Inhaled nitric oxide for high-altitude pulmonary edema

BACKGROUND. Pulmonary hypertension is a hallmark of high-altitude pulmonary edema and may contribute to its pathogenesis. When administered by inhalation, nitric oxide, an endothelium-derived relaxing factor, attenuates the pulmonary vasoconstriction produced by short-term hypoxia. METHODS. We studied the effects of inhaled nitric oxide on pulmonary-artery pressure and arterial oxygenation in 18 mountaineers prone to high-altitude pulmonary edema and 18 mountaineers resistant to this condition in a high altitude laboratory (altitude, 4559 m). We also obtained lung-perfusion scans before and during nitric oxide inhalation to gain further insight into the mechanism of action of nitric oxide. RESULTS. In the high-altitude laboratory, subjects prone to high-altitude pulmonary edema had more pronounced pulmonary hypertension and hypoxemia than subjects resistant to high-altitude pulmonary edema. Arterial oxygen saturation was inversely related to the severity of pulmonary hypertension (r=-0.50, P=0.002). In subjects prone to high-altitude pulmonary edema, the inhalation of nitric oxide (40 ppm for 15 minutes) produced a decrease in mean (+/-SD) systolic pulmonary-artery pressure that was three times larger than the decrease in subjects resistant to such edema (25.9+/-8.9 vs. 8.7+/-4.8 mm Hg, P<0.001). Inhaled nitric oxide improved arterial oxygenation in the 10 subjects who had radiographic evidence of pulmonary edema (arterial oxygen saturation increased from 67+/-10 to 73+/-12 percent, P=0.047), whereas it worsened oxygenation in subjects resistant to high-altitude pulmonary edema. The nitric oxide-induced improvement in arterial oxygenation in subjects with high-altitude pulmonary edema was accompanied by a shift in blood flow in the lung away from edematous segments and toward nonedematous segments. CONCLUSIONS. The inhalation of nitric oxide improves arterial oxygenation in high-altitude pulmonary edema, and this beneficial effect may be related to its favorable action on the distribution of blood flow in the lungs. A defect in nitric nitric oxide synthesis may contribute to high-altitude pulmonary edema

Update on hypertrophic cardiomyopathy and a guide to the guidelines

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM

Determination of Trace Concentration in TMD Detectors using PGAA

Transmutation detectors could be alternative to the traditional activation detector method for neutron fluence dosimetry at power nuclear reactors. This new method require an isotopically highly-sensitive, non-destructive in sense of compactness as well as isotopic content, precise and standardly used analytical method for trace concentration determination. The capability of Prompt Gamma-ray Activation Analysis (PGAA) for determination of trace concentrations of transmuted stable nuclides in the metallic foils of Ni, Au, Cu and Nb, which were irradiated for 21 days in the reactor core at the LVR-15 research reactor in Řež, is reported. The PGAA measurements of these activation foils were performed at the PGAA facility at Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRMII) in Garching

Determination of Trace Concentration in TMD Detectors using PGAA

Transmutation detectors could be alternative to the traditional activation detector method for neutron fluence dosimetry at power nuclear reactors. This new method require an isotopically highly-sensitive, non-destructive in sense of compactness as well as isotopic content, precise and standardly used analytical method for trace concentration determination. The capability of Prompt Gamma-ray Activation Analysis (PGAA) for determination of trace concentrations of transmuted stable nuclides in the metallic foils of Ni, Au, Cu and Nb, which were irradiated for 21 days in the reactor core at the LVR-15 research reactor in Řež, is reported. The PGAA measurements of these activation foils were performed at the PGAA facility at Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRMII) in Garching