The British Services Dhaulagiri Medical Research Expedition 2016: a unique military and civilian research collaboration.

INTRODUCTION: High-altitude environments lead to a significant physiological challenge and disease processes which can be life threatening; operational effectiveness at high altitude can be severely compromised. The UK military research is investigating ways of mitigating the physiological effects of high altitude. METHODS: The British Service Dhaulagiri Research Expedition took place from March to May 2016, and the military personnel were invited to consent to a variety of study protocols investigating adaptation to high altitudes and diagnosis of high-altitude illness. The studies took place in remote and austere environments at altitudes of up to 7500 m. RESULTS: This paper gives an overview of the individual research protocols investigated, the execution of the expedition and the challenges involved. 129 servicemen and women were involved at altitudes of up to 7500 m; 8 research protocols were investigated. CONCLUSIONS: The outputs from these studies will help to individualise the acclimatisation process and inform strategies for pre-acclimatisation should troops ever need to deploy at high altitude at short notice.

Metabolic alterations in the chronically denervated dog heart.

OBJECTIVE: Previous studies have shown that chronic cardiac denervation impairs myocardial glucose oxidation. To investigate this further we tested whether the tissue content of glucose transporters, activity of glycolytic enzymes or metabolic capacity of pyruvate dehydrogenase were altered. Moreover, we investigated whether the decline in glucose utilization was associated with an upregulation of proteins and enzymes involved in fatty acid handling. Chronic cardiac denervation results also in decreased left ventricular efficiency. We explored whether alterations in mitochondrial properties could be held responsible for this phenomenon. METHODS: Twelve adult dogs were included in the study. In 6 of them chronic cardiac denervation was accomplished by surgical ablation of the extrinsic nerve fibers. The other 6 dogs were sham-operated. Biopsies were obtained from the left ventricle after 4-5 weeks of denervation. The content or enzymatic activity of proteins involved in fatty acid and glucose handling was assessed. Features of glutamate oxidation were measured in freshly isolated mitochondria. RESULTS: The content or activity of a set of fatty acid handling proteins did not change during chronic cardiac denervation. In contrast GLUT1 content significantly increased in the chronically denervated left ventricle, while the active form of pyruvate dehydrogenase declined (p < 0.05). Glutamate oxidation characteristics in freshly isolated mitochondria were not affected by chronic denervation. CONCLUSION: The impairment of glucose oxidation in the chronically denervated myocardium is most likely caused by a decline of pyruvate dehydrogenase in its active form. It is unlikely that the decrease in work efficiency is caused by alterations in mitochondrial properties.

Enhancing regional perinatal care: a clinical traineeship for perinatal nurses in a predominantly rural area.

This article describes the objectives, content, teaching strategies, and evaluation methods for the Rural Perinatal Traineeship Program (RPTP). The RPTP is a five-day outreach education program sponsored by The Children's Hospital, Denver for perinatal RNs in the Rocky Mountain, western Great Plains region. The program emphasizes nursing assessment, recognition, stabilization, and transport of the high-risk pregnant woman and sick newborn. The goal is to enhance the nursing care of pregnant women and newborns provided by community hospital RNs by increasing knowledge, reviewing equipment, and updating care practices/skills. To assess effectiveness of the RPTP, participants took a pre, post, and follow-up test. Additionally, follow-up questionnaires, which identified changes in care practices and equipment acquisition, were sent at three different intervals to 299 nurses who participated from 1980-89 and their nursing directors. Overall, 105 participants (36 percent) and 110 of the 127 nursing directors (86 percent) responded to the questionnaire. Results from 86 participants who took all three tests indicated an increase in pre- to post-test scores from 76 percent to 89 percent (p < .001). Follow-up test scores averaged 85 percent (p .001). According to the nursing directors, participants suggested changes in 136 care practices, with 77 percent implemented; and 68 pieces of equipment of which 90 percent were acquired. Suggestions from past participants and nursing directors continue to influence the RPTP in the 1990s.

Beneficial effect of the calcium-sensitizing drug EMD 57033 in a canine model of dilated heart failure.

1. Pacing-induced heart failure was studied in eight dogs. Heart failure was induced by right ventricular pacing at 250-260 beats/min for 6 weeks. Evidence of heart failure was determined clinically and by measurement of left ventricular (LV) dimensions by transoesophageal echocardiography. 2. Haemodynamic measurements of LV pressure, maximum rate of rise of LV pressure (LVdP/dtmax), cardiac output, mean arterial pressure, heart rate, pulmonary artery and pulmonary wedge pressures were made during infusion of solvent (control) and the calcium sensitizer EMD 57033 (0.6 mg min-1 kg-1). 3. The degree of heart failure varied from mild to severe in different individuals, but in each case EMD 57033 exerted a positive inotropic effect on LV haemodynamics and dimension. 4. The positive inotropic effect of the calcium sensitizer was manifest by increased peak LVdP/dt with a subsequent increase in cardiac output at the same mean arterial pressure. 5. This study clearly demonstrates that there is the potential for improvement of contractility of the failing myocardium of the intact mammal by an agent with a mechanism of action which does not involve an increase in intracellular calcium.