SUMMARY. Studies in ischemic canine left ventricle have shown that the depletion of membrane phospholipids is a critical event in the development of a sarcolemmal calcium permeability defect and associated irreversible myocyte injury. The mechanism of phospholipid loss is unclear, but may be due to the activation of endogenous phospholipases. Since arachidonic acid is a fatty acid found almost entirely in phospholipid, increases in arachidonate provide evidence for increased phospholipase activity. The present study was designed to examine the temporal relationship of the accumulation of free arachidonate with the onset of phospholipid depletion during fixed ligation of the left anterior descending coronary artery in canine myocardium. The following results were demonstrated in ischemic canine myocardium: (1) the accumulation of unesterified arachidonate is minimal during 10-30 minutes of ischemia, but is significantly increased after prolonging the duration of ischemia to 1-3 hours; (2) significant increases in arachidonate precede the development of a significant decrease in total phospholipid content; (3) the decrease in the arachidonate content of phosphatidylcholine is accompanied by similar decreases in all of the fatty acyl moieties; (4) the arachidonate content of lysophosphatidylcholine and diacylglycerol are unchanged during myocardial ischemia; (5) there is evidence of a deacylarion-reacylation cycle in phosphatidylcholine prior to the accumulation of free arachidonate; (6) the fatty acyl specificity of the lysophosphatidylcholine acyltransferase corresponds to the pattern of fatty acyl remodeling of phosphatidylcholine during early myocardial ischemia. These data suggest that the accumulation of arachidonate may be a more sensitive measure of phospholipid degradation than the decrease in total phospholipid content in ischemic canine myocardium. It is postulated that the defective reacylation of arachidonate into phosphatidylcholine may contribute to the net loss of membrane phospholipid during myocardial ischemia. (Circ Res 54: 313-322, 1984)

Purpose: To determine medical student ability to accurately obtain and interpret POCUS exams of varying difficulty in the pediatric population after a short didactic and hands-on POCUS course.  Methods: Five medical students were trained in four POCUS applications (bladder volume, long bone for fracture, limited cardiac for left ventricular function, & inferior vena cava collapsibility) and enrolled pediatric ED patients. Ultrasound-fellowship-trained emergency medicine physicians reviewed each scan for image quality and interpretation accuracy using the American College of Emergency Physicians’ quality assessment scale. We report acceptable scan frequency and medical student vs. Ultrasound-fellowship-trained emergency medicine physician interpretation agreement with 95% confidence intervals (CI).  Results: Ultrasound-fellowship-trained emergency medicine physicians graded 51/53 bladder volume scans as acceptable (96.2%; 95% CI 87.3-99.0%) and agreed with 50/53 bladder volume calculations (94.3%; 95% CI 88.1-100%). Ultrasound-fellowship-trained emergency medicine physicians graded 35/37 long bone scans as acceptable (94.6%; 95% CI 82.3-98.5%) and agreed with 32/37 medical student long bone scan interpretations (86.5%; 95% CI 72.0-94.1%).  Ultrasound-fellowship-trained emergency medicine physicians graded 116/120 cardiac scans as acceptable (96.7%; 95% CI 91.7-98.7%) and agreed with 111/120 medical student left ventricular function interpretations (92.5%; 95% CI 86.4-96.0%). Ultrasound-fellowship-trained emergency medicine physicians graded 99/117 inferior vena cava scans as acceptable (84.6%; 95% CI 77.0-90.0%) and agreed with 101/117 medical student interpretations of inferior vena cava collapsibility (86.3%; 95% CI 78.9-91.4%).  Conclusions: Medical students demonstrated satisfactory ability within a short period of time in a range of POCUS scans on pediatric patients after a novel curriculum. This supports the incorporation of a formal POCUS education into medical school curricula and suggests that novice POCUS learners can attain a measure of competency in multiple applications after a short training course.

Recent studies have demonstrated that fatty acids can be successfully utilized as myocardial imaging agents. 125I-paraphenylpentadecanoic acid (IPPA), a synthetic fatty acid, accumulates within the myocardium and can be visualized by conventional gamma scintigraphy. To determine if IPPA was incorporated into cardiac lipids in a pattern similar to palmitate, IPPA was purified by liquid chromatography, bound to fat-free albumin, and administered by intravenous injection to male Sprague-Dawley rats. After 2.5, 5, 10, and 30 min, the hearts were excised and the lipids were extracted in chloroform-methanol. The uptake of IPPA into the myocardium reached a maximal value after 2.5 min, and 95% of the 125I was found in the cardiac lipid fraction after chromatographic separation. Over 65% of the IPPA was found in cardiac triglycerides, whereas approximately 10% was present in membrane phospholipids (predominantly phosphatidylcholine and phosphatidylethanolamine). This pattern of IPPA incorporation is similar to that reported for intravenously administered [3H]palmitate. The rate of turnover of IPPA present in the triglyceride fraction was threefold faster than the rate of the IPPA which was incorporated into membrane lipids. At all time periods examined, the methanol-water soluble end products of IPPA oxidation did not account for more than 5% of the total IPPA present within the myocardium. The present study indicates that IPPA is incorporated primarily into triglycerides and other cardiac lipids in a pattern similar to palmitate.