Pulmonary gas exchange kinetics during exercise: physiological inferences of model order and parameters

1. 1. The ventilatory and pulmonary gas exchange responses during moderate exercise can be appropriately modelled with first-order dynamics.

2. 2. A delay term, reflecting tissue-to-lung transit time, is needed for accurate characterization, however.

3. 3. The O₂ uptake time constant ( reflects the enzymatically controlled tissue O₂ utilization.

4. 4. is appreciably longer than , consequent to the tissue CO₂ capacitance.

5. 5. As typically longer than , transient errors in alveolar and arterial blood gas tensions are predicted: small for P_CO2 but much larger for P_O2.

6. 6. At work rates above the lactate threshold, a slow and delayed component of V̇_O2 induces an additional V̇ component (“excess” V̇_O2), leading to more rapid fatigue.

7. 7. The ventilatory compensation for the metabolic acidemia at these work rates is slow, with compensation being poor for rapid-incremental exercise.

8. 8. A justifiable control model of the coupling of ventilation to metabolism must cohere with these demonstrable physiological characteristics.

Decreased histone deacetylase 2 impairs Nrf2 activation by oxidative stress

Nuclear factor erythroid 2-related factor 2 (Nrf2) plays a crucial role in cellular defence against oxidative stress by inducing the expression of multiple anti-oxidant genes. However, where high levels of oxidative stress are observed, such as chronic obstructive pulmonary disease (COPD), Nrf2 activity is reduced, although the molecular mechanism for this defect is uncertain. Here, we show that down-regulation of histone deacetylase (HDAC) 2 causes Nrf2 instability, resulting in reduced anti-oxidant gene expression and increase sensitivity to oxidative stress. Although Nrf2 protein was clearly stabilized after hydrogen peroxide (H₂O₂) stimulation in a bronchial epithelial cell line (BEAS2B), Nrf2 stability was decreased and Nrf2 acetylation increased in the presence of an HDAC inhibitor, trichostatin A (TSA). TSA also reduced Nrf2-regulated heme-oxygenase-1 (HO-1) expression in these cells, and this was confirmed in acute cigarette-smoke exposed mice in vivo. HDAC2 knock-down by RNA interference resulted in reduced H₂O₂-induced Nrf2 protein stability and activity in BEAS2B cells, whereas HDAC1 knockdown had no effect. Furthermore, monocyte-derived macrophages obtained from healthy volunteers (non-smokers and smokers) and COPD patients showed a significant correlation between HDAC2 expression and Nrf2 expression (r = 0.92, p < 0.0001). Thus, reduced HDAC2 activity in COPD may account for increased Nrf2 acetylation, reduced Nrf2 stability and impaired anti oxidant defences.     

Heart valve macro- and microstructure

Each heart valve is composed of different structures of which each one has its own histological profile. Although the aortic and the pulmonary valves as well as the mitral and the tricuspid valves show similarities in their architecture, they are individually designed to ensure optimal function with regard to their role in the cardiac cycle.In this article, we systematically describe the structural elements of the four heart valves by different anatomical, light- and electron-microscopic techniques that have been presented. Without the demand of completeness, we describe main structural features that are in our opinion of importance in understanding heart valve performance. These features will also have important implications in the treatment of heart valve disease. They will increase the knowledge in the design of valve substitutes or partial substitutes and may participate to improve reconstructive techniques. In addition, understanding heart valve macro- and microstructure may also be of benefit in heart valve engineering techniques.     

莫西沙星溶液雾化吸入治疗COPD合并呼吸衰竭的疗效

目的:探讨莫西沙星溶液雾化吸入治疗慢性阻塞性肺病(COPD)合并呼吸衰竭的疗效。方法:选择2014年5月~2016年5月于我院就诊的94例COPD合并呼吸衰竭患者,参照抽签法分为对照组(n=47)与研究组(n=47),对照组行常规治疗,研究组基于对照组加用莫西沙星溶液雾化吸入治疗。比较两组的疗效,血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素10(IL-10)水平、肌酸磷酸激酶(CK)、谷草转氨酶(AST)水平,血氧分压(PaO_2)、二氧化碳分压(PaCO_2),APACHEⅡ评分和不良反应的发生情况。结果:治疗后,研究组的总有效率显著高于对照组(P0.05),血清TNF-α、CRP、CK、LDH、AST、PaCO_2、APACHEⅡ评分均明显低于对照组(P0.05),血清IL-10、PaO_2水平均高于对照组(P0.05)。两组不良反应的发生情况比较差异无统计学意义(P0.05)。结论:莫西沙星溶液雾化吸入治疗COPD合并呼吸衰竭的疗效确切,可能与其有效抑制炎症反应,改善呼吸有关。     

Triggered release of ciprofloxacin from nanostructured agglomerated vesicles

Nanostructured agglomerated vesicles encapsulating ciprofloxacin were evaluated for modulated delivery from the lungs in a healthy rabbit model. An aliphatic disulfide crosslinker, cleavable by cysteine was used to form cross-links between nanosized liposomes to form the agglomerates. The blood levels of drug after pulmonary instillation of free ciprofloxacin, liposomal ciprofloxacin, and the agglomerated liposomes encapsulating ciprofloxacin were evaluated. The liposomes and agglomerated vesicles showed extended release of drug into the blood over 24 hours, while the free ciprofloxacin did not. The agglomerates also allowed modulation of the drug release rate upon the introduction of cysteine into the lungs post-drug instillation; the cysteine-cleavable agglomerates accelerated their drug release rate, indicated by an increased level of drug in the blood. This technology holds promise for the post-administration modulation of antibiotic release, for the prevention and treatment of pulmonary and systemic infections.     

Beta-Adrenergic Blockers as a Potential Treatment for COVID-19 Patients

More than 15 million people have been affected by coronavirus disease 2019 (COVID-19) and it has caused 640 016 deaths as of July 26, 2020. Currently, no effective treatment option is available for COVID-19 patients. Though many drugs have been proposed, none of them has shown particular efficacy in clinical trials. In this article, the relationship between the Adrenergic system and the renin-angiotensin-aldosterone system (RAAS) is focused in COVID-19 and a vicious circle consisting of the Adrenergic system-RAAS-Angiotensin converting enzyme 2 (ACE2)-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (which is referred to as the “ARAS loop”) is proposed. Hyperactivation of the ARAS loop may be the underlying pathophysiological mechanism in COVID-19, and beta-adrenergic blockers are proposed as a potential treatment option. Beta-adrenergic blockers may decrease the SARS-CoV-2 cellular entry by decreasing ACE2 receptors expression and cluster of differentiation 147 (CD147) in various cells in the body. Beta-adrenergic blockers may decrease the morbidity and mortality in COVID-19 patients by preventing or reducing acute respiratory distress syndrome (ARDS) and other complications. Retrospective and prospective clinical trials should be conducted to check the validity of the hypothesis. Also see the video abstract here https://youtu.be/uLoy7do5ROo .     

The preventive and therapeutic effects of AAV1-KLF4-shRNA in cigarette smoke-induced pulmonary hypertension

We found previously that KLF4 expression was up-regulated in cultured rat and human pulmonary artery smooth muscle cells (PASMCs) exposed to cigarette smoke (CS) extract and in pulmonary artery from rats with pulmonary hypertension induced by CS. Here, we aim to investigate whether CS-induced pulmonary hypertension (PH) is prevented and ameliorated by targeted pulmonary vascular gene knockdown of KLF4 via adeno-associated virus 1 (AAV1)-KLF4-shRNA in vivo in rat model. The preventive and therapeutic effects were observed according to the different time-point of AAV1-KLF4-shRNA intratracheal administration. We tested haemodynamic measurements of systemic and pulmonary circulations and observed the degree of pulmonary vascular remodelling. In the preventive experiment, KLF4 expression and some pulmonary circulation hemodynamic measurements such as right ventricular systolic pressure (RVSP), mean right ventricular pressure (mRVP), peak RV pressure rate of rise (dP/dt max) and right ventricle (RV) contractility index were increased significantly in the CS-induced PH model. While in the prevention group (AAV1-KLF4-shRNA group), RVSP, mRVP, dP/dt max and RV contractility index which are associated with systolic function of right ventricle decreased and the degree of pulmonary vascular remodelling relieved. In the therapeutic experiment, we observed a similar trend. Our findings emphasize the feasibility of sustained pulmonary vascular KLF4 gene knockdown using intratracheal delivery of AAV1 in an animal model of cigarette smoke-induced PH and determined gene transfer of KLF4-shRNA could prevent and ameliorate the progression of PH.     

兔肺静脉肌袖心肌细胞动作电位的特性和一些离子流机制

研究兔肺静脉肌袖心肌细胞（cardiomyocytes from rabbit pulmonary vein sleeves, PVC）动作电位的特性和一些离子流机制——内向整流钾电流（IKl）、瞬时外向钾电流（ITo）和非选择性阳离子流（I NSCC）,并与左心房心肌细胞（left atrial cardiomyocytes,LAC）进行比较。采用全细胞膜片钳技术,记录动作电位和上述各离子流。发现PVC动作电位时程（action potential duration,APD）较LAC的明显延长,并可以诱发出第二平台反应。PVC上存在I NSCC. PVC的IKl、I To和I NSCC电流密度均较LAC的明显减小。PVC和LAC存在复极离子流的差异,这种差异构成了两者动作电位差异的基础,进而可能成为肺静脉肌袖致心律失常特性的重要离子流机制。