information

Module 3. Chapter 5 Microbial Metabolism. Catabolic and Anabolic Reactions Metabolism Two general types of metabolic reactions: o :

Module 3. Chapter 5 Microbial Metabolism. Catabolic and Anabolic Reactions Metabolism Two general types of metabolic reactions: o : Mdule 3 Chapter 5 Micrbial Metablism Catablic and Anablic Reactins Metablism Tw general types f metablic reactins: : : Recall frm Chapter 2: Energy can be when bnds Energy can be when bnds Catablism Purpse

More information

Test 3 Study Guide: Photosynthesis, Respiration, and the Cell Membrane

Test 3 Study Guide: Photosynthesis, Respiration, and the Cell Membrane Name Blck Date Test 3 Study Guide: Phtsynthesis, Respiratin, and the Cell Membrane Test Dates: December 13 (1 st and 7 th blck) and 12 (6 th blck) SOL: BIO.2d, 3d-e Related Ntes Phtsynthesis Respiratin

More information

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the

More information

Chapter 20 The Heart

Chapter 20 The Heart Chapter 20 The Heart ANATOMY OF THE HEART The adult heart is apprximately the size f. The heart is lcated in the cavity, between. Base is directed, and the apex is directed. The membrane surrunding and

More information

TREATMENT OF POLYCYTHEMIA VERA

TREATMENT OF POLYCYTHEMIA VERA RUSSELL L. HADEN, M.D. Plycythemia vera is characterized by an increase in the number f red bld cells. This disease is insidius in rigin, chrnic, and withut pathgnmnic symptms r physical findings. Early

More information

ventricular pressure in the dog, and they concluded contractility by the anesthetic agents and the surgical

ventricular pressure in the dog, and they concluded contractility by the anesthetic agents and the surgical Jurnal f Clinical Investigatin Vl. 42, N. 7, 1963 STUDIES ON DIGITALIS. IX. EFFECTS OF OUABAIN ON THE NONFAILING HUMAN HEART By DEAN T. MASON AND EUGENE BRAUNWALD (Frnt the Cardilgy Brantch, Natinal Heart

More information

A RECENT INVESTIGATION 7 of methods for determination of ovulation suggested

A RECENT INVESTIGATION 7 of methods for determination of ovulation suggested The Relatin f Urine V lume t the Menstrual Cycle and Ovulatin WAYNE L. RYAN, PH.D., ROBERT J. LUBY, M.D., AND MICHAEL J. HALLER, A.B. A RECENT INVESTIGATION 7 f methds fr determinatin f vulatin suggested

More information

Taste-sickness associations in youngrats over varying delays, stimulus, and test conditions

Taste-sickness associations in youngrats over varying delays, stimulus, and test conditions Animal Learning & Behavir 1980, 8(4), 529-533 Taste-sickness assciatins in yungrats ver varying delays, stimulus, and test cnditins GERARD M. MARTIN and W. K. TIMMINS Australian Natinal University, Canberra,

More information

Annex III. Amendments to relevant sections of the Product Information

Annex III. Amendments to relevant sections of the Product Information Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t

More information

THE LIBERATION OF RENIN BY PERFUSION OF KIDNEYS FOLLOWING REDUCTION OF PULSE PRESSURE* BY K. O. KOHLSTAEDT, M.D.,,~m~ IRVINE H. PAGE, M.D.

THE LIBERATION OF RENIN BY PERFUSION OF KIDNEYS FOLLOWING REDUCTION OF PULSE PRESSURE* BY K. O. KOHLSTAEDT, M.D.,,~m~ IRVINE H. PAGE, M.D. Published Online: 1 August, 1940 Supp Inf: http://di.rg/10.1084/jem.72.2.201 Dwnladed frm jem.rupress.rg n September 11, 2018 THE LIBERATION OF RENIN BY PERFUSION OF KIDNEYS FOLLOWING REDUCTION OF PULSE

More information

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 216 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS This briefing has been specifically prepared fr the Ministry f Health t prvide infrmatin frm this

More information

MEDICATION GUIDE Pioglitazone and Metformin Hydrochloride (PYE o GLI ta zone and met FOR min HYE-droe- KLOR-ide)Tablets, USP

MEDICATION GUIDE Pioglitazone and Metformin Hydrochloride (PYE o GLI ta zone and met FOR min HYE-droe- KLOR-ide)Tablets, USP MEDICATION GUIDE Piglitazne and Metfrmin Hydrchlride (PYE GLI ta zne and met FOR min HYE-dre- KLOR-ide)Tablets, USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride

More information

Teacher Ntes fr "Hw d muscles get the energy they need fr athletic activity?" 1 In this activity, students analyze hw aerbic cellular respiratin and anaerbic fermentatin cntribute t ATP prductin in muscle

More information

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.

More information

School Medication Authorization Form. School Grade Teacher. Emergency Phone No: To be completed by the student's physician: Name of Medication:

School Medication Authorization Form. School Grade Teacher. Emergency Phone No: To be completed by the student's physician: Name of Medication: Schl Medicatin Authrizatin Frm Student's Name Address Birth Date Hme Phne Schl Grade Teacher Emergency Phne N: T be cmpleted by the student's physician: Name f Medicatin: Dsage Frequency Time t be given

More information

MEDICATION GUIDE Pioglitazone (pie-oh-glit-ah-zohn) and Metformin (met-fore-min) Hydrochloride Tablets USP

MEDICATION GUIDE Pioglitazone (pie-oh-glit-ah-zohn) and Metformin (met-fore-min) Hydrochloride Tablets USP MEDICATION GUIDE Piglitazne (pie-h-glit-ah-zhn) and Metfrmin (met-fore-min) Hydrchlride Tablets USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride tablets

More information

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin Revisin 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin TABLE OF CONTENTS TABLE OF CONTENTS...

More information

OUR STUDIES on the seeming loss of

OUR STUDIES on the seeming loss of Evaluatin f Bld Vlume Measurement Techniques By JOHN W. REMINGTON, PH.D., AND CARLETON H. BAKEB, PH.D. OUR STUDIES n the seeming lss f plasma frm the circulatin after transfusin and the mbilizatin f plasma

More information

Department of Pharmacology, Medical College, Baroda

Department of Pharmacology, Medical College, Baroda EFFECT OF METABOLIC POISO S AND DIGOXIN 0 THE ADRENERGIC NEURONE BLOCKING ACTIO OF GUANETHIDINE SAROJA JAYKAR * AND O.D. GULATI Department f Pharmaclgy, Medical Cllege, Barda Summary: The adrenergic neurne

More information

Further Studies on the Influence of Steroids on

Further Studies on the Influence of Steroids on INFECTION AND IMMUNITY, Aug. 1973, p. 151-155 Cpyright ( 1973 American Sciety fr Micrbilgy Vl. 8, N. 2 Printed in U.S.A. Further Studies n the Influence f Sterids n Viral Infectin in Mice D. J. GIRON,

More information

ALCAT FREQUENTLY ASKED QUESTIONS

ALCAT FREQUENTLY ASKED QUESTIONS 1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age

More information

The clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only.

The clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only. The clinical trial infrmatin prvided in this public disclsure synpsis is supplied fr infrmatinal purpses nly. Please nte that the results reprted in any single trial may nt reflect the verall ptential

More information

Cardiac Rehabilitation Services

Cardiac Rehabilitation Services Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin

More information

Methadone Maintenance Treatment for Opioid Dependence

Methadone Maintenance Treatment for Opioid Dependence POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin

More information

Cancer Association of South Africa (CANSA)

Cancer Association of South Africa (CANSA) Cancer Assciatin f Suth Africa (CANSA) Fact Sheet and Psitin Statement n Cannabis in Suth Africa Intrductin Cannabis is a drug that cmes frm Indian hemp plants such as Cannabis sativa and Cannabis indica.

More information

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol. SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

AP Biology Lab 12: Introduction to the Scientific Method and Animal Behavior

AP Biology Lab 12: Introduction to the Scientific Method and Animal Behavior Name: AP Bilgy Lab 12: Intrductin t the Scientific Methd and Animal Behavir Overview In this lab yu will: -Observe an rganism and design an experiment t investigate their respnses t envirnmental variables.

More information

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria Benefits fr Anesthesia Services fr the CSHCN Services Prgram t Change Effective fr dates f service n r after July 1, 2008, benefit criteria fr anesthesia will change fr the Children with Special Health

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps.

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps. NAU Mdel Observatin Prtcl The mdel prtcl was develped with supprt and expertise frm the Natinal Institute fr Excellence in Teaching (NIET) and is based in great part n NIET s extensive experience cnducting

More information

Field Epidemiology Training Program

Field Epidemiology Training Program Field Epidemilgy Training Prgram Cancer Curriculum: Principles f Cancer Registries Case Study: Hspital-Based Cancer Registries FACILITATOR GUIDE FETP Cancer Curriculum: Principles f Cancer Registries Case

More information

with anemia caused by chronic blood loss from either Ten patients convalescing from a variety of illnesses,

with anemia caused by chronic blood loss from either Ten patients convalescing from a variety of illnesses, CEREBRAL CRCULATON AND METABOLSM N SCKLE CELL AND OTHER CHRONC ANEMAS, WTH OBSERVATONS ON THE EFFECTS OF OXYGEN NHALATON 1 By ALBERT HEYMAN, JOHN L. PATTERSON, JR., AND T. WHATLEY DUKE (Frm the Departments

More information

Managing the Symptoms of Stroke

Managing the Symptoms of Stroke Unit 26: Recgnising and Managing the Symptms f Strke Unit reference number: F/616/7312 Level: 2 Unit type: Optinal Credit value: 3 Guided learning hurs: 28 Unit summary A strke can be a life-threatening

More information

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT WOMEN AND NEWBORN HEALTH SERVICE CLINICAL GUIDELINES SECTION A: GUIDELINES RELEVANT TO OBSTETRICS AND GYNAECOLOGY 1 STANDARD PROTOCOLS 1.11 INSULIN INFUSION PUMP MANAGEMENT - INPATIENT Authrised by: OGCCU

More information

PROTOCOL 1850 Millrace Drive, Suite 3A Eugene, Oregon

PROTOCOL 1850 Millrace Drive, Suite 3A Eugene, Oregon PROTOCOL Cmplex II Enzyme Activity Micrplate Assay Kit 1850 Millrace Drive, Suite 3A Eugene, Oregn 97403 MS241 Rev.0 DESCRIPTION Cmplex II Enzyme Activity Micrplate Assay Kit Sufficient materials are prvided

More information

Materials Dissecting pan, dissecting kit, safety glasses, lab apron, pig heart, & gloves

Materials Dissecting pan, dissecting kit, safety glasses, lab apron, pig heart, & gloves Heart Dissectin Intrductin Mammals have fur-chambered hearts and duble circulatin. The heart f a bird r mammal has tw atria and tw cmpletely separated ventricles. The dublelp circulatin is similar t amphibians

More information

You may have a higher risk of bleeding if you take warfarin sodium tablets and:

You may have a higher risk of bleeding if you take warfarin sodium tablets and: MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain

More information

ALLERGY. The effect of alternate-day prednisone on the white blood count in children with chronic asthma

ALLERGY. The effect of alternate-day prednisone on the white blood count in children with chronic asthma The Jurnal f ALLERGY and CLINICAL IMMUNOLOGY VOLUME 51 NUMBER 2 The effect f alternate-day prednisne n the white bld cunt in children with chrnic asthma H. Cha, M.D., and A. Gilbert, M.T. Denver, Cl. Children

More information

Package leaflet: Information for the user. Fragmin Graduated Syringe 10,000 IU/ml Solution for Injection dalteparin sodium

Package leaflet: Information for the user. Fragmin Graduated Syringe 10,000 IU/ml Solution for Injection dalteparin sodium Package leaflet: Infrmatin fr the user Fragmin Graduated Syringe 10,000 IU/ml Slutin fr Injectin dalteparin sdium Read all f this leaflet carefully befre yu start using this medicine because it cntains

More information

ASSESSMENT OF PITUITARY FUNCTION IN PATIENTS WITH SERUM PROLACTIN LEVELS GREATER THAN 100 NG/ML*t

ASSESSMENT OF PITUITARY FUNCTION IN PATIENTS WITH SERUM PROLACTIN LEVELS GREATER THAN 100 NG/ML*t FERTILITY AND STERILITY Cpyright 1979 The American Fertility Sciety Vl. 32, N.2, August 1979 Printed in U.s.A. ASSESSMENT OF PITUITARY FUNCTION IN PATIENTS WITH SERUM PROLACTIN LEVELS GREATER THAN 100

More information

STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM

STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM Published Online: 1 June, 1936 Supp Inf: http://di.rg/1.184/jem.63.6.83 Dwnladed frm jem.rupress.rg n August 13, 218 STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM BY T. P. MAGILL,

More information

Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP

Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP Cntinuus Psitive Airway Pressure (CPAP) and Respiratry Assist Devices (RADs), Including Bi-Level PAP Benefit Criteria t Change fr Texas Medicaid Effective March 1, 2017 Overview f Benefit Changes Benefit

More information

THE RABBIT maintained on a highcholesterol

THE RABBIT maintained on a highcholesterol Fatty Acid Cmpsitin f Serum and Artic Intimal Lipids in Rabbits Fed Lw- and High-Chlesterl Diets By DONALD B. ZILVEKSMIT, PH.D., CHARLES C. SWEELEY, PH.D., AND HOWARD A. I. NEWMAN, PH.D. THE RABBIT maintained

More information

Hormonal Control of Cardiac Myosin Adenosine Triphosphatase in the Rat

Hormonal Control of Cardiac Myosin Adenosine Triphosphatase in the Rat Hrmnal Cntrl f Cardiac Mysin Adensine Triphsphatase in the Rat By Michael J. Rvett, Ake C. Hjalmarsn, Hward E. Mrgan, Michael J. Barrett, and Richard A. Gldstein ABSTRACT Cardiac functin was impaired in

More information

ARLA FOOD FOR HEALTH 4 th ANNUAL CALL FOR EXPRESSIONS OF INTEREST

ARLA FOOD FOR HEALTH 4 th ANNUAL CALL FOR EXPRESSIONS OF INTEREST ARLA FOOD FOR HEALTH 4 th ANNUAL CALL FOR EXPRESSIONS OF INTEREST 7 th July 2017 Cntent 1 Intrductin 2 Tpics fr EOI in the 4 th call 3 The applicatin prcess and imprtant dates 4 Guideline fr EOIs Deadline

More information

CDC Influenza Division Key Points MMWR Updates February 20, 2014

CDC Influenza Division Key Points MMWR Updates February 20, 2014 CDC Influenza Divisin Key Pints MMWR Updates In this dcument: Summary Key Messages Seasnal Influenza Vaccine Effectiveness: Interim Adjusted Estimates Influenza Surveillance Update: September 29, 2013-February

More information

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher:

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher: Year 10 Fd Technlgy Assessment Task 1: Fds fr Special Needs Name: Teacher: Due Date: Term 2, Week 1 Type f Task: Design Task Planning Fd Requirements Cllectin f Assessment: Submit in Class Assessment Plicy:

More information

Measurement of Renin Activity in Human Plasma

Measurement of Renin Activity in Human Plasma Measurement f Renin Activity in Human Plasma By Peter T. Pickens, M.B., M.R.C.P., F. Merlin Bumpus, Ph.D., A. Murray Llyd, M.B., M.R.A.C.P., Rbert R. Smeby, Ph.D., and Irvine H. Page, M.D. Many methds

More information

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate Package leaflet: Infrmatin fr the user Daceptn 5 mg/ml Slutin fr infusin Apmrphine hydrchlride hemihydrate Read all f this leaflet carefully befre yu start using this medicine because it cntains imprtant

More information

REVISION: PHOTOSYNTHESIS & CELLULAR RESPIRATION 18 JUNE 2014

REVISION: PHOTOSYNTHESIS & CELLULAR RESPIRATION 18 JUNE 2014 REVISION: PHOTOSYNTHESIS & CELLULAR RESPIRATION 18 JUNE 2014 Lessn Descriptin In this lessn, we revise: the prcess f phtsynthesis the prcesses invlved in cellular respiratin Summary Phtsynthesis (Slutins

More information

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this

More information

STUDIES ON THE FEASIBILITY OF PREDICTING FEEDLOT PERFORMANCE FROM CERTAIN LABORATORY GRAIN ANALYSES

STUDIES ON THE FEASIBILITY OF PREDICTING FEEDLOT PERFORMANCE FROM CERTAIN LABORATORY GRAIN ANALYSES University f Nebraska - Lincln DigitalCmmns@University f Nebraska - Lincln Faculty Papers and Publicatins in Animal Science Animal Science Department January 1978 STUDIES ON THE FEASIBILITY OF PREDICTING

More information

Printed copies of this document may not be up to date, obtain the most recent version from Author Position

Printed copies of this document may not be up to date, obtain the most recent version from   Author Position Printed cpies f this dcument may nt be up t date, btain the mst recent versin frm www.cats.nhs.uk Children s Acute Transprt Service Clinical Guidelines Diabetic Ketacidsis Dcument Cntrl Infrmatin Authr

More information

2017 Optum, Inc. All rights reserved BH1124_112017

2017 Optum, Inc. All rights reserved BH1124_112017 1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases

More information

PROTOCOL. SOD2 Protein Quantity Microplate Assay Kit. MS746 Rev.0 DESCRIPTION INTRODUCTION

PROTOCOL. SOD2 Protein Quantity Microplate Assay Kit. MS746 Rev.0 DESCRIPTION INTRODUCTION PROTOCOL SOD2 Prtein Quantity Micrplate Assay Kit 1850 Millrace Drive, Suite 3A Eugene, Oregn 97403 MS746 Rev.0 DESCRIPTION SOD2 Prtein Quantity Micrplate Assay Kit Sufficient materials are prvided fr

More information

* Manuscript received August 25, t Horticultural Research Section, CSIRO, Glen Osmond, South Australia.

* Manuscript received August 25, t Horticultural Research Section, CSIRO, Glen Osmond, South Australia. SUCROSE BREAKDOWN AND SYNTHESIS IN THE RIPENING GRAPE BERRY* By P. J. HARDyt Sucrse is the majr translcated sugar in the grapevine (Swansn and EIShishiny 1958), but in the berry glucse and fructse tgether

More information

Influence of Endosperm Type On the Nutritive Value Of Grain Sorghum and Corn

Influence of Endosperm Type On the Nutritive Value Of Grain Sorghum and Corn Influence f Endsperm Type On the Nutritive Value Of Grain Srghum and Crn c. A. Hibberd, R. Schemm and D. G. Wagner Stry in Brief The nutritive value f several varieties f grain srghum and crn was studied

More information

By Robert Zelis, M.D., Dean T. Mason, M.D., and Eugene Braunwald, M.D.

By Robert Zelis, M.D., Dean T. Mason, M.D., and Eugene Braunwald, M.D. Partitin f Bld Flw t the Cutaneus and Muscular Beds f the Frearm at Rest and during Leg Exercise in Nrmal Subjects and in Patients with Heart Failure By Rbert Zelis, M.D., Dean T. Masn, M.D., and Eugene

More information

Variation in Tissue Carnitine Concentrations with Age and Sex in the Rat

Variation in Tissue Carnitine Concentrations with Age and Sex in the Rat Bichem. J. (1978) 176, 677-681 Printed in Great Britain 677 Variatin in Tissue Carnitine Cncentratins with Age and Sex in the Rat By PEGGY R. BORUM Divisin fnutritin, Department fbichemistry, Vanderbilt

More information

METHOD 8032 ACRYLAMIDE BY GAS CHROMATOGRAPHY

METHOD 8032 ACRYLAMIDE BY GAS CHROMATOGRAPHY METHOD 8032 ACRYLAMIDE BY GAS CHROMATOGRAPHY 1.0 SCOPE AND APPLICATION 1.1 Methd 8032 is used t determine trace amunts f acrylamide mnmer in aqueus matrices. This methd may be applicable t ther matrices.

More information

(From the Laboratories of the International Health Division of The Rockefeller Foundation, New York)

(From the Laboratories of the International Health Division of The Rockefeller Foundation, New York) THE QUANTITATIVE DETERMINATION OF INFLUENZA VIRUS AND ANTIBODIES BY MEANS OF RED CELL AGGLUTINATION BY GEORGE K. HLRST, M.D. (Frm the Labratries f the Internatinal Health Divisin f The Rckefeller Fundatin,

More information

Commissioning Policy: South Warwickshire CCG (SWCCG)

Commissioning Policy: South Warwickshire CCG (SWCCG) Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Plicy Name: Plicy Number: Respnsible Department(s): CLINICAL MEDICAL POLICY Supervised Exercise Therapy fr Peripheral Artery Disease (PAD) MP-077-MD-DE Medical Management Prvider Ntice Date: 01/15/2019

More information

EASTERN ARIZONA COLLEGE Advanced Cardiovascular Life Support

EASTERN ARIZONA COLLEGE Advanced Cardiovascular Life Support EASTERN ARIZONA COLLEGE Advanced Cardivascular Life Supprt Curse Design 2013-2014 Curse Infrmatin Divisin Allied Health Curse Number EMT 220 Title Advanced Cardivascular Life Supprt Credits 1 Develped

More information

EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS

EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS 1 SECTION 1 INTRODUCTION: EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS The Nature Of Assessment The Definitin Of Assessment The Difference Between Testing, Measurement And Evaluatin Characteristics

More information

FOUNDATIONS OF DECISION-MAKING...

FOUNDATIONS OF DECISION-MAKING... Table f Cntents FOUNDATIONS OF DECISION-MAKING... Errr! Bkmark nt Describe the decisin-making prcess pp.62-66... Errr! Bkmark nt Explain the three appraches managers can use t make decisins pp.67-70 Errr!

More information

Triumeq (abacavir, dolutegravir and lamivudine) Product Backgrounder for US Media

Triumeq (abacavir, dolutegravir and lamivudine) Product Backgrounder for US Media Triumeq (abacavir, dlutegravir and lamivudine) Prduct Backgrunder fr US Media What is Triumeq and wh is Triumeq fr? Triumeq (abacavir 600mg, dlutegravir 50mg and lamivudine 300mg) is the first dlutegravir-based

More information

STUDIES IN THE RESPIRATORY AND CARBOHYDRATE METABOLISM OF PLANT TISSUES

STUDIES IN THE RESPIRATORY AND CARBOHYDRATE METABOLISM OF PLANT TISSUES New Phytl. (968) 67, 2327. STUDIES IN THE RESPIRATORY AND CARBOHYDRATE METABOLISM OF PLANT TISSUES III. THE MECHANISM OF THE 'CLIMACTERIC RISE IN RESPIRATION IN APPLES BY J. BARKER Btany Sclil, Liiiversitv

More information

Dependence of Defibrillation Threshold Upon Extracellular/Intracellular K+ Concentrations

Dependence of Defibrillation Threshold Upon Extracellular/Intracellular K+ Concentrations Purdue University Purdue e-pubs Weldn Schl f Bimedical Engineering Faculty Publicatins Weldn Schl f Bimedical Engineering 1980 Dependence f Defibrillatin Threshld Upn Extracellular/Intracellular K+ Cncentratins

More information

Intravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion

Intravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion Intravenus Vancmycin Use in Adults Intermittent (Pulsed) Infusin Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment

More information

MEDICATION GUIDE. (canagliflozin) Tablets

MEDICATION GUIDE. (canagliflozin) Tablets MEDICATION GUIDE INVOKANA (in-v-kahn-uh) (canagliflzin) Tablets What is the mst imprtant infrmatin I shuld knw abut INVOKANA? INVOKANA can cause imprtant side effects, including: Dehydratin. INVOKANA can

More information

Extraction of oleic acid from jojoba oil, soybean oil and olive oil Phase diagrams

Extraction of oleic acid from jojoba oil, soybean oil and olive oil Phase diagrams IndianJurnalfChemicalTechnlgy Vl.3, Nvember1996,pp. 299-305 Extractin f leic acid frm jjba il, sybean il and live il Phase diagrams JaimeWisniak*,AlexanderApelblat&Ahu-AkelKhaled epartmentfchemicalengineering,ben-gurianuniversityf

More information

Cnsideratin fr Optimizatin: Optimizatin is a prgram transfrmatin technique, which tries t imprve the cde by making it cnsume fewer resurces (i.e. CPU, Memry) and deliver high speed. In ptimizatin, high-level

More information

How to become an AME Online

How to become an AME Online Hw t becme an AME Online 1. Check that yu meet the minimum technical requirements in rder t use the AME Online system: Operating System: Windws Vista (Service Pack 2) Windws 7 Windws 8, 8.1 Windws 10 Please

More information

PET FORM Planning and Evaluation Tracking ( Assessment Period)

PET FORM Planning and Evaluation Tracking ( Assessment Period) Divisin f: Behaviral Studies PET FORM Planning and Evaluatin Tracking (2010 2011 Assessment Perid) Persn Respnsible fr this Divisin: Jerry Mller Department f: Behaviral Sciences Persn Respnsible fr this

More information

by Springer-Verlag 1977

by Springer-Verlag 1977 Diabetlgia 13, 615-61 (177) Diabetlgia @ by Springer-Verlag 177 Prevalence f Residual B-Cell Functin in Insulin-Treated Diabetics Evaluated by the Plasma C-Peptide Respnse t Intravenus Giucagn C. Hendriksen,

More information

LTCH QUALITY REPORTING PROGRAM

LTCH QUALITY REPORTING PROGRAM 4 LTCH QUALITY REPORTING PROGRAM GENERAL INFORMATION...3 LTCH FACILITY-LEVEL QUALITY MEASURE REPORT...5 LTCH PATIENT-LEVEL QUALITY MEASURE REPORT...18 LTCH REVIEW AND CORRECT REPORT...23 09/2018 v1.04

More information

CDC Influenza Technical Key Points February 15, 2018

CDC Influenza Technical Key Points February 15, 2018 CDC Influenza Technical Key Pints In this dcument: Summary Key Pints U.S. Vaccine Effectiveness U.S. Flu Activity Update Summary Key Pints On Thursday, tw influenza-related reprts appeared in the Mrbidity

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synpsis This Clinical Study Synpsis is prvided fr patients and healthcare prfessinals t increase the transparency f Bayer's clinical research. This dcument is nt intended t replace the advice

More information

Food information to consumers - Commission proposal - COM (2008) 40 final 2008/0028 (COD) The European Heart Network s position in a nutshell

Food information to consumers - Commission proposal - COM (2008) 40 final 2008/0028 (COD) The European Heart Network s position in a nutshell Fd infrmatin t cnsumers - Cmmissin prpsal - COM (2008) 40 final 2008/0028 (COD) The Eurpean Heart Netwrk s psitin in a nutshell Summary On 30 January 2008 the Eurpean Cmmissin published its prpsal fr a

More information

Relationship Between Fertility and the Nonprotein Sulfhydryl Concentration of Seminal Fluid in the Thoroughbred Stallion

Relationship Between Fertility and the Nonprotein Sulfhydryl Concentration of Seminal Fluid in the Thoroughbred Stallion Relatinship Between Fertility and the Nnprtein Sulfhydryl Cncentratin f Seminal Fluid in the Thrughbred Stallin Frederick M. Haag, D.V.M., * and N. T. Werthessen, Ph.D. IN AN EARLIER REPORT! it was shwn

More information

INTRODUCTION TO THE CIRCULATORY SYSTEM

INTRODUCTION TO THE CIRCULATORY SYSTEM INTRODUCTION TO THE CIRCULATORY SYSTEM What des bld d? 5. What makes this pssible? : In rder fr there t be an efficient exchange f xygen, waste and nutrients there must be a high surface area between the

More information

VITAPRO. Detoxification properties of Apple pectin formulation, PROPECTIN. CENTRE D ETUDE ET DE VALORISATION DES ALGUES FINAL REPORT.

VITAPRO. Detoxification properties of Apple pectin formulation, PROPECTIN. CENTRE D ETUDE ET DE VALORISATION DES ALGUES FINAL REPORT. CENTRE D ETUDE & DE VALORISATION DES ALGUES 2400 Detxificatin prperties f Apple pectin frmulatin, PROPECTIN. VITAPRO FINAL REPORT PrPectin July 2015 CENTRE D ETUDE ET DE VALORISATION DES ALGUES PRESQU

More information