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1.
Adv Exp Med Biol ; 1232: 33-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893391

RESUMO

Monitoring of cerebral tissue oxygen saturation (StO2) by near-infrared spectroscopy (NIRS oximetry) has great potential to reduce the incidence of hypoxic and hyperoxic events and thus prevent long-term disabilities in preterm neonates. Since the light has to penetrate superficial layers (bone, skin and cerebrospinal fluid) before it reaches the brain, the question arises whether these layers influence cerebral StO2 measurement. We assessed this influence on the accuracy of cerebral StO2 values. For that purpose, we simulated light propagation with 'N-layered medium' software. It was found that with a superficial layer thickness of ≤6 mm, typical for term and preterm neonates, StO2 accurately reflects cerebral tissue oxygenation.


Assuntos
Oximetria , Oxigênio , Crânio , Encéfalo/metabolismo , Humanos , Hipóxia/diagnóstico , Recém-Nascido , Oximetria/normas , Crânio/anatomia & histologia , Espectroscopia de Luz Próxima ao Infravermelho
3.
Crit Care Nurs Q ; 42(4): 417-430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449152

RESUMO

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.


Assuntos
Diagnóstico Diferencial , Hipóxia/diagnóstico , Pneumonia/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/diagnóstico , Humanos
4.
J Stroke Cerebrovasc Dis ; 28(9): 2481-2487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277996

RESUMO

The Goal: The aim of the study was to investigate whether stroke volume or the presence of ischemic stroke lesion on follow-up computed tomography 1 day after admission had association with sleep apnea among ischemic stroke patients undergoing thrombolysis. MATERIALS AND METHODS: We prospectively recruited 110 consecutive ischemic stroke patients and performed computed tomography on admission and after 24 hours after intravenous thrombolysis. Stroke volume was measured from post-thrombolysis computed tomography scans. Unattended cardiorespiratory polygraphy with a 3-channel device was performed during 48 hours after admission. FINDINGS: Of 110 ischemic stroke patients treated with thrombolysis 65.5% were men. Mean age was 65.8 years and body mass index 27.5 kg/m2. The mean Epworth sleepiness scale score was 4.7. Eight patients (12.7%) with visible acute stroke after thrombolysis and none in the other group had hemorrhage as complication (P ˂ .001). Sleep apnea, determined as a respiratory event index greater than or equal to 5/hour, was diagnosed in 96.4% patients. Respiratory event index greater than 15/h was found in 72.8% of patients. Both mean baseline oxygen desaturation index (23.9 versus 16.5, P = .028) and obstructive apneas/hour (6.2 versus 2.7, P = .007) were higher in visible stroke group. Stroke volume (mean 15.9 mL) correlated with proportion of time spent below saturation less than 90%, P = .025. CONCLUSIONS: Acute ischemic stroke patients treated with thrombolysis with visible stroke were more likely to have nocturnal hypoxemia than patients with not visible strokes. Stroke volume correlated with time spent below saturation of 90%.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hipóxia/etiologia , Síndromes da Apneia do Sono/etiologia , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Infusões Intravenosas , Pulmão/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração , Fatores de Risco , Sono , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Curr Opin Anaesthesiol ; 32(4): 453-456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169549

RESUMO

PURPOSE OF REVIEW: Capnography is an excellent tool for early detection of hypoxemia and apnea in patients undergoing sedation for gastrointestinal endoscopy. The current American Society of Anesthesiology (ASA) guidelines recommend the use of capnography in any patient undergoing moderate sedation. The purpose of this review was to compile the most recent data available on capnography use in gastrointestinal endoscopy with the focus primarily on the use of capnography in moderate sedation cases. RECENT FINDINGS: Recent high-quality studies have evaluated the utility of capnography in low risk patients undergoing moderate sedation and have found no benefit with addition of capnography. SUMMARY: Capnography is beneficial when used for patients who are at a higher risk for sedation-related complications. There is no benefit when capnography is used in low risk patients undergoing routine upper endoscopy and colonoscopy under moderate sedation but there is benefit when used in advanced endoscopic procedures that require deeper sedation and have longer procedure times.


Assuntos
Capnografia/normas , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Monitorização Fisiológica/normas , Dor Processual/prevenção & controle , Apneia/diagnóstico , Apneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Monitorização Fisiológica/métodos , Dor Processual/etiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores de Tempo
6.
Undersea Hyperb Med ; 46(1): 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154680

RESUMO

Hypoxia is one of the main problems an underwater diver may have to face. The probability of experiencing hypoxia is related to the type of dive and the equipment used. Hypoxia in diving is a potentially fatal event for the diver, as it can lead to the loss of brain functions and consequently to the loss of breathing control, all in the absence of specific premonitory symptoms. It is a risk that may be encountered more frequently by divers who use a closed-circuit rebreather (CCR). For those who use this type of equipment, hypoxia is usually the most frequent cause of death [1]. Our study was aimed at the detection of peripheral oxygen saturation in order to identify, in the future, a preclinical hypoxic condition. We combined the use of pulse oximetry with two forehead sensors on an underwater diver subject who was using an electronic closed-circuit rebreather (ECCR). Despite the known limits of this method and the preliminary status of these findings [2], the recorded data show a clear validity in the use of pulse oximetry in immersion for the detection of peripheral oxygen saturation. In the future, the pulse oximeter could become part of the instrumentation of the diver who uses CCR gear. The device could easily be implemented in these rebreathers. The possibility of being able to perform a basic instrumental analysis means that the diver can become more quickly aware of imminent hypoxia, characterized by the absence of clearly identifiable warning symptoms, and can put in place all the correct procedures for an emergency ascent, avoiding serious consequences.


Assuntos
Mergulho/efeitos adversos , Desenho de Equipamento , Hipóxia/diagnóstico , Oximetria , Oxigênio/sangue , Adulto , Gasometria/instrumentação , Gasometria/métodos , Equipamentos para Diagnóstico , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Imersão , Masculino , Oximetria/instrumentação , Oximetria/métodos , Sintomas Prodrômicos , Água do Mar , Avaliação de Sintomas/instrumentação , Temperatura Ambiente
7.
Curr Opin Anaesthesiol ; 32(4): 457-463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31219870

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss current drugs used for intravenous moderate and deep sedation by nonanesthesiologists in the United States. We also explore training expectations for moderate and deep sedation as they play key roles in anesthetic selection and preprocedural planning. RECENT FINDINGS: Although opioids and benzodiazepines are considered the standard for moderate sedation, increased interest in propofol, dexmedetomidine, and other sedative-hyptonic drugs require additional attention in terms of training providers and complying with current practice guidelines. SUMMARY: Moderate sedation providers should be familiar with titrating benzodiazepines and opioids to achieve targeted sedation. The use of propofol and ketamine is generally reserved for deep sedation by qualified professionals. However, the role of dexmedetomidine in procedural sedation continues to evolve as its use is explored in moderate sedation. Providers of all sedation types should be aware of hypotension, apnea, hypoventilation, and hypoxia that can develop and they should be able to manage the patient under these circumstances. Preprocedural planning is an integral training expectation to minimize patient risks.


Assuntos
Anestesiologia/educação , Sedação Consciente/métodos , Sedação Profunda/métodos , Educação Médica Continuada , Hipnóticos e Sedativos/administração & dosagem , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestesiologia/normas , Apneia/diagnóstico , Apneia/etiologia , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/normas , Estado de Consciência/efeitos dos fármacos , Sedação Profunda/efeitos adversos , Sedação Profunda/normas , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipoventilação/diagnóstico , Hipoventilação/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Guias de Prática Clínica como Assunto , Propofol/administração & dosagem , Propofol/efeitos adversos
8.
PLoS One ; 14(4): e0213937, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30986206

RESUMO

OBJECTIVE: This secondary analysis of data of a randomized controlled trial (RCT) retrospectively investigated the performance of pulse oximetry in identifying children with severe illnesses, with and without respiratory signs/symptoms, in a cohort of children followed for morbid episodes in an intervention trial assessing the efficacy of Intermittent Preventive Treatment for malaria in infants (IPTi) in Papua New Guinea (PNG) from June 2006 to May 2010. SETTING: The IPTi study was conducted in a paediatric population visiting two health centres on the north coast of PNG in the Mugil area of the Sumkar District. PARTICIPANTS: A total of 669 children visited the clinic and a total of 1921 illness episodes were recorded. Inclusion criteria were: age between 3 and 27 months, full clinical record (signs/symptoms) and pulse oximetry used systematically to assess sick children at all visits. Children were excluded if they visited the clinic in the previous 14 days. OUTCOMES: The outcome measures were severe illness, severe pneumonia, pneumonia, defined by the Integrated Management of Childhood Illness (IMCI) definitions, and hospitalization. RESULTS: Out of 1921 illness episodes, 1663 fulfilled the inclusion criteria. A total of 139 severe illnesses were identified, of which 93 were severe pneumonia. The ROC curves of pulse oximetry (continuous variable) showed an AUC of 0.63, 0.68 and 0.65 for prediction of severe illness, severe pneumonia and hospitalization, respectively. Pulse oximetry allowed better discrimination between severe and non-severe illness, severe and non-severe pneumonia, admitted and non-admitted patients, in children ≤12-months of age relative to older patients. For the threshold of peripheral arterial oxygen saturation ≤ 94% measured by pulse oximetry (SpO2), unadjusted odds ratios for severe illness, severe pneumonia and hospitalization were 6.1 (95% Confidence Interval (CI) 3.9-9.8), 8.5 (4.9-14.6) and 5.9 (3.4-10.3), respectively. CONCLUSION: Pulse oximetry was helpful in identifying children with severe illness in outpatient facilities in PNG. A SpO2 of 94% seems the most discriminative threshold. Considering its affordability and ease of use, pulse oximetry could be a valuable additional tool assisting the decision to admit for treatment.


Assuntos
Centros Comunitários de Saúde/organização & administração , Hipóxia/diagnóstico , Oximetria , Pneumonia/diagnóstico , Serviços de Saúde Rural/organização & administração , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Pré-Escolar , Estudos de Viabilidade , Feminino , Implementação de Plano de Saúde/organização & administração , Humanos , Hipóxia/etiologia , Lactente , Masculino , Papua Nova Guiné , Pneumonia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
Biomarkers ; 24(6): 538-548, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30995126

RESUMO

Objective: The study was to assess whether tumour expressions of hypoxia-inducible factor (HIF)-1α, glucose transporter (GLUT)-1, carbonic anhydrase (CA) IX and vascular endothelial growth factor (VEGF) predict response to neo-adjuvant chemotherapy (naCHT) in children with inoperable rhabdomyosarcoma (RMS). Methods: Immunohistochemical expressions of hypoxia markers were determined semi-quantitatively in tumour tissue microarray of 46 patients with embryonal RMS (RME) and 20 with alveolar (RMA), treated with CWS protocols (1992-2013). Results: In paediatric RME, response to naCHT was influenced significantly by tumour expression of CA IX and GLUT-1. Patients with RMA with low expressions of analysed markers responded well to naCHT, while all poor-responders expressed highly hypoxia markers. Only 5.88% of RMA and 11.11% of RME tumours did not express any of the proteins. In both RME and RMA subgroups, most poor-responders demonstrated simultaneous high expression of ≥3 markers, while most patients expressing ≤2 markers responded well to naCHT. In the whole cohort, co-expression of ≥3 markers, was the only independent factor predicting poor-response to chemotherapy (odds ratio 14.706; 95% CI 1.72-125.75; p = 0.014). Conclusions: Immunohistochemical expression pattern of four endogenous markers of hypoxia, in tumour tissue at diagnosis, emerges as a promising tool to predict response to naCHT in children with inoperable RMS.


Assuntos
Antígenos de Neoplasias/genética , Biomarcadores Tumorais/genética , Anidrase Carbônica IX/genética , Transportador de Glucose Tipo 1/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Neoplasias Musculares/tratamento farmacológico , Rabdomiossarcoma Alveolar/tratamento farmacológico , Rabdomiossarcoma Embrionário/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/genética , Adolescente , Antígenos de Neoplasias/metabolismo , Biomarcadores Tumorais/metabolismo , Biópsia , Anidrase Carbônica IX/metabolismo , Carboplatina/uso terapêutico , Quimioterapia Adjuvante/métodos , Criança , Pré-Escolar , Dactinomicina/uso terapêutico , Epirubicina/uso terapêutico , Feminino , Expressão Gênica , Transportador de Glucose Tipo 1/metabolismo , Humanos , Hipóxia/diagnóstico , Hipóxia/tratamento farmacológico , Hipóxia/genética , Hipóxia/mortalidade , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Ifosfamida/uso terapêutico , Lactente , Recém-Nascido , Masculino , Neoplasias Musculares/diagnóstico , Neoplasias Musculares/genética , Neoplasias Musculares/mortalidade , Terapia Neoadjuvante/métodos , Prognóstico , Estudos Prospectivos , Rabdomiossarcoma Alveolar/diagnóstico , Rabdomiossarcoma Alveolar/genética , Rabdomiossarcoma Alveolar/mortalidade , Rabdomiossarcoma Embrionário/diagnóstico , Rabdomiossarcoma Embrionário/genética , Rabdomiossarcoma Embrionário/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/metabolismo , Vincristina/uso terapêutico
10.
Chest ; 155(4): e113-e116, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30955582

RESUMO

CASE PRESENTATION: A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.


Assuntos
Dor no Peito/etiologia , Tosse/etiologia , Hemoptise/etnologia , Hipóxia/etiologia , Alvéolos Pulmonares/irrigação sanguínea , Edema Pulmonar/complicações , Convulsões/complicações , Biópsia , Dor no Peito/diagnóstico , Tosse/diagnóstico , Diagnóstico Diferencial , Feminino , Hemoptise/diagnóstico , Humanos , Hipóxia/diagnóstico , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
11.
Aerosp Med Hum Perform ; 90(5): 429-439, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023402

RESUMO

INTRODUCTION: The negative effects of hypoxia on human cognitive function have been well documented. In this study we assess the correlation of performance in the SynWin cognitive Multi-Task Battery (MTB) and the onset of hypoxia and describe the use of cognitive assessment scores for real-time hypoxia detection.METHODS: We performed a correlation analysis between MTB scores (Arithmetic, Memory, Audio Monitoring, Video Monitoring tasks) and blood oxygen saturation levels to discover if the scores are good candidates to detect hypoxia. Since this analysis showed positive correlation, we proceeded to develop a parallel decision fusion system that uses these cognitive scores for real-time hypoxia detection using the Neyman-Pearson criterion.RESULTS: We demonstrate that MTB scores have considerable hypoxia detection potential and can be used (if measurable passively) in a real-time detection framework. Analysis of receiver operating characteristic (ROC) curves established a hierarchy of importance of the various MTB modules. The Arithmetic task module had the most significant contribution toward correct hypoxia detection (improvement of ∼13.5% and ∼13.9% in detection accuracy under global false alarms of 0.1 and 0.05, respectively), followed by the Memory and Audio Monitoring modules. Fusion of multiple cognitive assessment scores resulted in significantly higher detection accuracy (>86%) than using any one of the scores by itself.DISCUSSION: When available, cognitive assessment scores can be a useful tool for real-time hypoxia detection. Since these MTB tests also assess neuropsychological functioning, study of distributed detection systems based on MTB scores could help in designing tests that are more useful for detecting hypoxic symptoms.Rajasekar A, Acharya S, Shender BS, Rorres C, Hrebien L, Kam M. Correlation of cognitive scores and the onset of hypoxia. Aerosp Med Hum Perform. 2019; 90(5):429-439.


Assuntos
Altitude , Cognição/fisiologia , Hipóxia/diagnóstico , Análise e Desempenho de Tarefas , Feminino , Voluntários Saudáveis , Humanos , Hipóxia/etiologia , Hipóxia/fisiopatologia , Masculino
12.
Eur Arch Otorhinolaryngol ; 276(4): 1117-1125, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30840126

RESUMO

OBJECTIVE: The promotion of neovascularisation is a crucial aspect of carcinogenesis. The study evaluates the microvascular density (MVD) and expression of hypoxia-induced factor (HIF-1α) in hypertrophic vocal fold (VF) lesions of different histopathological states including non-dysplastic, low-grade, high-grade dysplasia and invasive glottic cancer. MATERIALS AND METHODS: Histological specimens collected from patients diagnosed and treated in a single centre with different histological grades were immunohistochemically stained with CD31, CD34 and HIF-1α. Of the total number of 77 analysed VF specimens, 20 were non-dysplastic, 20 had low-grade dysplasia, 17 high-grade dysplasia and 20 were invasive cancers. RESULTS: The highest mean value for MVD evaluated with expression of CD31 (MVD CD31) was 21.23 ± 14.46 and identified in the low-grade dysplasia group. The average MVD CD31 was 13.74 ± 5.56 and 20.11 ± 9.28 in the high-grade dysplasia and invasive cancer group, respectively. The highest MVD evaluated with CD34 (MVD CD34) was revealed for invasive cancer 35.64 ± 17.21. The MVD CD34 was higher for low-grade than in high-grade dysplasia (25.87 ± 12.30 vs 24.65 ± 15.92, respectively). The expression of HIF-1α was strong or very strong in 60% of non-dysplastic lesions, 100% of low-grade dysplasia cases, 53% of high-grade dysplasia cases and 50% of invasive cancer cases. The comparison of MVD CD31 with MVD CD34 revealed a strong positive correlation (ρ value 0.727). The comparison of both MVD CD31 and MVD CD34 with HIF-1α resulted in no linear relationship (ρ value of 0.143 and 0.165, respectively). CONCLUSION: The stage of low-grade dysplasia in intraepithelial vocal fold lesions is related to significant advancement of angiogenesis together with the highest hypoxia level.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Hipóxia , Neoplasias Laríngeas/patologia , Microvasos , Neovascularização Patológica , Prega Vocal , Adulto , Idoso , Carcinogênese/metabolismo , Carcinogênese/patologia , Correlação de Dados , Feminino , Humanos , Hipertrofia , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/metabolismo , Masculino , Microvasos/diagnóstico por imagem , Microvasos/patologia , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/patologia , Prega Vocal/irrigação sanguínea , Prega Vocal/diagnóstico por imagem , Prega Vocal/patologia
13.
Klin Lab Diagn ; 64(2): 89-93, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30917249

RESUMO

Perinatal lesions of the Central nervous system (CNS) in newborns occupy a leading place in the structure of perinatal morbidity and subsequent disability of children. To identify the features of the content of sRAGE in pregnant women with threatening preterm labor (UPR) in the period of 22-27 weeks, who subsequently gave birth to children with perinatal CNS lesion. Serum of venous blood of pregnant women with UPR at the term of 22-27 weeks was determined by ELISA once the content of sRAGE. If the value of sRAGE in pregnant women is 659.5 PG/ml or less, perinatal hypoxic lesions of the Central nervous system in newborns are predicted with an accuracy of 75.8% (sensitivity of 82.6%, specificity of 66.7%).


Assuntos
Antígenos de Neoplasias/sangue , Sistema Nervoso Central/patologia , Hipóxia/diagnóstico , Proteínas Quinases Ativadas por Mitógeno/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipóxia/patologia , Recém-Nascido , Trabalho de Parto Prematuro , Gravidez , Sensibilidade e Especificidade
14.
Aerosp Med Hum Perform ; 90(4): 369-377, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30922424

RESUMO

INTRODUCTION: Prior research suggests there may be gender differences with regards to hypoxia resilience. Our study was designed to determine whether there were differences between genders in neuronal electrical activity at simulated altitude and whether those changes correlated with cognitive and aviation performance decrements.METHODS: There were 60 student Naval Aviators or Flight Officers who completed this study (30 women, 30 men). Participants were exposed to increasing levels of normobaric hypoxia and monitored with dry EEG while flying a fixed-base flight simulation. Gender differences in brainwave frequency power were quantified using MATLAB. Changes in flight and cognitive performance were analyzed via simulation tasks and with a cognitive test validated under hypoxia.RESULTS: Significant decreases in theta and gamma frequency power occurred for women compared to men with insidious hypoxic exposures to 20K, with an average frequency power decrease for women of 19.4% compared to 9.3% for men in theta, and a 42.2% decrease in gamma for women compared to 21.7% for men. Beta frequency power correlated highest between genders, with an average correlation coefficient of r = 0.95 across seven channels.DISCUSSION: Results of this study suggest there is identifiable brain wave suppression for both men and women with hypoxic exposure and, moreover, there are significant differences in this suppression between genders. Beta frequency power was most sensitive for both genders and highly correlative compared to other brainwave frequencies. The implications of these findings are important considerations for next-generation aviation helmets, which may employ this technology as an early warning mechanism.Rice GM, Snider D, Drollinger S, Greil C, Bogni F, Phillips J, Raj A, Marco K, Linnville S. Gender differences in dry-EEG manifestations during acute and insidious normobaric hypoxia. Aerosp Med Hum Perform. 2019; 90(4):369-377.


Assuntos
Altitude , Aviação , Encéfalo/fisiopatologia , Hipóxia/fisiopatologia , Pilotos , Adaptação Fisiológica/fisiologia , Adulto , Medicina Aeroespacial/instrumentação , Ondas Encefálicas/fisiologia , Desenho de Equipamento , Feminino , Dispositivos de Proteção da Cabeça , Humanos , Hipóxia/diagnóstico , Masculino , Fatores Sexuais , Adulto Jovem
16.
Br J Anaesth ; 122(3): 388-394, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30770057

RESUMO

BACKGROUND: The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure. METHODS: The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2) <95%. RESULTS: Of 2398 patients, hypoxaemia was observed in 158 (6.6%). We identified five preoperative independent risk factors: chronic obstructive pulmonary disease, hypertension, anticipated difficult mask ventilation and difficult tracheal intubation, and emergency surgery. There were also three pre-induction independent risk factors: difficult preoxygenation, difficult mask ventilation, and difficult tracheal intubation. We found a high negative predictive value of preoperative risk factors for difficult mask ventilation of 0.96 (0.95-0.96), and for difficult tracheal intubation (0.95 [0.94-0.96]). A total of 723 patients (30%) experienced difficult preoxygenation (FeO2 <90% at the end of preoxygenation). Male sex, chronic obstructive pulmonary disease, hypertension, emergency surgery, and predictable difficult mask ventilation were independent patient risk factors for difficult preoxygenation. CONCLUSIONS: Difficult mask ventilation and difficult tracheal intubation are risk factors for hypoxaemia at induction of general anaesthesia. Difficult preoxygenation was observed in 30% of patients and was also identified as a risk factor for hypoxaemia. This suggests that techniques improving preoxygenation should be implemented in daily practice.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Hipóxia/epidemiologia , Oxigênio/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Humanos , Hipóxia/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Oximetria , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
18.
Ecotoxicol Environ Saf ; 171: 484-492, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-30639875

RESUMO

Autophagy, a crucial process for maintaining cellular homeostasis, is under the control of several autophagy-related (ATG) proteins, and is highly conserved in most animals, but its response to adverse environmental conditions is poorly understood in crustaceans. Herein, we hypothesised that autophagy acts as a protective response to hypoxia, and Beclin 1, ATG7 and ATG8 in oriental river prawn (Macrobrachium nipponense) were chosen as potential biomarkers under hypoxia exposure; thus, their full-length cDNA sequences were cloned and characterised. Open reading frames (ORFs) of 1281, 2076 and 360 bp, encoding proteins of 427, 692 and 120 amino acid residues, respectively, were obtained. Phylogenetic analysis demonstrated the three M. nipponense proteins do not form a clade with vertebrate homologs. Protein and mRNA levels were investigated in different tissues and developmental stages, and all three were significantly upregulated in a time-dependent manner in the hepatopancreas following hypoxia stress. Biochemical and morphological analysis of hepatocytes revealed that hypoxia increased the abundance of hepatic autophagic vacuoles and stimulated anaerobic metabolism. RNA interference-mediated silencing of ATG8 significantly increased the death rate of M. nipponense juveniles under hypoxia stress conditions. Together, these results suggest that Beclin 1, ATG7 and ATG8 contribute to autophagy-based responses against hypoxia in M. nipponense. The findings also expand our understanding of the potential role of autophagy as an adaptive response against hypoxia toxicity in crustaceans. The results showed that hepatic ATG8 levels may be directly indicative of acute hypoxia in prawns, and provide insight into the time at which hypoxia exposure occurs. Autophagy-related genes expression pattern seems to be sensitive and good biomarkers of acute hypoxia exposure.


Assuntos
Autofagia/genética , Hipóxia/genética , Palaemonidae/genética , Animais , Proteína 7 Relacionada à Autofagia/genética , Proteína 7 Relacionada à Autofagia/metabolismo , Família da Proteína 8 Relacionada à Autofagia/genética , Família da Proteína 8 Relacionada à Autofagia/metabolismo , Proteína Beclina-1/genética , Proteína Beclina-1/metabolismo , Clonagem Molecular , Regulação da Expressão Gênica , Marcadores Genéticos , Hepatócitos/citologia , Hepatócitos/metabolismo , Hepatopâncreas/metabolismo , Hipóxia/diagnóstico , Palaemonidae/metabolismo , Filogenia , Interferência de RNA , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Rios/química , Análise de Sequência de DNA , Estresse Fisiológico
20.
J Forensic Leg Med ; 62: 56-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30677703

RESUMO

Drowning is the most common cause of unnatural death worldwide. There is no single biomarker to diagnose drowning, so the diagnosis of drowning is one of the most difficult tasks in forensic medicine. Especially, distinguishing a victim of drowning from a body disposed of in water following death remains a problem. The objective of this study was to identify specific biomarkers of drowning compared with other causes of death such as hypoxia and postmortem submersion. The present study investigated the intrapulmonary expression of receptor for advanced glycation end products (RAGE), aquaporin-5 (AQP5), surfactant protein-A (SP-A), interleukin 6 (IL-6) and interleukin 1ß (IL-1ß) as markers of drowning. In animal experiments, all rats (n = 45) were classified into four groups (drowning, postmortem-submersion, hypoxia and control group). The lungs of experimental animals were analyzed as mRNA expression, immunoblot expression and immunohistochemical staining. qRT-PCR demonstrated increased mRNA expression of RAGE and AQP5 in drowning group compared with that in control, hypoxia and postmortem-submersion group, but not other molecules. Western blotting also showed high expression of RAGE and AQP5 in drowning group, immunostaining of RAGE and AQP5 was highly detected in a linear pattern in type I alveolar epithelial cells, compared with control and postmortem-submersion group. These observations indicate a difference of expression in pulmonary molecular pathology compared with other causes, suggesting RAGE and AQP5 may be useful for differentiation between drowning and postmortem-submersion.


Assuntos
Aquaporina 5/metabolismo , Biomarcadores/metabolismo , Afogamento/diagnóstico , Pulmão/metabolismo , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Animais , Aquaporina 5/genética , Western Blotting , Células Epiteliais/metabolismo , Patologia Legal , Água Doce , Hipóxia/diagnóstico , Imuno-Histoquímica , Interleucina-1beta/genética , Interleucina-1beta/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Pulmão/patologia , Modelos Animais , Proteína A Associada a Surfactante Pulmonar/genética , Proteína A Associada a Surfactante Pulmonar/metabolismo , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real , Receptor para Produtos Finais de Glicação Avançada/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Água do Mar
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