Maternal hyperleptinemia is associated with male offspring’s altered vascular function and structure in mice

Children of mothers with gestational diabetes have greater risk of developing hypertension but little is known about the mechanisms by which this occurs. The objective of this study was to test the hypothesis that high maternal concentrations of leptin during pregnancy, which are present in mothers with gestational diabetes and/or obesity, alter blood pressure, vascular structure and vascular function in offspring. Wildtype (WT) offspring of hyperleptinemic, normoglycemic, Lepr db/+ dams were compared to genotype matched offspring of WT-control dams. Vascular function was assessed in male offspring at 6, and at 31 weeks of age after half the offspring had been fed a high fat, high sucrose diet (HFD) for 6 weeks. Blood pressure was increased by HFD but not affected by maternal hyperleptinemia. On a standard diet, offspring of hyperleptinemic dams had outwardly remodeled mesenteric arteries and an enhanced vasodilatory response to insulin. In offspring of WT but not Leprdb/+ dams, HFD induced vessel hypertrophy and enhanced vasodilatory responses to acetylcholine, while HFD reduced insulin responsiveness in offspring of hyperleptinemic dams. Offspring of hyperleptinemic dams had stiffer arteries regardless of diet. Therefore, while maternal hyperleptinemia was largely beneficial to offspring vascular health under astandard diet, it had detrimental effects in offspring fed HFD. These results suggest that circulating maternal leptin concentrations may interact with other factors in the pre- and post-natal environments to contribute to altered vascular function in offspring of diabetic pregnancie

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Enhancement of biological treatment performance of saline wastewater by halophilic bacteria

Performances of biological treatment processes of saline wastewater are usually low because of adverse effects of salt on microbial flora. High salt concentrations in wastewater cause plasmolysis and loss of activity of cells resulting in low COD removal efficiencies. In order to improve biological treatment performance of saline wastewater, a halophilic organism Halobacter halobium was used along with activated sludge culture

Performance of rotating biological disc system treating saline wastewater

Synthetic saline wastewater composed of diluted molasses, urea, KH2PO4 and different concentrations of salt (0-10%) was biologically treated in a rotating biodisc unit for COD removal. The performance of the system was evaluated under different operating conditions such as disc number (or surface area), COD loading rate (or feed GOD) and salt concentration. COD removal efficiency increased with increasing number of discs (N) or disc surface area (A), but decreased with increasing COD loading rate (L-s) and salt concentration. Experimental results were correlated by an empirical polynomial equation in terms of COD removal efficiency as functions of disc number (N) or disc surface area, feed COD and salt concentrations. Empirical constants were determined using the experimental data. (C) 2001 Elsevier Science Ltd. All rights reserved

Salt inhibition kinetics in nitrification of synthetic saline wastewater

Nitrification kinetics of synthetic saline wastewater was investigated by using an activated sludge unit. Initial experiments were performed with salt-free wastewater to obtain baseline information. Experiments with 3% salt concentration were performed at different sludge ages in order to investigate the system performance and salt inhibition effects on kinetic constants. Minimum sludge age required for complete nitrification increased From 12 days for salt-free wastewater to 25 days for 3% salt content. Salt inhibition was non-competitive type affecting both the maximum rate and the saturation constants. inhibition constants were determined by using the experimental data as K-T1 = 200 g/liter and K-T2 - 7.4 g/liter. Further experiments were performed with salt concentrations between 0-5% to quantify variation of the rate and extent of COD removal with salt concentration. The rate and extent of nitrification decreased approximately 20% with 5% salt as compared to salt-free wastewater. (C) 2001 Elsevier Science Inc. All rights reserved

Effect of salt concentration on biological treatment of saline wastewater by fed-batch operation

The performance of biological treatment processes for saline wastewater is usually low due to adverse effects of salt on microbial flora. High salt concentrations in wastewater cause plasmolysis and loss of cell activity, thereby resulting in low (COD) removal efficiencies, In order to quantify the adverse effects of salt on biological treatment of saline wastewater a synthetic wastewater composed of dilute molasses, urea, KH2PO4, and various concentrations of salt (1-5% NaCl) was treated under aerobic conditions in a biological reactor by fedbatch operation. Zooglea ramigera was used as the dominant culture throughout the studies. Variations in the COD removal rate and the efficiency with salt concentration were determined. A rate expression indicating the inhibition effects of salt was proposed. Kinetic constants were determined by using experimental data. (C) 1996 by Elsevier Science Inc

Biological treatment of saline wastewater by fed-batch operation

The adverse effects of salt on biological treatment of saline wastewater inoculated by activated sludge culture were investigated. A synthetic wastewater composed of diluted molasses, urea, KH2PO4 and various concentrations of salt (1-5% w/v NaCl) was treated in an aerobic-biological reactor operating in fed-batch mode. An activated sludge culture obtained from a wastewater treatment plant was used as the seed. Variations of chemical oxygen demand (COD) removal rate and efficiency with salt concentration were determined. A rate expression including salt inhibition effect was proposed and kinetic constants were determined by using the experimental data

Salt inhibition of nitrification and denitrification in saline wastewater

Biological processes used for nitrification and denitrification of saline wastewater results in low treatment efficiencies because of plasmolysis or loss of activity of organisms in the presence of salt. However, adverse effects of salt on performance of nitrifcation/denitrification processes has not been systematically investigated and mathematically formulated. Biological nitrification and denitrification of synthetic wastewater containing different concentrations of salt were investigated in this study. Effect of salt concentration on the system performance was investigated. Salt concentrations above 2% resulted in significant reductions in performances of both nitrification and denitrification. Denitrification was more sensitive to salt compared to nitrification. A mathematical model was developed and the salt inhibition constants were determined using the experimental data

Effect of sludge recycle on performance of a rotating biodisc contactor treating saline wastewater

A rotating biodisc contactor (RBC) was used for biological treatment of synthetic saline wastewater with and without sludge (cell) recycle. Synthetic wastewater composed of diluted molasses, urea, KHzPO4, MgSO4 and 3% salt (NaCl) was fed to the RBC unit with different flow rates. Underflow from a sedimentation tank placed at the end of RBC unit was recycled to the RBC unit with a constant flow rate. COD removal rates and efficiencies were determined for the cases of with and without sludge recycle and compared