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1.
J Sports Sci Med ; 18(2): 271-281, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31191097

RESUMO

According to recent literature sodium bicarbonate (NaHCO3) has been proposed as a performance enhancing aid by reducing acidosis during exercise. The aim of the current review is to investigate if the duration of exercise is an essential factor for the effect of NaHCO3. To collect the latest studies from electronic database of PubMed, study publication time was restricted from December 2006 to December 2016. The search was updated in July 2018. The studies were divided into exercise durations of > 4 or ≤ 4 minutes for easier comparability of their effects in different exercises. Only randomized controlled trials were included in this review. Of the 775 studies, 35 met the inclusion criteria. Study design, subjects, effects as well as outcome criteria were inconsistent throughout the studies. Seventeen of these studies reported performance enhancing effects after supplementing NaHCO3. Eleven of twenty studies with exercise duration of ≤ 4 minutes showed positive and four diverse results after supplementing NaHCO3. On the other hand six of fifteen studies with an exercise duration of >4 minutes showed performance enhancing and two studies showed diverse results. Consequently, the duration of exercise might be influential for inducing a performance enhancing effect when supplementing NaHCO3, but to which extent, remains unclear due to the inconsistencies in the study results.


Assuntos
Acidose/prevenção & controle , Desempenho Atlético/fisiologia , Substâncias para Melhoria do Desempenho/farmacologia , Bicarbonato de Sódio/farmacologia , Atletas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Curr Opin Anaesthesiol ; 32(3): 384-391, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30925513

RESUMO

PURPOSE OF REVIEW: The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative fluid management in children may lead to serious complications and a negative outcome. Therefore, in this review, historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. RECENT FINDINGS: Optimized fasting times and liberal clear fluid intake until 1 h improve patient comfort and metabolic and haemodynamic condition after induction of anaesthesia. Physiologically composed balanced isotonic electrolyte solutions are safer than hypotonic electrolyte solutions or saline 0.9% to protect young children against the risks of hyponatraemia and hyperchloraemic acidosis. For intraoperative maintenance infusion, addition of 1-2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss. SUMMARY: Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in patients with preexisting imbalances and have a wide margin of safety in case of accidental hyperinfusion.


Assuntos
Anestesia/métodos , Eletrólitos/administração & dosagem , Hidratação/métodos , Soluções Isotônicas/administração & dosagem , Assistência Perioperatória/métodos , Acidose/etiologia , Acidose/prevenção & controle , Anestesia/efeitos adversos , Criança , Jejum/fisiologia , Hidratação/normas , Homeostase/fisiologia , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Infusões Intravenosas , Assistência Perioperatória/normas
3.
J Anim Sci ; 97(3): 1347-1363, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753501

RESUMO

The objective of this trial was to determine the benefits of supplementing active dried yeast (ADY; 3 × 1010 CFU/d of Saccharomyces cerevisiae) in diets of growing and finishing steers on ruminal pH and liver health, and evaluate the relationship of these variables with performance traits. Growing beef steers (n = 120) were blocked by weight (i.e., heavy and light) and allocated to 1 of 4 pens in an automated feed intake monitoring system. Steers were fed either control (CON; no ADY) or ADY supplemented in 4 sequential diets: grower diet from days 0 to 70, 2 step up diets (STEP1 and STEP2) for 7 d each, and finishing diet from days 85 to 164. Indwelling rumen boli were administered to monitor rumen pH during days 56 to 106 during the dietary transition. An exchange of pen assignment, within block, occurred on day 70 resulting in 4 final treatment (TRT) assignments: steers fed CON before and after the exchange (CC; n = 30), steers fed CON before and ADY after the exchange (CY; n = 30), steers fed ADY before and CON after the exchange (YC; n = 30), and steers fed ADY (YY; n = 30). Ruminal parameters were analyzed as a randomized complete block design with repeated measures of day, diet and TRT as fixed effects, and block as random effects, using 2 approaches: preliminary analysis of the means or drift analysis (DA; units change from basal values over time). Ruminal pH duration (DUR) below 6.0 (P = 0.05) and 5.8 (P = 0.05) was greater for CY steers than CC steers. Acidosis bout prevalence (pH < 5.6 for 180 consecutive minutes; P < 0.01) and bout DUR (P = 0.05) were greater for CY than other TRT groups. The DA indicated that the ruminal pH variables range, variance, and amplitude of steers in the YC group drifted further from basal pH values than CY and YY steers during the dietary transition (P ≤ 0.02), indicating that removing ADY during the dietary transition was not favorable, but including ADY may reduce ruminal fluctuation. Steers with fewer days experiencing bouts (DEB) had numerically greater ADG (P = 0.11) and tended to have greater G:F (P = 0.06). Liver abscess severity negatively affected ADG (P = 0.04). However, liver abscess severity was not affected by DEB (P = 0.90). There is evidence to suggest that the addition of the specific ADY strain in the diets of beef cattle during the dietary transition may aid in ruminal stabilization, but our study did not find evidence that acidosis bouts were related to abscess prevalence or severity.


Assuntos
Acidose/veterinária , Ração Animal/análise , Doenças dos Bovinos/prevenção & controle , Suplementos Nutricionais , Abscesso Hepático/veterinária , Fermento Seco/farmacologia , Acidose/epidemiologia , Acidose/prevenção & controle , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Dieta/veterinária , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Fígado/efeitos dos fármacos , Fígado/fisiologia , Abscesso Hepático/epidemiologia , Abscesso Hepático/prevenção & controle , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Masculino , Prevalência , Distribuição Aleatória , Rúmen/metabolismo
4.
Medicine (Baltimore) ; 98(1): e13947, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608428

RESUMO

BACKGROUND: Spinal anesthesia is the standard technique for elective cesarean section, but the incidence of maternal hypotension in this setting is reportedly about 80%, without any prophylactic management. Vasopressors are the most reliable method for counteracting the hypotension induced by spinal anesthesia. However, studies investigating the effects of vasopressors have yielded inconsistent and debatable results. Therefore, we plan to conduct a systematic review and network meta-analysis to identify the most effective vasopressor to prevent maternal hypotension, and to decrease fetal acidosis in women undergoing spinal anesthesia for elective cesarean section. METHODS: A systematic and comprehensive search to detect all the randomized controlled studies on vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia will be performed using information in the databases, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, beginning from their inception to October 2018. We will conduct a network meta-analysis to combine the direct and indirect comparisons of the vasopressors. We will use the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of vasopressors. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool. All statistical analyses will be performed using Stata SE version 15.0. ETHICS AND DISSEMINATION: This systematic review and meta-analysis will be published in a peer-reviewed journal. Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. TRIAL REGISTRATION NUMBER: The protocol for this review has been registered in the PROSPERO network (registration number: CRD42018111852).


Assuntos
Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Hipotensão/tratamento farmacológico , Vasoconstritores/uso terapêutico , Acidose/prevenção & controle , Feminino , Doenças Fetais/tratamento farmacológico , Doenças Fetais/metabolismo , Humanos , Hipotensão/induzido quimicamente , Meta-Análise em Rede , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vasoconstritores/administração & dosagem
5.
FASEB J ; 33(4): 4996-5004, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30596520

RESUMO

Decreases in pH (acidosis) in vitro can alter skeletal muscle mitochondrial function [respiration and reactive oxygen species (ROS) emission]. However, because skeletal muscles readily adapt to exercise, the effects of acidosis may be different on sedentary vs. trained muscle. The aim of this work was to compare the effects of pH on skeletal muscle mitochondrial function between sedentary vs. exercise-trained male Sprague-Dawley rats ( n = 10 in each cohort). Rates of mitochondrial respiration and ROS emission were determined from the soleus muscle of both cohorts over a physiologic range of pH values (pH 6.2-7.1). Exercise-trained rats had 14% higher mean muscle buffering capacities; 46 and 40% greater enzyme activity of citrate synthase and lactate dehydrogenase, respectively; and greater activity of respiratory complexes I-IV. ADP-stimulated respiration with complex I and II substrates was ∼25% greater in exercise-trained rats but was unaffected by pH in either cohort. In both cohorts, lowering pH decreased respiration only in complex I- and complex II-supported nonphosphorylating (leak) state. However, as pH decreased, ROS emissions in complex I- and complex II-supported leak state decreased only in sedentary rats; in exercise-trained rats, ROS emissions in this state remained constant. We hypothesize that this effect may result from modulation at complex III, which declined 47% per unit pH in sedentary rats, in comparison to 23% in exercise-trained rats. Taken together, these data suggest that pH regulates mitochondrial respiratory complexes and that exercise training can decrease the effects of pH on skeletal muscle mitochondrial function.-Hedges, C. P., Bishop, D. J., Hickey, A. J. R. Voluntary wheel running prevents the acidosis-induced decrease in skeletal muscle mitochondrial reactive oxygen species emission.


Assuntos
Acidose/prevenção & controle , Mitocôndrias/metabolismo , Atividade Motora/fisiologia , Músculo Esquelético/metabolismo , Condicionamento Físico Animal/métodos , Animais , Citrato (si)-Sintase/metabolismo , Concentração de Íons de Hidrogênio , Masculino , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio
6.
J Sports Sci ; 37(7): 762-771, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30319077

RESUMO

The aim of this study was to perform a systematic review and meta-analysis on the acute and chronic effects of sodium bicarbonate (NaHCO3) ingestion on Wingate performance. Following a search through PubMed, Scopus and Web of Science, 9 studies were found meeting inclusion criteria (6 acute and 3 chronic). Random-effects meta-analysis of standardized mean difference (SMD) for peak and mean power was performed. Study quality was assessed using the QualSyst. Results of the meta-analysis showed that acute ingestion of NaHCO3 did not improve Wingate test peak (weighted average effect size Hedges's g = 0.02, 95%CI: - 0.19 to 0.23, P = 0.87) or mean power (weighted average effect size Hedges's g = 0.15, 95%CI: -0.06 to 0.36, P = 0.92). However, chronic ingestion of NaHCO3 improved Wingate test peak (weighted average effect size Hedges's g = 1.21, 95%CI: 0.83 to 1.42, P = 0.001) and mean power (weighted average effect size Hedges's g = 1.26, 95%CI: 0.96 to 1.56, P = 0.001). Quality assessment of selected articles was classified as strong. This meta-analysis provides evidence that chronic, but not acute, ingestion of NaHCO3 increases both Wingate test peak and mean power.


Assuntos
Acidose/prevenção & controle , Desempenho Atlético/fisiologia , Teste de Esforço/métodos , Bicarbonato de Sódio/administração & dosagem , Administração Oral , Esquema de Medicação , Metabolismo Energético/efeitos dos fármacos , Humanos , Fadiga Muscular/fisiologia , Bicarbonato de Sódio/sangue
7.
Am J Phys Anthropol ; 168(1): 170-179, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30462349

RESUMO

OBJECTIVES: Geophagy has several hypothesized functions, among them (1) detoxification of plant secondary compounds, for example, tannins, (2) buffering stomach pH to alleviate acidosis caused by high sugar intake, and (3) supplementing the diet with mineral nutrients. We tested these hypotheses in Nepal gray langurs (Semnopithecus schistaceus), a foregut fermenter for which fruits and leaves dominate the diet at different times of the year. MATERIALS AND METHODS: We collected data on feeding time per food item for 21 unprovisioned adult langurs at Ramnagar, Nepal, for 1 year using instantaneous sampling (773 observation hours). We combined these data with relative sugar and tannin content of food items to estimate diet content. We collected rainfall data to distinguish the wet season (May-September) from the dry season (October-April). We collected soil samples from consumption and control sites to test for pH and sodium, potassium, magnesium, and calcium concentrations. RESULTS: Langurs consumed soil from two sources: termite structures (in almost all months) and river banks and beds (mainly in the dry season). Soil feeding was not positively correlated with dietary tannin or sugar content (GLMM). Soil pH was not high enough to buffer stomach contents. Only sodium was significantly higher in consumed soil. DISCUSSION: The most likely function of geophagy was the acquisition of sodium. This conclusion is consistent with reports for other animals. Buffering stomach pH, an often-suggested function for animals with ruminant-like digestion, was not supported. Detoxification, often proposed for animals with a diet high in secondary compounds, was also not supported.


Assuntos
Comportamento Alimentar/fisiologia , Sódio/metabolismo , Acidose/prevenção & controle , Animais , Antropologia Física , Feminino , Concentração de Íons de Hidrogênio , Masculino , Nepal , Estações do Ano
8.
Anim Sci J ; 90(2): 189-195, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30554451

RESUMO

The effect of wood kraft pulp (KP) feed on dietary digestibility, ruminal fluid pH, rumen fermentation characteristics, and milk production performance in lactating dairy cows was examined. Four lactating dairy cows were used for the feeding experiment by the cross-over design. The control group and KP group were set up as treatments. The control group was fed total mixed ration (TMR) (40% roughage and 60% concentrate) and the KP group was fed TMR containing 12% KP that replaced half of the rolled corn in the control diet. The dry matter intake, digestibility of the feed components, and milk yield were not significantly different between control group and KP group. The number of times that the ruminal fluid pH was below 6.1 tended to decrease in the KP group compared to the control group (p < 0.10). The acetic acid ratio in the ruminal fluid of the KP group increased compared to the control group (p < 0.05) and the propionic acid ratio in the ruminal fluid of the KP group decreased compared to the control group (p < 0.05). The acetate:propionate acid ratio was increased in the KP group compared with the control group (p < 0.05). Lipopolysaccharide levels in the ruminal fluid of the KP group tended to decrease compared to the control group (p < 0.10). Based on these results, it was indicated that the use of KP feed for lactating dairy cows induced the same rumen fermentation characteristics as those in cows given a large amount of roughage without depressing milk productivity. Therefore, KP could be a valuable feed resource substitute for grains, which would also reduce the risk for subacute rumen acidosis.


Assuntos
Ração Animal , Bovinos/fisiologia , Dieta/veterinária , Fermentação/fisiologia , Lactação , Leite/metabolismo , Rúmen/metabolismo , Acidose/prevenção & controle , Acidose/veterinária , Animais , Doenças dos Bovinos/prevenção & controle , Indústria de Laticínios , Fibras na Dieta , Digestão , Feminino , Concentração de Íons de Hidrogênio , Madeira
9.
Eur J Orthop Surg Traumatol ; 29(3): 501-508, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30317470

RESUMO

The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the "second hit" of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying "do no further harm".


Assuntos
Fraturas Ósseas/cirurgia , Traumatismo Múltiplo/cirurgia , Procedimentos Ortopédicos/métodos , Lesões Relacionadas à Guerra/cirurgia , Acidose/prevenção & controle , Transtornos da Coagulação Sanguínea/prevenção & controle , Humanos , Hipotermia/prevenção & controle , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/fisiopatologia , Lesões Relacionadas à Guerra/complicações , Lesões Relacionadas à Guerra/fisiopatologia
10.
J Agric Food Chem ; 66(33): 8729-8736, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30008219

RESUMO

We investigated the effect of sodium butyrate feeding on the disruption of ruminal epithelium barrier function in goats fed a high-concentrate diet. A total of 18 male Boer goats (live weight of 31.75 ± 1.35 kg, aged 1 year) were randomly assigned to three groups, which were fed a low-concentrate diet (LC), a high-concentrate diet (HC), or a high-concentrate diet with 1% sodium butyrate by weight (SH) for 9 weeks. We found that the pH of rumen fluid in the SH and LC groups was higher than that in the HC group. The activity of protein kinase C (PKC) kinase in the rumen epithelium was higher in the HC group than that in the LC and SH groups. The mRNA expression and phosphorylated protein levels of mitogen-activated protein kinases (MAPKs) in the rumen epithelium were lower in the SH and LC groups than those in the HC group. The DNA methylation rate of occludin was higher in the HC group than that in the SH and LC groups. The mRNA and protein expression of claudin-1, claudin-4, occludin, and zona occludin-1 was greater in the SH and LC groups than that in the HC group. In addition, sodium butyrate mitigated damage to the rumen epithelium caused by the HC diet. Together, our results suggest that the supply of sodium butyrate reverses the damage of rumen epithelium tight junction by inhibiting PKC and MAPK signaling pathways and is protective to the rumen epithelium during subacute rumen acidosis.


Assuntos
Acidose/veterinária , Ração Animal/efeitos adversos , Ácido Butírico/administração & dosagem , Epitélio/metabolismo , Doenças das Cabras/prevenção & controle , Cabras/metabolismo , Rúmen/metabolismo , Acidose/genética , Acidose/metabolismo , Acidose/prevenção & controle , Ração Animal/análise , Animais , Claudina-1/genética , Claudina-1/metabolismo , Metilação de DNA , Doenças das Cabras/genética , Doenças das Cabras/metabolismo , Cabras/genética , Concentração de Íons de Hidrogênio , Masculino , Ocludina/genética , Ocludina/metabolismo , Proteína Quinase C/genética , Proteína Quinase C/metabolismo , Rúmen/química , Junções Íntimas/genética , Junções Íntimas/metabolismo
11.
Am J Physiol Renal Physiol ; 315(3): F711-F725, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29741098

RESUMO

Metabolic acidosis is the most common acid-base disorder in septic patients and is associated with increased mortality. Previously, we demonstrated that sepsis induced by cecal ligation and puncture (CLP) impairs [Formula: see text] absorption in the medullary thick ascending limb (MTAL) by 1) decreasing the intrinsic [Formula: see text] absorptive capacity and 2) enhancing inhibition of [Formula: see text] absorption by LPS through upregulation of Toll-like receptor (TLR) 4 signaling. Both effects depend on ERK activation. Monophosphoryl lipid A (MPLA) is a detoxified TLR4 agonist that enhances innate antimicrobial immunity and improves survival following sepsis. Pretreatment of MTALs with MPLA in vitro prevents LPS inhibition of [Formula: see text] absorption. Here we examined whether pretreatment with MPLA would protect the MTAL against sepsis. Vehicle or MPLA was administered to mice 48 h before sham or CLP surgery, and MTALs were studied in vitro 18 h postsurgery. Pretreatment with MPLA prevented the effects of sepsis to decrease the basal [Formula: see text] absorption rate and enhance inhibition by LPS. These protective effects were mediated through MPLA stimulation of a Toll/IL-1 receptor domain-containing adaptor-inducing IFN-ß-(TRIF)-dependent phosphatidylinositol 3-kinase-Akt pathway that prevents sepsis- and LPS-induced ERK activation. The effects of MPLA to improve MTAL [Formula: see text] absorption were associated with marked improvement in plasma [Formula: see text] concentration, supporting a role for the kidneys in the pathogenesis of sepsis-induced metabolic acidosis. These studies support detoxified TLR4-based immunomodulators, such as MPLA, that enhance antimicrobial responses as a safe and effective approach to prevent or treat sepsis-induced renal tubule dysfunction and identify cell signaling pathways that can be targeted to preserve MTAL [Formula: see text] absorption and attenuate metabolic acidosis during sepsis.


Assuntos
Acidose/prevenção & controle , Bicarbonatos/metabolismo , Lipídeo A/análogos & derivados , Alça do Néfron/efeitos dos fármacos , Reabsorção Renal/efeitos dos fármacos , Sepse/tratamento farmacológico , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/metabolismo , Acidose/fisiopatologia , Proteínas Adaptadoras de Transporte Vesicular/deficiência , Proteínas Adaptadoras de Transporte Vesicular/genética , Animais , Bicarbonatos/sangue , Bicarbonatos/urina , Modelos Animais de Doenças , Ativação Enzimática , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Lipídeo A/farmacologia , Alça do Néfron/metabolismo , Alça do Néfron/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fosfatidilinositol 3-Quinase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Sepse/metabolismo , Sepse/fisiopatologia , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/agonistas
12.
J Dairy Sci ; 101(2): 872-888, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29153519

RESUMO

Rumen health is of vital importance in ensuring healthy and efficient dairy cattle production. Current feeding programs for cattle recommend concentrate-rich diets to meet the high nutritional needs of cows during lactation and enhance cost-efficiency. These diets, however, can impair rumen health. The term "subacute ruminal acidosis" (SARA) is often used as a synonym for poor rumen health. In this review, we first describe the physiological demands of cattle for dietary physically effective fiber. We also provide background information on the importance of enhancing salivary secretions and short-chain fatty acid absorption across the stratified squamous epithelium of the rumen; thus, preventing the disruption of the ruminal acid-base balance, a process that paves the way for acidification of the rumen. On-farm evaluation of dietary fiber adequacy is challenging for both nutritionists and veterinarians; therefore, this review provides practical recommendations on how to evaluate the physical effectiveness of the diet based on differences in particle size distribution, fiber content, and the type of concentrate fed, both when the latter is part of total mixed ration and when it is supplemented in partial mixed rations. Besides considering the absolute amount of physically effective fiber and starch types in the diet, we highlight the role of several feeding management factors that affect rumen health and should be considered to control and mitigate SARA. Most importantly, transitional feeding to ensure gradual adaptation of the ruminal epithelium and microbiota; monitoring and careful management of particle size distribution; controlling feed sorting, meal size, and meal frequency; and paying special attention to primiparous cows are some of the feeding management tools that can help in sustaining rumen health in high-producing dairy herds. Supplementation of feed additives including yeast products, phytogenic compounds, and buffers may help attenuate SARA, especially during stress periods when the risk of a deficiency of physically effective fiber in the diet is high, such as during early lactation. However, the usage of feed additives cannot fully compensate for suboptimal feeding management.


Assuntos
Acidose/veterinária , Ração Animal/análise , Doenças dos Bovinos/prevenção & controle , Indústria de Laticínios/métodos , Dieta/veterinária , Fibras na Dieta/análise , Rúmen/fisiopatologia , Equilíbrio Ácido-Base , Acidose/fisiopatologia , Acidose/prevenção & controle , Animais , Bovinos , Doenças dos Bovinos/fisiopatologia , Suplementos Nutricionais/análise , Feminino
13.
Intern Med J ; 48(6): 668-673, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29193631

RESUMO

BACKGROUND: In developed countries, ambulances normally carry oxygen cylinders, but not compressed air. Treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with oxygen-driven nebulisers can result in hypercapnia and acidosis. Attempts to avoid this have involved interrupted administration of oxygen. However, small battery-powered air nebulisers are now available. This study aims to compare the prehospital oxygen saturations and treatment of patients suffering from AECOPD before and after the introduction of air nebulisers. METHODS: The oxygen saturations and treatment of 200 AECOPD patients before and 200 AECOPD patients after the introduction of air nebulisers were compared. Compliance with a target saturation of 88-92% was calculated. RESULTS: The median final oxygen saturation was lower for the post-intervention category (94%) than the pre-intervention category (96%). There was an increase in air nebuliser use from 0 to 56% (P < 0.001) and a decrease in oxygen use from 100 to 71.5% (P < 0.001). There was a numerical increase in the proportion of patients arriving at hospital with oxygen saturations of 88-92% following introduction of the air nebulisers (24 vs 16.5%) and a decrease in patients arriving with high saturations (67.5 vs 76.5%). The likelihood of achieving the target oxygen saturations following introduction of air nebulisers increased (odds ratio 1.598; 95% confidence interval 0.974, 2.621). CONCLUSION: The introduction of prehospital air nebulisers resulted in a reduction in oxygen therapy in patients with AECOPD and a lower median prehospital oxygen saturation. This study supports the use of air nebulisers in the prehospital setting.


Assuntos
Nebulizadores e Vaporizadores , Oxigenoterapia/instrumentação , Oxigênio/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/terapia , Acidose/prevenção & controle , Idoso , Progressão da Doença , Serviços Médicos de Emergência , Feminino , Humanos , Hipercapnia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Nova Zelândia
14.
J Crit Care ; 43: 13-20, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28826081

RESUMO

PURPOSE: To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. MATERIALS AND METHODS: In 2012, group instructions and workshops at two surgical intensive care units (ICUs) started, focusing on standardized protocols for mechanical ventilation and volutrauma prevention. Subsequently implemented CDS functions continuously monitor ventilation parameters, and from 2015 triggered graphical notifications when tidal volume (VT) violated individual thresholds. To estimate the effects of these educational and technical interventions, we retrospectively analyzed nine years of VT records from routine care. As outcome measures, we calculated relative frequencies of settings that conform to recommendations, case-specific mean excess VT, and total ICU survival. RESULTS: Assessing 571,478 VT records from 10,241 ICU cases indicated that adherence during pressure-controlled ventilation improved significantly after both interventions; the share of conforming VT records increased from 61.6% to 83.0% and then 86.0%. Despite increasing case severity, ICU survival remained nearly constant over time. CONCLUSIONS: Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation.


Assuntos
Cuidados Críticos , Sistemas de Apoio a Decisões Clínicas , Fidelidade a Diretrizes , Capacitação em Serviço , Síndrome do Desconforto Respiratório do Adulto/terapia , Acidose/prevenção & controle , Lesão Pulmonar Aguda/prevenção & controle , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Cuidados Críticos/normas , Medicina Baseada em Evidências , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Atelectasia Pulmonar/prevenção & controle , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Estudos Retrospectivos , Volume de Ventilação Pulmonar
15.
J Matern Fetal Neonatal Med ; 31(1): 123-127, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28027681

RESUMO

Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued.


Assuntos
Cardiotocografia/efeitos adversos , Parto Obstétrico , Eletrocardiografia/efeitos adversos , Procedimentos Desnecessários , Acidose/prevenção & controle , Feminino , Humanos , Gravidez
16.
Gene ; 642: 230-240, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29141196

RESUMO

Acid hydrarthrosis is another important pathological character in rheumatoid arthritis (RA), and acid-sensing ion channel 1a (ASIC1a) plays a destructive role in acidosis-induced articular chondrocyte cytotoxicity. Recently, ASIC2a has been reported to possess neuroprotective effect on acidosis-induced injury of neuronal cells. However, whether ASIC2a has an enhanced effect on the protective effect of blocking ASIC1a and ASIC3 against acid-induced chondrocyte apoptosis is still unclear. The aim of present study was to investigate the chondroprotective effect of ASIC2a with PcTx1 (ASIC1a specific blocker) and APETx2 (ASIC3 specific blocker) on acidosis-induced chondrocyte apoptosis. Our results revealed that acid (pH 6.0) decreased the cell viability and induced apoptosis of articular chondrocytes. PcTx1 and APETx2 combination significantly attenuated acidosis-induced chondrocyte cytotoxicity due to inhibit apoptosis, and this role could be enhanced by ASIC2a overexpression compared with the PcTx1 and APETx2 combination alone group. Moreover, both the [Ca2+]i levels and the levels of phosphorylated ERK1/2 as well as p38 were further reduced in acidosis-induced chondrocytes after ASIC2a overexpression in the presence of PcTx1 and APETx2. Furthermore, ASIC2a overexpression also reduced acid-induced the expression of ASIC1a. In addition, ASIC2a overexpression further promoted the PcTx1 and APETx2-increased levels of type II collagen in acidosis-induced chondrocytes. Taken together, the current data suggested that ASIC2a overexpression might enhance the anti-apoptotic and protective role of PcTx1 and APETx2 against acid-induced rat articular chondrocyte apoptosis by regulating ASIC1a expression and the [Ca2+]i levels and at least in part, suppressing p38 and ERK1/2 MAPK signaling pathways.


Assuntos
Bloqueadores do Canal Iônico Sensível a Ácido/farmacologia , Canais Iônicos Sensíveis a Ácido/genética , Acidose/genética , Ácidos Alcanossulfônicos/efeitos adversos , Condrócitos/efeitos dos fármacos , Morfolinas/efeitos adversos , Canais Iônicos Sensíveis a Ácido/metabolismo , Acidose/induzido quimicamente , Acidose/prevenção & controle , Animais , Apoptose/efeitos dos fármacos , Células Cultivadas , Condrócitos/citologia , Condrócitos/metabolismo , Venenos de Cnidários/farmacologia , Colágeno Tipo II/metabolismo , Sinergismo Farmacológico , Regulação da Expressão Gênica/efeitos dos fármacos , Vetores Genéticos/farmacologia , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Peptídeos/farmacologia , Plasmídeos/genética , Ratos , Venenos de Aranha/farmacologia
17.
Taiwan J Obstet Gynecol ; 56(6): 788-792, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29241921

RESUMO

OBJECTIVE: To predict acidosis in fetus showing deceleration associated with non-reassuring fetal status during delivery, we examined the relationship between duration of the deceleration and umbilical arterial pH. MATERIALS AND METHODS: A total of 19,907 deliveries in eight facilities of the Juntendo Perinatal Care Group, 895 cases of vaginal deliveries with level 3 decelerations were selected for the subjects of this study. The cut-off point of time when the umbilical arterial pH fell below 7.20 in all cases of level 3 and for each deceleration type were examined. The explanatory variables were the pH and pO2 of umbilical arterial gas and the time from onset of the level 3 pattern to delivery. From receiver operating characteristic (ROC) analysis using these variables, the critical point indicating low Apgar score was set at an umbilical arterial pH < 7.20. RESULTS: The cut-off point of time when the umbilical arterial pH fell below 7.2 was 33.5 min for all cases of level 3, and 604 cases of severe variable decelerations with normal baseline variability and normal baseline heart rates, the cut-off point was 33.5 min as well. For 108 cases of late decelerations, there was no significant cut-off point for either the mild or severe cases. Mild prolonged deceleration showed the cut-off point of 34.5 min. CONCLUSIONS: We confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important.


Assuntos
Cardiotocografia/normas , Parto Obstétrico/normas , Sofrimento Fetal/diagnóstico , Frequência Cardíaca Fetal/fisiologia , Tempo para o Tratamento/normas , Acidose/embriologia , Acidose/prevenção & controle , Índice de Apgar , Parto Obstétrico/métodos , Feminino , Sangue Fetal/química , Doenças Fetais/prevenção & controle , Humanos , Concentração de Íons de Hidrogênio , Gravidez , Curva ROC , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
18.
Chirurgia (Bucur) ; 112(5): 514-523, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29088551

RESUMO

Damage control surgery is a combination of temporizing surgical interventions to arrest hemorrhage and control infectious source, with goal directed resuscitation to restore normal physiology. The convention of damage control surgery largely arose following the discovery of the lethal triad of hypothermia, acidosis, and coagulopathy, with the goal of Damage Control Surgery (DCS) is to avoid the initiation of this "bloody vicious cycle" or to reverse its progression. While hypothermia and acidosis are generally corrected with resuscitation, coagulopathy remains a challenging aspect of DCS, and is exacerbated by excessive crystalloid administration. This chapter focuses on resuscitative principles in the four settings of trauma care: the prehospital setting, emergency department, operating room, and intensive care unit including historical perspectives, resuscitative methods, controversies, and future directions. Each setting provides unique challenges with specific goals of care.


Assuntos
Acidose/prevenção & controle , Transtornos da Coagulação Sanguínea/prevenção & controle , Hemorragia/prevenção & controle , Hipotermia/prevenção & controle , Ressuscitação/métodos , Humanos , Guias de Prática Clínica como Assunto , Ressuscitação/tendências , Choque Hemorrágico/prevenção & controle
20.
Anaesthesia ; 72(11): 1379-1387, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29047136

RESUMO

Surgery under apnoeic conditions with the use of high-flow nasal oxygen is novel. Between November 2016 and May 2017, 28 patients underwent tubeless laryngeal or tracheal surgery under apnoeic conditions with high-flow nasal oxygen as the sole method of gas exchange. Patients received total intravenous anaesthesia and neuromuscular blocking agents for the duration of their surgery. The median (IQR [range]) apnoea time was 19 (15-24 [9-37]) min. Four patients experienced an episode of oxygen desaturation to a value between 85% and 90%, lasting less than 2 min in each case. Median (IQR [range]) end-tidal carbon dioxide (ETCO2 ) level following apnoea was 8.2 (7.2-9.4 [5.8-11.8]) kPa. The mean (SD) rate of ETCO2 increase was 0.17 (0.07) kPa.min-1 from an approximated baseline value of 5.00 kPa. Venous blood sampling from 19 patients demonstrated a mean (SD) partial pressure of carbon dioxide (PV CO2 ) of 6.29 (0.71) kPa at baseline and 9.44 (1.12) kPa after 15 min of apnoea. This equates to a mean (SD) PV CO2 rise of 0.21 (0.08) kPa.min-1 during this period. Mean (SD) pH was 7.40 (0.03) at baseline and 7.23 (0.04) after 15 min of apnoea. Mean (SD) standard bicarbonate was 26.7 (1.8) mmol.l-1 at baseline and 25.4 (1.8) mmol.l-1 at 15 min. We conclude that high-flow nasal oxygen under apnoeic conditions can provide satisfactory gas exchange in order to allow tubeless anaesthesia for laryngeal surgery.


Assuntos
Apneia/fisiopatologia , Apneia/terapia , Laringe/cirurgia , Oxigenoterapia/métodos , Oxigênio/administração & dosagem , Acidose/prevenção & controle , Administração Intranasal , Adolescente , Adulto , Idoso , Dióxido de Carbono/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Troca Gasosa Pulmonar , Respiração Artificial , Adulto Jovem
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