Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients

Journal Article;INTRODUCTION Hemodynamic resuscitation should be aimed at achieving not only adequate cardiac output but also sufficient mean arterial pressure (MAP) to guarantee adequate tissue perfusion pressure. Since the arterial pressure response to volume expansion (VE) depends on arterial tone, knowing whether a patient is preload-dependent provides only a partial solution to the problem. The objective of this study was to assess the ability of a functional evaluation of arterial tone by dynamic arterial elastance (Ea(dyn)), defined as the pulse pressure variation (PPV) to stroke volume variation (SVV) ratio, to predict the hemodynamic response in MAP to fluid administration in hypotensive, preload-dependent patients with acute circulatory failure. METHODS We performed a prospective clinical study in an adult medical/surgical intensive care unit in a tertiary care teaching hospital, including 25 patients with controlled mechanical ventilation who were monitored with the Vigileo(®) monitor, for whom the decision to give fluids was made because of the presence of acute circulatory failure, including arterial hypotension (MAP ≤65 mmHg or systolic arterial pressure <90 mmHg) and preserved preload responsiveness condition, defined as a SVV value ≥10%. RESULTS Before fluid infusion, Ea(dyn) was significantly different between MAP responders (MAP increase ≥15% after VE) and MAP nonresponders. VE-induced increases in MAP were strongly correlated with baseline Ea(dyn) (r(2) = 0.83; P 0.89 predicted a MAP increase after fluid administration with a sensitivity of 93.75% (95% CI, 69.8%-99.8%) and a specificity of 100% (95% CI, 66.4%-100%). CONCLUSIONS Functional assessment of arterial tone by Ea(dyn), measured as the PVV to SVV ratio, predicted arterial pressure response after volume loading in hypotensive, preload-dependent patients under controlled mechanical ventilation.Ye

The negative effects of short-term extreme thermal events on the seagrass Posidonia oceanica are exacerbated by ammonium additions

Global warming is increasingly affecting our biosphere. However, in addition to global warming, a panoply of local stressors caused by human activities is having a profound impact on our environment. The risk that these local stressors could modify the response of organisms to global warming has attracted interest and fostered research on their combined effect, especially with a view to identifying potential synergies. In coastal areas, where human activities are heavily concentrated, this scenario is particularly worrying, especially for foundation species such as seagrasses. In this study we explore these potential interactions in the seagrass Posidonia oceanica. This species is endemic to the Mediterranean Sea. It is well known that the Mediterranean is already experiencing the effects of global warming, especially in the form of heat waves, whose frequency and intensity are expected to increase in the coming decades. Moreover, this species is especially sensitive to stress and plays a key role as a foundation species. The aim of this work is thus to evaluate plant responses (in terms of photosynthetic efficiency and growth) to the combined effects of short-term temperature increases and ammonium additions.To achieve this, we conducted a mesocosm experiment in which plants were exposed to three thermal treatments (20°C, 30°C and 35°C) and three ammonium concentrations (ambient, 30 μM and 120 μM) in a full factorial experiment. We assessed plant performance by measuring chlorophyll fluorescence variables (maximum quantum yield (Fv/Fm), effective quantum yield of photosystem II (ΔF/Fm'), maximum electron transport rate (ETRmax) and non-photochemical quenching (NPQ)), shoot growth rate and leaf necrosis incidence. At ambient ammonium concentrations, P. oceanica tolerates short-term temperature increases up to 30°C. However, at 35°C, the plant loses functionality as indicated by a decrease in photosynthetic performance, an inhibition of plant growth and an increase of the necrosis incidence in leaves. On the other hand, ammonium additions at control temperatures showed only a minor effect on seagrass performance. However, the combined effects of warming and ammonium were much worse than those of each stressor in isolation, given that photosynthetic parameters and, above all, leaf growth were affected. This serves as a warning that the impact of global warming could be even worse than expected (based on temperature-only approaches) in environments that are already subject to eutrophication, especially in persistent seagrass species living in oligotrophic environments

Generally Antisocial Batterers with High Neuropsychological Deficits Present Lower Treatment Compliance and Higher Recidivism

Objective: No studies have considered whether neuropsychological performance moderates the relationship between Holtzworth-Munroe and Stuart's intimate partner violence against women (IPVAW) offender typologies and treatment compliance and recidivism. Therefore, we first aimed to assess whether the typologies show differences in specific neuropsychological variables such as cognitive flexibility and emotion decoding processes. Second, we also assessed whether there are differences in treatment compliance and recidivism between the IPVAW offender typologies, based on their neuropsychological performance. Method: We administered a set of neuropsychological tests (e.g., Wisconsin card sorting test and eyes test) and self-reports to a group of IPVAW offenders (n=424). We also assessed their treatment compliance (i.e., dropout and intervention dose) and recidivism (i.e., risk of recidivism and official recidivism) after treatment. Results: Our analysis revealed that the FO offenders showed the best cognitive performance, followed by the BD group, with the GVA group showing the worst performance. Even though there were significant differences between the IPVAW offenders' typologies in their treatment compliance, and the recidivism, these differences were more pronounced when considering IPVAW offenders' typologies along with neuropsychological performance (high vs low). That is, FO with high cognitive functioning presented highest treatment compliance and lowest rates of recidivism. Conversely, GVA with low cognitive functioning presented the lowest treatment compliance and highest rate of recidivism. Conclusions: Our study highlights the need to design therapeutic programs with coadjutant neuropsychological training to attend not only to the psychological needs of IPVAW offenders, but also to the neuropsychological deficits that might facilitate lower treatment compliance and recidivism

The role of glucagon after bariatric/metabolic surgery: much more than an “anti-insulin” hormone

The biological activity of glucagon has recently been proposed to both stimulate hepatic glucose production and also include a paradoxical insulinotropic effect, which could suggest a new role of glucagon in the pathophysiology type 2 diabetes mellitus (T2DM). An insulinotropic role of glucagon has been observed after bariatric/metabolic surgery that is mediated through the GLP-1 receptor on pancreatic beta cells. This effect appears to be modulated by other members of the proglucagon family, playing a key role in the beneficial effects and complications of bariatric/metabolic surgery. Glucagon serves a dual role after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). In addition to maintaining blood glucose levels, glucagon exhibits an insulinotropic effect, suggesting that glucagon has a more complex function than simply an “anti-insulin hormone”

Anticipatory Antifungal Treatment in Critically Ill Patients with SARS-CoV-2 Pneumonia

Background. The aim of this study was to investigate the incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in critically ill patients and the impact of anticipatory antifungal treatment on the incidence of CAPA in critically ill patients. Methods. Before/after observational study in a mixed intensive care unit (ICU) of a university teaching hospital. The study took place between March 2020 and June 2022. Inclusion criteria were critically ill patients with severe SARSCoV- 2 pneumonia requiring invasive mechanical ventilation. Two analysis periods were compared according to whether or not antifungal therapy was given early. Results. A total of 160 patients with severe SARS-CoV-2 pneumonia and invasive mechanical ventilation were included. The incidence of CAPA in the first study period was 19 out of 58 patients (32.75%); during the second period, after implementation of the intervention (anticipatory antifungal therapy), the incidence of CAPA decreased to 10.78% (11 out of 102 patients). In patients with CAPA under invasive mechanical ventilation, the mortality rate decreased from 100% to 64%. Conclusions. Anticipating antifungal treatment in patients with SARS-CoV-2 pneumonia under invasive mechanical ventilation was associated with a decrease in the incidence and mortality of pulmonary aspergillosis

Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know

Background: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. Methods: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. Results and limitations: A total of 127 answers were obtained, in which ‘Urological infections’, ‘Renal colic’, ‘PSA levels and screening for prostate cancer’, ‘Benign prostatic hyperplasia’, ‘Hematuria’, ‘Scrotal pain’, ‘Prostate cancer diagnosis’, ‘Bladder cancer diagnosis’, ‘Urinary incontinence’, and ‘Erectile dysfunction’ were rated as Very high or High formative requirements (&gt;75%). Regarding urological skills, ‘Abdominal examination’, ‘Interpretation of urinalysis’, ‘Digital rectal examination’, ‘Genital examination’, and ‘Transurethral catheterization’ were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. Conclusions: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients’ proper care by future GPs

Somatostatin: From a supporting actor to the protagonist to explain the long-term effect of sleeve gastrectomy on glucose metabolism.

BACKGROUND: Bariatric/metabolic surgery has become the most effective treatment against type 2 Diabetes mellitus (T2DM). The role of many gastrointestinal hormones in T2DM has been proposed, but the pathophysiological models described vary greatly depending on the anatomical rearrangements after surgery. We focus on somatostatin as a common factor in two of the most commonly performed surgical procedures in a healthy rodent model. We performed sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) and also an experimental surgery without gastric involvement (intestinal resection of 50 % jejunum-ileum portion -IR50 %). METHODS: We used five groups of Wistar rats: fasting control, sham-operated, SG-operated, RYGB-operated and IR50-operated. We analysed several parameters 4 and 23 weeks after surgery: plasma SST-14/28 fractions, plasma glucose, insulin release and SST-producing cell expression in the duodenum and pancreatic islets. RESULTS: Numerous SST-producing cells in the duodenum but a low number in the pancreas and a long-term loss of glucose tolerance were observed in SG and RYGB animals. Additionally, a high plasma SST-28 fraction was found in animals after SG but not after RYGB. Finally, IR50 animals showed no differences versus controls. CONCLUSIONS: In our SG model the amplitude of insulin response after metabolic surgeries, is mediated by SST-28 plasma levels derived from the proportional compensatory effect of gastric SST-producing tissue ablation. In addition, a strong compensatory response to the surgical loss of gastric SST-producing cells, leads to long-term loss of insulin production after SG but not in the others. Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved

Dual effect of RYGB on the entero-insular axis: How GLP-1 is enhanced by surgical duodenal exclusion

Background: The role of the ileum and Glucagon Like Peptide-1 (GLP-1) secretion in the pathophysiological processes underlying the effects of Roux-en-Y gastric bypass (RYGB) on type 2 Diabetes mellitus (T2DM) improvement has been previously determined. However, the roles of duodenal exclusion and Glucose Insulinotropic Peptide (GIP) secretion change is not clear. To clarify this aspect, we compared the pathophysiological mechanisms triggered by RYGB, which implies the early arrival of food to the ileum with duodenal exclusion, and through pre-duodenal ileal transposition (PdIT), with early arrival of food to the ileum but without duodenal exclusion, in a nondiabetic rodent model. Methods: We compared plasma and insulin, glucose (OGTT), GIP and GLP-1 plasma levels, ileal and duodenal GIP and GLP-1 tissue expression and beta-cell mass for n = 12 Sham-operated, n = 6 RYGB-operated, and n = 6 PdIT-operated Wistar rats. Results: No surgery induced changes in blood glucose levels after the OGTT. However, RYGB induced a significant and strong insulin response that increased less in PdIT animals. Increased beta-cell mass was found in RYGB and PdIT animals as well as similar GLP-1 secretion and GLP-1 intestinal expression. However, differential GIP secretion and GIP duodenal expression were found between RYGB and PdIT. Conclusion: The RYGB effect on glucose metabolism is mostly due to early ileal stimulation; however, duodenal exclusion potentiates the ileal response within RYGB effects through enhanced GIP secretio