Ratio of carbon dioxide veno-arterial difference to oxygen arterial-venous difference is not associated with lactate decrease after fluid bolus in critically ill patients with hyperlactatemia: results from a prospective observational study

Background: High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (PvaCO2/CavO2) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO2). This study investigated whether PvaCO2/CavO2 was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia. Methods: This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels < 1.5 mmol/L or a decrease of more than 10% compared to baseline. Results: The study enrolled 40 critically ill patients, and their median concentration of blood lactate was 2.6 [IQR:1.9 − 3.8] mmol/L. There were 27 (68%) patients with PvaCO2/CavO2 ≥ 1.4 mmHg/ml, and 10 of them had an increase in oxygen consumption (dVO2) ≥ 15% after FB, while 13 (32%) patients had PvaCO2/CavO2 < 1.4 mmHg/ml before FB, and none of them had dVO2 ≥ 15% after FB. FB increased the cardiac index in patients with high and low preinfusion PvaCO2/CavO2 (13.4% [IQR: 8.3 − 20.2] vs. 8.8% [IQR: 2.9 − 17.4], p = 0.34). Baseline PvaCO2/CavO2 was not found to be associated with a decrease in blood lactate after FB (OR: 0.88 [95% CI: 0.39 − 1.98], p = 0.76). A positive correlation was observed between changes in blood lactate and baseline PvaCO2/CavO2 (r = 0.35, p = 0.02). Conclusions: In critically ill patients with hyperlactatemia, PvaCO2/CavO2 before FB cannot be used to predict decreases in blood-lactate levels after FB. Increased PvaCO2/CavO2 is associated with less decrease in blood-lactate levels

Searching for Anomalous Weak Couplings of Heavy Flavors at the SLC and LEP

The existence of anomalous electric($\tilde \kappa$) and/or magnetic($\kappa$) dipole moment couplings between the heavy flavor fermions ($c,b,\tau$) and the $Z$ boson can cause significant shifts in the values of several electroweak observables currently being probed at both the SLC and LEP. Using the good agreement between existing data and the predictions of the Standard Model we obtain strict bounds on the possible strength of these new interactions for all of the heavy flavors. The decay $Z\rightarrow b\bar b$, however, provides some possible hint of new physics. The corresponding anomalous couplings of $\tau$'s to photons is briefly examined.Comment: 21 pages, 14 figs(available on request), LaTex, SLAC-PUB-667

Ion Chambers for Monitoring the NuMI Neutrino Beam at FNAL

The Neutrinos at the Main Injector (NuMI) beamline will deliver an intense muon neutrino beam by focusing a beam of mesons into a long evacuated decay volume. The beam must be steered with 1 mRad angular accuracy toward the Soudan Underground Laboratory in northern Minnesota. We have built 4 arrays of ionization chambers to monitor the neutrino beam direction and quality. The arrays are located at 4 stations downstream of the decay volume, and measure the remnant hadron beam and tertiary muons produced along with neutrinos in meson decays. We review how the monitors will be used to make beam quality measurements, and as well we review chamber construction details, radiation damage testing, calibration, and test beam results.Comment: paper to appear in the proceedings of the 11th Beam Instrumentation Workshop, Oak Ridge, T

Search for the Rare Decays KL->pi0pi0mu+mu- and KL->pi0pi0X0->pi0pi0mu+mu-

The KTeV E799 experiment has conducted a search for the rare decays KL->pi0pi0mu+mu- and KL->pi0pi0X0->pi0pi0mu+mu-, where the X0 is a possible new neutral boson that was reported by the HyperCP experiment with a mass of (214.3 pm 0.5) MeV/c^{2}. We find no evidence for either decay. We obtain upper limits of Br(KL->pi0pi0X0->pi0pi0mu+mu-) pi0pi0mu+mu-) < 9.2 x 10^{-11} at the 90% confidence level. This result rules out the pseudoscalar X0 as an explanation of the HyperCP result under the scenario that the \bar{d}sX0 coupling is completely real

Search for the Rare Decay K_{L}\to\pi^{0}\pi^{0}\gamma

The KTeV E799 experiment has conducted a search for the rare decay $K_{L}\to\pi^{0}\pi^{0}\gamma$ via the topology $K_{L}\to\pi^{0}\pi^{0}_D\gamma$ (where $\pi^0_D\to\gamma e^+e^-$). Due to Bose statistics of the $\pi^0$ pair and the real nature of the photon, the $K_{L}\to\pi^{0}\pi^{0}\gamma$ decay is restricted to proceed at lowest order by the CP conserving direct emission (DE) of an E2 electric quadrupole photon. The rate of this decay is interesting theoretically since chiral perturbation theory predicts that this process vanishes at level $O(p^4)$. Therefore, this mode probes chiral perturbation theory at $O(p^6)$. In this paper we report a determination of an upper limit of $2.43\times 10^{-7}$ (90% CL) for $K_{L}\to\pi^{0}\pi^{0}\gamma$. This is approximately a factor of 20 lower than previous results.Comment: six pages and six figures in the submission. Reformatted for Physics Review

Covid-19 disease, women’s predominant non-heparin vaccine-induced thrombotic thrombocytopenia and kounis syndrome: A passepartout cytokine storm interplay

Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitute one of the deadliest pandemics in modern history demonstrating cardiovascular, gastrointestinal, hematologic, mucocutaneous, respiratory, neurological, renal and testicular manifestations and further complications. COVID-19-induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications. The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro-inflammatory cytokine release. COVID-19 relation with Kounis syndrome and post-COVID-19 vaccination correlation with heparin-induced thrombocytopenia with thrombosis (HITT), especially serious cerebral venous sinus thrombosis, were also reviewed. Methods: A current literature search in PubMed, Embase and Google databases was performed to reveal the pathophysiology, prevalence, clinical manifestation, correlation and treatment of COVID-19, anaphylaxis with profuse hypotension, Kounis acute coronary syndrome and thrombotic events post vaccination. Results: The same key immunological pathophysiology mechanisms and cells seem to underlie COVID-19 cardiovascular complications and the anaphylaxis-associated Kounis syndrome. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, plaque rupture and microthrombi formation, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. COVID-19-interrelated vaccine excipients as polysorbate, polyethelene glycol (PEG) and trometamol constitute potential allergenic substances. Conclusion: Better acknowledgement of the pathophysiological mechanisms, clinical similarities, multiorgan complications of COVID-19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention, treatment of the COVID-19 pandemic as well as post-COVID-19 vaccine adverse reactions

A Measurement of the K0 Charge Radius and a CP Violating Asymmetry Together with a Search for CP Violating E1 Direct Photon Emission in the Rare Decay KL->pi+pi-e+e-

Using the complete KTeV data set of 5241 candidate KL->pi+pi-e+e- decays (including an estimated background of 204+-14 events), we have measured the coupling gCR=0.163+- 0.014(stat)+-0.023(syst) of the CP conserving charge radius process and from it determined a K0 charge radius of (K0)=(-0.077+-0.007(stat)+-0.011(syst)) fm**2. We have also determined a first experimental upper limit of 0.04 (90% CL) for the ratio |g_{E1}|/|g_{M1}| of the coupling for the E1 direct photon emission process relative to the coupling for M1 direct photon emission process. We also report the measurement of its associated vector form factor |gM1`|(1+ (a_1/a_2)/(M(rho)**2-M(K)**2)+2M(K)E(gamma*)) where |gM1`|=(1.11+- 0.12(stat)+-0.08(syst) and a_1/a_2 = (-0.744+-0.027(stat)0.032(syst)) GeV**2/c**2. In addition, a measurement of the manifestly CP violating asymmetry of magnitude (13.6+- 1.4+-(stat)+-1.5(syst))% in the CP and T odd angle phi between the decay planes of the e+e- and pi+pi- pairs in the KL center of mass system is reported

Measurement of the rare decay pi0 -> e+ e-

The branching ratio of the rare decay pi0 -> e+ e- has been measured precisely, using the complete data set from the KTeV E799-II experiment at Fermilab. We observe 794 candidate pi0 -> e+ e- events using K0_L -> 3pi0 as a source of tagged pi0's. The expected background is 52.7 +- 11.2 events, predominantly from high e+ e- mass pi0 -> e+ e- gamma decays. We have measured B[(pi0 -> e+ e-), (m_e+e-/m_pi0)^2 > 0.95] = 6.44 +- 0.25(stat) +- 0.22(syst) x10^(-8), which is above the unitary bound from pi0 -> gamma gamma and within the range of theoretical expectations from the standard model.Comment: 6 pages, 4 figure