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Background: Traditional Framingham risk factors are highly prevalent in patients with chronic kidney disease (CKD); however, they do not completely account for the accelerated cardiovascular (CV) risk in CKD. Recently global longitudinal strain (GLS) has emerged as a superior method for detecting, often subclinical, left ventricular(LV) systolic dysfunction as compared to ejection fraction(EF). This study aimed to determine the relationship between GLS, traditional risk factors and novel CKD-related risk factors in patients with CKD.Methods: This was a cross sectional study of patients with moderate CKD stages 3 and 4 (n=136). Clinical characteristics, anthropometric, biochemical data including markers of inflammation [C-reactive protein (CRP)], novel uraemic toxins [indoxyl sulphate(IS), p-cresyl sulphate(PCS)], and arterial stiffness [pulse wave velocity (PWV)] were measured. Inducible ischaemia was detected using exercise stress echo. Associations between GLS, traditional risk factors and CKDrelated risk factors were explored using multivariate models.Results: The study population parameters included: mean age 59.4±9.8 years, 58% male, estimated glomerular filtration rate (eGFR) 44.4±10 ml/min/1.73m 2 , GLS -18.3±3.6% and EF 65.8%±7.8%. We demonstrated that GLS correlated with diabetes (r=0.21, p=0.01), history of heart failure (HF) (r=0.20, p=0.01), free IS (r=0.24, p=0.005) free PCS (r=0.23, p=0.007), body mass index (BMI) (r=0.28, p<0.001), and PWV (r=0.24, p=0.009). Following adjustment for demographic, baseline co-morbidities and laboratory parameters, GLS was independently associated with free IS, BMI and arterial stiffness (R 2 for model = 0.30, p<0.0001). Conclusion:In the CKD cohort, LV systolic function, assessed using GLS, was associated with novel uraemic toxins, obesity and arterial stiffness.

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BACKGROUND AND PURPOSE: Virtual reality (VR) is a promising tool for distraction analgesia. This study aims to compare brain perfusion patterns while patients were undergoing burn wound care in two conditions-VR distraction and control (NoVR). METHODS: With IRB approval, four patients hospitalized for acute burn care (three males and one female) participated in the study. All patients underwent wound care on two consecutive days; 1 day with standard analgesia and adjunctive VR, and the other day with standard analgesia alone, otherwise the wound care was very similar. Tc-99m ethyl cysteinate dimer was injected during wound care at the time of peak pain. Subjective patient reports on a 0-10 scale of pain intensity, time spent thinking about pain, and "fun" as well as opioid equivalent usage were analyzed. Voxel by voxel subtraction analysis of brain perfusion Single Photon Emission Computed Tomography (SPECT) images was performed at the group level. Statistical significance threshold was defined as P < .05.

The cholinergic antisynthesis agent HC-3 was given intraventricularly to young male rats 20-30 days old to deplete brain aeetylcholine (ACh). The rate of ~C-3 induced depletion of ACh was used as an index of ACh utilization. Total brain ACh was determined following various doses of ehlordiazepoxide, pentobarbital, ehlorprom~zine, methotrimeprazine, imipramine, morphine, d-amphetamine, scopolamine, LSD-25, and phencyelidine give~l i.p. alone and after intraventrieular administration of I-IC-3. It was found that psyehotropie drugs have marked differential effects on the rate of I-IC-3 induced ACh depletion.