Mechanisms controlling the volume of pleural fluid and extravascular lung water

Pleural and interstitial lung fluid volumes are strictly controlled and maintained at the minimum thanks to the ability of lymphatics to match the increase in filtration rate. In the pleural cavity, fluid accumulation is easily accommodated by retraction of lung and chest wall (high compliance of the pleural space); the increase of lymph flow per unit increase in pleural fluid volume is high due to the great extension of the parietal lymphatic. However, for the lung interstitium, the increase in lymph flow to match increased filtration does not need to be so great. In fact, increased filtration only causes a minor increase in extravascular water volume (<10%) due to a marked increase in interstitial pulmonary pressure (low compliance of the extracellular matrix) which, in turn, buffers further filtration. Accordingly, a less extended lymphatic network is needed. The efficiency of lymphatic control is achieved through a high lymphatic conductance in the pleural fluid and through a low interstitial compliance for the lung interstitium. Fluid volume in both compartments is so strictly controlled that it is difficult to detect initial deviations from the physiological state; thus, a great physiological advantage turns to be a disadvantage on a clinical basis as it prevents an early diagnosis of developing disease

The Effect of Therapist White Privilege Attitudes on Client Outcomes and the Therapist-Client Relationship

Counseling Psychology has emphasized the importance of using multicultural and social justice frameworks in psychotherapy to avoid reenacting in session the privilege and oppression dynamics that exist in larger society. People of Color have historically underutilized psychotherapy services and have higher attrition rates when they do attend therapy, even though they have been more likely to face more sources of psychological distress (Kearney, Draper, & Baron, 2005; Sue & Sue, 2008). Additionally, White therapists have been over-represented in professional and training settings (Fouad & Arredondo, 2007; Hays & Chang, 2003). Add to that the fact that therapists have been trained in and practice psychotherapy theories developed primarily by White men and you have a system of counseling that works for some and not all. Thus, White therapists could be at risk for harming their clients of Color, and possibly their White clients as well, because of the utilization of these Euro-centrically biased ways of conceptualizing and treating clients (Mindrup, Spray, & Lamberghini-West, 2011). In this study, I examined the impact of therapist-reported White privilege attitudes on client-reported counseling outcomes and the therapeutic relationship. Participating therapists (N = 36) were recruited from a community mental health agency in the southeast and administered measures of White privilege attitudes, multicultural knowledge and awareness, and motivation to control prejudiced reactions. Outcome and therapeutic relationship data from clients of participating therapists, seen between fall 2012 and fall 2013 semesters, were provided by the agency. Therapist self-reported White privilege attitudes were not directly predictive of therapy outcomes and the therapeutic alliance. Therapists’ willingness to confront White privilege, White privilege remorse, and apprehension about addressing White privilege moderated the effects first session outcome scores and client gender had on number of sessions attended by clients. Client race/ethnicity was not directly predictive of therapy outcome scores or therapeutic alliance scores. However, client race/ethnicity varied significantly across therapists, suggesting that therapists were differentially effective. Results of this study indicate that therapist White privilege awareness has an effect on outcomes and the therapeutic alliance, although the relationship is complicated. Study limitations, strengths, and implication for future research are discussed

Energy Intensity Reduction in Large-Scale Non-Residential Buildings by Dynamic Control of HVAC with Heat Pumps

One of the main elements for increasing energy efficiency in large-scale buildings is identified in the correct management and control of the Heating Ventilation and Air Conditioning (HVAC) systems, particularly those with Heat Pumps (HPs). The present study aimed to evaluate the perspective of energy savings achievable with the implementation of an optimal control of the HVAC with HPs. The proposed measures involve the use of a variable air volume system, demand-controlled ventilation, an energy-aware control of the heat recovery equipment, and an improved control of the heat pump and chiller supply water temperature. The analysis has been applied to an academic building located in Pisa and is carried out by means of dynamic simulation. The achieved energy saving can approach values of more than 80% if compared with actual plants based on fossil fuel technologies. A major part of this energy saving is linked to the use of heat pumps as thermal generators as well as to the implementation of an energy efficient ventilation, emphasizing the importance of such straightforward measures in reducing the energy intensity of large-scale buildings

mRNA expression profile of selected oxygen sensing genes in the lung during recovery from chronic hypoxia

This study analyzed the time dependence decay of the mRNA of selected genes important for the hypoxia response. The genes chosen were the two isoforms of hypoxia-inducible factors, the three isoforms of the prolyl hydroxylase domain protein, the vascular endothelial growth factor and endothelial nitric oxide synthase. mRNA and proteins were extracted from lungs obtained from control, hypoxic and 15 minutes normoxic recovered rats and analyzed by Real-time RT-PCR or by the Western Blot technique. Results indicated that in normoxia isoform 2á was the more represented hypoxia-inducible factor mRNA, and among the prolyl hydroxylase domain transcripts, isoform 3 was the least abundant. Moreover, in chronic hypoxia only hypoxia-inducible factor 1α and prolyl hydroxylase domain protein 3 increased significantly, while after 15 minutes of recovery all the mRNAs tested were decreased except endothelial nitric oxide synthase mRNA. In terms of proteins, hypoxia-inducible 1α was the isoform more significant in the nucleus, while 2á predominated in the cytosol. While the former was steady even after a brief recovery from hypoxia, the latter underwent a strong degradation. In conclusion we showed the relevance of the decay in the mRNA and protein levels upon re-oxygenation in normoxia. We believe that this has to be considered in research studies dealing with recovery from hypoxia

Translocation pathways for inhaled asbestos fibers

We discuss the translocation of inhaled asbestos fibers based on pulmonary and pleuro-pulmonary interstitial fluid dynamics. Fibers can pass the alveolar barrier and reach the lung interstitium via the paracellular route down a mass water flow due to combined osmotic (active Na+ absorption) and hydraulic (interstitial pressure is subatmospheric) pressure gradient. Fibers can be dragged from the lung interstitium by pulmonary lymph flow (primary translocation) wherefrom they can reach the blood stream and subsequently distribute to the whole body (secondary translocation). Primary translocation across the visceral pleura and towards pulmonary capillaries may also occur if the asbestos-induced lung inflammation increases pulmonary interstitial pressure so as to reverse the trans-mesothelial and trans-endothelial pressure gradients. Secondary translocation to the pleural space may occur via the physiological route of pleural fluid formation across the parietal pleura; fibers accumulation in parietal pleura stomata (black spots) reflects the role of parietal lymphatics in draining pleural fluid. Asbestos fibers are found in all organs of subjects either occupationally exposed or not exposed to asbestos. Fibers concentration correlates with specific conditions of interstitial fluid dynamics, in line with the notion that in all organs microvascular filtration occurs from capillaries to the extravascular spaces. Concentration is high in the kidney (reflecting high perfusion pressure and flow) and in the liver (reflecting high microvascular permeability) while it is relatively low in the brain (due to low permeability of blood-brain barrier). Ultrafine fibers (length < 5 μm, diameter < 0.25 μm) can travel larger distances due to low steric hindrance (in mesothelioma about 90% of fibers are ultrafine). Fibers translocation is a slow process developing over decades of life: it is aided by high biopersistence, by inflammation-induced increase in permeability, by low steric hindrance and by fibers motion pattern at low Reynolds numbers; it is hindered by fibrosis that increases interstitial flow resistances

Remodelling of Membrane Rafts Expression in Lung Cells as an Early Sign of Mechanotransduction-Signalling in Pulmonary Edema

Membrane rafts (MRs) are clusters of lipids, organized in a “quasicrystalline” liquid-order phase, organized on the cell surface and whose pattern of molecules and physicochemical properties are distinct from those of the surrounding plasma membrane. MRs may be considered an efficient and fairly rapid cell-activated mechanism to express or mask surface receptors aimed at triggering specific response pathways. This paper reports observations concerning the role of MRs in the control of lung extravascular water that ought to be kept at minimum to assure gas diffusion, supporting the hypothesis that MRs expression is a potential mechanism of sensing minor changes in the volume of extravascular water. We present the evidence that MRs expression specifically relates to signal-transduction processes evoked by mechanical stimuli arising in the interstitial lung compartment when a small increase in extravascular volume occurs. We further hypothesize that a differential expression of MRs might also reflect the damage to precise components of the extracellular matrix caused by the perturbation in water balance and thus can trigger a molecule-oriented specific matrix remodelling

First record of Hemidiaptomus (Gigantodiaptomus) superbus (Schmeil, 1895) in Italy, with notes on distribution and conservation status (Copepoda, Calanoida, Diaptomidae)

Hemidiaptomus (Gigantodiaptomus) superbus (Schmeil, 1895) was found in a temporary pool in the Pineta di Classe coastal pine-wood (Ravenna, northern Italy). This is the first official record of a species belonging to the subgenus Gigantodiaptomus of Italian fauna, and it widens the known distribution of this rare diaptomid to the Mediterranean basin. In order to supply data on this rare and poorly known species, original drawings for the Italian population have been provided, and some overlooked morphological features have been highlighted. In light of the growing evidence of the existence of a number of cryptic species in the Diaptomidae family, and considering the variability observed in the ornamentation of the fifth pair of female legs, the ribosomal DNA marker 16S was used to compare the specimens collected in Italy with those from the terra typica of the species. Molecular data confirmed the strict conspecificity of the two populations being studied. The environmental parameters relating to the new Italian site are described and compared with the few data currently available in the literature. A careful review of all the published data dealing with H. (G.) superbus has been performed, and the paucity of recent records is stressed, together with the opportunity to support dedicated conservation measures for the protection of this species

Stability, Structure and Scale: Improvements in Multi-modal Vessel Extraction for SEEG Trajectory Planning

Purpose Brain vessels are among the most critical landmarks that need to be assessed for mitigating surgical risks in stereo-electroencephalography (SEEG) implantation. Intracranial haemorrhage is the most common complication associated with implantation, carrying signi cant associated morbidity. SEEG planning is done pre-operatively to identify avascular trajectories for the electrodes. In current practice, neurosurgeons have no assistance in the planning of electrode trajectories. There is great interest in developing computer assisted planning systems that can optimise the safety pro le of electrode trajectories, maximising the distance to critical structures. This paper presents a method that integrates the concepts of scale, neighbourhood structure and feature stability with the aim of improving robustness and accuracy of vessel extraction within a SEEG planning system. Methods The developed method accounts for scale and vicinity of a voxel by formulating the problem within a multi-scale tensor voting framework. Feature stability is achieved through a similarity measure that evaluates the multi-modal consistency in vesselness responses. The proposed measurement allows the combination of multiple images modalities into a single image that is used within the planning system to visualise critical vessels. Results Twelve paired datasets from two image modalities available within the planning system were used for evaluation. The mean Dice similarity coe cient was 0.89 ± 0.04, representing a statistically signi cantly improvement when compared to a semi-automated single human rater, single-modality segmentation protocol used in clinical practice (0.80 ±0.03). Conclusions Multi-modal vessel extraction is superior to semi-automated single-modality segmentation, indicating the possibility of safer SEEG planning, with reduced patient morbidity

Previous, current, and future stereotactic EEG techniques for localising epileptic foci

INTRODUCTION: Drug-resistant focal epilepsy presents a significant morbidity burden globally, and epilepsy surgery has been shown to be an effective treatment modality. Therefore, accurate identification of the epileptogenic zone for surgery is crucial, and in those with unclear noninvasive data, stereoencephalography is required. AREAS COVERED: This review covers the history and current practices in the field of intracranial EEG, particularly analyzing how stereotactic image-guidance, robot-assisted navigation, and improved imaging techniques have increased the accuracy, scope, and use of SEEG globally. EXPERT OPINION: We provide a perspective on the future directions in the field, reviewing improvements in predicting electrode bending, image acquisition, machine learning and artificial intelligence, advances in surgical planning and visualization software and hardware. We also see the development of EEG analysis tools based on machine learning algorithms that are likely to work synergistically with neurophysiology experts and improve the efficiency of EEG and SEEG analysis and 3D visualization. Improving computer-assisted planning to minimize manual input from the surgeon, and seamless integration into an ergonomic and adaptive operating theater, incorporating hybrid microscopes, virtual and augmented reality is likely to be a significant area of improvement in the near future