The respiratory change in preejection period: a new method to predict fluid responsiveness.

The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Delta) in the preejection period (PEP; DeltaPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. DeltaPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Deltadown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH2O (PEEP10). When PEEP10 induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, DeltaPEP, Deltadown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r2 = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, DeltaPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP10.     

Basic concepts of fluid responsiveness

Predicting fluid responsiveness, the response of stroke volume to fluid loading, is a relatively novel concept that aims to optimise circulation, and as such organ perfusion, while avoiding futile and potentially deleterious fluid administrations in critically ill patients. Dynamic parameters have shown to be superior in predicting the response to fluid loading compared with static cardiac filling pressures. However, in routine clinical practice the conditions necessary for dynamic parameters to predict fluid responsiveness are frequently not met. Passive leg raising as a means to alter biventricular preload in combination with subsequent measurement of the change in stroke volume can provide a fast and accurate way to guide fluid management in a broad population of critically ill patients.     

The ability of left ventricular end-diastolic volume variations measured by TEE to monitor fluid responsiveness in high-risk surgical patients during craniotomy: a prospective cohort study

Background

This study was aimed to evaluate the ability of left ventricular end-diastolic volume variations (LVEDVV) measured by transesophageal echocardiography (TEE) compared with stroke volume variation (SVV) obtained by the FloTrac/Vigileo monitor to predict fluid responsiveness, in patients undergoing craniotomy with goal direct therapy.

Methods

We used SVV obtained by the FloTrac/Vigileo monitor to manage intraoperative hypotension in adult patients undergoing craniotomy (ASA III – IV) after obtaining IRB approval and informed consent. The LVEDVV were measured by TEE through the changes of left ventricular short diameter of axle simultaneously. When cardiac index (CI)?≤?2.5 and SVV?≥?15%, comparisons were made between the two devices before and after volume expansion.

Results

We enrolled twenty-six patients referred for craniotomy in this study and 145 pairs of data were obtained. Mean Vigileo-SVV and TEE-LVEDVV were 17.8?±?2.78% and 22.1?±?7.25% before volume expansion respectively, and were 10.95?±?2.8% and 13.58?±?3.78% after volume expansion respectively (P <?0.001). The relationship between Vigileo-SVV and TEE-LVEDVV was significant (r2?=?0.55; p <?0.001). Agreement between Vigileo-SVV and TEE-LVEDVV was 3.3%?±?3.9% (mean bias ± SD, Bland-Altman).

Conclusions

For fluid responsiveness of patients during craniotomy in ASA III-IV, LVEDVV measured by left ventricular short diameter of axle using M type echocaidiographic measurement seems an acceptable monitoring indicator. This accessible method has promising clinical applications in situations where volume and cardiac function monitoring is of great importance during surgery.

Trial registration

Chinese Clinical Trial Registry, ChiCTR-TRC-13003583, August 20, 2013.

     

Recognition of methylated histones: new twists and variations

Histone tails undergo methylation at their lysines and arginines. These chemical marks act as traffic signals that direct activity of chromatin remodeling complexes to appropriate regions of the genome. A surprisingly diverse group of effector protein modules in chromatin remodeling complexes and their associated factors are involved in the recognition of histone methyllysines. Previous studies generally painted a picture of individual lysines recognized by these protein modules in a 1:1 fashion. However, recent structural studies show more complex interactions where the critical lysines are recognized in pairs, or in the context of nucleosomal DNA, or within the central pore of repeat motifs. These interactions extend our understanding of how histone tail recognition can be enhanced through coupled interactions within a single module or through the cooperation of two different molecules.     

Human amniotic fluid stem cells: a new perspective

The discovery of amniotic fluid stem cells initiated a new and very promising field in stem cell research. In the last four years amniotic fluid stem cells have been shown to express markers specific to pluripotent stem cells, such as Oct-4. Due to their high proliferation potential, amniotic fluid stem cell lineages can be established. Meanwhile, they have been shown to harbor the potential to differentiate into cells of all three embryonic germ layers. It will be a major aim for the future to define the potential of this new source of stem cells for therapies related to specific diseases.     

Flow of a blood analogue fluid in a compliant abdominal aortic aneurysm model: Experimental modelling

The aim of this work is to develop a unique in vitro set-up in order to analyse the influence of the shear thinning fluid-properties on the flow dynamics within the bulge of an abdominal aortic aneurysm (AAA). From an experimental point of view, the goals are to elaborate an analogue shear thinning fluid mimicking the macroscopic blood behaviour, to characterise its rheology at low shear rates and to propose an experimental device able to manage such an analogue fluid without altering its feature while reproducing physiological flow rate and pressure, through compliant AAA. Once these experimental prerequisites achieved, the results obtained in the present work show that the flow dynamics is highly dependent on the fluid rheology. The main results point out that the propagation of the vortex ring, generated in the AAA bulge, is slower for shear thinning fluids inducing a smaller travelled distance by the vortex ring so that it never impacts the anterior wall in the distal region, in opposition to Newtonian fluids. Moreover, scalar shear rate values are globally lower for shear thinning fluids inducing higher maximum stress values than those for the Newtonian fluids. Consequently, this work highlights that a Newtonian fluid model is finally inadequate to obtain a reliable prediction of the flow dynamics within AAA.     

作物光能利用效率和收获指数时空变化研究进展

1972年Monteith提出的光能利用效率模型是当前大多数作物生长和产量形成模拟研究以及遥感估产所采用的主要方法.光能利用效率(radiation use efficiency, RUE)和收获指数(harvest index, HI)是其中的两个基本参量.鉴于目前作物RUE和HI研究与应用中仍存在着一些问题,本文综述了相关研究进展,总结了不同尺度上作物RUE和HI的研究方法;介绍了当前遥感估产应用中对RUE和HI两个关键参数的处置概况;建议今后研究应在点尺度开展作物RUE和HI研究的基础上,寻求其在区域尺度上定量评估的可行性途径,切实有效地发挥作物RUE和HI研究在作物实际生产管理中和遥感产量估算方面的应用价值及潜力.     

一种量化根系抗侵蚀指标的构建及应用:根系构架抗蚀指数

在侵蚀环境下,植被地下部根系系统的相互匹配是植被群落持续发挥抗侵蚀作用的关键。本研究尝试引入Amoeba图形法,从根系形态、数量和空间3个维度建立根系构架抗蚀指数(ERI_rf,%)来量化表征植被群落根系抗侵蚀功效,并分析黄土丘陵区撂荒地、柠条群落和刺槐群落植物根系的生长特征。结果表明:本研究构建的根系构架抗蚀指数的参数包括:根系构架作用系数(α)、根系密度(R_b,kg·m^-3)、根系构架度(S)、土壤容重(ρ,g·cm^-3)和水土保持作用系数(φ),表达式为:■;根系构架抗蚀指数能够较好地表征植被群落土壤抗侵蚀能力,且对数函数能较好地拟合土壤抗侵蚀能力与根系构架抗蚀指数之间的关系。期望本研究结果为抗侵蚀植被群落构建与生态建设评估提供科学参考。     

Respiratory muscle activity in the assessment of bronchial responsiveness in asthmatic children

We investigatedwhether an increase in transcutaneous electromyographic (EMG) activityof the diaphragm and intercostal muscles corresponds with theconcentration of histamine that induces a 20% fall in the forcedexpiratory volume in one second(FEV₁; PC₂₀). Eleven asthmatic children(mean age 11.9 yr) were studied after they were given histaminechallenge. EMG activity atPC₂₀ or at the highest histamineconcentration was compared with activity at baseline by calculating theratio of the mean peak-to-peak excursion at the highest histamine doseto that at baseline [EMG activity ratio (EMGAR)]. In allchildren reaching PC₂₀, anincrease in diaphragmatic and intercostal EMGAR was observed. Noincrease was found at the dose step beforePC₂₀ was reached. In sixchallenges, no fall in FEV₁ wasinduced, and no increase in EMGAR was seen. In two challenges, no fallin FEV₁ was induced, but increasein diaphragmatic or intercostal EMGAR was observed. Increase in the electrical activity of the diaphragm and intercostal muscles in asthmatic children corresponds closely to a 20% fall inFEV₁ induced by histaminechallenge.

     

Regional variations in the nonlinearity and anisotropy of bovine aortic elastin

Arterial walls have a regular and lamellar organization of elastin present as concentric fenestrated networks in the media. In contrast, elastin networks are longitudinally oriented in layers adjacent to the media. In a previous model exploring the biomechanics of arterial elastin, we had proposed a microstructurally motivated strain energy function modeled using orthotropic material symmetry. Using mechanical experiments, we showed that the neo-Hookean term had a dominant contribution to the overall form of the strain energy function. In contrast, invariants corresponding to the two fiber families had smaller contributions. To extend these investigations, we use biaxial force-controlled experiments to quantify regional variations in the anisotropy and nonlinearity of elastin isolated from bovine aortic tissues proximal and distal to the heart. Results from this study show that tissue nonlinearity significantly increases distal to the heart as compared to proximally located regions ( $p<0.05$ ). Distally located samples also have a trend for increased anisotropy ( $p=0.07$ ), with the circumferential direction stiffer than the longitudinal, as compared to an isotropic and relatively linear response for proximally located elastin samples. These results are consistent with the underlying tissue histology from proximally located samples that had higher optical density ( $p<0.05$ ), fiber thickness ( $p<0.05$ ), and trend for lower tortuosity ( $p<0.07$ ) in elastin fibers as compared to the thinner and highly undulating elastin fibers isolated from distally located samples. Our studies suggest that it is important to consider elastin fiber orientations in investigations that use microstructure-based models to describe the contributions of elastin and collagen to arterial mechanics.     

Z factor: a new index for measuring academic research output

Hereditary erythermalgia is a painful and debilitating genetic disorder associated with mutations in voltage-gated sodium channel Nav1.7. We have previously reported a Canadian family segregating erythermalgia consistently with a dominant genetic etiology. Molecular analysis of the proband from the family detected two different missense mutations in Nav1.7. In the present study we have performed a long-term follow-up clinical study of disease progression in three affected family members. A more extensive molecular study has also been completed, analyzing the segregation of the two missense variants in the family. The two variants (P610T, L858F) segregate independently with respect to clinical presentation. Detailed genotype/phenotype correlation suggests that one of the two variants (L858F) is causal for erythermalgia. The second variant (P610T) may modify the phenotype in the proband. This is the second reported study of potential compound heterozygosity for coding polymorphisms in Nav1.7, the first being in a patient with paroxysmal extreme pain disorder.     

Respiratory responses to aortic and carotid chemoreceptor activation in the dog

Respiratory responses arising from both chemical stimulation of vascularly isolated aortic body (AB) and carotid body (CB) chemoreceptors and electrical stimulation of aortic nerve (AN) and carotid sinus nerve (CSN) afferents were compared in the anesthetized dog. Respiratory reflexes were measured as changes in inspiratory duration (TI), expiratory duration (TE), and peak averaged phrenic nerve activity (PPNG). Tonic AN and AB stimulations shortened TI and TE with no change in PPNG, while tonic CSN and CB stimulations shortened TE, increased PPNG, and transiently lengthened TI. Phasic AB and AN stimulations throughout inspiration shortened TI with no changes in PPNG or the following TE; however, similar phasic stimulations of the CB and CSN increased both TI and PPNG and decreased the following TE. Phasic AN stimulation during expiration decreased TE and the following TI with no change in PPNG. Similar stimulations of the CB and CSN decreased TE; however, the following TI and PPNG were increased. These findings differ from those found in the cat and suggest that aortic chemoreceptors affect mainly phase timing, while carotid chemoreceptors affect both timing and respiratory drive.     

Respiratory failure after endotoxin infusion in sheep: lung mechanics and lung fluid balance

Infusion of Escherichia coli endotoxin (0.12-1.5 micrograms/kg) into unanesthetized sheep causes transient pulmonary hypertension and several hours of increased lung vascular permeability, after which sheep recover. To produce enough lung injury to result in pulmonary edema with respiratory failure, we infused larger doses of E. coli endotoxin (2.0-5.0 micrograms/kg) into 11 chronically instrumented unanesthetized sheep and continuously measured pulmonary arterial, left atrial and aortic pressures, dynamic lung compliance, lung resistance, and lung lymph flow. We intermittently measured arterial blood gas tensions and pH, made interval chest radiographs, and calculated postmortem extravascular bloodless lung water-to-dry lung weight ratio (EVLW/DLW). Of 11 sheep 8 developed respiratory failure; 7 died spontaneously 6.3 +/- 1.1 h, and one was killed 10 h after endotoxin infusion. All sheep that had a premortem room air alveolar-arterial gradient in partial pressure of O2 (PAo2-Pao2) greater than 42 Torr (58 +/- 5 (SE) Torr) died. Of eight sheep that had radiographs made, six developed radiographically evident interstitial or interstitial and alveolar edema. Pulmonary artery pressure rose from base line 22 +/- 2 to 73 +/- 3 cmH2O and remained elevated above baseline levels until death. There was an initial fourfold decrease in dynamic compliance and sixfold increase in pulmonary resistance; both variables remained abnormal until death. EVLW/DLW increased with increasing survival time after endotoxin infusion, suggesting that pulmonary edema accumulated at the same rate in all fatally injured sheep, regardless of other variables. The best predictor of death was a high PAo2-Pao2. The marked increase in pulmonary resistance and decrease in dynamic compliance occurred too early after endotoxin infusion (15-30 min) to be due to pulmonary edema. The response to high-dose endotoxin in sheep closely resembles acute respiratory failure in humans following gram-negative septicemia. Respiratory failure and death in this model were not due to pulmonary edema alone.     

Postimperative negativity of the contigent negative variations: a critical index of a stress reaction in the normal subject?]

21 subjects were recorded during two experimental sessions: 1st session: 2 CNVs in control conditions; 2nd session: 1) control CNV, 2) CNV and arithmetic calculation, 3) CNV and labyrinthine stimulation, 4) CNV, arithmetic calculation and labyrinthine stimulation, 5) control CNV. The results obtained show a post-imperative extension of the CNV in the situation 2: arithmetic calculation (P less than 0.025) and 4: double interference (P less than 0.05).