What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside. Alternatively, since pleural pressures are seldom measured, transmural CVP can also be estimated by subtracting half of the IAP from the end-expiratory CVP value, since abdominothoracic transmission is on average 50%. Volumetric preload indicators, such as global and right ventricular end-diastolic volumes or the left ventricular end-diastolic area, also correlate better with true preload. When using functional hemodynamic monitoring parameters like stroke volume variation (SVV) or pulse pressure variation (PPV) one must bear in mind that increased IAP will increase these values (via a concomitant increase in intrathoracic pressure). The passive leg raising test may be a false negative in IAH. Calculation of the abdominal perfusion pressure (as mean arterial pressure minus IAP) has been shown to be a better resuscitation endpoint than IAP alone. Finally, it is re-assuring that transpulmonary thermodilution techniques have been validated in the setting of IAH and abdominal compartment syndrome. In conclusion, the clinician must be aware of the different effects of IAH on cardiovascular function in order to assess the volume status accurately and to optimize hemodynamic performance

Natural Gas and LNG Supply/Demand Trends in Asia Pacific and Atlantic Markets

This paper discusses a portion of the outcome of a study undertaken by the Institute of Energy Economics, Japan (IEEJ) on commission from the Agency for Natural Resources and Energy, Ministry of Economy, Trade and Industry under the project title of FY2007 Research for Promotion of Natural Gas Development and Utilization (Study of Natural Gas Supply and Demand Trends in Asia Pacific and Atlantic Markets). The scope of the above study included a fixed-point observation survey on the on-going status of countries that are either exporting or importing LNG as well as trends in the LNG markets, which potentially may have an impact on Japans natural gas supply and demand situation. In the following sections, an overview will be presented in sequence on the natural gas supply and demand situation, natural gas trading, the LNG chain, and LNG supply and demand balance.

Perspectives of the European Natural Gas Markets until 2025

We apply the EMF 23 study design to simulate the effects of the reference case and the scenarios to European natural gas supplies to 2025. We use GASMOD, a strategic severallayer model of European gas supply, consisting of upstream natural gas producers, traders in each consuming European country (or region), and final demand. Our model results suggest rather modest changes in the overall supply situation of natural gas to Europe, indicating that current worries about energy supply security issues may be overrated. LNG will likely increase its share of European natural gas imports in the future, Russia will not dominate the European imports (~ share of 1/3), the Middle East will continue to be a rather modest supplier, the UK is successfully converting from being a natural gas exporter to become a transit node for LNG towards continental Europe, and congested pipeline infrastructure, and in some cases LNG terminals, will remain a feature of the European gas markets, but less than in the current situation.Natural gas, Europe, modeling, LNG, supply security

The Iron Ore, Coal and Gas Sectors

The industrialisation of Asia – particularly China and India – has led to a strong increase in global demand for key resource commodities. The associated sharp rise in the prices of these commodities has underpinned a significant increase in the levels of Australia’s resource investment, production and exports over the past five years, especially for iron ore, coal and liquefied natural gas (LNG). This article outlines some key features and recent developments in these three commodity sectors within Australia.Resource exports; resource capacity; iron ore; coal; LNG

LNG in the Northwestern Coast of Mexico: Impact on Prices of Natural Gas in Both Sides of the US-Mexico Border

This paper studies the possible impacts of LNG projects on natural gas prices in both sides of the US-Mexico border in California. In California, gas prices are high and the demand is expected to grow. Several projects of LNG facilities have been proposed and have to cope with public opinions against them. In Baja California, four LNG projects are under development given the rising demand forecasted for the next years. After a detailed study of the opportunity for LNG projects, we conclude with an analysis of the fundamentals of the current and future price formation in both sides of the US Mexico border.Liquefied Natural Gas (LNG), price formation, LNG projects, Mexico-US border, natural gas market

Progestins Related to Progesterone and Testosterone Elicit Divergent Human Endometrial Transcriptomes and Biofunctions.

Progestins are widely used for the treatment of gynecologic disorders and alone, or combined with an estrogen, are used as contraceptives. While their potencies, efficacies and side effects vary due to differences in structures, doses and routes of administration, little is known about their effects on the endometrial transcriptome in the presence or absence of estrogen. Herein, we assessed the transcriptome and pathways induced by progesterone (P4) and the three most commonly used synthetic progestins, medroxyprogesterone acetate (MPA), levonorgestrel (LNG), and norethindrone acetate (NETA), on human endometrial stromal fibroblasts (eSF), key players in endometrial physiology and reproductive success. While there were similar transcriptional responses, each progestin induced unique genes and biofunctions, consistent with their structural similarities to progesterone (P4 and MPA) or testosterone (LNG and NETA), involving cellular proliferation, migration and invasion. Addition of estradiol (E2) to each progestin influenced the number of differentially expressed genes and biofunctions in P4 and MPA, while LNG and NETA signatures were more independent of E2. Together, these data suggest different mechanisms of action for different progestins, with progestin-specific altered signatures when combined with E2. Further investigation is warranted for a personalized approach in different gynecologic disorders, for contraception, and minimizing side effects associated with their use

Differential Effects of the Hormonal and Copper Intrauterine Device on the Endometrial Transcriptome.

The contraceptive effectiveness of intrauterine devices (IUDs) has been attributed in part to a foreign body reaction in the endometrium. We performed this study to better understand mechanisms of action of contraceptives of by studying their effects on endometrial and cervical transcriptomes. We collected endometrial and cervical biopsies from women using the levonorgestrel-releasing intrauterine system (LNG-IUS, n = 11), copper intrauterine device (cu-IUD, n = 13) or levonorgestrel-containing combined oral contraceptives (COC, n = 12), and from women not using contraceptives (control group, n = 11). Transcriptional profiling was performed with Affymetrix arrays, Principal Component Analysis and the bioconductor package limma. In endometrial samples from cu-IUD users, there were no genes with statistically significant differential expression compared to controls. In LNG-IUS users, 2509 genes were differentially expressed and mapped predominantly onto immune and inflammatory pathways. The cervical samples showed no statistically significant differential gene expression compared to controls. Hormonal and copper IUDs have significantly different effects on the endometrial transcriptome, with the LNG-IUS transcriptome showing pronounced inflammation and immune activation compared to controls whereas the cu-IUD transcriptome was indistinguishable from luteal phase endometrium. These findings argue against a foreign body reaction as a common mechanism of action of IUDs

The Global Market for Liquefied Natural Gas

Liquefied natural gas (LNG) provides an economic means to transport natural gas over long distances, bringing production from remote gas reserves to market. A large expansion in global LNG trade is currently under way, and Australia is likely to emerge as the second largest supplier globally in coming years. This article describes the functioning of the global LNG market and outlines Australia's position within the market.LNG; liquefied natural gas; natural gas; resources; commodities; energy; exports; fossil fuel; market