Objective: Different types of colloidal priming for cardiopulmonary bypass (CPB) have been used to reduce fluid load and to avoid the fall of plasma colloid osmotic pressure (COP) that leads to edema ...formation and consequently can cause organ dysfunction. The discussion about the optimal priming composition, however, is still controversial. We investigated the effect of a hyperoncotic CPB-prime with hydroxyethyl starch (HES) 10% (200;0.5) on extravascular lung water (EVLW) and post-pump cardiac and pulmonary functions. Methods: In 20 randomized patients undergoing elective coronary artery bypass graft surgery (CABG), a colloid prime (COP: 48 mmHg, HES-group, n = 10) and a crystalloid prime (Ringer's lactate, crystalloid group, n = 10) of equal volume were compared with respect to the effects on cardiopulmonary function. Cardiac index (CI), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), pulmonary vascular resistance index (PVRI), alveolo-arterial oxygen difference (AaDO2), pulmonary shunt fraction (Qs/QT), EVLW (double-indicator dilution technique with ice-cold indocyanine green), COP, fluid balance and body weight were evaluated peri-operatively. Results: Pre-operative demographic and clinical data, CPB-time, cross-clamp time and the number of anastomoses were comparable for both groups. During CPB, COP was reduced by 20% in the HES-group (18.9 ± 3.7 vs. 23.7 ± 2.2 mmHg, P < 0.05) while it was reduced by more than 50% of the pre-CPB value (9.8 ± 2.0 vs. 21.4 ± 2.1 mmHg, P < 0.05) in the crystalloid group (P < 0.05 HES- vs. crystalloid group). Post-CPB EVLW was unchanged in the HES-group but it was elevated by 22% in the crystalloid group (P < 0.05 HES- vs. crystalloid group), CI was higher in the HES-group (3.4 ± 0.3 vs. 2.7 ± 0.51/min, P < 0.05). Fluid balance was less in the HES-group (813 < 619 vs. 2143 < 538, P < 0.05). Post-operative weight gain could be prevented in the HES-group but not in the crystalloid group (1.5 ± 1.2 vs. -0.3 ± 1.5, P < 0.05). No significant differences were seen for MAP, PAP, PCWP, SVRI, PVRI, AaDO2 and (Qs/QT) between the two groups at any time. Conclusions: Hyperoncotic CPB-prime using HES 10% improves CI and prevents EVLW accumulation in the early post-pump period, while pulmonary function is unchanged. This effect can be of benefit especially in patients with congestive heart failure.
The class I beta-1,3-glucanases are antifungal vacuolar proteins implicated in plant defense that show developmental, hormonal, and pathogenesis-related regulation. The tobacco enzymes are encoded by ...a small gene family with members derived from ancestors related to the present-day species Nicotiana sylvestris and N. tomentosiformis. We studied the expression in transgenic tobacco plants of a chimeric beta-glucuronidase (GUS) reporter gene fused to 1.6 kb of upstream sequence of the tobacco class I beta-1,3-glucanase B (GLB) gene, which is of N. tomentosiformis origin. Expression of the GUS reporter gene and the accumulation of class I beta-1,3-glucanase and its mRNA showed very similar patterns of regulation. In young seedlings the reporter gene was expressed in the roots. In mature tobacco plants it was preferentially expressed in lower leaves and roots and was induced in leaves by ethylene treatment and by infection with tobacco mosaic virus (TMV). Furthermore, it was down-regulated in cultured leaf discs by combinations of the hormones auxin and cytokinin. Histological studies of GUS activity showed that the GLB promoter shows highly localized expression in roots of seedlings. It is also expressed in a ring of cells around necrotic lesions induced by TMV infection, but not in cells immediately adjacent to the lesions or in the lesions themselves. The results of deletion analyses suggest that multiple positive and negative elements in the GLB promoter regulate its activity. The region from -1452 to -1193 containing two copies of the heptanucleotide AGCCGCC, which is highly conserved in plant-stress and defense-related genes, is necessary for high level expression in leaves. Additional regions important for organ-specific and regulated expression were: -568 to -402 for ethylene induction of leaves; -402 to -211 for expression in lower leaves and cultured leaf discs and for TMV induction of leaves; and -211 to -60 for expression in roots.
To provide Canadian physicians with comprehensive, evidence-based guidelines for the nonpharmacologic management and prevention of gestational hypertension and pre-existing hypertension during ...pregnancy.
Lifestyle modifications, dietary or nutrient interventions, plasma volume expansion and use of prostaglandin precursors or inhibitors.
In gestational hypertension, prevention of complications and death related to either its occurrence (primary or secondary prevention) or its severity (tertiary prevention). In pre-existing hypertension, prevention of superimposed gestational hypertension and intrauterine growth retardation.
Articles retrieved from the pregnancy and childbirth module of the Cochrane Database of Systematic Reviews; pertinent articles published from 1966 to 1996, retrieved through a MEDLINE search; and review of original randomized trials from 1942 to 1996. If evidence was unavailable, consensus was reached by the members of the consensus panel set up by the Canadian Hypertension Society.
High priority was given to prevention of adverse maternal and neonatal outcomes in pregnancies with established hypertension and in those at high risk of gestational hypertension through the provision of effective nonpharmacologic management.
Reduction in rate of long-term hospital admissions among women with gestational hypertension, with establishment of safe home-care blood pressure monitoring and appropriate rest. Targeting prophylactic interventions in selected high-risk groups may avoid ineffective use in the general population. Cost was not considered.
Nonpharmacologic management should be considered for pregnant women with a systolic blood pressure of 140-150 mm Hg or a diastolic pressure of 90-99 mm Hg, or both, measured in a clinical setting. A short-term hospital stay may be required for diagnosis and for ruling out severe gestational hypertension (preeclampsia). In the latter case, the only effective treatment is delivery. Palliative management, dependent on blood pressure, gestational age and presence of associated maternal and fetal risk factors, includes close supervision, limitation of activities and some bed rest. A normal diet without salt restriction is advised. Promising preventive interventions that may reduce the incidence of gestational hypertension, especially with proteinuria, include calcium supplementation (2 g/d), fish oil supplementation and low-dose acetylsalicylic acid therapy, particularly in women at high risk for early-onset gestational hypertension. Pre-existing hypertension should be managed the same way as before pregnancy. However, additional concerns are the effects on fetal well-being and the worsening of hypertension during the second half of pregnancy. There is, as yet, no treatment that will prevent exacerbation of the condition.
The guidelines share the principles in consensus reports from the US and Australia on the nonpharmacologic management of hypertension in pregnancy.
Abstract
Introduction
Sleep disturbances are pervasively reported in military service members and veterans, especially following traumatic brain injury (TBI). The purpose of this study was to examine ...the association between sleep disturbances and neurobehavioural outcomes in a large group of U.S. military service members and veterans, with and without a history of TBI.
Methods
Participants were enrolled into the Defense and Veterans Brain Injury Center/Traumatic Brain Injury Center of Excellence, 15-Year Longitudinal TBI study (N = 606). Participants self-reported sleep disturbances (PROMIS 8A) and neurobehavioral symptoms. Data were analyzed using analysis of variance with post-hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI (MTBI; n=218); complicated mild, moderate, severe, or penetrating - combined TBI (CTBI; n=118); injured controls (IC, i.e., orthopedic or soft-tissue injury without TBI; n=162); and non-injured controls (NIC; n=108).
Results
Participants in the MTBI group reported the highest proportion of moderate-severe sleep disturbances (66.5%) compared to the IC (54.9%), CTBI (47.5%), and NIC groups (34.3%). Participants classified as having Poor Sleep reported significantly worse scores on almost all TBI-QOL scales compared to those classified as having Good Sleep, regardless of TBI severity or even the presence of TBI (ps<.05, Cohen’s ds>.3).
Discussion
This study demonstrates that sleep disturbances remain a prevalent and debilitating concern in service member and veteran populations. Regardless of group (injured or NIC), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When assessing and treating neurobehavioural symptoms, it is important to assess sleep, especially in service member and veteran populations.
Between 1989 and 1992 meiotic chromosome studies and synaptonemal complex analyses were evaluated using light and, in part, electron microscopy in 46 infertile males with highly abnormal ...spermiograms. This examination focused on whether the breakdown of spermatogenesis could be attributed to pairing anomalies of bivalents. The study of meiotic chromosomes and synaptonemal complexes indicated normal spermatogenesis in five patients (11%); in the remainder, maturation arrest was diagnosed. In 21 individuals (50%) the breakdown was accompanied by pairing anomalies (asynapsis, fragmented synaptonemal complexes, X/Y univalence). Thus it is shown that male infertility can often partly be explained by meiotic disorders.
Chemical-specific emission rates for simple aromatic and polycyclic aromatic hydrocarbon compounds (PAHs) from bitumens during hot mix asphalt (HMA) production and placement activities were evaluated ...using a headspace gas chromatography method. Temperature-dependent headspace concentrations of the EPA listed aromatic and polycyclic aromatic compounds were measured in the laboratory using headspace gas chromatographs equipped with a variety of detectors. The methodology has previously been calibrated and verified by a program of simultaneous laboratory and field tests, and is accurate in identifying field inhalation exposure potential to individual compounds in asphalt fumes.
The results indicated that chemical-specific emission rates of aromatic and PAHs are strongly linked to both the performance grade of the asphalt binder and the binder temperature. Individual chemical compounds were quantified for 22 paving grade bitumen sources from throughout the United States. Chemical-specific emission rates from each binder were measured at a series of temperatures spanning the range, typically used for application of HMA, and at temperatures well in excess of those used for HMA applications in the United States. Emissions of all detected compounds increased with elevating temperature. The amount and composition of PAHs were markedly influenced by changes in temperature. At binder temperatures at or below 190°C, only very small amounts of mostly 2- and 3-ringed PAHs were emitted. Concentrations of individual two-ringed PAHs ranged from 0.5 to 11 μ g/m
3
at 150°C and ranged from 2.0 to 100 μ g/m
3
at 190°C. Concentrations of 3-ringed PAHs were below method detection level of 0.1 μ g/m
3
and ranged from 0.1 to 120 μ g/m
3
at 190°C. Larger ring number PAHs were below detection at 150°C and less than 10 μg/m
3
for 4-ringed PAHs at 190°C. As binder temperature increased above the typical limit for HMA production and application, several PAHs with greater ring numbers (4-, 5-, and 6-ringed PAHs) and more potent toxicity equivalency factors (carcinogenic potential) were detected.
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BFBNIB, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK, VSZLJ
Anthralin is the most common therapeutic agent among a small number of pro‐oxidant, 9‐anthrones effective in the topical treatment of psoriasis. However, the usefulness of this drug is diminished by ...toxic side effects, including skin irritation and inflammation. The activities of anthralin are believed to be mediated by the generation of reactive oxygen intermediates and anthrone radicals produced in the skin. In this study, the dermal inflammatory response to anthralin was determined using a mouse ear swelling test. Maximum ear swelling induced by anthralin coincided with the elevation of cytokine mRNA expression in the skin, including interleukin‐6, granulocyte‐macrophage colony‐stimulating factor, macrophage inflammatory protein‐2, and tumor necrosis factor α at 24 h post challenge. The role of free radical generation in ear swelling and cytokine modulation were examined by systemic administration of cell permeable and impermeable antioxidants before anthralin challenge. Superoxide dismutase and α‐tocopherol acetate, but not the glutathione precursor N‐acetyl cysteine, were effective inhibitors of anthralin‐induced ear swelling and cytokine elevation. Maximum inflammatory cell infiltration occurred 72–96 h post anthralin challenge and was also reduced by antioxidants. These data suggest that oxidative stress, generated at the site of anthralin treatment, alters the expression of dermal chemokines and other cytokines resulting in the recruitment of inflammatory cells. Systemic antioxidant administration may provide opportunities for therapeutic intervention against anthralin‐associated toxicities. J. Leukoc. Biol. 64: 170–176; 1998.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Rates of mercury accumulation were examined in male and female largemouth bass (Micropterus salmoides) from Lake Tohopekaliga, Florida, to establish methods for fish consumption advisories for the ...protection of human health. In addition, concentrations were determined in five lower trophic level fish species. Total mercury concentrations in adult largemouth bass muscle tissue ranged from 0.16 to 1.10 micrograms/g (fresh weight) and increased as fish increased in size and age. Whole-body mercury concentrations of 1990 year-class largemouth bass increased from 0.05 microgram/g at 20 mm and to 0.32 microgram/g at 320 mm (age 2). Significant differences were found in the rates of accumulation between sexes for length and weight, but not for age. Therefore, standardized mercury concentrations were determined using bass age to make comparisons among sampling dates. Although there were significant differences in adjusted mean mercury concentrations among two sampling dates, mercury content of standard-age bass remained relatively constant over time. Largemouth bass exceed the Florida Health Advisory level for limited consumption of fish (0.50 microgram Hg/g) based on a mean concentration of 0.59 microgram/g for 64 bass. Advisories based on fish morphological characteristics (i.e., length, weight) or age are not possible for Lake Tohopekaliga due to differences in mercury accumulation in male and female bass. Lower trophic level species of sport fish did not exceed the limited consumption level.
In the following sections, the recent published studies on modeling andsimulation of monolith reactors were reviewed. Mass transfer, and reaction kineticswere achieved by establishing mass, energy ...and momentum balance equations. Themodel equations were solved simultaneously. Such a model can be useful for studyingthe impact of changes of superficial gas and liquid velocities on reaction rate withinthe slug flow regime. The reaction system used is the hydrogenation α–methyl styrene(AMS) to cumene over a palladium on γ–alumina catalyst, It is a well knownsystem used to understand three-phase reactor performance under mass transferlimited condition by the gas mass transfer through the liquid film at the catalystsurface to the active sites. The effects of superficial gas and liquid velocities onreaction rate were studied with the range of 10 cm/s ≤ UL ≤ 30 cm/s, and 10 cm/s≤ UG ≤ 30 cm/s. The flow pattern for all these range of velocities was in the Taylorflow pattern.
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