Periodic Fluctuation of Tidal Volumes Further Improves Variable Ventilation in Experimental Acute Respiratory Distress Syndrome

In experimental acute respiratory distress syndrome (ARDS), random variation of tidal volumes (VT ) during volume controlled ventilation improves gas exchange and respiratory system mechanics (so-called stochastic resonance hypothesis). It is unknown whether those positive effects may be further enhanced by periodic VT fluctuation at distinct frequencies, also known as deterministic frequency resonance.We hypothesized that the positive effects of variable ventilation on lung functionmay be further amplified by periodic VT fluctuation at specific frequencies. In anesthetized and mechanically ventilated pigs, severe ARDS was induced by saline lung lavage and injurious VT (double-hit model). Animals were then randomly assigned to 6 h of protective ventilation with one of four VT patterns: (1) random variation of VT (WN); (2) P04, main VT frequency of 0.13Hz; (3) P10, main VT frequency of 0.05Hz; (4) VCV, conventional non-variable volume controlled ventilation. In groups with variable VT , the coefficient of variation was identical (30%). We assessed lung mechanics and gas exchange, and determined lung histology and inflammation. Compared to VCV, WN, P04, and P10 resulted in lower respiratory system elastance (63 ± 13 cm H2O/L vs. 50 ± 14 cm H2O/L, 48.4 ± 21 cm H2O/L, and 45.1 ± 5.9 cm H2O/L respectively, P < 0.05 all), but only P10 improved PaO2/FIO2 after 6 h of ventilation (318 ± 96 vs. 445 ± 110mm Hg, P < 0.05). Cycle-by-cycle analysis of lung mechanics suggested intertidal recruitment/de-recruitment in P10. Lung histologic damage and inflammation did not differ among groups. In this experimental model of severe ARDS, periodic VT fluctuation at a frequency of 0.05Hz improved oxygenation during variable ventilation, suggesting that deterministic resonance adds further benefit to variable ventilation

Effective Action for QED with Fermion Self-Interaction in D=2 and D=3 Dimensions

In this work we discuss the effect of the quartic fermion self-interaction of Thirring type in QED in D=2 and D=3 dimensions. This is done through the computation of the effective action up to quadratic terms in the photon field. We analyze the corresponding nonlocal photon propagators nonperturbatively in % \frac{k}{m}, where k is the photon momentum and m the fermion mass. The poles of the propagators were determined numerically by using the Mathematica software. In D=2 there is always a massless pole whereas for strong enough Thirring coupling a massive pole may appear . For D=3 there are three regions in parameters space. We may have one or two massive poles or even no pole at all. The inter-quark static potential is computed analytically in D=2. We notice that the Thirring interaction contributes with a screening term to the confining linear potential of massive QED_{2}. In D=3 the static potential must be calculated numerically. The screening nature of the massive QED$_{3}$ prevails at any distance, indicating that this is a universal feature of % D=3 electromagnetic interaction. Our results become exact for an infinite number of fermion flavors.Comment: Latex, 13 pages, 3 figure

Anatomical study of the mandibular canal course in felines (Felis catus domesticus)

Objetivou-se descrever, por meio de tomografia computadorizada, o trajeto do canal mandibular (CM) em 20 gatos sem raça definida, com ausência de alterações na cavidade oral, provenientes do Centro de Controle de Zoonoses do Distrito Federal. Foram realizados cortes tomográficos com 2mm de espessura, acompanhando todo o trajeto do CM, tendo como referência a região do forame mandibular, as raízes distais e mesiais dos dentes pré-molares e molares e o forame mentoniano, obtendo-se medidas desde o CM até as faces vestibular, lingual, ventral e alveolar (profundidade) do corpo da mandíbula, bem como seu diâmetro. Pôde constatar que o CM manteve-se no aspecto lingual do corpo da mandíbula desde o forame mandibular até a raiz mesial do 1º pré-molar, onde se deslocou para a face vestibular, emergindo no forame mentoniano. Com relação à profundidade, seu trajeto sofreu declive a partir do forame mandibular até a região da raiz mesial do 1º molar, onde alcançou seu ponto mais profundo para prosseguir em suave ascensão até o forame mentoniano. Os dados apresentados contribuem para o estudo anatômico da mandíbula de gatos, bem como auxiliam no melhor planejamento e execução de procedimentos cirúrgicos na mandíbula dessa espécie.This study aimed to describe the path of the mandibular canal (MC), using computerized tomography, in twenty mongrel cats, with no changes in the oral cavity, from the Zoonosis Control Center of the Federal District. 2mm thick tomographic sections were taken following the entire path of the mandibular canal, considering as reference the region of the mandibular foramen, the distal and mesial roots of premolar and molar teeth, and mental foramen, obtaining measurements from the MC until the buccal, lingual, ventral and alveolar (depth) surfaces of the mandibular body as well as its diameter. MC remained on the lingual aspect of the mandibular body from the mandibular foramen to the mesial root of the first premolar, where it displaced to the buccal surface, emerging from the mental foramen. Regarding the depth, we observed a downward path from the mandibular foramen to the mesial root of the first premolar, where it reached its deepest point, the path continued in gentle ascent until to the mental foramen. Our data contribute to the anatomical study of the feline jaw and allow a better planning and execution of surgical procedures in the mandible of this species

Phlebotomus papatasi SP15: mRNA expression variability and amino acid sequence polymorphisms of field populations

Citation: Ramalho-Ortigao, M., Coutinho-Abreu, I. V., Balbino, V. Q., Figueiredo, C. A. S., Mukbel, R., Dayem, H., . . . McDowell, M. A. (2015). Phlebotomus papatasi SP15: mRNA expression variability and amino acid sequence polymorphisms of field populations. Parasites & Vectors, 8, 14. doi:10.1186/s13071-015-0914-2Background: The Phlebotomus papatasi salivary protein PpSP15 was shown to protect mice against Leishmania major, suggesting that incorporation of salivary molecules in multi-component vaccines may be a viable strategy for anti-Leishmania vaccines. Methods: Here, we investigated PpSP15 predicted amino acid sequence variability and mRNA profile of P. papatasi field populations from the Middle East. In addition, predicted MHC class II T-cell epitopes were obtained and compared to areas of amino acid sequence variability within the secreted protein. Results: The analysis of PpSP15 expression from field populations revealed significant intra-and interpopulation variation.. In spite of the variability detected for P. papatasi populations, common epitopes for MHC class II binding are still present and may potentially be used to boost the response against Le. major infections. Conclusions: Conserved epitopes of PpSP15 could potentially be used in the development of a salivary gland antigen-based vaccine.Additional Authors: Lobo, N. F.;Mahon, A. R.;Emrich, S. J.;Kamhawi, S.;Collins, F. H.;McDowell, M. A

Driving pressure during general anesthesia for open abdominal surgery (DESIGNATION) : study protocol of a randomized clinical trial

Background Intraoperative driving pressure (Delta P) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (V-T) is kept constant, Delta P may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. Delta P may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery. Methods The "Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial" (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged >= 18 years and with a body mass index <= 40 kg/m(2), scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) ("individualized high PEEP") or one in which PEEP of 5 cm H2O without RM is used ("low PEEP"). In the "individualized high PEEP" group, PEEP is set at the level at which Delta P is lowest. In both groups of the trial, V-T is kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events. Discussion DESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery