Cutaneous angiomatosis in a llama (Lama glama).

PubMed

Luppi, M M; Malta, M C C; Ocarino, N M; França, S A; Serakides, R

2010-01-01

Cutaneous angiomatosis was diagnosed in an adult female llama (Lama glama). Lesions were raised or plaque-like, erythematous, firm to soft in consistency and were observed on the face and skin of the axillary, abdominal, perineal and inguinal regions. The lesions were not painful or pruritic. Microscopical examination revealed an irregular parakeratotic lamellar hyperkeratosis associated with diffuse proliferation of arterioles and venules in the superficial dermis. Immunohistochemical analysis determined that the cells forming these vessels and perivascular cells expressed factor VIII-related antigen, vascular endothelial growth factor (VEGF), CD31 and smooth-muscle alpha-actin. These studies confirmed the diagnosis of cutaneous angiomatosis. Copyright 2009 Elsevier Ltd. All rights reserved.

A complete mitochondrial genome sequence of the wild two-humped camel (Camelus bactrianus ferus): an evolutionary history of camelidae

PubMed Central

Cui, Peng; Ji, Rimutu; Ding, Feng; Qi, Dan; Gao, Hongwei; Meng, He; Yu, Jun; Hu, Songnian; Zhang, Heping

2007-01-01

Background The family Camelidae that evolved in North America during the Eocene survived with two distinct tribes, Camelini and Lamini. To investigate the evolutionary relationship between them and to further understand the evolutionary history of this family, we determined the complete mitochondrial genome sequence of the wild two-humped camel (Camelus bactrianus ferus), the only wild survivor of the Old World camel. Results The mitochondrial genome sequence (16,680 bp) from C. bactrianus ferus contains 13 protein-coding, two rRNA, and 22 tRNA genes as well as a typical control region; this basic structure is shared by all metazoan mitochondrial genomes. Its protein-coding region exhibits codon usage common to all mammals and possesses the three cryptic stop codons shared by all vertebrates. C. bactrianus ferus together with the rest of mammalian species do not share a triplet nucleotide insertion (GCC) that encodes a proline residue found only in the nd1 gene of the New World camelid Lama pacos. This lineage-specific insertion in the L. pacos mtDNA occurred after the split between the Old and New World camelids suggests that it may have functional implication since a proline insertion in a protein backbone usually alters protein conformation significantly, and nd1 gene has not been seen as polymorphic as the rest of ND family genes among camelids. Our phylogenetic study based on complete mitochondrial genomes excluding the control region suggested that the divergence of the two tribes may occur in the early Miocene; it is much earlier than what was deduced from the fossil record (11 million years). An evolutionary history reconstructed for the family Camelidae based on cytb sequences suggested that the split of bactrian camel and dromedary may have occurred in North America before the tribe Camelini migrated from North America to Asia. Conclusion Molecular clock analysis of complete mitochondrial genomes from C. bactrianus ferus and L. pacos suggested that the two tribes diverged from their common ancestor about 25 million years ago, much earlier than what was predicted based on fossil records. PMID:17640355

Presynaptic congenital myasthenic syndrome with a homozygous sequence variant in LAMA5 combines myopia, facial tics, and failure of neuromuscular transmission.

PubMed

Maselli, Ricardo A; Arredondo, Juan; Vázquez, Jessica; Chong, Jessica X; Bamshad, Michael J; Nickerson, Deborah A; Lara, Marian; Ng, Fiona; Lo, Victoria L; Pytel, Peter; McDonald, Craig M

2017-08-01

Defects in genes encoding the isoforms of the laminin alpha subunit have been linked to various phenotypic manifestations, including brain malformations, muscular dystrophy, ocular defects, cardiomyopathy, and skin abnormalities. We report here a severe defect of neuromuscular transmission in a consanguineous patient with a homozygous variant in the laminin alpha-5 subunit gene (LAMA5). The variant c.8046C>T (p.Arg2659Trp) is rare and has a predicted deleterious effect. The affected individual, who also carries a rare homozygous sequence variant in LAMA1, had muscle weakness, myopia, and facial tics. Magnetic resonance imaging of brain showed mild volume loss and periventricular T2 prolongation. Repetitive nerve stimulation revealed 50% decrement of compound muscle action potential amplitudes and 250% facilitation immediately after exercise, Endplate studies identified a profound reduction of the endplate potential quantal content and endplates with normal postsynaptic folding that were denuded or partially occupied by small nerve terminals. Expression studies revealed that p.Arg2659Trp caused decreased binding of laminin alpha-5 to SV2A and impaired laminin-521 cell-adhesion and cell projection support in primary neuronal cultures. In summary, this report describing severe neuromuscular transmission failure in a patient with a LAMA5 mutation expands the list of phenotypes associated with defects in genes encoding alpha-laminins. © 2017 Wiley Periodicals, Inc.

Y-chromosome and mtDNA variation confirms independent domestications and directional hybridization in South American camelids.

PubMed

Marín, J C; Romero, K; Rivera, R; Johnson, W E; González, B A

2017-10-01

Investigations of genetic diversity and domestication in South American camelids (SAC) have relied on autosomal microsatellite and maternally-inherited mitochondrial data. We present the first integrated analysis of domestic and wild SAC combining male and female sex-specific markers (male specific Y-chromosome and female-specific mtDNA sequence variation) to assess: (i) hypotheses about the origin of domestic camelids, (ii) directionality of introgression among domestic and/or wild taxa as evidence of hybridization and (iii) currently recognized subspecies patterns. Three male-specific Y-chromosome markers and control region sequences of mitochondrial DNA are studied here. Although no sequence variation was found in SRY and ZFY, there were seven variable sites in DBY generating five haplotypes on the Y-chromosome. The haplotype network showed clear separation between haplogroups of guanaco-llama and vicuña-alpaca, indicating two genetically distinct patrilineages with near absence of shared haplotypes between guanacos and vicuñas. Although we document some examples of directional hybridization, the patterns strongly support the hypothesis that llama (Lama glama) is derived from guanaco (Lama guanicoe) and the alpaca (Vicugna pacos) from vicuña (Vicugna vicugna). Within male guanacos we identified a haplogroup formed by three haplotypes with different geographical distributions, the northernmost of which (Peru and northern Chile) was also observed in llamas, supporting the commonly held hypothesis that llamas were domesticated from the northernmost populations of guanacos (L. g. cacilensis). Southern guanacos shared the other two haplotypes. A second haplogroup, consisting of two haplotypes, was mostly present in vicuñas and alpacas. However, Y-chromosome variation did not distinguish the two subspecies of vicuñas. © 2017 Stichting International Foundation for Animal Genetics.

Voluntary suppression of hyperthermia-induced hyperventilation mitigates the reduction in cerebral blood flow velocity during exercise in the heat.

PubMed

Tsuji, Bun; Honda, Yasushi; Ikebe, Yusuke; Fujii, Naoto; Kondo, Narihiko; Nishiyasu, Takeshi

2015-04-15

Hyperthermia during prolonged exercise leads to hyperventilation, which can reduce arterial CO2 pressure (PaCO2 ) and, in turn, cerebral blood flow (CBF) and thermoregulatory response. We investigated 1) whether humans can voluntarily suppress hyperthermic hyperventilation during prolonged exercise and 2) the effects of voluntary breathing control on PaCO2 , CBF, sweating, and skin blood flow. Twelve male subjects performed two exercise trials at 50% of peak oxygen uptake in the heat (37°C, 50% relative humidity) for up to 60 min. Throughout the exercise, subjects breathed normally (normal-breathing trial) or they tried to control their minute ventilation (respiratory frequency was timed with a metronome, and target tidal volumes were displayed on a monitor) to the level reached after 5 min of exercise (controlled-breathing trial). Plotting ventilatory and cerebrovascular responses against esophageal temperature (Tes) showed that minute ventilation increased linearly with rising Tes during normal breathing, whereas controlled breathing attenuated the increased ventilation (increase in minute ventilation from the onset of controlled breathing: 7.4 vs. 1.6 l/min at +1.1°C Tes; P < 0.001). Normal breathing led to decreases in estimated PaCO2 and middle cerebral artery blood flow velocity (MCAV) with rising Tes, but controlled breathing attenuated those reductions (estimated PaCO2 -3.4 vs. -0.8 mmHg; MCAV -10.4 vs. -3.9 cm/s at +1.1°C Tes; P = 0.002 and 0.011, respectively). Controlled breathing had no significant effect on chest sweating or forearm vascular conductance (P = 0.67 and 0.91, respectively). Our results indicate that humans can voluntarily suppress hyperthermic hyperventilation during prolonged exercise, and this suppression mitigates changes in PaCO2 and CBF. Copyright © 2015 the American Physiological Society.

Voluntary suppression of hyperthermia-induced hyperventilation mitigates the reduction in cerebral blood flow velocity during exercise in the heat

PubMed Central

Tsuji, Bun; Honda, Yasushi; Ikebe, Yusuke; Fujii, Naoto; Kondo, Narihiko

2015-01-01

Hyperthermia during prolonged exercise leads to hyperventilation, which can reduce arterial CO2 pressure (PaCO2) and, in turn, cerebral blood flow (CBF) and thermoregulatory response. We investigated 1) whether humans can voluntarily suppress hyperthermic hyperventilation during prolonged exercise and 2) the effects of voluntary breathing control on PaCO2, CBF, sweating, and skin blood flow. Twelve male subjects performed two exercise trials at 50% of peak oxygen uptake in the heat (37°C, 50% relative humidity) for up to 60 min. Throughout the exercise, subjects breathed normally (normal-breathing trial) or they tried to control their minute ventilation (respiratory frequency was timed with a metronome, and target tidal volumes were displayed on a monitor) to the level reached after 5 min of exercise (controlled-breathing trial). Plotting ventilatory and cerebrovascular responses against esophageal temperature (Tes) showed that minute ventilation increased linearly with rising Tes during normal breathing, whereas controlled breathing attenuated the increased ventilation (increase in minute ventilation from the onset of controlled breathing: 7.4 vs. 1.6 l/min at +1.1°C Tes; P < 0.001). Normal breathing led to decreases in estimated PaCO2 and middle cerebral artery blood flow velocity (MCAV) with rising Tes, but controlled breathing attenuated those reductions (estimated PaCO2 −3.4 vs. −0.8 mmHg; MCAV −10.4 vs. −3.9 cm/s at +1.1°C Tes; P = 0.002 and 0.011, respectively). Controlled breathing had no significant effect on chest sweating or forearm vascular conductance (P = 0.67 and 0.91, respectively). Our results indicate that humans can voluntarily suppress hyperthermic hyperventilation during prolonged exercise, and this suppression mitigates changes in PaCO2 and CBF. PMID:25632021

[Effect of dexmedetomidine and midazolam on respiration and circulation functions in patients undergoing open heart surgery under acupuncture-assisted general anesthesia].

PubMed

Tang, Wei; Wang, Jian; Fu, Guo-Qiang; Yuan, Lan

2014-06-01

To evaluate the effect of Dexmedetomidine and Midazolam on respiratory and circulation in patients experiencing open heart surgery under acupuncture-assisted general anesthesia. Sixty patients undergoing open heart surgery (cardiac valve replacement surgery and aortic valve replacement surgery) were randomly and equally divided into Dexmedetomidine (D) and Midazolam (M) groups. Electroacupuncture (EA) was applied to bilateral Yunmen (LU 2), Zhongfu (LU1), Lieque (LU7) and Neiguan (PC6). For patients of group D, Dexmedetomidine (i.v., loading dose: 1 microg/kg, and succedent dose: 0.2-1 microg x kg(-1) x h(-1)) was given. For patients of group M, Midazolam (i.v., loading dose: 0.05 mg/kg, succedent dose: 0.01-0.03 mg x kg(-1) x h(-1)) was given. Arterial oxygen pressure (PaO2), arterial carbondioxide tension (PaCO2), O2 saturation (SPO2), mean arterial pressure (MAP), heart rate (HR), anesthetic effect, time of spontaneous breathing recovery, and time of resuscitation were recorded before operation (T0), immediately after skin incision (T1), immediately after sternotomy (T2), before suspension of cardiopulmonary bypass (CPB, T3), immediately after cardiac re-beating (T4), immediately after CPB cessation (T5), and at the end of surgery (T6). Before operation, no significant differences were found between the group D and M in the levels of PaO2, PaCO2 and SPO2 (P > 0.05). The PaO2 and SPO2 levels after skin incision, sternotomy, before suspension of CPB and at the end of surgery were significantly lower in group M than in group D (P < 0.05), while the le- vels of PaCO2 after skin incision, sternotomy, before suspension of CPB and at the end of surgery, and HR after skin incision, sternotomy, before suspension of CPB, after heart re-beating,after CPB cessation and at the end of surgery in group M were considerably higher than those in group D (P < 0.05). In addition, the time of spontaneous breathing recovery of group M was significantly later than that of group D (P < 0.05). No significant differences were found between the two groups in MAP levels at the 6 time-points during surgery, in the PaO2, PaCO2 and SPO2 levels at the time-points of post-cardiac re-beating, and after CPB cessation (P > 0.05). It suggested that the respiration and circulation states in group D were more smoothly than those in group M. There was no significant difference between the two groups in the time of resuscitation (P > 0.05). Dexmedetomidine is superior to Midazolam in analgesia, and improving respiration and circulation functions for open heart surgery patients under acupuncture-assisted general anesthesia.

Alpaca (Lama pacos) as a convenient source of recombinant camelid heavy chain antibodies (VHHs)

PubMed Central

Maass, David R.; Sepulveda, Jorge; Pernthaner, Anton; Shoemaker, Charles B.

2007-01-01

Recombinant single domain antibody fragments (VHHs) that derive from the unusual camelid heavy chain only IgG class (HCAbs) have many favourable properties compared with single-chain antibodies prepared from conventional IgG. As a result, VHHs have become widely used as binding reagents and are beginning to show potential as therapeutic agents. To date, the source of VHH genetic material has been camels and llamas despite their large size and limited availability. Here we demonstrate that the smaller, more tractable and widely available alpaca is an excellent source of VHH coding DNA. Alpaca sera IgG consists of about 50% HCAbs, mostly of the short-hinge variety. Sequencing of DNA encoding more than 50 random VHH and hinge domains permitted the design of PCR primers that will amplify virtually all alpaca VHH coding DNAs for phage display library construction. Alpacas were immunized with ovine tumour necrosis factor α (TNFα) and a VHH phage display library was prepared from a lymph node that drains the sites of immunizations and successfully employed in the isolation of VHHs that bind and neutralize ovine TNFα. PMID:17568607

Characteristics and health care resource use of subjects with COPD in the year before initiating LAMA monotherapy or LAMA+LABA combination therapy: A U.S. database study.

PubMed

Nagar, Saurabh; Patel, Jeetvan; Stanford, Richard H

2018-05-01

To characterize subjects with chronic obstructive pulmonary disease (COPD) newly initiated on long-acting muscarinic antagonists (LAMA) or dual LAMA/long-acting β2-adrenergic agonist (LABA) therapy. This pilot/preliminary analysis was a retrospective crosssectional study of subjects with COPD from the Optum Impact National Managed Care Benchmark Database. Subjects with at least one LAMA prescription in the index period (July 2008-June 2009) were included and stratified by treatment. Data were collected in the year before the index date and included comorbidities, medication use, COPD-related costs, health care resource use, and exacerbations. Of 5,311 eligible subjects, 2,057 initiated LAMA therapy (LAMA cohort) and 191 initiated LAMA+LABA therapy (LAMA+LABA cohort). The Charlson comorbidity index was slightly lower in the LAMA+LABA cohort than the LAMA cohort (mean±SD: 0.63±1.13 vs. 0.66±1.28), but the number of prescriptions was higher (mean±SD: 42.9±23.2 vs. 30.5±27.2). The LAMA+LABA cohort had higher short-acting inhaled β2 agonist (56.0% vs. 35.7%), oral corticosteroid (37.7% vs. 32.6%), and home oxygen therapy use (14.1% vs. 3.2%) than the LAMA cohort. Total medical costs were greater in the LAMA+LABA cohort than the LAMA cohort (mean±SD: $3,320.40±4085.9 vs. $1,226.20±3602.9), although emergency department ($11.00±66.8 vs. $30.70±259.2) and outpatient visit ($39.60±163.1 vs. $41.70±424.3) costs were lower. Resource use and exacerbation incidence were similar between cohorts. In this first look, subjects with COPD initiating LAMA or LAMA+LABA therapy exhibited different clinical and resource use characteristics in the year before treatment. Subjects receiving LAMA+LABA were older, with higher COPD co-medication use, more prescriptions, and associated higher pharmacy costs compared with subjects initiating LAMA. These differences may reflect a higher severity of COPD in those starting LABA+LAMA treatment.

Clinical Investigation Program Annual Progress Report.

DTIC Science & Technology

1983-09-30

Antiemetics (A Phase II Study).(O) ............... 049 79/110 Evaluation of Local Anesthetic Skin Testing and Progressive Challenge in Patients with a History ...Associated with Oat Cell Carcinoma. J Assoc Mil Derm 8, 1982. Grimwood, R.E.: The History and Principles of Immunofluorescence. J Assn Mil Derm 9(1...December, 1981. ""’ PRESENTATIONS: 1.) Kindig, N.B.: D CO correction using PaCO back pressure predicted from venous bloo . Sfresented: Carl E

[The occurrence of "Candidatus Mycoplasma haemolamae" infections in clinically asymptomatic South American Camelids in Austria].

PubMed

Franz, Sonja; Spergser, Joachim; Schwendenwein, Ilse; Stanitznig, Anna; Lambacher, Bianca; Tichy, Alexander; Wittek, Thomas

2016-01-01

Reports of CMhl infections in South American Camelids in Europe are only available from the United Kingdom and Switzerland. Knowing that CMhl infections can lead to severe disease resulting in death if combined with other diseases or stress, it was the aim of this study to assess prevalence data from camelids in Austria. In comparison to the previous studies a representative number of camelids was investigated nationwide. Data were assessed due to differences in geographical region, age, sex, species, and origin. A relatively high prevalence of 25.8% was recorded. CMhl was detected significantly more often in alpacas (Vicunja pacos) than in llamas (Lama glama) and more frequently in animals younger than 2 years. Additionally regional differences have been observed, which might be due to climatic differences and/or variations in insect vectors. In this study apperantly clinical healthy animals were shown to be infected with CMhl. Camelids infected with CMhl are a pathogen reservoir. The results of this study indicate different risk levels of infection between llamas and alpacas and between younger and older animals. The data presented underline the necessity of further studies on CMhlI infections in South American Camelids.

Hyperthermic-induced hyperventilation and associated respiratory alkalosis in humans.

PubMed

Abbiss, Chris R; Nosaka, Kazunori; Laursen, Paul B

2007-05-01

The purpose of this study was to determine if increased environmental heat leads to hyperthermic-induced hypocapnia and associated alkalosis during prolonged self-paced cycling. Nine male cyclists completed three 100 km stochastic time trials in hot (34 degrees C), neutral (22 degrees C) and cold (10 degrees C) environments. Intermittent measurements of rectal and skin temperature, expired gases, blood pH, PaCO(2), PaO(2), and bicarbonate were made throughout. Rectal temperature increased significantly throughout all trials (P < 0.001) and was significantly correlated with increases in the ventilatory equivalent for carbon dioxide (Ve/ VCo2; r = 0.77; P < 0.001) and blood pH (r = 0.69; P < 0.05). Rectal temperature was also negatively correlated with a reduction in PaCO(2) (r = -0.80; P < 0.001). PaO(2) and bicarbonate concentration remained constant throughout all trials. This study has shown that prolonged self-paced cycling is associated with a hyperthermic-induced hyperventilation, causing a decrease in arterialized carbon dioxide tension and consequential respiratory alkalosis.

Laminin α1 is essential for mouse cerebellar development

PubMed Central

Ichikawa-Tomikawa, Naoki; Ogawa, Junko; Douet, Vanessa; Xu, Zhuo; Kamikubo, Yuji; Sakurai, Takashi; Kohsaka, Shinichi; Chiba, Hideki; Hattori, Nobutaka; Yamada, Yoshihiko; Arikawa-Hirasawa, Eri

2011-01-01

Laminin α1 (Lama1), which is a subunit of laminin-1 (laminin-111), a heterotrimeric ECM protein, is essential for embryonic development and promotes neurite outgrowth in culture. Because the deletion of Lama1 causes lethality at early embryonic stages in mice, the in vivo role of Lama1 in neural development and functions has not yet been possible to determine. In this study, we generated conditional Lama1 knockout (Lama1CKO) mice in the epiblast lineage using Sox2-Cre mice. These Lama1CKO mice survived, but displayed behavioral disorders and impaired formation of the cerebellum. Deficiency of Lama1 in the pial basement membrane of the meninges resulted in defects in the conformation of the meninges. During cerebellar development, Lama1 deficiency also caused a decrease in the proliferation and migration of granule cell precursors, disorganization of Bergmann glial fibers and endfeet, and a transient reduction in the activity of Akt. A marked reduction in numbers of dendritic processes in Purkinje cells was observed in Lama1CKO mice. Together, these results indicate that Lama1 is required for cerebellar development and functions. PMID:21983115

LAMA2-related myopathy: Frequency among congenital and limb-girdle muscular dystrophies.

PubMed

Løkken, Nicoline; Born, Alfred Peter; Duno, Morten; Vissing, John

2015-10-01

Muscular dystrophy caused by LAMA2-gene mutations is an autosomal recessive disease typically presenting as a severe, early-onset congenital muscular dystrophy (CMD). However, milder cases with a limb-girdle type muscular dystrophy (LGMD) have been described. In this study, we assessed the frequency and phenotypic spectrum of LAMA2-related muscular dystrophy in CMD (n = 18) and LGMD2 (n = 128) cohorts identified in the last 15 years in eastern Denmark. The medical history, brain-MRI, muscle pathology, muscle laminin-α2 expression, and genetic analyses were assessed. Molecular genetics revealed 2 pathogenic LAMA2 mutations in 5 of 18 CMD and 3 of 128 LGMD patients, corresponding to a LAMA2-mutation frequency of 28% in the CMD and 2.3% in the LGMD cohorts, respectively. This study demonstrates a wide clinical spectrum of LAMA2-related muscular dystrophy and its prevalence in an LGMD2 cohort, which indicates that LAMA2 muscular dystrophy should be included in the LGMD2 nomenclature. © 2015 Wiley Periodicals, Inc.

Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman.

PubMed

Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

2016-02-01

The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital's electronic system (27.9%) and telephone conversations with patients' parents (55.0%). No reasons for LAMA were documented in the hospital's electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA.

AB033. Assessing the appropriateness of pharmacological prescriptions for COPD to clinical guidelines: EPOCONSUL study

PubMed Central

Alcázar, Bernardino; Calle, Myrian; Soler, Juan José; López-Campos, José Luis; Rodriguez, José-Maria; Soriano, Joan

2016-01-01

Background Adherence to clinical practice guidelines is far from optimal for most of the chronic diseases. Spain has implemented a phenotype based chronic obstructive pulmonary disease (COPD) guideline and there is scarce data about the follow-up of this guideline. The aim of this study is to evaluate the suitability of the pharmacological treatment for COPD to the Spanish Guidelines (GesEPOC) recommendations in patients with COPD recruited at respiratory clinics around Spain. Methods EPOCONSUL study is a observational, multicentre, cross-sectional study aimed to audit clinical histories from stable COPD patients attended at respiratory offices. Patients were recruited prospectively from 62 centres around Spain along June 2014 to June 2015. Results The EPOCONSUL study audited 4,501 medical histories from patients with COPD. Characteristics of study population showed 86.0% males, with a mean age (± SD) of 69.77±9.79 years. In 76.9% of the cases patients were attended at general respiratory offices. Baseline FEV1 values were 52.3%±18.4% of predicted. A COPD diagnosis using GesEPOC guidelines was performed in 2,087 patients (46.3%). The most preferred treatment option was the association of ICS/LABA in fixed-dose combination and LAMA, that was used in 2,450 patients of the whole sample. Among patients with a diagnosis of COPD according to GesEPOC guidelines, the preferred form of treatment was: non-exacerbators (LAMA/LABA 37.8%, LAMA/LABA/ICS 36.6%, LAMA 15.9% and LABA/ICS 4.9%), Asthma-COPD overlap syndrome (LAMA/LABA/ICS 61.9%, LABA/ICS 21.9%, LAMA/LABA 10.3% and LAMA 2.9%), frequent exacerbator with emphysema (LAMA/LABA/ICS 69.2%, LAMA/LABA 18.3%, LABA/ICS 6.4%, and LAMA 3.2%) and finally frequent exacerbator with chronic bronchitis (LAMA/LABA/ICS 77.0%, LAMA/LABA 14.0%, LABA/ICS 5.9% and LAMA 1.1%). Conclusions According to EPOCONSUL study data, the most used pharmacological option for COPD in Spain is triple therapy, which is prescribed in more than half of the patients. There are many appropriate prescriptions in patients with frequent exacerbations but not so in patients without frequent exacerbations.

Noninvasive measurement of mean alveolar carbon dioxide tension and Bohr's dead space during tidal breathing.

PubMed

Koulouris, N G; Latsi, P; Dimitroulis, J; Jordanoglou, B; Gaga, M; Jordanoglou, J

2001-06-01

The lack of methodology for measuring the alveolar carbon dioxide tension (PA,CO2) has forced investigators to make several assumptions, such as that PA,CO2 is equal to end-tidal (PET,CO2) and arterial CO2 tension (Pa,CO2). The present study measured the mean PA,CO2 and Bohr's dead space ratio (Bohr's dead space/tidal volume (VD,Bohr/VT)) during tidal breathing. The method used is a new, simple and noninvasive technique, based on the analysis of the expired CO2 volume per breath (VCO2) versus the exhaled VT. This curve was analysed in 21 normal, healthy subjects and 35 chronic obstructive pulmonary disease (COPD) patients breathing tidally through a mouthpiece apparatus in the sitting position. It is shown that: 1) PA,CO2 is similar to Pa,CO2 in normal subjects, whilst it is significantly lower than Pa,CO2 in COPD patients; 2) PA,CO2 is significantly higher than PET,CO2 in all subjects, especially in COPD patients; 3) VD,Bohr/VT is increased in COPD patients as compared to normal subjects; and 4) VD,Bohr/VT is lower than the "physiological" dead space ratio (VD,phys/VT) in COPD patients. It is concluded that the expired carbon dioxide versus tidal volume curve is a useful tool for research and clinical work, because it permits the noninvasive and accurate measurement of Bohr's dead space and mean alveolar carbon dioxide tension accurately during spontaneous breathing.

Rates of escalation to triple COPD therapy among incident users of LAMA and LAMA/LABA.

PubMed

Hahn, Beth; Hull, Michael; Blauer-Peterson, Cori; Buikema, Ami R; Ray, Riju; Stanford, Richard H

2018-06-01

Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting β 2 -agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies. Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013-2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 1:1 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims. 35,357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (n = 1320) than in new UMEC/VI users (n = 1320) (0.92 vs 0.49 per 100 months of exposure, respectively; p < 0.001). Relative to the UMEC/VI cohort, the TIO cohort had an 87% higher risk of TT initiation (hazard ratio: 1.87; 95% confidence interval: 1.4-2.5; p = 0.001). Patients receiving UMEC/VI progressed to TT more slowly, and were at lower risk of progressing to TT, than patients receiving TIO. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Randomized controlled trials and real-world observational studies in evaluating cardiovascular safety of inhaled bronchodilator therapy in COPD.

PubMed

Kardos, Peter; Worsley, Sally; Singh, Dave; Román-Rodríguez, Miguel; Newby, David E; Müllerová, Hana

2016-01-01

Long-acting muscarinic antagonist (LAMA) or long-acting β2-agonist (LABA) bronchodilators and their combination are recommended for the maintenance treatment of chronic obstructive pulmonary disease (COPD). Although the efficacy of LAMAs and LABAs has been well established through randomized controlled trials (RCTs), questions remain regarding their cardiovascular (CV) safety. Furthermore, while the safety of LAMA and LABA monotherapy has been extensively studied, data are lacking for LAMA/LABA combination therapy, and the majority of the studies that have reported on the CV safety of LAMA/LABA combination therapy were not specifically designed to assess this. Evaluation of CV safety for COPD treatments is important because many patients with COPD have underlying CV comorbidities. However, severe CV and other comorbidities are often exclusion criteria for RCTs, contributing to a lack in external validity and generalizability. Real-world observational studies are another important tool to evaluate the effectiveness and safety of COPD therapies in a broader population of patients and can improve upon the external validity limitations of RCTs. We examine what is already known regarding the CV and cerebrovascular safety of LAMA/LABA combination therapy from RCTs and real-world observational studies, and explore the advantages and limitations of data derived from each study type. We also describe an ongoing prospective, observational, comparative post-authorization safety study of a LAMA/LABA combination therapy (umeclidinium/vilanterol) and LAMA monotherapy (umeclidinium) versus tiotropium, with a focus on the relative merits of the study design.

Llama VHH antibody fragments against GFAP: better diffusion in fixed tissues than classical monoclonal antibodies.

PubMed

Perruchini, Claire; Pecorari, Frederic; Bourgeois, Jean-Pierre; Duyckaerts, Charles; Rougeon, François; Lafaye, Pierre

2009-11-01

Camelids produce antibodies made of homodimeric heavy chains, and the antigen-binding region being composed of a single domain called VHH. These VHHs are much smaller than complete IgG. They are also more thermostable and more soluble in water; they should, therefore, diffuse more readily in the tissues. VHHs, expressed in bacteria, are easier to produce than conventional monoclonal antibodies. Because of these special characteristics, these antibody fragments could have interesting developments in immunohistochemistry and in the development of biomarkers. To test the possibility of their use in immunohistochemistry (IHC), we selected the glial fibrillary acidic protein (GFAP), a well-known marker of astrocytes. One alpaca (Lama pacos) was immunized against GFAP. Lymphocytes were isolated; the DNA was extracted; the VHH-coding sequences were selectively amplified. Three VHHs with a high affinity for GFAP and their corresponding mRNA were selected by ribosome display. Large quantities of the recombinant VHHs coupled with different tags were harvested from transfected bacteria. One of them was shown to immunolabel strongly and specifically to GFAP of human astrocytes in tissue sections. The quality of the IHC was comparable or, in some aspects, superior to the quality obtained with conventional IgG. The VHH was shown to diffuse on a longer distance than conventional monoclonal antibodies in fixed cortical tissue: a property that may be useful in immunolabeling of thick sections.

Conjunctivitis and ulcerative keratitis secondary to conjunctival plant foreign bodies in a herd of alpacas (Lama Pacos).

PubMed

Fischer, Kristin; Hendrix, Diane

2012-03-01

To describe six cases of conjunctivitis and ulcerative keratitis secondary to plant foreign bodies from weed-contaminated grass hay which were lodged within the temporal conjunctival fornix in a herd of alpacas. A total of 21 alpacas from the same farm developed blepharospasm and mucopurulent ocular discharge. Six of the 21 were evaluated at the University of Tennessee College of Veterinary Medicine within a 2-week period. The six animals evaluated received an ophthalmic examination including slit-lamp biomicroscopy, fluorescein staining, and topical corneal anesthesia for foreign body removal when necessary. Six animals had conjunctivitis characterized by hyperemia and mucopurulent discharge. Five animals had superficial ulcerative keratitis with intense corneal neovascularization and edema. In all cases, the keratitis was located at the temporal limbus. Seven plant foreign bodies were observed and were removed following topical corneal anesthesia in five animals. The plant seeds were identified as three common weed species found in orchard grass hay. Complete resolution of all clinical signs was achieved with foreign body removal and medical therapy. Fan-shaped temporal corneal ulcers may signify the presence of conjunctival foreign bodies in alpacas. Plant foreign bodies should be considered in addition to ocular infection when multiple animals of a herd are affected as outbreaks may occur with weed-contaminated hay. © 2011 American College of Veterinary Ophthalmologists.

Acetylated Chitosan Oligosaccharides Act as Antagonists against Glutamate-Induced PC12 Cell Death via Bcl-2/Bax Signal Pathway

PubMed Central

Hao, Cui; Gao, Lixia; Zhang, Yiran; Wang, Wei; Yu, Guangli; Guan, Huashi; Zhang, Lijuan; Li, Chunxia

2015-01-01

Chitosan oligosaccharides (COSs), depolymerized products of chitosan composed of β-(1→4) d-glucosamine units, have broad range of biological activities such as antitumour, antifungal, and antioxidant activities. In this study, peracetylated chitosan oligosaccharides (PACOs) and N-acetylated chitosan oligosaccharides (NACOs) were prepared from the COSs by chemcal modification. The structures of these monomers were identified using NMR and ESI-MS spectra. Their antagonist effects against glutamate-induced PC12 cell death were investigated. The results showed that pretreatment of PC12 cells with the PACOs markedly inhibited glutamate-induced cell death in a concentration-dependent manner. The PACOs were better glutamate antagonists compared to the COSs and the NACOs, suggesting the peracetylation is essential for the neuroprotective effects of chitosan oligosaccharides. In addition, the PACOs pretreatment significantly reduced lactate dehydrogenase release and reactive oxygen species production. It also attenuated the loss of mitochondrial membrane potential. Further studies indicated that the PACOs inhibited glutamate-induced cell death by preventing apoptosis through depressing the elevation of Bax/Bcl-2 ratio and caspase-3 activation. These results suggest that PACOs might be promising antagonists against glutamate-induced neural cell death. PMID:25775423

Prospecting for Marine Bacteria for Polyhydroxyalkanoate Production on Low-Cost Substrates

PubMed Central

Takahashi, Rodrigo Yoji Uwamori; Castilho, Nathalia Aparecida Santos; da Silva, Marcus Adonai Castro; Miotto, Maria Cecilia; Lima, André Oliveira de Souza

2017-01-01

Polyhydroxyalkanoates (PHAs) are a class of biopolymers with numerous applications, but the high cost of production has prevented their use. To reduce this cost, there is a prospect for strains with a high PHA production and the ability to grow in low-cost by-products. In this context, the objective of this work was to evaluate marine bacteria capable of producing PHA. Using Nile red, 30 organisms among 155 were identified as PHA producers in the medium containing starch, and 27, 33, 22 and 10 strains were found to be positive in media supplemented with carboxymethyl cellulose, glycerol, glucose and Tween 80, respectively. Among the organisms studied, two isolates, LAMA 677 and LAMA 685, showed strong potential to produce PHA with the use of glycerol as the carbon source, and were selected for further studies. In the experiment used to characterize the growth kinetics, LAMA 677 presented a higher maximum specific growth rate (µmax = 0.087 h−1) than LAMA 685 (µmax = 0.049 h−1). LAMA 677 also reached a D-3-hydroxybutyrate (P(3HB)) content of 78.63% (dry biomass), which was 3.5 times higher than that of LAMA 685. In the assay of the production of P(3HB) from low-cost substrates (seawater and biodiesel waste glycerol), LAMA 677 reached a polymer content of 31.7%, while LAMA 685 reached 53.6%. Therefore, it is possible to conclude that the selected marine strains have the potential to produce PHA, and seawater and waste glycerol may be alternative substrates for the production of this polymer. PMID:28952539

Infrared end-tidal CO2 measurement does not accurately predict arterial CO2 values or end-tidal to arterial PCO2 gradients in rabbits with lung injury.

PubMed

Hopper, A O; Nystrom, G A; Deming, D D; Brown, W R; Peabody, J L

1994-03-01

End-tidal PCO2 (PETCO2) measurements from two commercially available neonatal infrared capnometers with different sampling systems and a mass spectrometer were compared with arterial PCO2 (PaCO2) to determine whether the former could predict the latter in mechanically ventilated rabbits with and without lung injury. The effects of tidal volume, ventilator frequency and type of lung injury on the gradient between PETCO2 and PaCO2 (delta P(a-ET)CO2) were evaluated. Twenty rabbits were studied: 10 without lung injury, 5 with saline lavage and 5 with lung injury by meconium instillation. Paired measurements of PETCO2 by two infrared capnometers and a mass spectrometer were compared to PaCO2. In the rabbits without lung injury, the values from the infrared capnometers and mass spectrometer correlated strongly with PaCO2 (r > or = 0.91) despite differences in the slopes of the linear regression between PETCO2 and PaCO2 and in delta P(a-ET)CO2 (P < 0.05). Values from the mainstream IR-capnometer more closely approximated the line of identity than the regression between the sidestream IR-capnometer values or the mass spectrometer and PaCO2, but tended to overestimate PaCO2. The delta P(a-ET)CO2 was similar at all tidal volumes and ventilator frequencies, regardless of capnometer type. In the rabbits with induced lung injury, while there was a positive correlation between the slopes of the regression between PETCO2 and PaCO2 for both capnometers (r > or = 0.70), none of the regression slopes approximated the line of identity. The delta P(a-ET)CO2 was greater in rabbits with injured than noninjured lungs (P < 0.05). The delta P(a-ET)CO2 was similar among capnometers regardless of tidal volume, ventilator frequency, or type of lung injury. The 95% confidence interval of plots PaCO2 against PETCO2 was large for rabbits with injured and noninjured lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring gaseous exchange: implications for nursing care.

PubMed

Martin, Susan; Wilson, Michael

2002-02-01

The purpose of this study is to examine whether a relationship exists between arterial and end-tidal carbon dioxide tension (PaCO2 and PETCO2 respectively) in patients admitted to intensive care units (ICUs), and what the implications it has for nursing care. PaCO2 and PETCO2 are indicators of ventilatory adequacy which is an important aspect of respiratory function. These measures of carbon dioxide tension are obtained via invasive and non-invasive monitoring tools. Measurement of PETCO2 has only recently been introduced into ICUs and its usefulness in these environments is open to debate. A population of 30 intubated patients had 214 simultaneous measurements of PaCO2 and PETCO2 taken over a period of 10 months. The findings indicate that, despite strong significant correlations, PETCO2 cannot be used safely as a substitute for PaCO2 as the arterial/end-tidal carbon dioxide gradient is not constant, nor does capnography provide a consistently reliable indicator of PaCO2.

Reviewing Large LAMA2 Deletions and Duplications in Congenital Muscular Dystrophy Patients.

PubMed

Oliveira, Jorge; Gonçalves, Ana; Oliveira, Márcia E; Fineza, Isabel; Pavanello, Rita C M; Vainzof, Mariz; Bronze-da-Rocha, Elsa; Santos, Rosário; Sousa, Mário

2014-01-01

Congenital muscular dystrophy (CMD) type 1A (MDC1A) is caused by recessive mutations in laminin-α2 (LAMA2) gene. Laminin-211, a heterotrimeric glycoprotein that contains the α2 chain, is crucial for muscle stability establishing a bond between the sarcolemma and the extracellular matrix. More than 215 mutations are listed in the locus specific database (LSDB) for LAMA2 gene (May 2014). A limited number of large deletions/duplications have been reported in LAMA2. Our main objective was the identification of additional large rearrangements in LAMA2 found in CMD patients and a systematic review of cases in the literature and LSDB. In four of the fifty-two patients studied over the last 10 years, only one heterozygous mutation was identified, after sequencing and screening for a frequent LAMA2 deletion. Initial screening of large mutations was performed by multiplex ligation-dependent probe application (MLPA). Further characterization implied several techniques: long-range PCR, cDNA and Southern-blot analysis. Three novel large deletions in LAMA2 and the first pathogenic large duplication were successfully identified, allowing a definitive molecular diagnosis, carrier screening and prenatal diagnosis. A total of fifteen deletions and two duplications previously reported were also reviewed. Two possible mutational "hotspots" for deletions may exist, the first encompassing exons 3 and 4 and second in the 3' region (exons 56 to 65) of LAMA2. Our findings show that this type of mutation is fairly frequent (18.4% of mutated alleles) and is underestimated in the literature. It is important to include the screening of large deletions/duplications as part of the genetic diagnosis strategy.

Laboratory Animal Management Assistant (LAMA): a LIMS for active research colonies.

PubMed

Milisavljevic, Marko; Hearty, Taryn; Wong, Tony Y T; Portales-Casamar, Elodie; Simpson, Elizabeth M; Wasserman, Wyeth W

2010-06-01

Laboratory Animal Management Assistant (LAMA) is an internet-based system for tracking large laboratory mouse colonies. It has a user-friendly interface with powerful search capabilities that ease day-to-day tasks such as tracking breeding cages and weaning litters. LAMA was originally developed to manage hundreds of new mouse strains generated by a large functional genomics program, the Pleiades Promoter Project ( http://www.pleiades.org ). The software system has proven to be highly flexible, suitable for diverse management approaches to mouse colonies. It allows custom tagging and grouping of animals, simplifying project-specific handling and access to data. Finally, LAMA was developed in close collaboration with mouse technicians to ease the transition from paper- or Excel-based management systems to computerized tracking, allowing data export in a popular spreadsheet format and automatic printing of cage cards. LAMA is an open-access software tool, freely available to the research community at http://launchpad.net/mousedb .

The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

PubMed Central

Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

2014-01-01

To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2–PaCO2) and. (PTCCO2–PaCO2) were calculated. Bland–Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19–54 yr, mean 29, SD 9 yr; weight 86–160 kg, mean119.3, SD 22.1 kg; BMI 35.3–51.1 kg/m2, mean 42.1,SD 5.4 kg/m2) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2–PTCCO2 difference was 0.9±1.3 mmHg (mean±SD). And the average PaCO2–PetCO2 difference was 10.3±2.3 mmHg (mean±SD). The linear regression equation of PaCO2–PetCO2 is PetCO2 = 11.58+0.57×PaCO2 (r2 = 0.64, P<0.01), whereas the one of PaCO2–PTCCO2 is PTCCO2 = 0.60+0.97×PaCO2 (r2 = 0.89). The LOA (limits of agreement) of 95% average PaCO2–PetCO2 difference is 10.3±4.6 mmHg (mean±1.96 SD), while the LOA of 95% average PaCO2–PTCCO2 difference is 0.9±2.6 mmHg (mean±1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. PMID:24699267

CO2 reactivity and brain oxygen pressure monitoring in severe head injury.

PubMed

Carmona Suazo, J A; Maas, A I; van den Brink, W A; van Santbrink, H; Steyerberg, E W; Avezaat, C J

2000-09-01

To investigate the effect of hyperventilation on cerebral oxygenation after severe head injury. A prospective, observational study. Neurointensive care unit at a university hospital. A total of 90 patients with severe head injury (Glasgow Coma Scale score < or =8), in whom continuous monitoring of brain tissue oxygen pressure (PbrO2) was performed as a measure of cerebral oxygenation. Arterial PCO2 was decreased each day over a 5-day period for 15 mins by increasing minute volume on the ventilator setting to 20% above baseline. Arterial blood gas analysis was performed before and after changing ventilator settings. Multimodality monitoring, including PbrO2, was performed in all patients. Absolute and relative PbrO2/PaCO2 reactivity was calculated. Outcome at 6 months was evaluated according to the Glasgow Outcome Scale. Effective hyperventilation, defined by a decrease of PaCO2 > or =2 torr (0.27 kPa), was obtained in 218 (84%) of 272 tests performed. Baseline PaCO2 averaged 32.3 +/- 4.5 torr (4.31 +/- 0.60 kPa). Average reduction in PaCO2 was 3.8 +/- 1.7 torr (0.51 +/- 0.23 kPa). PbrO2 decreased by 2.8 +/- 3.7 torr (0.37 +/- 0.49 kPa; p < .001) from a baseline value of 26.5 +/- 11.6 torr (3.53 +/- 1.55 kPa). PbrO2/PaCO2 reactivity was low on day 1 (0.8 +/- 2.3 torr [0.11 +/- 0.31 kPa]), increasing on subsequent days to 6.1 +/- 4.4 torr (0.81 +/- 0.59 kPa) on day 5. PbrO2/PaCO2 reactivity on days 1 and 2 was not related to outcome. In later phases in patients with unfavorable outcome, relative reactivity was increased more markedly, reaching statistical significance on day 5. Increased hyperventilation causes a significant reduction in PbrO2, providing further evidence for possible increased risk of secondary ischemic damage during hyperventilation. The low PbrO2/PaCO2 reactivity on day 1 indicates the decreased responsiveness of cerebral microvascular vessels to PaCO2 changes, caused by generalized vascular narrowing. The increasing PbrO2/PaCO2 reactivity from days 2 to 5 suggests that the risk of compromising cerebral oxygenation by hyperventilation may increase over time.

Predicting what helminth parasites a fish species should have using Parasite Co-occurrence Modeler (PaCo)

USGS Publications Warehouse

Strona, Giovanni; Lafferty, Kevin D.

2013-01-01

Fish pathologists are often interested in which parasites would likely be present in a particular host. Parasite Co-occurrence Modeler (PaCo) is a tool for identifying a list of parasites known from fish species that are similar ecologically, phylogenetically, and geographically to the host of interest. PaCo uses data from FishBase (maximum length, growth rate, life span, age at maturity, trophic level, phylogeny, and biogeography) to estimate compatibility between a target host and parasite species–genera from the major helminth groups (Acanthocephala, Cestoda, Monogenea, Nematoda, and Trematoda). Users can include any combination of host attributes in a model. These unique features make PaCo an innovative tool for addressing both theoretical and applied questions in parasitology. In addition to predicting the occurrence of parasites, PaCo can be used to investigate how host characteristics shape parasite communities. To test the performance of the PaCo algorithm, we created 12,400 parasite lists by applying any possible combination of model parameters (248) to 50 fish hosts. We then measured the relative importance of each parameter by assessing their frequency in the best models for each host. Host phylogeny and host geography were identified as the most important factors, with both present in 88% of the best models. Habitat (64%) was identified in more than half of the best models. Among ecological parameters, trophic level (41%) was the most relevant while life span (34%), growth rate (32%), maximum length (28%), and age at maturity (20%) were less commonly linked to best models. PaCo is free to use at www.purl.oclc.org/fishpest.

Predicting what helminth parasites a fish species should have using Parasite Co-occurrence Modeler (PaCo).

PubMed

Strona, Giovanni; Lafferty, Kevin D

2013-02-01

Fish pathologists are often interested in which parasites would likely be present in a particular host. Parasite Co-occurrence Modeler (PaCo) is a tool for identifying a list of parasites known from fish species that are similar ecologically, phylogenetically, and geographically to the host of interest. PaCo uses data from FishBase (maximum length, growth rate, life span, age at maturity, trophic level, phylogeny, and biogeography) to estimate compatibility between a target host and parasite species-genera from the major helminth groups (Acanthocephala, Cestoda, Monogenea, Nematoda, and Trematoda). Users can include any combination of host attributes in a model. These unique features make PaCo an innovative tool for addressing both theoretical and applied questions in parasitology. In addition to predicting the occurrence of parasites, PaCo can be used to investigate how host characteristics shape parasite communities. To test the performance of the PaCo algorithm, we created 12,400 parasite lists by applying any possible combination of model parameters (248) to 50 fish hosts. We then measured the relative importance of each parameter by assessing their frequency in the best models for each host. Host phylogeny and host geography were identified as the most important factors, with both present in 88% of the best models. Habitat (64%) was identified in more than half of the best models. Among ecological parameters, trophic level (41%) was the most relevant while life span (34%), growth rate (32%), maximum length (28%), and age at maturity (20%) were less commonly linked to best models. PaCo is free to use at www.purl.oclc.org/fishpest.

Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids.

PubMed

Asche, Carl Victor; Leader, Shelah; Plauschinat, Craig; Raparla, Swetha; Yan, Ming; Ye, Xiangyang; Young, Dave

2012-01-01

To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD) with the combination of long-acting β(2)-agonist (LABA), long-acting muscarinic antagonist (LAMA) or inhaled corticosteroids (ICS). The Geisinger Health System (GHS) database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT) data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines. A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the cohort of LABA plus ICS, 74 patients were adherent and 180 patients non-adherent to current GOLD guidelines. In the cohort of LAMA plus LABA/ICS, 21 patients were adherent and 25 patients non-adherent to current GOLD guidelines. GOLD adherence was associated with mean total cost of all services savings of $5,889 for LAMA plus LABA, $3,330 for LABA + ICS, and $10,217 for LAMA plus LABA/ICS cohorts. Staging of COPD with a PFT and adherence to current GOLD guidelines was associated with lower costs in subjects with moderate to severe COPD. Appropriate use of LAMA plus LABA, LABA plus ICS, and LAMA plus LABA/ICS has economic as well as clinical benefits for patients and payers.

A glucose-sensitive block glycopolymer hydrogel based on dynamic boronic ester bonds for insulin delivery.

PubMed

Cai, Baoqi; Luo, Yanping; Guo, Qianqian; Zhang, Xinge; Wu, Zhongming

2017-06-05

Hydrogels are good candidates to satisfy many needs for functional and tunable biomaterials. How to precisely control the gel structure and functions is crucial for the construction of sophisticated soft biomaterials comprising the hydrogels, which facilitates the impact of the surrounding environment on a unique biological function occurring. Here, glucose-responsive hydrogels comprised of 3-acrylamidophenyl boronic acid copolymerized with 2-lactobionamidoethyl methacrylate (p(APBA-b-LAMA)) were synthesized, and further evaluated as carriers for insulin delivery. The formation of (p(APBA-b-LAMA)) hydrogel was based on dynamic covalent bond using the association of boronic acid with diols. P(APBA-b-LAMA) hydrogel with the typical porous structure showed a rapid increase in equilibrium of swelling, which was up to 1856% after incubation with aqueous solution. Using insulin as a model protein therapeutic, p(APBA-b-LAMA) hydrogel exhibited high drug loading capability up to 15.6%, and also displayed glucose-dependent insulin release under physiological conditions. Additionally, the viability of NIH3T3 cells was more than 90% after treated with p(APBA-b-LAMA) hydrogel, indicating that the hydrogel had no cytotoxicity. Consequently, the novel p(APBA-b-LAMA) hydrogel has a practical application for diabetes treatment. Copyright © 2017. Published by Elsevier Ltd.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meng, Xiangrui, E-mail: xiangruimengzz@163.com; Chen, Xiaoqi; Lu, Peng

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignancies in the gastrointestinal tract. Emerging studies have indicated that microRNAs (miRNAs) are strongly implicated in the development and progression of ESCC. Here, we focused on the function and the underlying molecular mechanism of miR-202 in ESCC. The results showed that miR-202 was significantly down-regulated in ESCC tissues and cell lines. Overexpression of miR-202 in ECa-109 and KYSE-510 cells markedly suppressed cell proliferation and cell migration, and induced cell apoptosis. Furthermore, laminin α1 (LAMA1) expression was frequently positive in ESCC tissues and inversely correlated with miR-202 expression. Then we demonstratedmore » that miR-202 targeted 3'-untranslated region (UTR) of LAMA1 and inhibited its protein expression. Additionally, LAMA1 overexpression rescued the proliferation inhibition and cell apoptosis elevation induced by miR-202. MiR-202 also inhibited the protein expression of p-FAK and p-Akt, which were all reversed by LAMA1 overexpression. Taken together, these findings suggest that miR-202 may function as a novel tumor suppressor in ESCC by repressing cell proliferation and migration, and its biological effects may attribute the inhibition of LAMA1-mediated FAK-PI3K-Akt signaling. - Highlights: • Expression of miR-202 was decreased in ESCC tissues and cell lines. • MiR-202 overexpression inhibited ESCC cell growth and induced apoptosis. • MiR-202 directly targeted LAMA1 in ESCC. • The LAMA1-FAK-PI3K signaling mediated the suppressive role of miR-202.« less

Association of Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent Asthma: A Systematic Review and Meta-analysis.

PubMed

Sobieraj, Diana M; Baker, William L; Nguyen, Elaine; Weeda, Erin R; Coleman, Craig I; White, C Michael; Lazarus, Stephen C; Blake, Kathryn V; Lang, Jason E

2018-04-10

Long-acting muscarinic antagonists (LAMAs) are a potential adjunct therapy to inhaled corticosteroids in the management of persistent asthma. To conduct a systematic review and meta-analysis of the effects associated with LAMA vs placebo or vs other controllers as an add-on therapy to inhaled corticosteroids and the use of a LAMA as add-on therapy to inhaled corticosteroids and long-acting β-agonists (LABAs; hereafter referred to as triple therapy) vs inhaled corticosteroids and LABA in patients with uncontrolled, persistent asthma. MEDLINE, EMBASE, Cochrane databases, and clinical trial registries (earliest date through November 28, 2017). Two reviewers selected randomized clinical trials or observational studies evaluating a LAMA vs placebo or vs another controller as an add-on therapy to inhaled corticosteroids or triple therapy vs inhaled corticosteroids and LABA in patients with uncontrolled, persistent asthma reporting on an outcome of interest. Meta-analyses using a random-effects model was conducted to calculate risk ratios (RRs), risk differences (RDs), and mean differences (MDs) with corresponding 95% CIs. Citation screening, data abstraction, risk assessment, and strength-of-evidence grading were completed by 2 independent reviewers. Asthma exacerbations. Of 1326 records identified, 15 randomized clinical trials (N = 7122 patients) were included. Most trials assessed adding LAMA vs placebo or LAMA vs LABA to inhaled corticosteroids. Adding LAMA vs placebo to inhaled corticosteroids was associated with a significantly reduced risk of exacerbation requiring systemic corticosteroids (RR, 0.67 [95% CI, 0.48 to 0.92]; RD, -0.02 [95% CI, -0.04 to 0.00]). Compared with adding LABA, adding LAMA to inhaled corticosteroids was not associated with significant improvements in exacerbation risk (RR, 0.87 [95% CI, 0.53 to 1.42]; RD, 0.00 [95% CI, -0.02 to 0.02]), or any other outcomes of interest. Triple therapy was not significantly associated with improved exacerbation risk vs inhaled corticosteroids and LABA (RR, 0.84 [95% CI, 0.57 to 1.22]; RD, -0.01 [95% CI, -0.08 to 0.07]). In this systematic review and meta-analysis, the use of LAMA compared with placebo as add-on therapy to inhaled corticosteroids was associated with a lower risk of asthma exacerbations; however, the association of LAMA with benefit may not be greater than that with LABA. Triple therapy was not associated with a lower risk of exacerbations.

Isolation of lactoferrin from milk of different species: calorimetric and antimicrobial studies.

PubMed

Conesa, Celia; Sánchez, Lourdes; Rota, Carmen; Pérez, María-Dolores; Calvo, Miguel; Farnaud, Sebastien; Evans, Robert W

2008-05-01

Lactoferrin (LF) is an iron-binding glycoprotein found in different biological fluids of mammals and in neutrophils. It has been proposed to be involved in many functions, including protection from pathogens. In this work, purification of lactoferrin using an ion-exchange chromatography (SP-Sepharose) was attempted for the milk of the following animals: sheep (Ovis aries), goat (Capra hircus), camel (Camelus bactrianus), alpaca (Lama pacos), elephant (Elephas maximus) and grey seal (Halichoerus grypus), as well as human (Homo sapiens). Lactoferrin was identified in all the milks apart from that from grey seal. The thermal stability of the purified lactoferrins, in their native and iron-saturated forms, was studied by differential scanning calorimetry (DSC). Maximum temperature, onset temperature and enthalpy change of denaturation were higher when lactoferrins were saturated with iron than in their native form, indicating an increase in the stability of the protein structure upon iron-binding. Human lactoferrin was found to be the most heat-resistant and the other lactoferrins presented different degrees of thermoresistance, that of elephant being the least resistant. The antimicrobial activity of the different isolated lactoferrins was investigated against Escherichia coli 0157:H7. The minimal inhibitory concentrations (MICs) were determined by measuring the absorbance at 620 nm. The minimum bactericidal concentrations (MBCs) were also measured and it was found that camel lactoferrin was the most active lactoferrin against E. coli 0157:H7, whereas alpaca and human lactoferrins were the least active.

Characterization of Fusobacterium necrophorum isolated from llama and alpaca.

PubMed

Kumar, Amit; Anderson, David; Amachawadi, Raghavendra G; Nagaraja, Tiruvoor G; Narayanan, Sanjeev K

2013-07-01

Fusobacterium necrophorum, a Gram-negative, anaerobic bacterium, is an opportunistic animal and human pathogen that causes a variety of infections termed necrobacillosis. There are 2 subspecies of F. necrophorum (subsp. necrophorum and subsp. funduliforme) that differ morphologically and biochemically and in virulence. Leukotoxin, a secreted protein, is considered to be the major virulence factor. In camelids, F. necrophorum causes a variety of infections, generally involving the lips, tongue, pharynx, interdigital spaces, foot pad, larynx, mandible, or maxillary bones. The objective of the current study was to characterize the presumptive Fusobacterium isolates from a variety of necrotic infections in llama (Lama glama) and alpaca (Vicugna pacos) and determine whether the strains possess leukotoxin activities. A total of 7 isolates from alpaca and 2 isolates from llama were characterized. Based on growth characteristics in broth culture, and biochemical and polymerase chain reaction analyses, all 9 isolates belonged to subsp. necrophorum and possessed the putative hemagglutinin gene. Western blot analysis with antileukotoxin antibodies raised in rabbit showed the presence of leukotoxin protein in the culture supernatant of all isolates. Furthermore, flow cytometry of the culture supernatants demonstrated cytotoxicity to bovine and alpaca polymorphonuclear leukocytes (PMNs). The extent of cytotoxicity to either alpaca or bovine PMNs differed among camelid strains. The cytotoxicity of many of the camelid strains was higher (P < 0.05) toward alpaca PMNs compared to bovine PMNs. Fusobacterium necrophorum isolates from llama and alpaca are similar to bovine isolates, and leukotoxin may be a major virulence factor.

Experimental infection of South American camelids with bluetongue virus serotype 8.

PubMed

Schulz, Claudia; Eschbaumer, Michael; Rudolf, Miriam; König, Patricia; Keller, Markus; Bauer, Christian; Gauly, Matthias; Grevelding, Christoph G; Beer, Martin; Hoffmann, Bernd

2012-01-27

Bluetongue (BT) is an infectious, non-contagious disease of wild and domestic ruminants. It is caused by bluetongue virus (BTV) and transmitted by Culicoides biting midges. Since 1998, BT has been emerging throughout Europe, threatening not only the naïve ruminant population. Historically, South American camelids (SAC) were considered to be resistant to BT disease. However, recent fatalities related to BTV in captive SAC have raised questions about their role in BTV epidemiology. Data on the susceptibility of SAC to experimental infection with BTV serotype 8 (BTV-8) were collected in an animal experiment. Three alpacas (Vicugna pacos) and three llamas (Lama glama) were experimentally infected with BTV-8. They displayed very mild clinical signs. Seroconversion was first measured 6-8 days after infection (dpi) by ELISA, and neutralising antibodies appeared 10-13 dpi. BTV-8 RNA levels in blood were very low, and quickly cleared after seroconversion. However, spleens collected post-mortem were still positive for BTV RNA, over 71 days after the last detection in blood samples. Virus isolation was only possible from blood samples of two alpacas by inoculation of highly sensitive interferon alpha/beta receptor-deficient (IFNAR(-/-)) mice. An in vitro experiment demonstrated that significantly lower amounts of BTV-8 adsorb to SAC blood cells than to bovine blood cells. Although this experiment showed that SAC are generally susceptible to a BTV-8 infection, it indicates that these species play a negligible role in BTV epidemiology. Copyright © 2011 Elsevier B.V. All rights reserved.

Anaesthesia for laparoscopic nephrectomy: Does end-tidal carbon dioxide measurement correlate with arterial carbon dioxide measurement?

PubMed

Jayan, Nithin; Jacob, Jaya Susan; Mathew, Mohan

2018-04-01

Not many studies have explored the correlation between arterial carbon dioxide tension (PaCO 2 ) and end-tidal carbon dioxide tension (ETCO 2 ) in surgeries requiring pneumoperitoneum of more than 1 hour duration with the patient in non-supine position. The aim of our study was to evaluate the correlation of ETCO 2 with PaCO 2 in patients undergoing laparoscopic nephrectomy under general anaesthesia. A descriptive study was performed in thirty patients undergoing laparoscopic nephrectomy from September 2014 to August 2015. The haemodynamic parameters, minute ventilation, PaCO 2 and ETCO 2 measured at three predetermined points during the procedure were analysed. Correlation was checked using Pearson's Correlation Coefficient Test. P <0.05 was considered statistically significant. Statistical analysis of the values showed a positive correlation between ETCO 2 and PaCO 2 ( P < 0.05). Following carbon dioxide insufflation, both ETCO 2 and PaCO 2 increased by 5.4 and 6.63 mmHg, respectively, at the end of the 1 st hour. The PaCO 2 -ETCO 2 gradient was found to increase during the 1 st hour following insufflation (4.07 ± 2.05 mmHg); it returned to the pre-insufflation values in another hour (2.93 ± 1.43 mmHg). Continuous ETCO 2 monitoring is a reliable indicator of the trend in arterial CO 2 fluctuations in the American Society of Anesthesiologists Grades 1 and 2 patients undergoing laparoscopic nephrectomy under general anaesthesia.

Use of 'ideal' alveolar air equations and corrected end-tidal PCO2 to estimate arterial PCO2 and physiological dead space during exercise in patients with heart failure.

PubMed

Van Iterson, Erik H; Olson, Thomas P

2018-01-01

Arterial CO 2 tension (PaCO 2 ) and physiological dead space (V D ) are not routinely measured during clinical cardiopulmonary exercise testing (CPET). Abnormal changes in PaCO 2 accompanied by increased V D directly contribute to impaired exercise ventilatory function in heart failure (HF). Because arterial catheterization is not standard practice during CPET, this study tested the construct validity of PaCO 2 and V D prediction models using 'ideal' alveolar air equations and basic ventilation and gas-exchangegas exchange measurements during CPET in HF. Forty-seven NYHA class II/III HF (LVEF=21±7%; age=55±9years; male=89%; BMI=28±5kg/m 2 ) performed step-wise cycle ergometry CPET to volitional fatigue. Breath-by-breath ventilation and gas exchange were measured continuously. Steady-state PaCO 2 was measured at rest and peak exercise via radial arterial catheterization. Criterion V D was calculated via 'ideal' alveolar equations, whereas PaCO 2 or V D models were based on end-tidal CO 2 tension (P ET CO 2 ), tidal volume (V T ), and/or weight. Criterion measurements of PaCO 2 (38±5 vs. 33±5mmHg, P<0.01) and V D (0.26±0.07 vs. 0.41±0.15L, P<0.01) differed at rest vs. peak exercise, respectively. The equation, 5.5+0.90×P ET CO 2 -0.0021×V T , was the strongest predictor of PaCO 2 at rest and peak exercise (bias±95%LOA=-3.24±6.63 and -0.98±5.76mmHg; R 2 =0.57 and 0.75, P<0.001, respectively). This equation closely predicted V D at rest and peak exercise (bias±95%LOA=-0.03±0.06 and -0.02±0.13L; R 2 =0.86 and 0.83, P<0.001, respectively). These data suggest predicted PaCO 2 and V D based on breath-by-breath gas exchange and ventilatory responses demonstrate acceptable agreement with criterion measurements at peak exercise in HF patients. Routine assessment of PaCO 2 and V D can be used to improve interpretability of exercise ventilatory responses in HF. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

New toxics, new poverty: a social understanding of the freebase cocaine/Paco in Buenos Aires, Argentina.

PubMed

Epele, María E

2011-01-01

Included within the field of research on changes in drug use patterns and vulnerability are conditions of emergency related to economic crisis, wars, and political conflict. This study addresses the complex connections between the rapid propagation of freebase cocaine (FBC)-locally known as "pasta base" or "Paco" in Argentina and the normalization of the consequences of Argentina's 2001-2002 political-economic crisis. On the basis of the results of an ethnographic study carried out in three neighborhoods of the Greater Buenos Aires area between 2001 and 2005, this article aims to analyze how changes in the material and social living conditions are interrelated with the high toxicity of FBC/Paco and engender the emerging compulsion of its consumption and deterioration to the bodies, subjectivities, and social activities of active drug users from these shantytowns. By analyzing the changes in transactions directly or indirectly involving drugs-specifically those ranging from cocaine to FBC/Paco-we can argue how structural poverty, "new poverty," is not only associated with the expansion of FBC/Paco but is also shaped by its use, modes of consumption, associated health problems, and sufferings.

Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids

PubMed Central

Asche, Carl Victor; Leader, Shelah; Plauschinat, Craig; Raparla, Swetha; Yan, Ming; Ye, Xiangyang; Young, Dave

2012-01-01

Background To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD) with the combination of long-acting β2-agonist (LABA), long-acting muscarinic antagonist (LAMA) or inhaled corticosteroids (ICS). Methods The Geisinger Health System (GHS) database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT) data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines. Results A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the cohort of LABA plus ICS, 74 patients were adherent and 180 patients non-adherent to current GOLD guidelines. In the cohort of LAMA plus LABA/ICS, 21 patients were adherent and 25 patients non-adherent to current GOLD guidelines. GOLD adherence was associated with mean total cost of all services savings of $5,889 for LAMA plus LABA, $3,330 for LABA + ICS, and $10,217 for LAMA plus LABA/ICS cohorts. Conclusion Staging of COPD with a PFT and adherence to current GOLD guidelines was associated with lower costs in subjects with moderate to severe COPD. Appropriate use of LAMA plus LABA, LABA plus ICS, and LAMA plus LABA/ICS has economic as well as clinical benefits for patients and payers. PMID:22500120

[The structure of the gastric mucosa of the llamas (Lama guanocoe and Lama lamae). I. Forestomach].

PubMed

Luciano, L; Voss-Wermbter, G; Behnke, M; von Engelhardt, W; Reale, E

1979-01-01

The mucous membrane of the first and second compartments (ventral regions) as well as of the third compartment of Lama guanacoe and Lama lamae stomach shows tubular glands opening into pits. Below the surface epithelium blood capillaries of the fenestrated type form a regular network, each mesh of which surrounds a gastric pit. From a morphological point of view (thin section and freeze-fracture replicas) the columnar cells of the surface epithelium and those of the pits closest to the capillaries are largely similar to the epithelial cells of the rabbit gallbladder. This similarity suggests that at the level of the columnar cells sodium-dependent water reabsorption occurs. This reabsorption has already been demonstrated in the abovementioned compartments by physiological methods. The surface and foveolae epithelial cells as well as some cells of the tubular glands have a secretory function. Their secretory granules contain mucosubstances, as indicated by light-(PAS- and Alcian blue reactions) and electron microscopic (PA-TCH-Ag-reaction) histochemistry. The secretory granules originate from the Golgi complex which shows a positive histochemical reaction in its innermost sacculi at the electron microscope level. Endocrine cells (s. second part of this investigation) are rare. The mucosal membrane of each muscular lip separating the glandular sacs in the first compartment shows a stratified, not keratinized, squamous epithelium.

The discovery and development of aclidinium bromide for the treatment of chronic obstructive pulmonary disease.

PubMed

Malerba, Mario; Radaeli, Alessandro; Santini, Giuseppe; Morjaria, Jaymin; Mores, Nadia; Mondino, Chiara; Macis, Giuseppe; Montuschi, Paolo

2018-06-01

Bronchodilators, including long-acting muscarinic receptor antagonists (LAMAs), are a mainstay of the pharmacological treatment of chronic obstructive pulmonary disease (COPD). LAMAs act as bronchodilators principally by antagonizing airway smooth muscle cells M 3 muscarinic receptors. Aclidinium bromide is a twice-daily LAMA which was developed to improve on the efficacy and/or safety of previous LAMAs. Area covered: Herein, the authors present the pharmacotherapeutic role of aclidinium in COPD and point out unmet need in this research area. The following aspects are covered: a) the discovery and medicinal chemistry of aclidinium bromide; b) an overview of the market; c) its mechanism of action; d) its pharmacokinetic/pharmacodynamic profile derived from pre-clinical studies; e) the clinical studies which led to its licensing; f) the evidence from meta-analyses; g) the aclidinium/formoterol fixed dose combination for COPD and h) priorities in this area of research. Expert opinion: Aclidinium bromide has the pharmacological properties, safety and efficacy profile and inhaler characteristics which makes it a valuable therapeutic option for pharmacological management of patients with COPD. Due to its rapid biotransformation into inactive metabolites, aclidinium is potentially one of the safest LAMAs. Further head-to-head randomized clinical trials are required to define efficacy and safety of aclidinium when compared to once-daily LAMAs. The clinical relevance of airway anti-remodeling effects of aclidinium has to be defined.

Application of end-tidal carbon dioxide monitoring via distal gas samples in ventilated neonates.

PubMed

Jin, Ziying; Yang, Maoying; Lin, Ru; Huang, Wenfang; Wang, Jiangmei; Hu, Zhiyong; Shu, Qiang

2017-08-01

Previous research has suggested correlations between the end-tidal partial pressure of carbon dioxide (P ET CO 2 ) and the partial pressure of arterial carbon dioxide (PaCO 2 ) in mechanically ventilated patients, but both the relationship between P ET CO 2 and PaCO 2 and whether P ET CO 2 accurately reflects PaCO 2 in neonates and infants are still controversial. This study evaluated remote sampling of P ET CO 2 via an epidural catheter within an endotracheal tube to determine the procedure's clinical safety and efficacy in the perioperative management of neonates. Abdominal surgery was performed under general anesthesia in 86 full-term newborns (age 1-30 days, weight 2.55-4.0 kg, American Society of Anesthesiologists class I or II). The infants were divided into 2 groups (n = 43 each), and carbon dioxide (CO 2 ) gas samples were collected either from the conventional position (the proximal end) or a modified position (the distal end) of the epidural catheter. The P ET CO 2 measured with the new method was significantly higher than that measured with the traditional method, and the difference between P ET CO 2 and PaCO 2 was also reduced. The accuracy of P ET CO 2 measured increased from 78.7% to 91.5% when the modified sampling method was used. The moderate correlation between P ET CO 2 and PaCO 2 by traditional measurement was 0.596, which significantly increased to 0.960 in the modified sampling group. Thus, the P ET CO 2 value was closer to that of PaCO 2 . P ET CO 2 detected via modified carbon dioxide monitoring had a better accuracy and correlation with PaCO 2 in neonates. Copyright © 2017. Published by Elsevier B.V.

[Correlation between end-tidal carbon dioxide and partial pressure of arterial carbon dioxide in ventilated newborns].

PubMed

Feng, Jin-Xing; Liu, Xiao-Hong; Huang, Hui-Jun; Yu, Zhen-Zhu; Yang, Hui; He, Liu-Fang

2014-05-01

To study the correlation between end-tidal carbon dioxide (PetCO2) and partial pressure of arterial carbon dioxide (PaCO2) in ventilated newborns. Thirty-one ventilated newborn underwent mainstream PetCO2 monitoring; meanwhile, arterial blood gas analysis was performed. The correlation and consistency between PetCO2 and PaCO2 were assessed. A total of 85 end-tidal and arterial CO2 pairs were obtained from 31 ventilated newborns. The mean PetCO2 (41±10 mm Hg) was significantly lower than the corresponding mean PaCO2 (46±11 mm Hg) (P<0.01). There was a significant positive correlation between PetCO2 and PaCO2 (r=0.92, P<0.01). The overall PetCO2 bias was 5.1±4.3 mm Hg (95% limits of consistency, -3.3 to 13.6 mmHg), and 5% (4/85) of the points were beyond the 95%CI. When the oxygenation index (OI) was less than 300 mm Hg (n=48), there was a significant positive correlation between PetCO2 and PaCO2 (r=0.85, P<0.01); the PetCO2 bias was 5.9±4.3 mm Hg (95% limits of consistency, -2.6 to 14.5 mm Hg), and 4.2% (2/48) of the points were beyond the 95%CI. When the OI was more than 300 mm Hg (n=37), there was also a significant positive correlation between PetCO2 and PaCO2 (r=0.91, P<0.01); the PetCO2 bias was 4.1±4.1 mm Hg (95% limits of consistency, -3.9 to 12.1 mm Hg), and 5% (2/37) of the points were beyond the 95%CI. There is a good correlation and consistency between PetCO2 and PaCO2 in ventilated newborns.

Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia

PubMed Central

Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin

2012-01-01

Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality. PMID:22677348

Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease.

PubMed

Kazmaier, S; Weyland, A; Buhre, W; Stephan, H; Rieke, H; Filoda, K; Sonntag, H

1998-10-01

Variation of the arterial carbon dioxide partial pressure (PaCO2) is not uncommon in anesthetic practice. However, little is known about the myocardial consequences of respiratory alkalosis and acidosis, particularly in patients with coronary artery disease. The aim of the current study was to investigate the effects of variation in PaCO2 on myocardial blood flow (MBF), metabolism, and systemic hemodynamics in patients before elective coronary artery bypass graft surgery. In 10 male anesthetized patients, measurements of MBF, myocardial contractility, metabolism, and systemic hemodynamics were made in a randomized sequence at PaCO2 levels of 30, 40, and 50 mmHg, respectively. The MBF was measured using the Kety-Schmidt technique with argon as a tracer. End-diastolic left ventricular pressure and the maximal increase of left ventricular pressure were assessed using a manometer-tipped catheter. The cardiac index significantly changed with varying PaCO2 levels (hypocapnia, - 9%; hypercapnia, 13%). This reaction was associated with inverse changes in systemic vascular resistance index levels. The MBF significantly increased by 15% during hypercapnia, whereas no change was found during hypocapnia. Myocardial oxygen and glucose uptake and the maximal increase of left ventricular pressure were not affected by varying PaCO2 levels. In anesthetized patients with coronary artery disease, short-term variations in PaCO2 have significant effects on MBF but do not influence global myocardial oxygen and glucose uptake. Changes in systemic hemodynamics associated with respiratory alkalosis and acidosis are caused by changes in systemic vascular resistance rather than by alterations in myocardial contractility.

Genetics Home Reference: LAMA2-related muscular dystrophy

MedlinePlus

... weakness of the facial muscles and tongue, but intelligence is usually normal. Heart problems and seizures occasionally ... walk and climb stairs, and life expectancy and intelligence are usually not affected in late-onset LAMA2 - ...

The ventilatory responsiveness to CO2 below eupnoea as a determinant of ventilatory stability in sleep

PubMed Central

Dempsey, Jerome A; Smith, Curtis A; Przybylowski, Tadeuez; Chenuel, Bruno; Xie, Ailiang; Nakayama, Hideaki; Skatrud, James B

2004-01-01

Sleep unmasks a highly sensitive hypocapnia-induced apnoeic threshold, whereby apnoea is initiated by small transient reductions in arterial CO2 pressure (PaCO2) below eupnoea and respiratory rhythm is not restored until PaCO2 has risen significantly above eupnoeic levels. We propose that the ‘CO2 reserve’ (i.e. the difference in PaCO2 between eupnoea and the apnoeic threshold (AT)), when combined with ‘plant gain’ (or the ventilatory increase required for a given reduction in PaCO2) and ‘controller gain’ (ventilatory responsiveness to CO2 above eupnoea) are the key determinants of breathing instability in sleep. The CO2 reserve varies inversely with both plant gain and the slope of the ventilatory response to reduced CO2 below eupnoea; it is highly labile in non-random eye movement (NREM) sleep. With many types of increases or decreases in background ventilatory drive and PaCO2, the slope of the ventilatory response to reduced PaCO2 below eupnoea remains unchanged from control. Thus, the CO2 reserve varies inversely with plant gain, i.e. it is widened with hyperventilation and narrowed with hypoventilation, regardless of the stimulus and whether it acts primarily at the peripheral or central chemoreceptors. However, there are notable exceptions, such as hypoxia, heart failure, or increased pulmonary vascular pressures, which all increase the slope of the CO2 response below eupnoea and narrow the CO2 reserve despite an accompanying hyperventilation and reduced plant gain. Finally, we review growing evidence that chemoreceptor-induced instability in respiratory motor output during sleep contributes significantly to the major clinical problem of cyclical obstructive sleep apnoea. PMID:15284345

CBP and Extracellular Matrix-Induced Apoptosis in p53(-) HMECs: A Model of Early Mammary Carcinogenesis

DTIC Science & Technology

2006-09-01

LAMA3A promoter activity. Early and late passage HMEC-E6 and passage-matched HMEC- LXSN controls were transiently transfected with a CAT reporter...CBP protein expression resulted in decreased LAMA3A promoter activity. LAMA3A- CAT reporter activity was compared in early passage HMEC-LXSN and HMEC...AF279435 was amplified with PCR primers, sense 5-AAG CTT AAG TTT TCC CAT CCG CAA C-3 and antisense 5-TCT AGA GCT GAC CGC CTC ACT GC-3. The PCR

Controversial opinion: evaluation of EGR1 and LAMA2 loci for high myopia in Chinese populations.

PubMed

Lin, Fang-yu; Huang, Zhu; Lu, Ning; Chen, Wei; Fang, Hui; Han, Wei

2016-03-01

Functional studies have suggested the important role of early growth response 1 (EGR1) and Laminin α2-chain (LAMA2) in human eye development. Genetic studies have reported a significant association of the single nucleotide polymorphism (SNP) in the LAMA2 gene with myopia. This study aimed to evaluate the association of the tagging SNPs (tSNPs) in the EGR1 and LAMA2 genes with high myopia in two independent Han Chinese populations. Four tSNPs (rs11743810 in the EGR1 gene; rs2571575, rs9321170, and rs1889891 in the LAMA2 gene) were selected, according to the HapMap database (http://hapmap.ncbi.nlm.nih.gov), and were genotyped using the ligase detection reaction (LDR) approach for 167 Han Chinese nuclear families with extremely highly myopic offspring (<-10.0 diopters) and an independent group with 485 extremely highly myopic cases (<-10.0 diopters) and 499 controls. Direct sequencing was used to confirm the LDR results in twenty randomly selected subjects. Family-based association analysis was performed using the family-based association test (FBAT) software package (Version 1.5.5). Population-based association analysis was performed using the Chi-square test. The association analysis power was estimated using online software (http://design.cs.ucla.edu). The FBAT demonstrated that all four tSNPs tested did not show association with high myopia (P>0.05). Haplotype analysis of tSNPs in the LAMA2 genes also did not show a significant association (P>0.05). Meanwhile, population-based association analysis also showed no significant association results with high myopia (P>0.05). On the basis of our family- and population-based analyses for the Han Chinese population, we did not find positive association signals of the four SNPs in the LAMA2 and EGR1 genes with high myopia.

Absence of microRNA-21 does not reduce muscular dystrophy in mouse models of LAMA2-CMD.

PubMed

Moreira Soares Oliveira, Bernardo; Durbeej, Madeleine; Holmberg, Johan

2017-01-01

MicroRNAs (miRNAs) are short non-coding RNAs that modulate gene expression post-transcriptionally. Current evidence suggests that miR-21 plays a significant role in the progression of fibrosis in muscle diseases. Laminin-deficient congenital muscular dystrophy (LAMA2-CMD) is a severe form of congenital muscular dystrophy caused by mutations in the gene encoding laminin α2 chain. Mouse models dy3K/dy3K and dy2J/dy2J, respectively, adequately mirror severe and milder forms of LAMA2-CMD. Both human and mouse LAMA2-CMD muscles are characterized by extensive fibrosis and considering that fibrosis is the final step that destroys muscle during the disease course, anti-fibrotic therapies may be effective strategies for prevention of LAMA2-CMD. We have previously demonstrated a significant up-regulation of the pro-fibrotic miR-21 in dy3K/dy3K and dy2J/dy2J skeletal muscle. Hence, the objective of this study was to explore if absence of miR-21 reduces fibrogenesis and improves the phenotype of LAMA2-CMD mice. Thus, we generated dy3K/dy3K and dy2J/dy2J mice devoid of miR-21 (dy3K/miR-21 and dy2J/miR-21 mice, respectively). However, the muscular dystrophy phenotype of dy3K/miR-21 and dy2J/miR-21 double knock-out mice was not improved compared to dy3K/dy3K or dy2J/dy2J mice, respectively. Mice displayed the same body weight, dystrophic muscles (with fibrosis) and impaired muscle function. These data indicate that miR-21 may not be involved in the development of fibrosis in LAMA2-CMD.

Respiratory medication used in COPD patients from seven Latin American countries: the LASSYC study

PubMed Central

Casas, Alejandro; Montes de Oca, Maria; Menezes, Ana MB; Wehrmeister, Fernando C; Lopez Varela, Maria Victorina; Mendoza, Laura; Ramírez, Larissa; Miravitlles, Marc

2018-01-01

Background Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region. Methods This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other. Results In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV1 of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence >50%) according to the TAI questionnaire. Conclusion COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence. PMID:29785104

Respiratory medication used in COPD patients from seven Latin American countries: the LASSYC study.

PubMed

Casas, Alejandro; Montes de Oca, Maria; Menezes, Ana Mb; Wehrmeister, Fernando C; Lopez Varela, Maria Victorina; Mendoza, Laura; Ramírez, Larissa; Miravitlles, Marc

2018-01-01

Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region. This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other. In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV 1 of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence >50%) according to the TAI questionnaire. COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence.

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis.

PubMed

Hertel, Nadine; Kotchie, Robert W; Samyshkin, Yevgeniy; Radford, Matthew; Humphreys, Samantha; Jameson, Kevin

2012-01-01

Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. The treatment algorithm recommended in UK clinical practice represents a cost-effective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.

Diagnosis of toxoplasmosis-associated abortion in an alpaca (Vicugna pacos) fetus

USDA-ARS?s Scientific Manuscript database

A near full term alpaca (Vicugna pacos) was stillborn two days before expected date of delivery; necropsy examination was conducted within six hours of delivery. Gross lesions were enlarged liver and hydrocephalus. On histologic examination, mild inflammatory lesions were identified in the placenta,...

The effects of arterial carbon dioxide partial pressure and sevoflurane on capillary venous cerebral blood flow and oxygen saturation during craniotomy.

PubMed

Klein, Klaus Ulrich; Glaser, Martin; Reisch, Robert; Tresch, Achim; Werner, Christian; Engelhard, Kristin

2009-07-01

Intraoperative routine monitoring of cerebral blood flow and oxygenation remains a technological challenge. Using the physiological principle of carbon dioxide reactivity of cerebral vasculature, we investigated a recently developed neuromonitoring device (oxygen-to-see, O2C device) for simultaneous measurements of regional cerebral blood flow (rvCBF), blood flow velocity (rvVelo), oxygen saturation (srvO2), and hemoglobin amount (rvHb) at the capillary venous level in patients subjected to craniotomy. Twenty-six neurosurgical patients were randomly assigned to anesthesia with 1.4% or 2.0% sevoflurane end-tidal concentration. After craniotomy, a fiberoptic probe was applied on a macroscopically healthy surface of cerebral tissue next to the site of surgery. Simultaneous measurements in 2 and 8 mm cerebral depth were performed in each patient during lower (35 mm Hg) and higher (45 mm Hg) levels (random order) of arterial carbon dioxide partial pressure (PaCO2). The principle of these measurements relies on the combination of laser-Doppler flowmetry (rvCBF, rvVelo) and photo-spectrometry (srvO2, rvHb). Linear models were fitted to test changes of end points (rvCBF, rvVelo, srvO2, rvHb) in response to lower and higher levels of PaCO2, 1.4% and 2.0% sevoflurane end-tidal concentration, and 2 and 8 mm cerebral depth. RvCBF and rvVelo were elevated by PaCO2 independent of sevoflurane concentration in 2 and 8 mm depth of cerebral tissue (P < 0.001). Higher PaCO2 induced an increase in mean srvO2 from 50% to 68% (P < 0.001). RvVelo (P < 0.001) and srvO2 (P = 0.007) were higher in 8 compared with 2 mm cerebral depth. RvHb was not influenced by alterations in PaCO2 but positively correlated to sevoflurane concentration (P = 0.005). Increases in rvCBF and rvVelo by PaCO2 suggest preserved hypercapnic vasodilation under anesthesia with sevoflurane 1.4% and 2.0% end-tidal concentration. A consecutive increase in srvO2 implies that cerebral arteriovenous difference in oxygen was decreased by elevated PaCO2. Unchanged levels of rvHb signify that there was no blood loss during measurements. Data suggest that the device allows detection of local changes in blood flow and oxygen saturation in response to different PaCO2 levels in predominant venous cerebral microvessels.

Cost-effectiveness of roflumilast in combination with bronchodilator therapies in patients with severe and very severe COPD in Switzerland

PubMed Central

Samyshkin, Yevgeniy; Schlunegger, Michael; Haefliger, Susan; Ledderhose, Sabine; Radford, Matthew

2013-01-01

Objective Chronic obstructive pulmonary disease (COPD) represents a burden on patients and health systems. Roflumilast, an oral, selective phosphodiesterase-4-inhibitor reduces exacerbations and improves lung function in severe/very severe COPD patients with a history of exacerbations. This study aimed to estimate the lifetime cost and outcomes of roflumilast added-on to commonly used COPD regimens in Switzerland. Methods A Markov cohort model was developed to simulate COPD progression in patients with disease states of severe, very severe COPD, and death. The exacerbation rate was assumed to be two per year in severe COPD. COPD progression rates were drawn from the published literature. Efficacy was expressed as relative ratios of exacerbation rates associated with roflumilast, derived from a mixed-treatment comparison. A cost-effectiveness analysis was conducted for roflumilast added to long-acting muscarinic antagonists (LAMA), long-acting β2-agonist/ inhaled corticosteroids (LABA/ICS), and LAMA + LABA/ICS. The analysis was conducted from the Swiss payer perspective, with costs and outcomes discounted at 2.5% annually. Parameter uncertainties were explored in one-way and probabilistic sensitivity analyses. Results In each of the comparator regimens mean life expectancy was 9.28 years and quality-adjusted life years (QALYs) gained were 6.19. Mean estimated lifetime costs per patient in the comparator arms were CHF 83,364 (LAMA), CHF 88,161 (LABA/ICS), and CHF 95,564 (LAMA + LABA/ICS) respectively. Adding roflumilast resulted in a mean cost per patient per lifetime of CHF 86,754 (LAMA + roflumilast), CHF 91,470 (LABA/ICS + roflumilast), and CHF 99,364 (LAMA + LABA/ICS + roflumilast), respectively. Life-expectancy and quality-adjusted life-expectancy were 9.63 years and 6.47 QALYs (LAMA + roflumilast), 9.64 years and 6.48 QALYs (LABA/ICS + roflumilast), and 9.63 years and 6.47 QALYs (LAMA + LABA/ ICS + roflumilast). Incremental cost-effectiveness ratios were CHF 12,313, CHF 11,456, and CHF 13,671 per QALY when roflumilast was added to the three regimens. Conclusion Treatment with roflumilast is estimated to reduce the health and economic burden of COPD exacerbations and represent a cost-effective treatment option for patients with frequent exacerbations in Switzerland. PMID:23386787

[Cowpox virus infection in an alpaca (Vicugna pacos) - clinical symptoms, laboratory diagnostic findings and pathological changes].

PubMed

Goerigk, D; Theuß, T; Pfeffer, M; Konrath, A; Kalthoff, D; Woll, D; Vahlenkamp, T W; Beer, M; Starke, A

2014-01-01

Orthopoxvirus infections appear to be rare in South American Camelids, because only a few cases have been reported in the literature. Based on a generalized infection with cowpox virus in an alpaca, the clinical symptoms, laboratory diagnostic findings and the pathological changes are described. The case history showed a long treatment because of chronic skin lesions. The main clinical symptom was miliary papules over the entire skin. Furthermore, a bilateral mucopurulent conjunctivitis occurred as well as excessive salivation due to a severe erosive-ulcerative stomatitis. Although the animal received intensive treatment, it died 8 days after admission to the clinic. During necropsy, an erosive-ulcerative laryngitis as well as a necrotising pneumonia and lymphadenitis were observed. Histopathological examination of representative organ samples led to the diagnosis of a suspected orthopoxvirus infection. Electron microscopy and quantitative polymerase chain reaction (qPCR) of tissue samples confirmed this diagnosis. The virus could be isolated in tissue culture and a PCR with subsequent nucleotide sequencing identified cowpox virus as the causative agent for this generalised infection.

Increased polyamines as protective disease modifiers in congenital muscular dystrophy.

PubMed

Kemaladewi, D U; Benjamin, J S; Hyatt, E; Ivakine, E A; Cohn, R D

2018-06-01

Most Mendelian disorders, including neuromuscular disorders, display extensive clinical heterogeneity that cannot be solely explained by primary genetic mutations. This phenotypic variability is largely attributed to the presence of disease modifiers, which can exacerbate or lessen the severity and progression of the disease. LAMA2-deficient congenital muscular dystrophy (LAMA2-CMD) is a fatal degenerative muscle disease resulting from mutations in the LAMA2 gene encoding Laminin-α2. Progressive muscle weakness is predominantly observed in the lower limbs in LAMA2-CMD patients, whereas upper limbs muscles are significantly less affected. However, very little is known about the molecular mechanism underlying differential pathophysiology between specific muscle groups. Here, we demonstrate that the triceps muscles of the dy2j/dy2j mouse model of LAMA2-CMD demonstrate very mild myopathic findings compared with the tibialis anterior (TA) muscles that undergo severe atrophy and fibrosis, suggesting a protective mechanism in the upper limbs of these mice. Comparative gene expression analysis reveals that S-Adenosylmethionine decarboxylase (Amd1) and Spermine oxidase (Smox), two components of polyamine pathway metabolism, are downregulated in the TA but not in the triceps of dy2j/dy2j mice. As a consequence, the level of polyamine metabolites is significantly lower in the TA than triceps. Normalization of either Amd1 or Smox expression in dy2j/dy2j TA ameliorates muscle fibrosis, reduces overactive profibrotic TGF-β pathway and leads to improved locomotion. In summary, we demonstrate that a deregulated polyamine metabolism is a characteristic feature of severely affected lower limb muscles in LAMA2-CMD. Targeted modulation of this pathway represents a novel therapeutic avenue for this devastating disease.

The impact of dual bronchodilation on cardiovascular serious adverse events and mortality in COPD: a quantitative synthesis

PubMed Central

Rogliani, Paola; Matera, Maria Gabriella; Ora, Josuel; Cazzola, Mario; Calzetta, Luigino

2017-01-01

Objective Long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are burdened by the potential risk of inducing cardiovascular serious adverse events (SAEs) in COPD patients. Since the risk of combining a LABA with a LAMA could be greater, we have carried out a quantitative synthesis to investigate the cardiovascular safety profile of LABA/LAMA fixed-dose combinations (FDCs). Methods A pair-wise and network meta-analysis was performed by using the data of the repository database ClinicalTrials.gov concerning the impact of approved LABA/LAMA FDCs versus monocomponents and/or placebo on cardiovascular SAEs in COPD. Results Overall, LABA/LAMA FDCs did not significantly (P>0.05) modulate the risk of cardiovascular SAEs versus monocomponents. However, the network meta-analysis indicated that aclidinium/formoterol 400/12 µg and tiotropium/olodaterol 5/5 µg were the safest FDCs, followed by umeclidinium/vilanterol 62.5/25 µg which was as safe as placebo, whereas glycopyrronium/formoterol 14.9/9.6, glycopyrronium/indacaterol 15.6/27.5 µg, and glycopyrronium/indacaterol 50/110 µg were the least safe FDCs. No impact on mortality was detected for each specific FDC. Conclusion This meta-analysis indicates that LABA/LAMA FDC therapy is characterized by an excellent cardiovascular safety profile in COPD patients. However, the findings of this quantitative synthesis have been obtained from populations that participated in randomized clinical trials, and were devoid of major cardiovascular diseases. Thus, post-marketing surveillance and observational studies may help to better define the real impact of specific FDCs with regard to the cardiovascular risk. PMID:29255354

Increased Expression of Laminin Subunit Alpha 1 Chain by dCas9-VP160.

PubMed

Perrin, Arnaud; Rousseau, Joël; Tremblay, Jacques P

2017-03-17

Laminin-111 protein complex links the extracellular matrix to integrin α7β1 in sarcolemma, thus replacing in dystrophic muscles links normally insured by the dystrophin complex. Laminin-111 injection in mdx mouse stabilized sarcolemma, restored serum creatine kinase to wild-type levels, and protected muscles from exercised-induced damages. These results suggested that increased laminin-111 is a potential therapy for DMD. Laminin subunit beta 1 and laminin subunit gamma 1 are expressed in adult human muscle, but laminin subunit alpha 1 (LAMA1) gene is expressed only during embryogenesis. We thus developed an alternative method to laminin-111 protein repeated administration by inducing expression of the endogenous mouse Lama1 gene. This was done with the CRSPR/Cas9 system, i.e., by targeting the Lama1 promoter with one or several gRNAs and a dCas9 coupled with the VP160 transcription activation domain. Lama1 mRNA (qRT-PCR) and proteins (immunohistochemistry and western blot) were not detected in the control C2C12 myoblasts and in control muscles. However, significant expression was observed in cells transfected and in mouse muscles electroporated with plasmids coding for dCas9-VP160 and a gRNA. Larger synergic increases were observed by using two or three gRNAs. The increased Lama1 expression did not modify the expression of the α7 and β1 integrins. Increased expression of Lama1 by the CRISPR/Cas9 system will have to be further investigated by systemic delivery of the CRISPR/Cas9 components to verify whether this could be a treatment for several myopathies. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Renal acidification responses to respiratory acid-base disorders.

PubMed

Madias, Nicolaos E

2010-01-01

Respiratory acid-base disorders are those abnormalities in acid-base equilibrium that are expressed as primary changes in the arterial carbon dioxide tension (PaCO2). An increase in PaCO2 (hypercapnia) acidifies body fluids and initiates the acid-base disturbance known as respiratory acidosis. By contrast, a decrease in PaCO2 (hypocapnia) alkalinizes body fluids and initiates the acid-base disturbance known as respiratory alkalosis. The impact on systemic acidity of these primary changes in PaCO2 is ameliorated by secondary, directional changes in plasma [HCO3¯] that occur in 2 stages. Acutely, hypercapnia or hypocapnia yields relatively small changes in plasma [HCO3¯] that originate virtually exclusively from titration of the body's nonbicarbonate buffers. During sustained hypercapnia or hypocapnia, much larger changes in plasma [HCO3¯] occur that reflect adjustments in renal acidification mechanisms. Consequently, the deviation of systemic acidity from normal is smaller in the chronic forms of these disorders. Here we provide an overview of the renal acidification responses to respiratory acid-base disorders. We also identify gaps in knowledge that require further research.

[Thirty years of laser-assisted microvascular anastomosis (LAMA): what are the clinical perspectives?].

PubMed

Leclère, F M; Duquennoy-Martinot, V; Schoofs, M; Buys, B; Mordon, S

2011-02-01

Since the first studies by Jain and Gorisch (1979), laser-assisted anastomoses have been steadily developed to a stage where clinical use is within reach. The laser-assisted vascular microanastomosis (LAMA) procedure is performed more quickly than conventional anastomosis, the surgically induced vessel damage is limited, and reduced bleeding after unclamping is observed. A Medline literature search, for the January 1979 to February 2010 period, was performed to review articles focusing on the LAMA technique. The search yielded a total of 354 publications, of which 87 were relevant: 82 were animal series and five clinical studies. Microsurgical techniques and principal characteristics of LAMA in patients are the focus of the analysis. This study discusses the technological innovations and new orientations in laser welding. The first two clinical series using the 1.9-μm diode laser appear promising. Technical innovation will most likely lead to greater ease of use of the laser handpiece in the operating room. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Current laser applications in reconstructive microsurgery: A review of the literature.

PubMed

Leclère, Franck Marie; Vogt, Peter; Schoofs, Michel; Delattre, Maryline; Mordon, Serge

2016-06-01

Microvascular surgery has become an important method for reconstructing surgical defects following trauma, tumor resection, or burns. Laser-assisted microanastomoses (LAMA) were introduced by Jain in 1979 in order to help the microsurgeon reduce both operating time and complications. This article reviews the literature on clinical applications of LAMA. A Medline literature search was performed and cross-referenced. Articles between 1979 and 2014 were included. Keywords used were laser, laser microanastomoses, laser microanastomosis, LAMA, and microsurgery. Only seven clinical studies using three different wavelengths were found in the literature: 1,064 nm (Nd: YAG), 10,600 nm (CO2), 514 nm (Argon), and 1,950 nm (Diode). Clinical outcomes, type of procedures, laser wavelength and parameters, and possible wider applications in the operating room are discussed in each case. The success rate for reconstructive free flap surgery and hand surgery achieved with LAMA appears promising. In particular, use of the 1950-nm diode laser for microsurgery is likely to increase in the near future.

Recent advances in COPD disease management with fixed-dose long-acting combination therapies.

PubMed

Bateman, Eric D; Mahler, Donald A; Vogelmeier, Claus F; Wedzicha, Jadwiga A; Patalano, Francesco; Banerji, Donald

2014-06-01

Combinations of two long-acting bronchodilators and long-acting bronchodilators with inhaled corticosteroids (ICS) are recommended therapies in the management of chronic obstructive pulmonary disease (COPD). Three fixed-dose combination products have recently been approved for the treatment of COPD (the long-acting β2-agonist plus long-acting muscarinic antagonist [LABA/LAMA] combinations glycopyrronium/indacaterol [QVA149] and umeclidinium/vilanterol, and the LABA/ICS fluticasone furoate/vilanterol), with others currently in late-stage development. LABA/LAMA and LABA/ICS combination therapies demonstrate positive effects on both lung function and patient-reported outcomes, with significant improvements observed with LABA/LAMA combinations compared with placebo, each component alone and other comparators in current use. No new safety concerns have been observed with combinations of long-acting bronchodilators. Combinations of two long-acting bronchodilators represent a new and convenient treatment option in COPD. This review summarizes published efficacy and safety data from clinical trials of both LABA/LAMA and novel LABA/ICS combinations in patients with COPD.

Effect of work intensity on time delay in mediation of ventilation by arterial carbon dioxide during recovery from impulse exercise.

PubMed

Afroundeh, R; Arimitsu, T; Yamanaka, R; Lian, C S; Shirakawa, K; Yunoki, T; Yano, T

2014-01-01

Time delay in the mediation of ventilation (V(.)E) by arterial CO(2) pressure (PaCO(2)) was studied during recovery from short impulse-like exercises with different work loads of recovery. Subjects performed two tests including 10-s impulse like exercise with work load of 200 watts and 15-min recovery with 25 watts in test one and 50 watts in test two. V(.)E, end tidal CO(2) pressure (PETCO(2)) and heart rate (HR) were measured continuously during rest, warming up, exercise and recovery. PaCO(2) was estimated from PETCO(2) and tidal volume (V(T)). Results showed that predicted arterial CO(2) pressure (PaCO(2 pre)) increased during recovery in both tests. In both tests, V(.)E increased and peaked at the end of exercise. V(.)E decreased in the first few seconds of recovery but started to increase again. The highest correlation coefficient between PaCO(2 pre) and V(.)E was obtained in the time delay of 7 s (r=0.854) in test one and in time delays of 6 s (r=0.451) and 31 s (r=0.567) in test two. HR was significantly higher in test two than in test one. These results indicate that PaCO(2 pre) drives V(.)E with a time delay and that higher work intensity induces a shorter time delay.

Facial immersion in cold water enhances cerebral blood velocity during breath-hold exercise in humans.

PubMed

Kjeld, Thomas; Pott, Frank C; Secher, Niels H

2009-04-01

The diving response is initiated by apnea and facial immersion in cold water and includes, besides bradycardia, peripheral vasoconstriction, while cerebral perfusion may be enhanced. This study evaluated whether facial immersion in 10 degrees C water has an independent influence on cerebral perfusion evaluated as the middle cerebral artery mean flow velocity (MCA V(mean)) during exercise in nine male subjects. At rest, a breath hold of maximum duration increased the arterial carbon dioxide tension (Pa(CO(2))) from 4.2 to 6.7 kPa and MCA V(mean) from 37 to 103 cm/s (mean; approximately 178%; P < 0.001). Similarly, during 100-W exercise, a breath hold increased Pa(CO(2)) from 5.9 to 8.2 kPa (P < 0.001) and MCA V(mean) from 55 to 113 cm/s ( approximately 105%), and facial immersion further increased MCA V(mean) to 122 cm/s ( approximately 88%; both P < 0.001). MCA V(mean) also increased during 180-W exercise (from 47 to 53 cm/s), and this increment became larger with facial immersion (76 cm/s, approximately 62%; P < 0.001), although Pa(CO(2)) did not significantly change. These results indicate that a breath hold diverts blood toward the brain with a >100% increase in MCA V(mean), largely because Pa(CO(2)) increases, but the increase in MCA V(mean) becomes larger when combined with facial immersion in cold water independent of Pa(CO(2)).

Exaggerated compensatory response to acute respiratory alkalosis in panic disorder is induced by increased lactic acid production.

PubMed

Ueda, Yoshiyasu; Aizawa, Masayo; Takahashi, Atsushi; Fujii, Masamitsu; Isaka, Yoshitaka

2009-03-01

In acute respiratory alkalosis, the severity of alkalaemia is ameliorated by a decrease in plasma [HCO(3)(-)] of 0.2 mEq/L for each 1 mmHg decrease in PaCO(2). Although hyperventilation in panic disorder patients is frequently encountered in outpatients, the drop in plasma [HCO(3)(-)] sometimes surpasses the expectation calculated from the above formula. The quantitative relationship between reduced PaCO(2) and plasma [HCO(3)(-)] in acute respiratory alkalosis has not been studied in panic disorder patients. Our objective was to provide reference data for the compensatory metabolic changes in acute respiratory alkalosis in panic disorder patients. In 34 panic disorder patients with hyperventilation attacks, we measured arterial pH, PaCO(2), plasma [HCO(3)(-)] and lactate on arrival at the emergency room. For each decrease of 1 mmHg in PaCO(2), plasma [HCO(3)(-)] decreased by 0.41 mEq/L. During hypocapnia, panic disorder patients exhibited larger increases in serum lactate levels (mean +/- SD; 2.59 +/- 1.50 mmol/L, range; 0.78-7.78 mmol/L) than previously reported in non-panic disorder subjects. Plasma lactate accumulation was correlated with PaCO(2) (P < 0.001). These results suggest that the compensatory metabolic response to acute respiratory alkalosis is exaggerated by increased lactic acid production in panic disorder patients. Here, we call attention to the diagnosis of acid-base derangements by means of plasma [HCO(3)(-)] and lactate concentration in panic disorder patients.

A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients.

PubMed

Gaur, Pallavi; Harde, Minal; Gujjar, Pinakin; Deosarkar, Devanand; Bhadade, Rakesh

2017-01-01

Monitoring carbon dioxide (CO 2 ) is of utmost importance in neurosurgical patients. It is measured by partial pressure of arterial CO 2 (PaCO 2 ) and end-tidal CO 2 (ETCO 2 ). We aimed to study the correlation between PaCO 2 and ETCO 2 in neurosurgical patients in the intraoperative and postoperative period on mechanical ventilation in Postanesthesia Care Unit (PACU). This was prospective observational study done at tertiary care teaching public hospital over a period of 1 year. We studied 30 patients undergoing elective craniotomy intraoperatively and in the postoperative period on mechanical ventilation for 24 h. Serial measurement of ETCO 2 and PaCO 2 at baseline, hourly intraoperatively and every 6 hourly in the PACU were studied. Data analysis was done using SPSS software version 20. The mean PaCO 2 -ETCO 2 gradient intraoperatively over 4 h is 3.331 ± 2.856 and postoperatively over 24 h is 2.779 ± 2.932 and lies in 95% confidence interval. There was statistically significant correlation between PaCO 2 and ETCO 2 intraoperatively baseline, 1 h, 2 h, 3 h, and 4 h with Pearson's correlation coefficients of 0.799, 0.522, 0582, 0.439, and 0.547, respectively ( P < 0.05). In PACU at baseline, 6 h, 12 h, 18 h, and 24 h Pearson's correlation coefficients were. 534, -0.032, 0.522, 0.242, 0.592, and 0.547, respectively, which are highly significant at three instances ( P < 0.01). ETCO 2 correlates PaCO 2 with acceptable accuracy in neurosurgical patients in the intraoperative and postoperative period on mechanical ventilation in Intensive Care Unit. Thus, continuous and noninvasive ETCO 2 can be used as a reliable guide to estimate arterial PCO 2 during neurosurgical procedures and in PACU.

Comparison of the effects of moderate and severe hypercapnic acidosis on ventilation-induced lung injury.

PubMed

Yang, Wanchao; Yue, Ziyong; Cui, Xiaoguang; Guo, Yueping; Zhang, Lili; Zhou, Huacheng; Li, Wenzhi

2015-04-30

We have proved that hypercapnic acidosis (a PaCO2 of 80-100 mmHg) protects against ventilator-induced lung injury in rats. However, there remains uncertainty regarding the appropriate target PaCO2 or if greater CO2 "doses" (PaCO2 > 100 mmHg) demonstrate this effect. We wished to determine whether severe acute hypercapnic acidosis can reduce stretch-induced injury, as well as the role of nuclear factor-κB (NF-κB) in the effects of acute hypercapnic acidosis. Fifty-four rats were ventilated for 4 hours with a pressure-controlled ventilation mode set at a peak inspiratory pressure (PIP) of 30 cmH2O. A gas mixture of carbon dioxide with oxygen (FiCO2 = 4-5%, FiCO2 = 11-12% or FiCO2 = 16-17%; FiO2 = 0.7; balance N2) was immediately administered to maintain the target PaCO2 in the NC (a PaCO2 of 35-45 mmHg), MHA (a PaCO2 of 80-100 mmHg) and SHA (a PaCO2 of 130-150 mmHg) groups. Nine normal or non-ventilated rats served as controls. The hemodynamics, gas exchange and inflammatory parameters were measured. The role of NF-κB pathway in hypercapnic acidosis-mediated protection from high-pressure stretch injury was then determined. In the NC group, high-pressure ventilation resulted in a decrease in PaO2/FiO2 from 415.6 (37.1) mmHg to 179.1 (23.5) mmHg (p < 0.001), but improved by MHA (379.9 ± 34.5 mmHg) and SHA (298.6 ± 35.3 mmHg). The lung injury score in the SHA group (7.8 ± 1.6) was lower than the NC group (11.8 ± 2.3, P < 0.05) but was higher than the MHA group (4.4 ± 1.3, P < 0.05). Compared with the NC group, after 4 h of high pressure ventilation, the MHA and SHA groups had decreases in MPO activity of 67% and 33%, respectively, and also declined the levels of TNF-α (58% versus 72%) and MIP-2 (76% versus 60%) in the BALF. Additionally, both hypercapnic acidosis groups reduced stretch-induced NF-κB activation (p < 0.05) and significantly decreased lung ICAM-1 expression (p < 0.05). Moderate hypercapnic acidosis (PaCO2 maintained at 80-100 mmHg) has a greater protective effect on high-pressure ventilation-induced inflammatory injury. The potential mechanisms may involve alterations in NF-κB activity.

Investigating formation of ‘place attachment’ at pasar lama communities, Kota Tangerang

NASA Astrophysics Data System (ADS)

Syahrida, O.; Sumabrata, J.

2018-03-01

Place attachment as bonding between people-meaningful places) has been researched quite broadly. Part of this interest stems from the awareness that people–place bonds have become fragile as urbanization, increased mobility, and encroaching environmental problems threaten the existence of/and the connections to, places influences sense of attachment in Pasar Lama, Kota Tangerang. Despite its stauts as a Chinatown, the amount of Chinese inhabitant in Pasar Lama is only 1/5 compared to then total number of Native. Therefore an investigation is needed whether the advances of Kota Tangerang and increasing number of people affecting the formation of place attachment at Pasar Lama Communities. The analysis were conducted through eight factors, such as: physical, social, cultural, personal, memories and experiences, place satisfaction, interaction and activity features, and time factor. Qualitative method (ethnography approach) participatory observation and in-depth interview used as the method of research. The informant of this research are the local figure, local citizen, and local authority. Research concludes that the rapid development of Kota Tangerang and the number of citizens do not significantly affect the formation of place attachment, since both communities in Pasar Lama are considered having high attachment. The other factor is, Place Attachment is valued in contribution, a qualitative value instead sheer number of population. These contributions can be seen in the social, cultural and religious aspect based on factors on Place Attachment.

In the Lab with the Dalai Lama

ERIC Educational Resources Information Center

Schmidt, Leigh E.

2005-01-01

The Dalai Lama, the exiled Tibetan Buddhist leader was invited to speak at the Society for Neuroscience meeting in November 2005 to promote the idea that through meditation, an emerging meeting point for science and religion in contemporary culture can be reached. However, some members of the association were offended at the implied endorsement…

Mutations in LAMA1 Cause Cerebellar Dysplasia and Cysts with and without Retinal Dystrophy

PubMed Central

Aldinger, Kimberly A.; Mosca, Stephen J.; Tétreault, Martine; Dempsey, Jennifer C.; Ishak, Gisele E.; Hartley, Taila; Phelps, Ian G.; Lamont, Ryan E.; O’Day, Diana R.; Basel, Donald; Gripp, Karen W.; Baker, Laura; Stephan, Mark J.; Bernier, Francois P.; Boycott, Kym M.; Majewski, Jacek; Parboosingh, Jillian S.; Innes, A. Micheil; Doherty, Dan

2014-01-01

Cerebellar dysplasia with cysts (CDC) is an imaging finding typically seen in combination with cobblestone cortex and congenital muscular dystrophy in individuals with dystroglycanopathies. More recently, CDC was reported in seven children without neuromuscular involvement (Poretti-Boltshauser syndrome). Using a combination of homozygosity mapping and whole-exome sequencing, we identified biallelic mutations in LAMA1 as the cause of CDC in seven affected individuals (from five families) independent from those included in the phenotypic description of Poretti-Boltshauser syndrome. Most of these individuals also have high myopia, and some have retinal dystrophy and patchy increased T2-weighted fluid-attenuated inversion recovery (T2/FLAIR) signal in cortical white matter. In one additional family, we identified two siblings who have truncating LAMA1 mutations in combination with retinal dystrophy and mild cerebellar dysplasia without cysts, indicating that cysts are not an obligate feature associated with loss of LAMA1 function. This work expands the phenotypic spectrum associated with the lamininopathy disorders and highlights the tissue-specific roles played by different laminin-encoding genes. PMID:25105227

A Mandala's Message

ERIC Educational Resources Information Center

Bonnell, Tom

2002-01-01

A Tibetan Buddhist monk, Lama Tenzin, spent a week at the Manhattan private school where the author of this article was the middle school director. Lama Tenzin did not come to introduce students to Buddhism or to explain the plight of the Tibetan people. Instead, he came to create a piece of art that is a specialty of his and his brother monks': a…

Endothelial basement membrane limits tip cell formation by inducing Dll4/Notch signalling in vivo.

PubMed

Stenzel, Denise; Franco, Claudio A; Estrach, Soline; Mettouchi, Amel; Sauvaget, Dominique; Rosewell, Ian; Schertel, Andreas; Armer, Hannah; Domogatskaya, Anna; Rodin, Sergey; Tryggvason, Karl; Collinson, Lucy; Sorokin, Lydia; Gerhardt, Holger

2011-10-28

How individual components of the vascular basement membrane influence endothelial cell behaviour remains unclear. Here we show that laminin α4 (Lama4) regulates tip cell numbers and vascular density by inducing endothelial Dll4/Notch signalling in vivo. Lama4 deficiency leads to reduced Dll4 expression, excessive filopodia and tip cell formation in the mouse retina, phenocopying the effects of Dll4/Notch inhibition. Lama4-mediated Dll4 expression requires a combination of integrins in vitro and integrin β1 in vivo. We conclude that appropriate laminin/integrin-induced signalling is necessary to induce physiologically functional levels of Dll4 expression and regulate branching frequency during sprouting angiogenesis in vivo.

Endothelial basement membrane limits tip cell formation by inducing Dll4/Notch signalling in vivo

PubMed Central

Stenzel, Denise; Franco, Claudio A; Estrach, Soline; Mettouchi, Amel; Sauvaget, Dominique; Rosewell, Ian; Schertel, Andreas; Armer, Hannah; Domogatskaya, Anna; Rodin, Sergey; Tryggvason, Karl; Collinson, Lucy; Sorokin, Lydia; Gerhardt, Holger

2011-01-01

How individual components of the vascular basement membrane influence endothelial cell behaviour remains unclear. Here we show that laminin α4 (Lama4) regulates tip cell numbers and vascular density by inducing endothelial Dll4/Notch signalling in vivo. Lama4 deficiency leads to reduced Dll4 expression, excessive filopodia and tip cell formation in the mouse retina, phenocopying the effects of Dll4/Notch inhibition. Lama4-mediated Dll4 expression requires a combination of integrins in vitro and integrin β1 in vivo. We conclude that appropriate laminin/integrin-induced signalling is necessary to induce physiologically functional levels of Dll4 expression and regulate branching frequency during sprouting angiogenesis in vivo. PMID:21979816

A-B-O and Rh affinities between highland and lowland Quechua-speaking Peruvian populations.

PubMed

Frisancho, A R; Klayman, J E

1975-09-01

According to the accounts of the Spanish chronicles and various historical analyses the Quechua-speaking population inhabiting the Province of Lamas in the Eastern Tropical Lowlands of Peru are descendants of the Chanca Tribes that migrated from the highlands about 500 years ago. The results of the present study indicate that in terms of the A-B-O and Rh systems the lowland Quechua-speaking population from the Province of Lamas and the highland Quechua population from the Province of Junin are more similar to each other than to other tropical tribes. Therefore, it is quite possible that the present lowland Quechua-speaking population from the Province of Lamas may be descendants of Andean populations.

The influence of graded degrees of chronic hypercapnia on the acute carbon dioxide titration curve

PubMed Central

Goldstein, Marc B.; Gennari, F. John; Schwartz, William B.

1971-01-01

Studies were carried out to determine the influence of the chronic level of arterial carbon dioxide tension upon the buffering response to acute changes in arterial carbon dioxide tension. After chronic adaptation to six levels of arterial CO2 tension, ranging between 35 and 110 mm Hg, unanesthetized dogs underwent acute whole body CO2 titrations. In each instance a linear relationship was observed between the plasma hydrogen ion concentration and the arterial carbon dioxide tension. Because of this linear relationship, it has been convenient to compare the acute buffering responses among dogs in terms of the slope, dH+/dPaco2. With increasing chronic hypercapnia there was a decrease in this slope, i.e. an improvement in buffer capacity, which is expressed by the equation dH+/dPaco2=-0.005 (Paco2)chronic + 0.95. In effect, the ability to defend pH during acute titration virtually doubled as chronic Paco2 increased from 35 to 110 mm Hg. The change in slope, dH+/dPaco2, was the consequence of the following two factors: the rise in plasma bicarbonate concentration which occurs with chronic hypercapnia of increasing severity, and the greater change in bicarbonate concentration which occurred during the acute CO2 titration in the animals with more severe chronic hypercapnia. These findings demonstrate the importance of the acid-base status before acute titration in determining the character of the carbon dioxide titration curve. They also suggest that a quantitative definition of the interplay between acute and chronic hypercapnia in man should assist in the rational analysis of acid-base disorders in chronic pulmonary insufficiency. PMID:5543876

Agreement between arterial partial pressure of carbon dioxide and saturation of hemoglobin with oxygen values obtained by direct arterial blood measurements versus noninvasive methods in conscious healthy and ill foals.

PubMed

Wong, David M; Alcott, Cody J; Wang, Chong; Bornkamp, Jennifer L; Young, Jessica L; Sponseller, Brett A

2011-11-15

To determine agreement between indirect measurements of end-tidal partial pressure of carbon dioxide (PetCO(2)) and saturation of hemoglobin with oxygen as measured by pulse oximetry (SpO(2)) with direct measurements of PaCO(2) and calculated saturation of hemoglobin with oxygen in arterial blood (SaO(2)) in conscious healthy and ill foals. Validation study. 10 healthy and 21 ill neonatal foals. Arterial blood gas analysis was performed on healthy and ill foals examined at a veterinary teaching hospital to determine direct measurements of PaCO(2) and PaO(2) along with SaO(2). Concurrently, PetCO(2) was measured with a capnograph inserted into a naris, and SpO(2) was measured with a reflectance probe placed at the base of the tail. Paired values were compared by use of Pearson correlation coefficients, and level of agreement was assessed with the Bland-Altman method. Mean ± SD difference between PaCO(2) and PetCO(2) was 0.1 ± 5.0 mm Hg. There was significant strong correlation (r = 0.779) and good agreement between PaCO(2) and PetCO(2). Mean ± SD difference between SaO(2) and SpO(2) was 2.5 ± 3.5%. There was significant moderate correlation (r = 0.499) and acceptable agreement between SaO(2) and SpO(2). Both PetCO(2) obtained by use of nasal capnography and SpO(2) obtained with a reflectance probe are clinically applicable and accurate indirect methods of estimating and monitoring PaCO(2) and SaO(2) in neonatal foals. Indirect methods should not replace periodic direct measurement of corresponding parameters.

Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD

PubMed Central

Izquierdo, José Luis; Paredero, José Manuel; Piedra, Raul

2016-01-01

Introduction The aim of this study was to assess the degree of adherence for two standard regimens for administrating anticholinergic drugs (12 and 24 hours) in patients with chronic obstruction of the airflow and to establish whether the use of a once-daily dose improves the level of treatment adherence. Methods We used long-acting anticholinergics (LAMAs) as a study variable, and included the entire health area of Castile-La Mancha, numbering 2,100,998 inhabitants, as the study population. We analyzed a total of 16,446 patients who had been prescribed a LAMA between January 1, 2013 and December 31, 2013. The follow-up period, based on a centralized system of electronic prescription management, was extended until December 2014. Results During 2013, the medication collected was 7.4%–10.7% higher than indicated by labeling. This was very similar for all LAMAs, irrespective of the patient’s sex, the molecule, the device, and the drug dosage. We did not observe seasonal variations in the consumption of LAMAs, nor did we detect differences between prescription drugs for once-daily (every 24 hours) versus twice-daily (every 12 hours) administration, between the different molecules, or between different types of inhalers for the same molecule. The results were similar in 2014. Conclusion The principal conclusion of this study is that, in an area with a centralized management system of pharmacological prescriptions, adherence to treatment with LAMAs is very high, irrespective of the molecules or inhalation device. We did not find that patients who used twice-daily medication had a lower adherence. PMID:26929614

Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD.

PubMed

Izquierdo, José Luis; Paredero, José Manuel; Piedra, Raul

2016-01-01

The aim of this study was to assess the degree of adherence for two standard regimens for administrating anticholinergic drugs (12 and 24 hours) in patients with chronic obstruction of the airflow and to establish whether the use of a once-daily dose improves the level of treatment adherence. We used long-acting anticholinergics (LAMAs) as a study variable, and included the entire health area of Castile-La Mancha, numbering 2,100,998 inhabitants, as the study population. We analyzed a total of 16,446 patients who had been prescribed a LAMA between January 1, 2013 and December 31, 2013. The follow-up period, based on a centralized system of electronic prescription management, was extended until December 2014. During 2013, the medication collected was 7.4%-10.7% higher than indicated by labeling. This was very similar for all LAMAs, irrespective of the patient's sex, the molecule, the device, and the drug dosage. We did not observe seasonal variations in the consumption of LAMAs, nor did we detect differences between prescription drugs for once-daily (every 24 hours) versus twice-daily (every 12 hours) administration, between the different molecules, or between different types of inhalers for the same molecule. The results were similar in 2014. The principal conclusion of this study is that, in an area with a centralized management system of pharmacological prescriptions, adherence to treatment with LAMAs is very high, irrespective of the molecules or inhalation device. We did not find that patients who used twice-daily medication had a lower adherence.

Genetic variants in the LAMA5 gene in pediatric nephrotic syndrome.

PubMed

Braun, Daniela A; Warejko, Jillian K; Ashraf, Shazia; Tan, Weizhen; Daga, Ankana; Schneider, Ronen; Hermle, Tobias; Jobst-Schwan, Tilman; Widmeier, Eugen; Majmundar, Amar J; Nakayama, Makiko; Schapiro, David; Rao, Jia; Schmidt, Johanna Magdalena; Hoogstraten, Charlotte A; Hugo, Hannah; Bakkaloglu, Sevcan A; Kari, Jameela A; El Desoky, Sherif; Daouk, Ghaleb; Mane, Shrikant; Lifton, Richard P; Shril, Shirlee; Hildebrandt, Friedhelm

2018-03-09

Nephrotic syndrome (NS), a chronic kidney disease, is characterized by significant loss of protein in the urine causing hypoalbuminemia and edema. In general, ∼15% of childhood-onset cases do not respond to steroid therapy and are classified as steroid-resistant NS (SRNS). In ∼30% of cases with SRNS, a causative mutation can be detected in one of 44 monogenic SRNS genes. The gene LAMA5 encodes laminin-α5, an essential component of the glomerular basement membrane. Mice with a hypomorphic mutation in the orthologous gene Lama5 develop proteinuria and hematuria. To identify additional monogenic causes of NS, we performed whole exome sequencing in 300 families with pediatric NS. In consanguineous families we applied homozygosity mapping to identify genomic candidate loci for the underlying recessive mutation. In three families, in whom mutations in known NS genes were excluded, but in whom a recessive, monogenic cause of NS was strongly suspected based on pedigree information, we identified homozygous variants of unknown significance (VUS) in the gene LAMA5. While all affected individuals had nonsyndromic NS with an early onset of disease, their clinical outcome and response to immunosuppressive therapy differed notably. We here identify recessive VUS in the gene LAMA5 in patients with partially treatment-responsive NS. More data will be needed to determine the impact of these VUS in disease management. However, familial occurrence of disease, data from genetic mapping and a mouse model that recapitulates the NS phenotypes suggest that these genetic variants may be inherited factors that contribute to the development of NS in pediatric patients.

Clinical potential of aclidinium bromide in chronic obstructive pulmonary disease.

PubMed

Jones, Paul W

2015-01-01

Three long-acting muscarinic antagonists (LAMAs) are now available in Europe, providing clinicians and patients with a choice of interventions, which is important in COPD, which is clinically a heterogeneous disease. The first LAMA, tiotropium, has been widely used over the last decade as a once-daily maintenance therapy in stable COPD to improve patients' health-related quality of life and to reduce the risk of exacerbations. Administered via the HandiHaler(®) device, it is safe and well tolerated. Another new once-daily LAMA, glycopyrronium, has also been shown to improve health status and reduce exacerbations, and is well tolerated. The subject of this review is a third LAMA, aclidinium bromide, which was approved as a twice-daily maintenance bronchodilator treatment. In the pivotal Phase III clinical trials, patients receiving aclidinium achieved significantly greater improvements in lung function, reductions in breathlessness, and improvements in health status compared with placebo, for up to 24 weeks. In continuation studies, these improvements were sustained for up to 52 weeks. Pooled data showed exacerbation frequency was significantly reduced with aclidinium versus placebo. Preclinical and pharmacological studies demonstrating low systemic bioavailability and a low propensity to induce cardiac arrhythmias were translated into a favorable tolerability profile in the clinical trial program - the adverse event profile of aclidinium was similar to placebo, with a low incidence of anticholinergic and cardiac adverse events. While additional studies are needed to evaluate its full clinical potential, aclidinium is an important part of this recent expansion of LAMA therapeutic options, providing clinicians and patients with an effective and well-tolerated COPD treatment.

Gas exchanges in children with cystic fibrosis or primary ciliary dyskinesia: A retrospective study.

PubMed

Fuger, Marilyn; Aupiais, Camille; Thouvenin, Guillaume; Taytard, Jessica; Tamalet, Aline; Escudier, Estelle; Boizeau, Priscilla; Corvol, Harriet; Beydon, Nicole

2018-05-01

Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) both entail bronchiectasis and pulmonary impairment as measured using spirometry, during childhood. We aimed at looking whether blood gas exchanges progressed differently between CF and PCD children in a retrospective study of repeated measurements. Comparisons between groups (Wilcoxon-Mann-Whitney and Chi-squared tests) and a mixed linear model, adjusted for age, evaluated associations between diseases and PaO 2 , PaCO 2, or PaO 2- PaCO 2 ratio. Among 42 PCD and 73 CF children, 62% and 59% had respectively bronchiectasis (P = 0.75). Spirometry and blood gases were similar at inclusion (PaO 2 median [IQR] PCD -1.80 [-3.40; -0.40]; CF -1.80 [-4.20; 0.60] z-scores; P = 0.72). PaO 2 and PaO 2 -PaCO 2 ratio similarly and significantly decreased with age in both groups (P < 0.01) whereas PaCO 2 increased more in CF (P = 0.02) remaining within the range of normal (except for one child). To conclude, gas exchange characteristics, similarly initially impaired in PCD and CF children, tended to less deteriorate with time in PCD children who could benefit from an early diagnosis. Copyright © 2018 Elsevier B.V. All rights reserved.

Human respiration at rest in rapid compression and at high pressures and gas densities

NASA Technical Reports Server (NTRS)

Gelfand, R.; Lambertsen, C. J.; Strauss, R.; Clark, J. M.; Puglia, C. D.

1983-01-01

The ventilation (V), end-tidal PCO2 (PACO2), and CO2 elimination rate were determined in men at rest breathing CO2-free gas over the pressure range 1-50 ATA and the gas density range 0.4-25 g/l, during slow and rapid compressions, at stable elevated ambient pressures and during slow decompressions. Progressive increase in pulmonary gas flow resistance due to elevation of ambient pressure and inspired gas density to the He-O2 equivalent of 5000 feet of seawater was found to produce a complex pattern of change in PACO2. It was found that as both ambient pressure and pulmonary gas flow resistance were progressively raised, PACO2 at first increased, went through a maximum, and then declined towards values near the 1 ATA level. It is concluded that this pattern of PACO2 change results from the interaction on ventilation of the increase in pulmonary resistance due to the elevation of gas density with the increase in respiratory drive postulated as due to generalized central nervous system excitation associated with exposure to high hydrostatic pressure. It is suggested that a similar interaction exists between increased gas flow resistance and the increase in respiratory drive related to nitrogen partial pressure and the resulting narcosis.

An Ehrlichia strain from a llama (Lama glama) and Llama-associated ticks (Ixodes pacificus).

PubMed Central

Barlough, J E; Madigan, J E; Turoff, D R; Clover, J R; Shelly, S M; Dumler, J S

1997-01-01

An ehrlichia was identified in the blood of a diseased llama (lama glama). Sequencing of its 16S rRNA gene showed the ehrlichia to be closely related to members of the Ehrlichia phagocytophila genogroup. The agent was also found in a pool of ticks (Ixodes pacificus) collected at the llama site. PMID:9157118

Functional decline at the aging neuromuscular junction is associated with altered laminin-α4 expression.

PubMed

Lee, Kah Meng; Chand, Kirat K; Hammond, Luke A; Lavidis, Nickolas A; Noakes, Peter G

2017-03-14

Laminin-α4 is involved in the alignment of active zones to postjunctional folds at the neuromuscular junction (NMJ). Prior study has implicated laminin-α4 in NMJ maintenance, with altered NMJ morphology observed in adult laminin-α4 deficient mice ( lama 4 -/- ). The present study further investigated the role of laminin-α4 in NMJ maintenance by functional characterization of transmission properties, morphological investigation of synaptic proteins including synaptic laminin-α4, and neuromotor behavioral testing. Results showed maintained perturbed transmission properties at lama 4 -/- NMJs from adult (3 months) through to aged (18-22 months). Hind-limb grip force demonstrated similar trends as transmission properties, with maintained weaker grip force across age groups in lama 4 -/- . Interestingly, both transmission properties and hind-limb grip force in aged wild-types resembled those observed in adult lama 4 -/- . Most significantly, altered expression of laminin-α4 was noted at the wild-type NMJs prior to the observed decline in transmission properties, suggesting that altered laminin-α4 expression precedes the decline of neurotransmission in aging wild-types. These findings significantly support the role of laminin-α4 in maintenance of the NMJ during aging.

The epidemiology of asthma and its comorbidities in Poland--Health problems of patients with severe asthma as evidenced in the Province of Lodz.

PubMed

Panek, Michał; Mokros, Łukasz; Pietras, Tadeusz; Kuna, Piotr

2016-03-01

Population studies supply interesting data regarding the epidemiology, comorbidity and risk factors of asthma, which have direct clinical implications for patients. The aim of the work was to evaluate the degree of severity of asthma in the studied group, the levels of anti-asthma treatment, the prevalence of asthma comorbidities and their influence on the clinical course of the illness. The study encompassed 451 participants: 52.11% were asthma patients (study group) and 47.89% were healthy subjects (controls). Respiratory function tests, ACT™ test and skin prick tests were performed. Asthma severity was mild in 14.89%, moderate in 49.36% and severe in 35.74%. Oral GCS were used by 29%, inhalers 44%, LABA 68%, SABA 67%, LAMA 6%, SAMA 14% and MX 16%. Rhinitis and allergy were significantly more common in patients. GERD and neurological diseases were risk factors for asthma, and GERD significantly intensified the risk of severe asthma. GERD, atherosclerosis, hypertension, ischaemic heart disease and other cardiac diseases, lipid disorders, COPD, and the presence of any neoplastic disease significantly worsened the degree of asthma control. Severe asthma was a significant clinical issue in over 35% of cases. The most commonly-used group of drugs were LABAs, while inhaled GCS and LAMA were uncommon, especially among severe cases. A significant problem was the high percentage of systemic GCS used by severe cases. The most important risk factor for asthma, including its severe form, is GERD. Numerous comorbid conditions significantly worsen the degree of asthma control. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Changes in blood gases with temperature: implications for clinical practice].

PubMed

Tremey, B; Vigué, B

2004-05-01

To understand changes in blood gases results with core temperature. Analysis from two case reports. Hypothermia induces a decrease in PaCO(2) with a related increase in pH, thus a physiologic alkalosis. Decrease in PaCO(2) is due to an increase of gas solubility and a decrease of peripheral consumption that can be estimated from comparison between corrected and non-corrected for temperature blood gases. For O(2), variations of temperature induce variations of solubility but also of haemoglobin affinity for O(2). During hyperthermia, haemoglobin affinity for O(2) is decreased with a decreased SvO(2) for a same PvO(2). SvO(2) ischemic or therapeutic thresholds are thus modified with core temperature. Blood gases cannot be understood without patient core temperature. Physiologic variations of PaCO(2) and pH must probably be tolerated. Ischemic threshold should be estimated on PvO(2), not only on PvO(2).

Severe metabolic alkalosis: a case report.

PubMed Central

Javaheri, S; Nardell, E A

1981-01-01

A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis. PMID:6794744

Draft Genome Sequence of Bacillus stratosphericus LAMA 585, Isolated from the Atlantic Deep Sea

PubMed Central

Cabral, Alencar; Andreote, Fernando Dini; Cavalett, Angélica; Pessatti, Marcos Luiz; Dini-Andreote, Francisco; da Silva, Marcus Adonai Castro

2013-01-01

Bacillus stratosphericus LAMA 585 was isolated from the Mid-Atlantic-Ridge seafloor (5,500-m depth). This bacterium presents the capacity for cellulase, xylanase, and lipase production when growing aerobically in marine-broth media. Genes involved in the tolerance of oligotrophic and extreme conditions and prospection of biotechnological products were annotated in the draft genome (3.7 Mb). PMID:23640380

1950-nm diode laser-assisted microanastomoses (LAMA): an innovative surgical tool for hand surgery emergencies.

PubMed

Leclère, Franck Marie; Schoofs, Michel; Vogt, Peter; Casoli, Vincent; Mordon, Serge

2015-05-01

Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size <1.5 mm, the following laser parameters were used: spot size 400 μm, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 ± 1.4 and 8.7 ± 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

1.9-μm diode-laser-assisted anastomoses (LAMA) in reconstructive microsurgery: results of the preliminary clinical study

NASA Astrophysics Data System (ADS)

Mordon, Serge R.; Schoofs, Michel; Martinot, Veronique L.; Capon, Alexandre; Buys, Bruno; Patenotre, Philippe; Pellerin, P. N.

2001-05-01

The authors report an original 1.9-micrometers diode laser assisted microvascular anastomosis (LAMA) in human. This technique has been applied in 20 patients during reconstructive surgery for digital replantations (nequals6), for digital revascularizations (nequals4) and for free flap transfers (nequals10). LAMA were always performed on vessel (16 arteries and 6 veins) which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9-micrometers diode laser after placement of 2 equidistant stitches at 180 degrees. The diode spot was obtained by means of a 300-micrometers optic fiber transmitted to the vessel wall via a pencil size hand piece. The following parameters were used: spot size equals 500 micrometers , power equals 70 to 220 mW, pulse duration equals 0.7 to 3 seconds. Ten to 15 spots were applied on each face. The mechanism involved is a thermal effect on the collagen of the adventitia and media leading to a phenomenon which the authors have termed 'heliofusion'. Immediate assessment consisted in evaluating the permeability by patency test (O'Brien) and water tightness. Secondary assessment consisted in evaluating the clinical success, confirmed by Doppler at one month.

Effect of intermittent exposure to 3% CO2 on respiration, acid-base balance, and calcium-phosphorus metabolism.

PubMed

Schaefer, K E; Carey, C R; Dougherty, J H; Morgan, C; Messier, A A

1979-01-01

One subject was exposed for six days to increasing levels of CO2, rising at a constant rate from 0.03 to 3.0% CO2 within a 15-h period followed by 9 h of air breathing. To assess acid-base parameters, arterialized capillary blood was taken from a finger twice daily (at 8 a.m. and 11 p.m.) at times corresponding to the beginning and end of the intermittent exposure to CO2. Venous blood samples were obtained on alternate days at the same times. Urine specimens were collected twice daily. The subject was on a liquid diet. Resting respiratory minute volume (VE), oxygen consumption (VO2), carbon dioxide excretion (VCO2), alveolar carbon dioxide and oxygen tension (PACO2) and PAO2) were measured twice daily. PACO2 and PAO2 were also determined at the end of breath-holding twice daily; CO2 tolerance tests and lung function tests were also carried out. In contrast to the effects of chronic exposure to 3% CO2, the CO2 tolerance tests showed an increased sensitivity (increase of slope) and breath-holding PACO2 did not change, indicating that acclimatization to CO2 did not develop. The ventilatory response to CO2 was not sufficient to prevent CO2 accumulation in the body; this accumulation was eliminated during the nightly air-breathing periods on the fourth and fifth days, indicated by higher values of PaCO2 and PACO2. The known renal response to hypercapnia, consisting of an increased excretion of titratable acidity, ammonia, and hydrogen ion excretion, occurred but was interrupted after the first day and was triggered again on the fourth and fith days when accumulated CO2 was released from body CO2 stores. The second renal response was associated with a marked calcium excretion, which suggests that bone CO2 stores were involved.

Establishing a gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in patients with acute respiratory distress syndrome.

PubMed

Yousuf, Tariq; Brinton, Taylor; Murtaza, Ghulam; Wozniczka, Daniel; Ahmad, Khansa; Iskandar, Joy; Mehta, Raju; Keshmiri, Hesam; Hanif, Tabassum

2017-02-01

End-tidal carbon dioxide (ETCO 2 ) monitoring is useful in many situations. However, ETCO 2 monitoring is unreliable in patients with acute respiratory distress syndrome (ARDS) due to widespread lung inflammation. In our study, we attempt to establish the gradient between the arterial pressure of carbon dioxide (PaCO 2 ) and ETCO 2 in patients with ARDS, which we defined as the PaETCO 2 gradient. The main objective of the study was to establish a PaETCO 2 gradient in each severity of ARDS. We analyzed 35 patients with ARDS and a total of 88 arterial blood gases were included. PaCO 2 , PaO 2 /FiO 2 and ETCO 2 were measured. Patients were stratified into mild, moderate and severe ARDS as classified by the Berlin ARDS criteria. PaCO 2 and ETCO 2 were compared at each severity stratification. The mean PaCO 2 was 50.0, the mean ETCO 2 was 26.6 and the gradient among all samples was 23.24 (±12.02). The mean gradient for each severity is as follows: mild: 19.3 (±9.9), moderate: 27.9 (±13.2) and severe: 23.9 (±7.8). The difference between the PaETCO 2 gradient of the mild to moderate (p=0.001) and mild to severe groups (p=0.01) reached statistical significance. However, the difference between the moderate to severe groups did not reach statistical significance (p=0.48). We found the gradient between PaCO 2 and ETCO 2 in patients with ARDS is vast and tends to worsen with increasing severity of ARDS. This indicates that the gradient between the 2 may be used as an indicator of increasing severity of ARDS. Copyright © 2016 American Federation for Medical Research.

Effects of Modes, Obesity, and Body Position on Non-invasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study.

PubMed

Türk, Murat; Aydoğdu, Müge; Gürsel, Gül

2018-01-01

Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure. In addition, short-term effects of body position and obesity within both modes were analyzed. We conducted a randomized controlled study in a 7-bed intensive care unit. The course of blood gas analysis and differences in ventilation variables were compared between BiPAP-S (n=33) and AVAPS-S (n=29), and between semi-recumbent and lateral positions in both modes. No difference was found in the length of hospital stay and the course of PaCO2, pH, and HCO3 levels between the modes. There was a mean reduction of 5.7±4.1 mmHg in the PaCO2 levels in the AVAPS-S mode, and 2.7±2.3 mmHg in the BiPAP-S mode per session (p<0.05). Obesity didn't have any effect on the course of PaCO2 in both the modes. Body positioning had no notable effect in both modes. Although the decrease in the PaCO2 levels in the AVAPS-S mode per session was remarkably high, the course was similar in both modes. Furthermore, obesity and body positioning had no prominent effect on the PaCO2 response and ventilator mechanics. Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between the modes.

The New Physics and Cosmology - Dialogues with the Dalai Lama

NASA Astrophysics Data System (ADS)

Zajonc, Arthur; Houshmand, Zara

2004-03-01

What happens when the Dalai Lama meets with leading physicists and a historian? This book is the carefully edited record of the fascinating discussions at a Mind and Life conference in which five leading physicists and a historian (David Finkelstein, George Greenstein, Piet Hut, Arthur Zajonc, Anton Zeilinger, and Tu Weiming) discussed with the Dalai Lama current thought in theoretical quantum physics, in the context of Buddhist philosophy. A contribution to the science-religion interface, and a useful explanation of our basic understanding of quantum reality, couched at a level that intelligent readers without a deep involvement in science can grasp. In the tradition of other popular books on resonances between modern quantum physics and Zen or Buddhist mystical traditions--notably The Dancing Wu Li Masters and The Tao of Physics , this book gives a clear and useful update of the genuine correspondences between these two rather disparate approaches to understanding the nature of reality.

Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD).

PubMed

Horita, Nobuyuki; Goto, Atsushi; Shibata, Yuji; Ota, Erika; Nakashima, Kentaro; Nagai, Kenjiro; Kaneko, Takeshi

2017-02-10

Three classes of inhaler medications are used to manage chronic obstructive pulmonary disease (COPD): long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS). When two classes of medications are required, LAMA plus LABA (LAMA+LABA) and LABA plus ICS (LABA+ICS) are often selected because these combinations can be administered via a single medication device. The previous Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidance recommended LABA+ICS as the first-line treatment for managing stable COPD in high-risk people of categories C and D. However, the updated GOLD 2017 guidance recommends LAMA+LABA over LABA+ICS. To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD. We performed an electronic search of the Cochrane Airways Group Specialised Register (2 February 2016), ClinicalTrials.gov (4 June 2016), and the World Health Organization Clinical Trials Search Portal (4 June 2016), followed by a handsearch (5 June 2016). Two review authors screened and scrutinised the selected articles. We included individual randomised controlled trials, parallel-group trials, and cross-over trials comparing LAMA+LABA and LABA+ICS for stable COPD. The minimum accepted trial duration was one month and trials should have been conducted in an outpatient setting. Two review authors independently extracted data and evaluated risk of bias. We resolved any discrepancies through discussion. We analysed dichotomous data as odds ratios (OR), and continuous data as mean differences (MD), with 95% confidence interval (CI) using Review Manager 5. Exacerbations were measured by counting the number of people experiencing one or more exacerbation. We included 11 studies comprising 9839 participants in our quantitative analysis. Most studies included people with moderate to severe COPD, without recent exacerbations. One pharmaceutical sponsored trial that included only people with recent exacerbations was the largest study and accounted for 37% of participants. All but one study were sponsored by pharmaceutical companies, thus we rated them as having a high risk of 'other bias'. The unsponsored study was at high risk of performance and detection bias, and possible selective reporting.Five studies recruited GOLD Category B participants, one study recruited Category D participants, two studies recruited Category A/B participants, and three studies recruited participants regardless of category. Follow-up ranged from 6 to 52 weeks.Compared to the LABA+ICS arm, the results for the pooled primary outcomes for the LAMA+LABA arm were as follows: exacerbations, OR 0.82 (95% CI 0.70 to 0.96, P = 0.01, I 2 = 17%, low quality evidence); serious adverse events (SAE), OR 0.91 (95% CI 0.79 to 1.05, P = 0.18, I 2 = 0, moderate quality evidence); St. George's Respiratory Questionnaire (SGRQ) total score change from the baseline, MD -1.22 (95% CI -2.52 to 0.07, P = 0.06, I 2 = 71%, low quality evidence); and trough forced expiratory volume in one second (FEV 1 ) change from the baseline, MD 0.08 L (95% CI 0.06 to 0.09, P < 0.0001, I 2 = 50%, moderate quality evidence). Compared to the LABA+ICS arm, the results for the pooled secondary outcomes for the LAMA+LABA arm were as follows: pneumonia, OR 0.57 (95% CI 0.42 to 0.79, P = 0.0006, I 2 = 0%, low quality evidence); all-cause death, OR 1.01 (95% CI 0.61 to 1.67, P = 0.88, I 2 = 0%, low quality evidence); and SGRQ total score change from the baseline of 4 points or greater (the minimal clinically important difference for the SGRQ is 4 points), OR 1.25 (95% CI 1.09 to 1.44, P = 0.002, I 2 = 0%, moderate quality evidence). For the treatment of COPD, LAMA+LABA has fewer exacerbations, a larger improvement of FEV 1 , a lower risk of pneumonia, and more frequent improvement in quality of life as measured by an increase over 4 units or more of the SGRQ. These data were supported by low or moderate quality evidence generated from mainly participants with moderate to severe COPD in heterogeneous trials with an observation period of less than one year. Our findings support the recently updated GOLD guidance.

Hyperventilation, cerebral perfusion, and syncope.

PubMed

Immink, R V; Pott, F C; Secher, N H; van Lieshout, J J

2014-04-01

This review summarizes evidence in humans for an association between hyperventilation (HV)-induced hypocapnia and a reduction in cerebral perfusion leading to syncope defined as transient loss of consciousness (TLOC). The cerebral vasculature is sensitive to changes in both the arterial carbon dioxide (PaCO2) and oxygen (PaO2) partial pressures so that hypercapnia/hypoxia increases and hypocapnia/hyperoxia reduces global cerebral blood flow. Cerebral hypoperfusion and TLOC have been associated with hypocapnia related to HV. Notwithstanding pronounced cerebrovascular effects of PaCO2 the contribution of a low PaCO2 to the early postural reduction in middle cerebral artery blood velocity is transient. HV together with postural stress does not reduce cerebral perfusion to such an extent that TLOC develops. However when HV is combined with cardiovascular stressors like cold immersion or reduced cardiac output brain perfusion becomes jeopardized. Whether, in patients with cardiovascular disease and/or defect, cerebral blood flow cerebral control HV-induced hypocapnia elicits cerebral hypoperfusion, leading to TLOC, remains to be established.

Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II).

PubMed

Apfelbacher, Christian J; Radulescu, Magda; Diepgen, Thomas L; Funke, Ulrich

2008-06-01

Only a few epidemiological studies on hand eczema (HE) in the metalworking industry have been conducted, and no study has attempted a long-term follow-up. In the Prospective Audi Cohort (PACO) II follow-up study, we aimed to estimate burden and prognosis of HE in a car industry setting (follow-up > 10 years). Eligible participants were individuals who had been examined in the original PACO study (1990-1998) and had been followed through until the end of their apprenticeship (n = 1909). Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm. The follow-up rate was 78.3% (1494/1909). Mean follow-up time was 13.3 [standard deviation 1.3] years. The period prevalence of HE in the follow-up period was 21.0% [95% confidence interval (CI) 19.0-23.1%], yielding a cumulative incidence of 29.3% (95% CI 26.9-31.6%) in the entire study period. HE persisted after the end of apprenticeship in 40.0% (95% CI 33.3-46.7%) of subjects who had had HE during apprenticeship (n = 205). 18.0% (95% CI 15.9-20.1%) developed HE in the follow-up period (n = 1289). Around 30% of subjects were affected by HE at least once during the study period. HE persisted in 40% of the participants affected during apprenticeship.

The venous-arterial difference in CO2 should be interpreted with caution in case of respiratory alkalosis in healthy volunteers.

PubMed

Morel, Jerome; Gergelé, Laurent; Dominé, Alexandre; Molliex, Serge; Perrot, Jean-Luc; Labeille, Bruno; Costes, Frederic

2017-08-01

The venous-arterial difference in CO 2 (ΔCO 2 ) has been proposed as an index of the adequacy of tissue perfusion in shock states. We hypothesized that the variation in PaCO 2 (hyper- or hypocapnia) could impact ΔCO 2 , partly through microcirculation adaptations. Fifteen healthy males volunteered to participate. For hypocapnia condition (hCO 2 ), the subjects were asked to hyperventilate, while they were asked to breathe a gas mixture containing 8 % CO 2 for hypercapnia condition (HCO 2 ). The 2 conditions were randomly assigned. Blood gases were measured at baseline before each condition, and after 5-7 min of either hCO 2 or HCO 2 condition. Microcirculation was assessed by the muscle reoxygenation slope measured with near infrared spectroscopy following a vascular occlusion test and by skin circulation with in vivo reflectance confocal microscopy. ΔCO 2 was significantly increased with hCO 2 while it tended to decrease with HCO 2 (non-significant). HCO 2 induced a moderate increase of the resaturation slope of NIRS oxygenation. Skin microcirculatory blood flow significantly dropped with hCO 2 , while it remained unchanged with hypercapnia. Our results warrant cautious interpretation of ΔCO 2 as an indicator of tissue perfusion during respiratory alkalosis.

Next-Generation Microshutter Arrays for Large-Format Imaging and Spectroscopy

NASA Technical Reports Server (NTRS)

Moseley, Samuel; Kutyrev, Alexander; Brown, Ari; Li, Mary

2012-01-01

A next-generation microshutter array, LArge Microshutter Array (LAMA), was developed as a multi-object field selector. LAMA consists of small-scaled microshutter arrays that can be combined to form large-scale microshutter array mosaics. Microshutter actuation is accomplished via electrostatic attraction between the shutter and a counter electrode, and 2D addressing can be accomplished by applying an electrostatic potential between a row of shutters and a column, orthogonal to the row, of counter electrodes. Microelectromechanical system (MEMS) technology is used to fabricate the microshutter arrays. The main feature of the microshutter device is to use a set of standard surface micromachining processes for device fabrication. Electrostatic actuation is used to eliminate the need for macromechanical magnet actuating components. A simplified electrostatic actuation with no macro components (e.g. moving magnets) required for actuation and latching of the shutters will make the microshutter arrays robust and less prone to mechanical failure. Smaller-size individual arrays will help to increase the yield and thus reduce the cost and improve robustness of the fabrication process. Reducing the size of the individual shutter array to about one square inch and building the large-scale mosaics by tiling these smaller-size arrays would further help to reduce the cost of the device due to the higher yield of smaller devices. The LAMA development is based on prior experience acquired while developing microshutter arrays for the James Webb Space Telescope (JWST), but it will have different features. The LAMA modular design permits large-format mosaicking to cover a field of view at least 50 times larger than JWST MSA. The LAMA electrostatic, instead of magnetic, actuation enables operation cycles at least 100 times faster and a mass significantly smaller compared to JWST MSA. Also, standard surface micromachining technology will simplify the fabrication process, increasing yield and reducing cost.

Coagulation Changes to Systemic Acidosis and Bicarbonate Correction in Swine

DTIC Science & Technology

2011-11-01

carbonate. Total experiment time and time between Base - line, Acidosis, and Acidosis-Corrected varied from pig to pig. y axis describes the pH of the swine...Infusion of HCl reduced arterial pH from 7.4 to 7.1 and also reduced HCO3 , base excess (BE), and PaCO2 (Acidosis, Table 1). In this group, bicarbonate...a decrease in respiration successfully lowered arterial pH to 7.1 ( Acido - sis, Table 2) and significantly elevated PaCO2 and HCO3 and lowered PaO2

A Frameshift Mutation within LAMC2 Is Responsible for Herlitz Type Junctional Epidermolysis Bullosa (HJEB) in Black Headed Mutton Sheep

PubMed Central

Mömke, Stefanie; Kerkmann, Andrea; Wöhlke, Anne; Ostmeier, Miriam; Hewicker-Trautwein, Marion; Ganter, Martin; Kijas, James; Distl, Ottmar

2011-01-01

Junctional epidermolysis bullosa (JEB) is a hereditary mechanobullous skin disease in humans and animals. A Herlitz type JEB was identified in German Black Headed Mutton (BHM) sheep and affected lambs were reproduced in a breeding trial. Affected lambs showed skin and mucous membranes blistering and all affected lambs died within the first weeks of life. The pedigree data were consistent with a monogenic autosomal recessive inheritance. Immunofluorescence showed a reduced expression of laminin 5 protein which consists of 3 subunits encoded by the genes LAMA3, LAMB3 and LAMC2. We screened these genes for polymorphisms. Linkage and genome-wide association analyses identified LAMC2 as the most likely candidate for HJEB. A two base pair deletion within exon 18 of the LAMC2 gene (FM872310:c.2746delCA) causes a frameshift mutation resulting in a premature stop codon (p.A928*) 13 triplets downstream of this mutation and in addition, introduces an alternative splicing of exon 18 LAMC2. This deletion showed a perfect co-segregation with HJEB in all 740 analysed BHM sheep. Identification of the LAMC2 deletion means an animal model for HJEB is now available to develop therapeutic approaches of relevance to the human form of this disease. PMID:21573221

Physiological dead space and arterial carbon dioxide contributions to exercise ventilatory inefficiency in patients with reduced or preserved ejection fraction heart failure.

PubMed

Van Iterson, Erik H; Johnson, Bruce D; Borlaug, Barry A; Olson, Thomas P

2017-12-01

Patients with heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction demonstrate an increased ventilatory equivalent for carbon dioxide (V̇ E /V̇CO 2 ) slope. The physiological correlates of the V̇ E /V̇CO 2 slope remain unclear in the two HF phenotypes. We hypothesized that changes in the physiological dead space to tidal volume ratio (V D /V T ) and arterial CO 2 tension (PaCO 2 ) differentially contribute to the V̇ E /V̇CO 2 slope in HFrEF vs. HFpEF. Adults with HFrEF (n = 32) and HFpEF (n = 27) [mean ± standard deviation (SD) left ventricular ejection fraction: 22 ± 7% and 61 ± 9%, respectively; mean ± SD body mass index: 28 ± 4 kg/m 2 and 33 ± 6 kg/m 2 , respectively; P < 0.01] performed cardiopulmonary exercise testing with breath-by-breath ventilation and gas exchange measurements. PaCO 2 was measured via radial arterial catheterization. We calculated the V̇ E /V̇CO 2 slope via linear regression, and V D /V T  = 1 - [(863 × V̇CO 2 )/(V̇ E  × PaCO 2 )]. Resting V D /V T (0.48 ± 0.08 vs. 0.41 ± 0.11; P = 0.04), but not PaCO 2 (38 ± 5 mmHg vs. 40 ± 3 mmHg; P = 0.21) differed between HFrEF and HFpEF. Peak exercise V D /V T (0.39 ± 0.08 vs. 0.32 ± 0.12; P = 0.02) and PaCO 2 (33 ± 6 mmHg vs. 38 ± 4 mmHg; P < 0.01) differed between HFrEF and HFpEF. The V̇ E /V̇CO 2 slope was higher in HFrEF compared with HFpEF (44 ± 11 vs. 35 ± 8; P < 0.01). Variance associated with the V̇ E /V̇CO 2 slope in HFrEF and HFpEF was explained by peak exercise V D /V T (R 2  = 0.30 and R 2  = 0.50, respectively) and PaCO 2 (R 2  = 0.64 and R 2  = 0.28, respectively), but the relative contributions of each differed (all P < 0.01). Relationships between the V̇ E /V̇CO 2 slope and both V D /V T and PaCO 2 are robust, but differ between HFpEF and HFrEF. Increasing V̇ E /V̇CO 2 slope appears to be strongly explained by mechanisms influential in regulating PaCO 2 in HFrEF, which contrasts with the strong role of increased V D /V T in HFpEF. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Variations in Alveolar Partial Pressure for Carbon Dioxide and Oxygen Have Additive Not Synergistic Acute Effects on Human Pulmonary Vasoconstriction

PubMed Central

Croft, Quentin P. P.; Formenti, Federico; Talbot, Nick P.; Lunn, Daniel; Robbins, Peter A.; Dorrington, Keith L.

2013-01-01

The human pulmonary vasculature constricts in response to hypercapnia and hypoxia, with important consequences for homeostasis and adaptation. One function of these responses is to direct blood flow away from poorly-ventilated regions of the lung. In humans it is not known whether the stimuli of hypercapnia and hypoxia constrict the pulmonary blood vessels independently of each other or whether they act synergistically, such that the combination of hypercapnia and hypoxia is more effective than the sum of the responses to each stimulus on its own. We independently controlled the alveolar partial pressures of carbon dioxide (Paco 2) and oxygen (Pao 2) to examine their possible interaction on human pulmonary vasoconstriction. Nine volunteers each experienced sixteen possible combinations of four levels of Paco 2 (+6, +1, −4 and −9 mmHg, relative to baseline) with four levels of Pao 2 (175, 100, 75 and 50 mmHg). During each of these sixteen protocols Doppler echocardiography was used to evaluate cardiac output and systolic tricuspid pressure gradient, an index of pulmonary vasoconstriction. The degree of constriction varied linearly with both Paco 2 and the calculated haemoglobin oxygen desaturation (1-So 2). Mixed effects modelling delivered coefficients defining the interdependence of cardiac output, systolic tricuspid pressure gradient, ventilation, Paco 2 and So 2. No interaction was observed in the effects on pulmonary vasoconstriction of carbon dioxide and oxygen (p>0.64). Direct effects of the alveolar gases on systolic tricuspid pressure gradient greatly exceeded indirect effects arising from concurrent changes in cardiac output. PMID:23935847

Variations in alveolar partial pressure for carbon dioxide and oxygen have additive not synergistic acute effects on human pulmonary vasoconstriction.

PubMed

Croft, Quentin P P; Formenti, Federico; Talbot, Nick P; Lunn, Daniel; Robbins, Peter A; Dorrington, Keith L

2013-01-01

The human pulmonary vasculature constricts in response to hypercapnia and hypoxia, with important consequences for homeostasis and adaptation. One function of these responses is to direct blood flow away from poorly-ventilated regions of the lung. In humans it is not known whether the stimuli of hypercapnia and hypoxia constrict the pulmonary blood vessels independently of each other or whether they act synergistically, such that the combination of hypercapnia and hypoxia is more effective than the sum of the responses to each stimulus on its own. We independently controlled the alveolar partial pressures of carbon dioxide (Paco 2) and oxygen (Pao 2) to examine their possible interaction on human pulmonary vasoconstriction. Nine volunteers each experienced sixteen possible combinations of four levels of Paco 2 (+6, +1, -4 and -9 mmHg, relative to baseline) with four levels of Pao 2 (175, 100, 75 and 50 mmHg). During each of these sixteen protocols Doppler echocardiography was used to evaluate cardiac output and systolic tricuspid pressure gradient, an index of pulmonary vasoconstriction. The degree of constriction varied linearly with both Paco 2 and the calculated haemoglobin oxygen desaturation (1-So2). Mixed effects modelling delivered coefficients defining the interdependence of cardiac output, systolic tricuspid pressure gradient, ventilation, Paco 2 and So2. No interaction was observed in the effects on pulmonary vasoconstriction of carbon dioxide and oxygen (p>0.64). Direct effects of the alveolar gases on systolic tricuspid pressure gradient greatly exceeded indirect effects arising from concurrent changes in cardiac output.

Respiratory acidosis prolongs, while alkalosis shortens, the duration and recovery time of vecuronium in humans.

PubMed

Yamauchi, Masanori; Takahashi, Hiromi; Iwasaki, Hiroshi; Namiki, Akiyoshi

2002-03-01

To determine the effects of respiratory acidosis and alkalosis by mechanical ventilation on the onset, duration, and recovery times of vecuronium. Randomized, prospective study. Operating rooms in the Sapporo Medical University Hospital and Kitami Red Cross Hospital. 90 ASA physical status I and II patients undergoing lower abdominal surgery. Patients were randomly allocated to one of three groups by arterial carbon dioxide tension level (PaCO2; mmHg) after induction: hyperventilation group (PaCO2 = 25-35), normoventilation group (PaCO2 = 35-45), and hypoventilation group (PaCO2 = 45-55). Anesthesia was maintained by spinal block with inhalation of 50% to 66% nitrous oxide in oxygen and intermittent intravenous administration of fentanyl and midazolam with tracheal intubation. After vecuronium 0.08 mg/kg was given, onset, duration, and recovery time were measured by mechanomyography (Biometer Myograph 2,000, Odense, Denmark). There were significant differences in the duration and recovery time of vecuronium among the normoventilation group (12.7 +/- 3.3 min and 11.8 +/- 2.8 min, respectively), the hyperventilation group (10.6 +/- 3.5 min and 9.2 +/- 2.7 min, respectively; p < 0.01), and the hypoventilation group (14.4 +/- 3.1 min and 15.0 +/- 3.7 min, respectively; p < 0.01) (mean SD). The closest significant correlation in this study was observed between recovery time and arterial blood pH (r = 0.57; p < 0.05). In humans, duration and recovery times of vecuronium are prolonged in respiratory acidosis and shortened in respiratory alkalosis.

Identification of a novel microRNA important for melanogenesis in alpaca (Vicugna pacos).

PubMed

Yang, S; Fan, R; Shi, Z; Ji, K; Zhang, J; Wang, H; Herrid, M; Zhang, Q; Yao, J; Smith, G W; Dong, C

2015-04-01

The molecular mechanisms underlying the formation of coat colors in animals are poorly understood. Recent studies have demonstrated that microRNA play important roles in the control of melanogenesis and coat color in mammals. In a previous study, we characterized the miRNA expression profiles in alpaca skin with brown and white coat color and identified a novel miRNA (named lpa-miR-nov-66) that is expressed significantly higher in white skin compared to brown skin. The present study was conducted to determine the functional roles of this novel miRNA in the regulation of melanogenesis in alpaca melanocytes. lpa-miR-nov-66 is predicted to target the soluble guanylate cyclase (sGC) gene based on presence of a binding site in the sGC coding sequence (CDS). Overexpression of lpa-miR-nov-66 in alpaca melanocyes upregulated the expression of sGC both at the mRNA and protein level. Overexpression of lpa-miR-nov-66 in melanocyes also resulted in decreased expression of key melanogenic genes including tyrosinase (TYR), tyrosinase related protein 1 (TYRP1), and microphthalmia transcription factor (MITF). Our ELISA assays showed increased cyclic guanosine monophosphate (cGMP) but decreased cyclic adenosine monophosphate (cAMP) production in melanocytes overexpressing lpa-miR-nov-66. In addition, overexpression of lpa-miR-nov-66 also reduced melanin production in cultured melanocytes. Results support a role of lpa-miR-nov-66 in melanocytes by directly or indirectly targeting , which regulates melanogenesis via the cAMP pathway.

Influence of cycling history on the ventilatory response to cycle-ergometry in humans: a role for respiratory memory?

PubMed

Cathcart, Andrew J; Whipp, Brian J; Turner, Anthony P; Wilson, John; Ward, Susan A

2010-01-01

The ventilatory (V' E) mechanisms subserving stability of alveolar and arterial PCO2 (PACO2, PaCO2) during moderate exercise (< lactate threshold, thetaL) remain controversial. As long-term modulation has been argued to be an important contributor to this control process, we proposed that subjects with no experience of cycling (NEx) might provide insight into this issue. With no exercise familiarization, 9 sedentary NEx subjects and 9 age-, sex-, and activity-matched controls (C) who had cycled regularly for recreational purposes since childhood completed a square-wave (6-min stage) cycle-ergometry test: 10 W-WR1-WR2-WR1-10 W; WR1 range 25-45 W, WR2 range 50-90 W. WRs were subsequently confirmed to

[Pulmonary function in patients with focal pulmonary tuberculosis].

PubMed

Nefedov, V B; Popova, L A; Shergina, E A

2008-01-01

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), Raw, Rin, Rcx, DLCO-SB, DLCO-SS/VA, PaO2, and PaCO2 were determined in 40 patients with focal pulmonary tuberculosis. Changes were found in lung volumes and capacities in 75%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 57.5 and 25%, respectively. The lung volume and capacity changes appeared mainly as increased TGV and PRV; impaired bronchial patency presented as decreased MEF50, MEF75, and FEV1/VC%; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, PaO2, and PaCO2. The magnitude of the observed functional changes was generally slight. TGV and PRL increased up to 148-187 and 142-223% of the normal values, respectively; MEF50, MEF75, FEV1/VC%, and DLCO decreased to 59-24, 58-26, 78-57, and 78-67% of the normal values and PaO2 and PaCO2 did to 79-69 and 34-30 cm Hg.

Methane Emission by Camelids

PubMed Central

Dittmann, Marie T.; Runge, Ullrich; Lang, Richard A.; Moser, Dario; Galeffi, Cordula; Kreuzer, Michael; Clauss, Marcus

2014-01-01

Methane emissions from ruminant livestock have been intensively studied in order to reduce contribution to the greenhouse effect. Ruminants were found to produce more enteric methane than other mammalian herbivores. As camelids share some features of their digestive anatomy and physiology with ruminants, it has been proposed that they produce similar amounts of methane per unit of body mass. This is of special relevance for countrywide greenhouse gas budgets of countries that harbor large populations of camelids like Australia. However, hardly any quantitative methane emission measurements have been performed in camelids. In order to fill this gap, we carried out respiration chamber measurements with three camelid species (Vicugna pacos, Lama glama, Camelus bactrianus; n = 16 in total), all kept on a diet consisting of food produced from alfalfa only. The camelids produced less methane expressed on the basis of body mass (0.32±0.11 L kg−1 d−1) when compared to literature data on domestic ruminants fed on roughage diets (0.58±0.16 L kg−1 d−1). However, there was no significant difference between the two suborders when methane emission was expressed on the basis of digestible neutral detergent fiber intake (92.7±33.9 L kg−1 in camelids vs. 86.2±12.1 L kg−1 in ruminants). This implies that the pathways of methanogenesis forming part of the microbial digestion of fiber in the foregut are similar between the groups, and that the lower methane emission of camelids can be explained by their generally lower relative food intake. Our results suggest that the methane emission of Australia's feral camels corresponds only to 1 to 2% of the methane amount produced by the countries' domestic ruminants and that calculations of greenhouse gas budgets of countries with large camelid populations based on equations developed for ruminants are generally overestimating the actual levels. PMID:24718604

Clinical Meaning of Early Oxygenation Improvement in Severe Acute Respiratory Distress Syndrome under Prolonged Prone Positioning

PubMed Central

Lee, Kwangha; Kim, Mi-Young; Yoo, Jung-Wan; Hong, Sang-Bum; Lim, Chae-Man

2010-01-01

Background/Aims Ventilating patients with acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve arterial oxygenation, but prolonged prone positioning frequently requires continuous deep sedation, which may be harmful to patients. We evaluated the meaning of early gas exchange in patients with severe ARDS under prolonged (≥ 12 hours) prone positioning. Methods We retrospectively studied 96 patients (mean age, 60.1 ± 15.6 years; 75% men) with severe ARDS (PaO2/FiO2 ≤ 150 mmHg) admitted to a medical intensive care unit (MICU). The terms "PaO2 response" and "PaCO2 response" represented responses that resulted in increases in the PaO2/FiO2 ratio of ≥ 20 mmHg and decreases in PaCO2 of ≥ 1 mmHg, respectively, 8 to 12 hours after first placement in the prone position. Results The mean duration of prone positioning was 78.5 ± 61.2 hours, and the 28-day mortality rate after MICU admission was 56.3%. No significant difference in clinical characteristics was observed between PaO2 and PaCO2 responders and non-responders. The PaO2 responders after prone positioning showed an improved 28-day outcome, compared with non-responders by Kaplan-Meier survival estimates (p < 0.05 by the log-rank test), but the PaCO2 responders did not. Conclusions Our results suggest that the early oxygenation improvement after prone positioning might be associated with an improved 28-day outcome and may be an indicator to maintain prolonged prone positioning in patients with severe ARDS. PMID:20195404

Evaluation of the effects of dorsal versus lateral recumbency on the cardiopulmonary system during anesthesia with isoflurane in red-tailed hawks (Buteo jamaicensis).

PubMed

Hawkins, Michelle G; Malka, Shachar; Pascoe, Peter J; Solano, Adrian M; Kass, Philip H; Ohmura, Hajime; Jones, James H

2013-01-01

To evaluate the effects of dorsal versus lateral recumbency on the cardiopulmonary system during isoflurane anesthesia in red-tailed hawks (Buteo jamaicensis). 6 adult 1.1- to 1.6-kg red-tailed hawks. A randomized, crossover study was used to evaluate changes in respiratory rate, tidal volume, minute ventilation, heart rate, mean arterial and indirect blood pressures, and end-tidal Pco(2) measured every 5 minutes plus Paco(2) and Pao(2) and arterial pH measured every 15 minutes throughout a 75-minute study period. Respiratory rate was higher, tidal volume lower, and minute ventilation not different in lateral versus dorsal recumbency. Position did not affect heart rate, mean arterial blood pressure, or indirect blood pressure, although heart rate decreased during the anesthetic period. Birds hypoventilated in both positions and Paco(2) differed with time and position × time interaction. The Petco(2) position × time interaction was significant and Petco(2) was a mean of 7 Torr higher than Paco(2). The Paco(2) in dorsal recumbency was a mean of 32 Torr higher than in lateral recumbency. Birds in both positions developed respiratory acidosis. Differences in tidal volume with similar minute ventilation suggested red-tailed hawks in dorsal recumbency might have lower dead space ventilation. Despite similar minute ventilation in both positions, birds in dorsal recumbency hypoventilated more yet maintained higher Pao(2), suggesting parabronchial ventilatory or pulmonary blood flow distribution changes with position. The results refute the hypothesis that dorsal recumbency compromises ventilation and O(2) transport more than lateral recumbency in red-tailed hawks.

Long-term gas exchange characteristics as markers of deterioration in patients with cystic fibrosis

PubMed Central

2009-01-01

Background and Aim In patients with cystic fibrosis (CF) the architecture of the developing lungs and the ventilation of lung units are progressively affected, influencing intrapulmonary gas mixing and gas exchange. We examined the long-term course of blood gas measurements in relation to characteristics of lung function and the influence of different CFTR genotype upon this process. Methods Serial annual measurements of PaO2 and PaCO2 assessed in relation to lung function, providing functional residual capacity (FRCpleth), lung clearance index (LCI), trapped gas (VTG), airway resistance (sReff), and forced expiratory indices (FEV1, FEF50), were collected in 178 children (88 males; 90 females) with CF, over an age range of 5 to 18 years. Linear mixed model analysis and binary logistic regression analysis were used to define predominant lung function parameters influencing oxygenation and carbon dioxide elimination. Results PaO2 decreased linearly from age 5 to 18 years, and was mainly associated with FRCpleth, (p < 0.0001), FEV1 (p < 0.001), FEF50 (p < 0.002), and LCI (p < 0.002), indicating that oxygenation was associated with the degree of pulmonary hyperinflation, ventilation inhomogeneities and impeded airway function. PaCO2 showed a transitory phase of low PaCO2 values, mainly during the age range of 5 to 12 years. Both PaO2 and PaCO2 presented with different progression slopes within specific CFTR genotypes. Conclusion In the long-term evaluation of gas exchange characteristics, an association with different lung function patterns was found and was closely related to specific genotypes. Early examination of blood gases may reveal hypocarbia, presumably reflecting compensatory mechanisms to improve oxygenation. PMID:19909502

Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange.

PubMed

Morán, Indalecio; Bellapart, Judith; Vari, Alessandra; Mancebo, Jordi

2006-04-01

To compare, in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients, the short-term effects of heat and moisture exchangers (HME) and heated humidifiers (HH) on gas exchange, and also on respiratory system mechanics when isocapnic conditions are met. Prospective open clinical study. Intensive Care Service. Seventeen invasively ventilated ALI/ARDS patients. The study was performed in three phases: (1) determinations were made during basal ventilatory settings with HME; (2) basal ventilatory settings were maintained and HME was replaced by an HH; (3) using the same HH, tidal volume (Vt) was decreased until basal PaCO2 levels were reached. FiO2, respiratory rate and PEEP were kept unchanged. Respiratory mechanics, Vdphys, gas exchange and hemodynamic parameters were obtained at each phase. By using HH instead of HME and without changing Vt, PaCO2 decreased from 46+/-9 to 40+/-8 mmHg (p<0.001) and Vdphys decreased from 352+/-63 to 310+/-74 ml (p<0.001). Comparing the first phase with the third, Vt decreased from 521+/-106 to 440+/-118 ml (p<0.001) without significant changes in PaCO2, Vd/Vt decreased from 0.69+/-0.11 to 0.62+/-0.12 (p<0.001), plateau airway pressure decreased from 25+/-6 to 21+/-6 cmH2O (p<0.001) and respiratory system compliance improved from 35+/-12 to 42+/-15 ml/cmH2O (p<0.001). PaO2 remained unchanged in the three phases. Reducing dead space with the use of HH decreases PaCO2 and more importantly, if isocapnic conditions are maintained by reducing Vt, this strategy improves respiratory system compliance and reduces plateau airway pressure.

Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

PubMed

Blasi, F; Canonica, G W; Miravitlles, M

2017-01-18

As emphasized by international recommendations and largely confirmed by clinical experience, long-acting bronchodilators play a central role in the maintenance treatment of chronic obstructive pulmonary disease (COPD) due to their proven efficacy in reducing airflow obstruction and improving symptoms. There are some important aspects to define with regard to inhalation therapy for COPD, particularly those concerning the selection criteria and the optimal use of long-acting bronchodilators. First of all, it needs to be determined in which patients and clinical situations monotherapy with one bronchodilator, such as a long-acting muscarinic antagonist (LAMA), should be considered adequate, and in which cases the use of combination therapies, such as the "double bronchodilation" with a LAMA and a long-acting β2-agonist (LABA), should be preferred. Another critical issue concerns the effect of the frequency of daily administration of inhaled agents on the control of symptoms during the 24 h. COPD symptoms are known to exhibit considerable circadian variability with worsening in the early morning, and a significant proportion of patients have disease-related sleep disorders which can adversely affect their quality of life. The worsening of symptoms in the early morning may be due, at least in part, to a reduction in airway caliber caused by an increased "cholinergic tone" at night. As such, the coverage of nighttime and early morning symptoms is a reasonable therapeutic goal, which can be achieved by many patients using LAMAs such as aclidinium bromide twice daily (BID). Therapeutic adherence is known to be a multifactorial phenomenon that is frequently affected by other aspects than dosing frequency, including the technical features and ease of use of the inhalers. To this end, it should be mentioned that certain new-generation inhalers such as Genuair® have been associated in clinical trials with higher patient preference. In this work, in addition to presenting an overview of the main evidence on the efficacy of COPD treatment with the LAMA aclidinium bromide BID, we suggest some selection criteria for the monotherapy with one long-acting bronchodilator or the combination therapy with LAMA and LABA in COPD patients, with particular reference to specific clinical scenarios.

Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model.

PubMed

Wilson, Michele R; Patel, Jeetvan G; Coleman, Amber; McDade, Cheryl L; Stanford, Richard H; Earnshaw, Stephanie R

2017-01-01

Bronchodilators such as long-acting muscarinic antagonists (LAMAs) and long-acting β 2 -agonists (LABAs) are central to the pharmacological management of COPD. Dual bronchodilation with umeclidinium/vilanterol (UMEC/VI; 62.5/25 μg) is a novel LAMA/LABA combination approved for maintenance treatment for patients with COPD. The objective of this study was to assess the cost-effectiveness of maintenance treatment with UMEC/VI compared with tiotropium (TIO) 18 μg, open dual LAMA + LABA treatment, or no long-acting bronchodilator treatment in patients with moderate to very severe COPD. A Markov model was developed to estimate the costs and outcomes associated with UMEC/VI treatment in patients with moderate to very severe COPD (GSK study number: HO-13-13411). Clinical efficacy, costs, utilities, and mortality obtained from the published literature were used as the model inputs. Costs are presented in US dollars based on 2015 prices. The model outputs are total costs, drug costs, other medical costs, number of COPD exacerbations, and quality-adjusted life-years (QALYs). Costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios were calculated. One-way and probabilistic sensitivity analyses were conducted to assess the effects of changing parameters on the uncertainty of the results. UMEC/VI treatment for moderate to very severe COPD was associated with lower lifetime medical costs ($82,344) compared with TIO ($88,822), open dual LAMA + LABA treatment ($114,442), and no long-acting bronchodilator ($86,751). Fewer exacerbations were predicted to occur with UMEC/VI treatment compared with no long-acting bronchodilator treatment. UMEC/VI provided an 0.11 and 0.25 increase in QALYs compared with TIO and no long-acting bronchodilator treatment, and as such, dominated these cost-effectiveness analyses. Sensitivity analyses confirmed that the results were robust. The results from this model suggest that UMEC/VI treatment would be dominant compared with TIO and no long-acting bronchodilator treatment, and less costly than open dual LAMA + LABA treatment in patients with moderate to very severe COPD.

Comparative efficacy of fixed-dose combinations of long-acting muscarinic antagonists and long-acting β2-agonists: a systematic review and network meta-analysis

PubMed Central

Schlueter, Max; Gonzalez-Rojas, N; Baldwin, Michael; Groenke, Lars; Voss, Florian; Reason, Tim

2016-01-01

Background: A number of long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) fixed-dose combinations (FDCs) for treatment of moderate-to-very severe chronic obstructive pulmonary disease (COPD) have recently become available, but none have been directly compared in head-to-head randomized controlled trials (RCTs). The purpose of this study was to assess the relative clinical benefit of all currently available LAMA/LABA FDCs using a Bayesian network meta-analysis (NMA). Methods: A systematic literature review identified RCTs investigating the efficacy, safety and quality of life associated with licensed LAMA/LABA FDCs for the treatment of moderate-to-very severe COPD. RCTs were screened for inclusion in the NMA using prespecified eligibility criteria. Data were extracted for outcomes of interest, including change in trough forced expiratory volume in 1 second (tFEV1) from baseline, St. George Respiratory Questionnaire (SGRQ) percentage of responders, Transition Dyspnea Index (TDI) percentage of responders, change in SGRQ score from baseline, change in TDI focal score from baseline, moderate-to-severe exacerbations, all-cause discontinuation, and discontinuation due to adverse events. Results: Following screening, a total of 27 trials from 26 publications with 30,361 subjects were eligible for inclusion in the NMA. Nonsignificant results were seen in most analyses comparing efficacy, exacerbations and discontinuation rates of included LAMA/LABA FDCs (i.e. aclidinium/formoterol 400/12 µg, glycopyrronium/indacaterol 110/50 µg, tiotropium + olodaterol 5/5 µg, umeclidinium/vilanterol 62.5/25 µg). Meta-regression controlling for post-bronchodilator percentage of tFEV1 predicted at baseline as well as meta-regression adjusting for concomitant use of inhaled corticosteroids at baseline was performed to assess the magnitude of effect modification and produced similar results as observed in the base case analysis. Conclusion: All LAMA/LABA FDCs were found to have similar efficacy and safety. Definitive assessment of the relative efficacy of different treatments can only be performed through direct comparison in head-to-head RCTs. In the absence of such data, this indirect comparison may be of value in clinical and health economic decision-making. PMID:26746383

Long-acting muscarinic antagonists vs. long-acting β 2 agonists in COPD exacerbations: a systematic review and meta-analysis

PubMed Central

Maia, Israel Silva; Pincelli, Mariângela Pimentel; Leite, Victor Figueiredo; Amadera, João; Buehler, Anna Maria

2017-01-01

ABSTRACT Objective: To determine whether long-acting muscarinic antagonists (LAMAs) provide superior therapeutic effects over long-acting β2 agonists (LABAs) for preventing COPD exacerbations. Methods: This was a systematic review and meta-analysis of randomized clinical trials involving patients with stable, moderate to severe COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria, treated with a LAMA (i.e., tiotropium bromide, aclidinium, or glycopyrronium), followed for at least 12 weeks and compared with controls using a LABA in isolation or in combination with a corticosteroid. Results: A total of 2,622 studies were analyzed for possible inclusion on the basis of their title and abstract; 9 studies (17,120 participants) were included in the analysis. In comparison with LABAs, LAMAs led to a greater decrease in the exacerbation rate ratio (relative risk [RR] = 0.88; 95% CI: 0.84-0.93]; a lower proportion of patients who experienced at least one exacerbation (RR = 0.90; 95% CI: 0.87-0.94; p < 0.00001); a lower risk of exacerbation-related hospitalizations (RR = 0.78; 95% CI: 0.69-0.87; p < 0.0001); and a lower number of serious adverse events (RR = 0.81; 95% CI: 0.67-0.96; p = 0.0002). The overall quality of evidence was moderate for all outcomes. Conclusions: The major findings of this systematic review and meta-analysis were that LAMAs significantly reduced the exacerbation rate (exacerbation episodes/year), as well as the number of exacerbation episodes, of hospitalizations, and of serious adverse events. PMID:28767773

Settlement preferences in the disaster-prone areas of Brantas River

NASA Astrophysics Data System (ADS)

Hariyani, S.

2018-01-01

Kota Lama is one of the urban villages in Malang city that has settlements along the Brantas River. Kota Lama experienced three landslides and flooding in 2015 and one in 2016. Those disasters caused the community to take action of post-disaster recovery, yet the people still choose to remain living in Kota Lama. Therefore, the study aims at determining the preferences of the citizens living in disaster-prone areas in Brantas River. The research used a factor analysis of 12 variables: 1) neighbourhood situation, 2) air condition, 3) relations between neighbours, 4) security, 5) location, 6) customs, 7) ethnic diversity, 8) the presence of social groups, 9) the community’s customs and habits, 10) proximity to the economic facilities, 11) adequate educational facilities, and 12) adequate medical/health facilities. The results show that two factors have been formed, namely Factor 1 (access) comprising variables of neighbourhood situation, air condition, relations between neighbours, location, ethnic diversity, the presence of a social group, supporting positive habits at home, close to the economic facilities, educational facilities, as well as medical facilities, and Factor 2 (assurance) consisting of customs and security.

[Procedural analysis of acid-base balance disorder: case serials in 4 patents].

PubMed

Ma, Chunyuan; Wang, Guijie

2017-05-01

To establish the standardization process of acid-base balance analysis, analyze cases of acid-base balance disorder with the aid of acid-base balance coordinate graph. The acid-base balance theory were reviewed systematically on recent research progress, and the important concepts, definitions, formulas, parameters, regularity and inference in the analysis of acid-base balance were studied. The analysis of acid-base balance disordered processes and steps were figured. The application of acid-base balance coordinate graph in the cases was introduced. The method of "four parameters-four steps" analysis was put forward to analyze the acid-base balance disorders completely. "Four parameters" included pH, arterial partial pressure of carbon dioxide (PaCO 2 ), HCO 3 - and anion gap (AG). "Four steps" were outlined by following aspects: (1) according to the pH, PaCO 2 and HCO 3 - , the primary or main types of acid-base balance disorder was determined; (2) primary or main types of acid-base disorder were used to choose the appropriate compensation formula and to determine the presence of double mixed acid-base balance disorder; (3) the primary acid-base balance disorders were divided into two parts: respiratory acidosis or respiratory alkalosis, at the same time, the potential HCO 3 - should be calculated, the measured HCO 3 - should be replaced with potential HCO 3 - , to determine whether there were three mixed acid-base disorders; (4) based on the above analysis the data judged as the simple AG increased-metabolic acidosis was needed to be further analyzed. The ratio of ΔAG↑/ΔHCO 3 - ↓ was also needed to be calculated, to determine whether there was normal AG metabolic acidosis or metabolic alkalosis. In the clinical practice, PaCO 2 (as the abscissa) and HCO 3 - (as the ordinate) were used to establish a rectangular coordinate system, through origin (0, 0) and coordinate point (40, 24) could be a straight line, and all points on the straight line pH were equal to 7.40. The acid-base balance coordinate graph could be divided into seven areas by three straight lines [namely pH = 7.40 isoline, PaCO 2 = 40 mmHg (1 mmHg = 0.133 kPa) line and HCO 3 - = 24 mmol/L line]: main respiratory alkalosis area, main metabolic alkalosis area, respiratory + metabolic alkalosis area, main respiratory acidosis area, main metabolic acidosis area, respiratory + metabolic acidosis area and normal area. It was easier to determine the type of acid-base balance disorders by identifying the location of the (PaCO 2 , HCO 3 - ) or (PaCO 2 , potential HCO 3 - ) point on the acid-base balance coordinate graph. "Four parameters-four steps" method is systematic and comprehensive. At the same time, by using the acid-base balance coordinate graph, it is simpler to estimate the types of acid-base balance disorders. It is worthy of popularizing and generalizing.

Peripheral nerve pathology, including aberrant Schwann cell differentiation, is ameliorated by doxycycline in a laminin-α2-deficient mouse model of congenital muscular dystrophy

PubMed Central

Homma, Sachiko; Beermann, Mary Lou; Miller, Jeffrey Boone

2011-01-01

The most common form of childhood congenital muscular dystrophy, Type 1A (MDC1A), is caused by mutations in the human LAMA2 gene that encodes the laminin-α2 subunit. In addition to skeletal muscle deficits, MDC1A patients typically show a loss of peripheral nerve function. To identify the mechanisms underlying this loss of nerve function, we have examined pathology and cell differentiation in sciatic nerves and ventral roots of the laminin-α2-deficient (Lama2−/−) mice, which are models for MDC1A. We found that, compared with wild-type, sciatic nerves of Lama2−/− mice had a significant increase in both proliferating (Ki67+) cells and premyelinating (Oct6+) Schwann cells, but also had a significant decrease in both immature/non-myelinating [glial fibrillary acidic protein (GFAP)+] and myelinating (Krox20+) Schwann cells. To extend our previous work in which we found that doxycycline, which has multiple effects on mammalian cells, improves motor behavior and more than doubles the median life-span of Lama2−/− mice, we also determined how nerve pathology was affected by doxycycline treatment. We found that myelinating (Krox20+) Schwann cells were significantly increased in doxycycline-treated compared with untreated sciatic nerves. In addition, doxycycline-treated peripheral nerves had significantly less pathology as measured by assays such as amount of unmyelinated or disorganized axons. This study thus identified aberrant proliferation and differentiation of Schwann cells as key components of pathogenesis in peripheral nerves and provided proof-of-concept that pharmaceutical therapy can be of potential benefit for peripheral nerve dysfunction in MDC1A. PMID:21505075

1.9-um diode-laser-assisted anastomoses in reconstructive microsurgery: preliminary results in 12 patients

NASA Astrophysics Data System (ADS)

Mordon, Serge R.; Schoffs, Michel; Martinot, Veronique L.; Buys, Bruno; Patenotre, Philippe; Lesage, Jean C.; Dhelin, Guy

1998-01-01

The authors reported an original 1.9 micrometer diode laser assisted microvascular anastomosis (LAMA) in human. This technique has been applied in 12 patients during reconstructive surgery for digital replantations (n equals 2), for digital revascularizations (n equals 3) and for free flap transfers (n equals 7). Fourteen end-to-end anastomoses (10 arteries, 4 veins) were performed. LAMA were always performed on vessel which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9 micrometer diode laser after placement of 2 equidistant stitches. The didoes spot was obtained by means of an optic fiber transmitted to the vessel wall via a pencil size hand piece. The used parameters were as followed: spot size equals 400 micrometer, power equals 70 to 220 mW, time equals 0.7 to 2 seconds, mean fluence equals 115 J/cm2. The mechanism involved is a thermal effect on the collagen of the adventitia and media leading to a phenomena which the authors have termed 'heliofusion.' This preliminary trial has permitted to define the modalities of its use in human. The technique is simple, rapid and easily learned. The equipment is not cumbersome, sterilizable and very ergonomic. LAMA does not replace sutures but is complementary, thanks to a reduction in the number of stitches used and to an access to surgical areas which are not easily accessible. This study must be completed by a larger scale study to confirm this technique and its reliability. Others uses could performed on different tissues such as biliary and urinary track, specially under laparoscopic conditions.

Surface grafted glycopolymer brushes to enhance selective adhesion of HepG2 cells.

PubMed

Chernyy, Sergey; Jensen, Bettina E B; Shimizu, Kyoko; Ceccato, Marcel; Pedersen, Steen Uttrup; Zelikin, Alexander N; Daasbjerg, Kim; Iruthayaraj, Joseph

2013-08-15

This work demonstrates the application of carbohydrate based methacrylate polymer brush, poly(2-lactobionamidoethyl methacrylate), for the purpose of cell adhesion studies. The first part of the work illustrates the effects of the structure of the aminosilane based ATRP initiator layer on the polymerization kinetics of 2-lactobionamidoethyl methacrylate) (LAMA) monomer on thermally oxidized silicon wafer. Both monolayer and multilayered aminosilane precursor layers have been prepared followed by reaction with 2-bromoisobutyrylbromide to form the ATRP initiator layer. It is inferred from the kinetic studies that the rate of termination is low on a multilayered initiator layer compared to a disordered monolayer structure. However both initiator types results in similar graft densities. Furthermore, it is shown that thick comb-like poly(LAMA) brushes can be constructed by initiating a second ATRP process on a previously formed poly(LAMA) brushes. The morphology of human hepatocellular carcinoma cancer cells (HepG2) on the comb-like poly(LAMA) brush layer has been studied. The fluorescent images of the HepG2 cells on the glycopolymer brush surface display distinct protrusions that extend outside of the cell periphery. On the other hand the cells on bare glass substrate display spheroid morphology. Further analysis using ToF-SIMS imaging shows that the HepG2 cells on glycopolymer surfaces is enriched with protein fragment along the cell periphery which is absent in the case of cells on bare glass substrate. It is suggested that the interaction of the galactose units of the polymer brush with the asialoglycoprotein receptor (ASGPR) of HepG2 cells has resulted in the protein enrichment along the cell periphery. Copyright © 2013 Elsevier Inc. All rights reserved.

Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes.

PubMed

van der Molen, Thys; Cazzola, Mario

2012-03-01

Bronchodilators are central to the management of chronic obstructive pulmonary disease (COPD). Clinical studies combining different classes of bronchodilators, in particular a long-acting muscarinic antagonist (LAMA) and a long-acting β2-agonist (LABA), have demonstrated greater improvements in lung function (forced expiratory volume in 1 second, FEV1) in patients with COPD than monotherapy. FEV1 has served as an important diagnostic measurement of COPD, and the majority of clinical studies of currently available pharmacotherapies grade effectiveness of treatment regimens based on improvements in FEV1. However, FEV1 alone may not adequately reflect the overall health status of the patient. Published evidence suggests that LABA/LAMA combination therapies demonstrate greater improvements in patient-centred outcomes such as dyspnoea, symptoms, rescue medication use, and quality of life than individual drugs used alone. Evaluating patient-centred outcomes associated with COPD is likely to play an important role in future research as a measure of overall treatment effectiveness. Raising awareness of the importance of outcomes beyond lung function alone, particularly in primary care where most patients initially present themselves for medical evaluation, should form a fundamental part of a more holistic approach to COPD management.

ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.

PubMed

Montes de Oca, María; López Varela, María Victorina; Acuña, Agustín; Schiavi, Eduardo; Rey, María Alejandra; Jardim, José; Casas, Alejandro; Tokumoto, Antonio; Torres Duque, Carlos A; Ramírez-Venegas, Alejandra; García, Gabriel; Stirbulov, Roberto; Camelier, Aquiles; Bergna, Miguel; Cohen, Mark; Guzmán, Santiago; Sánchez, Efraín

2015-08-01

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

A Randomized, Double-Blind Study of Larazotide Acetate to Prevent the Activation of Celiac Disease During Gluten Challenge

PubMed Central

Leffler, Daniel A; Kelly, C P; Abdallah, H Z; Colatrella, A M; Harris, L A; Leon, F; Arterburn, L A; Paterson, B M; Lan, Z H; Murray, J A

2012-01-01

OBJECTIVES: In patients with celiac disease, enteropathy is caused by the entry of gluten peptides into the lamina propria of the intestine, in which their immunogenicity is potentiated by tissue transglutaminase (tTG) and T-helper type 1–mediated immune responses are triggered. Tight junction disassembly and paracellular permeability are believed to have an important role in the transport of gluten peptides to the lamina propria. Larazotide acetate is a tight-junction regulator peptide that, in vitro, prevents the opening of intestinal epithelial tight junctions. The aim of this study was to evaluate the efficacy and tolerability of larazotide acetate in protecting against gluten-induced intestinal permeability and gastrointestinal symptom severity in patients with celiac disease. METHODS: In this dose-ranging, placebo-controlled study, 86 patients with celiac disease controlled through diet were randomly assigned to larazotide acetate (0.25, 1, 4, or 8 mg) or placebo three times per day with or without gluten challenge (2.4 g/day) for 14 days. The primary efficacy outcome was the urinary lactulose/mannitol (LAMA) fractional excretion ratio. Secondary endpoints included gastrointestinal symptom severity, quality-of-life measures, and antibodies to tTG. RESULTS: LAMA measurements were highly variable in the outpatient setting. The increase in LAMA ratio associated with the gluten challenge was not statistically significantly greater than the increase in the gluten-free control. Among patients receiving the gluten challenge, the difference in the LAMA ratios for the larazotide acetate and placebo groups was not statistically significant. However, larazotide acetate appeared to limit gluten-induced worsening of gastrointestinal symptom severity as measured by the Gastrointestinal Symptom Rating Scale at some lower doses but not at the higher dose. Symptoms worsened significantly in the gluten challenge–placebo arm compared with the placebo–placebo arm, suggesting that 2.4 g of gluten per day is sufficient to induce reproducible gluten toxicity. Larazotide acetate was generally well tolerated. No serious adverse events were observed. The most common adverse events were headache and urinary tract infection. CONCLUSIONS: LAMA variability in the outpatient setting precluded accurate assessment of the effect of larazotide acetate on intestinal permeability. However, some lower doses of larazotide acetate appeared to prevent the increase in gastrointestinal symptom severity induced by gluten challenge. PMID:22825365

Polysomnography versus limited respiratory monitoring and nurse-led titration to optimise non-invasive ventilation set-up: a pilot randomised clinical trial.

PubMed

Patout, Maxime; Arbane, Gill; Cuvelier, Antoine; Muir, Jean Francois; Hart, Nicholas; Murphy, Patrick Brian

2018-03-30

Polysomnography (PSG) is recommended for non-invasive ventilation (NIV) set-up in patients with chronic respiratory failure. In this pilot randomised clinical trial, we compared the physiological effectiveness of NIV set-up guided by PSG to limited respiratory monitoring (LRM) and nurse-led titration in patients with COPD-obstructive sleep apnoea (OSA) overlap. The principal outcome of interest was change in daytime arterial partial pressure of carbon dioxide (PaCO 2 ) at 3 months. Fourteen patients with daytime PaCO 2 >6 kPa and body mass index >30 kg/m 2 were recruited. At 3 months, PaCO 2 was reduced by -0.88 kPa (95% CI -1.52 to -0.24 kPa) in the LRM group and by -0.36 kPa (95% CI -0.96 to 0.24 kPa) in the PSG group. These pilot data provide support to undertake a clinical trial investigating the clinical effectiveness of attended limited respiratory monitoring and PSG to establish NIV in patients with COPD-OSA overlap. Results, NCT02444806. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lack of ventilatory threshold in patients with chronic obstructive pulmonary disease.

PubMed

Midorikawa, J; Hida, W; Taguchi, O; Okabe, S; Kurosawa, H; Mizusawa, A; Ogawa, H; Ebihara, S; Kikuchi, Y; Shirato, K

1997-01-01

We investigated whether the ventilatory threshold (VET) could be detected in 25 patients with severe chronic obstructive pulmonary disease (COPD). Exercise on a treadmill was performed until symptom-limited maximum oxygen uptake (VO2SL) was obtained. VET was absent in 14 patients (56%, VET(-) group) and present in the others (44%, VET(+) group). Basal pulmonary functions and dyspnea index (VE,SL/MVV) were not different between the two groups. Endurance time and exercise tolerance (VO2SL/bw) were significantly less in VET(-) than in VET(+). In the former group, PaO2 and pH at maximal exercise decreased and PaCO2 increased significantly, but HCO3- did not change compared with the corresponding values before exercise. In the latter group, PaCO2 at maximal exercise increased significantly, and pH and HCO3- decreased significantly compared with the values before exercise, but PaO2 did not. The changes in PaO2 and PaCO2 were not different between the two groups, but changes in pH and HCO3- in VET(+) were greater than those in VET(-). These results suggest that the absence of VET in some COPD patients indicates a lower exercise capacity without producing metabolic acidosis. This may be caused by rapidly developing dyspnea.

Do over 200 million healthy altitude residents really suffer from chronic Acid-base disorders?

PubMed

Zubieta-Calleja, Gustavo; Zubieta-Castillo, Gustavo; Zubieta-Calleja, Luis; Ardaya-Zubieta, Gustavo; Paulev, Poul-Erik

2011-01-01

As the oxygen tension of inspired air falls with increasing altitude in normal subjects, hyperventilation ensues. This acute respiratory alkalosis, induces increased renal excretion of bicarbonate, returning the pH back to normal, giving rise to compensated respiratory alkalosis or chronic hypocapnia. It seems a contradiction that so many normal people at high altitude should permanently live as chronic acid-base patients. Blood gas analyses of 1,865 subjects at 3,510 m, reported a P(a)CO(2) (arterial carbon dioxide tension ± SEM) = 29.4 ± 0.16 mmHg and pH = 7.40 ± 0.005. Base excess, calculated with the Van Slyke sea level equation, is -5 mM (milliMolar or mmol/l) as an average, suggesting chronic hypocapnia. THID, a new term replacing "Base Excess" is determined by titration to a pH of 7.40 at a P(a)CO(2) of 5.33 kPa (40 mmHg) at sea level, oxygen saturated and at 37°C blood temperature. Since our new modified Van Slyke equations operate with normal values for P(a)CO(2) at the actual altitude, a calculation of THID will always result in normal values-that is, zero.

Continuous neonatal blood gas monitoring using a multiparameter intra-arterial sensor

PubMed Central

Morgan, C; Newell, S; Ducker, D; Hodgkinson, J; White, D; Morley, C; Church, J

1999-01-01

AIMS—To compare arterial blood gas (ABG) readings obtained with a multiparameter intra-arterial sensor with those from an ABG analyser.
METHODS—An MPIAS with the ability to measure continuously pH, PaCO2, and PaO2 was introduced via an umbilical arterial catheter in 27 neonates requiring intensive care. They underwent 3260 hours of MPIAS monitoring, during which 753 ABG readings were performed.
RESULTS—Overall bias (mean difference: MPIAS-ABG) and precision (standard deviation of differences) values were: −0.002 and 0.022,respectively, for pH; +0.26 and 0.52 for PaCO2 (kPa); and −0.19 and 0.99 for PaO2 (kPa). This gave 95% limits of agreement as: −0.047 to +0.042 for pH, −0.76 to +1.28 kPa for PaCO2, and −2.13 to +1.75 kPa for PaO2. For each variable, precision across readings from the same individual was better than overall precision for all data. No complications related to the use of the catheter were observed.
CONCLUSIONS—Continuous MPIAS ABG monitoring is an exciting development, with the potential to reduce blood transfusions and improve ABG homeostasis.

 PMID:10325783

Physiological evaluation of free-ranging moose (Alces alces) immobilized with etorphine-xylazine-acepromazine in Northern Sweden.

PubMed

Evans, Alina L; Fahlman, Åsa; Ericsson, Göran; Haga, Henning Andreas; Arnemo, Jon M

2012-12-31

Evaluation of physiology during capture and anesthesia of free-ranging wildlife is useful for determining the effect that capture methods have on both ecological research results and animal welfare. This study evaluates capture and anesthesia of moose (Alces alces) with etorphine-xylazine-acepromazine in Northern Sweden. Fifteen adult moose aged 3-15 years were darted from a helicopter with a combination of 3.37 mg etorphine, 75 mg xylazine, and 15 mg acepromazine. Paired arterial blood samples were collected 15 minutes apart with the first sample at 15-23 minutes after darting and were analyzed immediately with an i-STAT®1 Portable Clinical Analyzer. All animals developed hypoxemia (PaO2 <10 kPa) with nine animals having marked hypoxemia (PaO2 5.5-8 kPa). All moose were acidemic (ph<7.35) with nine moose having marked acidemia (pH<7.20). For PaCO2, 14 moose had mild hypercapnia (PaCO2 6-8 kPa) and two had marked hypercapnia (PaCO2>8 kPa). Pulse, respiratory rate, pH and HCO3 increased significantly over time from darting whereas lactate decreased. The hypoxemia found in this study is a strong indication for investigating alternative drug doses or combinations or treatment with supplemental oxygen.

Ventilation is unstable during drowsiness before sleep onset.

PubMed

Thomson, Stuart; Morrell, Mary J; Cordingley, Jeremy J; Semple, Stephen J

2005-11-01

Ventilation is unstable during drowsiness before sleep onset. We have studied the effects of transitory changes in cerebral state during drowsiness on breath duration and lung volume in eight healthy subjects in the absence of changes in airway resistance and fluctuations of ventilation and CO2 tension, characteristic of the onset of non-rapid eye movement sleep. A volume-cycled ventilator in the assist control mode was used to maintain CO2 tension close to that when awake. Changes in cerebral state were determined by the EEG on a breath-by-breath basis and classified as alpha or theta breaths. Breath duration and the pause in gas flow between the end of expiratory airflow and the next breath were computed for two alpha breaths which preceded a theta breath and for the theta breath itself. The group mean (SD) results for this alpha-to-theta transition was associated with a prolongation in breath duration from 5.2 (SD 1.3) to 13.0 s (SD 2.1) and expiratory pause from 0.7 (SD 0.4) to 7.5 s (SD 2.2). Because the changes in arterial CO2 tension (PaCO2) are unknown during the theta breaths, we made in two subjects a continuous record of PaCO2 in the radial artery. PaCO2 remained constant from the alpha breaths through to the expiratory period of the theta breath by which time the duration of breath was already prolonged, representing an immediate and altered ventilatory response to the prevailing PaCO2. In the eight subjects, the CO2 tension awake was 39.6 Torr (SD 2.3) and on assisted ventilation 38.0 Torr (1.4). We conclude that the ventilatory instability recorded in the present experiments is due to the apneic threshold for CO2 being at or just below that when awake.

Tracheal gas insufflation combined with high-frequency oscillatory ventilation.

PubMed

Dolan, S; Derdak, S; Solomon, D; Farmer, C; Johanningman, J; Gelineau, J; Smith, R B

1996-03-01

To determine the efficacy of tracheal insufflation delivered by two different catheter designs on CO2 elimination when used in conjunction with high-frequency oscillatory ventilation. A nonrandomized before and after trial. Each animal served as his own control. Ten mongrel dogs weighing 20.9 +/- 1.9 kg. Four animals were assigned to a normal lung group and six animals underwent lung injury by large volume saline lavage. Permissive hypercapnia was allowed to occur by selecting oscillator settings that would lead to alveolar hypoventilation. Proximal mean airway pressure was kept constant. Tracheal gas was insufflated at 1 cm above the carina for 30 min periods at gas flows of 5 to 15 L/min. Carinal pressure, hemodynamic parameters (cardiac output, mean arterial pressure, pulmonary artery occlusion pressure), and gas exchange parameters (PaCO2, PaO2, PaO2/FIO2, shunt fraction, D O2) were measured. For the normal dogs, at catheter flow of 15 L/min; the forward thrust catheter increased carinal pressure and Pao2/FIO2 BY 30% (p<.003) and 105% (p<.005), respectively. The forward thrust catheter reduced Paco2 by 40% (p<.04). The reverse thrust catheter increased PaO2/FIO2 by 102% (p<.001) and decreased pressure and PaCO2 by 44% (p<.001) and 34% (p<.003), respectively. For the injured dogs, at catheter flow rate of 15 L/min, the forward thrust catheter increased carinal pressure, PaO2, and PaO2/FIO2 by 6% (p<.001), 23% (p<.001), and 24% (p<.02), respectively. The forward thrust catheter reduced PaCO2 by 29% (p<.002). The reverse thrust catheter increased PaO2 and PaO2/FIO2 both by 11% (p<.02) and reduced carinal pressure and PaCO2 by 23% (p<.001) and 18% (p<.002), respectively. Tracheal gas insufflation is capable of improving oxygenation and ventilation in acute lung injury when combined with high-frequency oscillatory ventilation. The addition of this second gas flow at the level of the carina raises or lowers distal airway pressure, the magnitude of which is dependent on the direction and rate of gas flow. The beneficial effects of tracheal gas insufflation may be tempered by the long-term effects of altering distal airway pressure; lowering distal airway pressure may lead to atelectasis, whereas raising distal airway pressure may lead to an auto-positive end-expiratory pressure (auto-PEEP) effect.

[Artificial hyperventilation in head injury. I. Spontaneous hyperventilation and assisted ventilation (author's transl)].

PubMed

Katsurada, K; Ogawa, M; Minami, T

1975-02-01

The present study was desined to clarify the roles of artificial hyperventilation in management of the patients with cerebral injury. Here reported is the first part of the serial studies and concerned with general informations about hyperventilation. The measurements of PaCO2, minute ventilation volume (VE), dead space (VD), tidal volume (VT), cardiac output (by dye dilution method), oxygen consumption (by Fick' principle) and oxygen equilibrium were performed in the patients suffering from acute, severe head injury. And the effect of assisted ventilation on them were investigated (using pressure-limited respirator). 1. There was a common finding that marked and sustained increase in VE, VA (alveolar ventilation), and decrease in PaCO2 existed during the first week of injury. 97% of both VE and VA were above normal and mean value of PaCO2 was 29-33 mmHg. The syndrome of spontaneous hyperventilation was evidently more prominent in the nonsurvived group of patients. It was noteworthy that increased VE (or VA) was dependent neither on VD or pulmonary dysfunction nor on metabolic acidosis of arterial blood. The relation of VA to base excess in head injury was well contrasted to that of acute CO poisoning. 2. Assisted ventilation resulted in increased VT and decreased respiratory rate, and little change in VE. Consequently, PaCO2 changed only from 33.0 to 29.4 mmHg as a mean of entire series of patients. But when the influence affected by hypoxemic drive was subsided, a significant reduction of PaCO2 was disclosed following assisted ventilation. The assisted ventilation with pure oxygen was also associated with reduced cardiac output (from 6.0l/min to 5.3l/min), though the oxygen consumption changed variedly among the patients. 3. The fact was confirmed that both hypocapnea and alkalosis produced the left-sised shift of oxygen dissociation curve, decrease in P50 (P02 at 50% saturation of oxygen), and in addition, narrowed arterio-mixed venous oxygen difference. The changes of artero-mixed venous oxygen saturation difference which were calculated at 100 mmHg of PaO2 and 40mmHg of mixed venous PO2 were in a linear fashion with those of P50. Apart from the problems on injured brain, the beneficial and non-beneficial effects of hyperventilation were further discussed. The availability and inidcation of artificial hyperventilation should be precisely evaluated later, in a comprehensive manner with the subsequent studies (Part 2 and 3) on cerebral metabolism and intracranial pressure.

Effect of acetazolamide on blood gases and 2,3 DPG during ascent and acclimatization to high altitude.

PubMed Central

Milles, J. J.; Chesner, I. M.; Oldfield, S.; Bradwell, A. R.

1987-01-01

Blood gases and red cell 2,3 DPG concentrations were measured during ascent and a stay for 6 days at 4846 m in 20 subjects. Acetazolamide improved Pa,O2 and reduced pH and Pa,CO2. 2,3 DPG concentrations were lower in the acetazolamide group during ascent and at high altitude. However, 2,3 DPG concentrations were significantly greater at high altitude in both the acetazolamide and placebo groups compared with low altitude. The acetazolamide group remained different from the placebo group during the stay at high altitude with higher Pa,O2, lower PaCO2, lower pH and lower 2,3 DPG concentrations. PMID:3118349

Effect of hypoxia and hypercapnia on catecholamine content in cat carotid body.

PubMed

Fitzgerald, R S; Garger, P; Hauer, M C; Raff, H; Fechter, L

1983-05-01

The purpose of this study was to determine the content of catecholamines (CA) in the cat carotid body before and after 0.5 h exposures to normoxic normocapnia [arterial O2 partial pressure (Pao2) 126 +/- 28 Torr, arterial CO2 partial pressure (Paco2) 36.4 +/- 1.5 Torr], hypoxic normocapnia (Pao2 25 +/- 3 Torr, Paco2 36.7 +/- 3.3 Torr), and normoxic hypercapnia (Pao2 132 +/- 13 Torr, Paco2 = 98.2 +/- 7.6 Torr). CA synthesis was blocked using alpha-methylparatyrosine methyl ester (AMPT) prior to alterations in the inspired air. There was a significant decrease in carotid body content of dopamine (DA), norepinephrine (NE), and epinephrine (E) 1 h after AMPT administration. Analysis of variance and Duncan new multiple range procedures revealed that during the subsequent 0.5-h exposures to normoxia, hypoxia, or hypercapnia, only the decrease in DA during hypoxia was significantly greater than that during normoxia; the loss during hypercapnia was not. The decreases in NE during the three exposures were indistinguishable among themselves as were the decreases in E. The decrease in CA content is probably attributable to increased release. The data reveal that the release of CAs during the chemoreception of hypoxia is different from that during the chemoreception of hypercapnia and support the concept of different mechanisms for the chemoreception of hypoxia and hypercapnia.

Physiological evaluation of free-ranging moose (Alces alces) immobilized with etorphine-xylazine-acepromazine in Northern Sweden

PubMed Central

2012-01-01

Background Evaluation of physiology during capture and anesthesia of free-ranging wildlife is useful for determining the effect that capture methods have on both ecological research results and animal welfare. This study evaluates capture and anesthesia of moose (Alces alces) with etorphine-xylazine-acepromazine in Northern Sweden. Methods Fifteen adult moose aged 3–15 years were darted from a helicopter with a combination of 3.37 mg etorphine, 75 mg xylazine, and 15 mg acepromazine. Paired arterial blood samples were collected 15 minutes apart with the first sample at 15–23 minutes after darting and were analyzed immediately with an i-STAT®1 Portable Clinical Analyzer. Results All animals developed hypoxemia (PaO2 <10 kPa) with nine animals having marked hypoxemia (PaO2 5.5-8 kPa). All moose were acidemic (ph<7.35) with nine moose having marked acidemia (pH<7.20). For PaCO2, 14 moose had mild hypercapnia (PaCO2 6-8 kPa) and two had marked hypercapnia (PaCO2>8 kPa). Pulse, respiratory rate, pH and HCO3 increased significantly over time from darting whereas lactate decreased. Conclusions The hypoxemia found in this study is a strong indication for investigating alternative drug doses or combinations or treatment with supplemental oxygen. PMID:23276208

EBM regeneration and changes in EBM component mRNA expression in stromal cells after corneal injury

PubMed Central

Santhanam, Abirami; Marino, Gustavo K.; Torricelli, Andre A. M.

2017-01-01

Purpose To investigate the production of the epithelial basement membrane (EBM) component mRNAs at time points before lamina lucida and lamina densa regeneration in anterior stromal cells after corneal injury that would heal with and without fibrosis. Methods Rabbit corneas were removed from 2 to 19 days after −4.5D or −9.0D photorefractive keratectomy (PRK) with the VISX S4 IR laser. Corneas were evaluated with transmission electron microscopy (TEM) for full regeneration of the lamina lucida and the lamina densa. Laser capture microdissection (LCM) based quantitative real-time (RT)–PCR was used to quantitate the expression of mRNAs for laminin α-3 (LAMA3), perlecan, nidogen-1, and nidogen-2 in the anterior stroma. Results After −4.5D PRK, EBM was found to be fully regenerated at 8 to 10 days after surgery. At 4 days after PRK, the nidogen-2 and LAMA3 mRNAs levels were detected at statistically significantly lower levels in the anterior stroma of the −9.0D PRK corneas (where the EBM would not fully regenerate) compared to the −4.5D PRK corneas (where the EBM was destined to fully regenerate). At 7 days after PRK, nidogen-2 and LAMA3 mRNAs continued to be statistically significantly lower in the anterior stroma of the −9.0D PRK corneas compared to their expression in the anterior stroma of the −4.5D PRK corneas. Conclusions Key EBM components LAMA3 and nidogen-2 mRNAs are expressed at higher levels in the anterior stroma during EBM regeneration in the −4.5D PRK corneas where the EBM is destined to fully regenerate and no haze developed compared to the −9.0D PRK corneas where the EBM will not fully regenerate and myofibroblast-related stromal fibrosis (haze) will develop. PMID:28275314

Pastoralism in Northern Peru during Pre-Hispanic Times: Insights from the Mochica Period (100–800 AD) Based on Stable Isotopic Analysis of Domestic Camelids

PubMed Central

Dufour, Elise; Goepfert, Nicolas; Gutiérrez Léon, Belkys; Chauchat, Claude; Franco Jordán, Régulo; Sánchez, Segundo Vásquez

2014-01-01

Llama (Lama glama) and alpaca (Vicugna pacos) are the only large domesticated animals indigenous to the Americas. Pastoralism occupies a fundamental economic, social and religious role in Andean life. Today, camelid livestock are confined to the ecozone of the puna (above 3,500 masl), while their presence on the Pacific coast during pre-Hispanic times is attested by archaeological skeletal remains. This study aims to document herding practices on the northern Peruvian coast during the Early Intermediate Period (200 BC-600 AD) by gaining insights into diet, location of breeding and mobility of archaeological camelids from the funerary and ritual contexts of two Mochica sites, Uhle Platform in Huacas de Moche and El Brujo. The three first early years and the long-term life histories of the animals were documented by the combined bulk analysis of bone collagen (δ13Ccol and δ15Ncol) and bone structural carbonate (δ13Cbone and δ18Obone) and the serial analysis of structural carbonate of molar tooth enamel (δ13Cenamel and δ18Oenamel). Mochica camelids were bred in the low and/or middle valleys, unlike their modern counterparts, who are restricted to highland puna C3 pastures. Archaeological camelids had diverse and complex life histories, usually with substantial maize foddering. An ontogenetic switch in diet and possible residential mobility during the course of life were identified for some specimens. Although the inference of geographic origin from δ18Obone and δ18Oenamel values was limited because of the lack of understanding of the influence of environmental and biological factors, tooth enamel analysis has great potential for exploring camelid herding practices and Andean pastoralism. Our study suggested that Mochica herders adapted their practices to the difficult lowland environment and that herding practices were varied and not restricted to breeding at higher altitudes. The role of maize in different aspects of the economic life of the Mochicas is also underlined. PMID:24498136

Laying hen responses to acute heat stress and carbon dioxide supplementation: I. Blood gas changes and plasma lactate accumulation.

PubMed

Koelkebeck, K W; Odom, T W

1994-04-01

Exposure to heat stress lowered partial pressure of arterial blood carbon dioxide (paCO2), arterial blood bicarbonate ion (HCO3-), but increased arterial blood pH (pHa) and plasma lactate (LA). Increasing ambient carbon dioxide (CO2) to 1.5% increased paCO2 from hypocapnic levels to normocapnic levels, raised HCO3-, lowered pHa and plasma LA to pre-heat stress levels. Following CO2 treatment, respiratory alkalosis conditions returned. It was evident in this study that increasing ambient chamber CO2 to 1.5% was effective in ameliorating acid-base disturbances and reducing elevated levels of plasma LA which normally develops when laying hens are subjected to an acute heat stress exposure.

Description of the female of Navicordulia aemulatrix Pinto & Lamas and additional notes on the male (Odonata: Corduliidae).

PubMed

Pinto, A P; Lamas, C J E

2011-01-01

The female of Navicordulia aemulatrix Pinto & Lamas is described and illustrated for the first time based on a single specimen from the same locality of the type series (state of Santa Catarina, [municipality of São Bento do Sul, 26°14'58"S, 49°22'59"W, railroad station] Rio Vermelho, 29.I.1952, in MZSP). In addition, further morphological notes for the male are provided based on three specimens collected at the type locality and at a new locality in the state of Santa Catarina (Timbó municipality). The pronotal process present in N. aemulatrix is re-evaluated and considered non-homologous to that found in Neocordulia setifera (Hagen in Selys) as previously suggested.

Lhasa, Tibet, China

NASA Image and Video Library

2009-08-18

JPL Advanced Spaceborne Thermal Emission and Reflection Radiometer aboard NASA Terra satellite, shows Lhasa, the traditional seat of the Dalai Lama and capital of the Tibet Autonomous Region in China.

Intestinal anti-inflammatory activity of Ground Cherry (Physalis angulata L.) standardized CO2 phytopharmaceutical preparation.

PubMed

Almeida Junior, Luiz Domingues; Quaglio, Ana Elisa Valencise; de Almeida Costa, Celso Acácio Rodrigues; Di Stasi, Luiz Claudio

2017-06-28

To investigate the effects of Ground Cherry ( Physalis angulata L.) standardized supercritical CO 2 extract in trinitrobenzenesulphonic acid (TNBS) model of rat intestinal inflammation. The animals were divided into groups that received vehicle or P. angulata extract (PACO 2 ) orally at the doses 25, 50 and 100 mg/kg daily by 5 d before TNBS damage. Protective effects of PACO 2 were assessed by macroscopic analysis, biochemical determinations of the levels of myeloperoxidase (MPO), alkaline phosphatase (ALP), glutathione and cytokines (such as INF-γ, IL-1β, IL-6, IL-10 and TNF-α), gene expression evaluation (including Hsp70, heparanase, NF-κB, mitogen-activated protein kinases (Mapk) 1, 3, 6 and 9, and the mucins genes Muc 1, 2, 3 and 4) and histopathological studies using optical, and electronic (transmission and scanning) microscopy. PACO 2 extract promoted a significant reduction in MPO and ALP activities, reducing oxidative stress and neutrophil infiltration. These effects were accompanied by significant reduction of colonic levels of IFN-γ and IL-6 and down-regulation of heparanase, Hsp70, Mapk3, Mapk9, Muc1 and Muc2 genes expression when compared with TNBS-control animals. In addition, protective effects were also evidenced by reduced neutrophil infiltration, recovery of cell architecture and replacement of mucin by histopathological and ultrastructural analysis. Physalis angulata supercritical CO 2 extract is an intestinal anti-inflammatory product that modulates oxidative stress, immune response and expression of inflammatory mediators, with potentially utility for treating inflammatory bowel disease.

Human influence on late Holocene fluvial landscape and stratigraphy in the Mixteca Alta of Oaxaca, Mexico

NASA Astrophysics Data System (ADS)

Leigh, D. S.; Holdridge, G. H.; Kowalewski, S. A.

2011-12-01

The Mixteca Alta of south-central Mexico (state of Oaxaca) is a high-elevation plateau where population and agricultural steadily grew over the past 3000 years, but with a few significant episodes of population decline. Currently, the landscape is highly eroded and gullied in response to widespread land abandonment and diminished population attributed to the Spanish conquest during the 1500s and 1600s. Abandonment apparently resulted in neglect of prehistoric cross-drainage retaining walls, known as lama-bordos, which had been constructed throughout agricultural watersheds for millennia to retain runoff and sediment. Our research seeks to establish the earliest ages for construction of lama-bordos, which are buried by more than 10 m of alluvium in some localities; and we hope to determine if the chronology of alluvial sedimentation is related to fluctuations in population density versus climate changes or other drivers. Sampling is focused on relatively small tributary watersheds (<10 km^2) in the valley of Rio Culebra near the town of Coixlahuaca. Our general hypothesis is counter to Malthusian theory in that we posit land degradation and erosion was punctuated by episodes of population decline when there were insufficient people to maintain the lama-bordo infrastructure. Methods involve: (1) detailed stratigraphic and pedogenic description and sampling of several outcrops; (2) radiocarbon and luminescence dating of stratigraphic sections; (3) geochemical and lithological tracing of sedimentary beds to discriminate time periods of gully erosion; (4) relating the alluvial chronology to archaeological surveys that have established the occupation history of the region. Results indicate that upland gully erosion had occurred prior to widespread human occupation of the area, because >4000 cal yr BP cut-and-fill stratigraphic units commonly contain detritus from upland subsoil and underlying bedrock. We provide numerous radiocarbon dates for the oldest lama-bordos, and they suggest that initial construction predates 2500 cal yr BP, which is older than prevailing archaeological evidence has indicated. It appears the lama-bordos were constructed to trap gully-derived upland sediment to facilitate agriculture (largely maize cultivation). Geochemistry and lithology indicate excellent discrimination of upland soil-surface versus upland gully-derived subsoil detritus, so we are optimistic about correlating periods of exacerbated upland erosion with cultural periods of abandonment. This correlation of upland gully erosion and rapid bottomland sedimentation appears clear for the post-conquest abandonment period (1520s-1600s) until bottomlands also became gullied during the middle 1600s, but we await more radiocarbon dates to extend such correlations back in time to fully test our hypothesis. Our research is shedding new light on the extent to which people have manipulated and managed upland erosion and bottomland sedimentation for thousands of years in Mesoamerica.

50 CFR 14.4 - What terms do I have to understand?

Code of Federal Regulations, 2010 CFR

2010-10-01

...; Ferret (domestic)—Mustela putorius; Goat—Capra hircus; Horse—Equus caballus; Llama—Lama glama; Pig—Sus... auratus. Birds: Chicken—Gallus domesticus; Ducks & geese—domesticated varieties; Guinea fowl—Numida...

The alpaca (Vicugna pacos) as a natural intermediate host of Taenia omissa (Cestoda: Taeniidae).

PubMed

Gomez-Puerta, Luis A; Yucra, Dora; Lopez-Urbina, Maria T; Gonzalez, Armando E

2017-11-15

Three metacestodes were collected from the mesentery and the surface of the liver of three adult alpacas (Vicugna pacos) in a slaughterhouse located in Puno, Peru. Various features of the metacestodes were observed for morphological identification. A molecular diagnosis was performed by PCR-based sequencing of mitochondrial genes of cytochrome c oxidase subunit 1 (cox1) and the NADH dehydrogenase subunit 1 (nad1). All metacestodes were identified as Taenia omissa by morphology and molecular methods The isolates from alpacas showed significant sequence similarity with previously reported isolates of T. omissa (95.7-98.1% in cox1 and 94.6-95.1% in nad1). Our report is the first to detect T. omissa metacestodes in alpacas and to reveal that alpacas are natural intermediate hosts for this parasite. Copyright © 2017 Elsevier B.V. All rights reserved.

[Lung dysfunction in patients with severe chronic obstructive bronchitis].

PubMed

Nefedov, V B; Popova, L A; Shergina, E A

2005-01-01

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TCL, TGV, RV, Raw, Rin, Rex, DLCO-SS, PaO2, and PaCO2 were determined in 36 patients with severe chronic obstructive lung disease (FEV1 < 50% of the normal value). All the patients were found to have impaired bronchial patency and changes in lung volumes and capacities; 83.3% of the patients had pulmonary gas exchange dysfunction. Impaired bronchial patency mainly appeared as decreased FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, Raw, Rin, Rex; altered lung volumes and capacities manifested by increased RV, TGV, and TLC, and by decreased VC and FVC; pulmonary gas exchange dysfunction showed up as lowered PaO2 and DLCO-SS, as decreased or increased PaCO2. The observed bronchial patency disorders varied from significant to severe; functional changes in lung volumes and capacities were mild to severe.

50 CFR 14.4 - What terms do I have to understand?

Code of Federal Regulations, 2013 CFR

2013-10-01

... the requirements of this subchapter B (except for species obtained from wild populations). Mammals...; Ferret (domestic)—Mustela putorius; Goat—Capra hircus; Horse—Equus caballus; Llama—Lama glama; Pig—Sus...

50 CFR 14.4 - What terms do I have to understand?

Code of Federal Regulations, 2011 CFR

2011-10-01

... the requirements of this subchapter B (except for species obtained from wild populations). Mammals...; Ferret (domestic)—Mustela putorius; Goat—Capra hircus; Horse—Equus caballus; Llama—Lama glama; Pig—Sus...

50 CFR 14.4 - What terms do I have to understand?

Code of Federal Regulations, 2014 CFR

2014-10-01

... the requirements of this subchapter B (except for species obtained from wild populations). Mammals...; Ferret (domestic)—Mustela putorius; Goat—Capra hircus; Horse—Equus caballus; Llama—Lama glama; Pig—Sus...

50 CFR 14.4 - What terms do I have to understand?

Code of Federal Regulations, 2012 CFR

2012-10-01

... the requirements of this subchapter B (except for species obtained from wild populations). Mammals...; Ferret (domestic)—Mustela putorius; Goat—Capra hircus; Horse—Equus caballus; Llama—Lama glama; Pig—Sus...

Determination of the recharge area and salinization degree of karst springs in the Lamas Basin (Turkey).

PubMed

Yüce, Galip

2005-12-01

The Lamas Basin is an area covering approximately 4,400 km(2) situated on the eastern Mediterranean coast of Turkey covered with highly karstified limestone and dolomitic limestone from the Miocene and Mesozoic age, respectively. Owing to the area's low karstification basement, groundwater in the karst aquifer circulates deep from the surface towards the springs along the coast as well as to the submarine springs. This study aims working out the salinization level and recharge characteristics of the Lamas Basin using environmental isotopes techniques. In the study, the data collected previously to discover, in general terms, the groundwater characteristics within the area are reanalyzed to fulfil the purpose of the study. In conclusion, it is found that the down gradient karst springs discharging along the Mediterranean coast mostly contain groundwater contributions from higher altitudes with depleted delta(18)O and delta(2)H compositions. The delta(18)O-altitude effect was determined as approximately-0.12 per thousand/100 m which may indicate sea-spray intrusion towards inland. As a result, the salinization level of coastal springs changes ranging between 1.2 % and 17.0 %. Owing to the seawater encroachment, Ca-HCO(3) water type changes to Na-HCO(3) or Na-Cl water by the cation exchange during the dry period. As the unique freshwater potential extends along the coastal area, the groundwater production should be exploited in a way that seawater encroachment is kept at minimum.

Lens-Aided Multi-Angle Spectroscopy (LAMAS) Reveals Small-Scale Outflow Structure in Quasars

NASA Astrophysics Data System (ADS)

Green, Paul J.

2006-06-01

Spectral differences between lensed quasar image components are common. Since lensing is intrinsically achromatic, these differences are typically explained as the effect of either microlensing, or as light path time delays sampling intrinsic quasar spectral variability. Here we advance a novel third hypothesis: some spectral differences are due to small line-of-sight differences through quasar disk wind outflows. In particular, we propose that variable spectral differences seen only in component A of the widest separation lens SDSS J1004+4112 are due to differential absorption along the sight lines. The absorber properties required by this hypothesis are akin to known broad absorption line (BAL) outflows but must have a broader, smoother velocity profile. We interpret the observed C IV emission-line variability as further evidence for spatial fine structure transverse to the line of sight. Since outflows are likely to be rotating, such absorber fine structure can consistently explain some of the UV and X-ray variability seen in AGNs. The implications are many: (1) Spectroscopic differences in other lensed objects may be due to this ``lens-aided multi-angle spectroscopy'' (LAMAS). (2) Outflows have fine structure on size scales of arcseconds, as seen from the nucleus. (3) Assuming either broad absorption line region sizes proposed in recent wind models, or typically assumed continuum emission region sizes, LAMAS and/or variability provide broadly consistent absorber size scale estimates of ~1015 cm. (4) Very broad smooth absorption may be ubiquitous in quasar spectra, even when no obvious troughs are seen.

[Oxyhemoglobin dissociation curve and 2,3-diphosphoglycerate in chronic hypoxemia].

PubMed

Koizumi, M

1991-05-01

The measurement of the oxyhemoglobin dissociation curve (ODC) and 2,3-diphosphoglycerate (2,3-DPG) in patients with chronic hypoxemia is important from the view point of tissue oxygenation. However, there have been no consistent results that explain the relation among chronic hypoxemia, 2,3-DPG and P50, which is oxygen pressure at an oxygen saturation of 50 percent. The aim of this study is to clarify what factors affect P50 and 2,3-DPG. 1) Patients with chronic hypoxemia, who showed PaO2 less than 60 Torr, had significantly higher P50 than normal subjects. 2) The concentration of Hb showed significant negative correlation with both P50 and 2,3-DPG. 3) Arterial blood pH showed significant positive correlation with both P50 and 2,3-DPG. 4) In a group with normal levels of Hb and pH, there was significant negative relationship between PaO2 and P50. 5) In a group with normal levels of Hb and pH, there was significant positive relationship between PaCO2 and P50. 6) In a group with normal levels of Hb, pH and PaCO2, there was significant negative relationship between PaO2 and 2,3-DPG. In conclusion, P50 and 2,3-DPG are affected largely by Hb concentration or blood pH, with or without hypoxemia. However there is a mechanism by which P50 and 2,3-DPG are increased by hypoxemia itself in a group with normal levels of Hb, pH and PaCO2.

Intestinal anti-inflammatory activity of Ground Cherry (Physalis angulata L.) standardized CO2 phytopharmaceutical preparation

PubMed Central

Almeida Junior, Luiz Domingues; Quaglio, Ana Elisa Valencise; de Almeida Costa, Celso Acácio Rodrigues; Di Stasi, Luiz Claudio

2017-01-01

AIM To investigate the effects of Ground Cherry (Physalis angulata L.) standardized supercritical CO2 extract in trinitrobenzenesulphonic acid (TNBS) model of rat intestinal inflammation. METHODS The animals were divided into groups that received vehicle or P. angulata extract (PACO2) orally at the doses 25, 50 and 100 mg/kg daily by 5 d before TNBS damage. Protective effects of PACO2 were assessed by macroscopic analysis, biochemical determinations of the levels of myeloperoxidase (MPO), alkaline phosphatase (ALP), glutathione and cytokines (such as INF-γ, IL-1β, IL-6, IL-10 and TNF-α), gene expression evaluation (including Hsp70, heparanase, NF-κB, mitogen-activated protein kinases (Mapk) 1, 3, 6 and 9, and the mucins genes Muc 1, 2, 3 and 4) and histopathological studies using optical, and electronic (transmission and scanning) microscopy. RESULTS PACO2 extract promoted a significant reduction in MPO and ALP activities, reducing oxidative stress and neutrophil infiltration. These effects were accompanied by significant reduction of colonic levels of IFN-γ and IL-6 and down-regulation of heparanase, Hsp70, Mapk3, Mapk9, Muc1 and Muc2 genes expression when compared with TNBS-control animals. In addition, protective effects were also evidenced by reduced neutrophil infiltration, recovery of cell architecture and replacement of mucin by histopathological and ultrastructural analysis. CONCLUSION Physalis angulata supercritical CO2 extract is an intestinal anti-inflammatory product that modulates oxidative stress, immune response and expression of inflammatory mediators, with potentially utility for treating inflammatory bowel disease. PMID:28706419

Dark adaptation during systemic hypoxia induced by chronic respiratory insufficiency.

PubMed

Thylefors, Joakim; Piitulainen, Eeva; Havelius, Ulf

2009-03-01

To investigate dark adaptation during hypoxia in patients with chronic respiratory failure. At three visits, dark adaptation was recorded by computerized dark adaptometry in 13 patients with chronic respiratory insufficiency treated by long-term oxygen therapy. At visits 1 and 3, the patients were administered their usual oxygen supplement. At visit 2, no oxygen was given. At each visit, an analysis of arterial blood gases measured pH, partial pressure of O(2) (Pao(2)), partial pressure of CO(2) (Paco(2)), base excess (BE), standard bicarbonate (HCO(3)), and arterial oxygen saturation. Pulse oximetry (POX) was also recorded. Significant differences were recorded between visits 1 and 2 and between visits 2 and 3 for Pao(2), arterial oxygen saturation, and POX; no differences were found for pH, Paco(2), BE, or HCO(3). No differences were seen between visits 1 and 3 for any of the laboratory parameters. All patients had normal and unchanged dark adaptation at the three visits. Hypoxia in chronic respiratory insufficiency was associated with normal dark adaptation, in contrast to hypoxia in healthy persons at high altitudes, which is known to produce impaired dark adaptation. The result may partly reflect the influence of Paco(2) on the lumen of choroidal and retinal vessels. At high altitudes, with hypocapnic vasoconstriction the oxygen supply to the retina is further compromised, resulting in reduced dark adaptation. The authors hypothesize that respiratory insufficiency with hypercapnia or normocapnia will have larger choroidal and retinal vessel lumens, added to by further dilation of retinal vessels during hypoxia. The tentative net effect would be preserved dark adaptation.

A comparison of the effects of carbon dioxide and medical air for abdominal insufflation on respiratory parameters in xylazine-sedated sheep undergoing laparoscopic artificial insemination.

PubMed

Haan, J D; Hay Kraus, B L; Sathe, S R

2018-07-01

To determine if abdominal insufflation with medical air will improve oxygenation and ventilation parameters when compared to insufflation with CO 2 in xylazine-sedated sheep undergoing laparoscopic artificial insemination (AI). Forty-seven sheep underwent oestrus synchronisation and were fasted for 24 hours prior to laparoscopic AI. Each animal was randomised to receive either CO 2 or medical air for abdominal insufflation. An auricular arterial catheter was placed and utilised for serial blood sampling. Respiratory rates (RR) and arterial blood samples were collected at baseline, after xylazine (0.1 mg/kg I/V) sedation, 2 minutes after Trendelenburg positioning, 5 minutes after abdominal insufflation, and 10 minutes after being returned to a standing position. Blood samples were collected in heparinised syringes, stored on ice, and analysed for arterial pH, partial pressure of arterial O 2 (PaO 2 ), and CO 2 (PaCO 2 ). The number of ewes conceiving to AI was also determined. Repeated measures ANOVA demonstrated temporal effects on RR, PaO 2 , PaCO 2 and arterial pH during the laparoscopic AI procedure (p<0.001), but no difference between insufflation groups (p>0.01). No sheep experienced hypercapnia (PaCO 2 >50 mmHg) or acidaemia (pH<7.35). Hypoxaemia (PaO 2 <70 mmHg) was diagnosed during the procedure in 14/22 (64%) ewes in the CO 2 group compared with 8/23 (35%) ewes in the medical air group (p=0.053). Overall, 15/20 (75%) ewes in the CO 2 group conceived to AI compared with 16/22 (72.7%) in the medical air group (p=0.867). There were no statistical or clinical differences in RR, PaO 2 , PaCO 2 , pH, or conception to AI when comparing the effects of CO 2 and medical air as abdominal insufflation gases. None of the sheep experienced hypercapnia or acidaemic, yet 42% (19/45) of sheep developed clinical hypoxaemia, with a higher percentage of ewes in the CO 2 group developing hypoxaemia than in the medical air group. Based on the overall analysis, medical air could be utilised as a comparable alternative for abdominal insufflation during laparoscopic AI procedures.

Rumbling Orchids: How To Assess Divergent Evolution Between Chloroplast Endosymbionts and the Nuclear Host.

PubMed

Pérez-Escobar, Oscar Alejandro; Balbuena, Juan Antonio; Gottschling, Marc

2016-01-01

Phylogenetic relationships inferred from multilocus organellar and nuclear DNA data are often difficult to resolve because of evolutionary conflicts among gene trees. However, conflicting or "outlier" associations (i.e., linked pairs of "operational terminal units" in two phylogenies) among these data sets often provide valuable information on evolutionary processes such as chloroplast capture following hybridization, incomplete lineage sorting, and horizontal gene transfer. Statistical tools that to date have been used in cophylogenetic studies only also have the potential to test for the degree of topological congruence between organellar and nuclear data sets and reliably detect outlier associations. Two distance-based methods, namely ParaFit and Procrustean Approach to Cophylogeny (PACo), were used in conjunction to detect those outliers contributing to conflicting phylogenies independently derived from chloroplast and nuclear sequence data. We explored their efficiency of retrieving outlier associations, and the impact of input data (unit branch length and additive trees) between data sets, by using several simulation approaches. To test their performance using real data sets, we additionally inferred the phylogenetic relationships within Neotropical Catasetinae (Epidendroideae, Orchidaceae), which is a suitable group to investigate phylogenetic incongruence because of hybridization processes between some of its constituent species. A comparison between trees derived from chloroplast and nuclear sequence data reflected strong, well-supported incongruence within Catasetum, Cycnoches, and Mormodes. As a result, outliers among chloroplast and nuclear data sets, and in experimental simulations, were successfully detected by PACo when using patristic distance matrices obtained from phylograms, but not from unit branch length trees. The performance of ParaFit was overall inferior compared to PACo, using either phylograms or unit branch lengths as input data. Because workflows for applying cophylogenetic analyses are not standardized yet, we provide a pipeline for executing PACo and ParaFit as well as displaying outlier associations in plots and trees by using the software R. The pipeline renders a method to identify outliers with high reliability and to assess the combinability of the independently derived data sets by means of statistical analyses. © The Author(s) 2015. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Planning Cultural Programs With the Community

ERIC Educational Resources Information Center

Furstenberg, Barbara; Carpenter, Thomas F.

1974-01-01

This article outlined the nature of the cooperation of many of Hawaii's communities and other agencies and individuals whose educational goals are similar as it applied to two programs, the Lyceum series and the Lama Ku. (Author/RK)

LAMA Preconference and Program Highlights.

ERIC Educational Resources Information Center

Library Administration & Management, 1988

1988-01-01

Highlights events of the Library Administration and Management Association 1988 conference, including presentation of awards and programs on: (1) transfer of training; (2) hiring; (3) mentoring; (4) acquisitions automation; (5) library building consultation; and (6) managing shared systems. (MES)

Mālama I Ka `Āina, Sustainability: learning from Hawai`i's displaced place and culture-based science standard

NASA Astrophysics Data System (ADS)

Chinn, Pauline W. U.

2011-03-01

This response to Mitchell and Mueller's "A philosophical analysis of David Orr's theory of ecological literacy" comments on their critique of Orr's use of the phrase "ecological crisis" and what I perceive as their conflicting views of "crisis." I present my views on ecological crisis informed by standpoint theory and the definition of crisis as turning point. I connect the concept of turning point to tipping point as used in ecology to describe potentially irreversible changes in coupled social-ecological systems. I suggest that sustainable societies may provide models of adaptive learning in which monitoring of ecological phenomena is coupled to human behavior to mitigate threats to sustainability before a crisis/tipping point is reached. Finally, I discuss the Hawai`i State Department of Education's removal of its Indigenous science content standard Mālama I Ka `Āina, Sustainability and its continued use in community-based projects.

Dynamic Proteomic Analysis of Pancreatic Mesenchyme Reveals Novel Factors That Enhance Human Embryonic Stem Cell to Pancreatic Cell Differentiation.

PubMed

Russ, Holger A; Landsman, Limor; Moss, Christopher L; Higdon, Roger; Greer, Renee L; Kaihara, Kelly; Salamon, Randy; Kolker, Eugene; Hebrok, Matthias

2016-01-01

Current approaches in human embryonic stem cell (hESC) to pancreatic beta cell differentiation have largely been based on knowledge gained from developmental studies of the epithelial pancreas, while the potential roles of other supporting tissue compartments have not been fully explored. One such tissue is the pancreatic mesenchyme that supports epithelial organogenesis throughout embryogenesis. We hypothesized that detailed characterization of the pancreatic mesenchyme might result in the identification of novel factors not used in current differentiation protocols. Supplementing existing hESC differentiation conditions with such factors might create a more comprehensive simulation of normal development in cell culture. To validate our hypothesis, we took advantage of a novel transgenic mouse model to isolate the pancreatic mesenchyme at distinct embryonic and postnatal stages for subsequent proteomic analysis. Refined sample preparation and analysis conditions across four embryonic and prenatal time points resulted in the identification of 21,498 peptides with high-confidence mapping to 1,502 proteins. Expression analysis of pancreata confirmed the presence of three potentially important factors in cell differentiation: Galectin-1 (LGALS1), Neuroplastin (NPTN), and the Laminin α-2 subunit (LAMA2). Two of the three factors (LGALS1 and LAMA2) increased expression of pancreatic progenitor transcript levels in a published hESC to beta cell differentiation protocol. In addition, LAMA2 partially blocks cell culture induced beta cell dedifferentiation. Summarily, we provide evidence that proteomic analysis of supporting tissues such as the pancreatic mesenchyme allows for the identification of potentially important factors guiding hESC to pancreas differentiation.

Dynamic Proteomic Analysis of Pancreatic Mesenchyme Reveals Novel Factors That Enhance Human Embryonic Stem Cell to Pancreatic Cell Differentiation

PubMed Central

Russ, Holger A.; Landsman, Limor; Moss, Christopher L.; Higdon, Roger; Greer, Renee L.; Kaihara, Kelly; Salamon, Randy; Kolker, Eugene; Hebrok, Matthias

2016-01-01

Current approaches in human embryonic stem cell (hESC) to pancreatic beta cell differentiation have largely been based on knowledge gained from developmental studies of the epithelial pancreas, while the potential roles of other supporting tissue compartments have not been fully explored. One such tissue is the pancreatic mesenchyme that supports epithelial organogenesis throughout embryogenesis. We hypothesized that detailed characterization of the pancreatic mesenchyme might result in the identification of novel factors not used in current differentiation protocols. Supplementing existing hESC differentiation conditions with such factors might create a more comprehensive simulation of normal development in cell culture. To validate our hypothesis, we took advantage of a novel transgenic mouse model to isolate the pancreatic mesenchyme at distinct embryonic and postnatal stages for subsequent proteomic analysis. Refined sample preparation and analysis conditions across four embryonic and prenatal time points resulted in the identification of 21,498 peptides with high-confidence mapping to 1,502 proteins. Expression analysis of pancreata confirmed the presence of three potentially important factors in cell differentiation: Galectin-1 (LGALS1), Neuroplastin (NPTN), and the Laminin α-2 subunit (LAMA2). Two of the three factors (LGALS1 and LAMA2) increased expression of pancreatic progenitor transcript levels in a published hESC to beta cell differentiation protocol. In addition, LAMA2 partially blocks cell culture induced beta cell dedifferentiation. Summarily, we provide evidence that proteomic analysis of supporting tissues such as the pancreatic mesenchyme allows for the identification of potentially important factors guiding hESC to pancreas differentiation. PMID:26681951

Multicasting for all-optical multifiber networks

NASA Astrophysics Data System (ADS)

Kã¶Ksal, Fatih; Ersoy, Cem

2007-02-01

All-optical wavelength-routed WDM WANs can support the high bandwidth and the long session duration requirements of the application scenarios such as interactive distance learning or on-line diagnosis of patients simultaneously in different hospitals. However, multifiber and limited sparse light splitting and wavelength conversion capabilities of switches result in a difficult optimization problem. We attack this problem using a layered graph model. The problem is defined as a k-edge-disjoint degree-constrained Steiner tree problem for routing and fiber and wavelength assignment of k multicasts. A mixed integer linear programming formulation for the problem is given, and a solution using CPLEX is provided. However, the complexity of the problem grows quickly with respect to the number of edges in the layered graph, which depends on the number of nodes, fibers, wavelengths, and multicast sessions. Hence, we propose two heuristics layered all-optical multicast algorithm [(LAMA) and conservative fiber and wavelength assignment (C-FWA)] to compare with CPLEX, existing work, and unicasting. Extensive computational experiments show that LAMA's performance is very close to CPLEX, and it is significantly better than existing work and C-FWA for nearly all metrics, since LAMA jointly optimizes routing and fiber-wavelength assignment phases compared with the other candidates, which attack the problem by decomposing two phases. Experiments also show that important metrics (e.g., session and group blocking probability, transmitter wavelength, and fiber conversion resources) are adversely affected by the separation of two phases. Finally, the fiber-wavelength assignment strategy of C-FWA (Ex-Fit) uses wavelength and fiber conversion resources more effectively than the First Fit.

The forkhead box m1 transcription factor is essential for embryonic development of pulmonary vasculature.

PubMed

Kim, Il-Man; Ramakrishna, Sneha; Gusarova, Galina A; Yoder, Helena M; Costa, Robert H; Kalinichenko, Vladimir V

2005-06-10

Transgenic and gene knock-out studies demonstrated that the mouse Forkhead Box m1 (Foxm1 or Foxm1b) transcription factor (previously called HFH-11B, Trident, Win, or MPP2) is essential for hepatocyte entry into mitosis during liver development, regeneration, and liver cancer. Targeted deletion of Foxm1 gene in mice produces an embryonic lethal phenotype due to severe abnormalities in the development of liver and heart. In this study, we show for the first time that Foxm1(-/-) lungs exhibit severe hypertrophy of arteriolar smooth muscle cells and defects in the formation of peripheral pulmonary capillaries as evidenced by significant reduction in platelet endothelial cell adhesion molecule 1 staining of the distal lung. Consistent with these findings, significant reduction in proliferation of the embryonic Foxm1(-/-) lung mesenchyme was found, yet proliferation levels were normal in the Foxm1-deficient epithelial cells. Severe abnormalities of the lung vasculature in Foxm1(-/-) embryos were associated with diminished expression of the transforming growth factor beta receptor II, a disintegrin and metalloprotease domain 17 (ADAM-17), vascular endothelial growth factor receptors, Polo-like kinase 1, Aurora B kinase, laminin alpha4 (Lama4), and the Forkhead Box f1 transcription factor. Cotransfection studies demonstrated that Foxm1 stimulates transcription of the Lama4 promoter, and this stimulation requires the Foxm1 binding sites located between -1174 and -1145 bp of the mouse Lama4 promoter. In summary, development of mouse lungs depends on the Foxm1 transcription factor, which regulates expression of genes essential for mesenchyme proliferation, extracellular matrix remodeling, and vasculogenesis.

Loss of laminin alpha 1 results in multiple structural defects and divergent effects on adhesion during vertebrate optic cup morphogenesis

PubMed Central

Bryan, Chase D.; Chien, Chi-Bin; Kwan, Kristen M.

2016-01-01

The vertebrate eye forms via a complex set of morphogenetic events. The optic vesicle evaginates and undergoes transformative shape changes to form the optic cup, in which neural retina and retinal pigmented epithelium enwrap the lens. It has long been known that a complex, glycoprotein-rich extracellular matrix layer surrounds the developing optic cup throughout the process, yet the functions of the matrix and its specific molecular components have remained unclear. Previous work established a role for laminin extracellular matrix in particular steps of eye development, including optic vesicle evagination, lens differentiation, and retinal ganglion cell polarization, yet it is unknown what role laminin might play in the early process of optic cup formation subsequent to the initial step of optic vesicle evagination. Here, we use the zebrafish lama1 mutant (lama1UW1) to determine the function of laminin during optic cup morphogenesis. Using live imaging, we find, surprisingly, that loss of laminin leads to divergent effects on focal adhesion assembly in a spatiotemporally-specific manner, and that laminin is required for multiple steps of optic cup morphogenesis, including optic stalk constriction, invagination, and formation of a spherical lens. Laminin is not required for single cell behaviors and changes in cell shape. Rather, in lama1UW1 mutants, loss of epithelial polarity and altered adhesion lead to defective tissue architecture and formation of a disorganized retina. These results demonstrate that the laminin extracellular matrix plays multiple critical roles regulating adhesion and polarity to establish and maintain tissue structure during optic cup morphogenesis. PMID:27339294

Respiratory CO2 response depends on plasma bicarbonate concentration in mechanically ventilated patients.

PubMed

Rialp, G; Raurich, J M; Llompart-Pou, J A; Ayestarán, I; Ibáñez, J

2014-05-01

There is controversy about the effects of high plasma bicarbonate concentration ([HCO3(-)]) and the CO2 response test. We analyzed the relationship between [HCO3(-)] and the variation in hydrogen ion concentration (pH) for a given change in PaCO2, and its effects upon CO2 response. A retrospective study was carried out. Two intensive care units. Subjects with and without chronic obstructive pulmonary disease (COPD), at the beginning of weaning from mechanical ventilation. The CO2 response was evaluated by the re-inhalation of expired air method, measuring the hypercapnic ventilatory response (ΔVE/ΔPaCO2) and hypercapnic drive response (ΔP01/ΔPaCO2), where VE is minute volume and P0.1 is airway occlusion pressure 0.1s after the initiation of inspiration. [HCO3(-)] and CO2 response. A total of 120 patients in the non-COPD group and 48 in the COPD group were studied. COPD patients had higher mean [HCO3(-)] than non-COPD patients (33.2 ± 5.4 vs. 25.7 ± 3.7 mmol/l, p<0.001). In both non-COPD and COPD patients we observed a significant inverse linear relationship between [HCO3(-)] and pH change per mmHg of PaCO2 (p<0.001), ΔVE/ΔPaCO2 (p<0.001) and ΔP0.1/ΔPaCO2 (p<0.001). There is an inverse linear relationship between [HCO3(-)] and the variation of pH for a given change in PaCO2 and the CO2 response. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model.

PubMed

Bian, Weishuai; Chen, Wei; Chao, Yangong; Wang, Lan; Li, Liming; Guan, Jian; Zang, Xuefeng; Zhen, Jie; Sheng, Bo; Zhu, Xi

2017-04-01

This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H 2 O. The PEEP was reduced by 2 cm H 2 O every 10 min until 0 cm H 2 O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single-breath analysis of CO 2 , and calculated from arterial CO 2 partial pressure (PaCO 2 ) and mixed expired CO 2 (PeCO 2 ) using the following formula: VD/VT = (PaCO 2 - PeCO 2 )/PaCO 2 . The optimal PEEP was identified by the lowest VD/VT method. Respiration and hemodynamic parameters were recorded during the periods of pre-injury and injury, and at 4 and 2 cm H 2 O below and above the optimal PEEP (Po). The optimal PEEP in this study was found to be 13.25±1.36 cm H 2 O. During the Po period, VD/VT decreased to a lower value (0.44±0.08) compared with that during the injury period (0.68±0.10) (P<0.05), while the intrapulmonary shunt fraction reached its lowest value. In addition, a significant change of dynamic tidal respiratory compliance and oxygenation index was induced by PEEP titration. These results indicate that minimal VD/VT can be used for PEEP titration in ARDS.

Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure.

PubMed

Storgaard, Line Hust; Hockey, Hans-Ulrich; Laursen, Birgitte Schantz; Weinreich, Ulla Møller

This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George's Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV 1 ), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO 2 ) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV 1 , FEV 1 %, PaCO 2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device. The average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p <0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively ( p <0.001). The HFNC group had improved mMRC scores from 3 months onward ( p <0.001) and improved SGRQ at 6 and 12 months ( p =0.002, p =0.033) and PaCO 2 ( p =0.005) and 6MWT ( p =0.005) at 12 months. There was no difference in all-cause mortality. HFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.

Magnesium sulfate micro air pump suction for bronchiolitis treatment in infants under two years old.

PubMed

Kan, R-X; Zhang, C-L; Zhen, Q; Chen, J

2016-01-01

To investigate the efficiency, clinical effects and nursing methods related to the use of magnesium sulfate micro air pump suction for treating infants under two years old suffering from bronchiolitis. From January 2014 to September 2014, ninety-six infants with capillary bronchitis were enrolled. Patients were randomly divided into two groups: experimental group (n=49) and control group (n=47). All patients went through conventional anti-inflammatory therapy. Based on this, infants in the control group were additionally treated with intravenous drip of magnesium sulfate while patients in the experimental group were treated with magnesium sulfate micro air pump suction. We recorded all changes in blood gas and clinical scores, the residence time of symptoms and signs of bronchiolitis, and hospitalization time. Results obtained on clinical effects and adverse reactions were compared and analyzed. The Variations of PaO2, PaCO2, SaO2 before treatment in both groups did not show any statistically significant differences (p>0.05); while after treatment analyses demonstrated that in both groups we had an increase in PaO2 and SaO2 and a decrease in PaCO2. The increase in PaO2 and SaO2 values were more pronounced while the decrease observed in PaCO2 was more significant in our experimental group. The total effective rate was significantly higher while the total adverse reaction rate, the resolution time of clinical symptoms and hospitalization time were significantly lower in our experimental group. Magnesium sulfate micro air pump suction was safe and effective in treating with bronchiolitis of infants below 2 years old, and its adverse reaction rate was low, nursing procedure was simple, and nursing difficulty level was low.

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

PubMed

Hassan, Fatma; Sadowski, Laura S; Bangdiwala, Shrikant I; Vizcarra, Beatriz; Ramiro, Laurie; De Paula, Cristiane S; Bordin, Isabel A S; Mitra, M K

2004-06-01

Violence against women is recognized by globally as a serious health and social problem that impedes development. To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. Population-based household surveys. Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. Women aged 15-49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors of actions--namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum) 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Restoring heat stress-associated reduction in middle cerebral artery velocity does not reduce fatigue in the heat.

PubMed

Keiser, S; Flück, D; Stravs, A; Hüppin, F; Lundby, C

2015-06-01

Heat-induced hyperventilation may reduce PaCO2 and thereby cerebral perfusion and oxygenation and in turn exercise performance. To test this hypothesis, eight volunteers completed three incremental exercise tests to exhaustion: (a) 18 °C ambient temperature (CON); (b) 38 °C (HEAT); and (c) 38 °C with addition of CO2 to inspiration to prevent the hyperventilation-induced reduction in PaCO2 (HEAT + CO2 ). In HEAT and HEAT + CO2 , rectal temperature was elevated prior to the exercise tests by means of hot water submersion and was higher (P < 0.05) than in CON. Compared with CON, ventilation was elevated (P < 0.01), and hence, PaCO2 reduced in HEAT. This caused a reduction (P < 0.05) in mean cerebral artery velocity (MCAvmean ) from 68.6 ± 15.5 to 53.9 ± 10.0 cm/s, which was completely restored in HEAT + CO2 (68.8 ± 5.8 cm/s). Cerebral oxygenation followed a similar pattern. V ˙ O 2   m a x was 4.6 ± 0.1 L/min in CON and decreased (P < 0.05) to 4.1 ± 0.2 L/min in HEAT and remained reduced in HEAT + CO2 (4.1 ± 0.2 L/min). Despite normalization of MCAvmean and cerebral oxygenation in HEAT + CO2 , this did not improve exercise performance, and thus, the reduced MCAvmean in HEAT does not seem to limit exercise performance. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cerebral blood volume in humans by NIRS and PET

NASA Astrophysics Data System (ADS)

Pott, Frank; Knudsen, Gitte M.; Rostrup, Egill; Ide, Kojiro; Secher, Niels H.; Paulson, Olaf B.

1997-12-01

Near infrared spectroscopy (NIRS) determined changes in the cerebral blood volume (CBV) were compared to those obtained by positron emission tomography (PET) in five healthy volunteers (2 females). Two NIRS optodes were placed on the left forehead and NIRS-CBV was derived from the sum of oxyhemoglobin and deoxyhemoglobin. CBV changes were induced by hyperventilation and inhalation of 6% CO2. After 2 min inhalation of labeled carbon monoxide, data were sampled during 8 min for both PET- and NIRS-CBV as well as for the arterial carbon dioxide tension (PaCO2). The region of interest for PET-CBV was `banana-shaped' with boundaries corresponding to the position of the NIRS optodes on the transmission scan and to a depth of approximately 2 cm. During hyperventilation, PaCO2 decreased from 5.2 (4.6 - 5.8) to 4.6 (4.2 - 4.9) kPa and equally PET-CBV (from 3.9 (2.5 - 5.2) to 3.6 (3.0 - 4.8) ml (DOT) 100 g-1) and NIRS-CBV were reduced (by -0.14 [-0.38 - 0.50] ml (DOT) 100 g-1). During hypercapnia PaCO2 increased to 6.0 (5.9 - 7.0) kPa accompanied by parallel changes in PET- (to 4.5 (3.9 - 4.9) ml (DOT) 100 g-1) and NIRS-CBV (by 0.04 [-0.02 - 0.30] ml (DOT) 100 g-1) and the two variables were correlated (r equals 0.78, p < 0.05). In conclusion, with a moderate change in the arterial carbon dioxide tension, the cerebral blood volumes determined by near infrared spectroscopy and by positron emission tomography change in parallel but the change in NIRS-CBV is small compared to that obtained by PET.

Cerebral blood volume in humans by NIRS and PET

NASA Astrophysics Data System (ADS)

Pott, Frank; Knudsen, Gitte M.; Rostrup, Egill; Ide, Kojiro; Secher, Niels H.; Paulson, Olaf B.

1998-01-01

Near infrared spectroscopy (NIRS) determined changes in the cerebral blood volume (CBV) were compared to those obtained by positron emission tomography (PET) in five healthy volunteers (2 females). Two NIRS optodes were placed on the left forehead and NIRS-CBV was derived from the sum of oxyhemoglobin and deoxyhemoglobin. CBV changes were induced by hyperventilation and inhalation of 6% CO2. After 2 min inhalation of labeled carbon monoxide, data were sampled during 8 min for both PET- and NIRS-CBV as well as for the arterial carbon dioxide tension (PaCO2). The region of interest for PET-CBV was `banana-shaped' with boundaries corresponding to the position of the NIRS optodes on the transmission scan and to a depth of approximately 2 cm. During hyperventilation, PaCO2 decreased from 5.2 (4.6 - 5.8) to 4.6 (4.2 - 4.9) kPa and equally PET-CBV (from 3.9 (2.5 - 5.2) to 3.6 (3.0 - 4.8) ml (DOT) 100 g-1) and NIRS-CBV were reduced (by -0.14 [-0.38 - 0.50] ml (DOT) 100 g-1). During hypercapnia PaCO2 increased to 6.0 (5.9 - 7.0) kPa accompanied by parallel changes in PET- (to 4.5 (3.9 - 4.9) ml (DOT) 100 g-1) and NIRS-CBV (by 0.04 [-0.02 - 0.30] ml (DOT) 100 g-1) and the two variables were correlated (r equals 0.78, p < 0.05). In conclusion, with a moderate change in the arterial carbon dioxide tension, the cerebral blood volumes determined by near infrared spectroscopy and by positron emission tomography change in parallel but the change in NIRS-CBV is small compared to that obtained by PET.

Hypercapnic Respiratory Acidosis During An In-Flight Oxygen Assessment.

PubMed

Spurling, Kristofer J; Moonsie, Ian K; Perks, Joseph L

2016-02-01

Patients with respiratory disease are at risk of excessive hypoxemia in the hypobaric commercial aircraft cabin environment, and the consensus is that this is easily corrected with supplementary oxygen. However, despite the risks of hypercapnia with increasing inspired oxygen in some patients being well established, this issue is not currently addressed in medical guidelines for air travel. A 76-yr-old woman with chronic type 2 respiratory failure underwent hypoxic challenge testing (HCT) to assess in-flight oxygen requirements. She is stable on home ventilation, and baseline arterial blood gases showed mild hypoxemia (Pao2 9.12 kPa), normal P(a)co(2) (5.64 kPa) and pH (7.36) with 98% S(p)O(2). HCT was performed delivering 15% FIo(2) via a mask, and the patient desaturated to < 85%. HCT blood gases revealed significant hypoxemia (P(a)o(2) < 6.6 kPa), indicating in-flight oxygen. Continuous oxygen at 2 L · min⁻¹ via nasal cannula corrected the hypoxia, although P(a)co(2) increased to 6.9 kPa with reduction in pH to the threshold of severe respiratory acidosis (pH 7.25). The patient was advised against flying due to hypoxemia during HCT and the precipitous drop in pH on oxygen. It is possible to hyperoxygenate patients with type 2 respiratory failure in flight with the minimum level of supplementary oxygen available on many aircraft. In these cases P(a)co(2) and pH should be scrutinized during HCT before recommending in-flight oxygen. No current guidelines discuss the risk of hypercapnia from in-flight oxygen; it is therefore recommended that this be addressed in future revisions of medical air travel guidelines, should further research indicate it.

Dysuria due to discospondylitis and intervertebral disc herniation in a male alpaca (Vicugna pacos).

PubMed

Sickinger, Marlene; Hirz, Manuela; Schmidt, Martin J; Reinacher, Manfred

2016-05-31

Dysuria in camelids is usually associated with the presence of lower urinary tract disease such as urolithiasis. As another differential diagnosis, urine retention may be caused by neurological disturbances resulting from infections of the spinal cord, discospondylitis or trauma. A 2.5-year-old male Huacaya alpaca (Vicugna pacos) presented with dysuria due to damage of the lumbosacral intumescence of the spinal cord. On presentation the alpaca was recumbent. Clinical examination revealed abdominal pain, oliguria, leucopenia with neutrophilia, and slightly elevated creatinine kinase. Ultrasonography of the abdomen showed an irregularly shaped, dilated urinary bladder with hyperechoic serosa. Magnetic resonance imaging revealed discospondylitis of the fourth and fifth lumbar vertebrae and herniation of the intervertebral disc between these vertebrae and the spinal cord. Postmortem examination confirmed severe chronic purulent discospondylitis with ventral spondylosis and narrowing of the spinal canal. Urolithiasis could not be verified. Although rare, diseases of the spinal cord should be considered as a differential diagnosis for impaired micturition in camelids.

Cranial arterial patterns of the alpaca (Camelidae: Vicugna pacos).

PubMed

O'Brien, Haley D

2017-03-01

Artiodactyl cranial arterial patterns deviate significantly from the standard mammalian pattern, most notably in the possession of a structure called the carotid rete (CR)-a subdural arterial meshwork that is housed within the cavernous venous sinus, replacing the internal carotid artery (ICA). This relationship between the CR and the cavernous sinus facilitates a suite of unique physiologies, including selective brain cooling. The CR has been studied in a number of artiodactyls; however, to my knowledge, only a single study to date documents a subset of the cranial arteries of New World camelids (llamas, alpacas, vicugñas and guanacoes). This study is the first complete description of the cranial arteries of a New World camelid species, the alpaca ( Vicugna pacos ), and the first description of near-parturition cranial arterial morphology within New World camelids. This study finds that the carotid arterial system is conserved between developmental stages in the alpaca, and differs significantly from the pattern emphasized in other long-necked ruminant artiodactyls in that a patent, homologous ICA persists through the animal's life.

[Impaired lung function in patients with moderate chronic obstructive bronchitis].

PubMed

Nefedov, V B; Popova, L A; Shergina, E A

2004-01-01

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, RV, Raw, Rin, Rex, DLCO-SS, paO2 and paCO2 were determined in 22 patients with moderate chronic obstructive bronchitis (FEV1, 79-50% of the normal value). All the patients were found to have impaired bronchial patency, 90.9% of the patients had lung volume and capacity changes; pulmonary gas exchange dysfunction was present in 72.7%. Bronchial patency impairments were manifested by a decrease in FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, and an increase in Raw, Rin, Rex. Changes in the lung volumes and capacities appeared as higher RV, TGV, TLC, lower VC and FVC. Pulmonary gas exchange dysfunction showed up as a reduction in pO2 and DLCO-SS a reduction and an increase in paCO2. The magnitude of the functional changes observed in most patients was low. Significant and pronounced disorders were seen in one third of the patients.

Genotypic characterization of Chilean llama (Lama glama) and alpaca (Vicugna pacos) pestivirus isolates.

PubMed

Aguirre, I M; Fuentes, R; Celedón, M O

2014-01-31

Llamas and alpacas are domesticated South American camelids (SACs) important to ancestral population in the Altiplano region, and to different communities worldwide where they have been introduced. These ungulates have shown to be susceptible to several livestock viral pathogens such as members of the Pestivirus genus, in particular Bovine Viral Diarrhea (BVDV), but there is little data available on Pestivirus infections in SACs. In this study we aimed to detect and identify Pestivirus genotypes and subgroups infecting SACs in both wild and confined environments. Samples were collected from 136 llamas and 30 alpacas from different areas in the Chilean Altiplano (wild animals), and from 22 llamas and 26 alpacas diagnosed as Pestivirus positive from the Metropolitana region in Chile (confined animals). Seroneutralization tests showed titers lower than 2 in all 166 samples from Chilean Altiplano. These samples were also negative to BVDV isolation, indicating that these animals have not been exposed to Pestivirus. After reactivation of positive samples from the Metropolitana region, the 5' non-codifying region (5'NCR) and E2 glycoprotein were amplified by RT-PCR from the Pestivirus genome. Viral sequences were pairwise compared and phylogenetic trees were constructed. The 5'NCR analysis showed that all 12 sequenced isolates belonged to BVDV-1. Of particular interest, isolates from eight llama and two alpaca were BVDV-1j and two alpacas were BVDV-1b. In agreement with these results, E2 phylogenetic analysis rendered a similar grouping indicating that all 16 isolates belong to BVDV-1. However, the lower availability of E2 sequences determines the creation of a smaller number of sub-groups than the 5'NCR sequences. Based on the E2 sequences, the 5'NCR BVDV 1j group consisting of all the llamas and 3 alpacas are completely included in the E2 BVDV 1e group. Due to the universal availability of the 5'NCR segment, we propose the classification of these Chilean llamas and alpacas Pestivirus isolates as BVDV 1j and BVDV 1b respectively. Thus, this is the first time BVDV-1j is obtained in SACs. In addition, these results indicate Pestivirus infection in llamas and alpacas is associated with bovine population as genotypes and sub-groups are the same as those affecting Chilean livestock. Copyright © 2013 Elsevier B.V. All rights reserved.

Simbolos Nacionales. National Symbols.

ERIC Educational Resources Information Center

Toro, Leonor

Written in Spanish and English, this booklet contains information on Puerto Rico's national symbols, including its anthem, emblem, and flag. Verses to "La Borinquena," the national anthem, are given , as well as the song's historical background and musical evolution, covering contributions of Felix Astol Artes, Paco Ramirez Ortiz, Lola Rodriques…

Preparation of A Spaceflight: Apoptosis Search in Sutured Wound Healing Models.

PubMed

Riwaldt, Stefan; Monici, Monica; Graver Petersen, Asbjørn; Birk Jensen, Uffe; Evert, Katja; Pantalone, Desiré; Utpatel, Kirsten; Evert, Matthias; Wehland, Markus; Krüger, Marcus; Kopp, Sascha; Frandsen, Sofie; Corydon, Thomas; Sahana, Jayashree; Bauer, Johann; Lützenberg, Ronald; Infanger, Manfred; Grimm, Daniela

2017-12-03

To prepare the ESA (European Space Agency) spaceflight project "Wound healing and Sutures in Unloading Conditions", we studied mechanisms of apoptosis in wound healing models based on ex vivo skin tissue cultures, kept for 10 days alive in serum-free DMEM/F12 medium supplemented with bovine serum albumin, hydrocortisone, insulin, ascorbic acid and antibiotics at 32 °C. The overall goal is to test: (i) the viability of tissue specimens; (ii) the gene expression of activators and inhibitors of apoptosis and extracellular matrix components in wound and suture models; and (iii) to design analytical protocols for future tissue specimens after post-spaceflight download. Hematoxylin-Eosin and Elastica-van-Gieson staining showed a normal skin histology with no signs of necrosis in controls and showed a normal wound suture. TdT-mediated dUTP-biotin nick end labeling for detecting DNA fragmentation revealed no significant apoptosis. No activation of caspase-3 protein was detectable. FASL , FADD , CASP3 , CASP8 , CASP10 , BAX , BCL2 , CYC1 , APAF1 , LAMA3 and SPP1 mRNAs were not altered in epidermis and dermis samples with and without a wound compared to 0 day samples (specimens investigated directly post-surgery). BIRC5 , CASP9 , and FN1 mRNAs were downregulated in epidermis/dermis samples with and/or without a wound compared to 0 day samples. BIRC2 , BIRC3 were upregulated in 10 day wound samples compared to 0 day samples in epidermis/dermis. RELA/FAS mRNAs were elevated in 10 day wound and no wound samples compared to 0 day samples in dermis. In conclusion, we demonstrate that it is possible to maintain live skin tissue cultures for 10 days. The viability analysis showed no significant signs of cell death in wound and suture models. The gene expression analysis demonstrated the interplay of activators and inhibitors of apoptosis and extracellular matrix components, thereby describing important features in ex vivo sutured wound healing models. Collectively, the performed methods defining analytical protocols proved to be applicable for post-flight analyzes of tissue specimens after sample return.

Molecular Characterization of the Llamas (Lama glama) Casein Cluster Genes Transcripts (CSN1S1, CSN2, CSN1S2, CSN3) and Regulatory Regions

PubMed Central

Pauciullo, Alfredo; Erhardt, Georg

2015-01-01

In the present paper, we report for the first time the characterization of llama (Lama glama) caseins at transcriptomic and genetic level. A total of 288 casein clones transcripts were analysed from two lactating llamas. The most represented mRNA populations were those correctly assembled (85.07%) and they encoded for mature proteins of 215, 217, 187 and 162 amino acids respectively for the CSN1S1, CSN2, CSN1S2 and CSN3 genes. The exonic subdivision evidenced a structure made of 21, 9, 17 and 6 exons for the αs1-, β-, αs2- and κ-casein genes respectively. Exon skipping and duplication events were evidenced. Two variants A and B were identified in the αs1-casein gene as result of the alternative out-splicing of the exon 18. An additional exon coding for a novel esapeptide was found to be cryptic in the κ-casein gene, whereas one extra exon was found in the αs2-casein gene by the comparison with the Camelus dromedaries sequence. A total of 28 putative phosphorylated motifs highlighted a complex heterogeneity and a potential variable degree of post-translational modifications. Ninety-six polymorphic sites were found through the comparison of the lama casein cDNAs with the homologous camel sequences, whereas the first description and characterization of the 5’- and 3’-regulatory regions allowed to identify the main putative consensus sequences involved in the casein genes expression, thus opening the way to new investigations -so far- never achieved in this species. PMID:25923814

Molecular Characterization of the Llamas (Lama glama) Casein Cluster Genes Transcripts (CSN1S1, CSN2, CSN1S2, CSN3) and Regulatory Regions.

PubMed

Pauciullo, Alfredo; Erhardt, Georg

2015-01-01

In the present paper, we report for the first time the characterization of llama (Lama glama) caseins at transcriptomic and genetic level. A total of 288 casein clones transcripts were analysed from two lactating llamas. The most represented mRNA populations were those correctly assembled (85.07%) and they encoded for mature proteins of 215, 217, 187 and 162 amino acids respectively for the CSN1S1, CSN2, CSN1S2 and CSN3 genes. The exonic subdivision evidenced a structure made of 21, 9, 17 and 6 exons for the αs1-, β-, αs2- and κ-casein genes respectively. Exon skipping and duplication events were evidenced. Two variants A and B were identified in the αs1-casein gene as result of the alternative out-splicing of the exon 18. An additional exon coding for a novel esapeptide was found to be cryptic in the κ-casein gene, whereas one extra exon was found in the αs2-casein gene by the comparison with the Camelus dromedaries sequence. A total of 28 putative phosphorylated motifs highlighted a complex heterogeneity and a potential variable degree of post-translational modifications. Ninety-six polymorphic sites were found through the comparison of the lama casein cDNAs with the homologous camel sequences, whereas the first description and characterization of the 5'- and 3'-regulatory regions allowed to identify the main putative consensus sequences involved in the casein genes expression, thus opening the way to new investigations -so far- never achieved in this species.

Pharmacological treatment optimization for stable chronic obstructive pulmonary disease. Proposals from the Société de Pneumologie de Langue Française.

PubMed

Zysman, M; Chabot, F; Devillier, P; Housset, B; Morelot-Panzini, C; Roche, N

2016-12-01

The Société de Pneumologie de Langue Française proposes a decision algorithm on long-term pharmacological COPD treatment. A working group reviewed the literature published between January 2009 and May 2016. This document lays out proposals and not guidelines. It only focuses on pharmacological treatments except vaccinations, smoking cessation treatments and oxygen therapy. Any COPD diagnosis, based on pulmonary function tests, should lead to recommend smoking cessation, vaccinations, physical activity, pulmonary rehabilitation in case of activity limitation, and short-acting bronchodilators. Symptoms like dyspnea and exacerbations determine the therapeutic choices. In case of daily dyspnea and/or exacerbations, a long-acting bronchodilator should be suggested (beta-2 agonist, LABA or anticholinergics, LAMA). A clinical and lung function reevaluation is suggested 1 to 3 months after any treatment modification and every 3-12 months according to the severity of the disease. In case of persisting dyspnea, a fixed dose LABA+LAMA combination improves pulmonary function (FEV1), quality of life, dyspnea and decreases exacerbations without increasing side effects. In case of frequent exacerbations and a FEV1≤70%, a fixed dose long-acting bronchodilator combination or a LABA+ inhaled corticosteroids (ICS) combination can be proposed. A triple combination (LABA+LAMA+ICS) is indicated when exacerbations persist despite one of these combinations. Dyspnea in spite of a bronchodilator combination or exacerbations in spite of a triple combination should lead to consider other pharmacological treatments (theophylline if dyspnea, macrolides if exacerbations, low-dose opioids if refractory dyspnea). Copyright © 2016. Published by Elsevier Masson SAS.

Impact of process improvements on measures of emergency department efficiency.

PubMed

Leung, Alexander K; Whatley, Shawn D; Gao, Dechang; Duic, Marko

2017-03-01

To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained. Patients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005). A combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

Anthelmintic resistance in a herd of alpacas (Vicugna pacos)

PubMed Central

Galvan, Noe; Middleton, John R.; Nagy, Dusty W.; Schultz, Loren G.; Schaeffer, Josh W.

2012-01-01

A herd of alpacas was examined because of a history of severe endoparasitism, anemia, hypoproteinemia, and weight loss. Resistance of gastrointestinal nematodes to albendazole, fenbendazole, and doramectin was documented. This report suggests that anthelmintic resistance may be an emerging problem in South American camelids in North America. PMID:23729829

A review of coccidiosis in South American camelids

USDA-ARS?s Scientific Manuscript database

Camelids (llama, alpaca, vicuñas, guanacos) are important for the economy of South America and Eimeria infections are important as cause of mortality in camelids. Of the five valid species of Eimeria in South American camelids, Eimeria macusaniensis, Eimeria lamae, Eimeria alpacae, Eimeria punoensis...

International Politics of the Reincarnation of the Dalai Lama

DTIC Science & Technology

2007-06-01

8 4. Unanswered Questions and Challenges ...........................................11 C. METHODS AND SOURCES...62 3. How do Political Interest Groups Differ ?........................................64 a. Supporters...government of Afghanistan.2 Ethnic minorities espousing different religions in China’s western regions potentially constitute the same threat to Chinese

Application of DNA forensic techniques for identifying poached guanacos (Lama guanicoe) in Chilean Patagonia*.

PubMed

Marín, Juan C; Saucedo, Cristian E; Corti, Paulo; González, Benito A

2009-09-01

Guanaco (Lama guanicoe) is a protected and widely distributed ungulate in South America. A poacher, after killing guanacos in Valle Chacabuco, Chilean Patagonia, transported and stored the meat. Samples were retrieved by local police but the suspect argued that the meat was from a horse. Mitochondrial cytochrome b gene (774 pb), 15 loci microsatellites, and SRY gene were used to identify the species, number of animals and their population origin, and the sex of the animals, respectively. Analysis revealed that the samples came from a female (absence of SRY gene) Patagonian guanaco (assignment probability between 0.0075 and 0.0282), and clearly distinguishing it from sympatric ungulates (E-value = 0). Based on the evidence obtained in the field in addition to forensic data, the suspect was convicted of poaching and illegally carrying fire arms. This is the first report of molecular tools being used in forensic investigations of Chilean wildlife indicating its promising future application in guanaco management and conservation.

[The behavior of arterial and mixed venous oxygen and carbon dioxide partial pressure and the pH value during and following intubation apnoea. Studies on the occurrence of the Christiansen-Douglas-Haldane effect].

PubMed

Merkelbach, D; Brandt, L; Mertzlufft, F

1993-10-01

The Christiansen-Douglas-Haldane effect describes the reduced CO2 binding capacity of oxygenated compared to deoxygenated haemoglobin. Under the condition of a "closed system", for example hyperoxic apnoea after adequate preoxygenation (continuous O2 uptake with lack of CO2 delivery), specific effects on the arterial and mixed venous blood gas status, due to the Haldane effect, are seen: within 30 s after onset of apnoea, "paradoxical pCO2" (paCO2 exceeds pvCO2) and "pH reversal" (pHa falls under pHv) can be observed. It was the aim of this study to demonstrate how fast arterial and mixed venous pCO2 and pH normalize when a change from apnoea ("closed system") to controlled ventilation ("open system") takes place. METHODS. 12 patients (ASA II-IV, NYHA II-III) scheduled for coronary artery bypass grafting were studied. Premedication consisted of flunitrazepam 2.0 mg p.o. given the evening before operation and another 2.0 mg p.o. given 90-120 min before induction of anaesthesia. Routine preparation for induction consisted of venous and arterial cannulas, pulmonary artery catheter and continuous pulse oximetry. Following standardized preoxygenation, induction of anaesthesia was performed with fentanyl, pancuronium and etomidate. After cessation of spontaneous respiration, controlled ventilation was continued with 100% O2 until intubation. Intubation and insertion of stomach tube and oesophageal temperature probe were undertaken after exactly 2 min. After reconnection to the semi-closed circle breathing system, controlled ventilation was continued with 100% O2. Eighteen arterial (a) and 18 mixed-venous (v) blood samples were drawn simultaneously in a sequential manner immediately before and during the last 20 s of apnoea, as well as within 4 min after onset of controlled ventilation (Table 1). The pO2 (mmHg), pCO2 (mmHg) and pH were determined using a Stat Profile 5 blood gas analyser. RESULTS. During apnoea and within the first 35 s of controlled ventilation the paO2 showed a total decrease of 131.5 mmHg that was followed by an almost linear increase of 29.7 mmHg/min (Fig. 1a). In the course of apnoea and controlled ventilation the pvO2 remained relatively stable, with values ranging from 42 to 43 mmHg (Fig. 1b). During apnoea the paCO2 showed an increase of 12.5 mmHg that was followed by a biphasic decrease (first 13.8 mmHg/min and then 0.75 mmHg/min) beginning 15 s after the onset of controlled ventilation (Fig. 2a). With an increase of 4.2 mmHg, the pvCO2 showed about a third of the increase of the paCO2 during apnoea, reaching a maximum 45 s after the onset of controlled ventilation and then being followed by a linear decrease of 0.86 mmHg/min (Fig.2b). Comparing the course of paCO2 and pvCO2 during apnoea as well as during the period of controlled ventilation, pHa and pHv changed in a reciprocal manner (Fig. 3a/b). The so-called normalization of pCO2 (paCO2 falls under pvCO2) and pH (pHa exceeds pHv) began 18.2 s and 23.2 s respectively after the onset of controlled ventilation (Fig. 4a, b). CONCLUSION. Considering the expected decrease of paO2 during hyperoxic apnoea, insufficient pulmonary N2 elimination prior to the onset of apnoea, as well as direct N2 delivery into the alveoli, due to the so-called a ventilatory mass flow, will limit unrestricted pulmonary O2 uptake. The continuing decrease of the paCO2 after the onset of controlled ventilation can be regarded as indirect proof of a ventilatory mass flow. The course of pCO2 and pH after the onset of controlled ventilation shows that normalization in arterial and mixed-venous blood gas status takes place in about 18.2 s after the cessation of apnoea.

Genetic variation of the prion protein gene (PRNP) in alpaca (Vicugna pacos)

USDA-ARS?s Scientific Manuscript database

Transmissible spongiform encephalopathies (TSE) are caused by accumulation of a misfolded form of the prion protein (PrP). The normal cellular isoform of PrP is produced by the prion gene (PRNP) and is highly expressed in the central nervous system. Currently, there is an absence of information rega...

Cranial arterial patterns of the alpaca (Camelidae: Vicugna pacos)

PubMed Central

2017-01-01

Artiodactyl cranial arterial patterns deviate significantly from the standard mammalian pattern, most notably in the possession of a structure called the carotid rete (CR)—a subdural arterial meshwork that is housed within the cavernous venous sinus, replacing the internal carotid artery (ICA). This relationship between the CR and the cavernous sinus facilitates a suite of unique physiologies, including selective brain cooling. The CR has been studied in a number of artiodactyls; however, to my knowledge, only a single study to date documents a subset of the cranial arteries of New World camelids (llamas, alpacas, vicugñas and guanacoes). This study is the first complete description of the cranial arteries of a New World camelid species, the alpaca (Vicugna pacos), and the first description of near-parturition cranial arterial morphology within New World camelids. This study finds that the carotid arterial system is conserved between developmental stages in the alpaca, and differs significantly from the pattern emphasized in other long-necked ruminant artiodactyls in that a patent, homologous ICA persists through the animal's life. PMID:28405385

A novel pulmonary polyomavirus in alpacas (Vicugna pacos).

PubMed

Dela Cruz, Florante N; Li, Linlin; Delwart, Eric; Pesavento, P A

2017-03-01

Viral metagenomic analysis detected a novel polyomavirus in a 6-month old female alpaca (Vicugna pacos) euthanized after a diagnosis of disseminated lymphosarcoma. The viral genome was fully sequenced, found to be similar to other polyomaviruses in gene architecture and provisionally named Alpaca polyomavirus or AlPyV. Viral nucleic acid was detected by PCR in venous blood, spleen, thymus, and lung. AlPyV phylogenetically clustered in the "Wuki" group of PyVs, which includes WU and KI polyomaviruses, commonly found in human respiratory samples. In an ISH analysis of 17 alpaca necropsies, 7 had detectable virus within the lung. In animals without pneumonia, probe hybridization was restricted to the nuclei of scattered individual bronchiolar epithelial cells. Three of the ISH positive alpacas had interstitial pneumonia of unknown origin, and in these animals there was viral nucleic acid detected in bronchiolar epithelium, type II pneumocytes, and alveolar macrophages. The pattern of AlPyV distribution is consistent with a persistent respiratory virus that has a possible role in respiratory disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Acute renal response to rapid onset respiratory acidosis.

PubMed

Ramadoss, Jayanth; Stewart, Randolph H; Cudd, Timothy A

2011-03-01

Renal strong ion compensation to chronic respiratory acidosis has been established, but the nature of the response to acute respiratory acidosis is not well defined. We hypothesized that the response to acute respiratory acidosis in sheep is a rapid increase in the difference in renal fractional excretions of chloride and sodium (Fe(Cl) - Fe(Na)). Inspired CO(2) concentrations were increased for 1 h to significantly alter P(a)CO(2) and pH(a) from 32 ± 1 mm Hg and 7.52 ± 0.02 to 74 ± 2 mm Hg and 7.22 ± 0.02, respectively. Fe(Cl) - Fe(Na) increased significantly from 0.372 ± 0.206 to 1.240 ± 0.217% and returned to baseline at 2 h when P(a)CO(2) and pH(a) were 37 ± 0.6 mm Hg and 7.49 ± 0.01, respectively. Arterial pH and Fe(Cl) - Fe(Na) were significantly correlated. We conclude that the kidney responds rapidly to acute respiratory acidosis, within 30 min of onset, by differential reabsorption of sodium and chloride.

[Pulmonary function in patients with infiltrative pulmonary tuberculosis].

PubMed

Nefedov, V B; Popova, L A; Shergina, E A

2007-01-01

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), R(aw), R(in),, R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 103 patients with infiltrative pulmonary tuberculosis. Pulmonary dysfunction was detected in 83.5% of the patients. Changes were found in lung volumes and capacities in 63.1%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 60.2 and 41.7%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC and FVC, and decreased and increased TGV and TLC; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, FEV1/VC% and increased R(aw) R(in), and R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, and PaO2 and decreased and increased PaCO2. The magnitude of the observed functional changes was generally slight. Significant disorders were observed rarely and very pronounced ones were exceptional.

[Pulmonary function in patients with disseminated pulmonary tuberculosis].

PubMed

Nefedov, V B; Shergina, E A; Popova, L A

2007-01-01

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25%, MEF50%, MEF75%, TLS, TGV, pulmonary residual volume (PRV), Raw, Rin, Rex, DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 29 patients with disseminated pulmonary tuberculosis. Pulmonary dysfunction was detected in 93.1% of the patients. Changes were found in lung volumes and capacities in 65.5%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 79.3 and 37.9%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC, FVC, and TLS, decreased and increased TGV; impaired bronchial patency presented as decreased PEF, MEF25%, MEF50%, MEF75%, and FEV1/VC% and increased Raw, Rin, and Rex; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SS and PaO2 and decreased and increased PaCO2. The observed functional changes varied from slight to significant and pronounced with a preponderance of small disorders, a lower detection rate of significant disorders, and rare detection of very pronounced ones.

U.S. EPA, Pesticide Product Label, , 04/25/1975

EPA Pesticide Factsheets

2011-04-14

... Examint' cpt tOil I,ianl:, (';1 l'l,l'l Ill\\' al1d if allY l''.·idpl1c(' ()f :-'c,U':, 01' i)tlte!'

Arts-Based Leadership: Theatrical Tributes

ERIC Educational Resources Information Center

Soumerai, Eve Nussbaum; Mazer, Rachel

2006-01-01

The first part of this article describes how, as an independent educator, Eve Nussbaum Soumerai developed numerous theatrical tributes to inspirational historical figures (Anne Frank, Martin Luther King, Jr., and the Dalai Lama, for example). By participating in these productions, young people learned about the lives of these figures and shared…

76 FR 20011 - Mark De La Lama, P.A.; Denial of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... had been convicted (in 1985) in Thailand of possession and attempted smuggling of marijuana, as well... an explanation of the circumstances surrounding a 1992 marijuana conviction. Id. Respondent wrote... Attempted Smuggling'' of approximately 145 grams of marijuana. GX 3, at 1. The court suspended the 21-month...

Improved packing of protein side chains with parallel ant colonies.

PubMed

Quan, Lijun; Lü, Qiang; Li, Haiou; Xia, Xiaoyan; Wu, Hongjie

2014-01-01

The accurate packing of protein side chains is important for many computational biology problems, such as ab initio protein structure prediction, homology modelling, and protein design and ligand docking applications. Many of existing solutions are modelled as a computational optimisation problem. As well as the design of search algorithms, most solutions suffer from an inaccurate energy function for judging whether a prediction is good or bad. Even if the search has found the lowest energy, there is no certainty of obtaining the protein structures with correct side chains. We present a side-chain modelling method, pacoPacker, which uses a parallel ant colony optimisation strategy based on sharing a single pheromone matrix. This parallel approach combines different sources of energy functions and generates protein side-chain conformations with the lowest energies jointly determined by the various energy functions. We further optimised the selected rotamers to construct subrotamer by rotamer minimisation, which reasonably improved the discreteness of the rotamer library. We focused on improving the accuracy of side-chain conformation prediction. For a testing set of 442 proteins, 87.19% of X1 and 77.11% of X12 angles were predicted correctly within 40° of the X-ray positions. We compared the accuracy of pacoPacker with state-of-the-art methods, such as CIS-RR and SCWRL4. We analysed the results from different perspectives, in terms of protein chain and individual residues. In this comprehensive benchmark testing, 51.5% of proteins within a length of 400 amino acids predicted by pacoPacker were superior to the results of CIS-RR and SCWRL4 simultaneously. Finally, we also showed the advantage of using the subrotamers strategy. All results confirmed that our parallel approach is competitive to state-of-the-art solutions for packing side chains. This parallel approach combines various sources of searching intelligence and energy functions to pack protein side chains. It provides a frame-work for combining different inaccuracy/usefulness objective functions by designing parallel heuristic search algorithms.

Effects of inspiratory pause on CO2 elimination and arterial PCO2 in acute lung injury

PubMed Central

Devaquet, Jérôme; Jonson, Björn; Niklason, Lisbet; Si Larbi, Anne-Gaëlle; Uttman, Leif; Aboab, Jérôme; Brochard, Laurent

2008-01-01

A high respiratory rate associated with the use of small tidal volumes, recommended for acute lung injury (ALI), shortens time for gas diffusion in the alveoli. This may decrease CO2 elimination. We hypothesized that a post-inspiratory pause could enhance CO2 elimination and reduce PaCO2 by reducing dead space in ALI. In 15 mechanically ventilated patients with ALI and hypercapnia, a 20% post-inspiratory pause (Tp20) was applied during a period of 30 min between two ventilation periods without post-inspiratory pause (Tp0). Other parameters were kept unchanged. The single breath test for CO2 was recorded every 5 minutes to measure tidal CO2 elimination (VtCO2), airway dead space (VDaw) and slope of the alveolar plateau. PaO2, PaCO2, physiological and alveolar dead space (VDphys, VDalv) were determined at the end of each 30 minute period. The post-inspiratory pause, 0.7±0.2 s, induced on average less than 0.5 cm H2O of intrinsic PEEP. During Tp20, VtCO2 increased immediately by 28±10% (14±5 ml per breath compared to 11±4 for Tp0) and then decreased without reaching the initial value within 30 minutes. The addition of a post-inspiratory pause decreased significantly VDaw by 14% and VDphys by 11% with no change in VDalv. During Tp20, the slope of alveolar plateau initially fell to 65±10 % of baseline value and continued to decrease. Tp20 induced a 10±3% decrease in PaCO2 at 30 minutes (from 55±10 to 49±9 mmHg, p<0.001) with no significant variation in PaO2. Post-inspiratory pause has a significant influence on CO2 elimination when small tidal volumes are used during mechanical ventilation for ALI. PMID:18801962

Effects of Changes in Arterial Carbon Dioxide and Oxygen Partial Pressures on Cerebral Oximeter Performance.

PubMed

Schober, Andrew; Feiner, John R; Bickler, Philip E; Rollins, Mark D

2018-01-01

Cerebral oximetry (cerebral oxygen saturation; ScO2) is used to noninvasively monitor cerebral oxygenation. ScO2 readings are based on the fraction of reduced and oxidized hemoglobin as an indirect estimate of brain tissue oxygenation and assume a static ratio of arterial to venous intracranial blood. Conditions that alter cerebral blood flow, such as acute changes in PaCO2, may decrease accuracy. We assessed the performance of two commercial cerebral oximeters across a range of oxygen concentrations during normocapnia and hypocapnia. Casmed FORE-SIGHT Elite (CAS Medical Systems, Inc., USA) and Covidien INVOS 5100C (Covidien, USA) oximeter sensors were placed on 12 healthy volunteers. The fractional inspired oxygen tension was varied to achieve seven steady-state levels including hypoxic and hyperoxic PaO2 values. ScO2 and simultaneous arterial and jugular venous blood gas measurements were obtained with both normocapnia and hypocapnia. Oximeter bias was calculated as the difference between the ScO2 and reference saturation using manufacturer-specified weighting ratios from the arterial and venous samples. FORE-SIGHT Elite bias was greater during hypocapnia as compared with normocapnia (4 ± 9% vs. 0 ± 6%; P < 0.001). The INVOS 5100C bias was also lower during normocapnia (5 ± 15% vs. 3 ± 12%; P = 0.01). Hypocapnia resulted in a significant decrease in mixed venous oxygen saturation and mixed venous oxygen tension, as well as increased oxygen extraction across fractional inspired oxygen tension levels (P < 0.0001). Bias increased significantly with increasing oxygen extraction (P < 0.0001). Changes in PaCO2 affect cerebral oximeter accuracy, and increased bias occurs with hypocapnia. Decreased accuracy may represent an incorrect assumption of a static arterial-venous blood fraction. Understanding cerebral oximetry limitations is especially important in patients at risk for hypoxia-induced brain injury, where PaCO2 may be purposefully altered.

Evolutionary adaptation of the sensitivity of connexin26 hemichannels to CO2.

PubMed

de Wolf, Elizabeth; Cook, Jonathan; Dale, Nicholas

2017-02-08

CO 2 readily combines with H 2 O to form [Formula: see text] and H + Because an increase of only 100 nM in the concentration of H + (a decrease of 0.1 unit of pH) in blood can prove fatal, the regulated excretion of CO 2 during breathing is an essential life-preserving process. In rodents and humans, this vital process is mediated in part via the direct sensing of CO 2 via connexin26 (Cx26). CO 2 binds to hemichannels of Cx26 causing them to open and allow release of the neurotransmitter ATP. If Cx26 were to be a universal and important CO 2 sensor across all homeothermic animals, then a simple hypothesis would posit that it should exhibit evolutionary adaptation in animals with different homeostatic set points for the regulation of partial pressure of arterial CO 2 (PaCO 2 ). In humans and rats, PaCO 2 is regulated around a set point of 40 mmHg. By contrast, birds are able to maintain cerebral blood flow and breathing at much lower levels of PaCO 2 Fossorial mammals, such as the mole rat, live exclusively underground in burrows that are both hypoxic and hypercapnic and can thrive under very hypercapnic conditions. We have therefore compared the CO 2 sensitivity of Cx26 from human, chicken, rat and mole rat (Heterocephalus glaber). We find that both the affinity and cooperativity of CO 2 binding to Cx26 have been subjected to evolutionary adaption in a manner consistent with the homeostatic requirements of these four species. This is analogous to the evolutionary adaptation of haemoglobin to the needs of O 2 transport across the animal kingdom and supports the hypothesis that Cx26 is an important and universal CO 2 sensor in homeotherms. © 2017 The Authors.

Non-invasive measurement of the mean alveolar O(2) tension from the oxygen uptake versus tidal volume curve.

PubMed

Jordanoglou, J; Latsi, P; Chroneou, A; Koulouris, N G

2007-10-01

The classical equations for measuring the mean and the ideal alveolar O(2) tension are based on assumptions, which are shown to be invalid. So we thought to develop a new, non-invasive method for measuring the mean alveolar P,O(2) within the volume domain (PA,O(2(Bohr))). This method is based on the oxygen uptake vs. tidal volume curve (VO(2) vs. VT) obtained during tidal breathing of room air and/or air enriched with oxygen. PA,O(2(Bohr)) and the ideal alveolar PO(2) (PA,O(2(ideal))) were simultaneously measured in 10 healthy subjects and 34 patients suffering from chronic obstructive pulmonary disease (COPD) breathing tidally room air at rest. Additionally, 10 subjects (three healthy subjects and seven COPD patients) were studied while breathing initially room air and subsequently air enriched with oxygen. According to the results, PA,O(2(Bohr)) considerably differed from PA,O(2(ideal)) (P = 0.004). The cause of the difference, at the individual's R, is: (1) the difference between the arterial and Bohr's alveolar CO(2) tension, mainly in COPD patients, and (2) the inequality between Bohr's alveolar part of the tidal volume for CO(2) and O(2). Furthermore, end-tidal gas tension (PET,CO(2) and PET,O(2)) differed from Pa,CO(2) and PA,O(2(Bohr)) respectively. The deviation of PA,O(2(Bohr)) from PA,O(2(ideal)) has a definite impact on Bohr's dead space ratio for O(2) and CO(2), and on the alveolar-arterial O(2) difference. The difference (PA,O(2(Bohr)) - PA,O(2(ideal))) is not related to the pathology of the disease. So, gas exchange within the lungs should be assessed at the subject's R from PA,O(2(Bohr)) and PA,CO(2(Bohr)) but not from PA,O(2(ideal)) nor Pa,CO(2).

Optimal clinical time for reliable measurement of transcutaneous CO2 with ear probes: counterbalancing overshoot and the vasodilatation effect.

PubMed

Domingo, Christian; Canturri, Elisa; Moreno, Amalia; Espuelas, Humildad; Vigil, Laura; Luján, Manel

2010-01-01

To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO(2)) and transcutaneous CO(2) (TcPCO(2)) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO(2)). EXPERIMENTAL SECTION: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO(2) and TcPCO(2) with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1-1.9 mm Hg); (b) moderate (2-4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO(2) and TcPCO(2) and arterial values of PaCO(2) and SpO(2). The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV(1): 72.9 ± 23.9%; FEV(1)/FVC: 70 ± 15.5%. ABG: PaO(2): 82.6 ± 13.2; PaCO(2): 39.9.1 ± 4.8 mmHg; SaO(2): 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO(2) was -0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO(2), measurements were reliable at minute 2. The optimal clinical reading measurement recommended for the ear lobe TcPCO(2) measurement ranges between minute 12 and 14. The SpO(2) measurement can be performed at minute 2.

Optimal Clinical Time for Reliable Measurement of Transcutaneous CO2 with Ear Probes: Counterbalancing Overshoot and the Vasodilatation Effect

PubMed Central

Domingo, Christian; Canturri, Elisa; Moreno, Amalia; Espuelas, Humildad; Vigil, Laura; Luján, Manel

2010-01-01

OBJECTIVES: To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO2) and transcutaneous CO2 (TcPCO2) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO2). EXPERIMENTAL SECTION: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO2 and TcPCO2 with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1–1.9 mm Hg); (b) moderate (2–4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO2 and TcPCO2 and arterial values of PaCO2 and SpO2. The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. RESULTS: The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV1: 72.9 ± 23.9%; FEV1/FVC: 70 ± 15.5%. ABG: PaO2: 82.6 ± 13.2; PaCO2: 39.9.1 ± 4.8 mmHg; SaO2: 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO2 was −0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO2, measurements were reliable at minute 2. CONCLUSIONS: The optimal clinical reading measurement recommended for the ear lobe TcPCO2 measurement ranges between minute 12 and 14. The SpO2 measurement can be performed at minute 2. PMID:22315552

Comparison of the respiratory effects of intravenous buprenorphine and fentanyl in humans and rats.

PubMed

Dahan, A; Yassen, A; Bijl, H; Romberg, R; Sarton, E; Teppema, L; Olofsen, E; Danhof, M

2005-06-01

There is evidence from animal studies suggesting the existence of a ceiling effect for buprenorphine-induced respiratory depression. To study whether an apparent ceiling effect exists for respiratory depression induced by buprenorphine, we compared the respiratory effects of buprenorphine and fentanyl in humans and rats. In healthy volunteers, the opioids were infused i.v. over 90 s and measurements of minute ventilation at a fixed end-tidal PCO2 of 7 kPa were obtained for 7 h. Buprenorphine doses were 0.7, 1.4, 4.3 and 8.6 microg kg(-1) (n=20 subjects) and fentanyl doses 1.1, 2.1, 2.9, 4.3 and 7.1 microg kg(-1) (n=21). Seven subjects received placebo. In rats, both opioids were infused i.v. over 20 min, and arterial PCO2 was measured 5, 10, 15 and 20 min after the start of fentanyl infusion and 30, 150, 270 and 390 min after the start of buprenorphine infusion. Doses tested were buprenorphine 0, 100, 300, 1000 and 3000 microg kg(-1) and fentanyl 0, 50, 68 and 90 microg kg(-1). In humans, fentanyl produced a dose-dependent depression of minute ventilation with apnoea at doses > or = 2.9 microg kg(-1); buprenorphine caused depression of minute ventilation which levelled off at doses > or = 3.0 microg kg(-1) to about 50% of baseline. In rats, the relationship of arterial PCO2 and fentanyl dose was linear, with maximum respiratory depression at 20 min (maximum PaCO2 8.0 kPa). Irrespective of the time at which measurements were obtained, buprenorphine showed a non-linear effect on PaCO2, with a ceiling effect at doses > 1.4 microg kg(-1). The effect on PaCO2 was modest (maximum value measured, 5.5 kPa). Our data confirm a ceiling effect of buprenorphine but not fentanyl with respect to respiratory depression.

[What is the contribution of Stewart's concept in acid-base disorders analysis?].

PubMed

Quintard, H; Hubert, S; Ichai, C

2007-05-01

To explain the different approaches for interpreting acid-base disorders; to develop the Stewart model which offers some advantages for the pathophysiological understanding and the clinical interpretation of acid-base imbalances. Record of french and english references from Medline data base. The keywords were: acid-base balance, hyperchloremic acidosis, metabolic acidosis, strong ion difference, strong ion gap. Data were selected including prospective and retrospective studies, reviews, and case reports. Acid-base disorders are commonly analysed by using the traditional Henderson-Hasselbalch approach which attributes the variations in plasma pH to the modifications in plasma bicarbonates or PaCO2. However, this approach seems to be inadequate because bicarbonates and PaCO2 are completely dependent. Moreover, it does not consider the role of weak acids such as albuminate, in the determination of plasma pH value. According to the Stewart concept, plasma pH results from the degree of plasma water dissociation which is determined by 3 independent variables: 1) strong ion difference (SID) which is the difference between all the strong plasma cations and anions; 2) quantity of plasma weak acids; 3) PaCO2. Thus, metabolic acid-base disorders are always induced by a variation in SID (decreased in acidosis) or in weak acids (increased in acidosis), whereas respiratory disorders remains the consequence of a change in PaCO2. These pathophysiological considerations are important to analyse complex acid-base imbalances in critically ill patients. For example, due to a decrease in weak acids, hypoalbuminemia increases SID which may counter-balance a decrease in pH and an elevated anion gap. Thus if using only traditional tools, hypoalbuminemia may mask a metabolic acidosis, because of a normal pH and a normal anion gap. In this case, the association of metabolic acidosis and alkalosis is only expressed by respectively a decreased SID and a decreased weak acids concentration. This concept allows to establish the relationship between hyperchloremic acidosis and infusion of solutes which contain large concentration of chloride such as NaCl 0.9%. Finally, the Stewart concept permits to understand that sodium bicarbonate as well as sodium lactate induces plasma alkalinization. In fact, sodium remains in plasma, whereas anion (lactate or bicarbonate) are metabolized leading to an increase in plasma SID. Due to its simplicity, the traditional Henderson-Hasselbalch approach of acid-base disorders, remains commonly used. However, it gives an inadequate pathophysiological analysis which may conduct to a false diagnosis, especially with complex acid-base imbalances. Despite its apparent complexity, the Stewart concept permits to understand precisely the mechanisms of acid-base disorders. It has to become the most appropriate approach to analyse complex acid-base abnormalities.

2007 Joint Chem Bio Decon and Protection Conference and Exhibition

DTIC Science & Technology

2007-10-25

Choung USMC Ms. Lindy Burkhart USN Mr. Carl Goalie Technical Manager (Navy) Mr. Kiko Lama Transition Manager (Joint) LTC Green Oversight Group DUSD (AS&C...may not be possible to pull units for decon for days at a time UNCLASSIFIED UNCLASSIFIED 13 Mud, Crud, & Blood • Should be assumed as a

Surveys of Librarians' Benefits: An Annotated Bibliography.

ERIC Educational Resources Information Center

Jennerich, Elaine Zaremba; And Others

This annotated bibliography cites 39 titles of reports on academic, research, and public library conditions, which were compiled over a 2-year period by the LAMA/PAS Committee on Economic Status, Welfare and Fringe Benefits. Each annotated item was personally examined by a committee member; the six items in the addendum were not examined because…

Deconstructing the Master Narrative on Tibet: Lessons for Education

ERIC Educational Resources Information Center

Yu, Tianlong

2010-01-01

In this article, I touch upon the complex and largely ignored controversy surrounding the Tibet question. Casting a critical eye on the "official" or dominant stature of the Dalai Lama in the West, I examine the socio-cultural construction of the common view of him. Specifically, I explore the question: what social discourses have…

A Comparison of Rational Emotive Therapy and Tibetan Buddhism: Albert Ellis and the Dalai Lama

ERIC Educational Resources Information Center

Holt, Susan A; Austad, Carol Shaw

2013-01-01

This article explores conceptual and methodological similarities between Rational Emotive Behavior Therapy (REBT) and Tibetan Buddhism (TB). The authors examine some of the values and concepts they share. They compare the two systems on a number of issues: philosophical underpinnings, concepts of what causes human psychopathology, techniques to…

Large active mirror in aluminium

NASA Astrophysics Data System (ADS)

Leblanc, Jean-M.; Rozelot, Jean-Pierre

1991-11-01

The Large Active Mirrors in Aluminum Project (LAMA) is intended as a metallic alternative to the conventional glass mirrors. This alternative is to bring about definite improvements in terms of lower cost, shorter manufacturing, and reduced brittleness. Combined in a system approach that integrates design, development, and manufacturing of both the aluminum meniscus and its active support, the LAMA project is a technologically consistent product for astronomical and laser telescopes. Large size mirrors can be delivered, up to 8 m diameter. Recent progress in active optics makes possible control, as well as real-time adjustment, of a metallic mirror's deformations, especially those induced by temperature variations and/or aging. It also enables correction of whatever low-frequency surface waves escaped polishing. Besides, the manufacturing process to produce the aluminum segments together with the electron welding technique ensure the material's homogeneity. Quality of the surface condition will result from optimized implementation of the specific aluminum machining and polishing techniques. This paper highlights the existing aluminum realizations compared to glass mirrors, and gives the main results obtained during a feasibility demonstration phase, based on 8 m mirror requirements.

Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide.

PubMed

Price, David; Kaplan, Alan; Jones, Rupert; Freeman, Daryl; Burden, Anne; Gould, Shuna; von Ziegenweidt, Julie; Ali, Muzammil; King, Christine; Thomas, Mike

2015-01-01

Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. Medical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001-2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β2 agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting β2 agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P<0.001) and the percentage having at least one acute respiratory event decreased from 58% to 47% (P<0.001). There were no significant changes in lung function, and usage of short-acting β2 agonists (in salbutamol/albuterol equivalents) increased from a median (interquartile range) of 274 (110, 548) to 329 (110, 603) μg/day (P=0.01). In this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year.

Trends in health care resource utilization and pharmacological management of COPD in Taiwan from 2004 to 2010.

PubMed

Tsai, Ying-Huang; Yang, Tsung-Ming; Lin, Chieh-Mo; Huang, Shu-Yi; Wen, Yu-Wen

2017-01-01

COPD has attracted widespread attention worldwide. The prevalence of COPD in Taiwan has been reported, but little is known about trends in health care resource utilization and pharmacologic management in COPD treatment. The objective of this article was to study trends in health care resource utilization, pharmacologic management, and medical costs of COPD treatment in Taiwan. Reimbursement claims in the Taiwan National Health Insurance System from 2004 to 2010 were collected. The disease burden of COPD, including health care resource utilization and medical costs, was evaluated. The pharmacy cost of COPD increased from 2004 to 2010 due to the increased utilization of long-acting muscarinic antagonist (LAMA) and fixed-dose combination of long-acting β2-agonist and inhaled corticosteroid (LABA/ICS), whereas the cost of all other COPD-related medications decreased. The average outpatient department (OPD) cost per patient increased 29.3% from 1,070 USD in 2004 to 1,383 USD in 2010. The highest average total medical cost per patient was 3,434 USD in 2005, and it decreased 12.4% to 3,008 USD in 2010. There was no significant difference in the average number of OPD visits and emergency department visits per patient. The highest average number of hospital admissions was 0.81 in 2005, and it decreased to 0.65 in 2010. The average number of intensive care unit (ICU) admissions decreased from 0.52 in 2005 to 0.31 in 2010. From 2004 to 2010, the average total medical cost per patient of COPD was slightly decreased because of the decreased average number of hospital admissions and ICU admissions. The costs of both LAMA and LABA/ICS increased, while the cost for all other COPD-related medications decreased. These findings suggest that the increased utilization of LAMA and LABA/ICS may have contributed to the decreased average number of hospital admissions and ICU admissions in COPD patients from 2004 to 2010.

Comparative Efficacy of Once-Daily Umeclidinium/Vilanterol and Tiotropium/Olodaterol Therapy in Symptomatic Chronic Obstructive Pulmonary Disease: A Randomized Study.

PubMed

Feldman, Gregory J; Sousa, Ana R; Lipson, David A; Tombs, Lee; Barnes, Neil; Riley, John H; Patel, Sadhana; Naya, Ian; Compton, Chris; Alcázar Navarrete, Bernardino

2017-11-01

We report the results of the first direct comparison of the once-daily fixed-dose long-acting muscarinic antagonist/long-acting β 2 -agonist (LAMA/LABA) combinations umeclidinium/vilanterol (UMEC/VI) and tiotropium/olodaterol (TIO/OLO) in patients with COPD. This was a randomized, two-period crossover open-label study in symptomatic patients with COPD [age 40 years or older, postbronchodilator forced expiratory volume in 1 s (FEV 1 ) of 70% or less and 50% or more of predicted normal values, and modified Medical Research Council Dyspnoea Scale score of 2 or greater] not receiving inhaled corticosteroid therapy. Patients were randomized to receive UMEC/VI (62.5/25 µg once daily) via a multidose dry powder inhaler (ELLIPTA) followed by TIO/OLO (5/5 µg once daily) via a soft mist inhaler (Respimat), each for 8 weeks with an interim 3-week washout or vice versa. The primary end point was the change from baseline in trough FEV 1 at week 8 with a noninferiority margin of - 50 mL in the per-protocol (PP) population. The incidence of adverse events was also assessed. In total, 236 patients (mean age 64.4 years, 60% male) were included in the intent-to-treat population and 227 were included in the PP population. UMEC/VI treatment was noninferior in the PP population and superior in the intent-to-treat population to TIO/OLO treatment with regard to trough FEV 1 at week 8 [FEV 1 change from baseline 180 mL vs 128 mL; difference 52 mL (95% confidence interval 28-77 mL); p < 0.001]. Patients receiving UMEC/VI had twofold increased odds of experiencing a clinically meaningful increase (100 mL or more) from baseline in trough FEV 1 at week 8 compared with patients receiving TIO/OLO (odds ratio 2.05; 95% confidence interval 1.34-3.14). Adverse events occurred in 25% of patients in the UMEC/VI group and in 31% of patients in the TIO/OLO group. In this first direct comparison of two once-daily fixed-dose LAMA/LABA combinations, superiority was observed for the primary end point of trough FEV 1 at week 8 with UMEC/VI compared with TIO/OLO in patients with symptomatic COPD. Both treatments had similar safety profiles. These findings confirm the results of previous indirect LAMA/LABA comparisons, and show that an efficacy gradient exists within the LAMA/LABA class. ClinicalTrials.gov identifier NCT02799784. GlaxoSmithKline.

Bovine leukemia virus infection in a juvenile alpaca with multicentric lymphoma

PubMed Central

Lee, Laura C.; Scarratt, William K.; Buehring, Gertrude C.; Saunders, Geoffrey K.

2012-01-01

A 13-month-old alpaca (Vicugna pacos) was presented for mandibular masses and weight loss. Histopathology of biopsy tissue was consistent with lymphoma. The alpaca was euthanized and necropsy revealed lymphoma masses in multiple organs. Immunohistochemistry for T- and B-cell typing was inconclusive. Serology and in-situ polymerase chain reaction hybridization were positive for bovine leukemia virus. PMID:22942445

[Application of continuous intra-arterial blood gas monitoring system "Paratrend 7" for pulmonary lavage of a patient with alveolar proteinosis].

PubMed

Harigae, M; Hirose, Y; Gamo, M; Hirose, M; Fujiwara, C; Matsuo, K

1999-03-01

We applied a continuous intra-arterial blood gas monitoring system (Paratrend 7) to a patient with pulmonary alveolar proteinosis during pulmonary lavage. Lavage was performed under general anesthesia with one lung ventilation. We inserted the sensor of Patatrend 7 through a 20 G catheter into the radial artery, and monitored pH, PaCO2 and PaO2 continuously throughout the procedure. SpO2 and EtCO2 were also monitored. Saline 1000-1500 ml was instilled and drained repeatedly by volume limited methods. PaO2 values by Paratrend 7 increased during instillation and decreased during drainage of the irrigating fluid. In contrast, PaCO2 value by Paratrend 7 decreased slightly during instillation and increased during drainage. The change of SpO2 was almost the same as that by Paratrend 7, but the response time of pulse oxymetry was a little quicker than Paratrend 7. During the lavage procedure, respiratory and circulatory condition changed very rapidly, and it is necessary to monitor blood gas change intensively. Paratrend 7 is useful as a perioperative monitoring system, but pulse oxymetry might be sufficient during pulmonary lavage considering its cost.

Use of helium-oxygen mixture in adult patients presenting with exacerbations of asthma and chronic obstructive pulmonary disease: a systematic review.

PubMed

Colebourn, C L; Barber, V; Young, J D

2007-01-01

We examined systematically all controlled and cross-over randomised trials in patients with acute exacerbations of asthma and chronic obstructive pulmonary disease comparing Heliox against air-oxygen mixtures. Fourteen studies were identified. In asthma studies, peak expiratory flow rate (PEFR) was increased by an average of 29.6% (95% CI 16.6-42.6) by Heliox-driven nebulisers, or by 13.3 l.min(-1) (95% CI 3.71-22.81) absolute. In studies of patients with chronic obstructive pulmonary disease receiving non-invasive ventilation the arterial carbon dioxide tension (P(a)co(2)) and respiratory rate were unchanged: weighted mean difference for P(a)co(2)-0.29kPa (95% CI - 0.64-0.07) favoured Heliox, and for respiratory rate 1.6 breaths.min(-1) (95% CI - 0.93, 4.14) favoured control. Heliox minimally reduced the work of breathing in intubated patients, and reduced intrinsic positive end expiratory pressure (iPEEP). The use of Heliox to drive nebulisers in patients with acute asthma slightly improves airflow measures. We were unable to determine whether this improved recovery.

Dynamic CO₂ inhalation: a novel treatment for CSR-CSA associated with CHF.

PubMed

Wan, Zhi Hui; Wen, Fang Jing; Hu, Ke

2013-05-01

Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is very common in patients with chronic congestive heart failure (CHF). A current concept of the key pathophysiological mechanism leading to CSR-CSA is a fluctuation of PaCO2 below and above the apneic threshold. A number of therapeutic approaches for CSR-CSA have been proposed-all with varying success, some of which include various modes of positive airway pressure among other strategies. However, CO2 oscillations seen in CSR-CSA have yet to be looked at as a specific therapeutic target by current treatments. Previous studies have shown that delivery of constant CO2 is efficacious in eliminating CSR-CSA by raising PaCO2, but there are serious concerns about the potential side effects, such as unwanted elevations in ventilation, work of breathing, and sympathetic nerve activity (SNA), and consequently CO2 inhalation therapy has not been recommended as a routine option for therapy. However, recent new studies into CO2 inhalation therapy have been made that may reshape its role as therapeutic. In this review, we will focus on the recent developments of administration of dynamic CO2 in the management of CSR-CSA in CHF patients.

Hearing in alpacas (Vicugna pacos): audiogram, localization acuity, and use of binaural locus cues.

PubMed

Heffner, Rickye S; Koay, Gimseong; Heffner, Henry E

2014-02-01

Behavioral audiograms and sound localization abilities were determined for three alpacas (Vicugna pacos). Their hearing at a level of 60 dB sound pressure level (SPL) (re 20 μPa) extended from 40 Hz to 32.8 kHz, a range of 9.7 octaves. They were most sensitive at 8 kHz, with an average threshold of -0.5 dB SPL. The minimum audible angle around the midline for 100-ms broadband noise was 23°, indicating relatively poor localization acuity and potentially supporting the finding that animals with broad areas of best vision have poorer sound localization acuity. The alpacas were able to localize low-frequency pure tones, indicating that they can use the binaural phase cue, but they were unable to localize pure tones above the frequency of phase ambiguity, thus indicating complete inability to use the binaural intensity-difference cue. In contrast, the alpacas relied on their high-frequency hearing for pinna cues; they could discriminate front-back sound sources using 3-kHz high-pass noise, but not 3-kHz low-pass noise. These results are compared to those of other hoofed mammals and to mammals more generally.

Control of ventilation during intravenous CO2 loading in the awake dog.

PubMed

Stremel, R W; Huntsman, D J; Casaburi, R; Whipp, B J; Wasserman, K

1978-02-01

The ventilatory response to venous CO2 loading and its effect on arterial CO2 tension was determined in five awake dogs. Blood, 200-500 ml/min, was diverted from a catheter in the right common carotid artery through a membrane gas exchanger and returned to the right jugular vein. CO2 loading was accomplished by changing the gas ventilating the gas exchanger from a mixture of 5% CO2 in air to 100% CO2. The ventilatory responses to this procedure were compared with those resulting from increased inspired CO2 concentrations (during which ventilation of the gas exchanger with the air and 5% CO2 mixture continued). The ventilatory response to each form of CO2 loading was computed as deltaVE/deltaPaco9. The mean ventilatory response to airway CO2 loading was 1.61 1/min per Torr PaCO2. The mean response for the venous CO2 loading was significantly higher and not significantly different from "infinite" CO2 sensitivity (i.e., isocapnic response). The results provide further evidence for a CO2-linked hyperpnea, not mediated by significant changes in mean arterial PCO2.

Circulatory and respiratory effects of methoxyflurane in dogs: comparison of halothane.

PubMed

Steffey, E P; Farver, T B; Woliner, M J

1984-12-01

Circulatory and respiratory effects of 3 alveolar concentrations (representing 1.0, 1.5, and 2.0 times the minimal alveolar concentration, MAC) of methoxyflurane in O2 were compared with similar MAC multiples of halothane in O2. Eight adult mixed breed dogs that were healthy and nonmedicated were studied in cross-over fashion with both agents during conditions of controlled ventilation (CV; PaCO2 averaged 34 to 38 mm of Hg) and spontaneous ventilation (SV). When ventilation was controlled, methoxyflurane similar to halothane caused dose-related cardiovascular depression. Except for a greater heart rate and lesser stroke volume with methoxyflurane, little difference was noticed between the anesthetics at equivalent doses during CV. There was less dose-related circulatory depression during SV with both agents but particularly with methoxyflurane. During SV, PaCO2 increased progressively with increases in alveolar concentrations of methoxyflurane and halothane. Methoxyflurane caused significantly greater (P less than 0.05) hypoventilation than halothane only at 2.0 MAC. Except for a greater respiratory gas flow and inspiratory-expiratory gas flow ratio and a lesser inspiratory-expiratory time ratio with methoxyflurane, there was no anesthetic- or dose-response effect on respiratory variables.

[Intraoperative monitoring in artificial respiration of premature and newborn infants. I. Monitoring of respiratory parameters and alveolar ventilation].

PubMed

Lenz, G; Heipertz, W; Leidig, E; Madee, S

1986-06-01

Monitoring of ventilation serves to ensure adequate alveolar ventilation and arterial oxygenation, and to avoid pulmonary damage due to mechanical ventilation. Basic clinical monitoring, i.e., inspection, auscultation (including precordial or oesophageal stethoscope) and monitoring of heart rate and blood pressure, is mandatory. Mechanical ventilation is monitored by ventilation pressures (peak pressure, plateau pressure and endexpiratory pressure), ventilation volumes (measured at the in/expiratory valve of the respirator and by hot-wire anemometry at the tube connector), ventilation rate, and inspiratory oxygen concentration (FiO2). Alveolar ventilation should be continuously and indirectly recorded by capnometry (pECO2) and by measurement of transcutaneous pCO2 (tcpCO2), whereas oxygenation is determined via measurement of transcutaneous pO2 (tcpO2). Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paCO2 may be estimated by capillary or venous blood gas analysis; arterial blood gas analysis is required for exact determination of paCO2 as well as arteriocutaneous pCO2 (atcDCO2) and arterio-end-expiratory (aEDCO2) gradients.

The Genetic Inheritance of the Blue-eyed White Phenotype in Alpacas (Vicugna pacos)

PubMed Central

Johnson, Warren E.; Appleton, Belinda R.

2014-01-01

White-spotting patterns in mammals can be caused by mutations in the gene KIT, whose protein is necessary for the normal migration and survival of melanocytes from the neural crest. The alpaca (Vicugna pacos) blue-eyed white (BEW) phenotype is characterized by 2 blue eyes and a solid white coat over the whole body. Breeders hypothesize that the BEW phenotype in alpacas is caused by the combination of the gene causing gray fleece and a white-spotting gene. We performed an association study using KIT flanking and intragenic markers with 40 unrelated alpacas, of which 17 were BEW. Two microsatellite alleles at KIT-related markers were significantly associated (P < 0.0001) with the BEW phenotype (bew1 and bew2). In a larger cohort of 171 related individuals, we identify an abundance of an allele (bew1) in gray animals and the occurrence of bew2 homozygotes that are solid white with pigmented eyes. Association tests accounting for population structure and familial relatedness are consistent with a proposed model where these alleles are in linkage disequilibrium with a mutation or mutations that contribute to the BEW phenotype and to individual differences in fleece color. PMID:23144493

Forced vital capacity and not central chemoreflex predicts maximal hyperoxic breath-hold duration in elite apneists.

PubMed

Bain, Anthony R; Barak, Otto F; Hoiland, Ryan L; Drvis, Ivan; Bailey, Damian M; Dujic, Zeljko; Mijacika, Tanja; Santoro, Antoinette; DeMasi, Daniel K; MacLeod, David B; Ainslie, Philip N

2017-08-01

The determining mechanisms of a maximal hyperoxic apnea duration in elite apneists have remained unexplored. We tested the hypothesis that maximal hyperoxic apnea duration in elite apneists is related to forced vital capacity (FVC) but not the central chemoreflex (for CO 2 ). Eleven elite apneists performed a maximal dry static-apnea with prior hyperoxic (100% oxygen) pre-breathing, and a central chemoreflex test via a hyperoxic re-breathing technique (hyperoxic-hypercapnic ventilatory response: HCVR); expressed as the increase in ventilation (pneumotachometry) per increase in arterial CO 2 tension (PaCO 2 ; radial artery). FVC was assessed using standard spirometry. Maximal apnea duration ranged from 807 to 1262s (mean=1034s). Average HCVR was 2.0±1.2Lmin -1 mmHg -1 PaCO 2 . The hyperoxic apnea duration was related to the FVC (r 2 =0.45, p<0.05), but not the HCVR (r 2 <0.01, p>0.05). These findings were interpreted to suggest that during a hyperoxic apnea, a larger initial lung volume prolongs the time before reaching intolerable discomfort associated with pending lung squeeze, while CO 2 sensitivity has little impact. Copyright © 2017 Elsevier B.V. All rights reserved.

[Function in patients with chronic fibrocavernous tuberculosis].

PubMed

Nefedov, V B; Popova, L A; Shergina, E A

2008-01-01

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, residual volume (RV), R(aw), R(in), R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 62 patients with chronic fibrocavernous tuberculosis. Lung dysfunctions were detected in 96.8% of the patients. Changes in lung volumes and capacities were found in 90.3%, impaired bronchial patency was in 90.3%, and pulmonary gas exchange dysfunction was in 79.0%. The lung volume and capacity changes appeared as decreased VC and FVC, decreased and increased TLC, TGV, RV; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, and FEV1/VC%; and increased R(aw), R(in), R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, PaO2, and decreased and increased PaCO2. The magnitude of the observed functional changes ranges from slight to significant and drastic with a predominance of considerable and drastic changes in lung volumes and capacities and mild impairments of bronchial patency and pulmonary gas exchange function.

A behaviour study on the potential for direct transmission of tuberculosis from possums (Trichosurus vulpecula) to alpacas (Lama pacos), and the converse from alpacas to possums.

PubMed

Black, H; Simper, J M; Bloom, D; Bloom, K

1999-12-01

To evaluate the potential for the direct transmission of tuberculosis from possums to alpacas, and vice versa. A field study was conducted on an alpaca farm in Northland, New Zealand on 7 January 1999. Observations were recorded on the interaction of one group of male alpacas with a simulated dead possum, one male and one female alpaca group with a simulated terminally tuberculous possum, and one group of male alpacas with a normal possum in an enclosure from which the animals could not escape. The possum was sedated with ketamine as hydrochloride to simulate death (inactive; no movement), and terminal illness (active, inco-ordinated movement around the paddock). The observations were based on the focal animal sampling technique, they were un-replicated, and recorded visually and manually with intermittent still photography. Both male and female alpacas showed strongly inquisitive interaction with the possum. They clustered around the possum (focal animal) very soon after it was observed by the first member of the group. The interest of the majority of both sex groups remained high for the observation periods of approximately 30 minutes, and most individuals remained within 5 metres of the possum for that time. Approximately 50% of the alpacas were within possible aerosol transmission distance of 2 metres from the sedated, erratically mobile possum with their heads towards it for approximately 50% of the two observation periods. Aggressive behaviour was recorded for a young male with stamping on the moving possum. Similar, but more vigorous and prolonged stamping behaviour was recorded for a female with a young (<1 week) offspring (cria). The stamping behaviour was accompanied by very close nose to nose contact of the alpaca and possum. At one point the female threw the possum approximately 1.5 metres in the air with her teeth. The group of male alpacas placed in an enclosure with an unsedated normal possum generally moved away from the possum during its rapid active attempts to escape. When it became inactive their approaches were cautious and only once elicited a defence reaction from the possum, from which they recoiled. One male made one attempt to stamp on the active possum. Soon after the possum became inactive in a small loose hay pile, the alpacas lost interest in it. The alpaca / possum behavioural interactions show there is potential for direct aerosol transmission of tuberculosis from possums to alpacas, but probably not from alpacas to possums.

Acute renal failure in 2 adult llamas after exposure to Oak trees (Quercus spp.)

PubMed Central

Chamorro, Manuel F.; Passler, Thomas; Joiner, Kellye; Poppenga, Robert H.; Bayne, Jenna; Walz, Paul H.

2013-01-01

Two adult llamas (Lama glama) previously exposed to oak trees (Quercus spp.) were presented with a history of depression and anorexia. Clinicopathological abnormalities included severe gastroenteritis, acute renal failure, and increased liver enzymes. This is believed to be the first report of oak toxicosis in South American camelids. PMID:23814303

Special Section: Write On! Introduction [and] Preparing Research for Publication [and] Transforming an Oral Presentation for Publication.

ERIC Educational Resources Information Center

Bluh, Pamela, Ed.; Giesecke, Joan; Di Vecchio, Jerry

1998-01-01

This special section includes papers from the 1997 Library Administration and Management Association (LAMA) Systems and Services Section (SASS) preconference, "Write On!" which introduced participants to the tenets of effective writing. Four topics of interest to librarians include: writing a research paper, transforming an oral presentation into…

Gandhi: Sources and Influences. A Curriculum Guide. Fulbright-Hays Summer Seminars Abroad, 1997 (India).

ERIC Educational Resources Information Center

Ragan, Paul

This unit is intended for secondary students in American literature, Asian history, U.S. history, or a world cultures class. Special emphasis is placed on the literary contributions of four individuals: Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr., and the Dalai Lama. The sections appear in chronological order and contain…

Complete Genome Sequence of a Genomovirus Associated with Common Bean Plant Leaves in Brazil.

PubMed

Lamas, Natalia Silva; Fontenele, Rafaela Salgado; Melo, Fernando Lucas; Costa, Antonio Felix; Varsani, Arvind; Ribeiro, Simone Graça

2016-11-10

A new genomovirus has been identified in three common bean plants in Brazil. This virus has a circular genome of 2,220 nucleotides and 3 major open reading frames. It shares 80.7% genome-wide pairwise identity with a genomovirus recovered from Tongan fruit bat guano. Copyright © 2016 Lamas et al.

Ka Lama o ke Kaiaulu: Research on Teacher Education for a Hawaiian Community.

ERIC Educational Resources Information Center

Au, Kathryn H.; Maaka, Margaret J.

1998-01-01

Introduces a three-year research project designed to answer the questions of how schools can better meet the educational needs of individuals from underrepresented groups. Provides overviews of a case study of a preservice teacher of Hawaiian ethnicity and a set of case studies of five Hawaiian women throughout their educations. (SLD)

The Chinese Invasion of Tibet and Sino-Indian Relations

DTIC Science & Technology

1982-05-20

the Chines and to open negotlations on the basis of the Simla Agreement, an agreement not recog- nized by the Chinese. Nopal w= in no position to help...Republic of China, Monsieur Ivan Chen, Officer of the Order of the Chia H 0; His Holiness the Dalai Lama of Tibet, Lonchen Ga -den Shatra Pal- jar Corje

Moderation of phenotypic severity in dystrophic and junctional forms of epidermolysis bullosa through in-frame skipping of exons containing non-sense or frameshift mutations.

PubMed

McGrath, J A; Ashton, G H; Mellerio, J E; Salas-Alanis, J C; Swensson, O; McMillan, J R; Eady, R A

1999-09-01

Non-sense mutations on both alleles of either the type VII collagen gene (COL7A1) or the genes encoding laminin 5 (LAMA3, LAMB3, or LAMC2) usually result in clinically severe forms of recessive dystrophic or junctional epidermolysis bullosa, respectively. In this study we assessed two unrelated families whose mutations in genomic DNA predicted severe recessive dystrophic epidermolysis bullosa or junctional epidermolysis bullosa phenotypes but in whom the manifestations were milder than expected. The recessive dystrophic epidermolysis bullosa patients had a homozygous single base-pair frameshift mutation in exon 19 of COL7A1 (2470insG). Clinically, there was generalized blistering but only mild scarring. Skin biopsy revealed positive type VII collagen immunoreactivity and recognizable anchoring fibrils. The junctional epidermolysis bullosa patients were compound heterozygotes for a frameshift/non-sense combination of mutations in exons 3 and 17 of LAMB3 (29insC/Q834X). These patients did not have the lethal form of junctional epidermolysis bullosa but, as adults, displayed the milder generalized atrophic benign epidermolysis bullosa variant. There was undetectable laminin 5 staining at the dermal-epidermal junction using an antibody to the beta3 chain, but faintly positive alpha3 and gamma2 chain labeling, and there was variable hypoplasia of hemidesmosomes. To explain the milder recessive dystrophic epidermolysis bullosa and junctional epidermolysis bullosa phenotypes in these families, reverse transcription-polymerase chain reaction, using RNA extracted from frozen skin, was able to provide evidence for some rescue of mutant mRNA transcripts with restoration of the open- reading frame. In the recessive dystrophic epidermolysis bullosa patients, transcripts containing in-frame skipping of exon 19 of COL7A1 in the cDNA were detected, and in the junctional epidermolysis bullosa patients transcripts with in-frame skipping of exon 17 of LAMB3 were identified. The truncated proteins encoded by these transcripts are expected to lack certain critical domains involved in cell-matrix attachment, but may still be able to contribute to adhesion thereby moderating the severity of the skin blistering. This study shows the limitations in predicting phenotype in epidermolysis bullosa solely based on mutation analysis of genomic DNA and emphasizes the importance of immunohistochemistry, electron microscopy, and mRNA assessment as parallel investigations.

Isolation and genetic characterization of Toxoplasma gondii from alpaca (Vicugna pacos) and sheep (Ovis aries) grazed on pasture in Virginia

USDA-ARS?s Scientific Manuscript database

Muscles (heart, skeletal muscle) of nine alpacas with MAT titers of 1:25 were fed to T. gondii-free cats; the cats did not shed oocysts. Viable T. gondii was isolated from tissues of two of six seropositive alpacas by bioassay in mice. Viable T. gondii was isolated from three of three seropositive s...

Improved packing of protein side chains with parallel ant colonies

PubMed Central

2014-01-01

Introduction The accurate packing of protein side chains is important for many computational biology problems, such as ab initio protein structure prediction, homology modelling, and protein design and ligand docking applications. Many of existing solutions are modelled as a computational optimisation problem. As well as the design of search algorithms, most solutions suffer from an inaccurate energy function for judging whether a prediction is good or bad. Even if the search has found the lowest energy, there is no certainty of obtaining the protein structures with correct side chains. Methods We present a side-chain modelling method, pacoPacker, which uses a parallel ant colony optimisation strategy based on sharing a single pheromone matrix. This parallel approach combines different sources of energy functions and generates protein side-chain conformations with the lowest energies jointly determined by the various energy functions. We further optimised the selected rotamers to construct subrotamer by rotamer minimisation, which reasonably improved the discreteness of the rotamer library. Results We focused on improving the accuracy of side-chain conformation prediction. For a testing set of 442 proteins, 87.19% of X1 and 77.11% of X12 angles were predicted correctly within 40° of the X-ray positions. We compared the accuracy of pacoPacker with state-of-the-art methods, such as CIS-RR and SCWRL4. We analysed the results from different perspectives, in terms of protein chain and individual residues. In this comprehensive benchmark testing, 51.5% of proteins within a length of 400 amino acids predicted by pacoPacker were superior to the results of CIS-RR and SCWRL4 simultaneously. Finally, we also showed the advantage of using the subrotamers strategy. All results confirmed that our parallel approach is competitive to state-of-the-art solutions for packing side chains. Conclusions This parallel approach combines various sources of searching intelligence and energy functions to pack protein side chains. It provides a frame-work for combining different inaccuracy/usefulness objective functions by designing parallel heuristic search algorithms. PMID:25474164

[The clinical and microbiological comparison of the use of heated humidifiers and heat and moisture exchanger filters with Booster in mechanically ventilated patients].

PubMed

Nadir Oziş, Türkan; Ozcan Kanat, Derya; Oğuzülgen, Ipek Kivilcim; Aydoğdu, Müge; Hizel, Kenan; Gürsel, Gül

2009-01-01

Ventilator associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units that is associated with prolonged mechanical ventilation, hospitalization and increased health-care costs. Various humidifiers can be used for humidification during mechanical ventilation. Many studies were conducted to identify the effects of two different humidifiers, i.e. heated humidifiers and heat and moisture exchanger filters (HME), on VAP development; and HME filters were found to decrease the VAP frequency. In this study we aimed to compare the efficacy and safety of heated humidifiers and HME-Booster. Heated humidifier with conventional microbiologic filter (CMF-HH) or HME-Booster were used in randomization to 41 mechanically ventilated patients of our intensive care unit, and patients were divided into two groups as group 1 receiving CMF-HH (20 patients) and group 2 (21 patients) receiving HME-Booster. Daily secretion scores, endotracheal tube occlusion due to secretions, VAP development rate for the assessment of microbiological safety of humidifiers and differences in PETCO(2) and PaCO(2) values for the assessment of their effect on arterial blood gas were recorded prospectively. The measurement of PETCO(2) and PaCO(2) values were performed with the presence of humidifiers and after removing them in both groups. In both groups with the removal of CMF-HH and HME-Booster, a decrease in PETCO(2) value was identified, but the decrease in group 2 was statistically significant (p= 0.016). The decrease in PaCO(2) after removal of humidifiers was greater in group 2 than in group 1, but the difference was not significant (p> 0.05).The rate of VAP and endotracheal tube occlusion was not significantly different between the groups. The mean secretion score was lower in group 1 (p= 0.041). In conclusion, although both humidifiers have similar microbiological effects, heated humidifiers could be preferred particularly for the patients with an underlying chronic lung disease due to its positive effects on PETCO(2) values and secretion scores.

Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure.

PubMed

Cordioli, Ricardo Luiz; Park, Marcelo; Costa, Eduardo Leite Vieira; Gomes, Susimeire; Brochard, Laurent; Amato, Marcelo Britto Passos; Azevedo, Luciano Cesar Pontes

2014-12-01

The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation. The animals were ventilated with a randomized sequence of respiratory rates: 30, 60, 90, 120, 150, followed by HFOV at 5 Hz. At each step, V T was adjusted to allow partial pressure of arterial carbon dioxide (PaCO2) to stabilize between 57 and 63 mmHg. Data are shown as median [P25th,P75th]. After lung injury, the PaO2/FiO2 (P/F) ratio was 92 [63,118] mmHg, pulmonary shunt 26 [17,31]%, and static compliance 11 [8,14] mL/cmH2O. Positive end-expiratory pressure (PEEP) was 14 [10,17] cmH2O. At 30 breaths/min, V T was higher than 6 (7.5 [6.8,10.2]) mL/kg, but at all higher frequencies, V T could be reduced and PaCO2 maintained, leading to reductions in plateau pressures and driving pressures. For frequencies of 60 to 150/min, V T progressively fell from 5.2 [5.1,5.9] to 3.8 [3.7,4.2] mL/kg (p < 0.001). There were no detrimental effects in terms of lung mechanics, auto-PEEP generation, hemodynamics, or gas exchange. Mean airway pressure was maintained constant and was increased only during HFOV. During protective mechanical ventilation, HFPPV delivered by a conventional ventilator in a severe ARDS swine model safely allows further tidal volume reductions. This strategy also allowed decreasing airway pressures while maintaining stable PaCO2 levels.

[Daytime hypercapnia in patients with obstructive sleep apnea hypopnea syndrome in Han and Uygur nationality].

PubMed

He, Z M; Jiang, X L; Da, Piliqing; Ye, Z; Li, J P; Zhang, Q L; Chen, Y; Shi, J; Li, M; Han, F

2016-11-29

Objective: To evaluate the incidence and factors related to daytime hypercapnia in Han and Uygur patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: There were 221 patients with OSAHS (include 179 Han patients and 42 Uygur patients) in Sleep Center of Department of Respiratory and Critical Care Medicine of Karamay Central Hospital from 2015, Jan to Dec. All the patients underwent polysomnography (PSG), nocturnal oximetry, daytime blood gas analysis, pulmonary function test and Mouth occlusion pressure (P 0.1 ) results were recorded. The features of hypercapnia was analyzed for patients with OSAHS, and linear regression analysis was used to evaluate the arterial carbon dioxide partial pressure (PaCO 2 ) levels and related factors. Results: Daytime hypercapnia occurred in 16.7% (37/221) of the 221 patients with OSAHS. Compare with no hypercapnia groups, the body mass [(31.6±5.6) vs (27.9±1.7) kg/m 2 ], sleep apnea index (AHI) [(40.9±26.3) vs (32.2±20.1) times/h], the percentage of time spent at oxygen saturation below 90 (SIT 90 ) [(38.6±31.9)% vs (23.9±23.6)%], P 0.1 [(3.08±2.86) vs (2.03±1.20) mmHg, 1 mmHg=0.133 kPa] were higher in hypercapnia groups, but the mean nocturnal arterial oxygen saturation (MSaO 2 ) [(86.0±15.5)% vs (92.0±3.0)%], the nadir arterial oxygen saturation (LSaO 2 ) [(68.9±13.0)% vs (75.3±9.9)%] and arterial partial pressure of oxygen (PaO 2 ) [(74.5±23.0) vs (86.1±14.8) were lower in hypercapnia groups (all P <0.05). Compare with Han patients with OSAHS, MSaO 2 and LSaO 2 was lower, PaCO 2 and P 0.1 was higher in Uygur patients (all P <0.05). Conclusions: Uygur OSAHS patients with hypercapnia have a higher daytime PaCO 2 than the Han counterparts. BMI, AHI, MSaO 2 , P 0.1 level are all related with daytime hypercapnia in OSAHS.

A resolution honoring the contributions of Lodi Gyaltsen Gyari as Special Envoy of His Holiness the Dalai Lama and in promoting the legitimate rights and aspirations of the Tibetan people.

THOMAS, 112th Congress

Sen. Kerry, John F. [D-MA

2012-09-13

Senate - 09/19/2012 Resolution agreed to in Senate without amendment and with a preamble by Unanimous Consent. (All Actions) Tracker: This bill has the status Agreed to in SenateHere are the steps for Status of Legislation:

Experimental Test of Nonlocal Realism Using a Fiber-Based Source of Polarization-Entangled Photon Paris

DTIC Science & Technology

2008-03-25

J. F. Clauser and M. A. Horne, Phys. Rev. D 10, 526 1974. 6 A. Zeilinger , Rev. Mod. Phys. 71, S288 1999; A. Aspect, Nature London 398, 189...Jennewein, M. Zukowski, M. Aspelmeyer, and A. Zeilinger , Phys. Rev. Lett. 99, 210406 2007; C. Branciard, A. Ling, N. Gisin, C. Kurt- siefer, A. Lamas

The Library as a Humanistic Workplace. A Report to the LAMA Board.

ERIC Educational Resources Information Center

American Library Association, Chicago, IL. Library Administration and Management Association.

While it may seem redundant to be considering the library as a humanistic workplace, since most libraries are probably at the upper end of the quality of workplace life, there is always some room for improvement, making the topic worthy of exploration. The most important consideration in a humanistic workplace is how people are treated. There is a…

Gastrointestinal and blood parasite determination in the guanaco (Lama guanicoe) under semi-captivity conditions.

PubMed

Correa, Loreto; Zapata, Beatriz; Soto-Gamboa, Mauricio

2012-01-01

The breeding of wild animals for commercial purposes is becoming more frequent nowadays. This situation has led to an increase in contact rates between wild and domestic animals, with subsequent reciprocal transmission of parasites. In this study, we characterized the gastrointestinal and blood parasites of a group of 15 semi-captive guanacos (Lama guanicoe). We characterized gastrointestinal parasites by analyzing fecal samples through the sedimentation-flotation technique and hemoparasites by using blood smears stained with Giemsa. We found several gastrointestinal parasites including Nematoda and protozoans. The most frequently found parasites were Nematodirus sp. and Eimeria sp. In contrast with previous studies, neither Cestoda nor Fasciola were found. The only hemoparasite detected was Mycoplasma haemolamae, a parasite already described in llamas and alpacas. We conclude that the most frequent gastrointestinal parasites of semi-captive guanacos were nematodes and protozoans. Also, the hemoparasite M. haemolamae seems to be prevalent among captive populations of South American camelids. Finally, captive guanacos share several parasites with the traditional livestock. Therefore, keeping captive or semi-captive guanacos without an adequate sanitary protocol might have adverse consequences to adjacent traditional cattle farming and/or for wild animals.

D Model Generation from Uav: Historical Mosque (masjid LAMA Nilai)

NASA Astrophysics Data System (ADS)

Nasir, N. H. Mohd; Tahar, K. N.

2017-08-01

Preserving cultural heritage and historic sites is an important issue. These sites are subjected to erosion and vandalism, and, as long-lived artifacts, they have gone through many phases of construction, damage and repair. It is important to keep an accurate record of these sites using the 3-D model building technology as they currently are, so that preservationists can track changes, foresee structural problems, and allow a wider audience to "virtually" see and tour these sites. Due to the complexity of these sites, building 3-D models is time consuming and difficult, usually involving much manual effort. This study discusses new methods that can reduce the time to build a model using the Unmanned Aerial Vehicle method. This study aims to develop a 3D model of a historical mosque using UAV photogrammetry. In order to achieve this, the data acquisition set of Masjid Lama Nilai, Negeri Sembilan was captured by using an Unmanned Aerial Vehicle. In addition, accuracy assessment between the actual and measured values is made. Besides that, a comparison between the rendering 3D model and texturing 3D model is also carried out through this study.

Nine Loci for Ocular Axial Length Identified through Genome-wide Association Studies, Including Shared Loci with Refractive Error

PubMed Central

Cheng, Ching-Yu; Schache, Maria; Ikram, M. Kamran; Young, Terri L.; Guggenheim, Jeremy A.; Vitart, Veronique; MacGregor, Stuart; Verhoeven, Virginie J.M.; Barathi, Veluchamy A.; Liao, Jiemin; Hysi, Pirro G.; Bailey-Wilson, Joan E.; St. Pourcain, Beate; Kemp, John P.; McMahon, George; Timpson, Nicholas J.; Evans, David M.; Montgomery, Grant W.; Mishra, Aniket; Wang, Ya Xing; Wang, Jie Jin; Rochtchina, Elena; Polasek, Ozren; Wright, Alan F.; Amin, Najaf; van Leeuwen, Elisabeth M.; Wilson, James F.; Pennell, Craig E.; van Duijn, Cornelia M.; de Jong, Paulus T.V.M.; Vingerling, Johannes R.; Zhou, Xin; Chen, Peng; Li, Ruoying; Tay, Wan-Ting; Zheng, Yingfeng; Chew, Merwyn; Rahi, Jugnoo S.; Hysi, Pirro G.; Yoshimura, Nagahisa; Yamashiro, Kenji; Miyake, Masahiro; Delcourt, Cécile; Maubaret, Cecilia; Williams, Cathy; Guggenheim, Jeremy A.; Northstone, Kate; Ring, Susan M.; Davey-Smith, George; Craig, Jamie E.; Burdon, Kathryn P.; Fogarty, Rhys D.; Iyengar, Sudha K.; Igo, Robert P.; Chew, Emily; Janmahasathian, Sarayut; Iyengar, Sudha K.; Igo, Robert P.; Chew, Emily; Janmahasathian, Sarayut; Stambolian, Dwight; Wilson, Joan E. Bailey; MacGregor, Stuart; Lu, Yi; Jonas, Jost B.; Xu, Liang; Saw, Seang-Mei; Baird, Paul N.; Rochtchina, Elena; Mitchell, Paul; Wang, Jie Jin; Jonas, Jost B.; Nangia, Vinay; Hayward, Caroline; Wright, Alan F.; Vitart, Veronique; Polasek, Ozren; Campbell, Harry; Vitart, Veronique; Rudan, Igor; Vatavuk, Zoran; Vitart, Veronique; Paterson, Andrew D.; Hosseini, S. Mohsen; Iyengar, Sudha K.; Igo, Robert P.; Fondran, Jeremy R.; Young, Terri L.; Feng, Sheng; Verhoeven, Virginie J.M.; Klaver, Caroline C.; van Duijn, Cornelia M.; Metspalu, Andres; Haller, Toomas; Mihailov, Evelin; Pärssinen, Olavi; Wedenoja, Juho; Wilson, Joan E. Bailey; Wojciechowski, Robert; Baird, Paul N.; Schache, Maria; Pfeiffer, Norbert; Höhn, René; Pang, Chi Pui; Chen, Peng; Meitinger, Thomas; Oexle, Konrad; Wegner, Aharon; Yoshimura, Nagahisa; Yamashiro, Kenji; Miyake, Masahiro; Pärssinen, Olavi; Yip, Shea Ping; Ho, Daniel W.H.; Pirastu, Mario; Murgia, Federico; Portas, Laura; Biino, Genevra; Wilson, James F.; Fleck, Brian; Vitart, Veronique; Stambolian, Dwight; Wilson, Joan E. Bailey; Hewitt, Alex W.; Ang, Wei; Verhoeven, Virginie J.M.; Klaver, Caroline C.; van Duijn, Cornelia M.; Saw, Seang-Mei; Wong, Tien-Yin; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Saw, Seang-Mei; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Saw, Seang-Mei; Wong, Tien-Yin; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Saw, Seang-Mei; Wong, Tien-Yin; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Saw, Seang-Mei; Tai, E-Shyong; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Saw, Seang-Mei; Teo, Yik-Ying; Fan, Qiao; Cheng, Ching-Yu; Zhou, Xin; Ikram, M. Kamran; Mackey, David A.; MacGregor, Stuart; Hammond, Christopher J.; Hysi, Pirro G.; Deangelis, Margaret M.; Morrison, Margaux; Zhou, Xiangtian; Chen, Wei; Paterson, Andrew D.; Hosseini, S. Mohsen; Mizuki, Nobuhisa; Meguro, Akira; Lehtimäki, Terho; Mäkelä, Kari-Matti; Raitakari, Olli; Kähönen, Mika; Burdon, Kathryn P.; Craig, Jamie E.; Iyengar, Sudha K.; Igo, Robert P.; Lass, Jonathan H.; Reinhart, William; Belin, Michael W.; Schultze, Robert L.; Morason, Todd; Sugar, Alan; Mian, Shahzad; Soong, Hunson Kaz; Colby, Kathryn; Jurkunas, Ula; Yee, Richard; Vital, Mark; Alfonso, Eduardo; Karp, Carol; Lee, Yunhee; Yoo, Sonia; Hammersmith, Kristin; Cohen, Elisabeth; Laibson, Peter; Rapuano, Christopher; Ayres, Brandon; Croasdale, Christopher; Caudill, James; Patel, Sanjay; Baratz, Keith; Bourne, William; Maguire, Leo; Sugar, Joel; Tu, Elmer; Djalilian, Ali; Mootha, Vinod; McCulley, James; Bowman, Wayne; Cavanaugh, H. Dwight; Verity, Steven; Verdier, David; Renucci, Ann; Oliva, Matt; Rotkis, Walter; Hardten, David R.; Fahmy, Ahmad; Brown, Marlene; Reeves, Sherman; Davis, Elizabeth A.; Lindstrom, Richard; Hauswirth, Scott; Hamilton, Stephen; Lee, W. Barry; Price, Francis; Price, Marianne; Kelly, Kathleen; Peters, Faye; Shaughnessy, Michael; Steinemann, Thomas; Dupps, B.J.; Meisler, David M.; Mifflin, Mark; Olson, Randal; Aldave, Anthony; Holland, Gary; Mondino, Bartly J.; Rosenwasser, George; Gorovoy, Mark; Dunn, Steven P.; Heidemann, David G.; Terry, Mark; Shamie, Neda; Rosenfeld, Steven I.; Suedekum, Brandon; Hwang, David; Stone, Donald; Chodosh, James; Galentine, Paul G.; Bardenstein, David; Goddard, Katrina; Chin, Hemin; Mannis, Mark; Varma, Rohit; Borecki, Ingrid; Chew, Emily Y.; Haller, Toomas; Mihailov, Evelin; Metspalu, Andres; Wedenoja, Juho; Simpson, Claire L.; Wojciechowski, Robert; Höhn, René; Mirshahi, Alireza; Zeller, Tanja; Pfeiffer, Norbert; Lackner, Karl J.; Donnelly, Peter; Barroso, Ines; Blackwell, Jenefer M.; Bramon, Elvira; Brown, Matthew A.; Casas, Juan P.; Corvin, Aiden; Deloukas, Panos; Duncanson, Audrey; Jankowski, Janusz; Markus, Hugh S.; Mathew, Christopher G.; Palmer, Colin N.A.; Plomin, Robert; Rautanen, Anna; Sawcer, Stephen J.; Trembath, Richard C.; Viswanathan, Ananth C.; Wood, Nicholas W.; Spencer, Chris C.A.; Band, Gavin; Bellenguez, Céline; Freeman, Colin; Hellenthal, Garrett; Giannoulatou, Eleni; Pirinen, Matti; Pearson, Richard; Strange, Amy; Su, Zhan; Vukcevic, Damjan; Donnelly, Peter; Langford, Cordelia; Hunt, Sarah E.; Edkins, Sarah; Gwilliam, Rhian; Blackburn, Hannah; Bumpstead, Suzannah J.; Dronov, Serge; Gillman, Matthew; Gray, Emma; Hammond, Naomi; Jayakumar, Alagurevathi; McCann, Owen T.; Liddle, Jennifer; Potter, Simon C.; Ravindrarajah, Radhi; Ricketts, Michelle; Waller, Matthew; Weston, Paul; Widaa, Sara; Whittaker, Pamela; Barroso, Ines; Deloukas, Panos; Mathew, Christopher G.; Blackwell, Jenefer M.; Brown, Matthew A.; Corvin, Aiden; Spencer, Chris C.A.; Bettecken, Thomas; Meitinger, Thomas; Oexle, Konrad; Pirastu, Mario; Portas, Laura; Nag, Abhishek; Williams, Katie M.; Yonova-Doing, Ekaterina; Klein, Ronald; Klein, Barbara E.; Hosseini, S. Mohsen; Paterson, Andrew D.; Genuth, S.; Nathan, D.M.; Zinman, B.; Crofford, O.; Crandall, J.; Reid, M.; Brown-Friday, J.; Engel, S.; Sheindlin, J.; Martinez, H.; Shamoon, H.; Engel, H.; Phillips, M.; Gubitosi-Klug, R.; Mayer, L.; Pendegast, S.; Zegarra, H.; Miller, D.; Singerman, L.; Smith-Brewer, S.; Novak, M.; Quin, J.; Dahms, W.; Genuth, Saul; Palmert, M.; Brillon, D.; Lackaye, M.E.; Kiss, S.; Chan, R.; Reppucci, V.; Lee, T.; Heinemann, M.; Whitehouse, F.; Kruger, D.; Jones, J.K.; McLellan, M.; Carey, J.D.; Angus, E.; Thomas, A.; Galprin, A.; Bergenstal, R.; Johnson, M.; Spencer, M.; Morgan, K.; Etzwiler, D.; Kendall, D.; Aiello, Lloyd Paul; Golden, E.; Jacobson, A.; Beaser, R.; Ganda, O.; Hamdy, O.; Wolpert, H.; Sharuk, G.; Arrigg, P.; Schlossman, D.; Rosenzwieg, J.; Rand, L.; Nathan, D.M.; Larkin, M.; Ong, M.; Godine, J.; Cagliero, E.; Lou, P.; Folino, K.; Fritz, S.; Crowell, S.; Hansen, K.; Gauthier-Kelly, C.; Service, J.; Ziegler, G.; Luttrell, L.; Caulder, S.; Lopes-Virella, M.; Colwell, J.; Soule, J.; Fernandes, J.; Hermayer, K.; Kwon, S.; Brabham, M.; Blevins, A.; Parker, J.; Lee, D.; Patel, N.; Pittman, C.; Lindsey, P.; Bracey, M.; Lee, K.; Nutaitis, M.; Farr, A.; Elsing, S.; Thompson, T.; Selby, J.; Lyons, T.; Yacoub-Wasef, S.; Szpiech, M.; Wood, D.; Mayfield, R.; Molitch, M.; Schaefer, B.; Jampol, L.; Lyon, A.; Gill, M.; Strugula, Z.; Kaminski, L.; Mirza, R.; Simjanoski, E.; Ryan, D.; Kolterman, O.; Lorenzi, G.; Goldbaum, M.; Sivitz, W.; Bayless, M.; Counts, D.; Johnsonbaugh, S.; Hebdon, M.; Salemi, P.; Liss, R.; Donner, T.; Gordon, J.; Hemady, R.; Kowarski, A.; Ostrowski, D.; Steidl, S.; Jones, B.; Herman, W.H.; Martin, C.L.; Pop-Busui, R.; Sarma, A.; Albers, J.; Feldman, E.; Kim, K.; Elner, S.; Comer, G.; Gardner, T.; Hackel, R.; Prusak, R.; Goings, L.; Smith, A.; Gothrup, J.; Titus, P.; Lee, J.; Brandle, M.; Prosser, L.; Greene, D.A.; Stevens, M.J.; Vine, A.K.; Bantle, J.; Wimmergren, N.; Cochrane, A.; Olsen, T.; Steuer, E.; Rath, P.; Rogness, B.; Hainsworth, D.; Goldstein, D.; Hitt, S.; Giangiacomo, J.; Schade, D.S.; Canady, J.L.; Chapin, J.E.; Ketai, L.H.; Braunstein, C.S.; Bourne, P.A.; Schwartz, S.; Brucker, A.; Maschak-Carey, B.J.; Baker, L.; Orchard, T.; Silvers, N.; Ryan, C.; Songer, T.; Doft, B.; Olson, S.; Bergren, R.L.; Lobes, L.; Rath, P. Paczan; Becker, D.; Rubinstein, D.; Conrad, P.W.; Yalamanchi, S.; Drash, A.; Morrison, A.; Bernal, M.L.; Vaccaro-Kish, J.; Malone, J.; Pavan, P.R.; Grove, N.; Iyer, M.N.; Burrows, A.F.; Tanaka, E.A.; Gstalder, R.; Dagogo-Jack, S.; Wigley, C.; Ricks, H.; Kitabchi, A.; Murphy, M.B.; Moser, S.; Meyer, D.; Iannacone, A.; Chaum, E.; Yoser, S.; Bryer-Ash, M.; Schussler, S.; Lambeth, H.; Raskin, P.; Strowig, S.; Zinman, B.; Barnie, A.; Devenyi, R.; Mandelcorn, M.; Brent, M.; Rogers, S.; Gordon, A.; Palmer, J.; Catton, S.; Brunzell, J.; Wessells, H.; de Boer, I.H.; Hokanson, J.; Purnell, J.; Ginsberg, J.; Kinyoun, J.; Deeb, S.; Weiss, M.; Meekins, G.; Distad, J.; Van Ottingham, L.; Dupre, J.; Harth, J.; Nicolle, D.; Driscoll, M.; Mahon, J.; Canny, C.; May, M.; Lipps, J.; Agarwal, A.; Adkins, T.; Survant, L.; Pate, R.L.; Munn, G.E.; Lorenz, R.; Feman, S.; White, N.; Levandoski, L.; Boniuk, I.; Grand, G.; Thomas, M.; Joseph, D.D.; Blinder, K.; Shah, G.; Boniuk; Burgess; Santiago, J.; Tamborlane, W.; Gatcomb, P.; Stoessel, K.; Taylor, K.; Goldstein, J.; Novella, S.; Mojibian, H.; Cornfeld, D.; Lima, J.; Bluemke, D.; Turkbey, E.; van der Geest, R.J.; Liu, C.; Malayeri, A.; Jain, A.; Miao, C.; Chahal, H.; Jarboe, R.; Maynard, J.; Gubitosi-Klug, R.; Quin, J.; Gaston, P.; Palmert, M.; Trail, R.; Dahms, W.; Lachin, J.; Cleary, P.; Backlund, J.; Sun, W.; Braffett, B.; Klumpp, K.; Chan, K.; Diminick, L.; Rosenberg, D.; Petty, B.; Determan, A.; Kenny, D.; Rutledge, B.; Younes, Naji; Dews, L.; Hawkins, M.; Cowie, C.; Fradkin, J.; Siebert, C.; Eastman, R.; Danis, R.; Gangaputra, S.; Neill, S.; Davis, M.; Hubbard, L.; Wabers, H.; Burger, M.; Dingledine, J.; Gama, V.; Sussman, R.; Steffes, M.; Bucksa, J.; Nowicki, M.; Chavers, B.; O’Leary, D.; Polak, J.; Harrington, A.; Funk, L.; Crow, R.; Gloeb, B.; Thomas, S.; O’Donnell, C.; Soliman, E.; Zhang, Z.M.; Prineas, R.; Campbell, C.; Ryan, C.; Sandstrom, D.; Williams, T.; Geckle, M.; Cupelli, E.; Thoma, F.; Burzuk, B.; Woodfill, T.; Low, P.; Sommer, C.; Nickander, K.; Budoff, M.; Detrano, R.; Wong, N.; Fox, M.; Kim, L.; Oudiz, R.; Weir, G.; Espeland, M.; Manolio, T.; Rand, L.; Singer, D.; Stern, M.; Boulton, A.E.; Clark, C.; D’Agostino, R.; Lopes-Virella, M.; Garvey, W.T.; Lyons, T.J.; Jenkins, A.; Virella, G.; Jaffa, A.; Carter, Rickey; Lackland, D.; Brabham, M.; McGee, D.; Zheng, D.; Mayfield, R.K.; Boright, A.; Bull, S.; Sun, L.; Scherer, S.; Zinman, B.; Natarajan, R.; Miao, F.; Zhang, L.; Chen;, Z.; Nathan, D.M.; Makela, Kari-Matti; Lehtimaki, Terho; Kahonen, Mika; Raitakari, Olli; Yoshimura, Nagahisa; Matsuda, Fumihiko; Chen, Li Jia; Pang, Chi Pui; Yip, Shea Ping; Yap, Maurice K.H.; Meguro, Akira; Mizuki, Nobuhisa; Inoko, Hidetoshi; Foster, Paul J.; Zhao, Jing Hua; Vithana, Eranga; Tai, E-Shyong; Fan, Qiao; Xu, Liang; Campbell, Harry; Fleck, Brian; Rudan, Igor; Aung, Tin; Hofman, Albert; Uitterlinden, André G.; Bencic, Goran; Khor, Chiea-Chuen; Forward, Hannah; Pärssinen, Olavi; Mitchell, Paul; Rivadeneira, Fernando; Hewitt, Alex W.; Williams, Cathy; Oostra, Ben A.; Teo, Yik-Ying; Hammond, Christopher J.; Stambolian, Dwight; Mackey, David A.; Klaver, Caroline C.W.; Wong, Tien-Yin; Saw, Seang-Mei; Baird, Paul N.

2013-01-01

Refractive errors are common eye disorders of public health importance worldwide. Ocular axial length (AL) is the major determinant of refraction and thus of myopia and hyperopia. We conducted a meta-analysis of genome-wide association studies for AL, combining 12,531 Europeans and 8,216 Asians. We identified eight genome-wide significant loci for AL (RSPO1, C3orf26, LAMA2, GJD2, ZNRF3, CD55, MIP, and ALPPL2) and confirmed one previously reported AL locus (ZC3H11B). Of the nine loci, five (LAMA2, GJD2, CD55, ALPPL2, and ZC3H11B) were associated with refraction in 18 independent cohorts (n = 23,591). Differential gene expression was observed for these loci in minus-lens-induced myopia mouse experiments and human ocular tissues. Two of the AL genes, RSPO1 and ZNRF3, are involved in Wnt signaling, a pathway playing a major role in the regulation of eyeball size. This study provides evidence of shared genes between AL and refraction, but importantly also suggests that these traits may have unique pathways. PMID:24144296

Physiological Equivalence of Normobaric and Hypobaric Exposures of Humans to 25,000 Feet

DTIC Science & Technology

2010-12-01

alveolar oxygen tension (PAO2), alveolar carbon dioxide tension (PACO2), and respiratory quotient (RQ) differed significantly between the chamber and...the U.S. Navy (1) and Air force (2) physiological training programs have instituted ground-level hypoxia training. Respiratory physiologists have been...gas composition and respiratory quotients (RQ) under hypobaric and normobaric condi- tions will be quite different at the same level of ventilatory

Hypercapnia shortens emergence time from inhaled anesthesia in pigs.

PubMed

Gopalakrishnan, Nishant A; Sakata, Derek J; Orr, Joseph A; McJames, Scott; Westenskow, Dwayne R

2007-04-01

Anesthetic clearance from the lungs and the circle rebreathing system can be maximized using hyperventilation and high fresh gas flows. However, the concomitant clearance of CO2 decreases PAco2, thereby decreasing cerebral blood flow and slowing the clearance of anesthetic from the brain. This study shows that in addition to hyperventilation, hypercapnia (CO2 infusion or rebreathing) is a significant factor in decreasing emergence time from inhaled anesthesia. We anesthetized seven pigs with 2 MACPIG of isoflurane and four with 2 MACPIG of sevoflurane. After 2 h, anesthesia was discontinued, and the animals were hyperventilated. The time to movement of multiple limbs was measured under hypocapnic (end-tidal CO2 = 22 mm Hg) and hypercapnic (end-tidal CO2 = 55 mm Hg) conditions. The time between turning off the vaporizer and to movement of multiple limbs was faster with hypercapnia during hyperventilation. Emergence time from isoflurane and sevoflurane anesthesia was shortened by an average of 65% with rebreathing or with the use of a CO2 controller (P < 0.05). Hypercapnia, along with hyperventilation, may be used clinically to decrease emergence time from inhaled anesthesia. These time savings might reduce drug costs. In addition, higher PAco2 during emergence may enhance respiratory drive and airway protection after tracheal extubation.

Endovascular vein harvest: systemic carbon dioxide absorption.

PubMed

Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

2006-06-01

Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

PubMed Central

Dupras, J; Vachon, P; Cuvelliez, S; Blais, D

2001-01-01

In this study, anesthesia levels obtained with tiletamine-zolazepam (TZ) and ketamine-midazolam (KM) with or without xylazine (X) were compared in rabbits. Reflexes (corneal, palpebral and withdrawal), blood parameters (PaO2, PaCO2, pH and ions HCO3-), cardiovascular function (heart rate and mean arterial blood pressure) and body temperature were evaluated before and after the injections of the anesthetic combination in the same rabbits (n = 10). With KM and TZ, no suppression of reflexes occurred. The body temperature and pH decreased and HCO3- increased similarly to KMX et TZX. Some physiological and blood parameters were less (PAM, PaCO2) and not (PaO2) affected comparatively to KMX et TZX. These protocols were of short duration of action and did not offer any anesthesia or analgesia. Therefore, their utilization should be restricted to short procedures where no painful manipulations are performed. Ketamine-midazolam-xylazine and tiletamine-zolazepam-xylazine on the other hand are indicated for interventions that require anesthesia. With these combinations, all reflexes were absent for 30-45 and 60-90 min following injections of KMX et TZX, respectively. However, these combinations induce cardiac depression, as well as a decrease of all measured blood parameters and body temperature and a reduction of PaO2. Supplementation with oxygen is recommended with the introduction of xylazine in the protocol. PMID:11424577

[Anesthesia experiences on laparoscopic nephrectomy with da Vinci S robotics].

PubMed

Mou, Ling; Lan, Zhixun

2015-09-01

To summarize the clinical anesthesia experiences in 20 patients who underwent laparoscopic nephrectomy with da Vinci S robotics.
 Anesthesia data of 20 patients from Sichuan Provincial People's Hospital, who underwent laparoscopic nephrectomy with da Vinci S robotics from August 2014 to November 2014, were analyzed and summarized. The anesthesia time, operation time, CO(2) pneumoperitoneum time, PaCO(2) and PETCO(2) were recorded.
 All patients were anesthetized and underwent surgery with da Vinci S robotics. The anesthesia time was (220±14) min, the operation time was (187±11) min, and the CO(2) pneumoperitoneum time was (180±13) min. The PaCO(2) and PETCO(2) were significantly elevated at 1.5 h after operation compared with those at the baseline (before pneumoperitoneum) (P<0.05). The pH value was significantly decreased at 2.5 h after operation compared to that at the baseline (P<0.05). The peak airway pressure of inspiration was significantly elevated at 0.5 h after the beginning of pneumoperitoneum compared to that at the baseline (P<0.05).
 The hemodynamics is stable during the laparoscopic nephrectomy with da vinci S robotics. However, the duration of CO(2) pneumoperitoneum is significantly increased compared to that of other surgical procedures, resulting in high airway resistance and acid-base disturbance.

An analysis of prognostic factors after percutaneous endoscopic gastrostomy placement in Japanese patients with amyotrophic lateral sclerosis.

PubMed

Nagashima, Kazuaki; Furuta, Natsumi; Makioka, Kouki; Fujita, Yukio; Ikeda, Masaki; Ikeda, Yoshio

2017-05-15

A percutaneous endoscopic gastrostomy (PEG) is an useful intervention for feeding of amyotrophic lateral sclerosis (ALS) patients who have lost oral intake function. The aim of this study was to investigate the risk factors for early death and the survival after PEG placement. A total of 102 ALS patients who underwent PEG placement were enrolled in this study. Patients were divided into two groups; the poor prognosis group included patients who died or needed permanent mechanical ventilation within 30days after PEG placement, and the good prognosis group included patients who did not meet the criteria of the poor prognosis group. Clinical characteristics, respiratory function, and nutritional parameters were compared for the two groups to assess the correlations between clinical and laboratory variables and early death after PEG placement. Multivariate analysis between two groups revealed that higher arterial carbon dioxide pressure (PaCO 2 ) and aphagia before PEG placement were significantly associated with the poor prognosis group. Multivariate analysis for survival also revealed that higher PaCO 2 and shorter duration from onset to PEG placement were significantly associated with shorter survival after PEG placement. In conclusion, respiratory and nutritional parameters are revealed to be important prognostic factors for ALS patients who undergo PEG placement. Copyright © 2017 Elsevier B.V. All rights reserved.

Putting "Service" into Library Staff Training: A Library Manager's Training Guide. LAMA Occasional Papers Series. A Patron-Centered Guide.

ERIC Educational Resources Information Center

Bessler, Joanne M.

This guide is built on librarianship training literature and customer service research from a variety of professions. It tells library managers how to identify and describe service ideals, to translate these ideals into realistic goals, and to lead new and experienced staff in fulfilling these service ideals. They are encouraged to focus the…

Correlations between FEV1 and patient-reported outcomes: A pooled analysis of 23 clinical trials in patients with chronic obstructive pulmonary disease.

PubMed

Donohue, James F; Jones, Paul W; Bartels, Christian; Marvel, Jessica; D'Andrea, Peter; Banerji, Donald; Morris, David G; Patalano, Francesco; Fogel, Robert

2018-04-01

In clinical trials of inhaled bronchodilators, chronic obstructive pulmonary disease (COPD) guidelines recommend that patient-reported outcomes (PROs) are assessed alongside lung function. How these endpoints are related is unclear. Pooled longitudinal data from 23 randomised controlled COPD studies were analyzed (N = 23,213). Treatments included long-acting β 2 agonists, long-acting muscarinic antagonists (LABAs or LAMAs) and the LABA/LAMA combination QVA149. Outcome measures were Transition Dyspnoea Index (TDI) and St. George's Respiratory Questionnaire (SGRQ) scores, COPD exacerbation frequency and rescue medication use. Relationships between changes in trough forced expiratory volume in one second (ΔFEV 1 ) and outcomes following treatment were assessed using correlations of data summaries and model-based analysis: generalized linear mixed-effect regression modelling to determine if ΔFEV 1 could predict patient outcomes with different treatments. Mean age was 64 years, 73% were male, and most had moderate (45%) or severe (52%) disease. Statistically significant correlations were observed between ΔFEV 1 and each outcome measure (exacerbations Rs = 0.05; rescue medication, SGRQ, TDI, r = 0.11-0.16; all p < .001). Patients with greater improvements in trough FEV 1 had on average better SGRQ and TDI scores, fewer exacerbations, and used less rescue medication. For SGRQ and TDI scores, minimal clinically important differences were observed over the range of pooled ΔFEV 1 values. Model-based predictions confirmed the treatment effect was partly explained by changes in FEV 1 from baseline with improvements in PROs observed across all treatments when trough FEV 1 improved. Across all endpoints active treatments were better than placebo (p < .0001), and LABA/LAMA treatment resulted in numerically better treatment outcomes than either monocomponent. These data suggest that FEV 1 improvements post-bronchodilation correlate with PRO improvements. Further improvements in patient outcomes may be expected by maximizing lung function improvements. Registration details for the 23 randomised controlled studies used in this pooled analysis are supplied in Additional File 4. Copyright © 2017 Elsevier Ltd. All rights reserved.

Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic Shock

DTIC Science & Technology

2015-07-01

excess deficit, likely related to a flow dependent reduction in systemic oxygen consumption (VO2), but this effect was transient attain- ing values... oxygen delivery index; VO2, systemic oxygen consumption index; Hct, hematocrit, PaCO2, arterial PCO2; PETCO2, end-tidal PCO2. Table S1: Effect of...response that enabled maintaining oxygen consumption close to baseline resulting in minimal lactate increases and high resuscitability and survival without

Effect of Six Days of Staging on Physiologic Adjustments and Acute Mountain Sickness During Ascent to 4300 Meters

DTIC Science & Technology

2009-01-01

respiratory alkalosis due to hyperventilation that was partially compensated for by increased excretion of HCO3 to maintain a normal pH following...carbon dioxide; RER, respiratory exchange quotient; Sao2, arterial oxygen saturation; Paco2, partial pressure of capillary-arterialized carbon dioxide...dioxide production; E=O2, ventilatory equivalent for oxygen; E=CO2, ventilatory equivalent for carbon dioxide; RER, respiratory exchange quotient

Nine loci for ocular axial length identified through genome-wide association studies, including shared loci with refractive error.

PubMed

Cheng, Ching-Yu; Schache, Maria; Ikram, M Kamran; Young, Terri L; Guggenheim, Jeremy A; Vitart, Veronique; MacGregor, Stuart; Verhoeven, Virginie J M; Barathi, Veluchamy A; Liao, Jiemin; Hysi, Pirro G; Bailey-Wilson, Joan E; St Pourcain, Beate; Kemp, John P; McMahon, George; Timpson, Nicholas J; Evans, David M; Montgomery, Grant W; Mishra, Aniket; Wang, Ya Xing; Wang, Jie Jin; Rochtchina, Elena; Polasek, Ozren; Wright, Alan F; Amin, Najaf; van Leeuwen, Elisabeth M; Wilson, James F; Pennell, Craig E; van Duijn, Cornelia M; de Jong, Paulus T V M; Vingerling, Johannes R; Zhou, Xin; Chen, Peng; Li, Ruoying; Tay, Wan-Ting; Zheng, Yingfeng; Chew, Merwyn; Burdon, Kathryn P; Craig, Jamie E; Iyengar, Sudha K; Igo, Robert P; Lass, Jonathan H; Chew, Emily Y; Haller, Toomas; Mihailov, Evelin; Metspalu, Andres; Wedenoja, Juho; Simpson, Claire L; Wojciechowski, Robert; Höhn, René; Mirshahi, Alireza; Zeller, Tanja; Pfeiffer, Norbert; Lackner, Karl J; Bettecken, Thomas; Meitinger, Thomas; Oexle, Konrad; Pirastu, Mario; Portas, Laura; Nag, Abhishek; Williams, Katie M; Yonova-Doing, Ekaterina; Klein, Ronald; Klein, Barbara E; Hosseini, S Mohsen; Paterson, Andrew D; Makela, Kari-Matti; Lehtimaki, Terho; Kahonen, Mika; Raitakari, Olli; Yoshimura, Nagahisa; Matsuda, Fumihiko; Chen, Li Jia; Pang, Chi Pui; Yip, Shea Ping; Yap, Maurice K H; Meguro, Akira; Mizuki, Nobuhisa; Inoko, Hidetoshi; Foster, Paul J; Zhao, Jing Hua; Vithana, Eranga; Tai, E-Shyong; Fan, Qiao; Xu, Liang; Campbell, Harry; Fleck, Brian; Rudan, Igor; Aung, Tin; Hofman, Albert; Uitterlinden, André G; Bencic, Goran; Khor, Chiea-Chuen; Forward, Hannah; Pärssinen, Olavi; Mitchell, Paul; Rivadeneira, Fernando; Hewitt, Alex W; Williams, Cathy; Oostra, Ben A; Teo, Yik-Ying; Hammond, Christopher J; Stambolian, Dwight; Mackey, David A; Klaver, Caroline C W; Wong, Tien-Yin; Saw, Seang-Mei; Baird, Paul N

2013-08-08

Refractive errors are common eye disorders of public health importance worldwide. Ocular axial length (AL) is the major determinant of refraction and thus of myopia and hyperopia. We conducted a meta-analysis of genome-wide association studies for AL, combining 12,531 Europeans and 8,216 Asians. We identified eight genome-wide significant loci for AL (RSPO1, C3orf26, LAMA2, GJD2, ZNRF3, CD55, MIP, and ALPPL2) and confirmed one previously reported AL locus (ZC3H11B). Of the nine loci, five (LAMA2, GJD2, CD55, ALPPL2, and ZC3H11B) were associated with refraction in 18 independent cohorts (n = 23,591). Differential gene expression was observed for these loci in minus-lens-induced myopia mouse experiments and human ocular tissues. Two of the AL genes, RSPO1 and ZNRF3, are involved in Wnt signaling, a pathway playing a major role in the regulation of eyeball size. This study provides evidence of shared genes between AL and refraction, but importantly also suggests that these traits may have unique pathways. Copyright © 2013 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Cosmology of a Friedmann-Lamaître-Robertson-Walker 3-brane, late-time cosmic acceleration, and the cosmic coincidence.

PubMed

Doolin, Ciaran; Neupane, Ishwaree P

2013-04-05

A late epoch cosmic acceleration may be naturally entangled with cosmic coincidence--the observation that at the onset of acceleration the vacuum energy density fraction nearly coincides with the matter density fraction. In this Letter we show that this is indeed the case with the cosmology of a Friedmann-Lamaître-Robertson-Walker (FLRW) 3-brane in a five-dimensional anti-de Sitter spacetime. We derive the four-dimensional effective action on a FLRW 3-brane, from which we obtain a mass-reduction formula, namely, M(P)(2) = ρ(b)/|Λ(5)|, where M(P) is the effective (normalized) Planck mass, Λ(5) is the five-dimensional cosmological constant, and ρ(b) is the sum of the 3-brane tension V and the matter density ρ. Although the range of variation in ρ(b) is strongly constrained, the big bang nucleosynthesis bound on the time variation of the effective Newton constant G(N) = (8πM(P)(2))(-1) is satisfied when the ratio V/ρ ≳ O(10(2)) on cosmological scales. The same bound leads to an effective equation of state close to -1 at late epochs in accordance with astrophysical and cosmological observations.

Smart Polyacrylonitrile (PAN) Nanofibers with Thermal Energy Storage and Retrieval Functionality

NASA Astrophysics Data System (ADS)

Cherry, De'Andre James

Phase change materials (PCMs) are generally substances with a high heat of fusion in the process of solid to liquid phase change. The nature of PCMs make them efficient materials to store and retrieve large amounts of thermal energy. Presently, high efficiency thermal energy storage/retrieval in applications where flexibility and space saving are required, such as smart textiles, still remains as a challenge. In this study, lauric acid (LA) and myristic acid (MA) were combined to prepare a specific binary fatty acid eutectic (LA-MA) with a melting point near the operating body temperature of a human being and then encapsulated in polyacrylonitrile (PAN) nanofibers through the electrospinning technique. Functionalized PCM-enhanced PAN nanofibers containing LA-MA at 30%, 50%, 70% and 100% of the weight of the PAN were successfully synthesized. The morphological structures and thermal energy storage capacity of the PCM-enhanced PAN nanofibers were characterized by electron microscopy (EM) and differential scanning calorimetry (DSC). The novel PCM-enhanced PAN nanofibers maintained their cylindrical fiber morphology after multiple heating-cooling cycles and retained their latent heat storage functionality. Thus, it is envisioned that the prepared PCM-enhanced PAN nanofibers will find use in applications such as smart textiles where temperature regulation functionality is required.

The influence of the arid Andean high plateau on the phylogeography and population genetics of guanaco (Lama guanicoe) in South America

PubMed Central

MARIN, JUAN C.; GONZÁLEZ, BENITO A.; POULIN, ELIE; CASEY, CIARA S.; JOHNSON, WARREN E.

2012-01-01

A comprehensive study of the phylogeography and population genetics of the largest wild artiodactyl in the arid and cold-temperate South American environments, the guanaco (Lama guanicoe) was conducted. Patterns of molecular genetic structure were described using 514 bp of mtDNA sequence and 14 biparentally-inherited microsatellite markers from 314 samples. These individuals originated from 17 localities throughout the current distribution across Peru, Bolivia, Argentina and Chile. This confirmed well-defined genetic differentiation and subspecies designation of populations geographically separated to the northwest (L. g. cacsilensis) and southeast (L. g. guanicoe) of the central Andes plateau. However, these populations are not completely isolated, as shown by admixture prevalent throughout a limited contact zone, and a strong signal of expansion from north to south in the beginning of the Holocene. Microsatellite analyses differentiated 3 northwestern and 4-5 southeastern populations, suggesting patterns of genetic contact among these populations. Possible genetic refuges were identified, as were source-sink patterns of gene flow at historical and recent time scales. Conservation and management of guanaco should be implemented with an understanding of these local population dynamics while also considering the preservation of broader adaptive variation and evolutionary processes. PMID:23206254

Xuebijing injection improves the respiratory function in rabbits with oleic acid-induced acute lung injury by inhibiting IL-6 expression and promoting IL-10 expression at the protein and mRNA levels

PubMed Central

WANG, YUXIA; JI, MINGLI; WANG, LEI; CHEN, LIPING; LI, JING

2014-01-01

Xuebijing injection is a complex herbal medicine, and clinical and experimental studies have shown that it has a significant effect on acute respiratory distress syndrome and multiple organ dysfunction syndrome. However, the majority of studies regarding Xuebijing injection have focused on serum inflammatory factors, and few studies have been carried out from the perspective of the protein and mRNA expression of inflammatory cytokines. In this study, 60 healthy rabbits of mixed gender were randomly assigned to a normal control group (CG), oleic acid group (model group; MG) and oleic acid + Xuebijing injection group (treatment group; TG). Rabbits of the CG were treated with normal saline through the ear vein, rabbits of the MG were injected with oleic acid (0.4 ml/kg) and rabbits of the TG received 0.4 ml/kg oleic acid + 10 ml/kg Xuebijing injection. Blood samples were collected from the common carotid artery of all rabbits of all groups 1 h after the ear vein was injected with the corresponding reagent, and was used to measure the arterial partial pressure of oxygen (PaO2) and of carbon dioxide (PaCO2). The activity of myeloperoxidase (MPO) was tested, and the protein and mRNA expression levels of interleukin (IL)-6 and IL-10 were determined. Rabbits of the MG exhibited evident respiratory dysfunction (PaO2 and PaCO2 were low), histopathological lung damage and overactive inflammatory responses (the expression of the proinflammatory cytokine IL-6 and the anti-inflammatory cytokine IL-10 was increased at the protein and mRNA levels). Following the administration of the Xuebijing injection, the inflammatory response of the rabbits was significantly reduced. Xuebijing injection raised PaO2 and PaCO2, weakened the activity of MPO in the lung tissue, downregulated the expression of the proinflammatory cytokine IL-6 and further increased the expression of the anti-inflammatory cytokine IL-10. These results demonstrated that Xuebijing injection improved the respiratory function of rabbits with acute oleic acid-induced lung injury by inhibiting IL-6 expression and promoting IL-10 expression. PMID:25289065

Home noninvasive positive pressure ventilation with built-in software in stable hypercapnic COPD: a short-term prospective, multicenter, randomized, controlled trial.

PubMed

Zhou, Luqian; Li, Xiaoying; Guan, Lili; Chen, Jianhua; Guo, Bingpeng; Wu, Weiliang; Huo, Yating; Zhou, Ziqing; Liang, Zhenyu; Zhou, Yuqi; Tan, Jie; Chen, Xin; Song, Yuanlin; Chen, Rongchang

2017-01-01

The benefits of noninvasive positive pressure ventilation (NPPV) in patients with hypercapnic COPD are controversial. It is presumed that methodology and appropriate use of NIV ventilator might be crucial for the outcomes. With the new built-in software, the performance of NIV can be monitored at home, which can guarantee the compliance and appropriate use. This study investigated effects of home use of NIV in hypercapnia in COPD patients using the NIV ventilator with built-in software for monitoring. The current multicenter prospective, randomized, controlled trial enrolled patients with stable GOLD stages III and IV hypercapnic COPD. Patients were randomly assigned via a computer-generated randomization sequence, with a block size of four patients, to continue optimized treatment (control group) or to receive additional NPPV (intervention group) for 3 months. The primary outcome was arterial carbon dioxide pressure (PaCO 2 ). Data were derived from built-in software and analyzed every 4 weeks. Analysis was carried out with the intention to treat. This study is registered with ClinicalTrials.gov, number NCT02499718. Patients were recruited from 20 respiratory units in China from October 1, 2015, and recruitment was terminated with a record of the vital statistics on May 31, 2016. A total of 115 patients were randomly assigned to the NPPV group (n=57) or the control group (n=58). Patients complied well with NPPV therapy (mean [± standard deviation] day use 5.6±1.4 h). The mean estimation of leaks was 37.99±13.71 L/min. The changes in PaCO 2 (-10.41±0.97 vs -4.32±0.68 mmHg, P =0.03) and 6-min walk distance (6MWD) (38.2% vs 18.2%, P =0.02) were statistically significant in the NPPV group versus the control group. COPD assessment test (CAT) showed a positive trend ( P =0.06) in favor of the NPPV group. Pulmonary function and dyspnea were not different between groups. Ventilators equipped with built-in software provided methodology for monitoring NIV use at home, which could facilitate the improvement of compliance and quality control of NIV use. It was shown that three months use of NIV at home could reduce the PaCO 2 and improve exercise tolerance (6MWD) in chronic hypercapnic COPD patients.

Effects of hyperventilation on cerebral oxygen saturation estimated using near-infrared spectroscopy: A randomised comparison between propofol and sevoflurane anaesthesia.

PubMed

Ishiyama, Tadahiko; Kotoda, Masakazu; Asano, Nobumasa; Ikemoto, Kodai; Shintani, Noriyuki; Matsuoka, Toru; Matsukawa, Takashi

2016-12-01

Near-infrared spectroscopy estimates cerebral regional tissue oxygen saturation (rSO2), which may decrease under hyperventilation. Propofol and sevoflurane act differently on cerebral blood vessels. Consequently, cerebral blood flow during hyperventilation with propofol and sevoflurane anaesthesia may differ. The first aim of this study was to compare the changes in rSO2 between propofol and sevoflurane anaesthesia during hyperventilation. The second aim was to assess changes in rSO2 with ventilation changes. A randomised, open-label study. University of Yamanashi Hospital, Yamanashi, Japan from January 2014 to September 2014. Fifty American Society of Anesthesiologists physical status 1 or 2 adult patients who were scheduled for elective abdominal surgery were assigned randomly to receive either propofol or sevoflurane anaesthesia. Exclusion criterion was a known history of cerebral disease such as cerebral infarction, cerebral haemorrhage, transient ischaemic attack and subarachnoid haemorrhage. After induction of anaesthesia but before the start of surgery, rSO2, arterial carbon dioxide partial pressure (PaCO2) and arterial oxygen saturation were measured. Measurements were repeated at 5-min intervals during 15 min of hyperventilation with a PaCO2 around 30 mmHg (4 kPa), and again after ventilation was normalised. The primary outcome was the difference of changes in rSO2 between propofol anaesthesia and sevoflurane anaesthesia during and after hyperventilation. The second outcome was change in rSO2 after the initiation of hyperventilation and after the normalisation of ventilation. Changes of rSO2 during hyperventilation were -10 ± 7% (left) and -11 ± 8% (right) in the propofol group, and -10 ± 8% (left) and -9 ± 7% (right) in the sevoflurane group. After normalisation of PaCO2, rSO2 returned to baseline values. Arterial oxygen saturation remained stable throughout the measurement period. The rSO2 values were similar in the propofol and the sevoflurane groups at each time point. The effects of hyperventilation on estimated rSO2 were similar with propofol and sevoflurane anaesthesia. Changes in rSO2 correlated well with ventilation changes. Japan Primary Registries Network (JPRN); UMIN-CTR ID; UMIN000010640.

Three Essays on Education Policy: Empirical Analyses of the Challenges and Opportunities with For-Profit Colleges, Military Enlistment and Immigration

DTIC Science & Technology

2014-01-01

on immigrant students was made possible by a broader project funded by the Spencer Foundation. RAND Labor and Population and RAND Education...under financial support from the Spencer Foundation, and I thank Robert Bozick and Trey Miller for entrusting me with the opportunity to develop...financial support from the Spencer Foundation and thank Peter Brownell and Paco Martorell for their comments. 94 rankings of development other than

PaCO2 measurement in cerebral haemodynamics: face mask or nasal cannulae?

PubMed

Minhas, J S; Robinson, T; Panerai, R

2017-06-22

PaCO 2 affects cerebral blood flow (CBF) and its regulatory mechanisms, but the effects of CO 2 measurement technique on cerebrovascular parameters are unknown. In order to determine if the two most commonly used approaches, face mask (FM) or nasal cannulae (NC), are interchangeable or not, we tested the hypothesis that the use of FM versus NC does not lead to significant differences in CO 2 -related systemic and cerebrovascular parameters. Recordings of CBF velocity (CBFV), blood pressure (BP), heart rate, and end-tidal CO 2 (EtCO 2 ) were performed in 42 subjects during normocapnia (FM or NC) and 5% CO 2 inhalation (FM) or hyperventilation (NC). Dynamic cerebral autoregulation was assessed with the autoregulation index (ARI), derived by transfer function analysis from the CBFV response to a hypothetical step change in BP. Significant differences in physiological parameters were seen between FM and NC: EtCO 2 (37.40 versus 35.26 mmHg, p  =  0.001) and heart rate (69.6 versus 66.7 bpm, p  =  0.001) respectively. No differences were observed for mean BP, CBFV or the ARI index. Use of FM or NC for measurement of EtCO 2 leads to physiological changes and differences in parameter values that need to be taken into consideration when interpreting and/or comparing results in studies of cerebral haemodynamics.

Dystrophic mineralization of the arterial fibrovascular tissue associated with a vitamin D hypervitaminosis in an 8-year-old female Alpaca (Vicugna pacos).

PubMed

Tavella, Alexander; Stefani, Annalisa; Zanardello, Claudia; Bettini, Astrid; Gauly, Matthias; Zanolari, Patrik

2016-01-01

Prophylactic Vitamin D supplementation is a common practice in Alpaca breeding in many regions around the world. An overdosage can lead to dystrophic mineralization of soft tissues. In this paper we illustrate a suspected case of hypervitaminosis D in an 8-year-old female Alpaca. In June 2015, the carcass of an 8-year-old female Alpaca ( Vicugna pacos ) was submitted to the diagnostic laboratory of the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe) for necropsy. The animal had undergone a spontaneous abortion with uterine prolapse and delivery of the placenta, and had died shortly thereafter. Death occurred due to internal haemorrhage related to dystrophic mineralization of the left renal artery with subsequent rupture and damage of the renal hilum. During the necropsy, histopathological and serum biochemical analyses were performed. After laboratory analyses and the history of mineral and vitamin supplementation reported by the breeder, a hypervitaminosis D was suspected to be the most probable cause of the dystrophic mineralization observed in the left renal artery. Most of the information regarding Llamas and Alpacas comes from the South American and Australian regions. It is therefore important to provide scientific information about these animals in other regions of the world in order to have a better and wider understanding of the nutritional and environmental conditions necessary for optimal breeding.

Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

PubMed

Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

2017-02-01

In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO 2 , forced vital capacity, maximal inspiratory pressures and time spent with SpO 2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO 2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos).

PubMed

Longo, F; Finotti, L; Bellini, L; Zavan, B; Busetto, R; Isola, M

2016-05-01

A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union. Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus. Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity. For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.

Spatial perseveration error by alpacas (Vicugna pacos) in an A-not-B detour task.

PubMed

Abramson, José Z; Paulina Soto, D; Beatriz Zapata, S; Lloreda, María Victoria Hernández

2018-05-01

Spatial perseveration has been documented for domestic animals such as mules, donkeys, horses and dogs. However, evidence for this spatial cognition behavior among other domestic species is scarce. Alpacas have been domesticated for at least 7000 years yet their cognitive ability has not been officially reported. The present article used an A-not-B detour task to study the spatial problem-solving abilities of alpacas (Vicugna pacos) and to identify the perseveration errors, which refers to a tendency to maintain a learned route, despite having another available path. The study tested 51 alpacas, which had to pass through a gap at one end of a barrier in order to reach a reward. After one, two, three or four repeats (A trials), the gap was moved to the opposite end of the barrier (B trials). In contrast to what has been found in other domestic animals tested with the same task, the present study did not find clear evidence of spatial perseveration. Individuals' performance in the subsequent B trials, following the change of gap location, suggests no error persistence in alpacas. Results suggest that alpacas are more flexible than other domestic animals tested with this same task, which has important implications in planning proper training for experimental designs or productive purposes. These results could contribute toward enhancing alpacas' welfare and our understanding of their cognitive abilities.

Carbon mineralization and soil fertility at high altitude grasslands in the Bolivian Andean

NASA Astrophysics Data System (ADS)

Zornoza, R.; Muñoz, M. A.; Faz, A.

2012-04-01

The high grasslands of Apolobamba provide a natural habitat for a high number of wild and domestic camelids such as vicuna (Vicugna vicugna) and alpaca (Lama pacos) in Bolivia. Because of the importance of the camelid raising for the Apolobambás inhabitant economy, it is fundamental to determine the natural resources condition and their availability for the camelid support. The soil organic matter plays a crucial role in the maintenance of the soil fertility at high grasslands. On the other hand, soil respiration is the primary pathway for CO2 fixed by plants returning to the atmosphere and its study is essential to evaluate the soil organic matter mineralization and the global C cycle. Based on this, the objectives of this research were to: (i) evaluate the soil fertility and (ii) determine soil organic matter mineralization on the basis of CO2 releases in Apolobamba. Regarding the lastly vicuna censuses carried out in the studied area, eight representative zones with dissimilar vicuna densities were selected. Other characteristics were also considered to select the study zones: (1) alpaca densities, (2) vegetation communities (3) plant cover and (4) landscape and geo-morphological description. Soil samples from different samplings were collected. Soil respiration was determined at two temperatures: 15 °C (based on the highest atmosphere temperature that was registered in the area) and 25 °C, in order to monitor the increase in soil respiration (Q10). The physico-chemical soil results pointed out the good soil fertility. However, erosive processes could be taken place likely caused by the alpaca grazing. High total organic carbon contents were observed corresponding to the highest soil respiration at 15 °C. This observation was supported by the relationship found between the total organic carbon and the soil respiration. A noticeable increase of the soil respiration when the temperature increased 10 °C was reported (from 1083 ± 47 g C m-2 yr-1 at 15 °C to 2786 ± 343 g C m-2 yr-1 at 25 °C ) which indicated the organic matter mineralization increase and likely the high C reservoirs decrease. Additionally, high Q10 values were observed (13.8 ± 1.5 in subsurface). This indicates that basically climate conditions are actually controlling organic matter mineralization and it is more evident in zones with high total organic carbon contents. Although no vicuna affection on the soil fertility was observed, the camelid grazing generally causes a reduction in the soil respiration rate in Apolobamba. Therefore, it should be undertaken some protection actions to prevent the biodiversity affection bringing camelid overexploitation under control in Bolivian Andean. Keywords: biodiversity, high grasslands, camelid grazing, carbon mineralization, soil respiration

Revolution at Sea Starts Here. A 1987 History of the Naval Surface Warfare Center

DTIC Science & Technology

1988-03-01

MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10 . SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY...Blake, Mary H. Hagen, Mark E. Chase, Gary Kendrick, Barbara Wisdom, George L. Hamlin, Pamela 0. Lama, Marcella Westermeyer, and Dave Meggs. Without...needs over the next 10 to 20 years. These thrusts were to: * Emphasize development and integration of Shipboard Electronic Warfare Systems; * Increase

Library Buildings, Equipment, and the ADA: Compliance Issues and Solutions. Proceedings of the Library Administration and Management Association Buildings and Equipment Section Preconference (New Orleans, Louisiana, June 24-25, 1993).

ERIC Educational Resources Information Center

Cirillo, Susan E., Ed.; Danford, Robert E., Ed.

These proceedings are the record of the presentations and deliberations of a 1993 Library Administration and Management Association (LAMA) sponsored conference. The speakers at this conference provided insights into the conditions of disability explanations of the intent and the detail of the law, and techniques for meeting the needs of library…

Auto-trilevel versus bilevel positive airway pressure ventilation for hypercapnic overlap syndrome patients.

PubMed

Su, Mei; Huai, De; Cao, Juan; Ning, Ding; Xue, Rong; Xu, Meijie; Huang, Mao; Zhang, Xilong

2018-03-01

Although bilevel positive airway pressure (Bilevel PAP) therapy is usually used for overlap syndrome (OS), there is still a portion of OS patients in whom Bilevel PAP therapy could not simultaneously eliminate residual apnea events and hypercapnia. The current study was expected to explore whether auto-trilevel positive airway pressure (auto-trilevel PAP) therapy with auto-adjusting end expiratory positive airway pressure (EEPAP) can serve as a better alternative for these patients. From January of 2014 to June of 2016, 32 hypercapnic OS patients with stable chronic obstructive pulmonary diseases (COPD) and moderate-to-severe obstructive sleep apnea syndrome (OSAS) were recruited. Three variable modes of positive airway pressure (PAP) from the ventilator (Prisma25ST, Weinmann Inc., Germany) were applicated for 8 h per night. We performed the design of each mode at each night with an interval of two nights with no PAP treatment as a washout period among different modes. In Bilevel-1 mode (Bilevel-1), the expiratory positive airway pressure (EPAP) delivered from Bilevel PAP was always set as the lowest PAP for abolishment of snoring. For each patient, the inspiratory positive airway pressure (IPAP) was constantly set the same as the minimal pressure for keeping end-tidal CO 2 (ETCO 2 ) ≤45 mmHg for all three modes. However, the EPAP issued by Bilevel PAP in Bilevel-2 mode (Bilevel-2) was kept 3 cmH 2 O higher than that in Bilevel-1. In auto-trilevel mode (auto-trilevel) with auto-trilevel PAP, the initial part of EPAP was fixed at the same PAP as that in Bilevel-1 while the EEPAP was automatically regulated to rise at a range of ≤4 cmH 2 O based on nasal airflow wave changes. Comparisons were made for parameters before and during or following treatment as well as among different PAP therapy modes. The following parameters were compared such as nocturnal apnea hypopnea index (AHI), minimal SpO 2 (minSpO 2 ), arousal index, sleep structure and efficiency, morning PaCO 2 , and daytime Epworth Sleepiness Scale (ESS). Compared with the parameters before PAP therapies, during each mode of PAP treatment, significant reduction was detected in nocturnal AHI, arousal index, morning PaCO 2 , and daytime ESS while significant elevation was revealed in nocturnal minSpO 2 and sleep efficiency (all P < 0.01). Comparison among three PAP modes indicated that under the same IPAP, the auto-trilevel PAP mode could result in the lowest arousal index, daytime ESS, and the highest sleep efficiency. Compared with Bilevel-1, it was detected that (a) AHI was lower but minSpO 2 was higher in both Bilevel-2 and auto-trilevel (all P < 0.05) and (b) morning PaCO 2 showed no statistical difference from that in auto-trilevel but displayed higher in Bilevel-2 (P < 0.05). Compared with Bilevel-2, in auto-trilevel, both AHI and minSpO 2 showed no obvious changes (all P > 0.05) except with a lower morning PaCO 2 (P < 0.05). Auto-trilevel PAP therapy was superior over conventional Bilevel PAP therapy for hypercapnic OS patients with their OSAS moderate to severe, since auto-trilevel PAP was more efficacious in synchronous elimination of residual obstructive apnea events and CO 2 retention as well as in obtaining a better sleep quality and milder daytime drowsiness.

The Noninvasive Carbon Dioxide Gradient (NICO2G) during Hemorrhagic Shock

DTIC Science & Technology

2014-07-01

as well as a tPCO2- PaCO2 gap more than 16 mmHg were reported to be associated with poor outcomes in patients with septic shock (18). Previously, our...shortcomings, which include the need for frequent calibration with a tank of standardized cali- bration gas (24), relative bulk, need for a heated sensor, and...hemorrhagic, septic , and cardiogenic shock (27). Van der Linden et al. (28) demonstrated a venous-arterial gradient for PCO2 in hemorrhaged dogs. There was

Two new species and records of Olophrum laxum species group (Coleoptera: Staphylinidae: Omaliinae: Anthophagini) from China and Nepal.

PubMed

Shavrin, Alexey V

2018-03-21

Two new species of the genus Olophrum Erichson, 1839 of the laxum group are described and illustrated: O. lama Shavrin, sp.n. (Nepal: Rolwaling Himal) and O. schuelkei Shavrin, sp.n. (China: Shaanxi). Olophrum laxum Shavrin Smetana, 2017 from Yunnan and O. pacei Shavrin Smetana, 2017 from Shaanxi and Hubei provinces of China are recorded for the first time. A modified key of the laxum group is provided.

[Unilateral laparoscopic cryptorchidectomy in a llama].

PubMed

Zulauf, M; Bergadano, A; Steiner, A

2002-05-01

Cryptorchism is an inherited congenital abnormality characterized by the failure of one or both testes to descend into the scrotum. Diagnosis can be difficult if the retained testicular tissue cannot be localized during clinical examination and the history of the animal is unknown, or if the animal shows persistent male behaviour despite the history of successful previous castration. The present case report describes the history of a cryptorchid Lama and the techniques of general anesthesia and laparoscopic cryptorchidectomy advocated.

Nomenclatural status of Euptychia mollina Hübner, 1818 (Lepidoptera: Nymphalidae: Satyrinae).

PubMed

Lamas, Gerardo; Nakahara, Shinichi

2015-04-13

The purpose of this note is to clarify the nomenclatural status of Euptychia mollina Hübner, 1818, the type species of Euptychia Hübner, 1818, as there seems to be confusion regarding its year of publication. Due to an unfortunate oversight, Lamas (2004) listed the name as Euptychia mollina (Hübner, [1813]), and this mistake has been repeated in the subsequent literature (e.g. Brévignon 2005; Warren et al. 2014; Neild et al. 2014).

China’s New Relationships With It’s Neighbors

DTIC Science & Technology

2004-01-01

denied a visit request to Taiwan’s first lady, and denied an Asiana airlines flight to Ulan Bator to the Dalai Lama. The Forum attributes both to...reunion in 1995.10 Following that exchange, the event that spawned great anxiety was the 1995-1996 Taiwan Straits Crisis , during which the People’s...years of negotiations, the events of Tiananmen and the Taiwan Straits crisis not only interrupted the proceedings, but added fuel for those seeking

The Genetic History of Peruvian Quechua‐Lamistas and Chankas: Uniparental DNA Patterns among Autochthonous Amazonian and Andean Populations

PubMed Central

Sandoval, José R.; Lacerda, Daniela R.; Acosta, Oscar; Jota, Marilza S.; Robles‐Ruiz, Paulo; Salazar‐Granara, Alberto; Vieira, Pedro Paulo R.; Paz‐y‐Miño, César; Fujita, Ricardo

2016-01-01

Summary This study focuses on the genetic history of the Quechua‐Lamistas, inhabitants of the Lamas Province in the San Martin Department, Peru, who speak their own distinct variety of the Quechua family of languages. It has been suggested that different pre‐Columbian ethnic groups from the Peruvian Amazonia, like the Motilones or “shaven heads”, assimilated the Quechua language and then formed the current native population of Lamas. However, many Quechua‐Lamistas claim to be direct descendants of the Chankas, a famous pre‐Columbian indigenous group that escaped from Inca rule in the Andes. To investigate the Quechua‐Lamistas and Chankas’ ancestries, we compared uniparental genetic profiles (17 STRs of Q‐M3 Y‐chromosome and mtDNA complete control region haplotypes) among autochthonous Amazonian and Andean populations from Peru, Bolivia and Ecuador. The phylogeographic and population genetic analyses indicate a fairly heterogeneous ancestry for the Quechua‐Lamistas, while they are closely related to their neighbours who speak Amazonian languages, presenting no direct relationships with populations from the region where the ancient Chankas lived. On the other hand, the genetic profiles of self‐identified Chanka descendants living in Andahuaylas (located in the Apurimac Department, Peru, in the Central Andes) were closely related to those living in Huancavelica and the assumed Chanka Confederation area before the Inca expansion. PMID:26879156

Pharmacokinetics of ivermectin in llamas (Lama glama).

PubMed

Jarvinen, J A; Miller, J A; Oehler, D D

2002-03-16

The pharmacokinetic behaviour of ivermectin was investigated in adult llamas (Lama glama) by using high performance liquid chromatography with a lower limit of quantification of 2 ng/ml to measure its concentration in serum. Llamas were treated with one of three commercial formulations (injectable, pour-on or oral paste) at dosages recommended by the manufacturer, or with an experimental injectable sustained-release formulation. In five llamas given 1 per cent ivermectin subcutaneously at 200 microg/kg, the median peak serum concentration (Cmax) was 3 ng/ml and the area under the serum concentration-time curve (AUC) was 13.5 ng x day/ml. In six llamas treated topically with 0.5 per cent ivermedin pour-on at 500 microg/kg, Cmax was 2.5 ng/ml or less and the AUC was 7.75 ng x day/ml or less. In seven llamas with measurable concentrations of ivermedin, the median times to peak serum concentration (tmax) were six days after subcutaneous injection and seven days after treatment with the pour-on formulation. In six llamas, the serum concentration of ivermectin remained less than 2 ng/ml for 124 hours after treatment with a 1.87 per cent oral paste at 200 microg/kg. In five llamas treated subcutaneously with 25 per cent ivermectin sustained-release microspheres at 1500 microg/kg, the median Cmax was 5 ng/ml and the median AUC was 224 ng x day/ml.

Validation of CRIB II for prediction of mortality in premature babies.

PubMed

Rastogi, Pallav Kumar; Sreenivas, V; Kumar, Nirmal

2010-02-01

Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates < or = 32 weeks gestational age. Prospective cohort study. Tertiary care neonatal unit. 86 consecutively born preterm neonates with gestational age < or = 32 weeks. The five variables related to CRIB II were recorded within the first hour of admission for data analysis. The receiver operating characteristics (ROC) curve was used to check the accuracy of the mortality prediction. HL Goodness of fit test was used to see the discrepancy between observed and expected outcomes. A total of 86 neonates (males 59.6% mean birthweight: 1228 +/- 398 grams; mean gestational age: 28.3 +/- 2.4 weeks) were enrolled in the study, of which 17 (19.8%) left hospital against medical advice (LAMA) before reaching the study end point. Among 69 neonates completing the study, 24 (34.8%) had adverse outcome during hospital stay and 45 (65.2%) had favorable outcome. CRIB II correctly predicted adverse outcome in 90.3% (Hosmer Lemeshow goodness of fit test P=0.6). Area under curve (AUC) for CRIB II was 0.9032. In intention to treat analysis with LAMA cases included as survivors, the mortality prediction was 87%. If these were included as having died then mortality prediction was 83.1%. The CRIB II score was found to be a good predictive instrument for mortality in preterm infants < or = 32 weeks gestation.

Evaluation of mangrove management through community-based silvofishery in North Sumatra, Indonesia

NASA Astrophysics Data System (ADS)

Basyuni, M.; Yani, P.; Hartini, K. S.

2018-02-01

Aquaculture expansion has been reported as the primary driver of mangrove loss and a significant cause of mangrove deforestation in North Sumatra, Indonesia. Development of silvofishery based on creating balance condition between conserving mangrove forest and offering better livelihood for local communities surrounding mangrove. The present study evaluates of mangrove management through community-based silvofishery in three villages, namely Paluh Manan, Paluh Kurau, and Lama, Hamparan Perak of Deli Serdang Regency, North Sumatra, Indonesia. Three communities used the same ecological type-silvofishery, characterized by planted mangrove surrounded aquaculture. Results showed that in the Paluh Manan village, planted mangrove and aquaculture in the ratio of 75:25 with planting distance of mangrove 50x50 cm, containing 2,500 trees/ha, resulted in US 36.2/month/ha of fish and shrimp farming. In the Paluh Kurau village, a mixture mangrove and aquaculture in an 84:16 ratio, planting distance of 1x1 m, consists of 1,600 trees/ha, US 23.8 of generating revenue from crab farming. Furthermore, in the third village, Lama village, consists of mangrove and aquaculture in the proportions 90:10, with planting spacing 2x2 m, composing 1,000 trees/ha, led to US 45.8/month/ha from fish, shrimp and crab farming. The present study suggested the mangrove management through community-based mangrove-friendly aquaculture.

The Genetic History of Peruvian Quechua-Lamistas and Chankas: Uniparental DNA Patterns among Autochthonous Amazonian and Andean Populations.

PubMed

Sandoval, José R; Lacerda, Daniela R; Acosta, Oscar; Jota, Marilza S; Robles-Ruiz, Paulo; Salazar-Granara, Alberto; Vieira, Pedro Paulo R; Paz-Y-Miño, César; Fujita, Ricardo; Santos, Fabricio R

2016-03-01

This study focuses on the genetic history of the Quechua-Lamistas, inhabitants of the Lamas Province in the San Martin Department, Peru, who speak their own distinct variety of the Quechua family of languages. It has been suggested that different pre-Columbian ethnic groups from the Peruvian Amazonia, like the Motilones or "shaven heads", assimilated the Quechua language and then formed the current native population of Lamas. However, many Quechua-Lamistas claim to be direct descendants of the Chankas, a famous pre-Columbian indigenous group that escaped from Inca rule in the Andes. To investigate the Quechua-Lamistas and Chankas' ancestries, we compared uniparental genetic profiles (17 STRs of Q-M3 Y-chromosome and mtDNA complete control region haplotypes) among autochthonous Amazonian and Andean populations from Peru, Bolivia and Ecuador. The phylogeographic and population genetic analyses indicate a fairly heterogeneous ancestry for the Quechua-Lamistas, while they are closely related to their neighbours who speak Amazonian languages, presenting no direct relationships with populations from the region where the ancient Chankas lived. On the other hand, the genetic profiles of self-identified Chanka descendants living in Andahuaylas (located in the Apurimac Department, Peru, in the Central Andes) were closely related to those living in Huancavelica and the assumed Chanka Confederation area before the Inca expansion. © 2016 John Wiley & Sons Ltd/University College London.

Effect of hyper- and hypocapnia on cerebral arterial compliance in normal subjects.

PubMed

Carrera, Emmanuel; Kim, Dong-Joo; Castellani, Gianluca; Zweifel, Christian; Smielewski, Peter; Pickard, John D; Czosnyka, Marek

2011-04-01

Changes in partial pressure of carbon dioxide (PaCO2) are associated with a decrease in cerebral blood flow (CBF) during hypocapnia and an increase in CBF during hypercapnia. However, the effects of changes in PaCO2 on cerebral arterial compliance (Ca) are unknown. We assessed the changes in Ca in 20 normal subjects using monitoring of arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV). Cerebral arterial blood volume (CaBV) was extracted from CBFV. Ca was defined as the ratio between the pulse amplitudes of CaBV (AMPCaBV ) and ABP (AMPABP). All parameters were recorded during normo-, hyper-, and hypocapnia. During hypocapnia, Ca was significantly lower than during normocapnia (.10±.04 vs. .17±.06; P<.001) secondary to a decrease in AMPCaBV (1.3±.4 vs. 1.9±.5; P<.001) and a concomitant increase in AMPABP (13.8±3.4 vs. 11.6±1.7 mmHg; P<.001). During hypercapnia, there was no change in Ca compared with normocapnia. Ca was inversely correlated with the cerebrovascular resistance during hypo- (R2=0.86; P<.001), and hypercapnia (R2=0.61; P<.001). Using a new mathematical model, we have described a reduction of Ca during hypocapnia. Further studies are needed to determine whether Ca may be an independent predictor of outcome in pathological conditions. Copyright © 2009 by the American Society of Neuroimaging.

Global ischemia in dogs: cerebrovascular CO2 reactivity and autoregulation.

PubMed

Nemoto, E M; Snyder, J V; Carroll, R G; Morita, H

1975-01-01

One hypothesis on the pathogenesis of post-ischemic-anoxic encephalopathy is impaired cerebral perfusion or the no-reflow phenomenon. Therapies aimed at preventing the development of this phenomenon are increased cerebral perfusion pressure (CPP) and hyperventilation or hypercapnia. Using a dog model in which we have described the progressive development of post-ischemic (PI) cerebral hypoperfusion after 15 minutes of global ischemia induced by aortic and vena cavae clamping, our aims in this study were to determine during the PI cerebral hypoperfusion period: (1) cerebrovascular reactivity to CO2, and (2) cerebral blood (CBF) autoregulation. Post-ischemic cerebral hypoperfusion to about 50% of normal was not accompanied by raised intracranial pressure (ICP) but cerebrovascular CO2 reactivity was markedly attenuated while maintaining some kind of autoregulatory phenomenon. Cerebral uptake of oxygen was not significantly affected by changing PACO2 from 20 to 60 torr at constant CPP or by changing CPP from 64 to 104 torr at constant PaCO2. These results suggest that increasing both CPP and hypocapnia/hypercapnia would not significantly attenuate PI neurological deficit after global cerebral ischemia. However, in two dogs inadvertently hemodiluted in the PI period, increasing CPP from 50 to 200 torr increased CBF by 200%, suggesting that hemodilution plus increased CPP may be effective therapy for amelioration of post-ischemic-anoxic encephalopathy. The significance of our findings on cerebrovascular CO2 reactivity and autoregulation with respect to the mechanism of the no-reflow phenomenon is discussed.

An ontogenetic perspective on symphyseal fusion, occlusion and mandibular loading in alpacas (Vicugna pacos).

PubMed

Stover, Kristin K; Sidote, JoAnna; Williams, Susan H

2017-10-01

A primary hypothesis for the evolution of mandibular symphyseal fusion in some mammals is that it functions to resist loads incurred during routine mastication. Anecdotal support for this hypothesis is based on the fact that when the symphysis fuses, it typically does so early during postnatal ontogeny prior to or around the time of weaning. However, little is known about the process of fusion, particularly relative to feeding behaviors and the dynamics of mastication, including occlusion and masticatory loading. In the present study, we investigate the timing and process of symphyseal fusion in alpacas (Vicugna pacos) in the context of maturation of the oral apparatus and oral behavior. We also report on in vivo strains from the symphysis and corpus in young alpacas prior to and following full fusion and M 1 occlusion. Results show that fusion begins rostrally by 1 month and is complete by 6-7 months whereas all deciduous premolars and M 1 come into occlusion by 6 months. Although symphyseal loading patterns are maintained throughout ontogeny, in young alpacas symphyseal strain magnitudes are low compared with adults but corpus strain magnitudes are comparable to those found in adults. Reduced symphyseal loading in young individuals is contrary to what might be predicted given that the symphysis is still fusing. When considered in light of the development of occlusion and rumination, strain magnitudes may be necessarily low and reflect an overall delay in the maturation of masticatory dynamics. Copyright © 2017 Elsevier GmbH. All rights reserved.

Non-invasive Pregnancy Diagnosis from Urine by the Cuboni Reaction and the Barium Chloride Test in Donkeys (Equus asinus) and Alpacas (Vicugna pacos).

PubMed

Kubátová, A; Fedorova, T; Skálová, I; Hyniová, L

2016-09-01

The aim of the research was to evaluate two chemical tests for non-invasive pregnancy diagnosis from urine, the Cuboni reaction and the barium chloride test, in donkeys (Equus asinus) and alpacas (Vicugna pacos). The research was carried out from April 2013 to September 2014. Urine samples were collected on five private Czech farms from 18 jennies and 12 alpaca females. Urine was collected non-invasively into plastic cups fastened on a telescopic rod, at 6-9 week intervals. In total, 60 and 54 urine samples from alpacas and jennies, respectively, were collected. The Cuboni reaction was performed by the State Veterinary Institute Prague. The barium chloride test was done with 5 ml of urine mixed together with 5 ml of 1% barium chloride solution. Results of the Cuboni reaction were strongly influenced by the reproductive status of jennies; the test was 100% successful throughout the second half of pregnancy. However, no relationship was found between the real reproductive status of alpaca females and results of the Cuboni reaction. It was concluded that the barium chloride test is not suitable for pregnancy diagnosis either in donkeys, due to significant influence of season on the results, or in alpacas, because no relationship between results of the test and the reproductive status of alpaca females was found. In conclusion, the Cuboni reaction has potential to become a standard pregnancy diagnostic method in donkeys.

Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease.

PubMed

Molinos, L; Clemente, M G; Miranda, B; Alvarez, C; del Busto, B; Cocina, B R; Alvarez, F; Gorostidi, J; Orejas, C

2009-06-01

The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group. 710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry. COPD was associated with mortality in patients with CAP (OR=2.62 CI: 1.08-6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO(2)< or =60 mmHg (OR=7.95; 95% CI: 3.40-27.5), PaCO(2)> or =45 mmHg (OR=4.6; CI: 2.3-15.1); respiratory rate > or =30/min (OR=12.25; CI: 3.45-35.57), pleural effusion (OR=8.6; 95% CI: 2.01-24.7), septic shock (OR=12.6; 95% CI: 3.4-45.66) and renal failure (OR=13.4; 95% CI: 3.2-37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors. COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO(2) value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.

Lung Transplantation in Cystic Fibrosis and the Impact of Extracorporeal Circulation.

PubMed

Jauregui, Alberto; Deu, Maria; Romero, Laura; Roman, Antonio; Moreno, Antonio; Armengol, Manuel; Solé, Juan

2018-03-10

Lung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival. We performed a retrospective observational study of all trasplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed. Five- and 10-year survival of trasplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO 2 is an independent risk factor for the need for ECC. The survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO 2 is a risk factor for the need for ECC during lung transplantation. Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

The effect of temperature correction of blood gas values on the accuracy of end-tidal carbon dioxide monitoring in children after cardiac surgery.

PubMed

Suominen, Pertti K; Stayer, Stephen; Wang, Wei; Chang, Anthony C

2007-01-01

We evaluated accuracy of end-tidal carbon dioxide tension (PETco2) monitoring and measured the effect of temperature correction of blood gas values in children after cardiac surgery. Data from 49 consecutive mechanically ventilated children after cardiac surgery in the cardiac intensive care unit were prospectively collected. One patient was excluded from the study. Four arterial-end-tidal CO2 pairs in each patient were obtained. Both the arterial carbon dioxide tension (Paco2) values determined at a temperature of 37 degrees C and values corrected to body temperature (Patcco2) were compared with the PETco2 values. After the surgical correction 28 patients had biventricular, acyanotic (mean age 2.7 +/- 4.8 years) and 20 patients had a cyanotic lesion (mean age 1.0 +/- 1.7 years). The body temperature ranged from 35.2 degrees C to 38.9 degrees C. The Pa-PETco2 discrepancy was affected both by the type of cardiac lesion and by the temperature correction of Paco2 values. Correlation slopes of the Pa-PETco2 and Patc-PETco2 discrepancies were significantly different (p = 0.040) when the body temperature was higher or lower than 37 degrees C. In children, after cardiac surgery, end-tidal CO2 monitoring provided a clinically acceptable estimate of arterial CO2 value, which remained stabile in repeated measurements. End-tidal CO2 monitoring more accurately reflects temperature-corrected blood gas values.

Comparative cardiopulmonary effects of carfentanil-xylazine and medetomidine-ketamine used for immobilization of mule deer and mule deer/white-tailed deer hybrids.

PubMed Central

Caulkett, N A; Cribb, P H; Haigh, J C

2000-01-01

Three mule deer and 4 mule deer/white-tailed deer hybrids were immobilized in a crossover study with carfentanil (10 microg/kg) + xylazine (0.3 mg/kg) (CX), and medetomidine (100 microg/kg) + ketamine (2.5 mg/kg) (MK). The deer were maintained in left lateral recumbency for 1 h with each combination. Deer were immobilized with MK in 230+/-68 s (mean +/- SD) and with CX in 282+/-83 seconds. Systolic, mean and diastolic arterial pressure were significantly higher with MK. Heart rate, PaO2, PaCO2, pH, and base excess were not significantly different between treatments. Base excess and pH increased significantly over time with both treatments. Both treatments produced hypoventilation (PaCO2 > 50 mm Hg) and hypoxemia (PaO2 < 60 mm Hg). PaO2 increased significantly over time with CX. Body temperature was significantly (P<0.05) higher with CX compared to MK. Ventricular premature contractions, atrial premature contractions, and a junctional escape rhythm were noted during CX immobilization. No arrhythmias were noted during MK immobilization. Quality of immobilization was superior with MK, with no observed movement present for the 60 min of immobilization. Movement of the head and limbs occurred in 4 animals immobilized with CX. The major complication observed with both of these treatments was hypoxemia, and supplemental inspired oxygen is recommended during immobilization. Hyperthermia can further complicate immobilization with CX, reinforcing the need for supplemental oxygen. PMID:10680659

Effects of short-term mechanical hyperventilation on cerebral blood flow and dynamic cerebral autoregulation in critically ill patients with sepsis.

PubMed

Berg, Ronan M G; Plovsing, Ronni R

2016-01-01

In sepsis, higher PaCO2 levels are associated with impaired dynamic cerebral autoregulation (dCA), which may expose the brain to hypo- and hyperperfusion during acute fluctuations in blood pressure. We hypothesised that short-term mechanical hyperventilation would dCA in critically ill patients with sepsis. Seven mechanically ventilated septic patients were included. We assessed dCA before and after 30 min of mechanical hyperventilation. Transfer function analysis of spontaneous oscillations in transcranial Doppler-based middle cerebral artery blood flow velocity (MCAv) and invasive mean arterial blood pressure was used to assess dCA. Mechanical enhance hyperventilation reduced the median PaCO2 from 5.3 (IQR, 5.0-6.5) to 4.7 (IQR, 4.2-5.1) kPa (p < 0.05). This was associated with a reduction in the median MCAv from 57 (IQR, 33-68) to 32 (IQR, 21-40) cm sec(-1) (p < 0.05). Apart from a small increase in gain in the low frequency range (2.32 [IQR 1.80-2.41] vs. 2.59 (2.40-4.64) cm mmHg(-1) sec(-1); p < 0.05), this was not associated with any enhancement in dCA. In conclusion, cerebral CO2 vasoreactivity was found to be preserved in septic patients; nevertheless, and in contrast to our working hypothesis, short-term mechanical hyperventilation did not enhance dCA.

Topological congruence between phylogenies of Anacanthorus spp. (Monogenea: Dactylogyridae) and their Characiformes (Actinopterygii) hosts: A case of host-parasite cospeciation

PubMed Central

Fabrin, Thomaz M. C.; Gasques, Luciano S.; Prioli, Sônia M. A. P.; Balbuena, Juan A.; Prioli, Alberto J.; Takemoto, Ricardo M.

2018-01-01

Cophylogenetic studies aim at testing specific hypotheses to understand the nature of coevolving associations between sets of organisms, such as host and parasites. Monogeneans and their hosts provide and interesting platform for these studies due to their high host specificity. In this context, the objective of the present study was to establish whether the relationship between Anacanthorus spp. with their hosts from the upper Paraná River and its tributaries can be explained by means of cospeciation processes. Nine fish species and 14 monogenean species, most of them host specific, were studied. Partial DNA sequences of the genes RAG1, 16S and COI of the fish hosts and of the genes ITS2, COI and 5.8S of the parasite species were used for phylogenetic reconstruction. Maximum likelihood phylogenetic trees of the host and parasite species were built and used for analyses of topological congruence with PACo and ParaFit. The program Jane was used to estimate the nature of cospeciation events. The comparison of the two phylogenies revealed high topological congruence between them. Both PACo and ParaFit supported the hypothesis of global cospeciation. Results from Jane pointed to duplications as the most frequent coevolutionary event, followed by cospeciation, whereas duplications followed by host-switching were the least common event in Anacanthorus spp. studied. Host-sharing (spreading) was also identified but only between congeneric host species. PMID:29538463

Topological congruence between phylogenies of Anacanthorus spp. (Monogenea: Dactylogyridae) and their Characiformes (Actinopterygii) hosts: A case of host-parasite cospeciation.

PubMed

da Graça, Rodrigo J; Fabrin, Thomaz M C; Gasques, Luciano S; Prioli, Sônia M A P; Balbuena, Juan A; Prioli, Alberto J; Takemoto, Ricardo M

2018-01-01

Cophylogenetic studies aim at testing specific hypotheses to understand the nature of coevolving associations between sets of organisms, such as host and parasites. Monogeneans and their hosts provide and interesting platform for these studies due to their high host specificity. In this context, the objective of the present study was to establish whether the relationship between Anacanthorus spp. with their hosts from the upper Paraná River and its tributaries can be explained by means of cospeciation processes. Nine fish species and 14 monogenean species, most of them host specific, were studied. Partial DNA sequences of the genes RAG1, 16S and COI of the fish hosts and of the genes ITS2, COI and 5.8S of the parasite species were used for phylogenetic reconstruction. Maximum likelihood phylogenetic trees of the host and parasite species were built and used for analyses of topological congruence with PACo and ParaFit. The program Jane was used to estimate the nature of cospeciation events. The comparison of the two phylogenies revealed high topological congruence between them. Both PACo and ParaFit supported the hypothesis of global cospeciation. Results from Jane pointed to duplications as the most frequent coevolutionary event, followed by cospeciation, whereas duplications followed by host-switching were the least common event in Anacanthorus spp. studied. Host-sharing (spreading) was also identified but only between congeneric host species.

Vγ9 and Vδ2 T cell antigen receptor genes and butyrophilin 3 (BTN3) emerged with placental mammals and are concomitantly preserved in selected species like alpaca (Vicugna pacos).

PubMed

Karunakaran, Mohindar M; Göbel, Thomas W; Starick, Lisa; Walter, Lutz; Herrmann, Thomas

2014-04-01

Human Vγ9Vδ2 T cells recognize phosphorylated products of isoprenoid metabolism (phosphoantigens) PAg with TCR comprising Vγ9JP γ-chains and Vδ2 δ-chains dependent on butyrophilin 3 (BTN3) expressed by antigen-presenting cells. They are massively activated in many infections and show anti-tumor activity and so far, they have been considered to exist only in higher primates. We performed a comprehensive analysis of databases and identified the three genes in species of both placental magnorders, but not in rodents. The common occurrence or loss of in silico translatable Vγ9, Vδ2, and BTN3 genes suggested their co-evolution based on a functional relationship. In the peripheral lymphocytes of alpaca (Vicugna pacos), characteristic Vγ9JP rearrangements and in-frame Vδ2 rearrangements were found and could be co-expressed in a TCR-negative mouse T cell hybridoma where they rescued CD3 expression and function. Finally, database sequence analysis of the extracellular domain of alpaca BTN3 revealed complete conservation of proposed PAg binding residues of human BTN3A1. In summary, we show emergence and preservation of Vγ9 and Vδ2 TCR genes with the gene of the putative antigen-presenting molecule BTN3 in placental mammals and lay the ground for analysis of alpaca as candidate for a first non-primate species to possess Vγ9Vδ2 T cells.

Nalbuphine and butorphanol reverse opioid-induced respiratory depression but increase arousal in etorphine-immobilized goats (Capra hircus).

PubMed

Haw, Anna J; Meyer, Leith Cr; Fuller, Andrea

2016-09-01

To evaluate and compare the efficacy of two opioid agonist-antagonists, nalbuphine and butorphanol, in reversing etorphine-induced respiratory depression in immobilized goats. Prospective, crossover, experimental trial conducted at 1753 m.a.s.l. Eight adult female Boer goats (Capra hircus). Eight minutes following immobilization with an intramuscular injection of 0.1 mg kg(-1) etorphine, goats were given one of nalbuphine (0.8 mg kg(-1) ), butorphanol (0.1 mg kg(-1) ) or sterile water intravenously, in random order in three trials. Respiratory rate (fR ), ventilation, tidal volume, oxygen consumption (V˙O2 ) and carbon dioxide production (V˙CO2 ) were measured continuously. Arterial blood samples to determine PaO2 and PaCO2 were taken 2 minutes before and at 5 minute intervals after etorphine administration for 25 minutes. Both nalbuphine and butorphanol increased mean PaO2 from 44 mmHg (5.9 kPa) to 63 mmHg (8.4 kPa) after etorphine administration. Butorphanol, but not nalbuphine, also corrected hypopnea and hypoventilation such that fR increased from 13 ± 4 to 21 ± 7 breaths minute(-1) (compared with 16 ± 6 breaths minute(-1) following nalbuphine) and ventilation increased from 4.69 ± 3.04 to 6.91 ± 4.42 L minute(-1) following butorphanol administration. Despite decreases in PaCO2 following nalbuphine and butorphanol, PaCO2 remained elevated compared with pre-immobilization values [nalbuphine: 34 ± 3 mmHg (4.5 ± 0.3 kPa); butorphanol: 34 ± 2 mmHg (4.5 ± 0.3 kPa)] throughout the immobilization. Both agents also decreased the level of immobilization, and increased V˙O2 and V˙CO2 . Nalbuphine and butorphanol significantly improved respiratory function in immobilized goats, with butorphanol eliciting a greater positive response than nalbuphine. However, both opioid agonist-antagonists partly reversed etorphine-induced immobilization. Butorphanol and nalbuphine can be used to improve respiratory parameters in etorphine-immobilized wildlife, with butorphanol being more effective, but unwanted arousal can occur. © 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Changes of Arterial Blood Gases After Different Ranges of Surgical Lung Resection

PubMed Central

Cukic, Vesna; Lovre, Vladimir

2012-01-01

Introduction: In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency. Objective: To show the changes in the level of arterial blood gases after various ranges of lung resection. Material and methods: The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%. Results: In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value of the PaCO2 was significantly decreased after lung surgery compared to preoperative values (p <0.05). Respiratory insufficiency was developed in none of patients. Conclusion: If the % ppoFEV1 (% prognosed postoperative FEV1) is bigger than 30% of normal values of FEV1 (according to sex, weight, height, age) in patient planned for lung resection surgery there is no development of respiratory insufficiency after resection. PMID:23922525

The Changes of Arterial Blood Gases in COPD During Four-year Period

PubMed Central

Cukic, Vesna

2014-01-01

ABSTRACT Introduction: COPD (Chronic Obstructive Pulmonary Disease) is characterized by airflow limitation that is not fully reversible and that can lead to respiratory failure. Objective: to show the changes of arterial blood gases in COPD during the 4 -year evolution of illness. Material and Methods: The research was done on patients suffering from COPD treated at the Clinic “Podhrastovi” during 2006 and 2007 year. The tested parameters were examined from the date of receiving patient with COPD to hospital treatment in 2006 and 2007 and then followed prospectively until 2010 or 2011 year (the follow-up period was 4 years). There were total 199 treated patients who were chosen at random and regularly attended the control examinations. The study was conducted on adult patients of both sexes, different age group. In each patient the duration of illness was recorded so is sex, age, data of smoking habits, information about the regularity of taking bronchodilator therapy during remissions of disease, about the treatment of disease exacerbations, results of blood gases analysis as follows : pH value, PaO2 (partial pressure of oxygen in arterial blood), PaCO2 (partial pressure of carbon dioxide in arterial blood). All these parameters were measured at the beginning and at the end of each hospital treatment. We took in elaboration data obtained in the beginning of the first hospitalization and at the end of the last hospitalization or at the last control in outpatient department when patient was in stable state. Patients were divided into three groups according to the number of exacerbations per year. Results: there is the statistically significant decrease of PaO2 (p<0.01) and pH, (p<0.05) and an increase of PaCO2 (p<0.01) during follow-up period. But in patients regularly treated in phases of remission and exacerbations of illness the course of illness is slower. The decrease of pH and PaO2 and increase of PaCO2 is statistically significantly smaller in those received regular treatment in phases of remissions (P values are respectively <0.05, <0.01 and <0.01) and exacerbations of illness (p values are respectively: <0.01, <0.01 and <0.05). Conclusion: COPD is characterized with airflow limitation which is progressive in the course of illness, and by the changes in arterial blood gases that can lead to respiratory failure, but that course may be made slower using appropriate treatment during remission and exacerbations of diseases. PMID:24783904

Effect of continuous dialysis on blood ph in acidemic hypercapnic animals with severe acute kidney injury: a randomized experimental study comparing high vs. low bicarbonate affluent.

PubMed

Romano, Thiago Gomes; Azevedo, Luciano Cesar Pontes; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Park, Marcelo

2017-12-01

Controlling blood pH during acute ventilatory failure and hypercapnia in individuals suffering from severe acute kidney injury (AKI) and undergoing continuous renal replacement therapy (CRRT) is of paramount importance in critical care settings. In this situation, the optimal concentration of sodium bicarbonate in the dialysate is still an unsolved question in critical care since high concentrations may worsen carbon dioxide levels and low concentrations may not be as effective in controlling pH. We performed a randomized, non-blinded, experimental study. AKI was induced in 12 female pigs via renal hilum ligation and hypoventilation by reducing the tidal volume during mechanical ventilation with the goal of achieving a pH between 7.10-7.15. After achieving the target pH, animals were randomized to undergo isovolemic hemodialysis with one of two bicarbonate concentrations in the dialysate (40 mEq/L [group 40] vs. 20 mEq/L [group 20]). Hemodynamic, respiratory, and laboratory data were collected. The median pH value at CRRT initiation was 7.14 [7.12, 7.15] in group 20 and 7.13 [7.09, 7.14] in group 40 (P = ns). The median baseline PaCO 2 was 74 [72, 81] mmHg in group 20 vs. 79 [63, 85] mmHg in group 40 (P = ns). After 3 h of CRRT, the pH value was 7.05 [6.95, 7.09] in group 20 and 7.12 [7.1, 7.14] in group 40 (P < 0.05), with corresponding values of PaCO 2 of 85 [79, 88] mmHg vs. 81 [63, 100] mmHg (P = ns). The difference in pH after 3 h was due to a metabolic component [standard base excess -10.4 [-12.5, -9.5] mEq/L in group 20 vs. -7.6 [-9.2, -5.1] mEq/L in group 40) (P < 0.05)]. Despite the increased infusion of bicarbonate in group 40, the blood CO 2 content did not change during the experiment. The 12-h survival rate was higher in group 40 (67% vs. 0, P = 0.032). A higher bicarbonate concentration in the dialysate of animals undergoing hypercapnic respiratory failure was associated with improved blood pH control without increasing the PaCO 2 levels.

A Pilot Study of the Performance Characteristics of the D-dimer in Presumed Sepsis

DTIC Science & Technology

2010-05-01

20 breaths/min or PaCO2 ថ mm Hg White Blood Cell Count >12,000 cells /mm3, ɜ,000 cells /mm3, or >10% bands Table 2. Sepsis Definitions Sepsis 2 or...Jersey), a quantitative, microlatex agglutination test with a reference cut-off of 0.4 mg/dL as positive. The assay is run on venous blood collected...sensitivity of only ~61- 67% for patients who ultimately were found to have positive blood cultures.12 This study used a semi-quantitative D-dimer

Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions

PubMed Central

Parati, Gianfranco; Agostoni, Piergiuseppe; Basnyat, Buddha; Bilo, Grzegorz; Brugger, Hermann; Coca, Antonio; Festi, Luigi; Giardini, Guido; Lironcurti, Alessandra; Luks, Andrew M; Maggiorini, Marco; Modesti, Pietro A; Swenson, Erik R; Williams, Bryan; Bärtsch, Peter; Torlasco, Camilla

2018-01-01

Abstract Take home figureAdapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide. PMID:29340578

Combined bronchodilators (tiotropium plus olodaterol) for patients with chronic obstructive pulmonary disease.

PubMed

Ramadan, Wijdan H; Kabbara, Wissam K; El Khoury, Ghada M; Al Assir, Sarah A

2015-01-01

Chronic obstructive pulmonary disease (COPD), a respiratory disease characterized by a progressive decline in lung function, is considered to be a leading cause of morbidity and mortality. Long-acting inhaled bronchodilators, such as long-acting β2 agonists (LABAs) or long-acting muscarinic antagonists (LAMAs), are the cornerstone of maintenance therapy for patients with moderate-to-very-severe COPD. For patients not sufficiently controlled on a single long-acting bronchodilator, a combination of different bronchodilators has shown a significant increase in lung function. Tiotropium, a once-daily dosing LAMA, demonstrated sustained improvements in lung function as well as improved health-related quality of life, reduced exacerbations, and increased survival without altering the rate of decline in the mean forced expiratory volume in 1 second (FEV1) with fairly tolerable side effects. Olodaterol is a once-daily dosing LABA that has proven to be effective in improving lung function, reducing rescue medication use, and improving dyspnea and health-related quality of life, as well as improving exercise endurance with an acceptable safety profile. The combination of olodaterol and tiotropium provided additional improvements in lung function greater than monotherapy with each drug alone. Several well-designed randomized trials confirmed that the synergistic effect of both drugs in combination was able to improve lung function and health-related quality of life without a significant increase in adverse effects. The objective of this paper is to review available evidence on the clinical efficacy and safety of tiotropium, olodaterol, and their combination in patients with COPD.

Lama guanicoe remains from the Chaco ecoregion (Córdoba, Argentina): An osteological approach to the characterization of a relict wild population

PubMed Central

Barri, Fernando

2018-01-01

Guanacos (Lama guanicoe) are large ungulates that have been valued by human populations in South America since the Late Pleistocene. Even though they were very abundant until the end of the 19th century (before the high deforestation rate of the last decades), guanacos have nearly disappeared in the Gran Chaco ecoregion, with relicts and isolated populations surviving in some areas, such as the shrubland area near the saline depressions of Córdoba province, Argentina. In this report, we present the first data from a locally endangered guanaco wild population, through the study of skeletal remains recovered in La Providencia ranch. Our results showed that most of the elements belonged to adults aged between 36 and 96 months; sex evaluation showed similar numbers of males and females. Statistical analysis of the body size of modern samples from Córdoba demonstrated that guanacos from the Chaco had large dimensions and presented lower size variability than the modern and archaeological specimens in our database. Moreover, they exhibited dimensions similar to those of modern guanacos from Patagonia and San Juan, and to archaeological specimens from Ongamira and Cerro Colorado, although further genetic studies are needed to corroborate a possible phylogenetic relationship. Finally, we used archaeozoological techniques to provide a first characterization of a relict guanaco population from the Chaco ecoregion, demonstrating its value to the study of modern skeletal remains and species conservation biology. PMID:29641579

Inhaled glycopyrrolate for the treatment of chronic obstructive pulmonary disease.

PubMed

Tashkin, Donald P; Gross, Nicholas J

2018-01-01

Long-acting muscarinic antagonists (LAMAs), along with long-acting β 2 -agonists (LABAs), are the mainstay for treatment of patients with COPD. Glycopyrrolate, or glycopyrronium bromide, like other LAMAs, inhibits parasympathetic nerve impulses by selectively blocking the binding of acetylcholine to muscarinic receptors. Glycopyrrolate is unusual in that it preferentially binds to M 3 over M 2 muscarinic receptors, thereby specifically targeting the primary muscarinic receptor responsible for bronchoconstriction occurring in COPD. Inhaled glycopyrrolate is slowly absorbed from the lungs and rapidly eliminated from the bloodstream, most likely by renal excretion in its unmetabolized form, limiting the potential for systemic adverse events. Inhaled glycopyrrolate is a fast-acting, efficacious treatment option for patients with moderate-severe COPD. It improves lung function, reduces the risk of exacerbations, and alleviates the symptoms of breathlessness, which in turn may explain the improvement seen in patients' quality of life. Inhaled formulations containing glycopyrrolate are well tolerated, and despite being an anticholinergic, few cardiovascular-related events have been reported. Inhaled glycopyrrolate is thus of value as both monotherapy and in combination with other classes of medication for maintenance treatment of COPD. This review covers the mechanism of action of inhaled glycopyrrolate, including its pharmacokinetic, pharmacodynamic, and safety profiles, and effects on mucus secretion. It also discusses the use of inhaled glycopyrrolate in the treatment of COPD, as monotherapy and in fixed-dose combinations with LABAs and inhaled corticosteroid-LABAs, including a triple therapy recently approved in Europe.

DOE Office of Scientific and Technical Information (OSTI.GOV)

H. Nolen, S. Maxwell, R. Neri, J. Grab

This research effort sought to achieve a solution package that yields energy savings greater than 30 percent over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios tomore » 5-bedroom units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50 percent complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5 percent in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

The role of indacaterol for chronic obstructive pulmonary disease (COPD)

PubMed Central

Bardaro, Floriana; Stirpe, Emanuele

2013-01-01

Indacaterol is the first long-acting β2-agonist (LABAs) approved for the treatment of chronic obstructive pulmonary disease (COPD) that allows for once-daily (OD) administration. It is rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. In long-term clinical studies (12 weeks to 1 year) in patients with moderate to severe COPD, OD indacaterol 150 or 300 μg improved lung function (primary endpoint) significantly more than placebo, and improvements were significantly greater than twice-daily formoterol 12 μg or salmeterol 50 μg, and noninferior to OD tiotropium bromide 18 μg. Indacaterol was well tolerated at all doses and with a good overall safety profile. Cost-utility analyses show that indacaterol 150 μg has lower total costs and better outcomes than tiotropium and salmeterol. These findings suggest that indacaterol can be considered a first choice drug in the treatment of the patient with mild/moderate stable COPD. However, in people with COPD who remain symptomatic on treatment with indacaterol, adding a long-acting muscarinic antagonist (LAMA) is the preferable option. In any case, it is advisable to combine indacaterol with a OD inhaled corticosteroid (ICS), such as mometasone furoate or ciclesonide, in patients with low FEV1, and, in those patients who have many symptoms and a high risk of exacerbations, to combine it with a LAMA and a OD ICS. PMID:23991316

Seroprevalence and characterization of pestivirus infections in small ruminants and new world camelids in Switzerland.

PubMed

Danuser, R; Vogt, H-R; Kaufmann, Th; Peterhans, E; Zanoni, R

2009-03-01

The seroprevalence of pestivirus infections in small ruminants and new world camelids in Switzerland was determined. In 5'059 sera of sheep from 382 herds, 503 sera of goats from 54 herds and 109 sera of alpacas and lamas from 53 herds, population prevalences of 16.1% (sheep), 25.4% (goats) and 4.6% (new world camelids), respectively, were found. In order to determine the source of infection, the serological reactions were further characterized by cross-neutralization against two pestiviruses representing the genotypes BVDV (Bovine Virus Diarrhea Virus)-1 and BDV (Border Disease Virus)-1. Based on the ratio of respective antibody titres, 56.1% of the infections in sheep were induced by a BDV-1, 12.9% by a BVDV-1 and 31.0% by an unresolved pestivirus. In goats, the corresponding proportions were 23.4%, 10.2% and 66.4%, respectively. In Alpacas and Lamas, the source of infection of 1 animal was BDV-1 and that of 4 seropositive animals remained unresolved. In view of the phylogenetic relationship between pestiviruses, the unresolved source of infection is most probably attributable to other pestivirus genotypes circulating in small ruminants and new world camelids. Due to the predominance of pestiviral genotypes other than BVDV-1, the risk of transmission of BVDV from persistently infected small ruminants and new world camelids to cattle appears to be moderate, apart from close direct contact in mixed animal husbandry, communal pasturing and grazing in the Alps.

Cooperative vigilance: the guanaco's (Lama guanicoe) key antipredator mechanism.

PubMed

Taraborelli, Paula; Gregorio, Pablo; Moreno, Pablo; Novaro, Andrés; Carmanchahi, Pablo

2012-09-01

The concept of sociality has been associated with the effectiveness of antipredator mechanisms, like cooperative vigilance and the dilution effect. Lama guanicoe (guanaco) is a social native herbivore in South America and a social species. The objectives of this study were to evaluate the antipredator responses of different-sized groups of guanacos in areas with varying predation risks and to determine antipredator mechanisms in guanacos. For this, we measured different antipredator responses to a potential predator (human subjects). Detection of predator and flight distances from predator both increased with a greater number of guanacos per group and with greater distances among guanacos within the social group. Both buffer distance and flight time decreased with a greater number of guanacos per group, but increased with greater distances among guanacos inside the social group. Solitary adult males moved shorter distance and mixed groups moved greater distances. Flight distances were greater in areas with tall and dense vegetation than in areas with low vegetation. Buffer distance and flight time were shorter in undulating land than on flat lands, and groups were usually observed on hill slopes. Our results suggest that the benefit of social grouping in guanacos is the increased probability of avoiding predator with cooperative vigilance and not with the dilution effect. This means that a predator could be detected earlier when approaching a guanaco group than when approaching a solitary individuals and could thus be avoided. Copyright © 2012 Elsevier B.V. All rights reserved.

Grazing behaviour and dry matter intake of llamas (Lama glama) and German black- head mutton sheep (Ovis orientalis forma aries) under Central European conditions.

PubMed

Stölzl, Anna Maria; Lambertz, Christian; Gauly, Matthias

2015-01-01

The aim of the present study was to assess the behaviour of llamas (Lama glama) and German blackhead mutton sheep (Ovis orientalis forma aries) when kept under Central European grazing conditions. In total, six adult female sheep and six adult female llamas were observed by direct observation during one week, in which each group was observed for a total time of 24 h. The animals were kept on the same pasture, but the species were raised in separate plots. Forage height before and after the experimental period were determined using a rising plate meter to calculate the average daily dry matter intake (DMI). Llamas had a daily DMI of 0.85%/BW and sheep of 1.04%/BW, respectively. The following behaviours were recorded by direct observation: grazing standing up, grazing lying down, ruminating standing up, ruminating lying down, lying down, lying down lateral and standing. Both species grazed for more than 50% of the time. Ruminating was predominantly performed while standing and lying by sheep (about 50% of the night and 12% of the day) and while lying by llamas (54% of the night and 10% of the day). In conclusion, sheep and llamas differed in grazing behaviour and daily biorhythm. These differences indicate that sheep and llamas may not synchronize their behaviour when co-grazed, though particularly in co-grazing studies the observation period should be extended.

PHOTOCHEMICAL AIR POLLUTION IN THE NORTH OF PORTUGAL: A HIGH TROPOSHERIC OZONE EPISODE

NASA Astrophysics Data System (ADS)

Monteiro, A.; Carvalho, A.; Tchepel, O.; Ferreira, J.; Martins, H.; Miranda, A.; Borrego, C.; Saavedra, S.; Rodríguez, A.; Souto, J. A.

2009-12-01

Very high concentrations of ozone are continuously measured at the monitoring station at Lamas d’Olo, located at the North of Portugal,. A particular high photochemical episode occurred between 11 and 13 of July 2005, registering ozone hourly maximum values above 350 µg.m-3. This ozone-rich episode is investigated in this paper, in order to identify its origin and formation. Besides the analysis of both meteorological and air quality monitoring datasets, a numerical modelling approach, based on MM5-CAMx system, was used to simulate the dispersion and transport (horizontal and vertical) of the photochemical pollutants and its precursors. A cross spectrum analysis of the meteorological and air quality time series was performed, in the frequency domain, to establish the relationships between ozone data measured at Lamas d’Olo with air quality data from neighbourhood stations and meteorological parameters. Results point out different behaviour/contribution between the analysed sites. Moreover, different contributions of the u and v wind component on the ozone concentration fluctuations were found suggesting the presence a mountain breeze circulation and a north synoptic transport. The preliminary modelling results pointed out that the vertical transport of pollutants are responsible for the measured high concentrations, combined with particular meteorological conditions, related to the planetary boundary layer (PBL) development. The pollutants transported and existent at high vertical levels are captured/trapped when the PBL height reaches its daily maximum, and extremely high ozone ground level concentrations are consequently measured.

Spatial abundance models and seasonal distribution for guanaco (Lama guanicoe) in central Tierra del Fuego, Argentina.

PubMed

Flores, Celina E; Deferrari, Guillermo; Collado, Leonardo; Escobar, Julio; Schiavini, Adrián

2018-01-01

Spatially explicit modelling allows to estimate population abundance and predict species' distribution in relation to environmental factors. Abiotic factors are the main determinants of a herbivore´s response to environmental heterogeneity on large spatiotemporal scales. We assessed the influence of elevation, geographic location and distance to the coast on the seasonal abundance and distribution of guanaco (Lama guanicoe) in central Tierra del Fuego, by means of spatially explicit modelling. The estimated abundance was 23,690 individuals for the non-breeding season and 33,928 individuals for the breeding season. The factors influencing distribution and abundance revealed to be the elevation for the non-breeding season, and the distance to the coast and geographic location for the breeding season. The southwest of the study area presented seasonal abundance variation and the southeast and northeast presented high abundance during both seasons. The elevation would be the driving factor of guanaco distribution, as individuals move to lower areas during the non-breeding season and ascend to high areas during the breeding season. Our results confirm that part of the guanaco population performs seasonal migratory movements and that the main valleys present important wintering habitats for guanacos as well as up-hill zones during summer. This type of study would help to avoid problems of scale mismatch and achieve better results in management actions and is an example of how to assess important seasonal habitats from evaluations of abundance and distribution patterns.

Spatial abundance models and seasonal distribution for guanaco (Lama guanicoe) in central Tierra del Fuego, Argentina

PubMed Central

Deferrari, Guillermo; Collado, Leonardo; Escobar, Julio; Schiavini, Adrián

2018-01-01

Spatially explicit modelling allows to estimate population abundance and predict species’ distribution in relation to environmental factors. Abiotic factors are the main determinants of a herbivore´s response to environmental heterogeneity on large spatiotemporal scales. We assessed the influence of elevation, geographic location and distance to the coast on the seasonal abundance and distribution of guanaco (Lama guanicoe) in central Tierra del Fuego, by means of spatially explicit modelling. The estimated abundance was 23,690 individuals for the non-breeding season and 33,928 individuals for the breeding season. The factors influencing distribution and abundance revealed to be the elevation for the non-breeding season, and the distance to the coast and geographic location for the breeding season. The southwest of the study area presented seasonal abundance variation and the southeast and northeast presented high abundance during both seasons. The elevation would be the driving factor of guanaco distribution, as individuals move to lower areas during the non-breeding season and ascend to high areas during the breeding season. Our results confirm that part of the guanaco population performs seasonal migratory movements and that the main valleys present important wintering habitats for guanacos as well as up-hill zones during summer. This type of study would help to avoid problems of scale mismatch and achieve better results in management actions and is an example of how to assess important seasonal habitats from evaluations of abundance and distribution patterns. PMID:29782523

In vitro testing of drug combinations employing nilotinib and alkylating agents with regard to pretransplant conditioning treatment of advanced-phase chronic myeloid leukemia.

PubMed

Radujkovic, Aleksandar; Luft, Thomas; Dreger, Peter; Ho, Anthony D; Jens Zeller, W; Fruehauf, Stefan; Topaly, Julian

2014-08-01

The prognosis of patients with advanced-phase chronic myeloid leukemia (CML) remains dismal despite the availability of targeted therapies and allogeneic stem cell transplantation (allo-SCT). Increasing the antileukemic efficacy of the pretransplant conditioning regimen may be a strategy to increase remission rates and duration. We therefore investigated the antiproliferative effects of nilotinib in combination with drugs that are usually used for conditioning: the alkylating agents mafosfamide, treosulfan, and busulfan. Drug combinations were tested in vitro in different imatinib-sensitive and imatinib-resistant BCR-ABL-positive cell lines. A tetrazolium-based MTT assay was used for the assessment and quantification of growth inhibition after exposure to alkylating agents alone or to combinations with nilotinib. Drug interaction was analyzed using the median-effect method of Chou and Talalay, and combination index (CI) values were calculated according to the classic isobologram equation. Treatment of imatinib-sensitive, BCR-ABL-positive K562 and LAMA84 cells with nilotinib in combination with mafosfamide, treosulfan, or busulfan resulted in synergistic (CI < 1), additive (CI ~ 1), and predominantly antagonistic (CI > 1) effects, respectively. In imatinib-resistant K562-R and LAMA84-R cells, all applied drug combinations were synergistic (CI < 1) at higher growth inhibition levels. Our in vitro data warrant further investigation and may provide the basis for nilotinib-supplemented conditioning regimens for allo-SCT in advanced-phase CML.

Ventilation by high-frequency chest wall compression in dogs with normal lungs.

PubMed

Zidulka, A; Gross, D; Minami, H; Vartian, V; Chang, H K

1983-06-01

In 6 anesthetized and paralyzed supine dogs, ventilation by high-frequency chest wall compression (HFCWC) was accomplished by a piston pump rapidly oscillating the pressure in a modified double blood pressure cuff wrapped around the lower thorax. Testing applied frequencies at 3, 5, 8, and 11 Hz, applied peak cuff pressures ranged from 30 to 230 cmH2O. This produced swings of esophageal pressure as high as 18 cmH2O and peak oscillatory air flow ranging from 0.7 to 1.6 L/s. Oscillatory tidal volume declined with increasing frequency and ranged from a mean of 61 to 45 ml. After 30 min of applied HFCWC, arterial blood gas determinations revealed a mean PaCO2 of 29.3 mmHg at 5 Hz, 35 mmHg at 3 Hz, 36 mmHg at 8 Hz, and 51 mmHg at 11 Hz. Mean PaO2 improved from ventilator control values at 3 Hz, remained unchanged at 5 and 8 Hz, and declined at 11 Hz. In 2 dogs breathing spontaneously, HFCWC applied at 5 and 11 Hz resulted in a reduction in spontaneous minute ventilation, mainly by a reduction in spontaneous tidal volume, whereas arterial blood gas values changed slightly. One dog ceased to breath spontaneously within 5 min of application of HFCWC as the PaCO2 fell below control values. We conclude that in dogs with normal lungs, HFCWC may assist spontaneous ventilation. In paralyzed dogs, HFCWC may be of sufficient magnitude to cause hyperventilation.

Comparative Effects of Dexmedetomidine and Propofol on US-Guided Radiofrequency Ablation of Hepatic Neoplasm Under Monitored Anesthesia Care

PubMed Central

Joung, Kyoung-Woon; Choi, Seong-Soo; Jang, Dong-Min; Kong, Yu-Gyeong; Lee, Hwa-Mi; Shim, Ji-Hoon; Won, Hyung-Jin; Shin, Yong-Moon; Kim, Pyo-Nyun; Song, Myung-Hee

2015-01-01

Abstract Percutaneous radiofrequency ablation (RFA) is a useful and safe procedure for treating hepatic neoplasm. However, liver RFA causes severe pain, which thereby increases the demand for monitored anesthesia care (MAC). Here, we compared the efficacy and safety of propofol and dexmedetomidine, which are commonly administered during MAC when performing RFA to assess hepatic neoplasm. In this randomized controlled trial, 40 patients were randomly allocated to 2 groups for elective RFA. Patients received either dexmedetomidine (group D) or propofol (group P). Both groups received the continuous infusion of remifentanil for pain control. The primary outcomes were opioid consumption and differences in partial pressure of arterial carbon dioxide (PaCO2) between pre- and postprocedure RFA. In addition, hemodynamic parameters, patient satisfaction, and interventional radiologist satisfaction were determined. There were significant differences in opioid consumption (50.1 ± 16.8 ng/kg/min [group D] vs 71.2 ± 18.7 ng/kg/min [group P]; P = 0.001) and delta PaCO2 (10.4 ± 6.4 mm Hg vs 17.2 ± 9.2 mm Hg, respectively; P = 0.016). Moreover, respiratory rates were significantly different between groups during RFA (P < 0.001). However, blood pressure and heart rate did not significantly change during RFA. Neither patient nor interventional radiologist satisfaction was significantly different between groups. Dexmedetomidine provides better respiratory stability and reduces opioid consumption in comparison with propofol when administered under MAC when performing RFA for hepatic neoplasm. PMID:26266387

Rapamycin reverses paraquat-induced acute lung injury in a rat model through inhibition of NFκB activation

PubMed Central

Chen, Da; Ma, Tao; Liu, Xiao-Wei; Yang, Chen; Liu, Zhi

2015-01-01

Objective: To evaluate the role of rapamycin (RAPA) in paraquat (PQ)-induced acute lung injury. Methods: Lung tissues were stained with HE and lung histology was observed. Mortality rate, and neutrophil and leukocyte count in blood and bronchoalveolar lavage fluid (BALF) were recorded. Protein content in BALF was determined by Coomassie blue staining. Malondialdehyde (MDA) content, glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activity in blood were determined by thiobarbituric acid (TBA) assay, pyrogallol autoxidation method, and modified Haefman method, respectively. The NF-κB activity was measured by gel electrophoretic mobility shift assay (EMSA). Carbon dioxide partial pressure (PaCO2), partial pressure of oxygen (PaO2) and pH values were measured by automated blood gas analyzer. Results: HE staining results demonstrated RAPA alleviated pathological changes of acute alveolitis in SD rats. Trend of protein content in BALF was PQ group > RAPA treatment group > control group (P < 0.05). Neutrophil and leukocyte count in RAPA treatment group was significantly lower than PQ group at 3, 5, and 7 days after injection (P < 0.05). Trend of MDA content was RAPA treatment group > PQ group > control group (P < 0.05). Trend of GSH-Px and SOD activity was control group > RAPA treatment group > PQ group (P < 0.05). Compared with PQ group, PaO2 in RAPA treatment group was markedly higher and PaCO2 was lower (P < 0.05). Conclusion: PQ-induced acute lung injury was effectively reversed with RAPA, through inhibition of NF-κB activation. PMID:26191153

Cardiorespiratory effects of a tiletamine/zolazepam-ketamine-detomidine combination in horses.

PubMed

Muir, W W; Gadawski, J E; Grosenbaugh, D A

1999-06-01

To determine cardiorespiratory effects of a tiletamine/zolazepam-ketamine-detomidine (TZKD) combination in horses. 8 healthy adult horses. Horses were instrumented for measurement of cardiorespiratory, acid-base, and electrolyte values. Each horse was given xylazine (0.44 mg/kg of body weight, IV) 10 to 15 minutes prior to induction of recumbency by administration of the TZKD combination. Cardiorespiratory, acid-base, and electrolyte values were measured at 5-minute intervals for > or =30 minutes. All horses became recumbent within 1 minute after IV administration of TZKD. Mean +/- SD duration of recumbency was 40+/-8 minutes. All horses regained standing position after < or =2 attempts. Quality of anesthesia and analgesia was determined to be satisfactory in all horses. Xylazine induced decreases in respiratory rate, heart rate, cardiac output, maximum rate of increase of right ventricular pressure, and rate pressure product. The PaCO2, right atrial pressure, and peripheral vascular resistance increased, whereas blood temperature, PO2, pHa, HCO3-, PCV, total solids, Na, and K values remained unchanged. Subsequent administration of TZKD caused right atrial pressure and PaCO2 to increase and PaO2 to decrease, compared with values obtained after xylazine administration. Remaining cardiorespiratory, acid-base, hematologic, and electrolyte values did not differ from those obtained after xylazine administration. IV administration of TZKD induces short-term anesthesia in horses. Potential advantages of this drug combination are the small volume of drug administered; minimal cardiorespiratory depression; quality of induction and maintenance of, and recovery from, anesthesia; and duration of drug effects.

Effects of two fractions of inspired oxygen during anesthesia on early postanesthesia oxygenation in healthy dogs.

PubMed

Martin-Flores, Manuel; Tseng, Chia T; Robillard, Steven D; Abrams, Brittany E; Campoy, Luis; Harvey, H Jay; Gleed, Robin D

2018-02-01

OBJECTIVE To evaluate the effects of 2 fractions of inspired oxygen (Fio 2 s) during anesthesia on postanesthesia Pao 2 and other measures of oxygen exchange. ANIMALS 22 healthy adult sexually intact female dogs undergoing ovariohysterectomy by ventral midline celiotomy. PROCEDURES Dogs were randomly assigned to receive either oxygen (Fio 2 > 0.9 [100% oxygen]; n = 11; control group) or a mixture of nitrogen and oxygen (Fio 2 = 0.4; 11; 40% oxygen group) as the carrier gas for isoflurane while anesthetized. All dogs were allowed to breathe spontaneously while anesthetized. For each dog, the Pao 2 , Paco 2 , other indices of oxygenation, and extent of sedation were monitored at predetermined times during and for 1 hour after anesthesia. Measured variables were compared between the 2 treatment groups and over time within each treatment group. RESULTS None of the measured variables differed significantly between the control and 40% oxygen groups at any time during the postanesthesia period. Within each treatment group, the Paco 2 and extent of sedation decreased over time during the postanesthesia period. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that indices of oxygenation did not differ significantly between healthy dogs in which the Fio 2 was maintained at > 0.9 and those in which the Fio 2 was maintained at 0.4 while anesthetized for ovariohysterectomy. Thus, the addition of nitrogen to the carrier gas for an inhalant anesthetic conferred neither an advantage nor disadvantage in regard to oxygenation during the first hour of anesthesia recovery.

Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients.

PubMed

Fontana, V; Santinelli, S; Internullo, M; Marinelli, P; Sardo, L; Alessandrini, G; Borgognoni, L; Ferrazza, A M; Bonini, M; Palange, P

2016-01-01

Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV. Eleven AECOPD patients, with hypercapnic respiratory failure and MA following NIV, were treated with ACET 500 mg for two consecutive days and compared to a matched control group. Patients and controls were non invasively ventilated in a bilevel positive airway pressure (BiPAP) mode to a standard maximal pressure target of 15-20 cmH2O. ACET intra-group analysis showed a significant improvement for PaCO2 (63.9 ± 9.8 vs. 54.9 ± 8.3 mmHg), HCO3- (43.5 ± 5.9 vs. 36.1 ± 5.4 mmol/L) and both arterial pH (7.46 ± 0.06 vs. 7.41 ± 0.06) and urinary pH (6.94 ± 0.77 vs 5.80 ± 0.82), already at day 1. No significant changes in endpoints considered were observed in the control group at any time-point. Inter-group analysis showed significant differences between changes in PaCO2 and HCO3- (delta), both at day 1 and 2. Furthermore, the length of NIV treatment was significantly reduced in the ACET group compared to controls (6 ± 8 vs. 19 ± 19 days). No adverse events were recorded in the ACET and control groups. ACET appears to be effective and safe in AECOPD patients with post-NIV MA.

Effectiveness of acetazolamide for reversal of metabolic alkalosis in weaning COPD patients from mechanical ventilation.

PubMed

Faisy, Christophe; Mokline, Amel; Sanchez, Olivier; Tadié, Jean-Marc; Fagon, Jean-Yves

2010-05-01

To evaluate the effects of a single daily dose of acetazolamide (ACET) on metabolic alkalosis and respiratory parameters in weaning chronic obstructive pulmonary disease (COPD) patients from invasive mechanical ventilation. Case-control study. An 18-bed intensive care unit (ICU) in a university hospital. Twenty-six intubated COPD patients with mixed metabolic alkalosis (serum bicarbonate >26 mmol/l and arterial pH >or=7.38) were compared with a historical control group (n = 26) matched for serum bicarbonate, arterial pH, age, and severity of illness at admission to ICU. ACET administration (500 mg intravenously) was monitored daily according to arterial blood gas analysis from readiness to wean until extubation. ACET was administered 4 (1-11) days throughout the weaning period. Patients with ACET treatment significantly decreased their serum bicarbonate (p = 0.01 versus baseline) and arterial blood pH (p < 0.0001), increased their PaO(2)/FiO(2) ratio (p = 0.04), but did not change their PaCO(2) (p = 0.71). Compared with matched controls, administration of ACET did not improve arterial blood gas and respiratory parameters except PaO(2)/FiO(2) ratio (p = 0.03). ACET patients and their matched controls had similar duration of weaning. Extubation success rate was not significantly different between groups, and causes of reintubation were comparable. ACET used at the dosage of 500 mg per day reduces metabolic alkalosis but has no benefit in terms of improving PaCO(2) or respiratory parameters in weaning COPD patients from mechanical ventilation.

Does ammonia trigger hyperventilation in the elasmobranch, Squalus acanthias suckleyi?

PubMed

De Boeck, Gudrun; Wood, Chris M

2015-01-15

We examined the ventilatory response of the spiny dogfish, to elevated internal or environmental ammonia. Sharks were injected via arterial catheters with ammonia solutions or their Na salt equivalents sufficient to increase plasma total ammonia concentration [TAmm]a by 3-5 fold from 145±21μM to 447±150μM using NH4HCO3 and a maximum of 766±100μM using (NH4)2SO4. (NH4)2SO4 caused a small increase in ventilation frequency (+14%) and a large increase in amplitude (+69%), while Na2SO4 did not. However, CO2 partial pressure (PaCO2) also increased and arterial pHa and plasma bicarbonate concentration ([HCO3(-)]a) decreased. NH4HCO3 caused a smaller increase in plasma ammonia resulting in a smaller but significant, short lived increases in ventilation frequency (+6%) and amplitude (36%), together with a rise in PaCO2 and [HCO3(-)]a. Injection with NaHCO3 which increased pHa and [HCO3(-)]a did not change ventilation. Plasma ammonia concentration correlated significantly with ventilation amplitude, while ventilation frequency showed a (negative) correlation with pHa. Exposure to high environmental ammonia (1500μM NH4HCO3) did not induce changes in ventilation until plasma [TAmm]a increased and ventilation amplitude (but not frequency) increased in parallel. We conclude that internal ammonia stimulates ventilation in spiny dogfish, especially amplitude or stroke volume, while environmental ammonia only stimulates ventilation after ammonia diffuses into the bloodstream. Copyright © 2014 Elsevier B.V. All rights reserved.

Molecular characterization of rotavirus isolated from alpaca (Vicugna pacos) crias with diarrhea in the Andean Region of Cusco, Peru.

PubMed

Garmendia, Antonio E; Lopez, Wellington; Ortega, Nastassja; Chamorro, Marycris J

2015-10-22

Alpacas (Vicugna pacos), a species of South American camelids (SAC), suffer high morbidity and mortality from infectious diseases. Diarrhea is one of the leading causes of alpaca cria mortality in Peru and elsewhere. In order to develop appropriate control and/or treatment, it is necessary to identify infectious pathogens that cause diarrhea in crias. Rotavirus was isolated in cell culture from feces collected from crias with acute diarrhea that tested positive to rotaviral antigen by rapid immunochromatographic methods in an earlier study. The isolates were identified as rotaviruses by RT-PCR run with specific primers for human rotavirus VP7 coding sequences using total RNA extracted from cells displaying cytopathic effects as template. These alpaca isolates were further identified as group A rotaviruses by means of a VP6-specific PCR and were designated as ALRVA-K'ayra/Perú/3368-10 and ALRVA-K'ayra/Perú/3386-10. Molecular G and P typing, placed the former as G3/P11 and the latter as G3/P?. Sequence analysis of two genome segments (coding for VP4 and VP7) from the alpaca isolates revealed partial homologies to swine and human rotaviruses, respectively. These results demonstrate that rotaviruses are associated with a proportion of cases of diarrhea in crias, although prevalence and impact remain to be determined. The isolation of rotaviruses from alpaca crias with diarrhea will contribute positively to further understand the pathogen and its role in the diarrhea complex. Copyright © 2015 Elsevier B.V. All rights reserved.

Evaluation of Pharmacologic Agents to Suppress Intraocular Cellular Proliferation Following Trauma

DTIC Science & Technology

1986-07-01

Tracttonal Detachment* aniawl op uVeitis agent-- -- 1 (1-4) or control 1 wk 2 wk 4 wk 6 wk 12 wk Gross Lama* Imadi to Injaetica or drug 61 1 D S L C R F...BIBLIOGRAPHY 1. Mimura Y: The effect of colchicine treatment on ocular lesions in Behcet’s disease. Ophthalmol Jpn 26:902-908, 1985. 2. Brown W O... Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol 90:810, 1980. 9. Trese MT, Spitznas M

Medication effects on sleep and breathing.

PubMed

Seda, Gilbert; Tsai, Sheila; Lee-Chiong, Teofilo

2014-09-01

Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration. Published by Elsevier Inc.

A Quick Reference on Respiratory Alkalosis.

PubMed

Johnson, Rebecca A

2017-03-01

Respiratory alkalosis, or primary hypocapnia, occurs when alveolar ventilation exceeds that required to eliminate the carbon dioxide produced by tissues. Concurrent decreases in Paco 2 , increases in pH, and compensatory decreases in blood HCO 3 - levels are associated with respiratory alkalosis. Respiratory alkalosis can be acute or chronic, with metabolic compensation initially consisting of cellular uptake of HCO 3 - and buffering by intracellular phosphates and proteins. Chronic respiratory alkalosis results in longer-lasting decreases in renal reabsorption of HCO 3 - ; the arterial pH can approach near-normal values. Copyright © 2016 Elsevier Inc. All rights reserved.

High-frequency oscillation and tracheal gas insufflation in patients with severe acute respiratory distress syndrome and traumatic brain injury: an interventional physiological study

PubMed Central

2013-01-01

Introduction In acute respiratory distress syndrome (ARDS), combined high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves gas exchange compared with conventional mechanical ventilation (CMV). We evaluated the effect of HFO-TGI on PaO2/fractional inspired O2 (FiO2) and PaCO2, systemic hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) in patients with traumatic brain injury (TBI) and concurrent severe ARDS. Methods We studied 13 TBI/ARDS patients requiring anesthesia, hyperosmolar therapy, and ventilation with moderate-to-high CMV-tidal volumes for ICP control. Patients had PaO2/FiO2 <100 mm Hg at end-expiratory pressure ≥10 cm H2O. Patients received consecutive, daily, 12-hour rescue sessions of HFO-TGI interspersed with 12-hour periods of CMV. HFO-TGI was discontinued when the post-HFO-TGI PaO2/FiO2 exceeded 100 mm Hg for >12 hours. Arterial/central-venous blood gases, hemodynamics, and ICP were recorded before, during (every 4 hours), and after HFO-TGI, and were analyzed by using repeated measures analysis of variance. Respiratory mechanics were assessed before and after HFO-TGI. Results Each patient received three to four HFO-TGI sessions (total sessions, n = 43). Pre-HFO-TGI PaO2/FiO2 (mean ± standard deviation (SD): 83.2 ± 15.5 mm Hg) increased on average by approximately 130% to163% during HFO-TGI (P < 0.01) and remained improved by approximately 73% after HFO-TGI (P < 0.01). Pre-HFO-TGI CMV plateau pressure (30.4 ± 4.5 cm H2O) and respiratory compliance (37.8 ± 9.2 ml/cm H2O), respectively, improved on average by approximately 7.5% and 20% after HFO-TGI (P < 0.01 for both). During HFO-TGI, systemic hemodynamics remained unchanged. Transient improvements were observed after 4 hours of HFO-TGI versus pre-HFO-TGI CMV in PaCO2 (37.7 ± 9.9 versus 41.2 ± 10.8 mm Hg; P < 0.01), ICP (17.2 ± 5.4 versus 19.7 ± 5.9 mm Hg; P < 0.05), and CPP (77.2 ± 14.6 versus 71.9 ± 14.8 mm Hg; P < 0.05). Conclusions In TBI/ARDS patients, HFO-TGI may improve oxygenation and respiratory mechanics, without adversely affecting PaCO2, hemodynamics, or ICP. These findings support the use of HFO-TGI as a rescue ventilatory strategy in patients with severe TBI and imminent oxygenation failure due to severe ARDS. PMID:23844839

Influence of locomotor muscle afferent inhibition on the ventilatory response to exercise in heart failure.

PubMed

Olson, Thomas P; Joyner, Michael J; Eisenach, John H; Curry, Timothy B; Johnson, Bruce D

2014-02-01

What is the central question of this study? Patients with heart failure often develop ventilatory abnormalities at rest and during exercise, but the mechanisms underlying these abnormalities remain unclear. This study investigated the influence of inhibiting afferent neural feedback from locomotor muscles on the ventilatory response during exercise in heart failure patients. What is the main finding and its importance? Our results suggest that inhibiting afferent feedback from locomotor muscle via intrathecal opioid administration significantly reduces the ventilatory response to exercise in heart failure patients. Patients with heart failure (HF) develop ventilatory abnormalities at rest and during exercise, but the mechanism(s) underlying these abnormalities remain unclear. We examined whether the inhibition of afferent neural feedback from locomotor muscles during exercise reduces exercise ventilation in HF patients. In a randomized, placebo-controlled design, nine HF patients (age, 60 ± 2 years; ejection fraction, 27 ± 2%; New York Heart Association class 2 ± 1) and nine control subjects (age, 63 ± 2 years) underwent constant-work submaximal cycling (65% peak power) with intrathecal fentanyl (impairing the cephalad projection of opioid receptor-sensitive afferents) or sham injection. The hypercapnic ventilatory response was measured to determine whether cephalad migration of fentanyl occurred. There were no differences in hypercapnic ventilatory response within or between groups in either condition. Despite a lack of change in ventilation, tidal volume or respiratory rate, HF patients had a mild increase in arterial carbon dioxide (P(aCO(2)) and a decrease in oxygen (P(aO(2)); P < 0.05 for both) at rest. The control subjects demonstrated no change in P(aCO(2)), P(aO(2)), ventilation, tidal volume or respiratory rate at rest. In response to fentanyl during exercise, HF patients had a reduction in ventilation (63 ± 6 versus 44 ± 3 l min(-1), P < 0.05) due to a lower respiratory rate (30 ± 1 versus 26 ± 2 breaths min(-1), P < 0.05). The reduced ventilation resulted in lower P aO 2 (97.6 ± 2.5 versus 79.5 ± 3.0 mmHg, P < 0.05) and increased P(aCO(2)) (37.3 ± 0.9 versus 43.5 ± 1.1 mmHg, P < 0.05), with significant improvement in ventilatory efficiency (reduction in the ventilatory equivalent for carbon dioxide; P < 0.05 for all). The control subjects had no change in ventilation or measures of arterial blood gases. These data suggest that inhibition of afferent feedback from locomotor muscle significantly reduces the ventilatory response to exercise in HF patients.

Osmolality and respiratory regulation in humans: respiratory compensation for hyperchloremic metabolic acidosis is absent after infusion of hypertonic saline in healthy volunteers.

PubMed

Moen, Vibeke; Brudin, Lars; Rundgren, Mats; Irestedt, Lars

2014-10-01

Several animal studies show that changes in plasma osmolality may influence ventilation. Respiratory depression caused by increased plasma osmolality is interpreted as inhibition of water-dependent thermoregulation because conservation of body fluid predominates at the cost of increased core temperature. Respiratory alkalosis, on the other hand, is associated with a decrease in plasma osmolality and strong ion difference (SID) during human pregnancy. We investigated the hypothesis that osmolality would influence ventilation, so that increased osmolality will decrease ventilation and decreased osmolality will stimulate ventilation in both men and women. Our study participants were healthy volunteers of both sexes (ASA physical status I). Ten men (mean 28 years; range 20-40) and 9 women (mean 33 years; range 22-43) were included. All women participated in both the follicular and luteal phases of the menstrual cycle. Hyperosmolality was induced by IV infusion of hypertonic saline 3%, and hypoosmolality by drinking tap water. Arterial blood samples were collected for analysis of electrolytes, osmolality, and blood gases. Sensitivity to CO2 was determined by rebreathing tests performed before and after the fluid-loading procedures. Infusion of hypertonic saline caused hyperchloremic metabolic acidosis with decreased SID in all subjects. Analysis of pooled data showed absence of respiratory compensation. Baseline arterial PCO2 (PaCO2) mean (SD) 37.8 (2.9) mm Hg remained unaltered, with lowest PaCO2 37.8 (2.9) mm Hg after 100 minutes, P = 0.70, causing a decrease in pH from mean (SD) 7.42 (0.02) to 7.38 (0.02), P < 0.001. Metabolic acidosis was also observed during water loading. Pooled results show that PaCO2 decreased from 38.2 (3.3) mm Hg at baseline to 35.7 (2.8) mm Hg after 80 minutes of drinking water, P = 0.002, and pH remained unaltered: pH 7.43 (0.02) at baseline to pH 7.42 (0.02), P = 0.14, mean difference (confidence interval) = pH -0.007 (-0.017 to 0.003). Our results indicate that osmolality has an influence on ventilation. Respiratory compensation for hyperchloremic metabolic acidosis was suppressed during hyperosmolality. Water loading caused a decrease in plasma osmolality and metabolic acidosis, and although the decrease in SID was smaller compared with salt loading, the expected respiratory compensation was observed. Ventilation was also stimulated in men, therefore independently of progesterone levels. We propose that the influence of osmolality on ventilation consists mainly as depression in conditions of hyperosmolality and that this depression is absent during hypoosmolality.

Afferent Neural Feedback Overrides the Modulating Effects of Arousal, Hypercapnia and Hypoxemia on Neonatal Cardio-respiratory Control.

PubMed

Lumb, Kathleen J; Schneider, Jennifer M; Ibrahim, Thowfique; Rigaux, Anita; Hasan, Shabih U

2018-04-20

Evidence at whole animal, organ-system, and cellular and molecular levels suggests that afferent volume feedback is critical for establishment of adequate ventilation at birth. Due to the irreversible nature of vagal ablation studies to date, it was difficult to quantify the roles of afferent volume input, arousal and changes in blood gas tensions on neonatal respiratory control. During reversible perineural vagal block, profound apneas, and hypoxemia and hypercarbia were observed necessitating termination of perineural blockade. Respiratory depression and apneas were independent of the sleep states. We demonstrate that profound apneas and life-threatening respiratory failure in vagally denervated animals do not result from lack of arousal or hypoxemia. Change in sleep state and concomitant respiratory depression result from lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period. Afferent volume feedback plays a vital role in neonatal respiratory control. Mechanisms for the profound respiratory depression and life-threatening apneas observed in vagally denervated neonatal animals remain unclear. We investigated the roles of sleep states, hypoxic-hypercapnia and afferent volume feedback on respiratory depression using reversible perineural vagal block during early postnatal period. Seven lambs were instrumented during the first 48h of life to record/analyze sleep states, diaphragmatic electromyograph, arterial blood gas tensions, systemic arterial blood pressure and rectal temperature. Perineural cuffs were placed around the vagi to attain reversible blockade. Post-operatively, during the awake state, both vagi were blocked using 2% xylocaine for up to 30 minutes. Compared with baseline values, pHa, PaO 2 and SaO 2 decreased and PaCO 2 increased during perineural blockade (P < 0.05). Four of seven animals exhibited apneas of ≥20 sec requiring immediate termination of perineural blockade. Breathing rates decreased from the baseline value of 53 ± 12 to 24 ± 20 breaths/min during blockade despite an increased PaCO 2 (P < 0.001). Following blockade, breathing patterns returned to baseline values despite marked hypocapnia (PaCO 2 33 ± 3 torr; P = 0.03). Respiratory depression and apneas were independent of sleep states. This study provides the much needed physiologic evidence that profound apneas and life-threatening respiratory failure in vagally denervated animals do not result from lack of arousal or hypoxemia. Rather, change in sleep state and concomitant respiratory depression result from lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Using Big Data to Assess Prescribing Patterns in Greece: The Case of Chronic Obstructive Pulmonary Disease.

PubMed

Souliotis, Kyriakos; Kani, Chara; Papageorgiou, Manto; Lionis, Dimitrios; Gourgoulianis, Konstantinos

2016-01-01

Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees' age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. 174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35-54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD. The study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing.

Significance of Medication History at the Time of Entry into the COPDGene Study: Relationship with Exacerbation and CT Metrics

PubMed Central

Park, Seoung Ju; Make, Barry; Hersh, Craig P.; Bowler, Russell P.

2015-01-01

Background Despite the importance of respiratory medication use in COPD, relatively little is known about which clinical phenotypes were associated with respiratory medications. Methods To determine the association between respiratory medication use and exacerbations or quantitative CT metrics, we analyzed medication history from 4,484 COPD subjects enrolled in the COPDGene Study. Results 2,941 (65.6%) subjects were receiving one or more respiratory medications; this group experienced more frequent exacerbations in the year before study entry and had increased gas trapping, emphysema, and subsegmental airway wall area, compared to the patients who were on no respiratory medication. In subgroup analysis, subjects who were on triple therapy (long-acting beta2-agonist [LABA], long-acting muscarinic antagonist [LAMA], and inhaled corticosteroids [ICS]) had the highest frequencies of exacerbations and severe exacerbations and tended to have increased quantitative measures of emphysema and gas trapping on CT compared to other five groups. After adjustment for confounding variables, the triple therapy group experienced more exacerbations and severe exacerbations compared with other five groups. In addition, the LABA+LAMA+ICS group was more likely to have emphysema and gas trapping on CT than other groups in multivariable logistic analysis. Interestingly, the total number of respiratory medications was significantly associated with not only the frequency of exacerbations but also gas trapping and airway wall thickness as assessed by CT scan in multivariable analysis. Conclusions These results suggest that the use of respiratory medications, especially the number of medications, may identify a more severe phenotype of COPD that is highly susceptible to COPD exacerbations. PMID:25254928

Identifying ideal brow vector position: empirical analysis of three brow archetypes.

PubMed

Hamamoto, Ashley A; Liu, Tiffany W; Wong, Brian J

2013-02-01

Surgical browlifts counteract the effects of aging, correct ptosis, and optimize forehead aesthetics. While surgeons have control over brow shape, the metrics defining ideal brow shape are subjective. This study aims to empirically determine whether three expert brow design strategies are aesthetically equivalent by using expert focus group analysis and relating these findings to brow surgery. Comprehensive literature search identified three dominant brow design methods (Westmore, Lamas and Anastasia) that are heavily cited, referenced or internationally recognized in either medical literature or by the lay media. Using their respective guidelines, brow shape was modified for 10 synthetic female faces, yielding 30 images. A focus group of 50 professional makeup artists ranked the three images for each of the 10 faces to generate ordinal attractiveness scores. The contemporary methods employed by Anastasia and Lamas produce a brow arch more lateral than Westmore's classic method. Although the more laterally located brow arch is considered the current trend in facial aesthetics, this style was not empirically supported. No single method was consistently rated most or least attractive by the focus group, and no significant difference in attractiveness score for the different methods was observed (p = 0.2454). Although each method of brow placement has been promoted as the "best" approach, no single brow design method achieved statistical significance in optimizing attractiveness. Each can be used effectively as a guide in designing eyebrow shape during browlift procedures, making it possible to use the three methods interchangeably. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Retrofitting Garden-Style Apartments in Brooklyn, New York

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nolen, Heather; Maxwell, Sean; Neri, Robin

This research effort sought to achieve a solution package that yields energy savings greater than 30% over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios to 5-bedroommore » units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50% complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5% in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

Building America Case Study: Retrofitting Garden-Style Apartments, Brooklyn, New York

DOE Office of Scientific and Technical Information (OSTI.GOV)

This research effort sought to achieve a solution package that yields energy savings greater than 30 percent over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios tomore » 5-bedroom units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50 percent complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5 percent in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

Some characteristics about marriage and childbearing of Tibetan population in Tibet.

PubMed

Gu, J

1992-02-01

The Tibetans are a major ethnic group in China. Tibet lies in the southwestern section of China at an altitude of 4000 m above sea level. Between 1951-90, its population grew from 1.15 to 2.19 million. Tibetans make up 95% of the population in Tibet. 33.02% of Tibetans =or 15 years old are not married. Males are more likely to be unmarried than females (36.08% vs. 29.98%). The high percentage of unmarrieds in Tibet is 5.3%, 4.7%, and 5.8% higher than the Chinese provinces of Sichuan, Qinghai, and Guizhou, respectively. When the Population Research Institute (PRI) standardized data according to the age structure, the differences between Tibet and Guizhou widened (33.54% vs. 26.8%). The proportion of the married population in Tibet is quite low especially for females. The PRI attributes this lower proportion of married females to the high ratio of spontaneous abortions, high maternal mortality, and high infant and child mortality. Since many young and adult Tibetans become lamas who cannot marry, Buddhism contributes to the high rate of unmarried in Tibet. In 1951, 9.5% (110,000) of the population were lamas. Women can have 1 husband. Tibet has a high mean age at 1st marriage (24.6 years for males and 23.1 years for females). It also has a low sex ratio (97.84, 1982) and age specific sex ratios compared with other major ethnic groups in China. The sex ratio is growing, however (100.13, 1990).

Effects of Pleurotomy on Respiratory Sequelae after Internal Mammary Artery Harvesting

PubMed Central

Iyem, Hikmet; Islamoglu, Fatih; Yagdi, Tahir; Sargin, Murat; Berber, Ozbek; Hamulu, Ahmet; Buket, Suat; Durmaz, Isa

2006-01-01

The preservation of pleural integrity during mammary artery harvesting may decrease atelectasis and pleural effusion during the postoperative period. We designed this retrospective study to evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. The study group consisted of 1,141 patients who underwent elective coronary artery bypass grafting. The patients were retrospectively evaluated and divided into 2 groups: those who underwent internal mammary artery harvesting with opened pleura (n=873) or with pleural integrity (n=268). To monitor pleural effusion and atelectasis, chest radiography was performed routinely 1 day before operation and on the 2nd, 5th, and 7th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure (PaO2), partial carbon dioxide pressure (PaCO2), and oxygen (O2) saturation were recorded for comparison, as was the hematocrit. The mean age of the patients was 57.4 ± 8.81 years. There were no significant differences between the groups in mean values of PaO2, PaCO2, O2 saturation, and hematocrit after extubation or on the 1st postoperative day. Atelectasis on the 5th and 7th postoperative days, pleural effusion on the 2nd, 5th, and 7th days, and postoperative bleeding were significantly less in the group with preserved pleural integrity. We showed that preservation of pleural integrity during internal mammary artery harvesting decreases postoperative bleeding, pleural effusion, and atelectasis. We conclude that preservation of pleural integrity, when possible, can decrease these postoperative complications of coronary artery bypass grafting. PMID:16878610

Hypercapnic hyperventilation shortens emergence time from isoflurane anesthesia.

PubMed

Sakata, Derek J; Gopalakrishnan, Nishant A; Orr, Joseph A; White, Julia L; Westenskow, Dwayne R

2007-03-01

To shorten emergence time after a procedure using volatile anesthesia, 78% of anesthesiologists recently surveyed used hyperventilation to rapidly clear the anesthetic from the lungs. Hyperventilation has not been universally adapted into clinical practice because it also decreases the Paco2, which decreases cerebral bloodflow and depresses respiratory drive. Adding deadspace to the patient's airway may be a simple and safe method of maintaining a normal or slightly increased Paco2 during hyperventilation. We evaluated the differences in emergence time in 20 surgical patients undergoing 1 MAC of isoflurane under mild hypocapnia (ETco2 approximately 28 mmHg) and mild hypercapnia (ETco2 approximately 55 mmHg). The minute ventilation in half the patients was doubled during emergence, and hypercapnia was maintained by insertion of additional airway deadspace to keep the ETco2 close to 55 mmHg during hyperventilation. A charcoal canister adsorbed the volatile anesthetic from the deadspace. Fresh gas flows were increased to 10 L/min during emergence in all patients. The time between turning off the vaporizer and the time when the patients opened their eyes and mouths, the time of tracheal extubation, and the time for normalized bispectral index to increase to 0.95 were faster whenever hypercapnic hyperventilation was maintained using rebreathing and anesthetic adsorption (P < 0.001). The time to tracheal extubation was shortened by an average of 59%. The emergence time after isoflurane anesthesia can be shortened significantly by using hyperventilation to rapidly clear the anesthetic from the lungs and CO2 rebreathing to induce hypercapnia during hyperventilation. The device should be considered when it is important to provide a rapid emergence, especially after surgical procedures where a high concentration of the volatile anesthetic was maintained right up to the end of the procedure, or where surgery ends abruptly and without warning.

[Nocturnal hypoxemia and arrhythmia in patients with chronic obstructive lung diseases (COLD)].

PubMed

Skwarski, K

1989-05-01

A decrease in the arterial blood saturation by oxygen in patients with POChP is a frequent phenomenon. It is more serious in patients type blue boaters and less frequent among patients type pink puffers. The aim of the paper was to compare the arterial blood saturation by oxygen in the groups examined during two nights: during the first night the patients breathed atmospheric air whereas during the second night they were given oxygen. The author also studied the influence of oxygenation of an organism on the frequency of cardiac rhythm disorders (ZRS). The author examined a group of 20 patients with the predominance of chronic bronchitis--blue boaters (average VC was 1.95 l, FEV1--0.81 l, PaO2 while breathing atmospheric air 52 mm Hg and 68 mm Hg after giving oxygen, PaCO2 47 and 51 mm Hg respectively) and 20 patients with the predominance of emphysema--pink puffers (average VC--2.30 l, FEV1--0.86 l, PaO2 while breathing atmospheric air 60 mm Hg and 70 mm Hg after giving oxygen, PaCO2 39 and 40 mm respectively). It was found that the patients with heavy hypoxaemia and hypercapnia had worse arterial blood saturation by oxygen during the two nights of investigation in comparison with the other group. The author also found more frequent cardiac rhythm disorders in this group of patients. Giving oxygen improved blood oxygenation in the two groups and lowered the frequency of cardiac rhythm disorders. The results obtained indicate to the need of oxygen therapy in patients with advanced POChP, especially during the night so as to avoid nocturnal hypoxaemia of an organism.

Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study.

PubMed

Simon, Marcel; Harbaum, Lars; Oqueka, Tim; Kluge, Stefan; Klose, Hans

2017-01-01

Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. In the advanced stages, emphysema leads to respiratory failure: hypoxemia and eventually chronic hypercapnic respiratory failure. It can be hypothesized that LVRC treatment, a procedure targeting hyperinflation and thereby reducing ventilatory workload, may be especially beneficial in patients with chronic hypercapnic respiratory failure. This study was conducted to gain first insights into the effects and the safety of LVRC treatment in patients with emphysema and chronic hypercapnic respiratory failure. A retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf, Germany on all patients with chronic hypercapnic respiratory failure in whom bilateral LVRC treatment was performed between 1 April 2012 and 30 September 2015. During the study period, bilateral LVRC treatment was performed in 10 patients with chronic hypercapnic respiratory failure. Compared with baseline, bilateral LVRC treatment led to a significant increase in mean forced expiratory volume in one second (FEV 1 ) from 0.5 ± 0.1 l to 0.6 ± 0.2 l ( p = 0.004), a decrease in residual volume (RV) from 6.1 ± 0.9 l to 5.6 ± 1.1 l ( p = 0.02) and a reduction in partial pressure of carbon dioxide in arterial blood (PaCO 2 ) from 53 ± 5 mmHg to 48 ± 4 mmHg ( p = 0.03). One case of hemoptysis requiring readmission to hospital was the only severe adverse event. LVRC treatment was safe and effective in patients with nonsevere chronic hypercapnic respiratory failure. It led not only to an improvement in lung function but also to a significant decrease in PaCO 2 .

High-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory disturbances: case reports of two infants.

PubMed

Kiszel, J; Seri, I; Machay, T

1985-01-01

The technique of high-frequency oscillatory ventilation (HFOV) was successfully used in a preterm infant with severe hyaline membrane disease and in a term neonate presenting with intrauterine pneumonia and associated severe pneumomediastinum. None of the infants could adequately be ventilated by conventional ventilation; both of them deteriorated owing to severe hypoxaemia and hypercapnia. In the preterm infant with HMD a rapid and progressive improvement of oxygenation had been observed immediately after the beginning of HFOV, and he was successfully weaned off the ventilator after 71 hours on HFOV. His recovery was uncomplicated and definitive. In the term neonate presenting with IUP and associated severe PM, an improvement in oxygenation was detected, whereas the retention of paCO2 remained unaltered. On leaving the MAP unchanged but doubling the flow rate, paCO2 and arterial pH also normalised. No sign of PM was seen on the X-ray picture 17.5 hours after the start of HFOV. This patient was weaned off the ventilator after 29 hours on HFOV and his recovery was also uncomplicated. It is believed that recovery of the PM was secondary to the low MAP and to the higher arterial pO2 levels, and that HFOV may also have a direct role in the treatment of preexisting air leaks and perhaps also in their prevention. In our patients HFOV resulted in a definitive recovery, while no improvement had occurred on using conventional ventilation. To determine the exact mechanism of action, the clear cut fields of indications and the possible side effects of HFOV, further investigations are needed.

Supplemental oxygen effect on hypoxemia at moderate altitude in patients with COPD.

PubMed

Kelly, Paul T; Swanney, Maureen P; Stanton, Josh D; Frampton, Chris; Peters, Matthew J; Beckert, Lutz E

2009-09-01

Altitude exposure will cause moderate to severe hypoxemia in patients with chronic obstructive pulmonary disease (COPD). Supplemental oxygen can be used to attenuate this hypoxemia; however, individual response is variable and difficult to predict. The aim of this study was to assess the efficacy of oxygen supplementation in patients with COPD at a barometric pressure similar to that of a commercial aircraft cabin. Following sea-level (40 m) arterial blood gases measurements, 18 patients with COPD were driven to altitude (2086 m), where blood gases were repeated at rest and while on 2 L x min(-1) of supplementary oxygen (altitude O2). Ascent from sea level to altitude caused significant hypoxemia (75 +/- 9 vs. 51 +/- 6 mmHg), which was partially reversed by supplemental oxygen (64 +/- 9 mmHg). Oxygen supplementation did not significantly alter PaCO2 levels (vs. altitude PaCO2). There was a significant relationship between the sea-level CaO2 versus the altitude O2 CaO2 (r = 0.89, P < 0.001). There was a significant relationship (r = 0.81, P < 0.001) between altitude-induced desaturation and resaturation with the administration of oxygen. There was a significant negative correlation (r = -0.74, P < 0.001) between baseline K(CO) and the improvement in CaO2 with the administration of oxygen. Low-flow supplemental oxygen during acute altitude exposure will partially reverse altitude-induced hypoxemia in patients with COPD. Patients with diffusion impairments are likely to experience the greatest altitude desaturation, but will gain the most benefit from supplemental oxygen. Supplemental oxygen, delivered at 2 L x min(-1), should maintain clinically acceptable oxygenation during commercial air travel in patients with COPD.

Clinical characteristics and risk factors of pulmonary hypertension associated with chronic respiratory diseases: a retrospective study.

PubMed

Chen, Yonghua; Liu, Chunli; Lu, Wenju; Li, Mengxi; Hadadi, Cyrus; Wang, Elizabeth Wenqian; Yang, Kai; Lai, Ning; Huang, Junyi; Li, Shiyue; Zhong, Nanshan; Zhang, Nuofu; Wang, Jian

2016-03-01

Chronic respiratory disease-associated pulmonary hypertension (PH) is an important subtype of PH, which lacks clinical epidemiological data in China. Six hundred and ninety three patients hospitalized from 2010 to 2013 were classified by echocardiography according to pulmonary arterial systolic pressure (PASP): mild (36≤ PASP <50 mmHg); moderate (50≤ PASP <70 mmHg) and severe (PASP ≥70 mmHg). Dyspnea (93.51%) was the most common symptom. Hemoptysis observed in the severe group (6.42%) was significantly higher than the other two groups (P<0.05). COPD (78.35%), lung bullae (44.16%), tuberculosis (including obsolete pulmonary tuberculosis) (38.82%), and bronchiectasis (30.45%) were frequently present. Mild group occupied the highest proportion (84.7%) in COPD, while severe group occupied the highest proportion (19.3%) in pulmonary embolism (P<0.01). Age, partial pressure of oxygen (PaO2), hematocrit (HCT), partial pressure of carbon dioxide (PaCO2), increase of N-terminal pro brain natriuretic peptide (NT-proBNP) and right ventricular (RV) diameter (>20 mm) were associated with moderate-to-severe PH, while RV [odds ratio (OR) =3.53, 95% CI, 2.17-5.74], NT-proBNP (OR=2.44, 95% CI, 1.51-3.95), HCT (OR=1.03, 95% CI, 1.00-1.07) and PaCO2 (OR=1.01, 95% CI, 1.00-1.03) were independent risk factors. PH related to respiratory diseases is mostly mild to moderate, and the severity is associated with the category of respiratory disease. Increased HCT can be an independent risk factor for PH related to chronic respiratory diseases.

Effect of sedation with detomidine and butorphanol on pulmonary gas exchange in the horse.

PubMed

Nyman, Görel; Marntell, Stina; Edner, Anna; Funkquist, Pia; Morgan, Karin; Hedenstierna, Göran

2009-05-07

Sedation with alpha2-agonists in the horse is reported to be accompanied by impairment of arterial oxygenation. The present study was undertaken to investigate pulmonary gas exchange using the Multiple Inert Gas Elimination Technique (MIGET), during sedation with the alpha2-agonist detomidine alone and in combination with the opioid butorphanol. Seven Standardbred trotter horses aged 3-7 years and weighing 380-520 kg, were studied. The protocol consisted of three consecutive measurements; in the unsedated horse, after intravenous administration of detomidine (0.02 mg/kg) and after subsequent butorphanol administration (0.025 mg/kg). Pulmonary function and haemodynamic effects were investigated. The distribution of ventilation-perfusion ratios (VA/Q) was estimated with MIGET. During detomidine sedation, arterial oxygen tension (PaO2) decreased (12.8 +/- 0.7 to 10.8 +/- 1.2 kPa) and arterial carbon dioxide tension (PaCO2) increased (5.9 +/- 0.3 to 6.1 +/- 0.2 kPa) compared to measurements in the unsedated horse. Mismatch between ventilation and perfusion in the lungs was evident, but no increase in intrapulmonary shunt could be detected. Respiratory rate and minute ventilation did not change. Heart rate and cardiac output decreased, while pulmonary and systemic blood pressure and vascular resistance increased. Addition of butorphanol resulted in a significant decrease in ventilation and increase in PaCO2. Alveolar-arterial oxygen content difference P(A-a)O2 remained impaired after butorphanol administration, the VA/Q distribution improved as the decreased ventilation and persistent low blood flow was well matched. Also after subsequent butorphanol no increase in intrapulmonary shunt was evident. The results of the present study suggest that both pulmonary and cardiovascular factors contribute to the impaired pulmonary gas exchange during detomidine and butorphanol sedation in the horse.

Effects of Intermittent Positive Pressure Ventilation on Cardiopulmonary Function in Horses Anesthetized with Total Intravenous Anesthesia Using Combination of Medetomidine, Lidocaine, Butorphanol and Propofol (MLBP-TIVA)

PubMed Central

ISHIZUKA, Tomohito; TAMURA, Jun; NAGARO, Tsukasa; SUDO, Kanako; ITAMI, Takaharu; UMAR, Mohammed Ahamed; MIYOSHI, Kenjirou; SANO, Tadashi; YAMASHITA, Kazuto

2014-01-01

Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33–35 beats/min, cardiac output: 27–30 l/min, mean arterial blood pressure [MABP]: 114–123 mmHg, mean pulmonary arterial pressure [MPAP]: 28–29 mmHg and mean right atrial pressure [MRAP]: 19–21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO2 pressure [PaCO2]: 84–103 mmHg and arterial O2 pressure [PaO2]: 155–172 mmHg). In the CV-group, normocapnea (PaCO2: 42–50 mmHg) and good oxygenation (PaO2: 395–419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29–31 beats/min, cardiac output: 17–21 l /min, MABP: 111–123 mmHg, MPAP: 27–30 mmHg and MRAP: 15–16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated. PMID:25649938

Use of medetomidine and ketamine for immobilization of free-ranging giraffes.

PubMed

Bush, M; Grobler, D G; Raath, J P; Phillips, L G; Stamper, M A; Lance, W R

2001-01-15

To develop a dosage correlated with shoulder height (SH) in centimeters for effective immobilization of free-ranging giraffes, using a combination of medetomidine (MED) and ketamine (KET) and reversal with atipamezole (ATP). Prospective study. 23 free-ranging giraffes. The drug combination (MED and KET) was administered by use of a projectile dart. Quality of induction, quality of immobilization, and time to recovery following injection of ATP were evaluated. Physiologic variables measured during immobilization included PaO2, PaCO2, oxygen saturation, end-tidal CO2, blood pH, indirect arterial blood pressure, heart and respiratory rates, and rectal temperature. Sixteen giraffes became recumbent with a dosage (mean +/- SD) of 143 +/- 29 microg of MED and 2.7 +/- 0.6 mg of KET/cm of SH. Initially, giraffes were atactic and progressed to lateral recumbency. Three giraffes required casting with ropes for data collection, with dosages of 166 +/- 5 microg of MED and 3.2 +/- 0.6 mg of KET/cm of SH. Four giraffes required administration of etorphine (n = 2) or were cast with ropes (2) for capture but remained dangerous to personnel once recumbent, precluding data collection. In giraffes successfully immobilized, physiologic monitoring revealed hypoxia and increased respiratory rates. Values for PaCO2, end-tidal CO2, and heart rate remained within reference ranges. All giraffes were hypertensive and had a slight increase in rectal temperature. Atipamezole was administered at 340 +/- 20 microg/cm of SH, resulting in rapid and smooth recoveries. Medetomidine and KET was an effective immobilizing combination for free-ranging giraffes; however, at the dosages used, it does not induce adequate analgesia for major manipulative procedures. Quality of induction and immobilization were enhanced if the giraffe was calm. Reversal was rapid and complete following injection of ATP.

Effects of respiratory acidosis and alkalosis on the distribution of cyanide into the rat brain.

PubMed

Djerad, A; Monier, C; Houzé, P; Borron, S W; Lefauconnier, J M; Baud, F J

2001-06-01

The aim of this study was to determine whether respiratory acidosis favors the cerebral distribution of cyanide, and conversely, if respiratory alkalosis limits its distribution. The pharmacokinetics of a nontoxic dose of cyanide were first studied in a group of 7 rats in order to determine the distribution phase. The pharmacokinetics were found to best fit a 3-compartment model with very rapid distribution (whole blood T(1/2)alpha = 21.6 +/- 3.3 s). Then the effects of the modulation of arterial pH on the distribution of a nontoxic dose of intravenously administered cyanide into the brains of rats were studied by means of the determination of the permeability-area product (PA). The modulation of arterial blood pH was performed by variation of arterial carbon dioxide tension (PaCO2) in 3 groups of 8 anesthetized mechanically ventilated rats. The mean arterial pH measured 20 min after the start of mechanical ventilation in the acidotic, physiologic, and alkalotic groups were 7.07 +/- 0.03, 7.41 +/- 0.01, and 7.58 +/- 0.01, respectively. The mean PAs in the acidotic, physiologic, and alkalotic groups, determined 30 s after the intravenous administration of cyanide, were 0.015 +/- 0.002, 0.011 +/- 0.001, and 0.008 +/- 0.001 s(-1), respectively (one-way ANOVA; p < 0.0087). At alkalotic pH the mean permeability-area product was 43% of that measured at acidotic pH. This effect of pH on the rapidity of cyanide distribution does not appear to be limited to specific areas of the brain. We conclude that modulation of arterial pH by altering PaCO2 may induce significant effects on the brain uptake of cyanide.

Metabolic alkalosis contributes to acute hypercapnic respiratory failure in adult cystic fibrosis.

PubMed

Holland, Anne E; Wilson, John W; Kotsimbos, Thomas C; Naughton, Matthew T

2003-08-01

and study objectives: Patients with end-stage cystic fibrosis (CF) develop respiratory failure and hypercapnia. In contrast to COPD patients, altered electrolyte transport and malnutrition in CF patients may predispose them to metabolic alkalosis and, therefore, may contribute to hypercapnia. The aim of this study was to determine the prevalence of metabolic alkalosis in adults with hypercapnic respiratory failure in the setting of acute exacerbations of CF compared with COPD. Levels of arterial blood gases, plasma electrolytes, and serum albumin from 14 consecutive hypercapnic CF patients who had been admitted to the hospital with a respiratory exacerbation were compared with 49 consecutive hypercapnic patients with exacerbations of COPD. Hypercapnia was defined as a PaCO(2) of > or = 45 mm Hg. Despite similar PaCO(2) values, patients in the CF group were significantly more alkalotic than were those in the COPD group (mean [+/- SD] pH, 7.43 +/- 0.03 vs 7.37 +/- 0.05, respectively; p < 0.01). A mixed respiratory acidosis and metabolic alkalosis was evident in 71% of CF patients and 22% of COPD patients (p < 0.01). The mean concentrations of plasma chloride (95.1 +/- 4.9 vs 99.8 +/- 5.2 mmol/L, respectively; p < 0.01) and sodium (136.5 +/- 2.8 vs 140.4 +/- 4.5 mmol/L, respectively; p < 0.01) were significantly lower in the CF group, and the levels of serum albumin were significantly reduced (27.4 +/- 5.8 vs 33.7 +/- 4.8 mmol/L, respectively; p < 0.01). Metabolic alkalosis contributes to hypercapnic respiratory failure in adults with acute exacerbations of CF. This acid-base disturbance occurs in conjunction with reduced total body salt levels and hypoalbuminemia.

The clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation.

PubMed

Mizota, Toshiyuki; Matsukawa, Shino; Fukagawa, Hiroshi; Daijo, Hiroki; Tanaka, Tomoharu; Chen, Fengshi; Date, Hiroshi; Fukuda, Kazuhiko

2015-08-01

We examined the clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation (post-HSCT), focusing on ventilatory management. We aimed to determine the incidence of oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction in post-HSCT lung transplant recipients, and to explore factors associated with their development. Nineteen consecutive patients who underwent lung transplantation post-HSCT at Kyoto University Hospital (Japan) were retrospectively studied. Data regarding patient characteristics, preoperative examination, and clinical course during anesthetic induction were analyzed. The incidence of oxygen desaturation (SpO2 < 90 %) during anesthetic induction and severe respiratory acidosis (pH < 7.2) after anesthetic induction were 21.1 and 26.3 %, respectively. Reduced dynamic compliance (Cdyn) during mechanical ventilation was significantly associated with oxygen desaturation during anesthetic induction (p = 0.01), as well as severe respiratory acidosis after anesthetic induction (p = 0.01). The preoperative partial pressure of carbon dioxide in arterial blood (PaCO2; r = -0.743, p = 0.002) and body mass index (BMI; r = 0.61, p = 0.021) significantly correlated with Cdyn, and multivariate analysis revealed that both PaCO2 and BMI were independently associated with Cdyn. Oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction frequently occur in post-HSCT lung transplant recipients. Low Cdyn may, at least partially, explain oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction. Moreover, preoperative hypercapnia and low BMI were predictive of low Cdyn.

Effect of changes in PCO2 and body positions on intraocular pressure during general anaesthesia.

PubMed

Hvidberg, A; Kessing, S V; Fernandes, A

1981-08-01

Elevated arterial carbon dioxide tension, induced by the administration of CO2 via the respiratory air or by hypoventilation, entailed a gradual increase in the IOP in patients without eye diseases under general anaesthesia. A sudden cessation of CO2 administration or hyperventilation caused such a rapid, simultaneous fall in IOP to values below the initial level that the pressure variations must be of vascular nature, presumably related to changes in choroidal blood volume. The above-mentioned procedures always cause a change in the central venous pressure (CVP) simultaneously with the IOP changes. Alterations of the CVP induced by hydrostatic factors in postural changes, placing the head 15 degrees above or below the horizontal level while keeping the PaCO2 constant, caused IOP changes of the same configuration and magnitude as described above. It is concluded, therefore, that presumably the CO2-conditioned IOP changes are due predominantly to changes in central venous pressure, being one link in a CO2-conditioned action upon the general circulation, entailing passive secondary changes in the choroidal venous blood volume and thereby an influence upon the IOP. On the basis of the present results it appears rational to recommend hyperventilation to keep the PaCO2 between 25 and 30 mm and a 15 degree anti-Trendelenburg position in operations on the eye under general anaesthesia, since both procedures afford a low central venous pressure and consequently a low pressure in the posterior segment of the eye, with its attendant advantages as regards vitreous complications and the insertion of intraocular lenses. Owing to the risk of an unacceptable fall in BP in the combined procedure, a frequent checking of the BP is needed.

Constant-flow ventilation in canine experimental pulmonary emphysema.

PubMed

Hachenberg, T; Wendt, M; Meyer, J; Struckmeier, O; Lawin, P

1989-07-01

The efficacy of constant-flow ventilation (CFV) was investigated in eight mongrel dogs before (control-phase) and after development of papain-induced panlobular emphysema (PLE-phase). For CFV, heated, humidified and oxygen-enriched air was continuously delivered via two catheters positioned within each mainstem bronchus at flow rates (V) of 0.33, 0.5 and 0.66 l/s. Data obtained during intermittent positive pressure ventilation (IPPV) served as reference. In the control-phase, Pao2 was lower (P less than or equal to 0.05) and alveolo-arterial O2 difference (P(A-a)O2) was higher (P less than or equal to 0.01) during CFV at all flow rates when compared with IPPV. This may be due to inhomogeneities of intrapulmonary gas distribution and increased ventilation-perfusion (VA/Q) mismatching. Paco2 and V showed a hyperbolic relationship; constant normocapnia (5.3 kPa) was achieved at 0.48 +/- 0.21 l/s (V53). Development of PLE resulted in an increase of functional residual capacity (FRC), residual volume (RV) and static compliance (Cstat) (P less than or equal to 0.05). PaO2 had decreased and P(A-a)O2 had increased (P less than or equal to 0.05), indicating moderate pulmonary dysfunction. Oxygenation during CFV was not significantly different in the PLE-phase when compared with the control-phase. Paco2 and V showed a hyperbolic relationship and V5.3 was even lower than in the control-group (0.42 +/- 0.13 l/s). In dogs with emphysematous lungs CFV maintains sufficient gas exchange. This may be due to preferential ventilation of basal lung units, thereby counterbalancing the effects of impaired lung morphometry and increased airtrapping. Conventional mechanical ventilation is more effective in terms of oxygenation and CO2-elimination.

Altered respiratory response to substance P in capsaicin-treated rats.

PubMed

Towle, A C; Mueller, R A; Breese, G R; Lauder, J

1985-01-01

The present investigation sought to examine the importance of substance P in the altered respiratory activity after neonatal capsaicin administration. Halothane-anesthetized adult rats given capsaicin neonatally exhibit a decreased basal minute ventilation with PaCO2 equal to and PaO2 greater than vehicle injected controls. In addition, the minute ventilation-PaCO2 curve was displaced to the right. Acute bilateral cervical vagotomy severely blunted the minute ventilation response to PaCO2 and abolished the differences in ventilation between capsaicin treated and control rats. Neonatal capsaicin significantly reduced pons-medulla substance P content but not TRH, serotonin or 5-hydroxyindole acetic acid. Immunohistochemical studies revealed that substance P fibers of the trigeminal spinal nucleus were the most severely affected in the brain stem and that substance P fibers in the lung were totally absent. The intracerebroventricular administration of substance P increased minute ventilation similarly in both control and capsaicin treated rats, largely as a result of increases in tidal volume. The minute ventilation-PaCO2 curve was similar in both groups after substance P administration. Simultaneous administration of the peptidase inhibitor captopril with substance P increased the respiratory response to substance P in normal rats. Administration of captopril to capsaicin treated rats restored the ventilation-PaCO2 curve to the position observed in normal rats. The hypotensive response to intracerebroventricular captopril alone in control rats was less profound in rats given neonatal capsaicin. These results are consistent with the thesis that respiratory depression after capsaicin treatment is at least in part due to the loss of substance P primary afferent nerve terminals in the brain stem, suggesting that substance P fibers in the brain stem may participate in the normal modulation of respiratory activity.

Influence of cerebrovascular resistance on the dynamic relationship between blood pressure and cerebral blood flow in humans.

PubMed

Smirl, J D; Tzeng, Y C; Monteleone, B J; Ainslie, P N

2014-06-15

We examined the hypothesis that changes in the cerebrovascular resistance index (CVRi), independent of blood pressure (BP), will influence the dynamic relationship between BP and cerebral blood flow in humans. We altered CVRi with (via controlled hyperventilation) and without [via indomethacin (INDO, 1.2 mg/kg)] changes in PaCO2. Sixteen subjects (12 men, 27 ± 7 yr) were tested on two occasions (INDO and hypocapnia) separated by >48 h. Each test incorporated seated rest (5 min), followed by squat-stand maneuvers to increase BP variability and improve assessment of the pressure-flow dynamics using linear transfer function analysis (TFA). Beat-to-beat BP, middle cerebral artery velocity (MCAv), posterior cerebral artery velocity (PCAv), and end-tidal Pco2 were monitored. Dynamic pressure-flow relations were quantified using TFA between BP and MCAv/PCAv in the very low and low frequencies through the driven squat-stand maneuvers at 0.05 and 0.10 Hz. MCAv and PCAv reductions by INDO and hypocapnia were well matched, and CVRi was comparably elevated (P < 0.001). During the squat-stand maneuvers (0.05 and 0.10 Hz), the point estimates of absolute gain were universally reduced, and phase was increased under both conditions. In addition to an absence of regional differences, our findings indicate that alterations in CVRi independent of PaCO2 can alter cerebral pressure-flow dynamics. These findings are consistent with the concept of CVRi being a key factor that should be considered in the correct interpretation of cerebral pressure-flow dynamics as indexed using TFA metrics. Copyright © 2014 the American Physiological Society.

A Quick Reference on Respiratory Acidosis.

PubMed

Johnson, Rebecca A

2017-03-01

Respiratory acidosis, or primary hypercapnia, occurs when carbon dioxide production exceeds elimination via the lung and is mainly owing to alveolar hypoventilation. Concurrent increases in Paco 2 , decreases in pH and compensatory increases in blood HCO 3 - concentration are associated with respiratory acidosis. Respiratory acidosis can be acute or chronic, with initial metabolic compensation to increase HCO 3 - concentrations by intracellular buffering. Chronic respiratory acidosis results in longer lasting increases in renal reabsorption of HCO 3 - . Alveolar hypoventilation and resulting respiratory acidosis may also be associated with hypoxemia, especially evident when patients are inspiring room air (20.9% O 2 ). Copyright © 2016 Elsevier Inc. All rights reserved.

Following the 'tracks': Tramtrack69 regulates epithelial tube expansion in the Drosophila ovary through Paxillin, Dynamin, and the homeobox protein Mirror.

PubMed

Peters, Nathaniel C; Thayer, Nathaniel H; Kerr, Scott A; Tompa, Martin; Berg, Celeste A

2013-06-15

Epithelial tubes are the infrastructure for organs and tissues, and tube morphogenesis requires precise orchestration of cell signaling, shape, migration, and adhesion. Follicle cells in the Drosophila ovary form a pair of epithelial tubes whose lumens act as molds for the eggshell respiratory filaments, or dorsal appendages (DAs). DA formation is a robust and accessible model for studying the patterning, formation, and expansion of epithelial tubes. Tramtrack69 (TTK69), a transcription factor that exhibits a variable embryonic DNA-binding preference, controls DA lumen volume and shape by promoting tube expansion; the tramtrack mutation twin peaks (ttk(twk)) reduces TTK69 levels late in oogenesis, inhibiting this expansion. Microarray analysis of wild-type and ttk(twk) ovaries, followed by in situ hybridization and RNAi of candidate genes, identified the Phospholipase B-like protein Lamina ancestor (LAMA), the scaffold protein Paxillin, the endocytotic regulator Shibire (Dynamin), and the homeodomain transcription factor Mirror, as TTK69 effectors of DA-tube expansion. These genes displayed enriched expression in DA-tube cells, except lama, which was expressed in all follicle cells. All four genes showed reduced expression in ttk(twk) mutants and exhibited RNAi phenotypes that were enhanced in a ttk(twk)/+ background, indicating ttk(twk) genetic interactions. Although previous studies show that Mirror patterns the follicular epithelium prior to DA tubulogenesis, we show that Mirror has an independent, novel role in tube expansion, involving positive regulation of Paxillin. Thus, characterization of ttk(twk)-differentially expressed genes expands the network of TTK69 effectors, identifies novel epithelial tube-expansion regulators, and significantly advances our understanding of this vital developmental process. Copyright © 2013 Elsevier Inc. All rights reserved.

Identification of Lama glama as Reservoirs for Acinetobacter lwoffii

PubMed Central

Ledesma, Martín M.; Díaz, Ailén M.; Barberis, Claudia; Vay, Carlos; Manghi, Marcela A.; Leoni, Juliana; Castro, Marisa S.; Ferrari, Alejandro

2017-01-01

South American Camelids have an increasing relevance in local economies, worldwide. These animals are bred for their meat, fur and as companion and therapy animals. Thus, their sanitary status should be well-established. According to the OIE (World Organization for Animal Health), respiratory infections mainly produced by Pasteurella spp. have been reported for camelids. It has been stated that this microorganism causes a mild disease, although many authors report it is an important cause of mortality among alpacas. Nevertheless, the incidence of infection by Pasteurella spp. in camelids still needs to be investigated. The aim of the present study was to analyze the occurrence of nasopharyngeal colonization of Lama glama by respiratory bacteria, and to assess the usefulness of serological tests for clinical diagnosis. The colonization was studied by culture techniques carried out with material taken by nasopharyngeal swabs. Bacterial isolates were first phenotypically characterized and then identified by MALDI/TOF-MS. The presence of specific serum antibodies was studied by ELISA and Western blot. In the present work Pasteurella spp. was not found. Nevertheless, we report for the first time, the colonization of L. glama by bacteria of the Acinetobacter lwoffii, at a reliable level in 19.4% of the animals. Acinetobacter species are found in different environmental sources, as well as vegetables, animals, and humans, and their role in infections has recently gained relevance. The results presented herein contribute to a better understanding of the respiratory microbiota in camelids, and increase the knowledge about environmental distribution of Acinetobacter non-baumanii species. Given that these respiratory bacteria might be the cause of infection among cattle, and even humans, this report highlights the need for further research. PMID:28303121

Respiratory pharmacotherapy use in patients newly diagnosed with chronic obstructive pulmonary disease in a primary care setting in the UK: a retrospective cohort study.

PubMed

Wurst, Keele E; Shukla, Amit; Muellerova, Hana; Davis, Kourtney J

2014-09-01

This retrospective cohort study aimed to analyze the prescribing practices of general practitioners treating patients with newly diagnosed chronic obstructive pulmonary disease (COPD), and to assess characteristics associated with initial pharmacotherapy. Patients were identified in the General Practice Research Database, a population-based UK electronic medical record (EMR) with data from January 1, 2008 to December 31, 2009. Patient characteristics, prescribed COPD pharmacotherapies (≤12 months before diagnosis and within 3 months following diagnosis), co-morbidities, hospitalizations, and events indicative of a possible COPD exacerbation (≤12 months before diagnosis) were analyzed in 7881 patients with newly diagnosed COPD. Most patients (64.4%) were prescribed COPD pharmacotherapy in the 12 months before diagnosis. Following diagnosis, COPD pharmacotherapy was prescribed within 3 months in 85.0% of patients. Short-acting bronchodilators alone (22.9%) or inhaled corticosteroids + long-acting beta-2 agonists (ICS+LABA, 22.1%) were prescribed most frequently. Compared with other pharmacotherapies, the prevalence of severe airflow limitation was highest in patients prescribed ICS+LABA+long-acting muscarinic antagonists (LAMA). Moderate-to-severe dyspnea was identified most frequently in patients prescribed a LAMA-containing regimen. Patients prescribed an ICS-containing regimen had a higher prevalence of asthma or possible exacerbations recorded in the EMR than those not prescribed ICS. In conclusion, pharmacotherapy prescribed at initial COPD diagnosis varied by disease severity indicators as assessed by airflow limitation, dyspnea, history of asthma, and possible exacerbations. Frequent prescription of COPD pharmacotherapies before the first-recorded COPD diagnosis indicates a delay between obstructive lung disease presentation in primary care practice and assignment of a medical diagnosis.

Seventeen-Year Nationwide Trends in Use of Long-acting Bronchodilators and Inhaled Corticosteroids among Adults - A Danish Drug Utilization Study.

PubMed

Reilev, Mette; Pottegård, Anton; Davidsen, Jesper Rømhild; Rasmussen, Lotte; Søndergaard, Jens; Laursen, Christian B; Henriksen, Daniel Pilsgaard

2018-02-08

Long-acting bronchodilators and inhaled corticosteroids (ICS) are the cornerstones in treatment of chronic obstructive and inflammatory pulmonary diseases. However, non-adherence to guidelines is widespread. Detailed information on real-life treatment patterns is needed to promote rational use. We aimed to investigate nationwide time trends in individual-level treatment patterns of long-acting bronchodilators and ICS. Using nationwide Danish health registries, we identified all Danish adults with a prescription for long-acting bronchodilators and/or ICS from 2000 to 2016. We investigated the total use of long-acting bronchodilators and ICS, the proportion of current users and the rate of new users over time. Finally, we assessed treatment persistence. We included 23,061,681 prescriptions for long-acting bronchodilators and ICS issued to 805,860 individuals from 2000 to 2016. Over this period, the total annual amount of prescribed long-acting bronchodilators and ICS increased by 39%. Similarly, the proportion of adult users increased from 2.6% to 4.5%, mainly driven by the introduction of combination therapy and long-acting muscarinic antagonist (LAMA). Although the rate of new users of fixed-dose combination drugs increased substantially over time, the overall rate of new users was stable. In general, the proportion of patients on therapy after 1 year was low (25-53%), especially among young individuals and users of ICS. We document a pronounced increase in the total use of long-acting bronchodilators and ICS over time, mainly driven by the introduction of combination drugs and LAMA. Special attention should be paid to the low level of persistence, especially among young individuals and users of ICS. © 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Social structure in a family group of Guanaco (Lama guanicoe, Ungulate): is female hierarchy based on 'prior attributes' or 'social dynamics'?

PubMed

Correa, Loreto A; Zapata, Beatriz; Samaniego, Horacio; Soto-Gamboa, Mauricio

2013-09-01

Social life involves costs and benefits mostly associated with how individuals interact with each other. The formation of hierarchies inside social groups has evolved as a common strategy to avoid high costs stemming from social interactions. Hierarchical relationships seem to be associated with different features such as body size, body condition and/or age, which determine dominance ability ('prior attributes' hypothesis). In contrast, the 'social dynamic' hypothesis suggests that an initial social context is a determinant in the formation of the hierarchy, more so than specific individual attributes. Hierarchical rank places individuals in higher positions, which presumably increases resource accessibility to their benefit, including opportunities for reproduction. We evaluate the maintenance of hierarchy in a family group of guanacos (Lama guanicoe) and evaluate the possible mechanisms involved in the stability of these interactions and their consequences. We estimate the linearity of social hierarchy and their dynamics. We find evidence of the formation of a highly linear hierarchy among females with males positioned at the bottom of the hierarchy. This hierarchy is not affected by physical characteristics or age, suggesting that it is established only through intra-group interactions. Rank is not related with calves' weight gain either; however, subordinated females, with lower rank, exhibit higher rates of allosuckling. We found no evidence of hierarchical structure in calves suggesting that hierarchical relationship in guanacos could be established during the formation of the family group. Hence, our results suggest that hierarchical dynamics could be related more to social dynamics than to prior attributes. We finally discuss the importance of hierarchies established by dominance and their role in minimizing social costs of interactions. Copyright © 2013 Elsevier B.V. All rights reserved.

Kinetics of the histologic, serologic and symptomatic responses to gluten challenge in adults with coeliac disease

PubMed Central

Leffler, Daniel A.; Schuppan, Detlef; Pallav, Kumar; Najarian, Robert; Goldsmith, Jeffery D.; Hansen, Joshua; Kabbani, Toufic; Dennis, Melinda; Kelly, Ciarán P.

2012-01-01

Objective Coeliac disease is defined by gluten responsiveness, yet there are few data on gluten challenge (GC) in adults on a gluten free diet. Lack of data regarding the kinetics of responses to gluten is a limitation in clinical practice and research when GC is performed. Design 20 adults with biopsy-proven coeliac disease participated. The study included two run-in visits followed by a 14 day GC at a randomly assigned dose of 3 or 7.5 grams of gluten/day. Study visits occurred 3, 7, 14 and 28 days after starting GC. Duodenal biopsy was performed during the run-in and at days 3 and 14 of GC. Villous height to crypt depth ratio (Vh:Cd) and intraepithelial lymphocyte (IEL) count/100 enterocytes were measured by two pathologists. Antibodies to tTG and DGP, lactulose to mannitol ratio (LAMA), and symptoms were assessed at each visit. Results Significant reduction in Vh:Cd (2.2 to 1.1, p < 0.001) and increase in IELs (32.6 to 51.8, p < 0.001) were seen from baseline to day 14. Antibody titers increased slightly from baseline to day 14 of GC but markedly by day 28. LAMA did not change significantly. Gastrointestinal symptoms increased significantly by day 3 and returned to baseline by day 28. No differences were seen between the two gluten doses. Conclusions 14 day GC at ≥3 grams of gluten/day induces histological and serological changes in the majority of adults with coeliac disease. These data permit accurate design of clinical trials and indicate that many individuals will meet coeliac diagnostic criteria after a two week GC. PMID:22619366

Low habitat overlap at landscape scale between wild camelids and feral donkeys in the Chilean desert

NASA Astrophysics Data System (ADS)

Malo, Juan E.; González, Benito A.; Mata, Cristina; Vielma, André; Donoso, Denise S.; Fuentes, Nicolás; Estades, Cristián F.

2016-01-01

Feral domestic ungulates may compete with the populations of wild herbivores with which they coexist, particularly so in arid regions. The potential competition between wild camelids and feral donkeys at the eastern sector of the Atacama Desert is evaluated in terms of their coincidence or segregation in habitat use and complemented with a comparison of reproductive output (yearling/adult ratio) of vicuña family groups in the proximity vs. distant from donkey observations. Habitat use of wild camelids and donkeys was sampled driving some 1250 km of roads and tracks at the dry and wet seasons. There were 221 vicuñas (Vicugna vicugna) sightings, 77 for donkeys (Equus asinus), 25 for guanacos (Lama guanicoe) and 8 for hybrids between guanacos and domestic llamas (Lama glama), as well as 174 randomly selected control locations. By means of Generalised Discriminant Analysis and Analysis of Variance we show that all ungulates actively select their habitat, with significant differences between use and availability in the area. Donkeys are relatively abundant in comparison with camelids and coincide broadly with both of them across the altitudinal gradient, but they fall between them in local scale habitat selection and do not seem to force their displacement from their preferred habitats. Thus donkeys occur preferentially on slopes with a high cover of tall shrubs, whereas vicuñas use valley bottoms with grass and guanacos the upper slope zones with grass. The potential for competition between donkeys and wild camelids is thus limited and it does not affect the reproductive output of vicuña in this region. Therefore, with the present knowledge we suggest that population control is not currently merited for feral donkeys.

Impact of early diagenesis and bulk particle grain size distribution on estimates of relative geomagnetic palaeointensity variations in sediments from Lama Lake, northern Central Siberia

NASA Astrophysics Data System (ADS)

Nowaczyk, Norbert R.; Harwart, Stefanie; Melles, Martin

2001-04-01

High-resolution analyses of rock magnetic and sedimentological parameters were conducted on an 11m long sediment core from Lama Lake, Northern Siberia, which encompasses the late Pleistocene and the Holocene epochs. The results reveal a strong link between the median grain size of the magnetic particles, identified as magnetite, and the oxidation state of the sediment. Reducing conditions associated with a relative high total organic carbon (TOC) content of the sediment characterize the upper 7m of the core (~Holocene), and these have led to a partial dissolution of detrital magnetite grains, and a homogenization of grain-size-related rock magnetic parameters. The anoxic sediments are characterized by significantly larger median magnetic grain sizes, as indicated, for example, by lower median destructive fields of the natural remanent magnetization (MDFNRM) and lower ratios of saturation remanence to saturation magnetization (MSR/MS). Consequently, estimates of relative geomagnetic palaeointensity variations yielded large amplitude shifts associated with anoxic/oxic boundaries. Despite the partial reductive dissolution of magnetic particles within the anoxic section, and consequent minimal variations in magnetic concentration and grain size, palaeointensity estimates for this part of the core were still lithologically distorted by the effects of particle size (and subsidiary TOC) variations. Anomalously high values coincide with an interval of significantly more fine-grained sediment, which is also associated with a decrease in TOC content, which may thus imply a decreased level of magnetite dissolution in this interval. Calculation of relative palaeointensity estimates therefore seems to be compromised by a combined effect of shifts in the particle size distribution of the bulk sediment and by partial magnetite dissolution varying in association with the TOC content of the sediment.

Computed tomographic features of the osseous structures of the external acoustic meatus, tympanic cavity, and tympanic bulla of llamas (Lama glama).

PubMed

Concha-Albornoz, Ismael; Stieger-Vanegas, Susanne M; Cebra, Christopher K

2012-01-01

To evaluate the osseous structures of the external acoustic meatus, tympanic cavity, and tympanic bulla of llamas (Lama glama) by use of computed tomography (CT) and establish measurement values for use in detection of abnormalities associated with the external or middle ear in llamas. 10 adult llama heads without any evidence of ear disease. Heads of 10 healthy llamas euthanized by use of a captive bolt striking the dorsal aspect of the skull were collected. Transverse images of the heads were acquired with 1-mm slice thickness, and images were reconstructed in sagittal and dorsal planes. Measurements of the bony structures of the external and middle ear of each head were obtained. The osseous external acoustic meatus curved ventrally as it tracked medially. Its narrowest portion was located at the level of the tympanic annulus. The tympanic bulla conformation differed widely from the bubble-shaped tympanic bulla in dogs and cats. The bulla was divided by the stylohyoid fossa into a larger caudolateral and a smaller caudomedial process; its interior had a honeycombed structure with pneumatized cells similar to the honeycombed appearance of the human mastoid process. Results provided new information regarding the shape and dimensions of the osseous external and middle ear structures in adult llamas without ear disease. Specific landmarks for location of the external acoustic meatus, tympanic cavity, and tympanic bulla in relation to each other were identified. Knowledge of the CT appearance of normal structures will help clinicians to identify changes attributable to middle ear otitis, external ear canal stenosis, or congenital malformations of the ear in this species.

High ozone levels in the northeast of Portugal: Analysis and characterization

NASA Astrophysics Data System (ADS)

Carvalho, A.; Monteiro, A.; Ribeiro, I.; Tchepel, O.; Miranda, A. I.; Borrego, C.; Saavedra, S.; Souto, J. A.; Casares, J. J.

2010-03-01

Each summer period extremely high ozone levels are registered at the rural background station of Lamas d'Olo, located in the Northeast of Portugal. In average, 30% of the total alert threshold registered in Portugal is detected at this site. The main purpose of this study is to characterize the atmospheric conditions that lead to the ozone-rich episodes at this site. Synoptic patterns anomalies and back trajectories cluster analysis were performed, for the period between 2004 and 2007, considering 76 days when ozone maximum hourly concentrations were above 200 μg m -3. The obtained atmospheric anomaly fields suggested that a positive temperature anomaly is visible above the Iberian Peninsula. A strong wind flow pattern from NE is observable in the North of Portugal and Galicia, in Spain. These two features may lead to an enhancement of the photochemical production and to the transport of pollutants from Spain to Portugal. In addition, the 3D mean back trajectories associated to the ozone episode days were analysed. A clustering method has been applied to the obtained back trajectories. Four main clusters of ozone-rich episodes were identified, with different frequencies of occurrence: north-westerly flows (11%); north-easterly flows (45%), southern flow (4%) and westerly flows (40%). Both analyses highlight the NE flow as a dominant pattern over the North of Portugal during summer. The analysis of the ozone concentrations for each selected cluster indicates that this northeast circulation pattern, together with the southern flow, are responsible for the highest ozone peak episodes. This also suggests that long-range transport of atmospheric pollutants is the main contributor to the ozone levels registered at Lamas d'Olo. This is also highlighted by the correlation of the ozone time-series with the meteorological parameters analysed in the frequency domain.

The PDE4 inhibitor CHF-6001 and LAMAs inhibit bronchoconstriction-induced remodeling in lung slices.

PubMed

Kistemaker, Loes E M; Oenema, Tjitske A; Baarsma, Hoeke A; Bos, I Sophie T; Schmidt, Martina; Facchinetti, Fabrizio; Civelli, Maurizio; Villetti, Gino; Gosens, Reinoud

2017-09-01

Combination therapy of PDE4 inhibitors and anticholinergics induces bronchoprotection in COPD. Mechanical forces that arise during bronchoconstriction may contribute to airway remodeling. Therefore, we investigated the impact of PDE4 inhibitors and anticholinergics on bronchoconstriction-induced remodeling. Because of the different mechanism of action of PDE4 inhibitors and anticholinergics, we hypothesized functional interactions of these two drug classes. Guinea pig precision-cut lung slices were preincubated with the PDE4 inhibitors CHF-6001 or roflumilast and/or the anticholinergics tiotropium or glycopyorrolate, followed by stimulation with methacholine (10 μM) or TGF-β 1 (2 ng/ml) for 48 h. The inhibitory effects on airway smooth muscle remodeling, airway contraction, and TGF-β release were investigated. Methacholine-induced protein expression of smooth muscle-myosin was fully inhibited by CHF-6001 (0.3-100 nM), whereas roflumilast (1 µM) had smaller effects. Tiotropium and glycopyrrolate fully inhibited methacholine-induced airway remodeling (0.1-30 nM). The combination of CHF-6001 and tiotropium or glycopyrrolate, in concentrations partially effective by themselves, fully inhibited methacholine-induced remodeling in combination. CHF-6001 did not affect airway closure and had limited effects on TGF-β 1 -induced remodeling, but rather, it inhibited methacholine-induced TGF-β release. The PDE4 inhibitor CHF-6001, and to a lesser extent roflumilast, and the LAMAs tiotropium and glycopyrrolate inhibit bronchoconstriction-induced remodeling. The combination of CHF-6001 and anticholinergics was more effective than the individual compounds. This cooperativity might be explained by the distinct mechanisms of action inhibiting TGF-β release and bronchoconstriction. Copyright © 2017 the American Physiological Society.

ANALYSIS AND CHARACTERIZATION OF OZONE-RICH EPISODES IN NORTHEAST PORTUGAL

NASA Astrophysics Data System (ADS)

Carvalho, A.; Monteiro, A.; Ribeiro, I.; Tchepel, O.; Miranda, A.; Borrego, C.; Saavedra, S.; Souto, J. A.; Casares, J. J.

2009-12-01

Each summer period extremely high ozone levels are registered at the rural background station of Lamas d’Olo, located in the Northeast of Portugal. In average, 30% of the total alert threshold registered in Portugal is detected at this site. The main purpose of this study is to characterize the atmospheric conditions that lead to the ozone-rich episodes. Synoptic patterns anomalies and back trajectories cluster analysis were performed for a period of 76 days where ozone maximum concentrations were above 200 µg.m-3. This analysis was performed for the period between 2004 and 2007. The obtained anomaly fields suggested that a positive temperature anomaly is visible above the Iberian Peninsula. In addition, a strong wind flow pattern from NE is visible in the North of Portugal and Galicia, in Spain. These two features may lead to an enhancement of the photochemical production and to the transport of pollutants from Spain to Portugal. In addition, the 3D mean back trajectories associated to the ozone episode days were analysed. A clustering method has been applied to the obtained back trajectories. Four main clusters of ozone-rich episodes were identified, with different frequencies of occurrence: north-westerly flows (11%); north-easterly flows (45%), southern flow (4%) and westerly flows (40%). Both analyses highlight the NE flow as a dominant pattern over the North of Portugal. The analysis of the ozone concentrations for each selected cluster indicates that this northeast circulation pattern, together with the southern flow, is responsible for the highest ozone peak episodes. This also suggests that long-range transport of atmospheric pollutants may be the main contributor to the ozone levels registered at Lamas d’Olo. This is also highlighted by the correlation of the ozone time series with the meteorological parameters analysed in the frequency domain.

Downregulation of the cough reflex by aclidinium and tiotropium in awake and anesthetized rabbits.

PubMed

Mutolo, Donatella; Cinelli, Elenia; Iovino, Ludovica; Pantaleo, Tito; Bongianni, Fulvia

2016-06-01

Long-acting muscarinic receptor antagonists (LAMAs) have been reported to attenuate cough in preclinical and clinical studies. The present study was performed on rabbits to compare aclidinium and tiotropium efficacy in the downregulation of the cough reflex. This reflex was evoked by citric acid inhalation in unanesthetized animals and by both citric acid inhalation and mechanical stimulation of the tracheobronchial tree in anesthetized animals 90 min following the inhalation of each drug (nebulizer output always at 1 mL/min). Aclidinium 4 mg/mL and tiotropium 200 μg/mL inhaled in 1 min proved to have similar protective effect on methacholine-induced bronchoconstriction in anesthetized animals. The total dosage employed for aclidinium and tiotropium was 4 mg and 200 μg, respectively. In awake animals, similar reductions in the cough number were observed following 10-min inhalation of each drug with a slight, not significant tendency to higher antitussive effects for aclidinium. In anesthetized animals, 1-min inhalation of each drug caused similar depressant effects on cough responses induced by both mechanical and chemical stimulation. A complete suppression of cough responses to mechanical stimuli was seen in some preparations. The results strongly suggest that the LAMA-induced downregulation of cough may be mediated not only by transient receptor potential vanilloid type 1 channels, as already reported, but also by acid-sensing ion channels and mechanoreceptors. The route of administration along with the more rapid hydrolysis of aclidinium into inactive metabolites minimize potential systemic side effects and give to this drug a very favorable safety profile. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cultural Earth Science in Hawai`i: Hands-on Place-Based Investigations that Merge Traditional Knowledge with Earth Science Inquiry

NASA Astrophysics Data System (ADS)

Moxey, L.; Dias, R. K.; Legaspi, E.

2011-12-01

During the summer of 2011, the Mālama Ke Ahupua`a (to care of our watershed) GEARUP summer program provided 25 under-served and under-represented minority public high school students (Hawaiian, part-Hawaiian, Filipino, Pacific Islanders) from Farrington High School (Kalihi, Honolulu) with a hands-on place-based multidiscipline course located within Manoa Valley (Ahupua`a O Kona) with the objective of engaging participants in scientific environmental investigations while exploring Hawaii's linkages between traditional knowledge, culture and science. The 4-week field program enabled students to collect samples along the perennial Manoa Stream and conduct water quality assessments throughout the Manoa watershed. Students collected science quality data from eight different sampling stations by means of field- and laboratory-based quantitative water quality testing equipment and GPS/GIS technology. While earning Hawaii DOE academic credits, students were able to document changes along the stream as related to pollution and urbanization. While conducting the various scientific investigations, students also participated in cultural fieldtrips and activities that highlighted the linkages between historical sustainable watershed uses by native Hawaiian communities, and their connections with natural earth processes. Additionally, students also participated in environmental service-learning projects that highlight the Hawaiian values of laulima (teamwork), mālama (to care for), and imi `ike (to seek knowledge). By contextualizing and merging hands-on place-based earth science inquiry with native Hawaiian traditional knowledge, students experienced the natural-cultural significance of their ahupua`a (watershed). This highlighted the advantages for promoting environmental literacy and geoscience education to under-served and under-represented minority populations in Hawaii from a rich native Hawaiian cultural framework.

Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease.

PubMed

Leffler, Daniel; Schuppan, Detlef; Pallav, Kumar; Najarian, Robert; Goldsmith, Jeffery D; Hansen, Joshua; Kabbani, Toufic; Dennis, Melinda; Kelly, Ciarán P

2013-07-01

Coeliac disease is defined by gluten responsiveness, yet there are few data on gluten challenge (GC) in adults on a gluten-free diet. Lack of data regarding the kinetics of responses to gluten is a limitation in clinical practice and research when GC is performed. 20 adults with biopsy-proven coeliac disease participated. The study included two run-in visits followed by a 14-day GC at a randomly assigned dose of 3 or 7.5 g of gluten/day. Study visits occurred 3, 7, 14 and 28 days after starting GC. Duodenal biopsy was performed during the run-in and at days 3 and 14 of GC. Villous height to crypt depth ratio (Vh:Cd) and intraepithelial lymphocyte (IEL) count/100 enterocytes were measured by two pathologists. Antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and symptoms were assessed at each visit. Significant reduction in Vh:Cd (2.2-1.1, p<0.001) and increase in IELs (32.6-51.8, p<0.001) were seen from baseline to day 14. Antibody titres increased slightly from baseline to day 14 of GC but markedly by day 28. LAMA did not change significantly. Gastrointestinal symptoms increased significantly by day 3 and returned to baseline by day 28. No differences were seen between the two gluten doses. 14 day GC at ≥ 3 g of gluten/day induces histological and serological changes in the majority of adults with coeliac disease. These data permit accurate design of clinical trials and indicate that many individuals will meet coeliac diagnostic criteria after a 2-week GC.

Landscape connectivity among remnant populations of guanaco (Lama guanicoe Müller, 1776) in an arid region of Chile impacted by global change.

PubMed

Espinosa, Mara I; Gouin, Nicolas; Squeo, Francisco A; López, David; Bertin, Angéline

2018-01-01

Connectivity between populations plays a key role in the long-term persistence of species in fragmented habitats. This is of particular concern for biodiversity preservation in drylands, since water limited landscapes are typically characterized by little suitable habitat cover, high habitat fragmentation, harsh matrices, and are being rapidly degraded at a global scale. In this study, we modelled landscape connectivity between 11 guanaco Lama guanicoe populations in Chile's arid Norte Chico, a region that supports the last remnant coastal populations of this emblematic herbivore indigenous to South America. We produced a habitat suitability model to derive a regional surface resistance map, and used circuit theory to map functional connectivity, investigate the relative isolation between populations, and identify those that contribute most to the patch connectivity network. Predicted suitable habitat for L. guanicoe represented about 25% of the study region (i.e., 29,173 km 2 ) and was heterogeneously distributed along a continuous stretch along the Andes, and discontinuous patches along the coast. As a result, we found that high connectivity current flows in the mid and high Andes formed a wide, continuous connectivity corridor, enabling connectivity between all high Andean populations. Coastal populations, in contrast, were more isolated. These groups demonstrate no inter-population connectivity between themselves, only with higher altitude populations, and for two of them, animal movement was linked to the effectiveness of wildlife crossings along the Pan-American highway. Our results indicate that functional connectivity is an issue of concern for L. guanicoe in Chile's Norte Chico, implying that future conservation and management plans should emphasize strategies aimed at conserving functional connectivity between coastal and Andean populations, as well as the protection of habitat patches likely to act as stepping stones within the connectivity network.

The analgesic effects of intrathecal xylazine and detomidine in sheep and their antagonism with systemic atipamezole.

PubMed

Christina Haerdi-Landerer, M; Schlegel, Urs; Neiger-Aeschbacher, Gina

2005-09-01

To evaluate the analgesic and adverse side effects of intrathecal (IT) xylazine (XYL) and detomidine (DET) and the subsequent effects of two doses of intravenous (IV) atipamezole (ATI). Prospective, randomized, cross-over. Five adult healthy female sheep with mean body mass of 55 +/- 2.3 kg. Material and methods Each sheep underwent four treatments: 1) 50 microg kg(-1) XYL IT and 5 microg kg(-1) ATI IV, 2) 50 microg kg(-1) XYL IT and 2.5 microg kg(-1) ATI IV, 3) 10 microg kg(-1) DET IT and 5 microg kg(-1) ATI IV, 4) 10 microg kg(-1) DET IT and 2.5 microg kg(-1) ATI IV. Pain threshold (TH) was tested by applying pulsed and stepwise incremental direct current to the skin overlying the pastern. The current at the point of foot lift was recorded as the TH. Heart rate (HR), mean arterial pressure, arterial oxygen (PO(2)) and carbon dioxide (PCO(2)) tensions were monitored. Outcomes were derived as differences between baseline assessment and measurements after treatment. Two-way anova was used to analyse drug effects, treatment differences between groups were examined with an F-test or Wilcoxon's rank sum test in case of non-parametric data distribution. p was set at 0.05. Both drugs increased the pain TH, caused small increases in PCO(2), and small decreases in HR, the latter was only significant for XYL recipients. Xylazine produced a significantly higher TH, more rapidly and for longer than DET. Atipamezole only significantly affected PaCO(2) in the XYL group 2. The pain TH was not affected in either group after IV ATI. At the doses used, IT XYL, and to a lesser extent DET, induced pastern analgesia. Atipamezole 5 microg kg(-1) IV antagonized some side effects without affecting analgesia. Intrathecal XYL may be useful as an analgesic in sheep. Its safety is increased because IV ATI antagonizes side effects, but not analgesia.

A Regional Seismic Experiment in India to Increase Knowledge of Velocity Structure

DTIC Science & Technology

2006-05-01

1995. Shylb,S.K.,RSDPPaylmSN.M P. hfmddl I. P. m, d RK ah cmr(sl rmd -2Emclorrofm*In& and~ pm m a m o f t h c 2 1 M . y 1997,J.b.Bm~I.M~- 58): Umh...srmctun known as the Oman Lme (HI. 1). Ths Maknm auMudioo pm is knoam to produce && to depths of approximately 200 bn (Jackson & McKenzic 1% Lama & Chm...k e d 8s grsdational thkpbg df cmat(42’ to 36 km) fhm Chitradurga thwt to the westcm part of o lose pet granite. ’~besc details pmdd

[Experiences with ivermectin in exotic animals: scabies in camelids (Camelus bactrianus, Lama guanicoe, L. glama) and scabies and roundworms in bears (Thalarctos maritimus and Ursus arctos)].

PubMed

Kuntze, A; Kuntze, O

1991-02-01

For the control of scabies in tylopodes (L. bactrianus, L. guanicoe, L. glama) and brown bears 0.2 mg/kg body weight (1 ml/50 kg body weight) of Ivermectin subcutaneously injected proved to be remedy of choice. In Kodiak-bears the oral application of Ivomec-solution was effective against ascariasis, not, however, in polar bears. Sufficient effect was reached only once, whereas Equalan-paste proved to be highly effective. Despite of strong hygienic measures continous follow-up treatment for the prevention of re-invasion is indispensible.

The effect of short duration transportation on serum cortisol response in alpacas (Llama pacos).

PubMed

Anderson, D E; Grubb, T; Silveira, F

1999-03-01

This research project evaluated the changes in serum cortisol in six male and six female alpacas in response to transportation of short duration. All alpacas were subjected to trailer transportation for 30 min. Serum samples were obtained prior to transportation, immediately after transportation, and after a 4-h recovery period. Heart rate was recorded at each time interval and observations of individual behavioural characteristics were recorded. Data were analysed using analysis of variance. Heart rate was not significantly changed by transportation stress. Serum cortisol concentration was significantly higher after transportation, but head returned to baseline concentration after the 4-h recovery period. Behavioural characteristics were not associated with changes in serum cortisol concentration.

Macroscopic and histological investigation of guanaco footpads (Lama guanicoe, Müller 1776).

PubMed

König, Horst Erich; Skewes, Oscar; Helmreich, Magda; Böck, Peter

2015-03-01

The surface of guanaco footpads is characterized by hairless skin with up to 4-mm-thick stratum corneum that protects from abrasion. The horny layer is pliable and elastic, and ensures firm contact with irregular ground. It is padded with a particular structure of the subcutaneous layer, the digital cushion. The flat cushions of each of the two digits are of elongated ovate shape, each about 45-mm long, up to 20-mm wide, and 8-mm thick. The cushions are lined by a 1-2-mm-thick capsule that resembles a tunica albuginea. The capsule consists of coarse collagen fibers, with elastic fibers absent. The cushion capsule and dermis approach each other, and fuse along a line that runs parallel to the longitudinal axes of cushion and digit. Loose connective tissue rich in elastic fibers and acidic glycosaminoglycans separates dermis and cushion capsule lateral to the narrow interconnecting zone. The cushion capsule encloses cloudy yellowish, gelatinous material. Microscopy shows bundles of elastic fibers in abundant mucinous matrix. Tightly gathered elastic bundles adjoin the inner surface of the capsule. Rough cords of elastic fibers branch out from there and traverse to the opposite side. The cushion is pressed flat, and elastic fibers are stretched when bearing weight. With relief of load, elastic fibers contract and reset the cushion's shape. Contractile cells are absent. A resistant capsule and easily malleable mucinous contents establish the functioning as a gel pad. Mucinous connective tissue between elastic fiber bundles contains abundant basophilic matrix. Hyaluronan, chondroitin sulfate, and dermatan sulfate are main matrix constituents. Spindle-shaped or stellate fibroblasts contain vimentin, S100 protein, and neuron specific enolase. Moprhology, staining characteristics and synthesis activities of these cells meet the criteria to be classified as myxoid cells. The connective tissue in guanaco digital cushions represents myxoid tissue. © 2014 Wiley Periodicals, Inc.

Circulatory, respiratory and metabolic responses in Thoroughbred horses during the first 400 meters of exercise.

PubMed

Littlejohn, A; Snow, D H

1988-01-01

These studies investigated circulatory, respiratory and metabolic responses in four Thoroughbred geldings during the first 400 metres of galloping (mean speed 14.4 +/- 0.38 m.s-1), cantering (mean speed 10.0 +/- 0.61 m.s-1) and walking (mean speed 1.58 +/- 0.05 m.s-1) from a standing start. A radio-controlled device which collected blood samples anaerobically during each 100 m section of the exercise track allowed analyses of changes in and functional relationships of the variables measured. During the 400 m gallop, the mean heart rate (HR) increased from 125 to 201 beats.min-1 and the haematocrit (Hct) from 0.513 to 0.589 l/l-1. The haemoglobin [Hb], lactate [LA] and potassium [K+] concentrations increased significantly, while the pH and the partial pressure of oxygen (PaO2) decreased significantly. The arterial partial pressure of carbon dioxide (PaCO2) and the plasma bicarbonate concentration did not change significantly. There were significant correlations between HR and Hct, HR and [Hb], HR and PaO2, HR and pH, HR and PvCO2, HR and [LA], HR and [K+], pH and [K+], Hct and PaO2, [Hb] and PaO2, PaCO2 and PaO2, [LA] and PaO2, pH and PaO2, [K+] and PaO2, stride frequency and PaO2. With the exception of the PvCO2 which increased significantly, changes in venous blood during the gallop were in the same direction as those of arterial blood. Thirty seconds before the start of the gallop, both HR and [Hb] were significantly higher than at rest, providing an approximate three-fold increase in oxygen delivery compared to that of the resting state.(ABSTRACT TRUNCATED AT 250 WORDS)

High altitude pulmonary edema and exercise at 4,400 meters on Mount McKinley. Effect of expiratory positive airway pressure.

PubMed

Schoene, R B; Roach, R C; Hackett, P H; Harrison, G; Mills, W J

1985-03-01

Breathing against positive expiratory pressure has been used to improve gas exchange in many forms of pulmonary edema, and forced expiration against resistance during exercise has been advocated for climbing at high altitude as a method to optimize performance. To evaluate the effect of expiratory positive airway pressure (EPAP) on climbers with high altitude pulmonary edema (HAPE) and on exercise at high altitude, we studied four climbers with HAPE at rest and 13 healthy climbers during exercise on a bicycle ergometer at 4400 m. We measured minute ventilation (VI, L/min), arterial oxygen saturation (SaO2 percent), end-tidal carbon dioxide (PACO2, mm Hg), respiratory rate (RR), and heart rate (HR) during the last minute of a five minute interval at rest in the climbers with HAPE, and at rest, 300, and 600 kpm/minute workloads on a bicycle ergometer in the healthy subjects. The HAPE subjects demonstrated an increased SaO2 percent, no change in HR or VI, and a decrease in RR on EPAP as compared to control. In normal subjects, SaO2 percent, VI, and heart rate were significantly higher on EPAP 10 cm H2O than 0 cm H2O control (p less than 0.01, 0.01, and 0.05, respectively). The RR and PaCO2 were not significantly different. In summary, EPAP improves gas exchange in HAPE subjects at rest. The EPAP in normal subjects at high altitude resulted in a higher SaO2 percent at the expense of a higher VI and higher HR. These results suggest that the work of breathing is higher and the stroke volume lower on EPAP. The positive pressure mask may be an effective temporizing measure for victims of HAPE who cannot immediately go to a lower altitude.

Reproducibility of the exponential rise technique of CO(2) rebreathing for measuring P(v)CO(2) and C(v)CO(2 )to non-invasively estimate cardiac output during incremental, maximal treadmill exercise.

PubMed

Cade, W Todd; Nabar, Sharmila R; Keyser, Randall E

2004-05-01

The purpose of this study was to determine the reproducibility of the indirect Fick method for the measurement of mixed venous carbon dioxide partial pressure (P(v)CO(2)) and venous carbon dioxide content (C(v)CO(2)) for estimation of cardiac output (Q(c)), using the exponential rise method of carbon dioxide rebreathing, during non-steady-state treadmill exercise. Ten healthy participants (eight female and two male) performed three incremental, maximal exercise treadmill tests to exhaustion within 1 week. Non-invasive Q(c) measurements were evaluated at rest, during each 3-min stage, and at peak exercise, across three identical treadmill tests, using the exponential rise technique for measuring mixed venous PCO(2) and CCO(2) and estimating venous-arterio carbon dioxide content difference (C(v-a)CO(2)). Measurements were divided into measured or estimated variables [heart rate (HR), oxygen consumption (VO(2)), volume of expired carbon dioxide (VCO(2)), end-tidal carbon dioxide (P(ET)CO(2)), arterial carbon dioxide partial pressure (P(a)CO(2)), venous carbon dioxide partial pressure ( P(v)CO(2)), and C(v-a)CO(2)] and cardiorespiratory variables derived from the measured variables [Q(c), stroke volume (V(s)), and arteriovenous oxygen difference ( C(a-v)O(2))]. In general, the derived cardiorespiratory variables demonstrated acceptable (R=0.61) to high (R>0.80) reproducibility, especially at higher intensities and peak exercise. Measured variables, excluding P(a)CO(2) and C(v-a)CO(2), also demonstrated acceptable (R=0.6 to 0.79) to high reliability. The current study demonstrated acceptable to high reproducibility of the exponential rise indirect Fick method in measurement of mixed venous PCO(2) and CCO(2) for estimation of Q(c) during incremental treadmill exercise testing, especially at high-intensity and peak exercise.

CO2 insufflation versus air insufflation for endoscopic submucosal dissection: A meta-analysis of randomized controlled trials.

PubMed

Li, Xuan; Dong, Hao; Zhang, Yifeng; Zhang, Guoxin

2017-01-01

Carbon dioxide (CO2) insufflation is increasingly used for endoscopic submucosal dissection (ESD) owing to the faster absorption of CO2 as compared to that of air. Studies comparing CO2 insufflation and air insufflation have reported conflicting results. This meta-analysis is aimed to assess the efficacy and safety of use of CO2 insufflation for ESD. Clinical trials of CO2 insufflation versus air insufflation for ESD were searched in PubMed, Embase, the Cochrane Library and Chinese Biomedical Literature Database. We performed a meta-analysis of all randomized controlled trials (RCTs). Eleven studies which compared the use of CO2 insufflation and air insufflation, with a combined study population of 1026 patients, were included in the meta-analysis (n = 506 for CO2 insufflation; n = 522 for air insufflation). Abdominal pain and VAS scores at 6h and 24h post-procedure in the CO2 insufflation group were significantly lower than those in the air insufflation group, but not at 1h and 3h after ESD. The percentage of patients who experienced pain 1h and 24h post-procedure was obviously decreased. Use of CO2 insufflation was associated with lower VAS scores for abdominal distention at 1h after ESD, but not at 24h after ESD. However, no significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO2), arterial blood carbon dioxide partial pressure (PaCO2), oxygen saturation (SpO2%), abdominal circumference, hospital stay, white blood cell (WBC) counts, C-Reactive protein (CRP) level, dosage of sedatives used, incidence of dysphagia and other complications. Use of CO2 insufflation for ESD was safe and effective with regard to abdominal discomfort, procedure time, and the residual gas volume. However, there appeared no significant differences with respect to other parameters namely, PtcCO2, PaCO2, SpO2%, abdominal circumference, hospital stay, sedation dosage, complications, WBC, CRP, and dysphagia.

Survival of patients with chronic respiratory failure on long-term oxygen therapy and or non-invasive ventilation at home.

PubMed

Cano, Noël J; Pichard, Claude; Court-Fortune, Isabelle; Costes, Frédéric; Cynober, Luc; Gérard-Boncompain, Michèle; Molano, Luis Carlos; Cuvelier, Antoine; Laaban, Jean-Pierre; Melchior, Jean-Claude; Raphaël, Jean-Claude; France, Julie; Lloret, Thomas; Roth, Hubert; Pison, Christophe

2015-08-01

Chronic respiratory failure (CRF) is the common fate of respiratory diseases where systemic effects contribute to outcomes. In a prospective cohort of home-treated patients with CRF, we looked for predictors of long-term survival including respiratory, nutritional and inflammatory dimensions. 637 stable outpatients with CRF, 397 men, 68 ± 11 years, on long-term oxygen therapy and/or non-invasive ventilation from 21 chest clinics were enrolled and followed over 53 ± 31 months. CRF resulted from Chronic Obstructive Pulmonary Disease (COPD) in 48.5%, restrictive disorders 32%, mixed (obstructive and restrictive patterns) respiratory failure 13.5%, bronchiectasis 6%. Demographic characteristics, smoking habits, underlying respiratory diseases, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), arterial blood gases, 6-min walking distance (6MWD), hemoglobin, body mass index (BMI), serum albumin, transthyretin, C-reactive protein (CRP), history of respiratory assistance, antibiotic and oral corticosteroid use during the previous year were recorded. 322 deaths occurred during the follow-up. One-, five- and 8-year actuarial survival was 89%, 56% and 47%. By Cox univariate analysis, age, respiratory disease, PaO2, PaCO2, FEV1/FVC, BMI, 6MWD, activity score, type and length of home respiratory assistance, smoking habits, oral corticosteroid and antibiotic uses, albumin, transthyretin, hemoglobin and CRP levels were associated with survival. Multivariate analysis identified eight independent markers of survival: age, FEV1/FVC, PaO2, PaCO2, 6MWD, BMI, serum transthyretin, CRP ≥ 5 mg/l. In CRF, whatever the underlying diseases, besides the levels of obstructive ventilatory defect and gas exchange failure, 6MWD, BMI, serum transthyretin and CRP ≥ 5 mg/l predicted long-term survival identifying potential targets for nutritional rehabilitation. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Efficacy of noninvasive volume targeted ventilation in patients with chronic respiratory failure due to kyphoscoliosis.

PubMed

Piesiak, P; Brzecka, A; Kosacka, M; Jankowska, R

2015-01-01

Severe kyphoscoliosis can cause chronic respiratory failure. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of average volume-assured pressure support (AVAPS) NIMV in patients with kyphoscoliotic chronic respiratory failure. The study was performed in 12 patients (mean age 49±11 years and body mass index 27.5±7.9 kg/m2) with advanced kyphoscoliosis complicated by severe respiratory failure (PaO2 6.68±0.34 kPa, SaO2 81.7±3.1%, PaCO2 9.51±1.08 kPa) treated by the NIMV. The short-term, after 5 days, and long-term, after 1 year of home treatment, efficacy of NIMV was evaluated. We found a significant improvement of diurnal PaO2 and PaCO2 on the 5th day of NIMV (an increase of 1.4±0.3 kPa and a decrease of 1.8±0.8 kPa, respectively; p<0.05) and after one year NIMV (an increase of 2.07±0.46 kPa and a decrease of 2.68±0.85 kPa, respectively; p<0.05). There was a significant increase of mean blood oxygen saturation during sleep on the 5th day (86.2±3.2%) and after 1 year of treatment (89.4±2.1%) compared with the baseline level (83.2±3.2%). The forced vital capacity also increased after 1 year (1,024±258 ml vs. the baseline 908±267 ml; p<0.05). The NIMV was well tolerated and no patient discontinued the treatment during the observation period. We conclude that AVAPS NIMV is an effective treatment option in kyphoscoliotic patients with chronic respiratory failure, resulting in a prompt and long-term improvement of daytime and nocturnal blood gas exchange.

Liquid extracorporeal carbon dioxide removal: use of THAM (tris-hydroxymethyl aminomethane) coupled to hemofiltration to control hypercapnic acidosis in a porcine model of protective mechanical ventilation

PubMed Central

Tapia, Pablo; Lillo, Felipe; Soto, Dagoberto; Escobar, Leslie; Simon, Felipe; Hernández, Karina; Alegría, Leyla; Bruhn, Alejandro

2016-01-01

A promising approach to facilitate protective mechanical ventilation is the use of extracorporeal CO2 removal techniques. Several strategies based on membrane gas exchangers have been developed. However, these techniques are still poorly available. The goal of this study was to assess the efficacy and safety of THAM infusion coupled to hemofiltration for the management of hypercapnic acidosis. A severe respiratory acidosis was induced in seven anesthetized pigs. Five of them were treated with THAM 8-mmol·kg-1·h-1 coupled to hemofiltration (THAM+HF group) at 100 mL·kg-1·h-1. After 18-hours of treatment the THAM infusion was stopped but hemofiltration was kept on until 24-hours. The 2 other animals were treated with THAM but without hemofiltration. After 1-hour of treatment in THAM+HF, PaCO2 rapidly decreased from a median of 89.0 (IQR) (80.0, 98.0) to 71.3 (65.8, 82.0) mmHg (P<0.05), while pH increased from 7.12 (7.01, 7.15) to 7.29 (7.27, 7.30) (P<0.05). Thereafter PaCO2 remained stable between 60-70 mmHg, while pH increased above 7.4. After stopping THAM at 18 hours of treatment a profound rebound effect was observed with severe hypercapnic acidosis. The most important side effect we observed was hyperosmolality, which reached a maximum of 330 (328, 332) mOsm·kg H2O-1 at T18. The animals treated only with THAM developed severe hypercapnia, despite the fact that pH returned to normal values, and died after 12 hours. Control-group had an uneven evolution until the end of the experiment. A combined treatment with THAM coupled to hemofiltration may be an effective treatment to control severe hypercapnic acidosis. PMID:27648139

The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Respiratory Function in the Early Postoperative Period.

PubMed

Chiarenza, Federica; Tsoutsouras, Theodoros; Cassisi, Cesare; Santonocito, Cristina; Gerry, Stephen; Astuto, Marinella; George, Shane; Sanfilippo, Filippo

2017-01-01

Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. We hypothesized a better postoperative respiratory function in off-pump coronary artery bypass grafting (OPCABG) as compared with "on-pump coronary artery bypass grafting" (ONCABG). This is a retrospective, single-center study at a cardiothoracic intensive care unit (ICU) in a tertiary university hospital. Consecutive data on 339 patients undergoing elective CABG (n = 215 ONCABG, n = 124 OPCABG) were collected for 1 year from the ICU electronic medical records. We compared respiratory variables (Pao 2 , Pao 2 /Fio 2 ratio, Sao 2 , and Paco 2 ) at 7 predefined time points (ICU admission, postoperative hours 1, 3, 6, 12, 18, and 24). We also evaluated time to extubation, rates of reintubation, and use of noninvasive ventilation (NIV). We used mixed-effects linear regression models (with time as random effect for clustering of repeated measures) adjusted for a predetermined set of covariates. The values of Pao 2 and Pao 2 /Fio 2 were significantly higher in the OPCABG group only at ICU admission (mean differences: 9.7 mm Hg, 95% confidence interval [CI] 3.1-16.2; and 27, 95% CI 6.1-47.7, respectively). The OPCABG group showed higher Paco 2 , overall ( P = .02) and at ICU admission (mean difference 1.8 mm Hg, 95% CI: 0.6-3), although mean values were always within normal range in both groups. No differences were seen in Sao 2 values, time to extubation, rate of reintubation rate, and use of postoperative NIV. Extubation rate was higher in OPCABG only at postoperative hour 12 (92% vs ONCABG 82%, P = .02). The OPCABG showed only marginal improvements of unlikely clinical meaning in oxygenation as compared to ONCABG in elective low-risk patients.

Oxygenation and ventilation characteristics in obese sedated dogs before and after weight loss: a clinical trial.

PubMed

Mosing, M; German, A J; Holden, S L; MacFarlane, P; Biourge, V; Morris, P J; Iff, I

2013-11-01

This prospective clinical study examined the effect of obesity and subsequent weight loss on oxygenation and ventilation during deep sedation in pet dogs. Data from nine dogs completing a formalised weight loss programme were evaluated. Dual-energy X-ray absorptiometry (DEXA) was used to quantify body fat mass prior to and after weight loss. Dogs were deeply sedated and positioned in dorsal recumbency. Sedation was scored using a semi-objective scheme. As part of the monitoring of sedation, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) were measured after 10 min in dorsal recumbency. Oxygen saturation of haemoglobin (SpO2) was monitored continuously using pulse oximetry, starting oxygen supplementation where indicated (SpO2<90%) via a face mask. Morphometric measurements were taken from DEXA images and compared before and after weight loss. Several oxygen indices were calculated and correlated with body fat variables evaluated by DEXA. All body fat variables improved significantly after weight loss. PaO2 increased from 27.9±19.2 kPa to 34.8±24.4 kPa, while FiO2 decreased from 0.74±0.31 to 0.66±0.35. Morphometric measurements improved significantly after weight loss. PaO2/FiO2 (inspired oxygen fraction) and Pa/AO2 (ratio of PaO2 to alveolar PO2) also improved significantly, but there was no change in f-shunt and PaCO2 after weight loss. On multiple linear regression analysis, all oxygen indices were negatively associated with thoracic fat percentage. In conclusion, obesity decreases oxygenation in dogs during deep sedation. Oxygenation status improves with successful weight loss, but ventilation is not influenced by obesity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of sedation with detomidine and butorphanol on pulmonary gas exchange in the horse

PubMed Central

Nyman, Görel; Marntell, Stina; Edner, Anna; Funkquist, Pia; Morgan, Karin; Hedenstierna, Göran

2009-01-01

Background Sedation with α2-agonists in the horse is reported to be accompanied by impairment of arterial oxygenation. The present study was undertaken to investigate pulmonary gas exchange using the Multiple Inert Gas Elimination Technique (MIGET), during sedation with the α2-agonist detomidine alone and in combination with the opioid butorphanol. Methods Seven Standardbred trotter horses aged 3–7 years and weighing 380–520 kg, were studied. The protocol consisted of three consecutive measurements; in the unsedated horse, after intravenous administration of detomidine (0.02 mg/kg) and after subsequent butorphanol administration (0.025 mg/kg). Pulmonary function and haemodynamic effects were investigated. The distribution of ventilation-perfusion ratios (VA/Q) was estimated with MIGET. Results During detomidine sedation, arterial oxygen tension (PaO2) decreased (12.8 ± 0.7 to 10.8 ± 1.2 kPa) and arterial carbon dioxide tension (PaCO2) increased (5.9 ± 0.3 to 6.1 ± 0.2 kPa) compared to measurements in the unsedated horse. Mismatch between ventilation and perfusion in the lungs was evident, but no increase in intrapulmonary shunt could be detected. Respiratory rate and minute ventilation did not change. Heart rate and cardiac output decreased, while pulmonary and systemic blood pressure and vascular resistance increased. Addition of butorphanol resulted in a significant decrease in ventilation and increase in PaCO2. Alveolar-arterial oxygen content difference P(A-a)O2 remained impaired after butorphanol administration, the VA/Q distribution improved as the decreased ventilation and persistent low blood flow was well matched. Also after subsequent butorphanol no increase in intrapulmonary shunt was evident. Conclusion The results of the present study suggest that both pulmonary and cardiovascular factors contribute to the impaired pulmonary gas exchange during detomidine and butorphanol sedation in the horse. PMID:19422714

Comparison of azaperone-detomidine-butorphanol-ketamine and azaperone-tiletamine-zolazepam for anaesthesia in piglets.

PubMed

Heinonen, Mari L; Raekallio, Marja R; Oliviero, Claudio; Ahokas, Sanna; Peltoniemi, Olli A T

2009-03-01

To investigate a combination of azaperone, detomidine, butorphanol and ketamine (DBK) in pigs and to compare it with the combination of azaperone, tiletamine and zolazepam (TZ). Prospective, randomized, blinded, cross-over study. Twelve clinically healthy crossbred pigs aged about 2 months and weighing 16-25 kg. Pigs were pre-medicated with azaperone (4 mg kg(-1)). Ten minutes later anaesthesia was induced with intramuscular DBK (detomidine 0.08 mg kg(-1), butorphanol 0.2 mg kg(-1), ketamine 10 mg kg(-1)) or TZ (tiletamine and zolazepam 5 mg kg(-1)). The pigs were positioned in dorsal recumbency. Heart and respiratory rates, posture, anaesthesia score, PaO(2), PaCO(2), pH and bicarbonate concentration were measured. t-test was used to compare the areas under time-anaesthesia index curve (AUC(anindex)) between treatments. Data concerning heart and respiratory rates, PaO(2), PaCO(2) and anaesthesia score were analysed with anova for repeated measurements. Wilcoxon signed rank test was used for the data concerning the duration of sedation and anaesthesia. The sedation, analgesia and anaesthesia lasted longer after DBK than TZ. The AUC(anscore) were 863 +/- 423 and 452 +/- 274 for DBK and TZ, respectively (p = 0.002). The duration of surgical anaesthesia lasted a median of 35 minutes (0-105 minutes) after DBK and a median of 15 minutes (0-35 minutes) after TZ (p = 0.05). Four pigs after DBK and six after TZ did not achieve the plane of surgical anaesthesia. The heart rate was lower after DBK than after TZ. Both treatments had similar effects on the other parameters measured. At the doses used DBK was more effective than TZ for anaesthesia in pigs under field conditions. The combinations can be used for sedation and minor field surgery in pigs. The doses and drugs chosen were insufficient to produce a reliable surgical plane of anaesthesia in these young pigs.

Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial.

PubMed

Weinberg, Laurence; Huang, Andrew; Alban, Daniel; Jones, Robert; Story, David; McNicol, Larry; Pearce, Brett

2017-01-23

Perioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We hypothesized that in patients undergoing OLT the use of a humidified high flow CO 2 warming system maintains higher intraoperative temperatures when compared to standardized multimodal strategies to maintain thermoregulatory homeostasis. We performed a randomized pilot study in adult patients undergoing primary OLT. Participants were randomized to receive either open wound humidification with a high flow CO 2 warming system in addition to standard care (Humidification group) or to standard care alone (Control group). The primary end point was nasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage 3 - 5 min). Secondary endpoints included intraoperative PaCO 2 , minute ventilation and the use of vasoconstrictors. Eleven patients were randomized to each group. Both groups were similar for age, body mass index, MELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion (Stage 3 - 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the Control Group: 36.0 °C (0.13) vs. 35.4 °C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures over time during the stages of the transplant were higher in the Humidification Group compared to the Control Group (p < 0.0001). There were no significant differences in the ETCO 2 , PaCO 2 , minute ventilation, or inotropic support. The humidified high flow CO 2 warming system was superior to standardized multimodal strategies in maintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any aspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated with improved patient outcomes. ACTRN12616001631493 . Retrospectively registered 25 November 2016.

Executive Function, Survival, and Hospitalization in Chronic Obstructive Pulmonary Disease. A Longitudinal Analysis of the National Emphysema Treatment Trial (NETT).

PubMed

Dodd, James W; Novotny, Paul; Sciurba, Frank C; Benzo, Roberto P

2015-10-01

Cognitive dysfunction has been demonstrated in chronic obstructive pulmonary disease (COPD), but studies are limited to cross-sectional analyses or incompletely characterized populations. We examined longitudinal changes in sensitive measures of executive function in a well-characterized population of patients with severe COPD. This study was performed on patients enrolled in the National Emphysema Treatment Trial. To assess executive function, we analyzed trail making (TM) A and B times at enrollment in the trial (2,128 patients), and at 12 (731 patients) and 24 months (593 patients) after enrollment, adjusted for surgery, marriage status, age, education, income, depression, PaO2, PaCO2, and smoking. Associations with survival and hospitalizations were examined using Cox regression and linear regression models. The average age of the patients was 66.4 years, and the average FEV1 was 23.9% predicted. At the time of enrolment, 38% had executive dysfunction. Compared with those who did not, these patients were older, less educated, had higher oxygen use, higher PaCO2, worse quality of life as measured by the St. George's Respiratory Quotient, reduced well-being, and lower social function. There was no significant change over 2 years in TM A or B times after adjustment for covariables. Changes in TM B times were modestly associated with survival, but changes in TM B-A times were not. Changes in TM scores were not associated with frequency of hospitalization. Lung function, PaO2, smoking, survival, and hospitalizations were not significantly different in those with executive dysfunction. In this large population of patients with severe emphysema and heavy cigarette smoking exposure, there was no significant decline over 2 years in cognitive executive function as measured by TM tests. There was no association between executive function impairment and frequency of hospitalization, and there was a possible modest association with survival. It is plausible that cerebrovascular comorbidities explain previously described cognitive pathology in COPD.

Peripheral chemoreflex inhibition with low-dose dopamine: new insight into mechanisms of extreme apnea.

PubMed

Bain, Anthony R; Dujic, Zeljko; Hoiland, Ryan L; Barak, Otto F; Madden, Dennis; Drvis, Ivan; Stembridge, Mike; MacLeod, David B; MacLeod, Douglas M; Ainslie, Philip N

2015-11-01

The purpose of this study was to determine the impact of peripheral chemoreflex inhibition with low-dose dopamine on maximal apnea time, and the related hemodynamic and cerebrovascular responses in elite apnea divers. In a randomized order, participants performed a maximal apnea while receiving either intravenous 2 μg·kg(-1)·min(-1) dopamine or volume-matched saline (placebo). The chemoreflex and hemodynamic response to dopamine was also assessed during hypoxia [arterial O2 tension, (PaO2 ) ∼35 mmHg] and mild hypercapnia [arterial CO2 tension (PaCO2 ) ∼46 mmHg] that mimicked the latter parts of apnea. Outcome measures included apnea duration, arterial blood gases (radial), heart rate (HR, ECG), mean arterial pressure (MAP, intra-arterial), middle (MCAv) and posterior (PCAv) cerebral artery blood velocity (transcranial ultrasound), internal carotid (ICA) and vertebral (VA) artery blood flow (ultrasound), and the chemoreflex responses. Although dopamine depressed the ventilatory response by 27 ± 41% (vs. placebo; P = 0.01), the maximal apnea duration was increased by only 5 ± 8% (P = 0.02). The PaCO2 and PaO2 at apnea breakpoint were similar (P > 0.05). When compared with placebo, dopamine increased HR and decreased MAP during both apnea and chemoreflex test (P all <0.05). At rest, dopamine compared with placebo dilated the ICA (3.0 ± 4.1%, P = 0.05) and VA (6.6 ± 5.0%, P < 0.01). During apnea and chemoreflex test, conductance of the cerebral vessels (ICA, VA, MCAv, PCAv) was increased with dopamine; however, flow (ICA and VA) was similar. At least in elite apnea divers, the small increase in apnea time and similar PaO2 at breakpoint (∼31 mmHg) suggest the apnea breakpoint is more related to PaO2 , rather than peripheral chemoreflex drive to breathe. Copyright © 2015 the American Physiological Society.

Differences in baseline factors and survival between normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis in COPD exacerbation: A pilot study.

PubMed

Lun, Chung-Tat; Tsui, Miranda S N; Cheng, Suet-Lai; Chan, Veronica L; Leung, Wah-Shing; Cheung, Alice P S; Chu, Chung-Ming

2016-01-01

Patients with chronic obstructive pulmonary disease (COPD) experiencing acute exacerbation (AE-COPD) with decompensated respiratory acidosis are known to have poor outcomes in terms of recurrent respiratory failure and death. However, the outcomes of AE-COPD patients with compensated respiratory acidosis are not known. We performed a 1-year prospective, single-centre, cohort study in patients surviving the index admission for AE-COPD to compare baseline factors between groups with normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis. Survival analysis was done to examine time to readmissions, life-threatening events and death. A total of 250 patients fulfilling the inclusion and exclusion criteria were recruited and 245 patients were analysed. Compared with normocapnia, both compensated and decompensated respiratory acidosis are associated with lower FEV1 % (P < 0.001), higher GOLD stage (P = 0.003, <0.001) and higher BODE index (P = 0.038, 0.001) and a shorter time to life-threatening events (P < 0.001). Comparing compensated and decompensated respiratory acidosis, there was no difference in FEV1 (% predicted) (P = 0.15), GOLD stage (P = 0.091), BODE index (P = 0.158) or time to life-threatening events (P = 0.301). High PaCO2 level (P = 0.002) and previous use of non-invasive ventilation (NIV) in acute setting (P < 0.001) are predictive factors of future life-threatening events by multivariate analysis. Compared with normocapnia, both compensated and decompensated respiratory acidosis are associated with poorer lung function and higher risk of future life-threatening events. High PaCO2 level and past history of NIV use in acute settings were predictive factors for future life-threatening events. Compensated respiratory acidosis warrants special attention and optimization of medical therapy as it poses risk of life-threatening events. © 2015 Asian Pacific Society of Respirology.

Acute but not chronic metabolic acidosis potentiates the acetylcholine-induced reduction in blood pressure: an endothelium-dependent effect

PubMed Central

Celotto, A.C.; Ferreira, L.G.; Capellini, V.K.; Albuquerque, A.A.S.; Rodrigues, A.J.; Evora, P.R.B.

2015-01-01

Metabolic acidosis has profound effects on vascular tone. This study investigated the in vivo effects of acute metabolic acidosis (AMA) and chronic metabolic acidosis (CMA) on hemodynamic parameters and endothelial function. CMA was induced by ad libitum intake of 1% NH4Cl for 7 days, and AMA was induced by a 3-h infusion of 6 M NH4Cl (1 mL/kg, diluted 1:10). Phenylephrine (Phe) and acetylcholine (Ach) dose-response curves were performed by venous infusion with simultaneous venous and arterial blood pressure monitoring. Plasma nitrite/nitrate (NOx) was measured by chemiluminescence. The CMA group had a blood pH of 7.15±0.03, which was associated with reduced bicarbonate (13.8±0.98 mmol/L) and no change in the partial pressure of arterial carbon dioxide (PaCO2). The AMA group had a pH of 7.20±0.01, which was associated with decreases in bicarbonate (10.8±0.54 mmol/L) and PaCO2 (47.8±2.54 to 23.2±0.74 mmHg) and accompanied by hyperventilation. Phe or ACh infusion did not affect arterial or venous blood pressure in the CMA group. However, the ACh infusion decreased the arterial blood pressure (ΔBP: -28.0±2.35 mm Hg [AMA] to -4.5±2.89 mmHg [control]) in the AMA group. Plasma NOx was normal after CMA but increased after AMA (25.3±0.88 to 31.3±0.54 μM). These results indicate that AMA, but not CMA, potentiated the Ach-induced decrease in blood pressure and led to an increase in plasma NOx, reinforcing the effect of pH imbalance on vascular tone and blood pressure control. PMID:26648089

Effects of different concentrations of isoflurane pretreatment on respiratory mechanics, oxygenation and hemodynamics in LPS-induced acute respiratory distress syndrome model of juvenile piglets.

PubMed

Fu, Haibin; Sun, Minli; Miao, Changhong

2015-01-01

This study was prospectively designed to investigate the effects of different concentrations of isoflurane (ISO) pretreatment on respiratory mechanics, oxygenation, and hemodynamics in lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) model of juvenile piglets. Twenty-four piglets (9-14 kg, 5-6 weeks old) were randomly assigned to four groups (n = 6): LPS group, which was injected with LPS (20 μg/kg) to induce ARDS; 0.5 ISO-LPS, 1.0 ISO-LPS, and 1.3 ISO-LPS groups, which were pretreated with 0.5, 1.0, and 1.3 minimum alveolar concentrations (MAC) ISO for 30 min before immediate LPS infusion, respectively. After establishment of ARDS, respiratory mechanism, oxygenation and hemodynamics parameters were measured at baseline, and 0, 1, 2, 3, and 4 hours after induction of ARDS. After induction of ARDS, there were increases in alveolar-arterial oxygen difference (A-aDO2), oxygenation index (OI), mean airway pressure (MAP), dead space-to-tidal volume ratio, heart rate (HR), dP/dtmax, extravascular lung water index, pulmonary vascular permeability index, and PaCO2, and decreases in PaO2/FIO2, respiratory rate (RR), dynamic lung compliance (Cdyn), mean arterial blood pressure (MABP) and systemic vascular resistance (SVR) compared with baseline (P(time) < 0.05). Pretreatment with 1.0 and 1.3 MAC ISO alleviated changes in dP/dtmax and PaCO2 at ARDS 0-2 hours, SVR at 0-3 hours, PaO2/FIO2, RR, and MABP at 1-2 hours, HR at 2-3 hours, A-aDO2 at 3-4 hours, and OI at 4 hours (P(group) < 0.05). Pretreatment with 1.0 and 1.3 MAC ISO had protective effects on respiratory mechanics, oxygenation, and hemodynamics in piglets with LPS-induced ARDS.

Targeted therapeutic mild hypercapnia after cardiac arrest: A phase II multi-centre randomised controlled trial (the CCC trial).

PubMed

Eastwood, Glenn M; Schneider, Antoine G; Suzuki, Satoshi; Peck, Leah; Young, Helen; Tanaka, Aiko; Mårtensson, Johan; Warrillow, Stephen; McGuinness, Shay; Parke, Rachael; Gilder, Eileen; Mccarthy, Lianne; Galt, Pauline; Taori, Gopal; Eliott, Suzanne; Lamac, Tammy; Bailey, Michael; Harley, Nerina; Barge, Deborah; Hodgson, Carol L; Morganti-Kossmann, Maria Cristina; Pébay, Alice; Conquest, Alison; Archer, John S; Bernard, Stephen; Stub, Dion; Hart, Graeme K; Bellomo, Rinaldo

2016-07-01

In intensive care observational studies, hypercapnia after cardiac arrest (CA) is independently associated with improved neurological outcome. However, the safety and feasibility of delivering targeted therapeutic mild hypercapnia (TTMH) for such patients is untested. In a phase II safety and feasibility multi-centre, randomised controlled trial, we allocated ICU patients after CA to 24h of targeted normocapnia (TN) (PaCO2 35-45mmHg) or TTMH (PaCO2 50-55mmHg). The primary outcome was serum neuron specific enolase (NSE) and S100b protein concentrations over the first 72h assessed in the first 50 patients surviving to day three. Secondary end-points included global measure of function assessment at six months and mortality for all patients. We enrolled 86 patients. Their median age was 61 years (58, 64 years) and 66 (79%) were male. Of these, 50 patients (58%) survived to day three for full biomarker assessment. NSE concentrations increased in the TTMH group (p=0.02) and TN group (p=0.005) over time, with the increase being significantly more pronounced in the TN group (p(interaction)=0.04). S100b concentrations decreased over time in the TTMH group (p<0.001) but not in the TN group (p=0.68). However, the S100b change over time did not differ between the groups (p(interaction)=0.23). At six months, 23 (59%) TTMH patients had good functional recovery compared with 18 (46%) TN patients. Hospital mortality occurred in 11 (26%) TTMH patients and 15 (37%) TN patients (p=0.31). In CA patients admitted to the ICU, TTMH was feasible, appeared safe and attenuated the release of NSE compared with TN. These findings justify further investigation of this novel treatment. Copyright © 2016. Published by Elsevier Ireland Ltd.

[Alveolar arterial O2 gradient in patients with cardiopulmonary pathology. Its study at rest with respiration of environmental air].

PubMed

Martínez Guerra, M L; Fernández Bonett, P; Lupi Herrera, E

1979-01-01

The arterial oxygen pressure (PAO2) and the arterial carbon dioxide pressure (PACO2) are the mirror of the whole stage in alveolar ventilation, because there is a numerical correlation between them, in the alveolar air equation. In our material no difference was found when the respiratory cocient is used to calculate the equation modifying the PACO2 value. On the other hand, the PaO depends on a great amount of variables, i.e., the rationship V/Q. Qs/Qt and the arteriovenous oxygen difference in volume percentage, which reflect the functional stage of the gaseous interchange; other variables depend essentially of technical factors as the methodology used in the obtention and management of the samples and the measurement of the PAO2 at the laboratory. Thus, the alveolo-arterial oxigen Difference delta (A-a)O2 is considered as a mirror of the fluctuations in gaseous interchange, only if the alveolar ventilation the cardiac output, the systemic arterial-vein oxygen difference and in minor importance the respiratory cocient (RP remain constant. The delta (A-a)O2 is not always correlated with other parameters far from the gaseous interchange at lung level in the critically ill patient, for this, it has not a pronostic mecaning by itself. Nevertheless, we believe that delta (A-a)O2 continues being a useful measurement to evaluate the gaseous interchange if at the same time all the factors which may have influence in it are analysed. We consider, for trying to be simple in the management of the acute respiratory failure at the bedside that the (A-a)O2 must not be linked to only one parameter of the respiratory function, i.e. the intrapulmonar veno-arterial shunt, without considering the cardiac output and the systemic arterial-vein oxygen difference.

Feasibility and safety of low-flow extracorporeal CO2 removal managed with a renal replacement platform to enhance lung-protective ventilation of patients with mild-to-moderate ARDS.

PubMed

Schmidt, Matthieu; Jaber, Samir; Zogheib, Elie; Godet, Thomas; Capellier, Gilles; Combes, Alain

2018-05-10

Extracorporeal carbon-dioxide removal (ECCO 2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (P plat ) (< 30 cmH 2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO 2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS). Twenty patients with mild (n = 8) or moderate (n = 12) ARDS were included. VT was gradually lowered from 6 to 5, 4.5, and 4 ml/kg, and PEEP adjusted to reach 23 ≤ P plat  ≤ 25 cmH 2 O. Standalone ECCO 2 R (no hemofilter associated with the RRT platform) was initiated when arterial PaCO 2 increased by > 20% from its initial value. Ventilation parameters (VT, respiratory rate, PEEP), respiratory system compliance, P plat and driving pressure, arterial blood gases, and ECCO 2 R-system operational characteristics were collected during at least 24 h of very low tidal volume ventilation. Complications, day-28 mortality, need for adjuvant therapies, and data on weaning off ECCO 2 R and mechanical ventilation were also recorded. While VT was reduced from 6 to 4 ml/kg and P plat kept < 25 cmH 2 O, PEEP was significantly increased from 13.4 ± 3.6 cmH 2 O at baseline to 15.0 ± 3.4 cmH 2 O, and the driving pressure was significantly reduced from 13.0 ± 4.8 to 7.9 ± 3.2 cmH 2 O (both p < 0.05). The PaO 2 /FiO 2 ratio and respiratory-system compliance were not modified after VT reduction. Mild respiratory acidosis occurred, with mean PaCO 2 increasing from 43 ± 8 to 53 ± 9 mmHg and mean pH decreasing from 7.39 ± 0.1 to 7.32 ± 0.10 from baseline to 4 ml/kg VT, while the respiratory rate was not altered. Mean extracorporeal blood flow, sweep-gas flow, and CO 2 removal were 421 ± 40 ml/min, 10 ± 0.3 L/min, and 51 ± 26 ml/min, respectively. Mean treatment duration was 31 ± 22 h. Day-28 mortality was 15%. A low-flow ECCO 2 R device managed with an RRT platform easily and safely enabled very low tidal volume ventilation with moderate increase in PaCO 2 in patients with mild-to-moderate ARDS. ClinicalTrials.gov, NCT02606240. Registered on 17 November 2015.

Metallic alternative to glass mirrors (active mirrors in aluminium) - A review

NASA Astrophysics Data System (ADS)

Rozelot, Jean P.; Leblanc, Jean-M.

1991-09-01

Present-day glass mirrors for telescopes, including the most recent results obtained with aluminum mirrors developed within the European EUREKA procedure (LAMA program) are reviewed. The major advantages of the aluminum-alloy solution, which can be extrapolated today for large size, are discussed. It is shown that aluminum-alloy meniscus blanks, polished on a thin nickel coating, are appropriate to manufacture mirrors of astronomical quality. With the technique of electron-beam welding, large sizes can be envisaged. The development of active optics makes it possible to easily compensate for real-time deformations. The good thermal diffusivity of aluminum alloys leads to a better and faster thermal equilibrium than all other glass structures.

A faint field-galaxy redshift survey in quasar fields

NASA Technical Reports Server (NTRS)

Yee, Howard K. C.; Ellingson, Erica

1993-01-01

Quasars serve as excellent markers for the identification of high-redshift galaxies and galaxy clusters. In past surveys, nearly 20 clusters of Abell richness class 1 or richer associated with quasars in the redshift range 0.2 less than z less than 0.8 were identified. In order to study these galaxy clusters in detail, a major redshift survey of faint galaxies in these fields using the CFHT LAMA/MARLIN multi-object spectroscopy system was carried out. An equally important product in such a survey is the redshifts of the field galaxies not associated with the quasars. Some preliminary results on field galaxies from an interim set of data from our redshift survey in quasar fields are presented.

Gravity-induced hyperventilation is caused by a reduced brain perfusion.

PubMed

Arieli, R; Farhi, L E

1987-08-01

The suggestion that hyperventilation caused by increased gravity is mediated by a decrease in brain perfusion has led us to propose a mathematical model based on: (1) the CO2 balance equation for the respiratory center (RC), and (2) the relationship between RC blood flow (QRC), foot-to-head acceleration (Gz) and PRCCO2, namely, QRC = [1 - a(Gz - 1)](b X PRCCO2 + c), where the coefficients a, b and c can be calculated from data in the literature. QRC is significantly affected by + GZ only at high PaCO2. The model can be used to calculate oxygen pressure in the RC; the numbers so obtained are in good agreement with measurements of jugular vein PO2 obtained by others.

A novel taxon within the genus Actinobacillus isolated from alpaca (Vicugna pacos) in the United Kingdom.

PubMed

Hunt, Brian; Bidewell, Cornelia; Koylass, Mark S; Whatmore, Adrian M

2013-05-03

Members of the genus Actinobacillus comprise a diverse group of bacteria associated with mammals and birds including both pathogens and commensals. Here we describe the isolation of a previously undescribed Actinobacillus-like organism from seven epidemiologically unrelated infections of alpaca. The isolates are phenotypically and genotypically distinct from any previously described Actinobacillus species but 16S rRNA analysis unequivocally places the isolates as a novel lineage within the Actinobacillus sensu stricto. The clinical relevance of the organism requires further study however isolation in pure culture from organs of some cases suggests it may be associated with septicaemia in juvenile alpaca. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Landscape connectivity among remnant populations of guanaco (Lama guanicoe Müller, 1776) in an arid region of Chile impacted by global change

PubMed Central

Espinosa, Mara I.; Gouin, Nicolas; Squeo, Francisco A.; López, David

2018-01-01

Connectivity between populations plays a key role in the long-term persistence of species in fragmented habitats. This is of particular concern for biodiversity preservation in drylands, since water limited landscapes are typically characterized by little suitable habitat cover, high habitat fragmentation, harsh matrices, and are being rapidly degraded at a global scale. In this study, we modelled landscape connectivity between 11 guanaco Lama guanicoe populations in Chile’s arid Norte Chico, a region that supports the last remnant coastal populations of this emblematic herbivore indigenous to South America. We produced a habitat suitability model to derive a regional surface resistance map, and used circuit theory to map functional connectivity, investigate the relative isolation between populations, and identify those that contribute most to the patch connectivity network. Predicted suitable habitat for L. guanicoe represented about 25% of the study region (i.e., 29,173 km2) and was heterogeneously distributed along a continuous stretch along the Andes, and discontinuous patches along the coast. As a result, we found that high connectivity current flows in the mid and high Andes formed a wide, continuous connectivity corridor, enabling connectivity between all high Andean populations. Coastal populations, in contrast, were more isolated. These groups demonstrate no inter-population connectivity between themselves, only with higher altitude populations, and for two of them, animal movement was linked to the effectiveness of wildlife crossings along the Pan-American highway. Our results indicate that functional connectivity is an issue of concern for L. guanicoe in Chile’s Norte Chico, implying that future conservation and management plans should emphasize strategies aimed at conserving functional connectivity between coastal and Andean populations, as well as the protection of habitat patches likely to act as stepping stones within the connectivity network. PMID:29507827

Morphological and proteomic analysis of early stage of osteoblast differentiation in osteoblastic progenitor cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hong, Dun; Orthopedic Department, Taizhou Hospital, Wenzhou Medical College, Linhai, Zhejiang 317000; Chen, Hai-Xiao, E-mail: Hxchen-1@163.net

Bone remodeling relies on a dynamic balance between bone formation and resorption, mediated by osteoblasts and osteoclasts, respectively. Under certain stimuli, osteoprogenitor cells may differentiate into premature osteoblasts and further into mature osteoblasts. This process is marked by increased alkaline phosphatase (ALP) activity and mineralized nodule formation. In this study, we induced osteoblast differentiation in mouse osteoprogenitor MC3T3-E1 cells and divided the process into three stages. In the first stage (day 3), the MC3T3-E1 cell under osteoblast differentiation did not express ALP or deposit a mineralized nodule. In the second stage, the MC3T3-E1 cell expressed ALP but did not formmore » a mineralized nodule. In the third stage, the MC3T3-E1 cell had ALP activity and formed mineralized nodules. In the present study, we focused on morphological and proteomic changes of MC3T3-E1 cells in the early stage of osteoblast differentiation - a period when premature osteoblasts transform into mature osteoblasts. We found that mean cell area and mean stress fiber density were increased in this stage due to enhanced cell spreading and decreased cell proliferation. We further analyzed the proteins in the signaling pathway of regulation of the cytoskeleton using a proteomic approach and found upregulation of IQGAP1, gelsolin, moesin, radixin, and Cfl1. After analyzing the focal adhesion signaling pathway, we found the upregulation of FLNA, LAMA1, LAMA5, COL1A1, COL3A1, COL4A6, and COL5A2 as well as the downregulation of COL4A1, COL4A2, and COL4A4. In conclusion, the signaling pathway of regulation of the cytoskeleton and focal adhesion play critical roles in regulating cell spreading and actin skeleton formation in the early stage of osteoblast differentiation.« less

A defective retroviral vector encoding human interferon-alpha2 can transduce human leukemic cell lines.

PubMed

Austruy, E; Bagnis, C; Carbuccia, N; Maroc, C; Birg, F; Dubreuil, P; Mannoni, P; Chabannon, C

1998-01-01

Using the LXSN backbone, a defective retroviral vector (LISN) was constructed that encodes the human interferon (IFN)-alpha2 (hIFN-alpha2) gene and the neomycin resistance gene; the hIFN-alpha2 gene was cloned from human placental genomic DNA. High titers of the LISN retrovirus were produced by the amphotropic packaging cell line GP+envAM12. LISN is able to infect three human hematopoietic and leukemic cell lines: K562, LAMA-84, and TF-1. G418-resistant cells were detected in a similar proportion after infection with either the LISN retroviral vector or the LnLSN retroviral vector (encoding the nlsLacZ gene instead of hIFN-alpha2), suggesting that hIFN-alpha2 does not inhibit (or only partially inhibits) the production of retroviral particles by the packaging cell line and the infection of human cells. LISN-infected cells express and secrete hIFN-alpha2 as demonstrated by Northern blot analysis of poly(A)+ RNA, detection of the intracellular protein by fluorescence-activated cell sorter analysis, and detection of secreted hIFN-alpha in cell supernatants using an enzyme-linked immunosorbent assay. Retrovirally produced hIFN-alpha2 is biologically active, as demonstrated by the partial inhibition of the growth of K562 and TF-1, the modulation of the expression of cell surface antigens, the induction of the (2'-5') oligoadenylate synthetase, and, for LAMA-84, the down-modulation of the BCR-ABL protein. We conclude that the infection of human leukemic cell lines with a retroviral vector encoding hIFN-alpha2 is feasible and induces the expected biological effects. This experimental model will be useful in investigating the possibility of transducing normal and leukemic cells and hematopoietic progenitors and in determining the consequences of the autocrine production of hIFN-alpha2 on the behavior of these cells.

Is the 20th century warming unprecedented in the Siberian north?

NASA Astrophysics Data System (ADS)

Sidorova, Olga V.; Saurer, Matthias; Andreev, Andrei; Fritzsche, Diedrich; Opel, Thomas; Naurzbaev, Mukhtar M.; Siegwolf, Rolf

2013-08-01

To answer the question "Has the recent warming no analogues in the Siberian north?" we analyzed larch tree samples (Larix gmelinii Rupr.) from permafrost zone in the eastern Taimyr (TAY) (72°N, 102°E) using tree-ring and stable isotope analyses for the Climatic Optimum Period (COP) 4111-3806 BC and Medieval Warm Period (MWP) 917-1150 AD, in comparison to the recent period (RP) 1791-2008 AD. We developed a description of the climatic and environmental changes in the eastern Taimyr using tree-ring width and stable isotope (δ13C, δ18O) data based on statistical verification of the relationships to climatic parameters (temperature and precipitation). Additionally, we compared our new tree-ring and stable isotope data sets with earlier published July temperature and precipitation reconstructions inferred from pollen data of the Lama Lake, Taimyr Peninsula, δ18O ice core data from Akademii Nauk ice cap on Severnaya Zemlya (SZ) and δ18O ice core data from Greenland (GISP2), as well as tree-ring width and stable carbon and oxygen isotope data from northeastern Yakutia (YAK). We found that the COP in TAY was warmer and drier compared to the MWP but rather similar to the RP. Our results indicate that the MWP in TAY started earlier and was wetter than in YAK. July precipitation reconstructions obtained from pollen data of the Lama Lake, oxygen isotope data from SZ and our carbon isotopes in tree cellulose agree well and indicate wetter climate conditions during the MWP. Consistent large-scale patterns were reflected in significant links between oxygen isotope data in tree cellulose from TAY and YAK, and oxygen isotope data from SZ and GISP2 during the MWP and the RP. Finally, we showed that the recent warming is not unprecedented in the Siberian north. Similar climate conditions were recorded by tree-rings, stable isotopes, pollen, and ice core data 6000 years ago.

Upper extremity outcome measures for collagen VI-related myopathy and LAMA2-related muscular dystrophy

PubMed Central

Bendixen, Roxanna M.; Butrum, Jocelyn; Jain, Mina S.; Parks, Rebecca; Hodsdon, Bonnie; Nichols, Carmel; Hsia, Michelle; Nelson, Leslie; Keller, Katherine C.; McGuire, Michelle; Elliott, Jeffrey S.; Linton, Melody M.; Arveson, Irene C.; Tounkara, Fatou; Vasavada, Ruhi; Harnett, Elizabeth; Punjabi, Monal; Donkervoort, Sandra; Dastgir, Jahannaz; Leach, Meganne E.; Rutkowski, Anne; Waite, Melissa; Collins, James; Bönnemann, Carsten G.; Meilleur, Katherine G.

2017-01-01

Purpose Congenital muscular dystrophy (CMD) comprises a rare group of genetic muscle diseases that present at birth or early during infancy. Two common subtypes of CMD are collagen VI-related muscular dystrophy (COL6-RD) and laminin alpha 2-related dystrophy (LAMA2-RD). Traditional outcome measures in CMD include gross motor and mobility assessments, yet significant motor declines underscore the need for valid upper extremity (UE) motor assessments as a clinical endpoint. This study validated a battery of UE measures in these two CMD subtypes for future clinical trials. Methods For this cross-sectional study, 42 participants were assessed over the same 2–5 day period at the National Institutes of Health Clinical Center (CC). All UE measures were correlated with the Motor Function Measure 32 (MFM32). The battery of UE assessments included the Jebsen Taylor Hand Function Test, Quality of Upper Extremity Skills Test (QUEST), hand held dynamometry, goniometry, and MyoSet Tools. Spearman Rho was used for correlations to the MFM32. Pearson was performed to correlate the Jebsen, QUEST, hand-held dynamometry, goniometry and the MyoSet Tools. Correlations were considered significant at the 0.01 level (2-tailed). Results Significant correlations were found between both the MFM32 and MFM Dimension 3 only (Distal Motor function) and the Jebsen, QUEST, MyoGrip and MyoPinch, elbow flexion/extension ROM and myometry. Additional correlations between the assessments are reported. Conclusions The Jebsen, the Grasp and Dissociated Movements domains of the QUEST, the MyoGrip and the MyoPinch tools, as well as elbow ROM and myometry were determined to be valid and feasible in this population, provided variation in test items, and assessed a range of difficulty in CMD. To move forward, it will be of utmost importance to determine whether these UE measures are reproducible and sensitive to change over time. PMID:28087121

Indacaterol vs tiotropium in COPD patients classified as GOLD A and B.

PubMed

Mahler, Donald A; Kerstjens, Huib A M; Donohue, James F; Buhl, Roland; Lawrence, David; Altman, Pablo

2015-08-01

According to current GOLD strategy, patients with COPD classified as groups A and B may be treated with inhaled bronchodilators, either long-acting β2-agonist (LABA) or long-acting muscarinic antagonist (LAMA). However, there is little guidance on which class of agent is preferred and a lack of prospective data to differentiate the two. In this study, we performed post-hoc analyses of pooled data from two prospective, controlled clinical trials comparing the LABA indacaterol and LAMA tiotropium in 1422 patients with moderate airflow limitation and no history of exacerbations in the previous year. This population fits the definitions of GOLD A and B groups and could be further stratified by symptom severity using Baseline Dyspnea Index (i.e. modeling GOLD A or B) and inhaled corticosteroid (ICS) use at baseline. Outcomes measured after 12 weeks of treatment were lung function (forced expiratory volume in 1 s; FEV1), health status (St George's Respiratory Questionnaire; SGRQ), symptoms (Transition Dyspnea Index; TDI) and rescue medication use. In 'GOLD A' patients not receiving ICS, differences favored indacaterol versus tiotropium (trough FEV1 0.05 L; rescue medication use -0.41 puffs/day; TDI total score 0.94 points; SGRQ total score -3.13 units, all p < 0.01). In 'GOLD B, no ICS' patients, compared with tiotropium, indacaterol treatment increased trough FEV1 (0.055 L, p < 0.05) and permitted a larger reduction in rescue medication use (-0.81 puffs/day, p = 0.004). In all patients, and in patients not using ICS, differences favored indacaterol for all variables. Our findings suggest that patients in GOLD groups A and B may experience greater benefits with indacaterol than with tiotropium. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Application of a haematopoetic progenitor cell-targeted adeno-associated viral (AAV) vector established by selection of an AAV random peptide library on a leukaemia cell line

PubMed Central

Stiefelhagen, Marius; Sellner, Leopold; Kleinschmidt, Jürgen A; Jauch, Anna; Laufs, Stephanie; Wenz, Frederik; Zeller, W Jens; Fruehauf, Stefan; Veldwijk, Marlon R

2008-01-01

Background For many promising target cells (e.g.: haematopoeitic progenitors), the susceptibility to standard adeno-associated viral (AAV) vectors is low. Advancements in vector development now allows the generation of target cell-selected AAV capsid mutants. Methods To determine its suitability, the method was applied on a chronic myelogenous leukaemia (CML) cell line (K562) to obtain a CML-targeted vector and the resulting vectors tested on leukaemia, non-leukaemia, primary human CML and CD34+ peripheral blood progenitor cells (PBPC); standard AAV2 and a random capsid mutant vector served as controls. Results Transduction of CML (BV173, EM3, K562 and Lama84) and AML (HL60 and KG1a) cell lines with the capsid mutants resulted in an up to 36-fold increase in CML transduction efficiency (K562: 2-fold, 60% ± 2% green fluorescent protein (GFP)+ cells; BV173: 9-fold, 37% ± 2% GFP+ cells; Lama84: 36-fold, 29% ± 2% GFP+ cells) compared to controls. For AML (KG1a, HL60) and one CML cell line (EM3), no significant transduction (<1% GFP+ cells) was observed for any vector. Although the capsid mutant clone was established on a cell line, proof-of-principle experiments using primary human cells were performed. For CML (3.2-fold, mutant: 1.75% ± 0.45% GFP+ cells, p = 0.03) and PBPC (3.5-fold, mutant: 4.21% ± 3.40% GFP+ cells) a moderate increase in gene transfer of the capsid mutant compared to control vectors was observed. Conclusion Using an AAV random peptide library on a CML cell line, we were able to generate a capsid mutant, which transduced CML cell lines and primary human haematopoietic progenitor cells with higher efficiency than standard recombinant AAV vectors. PMID:18789140

Global hypomethylation and promoter methylation in small intestinal neuroendocrine tumors: an in vivo and in vitro study.

PubMed

Fotouhi, Omid; Adel Fahmideh, Maral; Kjellman, Magnus; Sulaiman, Luqman; Höög, Anders; Zedenius, Jan; Hashemi, Jamileh; Larsson, Catharina

2014-07-01

Aberrant DNA methylation is a feature of human cancer affecting gene expression and tumor phenotype. Here, we quantified promoter methylation of candidate genes and global methylation in 44 small intestinal-neuroendocrine tumors (SI-NETs) from 33 patients by pyrosequencing. Findings were compared with gene expression, patient outcome and known tumor copy number alterations. Promoter methylation was observed for WIF1, RASSF1A, CTNNB1, CXCL14, NKX2-3, P16, LAMA1, and CDH1. By contrast APC, CDH3, HIC1, P14, SMAD2, and SMAD4 only had low levels of methylation. WIF1 methylation was significantly increased (P = 0.001) and WIF1 expression was reduced in SI-NETs vs. normal references (P = 0.003). WIF1, NKX2-3, and CXCL14 expression was reduced in metastases vs. primary tumors (P<0.02). Low expression of RASSF1A and P16 were associated with poor overall survival (P = 0.045 and P = 0.011, respectively). Global methylation determined by pyrosequencing of LINE1 repeats was reduced in tumors vs. normal references, and was associated with loss in chromosome 18. The tumors fell into three clusters with enrichment of WIF1 methylation and LINE1 hypomethylation in Cluster I and RASSF1A and CTNNB1 methylation and loss in 16q in Cluster II. In Cluster III, these alterations were low-abundant and NKX2-3 methylation was low. Similar analyses in the SI-NET cell lines HC45 and CNDT2 showed methylation for CDH1 and WIF1 and/or P16, CXCL14, NKX2-3, LAMA1, and CTNNB1. Treatment with the demethylating agent 5-azacytidine reduced DNA methylation and increased expression of these genes in vitro. In conclusion, promoter methylation of tumor suppressor genes is associated with suppressed gene expression and DNA copy number alterations in SI-NETs, and may be restored in vitro.

Expression of adhesion and extracellular matrix genes in human blastocysts upon attachment in a 2D co-culture system.

PubMed

Aberkane, A; Essahib, W; Spits, C; De Paepe, C; Sermon, K; Adriaenssens, T; Mackens, S; Tournaye, H; Brosens, J J; Van de, Velde H

2018-05-26

What are the changes in human embryos, in terms of morphology and gene expression, upon attachment to endometrial epithelial cells? Apposition and adhesion of human blastocysts to endometrial epithelial cells are predominantly initiated at the embryonic pole and these steps are associated with changes in expression of adhesion and extracellular matrix (ECM) genes in the embryo. Both human and murine embryos have been co-cultured with Ishikawa cells, although embryonic gene expression associated with attachment has not yet been investigated in an in-vitro implantation model. Vitrified human blastocysts were warmed and co-cultured for up to 48 h with Ishikawa cells, a model cell line for receptive endometrial epithelium. Six-days post fertilisation (6dpf) human embryos were co-cultured with Ishikawa cells for 12 h, 24 h (7dpf) or 48 h (8dpf) and attachment rate and morphological development investigated. Expression of 84 adhesion and ECM genes was analysed by quantitative PCR. Immunofluorescence microscopy was used to assess the expression of three informative genes at the protein level. Data are reported on 115 human embryos. Mann-Whitney U was used for statistical analysis between two groups, with P < 0.05 considered significant. The majority of embryos attached to Ishikawa cells at the level of the polar trophectoderm; 41% of co-cultured embryos were loosely attached after 12 h and 86% firmly attached after 24 h. Outgrowth of hCG-positive embryonic cells at 8dpf indicated differentiation of trophectoderm into invasive syncytiotrophoblast. Gene expression analysis was performed on loosely attached and unattached embryos co-cultured with Ishikawa cells for 12 h. In contrast to unattached embryos, loosely attached embryos expressed THBS1, TNC, COL12A1, CTNND2, ITGA3, ITGAV, and LAMA3 and had significantly higher CD44 and TIMP1 transcript levels (P = 0.014 and P = 0.029, respectively). LAMA3, THBS1 and TNC expression was validated at the protein level in firmly attached 7dpf embryos. Thrombospondin 1 (THBS1) resided in the cytoplasm of embryonic cells whereas laminin subunit alpha 3 (LAMA3) and tenascin C (TNC) were expressed on the cell surface of trophectoderm cells. Incubation with a neutralizing TNC antibody did not affect the rate of embryo attachment or hCG secretion. None. This in-vitro study made use of an endometrial adenocarcinoma cell line to mimic receptive luminal epithelium. Also, the number of embryos was limited. Contamination of recovered embryos with Ishikawa cells was unlikely based on their differential gene expression profiles. Taken together, we provide a 'proof of concept' that initiation of the implantation process coincides with the induction of specific embryonic genes. Genome-wide expression profiling of a larger sample set may provide insights into the molecular embryonic pathways underlying successful or failed implantation. A.A. was supported by a grant from the "Instituut voor Innovatie door Wetenschap en Technologie" (IWT, 121716, Flanders, Belgium). This work was supported by the "Wetenschappelijk Fonds Willy Gepts" (WFWG G142 and G170, Universitair Ziekenhuis Brussel). The authors declare no conflict of interest.

Five-year epidemiology of liquefied petroleum gas-related burns.

PubMed

Jin, Ronghua; Wu, Pan; Ho, Jon Kee; Wang, Xingang; Han, Chunmao

2018-02-01

The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32±25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90±19.47days (range 2-84 days). Only 48 patients (24.62%) had medical insurance, while 124 patients (63.59%) had no medical insurance. The average hospital cost of the no medical insurance group was significantly higher (p<0.0001) than that of the medical insurance group. In addition, 72.73% of patients who left against medical advice (LAMA) were uninsured. The number of patients who recovered at our hospital was 165 (84.62%), while 22 patients (11.28%) LAMA. The overall mortality rate was 4.10% (8 patients). Our study shows that the exponential increase in LPG-related burns is alarming. This calls for rigorous precautions. Because gas leak was the main cause of LPG-related burns, any part of LPG stove system that shows signs of weathering should be replaced regularly. In addition, we also found that most of the LAMA patients were uninsured. Thus, comprehensive medical insurance should be involved early in the recovery process to assure a safe and adequate discharge. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Soil organic carbon in Apolobamba (Bolivia): Quantity and quality of the reservoir

NASA Astrophysics Data System (ADS)

Muñoz, M. Á.; Faz, A.

2009-04-01

Global carbon cycle mainly depends on the soil organic matter (SOM). Some reducction of climatic impact techiques are related to the increase of the soil organic carbon (SOC) contents in order to elevate atmospherical carbon inputs. Kinetic mechanisms of the SOC are differents due to the complex interation between biological, physical and chemical processes in the soil. For a full understanding of the SOM contribution to the carbon cycle in the soil, the SOC contents should be addressed. The vicuna (Vicugna vicugna) is an endangered species which belongs to camelid family. Its natural habitat is located in highland grasses in the Andes Montain Range, above 4,000 m.a.s.l. In Bolivia the vicuna is distributed around some andean regions such as Apolobamba. It is a protected area located in the Northwest of Bolivia where native inhabitants carry out a sustainable management of the vicuna. This activity is considered within a programme to improve economical conditions in the area. The vicuna lives in the same habitat than other cattle camelid like alpaca (Lama pacos). The soil is an essential natural resource in the vicuna development and the biodiversity conservation due to its role to support the native vegetation in Apolobamba. The objectives of this research were: (i) the quantification of SOC contents, (ii) the study of the SOC quality and (iii) the determination of the soil degradation degree in some zones in Apolobamba. Eight zones or census places, separated areas with geographic accidents, with different vicuna and alpaca densities were selected: Ulla-Ulla and Killu (low density), Ucha-Ucha and Wakampata (medium density), Sucondori and Caballchiñuni (high density) and Puyo-Puyo and Japu (very high density). One soil profile was taken and three sampling plots were determined in each zone. Three sampling points were selected in each plot and surface (0-5 cm) and subsurface samples (5-15 cm) were collected. Total carbon, total organic carbon (TOC) and water soluble organic carbon (WSOC) were messure. In addition, 13C MNR technique was used in surface samples in each plot in order to determine the main carbonide groups: alkyl, O-alkyl, aromatic and carboxilic. Results were discussing through statistical analyses. Soil profile datas exhibited very low TOC in Ulla-Ulla zone including the surface horizon. Sampling plot results showed maximum TOC contents in Wakampata and Puyo-Puyo surface samples; on the other hand, Sucondori, Caballchiñuni and Ulla-Ulla presented minimum contents. Generally speaking, low and medium WSOC inputs were determined in surface and subsurface samples, respectively, in studied areas. Moreover, Wakampata and Japu zones presented high O-alkyl percentages; it could be related to highest polysacharide concentrations and the easiest SOM degradation, taking into account alkyl/O-alkyl ratios. On the contrary, Ulla-Ulla and Caballchiñuni exhibited highest carboxilic percentages pointing out a SOM oxidation increase. In conclusion, Apolobamba soils presented different SOC conditions. There were some zones which could be characterized as excellent carbon reservoirs due to high SOM quantity and quality; however, in other census places could be identify a certain soil exhaustion degree, as a consequence to the soil overexploitation due to the cattle camelid concentrations both the natural wind erosion in these zones. It should be carried out conservation actions in order to improve the carbon sink and to preserve the soil and the biodiversity in Apolobamba.

[Suckling behavior of llamas (Lama glama)].

PubMed

Gauly, M; Pouillion, C; Erhardt, G

2003-10-01

In the present study the suckling behaviour of six Ilama crias was analysed. A total of 3398 suckling bouts were observed and evaluated. The crias mostly suckled in a reverse parallel position with no side preference. The cria initiated suckling in most suckling bouts whereas the dams usually ended them. The total number of suckling bouts could be divided into two types: suckling bouts of short duration and suckling bouts of long duration. There were no significant differences in duration per suckling bout among the different ages of crias. But the animals suckled less frequently and spent less total time suckling as they grow older. The age related differences and evidence for a dual function (nutrition, social contact) of suckling behaviour are discussed.

Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: A joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine.

PubMed

Parati, Gianfranco; Agostoni, Piergiuseppe; Basnyat, Buddha; Bilo, Grzegorz; Brugger, Hermann; Coca, Antonio; Festi, Luigi; Giardini, Guido; Lironcurti, Alessandra; Luks, Andrew M; Maggiorini, Marco; Modesti, Pietro A; Swenson, Erik R; Williams, Bryan; Bärtsch, Peter; Torlasco, Camilla

2018-05-01

Take home figureAdapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide.

The upper airway in sleep-disordered breathing: UA in SDB.

PubMed

Taranto Montemurro, L; Kasai, T

2014-02-01

Sleep disordered breathing (SDB) is a common condition and could be a risk factor for cardiovascular morbidity and mortality. However, the pathogenesis of SDB remains to be elucidated. In general, SDB is divided into two forms, obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from the sleep-related collapse of the upper airway (UA) in association with multiple factors like race, gender, obesity and UA dimensions. CSA primarily results from a fall in PaCO2 to a level below the apnea threshold during sleep through the reflex inhibition of central respiratory drive. It has been reported that UA alterations (i.e., collapse or dilation) can be observed in CSA. This review highlights the roles of the UA in the pathogenesis and pathophysiology of SDB.

Effect of one-lung ventilation on end-tidal carbon dioxide during cardiopulmonary resuscitation in a pig model of cardiac arrest.

PubMed

Ryu, Dong Hyun; Jung, Yong Hun; Jeung, Kyung Woon; Lee, Byung Kook; Jeong, Young Won; Yun, Jong Geun; Lee, Dong Hun; Lee, Sung Min; Heo, Tag; Min, Yong Il

2018-01-01

Unrecognized endobronchial intubation frequently occurs after emergency intubation. However, no study has evaluated the effect of one-lung ventilation on end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR). We compared the hemodynamic parameters, blood gases, and ETCO2 during one-lung ventilation with those during conventional two-lung ventilation in a pig model of CPR, to determine the effect of the former on ETCO2. A randomized crossover study was conducted in 12 pigs intubated with double-lumen endobronchial tube to achieve lung separation. During CPR, the animals underwent three 5-min ventilation trials based on a randomized crossover design: left-lung, right-lung, or two-lung ventilation. Arterial blood gases were measured at the end of each ventilation trial. Ventilation was provided using the same tidal volume throughout the ventilation trials. Comparison using generalized linear mixed model revealed no significant group effects with respect to aortic pressure, coronary perfusion pressure, and carotid blood flow; however, significant group effect in terms of ETCO2 was found (P < 0.001). In the post hoc analyses, ETCO2 was lower during the right-lung ventilation than during the two-lung (P = 0.006) or left-lung ventilation (P < 0.001). However, no difference in ETCO2 was detected between the left-lung and two-lung ventilations. The partial pressure of arterial carbon dioxide (PaCO2), partial pressure of arterial oxygen (PaO2), and oxygen saturation (SaO2) differed among the three types of ventilation (P = 0.003, P = 0.001, and P = 0.001, respectively). The post hoc analyses revealed a higher PaCO2, lower PaO2, and lower SaO2 during right-lung ventilation than during two-lung or left-lung ventilation. However, the levels of these blood gases did not differ between the left-lung and two-lung ventilations. In a pig model of CPR, ETCO2 was significantly lower during right-lung ventilation than during two-lung ventilation. However, interestingly, ETCO2 during left-lung ventilation was comparable to that during two-lung ventilation.

Executive Function, Survival, and Hospitalization in Chronic Obstructive Pulmonary Disease. A Longitudinal Analysis of the National Emphysema Treatment Trial (NETT)

PubMed Central

Dodd, James W.; Novotny, Paul; Sciurba, Frank C.

2015-01-01

Rationale: Cognitive dysfunction has been demonstrated in chronic obstructive pulmonary disease (COPD), but studies are limited to cross-sectional analyses or incompletely characterized populations. Objectives: We examined longitudinal changes in sensitive measures of executive function in a well-characterized population of patients with severe COPD. Methods: This study was performed on patients enrolled in the National Emphysema Treatment Trial. To assess executive function, we analyzed trail making (TM) A and B times at enrollment in the trial (2,128 patients), and at 12 (731 patients) and 24 months (593 patients) after enrollment, adjusted for surgery, marriage status, age, education, income, depression, PaO2, PaCO2, and smoking. Associations with survival and hospitalizations were examined using Cox regression and linear regression models. Measurements and Main Results: The average age of the patients was 66.4 years, and the average FEV1 was 23.9% predicted. At the time of enrolment, 38% had executive dysfunction. Compared with those who did not, these patients were older, less educated, had higher oxygen use, higher PaCO2, worse quality of life as measured by the St. George’s Respiratory Quotient, reduced well-being, and lower social function. There was no significant change over 2 years in TM A or B times after adjustment for covariables. Changes in TM B times were modestly associated with survival, but changes in TM B − A times were not. Changes in TM scores were not associated with frequency of hospitalization. Lung function, PaO2, smoking, survival, and hospitalizations were not significantly different in those with executive dysfunction. Conclusions: In this large population of patients with severe emphysema and heavy cigarette smoking exposure, there was no significant decline over 2 years in cognitive executive function as measured by TM tests. There was no association between executive function impairment and frequency of hospitalization, and there was a possible modest association with survival. It is plausible that cerebrovascular comorbidities explain previously described cognitive pathology in COPD. PMID:26288391

Hemodynamic effects of butorphanol in desflurane-anesthetized dogs.

PubMed

dos Santos, Paulo Sérgio P; Nunes, Newton; de Souza, Almir P; de Rezende, Márlis L; Nishimori, Celina T D; de Paula, Danielli P; Ferro Lopes, Patrícia C

2011-09-01

To evaluate the effects of butorphanol on cardiopulmonary parameters in dogs anesthetized with desflurane and breathing spontaneously. Prospective, randomized experimental trial. Twenty dogs weighing 12 ± 3 kg. Animals were distributed into two groups: a control group (CG) and butorphanol group (BG). Propofol was used for induction and anesthesia was maintained with desflurane (10%). Forty minutes after induction, the dogs in the CG received sodium chloride 0.9% (0.05 mL kg(-1) IM), and dogs in the BG received butorphanol (0.4 mg kg(-1) IM). The first measurements of body temperature (BT), heart rate (HR), arterial pressures (AP), cardiac output (CO), cardiac index (CI), central venous pressure (CVP), stroke volume index (SVI), pulmonary arterial occlusion pressure (PAOP), mean pulmonary arterial pressure (mPAP), left ventricular stroke work (LVSW), systemic (SVR) and pulmonary (PVR) vascular resistances, respiratory rate (f(R) ), and arterial oxygen (PaO(2) ) and carbon dioxide (PaCO(2) ) partial pressures were taken immediately before the administration of butorphanol or sodium chloride solution (T0) and then at 15-minute intervals (T15-T75). In the BG, HR, AP, mPAP and SVR decreased significantly from T15 to T75 compared to baseline. f(R) was lower at T30 than at T0 in the BG. AP and f(R) were significantly lower than in the CG from T15 to T75. PVR was lower in the BG than in the CG at T30, while PaCO(2) was higher compared with T0 from T30 to T75 in the BG and significantly higher than in the CG at T30 to T75. At the studied dose, butorphanol caused hypotension and decreased ventilation during desflurane anesthesia in dogs. The hypotension (from 86 ± 10 to 64 ± 10 mmHg) is clinically relevant, despite the maintenance of cardiac index. © 2011 The Authors. Veterinary Anaesthesia and Analgesia. © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

AltitudeOmics: Resetting of Cerebrovascular CO2 Reactivity Following Acclimatization to High Altitude

PubMed Central

Fan, Jui-Lin; Subudhi, Andrew W.; Duffin, James; Lovering, Andrew T.; Roach, Robert C.; Kayser, Bengt

2016-01-01

Previous studies reported enhanced cerebrovascular CO2 reactivity upon ascent to high altitude using linear models. However, there is evidence that this response may be sigmoidal in nature. Moreover, it was speculated that these changes at high altitude are mediated by alterations in acid-base buffering. Accordingly, we reanalyzed previously published data to assess middle cerebral blood flow velocity (MCAv) responses to modified rebreathing at sea level (SL), upon ascent (ALT1) and following 16 days of acclimatization (ALT16) to 5260 m in 21 lowlanders. Using sigmoid curve fitting of the MCAv responses to CO2, we found the amplitude (95 vs. 129%, SL vs. ALT1, 95% confidence intervals (CI) [77, 112], [111, 145], respectively, P = 0.024) and the slope of the sigmoid response (4.5 vs. 7.5%/mmHg, SL vs. ALT1, 95% CIs [3.1, 5.9], [6.0, 9.0], respectively, P = 0.026) to be enhanced at ALT1, which persisted with acclimatization at ALT16 (amplitude: 177, 95% CI [139, 215], P < 0.001; slope: 10.3%/mmHg, 95% CI [8.2, 12.5], P = 0.003) compared to SL. Meanwhile, the sigmoidal response midpoint was unchanged at ALT1 (SL: 36.5 mmHg; ALT1: 35.4 mmHg, 95% CIs [34.0, 39.0], [33.1, 37.7], respectively, P = 0.982), while it was reduced by ~7 mmHg at ALT16 (28.6 mmHg, 95% CI [26.4, 30.8], P = 0.001 vs. SL), indicating leftward shift of the cerebrovascular CO2 response to a lower arterial partial pressure of CO2 (PaCO2) following acclimatization to altitude. Sigmoid fitting revealed a leftward shift in the midpoint of the cerebrovascular response curve which could not be observed with linear fitting. These findings demonstrate that there is resetting of the cerebrovascular CO2 reactivity operating point to a lower PaCO2 following acclimatization to high altitude. This cerebrovascular resetting is likely the result of an altered acid-base buffer status resulting from prolonged exposure to the severe hypocapnia associated with ventilatory acclimatization to high altitude. PMID:26779030

Determinants of oxygen and carbon dioxide transfer during extracorporeal membrane oxygenation in an experimental model of multiple organ dysfunction syndrome.

PubMed

Park, Marcelo; Costa, Eduardo Leite Vieira; Maciel, Alexandre Toledo; Silva, Débora Prudêncio E; Friedrich, Natalia; Barbosa, Edzangela Vasconcelos Santos; Hirota, Adriana Sayuri; Schettino, Guilherme; Azevedo, Luciano Cesar Pontes

2013-01-01

Extracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, P<0.001) and a negative association with pre-membrane PaCO(2) (slope = -0.96, P = 0.001) and SatO(2) (slope = -1.7, P<0.001). Carbon dioxide transfer had a positive association with blood flow (slope = 17, P<0.001), gas flow (slope = 33, P<0.001), pre-membrane PaCO(2) (slope = 1.2, P<0.001) and a negative association with the hemoglobin (slope = -3.478, P = 0.042). We found an increase in pH in the baseline from 7.50[7.46,7.54] to 7.60[7.55,7.65] (P<0.001), and during the MOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (P<0.001). Likewise, the PCO(2) fell in the baseline from 35 [32,39] to 25 [22,27] mmHg (P<0.001), and during the MOF from 59 [47,91] to 34 [28,45] mmHg (P<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO(2) and CO(2), while carbon dioxide transfer was affected by the gas flow, pre-membrane CO(2) and hemoglobin.

Prevalence of Candidatus Mycoplasma haemolamae, bovine viral diarrhoea virus, and gastrointestinal parasitism in a sample of adult New Zealand alpaca (Vicugna pacos).

PubMed

Dittmer, K E; Hinkson, J A; Dwyer, C; Adlington, B; van Andel, M

2018-01-01

To determine the prevalence of infection with Candidatus Mycoplasma haemolamae (Mhl), antibodies to bovine viral diarrhoea virus (BVDV), and BVDV antigen, and the prevalence of animals with elevated faecal nematode egg counts (FEC) in a sample of adult New Zealand alpaca (Vicugna pacos). Blood samples were obtained from 175 alpaca, collected from 15 farms around New Zealand, and from 31 samples sent to a diagnostic laboratory for routine haematology. Blood smears (n=170) were examined microscopically for the presence of haemoplasma, and DNA was extracted from whole blood (n=206) for real-time PCR testing for Mhl. Packed cell volume (PCV) was determined for 193 samples. Serum samples (n=195) were tested for BVDV antibody using ELISA, and for BVDV antigen using a real-time PCR assay. Faecal samples were collected from 143 animals; FEC were measured, and samples pooled for larval culture. No haemoplasma organisms were present on blood smear examination. Of the 206 blood samples, two (from the same farm) were positive for Mhl by real-time PCR testing, giving a prevalence of infection with Mhl of 0.97%. Of the 195 serum samples tested, four (2.1%) were positive for antibodies to BVDV; animals with BVDV antibodies were from 3/15 (20%) farms, none of which farmed cattle. None of the serum samples were positive by PCR for BVDV antigen. The median FEC was 50 epg (min 0, max 4,700), with 55/143 (38.5%) samples having 0 epg, and 33/143 (23.1%) having ≥250 epg. Haemonchus spp. were the most common nematodes present in faecal larval cultures from the North Island. Log 10 FEC was negatively associated with PCV (p=0.02), and was higher in males than females (p<0.001), and in animals that were positive compared with negative for Mhl (p=0.022). The number of alpaca infected with Mhl was low, as was the seroprevalence of BVDV. Gastrointestinal parasitism was, however, a common finding in this sample of New Zealand alpaca.

A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

PubMed Central

Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

2016-01-01

Background COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. Objective We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Patients and methods Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours. Results Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05). Conclusion Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation – volume control. PMID:27274223

Elective decompression of the left ventricle in pediatric patients may reduce the duration of venoarterial extracorporeal membrane oxygenation.

PubMed

Hacking, Douglas F; Best, Derek; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E; Millar, Johnny; Butt, Warwick

2015-04-01

We aimed to determine the effect of elective left heart decompression at the time of initiation of central venoarterial extracorporeal membrane oxygenation (VA ECMO) on VA ECMO duration and clinical outcomes in children in a single tertiary ECMO referral center with a large pediatric population from a national referral center for pediatric cardiac surgery. We studied 51 episodes of VA ECMO in a historical cohort of 49 pediatric patients treated between the years 1990 and 2013 in the Paediatric Intensive Care Unit (PICU) of the Royal Children's Hospital, Melbourne. The cases had a variety of diagnoses including congenital cardiac abnormalities, sepsis, myocarditis, and cardiomyopathy. Left heart decompression as an elective treatment or an emergency intervention for left heart distension was effectively achieved by a number of methods, including left atrial venting, blade atrial septostomy, and left ventricular cannulation. Elective left heart decompression was associated with a reduction in time on ECMO (128 h) when compared with emergency decompression (236 h) (P = 0.013). Subgroup analysis showed that ECMO duration was greatest in noncardiac patients (elective 138 h, emergency 295 h; P = 0.02) and in patients who died despite both emergency decompression and ECMO (elective 133 h, emergency 354 h; P = 0.002). As the emergency cases had a lower pH, a higher PaCO2 , and a lower oxygenation index and were treated with a higher mean airway pressure, positive end-expiratory pressure, and respiratory rate prior to receiving VA ECMO, we undertook multivariate linear regression modeling to show that only PaCO2 and the timing of left heart decompression were associated with ECMO duration. However, elective left heart decompression was not associated with a reduction in length of PICU stay, duration of mechanical ventilation, or duration of oxygen therapy. Elective left heart decompression was not associated with improved ECMO survival or survival to PICU discharge. Elective left heart decompression may reduce ECMO duration and has therefore the potential to reduce ECMO-related complications. A prospective, randomized controlled trial is indicated to study this intervention further. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Comparison of arterial potassium and ventilatory dynamics during sinusoidal work rate variation in man.

PubMed Central

Casaburi, R; Stringer, W W; Singer, E

1995-01-01

1. The mechanisms underlying the exercise hyperpnoea have been difficult to define. Recently it has been suggested that exercise ventilation (VE) changes in proportion to changes in arterial potassium concentration ([K+]a). Similar VE and [K+]a time courses following work rate changes have been cited as supporting evidence. This study compared [K+]a and VE dynamics during moderate exercise in man. 2. We observed VE and gas exchange responses in five healthy men to sinusoidal work rate variation between 25 and approximately 105 W. Tests of approximately 30 min duration were performed at sinusoidal periods of 9, 6 and 3 min and in the steady state. In each test, during two or three sine periods, arterial blood was sampled (24 per test) and analysed for [K+] and blood gases. Response amplitude and phase (relative to work rate) were determined for each variable. 3. [K+]a fluctuated in response to sinusoidal work rate forcing with mean-to-peak amplitude averaging 0.15 mmol 1(-1). However, among tests, VE amplitude and phase were not highly correlated with [K+]a (r = 0.36 and 0.67, respectively). Further, average [K+]a amplitude in the 9 and 6 min sinusoidal studies tended to exceed the steady-state amplitude, while average VE amplitude fell progressively with increasing forcing frequency. The dissimilar dynamics of [K+]a and VE seem inconsistent with a major role for [K+]a as a proportional controller of ventilation during non-steady state moderate exercise in man. 4. Among tests, VE and CO2 output (VCO2) amplitude and phase were closely correlated (r = 0.87 and 0.94, respectively). Further, arterial CO2 pressure (Pa,CO2) and arterial pH(pHa) did not fluctuate significantly in ten of twenty and thirteen of twenty studies, respectively. In tests where sinusoidal fluctuation was detected, amplitude averaged 1.1 mmHg and 0.008 units, respectively. Thus VE demonstrated a close dynamic coupling to CO2 output, with consequent tight regulation of Pa,CO2 and pHa. PMID:7666376

A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure.

PubMed

Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

2016-01-01

COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation - volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2-4 hours and 48 hours. Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2-4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2-4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2-4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05). Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation - volume control.

High pressure versus high intensity noninvasive ventilation in stable hypercapnic chronic obstructive pulmonary disease: a randomized crossover trial.

PubMed

Murphy, Patrick B; Brignall, Kate; Moxham, John; Polkey, Michael I; Davidson, A Craig; Hart, Nicholas

2012-01-01

High-intensity (high-pressure and high backup rate) noninvasive ventilation has recently been advocated for the management of stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the relative contributions of high inspiratory pressure and high backup rate to ventilator adherence and physiological outcome have not been investigated. Patients with stable hypercapnic COPD (daytime PaCO(2) > 6 kPa) and nocturnal hypoventilation were enrolled. Patients were randomly allocated to high-pressure and high backup rate (high-intensity) and high-pressure and low backup rate (high-pressure) for a 6-week period. At the end of the first treatment period, patients were switched to the alternative treatment. The primary outcome measure was mean nightly ventilator usage. Twelve patients were recruited, with seven completing the 12-week trial protocol. The mean patient age was 71 ± 8 years, with a forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) of 50% ± 13% and FEV(1) of 32% ± 12%. The baseline PaCO(2) and PaO(2) were 8.6 ± 1.7 kPa and 7.3 ± 1.4 kPa, respectively. There was no significant difference demonstrated in mean nightly ventilator usage between the high-intensity and high-pressure groups (difference of 4 minutes; 95% confidence interval -45 to 53; P = 0.9). Furthermore, there were no differences in any of the secondary endpoints, with the exception of the respiratory domain of the Severe Respiratory Insufficiency questionnaire, which was lower in the high-intensity arm than in the high-pressure arm (57 ± 11 versus 69 ± 16; P < 0.05). There was no additional benefit, in terms of night-time ventilator adherence or any of the other measured parameters, demonstrated by addition of a high backup rate to high-pressure noninvasive ventilation. These data suggest that it is the high-pressure component of the high-intensity noninvasive ventilation approach that plays the important therapeutic role in the management of hypercapnic respiratory failure in COPD patients.

Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders.

PubMed Central

Simonds, A. K.; Elliott, M. W.

1995-01-01

BACKGROUND--Nasal intermittent positive pressure ventilation (NIPPV) is a new technique which has rapidly supplanted other non-invasive methods of ventilation over the last 5-10 years. Data on its effectiveness are limited. METHODS--The outcome of long term domiciliary NIPPV has been analysed in 180 patients with hypercapnic respiratory failure predominantly due to chest wall restriction, neuromuscular disorders, or chronic obstructive lung disease. One hundred and thirty eight patients were started on NIPPV electively, and 42 following an acute hypercapnic exacerbation. Outcome measures were survival (five year probability of continuing NIPPV), pulmonary function, and health status. A crossover study from negative pressure ventilation to NIPPV was carried out in a subgroup of patients. RESULTS--Five year acturial probability of continuing NIPPV for individuals with early onset scoliosis (n = 47), previous poliomyelitis (n = 30), following tuberculous lung disease (n = 20), general neuromuscular disorders (n = 29), and chronic obstructive pulmonary disease (n = 33) was 79% (95% CI 66 to 92), 100%, 94% (95% CI 83 to 100), 81% (95% CI 61 to 100), 43% (95% CI 6 to 80), respectively. Most of the patients with bronchiectasis died within two years. One year after starting NIPPV electively the mean (SD) PaO2 compared with the pretreatment value was +1.8 (1.9) kPa, mean PaCO2 -1.4 (1.3) kPa in patients with extrapulmonary restrictive disorders, and PaO2 +0.8 (1.0) kPa, PaCO2 -0.9 (0.8) kPa in patients with obstructive lung disease. Arterial blood gas tensions improved in patients transferred from negative pressure ventilation to NIPPV. Health status was ranked highest in patients with early onset scoliosis, previous poliomyelitis, and following tuberculous lung disease. In the group as a whole health perception was comparable to outpatients with other chronic disorders. CONCLUSIONS--The long term outcome of domiciliary NIPPV in patients with chronic respiratory failure due to scoliosis, previous poliomyelitis, and chest wall and pulmonary disease secondary to tuberculosis is encouraging. The results of NIPPV in patients with COPD and progressive neuromuscular disorders show benefit in some subgroups. The outcome in end stage bronchiectasis is poor. Images PMID:7638799

Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders.

PubMed

Simonds, A K; Elliott, M W

1995-06-01

Nasal intermittent positive pressure ventilation (NIPPV) is a new technique which has rapidly supplanted other non-invasive methods of ventilation over the last 5-10 years. Data on its effectiveness are limited. The outcome of long term domiciliary NIPPV has been analysed in 180 patients with hypercapnic respiratory failure predominantly due to chest wall restriction, neuromuscular disorders, or chronic obstructive lung disease. One hundred and thirty eight patients were started on NIPPV electively, and 42 following an acute hypercapnic exacerbation. Outcome measures were survival (five year probability of continuing NIPPV), pulmonary function, and health status. A crossover study from negative pressure ventilation to NIPPV was carried out in a subgroup of patients. Five year acturial probability of continuing NIPPV for individuals with early onset scoliosis (n = 47), previous poliomyelitis (n = 30), following tuberculous lung disease (n = 20), general neuromuscular disorders (n = 29), and chronic obstructive pulmonary disease (n = 33) was 79% (95% CI 66 to 92), 100%, 94% (95% CI 83 to 100), 81% (95% CI 61 to 100), 43% (95% CI 6 to 80), respectively. Most of the patients with bronchiectasis died within two years. One year after starting NIPPV electively the mean (SD) PaO2 compared with the pretreatment value was +1.8 (1.9) kPa, mean PaCO2 -1.4 (1.3) kPa in patients with extrapulmonary restrictive disorders, and PaO2 +0.8 (1.0) kPa, PaCO2 -0.9 (0.8) kPa in patients with obstructive lung disease. Arterial blood gas tensions improved in patients transferred from negative pressure ventilation to NIPPV. Health status was ranked highest in patients with early onset scoliosis, previous poliomyelitis, and following tuberculous lung disease. In the group as a whole health perception was comparable to outpatients with other chronic disorders. The long term outcome of domiciliary NIPPV in patients with chronic respiratory failure due to scoliosis, previous poliomyelitis, and chest wall and pulmonary disease secondary to tuberculosis is encouraging. The results of NIPPV in patients with COPD and progressive neuromuscular disorders show benefit in some subgroups. The outcome in end stage bronchiectasis is poor.

Cerebral Hemodynamic Effects of Acute Hyperoxia and Hyperventilation after Severe Traumatic Brain Injury

PubMed Central

Rangel-Castilla, Leonardo; Lara, Lucia Rivera; Gopinath, Shankar; Swank, Paul R.; Valadka, Alex

2010-01-01

Abstract The purpose of this study was to examine the effects of hyperventilation or hyperoxia on cerebral hemodynamic parameters over time in patients with severe traumatic brain injury (TBI). We prospectively studied 186 patients with severe TBI. CO2 and O2 reactivity tests were conducted twice a day on days 1–5 and once daily on days 6–10 after injury. During hyperventilation there was a significant decrease in intracranial pressure (ICP), mean arterial pressure (MAP), jugular venous oxygen saturation (Sjvo2), brain tissue Po2 (Pbto2), and flow velocity (FV). During hyperoxia there was an increase in Sjvo2 and Pbto2, and a small but consistent decrease in ICP, end-tidal carbon dioxide (etco2), partial arterial carbon dioxide pressure (Paco2), and FV. Brain tissue oxygen reactivity during the first 12 h after injury averaged 19.7 ± 3.0%, and slowly decreased over the next 7 days. The autoregulatory index (ARI; normal = 5.3 ± 1.3) averaged 2.2 ± 1.5 on day 1 post-injury, and gradually improved over the 10 days of monitoring. The ARI significantly improved during hyperoxia, by an average of 0.4 ± 1.8 on the left, and by 0.5 ± 1.8 on the right. However, the change in ARI with hyperoxia was much smaller than that observed with hyperventilation. Hyperventilation increased ARI by an average of 1.3 ± 1.9 on the left, and 1.5 ± 2.0 on the right. Pressure autoregulation, as assessed by dynamic testing, was impaired in these head-injured patients. Acute hyperoxia significantly improved pressure autoregulation, although the effect was smaller than that induced by hyperventilation. The very small change in Paco2 induced by hyperoxia does not appear to explain this finding. Rather, the vasoconstriction induced by acute hyperoxia may allow the cerebral vessels to respond better to transient hypotension. Further studies are needed to define the clinical significance of these observations. PMID:20684672

Effect of body position changes on pulmonary gas exchange in Eisenmenger's syndrome.

PubMed

Sandoval, J; Alvarado, P; Martínez-Guerra, M L; Gómez, A; Palomar, A; Meza, S; Santos, E; Rosas, M

1999-04-01

Preliminary studies on sleep of patients with congenital heart disease and Eisenmenger's syndrome (ES) at our institution demonstrated nocturnal worsening arterial unsaturation, which appeared to be a body position-related phenomenon. To investigate the potential effect of body position on gas exchange in ES, we carried out a prospective study of 28 patients (mean age, 34.8 +/- 11.7 yr) with established ES due to congenital heart disease. In every patient, arterial blood gases were performed during both sitting and supine positions under three different conditions: room air, while breathing 100% oxygen, and after breathing oxygen at a flow rate of 3 L/min through nasal prongs. Alveolar oxygen pressure (PaO2) for the calculation of alveolar-arterial oxygen tension differences (AaPO2) was derived from the alveolar gas equation using PaCO2 and assuming R = 1. We used paired t test, repeated-measures two-way ANOVA with Bonferroni's test, and regression analysis. From sitting to supine position on room air, there was a significant decrease in PaO2 (from 52.5 +/- 7.5 to 47.5 +/- 5.5 mm Hg; p < 0. 001) and SaO2 (from 86.7 +/- 4.6 to 83.3 +/- 4.9%; p < 0.001), both of which were corrected by nasal O2 (to 68.2 +/- 21 mm Hg and to 92 +/- 4%, respectively, p < 0.005). PaCO2 and pH remained unchanged. The magnitude of the change in PaO2 correlated with the change in AaPO2 on room air (r = 0.77; p < 0.01) but not with the change in AaPO2 on 100% oxygen. It is concluded that in adult patients with ES there is a significant decrease in PaO2 and SaO2 when they change from the sitting to the supine position. A ventilation-perfusion (V/Q) distribution abnormality and/or a diffusion limitation phenomenon rather than an increase in true shunt may be the mechanisms responsible for this finding. The response to nasal O 2 we observed warrants a trial with long-term nocturnal oxygen therapy in these patients.

Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory function.

PubMed

Huang, Chih-Hung

2007-12-01

Cervical epidural anesthesia has been used widely for surgery of upper limbs. Although cervical epidural anesthesia with local anesthetic of 2% lidocaine (plain) has demonstrated the safety in respiratory function in spite of unavoidable phrenic and intercostal palsies to certain extent, the replacement of local anesthetics with 2% lidocaine plus epinephrine has not been investigated yet. I conducted this study to look into the effect of 2% lidocaine plus epinephrine on respiratory function. I collected data from 50 patients with mean age of 24 +/- 3 yrs, mean weight of 65 +/- 10 kg, ASA status: I-II without preoperative pulmonary dysfunction undergoing orthropedic open-reduction with internal fixation because of fractures of upper limbs. Cervical epidural space (C7-T1) was approached by hanging-drop method, using a 17G Tuohy needle. A catheter was inserted craniad to a distance of 12 cm. Pulmonary function measurement and arterial blood gas data were obstained before, 20 min, 50 min and 105 min after injection of 12 mL 2% lidocaine with 1:200,000 epinephrine. The anesthesia levels were between C3-T3 and obtained 15 +/- 2 min after injection. Mean arterial blood gas analysis showed mild respiratory acidosis at 20 min (PaCO2: 48 +/- 3 mmHg) and 50 min (PaCO2: 44 +/- 2 mmHg). The measured values of inspiratory vital capacity (IVC), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF) when compaired with control values, were decreased about 18.0% and 12.1% of the control values at 20 min and 50 min respectively. The ratios of FEV1/VC, FEV1/FVC were still within normal limits (> 80%). The results were significantly compatible with the criteria of mild restrictive type of pulmonary function. Cervical epidural anesthesia with 2% lidocaine plus epinephrine could reduce lung volumes and capacities, resulting from partially paralytic intercostal muscles and diaphragm innervated respectively by thoracic intercostal nerve and phrenic nerve. Without inadvertant total spinal or intravenous anesthesia or pre-existing pulmonary dysfunction, the patients with normal lungs could tolerate these changes well with the procedure.

Liolaemus lizards (Squamata: Liolaemidae) as hosts for the nymph of Amblyomma parvitarsum (Acari: Ixodidae), with notes on Rickettsia infection.

PubMed

Muñoz-Leal, Sebastián; Tarragona, Evelina L; Martins, Thiago F; Martín, Claudia M; Burgos-Gallardo, Freddy; Nava, Santiago; Labruna, Marcelo B; González-Acuña, Daniel

2016-10-01

Adults of Amblyomma parvitarsum are common ectoparasites of South American camelids of the genera Lama and Vicugna, occuring in highlands of Argentina, Bolivia, Chile, Peru and also in Argentinean Patagonia. Whereas larval stages of this tick are known to feed on small lizards, host records for the nymphal instar have remained unreported. Supported by morphological and molecular analyses, herein we report A. parvitarsum nymphs parasitizing two Liolaemus species (Reptilia: Squamata) in the Andean Plateau of Argentina and Chile. Additionally, by a PCR screening targetting gltA and ompA genes, DNA of Rickettsia was detected in one of the collected nymphs. Obtained sequences of this agent were identical to a recent Rickettsia sp. described infecting adults of this tick species in Chile and Argentina.

[Renal response to intravenous administration of sodium bicarbonate in newborn infants of different gestational ages].

PubMed

Jasso-Gutiérrez, L; Araujo, B; Fuse-Moteji, R; del Castillo, E D

1976-01-01

The study comprised a series of 16 neonates made up of 5 patients of 33 weeks of gestation, 5 infants of 35 weeks and 6 more of 40 weeks of gestation. Blood pH, PaCO2 and HCO3- were measured together with bicarbonate, ammonium, titrable acidity and hydrogen ions in urine before and after intravenous infusion of sodium bicarbonate. Before infusion of bicarbonate, titrable acidity, ammonium and net acidity in urine were higher in accordance with a greater gestational age. As the administration of bicarbonate elapsed, titrable acidity, ammonium and net acidity dropped with increase in concentration of bicarbonate. A hypothesis is set forth that the differences found in the factors evaluated in urine before administration of bicarbonate depend on the physiologic characteristics set in the newborn by gestational age.

Data Publishing Services in a Scientific Project Platform

NASA Astrophysics Data System (ADS)

Schroeder, Matthias; Stender, Vivien; Wächter, Joachim

2014-05-01

Data-intensive science lives from data. More and more interdisciplinary projects are aligned to mutually gain access to their data, models and results. In order to achieving this, an umbrella project GLUES is established in the context of the "Sustainable Land Management" (LAMA) initiative funded by the German Federal Ministry of Education and Research (BMBF). The GLUES (Global Assessment of Land Use Dynamics, Greenhouse Gas Emissions and Ecosystem Services) project supports several different regional projects of the LAMA initiative: Within the framework of GLUES a Spatial Data Infrastructure (SDI) is implemented to facilitate publishing, sharing and maintenance of distributed global and regional scientific data sets as well as model results. The GLUES SDI supports several OGC webservices like the Catalog Service Web (CSW) which enables it to harvest data from varying regional projects. One of these regional projects is SuMaRiO (Sustainable Management of River Oases along the Tarim River) which aims to support oasis management along the Tarim River (PR China) under conditions of climatic and societal changes. SuMaRiO itself is an interdisciplinary and spatially distributed project. Working groups from twelve German institutes and universities are collecting data and driving their research in disciplines like Hydrology, Remote Sensing, and Agricultural Sciences among others. Each working group is dependent on the results of another working group. Due to the spatial distribution of participating institutes the data distribution is solved by using the eSciDoc infrastructure at the German Research Centre for Geosciences (GFZ). Further, the metadata based data exchange platform PanMetaDocs will be used by participants collaborative. PanMetaDocs supports an OAI-PMH interface which enables an Open Source metadata portal like GeoNetwork to harvest the information. The data added in PanMetaDocs can be labeled with a DOI (Digital Object Identifier) to publish the data and to harvest this information subsequently by the GLUES SDI. Our contribution will show the architecture of this new established SuMaRiO infrastructure node in a superordinate network of the GLUES infrastructure.

Cloning and analysis of the positively acting regulatory gene amdR from Aspergillus nidulans.

PubMed Central

Andrianopoulos, A; Hynes, M J

1988-01-01

The positively acting regulatory gene amdR of Aspergillus nidulans coordinately regulates the expression of four unlinked structural genes involved in acetamide (amdS), omega amino acid (gatA and gabA), and lactam (lamA) catabolism. By the use of DNA-mediated transformation of A. nidulans, the amdR regulatory gene was cloned from a genomic cosmid library. Southern blot analysis of DNA from various loss-of-function amdR mutants revealed the presence of four detectable DNA rearrangements, including a deletion, an insertion, and a translocation. No detectable DNA rearrangements were found in several constitutive amdRc mutants. Analysis of the fate of amdR-bearing plasmids in transformants showed that 10 to 20% of the transformation events were homologous integrations or gene conversions, and this phenomenon was exploited in developing a strategy by which amdRc and amdR- alleles can be readily cloned and analyzed. Examination of the transcription of amdR by Northern blot (RNA blot) analysis revealed the presence of two mRNAs (2.7 and 1.8 kilobases) which were constitutively synthesized at a very low level. In addition, amdR transcription did not appear to depend on the presence of a functional amdR product nor was it altered in amdRc mutants. The dosage effects of multiple copies of amdR in transformants were examined, and it was shown that such transformants exhibited stronger growth than did the wild type on acetamide and pyrrolidinone media, indicating increased expression of the amdS and lamA genes, respectively. These results were used to formulate a model for amdR-mediated regulation of gene expression in which the low constitutive level of amdR product sets the upper limits of basal and induced transcription of the structural genes. Multiple copies of 5' sequences from the amdS gene can result in reduced growth on substrates whose utilization is dependent on amdR-controlled genes. This has been attributed to titration of limiting amdR gene product. Strong support for this proposal was obtained by showing that multiple copies of the amdR gene can reverse this phenomenon (antititration). Images PMID:3062382

Medicinal use of wild fauna by mestizo communities living near San Guillermo Biosphere Reserve (San Juan, Argentina).

PubMed

Hernandez, Jorge; Campos, Claudia M; Borghi, Carlos E

2015-01-21

Wild and domestic animals and their by-products are important ingredients in the preparation of curative, protective and preventive medicines. Despite the medicinal use of animals worldwide, this topic has received less attention than the use of medicinal plants. This study assessed the medicinal use of animals by mestizo communities living near San Guillermo MaB Reserve by addressing the following questions: What animal species and body parts are used? What ailments or diseases are treated with remedies from these species? To what extent do mestizo people use animals as a source of medicine? Is the use related to people's age? We conducted semi-structured interviews with 171 inhabitants (15-93 years old) of four villages close to the Reserve: Tudcúm, Angualasto, Malimán and Colangüil. We calculated the informant consensus factor and fidelity level to test homogeneity of knowledge and to know the importance of different medicinal uses for a given species. The medicinal use of animals was reported by 57% of the surveyed people. Seven species were mentioned: Rhea pennata, Lama guanicoe, Puma concolor, Pseudalopex sp., Lama vicugna, Lepus europaeus and Conepatus chinga. Several body parts were used: fat, leg, bezoar-stone, stomach, feather, meat, blood, feces, wool, and liver. The fat of R. pennata was the most frequently used animal part, followed by the bezoar stone and the leg of L. guanicoe. Animals were used to treat 22 ailments, with respiratory and nervous system disorders being the most frequently treated diseases with a high degree of consensus. Old people used animals as remedies more frequently than young residents, showing some differences among villages. A low number of animal species was mentioned as used for medicinal purposes, which could be explained by the perception of strong control related the legislation that bans hunting and the erosion of traditional knowledge produced by mestizaje. However, the presence of a traditional medicine is deeply rooted in the community culture. Management strategy for protected areas should focus not only on the conservation and sustainability of biological resources, but also on the ancestral knowledge of local communities, such as the medicinal use of animals.

Comparative safety and effectiveness of long-acting inhaled agents for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis.

PubMed

Tricco, Andrea C; Strifler, Lisa; Veroniki, Areti-Angeliki; Yazdi, Fatemeh; Khan, Paul A; Scott, Alistair; Ng, Carmen; Antony, Jesmin; Mrklas, Kelly; D'Souza, Jennifer; Cardoso, Roberta; Straus, Sharon E

2015-10-26

To compare the safety and effectiveness of long-acting β-antagonists (LABA), long-acting antimuscarinic agents (LAMA) and inhaled corticosteroids (ICS) for managing chronic obstructive pulmonary disease (COPD). Systematic review and network meta-analysis (NMA). 208 randomised clinical trials (RCTs) including 134,692 adults with COPD. LABA, LAMA and/or ICS, alone or in combination, versus each other or placebo. The proportion of patients with moderate-to-severe exacerbations. The number of patients experiencing mortality, pneumonia, serious arrhythmia and cardiovascular-related mortality (CVM) were secondary outcomes. NMA was conducted including 20 RCTs for moderate-to-severe exacerbations for 26,141 patients with an exacerbation in the past year. 32 treatments were effective versus placebo including: tiotropium, budesonide/formoterol, salmeterol, indacaterol, fluticasone/salmeterol, indacaterol/glycopyrronium, tiotropium/fluticasone/salmeterol and tiotropium/budesonide/formoterol. Tiotropium/budesonide/formoterol was most effective (99.2% probability of being the most effective according to the Surface Under the Cumulative RAnking (SUCRA) curve). NMA was conducted on mortality (88 RCTs, 97 526 patients); fluticasone/salmeterol was more effective in reducing mortality than placebo, formoterol and fluticasone alone, and was the most effective (SUCRA=71%). NMA was conducted on CVM (37 RCTs, 55,156 patients) and the following were safest: salmeterol versus each OF placebo, tiotropium and tiotropium (Soft Mist Inhaler (SMR)); fluticasone versus tiotropium (SMR); and salmeterol/fluticasone versus tiotropium and tiotropium (SMR). Triamcinolone acetonide was the most harmful (SUCRA=81%). NMA was conducted on pneumonia occurrence (54 RCTs, 61 551 patients). 24 treatments were more harmful, including 2 that increased risk of pneumonia versus placebo; fluticasone and fluticasone/salmeterol. The most harmful agent was fluticasone/salmeterol (SUCRA=89%). NMA was conducted for arrhythmia; no statistically significant differences between agents were identified. Many inhaled agents are available for COPD, some are safer and more effective than others. Our results can be used by patients and physicians to tailor administration of these agents. PROSPERO # CRD42013006725. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting.

PubMed

Price, David; Keininger, Dorothy; Costa-Scharplatz, Madlaina; Mezzi, Karen; Dimova, Maria; Asukai, Yumi; Ställberg, Björn

2014-12-01

Indacaterol/glycopyrronium (IND/GLY) is a once-daily inhaled fixed-dose combination of indacaterol (IND), a long-acting β2-adrenergic agonist (LABA), and glycopyrronium (GLY), a long-acting muscarinic antagonist (LAMA) for use as maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults. To determine the economic benefits of IND/GLY compared with the free combination of indacaterol and glycopyrronium (IND + GLY), and with the fixed-dose combination of salmeterol/fluticasone (SFC), in a moderate-to-severe COPD population with low-exacerbation risk. The model-based analysis extrapolated results up to lifetime time horizon and calculated costs per quality-adjusted life year. Assuming equal efficacy, a cost-minimisation analysis compared IND/GLY vs IND + GLY using model inputs from the double-blind, randomised SHINE trial. The double-blind, randomised ILLUMINATE and TORCH trials were used to analyse cost-effectiveness versus SFC. To consider ICS-related pneumonia events, published odds ratio comparing an ICS-exposed group to a control group of COPD patients was used. Direct and indirect drug costs as well as drug acquisition costs (in Swedish Krona [SEK]) were derived from published Swedish sources. Cost and effects were discounted with 3%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses (PSA). IND/GLY was cost-saving vs IND + GLY with incremental savings of SEK (EUR) 768 (85), and 3309 (368) per patient over one and five years. IND/GLY was found to be less costly and more effective compared to SFC with cost savings of SEK (EUR) 2744 (303), 8854 (976), 13,938 (1536), 27,495 (3031) and 43,033 (4744) over one, three, five, ten years and lifetime. The PSA indicated that all iterations produced dominant results for IND/GLY. IND/GLY is cost-minimising vs IND + GLY and dominates SFC in the maintenance treatment of COPD patients in Sweden. Encouraging dual bronchodilator therapy over an ICS-containing combination results in lower total costs and better outcomes compared to combination therapy including fluticasone in moderate-to-severe COPD patients with low exacerbation risk. Copyright © 2014 Elsevier Ltd. All rights reserved.

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

PubMed Central

Price, David; West, Daniel; Brusselle, Guy; Gruffydd-Jones, Kevin; Jones, Rupert; Miravitlles, Marc; Rossi, Andrea; Hutton, Catherine; Ashton, Valerie L; Stewart, Rebecca; Bichel, Katsiaryna

2014-01-01

Background Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis. Results A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10). Conclusion COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms. PMID:25210450

Change of niche in guanaco (Lama guanicoe): the effects of climate change on habitat suitability and lineage conservatism in Chile.

PubMed

Castillo, Andrea G; Alò, Dominique; González, Benito A; Samaniego, Horacio

2018-01-01

The main goal of this contribution was to define the ecological niche of the guanaco ( Lama guanicoe ), to describe potential distributional changes, and to assess the relative importance of niche conservatism and divergence processes between the two lineages described for the species ( L.g. cacsilensis and L.g. guanicoe ). We used maximum entropy to model lineage's climate niche from 3,321 locations throughout continental Chile, and developed future niche models under climate change for two extreme greenhouse gas emission scenarios (RCP2.6 and RCP8.5). We evaluated changes of the environmental niche and future distribution of the largest mammal in the Southern Cone of South America. Evaluation of niche conservatism and divergence were based on identity and background similarity tests. We show that: (a) the current geographic distribution of lineages is associated with different climatic requirements that are related to the geographic areas where these lineages are located; (b) future distribution models predict a decrease in the distribution surface under both scenarios; (c) a 3% decrease of areal protection is expected if the current distribution of protected areas is maintained, and this is expected to occur at the expense of a large reduction of high quality habitats under the best scenario; (d) current and future distribution ranges of guanaco mostly adhere to phylogenetic niche divergence hypotheses between lineages. Associating environmental variables with species ecological niche seems to be an important aspect of unveiling the particularities of, both evolutionary patterns and ecological features that species face in a changing environment. We report specific descriptions of how these patterns may play out under the most extreme climate change predictions and provide a grim outlook of the future potential distribution of guanaco in Chile. From an ecological perspective, while a slightly smaller distribution area is expected, this may come with an important reduction of available quality habitats. From the evolutionary perspective, we describe the limitations of this taxon as it experiences forces imposed by climate change dynamics.

Change of niche in guanaco (Lama guanicoe): the effects of climate change on habitat suitability and lineage conservatism in Chile

PubMed Central

Castillo, Andrea G.; González, Benito A.

2018-01-01

Background The main goal of this contribution was to define the ecological niche of the guanaco (Lama guanicoe), to describe potential distributional changes, and to assess the relative importance of niche conservatism and divergence processes between the two lineages described for the species (L.g. cacsilensis and L.g. guanicoe). Methods We used maximum entropy to model lineage’s climate niche from 3,321 locations throughout continental Chile, and developed future niche models under climate change for two extreme greenhouse gas emission scenarios (RCP2.6 and RCP8.5). We evaluated changes of the environmental niche and future distribution of the largest mammal in the Southern Cone of South America. Evaluation of niche conservatism and divergence were based on identity and background similarity tests. Results We show that: (a) the current geographic distribution of lineages is associated with different climatic requirements that are related to the geographic areas where these lineages are located; (b) future distribution models predict a decrease in the distribution surface under both scenarios; (c) a 3% decrease of areal protection is expected if the current distribution of protected areas is maintained, and this is expected to occur at the expense of a large reduction of high quality habitats under the best scenario; (d) current and future distribution ranges of guanaco mostly adhere to phylogenetic niche divergence hypotheses between lineages. Discussion Associating environmental variables with species ecological niche seems to be an important aspect of unveiling the particularities of, both evolutionary patterns and ecological features that species face in a changing environment. We report specific descriptions of how these patterns may play out under the most extreme climate change predictions and provide a grim outlook of the future potential distribution of guanaco in Chile. From an ecological perspective, while a slightly smaller distribution area is expected, this may come with an important reduction of available quality habitats. From the evolutionary perspective, we describe the limitations of this taxon as it experiences forces imposed by climate change dynamics. PMID:29868293

Kindern das Wort Geben ein interkulturell-kreativer Arbeitsansatz, aufgezeigt an der Arbeit mit tibetischen Migrantenkindern

NASA Astrophysics Data System (ADS)

Rabkin, Gabriele

2001-03-01

Promotion of creativity in the cause of peace and international understanding is a fundamental part of the UNESCO programme to build a culture of peace. A central aspect of this undertaking consists in encouraging children to express themselves freely on this subject in writing and art. An approach has been developed to stimulate children's creativity and to create a link between creative expression and education for intercultural understanding. This article is divided into two parts. The first explains the pedagogical and psychological concepts behind this approach. The second describes a project in which these concepts were applied. It focuses on a minority dispersed over many parts of the world, namely children of Tibetan families. The description is accompanied by commentaries of the Fourteenth Dalai Lama, arising from a personal audience granted to the author in 1999.

Implementation of an attack scheme on a practical QKD system

NASA Astrophysics Data System (ADS)

Lamas-Linares, Antia; Liu, Qin; Gerhardt, Ilja; Makarov, Vadim; Kurtsiefer, Christian

2010-03-01

We report on an experimental implementation of an attack of a practical quantum key distribution system [1], based on a vulnerability of single photon detectors [2]. An intercept/resend-like attack has been carried out which revealed 100% of the raw key generated between the legitimate communication partners. No increase of the error ratio was observed, which is usually considered a reliable witness for any eavesdropping attempt. We also present an experiment which shows that this attack is not revealed by key distribution protocols probing for eavesdroppers by testing a Bell inequality [3], and discuss implications for practical quantum key distribution.[4pt] [1] I. Marcikic, A. Lamas-Linares, C. Kurtsiefer, Appl. Phys. Lett. 89, 101122 (2006); [2] V. Makarov, New J. Phys. 11, 065003 (2009); [3] A. Ling et al., Phys. Rev. A 78, 020301(R), (2008)

"Stuck in the muck": an eco-idiom of distress from childhood respiratory diseases in an urban mangrove in Northeast Brazil.

PubMed

Nations, Marilyn; Gondim, Ana Paula Soares

2013-02-01

Situated in neo-democratic globalizing Northeast Brazil, this anthropological study probes the role of ecological context in framing, experiencing, and expressing human distress. Ethnographic interviews, narratives, and "contextualized semantic analysis" reveal the lived experience of childhood respiratory diseases among 22 urban mangrove dwellers. Informants speak an "eco-idiom of respiratory distress" based on a popular "eco-logic", reflecting the harsh reality of "living in dampness". "Higher-up" residents legitimize their feelings of superiority by stigmatizing "lowlanders" as taboo, diseased (with porcine cysticercosis, swine flu) "filthy pigs, stuck in the muck" (atolados na lama). Animalizing inhabitants' identities demotes them to nonpersons. Besides infections, children suffer social stigma, ostracism, and barriers for accessing care. Promoting a "favorable environment" requires reducing ecological risk, challenging class-based prejudice, and restoring human dignity.

Camelid genomes reveal evolution and adaptation to desert environments.

PubMed

Wu, Huiguang; Guang, Xuanmin; Al-Fageeh, Mohamed B; Cao, Junwei; Pan, Shengkai; Zhou, Huanmin; Zhang, Li; Abutarboush, Mohammed H; Xing, Yanping; Xie, Zhiyuan; Alshanqeeti, Ali S; Zhang, Yanru; Yao, Qiulin; Al-Shomrani, Badr M; Zhang, Dong; Li, Jiang; Manee, Manee M; Yang, Zili; Yang, Linfeng; Liu, Yiyi; Zhang, Jilin; Altammami, Musaad A; Wang, Shenyuan; Yu, Lili; Zhang, Wenbin; Liu, Sanyang; Ba, La; Liu, Chunxia; Yang, Xukui; Meng, Fanhua; Wang, Shaowei; Li, Lu; Li, Erli; Li, Xueqiong; Wu, Kaifeng; Zhang, Shu; Wang, Junyi; Yin, Ye; Yang, Huanming; Al-Swailem, Abdulaziz M; Wang, Jun

2014-10-21

Bactrian camel (Camelus bactrianus), dromedary (Camelus dromedarius) and alpaca (Vicugna pacos) are economically important livestock. Although the Bactrian camel and dromedary are large, typically arid-desert-adapted mammals, alpacas are adapted to plateaus. Here we present high-quality genome sequences of these three species. Our analysis reveals the demographic history of these species since the Tortonian Stage of the Miocene and uncovers a striking correlation between large fluctuations in population size and geological time boundaries. Comparative genomic analysis reveals complex features related to desert adaptations, including fat and water metabolism, stress responses to heat, aridity, intense ultraviolet radiation and choking dust. Transcriptomic analysis of Bactrian camels further reveals unique osmoregulation, osmoprotection and compensatory mechanisms for water reservation underpinned by high blood glucose levels. We hypothesize that these physiological mechanisms represent kidney evolutionary adaptations to the desert environment. This study advances our understanding of camelid evolution and the adaptation of camels to arid-desert environments.

Hypoxemia, hypercapnia, and breathing pattern in patients with chronic obstructive pulmonary disease.

PubMed

Parot, S; Miara, B; Milic-Emili, J; Gautier, H

1982-11-01

The results of lung function tests (total and functional residual capacities, residual volume/total lung capacity ratio, forced expiratory volume in one second) breathing patterns and arterial PO2 and PCO2 were studied in 651 ambulatory male patients with chronic obstructive pulmonary disease, functionally and clinically stable. Function tests were only loosely correlated with gas tensions: abnormalities in mechanics and in gas exchange are not necessarily related. In patients matched for the degree of obstruction, the breathing pattern depended upon both PaO2 and PaCO2. Isolated hypoxemia was accompanied by increased respiratory frequency without any variation in tidal volume: this suggests that the chemoreceptive systems still responded to changes in PaO2. Isolated hypercapnia was accompanied by a decrease in tidal volume and an increase in respiratory frequency. Consequently, the dead space/tidal volume ratio increased, leading to a drop in alveolar ventilation and to CO2 retention.

[Comparative study of respiratory exchanging surfaces in birds and mammals].

PubMed

Jammes, Y

1975-01-01

Anatomical studies of the respiratory apparatus of birds show evidences for a gas exchanging tubular system (parabronchi and air capillaries); these exchanging structures are entirely dissociated from the ventilatory drive acting on the air sacs. A "cross-current" gas exchanging system (perpendicular disposition of air and blood capillaries) allow a good wash-out of carbon dioxide (PaCO2 lower than PECO2). The great efficiency of this lung is allowed by its very large diffusive surface (ASa) and by the high values of lung specific oxygen diffusing capacity (DO2/ASa) and of O2 extraction coefficient in inspired air. The ventilatory pattern of birds is characterized by a greater tidal volume and a smaller respiratory frequency than in mammals of same weight. Respiratory centers of birds receive afferences from lung stretch receptors, CO2-sensitive lung receptors and arterial chemoreceptors.

Obstructive sleep apnoea syndrome as a cause of road traffic accidents.

PubMed

Aguiar, M; Valença, J; Felizardo, M; Caeiro, F; Moreira, S; Staats, R; Bugalho de Almeida, A A

2009-01-01

Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 < 90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test). Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6+/-11.8 vs. 54.7+/-10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3+/-5.4 vs. 17.6+/-4.3 (p<0.001); BMI, (Kg/m2) 36.2+/-8.1 vs. 35.6+/-6.3 (ns); PaO2 (mmHg), 76.1+/-11.4 vs. 78.5+/-12.6 (ns); PaCO2 (mmHg), 42.6+/-5.1 vs. 42.2+/-4.7 (ns); FOSQ, 15.1+/-3.1 vs. 12.9+/-3.4 (p<0.001). NPSG data revealed differences only in AHI: 45.0+/-21.6 vs. 56.2+/-29.7 (p=0.01) and in TDAH (minutes), 98.5+/-63.7 vs. 133.3+/-83.2 (p=0,005). In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.

Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise

PubMed Central

Criner, Gerard J.; Belt, Patricia; Sternberg, Alice L.; Mosenifar, Zab; Make, Barry J.; Utz, James P.; Sciurba, Frank

2009-01-01

Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇e), tidal volume (Vt), carbon dioxide output (V̇co2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. Pao2, Paco2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum V̇e (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇co2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), Vt (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in Paco2 vs V̇co2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non–upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea. PMID:19420196

Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance.

PubMed

Ferrando, Carlos; Suárez-Sipmann, Fernando; Gutierrez, Andrea; Tusman, Gerardo; Carbonell, Jose; García, Marisa; Piqueras, Laura; Compañ, Desamparados; Flores, Susanie; Soro, Marina; Llombart, Alicia; Belda, Francisco Javier

2015-01-13

The stress index (SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg(-1), P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences. Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.

Chronic respiratory failure in patients with chronic obstructive pulmonary disease under home noninvasive ventilation: Real-life study.

PubMed

Durão, V; Grafino, M; Pamplona, P

2018-04-05

Home noninvasive ventilation (NIV) has been increasingly used in stable chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure (CHRF). However its effectiveness remains debatable. To describe a follow-up of COPD patients under home NIV. Retrospective descriptive study based on a prospective 3-year database that included COPD patients under home NIV between August 2011 and July 2014. Within the 334 patients initially screened, 109 (32.6%) had COPD with a mean±SD post-bronchodilator FEV1 of 38.6±14.9% predicted; age of 65.6±9.6 years. The mean±SD duration of ventilation was 63.4±51.1 months. Heterogeneous comorbidities that can contribute to CHRF were not excluded: obstructive sleep apnea and obesity were the most prevalent. Sixty-two (56.9%) patients started NIV during admission with acute respiratory failure. During follow-up there was a significant increase in mean inspiratory positive airway pressure (IPAP) and respiratory rate (19.5±4.4 vs. 23.6±5.3cmH 2 O and 10.7±5.2 vs. 15.2±1.4 breaths/min, respectively, p<0.0001), with a significant improvement in hypercapnia (PaCO 2 : 52.9±7.7 vs. 49.5±7.5mmHg, p<0.0001), with 93.3% of patients compliant to NIV. Admissions and days spent in hospital for respiratory illness significantly decreased after institution of NIV (respectively, 1.2±1.1 vs. 0.7±1.8 and 15.0±16.8 vs. 8.8±19.4, p<0.001). At final evaluation, patients with severe hypercapnia (n=47; PaCO 2 ≥50mmHg) performing NIV at higher pressures (n=30; IPAP ≥25cmH 2 O) were more compliant (10.1±3.3 vs. 6.1±3.6h/day). Three-year mortality was 24.8% (27 of 109 patients). This is a real-life retrospective study in COPD patients with CHRF which results suggest benefit from home NIV. For most, NIV was effective and tolerable even at high pressures. Copyright © 2018 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Different meal, same flavor: cospeciation and host switching of haemosporidian parasites in some non-passerine birds

PubMed Central

2014-01-01

Background Previous studies have shown that haemosporidian parasites (Haemoproteus (Parahaemoproteus) and Plasmodium) infecting passerine birds have an evolutionary history of host switching with little cospeciation, in particular at low taxonomic levels (e.g., below the family level), which is suggested as the main speciation mechanism of this group of parasites. Recent studies have characterized diverse clades of haemosporidian parasites (H. (Haemoproteus) and H. (Parahaemoproteus)) infecting non-passerine birds (e.g., Columbiformes, Pelecaniiformes). Here, we explore the cospeciation history of H. (Haemoproteus) and H. (Parahaemoproteus) parasites with their non-passerine hosts. Methods We sequenced the mtDNA cyt b gene of both haemosporidian parasites and their avian non-passerine hosts. We built Bayesian phylogenetic hypotheses and created concensus phylograms that were subsequently used to conduct cospeciation analyses. We used both a global cospeciation test, PACo, and an event-cost algorithm implemented in CoRe-PA. Results The global test suggests that H. (Haemoproteus) and H. (Parahaemoproteus) parasites have a diversification history dominated by cospeciation events particularly at the family level. Host-parasite links from the PACo analysis show that host switching events are common within families (i.e., among genera and among species within genera), and occasionally across different orders (e.g., Columbiformes to Pelecaniiformes). Event-cost analyses show that haemosporidian coevolutionary history is dominated by host switching and some codivergence, but with duplication events also present. Genetic lineages unique to raptor species (e.g., FALC11) commonly switch between Falconiformes and Strigiformes. Conclusions Our results corroborate previous findings that have detected a global cospeciation signal at the family taxonomic level, and they also support a history of frequent switching closer to the tips of the host phylogeny, which seems to be the main diversification mechanism of haemosporidians. Such dynamic host-parasite associations are relevant to the epidemiology of emerging diseases because low parasite host specificity is a prerequisite for the emergence of novel diseases. The evidence on host distributions suggests that haemosporidian parasites have the potential to rapidly develop novel host-associations. This pattern has also been recorded in fish-monogenean interactions, suggesting a general diversification mechanism for parasites when host choice is not restricted by ecological barriers. PMID:24957563

The effects of ketamine on the minimum alveolar concentration of isoflurane in cats.

PubMed

Pascoe, Peter J; Ilkiw, Janet E; Craig, Carolyn; Kollias-Baker, Cynthia

2007-01-01

To determine the minimum alveolar concentration (MAC) of isoflurane during the infusion of ketamine. Prospective, experimental trial. Twelve adult spayed female cats weighing 5.1 +/- 0.9 kg. Six cats were anesthetized with isoflurane in oxygen, intubated and attached to a circle-breathing system with mechanical ventilation. Catheters were placed in a peripheral vein for the infusion of fluids and ketamine, and the jugular vein for blood sampling for the measurement of ketamine concentrations. An arterial catheter was placed to allow blood pressure measurement and sampling for the measurement of PaCO2, PaO2 and pH. PaCO2 was maintained between 29 and 41 mmHg (3.9-5.5 kPa) and body temperature was kept between 37.8 and 39.3 degrees C. Following instrumentation, the MAC of isoflurane was determined in triplicate using a tail clamp method. A loading dose (2 mg kg(-1) over 5 minutes) and an infusion (23 microg kg(-1) minute(-1)) of ketamine was started and MAC was redetermined starting 30 minutes later. Two further loading doses and infusions were used, 2 mg kg(-1) and 6 mg kg(-1) with 46 and 115 microg kg(-1) minute(-1), respectively and MAC was redetermined. Cardiopulmonary measurements were taken before application of the noxious stimulus. The second group of six cats was used for the measurement of steady state plasma ketamine concentrations at each of the three infusion rates used in the initial study and the appropriate MAC value determined from the first study. The MAC decreased by 45 +/- 17%, 63 +/- 18%, and 75 +/- 17% at the infusion rates of 23, 46, and 115 microg kg(-1) minute(-1). These infusion rates corresponded to ketamine plasma concentrations of 1.75 +/- 0.21, 2.69 +/- 0.40, and 5.36 +/- 1.19 microg mL(-1). Arterial blood pressure and heart rate increased significantly with ketamine. Recovery was protracted. The MAC of isoflurane was significantly decreased by an infusion of ketamine and this was accompanied by an increase in heart rate and blood pressure. Because of the prolonged recovery in our cats, further work needs to be performed before using this in patients.

The Tanytarsini (Diptera: Chironomidae) in the collection of the Museum of Amber Inclusions, University of Gdańsk.

PubMed

Zakrzewska, Marta; Giłka, Wojciech

2015-04-10

Non-biting midges of the tribe Tanytarsini collected in the Museum of Amber Inclusions, University of Gdańsk, Poland, are reviewed. Among over 1500 chironomid specimens examined (inclusions in Baltic amber), 44 Tanytarsini individuals were found, of which 27 well preserved specimens were determined to 7 species, including 3 species described as new. Stempellinella electra sp. nov. (male) displays morphological hypopygial characters unique for the genus, and the antenna composed of 13 flagellomeres. A new checklist of fossil and extant species of this genus is also given, including Stempellinella sofiae (Fusari et Lamas, 2014) comb. nov. Tanytarsus glaesarius sp. nov. (male) is the only Eocene species of the genus with a reduced number of antennal flagellomeres. Tanytarsus protogregarius sp. nov. (male) is the oldest known representative of the gregarius species group. Notes on phylogenetic relations of the new species with their extant congeners are also provided.

[Experimental validation of the efficacy of laser-magnetic therapy for chronic placental insufficiency].

PubMed

Ordzhonikidze, N V; Filimonov, V G; Klimenko, P A; Kondrikov, N I; Akin'shina, V S; Berlin, Iu V

1994-01-01

A new pathogenetically based non-medicamentous method for correction of uteroplacental bloodflow disturbances has been developed on the model of chronic placental insufficiency in rats. A single 5 min laser-magnetic exposure on day 21 of normal pregnancy resulted in a vasodilating effect with reduction of the peripheral resistance in the uterine horn vessels and with improvement of their blood supply. A new LAMA laser magneto-therapeutic device was employed. Daily 5 min sessions of laser magnetic therapy administered to rats with chronic placental insufficiency from pregnancy days 15-16 to 21 normalized uterine horn contractility and resulted in positive morphofunctional changes in the components of the uterine horns and placenta, being associated with a noticeable improvement of fetal functions. Hence, laser magnetic therapy may be regarded as an effective non-drug method for therapy of chronic placental insufficiency.

Hepatic encephalopathy associated with hepatic lipidosis in llamas (Lama glama).

PubMed

Pillitteri, C A; Craig, L E

2013-01-01

Hepatic encephalopathy has been listed as a differential for llamas displaying neurologic signs, but it has not been histopathologically described. This report details the neurologic histopathologic findings associated with 3 cases of hepatic lipidosis with concurrent neurologic signs and compares them to 3 cases of hepatic lipidosis in the absence of neurologic signs and 3 cases without hepatic lipidosis. Brain from all 3 llamas displaying neurologic signs contained Alzheimer type II cells, which were not detected in either subset of llamas without neurologic signs. Astrocytic immunohistochemical staining intensity for glial fibrillary acid protein was decreased in llamas with neurologic signs as compared to 2 of 3 llamas with hepatic lipidosis and without neurologic signs and to 2 of 3 llamas without hepatic lipidosis. Immunohistochemical staining for S100 did not vary between groups. These findings suggest that hepatic encephalopathy may be associated with hepatic lipidosis in llamas.

Lightweight telescopes for lunar observatories

NASA Astrophysics Data System (ADS)

Rozelot, J. P.; Bingham, R.; Walker, D.

1994-06-01

Future optical observatories in space will require telescopes of very high resolution. To satisfy this demand, technology must be developed for large mirrors capable of diffraction-limited imaging. Conventional monolithic glass substrates (light-weight or not) have serious limitations for future development. In particular, glass is susceptible to fracture during ground-handling, transport and launch. An alternative solution is aluminium. It has lower cost, increased strength, easier and safer methods of fixing, amongst other advantages. It is readily lightweighted and can be produced with good polishing quality with nickel coating. We foresee applications for satellite telescope for astronomy, remote sensing, surveys of asteroids and debris in space. Furthermore, this technology is ideally suitable for lunar mounted interferometric experiments - as mirrors can be easily replicate, saving cost - and for telescopes deployed on planetary surfaces. Some results from the European Eureka Large Active Mirrors in Aluminium (LAMA) are here presented, which show the feasibility of such systems.

De novo gene mutations highlight patterns of genetic and neural complexity in schizophrenia

PubMed Central

Xu, Bin; Ionita-Laza, Iuliana; Roos, J. Louw; Boone, Braden; Woodrick, Scarlet; Sun, Yan; Levy, Shawn; Gogos, Joseph A.; Karayiorgou, Maria

2013-01-01

To evaluate evidence for de novo etiologies in schizophrenia, we sequenced at high coverage the exomes of families recruited from two populations with distinct demographic structure and history. We sequenced a total of 795 exomes from 231 parent-proband trios enriched for sporadic schizophrenia cases, as well as 34 unaffected trios. We observed in cases an excess of non-synonymous single nucleotide variants as well as a higher prevalence of gene-disruptive de novo mutations. We found four genes (LAMA2, DPYD, TRRAP and VPS39) affected by recurrent de novo events within or across the two populations, a finding unlikely to have occurred by chance. We show that de novo mutations affect genes with diverse functions and developmental profiles but we also find a substantial contribution of mutations in genes with higher expression in early fetal life. Our results help define the pattern of genomic and neural architecture of schizophrenia. PMID:23042115

Oestradiol-17β plasma concentrations after intramuscular injection of oestradiol benzoate or oestradiol cypionate in llamas (Lama glama)

PubMed Central

2010-01-01

Background Llamas (Lama glama) are induced ovulators and the process of ovulation depends on dominant follicular size. In addition, a close relationship between behavioural estrus and ovulation is not registered in llamas. Therefore, the exogenous control of follicular development with hormones aims to predict the optimal time to mate. Oestradiol-17β (E2) and its esters are currently used in domestic species, including camelids, in synchronization treatments. But, in llamas, there is no reports regarding the appropriate dosages to be used and most protocols have been designed by extrapolation from those recommended for other ruminants. The aim of the present study was to characterize plasma E2 concentrations in intact female llamas following a single intramuscular (i.m.) injection of two oestradiol esters: oestradiol benzoate (EB) and oestradiol cypionate (ECP). Methods Twelve non pregnant and non lactating sexually mature llamas were i.m. injected on day 0 with 2.5 mg of EB (EB group, n = 6) or ECP (ECP group, n = 6). Blood samples were collected immediately before injection, at 1, 6, 12, 24 h after treatment and then daily until day 14 post injection. Changes in hormone concentrations with time were analyzed in each group by analysis of variance (ANOVA) using a repeated measures (within-SS) design. Plasma E2 concentrations and area under the concentration-time curve (AUC) values were compared between groups by ANOVA. In all cases a Least-Significant Difference test (LSD) was used to determine differences between means. Hormonal and AUC data are expressed as mean ± S.E.M. Results Peak plasma E2 concentrations were achieved earlier and were higher in EB group than in ECP group. Thereafter, E2 returned to physiological concentrations earlier in EB group (day 5) than in ECP group (day 9). Although plasma E2 profiles differed over time among groups there were no differences between them on AUC values. Conclusions The i.m. injection of a single dose of both oestradiol esters resulted in plasma E2 concentrations exceeding physiological values for a variable period. Moreover, the plasma E2 profiles observed depended on the derivative of oestradiol administered. This basic information becomes relevant at defining treatment protocols including oestrogens in llamas. PMID:20149242

Clonal Evolution and Blast Crisis Correlate with Enhanced Proteolytic Activity of Separase in BCR-ABL b3a2 Fusion Type CML under Imatinib Therapy.

PubMed

Haaß, Wiltrud; Kleiner, Helga; Weiß, Christel; Haferlach, Claudia; Schlegelberger, Brigitte; Müller, Martin C; Hehlmann, Rüdiger; Hofmann, Wolf-Karsten; Fabarius, Alice; Seifarth, Wolfgang

2015-01-01

Unbalanced (major route) additional cytogenetic aberrations (ACA) at diagnosis of chronic myeloid leukemia (CML) indicate an increased risk of progression and shorter survival. Moreover, newly arising ACA under imatinib treatment and clonal evolution are considered features of acceleration and define failure of therapy according to the European LeukemiaNet (ELN) recommendations. On the basis of 1151 Philadelphia chromosome positive chronic phase patients of the randomized CML-study IV, we examined the incidence of newly arising ACA under imatinib treatment with regard to the p210BCR-ABL breakpoint variants b2a2 and b3a2. We found a preferential acquisition of unbalanced ACA in patients with b3a2 vs. b2a2 fusion type (ratio: 6.3 vs. 1.6, p = 0.0246) concurring with a faster progress to blast crisis for b3a2 patients (p = 0.0124). ESPL1/Separase, a cysteine endopeptidase, is a key player in chromosomal segregation during mitosis. Separase overexpression and/or hyperactivity has been reported from a wide range of cancers and cause defective mitotic spindles, chromosome missegregation and aneuploidy. We investigated the influence of p210BCR-ABL breakpoint variants and imatinib treatment on expression and proteolytic activity of Separase as measured with a specific fluorogenic assay on CML cell lines (b2a2: KCL-22, BV-173; b3a2: K562, LAMA-84). Despite a drop in Separase protein levels an up to 5.4-fold increase of Separase activity under imatinib treatment was observed exclusively in b3a2 but not in b2a2 cell lines. Mimicking the influence of imatinib on BV-173 and LAMA-84 cells by ESPL1 silencing stimulated Separase proteolytic activity in both b3a2 and b2a2 cell lines. Our data suggest the existence of a fusion type-related feedback mechanism that posttranslationally stimulates Separase proteolytic activity after therapy-induced decreases in Separase protein levels. This could render b3a2 CML cells more prone to aneuploidy and clonal evolution than b2a2 progenitors and may therefore explain the cytogenetic results of CML patients.

Adaptive functional specialisation of architectural design and fibre type characteristics in agonist shoulder flexor muscles of the llama, Lama glama.

PubMed

Graziotti, Guillermo H; Chamizo, Verónica E; Ríos, Clara; Acevedo, Luz M; Rodríguez-Menéndez, J M; Victorica, C; Rivero, José-Luis L

2012-08-01

Like other camelids, llamas (Lama glama) have the natural ability to pace (moving ipsilateral limbs in near synchronicity). But unlike the Old World camelids (bactrian and dromedary camels), they are well adapted for pacing at slower or moderate speeds in high-altitude habitats, having been described as good climbers and used as pack animals for centuries. In order to gain insight into skeletal muscle design and to ascertain its relationship with the llama's characteristic locomotor behaviour, this study examined the correspondence between architecture and fibre types in two agonist muscles involved in shoulder flexion (M. teres major - TM and M. deltoideus, pars scapularis - DS and pars acromialis - DA). Architectural properties were found to be correlated with fibre-type characteristics both in DS (long fibres, low pinnation angle, fast-glycolytic fibre phenotype with abundant IIB fibres, small fibre size, reduced number of capillaries per fibre and low oxidative capacity) and in DA (short fibres, high pinnation angle, slow-oxidative fibre phenotype with numerous type I fibres, very sparse IIB fibres, and larger fibre size, abundant capillaries and high oxidative capacity). This correlation suggests a clear division of labour within the M. deltoideus of the llama, DS being involved in rapid flexion of the shoulder joint during the swing phase of the gait, and DA in joint stabilisation during the stance phase. However, the architectural design of the TM muscle (longer fibres and lower fibre pinnation angle) was not strictly matched with its fibre-type characteristics (very similar to those of the postural DA muscle). This unusual design suggests a dual function of the TM muscle both in active flexion of the shoulder and in passive support of the limb during the stance phase, pulling the forelimb to the trunk. This functional specialisation seems to be well suited to a quadruped species that needs to increase ipsilateral stability of the limb during the support phase of the pacing gait. Compared with other species, llama skeletal muscles are well suited for greater force generation combined with higher fatigue resistance during exercise. These characteristics are interpreted as being of high adaptive value, given the llama's habitat and its use as a pack animal. © 2012 The Authors. Journal of Anatomy © 2012 Anatomical Society.

Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations.

PubMed

van der Schans, Simon; Goossens, Lucas M A; Boland, Melinde R S; Kocks, Janwillem W H; Postma, Maarten J; van Boven, Job F M; Rutten-van Mölken, Maureen P M H

2017-01-01

Worldwide, chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease with considerable clinical and socioeconomic impact. Pharmacologic maintenance drugs (such as bronchodilators and inhaled corticosteroids) play an important role in the treatment of COPD. The cost effectiveness of these treatments has been frequently assessed, but studies to date have largely neglected the impact of treatment sequence and the exact stage of disease in which the drugs are used in real life. We aimed to systematically review recently published articles that reported the cost effectiveness of COPD maintenance treatments, with a focus on key findings, quality and methodological issues. We performed a systematic literature search in Embase, PubMed, the UK NHS Economic Evaluation Database (NHS-EED) and EURONHEED (European Network of Health Economics Evaluation Databases) and included all relevant articles published between 2011 and 2015 in either Dutch, English or German. Main study characteristics, methods and outcomes were extracted and critically assessed. The Quality of Health Economic Studies (QHES) instrument was used as basis for quality assessment, but additional items were also addressed. The search identified 18 recent pharmacoeconomic analyses of COPD maintenance treatments. Papers reported the cost effectiveness of long-acting muscarinic antagonist (LAMA) monotherapy (n = 6), phosphodiesterase (PDE)-4 inhibitors (n = 4), long-acting beta agonist/inhaled corticosteroid (LABA/ICS) combinations (n = 4), LABA monotherapy (n = 2) and LABA/LAMA combinations (n = 2). All but two studies were funded by the manufacturer, and all studies indicated favourable cost effectiveness; however, the number of quality-adjusted life-years (QALYs) gained was small. Less than half of the studies reported a COPD-specific outcome in addition to a generic outcome (mostly QALYs). Exacerbation and mortality rates were found to be the main drivers of cost effectiveness. According to the QHES, the quality of the studies was generally sufficient, but additional assessment revealed that most studies poorly represented the cost effectiveness of real-life medication use. The majority of studies showed that pharmacologic COPD maintenance treatment is cost effective, but most studies poorly reflected real-life drug use. Consistent and COPD-specific methodology is recommended.

LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD.

PubMed

Zhong, Nanshan; Wang, Changzheng; Zhou, Xiangdong; Zhang, Nuofu; Humphries, Michael; Wang, Linda; Thach, Chau; Patalano, Francesco; Banerji, Donald

2015-01-01

The current Global initiative for chronic Obstructive Lung Disease (GOLD) treatment strategy recommends the use of one or more bronchodilators according to the patient's airflow limitation, their history of exacerbations, and symptoms. The LANTERN study evaluated the effect of the long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) dual bronchodilator, QVA149 (indacaterol/glycopyrronium), as compared with the LABA/inhaled corticosteroid, salmeterol/fluticasone (SFC), in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year. In this double-blind, double-dummy, parallel-group study, 744 patients with moderate-to-severe COPD with a history of ≤1 exacerbations in the previous year were randomized (1:1) to QVA149 110/50 μg once daily or SFC 50/500 μg twice daily for 26 weeks. The primary endpoint was noninferiority of QVA149 versus SFC for trough forced expiratory volume in 1 second (FEV1) at week 26. Overall, 676 patients completed the study. The primary objective of noninferiority between QVA149 and SFC in trough FEV1 at week 26 was met. QVA149 demonstrated statistically significant superiority to SFC for trough FEV1 (treatment difference [Δ]=75 mL; P<0.001). QVA149 demonstrated a statistically significant improvement in standardized area under the curve (AUC) from 0 hours to 4 hours for FEV1 (FEV1 AUC0-4h) at week 26 versus SFC (Δ=122 mL; P<0.001). QVA149 and SFC had similar improvements in transition dyspnea index focal score, St George Respiratory Questionnaire total score, and rescue medication use. However, QVA149 significantly reduced the rate of moderate or severe exacerbations by 31% (P=0.048) over SFC. Overall, the incidence of adverse events was comparable between QVA149 (40.1%) and SFC (47.4%). The incidence of pneumonia was threefold lower with QVA149 (0.8%) versus SFC (2.7%). These findings support the use of the LABA/LAMA, QVA149 as an alternative treatment, over LABA/inhaled corticosteroid, in the management of moderate-to-severe COPD patients (GOLD B and GOLD D) with a history of ≤1 exacerbation in the previous year.

Adaptive functional specialisation of architectural design and fibre type characteristics in agonist shoulder flexor muscles of the llama, Lama glama

PubMed Central

Graziotti, Guillermo H; Chamizo, Verónica E; Ríos, Clara; Acevedo, Luz M; Rodríguez-Menéndez, J M; Victorica, C; Rivero, José-Luis L

2012-01-01

Like other camelids, llamas (Lama glama) have the natural ability to pace (moving ipsilateral limbs in near synchronicity). But unlike the Old World camelids (bactrian and dromedary camels), they are well adapted for pacing at slower or moderate speeds in high-altitude habitats, having been described as good climbers and used as pack animals for centuries. In order to gain insight into skeletal muscle design and to ascertain its relationship with the llama’s characteristic locomotor behaviour, this study examined the correspondence between architecture and fibre types in two agonist muscles involved in shoulder flexion (M. teres major – TM and M. deltoideus, pars scapularis – DS and pars acromialis – DA). Architectural properties were found to be correlated with fibre-type characteristics both in DS (long fibres, low pinnation angle, fast-glycolytic fibre phenotype with abundant IIB fibres, small fibre size, reduced number of capillaries per fibre and low oxidative capacity) and in DA (short fibres, high pinnation angle, slow-oxidative fibre phenotype with numerous type I fibres, very sparse IIB fibres, and larger fibre size, abundant capillaries and high oxidative capacity). This correlation suggests a clear division of labour within the M. deltoideus of the llama, DS being involved in rapid flexion of the shoulder joint during the swing phase of the gait, and DA in joint stabilisation during the stance phase. However, the architectural design of the TM muscle (longer fibres and lower fibre pinnation angle) was not strictly matched with its fibre-type characteristics (very similar to those of the postural DA muscle). This unusual design suggests a dual function of the TM muscle both in active flexion of the shoulder and in passive support of the limb during the stance phase, pulling the forelimb to the trunk. This functional specialisation seems to be well suited to a quadruped species that needs to increase ipsilateral stability of the limb during the support phase of the pacing gait. Compared with other species, llama skeletal muscles are well suited for greater force generation combined with higher fatigue resistance during exercise. These characteristics are interpreted as being of high adaptive value, given the llama’s habitat and its use as a pack animal. PMID:22625659

Investigating the effect of cardiac oscillations and deadspace gas mixing during apnea using computer simulation.

PubMed

Laviola, Marianna; Das, Anup; Chikhani, Marc; Bates, Declan G; Hardman, Jonathan G

2017-07-01

Gaseous mixing in the anatomical deadspace with stimulation of respiratory ventilation through cardiogenic oscillations is an important physiological mechanism at the onset of apnea, which has been credited with various beneficial effects, e.g. reduction of hypercapnia during the use of low flow ventilation techniques. In this paper, a novel method is proposed to investigate the effect of these mechanisms in silico. An existing computational model of cardio-pulmonary physiology is extended to include the apneic state, gas mixing within the anatomical deadspace, insufflation into the trachea and cardiogenic oscillations. The new model is validated against data published in an experimental animal (dog) study that reported an increase in arterial partial pressure of carbon dioxide (PaCO 2 ) during apnea. Computational simulations confirm that the model outputs accurately reproduce the available experimental data. This new model can be used to investigate the physiological mechanisms underlying clearance of carbon dioxide during apnea, and hence to develop more effective ventilation strategies for apneic patients.

Pharmacokinetics and therapeutic efficacy of gentamicin in an experimental pleural empyema rabbit model.

PubMed Central

Shohet, I; Yellin, A; Meyerovitch, J; Rubinstein, E

1987-01-01

The pharmacokinetics and therapeutic efficacy of gentamicin were investigated in an experimental pleural empyema rabbit model. Pleural effusion was induced by the intrapleural administration of turpentine, and empyema was induced by direct inoculation of the effusion with Klebsiella pneumoniae. Pleural empyema compared with effusion was characterized by lower pH, oxygen tension (PaO2), and glucose levels and higher leukocyte count, lactic acid concentration, and PaCO2. After a single administration, gentamicin was first detectable in the pleural fluid at 60 min, whereas peak levels in empyema were observed at 180 min. Gentamicin persisted in the empyema longer than in blood. Animals treated with gentamicin only had 60% bacterial cure on day 7; those treated with gentamicin in an oxygen chamber had 100% cure on day 5 (P = 0.004). Low oxygen tension diminished the antibacterial efficacy of gentamicin in this model. An increase in oxygen tension improved the therapeutic results without alteration of the pharmacokinetics of gentamicin. PMID:3116920

Common High Altitudes Illnesses a Primer for Healthcare Provider

PubMed Central

Mohsenin, Vahid

2015-01-01

Exposure to high altitude imposes significant strain on cardiopulmonary system and the brain. As a consequence, sojourners to high altitude frequently experience sleep disturbances, often reporting restless and sleepless nights. At altitudes above 3,000 meters (9,800 ft) almost all healthy subjects develop periodic breathing especially during NREM sleep. Sleep architecture gradually improves with increased NREM and REM sleep despite persistence of periodic breathing. The primary reason for periodic breathing at high altitude is a hypoxic-induced increase in chemoreceptor sensitivity to changes in PaCO2 – both above and below eupnea, leading to periods of apnea and hyperpnea. Acetazolamide improves sleep by reducing the periodic breathing through development of metabolic acidosis and induced hyperventilation decreasing the plant gain and widening the PCO2 reserve. This widening of the PCO2 reserve impedes development of central apneas during sleep. Benzodiazepines and GABA receptor antagonist such as zolpidem improve sleep without affecting breathing pattern or cognitive functions. PMID:27057512

Occlusion pressures in men rebreathing CO2 under methoxyflurane anesthesia.

PubMed

Derenne, J P; Couture, J; Iscoe, S; Whitelaw, A; Milic-Emili, J

1976-05-01

The effect of general anesthesia on control of breathing was studied by CO2 rebreathing and occlusion pressure measurements in six normal human subjects under methoxyflurane anesthesia. CO2 was found to increase the amplitude of the occlusion pressure wave without changing its shape, so that CO2 responses in terms of the occlusion pressure developed 100 ms after the onset of inspiration (Po/0.1) gave results equivalent to the responses in terms of Po/1.o or any other parameter of the pressure wave. Methoxyflurane depressed the ventilatory response to CO2 but not the occlusion pressure response, implying that the most important action of the anesthetic was to increase the effective elastance of the respiratory system rather than to depress the respiratory centers. The elastance was further increased by CO2, and this mechanical change had the effect of shifting the "apneic threshold" extrapolated from the ventilatory response curve to a lower PAco2. Frequency of breathing, inspiratory and expiratory times were not altered by CO2 in anesthetized subjects.

The combined effects of grain supplementation and tenderstretching on alpaca (Vicugna pacos) meat quality.

PubMed

Smith, M A; Bush, R D; van de Ven, R J; Hopkins, D L

2017-03-01

This study investigated the effects of feeding a mixed grain supplement and tenderstretching (TS) alpaca carcasses on meat quality. A total of 56 castrated 24month old alpacas were divided into two treatments (pasture-only, and pasture plus supplementation). Supplemented groups were fed a mixed grain ration in addition to ad lib pasture for 10weeks. Animals were slaughtered across two kill days (n=28). One half of each carcass was suspended by the pelvis (TS) prior to chilling, and the other half was Achilles tendon hung (AH). After 24h, muscles were removed and aged for 10 and 25d. TS significantly increased sarcomere length and reduced shear force and cooking loss in the m. semimembranosus. This trend was not observed in other muscles including the m. longissimus thoracis et lumborum (LL) and m. psoas major. Ageing period resulted in a marginal improvement in LL tenderness. There is clear evidence that TS improves tenderness in the hindquarter of alpacas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.

PubMed

Huijben, Jilske A; Volovici, Victor; Cnossen, Maryse C; Haitsma, Iain K; Stocchetti, Nino; Maas, Andrew I R; Menon, David K; Ercole, Ari; Citerio, Giuseppe; Nelson, David; Polinder, Suzanne; Steyerberg, Ewout W; Lingsma, Hester F; van der Jagt, Mathieu

2018-04-13

General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO 2 ) was 36-40 mmHg (4.8-5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO 2 target of 30-35 mmHg (4-4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.

[Effect of Transcutaneous Acupoint Electrical Stimulation on Hemodynamic Fluctuation Caused by Loosing Tourniquet in Elderly Patients Undergoing Knee Joint Replacement].

PubMed

Liang, Han-Sheng; Feng, Yi

2017-12-25

To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement. A total of 60 ASA (America Society Anesthesiologist) I or II elderly patients for elective knee joint replacement surgery were randomly divided into control group (30 cases) and TAES group (30 cases). Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index (BIS, between 45－60) for anesthesia depth, stroke volume variation (SVV) for fluid management, mean arterial pressure (MAP) and cardiac index (CI) for hemodynamic fluctuation evaluation, and with analgesia nociception index (ANI, between 50－70) for remifentanil dosage adjustment. TAES (2 Hz/100 Hz, 8－20 mA) was applied to bilateral Xinshu (BL 15), Feishu (BL 13), Neiguan (PC 6) and Hegu (LI 4) acupoints for 30 min first (followed by anesthesia induction and operation), and given continuously until 15 min after tourniquet loosing. Patients of the control group were only given with electrodes attachment without electrical stimulation. The levels of MAP, CI, and arterial blood pH, PaCO 2 , PaO 2 , base excess (BE) and lactic acid (Lac) 1 min before, and 5 and 15 min after tourniquet loosing, and the dosages of remifentanil and ephedrine after tourniquet loosing were recorded. The changed levels of MAP, CI and blood Lac at 5 min after tourniquet loosing (relevant to the baseline levels), and blood Lac content at 15 min after tourniquet loosing (relevant to 5 min after tourniquet loosing) were significantly lower in the TAES group than in the control group ( P <0.05), but the levels of MAP and CI at 15 min after tourniquet loosing (relevant to 5 min following tourniquet loosing) were significantly higher in the TAES group than in the control group ( P <0.05), suggesting an improvement of blood pressure, cardiac function and substance metabolism after TAES. Moreover, the dosages of remifentanil and ephedrine after tourniquet loosing were considerably lower in the TAES group than in the control group ( P <0.05), suggesting a better stabilization of hemodynamics after TAES. No significant differences were found between the two groups in the levels of blood pH, PaCO 2 , PaO 2 and BE at 5 and 15 min after tourniquet loosing ( P >0.05). TAES has a positive effect on hemodynamics fluctuation caused by loosing tourniquet in the aged patients undergoing knee joint replacement.

Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis.

PubMed

Cigarroa, Claire L; van den Bosch, Sarah J; Tang, Xiaoqi; Gauvreau, Kimberlee; Baird, Christopher W; DiNardo, James A; Kheir, John Nagi

2018-01-01

Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis. In a retrospective case-control study, we examined for associations between alveolar dead space fraction ([PaCO2 - end-tidal CO2]/PaCO2), arterial oxyhemoglobin saturation, and transpulmonary gradient upon postoperative ICU admission with a composite primary outcome (requirement for surgical or catheter-based intervention, death, or transplant prior to hospital discharge, defining cases) and several secondary endpoints in infants following bidirectional cavopulmonary anastomosis. Cardiac ICU in a tertiary care pediatric hospital. Patients undergoing bidirectional cavopulmonary anastomosis at our institution between 2011 and 2016. None. Of 191 patients undergoing bidirectional cavopulmonary anastomosis, 28 patients were cases and 163 were controls. Alveolar dead space fraction was significantly higher in the case (0.26 ± 0.09) versus control group (0.17 ± 0.09; p < 0.001); alveolar dead space fraction at admission was less than 0.12 in 0% of cases and was greater than 0.28 in 35% of cases. Admission arterial oxyhemoglobin saturation was significantly lower in the case (77% ± 12%) versus control group (83% ± 9%; p < 0.05). Sensitivity and specificity for future case versus control assignment was best when prebidirectional cavopulmonary anastomosis risk factors, admission alveolar dead space fraction (AUC, 0.74), and arterial oxyhemoglobin saturation (AUC, 0.65) were combined in a summarial model (AUC, 0.83). For a given arterial oxyhemoglobin saturation, the odds of becoming a case increased on average by 181% for every 0.1 unit increase in alveolar dead space fraction. Admission alveolar dead space fraction and arterial oxyhemoglobin saturation were linearly associated with prolonged ICU length of stay, hospital length of stay, duration of mechanical ventilation, and duration of thoracic drainage (p < 0.001 for all). Following bidirectional cavopulmonary anastomosis, alveolar dead space fraction in excess of 0.28 or arterial oxyhemoglobin saturation less than 78% upon ICU admission indicates an increased likelihood of requiring intervention prior to hospital discharge. Increasing alveolar dead space fraction and decreasing arterial oxyhemoglobin saturation are associated with increased lengths of stay.

Cardiorespiratory and antinociceptive effects of two different doses of lidocaine administered to horses during a constant intravenous infusion of xylazine and ketamine

PubMed Central

2013-01-01

Background This study investigated the antinociceptive effects of a constant rate infusion (CRI) of lidocaine during xylazine and ketamine anesthesia in horses and aimed to correlate these effects with cardiorespiratory variables, bispectral index (BIS) and plasma lidocaine concentrations. Six adult crossbred mares weighing 320–400 kg were anesthetized on three different occasions. Sedation was performed with xylazine (0.75 mg/kg IV) and anesthetic induction with guaifenesin (75 mg/kg IV) and ketamine (2 mg/kg IV). Anesthesia was maintained with 37.5 μg/kg/min of xylazine and 87.5 μg/kg/min of ketamine both administered intravenously for 75 min. The three treatments consisted of: lidocaine (loading dose: 5 mg/kg, CRI: 100 μg/kg/min; THL); lidocaine (loading dose: 2.5 mg/kg; CRI: 50 μg/kg/min: TLL); and saline (TS); all given 15 min after induction and maintained for 1 h. Antinociception was measured by response to electrical stimulation and bispectral index (BIS) was recorded during anesthesia. Parametric and non-parametric data were compared using ANOVA followed by Student-Newman-Keuls and Friedman tests, respectively. Results Plasma lidocaine concentrations peaked at the end of lidocaine loading dose and was greater in THL (9.61 ± 2.75 μg/mL) vs TLL (4.50 ± 3.34 μg/mL). Electrical noxious stimulation caused purposeful movement in all horses from TS, but no response in THL. The BIS was decreased in THL only and was less when compared to the other treatments throughout anesthesia. Blood pressure, PaO2 and PaCO2 increased and heart rate (HR), respiratory rate (RR), pH, total plasma protein and temperature decreased during anesthesia in all treatments. PaCO2 and HR were greater and RR and pH less in THL compared to TLL and TS at 30 min during anesthesia. All recoveries were considered excellent. Time to standing was longer after THL (60 ± 20 min) than following TLL and TS (32 ± 17 and 30 ± 15 min, respectively). Conclusions At the highest dose administered (THL) lidocaine CRI during xylazine/ketamine anesthesia decreased BIS and motor response to noxious stimulation, and prolonged recovery time without significant added cardiorespiratory depression. PMID:24103634

[A model of multiple organ injury induced by Klebsiella pneumoniae pneumonia in aged rats].

PubMed

Li, Jian-sheng; Wang, Shou-fu; Qin, Jin-li; Zhang, Hui-jian; Li, Su-yun; Yu, Hai-bin; Wang, Feng; Liu, Si-hua; Li, Ya

2009-04-01

To reproduce a model of bacterial multiple organ injury (MOI) in aged rats. Male Sprague-Dawley (SD) rats were used. The young rats were divided into young control group (YCG, n=10) and young model group (YMG, n=15), and the elderly, aged control group (ACG, n=10) and aged model group (AMG, n=25). The model of rats with Klebsiella pneumoniae pneumonia was produced by tracheal instillation of the bacteria, and injury to various organs was observed and evaluated with changes in biochemical parameters, pathological pictures and mortality. Between YMG and AMG, the mortality rates were 33.33% (5/15) and 60.00% (15/25), respectively, at 24 hours after instillation of the bacteria. Compared with YCG and ACG, the neutrophil percentage and white blood cell (WBC) counts in peripheral blood increased significantly in YMG and AMG groups (all P<0.01), the rates of dysfunction of the lungs, the heart and the liver, were 60%-100%. The respiratory dysfunction was evidenced by an increase in the arterial partial pressure of carbon dioxide (PaCO(2), P<0.01), and a decrease in the arterial partial pressure of oxygen (PaO(2), P<0.05 or P<0.01). Myocardial dysfunction was shown by a the sharp increase in creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB) and lactate dehydrogenase (LDH), and that of the liver by changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST, P<0.05 or P<0.01). The pathological changes under light and electronic microscopy were obvious, and the main feature was infiltration of the inflammatory cells. Compared with YMG, PaO(2) in AMG dropped significantly, PaCO(2) increased, CK, CK-MB, LDH, ALT and AST also increased significantly (P<0.05 or P<0.01). The scores of pathological injury in the lungs, the heart and the small intestine in the AMG were obviously higher than that in YMG group (all P<0.05), and the same was trend in the liver and the kidney. The model of bacterial MOI in aged rats is reproduced successfully, and it mimics the pathogenesis of multiple organ dysfunction syndrome (MODS) which initiates from infection in the lungs. The model is simple and convenient to replicate with a high success rate. The MOI in the aged rats is characterized by the severity of the organ injury and a high mortality rate.

Mercury Levels in Human Hair and Farmed Fish near Artisanal and Small-Scale Gold Mining Communities in the Madre de Dios River Basin, Peru

PubMed Central

Langeland, Aubrey L.; Hardin, Rebecca D.; Neitzel, Richard L.

2017-01-01

Artisanal and small-scale gold mining (ASGM) has been an important source of income for communities in the Madre de Dios River Basin in Peru for hundreds of years. However, in recent decades, the scale of ASGM activities in the region has increased dramatically, and exposures to a variety of occupational and environmental hazards related to ASGM, including mercury, are becoming more widespread. The aims of our study were to: (1) examine patterns in the total hair mercury level of human participants in several communities in the region and compare these results to the 2.2 µg/g total hair mercury level equivalent to the World Health Organization (WHO) Expert Committee of Food Additives (JECFA)’s Provisional Tolerable Weekly Intake (PTWI); and (2), to measure the mercury levels of paco (Piaractus brachypomus) fish raised in local aquaculture ponds, in order to compare these levels to the EPA Fish Tissue Residue Criterion of 0.3 µg Hg/g fish (wet weight). We collected hair samples from 80 participants in four communities (one control and three where ASGM activities occurred) in the region, and collected 111 samples from fish raised in 24 local aquaculture farms. We then analyzed the samples for total mercury. Total mercury levels in hair were statistically significantly higher in the mining communities than in the control community, and increased with increasing geodesic distance from the Madre de Dios headwaters, did not differ by sex, and frequently exceeded the reference level. Regression analyses indicated that higher hair mercury levels were associated with residence in ASGM communities. The analysis of paco fish samples found no samples that exceeded the EPA tissue residue criterion. Collectively, these results align with other recent studies showing that ASGM activities are associated with elevated human mercury exposure. The fish farmed through the relatively new process of aquaculture in ASGM areas appeared to have little potential to contribute to human mercury exposure. More research is needed on human health risks associated with ASGM to discern occupational, residential, and nutritional exposure, especially through tracking temporal changes in mercury levels as fish ponds age, and assessing levels in different farmed fish species. Additionally, research is needed to definitively determine that elevated mercury levels in humans and fish result from the elemental mercury from mining, rather than from a different source, such as the mercury released from soil erosion during deforestation events from mining or other activities. PMID:28335439

Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome.

PubMed

Fanelli, Vito; Ranieri, Marco V; Mancebo, Jordi; Moerer, Onnen; Quintel, Michael; Morley, Scott; Moran, Indalecio; Parrilla, Francisco; Costamagna, Andrea; Gaudiosi, Marco; Combes, Alain

2016-02-10

Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal carbon dioxide removal (ECCO2R). In fifteen patients with moderate ARDS, VT was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure--(Pplat) between 23 and 25 cmH2O. Low-flow ECCO2R was initiated when respiratory acidosis developed (pH < 7.25, PaCO2 > 60 mmHg). Ventilation parameters (VT, respiratory rate, PEEP), respiratory compliance (CRS), driving pressure (DeltaP = VT/CRS), arterial blood gases, and ECCO2R system operational characteristics were collected during the period of ultra-protective ventilation. Patients were weaned from ECCO2R when PaO2/FiO2 was higher than 200 and could tolerate conventional ventilation settings. Complications, mortality at day 28, need for prone positioning and extracorporeal membrane oxygenation, and data on weaning from both MV and ECCO2R were also collected. During the 2 h run in phase, VT reduction from baseline (6.2 mL/kg PBW) to approximately 4 mL/kg PBW caused respiratory acidosis (pH < 7.25) in all fifteen patients. At steady state, ECCO2R with an average blood flow of 435 mL/min and sweep gas flow of 10 L/min was effective at correcting pH and PaCO2 to within 10 % of baseline values. PEEP values tended to increase at VT of 4 mL/kg from 12.2 to 14.5 cmH2O, but this change was not statistically significant. Driving pressure was significantly reduced during the first two days compared to baseline (from 13.9 to 11.6 cmH2O; p < 0.05) and there were no significant differences in the values of respiratory system compliance. Rescue therapies for life threatening hypoxemia such as prone position and ECMO were necessary in four and two patients, respectively. Only two study-related adverse events were observed (intravascular hemolysis and femoral catheter kinking). The low-flow ECCO2R system safely facilitates a low volume, low pressure ultra-protective mechanical ventilation strategy in patients with moderate ARDS.

Mercury Levels in Human Hair and Farmed Fish near Artisanal and Small-Scale Gold Mining Communities in the Madre de Dios River Basin, Peru.

PubMed

Langeland, Aubrey L; Hardin, Rebecca D; Neitzel, Richard L

2017-03-14

Artisanal and small-scale gold mining (ASGM) has been an important source of income for communities in the Madre de Dios River Basin in Peru for hundreds of years. However, in recent decades, the scale of ASGM activities in the region has increased dramatically, and exposures to a variety of occupational and environmental hazards related to ASGM, including mercury, are becoming more widespread. The aims of our study were to: (1) examine patterns in the total hair mercury level of human participants in several communities in the region and compare these results to the 2.2 µg/g total hair mercury level equivalent to the World Health Organization (WHO) Expert Committee of Food Additives (JECFA)'s Provisional Tolerable Weekly Intake (PTWI); and (2), to measure the mercury levels of paco ( Piaractus brachypomus ) fish raised in local aquaculture ponds, in order to compare these levels to the EPA Fish Tissue Residue Criterion of 0.3 µg Hg/g fish (wet weight). We collected hair samples from 80 participants in four communities (one control and three where ASGM activities occurred) in the region, and collected 111 samples from fish raised in 24 local aquaculture farms. We then analyzed the samples for total mercury. Total mercury levels in hair were statistically significantly higher in the mining communities than in the control community, and increased with increasing geodesic distance from the Madre de Dios headwaters, did not differ by sex, and frequently exceeded the reference level. Regression analyses indicated that higher hair mercury levels were associated with residence in ASGM communities. The analysis of paco fish samples found no samples that exceeded the EPA tissue residue criterion. Collectively, these results align with other recent studies showing that ASGM activities are associated with elevated human mercury exposure. The fish farmed through the relatively new process of aquaculture in ASGM areas appeared to have little potential to contribute to human mercury exposure. More research is needed on human health risks associated with ASGM to discern occupational, residential, and nutritional exposure, especially through tracking temporal changes in mercury levels as fish ponds age, and assessing levels in different farmed fish species. Additionally, research is needed to definitively determine that elevated mercury levels in humans and fish result from the elemental mercury from mining, rather than from a different source, such as the mercury released from soil erosion during deforestation events from mining or other activities.

Interactive Tailored Website to Promote Sun Protection and Skin Self-Check Behaviors in Patients With Stage 0-III Melanoma

ClinicalTrials.gov

2017-11-15

Stage 0 Skin Melanoma; Stage I Skin Melanoma; Stage IA Skin Melanoma; Stage IB Skin Melanoma; Stage II Skin Melanoma; Stage IIA Skin Melanoma; Stage IIB Skin Melanoma; Stage IIC Skin Melanoma; Stage III Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma

Magnetic Resonance Imaging of Malformations of Midbrain-Hindbrain.

PubMed

Abdel Razek, Ahmed Abdel Khalek; Castillo, Mauricio

2016-01-01

We aim to review the magnetic resonance imaging appearance of malformations of midbrain and hindbrain. These can be classified as predominantly cerebellar malformations, combined cerebellar and brain stem malformations, and predominantly brain stem malformations. The diagnostic criteria for the majority of these morphological malformations are based on neuroimaging findings. The predominantly cerebellar malformations include predominantly vermian hypoplasia seen in Dandy-Walker malformation and rhombencephalosynapsis, global cerebellar hypoplasia reported in lissencephaly and microlissencephaly, and unilateral cerebellar hypoplasia seen in PHACES, vanishing cerebellum, and cerebellar cleft. Cerebellar dysplasias are seen in Chudley-McCullough syndrome, associated with LAMA1 mutations and GPR56 mutations; Lhermitte-Duclos disease; and focal cerebellar dysplasias. Cerebellar hyperplasias are seen in megalencephaly-related syndromes and hemimegalencephaly with ipsilateral cerebellomegaly. Cerebellar and brain stem malformations include tubulinopathies, Joubert syndrome, cobblestone malformations, pontocerebellar hypoplasias, and congenital disorders of glycosylation type Ia. Predominantly brain stem malformations include congenital innervation dysgenesis syndrome, pontine tegmental cap dysplasia, diencephalic-mesencephalic junction dysplasia, disconnection syndrome, and pontine clefts.