Microcirculation vs. Mitochondria-What to Target?

Circulatory shock is associated with marked disturbances of the macro- and microcirculation and flow heterogeneities. Furthermore, a lack of tissue adenosine trisphosphate (ATP) and mitochondrial dysfunction are directly associated with organ failure and poor patient outcome. While it remains unclear if microcirculation-targeted resuscitation strategies can even abolish shock-induced flow heterogeneity, mitochondrial dysfunction and subsequently diminished ATP production could still lead to organ dysfunction and failure even if microcirculatory function is restored or maintained. Preserved mitochondrial function is clearly associated with better patient outcome. This review elucidates the role of the microcirculation and mitochondria during circulatory shock and patient management and will give a viewpoint on the advantages and disadvantages of tailoring resuscitation to microvascular or mitochondrial targets

Renal Athersosclerotic reVascularization Evaluation (RAVE Study): Study protocol of a randomized trial [NCT00127738]

BACKGROUND: It is uncertain whether patients with renal vascular disease will have renal or mortality benefit from re-establishing renal blood flow with renal revascularization procedures. The RAVE study will compare renal revascularization to medical management for people with atherosclerotic renal vascular disease (ARVD) and the indication for revascularization. Patients will be assessed for the standard nephrology research outcomes of progression to doubling of creatinine, need for dialysis, and death, as well as other cardiovascular outcomes. We will also establish whether the use of a new inexpensive, simple and available ultrasound test, the renal resistance index (RRI), can identify patients with renal vascular disease who will not benefit from renal revascularization procedures[1]. METHODS/DESIGN: This single center randomized, parallel group, pilot study comparing renal revascularization with medical therapy alone will help establish an infrastructure and test the feasibility of answering this important question in clinical nephrology. The main outcome will be a composite of death, dialysis and doubling of creatinine. Knowledge from this study will be used to better understand the natural history of patients diagnosed with renal vascular disease in anticipation of a Canadian multicenter trial. Data collected from this study will also inform the Canadian Hypertension Education Program (CHEP) Clinical Practice Guidelines for the management of Renal and Renal Vascular Disease. The expectation is that this program for ARVD, will enable community based programs to implement a comprehensive guidelines based diagnostic and treatment program, help create an evidence based approach for the management of patients with this condition, and possibly reduce or halt the progression of kidney disease in these patients. DISCUSSION: Results from this study will determine the feasibility of a multicentered study for the management of renovascular disease

Target blood pressure in sepsis: between a rock and a hard place

The optimal target blood pressure in septic shock is still unknown. Therefore, in a long-term, resuscitated porcine model of fecal peritonitis-induced septic shock, Correa and colleagues tested whether different titrations of mean arterial pressure (50 to 60 and 75 to 85 mm Hg) would produce different effects on sepsis-related organ dysfunction. The higher blood pressure window was associated with increased needs for fluid resuscitation and norepinephrine support. However, titrating the lower blood pressure range coincided with an increased incidence of acute kidney injury. In contrast, neither the inflammatory response nor tissue mitochondrial activity showed any difference. This research paper in a clinically relevant model elegantly demonstrates that any standard resuscitation strategy may be a double-edged sword with respect to various therapeutic endpoints. Furthermore, it adds an important piece to the puzzle of the complex pathophysiology of sepsis-related acute kidney injury

Does vasopressor therapy have an indication in hemorrhagic shock?

This review aimed to answer whether the vasopressors are useful at the early phase of hemorrhagic shock. Data were taken from published experimental studies and clinical trials. Published case reports were discarded. A search of electronic database PubMed was conducted using keywords of hemorrhagic shock, vasopressors, vasoconstrictors, norepinephrine, epinephrine, vasopressin. The redundant papers were not included. We identified 15 experimental studies that compared hemorrhagic shock resuscitated with or without vasopressors, three retrospective clinical studies, and one controlled trial. The experimental and clinical studies are discussed in the clinical context, and their strengths as well as limitations are highlighted. There is a strong rationale for a vasopressor support in severe hemorrhagic shock. However, this should be tempered by the risk of excessive vasoconstriction during such hypovolemic state. The experimental models must be analyzed within their own limits and cannot be directly translated into clinical practice. In addition, because of many biases, the results of clinical trials are debatable. Therefore, based on current information, further clinical trials comparing early vasopressor support plus fluid resuscitation versus fluid resuscitation alone are warranted

Former of Turn Trajectory of Sliding Valve Shaft of Gas Line

Former of turn trajectory of sliding valve shaft of gas line, that allows to provide desired motion trajectory of sliding valve and its full closing, is considered in that paper. Imitation model of that former, research results, which allow to detect influence of gain factor and time constant of position controller on value of speed error, that has impact on delay of output coordinate from setting, and that results to delay of sliding valve motion process to setting position point, are shown

A CT-based revised description and phylogenetic analysis of the skull of the basal maniraptoran Ornitholestes hermanni Osborn 1903

Ornitholestes hermanni was one of the first small-bodiedtheropods named in the 1900s. It is known from a singlespecimen discovered during the American MuseumExpedition of 1900, at the Jurassic Morrison Formationsite known as Bone Cabin Quarry, in Wyoming. It haslong been a critical taxon in understanding the evolutionof the Coelurosauria, the clade that includestyrannosauroids, living birds, and their commonancestors. The holotype specimen comprises a nearlycomplete skull and most of a postcranial skeleton. Despitethis abundant material, its precise phylogeneticrelationships have been difficult to determine. This is inpart due to the intense mediolateral crushing of the skulland the relatively generalized postcranial anatomy. Herewe present the results of a micro- computed tomographybasedinvestigation of the cranial anatomy and subsequentincorporation of these data into a phylogenetic data matrixdesigned to test coelurosaurian interrelationships. We findrobust evidence across different optimality criteria thatOrnitholestes is the earliest-branching oviraptorosaurianspecies. Using parsimony as an optimality criterion, thisphylogenetic position is supported by 14 unambiguoussynapomorphies, including: a short frontal process of thepostorbital; short, deep, and pendant paroccipitalprocesses; a large mandibular foramen; an anterodorsallyoriented dentary symphysis; a surangular that is longerthan the dentary; short maxillary and dentary tooth rows;and procumbent dentary and premaxillary teeth. UsingBayesian fossilized birth-death models, we find highposterior probabilities (>.99) that Ornitholestes is theearliest-branching oviraptorosaurian species. Weadditionally find strong support in both analyses that thesuperficially bat-like and possibly arborealscansoriopterygids are an early branching lineage withinOviraptorosauria. This new phylogenetic position fills in apersistent ghost lineage in Oviraptorosauria and confirmsthat scansoriopterygids are basally branchingoviraptorosaurians that represent an independent origin ofaerial habits, separate from those of dromaeosaurs andavialans.Fil: Chapelle, Kimberley E.. American Museum of Natural History; Estados UnidosFil: Norell, Mark. American Museum of Natural History; Estados UnidosFil: Ford, David P.. University of the Witwatersrand; SudáfricaFil: Hendrickx, Christophe. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - Tucumán. Unidad Ejecutora Lillo; ArgentinaFil: Radermacher, Viktor J.. University of Minnesota; Estados UnidosFil: Balanoff, Amy. University Johns Hopkins; Estados UnidosFil: Zanno, Lindsay E.. North Carolina Museum of Natural Sciences; Estados UnidosFil: Choiniere, Jonah N.. University of the Witwatersrand; Sudáfrica81st Annual Meeting of the Society of Vertebrate PaleontologyMc LeanEstados UnidosSociety of Vertebrate Paleontolog

Effects of residue management on decomposition in irrigated rice fields are not related to changes in the decomposer community

Copyright: © 2015 Schmidt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Decomposers provide an essential ecosystem service that contributes to sustainable production in rice ecosystems by driving the release of nutrients from organic crop residues. During a single rice crop cycle we examined the effects of four different crop residue management practices (rice straw or ash of burned straw scattered on the soil surface or incorporated into the soil) on rice straw decomposition and on the abundance of aquatic and soildwelling invertebrates. Mass loss of rice straw in litterbags of two different mesh sizes that either prevented or allowed access of meso- and macro-invertebrates was used as a proxy for decomposition rates. Invertebrates significantly increased total loss of litter mass by up to 30%. Initially, the contribution of invertebrates to decomposition was significantly smaller in plots with rice straw scattered on the soil surface; however, this effect disappeared later in the season. We found no significant responses in microbial decomposition rates to management practices. The abundance of aquatic fauna was higher in fields with rice straw amendment, whereas the abundance of soil fauna fluctuated considerably. There was a clear separation between the overall invertebrate community structure in response to the ash and straw treatments. However, we found no correlation between litter mass loss and abundances of various lineages of invertebrates. Our results indicate that invertebrates can contribute to soil fertility in irrigated paddy fields by decomposing rice straw, and that their abundance as well as efficiency in decomposition may be promoted by crop residue management practices

Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock

PURPOSE: Guidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65 mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient variables modify the effect of different MAP targets. METHODS: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials of higher versus lower blood pressure targets for vasopressor therapy in adult patients in shock (until November 2017). After obtaining individual patient data from both eligible trials, we used a modified version of the Cochrane Collaboration\u27s instrument to assess the risk of bias of included trials. The primary outcome was 28-day mortality. RESULTS: Included trials enrolled 894 patients. Controlling for trial and site, the OR for 28-day mortality for the higher versus lower MAP targets was 1.15 (95% CI 0.87-1.52). Treatment effect varied by duration of vasopressors before randomization (interaction p = 0.017), but not by chronic hypertension, congestive heart failure or age. Risk of death increased in higher MAP groups among patients on vasopressors > 6 h before randomization (OR 3.00, 95% CI 1.33-6.74). CONCLUSIONS: Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6 h. Lower blood pressure targets were not associated with patient-important adverse events in any subgroup, including chronically hypertensive patients

First results from the NA60 experiment at CERN

Since 1986, several heavy ion experiments have studied some signatures of the formation of the quark-gluon plasma and a few exciting results have been found. However, some important questions are still unanswered and require new measurements. The NA60 experiment, with a new detector concept that vastly improves dimuon detection in proton-nucleus and heavy-ion collisions, studies several of those open questions, including the production of open charm. This paper presents the experiment and some first results from data collected in 2002.Comment: Paper presented at the XXXVIII Rencontres de Moriond, QCD and High Energy Hadronic Interactions, Les Arcs, March 22-29, 2003. 4 pages, 6 figure