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1.
J Zoo Wildl Med ; 50(4): 874-878, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926518

RESUMEN

Hypoxic physiological states may occur during anesthetic events of snakes but accurate monitoring of oxygenation is challenging. Oxygenation levels of nine Louisiana pine snakes (Pituophis ruthveni) were assessed using transcutaneous regional oxygen saturation (rSO2) at the level of the liver (rSO2Liver) and at the halfway point of the body (rSO2Half ). Reflectance pulse oximetry measured SpO2, with a sensor overlying the heart. Values were compared with the venous partial pressure of oxygen (PvO2). Measurements were taken during four phases, simulating an anesthetic event: phase 1, breathing room air; phase 2, while supplied with supplemental oxygen via face mask; phase 3, during ketamine and dexmedetomidine sedation; and phase 4, after receiving atipamezole. There were no significant changes in any oxygenation parameters between concurrent phases, but respiratory rate significantly decreased (P = 0.02) between phases 1 and 2. Strong positive associations were found between both rSO2Liver and rSO2Half when compared with PvO2 irrespective of phase (r = 0.72, r = 0.63 respectively), but not with SpO2 (r = 0.3). Strength of correlation varied with each phase but was uniformly strongest for rSO2Liver. The measurement of rSO2 appears superior compared with traditional pulse oximetry for assessing oxygenation levels of snakes.


Asunto(s)
Monitoreo de Gas Sanguíneo Transcutáneo/veterinaria , Oxígeno/sangre , Serpientes/sangre , Animales
2.
J Zoo Wildl Med ; 50(4): 1026-1030, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926542

RESUMEN

The Galápagos shearwater, Puffinus subalaris, is a seabird endemic to the Galápagos archipelago. Hematology, blood chemistry, and general health parameters have not been published for this species. Analyses were run on blood samples drawn from 20 clinically healthy Galápagos shearwaters captured by hand at their nests at Islote Pitt on San Cristóbal Island in July 2016. A portable blood analyzer (iSTAT) was used to obtain near immediate field results for pH, pO2, pCO2, TCO2, HCO3 -, hematocrit, hemoglobin, sodium, potassium, chloride, ionized calcium, creatinine, urea nitrogen, anion gap, and glucose. Blood lactate was measured using a portable Lactate Plus analyzer. The reported results provide baseline data that can be used for comparisons among populations and in detecting changes in health status among Galápagos shearwaters.


Asunto(s)
Bicarbonatos/sangre , Aves/sangre , Dióxido de Carbono/sangre , Hematócrito/veterinaria , Oxígeno/sangre , Equilibrio Ácido-Base , Animales , Glucemia , Calcio/sangre , Cloruros/sangre , Creatinina/sangre , Hemoglobinas , Concentración de Iones de Hidrógeno , Lactatos/sangre , Potasio/sangre , Sodio/sangre
3.
Adv Exp Med Biol ; 1232: 85-90, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893398

RESUMEN

Delayed orthostatic hypotension (OH) is a minor subset of orthostatic dysregulation (OD). Cerebral blood oxygenation in juvenile patients with delayed OH has not been studied. We investigated the bilateral changes in cerebral oxygenation in the prefrontal cortex during an active standing test in 23 juvenile patients with delayed OH using near-infrared spectroscopy (NIRS). We measured the oxy-Hb, deoxy-Hb, and total-Hb during the active standing test. Four observations were made during the test: t1 in a resting supine position, t2 when maintaining blood pressure, and the remaining two (t3, t4) during hypotension. The concentration of oxy-Hb significantly decreased prior to satisfying the diagnostic criteria of delayed OH after standing and did not change thereafter. The concentration of deoxy-Hb increased gradually during the measurement periods. In addition, total-Hb increased from t2 to t3. There was no significant difference in the change in each Hb parameter between the left and right cerebral hemispheres. Our results indicate that NIRS parameters are more sensitive than blood pressure for the interpretation of cerebral autoregulation in juvenile patients with delayed OH.


Asunto(s)
Sistema Cardiovascular , Circulación Cerebrovascular , Hipotensión Ortostática , Oxígeno , Posición de Pie , Adolescente , Presión Sanguínea , Circulación Cerebrovascular/fisiología , Humanos , Hipotensión Ortostática/sangre , Hipotensión Ortostática/diagnóstico , Oxígeno/sangre , Espectroscopía Infrarroja Corta
4.
Adv Exp Med Biol ; 1232: 99-104, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893400

RESUMEN

The incidence of stress-induced psychological and somatic diseases has been increasing rapidly, and it is important to clarify the neurophysiological mechanisms of stress response in order to establish effective stress management methods. We previously reported that the prefrontal cortex (PFC) plays an important role in stress response. In the present study, we employed near-infrared spectroscopy (NIRS) and electroencephalography (EEG) to investigate the characteristics of PFC activity during mental arithmetic tasks. A two-channel NIRS device was used to measure hemoglobin (Hb) concentration changes in the bilateral PFC during a mental arithmetic task (2 min) in normal adults. Simultaneously, EEG was used to also measure bilateral PFC activity during the same task. We evaluated concentration changes of oxy-Hb induced by the task while analyzing α wave changes using power spectrum analysis. It was observed that oxy-Hb in the bilateral PFC increased significantly during the task (p < 0.05), while α wave power in the PFC decreased significantly (p < 0.01). The present results indicate that mental stress tasks caused the activation of the bilateral PFC. Simultaneous measurements of NIRS and EEG are useful for evaluating the neurophysiological mechanism of stress responses in the brain.


Asunto(s)
Electroencefalografía , Fenómenos Electromagnéticos , Oxígeno , Espectroscopía Infrarroja Corta , Estrés Psicológico , Adulto , Hemoglobinas/análisis , Humanos , Oxígeno/sangre , Oxihemoglobinas/análisis , Corteza Prefrontal/fisiopatología , Estrés Psicológico/fisiopatología
5.
Medicine (Baltimore) ; 99(4): e18657, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977855

RESUMEN

BACKGROUND: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX). RESULTS: Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36-4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24-15.07]). However, as a selective ß2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD -0.11 [95% CI -0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI -0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI -0.35 to 0.75]). CONCLUSION: Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.


Asunto(s)
Albuterol/uso terapéutico , Bronquiolitis/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Lactante , Tiempo de Internación , Oxígeno/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto , Frecuencia Respiratoria/efectos de los fármacos , Índice de Severidad de la Enfermedad
6.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 87-93, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31123057

RESUMEN

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology. STUDY DESIGN: A prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000-1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8-2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8-2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured. RESULTS: A total of 44 preterm infants, birth weights 500-1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3-6.1 cm H2O) and reduced pEECO2 (mean 2.3%-0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6-2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6-8 L/min was greater than nCPAP (2.4-13.5 vs 3.5-9.9 cm H2O). CONCLUSIONS: HFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC's role in dead space washout.


Asunto(s)
Terapia por Inhalación de Oxígeno/métodos , Respiración con Presión Positiva , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Peso Corporal , Dióxido de Carbono/sangre , Presión de las Vías Aéreas Positiva Contínua , Estudios Cruzados , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Oxígeno/sangre , Estudios Prospectivos , Volumen de Ventilación Pulmonar , Signos Vitales
7.
Br J Anaesth ; 124(1): 110-120, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31767144

RESUMEN

BACKGROUND: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. METHODS: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. RESULTS: We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. CONCLUSIONS: An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. CLINICAL TRIAL REGISTRATION: NCT02776046.


Asunto(s)
Oxígeno/uso terapéutico , Respiración Artificial/métodos , Infección de la Herida Quirúrgica/prevención & control , Abdomen/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Oxihemoglobinas/análisis , Oxihemoglobinas/metabolismo , Atención Perioperativa , Respiración con Presión Positiva , Medicina de Precisión , Atelectasia Pulmonar/epidemiología , Atelectasia Pulmonar/etiología , Resultado del Tratamiento
8.
Life Sci ; 240: 117081, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31756342

RESUMEN

BACKGROUND AND GOAL OF THE STUDY: Pulmonary inflammation, increased vascular permeability, and pulmonary edema, occur in response to primary pulmonary infections like pneumonia but are also evident in endotoxemia or sepsis. Mechanical ventilation augments pre-existing lung injury and inflammation resulting from exposure to microbial products. The objective of this study was to test the hypothesis that low-tidal-volume prevent ventilation induced lung injury in sepsis. MATERIALS AND METHODS: 10-12-week-old male C57BL/6N-mice received an intraperitoneal (i.p.) injection with equipotent dosages of LPS, 1668-thioate, 1612-thioate, or PBS. 120 min after injection, mice were randomized to low- (LV, 7 ± 1 ml/kg) or high-tidal-volume (HV, 25 ± 1 ml/kg) ventilation. Hemodynamic and ventilatory parameters were recorded and inflammatory markers were analyzed form BAL that was generated after 90 minute ventilation. RESULTS AND DISCUSSION: Arterial blood pressures declined during mechanical ventilation in all groups. pO2 decreased in LPS injected and CO2 increased in sham, LPS, and 1612-thioate administered mice at 45 min and in 1668-thioate injected mice after 90 minute LV ventilation compared to respective HV groups. BAL protein concentrations increased in HV ventilated and 1668- or 1612-thioat pre-treated mice. BAL TNF-α protein concentrations increased in both LPS- and 1668-thioate-injected and IL-1ß protein concentrations only in LPS-injected and HV ventilated mice. Most notably, no increased protein concentrations were observed in any of the LV ventilated groups. CONCLUSION: We conclude that low-tidal-volume ventilation may be a potential strategy for the prevention of ventilator induced lung injury in a murine model of systemic TLR agonist induced lung injury.


Asunto(s)
Inflamación/terapia , Sepsis/terapia , Volumen de Ventilación Pulmonar , Lesión Pulmonar Inducida por Ventilación Mecánica/prevención & control , Animales , Presión Arterial , Líquido del Lavado Bronquioalveolar , Dióxido de Carbono/sangre , Hemodinámica , Inflamación/complicaciones , Inflamación/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Oxígeno/sangre , Mecánica Respiratoria , Sepsis/complicaciones , Sepsis/patología , Lesión Pulmonar Inducida por Ventilación Mecánica/patología
9.
Int J Sports Med ; 41(1): 21-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31756737

RESUMEN

The aim of the study was to verify the relative contributions of energetic and kinematic parameters to the performance in 400-m front crawl test. Fourteen middle-distance swimmers participated in the study. Oxygen consumption was measured directly and blood samples were collected to assay lactate concentration. Both oxygen consumption and lactate concentration were used to calculate the: (i) overall energy expenditure, (ii) anaerobic (alactic and lactic) and (iii) aerobic contributions. The mean centre of mass speed and intracycle velocity variation were determined through three-dimensional kinematic analysis. Mean completion time was 315.64±26.91s. Energetic contributions were as follows: 6.1±0.28% from alactic anaerobic metabolism, 5.9±0.63% from anaerobic lactic and 87.8±0.88% from aerobic. Mean intracycle velocity variation was 0.14±0.03. The results indicated that performance of 400-m test relies predominantly on aerobic power. Parameters such as lactate, mean speed, anaerobic lactic and alactic (kW) correlated with performance of 400-m test (p <0.05). Multiple linear regressions indicated that mean centre of mass speed and anaerobic alactic (kW) determined the 400-m test performance (R2=0.92). Even though the T400 is characterized by aerobic metabolism, the anaerobic alactic component cannot be negligible at this competition level.


Asunto(s)
Metabolismo Energético/fisiología , Prueba de Esfuerzo/métodos , Natación/fisiología , Fenómenos Biomecánicos/fisiología , Conducta Competitiva/fisiología , Humanos , Ácido Láctico/sangre , Masculino , Oxígeno/sangre , Consumo de Oxígeno , Estudios de Tiempo y Movimiento , Grabación en Video , Adulto Joven
10.
Equine Vet J ; 52(1): 76-82, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31009091

RESUMEN

BACKGROUND: Administration of pulsed inhaled nitric oxide (PiNO) improves arterial oxygenation in spontaneously breathing anaesthetised healthy horses and in horses undergoing colic surgery. However, because hypoventilation commonly occurs, horses are often mechanically ventilated to prevent hypercarbia. OBJECTIVES: To evaluate the effects of PiNO on arterial oxygenation during anaesthesia in mechanically ventilated healthy horses and horses undergoing colic surgery. STUDY DESIGN: Prospective nonblinded clinical trial. METHODS: Fifty horses undergoing elective arthroscopy (Group A) and 30 horses undergoing colic surgery (Group C) in dorsal recumbency were included in the study. Every second horse in each group received PiNO (A-INO, C-INO), the others served as controls (A-CN, C-CN). All horses were mechanically ventilated and anaesthesia was maintained with isoflurane. PiNO was mechanically delivered at the proximal end of the endotracheal tube as a pulse during the first part of each inspiration. Data were collected at the start (baseline, before PiNO) and at the end of inhalation anaesthesia. The Tukey method was used to compare baseline and end values for each parameter. RESULTS: Arterial oxygen tension (PaO2 ) increased from (median [IQR]) 13.6 (9.3, 30.1) at baseline to 24.2 (18.6, 37.0) kPa at the end of anaesthesia in A-INO (P = 0.005) and from 7.7 (6.4, 8.5) to 15.5 (9.9, 26.9) kPa in C-INO (P = 0.007). Mean (95% CI) difference in F-shunt between baseline and end were -6 (-10; -1) and -11 (-22; -1) % in A-INO (P = 0.005) and C-INO (P = 0.04) respectively. There was no change in PaO2 or F-shunt from baseline to end of anaesthesia in A-CN or C-CN. MAIN LIMITATIONS: Cardiac output was not measured, thus O2 delivery could not be calculated. CONCLUSIONS: The combination of mechanical ventilation and PiNO improved pulmonary gas exchange during anaesthesia by a simultaneous decrease in F-shunt and improved alveolar ventilation.


Asunto(s)
Anestesia/veterinaria , Cólico/veterinaria , Enfermedades de los Caballos/cirugía , Óxido Nítrico/administración & dosificación , Oxígeno/sangre , Respiración Artificial/veterinaria , Animales , Artroscopía/veterinaria , Cólico/cirugía , Caballos
12.
Isr Med Assoc J ; 21(11): 743-746, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31713363

RESUMEN

BACKGROUND: The use of oral midazolam as premedication to induce anxiolysis before surgical procedures under local anesthesia is widely accepted in plastic surgery. Rhinoplasty performed under local anesthesia is known to generate high levels of perioperative anxiety, thus the use of appropriate premedication is important. Oral midazolam has been shown to be safe in various procedures. However, the safety of oral midazolam before rhinoplasty has not been evaluated. OBJECTIVES: To evaluate the safety of premedication with oral midazolam prior to rhinoplasty by analyzing the intraoperative blood oxygen saturation levels as predictors of adverse respiratory events. METHODS: We retrospectively reviewed the anesthesia records of 62 patients who underwent rhinoplasty under local anesthesia and received premedication with oral midazolam for anxiolysis between March 2017 and December 2017. The median age of the patients was 25.4 years, and they were all classified as American Society of Anesthesiologists class 1. The patients received 10 mg midazolam hydrochloride orally 1 hour prior to the procedure. Oxygen blood saturation was monitored using a pulse oximeter and recorded every 15 minutes. RESULTS: All the patients maintained blood oxygen saturation levels above 95% (median peripheral capillary oxygen saturation 99%) on room air, and they did not require supplemental intraoperative oxygen. There were no transient hypoxemic events during and following the procedure. CONCLUSIONS: Our study confirmed the safety of oral midazolam premedication to reduce perioperative anxiety when performing rhinoplasty under local anesthesia.


Asunto(s)
Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Oxígeno/sangre , Rinoplastia , Administración Oral , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oximetría , Premedicación , Estudios Retrospectivos
13.
World Neurosurg ; 131: 356-363, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31658578

RESUMEN

The aim of this study was to introduce resting-state functional magnetic resonance imaging (rest-fMRI) capability for brain tumor surgical planning. rest-fMRI is an emerging functional neuroimaging technique potentially able to provide new insights into brain physiology and to provide useful information regarding brain tumors in preoperative and postoperative settings. rest-fMRI evaluates low-frequency fluctuations in the blood oxygen level-dependent signal while the subject is at rest during magnetic resonance imaging examination. Multiple resting-state networks have been identified, including the somatosensory, language, and visual networks, which are of primary importance for surgical planning. We discuss the feasibility of rest-fMRI examination before and after surgical resection of brain tumors in routine clinical practice and the usefulness of the information obtained for surgical planning in brain tumor resection. rest-fMRI is particularly useful for patients who are unable to cooperate with the task-based paradigm, such as children or patients who are sedated, paretic, or aphasic. Although standardization and validation of rest-fMRI are still ongoing, this technique is feasible and valuable and can be implemented for routine clinical surgical planning.


Asunto(s)
Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Craneotomía/métodos , Estudios de Factibilidad , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Planificación de Atención al Paciente , Cuidados Preoperatorios/métodos , Lóbulo Temporal/patología , Lóbulo Temporal/cirugía
14.
Top Magn Reson Imaging ; 28(5): 285-297, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31592995

RESUMEN

The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort.


Asunto(s)
Hiperoxia/diagnóstico por imagen , Hiperoxia/patología , Imagen por Resonancia Magnética/métodos , Oxígeno/sangre , Placenta/diagnóstico por imagen , Placenta/patología , Animales , Femenino , Humanos , Embarazo
16.
Clin Biochem ; 74: 47-53, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31533025

RESUMEN

BACKGROUND: Blood gas analyzers are frequently installed as point of care devices and thus allow rapid decision making. Few data are available regarding analytical performance of large sets of BGA. We aimed at evaluating 22 ABL 90 Flex Plus analyzers intended to be deployed. The evaluation was performed at the device level and at the entire set level to characterize the quality of measurements but also to ensure consistency across the devices deployed in the hospital. METHODS: Imprecision and total error were assessed for pH, pCO2, pO2, sodium, potassium, ionized calcium, glucose, lactate and oximetry parameters. Imprecision at the hospital level including between device variability was also evaluated. One of the two analyzers used in the central laboratory was correlated with a GEM Premier 4000 and a Cobas b221 analyzers. Thereafter, we tested sequentially the 20 instruments intended to be deployed in care service in comparison with the reference device. RESULTS: Heterogeneity of analytical performance across the different analyzers was low, allowing to consider the whole set as a unique analyzer. The total error was in line with performance goals. Analytical performance of the analyzers was found suitable for use in clinical practice. CONCLUSIONS: Our study is an example of the qualification of a set of point and underscores 1)The need for a unified qualification scheme when multiple analyzers are deployed simultaneously 2) analytical performance goals compatible with clinical use and the state of the art for all parameters.


Asunto(s)
Análisis de los Gases de la Sangre/instrumentación , Sistemas de Atención de Punto , Glucemia , Calcio/sangre , Dióxido de Carbono/sangre , Toma de Decisiones Clínicas , Equipos y Suministros de Hospitales , Humanos , Concentración de Iones de Hidrógeno , Laboratorios de Hospital , Ácido Láctico/sangre , Oxígeno/sangre , Potasio/sangre , Reproducibilidad de los Resultados , Sodio/sangre
17.
Invest Ophthalmol Vis Sci ; 60(12): 3762-3767, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31499531

RESUMEN

Purpose: Diabetic retinopathy is characterized by disturbances in retinal blood flow mediated by capillary occlusion, intraretinal microvascular abnormalities (IRMAs), neovascularizations, and omega loops and reduplications. It is likely that the study of oxygen saturation in these abnormalities can provide knowledge about their role in the development of diabetic retinopathy. Methods: The oxygen saturation in IRMA vessels and venous loops and reduplications were studied in 40 diabetic patients with severe nonproliferative or proliferative diabetic retinopathy. The saturation values in the studied vascular abnormalities were compared to those of the larger retinal arterioles and venules. Results: There was a similar oxygen saturation (mean ± SD) in IRMAs observed to connect arterioles with venules (78.6% ± 11.8%, n = 22) and IRMAs connecting venules with venules (79.2% ± 9.0%, n = 12; P > 0.999). The saturation in IRMAs was significantly lower (P < 0.0002) than in arterioles (97.4% ± 5.2%, n = 40) and significantly higher (P < 0.0001) than the saturation in omega loops and reduplications (54.2% ± 19.3%, n = 6), which in turn showed no significant difference from the saturation in the venules (61.8% ± 6.8%, n = 40, P = 0.4). Conclusions: The findings suggest that the oxygen saturation in vascular abnormalities in diabetic retinopathy depends on the extent of arteriovenous (A-V) shunting, with venous saturation due to no A-V shunting in venous loops and reduplications, and intermediate oxygen saturation due to moderate shunting in IRMAs. This may precede the development of neovascularizations with arterial oxygen saturation due to high A-V shunting.


Asunto(s)
Malformaciones Arteriovenosas/fisiopatología , Retinopatía Diabética/fisiopatología , Oxígeno/sangre , Vasos Retinianos/anomalías , Adulto , Diabetes Mellitus Tipo 1/fisiopatología , Femenino , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Oximetría , Consumo de Oxígeno/fisiología , Flujo Sanguíneo Regional/fisiología , Arteria Retiniana/anomalías , Arteria Retiniana/fisiología , Vena Retiniana/anomalías , Vena Retiniana/fisiología , Vasos Retinianos/fisiopatología , Agudeza Visual/fisiología
18.
N Engl J Med ; 381(10): 923-932, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31483963

RESUMEN

BACKGROUND: Pulmonary alveolar proteinosis is a disease characterized by abnormal accumulation of surfactant in the alveoli. Most cases are autoimmune and are associated with an autoantibody against granulocyte-macrophage colony-stimulating factor (GM-CSF) that prevents clearing of pulmonary surfactant by alveolar macrophages. An open-label, phase 2 study showed some therapeutic efficacy of inhaled recombinant human GM-CSF in patients with severe pulmonary alveolar proteinosis; however, the efficacy in patients with mild-to-moderate disease remains unclear. METHODS: We conducted a double-blind, placebo-controlled trial of daily inhaled recombinant human GM-CSF (sargramostim), at a dose of 125 µg twice daily for 7 days, every other week for 24 weeks, or placebo in 64 patients with autoimmune pulmonary alveolar proteinosis who had a partial pressure of arterial oxygen (Pao2) while breathing ambient air of less than 70 mm Hg (or <75 mm Hg in symptomatic patients). Patients with severe pulmonary alveolar proteinosis (Pao2 <50 mm Hg) were excluded to avoid possible exacerbation of the disease in patients who were assigned to receive placebo. The primary end point was the change in the alveolar-arterial oxygen gradient between baseline and week 25. RESULTS: The change in the mean (±SD) alveolar-arterial oxygen gradient was significantly better in the GM-CSF group (33 patients) than in the placebo group (30 patients) (mean change from baseline, -4.50±9.03 mm Hg vs. 0.17±10.50 mm Hg; P = 0.02). The change between baseline and week 25 in the density of the lung field on computed tomography was also better in the GM-CSF group (between-group difference, -36.08 Hounsfield units; 95% confidence interval, -61.58 to -6.99, calculated with the use of the Mann-Whitney U test and the Hodges-Lehmann estimate of confidence intervals for pseudo-medians). Serious adverse events developed in 6 patients in the GM-CSF group and in 3 patients in the placebo group. CONCLUSIONS: In this randomized, controlled trial, inhaled recombinant human GM-CSF was associated with a modest salutary effect on the laboratory outcome of arterial oxygen tension, and no clinical benefits were noted. (Funded by the Japan Agency for Medical Research and Development and the Ministry of Health, Labor, and Welfare of Japan; PAGE ClinicalTrials.gov number, NCT02835742; Japan Medical Association Center for Clinical Trials number, JMA-IIA00205.).


Asunto(s)
Enfermedades Autoinmunes/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéutico , Factores Inmunológicos/uso terapéutico , Proteinosis Alveolar Pulmonar/tratamiento farmacológico , Administración por Inhalación , Adulto , Anciano , Autoanticuerpos/sangre , Enfermedades Autoinmunes/diagnóstico por imagen , Método Doble Ciego , Esquema de Medicación , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/administración & dosificación , Factor Estimulante de Colonias de Granulocitos y Macrófagos/efectos adversos , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Proteinosis Alveolar Pulmonar/diagnóstico por imagen , Proteinosis Alveolar Pulmonar/inmunología , Capacidad de Difusión Pulmonar , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Fumar/efectos adversos , Tomografía Computarizada por Rayos X , Prueba de Paso
19.
Clin Biochem ; 74: 80-85, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31493379

RESUMEN

Hb variants are structurally abnormal haemoglobins which can originate a wide range of phenotypes from clinically silent conditions to very severe disorders. In many cases, diagnosis is very difficult due to the instability of Hb mutants or the occurrence of misleading symptoms, such as cyanosis or hypoxia. Here we report the case of a young female with undiagnosed chronic haemolytic anaemia and low oxygen saturation in the absence of respiratory distress. High performance liquid chromatography showed the occurrence of an abnormal peak in the HbA2 region, which disappeared few days after blood sampling. Genetic analysis of both α genes revealed the -α3.7 deletion in heterozygous state and a novel mutation c.130 T > C leading to the substitution of Phenylalanine at codon 43 with Leucine in the α1 gene. This substitution originated a new Hb variant, named Hb Vanvitelli, with a molecular mass of 15,092.2 ±â€¯0.4 Da. Biochemical and laboratory tests described a hyper unstable Hb variant with altered oxygen affinity that was clinically significant only when co-inherited with genetic defects affecting the α2 locus. This case highlights the genetic complexity and diagnostic pitfalls of Hb variants, defined "experiments of nature" which can generate severe clinical conditions.


Asunto(s)
Anemia Hemolítica/diagnóstico , Anemia Hemolítica/genética , Hemoglobinas Anormales/genética , Eliminación de Secuencia , Globinas alfa/genética , Adolescente , Secuencia de Aminoácidos/genética , Sustitución de Aminoácidos/genética , Anemia Hemolítica/sangre , Cromatografía Liquida , Enfermedad Crónica , Codón/genética , Femenino , Pruebas Genéticas , Heterocigoto , Humanos , Italia , Espectrometría de Masas , Oximetría , Oxígeno/sangre , Linaje , Fenotipo
20.
J Strength Cond Res ; 33(10): 2622-2628, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31403576

RESUMEN

Walker, AJ, McFadden, BA, Sanders, DJ, Rabideau, MM, Hofacker, ML, and Arent, SM. Biomarker response to a competitive season in Division I female soccer players. J Strength Cond Res 33(10): 2622-2628, 2019-The purpose of this study was to evaluate effects of training load (TL) on performance and biomarkers of health, performance, and recovery in Division I female soccer players throughout a competitive season. Subjects (N = 25, Mage = 20 ± 1.1 years) were monitored before the start of preseason and every 4-weeks thereafter (T1-T5). A battery of performance tests was administered before the start of preseason (P1) and end-of-season (P2), including body composition (percent body fat [%BF], fat free mass [FFM], and fat mass), vertical jump (VJ), and VO2max. Blood draws were conducted at every time point (T1-T5) to assess free and total cortisol (CORTF and CORTT), prolactin (PRL), T3, IL-6, creatine kinase (CK), sex-hormone binding globulin, omega-3 (n-3FA), vitamin-D (Vit-D), iron (Fe), hematocrit (HcT), ferritin (Fer), percent saturation (%Sat), and total iron-binding capacity (TIBC). Daily exercise energy expenditure (EEE) and TL were determined. There were significant declines in VO2max, VJ, weight, and %BF from P1-P2 (p < 0.05) with no significant differences in FFM. Training load and EEE significantly decreased from T1-T3 (p < 0.05). Significant increases were seen in CORTT, CORTF, PRL, T3, IL-6, CK, and TIBC throughout the season (p < 0.05). Significant decreases were seen in n-3FA, Fe, Fer, %Sat, and Hct throughout the season (p < 0.05). Female athletes experience significant physiological changes following high TL and EEE associated with preseason and appear to be further exacerbated by the cumulative effects of the season. Unique insights provided by biomarkers enable athletes and coaches to be cognizant of the physiological changes that are occurring throughout the season.


Asunto(s)
Rendimiento Atlético/fisiología , Ejercicio/fisiología , Esfuerzo Físico/fisiología , Fútbol/fisiología , Adolescente , Biomarcadores/sangre , Composición Corporal , Peso Corporal , Creatina Quinasa/sangre , Prueba de Esfuerzo , Ácidos Grasos Omega-3/sangre , Femenino , Ferritinas/sangre , Hematócrito , Humanos , Hidrocortisona/sangre , Interleucina-6/sangre , Hierro/sangre , Oxígeno/sangre , Consumo de Oxígeno , Acondicionamiento Físico Humano/fisiología , Prolactina/sangre , Globulina de Unión a Hormona Sexual/metabolismo , Triyodotironina/sangre , Vitamina D/sangre , Adulto Joven
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