OSA is a common yet underdiagnosed disorder encountered in everyday practice. The disease is a unique physiologic stressor that contributes to the development or progression of many other disorders, ...particularly cardiovascular conditions. The pulmonary circulation is specifically affected by the intermittent hypoxic apneas associated with OSA. The general consensus has been that OSA is associated with pulmonary hypertension (PH), but only in a minority of OSA patients and generally of a mild degree. Consequently, there has been no sense of urgency to screen for either condition when evaluating the other. In this review, we explore available evidence describing the interaction between OSA and PH and seek to better understand underlying pathophysiology. We describe certain groups of patients who have a particular preponderance of OSA and PH. Failure to recognize the mutual additive effects of these disorders can lead to suboptimal patient outcomes. Among patients with PH and OSA, CPAP, the mainstay treatment for OSA, may ameliorate pulmonary pressure elevations, but has not been studied adequately. Conversely, among patients with OSA, PH significantly limits functional capacity and potentially shortens survival; yet, there is no routine screening for PH in patients with OSA. We think it is time to study the interaction between OSA and PH more carefully to identify high-risk subgroups. These would be screened for the presence of combined disorders, facilitating earlier institution of therapy and improving outcomes.
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death. Advancements in navigational bronchoscopy have shown encouraging results but the diagnostic yield of ...small lung nodules by bronchoscopic techniques is still below that of transthoracic needle aspiration. The development of robotic bronchoscopy has demonstrated a significantly improved navigational success but the diagnostic yield is regularly limited by near-miss of the target nodule. Needle-based confocal laser endomicroscopy is a novel imaging technique that allows for the real-time visualization of individual cells and structures with microscopic resolution at the tip of the needle. We present the first reported case of confocal laser endomicroscopy guided robotic bronchoscopy for the real-time diagnosis of a small, partially cystic lung nodule.
Abstract Although abundant ryanodine receptors (RyRs) exist in cardiomyocytes from newborn (NB) rat and despite the maturity of their single-channel properties, the RyR contribution to ...excitation–contraction (E-C) coupling is minimal. Immature arrangement of RyRs in the Ca2+ release site of the sarcoplasmic reticulum and/or distant RyRs location from the sarcolemmal Ca2+ signal could explain this quiescence. Consequently, Ca2+ sparks and their cellular distribution were studied in NB myocytes and correlated with the formation of dyads and transverse (T) tubules. Ca2+ sparks were recorded in fluo-4-loaded intact ventricular myocytes acutely dissociated from adult and NB rats (0–9 days old). Sparks were defined/compared in the center and periphery of the cell. Co-immunolocalization of RyRs with dihydropyridine receptors (DHPR) was used to estimate dyad formation, while the development of T tubules was studied using di-8-ANEPPS and diIC12. Our results indicate that in NB cells, Ca2+ sparks exhibited lower amplitude (1.7 ± 0.5 vs. 3.6 ± 1.7 F / F0 ), shorter duration (47 ± 3.2 vs. 54.1 ± 3 ms), and larger width (1.7 ± 0.8 vs. 1.2 ± 0.4 μm) than in adult. Although no significant changes were observed in the overall frequency, central sparks increased from ~ 60% at 0–1 day to 82% at 7–9 days. While immunolocalization revealed many central release sites at 7–8 days, fluorescence labeling of the plasma membrane showed less abundant internal T tubules. This could imply that although during the first week, release sites emerge forming dyads with DHPR-containing T tubules; some of these T tubules may not be connected to the surface, explaining the RyR quiescence during E-C coupling in NB.
A convergent synthesis of indoprofen via a Buchwald coupling approach is reported. Using this methodology, indoprofen and a set of analogs of indoprofen were readily prepared.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Oxindole (
2) is a potent and selective PDE2 inhibitor with a favorable ADME, physiochemical and pharmacokinetic profile to allow for use as a chemical tool in elucidating the physiological role of ...PDE2.
Oxindole (
2) is a potent and selective PDE2 inhibitor with a favorable ADME, physiochemical and pharmacokinetic profile to allow for use as a chemical tool in elucidating the physiological role of PDE2.
Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung ...nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos.
In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice.
Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54-0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy.
nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.
The Tripletail, Lobotes surinamensis, is a warm‐water pelagic fish that is increasingly targeted by U.S. anglers. The superior quality of Tripletail flesh coupled with the lack of domestic commercial ...fisheries stimulated interests to develop aquaculture of this species. In this work, photo‐thermal conditioning of captive‐held broodstocks promoted maturation in females, but spontaneous spawning was not observed. GnRHa slow‐release implants induced ovulation in late vitellogenic females but fertility remained below 10% when GnRHa was administered alone. However, spawns with high fertility (up to 85%) were obtained when a dopamine antagonist was administered in conjunction with GnRHa implants indicating dopamine inhibition impaired final gamete maturation, in particular sperm production in males, in aquaculture conditions. Tripletail larvae successfully initiated exogenous feeding on enriched rotifers followed by Artemia nauplii and were weaned to prepared feeds at 25 days post hatch, yet with low survival through the late phases of larval culture. Pilot grow‐out trials at low density in recirculating systems revealed impressive growth rates averaging over 170 g/month through a market size above 1 kg. While protocols for hatchery culture and grow‐out still need to be optimized, current data suggest that Tripletail could become a successful species for U.S. marine aquaculture.
Abstract People with disability have a poorer level of oral health than those who do not have a disability, This may be partly due to reasons of reduction in preventive care but also lesser ...opportunities for the provision of restorative dentistry, The use of a special management technique using intravenous conscious sedation provides a valuable opportunity to open doors that can help reduce the inequality that is experienced by people with disability, Keywords: Dental treatment problems; Conscious sedation; Oral health; Disability Introduction People with disability have a poorer oral health than those who do not have a disability 1, For some this is partly due to problems in maintaining good oral hygiene as a result of their limitation in manual dexterity, The importance of dietary control with the frequent intake of sugary foods may not be fully appreciated by those whose cognitive ability and communication skills are reduced 2, These issues of prevention are important, however for people with a disability the opportunities for treatment are also reduced 3, For many people with disability all aspects of dental treatment may be provided in the conventional form using local anaesthetic and careful gentle patient management, However for some individuals with challenging behaviour and or movement features dental care will be difficult perhaps resulting in undiagnosed oral health problems, For these reasons some degree of pharmacological intervention may be required, This can vary from general anaesthesia to conscious sedation, General anaesthesia for dental treatment can now only be provided in the UK in a hospital environment, Complex restorative treatment and or periodontal treatment may require a course of visits and as multiple sessions of general anaesthetic should be avoided these options are generally not advisable, Even the provision of non-complex fillings may be overridden by the risk of further problems resulting in possible dental pain if the decay is extensive, An extraction removes this risk and is a decision that the surgeon may make in the patients best interest particularly for challenging patients for whom the possibility of dental pain can have serious behavioural consequences As an alternative Intravenous conscious sedation can provide for people with disability an increased chance of having their teeth restored rather than simply extracted 4, Evidence providing the option of conscious sedation strongly supports this alternative 5,6, Intravenous conscious sedation can be provided by a single dental surgeon acting as an operator/sedationist within a primary care dental surgery assisted by a trained nurse. Conscious sedation can be less expensive, more readily available as well as providing restorative dentistry rather than extractions, Complex treatment and preventive periodontal care can be provided over a series of appointments, An example shows the provision of a bridge to replace lower anterior teeth of an adult with severe choreic movements as a result of Huntington's disease 7 (Figures 1-3). Conscious sedation makes available the possibility of investigations or treatments by other medical disciplines thereby enabling a truly holistic approach for the person with a disability This is shown by the case of an adult with severe brain injury 8who had a variety of investigations over several years whilst having dental care using intravenous conscious sedation. (ie Blood taking, removal of cranial clips post-surgery, examination and syringing of ears, removal of ear wax, podiatry) Other cases have also demonstrated the value that intravenous sedation provides in holistic care 9 The technique can and is readily available provided by a trained dental practitioner and dental nurse in a community general dental practice.
A New Purpose for Proportional Assist Ventilation? Manley, Christopher; Garpestad, Erik; Hill, Nicholas S.
Critical care medicine,
2013-September, 2013-Sep, 2013-09-00, 20130901, Letnik:
41, Številka:
9
Journal Article
On seeking office and in coming to power, New Labour presented its vision for Britain in moral terms. During the course of the New Labour administration, further moral themes have been introduced: ...responsibility and respect, the merits of local government and self-governance, and the moral imperative to confront threats of 'terror' from abroad. This moral agenda, with its apparently religious roots, has been much noted, but not much discussed. The political phenomenon of New Labour requires the disciplines of theology and ethics, as well as social theory and politics, to be properly understood and assessed. Drawing together for the first time theorists from a range of disciplines and commitments, this interdisciplinary collection offers a reckoning of this New Labour decade. As such, it has four central research questions: What is the nature of this remoralising? What are its sources? How effective has it been and what difference has this moral discourse made? What can be learned from Blairism about the relationship between faith, morals and governance?.
PDF
