Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients

INTRODUCTION: Esophageal Doppler provides a continuous and non-invasive estimate of descending aortic blood flow (ABF) and corrected left ventricular ejection time (LVETc). Considering passive leg raising (PLR) as a reversible volume expansion (VE), we compared the relative abilities of PLR-induced ABF variations, LVETc and respiratory pulsed pressure variations (ΔPP) to predict fluid responsiveness. METHODS: We studied 22 critically ill patients in acute circulatory failure in the supine position, during PLR, back to the supine position and after two consecutive VEs of 250 ml of saline. Responders were defined by an increase in ABF induced by 500 ml VE of more than 15%. RESULTS: Ten patients were responders and 12 were non-responders. In responders, the increase in ABF induced by PLR was similar to that induced by a 250 ml VE (16% versus 20%; p = 0.15). A PLR-induced increase in ABF of more than 8% predicted fluid responsiveness with a sensitivity of 90% and a specificity of 83%. Corresponding positive and negative predictive values (PPV and NPV, respectively) were 82% and 91%, respectively. A ΔPP threshold value of 12% predicted fluid responsiveness with a sensitivity of 70% and a specificity of 92%. Corresponding PPV and NPV were 87% and 78%, respectively. A LVETc of 245 ms or less predicted fluid responsiveness with a sensitivity of 70%, and a specificity of 67%. Corresponding PPV and NPV were 60% and 66%, respectively. CONCLUSION: The PLR-induced increase in ABF and a ΔPP of more than 12% offer similar predictive values in predicting fluid responsiveness. An isolated basal LVETc value is not a reliable criterion for predicting response to fluid loading

A Hot Gap Around Jupiter's Orbit in the Solar Nebula

The Sun was an order of magnitude more luminous during the first few hundred thousand years of its existence, due in part to the gravitational energy released by material accreting from the Solar nebula. If Jupiter was already near its present mass, the planet's tides opened an optically-thin gap in the nebula. We show using Monte Carlo radiative transfer calculations that sunlight absorbed by the nebula and re-radiated into the gap raised temperatures well above the sublimation threshold for water ice, with potentially drastic consequences for the icy bodies in Jupiter's feeding zone. Bodies up to a meter in size were vaporized within a single orbit if the planet was near its present location during this early epoch. Dust particles lost their ice mantles, and planetesimals were partially to fully devolatilized, depending on their size. Scenarios in which Jupiter formed promptly, such as those involving a gravitational instability of the massive early nebula, must cope with the high temperatures. Enriching Jupiter in the noble gases through delivery trapped in clathrate hydrates will be more difficult, but might be achieved by either forming the planet much further from the star, or capturing planetesimals at later epochs. The hot gap resulting from an early origin for Jupiter also would affect the surface compositions of any primordial Trojan asteroids.Comment: 25 pages, 10 figures. ApJ in press. Discussion of Jupiter's volatile enrichment revised in sec. 4.

Sample Handling and Instruments for the In-Situ Exploration of Ice-Rich Planets

NASA's key science goals for the exploration of the solar system seek a better understanding of the formation and evolutionary processes that have shaped planetary bodies and emphasize the search for habitable environments. Efforts are also made to detect and quantify resources that could be used for the support of human exploration. These themes call for chemistry and physical property observations that may be best approached by in situ measurements. NASA's planetary missions have progressively evolved from remote reconnaissance to in situ exploration with the ultimate goal to return samples. This chapter focuses on the techniques, available or in development, for advanced geophysical and chemical characterization of icy bodies, especially Mars polar areas, Enceladus, Titan, Europa, and Ceres. These astrobiological targets are the objects of recent or ongoing exploration whose findings are driving the formulation of new missions that involve in situ exploration. After reviewing the overall objectives of icy body exploration (Section 9.1) we describe key techniques used for addressing these objectives from surface platforms via geophysical observations (Section 9.2) and chemical measurements (Section 9.3)

Human tribbles-1 controls proliferation and chemotaxis of smooth muscle cells via MAPK signaling pathways

Migration and proliferation of smooth muscle cells are key to a number of physiological and pathological processes, including wound healing and the narrowing of the vessel wall.Previous work has shown links between inflammatory stimuli and vascular smooth muscle cell proliferation and migration through mitogen activated protein kinase (MAPK) activation, though the molecular mechanisms of this process are poorly understood. Here we report that tribbles-1, a recently described modulator of MAPK activation controls vascular smooth muscle cell proliferation and chemotaxis via the Jun Kinase pathway. Our findings demonstrate that this regulation takes place via direct interactions between tribbles-1 and MKK4/SEK1, a Jun activator kinase. The activity of this kinase is dependent on tribbles-1 levels, whilst the activation and the expression of MKK4/SEK1 is not. In addition, tribbles-1 expression is elevated in human atherosclerotic arteries compared to non-atherosclerotic controls, suggesting that this protein may pay a role in disease in vivo. In summary, the data presented here suggest an important regulatory role for trb-1 in vascular smooth muscle cell biology

Electron Spin Resonance in S=1/2 antiferromagnetic chains

A systematic field-theory approach to Electron Spin Resonance (ESR) in the $S=1/2$ quantum antiferromagnetic chain at low temperature $T$ (compared to the exchange coupling $J$) is developed. In particular, effects of a transverse staggered field $h$ and an exchange anisotropy (including a dipolar interaction) $\delta$ on the ESR lineshape are discussed. In the lowest order of perturbation theory, the linewidth is given as $\propto Jh^2/T^2$ and $\propto (\delta/J)^2 T$, respectively. In the case of a transverse staggered field, the perturbative expansion diverges at lower temperature; non-perturbative effects at very low temperature are discussed using exact results on the sine-Gordon field theory. We also compare our field-theory results with the predictions of Kubo-Tomita theory for the high-temperature regime, and discuss the crossover between the two regimes. It is argued that a naive application of the standard Kubo-Tomita theory to the Dzyaloshinskii-Moriya interaction gives an incorrect result. A rigorous and exact identity on the polarization dependence is derived for certain class of anisotropy, and compared with the field-theory results.Comment: 53 pages in REVTEX, 7 figures in EPS included; revised version with missing references and correction

JNK modulates FOXO3a for the expression of the mitochondrial death and mitophagy marker BNIP3 in pathological hypertrophy and in heart failure

Bcl-2 E1B 19-KDa interacting protein 3 (BNIP3) is a mitochondrial death and mitophagy marker, which is involved in inducing cardiac remodeling post myocardial infarction. In this study, we show that BNIP3 expression increases in stressed cardiomyocytes in vitro and in response to pressure overload in vivo, and that its transcription is directly related to JNK activity. BNIP3 expression gradually increased in the first weeks after pressure overload and peaked at the heart failure stage. Ultrastructurally, the mitochondrial area was inversely proportional to BNIP3 expression. Both JNK and AKT activities increased with pressure overload; however, JNK signaling dominated over AKT signaling for the activation of the transcription factor FOXO3a and for the transcription of its effector, BNIP3. 3-methyladenine attenuated JNK signaling and significantly decreased BNIP3 expression and reversed cardiac remodeling in heart failure. Ultrastructurally, the mitochondrial area was significantly increased in the 3-methyladenine group compared with placebo. Moreover, adenoviral gene delivery of dominant negative JNK in a rat model of pressure overload hypertrophy abolished the increase in BNIP3 expression in response to pressure overload. These results suggest that JNK signaling is a critical modulator of the transcription factor FOXO3a driving the expression of its effector, BNIP3, in heart failure and that JNK, through BNIP3, induces mitochondrial apoptosis and mitophagy

Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome : Workshop recommendations

Management of idiopathic glomerular disease associated with nephrotic syndrome (INS) remains controversial and one of the most complex areas relates to utilization of the drug cyclosporin. This is despite its demonstrated effectiveness in several histologic types of the INS in randomized controlled trials. Cyclosporin is effective in inducing remission of proteinuria in approximately 80% of steroid-sensitive cases of minimal change disease (MCD). Cyclosporin is also effective in both the induction of remission and long-term preservation of renal function in steroid-dependent/-resistant MCD and steroid-resistant focal segmental glomerulosclerosis (FSGS). The overall response rate in FSGS is lower than in MCD, and long-term therapy (>12 months) may be required to both achieve remission and sustain it. Cyclosporin therapy is also of benefit in reducing proteinuria in 70-80% of patients with steroid-resistant membranous nephropathy (MGN). In MGN, the maximum benefit is often delayed compared to MCD (>12 weeks). Cyclosporin is generally well tolerated and safe. The major concern remains the nephrotoxicity, but with careful monitoring of the patient's renal function; minimizing the maintenance dose and utilizing repeat renal biopsy in those receiving long-term therapy, this risk can be minimized. The algorithms have been developed derived from the best evidence in the literature in each of the histologic types to help provide a guide to the integration of cyclosporin into the management of INS for the practicing nephrologist