Preventative Management of Sepsis-Induced Acute Respiratory Distress Syndrome in the Geriatric Population.

Sepsis and its treatment are the most common etiologies of acute respiratory distress syndrome (ARDS), which has a disturbing mortality rate. Sepsis management relies heavily on the introduction of resuscitative fluids. However, when fluids are paired with the circulating inflammatory mediators of sepsis, patients are prone to lung damage. Survivors of sepsis-induced ARDS become plagued with functional and/or psychological sequelae such as impaired memory, difficulty in concentrating, and decreased mental processing speed. Specific techniques can be implemented when diagnosing and treating elderly patients with sepsis to prevent the onset of ARDS, including bed elevation and early antibiotics. Additionally, albumin infusion may be beneficial; however, more research must be conducted. Finally, inflammatory mediators, including serum mannose biomarkers and extracellular histone therapy, show a promising avenue for future treatment. Although there is limited research on osteopathic manipulative medicine (OMT) on ARDS or sepsis-induced ARDS, OMT that focuses on alleviating rib and thoracic somatic dysfunctions has been used as an adjunct therapy to treat other respiratory diseases, such as pneumonia and chronic obstructive pulmonary disease (COPD). The results of these studies may garner interest in whether the use of OMT as an adjunct therapy may be beneficial for patients with ARDS or sepsis-induced ARDS. This paper is intended to review the current guidelines for sepsis and ARDS management in elderly patients to identify measures to prevent sepsis-induced ARDS.

The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review.

Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is commonly used as an anesthetic and analgesic but has recently shown promising research in treating certain psychiatric conditions such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, and substance use disorder. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which has led to rigid regulation of medication. The COVID-19 pandemic has been an unprecedented challenge for the American population which was reflected in increased reports of problems regarding their mental health. Mood disorders have dramatically increased in the past two years. Approximately one in ten people stated that they had started or increased substance use because of the COVID-19 pandemic. Furthermore, rates of suicidal ideation have significantly increased when compared to pre-pandemic levels, with more than twice the number of adults surveyed in 2018 indicating suicidal thoughts "within the last 30 days" at the time they were surveyed. Moreover, many responders indicated they had symptoms of PTSD. The PubMed database was searched using the keyword "ketamine," in conjunction with "depression," "suicidal ideation," "substance use disorder," and "post-traumatic stress disorder." The inclusion criteria encompassed articles from 2017 to 2022 published in the English language that addressed the relationship between ketamine and mental health disorders. With this sharp increase in the prevalence of psychiatric disorders and an increased public interest in mental health combined with the promise of the therapeutic value of ketamine for certain mental health conditions, including suicidal ideation, this narrative review sought to identify recently published studies that describe the therapeutic uses of ketamine for mental health. Results of this review indicate that ketamine's therapeutic effects offer a potential alternative treatment for depression, suicidal ideation, substance use disorders, and PTSD.

Fine-Sampled Photographic Quantitation of Dermal Wound Healing Senescence in Aged BALB/cByJ Mice and Therapeutic Intervention with Fibroblast Growth Factor-1.

Objective: To determine quantitative parameters of dermal wound healing senescence in aged BALB/cByJ mice (an important animal model of aging) and to evaluate the potential for therapeutic intervention by fibroblast growth factor-1 (FGF-1). Approach: Utilize a novel noninvasive fine-sampled photographic methodology to quantify wound healing parameters for healing phases from wounding through to wound closure. Results: Parameters associated with key healing phases were quantified and compared between nonaged and aged cohorts of both genders. The results identify a sexual dimorphism in dermal wound healing, with nonaged females exhibiting a greater overall healing efficiency than males. This enhanced healing in females, however, senesces with age such that healing parameters for aged males and females are statistically indistinguishable. Topical application of FGF-1 was identified as an effective therapeutic intervention to treat dermal healing senescence in aged females. Innovation: The FGF intervention is being analyzed using a new recently published model. This approach significantly increases the amount of preclinical animal data obtainable in wound healing studies, minimizes cohort number compared with (lethal) histological studies, and permits a direct statistical comparison between different healing studies. Conclusion: Quantitative parameters of dermal wound healing, obtained from noninvasive fine-sampled photographic data, identify topical FGF-1 as an effective therapeutic to treat the senescence of dermal healing present in aged female BALB/cByJ mice.

Effects of perfluorocarbon emulsion in rheology.

AIM: To study effects of a perfluorocarbon emulsion on plasma and whole human blood viscosity in the presence of albumin or modified fluid gelatin. MATERIAL AND METHODS: We investigated the effects of several PFC concentrations on plasma and whole blood viscosity in the presence of human albumin solution (HAS) or modified fluid gelatine (MFG; Gelofusine) to obtain three PFC emulsion concentrations (4, 8 and 15 g/dL). Three hematocrit levels (Hct) were investigated: 30, 20 and 13%, corresponding to different clinical situations. Plasma and whole blood viscosity was measured at 37 degrees C, using a Couette viscometer for shear rates ranging from 0.2 to128 s(-1). RESULTS AND DISCUSSION: All PFC concentrations increased plasma and whole blood viscosity for the same Hct. Viscosity values similar to physiological ones were observed at Hct 13%, with MFG - PFC 4, 8 g/dL and HAS - PFC 15 g/dL; at Hct 20%, with MFG - PFC 4g/dL and HAS - PFC 15 g/dL; at Hct 30%, and HAS - PFC 4, 8 g/dL. CONCLUSIONS: We conclude that this PFC emulsion increases plasma and blood viscosity and that among the three studied volume expanders, the interaction with MFG can result in viscosity values above the physiological one even at low Hct values. Our results suggest that such increased blood viscosity could decrease skeletal muscle oxygen pressure.

Study on erythrocyte aggregation using computerized image analysis methods.

AIM: To study the relationship between erythrocyte aggregation and physical parameters: temperature and pH. MATERIAL AND METHODS: Aggregation was evaluated using computerized image analysis by Aggregate Shape Parameter (ASP), defined as the ratio of the aggregate projected area to its square perimeter, and erythrocyte aggregation index (EAI). EAI was measured and compared at different temperatures (4 degreeC, 20 degreeC, 37 degreeC) and different pH values (3, 5, 7 and 9). RESULTS AND DISCUSSION: The results show that the increase in temperature induces EAI increase and a decrease in Ph, a decrease of erythrocyte aggregation. It was found that, at pH=3 and 5, erythrocytes are destroyed and, at pH=9 RBC clusters are formed. CONCLUSIONS: RBC aggregate shape reflects intercellular interaction and its quantification may thus be another characteristic of RBC aggregation. Increased RBC aggregation was observed in various pathological states, such as diabetes and myocardial infarction, or following trauma.

[Studying erythrocyte deformation by optical methods]. / Studiul deformabilitatii eritrocitare prin metode optice.

UNLABELLED: Erythrocyte deformation is an important factor of the microcirculation in physiological and pathophysiological conditions. MATERIAL AND METHOD: Deformability was evaluated through the elongation index (IE) using two instruments based on optical methods: LORCA and RHEODYN-SSD. RESULTS: The elongation index (IE) was compared for normal red blood cell (RBC) and heated RBC at 49 degrees C for 9, 30, 60 minutes duration. Erythrocyte deformability was measured for RBC treated with diamide (two concentrations), too. The results show that the increase of the diamide concentration induces the increase of the rigidity and a decreased deformability through the decreased IE. The elongation index was found decreasing as long as the time of heating is bigger, the RBC becoming more rigid.

[Red cell shape--a biophysical analysis]. / Forma eritrocitului--o analiza biofizica.

Red cells have three main characteristics: specific shape--discoidal, deformability and aggregability. To give an explanation for his specific shape there are two ways: a) one, use hypothesis from mechanics, as: interfacial pressure, stress, deformability; b) the other way try to explain it by using data from molecular structure of biomembrane and cytoskeleton who are responsible of specific interactions between molecules. First direction was supported by many models, interesting but unrealized some of them because the theories from macroscopic mechanics wasn't well supported. The second direction, even more interesting then the first, was the subject of many studies but none of them gives a complete explanation for this particular shape of red cells. In present, there are many artificial data obtained experimental or in relation with pathological states. In our opinion, sustained also of literature data, the Helfrich's model is the most truth-like. After 1970, W. Helfrich tries to give an explanation of the particular shape of red cells, based on the curvature of elasticity and the grade of filled with hemoglobin. This model was proved also by experimental data, using "simplified red cells", and has also many others extensions. In the same direction are the studies of T.M. Fischer who describes a shape memory of human red blood cells, sustained experimental.

Effects of a new perfluorocarbon emulsion on human plasma and whole-blood viscosity in the presence of albumin, hydroxyethyl starch, or modified fluid gelatin: an in vitro rheologic approach.

BACKGROUND: Artificial oxygen carriers such as perfluorocarbon (PFC) emulsions have reached Phase III clinical trials as alternatives to homologous blood, but their rheologic effects have not been characterized. In this study, the rheologic effects of PFC emulsion in the presence of clinically used volume expanders were investigated. STUDY DESIGN AND METHODS: The effects of a new PFC emulsion (small droplet size with narrow size distribution) at two PFC concentrations (4 and 8 g/dL) on plasma and whole-blood viscosity in the presence of human albumin solution (HAS), hydroxyethyl starch (HES), or modified fluid gelatin (MFG) were investigated. Three hematocrit (Hct) levels were investigated: 30, 20, and 13 percent. Plasma, PFC emulsions, and whole-blood viscosity, with a Couette viscometer, and RBC elongation, with an ektacytometer, were measured for shear rates of 0.2 to 128 per second. RESULTS: The two PFC concentrations increased plasma and whole-blood viscosities. Viscosity values similar to physiologic ones (Hct level, 40%) were observed at: 1) Hct level of 13 percent, with 4 or 8 g per dL MFG-PFC; 2) Hct level of 20 percent, with 4 g per dL MFG-PFC; and 3) Hct level of 30 percent, with 4 g per dL HES-PFC and 4 and 8 g per dL HAS-PFC. RBC deformability was unchanged. CONCLUSION: It is concluded that this new PFC emulsion increases plasma and blood viscosity and that among the three studied volume expanders, the interaction with MFG can result in viscosity values above the physiologic one even at low Hct values. The possible consequences of the increased viscosity at low Hct values are discussed.