Contribution of red blood cells to the compensation for hypocapnic alkalosis through plasmatic strong ion difference variations

Introduction Chloride shift is the movement of chloride between red blood cells (RBC) and plasma (and vice versa) caused by variations in pCO2. The aim of our study was to investigate changes in plasmatic strong ion diff erence (SID) during acute variations in pCO2 and their possible role in the compensation for hypocapnic alkalosis.Methods Patients admitted in this year to our ICU requiring extracorporeal CO2 removal were enrolled. Couples of measurements of gases and electrolytes on blood entering (v) and leaving (a) the respiratory membrane were analyzed. SID was calculated as [Na+] + [K+] + 2[Ca2+] \u2013 [Cl\u2013] \u2013 [Lac\u2013]. Percentage variations in SID (SID%) were calculated as (SIDv \u2013 SIDa) x 100 / SIDv. The same calculation was performed for pCO2 (pCO2%). Comparison between v and a values was performed by paired t test or the signed-rank test, as appropriate. Results Analysis was conducted on 205 sample-couples of six enrolled patients. A signifi cant diff erence (P <0.001) between mean values of v\u2013a samples was observed for pH (7.41 \ub1 0.05 vs. 7.51 \ub1 0.06), pCO2 (48 \ub1 6 vs. 35 \ub1 7 mmHg), [Na+] (136.3 \ub1 4.0 vs. 135.2 \ub1 4.0 mEq/l), [Cl\u2013] (101.5 \ub1 5.3 vs. 102.8 \ub1 5.2 mEq/l) and therefore SID (39.5 \ub1 4.0 vs. 36.9 \ub1 4.1 mEq/l). pCO2% and SID% signifi cantly correlated (r2 = 0.28, P <0.001). Graphical representation by quartiles of pCO2% is shown in Figure 1. Conclusions As a reduction in SID decreases pH, the observed movement of anions and cations probably limited the alkalinization caused by hypocapnia. In this model, the only source of electrolytes are blood cells (that is, no interstitium and no infl uence of the kidney is present); it is therefore conceivable to consider the observed phenomenon as the contribution of RBC for the compensation of acute hypocapnic alkalosi

Prolapso de uretra em cão da raça maltês. Relato de caso

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Múltiplos sarcomas atípicos recidivantes em um felino. Relato de caso

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Prevalence of interstitial pneumonia suggestive of COVID-19 at 18F-FDG PET/CT in oncological asymptomatic patients in a high prevalence country during pandemic period: a national multi-centric retrospective study

Purpose: To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. Methods: This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January\u2013February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. Results: Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p&nbsp;&lt; 0.001). Instead, no significant difference among pre-COVID and control periods was present. The prevalence of interstitial pneumonia detected at PET/CT was directly associated with geographic virus diffusion, with the higher rate in Northern Italy. Among 284 interstitial pneumonia detected during COVID period, 169 (59%) were FDG-avid (average SUVmax of 4.1). Conclusions: A significant increase of interstitial pneumonia incidentally detected with [18F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management

Electrolyte shifts across the artificial lung in patients on extracorporeal membrane oxygenation : interdependence between partial pressure of carbon dioxide and strong ion difference

Purpose: Partial pressure of carbon dioxide (P-CO2), strong ion difference (SID), and total amount of weak acids independently regulate pH. When blood passes through an extracorporeal membrane lung, P-CO2 decreases. Furthermore, changes in electrolytes, potentially affecting SID, were reported. We analyzed these phenomena according to Stewart's approach. Methods: Couples of measurements of blood entering (venous) and leaving (arterial) the extracorporeal membrane lung were analyzed in 20 patients. Changes in SID, P-CO2, and pH were computed and pH variations in the absence of measured SID variations calculated. Results: Passing from venous to arterial blood, PCO2 was reduced (46.5 +/- 7.7 vs 34.8 +/- 7.4 mm Hg, P < .001), and hemoglobin saturation increased (78 +/- 8 vs 100% +/- 2%, P < .001). Chloride increased, and sodium decreased causing a reduction in SID (38.7 +/- 5.0 vs 36.4 +/- 5.1 mEq/L, P < .001). Analysis of quartiles of Delta P-CO2 revealed progressive increases in chloride (P < .001), reductions in sodium (P < .001), and decreases in SID (P < .001), at constant hemoglobin saturation variation (P = .12). Actual pH variation was lower than pH variations in the absence of measured SID variations (0.09 +/- 0.03 vs 0.12 +/- 0.04, P < .001). Conclusions: When P-CO2 is reduced and oxygen added, several changes in electrolytes occur. These changes cause a P-CO2-dependent SID reduction that, by acidifying plasma, limits pH correction caused by carbon dioxide removal. In this particular setting, P-CO2 and SID are interdependent

Modes and Cuts in Metabolic Networks:Complexity and Algorithms

Constraint-based approaches recently brought new insight into our understanding of metabolism. By making very simple assumptions such as that the system is at steady-state and some reactions are irreversible, and without requiring kinetic parameters, general properties of the system can be derived. A central concept in this methodology is the notion of an elementary mode (EM for short) which represents a minimal functional subsystem. The computation of EMs still forms a limiting step in metabolic studies and several algorithms have been proposed to address this problem leading to increasingly faster methods. However, although a theoretical upper bound on the number of elementary modes that a network may possess has been established, surprisingly, the complexity of this problem has never been systematically studied. In this paper, we give a systematic overview of the complexity of optimisation problems related to modes. We first establish results regarding network consistency. Most consistency problems are easy, i.e., they can be solved in polynomial time. We then establish the complexity of finding and counting elementary modes. We show in particular that finding one elementary mode is easy but that this task becomes hard when a specific EM (i.e. an EM containing some specified reactions) is sought. We then show that counting the number of elementary modes is P-complete. We emphasize that the easy problems can be solved using currently existing software packages. We then analyse the complexity of a closely related task which is the computation of so-called minimum reaction cut sets and we show that this problem is hard. We then present two positive results which both allow to avoid computing EMs as a prior to the computation of reaction cuts. The first one is a polynomial approximation algorithm for finding a minimum reaction cut set. The second one is a test for verifying whether a set of reactions constitutes a reaction cut; this test can be readily included in existing algorithms to improve their performance. Finally, we discuss the complexity of other cut-related problems