Our results suggest that the PLR-TEB is a feasible method in spontaneously breathing volunteers with reasonable reproducibility. The age and baseline stroke volume effect suggests a more complex underlying physiology than commonly appreciated. The fact that half of the volunteers had a positive preload response, against the 10% threshold, leads to questions about how this measurement should be used in emergency care and will help shape future patient studies.

BackgroundFluid therapy is a common and crucial treatment in the emergency department (ED). While fluid responsiveness seems to be a promising method to titrate fluid therapy, the evidence for its value in ED is unclear. We aim to synthesise the existing literature investigating fluid responsiveness in ED.MethodsMEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present.ResultsA total of 249 publications were retrieved of which 22 studies underwent full-text review and eight relevant studies were identified. Only 3 studies addressed clinical outcomes - including 2 randomised controlled trials and one feasibility study. Five articles evaluated the diagnostic accuracy of fluid responsiveness techniques in ED. Due to marked heterogeneity, it was not possible to combine results in a meta-analysis.ConclusionHigh quality, adequately powered outcome studies are still lacking, so the place of fluid responsiveness in ED remains undefined. Future studies should have standardisation of patient groups, the target response and the underpinning theoretic concept of fluid responsiveness. The value of a fluid responsiveness based fluid resuscitation protocol needs to be established in a clinical trial.

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BackgroundCardiovascular disease (CVD) is a major cause of morbidity and mortality in rheumatoid arthritis (RA) patients. It has been postulated that chronic inflammatory activity is important for the development of CVD in RA even after adjustment for traditional cardiovascular risk factors.(1) One of the changes occurring in the context of inflammation is citrullination. Development of anti-citrullinated protein antibodies (ACPA) is implicated in higher frequency of extra-articular manifestations including cardiovascular complications.(2)ObjectivesTo assess the relation of ACPA to subclinical cardiac affection in RA patients.MethodsThirty RA patients fulfilling the 2010 ACR-EULAR classification criteria for RA with no clinically evident CVD were subjected to full history taking and clinical examination. Disease activity was assessed by 28-joint disease activity score based on C-reactive protein (DAS28-CRP) (4 variables). The levels of ACPA, CRP, total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol were measured. The patients were subjected to M-mode and colour Doppler echocardiographic examination.Patients were subdivided into two subgroups according to ACPA positivity (ACPA positive patients represented “group A” and ACPA negative patients represented “group B”).ResultsThe frequency of subclinical cardiac affection by echocardiographic examination was significantly higher among group A patients (4 patients had valvular lesion and 9 patients had diastolic dysfunction) than in group B patients (3 patients had diastolic dysfunction), (p=0.011). ACPA level showed significant positive correlation with isovolumic relaxation time (IVRT) in group A patients (prolongation of IVRT is a sign of diastolic dysfunction), (p=<0.001).Comparison between the two studied groups according to subclinical cardiac affectionGroup A (n=18)Group B (n=12)Test of sig. p No.%No.% Subclinical cardiac affectionPresent1372.2325.0FEχ2=6.4510.011*Absent527.8975.0FE: Fisher Exact for Chi square test, χ2: Chi square test. *Statistically significant at p≤0.05.ConclusionsThe presence of ACPA is related to development of subclinical cardiac involvement in RA patients and all RA patients with high level of ACPA should be routinely evaluated with echocardiography to assess their cardiovascular status.References Arnab B, Biswadip G, Arindam P, Shyamash M, Anirban G, Rajan P. Anti-CCP antibody in patients with established rheumatoid arthritis: Does it predict adverse cardiovascular profile? J Cardiovasc Dis 2013; 4(2):102–6.Crowson C, Liao K, Davis J, Solomon D, Matteson E, Knutson K, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J 2013; 166(4):622–28. Disclosure of InterestNone declared

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