Andrea Morelli, M.D., of the University of Rome, Italy, and colleagues conducted a study to investigate the effect of the short-acting beta-blocker esmolol on the heart rate of patients with severe septic shock and high risk of death.
Septic shock is associated with adverse effects on cardiac function. Beta-blocker therapy controls heart rate and may improve cardiovascular performance, but concerns remain that this therapy may lead to cardiovascular decompensation (inability of the heart to maintain adequate circulation), according to background information in the article.
The randomised phase 2 study was conducted in a university hospital intensive care unit (ICU) between November 2010 and July 2012. It recruited patients in septic shock with a heart rate of 95/min or higher requiring high-dose norepinephrine to maintain an average arterial pressure of 65 mm Hg or higher. The researchers randomly assigned 77 patients to receive a continuous infusion of esmolol to maintain heart rate between 80 beats per minute (BPM) and 94 BPM for the duration of their ICU stay and 77 patients to standard treatment. The primary outcome was a reduction in heart rate below the predefined threshold of 95 BPM and maintain a heart rate between 80 and 94 BPM over a 96-hour period.
The researchers found that the target range for heart rate was achieved in all patients in the esmolol group, which was significantly lower throughout the intervention period than what was achieved in the control group. In addition, the esmolol group had a 28-day mortality rate of 49.4 percent vs. 80.5 percent in the control group. Overall survival was higher in the esmolol group.
There was no clinically relevant differences between groups in other investigated cardiopulmonary variables nor in rescue therapy requirements.
‘Further investigation of the effects of esmolol on clinical outcomes is warranted,’ the authors write. EurekAlert

Twenty grams of essential amino acids taken twice daily for a week before and for two weeks after knee-replacement surgeries helped 16 patients, mean age 69, recover faster and with much less muscle atrophy than a control group ingesting a placebo.
The approach could spell relief and speed recovery for a growing population of ageing adults who face total knee-replacements because of loss of mobility and pain problems. An estimated 3.48 million Americans are projected to need the surgery, known as total knee arthroplasty (TKA), by 2030.
The findings are part of an ongoing collaboration led by Hans C. Dreyer, a professor of human physiology at the University of Oregon, with the Eugene-based Slocum Research & Education Foundation and the Oregon Research Institute.
Atrophy in the quadriceps, a group of four muscles on the front of the thigh, has been a long-running problem following knee-replacement surgeries, Dreyer said.
In the study, 12 members of a control group receiving 40 grams a day of a non-essential amino acid supplement, a placebo, averaged an 18.4 loss in quadriceps muscle mass in their operated leg six weeks after surgery; those getting the supplement of eight essential amino acids (EEA) averaged a 6.2 percent loss. Eighty percent of atrophy occurred in the first two weeks after surgery. Atrophy in non-operative legs was about 50 percent of that in the operative leg in both groups. Muscle mass changes were seen with magnetic resonance imaging done at two and six weeks after surgery.
‘We’ve learned that the essential amino acids were able to mitigate the amount of muscle loss,’ Dreyer said. ‘The functional measures that we looked at

Dr Tom Lynch said the medical and IT worlds have come together to produce something unique. A group of medical consultants in Belfast have teamed up with IT specialists to develop a mobile app that can identify where a doctor is going wrong when interpreting X-rays. The app also helps medics develop their skills. It identifies areas of weakness that can be worked on in training and that could potentially save lives. According to those behind the training tool, it is the first of its kind in the world.
Dr Tom Lynch is among the founders. He said: ‘This is the medical and IT worlds coming together in Northern Ireland and producing something which is really unique.’
The app provides immediate feedback, and the more it is used by a doctor the more targeted and personalised the feedback becomes. Each doctor has particular strengths and weaknesses – this app means that the doctors are highlighted and then targeted. Primarily the device, known as Experior, will be used in accident and emergency and cancer departments, but could eventually be rolled out across all health specialities and even into education, industry and financial services. BBC

Scientists have developed an

A new study shows that a neurologist in an office thousands of miles away can deliver effective specialized care to people with Parkinson