Neuromuscular Blockade with Rocuronium Bromide Increases the Tolerance of Acute Normovolemic Anemia in Anesthetized Pigs

Background: The patient's individual anemia tolerance is pivotal when blood transfusions become necessary, but are not feasible for some reason. To date, the effects of neuromuscular blockade (NMB) on anemia tolerance have not been investigated. Methods: 14 anesthetized and mechanically ventilated pigs were randomly assigned to the Roc group (3.78 mg/kg rocuronium bromide followed by continuous infusion of 1 mg/kg/min, n = 7) or to the Sal group (administration of the corresponding volume of normal saline, n = 7). Subsequently, acute normovolemic anemia was induced by simultaneous exchange of whole blood for a 6% hydroxyethyl starch solution (130/0.4) until a sudden decrease of total body O-2 consumption (VO2) indicated a critical limitation of O-2 transport capacity. The Hb concentration quantified at this time point (Hb(crit)) was the primary end-point of the protocol. Secondary endpoints were parameters of hemodynamics, O-2 transport and tissue oxygenation. Results: Hb(crit) was significantly lower in the Roc group (2.4 +/- 0.5 vs. 3.2 +/- 0.7 g/dl) reflecting increased anemia tolerance. NMB with rocuronium bromide reduced skeletal muscular VO2 and total body O-2 extraction rate. As the cardiac index increased simultaneously, total body VO2 only decreased marginally in the Roc group (change of VO2 relative to baseline -1.7 +/- 0.8 vs. 3.2 +/- 1.9% in the Sal group, p < 0.05). Conclusion: Deep NMB with rocuronium bromide increases the tolerance of acute normovolemic anemia. The underlying mechanism most likely involves a reduction of skeletal muscular VO2. During acellular treatment of an acute blood loss, NMB might play an adjuvant role in situations where profound stages of normovolemic anemia have to be tolerated (e.g. bridging an unexpected blood loss until blood products become available for transfusion). Copyright (C) 2011 S. Karger AG, Base

CO 2 REACTIVE TRANSPORT IN LIMESTONE: FLOW REGIMES, FLUID FLOW AND MECHANICAL ROCK PROPERTIES

ABSTRACT The influence of chemical reactions between injected CO 2 , formation fluids and the target rock formation leads to uncertainties for geological sequestration projects. Reactions may influence the fluid-flow field, i.e. reactive transport, and the mechanical rock properties, which might degrade, leading to uncertainties with respect to the rock integrity in the affected region. We investigate both the influence of calcite dissolution on the fluid flow and the mechanical rock properties for two cases: first under realistic CO 2 /brine field flow rates leading to heterogeneous dissolution, i.e. wormholing, and second under noflow conditions leading to a rather homogeneous dissolution. We find a significant influence of dissolution on single-and two-phase flow and changes of the elastic rock properties and the failure behavior. The study is an essential step toward understanding CO 2 plume migration and the effects caused by long-term migration of CO 2 in carbonate reservoirs, providing input parameters for reservoir models and reservoir surveillance

Recent Developments of NEMO: Detection of Solar Eruptions Characteristics

The recent developments in space instrumentation for solar observations and telemetry have caused the necessity of advanced pattern recognition tools for the different classes of solar events. The Extreme ultraviolet Imaging Telescope (EIT) of solar corona on-board SOHO spacecraft has uncovered a new class of eruptive events which are often identified as signatures of Coronal Mass Ejection (CME) initiations on solar disk. It is evident that a crucial task is the development of an automatic detection tool of CMEs precursors. The Novel EIT wave Machine Observing (NEMO) (http://sidc.be/nemo) code is an operational tool that detects automatically solar eruptions using EIT image sequences. NEMO applies techniques based on the general statistical properties of the underlying physical mechanisms of eruptive events on the solar disc. In this work, the most recent updates of NEMO code - that have resulted to the increase of the recognition efficiency of solar eruptions linked to CMEs - are presented. These updates provide calculations of the surface of the dimming region, implement novel clustering technique for the dimmings and set new criteria to flag the eruptive dimmings based on their complex characteristics. The efficiency of NEMO has been increased significantly resulting to the extraction of dimmings observed near the solar limb and to the detection of small-scale events as well. As a consequence, the detection efficiency of CMEs precursors and the forecasts of CMEs have been drastically improved. Furthermore, the catalogues of solar eruptive events that can be constructed by NEMO may include larger number of physical parameters associated to the dimming regions.Comment: 12 Pages, 5 figures, submitted to Solar Physic

Properties of lightly doped t-J two-leg ladders

We have numerically investigated the doped t-J ladder using exact diagonalization. We have studied both the limit of strong inter-chain coupling and isotropic coupling. The ladder scales to the Luther-Emery liquid regime in the strong inter-chain coupling limit. In this strong coupling limit there is a simple picture of the excitation spectrum that can be continued to explain the behavior at isotropic coupling. At J=0 we have indications of a ferromagnetic ground state. At a large $J/t$ the ladder is phase separated into holes and a Heisenberg ladder. At intermediate coupling the ground state shows hole pairing with a modified d-wave symmetry. The excitation spectrum separates into a limited number of quasiparticles which carry charge $+|e|$ and spin ${1\over 2}$ and a triplet magnon mode. At half-filling the former vanish but the latter evolves continuously into the magnon band of the spin liquid. At low doping the quasiparticles form a dilute Fermi gas with a strong attraction but simultaneously the Fermi wave vector, as would be measured in photoemission, is large. The dynamical structure factors are calculated and are found to be very similar to calculations on 2D clusters

Magnetic phases near the Van Hove singularity in s- and d-band Hubbard model

We investigate the magnetic instabilities of the nondegenerate (s-band) and a degenerate (d-band) Hubbard model in two dimensions using many-body effects due to the particle-particle diagrams and Hund's rule local correlations. The density of states and the position of Van Hove singularity change depending on the value of next-nearest neighbor hopping t'. The Stoner parameter is strongly reduced in the s-band case, and ferromagnetism survives only if electron density is small, and the band is almost flat at small momenta due to next-nearest neighbor hopping. In contrast, for the d-band case the reduction of the Stoner parameter which follows from particle-particle correlations is much smaller and ferromagnetism survives to a large extent. Inclusion of local spin-spin correlations has a limited destabilizing effect on the magnetic states.Comment: 8 pages, 7 figure

Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram

BACKGROUND: Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment. METHODS: Single photon emission computed tomography (SPECT) using Tc-(99 m )HMPAO to assess brain perfusion was performed on subjects with OCD, PTSD, and SAD before and after 8 weeks (SAD) and 12 weeks (OCD and PTSD) treatment with the SSRI citalopram. Statistical parametric mapping (SPM) was used to compare scans (pre- vs post-medication, and responders vs non-responders) in the combined group of subjects. RESULTS: Citalopram treatment resulted in significant deactivation (p = 0.001) for the entire group in the superior (t = 4.78) and anterior (t = 4.04) cingulate, right thalamus (t = 4.66) and left hippocampus (t = 3.96). Deactivation (p = 0.001) within the left precentral (t = 4.26), right mid-frontal (t = 4.03), right inferior frontal (t = 3.99), left prefrontal (3.81) and right precuneus (t= 3.85) was more marked in treatment responders. No pattern of baseline activation distinguished responders from non-responders to subsequent pharmacotherapy. CONCLUSIONS: Although each of the anxiety disorders may be mediated by different neurocircuits, there is some overlap in the functional neuro-anatomy of their response to SSRI treatment. The current data are consistent with previous work demonstrating the importance of limbic circuits in this spectrum of disorders. These play a crucial role in cognitive-affective processing, are innervated by serotonergic neurons, and changes in their activity during serotonergic pharmacotherapy seem crucial

International Consortium for Health Outcome Measurement Set of Outcomes That Matter to People Living With Inflammatory Arthritis: Consensus From an International Working Group

© 2018, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology. Objective: The implementation of value-based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk-adjustment variables that is feasible to implement worldwide. Methods: The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk-adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts. Results: The ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient-reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti-citrullinated protein antibody lab testing for RA and JIA should be collected as risk-adjustment variables. Conclusion: We present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value-based health care framework and compare outcomes that are important to patients with inflammatory arthritis

Integrable discretizations of derivative nonlinear Schroedinger equations

We propose integrable discretizations of derivative nonlinear Schroedinger (DNLS) equations such as the Kaup-Newell equation, the Chen-Lee-Liu equation and the Gerdjikov-Ivanov equation by constructing Lax pairs. The discrete DNLS systems admit the reduction of complex conjugation between two dependent variables and possess bi-Hamiltonian structure. Through transformations of variables and reductions, we obtain novel integrable discretizations of the nonlinear Schroedinger (NLS), modified KdV (mKdV), mixed NLS, matrix NLS, matrix KdV, matrix mKdV, coupled NLS, coupled Hirota, coupled Sasa-Satsuma and Burgers equations. We also discuss integrable discretizations of the sine-Gordon equation, the massive Thirring model and their generalizations.Comment: 24 pages, LaTeX2e (IOP style), final versio