Assessing fluid-responsiveness by a standardized ventilatory maneuver: the respiratory systolic variation test

Respiratory-induced changes in arterial blood pressure predict fluid responsiveness. However, the accuracy of these variables is affected by the preset tidal volume and by the early inspiratory increase in arterial blood pressure. We have therefore calculated the slope produced by the minimal systolic blood pressures (plotted against the respective airway pressures) during a ventilatory maneuver consisting of four incremental, successive, pressure-controlled breaths, termed the Respiratory Systolic Variation Test (RSVT). In 14 ventilated patients, after major vascular surgery, the slope of the RSVT decreased significantly after intravascular fluid administration and correlated with the end-diastolic area and with changes in cardiac output better than filling pressures. This preliminary study suggests that a standardized ventilatory maneuver may be useful in guiding fluid therapy in ventilated patients.     

Effect of donors' intravenous drug use, cigarette smoking, and alcohol dependence on kidney transplant outcome

BACKGROUND: The shortage of organ donors for kidney transplants has made the expansion of the kidney donor pool a clinically significant issue. Previous studies suggest that kidneys from donors with a history of intravenous (IV) drug, cigarette, and/or alcohol use are considered to be a risky choice. However, these kidneys could potentially be used and expand the kidney supply pool if no evidence shows their association with adverse transplant outcomes. METHODS: This study analyzed the United Network for Organ Sharing dataset from 1994 to 1999 using Kaplan-Meier survival analysis and Cox modeling. The effects on transplant outcome (graft and recipient survival) were examined with respect to the donors' IV drug use, cigarette smoking, and alcohol dependency. Covariates including the recipient variables, the donor variables, and the transplant procedure variables were included in the Cox models. RESULTS: The results show that the donors' history of cigarette smoking is a statistically significant risk factor for both graft survival (hazard ratio=1.05, P<0.05) and recipient survival (1.06, P<0.05), whereas neither IV drug use nor alcohol dependency had significant adverse impact on graft or recipient survival. CONCLUSIONS: Assuming that adequate testing for potential infections is performed, there is no evidence to support avoiding the kidneys from donors with IV drug use or alcohol dependency in transplantation. Utilizing these kidneys would clearly expand the potential pool of donor organs.     

Laboratory and field evaluation of a new personal sampling system for assessing the protection provided by the N95 filtering facepiece respirators against particles

OBJECTIVES: We have recently developed a new personal sampling system for the real-time measurement of the protection provided by respirators against airborne dust and micro-organisms. The objective of this study was to evaluate the performance characteristics of the new sampling system in both laboratory and field conditions. METHODS: The measurements were conducted using the N95 filtering facepiece respirators and the newly developed personal sampling system put on a manikin (laboratory study) or donned by a human subject (laboratory and field studies). Two inhalation flow rates (0 and 40 l min(-1)) in conjunction with the sampling flow rate (10 l min(-1)) were tested in the manikin-based experiments to investigate the effects of the leak location (nose, cheek and chin) and the depth of the sampling probe (0, 5, 10 and 15 mm) within the respirator. The effect of human activity on the protection factor was evaluated using a variety of head movements and breathing patterns when a human subject wore the respirator in a room-size laboratory test chamber. The field study was conducted during corn harvesting with a respirator worn by a human subject on a combine. RESULTS: There was no significant difference in the protection factors for different leak locations, or for sampling probe depths, when the inhalation rate was 0 l min(-1). For the inhalation rate of 40 l min(-1), the protection factors for nose leaks were higher than those for chin and cheek leaks. Furthermore, the protection factor was the lowest and showed the least variation when the sampling probe depth was equal to 0 mm (imbedded on the respirator surface). Human subject testing showed that the grimace maneuver decreased the protection factor and changed the original respirator fit. The protection factor during breath holding was lower than that found during inhalation and exhalation. Field results showed greater variation than laboratory results. CONCLUSIONS: The newly designed personal sampling system efficiently detected the changes in protection factors in real time. The sampling flow was least affected by the inhalation flow when the sampling probe was imbedded on the respirator surface. Leak location, breathing patterns and exercises did affect the measurement of the protection factors obtained using an N95 filtering facepiece respirator. This can be attributed to the differences in the in-mask airflow dynamics contributed by the leak, filter material, sampling probe and inhalation. In future studies, it would be beneficial if the laboratory data could be integrated with the field database.     

Quantitative genetic study of head size related phenotypes in ethnically homogeneous Chuvasha pedigrees

BACKGROUND: It is well established that genetic factors contribute significantly to the determination of head size and shape traits variability. However, the controversies in views and findings with respect to the more specific aspects of this issue have not yet been resolved. AIM: The primary objective of the study was to examine the patterns of the intergenerational familial transmission of 12 head size related traits in a large ethnically homogeneous sample of Chuvasha pedigrees. SUBJECTS AND METHODS: The research was carried out on 1406 individuals belonging to 357 nuclear and more complex families. Univariate and bivariate family-based analyses were performed to establish the pattern of head traits inheritance. RESULTS: Maximum heritability estimates ranged from 0.52 to 0.72 for traits adjusted for significant covariates. No significant sex differences were observed with respect to the genetic determination of the studied traits. Bivariate analysis of horizontal and vertical head size components suggested the existence of common genetic and environmental factors that explained 33.0% and 23.2% of the total variance of the adjusted traits, respectively. CONCLUSIONS: A significant genetic component is involved in inter-individual variation and covariation of various studied craniofacial traits.     

Clinical results of Perftoran application: present and future

Clinical experience of Perftoran (commercial drug of low concentrated perfluorocheminal emulsion) applications is presented in some statistical data and in brief analysis of clinical trials and following clinical studies described in the Russian scientific literature. Observed data allow us to suppose that Perftoran facilitates oxygen delivery together with remaining red blood cells at blood replacements and will have more wider area for application than just a blood substitute. Its infusion alleviates symptoms of ischemia at different types of occlusion vessels disease, improves grafting in plastic surgery, diminishes inflammation and prevents rejection of transplants, activates detoxication functions of liver, inhibits retro-virus infection development. Local PF applications is able to accelerate wounds and ulcers healing.     

Red fluorescent protein eqFP611 and its genetically engineered dimeric variants

The red fluorescent protein (FP) eqFP611 from the sea anemone Entacmaea quadricolor shows favorable properties for applications as a molecular marker. Like other anthozoan FPs, it forms tetramers at physiological concentrations. The interactions among the monomers, however, are comparatively weak, as inferred from the dissociation into monomers in the presence of sodium dodecyl sulfate (SDS) or at high dilution. Analysis at the single-molecule level revealed that the monomers are highly fluorescent. For application as fusion markers, monomeric FPs are highly desirable. Therefore, we examine the monomer interfaces in the x-ray structure of eqFP611 to provide a basis for the rational design of monomeric variants. The arrangement of the four beta cans is very similar to that of other green fluorescent protein (GFP-like) proteins such as DsRed and RTMS5. A variety of structural features of the tetrameric interfaces explain the weak subunit interactions in eqFP611. We produce functional dimeric variants by introducing single point mutations in the A/B interface (Thr122Arg, Val124Thr). By contrast, structural manipulations in the A/C interface result in essentially complete loss of fluorescence, suggesting that A/C interfacial interactions play a crucial role in the folding of eqFP611 into its functional form.     

Hemoglobin adsorption isotherm at the silica-water interface with evanescent wave cavity ring-down spectroscopy

Evanescent wave cavity ring-down spectroscopy (EW-CRDS) is used to observe the adsorption isotherm for hemoglobin (Hb) from controlled urine samples to assess the potential for rapid diagnosis in hemoglobinuria. The absorbance of Hb at 425 nm is monitored using an alexandrite laser-pumped, room temperature, LiF:F2+** color-center pulsed laser. A minimum absorbance detection level of 2.57 x 10(-4) is achieved, corresponding to a minimum detectable concentration of Hb in urea of 5.8 nM. A multilayered Hb biofilm is formed, and a minimum of eight layers are required to model the adsorption isotherm, allowing for cooperative binding within the layers and extending 56 nm into the interface. A binding constant for Hb to silica 18.23+/-7.58 x 10(6) M is derived, and a binding constant for Hb to Hb in subsequent layers is determined to be 5.631+/-0.432 x 10(5) M. Stoichiometric binding coefficients of 1.530+/-0.981 for layer one and 1.792+/-0.162 for subsequent layers suggest that cooperative binding both to the silica surface and between the layers of the biofilm is important.