ICT-based solution for efficient fecal sludge management: An experience from Bangladesh.

In Bangladesh, people primarily depend on on-site sanitation facilities (OSSF) with an immense challenge in achieving safe sanitation due to unplanned infrastructure development, improper management of fecal sludge, and inadequate monitoring. The commitment of attaining Sustainable Development Goals (SDG) 6.2 (ensuring safe sanitation for all) by 2030 requires immediate attention in the management of fecal sludge for low-middle income countries. This paper presented the findings, challenges, and possible ways forward from a study conducted to provide data for Information and Communication Technology (ICT)-based fecal sludge management (FSM) at a municipality in the northwest of Bangladesh. A total of 18,808 households and 407 institutions in Saidpur municipality, a non-sewered town in Nilphamari district, were studied to understand the type of containment structures and on-ground desludging practices. The study showed around 10% of containments were connected to the drains illegally, 95% of the people in Saidpur practiced unsafe disposal, and 7% still practiced open defecation. To identify these malpractices, the study also implemented an ICT-based sustainable solution through a web application that enabled the local administrator to have a global look at the sanitation scenario of the municipality. The dashboard was developed to create a total sanitation monitoring system, identify defaulters, allow target-based safe managed sanitation service strategies, and ensure sustainability in FSM. The study highlighted the accessibility of vacuum truck services projecting through a spatial map and identified methods to empty the septic tanks where Vacutag services are unavailable by engaging local pit emptiers. The innovative approach of fecal sludge management will help not only to improve the existing sanitation practices but also raise community awareness to ensure sustainable sanitation system. Altogether, the web system will work as a medium to manage the faecal sludge for the existing co-compost plant where the faeces is converted into organic soil conditioner, creating prospects for a green business mechanism.

Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh.

A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.

Colonoscopy skills improvement training improves patient comfort during colonoscopy.

INTRODUCTION: We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy. METHODS: This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis. RESULTS: 2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training. CONCLUSION: CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.

Consensus statement from the international consensus meeting on post-traumatic cranioplasty.

BACKGROUND: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Effect of sheath material and reaction overpressure on Ag extrusions into the TiO2 insulation coating of Bi-2212 round wire.

In order to develop a high current density in coils, Bi-2212 wires must be electrically discrete in tight winding packs. It is vital to use an insulating layer that is thin, fulfils the dielectric requirements, and can survive the heat treatment whose maximum temperature reaches 890 °C. A thin (20-30 µm) ceramic coating could be better as the insulating layer compared to alumino-silicate braided fiber insulation, which is about 100 µm thick and reacts with the Ag sheath during heat treatment, degrading the critical current density (Jc). At present, TiO2 seems to be the most viable ceramic material for such a thin insulation because it is chemically compatible with Ag and Bi-2212 and its sintering temperature is lower than the maximum temperature used for the Bi-2212 heat treatment. However, recent tests of a large Bi-2212 coil insulated only with TiO2 showed severe electrical shorting between the wires after over pressure heat treatment (OPHT). The origin of the shorting was frequent silver extrusions that penetrated the porous TiO2 layer and electrically connected adjacent Bi-2212 wires. To understand the mechanism of this unexpected behaviour, we investigated the effect of sheath material and hydrostatic pressure on the formation of Ag extrusions. We found that Ag extrusions occur only when TiO2-insulated Ag-0.2%Mg sheathed wire (Ag(Mg) wire) undergoes OPHT at 50 bar. No Ag extrusions were observed when the TiO2-insulated Ag(Mg) wire was processed at 1 bar. The TiO2-insulated wires sheathed with pure Ag that underwent 50 bar OPHT were also free from Ag extrusions. A key finding is that the Ag extrusions emanating from the Ag(Mg) sheath actually contain no MgO, suggesting that local depletion of MgO facilitates local, heterogeneous deformation of the sheath under hydrostatic overpressure. Our study also suggests that predensifying the Ag(Mg) wire before insulating it with TiO2 and doing the final OPHT can potentially prevent Ag extrusion.

Elevated levels of serum uric acid and insulin resistance are associated with nonalcoholic fatty liver disease among prediabetic subjects.

Background: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of insulin resistance and serum uric acid (SUA) levels seemed to be elevated during this disorder. There is a paucity of data regarding the association of SUA with NAFLD in prediabetes. In this context, the present study has been undertaken to investigate this association. Methods: In a cross-sectional analytical design, a total of 110 prediabetic subjects [M/F; 63/47, age in ranges, 45 (25-68)] were recruited in the study and divided into non NAFLD (n = 62) and NAFLD (n = 48) group after examined with ultrasonogram. Insulin resistance (HOMA-IR) was calculated by homeostasis model assessment. Results: NAFLD subjects had significantly higher levels of SUA compared to non NAFLD subjects (6.10 ± 1.42 vs. 5.38 ± 1.14, p = 0.004). They also had significantly higher levels of HOMA-IR (2.4 ± 1.09 vs. 1.4 ± 0.45, p < 0.001). In binary logistic regression analysis, HbA1c (OR = 3.505, p = 0.002), SUA (OR = 1.514, p = 0.023) and HOMA-IR (OR = 1.478, p = 0.029) were found to be significant determinants of NAFLD after adjusting the effects of BMI and triglyceride (TG). In multiple linear regression analysis, SUA showed significant positive association with HOMA-IR (ß = 0.355, p = 0.027) and TG (ß = 0.325, p = 0.033) after adjusting the effects of BMI and HbA1c. Conclusions: Increased levels of serum uric acid are significantly associated with NAFLD and this association seemed to be mediated by insulin resistance among prediabetic subjects.

Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh.

BACKGROUND: Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. METHODS: Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. RESULTS: Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. CONCLUSION: The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.

Thermoluminescence responses of the Yb- and Yb-Tb-doped SiO2 optical fibers to 6-MV photons.

Characteristics of the thermoluminescence (TL) responses of Yb- and Yb-Tb-doped optical fibers irradiated with 6MV photons are reported. The concentration of Yb in the Yb-doped optical fiber was 0.26mol%; the concentrations of Yb and Tb in the Yb-Tb-doped optical fiber were 0.62 and 0.2mol%, respectively. The TL dose responses are linear in the dose range 0.5-4Gy. The radiation sensitivity of the Yb-Tb material is almost two orders of magnitude higher than the sensitivity of the material doped with Yb alone.

Wandering spleen associated with ß-Thalassemia: a case report.

The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed ß-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.

Screening heavy metals levels in hair of sanitation workers by X-ray fluorescence analysis.

This work presents a study of human hair as a bio-indicator for detection of heavy metals as part of environmental health surveillance programs project to develop a subject of interest in the biomedical and environmental sciences. A total of 34 hair samples were analyzed that consisting of 29 samples from sanitation workers and five samples from students. The hair samples were prepared and treated in accordance to the International Atomic Energy Agency (IAEA) recommendations. The concentrations of heavy metals were analyzed using the energy dispersive X-ray fluorescence (EDXRF) technique by X-50 Mobile X-ray Fluorescence (XRF) at Oceanography Institute, Universiti Malaysia Terengganu. The performance of EDXRF analyzer was tested by Standard Reference Material (SRM 2711) Montana Soil which was in good agreement with certified value within 14% deviations except for Hg. While seven heavy metals: Mn, Fe, Ni, Cu, Zn, Se, and Sb were detected in both groups, three additional elements, i.e. As, Hg and Pb, were detected only in sanitation workers group. For sanitation workers group, the mean concentration of six elements, Mn, Fe, Cu, Zn, Se, and Sb, shows elevated concentration as compared to the control samples concentration. Results from both groups were compared and discussed in relation to their respective heavy metals concentrations.

Integrated management of foot rot of lentil using biocontrol agents under field condition.

The efficacy of cowdung, Bangladesh Institute of Nuclear Agriculture (BINA)-biofertilizer, and Bangladesh Agricultural University (BAU)-biofungicide, alone or in combination, was evaluated for controlling foot rot disease of lentil. The results exhibited that BINA-biofertilizer and BAUbiofungicide (peat soil-based Rhizobium leguminosarum and black gram bran-based Trichoderma harzianum) are compatible and have combined effects in controlling the pathogenic fungi Fusarium oxysporum and Sclerotium rolfsii, which cause the root rot of lentil. Cowdung mixing with soil (at 5 t/ha) during final land preparation and seed coating with BINA-biofertilizer and BAU-biofungicide (at 2.5% of seed weight) before sowing recorded 81.50% field emergence of lentil, which showed up to 19.85% higher field emergence over the control. Post-emergence deaths of plants due to foot rot disease were significantly reduced after combined seed treatment with BINA-biofertilizer and BAU-biofungicide. Among the treatments used, only BAU-biofungicide as the seed treating agent resulted in higher plant stand (84.82%). Use of BINA-biofertilizer and BAU-biofungicide as seed treating biocontrol agents and application of cowdung in the soil as an organic source of nutrient resulted in higher shoot and root lengths, and dry shoot and root weights of lentil. BINA-biofertilizer significantly increased the number of nodules per plant and nodules weight of lentil. Seeds treating with BAUbiofungicide and BINA-biofertilizer and soil amendment with cowdung increased the biomass production of lentil up to 75.56% over the control.

Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer.

BACKGROUND: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. METHODS: A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). RESULTS: Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. CONCLUSION: Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.

Evaluation of plant activator and chemical fungicides on leaf blight (Bipolaris sorokiniana) development and yield of wheat.

Bion 50 WG (Benzothiodiazole), Tilt-250 EC (Propiconazole) and Amistar (Azoxystrobin) either alone and some of their combinations were evaluated against leaf blight/spot (Bipolaris sorokiniana) development and yield of wheat. All the treatments significantly reduced leaf spot reaction of wheat over untreated control. But Bion in combination with Amistar resulted significantly highest reduction of leaf spot reaction of wheat (p = 0.05) against all the tested pathotypes inoculated at flag leaf stage. In the field, Bion reduced leaf spot severity at heading and flowering stage in 2000-2001 and at hard dough stage in 2001-2002. Number of grains/ear not significantly increased by treating seeds with Bion though 1000-grain weight is significantly increased (p = 0.05) in 2000-2001 by Bion. Statistically higher grain yield was obtained from the experimental plot by treating seeds with Bion and Amistar. Bion resulted 53.33% higher grain yield in compare to untreated control.

Finding the lung sound-flow relationship in normal and asthmatic subjects.

To investigate the relationship between lung sound (LS) and flow, we studied LS signals from 5 healthy adults (group I), 10 healthy children (group II) and 7 asthmatic children (group III). The LS signals were recorded on right upper lung lobe at different flow rates varied from 0.4 to 3.0 L/s and the flow signals were measured at mouth. The LS and flow signals were parsed into segments of 1024 data points with 50% overlap between successive segments. The mean LS amplitude (mean AMP) and mean flow (flow) were calculated for each segment. The average power (Pave) of each segment was calculated from LS spectrum for different frequency bands between 20-600 Hz. Four different types of models, representing the relationship between mean AMP or Pave and flow, were investigated using different percentage of flow signal in each inspiratory phase. The model coefficients were derived from either linear regression analysis or polynomial curve fitting between the data and model variables. The correlation coefficients (r) between the experimental data and data estimated from the model coefficients were calculated for each subject in each model and averaged between the subjects. The results showed much stronger correlation between Pave and flow than mean AMP and flow for all groups. The best model to describe Pave relationship with flow was found to be power relationship in both healthy adults and children whereas a third-order polynomial curve best fitted the Pave and flow data in asthmatic group. The optimum frequency band to calculate Pave was found to be 150-450 Hz for healthy subjects and 300-600 Hz for asthmatic children. The diminution of heart sound (HS) from LS recordings showed no change in the selected model in all three groups. The results of this study suggest the difference in Pave- flow relationship in healthy and asthmatic subjects may be used as a diagnostic tool for asthma.

Bilateral giant angiomyolipoma of kidneys: a case report and review of literature.

Angiomyolipoma is uncommon benign tumor of the kidney. Bilateral and multiple lesions are associated with tuberous sclerosis. We report a case with bilateral giant angiomyolipomas in a patient who had no other features of tuberous sclerosis. In this case, the involvement of the kidneys was diffuse rather than usual well-circumscribed lesions.

Randomized, placebo-controlled, clinical trial of hyperimmunized chicken egg yolk immunoglobulin in children with rotavirus diarrhea.

BACKGROUND: Hyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea were treated with immunoglobulin extracted from eggs of chicken immunized with human rotavirus strains. METHODS: In a randomized, double-blind study, 79 children with known rotavirus diarrhea were assigned to receive either 10 g hyperimmune egg yolk (HEY) daily in four equally divided doses for 4 days (HEY group) or a similar preparation obtained from nonimmunized chicken (placebo group). The daily stool frequency and amount, oral rehydration solution iORS) intake, and presence of rotavirus in the stool were monitored for 4 days. RESULTS: In the HEY-treated group, there was significant reduction in stool output (in grams per kilogram per day; HEY vs. placebo; 87+/-59 vs. 120+/-75, P = 0.03), and significant reduction of ORS intake (in milliliters per kilogram per day) (HEY vs. placebo; 84+/-46 vs. 122+/-72, P = 0.008) on day 1 and clearance of virus on day 4 (HEY vs. placebo; 73% vs. 46%, P = 0.02). There was, however, no difference in diarrheal duration between the groups. CONCLUSIONS: Treatment with HEY against four human rotavirus strains resulted in modest improvement of diarrhea associated with earlier clearance of rotavirus from stools. These results indicate an encouraging role of HEY in the treatment of rotavirus-induced diarrhea in children. Further studies are needed to optimize the dose and neutralization titer and thus improve the efficacy of egg yolk immunoglobulin IgY derived from immunized hens.

Core-excited states in the doubly magic 68Ni and its neighbor 69Cu

In deep-inelastic collisions of 8 MeV/nucleon 70Zn projectiles with 198Pt, we have found an 8(+) isomer with T(1/2) = 23(1) ns at 4208 keV in 68Ni; the nug(9/2) E2 effective charge was determined to be 1. 5(1)e. In 69Cu, a 19/2(-) isomer with T(1/2) = 22(1) ns at 3691 keV was identified and its decay data were calculated quite accurately by a parameter-free shell model calculation using empirical input parameters. Proton 2p- 1h excitation, fed by another T(1/2) = 39(6) ns isomer at 3827 keV, induces large collectivity in 69Cu.

Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery.

PURPOSE: Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients. METHODS: One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug. RESULTS: There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups. CONCLUSION: Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.

Acute graded hypercapnia increases collateral coronary blood flow in a swine model of chronic coronary artery obstruction.

OBJECTIVE: To evaluate the effect of acute hypercapnia on regional myocardial blood flow in a swine model of chronic, single-vessel coronary artery obstruction. Permissive hypercapnia is being used frequently in critical care settings. One possible detrimental effect of hypercapnia is the initiation of coronary "steal" in patients with coronary artery disease. The effects of hypercapnia on collateral coronary blood flow in the setting of coronary obstruction have not been defined. DESIGN: Prospective controlled experimental study. SETTING: Institutional animal research facility. SUBJECTS: Eight juvenile swine weighing 25-30 kg. INTERVENTIONS: Collateral coronary circulation was induced in eight piglets by banding the proximal left anterior descending coronary artery for 8-10 wks followed by total ligation. Graded hypercapnia (mean Paco2, 81 torr [10.80 kPa; Paco2 = 81 torr] and 127 torr [16.93 kPa; Paco2 = 127 torr]) was induced by increasing inspiratory carbon dioxide under isoflurane anesthesia (1 minimum alveolar concentration). MEASUREMENTS AND MAIN RESULTS: Animals were attached to instruments to measure pulmonary and systemic hemodynamics, regional myocardial blood flow, and cardiac output. Regional myocardial blood flow was determined using radiolabeled microspheres. Cardiac output, mean arterial pressure, and coronary perfusion pressure were unchanged at both levels of hypercapnia compared with baseline values. Heart rate was increased at Paco2 [HI] (p < .05). Regional blood flow was increased at both levels of hypercapnia in the collateral-dependent and normally perfused myocardium (p < .05; as high as 56% for subendocardium and as high as 106% for subepicardium at Paco2 [HI]). The intercoronary blood flow ratio remained unaltered. The transmural flow ratio was reduced at Paco2 [HI] (P < .05). During hypercapnia, regional lactate extraction remained unaltered, and regional oxygen extraction was unchanged or reduced despite the increase in oxygen consumption. CONCLUSIONS: In this swine model of chronic single-vessel coronary artery obstruction, acute hypercapnia does not induce coronary steal from collateral-dependent myocardium, but it does increase global coronary blood flow.