Management of Mechanical Ventilation in Decompensated Heart Failure.

Mechanical ventilation (MV) is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence

A spread spectrum approach to time-domain near-infrared diffuse optical imaging using inexpensive optical transceiver modules

We introduce a compact time-domain system for near-infrared spectroscopy using a spread spectrum technique. The proof-of-concept single channel instrument utilises a low-cost commercially available optical transceiver module as a light source, controlled by a Kintex 7 field programmable gate array (FPGA). The FPGA modulates the optical transceiver with maximum-length sequences at line rates up to 10Gb/s, allowing us to achieve an instrument response function with full width at half maximum under 600ps. The instrument is characterised through a set of detailed phantom measurements as well as proof-of-concept in vivo measurements, demonstrating performance comparable with conventional pulsed time-domain near-infrared spectroscopy systems

Patient experience of care in a student-faculty collaborative practice

Student Run Clinics (SRCs) are a popular means of caring for the underserved while providing valuable medical education opportunities. Reports of patient experience surveys are rare in this setting. This is troublesome because it is possible that underserved patients, who are more likely to receive care at SRCs, are not receiving the same level of care as at more traditional medical practices. The purpose of this research was to measure patient experience in a student-led medical clinic. The method included the use of patient experience surveys, which were self-administered pre-visit and self- and interviewer administered post-visit. The key results, 100% of patients felt treated with respect. 81.4% of patients would “definitely” and 16.3% would “somewhat” refer their family and friends to the clinic. 87% reported being seen within 15 minutes of their appointment time; 60% reported that they knew they would be seen by medical students and a doctor. This data has been useful to our student-led clinic in streamlining clinic flow, reducing wait times and building awareness of our structure. Our hope is this study will encourage others SRCs to adopt similar student-faculty collaborative research based practices to enhance care for SRC patients while teaching students to use patient feedback to improve quality of care

The Effects of Energy Intake on Upper Respiratory Symptoms in Ultra-Endurance Triathletes

Background: It is unclear whether energy intake can impact the incidence of upper respiratory symptoms (URS). The purpose of this study was to examine if there are differences in energy intake between symptomatic (SYM) and asymptomatic (ASYM) groups of URS in Ironman-triathletes. Methods: Thirty-three subjects competing in the Lake Placid Ironman-triathlon (mean±SD; age,37±8y; height,178±8cm; mass,76.3±10.4kg; body fat,10.8±3.8%) were randomized into either the control (CON) or intervention (INT). INT consumed 4-commercial recovery drinks, two immediately post-race and two 3-hours post-race. Calorie and macronutrient intake were recorded pre-, during, and post-race. Subjects completed the Wisconsin URS Survey to assess URS over the next two weeks. Two analyses were done by comparing results between CON and INT, and when subjects were classified as either asymptomatic (ASYM=20) or symptomatic (SYM=13). Results: There were no differences in energy intake (p\u3e0.05) and URS (INT,32±38; CON,16±23; p=0.155). However, on the race day, SYM (9,044±2,598kcal) consumed less energy intake than ASYM (10,991±2497kcal) (p=0.044). Also, SYM consumed less energy the day before the race (p=0.031) and post-race (p=0.008). ASYM consumed greater carbohydrate the day before the race (p=0.032), fat the day of the race (p=0.006), carbohydrate post-race (p=0.08) and fat post-race (p=0.002). Conclusions: Overall energy intake was similar between CON and INT. However, when subjects were differentiated by URS, SYM consumed less calories the day before and day of the race versus ASYM

CHronic hypERtension and L-citRulline studY (CHERRY): an Early-Phase Randomised Controlled Trial in Pregnancy.

Oral supplementation with L-citrulline, which is sequentially converted to L-arginine then nitric oxide, improves vascular biomarkers and reduces blood pressure in non-pregnant, hypertensive human cohorts and pregnant mice with a pre-eclampsia-like syndrome. This early-phase randomised feasibility trial assessed the acceptability of L-citrulline supplementation to pregnant women with chronic hypertension and its effects on maternal BP and other vascular outcomes. Pregnant women with chronic hypertension were randomised at 12-16 weeks to receive 3-g L-citrulline twice daily (n = 24) or placebo (n = 12) for 8 weeks. Pregnant women reported high acceptability of oral L-citrulline. Treatment increased maternal plasma levels of citrulline, arginine and the arginine:asymmetric dimethylarginine ratio, particularly in women reporting good compliance. L-citrulline had no effect on diastolic BP (L-citrulline: - 1.82 95% CI (- 5.86, 2.22) vs placebo: - 5.00 95% CI (- 12.76, 2.76)), uterine artery Doppler or angiogenic biomarkers. Although there was no effect on BP, retrospectively, this study was underpowered to detect BP changes < 9 mmHg, limiting the conclusions about biological effects. The increase in arginine:asymmetric dimethylarginine ratio was less than in non-pregnant populations, which likely reflects altered pharmacokinetics of pregnancy, and further pharmacokinetic assessment of L-citrulline in pregnancy is advised.Trial Registration EudraCT 2015-005792-25 (2017-12-22) and ISRCTN12695929 (2018-09-20) In pregnant women with chronic hypertension, L-citrulline is an acceptable intervention which increased plasma L-citrulline bioavailability but did not affect BP, potentially due to altered pharmacokinetics of pregnancy

Girls' Aesthetics of Existence in/With Hayao Miyazaki's Films

In this article, I analyze the processual aesthetic production of girl subjectivity in/with Hayao Miyazaki's films through a feminist materialist perspective informed by the writings of Karen Barad, Rosi Braidotti, Donna Haraway, Elizabeth Grosz, and Affrica Taylor. I elaborate on feminist materialist concepts such as those of relational ontology, aesthetics of existence, worldmaking, mythopoesis, queer kin, and gender/sexual difference. With these concepts, I philosophically and ethnographically inquire in/with girl spectators who are interested in the experimentation with new modalities of existence that do not limit to those of success and alienation, but allow for creative possibilities of rupture, recomposition, and transversalization of girl subjectivities

Mutations in LAMA1 Cause Cerebellar Dysplasia and Cysts with and without Retinal Dystrophy

Cerebellar dysplasia with cysts (CDC) is an imaging finding typically seen in combination with cobblestone cortex and congenital muscular dystrophy in individuals with dystroglycanopathies. More recently, CDC was reported in seven children without neuromuscular involvement (Poretti-Boltshauser syndrome). Using a combination of homozygosity mapping and whole-exome sequencing, we identified biallelic mutations in LAMA1 as the cause of CDC in seven affected individuals (from five families) independent from those included in the phenotypic description of Poretti-Boltshauser syndrome. Most of these individuals also have high myopia, and some have retinal dystrophy and patchy increased T2-weighted fluid-attenuated inversion recovery (T2/FLAIR) signal in cortical white matter. In one additional family, we identified two siblings who have truncating LAMA1 mutations in combination with retinal dystrophy and mild cerebellar dysplasia without cysts, indicating that cysts are not an obligate feature associated with loss of LAMA1 function. This work expands the phenotypic spectrum associated with the lamininopathy disorders and highlights the tissue-specific roles played by different laminin-encoding genes

Clinical trial to assess the effect of physical exercise on endothelial function and insulin resistance in pregnant women

<p>Abstract</p> <p>Background</p> <p>Preeclampsia (PE) is a common maternal disease that complicates 5 to 10% of pregnancies and remains as the major cause of maternal and neonatal mortality. Cost-effective interventions aimed at preventing the development of preeclampsia are urgently needed. However, the pathogenesis of PE is not well known. Multiple mechanisms such as oxidative stress, endothelial dysfunction and insulin resistance may contribute to its development. Regular aerobic exercise recovers endothelial function; improves insulin resistance and decreases oxidative stress. Therefore the purpose of this clinical trial is to determine the effect of regular aerobic exercise on endothelial function, on insulin resistance and on pregnancy outcome.</p> <p>Methods and design</p> <p>64 pregnant women will be included in a blind, randomized clinical trial, and parallel assignment. The exercise group will do regular aerobic physical exercise: walking (10 minutes), aerobic exercise (30 minutes), stretching (10 minutes) and relaxation exercise (10 minutes) in three sessions per week. Control group will do the activities of daily living (bathing, dressing, eating, and walking) without counselling from a physical therapist.</p> <p>Trial registration</p> <p>NCT00741312.</p