Pulmonary hemodynamic responses to in utero ventilation in very immature fetal sheep

<p>Abstract</p> <p>Background</p> <p>The onset of ventilation at birth decreases pulmonary vascular resistance (PVR) resulting in a large increase in pulmonary blood flow (PBF). As the large cross sectional area of the pulmonary vascular bed develops late in gestation, we have investigated whether the ventilation-induced increase in PBF is reduced in immature lungs.</p> <p>Methods</p> <p>Surgery was performed in fetal sheep at 105 d GA (n = 7; term ~147 d) to insert an endotracheal tube, which was connected to a neonatal ventilation circuit, and a transonic flow probe was placed around the left pulmonary artery. At 110 d GA, fetuses (n = 7) were ventilated <it>in utero </it>(IUV) for 12 hrs while continuous measurements of PBF were made, fetuses were allowed to develop <it>in utero </it>for a further 7 days following ventilation.</p> <p>Results</p> <p>PBF changes were highly variable between animals, increasing from 12.2 ± 6.6 mL/min to a maximum of 78.1 ± 23.1 mL/min in four fetuses after 10 minutes of ventilation. In the remaining three fetuses, little change in PBF was measured in response to IUV. The increases in PBF measured in responding fetuses were not sustained throughout the ventilation period and by 2 hrs of IUV had returned to pre-IUV control values.</p> <p>Discussion and conclusion</p> <p>Ventilation of very immature fetal sheep <it>in utero </it>increased PBF in 57% of fetuses but this increase was not sustained for more than 2 hrs, despite continuing ventilation. Immature lungs can increase PBF during ventilation, however, the present studies show these changes are transient and highly variable.</p

2013 WSES guidelines for management of intra-abdominal infections

Peer reviewe

Non-alcoholic steatohepatitis in children and adolescents

Copyright © 2000 Australasian Medical PublishingWe describe 17 children with non-alcoholic steatohepatitis. All had elevated levels of serum liver enzymes and 16 were morbidly obese. Liver biopsy showed variable steatosis and fibrosis in nine patients. At follow-up, 12 of 14 patients had persistent morbid obesity and 11 had elevated liver enzyme levels.Nicholas D Manton, Jill Lipsett, David J Moore, Geoffrey P Davidson, Anthony J Bourne and Richard T L Coupe

Savanna fire management can generate enough carbon revenue to help restore Africa’s rangelands and fill protected area funding gaps

Many savanna-dependent species in Africa including large herbivores and apex predators are at increasing risk of extinction. Achieving effective management of protected areas (PAs) in Africa where lions live will cost an estimated US$>1–2 billion/year in new funding. We explore the potential for fire-management-based carbon financing programs to fill this funding gap and benefit degrading savanna ecosystems. We demonstrate how introducing early dry season fire management programs could produce potential carbon revenues (PCRs) from either a single carbon financing method (avoided emissions) or from multiple sequestration methods ranging from US$ 59.6–655.9 million/year (at US$5/ton) or US$ 155.0 million/year to US$1.7 billion/year (at US$ 13/ton). We highlight variable but significant PCRs for savanna PAs from US$ 1.5–44.4 million/year per PA. We suggest investing in fire management programs to jump-start the United Nations Decade of Ecological Restoration to help restore degraded African savannas and conserve imperiled keystone herbivores and apex predators

Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections: A Post Hoc Analysis

Background: Management of complicated intra-abdominal infections (cIAIs) includes broad-spectrum antimicrobial coverage and commonly includes vancomycin for the empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Ideally, culture-guided de-escalation follows to promote robust antimicrobial stewardship. This study assessed the impact and necessity of vancomycin in cIAI treatment regimens. Patients and Methods: A post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was performed. Patients receiving piperacillin-tazobactam (P/T) and/or a carbapenem were included with categorization based on use of vancomycin. Univariate and multivariable analyses evaluated effects of including vancomycin on individual and the composite of undesirable outcomes (recurrent IAI, surgical site infection [SSI], or death). Results: The study cohort included 344 patients with 110 (32%) patients receiving vancomycin. Isolation of MRSA occurred in only eight (2.3%) patients. Vancomycin use was associated with a similar composite outcome, 29.1%, vs. no vancomycin, 22.2% (p = 0.17). Patients receiving vancomycin had (mean [standard deviation]) higher Acute Physiology and Chronic Health Evaluation II scores (13.1 [6.6] vs. 9.4 [5.7], p < 0.0001), extended length of stay (12.6 [10.2] vs. 8.6 [8.0] d, p < 0.001), and prolonged antibiotic courses (9.1 [8.0] vs. 7.1 [4.9] d, p = 0.02). After risk adjustment in a multivariate model, no significant difference existed for the measured outcomes. Conclusions: This post hoc analysis reveals that addition of vancomycin occurred in nearly one third of patients and more often in sicker patients. Despite this selection bias, no appreciable differences in undesired outcomes were demonstrated, suggesting limited utility for adding vancomycin to cIAI treatment regimens

Developing marine protected area networks in the Coral Triangle: good practices for expanding the Coral Triangle Marine Protected Area System

The Coral Triangle Marine Protected Area System aspires to become a region-wide, comprehensive, ecologically representative and well-managed system of marine protected areas (MPAs) and MPA networks. The development of this system will proceed primarily through the implementation of ecological, social, and governance MPA networks at the sub-national scale. We describe six case studies that exemplify different approaches taken to develop MPA networks in the Coral Triangle region at different scales: Nusa Penida in Indonesia; Tun Mustapha Park in Malaysia; Kimbe Bay in Papua New Guinea; Verde Island Passage in the Philippines; The Lauru Ridges to Reefs Protected Area Network in Choiseul, Solomon Islands; and Nino Konis Santana Park in Timor Leste. Through synthesis of these case studies, we identify five common themes that contributed to successful outcomes: (1) the need for multi-stakeholder and cross-level management institutions; (2) the value of integrating cutting-edge science with local knowledge and community-based management; (3) the importance of building local capacity; (4) using multiple-use zoning to balance competing objectives; and (5) participation in learning and governance networks. These lessons will be invaluable in guiding future efforts to expand the Coral Triangle Marine Protected Area System, and provide important insights for MPA practitioners elsewhere