Neonatal Hemodynamics: From Developmental Physiology to Comprehensive Monitoring.

Maintenance of neonatal circulatory homeostasis is a real challenge, due to the complex physiology during postnatal transition and the inherent immaturity of the cardiovascular system and other relevant organs. It is known that abnormal cardiovascular function during the neonatal period is associated with increased risk of severe morbidity and mortality. Understanding the functional and structural characteristics of the neonatal circulation is, therefore, essential, as therapeutic hemodynamic interventions should be based on the assumed underlying (patho)physiology. The clinical assessment of systemic blood flow (SBF) by indirect parameters, such as blood pressure, capillary refill time, heart rate, urine output, and central-peripheral temperature difference is inaccurate. As blood pressure is no surrogate for SBF, information on cardiac output and systemic vascular resistance should be obtained in combination with an evaluation of end organ perfusion. Accurate and reliable hemodynamic monitoring systems are required to detect inadequate tissue perfusion and oxygenation at an early stage before this result in irreversible damage. Also, the hemodynamic response to the initiated treatment should be re-evaluated regularly as changes in cardiovascular function can occur quickly. New insights in the understanding of neonatal cardiovascular physiology are reviewed and several methods for current and future neonatal hemodynamic monitoring are discussed

Transpulmonary thermodilution cardiac output measurement is not affected by severe pulmonary oedema: a newborn animal study

Contains fulltext : 117883.pdf (publisher's version ) (Closed access)BACKGROUND: /st> The transpulmonary thermodilution (TPTD) technique is widely used in clinical practice for measuring cardiac output (CO). This study was designed to investigate the influence of various levels of pulmonary oedema on the reliability of CO measurements by the TPTD method. METHODS: /st> In 11 newborn lambs pulmonary oedema was induced using a surfactant washout technique. Serial CO measurements using TPTD (COTPTD) were performed at various amounts of lung water. Simultaneously, CO was measured by an ultrasound flow probe around the main pulmonary artery (COMPA) and used as the standard reference. CO was divided by the body surface area to calculate cardiac index (CI). Data were analysed using correlational statistics and Bland-Altman analysis. RESULTS: /st> One lamb died prematurely. A total of 56 measurements in 10 lambs were analysed with a median CIMPA of 2.95 (IQR 1.04) litre min(-1) m(-2). Mean percentage increase in extravascular lung water (EVLW) between the start and the end of the study was 126.4% (sd 40.4). Comparison of the two CO methods showed a mean bias CI of -0.16 litre min(-1) m(-2) (limits of agreement +/-0.73 litre min(-1) m(-2)) and a percentage error of 23.8%. Intraclass correlation coefficients were 0.91 (95% CI 0.81-0.95) for absolute agreement and 0.92 (95% CI 0.87-0.95) for consistency. Acceptable agreement was confirmed by a tolerability-agreement ratio of 0.39. The within-subject correlation between the amount of EVLWI and the bias between the two methods was not significant (-0.02; P=0.91). CONCLUSIONS: /st> CO measurements by the transpulmonary thermodilution technique over a wide range of CI values are not affected by the presence of high EVLWI. The slight underestimation of the CO is independent of the amount of pulmonary oedema

Validation of extravascular lung water measurement by transpulmonary thermodilution in a pediatric animal model

Contains fulltext : 137171.pdf (publisher's version ) (Closed access)OBJECTIVE: The measurement of extravascular lung water using the transpulmonary thermodilution technique enables the bedside quantification of the amount of pulmonary edema. Children have higher indexed to body weight values of extravascular lung water compared with adults. Transpulmonary thermodilution measurements of extravascular lung water in children have not yet been validated. The purpose of this study was to validate the extravascular lung water measurements with the transpulmonary thermodilution method over a wide range of lung water values in a pediatric animal model. DESIGN: Experimental animal intervention study. SETTING: Animal laboratory at the Radboud University Nijmegen, The Netherlands. SUBJECTS: Eleven lambs. INTERVENTION: Pulmonary edema was induced using a surfactant washout model. MEASUREMENTS AND MAIN RESULTS: Between the lavages, extravascular lung water index was estimated using transpulmonary single and double indicator dilution. Two additional lambs were used to estimate extravascular lung water index in lungs without pulmonary edema. The final extravascular lung water index results were compared with the extravascular lung water index estimations by postmortem gravimetry (EVLWIG). The results were analyzed using both correlation and Bland-Altman statistics. Extravascular lung water index by transpulmonary thermodilution (EVLWITPTD) correlated significantly with either EVLWIG (r = 0.88) or with extravascular lung water index by transpulmonary double indicator dilution (EVLWITPDD) (r = 0.98). The mean bias with EVLWIG was 12.2 mL/kg (limits of agreement +/- 10.9 mL/kg) and with EVLWITPDD 2.4 mL/kg (limits of agreement +/- 3.8 mL/kg). The percentage errors were 41% and 14%, respectively. The bias became more positive when the mean of EVLWITPTD and EVLWIG increased (r = 0.72; p = 0.003). CONCLUSIONS: EVLWITPTD was significantly correlated to the postmortem gravimetric gold standard, although a significant overestimation was demonstrated with increasing pulmonary edema

In search of covariates of HIV-1 subtype B spread in the United States—a cautionary tale of large-scale Bayesian phylogeography

Infections with HIV-1 group M subtype B viruses account for the majority of the HIV epidemic in the Western world. Phylogeographic studies have placed the introduction of subtype B in the United States in New York around 1970, where it grew into a major source of spread. Currently, it is estimated that over one million people are living with HIV in the US and that most are infected with subtype B variants. Here, we aim to identify the drivers of HIV-1 subtype B dispersal in the United States by analyzing a collection of 23,588 pol sequences, collected for drug resistance testing from 45 states during 2004–2011. To this end, we introduce a workflow to reduce this large collection of data to more computationally-manageable sample sizes and apply the BEAST framework to test which covariates associate with the spread of HIV-1 across state borders. Our results show that we are able to consistently identify certain predictors of spread under reasonable run times across datasets of up to 10,000 sequences. However, the general lack of phylogenetic structure and the high uncertainty associated with HIV trees make it difficult to interpret the epidemiological relevance of the drivers of spread we are able to identify. While the workflow we present here could be applied to other virus datasets of a similar scale, the characteristic star-like shape of HIV-1 phylogenies poses a serious obstacle to reconstructing a detailed evolutionary and spatial history for HIV-1 subtype B in the US.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Effect of Heat Treatment on the Electrochemical and Mechanical Behavior of the Ti6Al4V Alloy

The effects of heat treatment on the hardness and electrochemical behavior of the Ti6Al4V alloy were studied. Two heat treatments were performed: one below (800 °C) and the other above (1050 °C) its beta transformation temperature (T= 980 ± 20 °C) and cooled using three conditions: water quenching, normalizing, and furnace. A microstructure observed using Optical Microscopy showed dependence on the heat treatment temperature applied; mainly three microstructures were obtained: martensitic, globular, and lamellar. Besides, alpha and beta phases were characterized by X-ray diffraction (XRD) technique. The Berkovich tests were performed to measure the hardness and reduced modulus (E). The Ti6Al4V alloy treated at 1050 °C and air-cooled exhibited hardness values closer to those of the Ti6Al4V as-received alloy. Electrochemical tests were carried out to analyze the electrochemical behavior after 7-day immersion in Hank’s solution at 37 °C and pH 7.40. Open Circuit Potentials (E) showed less negative values for Ti6Al4V and Ti6Al4V alloys, suggesting ennoblement of these materials. Furthermore, these alloys exhibited an outstanding electrochemical behavior compared to the Ti6Al4V as-received alloy by Electrochemical Impedance Spectroscopy (EIS) technique.The authors thank David Pérez-Risco for sharing his experience and useful advice on Berkovich Nano-indenter at the National Metallurgical Research Center (CENIM-CSIC Madrid, Spain), allowing this work to be carried out. Mercedes Paulina Chávez-Díaz thanks the National Science and Technology Council (CONACyT) for a doctoral fellowship to hold a research stay at CENIM-CSIC. This work was supported by the Government of Spain, through the Ministry of Economy and Competitiveness [MAT2015-67750-C3-1]. Elsa Miriam Arce-Estrada and Román Cabrera-Sierra wish to thank the National Research System (SNI) for the distinction of its members and the stipend received