Monitoring with electrical impedance tomography (EIT) during a decremental PEEP trial has been used to identify the PEEP that yields the optimal balance of pulmonary overdistension and collapse. This ...method is based on pixel-level changes in respiratory system compliance and depends on fixed or measured airway driving pressure. We developed a novel approach to quantify overdistension and collapse during pressure support ventilation (PSV) by integrating transpulmonary pressure and EIT monitoring and performed pilot tests in three hypoxemic patients. We report that our experimental approach is feasible and capable of identifying a PEEP that balances overdistension and collapse in intubated hypoxemic patients undergoing PSV.
Acute respiratory distress syndrome (ARDS) remains an important clinical challenge with a mortality rate of 35-45%. It is being increasingly demonstrated that the improvement of outcomes requires a ...tailored, individualized approach to therapy, guided by a detailed understanding of each patient's pathophysiology. In patients with ARDS, disturbances in the physiological matching of alveolar ventilation (V) and pulmonary perfusion (Q) (
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mismatch) are a hallmark derangement. The perfusion of collapsed or consolidated lung units gives rise to intrapulmonary shunting and arterial hypoxemia, whereas the ventilation of non-perfused lung zones increases physiological dead-space, which potentially necessitates increased ventilation to avoid hypercapnia. Beyond its impact on gas exchange,
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mismatch is a predictor of adverse outcomes in patients with ARDS; more recently, its role in ventilation-induced lung injury and worsening lung edema has been described. Innovations in bedside imaging technologies such as electrical impedance tomography readily allow clinicians to determine the regional distributions of V and Q, as well as the adequacy of their matching, providing new insights into the phenotyping, prognostication, and clinical management of patients with ARDS. The purpose of this review is to discuss the pathophysiology, identification, consequences, and treatment of
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mismatch in the setting of ARDS, employing experimental data from clinical and preclinical studies as support.
A relevant aspect of the interactions between charged fermions and crystal targets is coherence, which can exist at both classical and quantum levels. In the case of antiprotons crossing crystal ...targets, there are theories and measurements of classical-level coherence effects, in particular, channeling effects. For the present study, we assume the existence of a low-energy regime where the electrostatic interactions between an antiproton and the crystal atoms lead to a local loss in the beam flux as their leading effect. We expect this assumption to be well-justified for antiproton (p¯) energies below 100 eV, with a progressive transition to a standard “Rutherford regime” in the energy range 100–1000 eV. Under these conditions, the target can be treated as an optical absorber with a periodical structure, which can be simplified by considering a multi-layer planar structure only. As in standard optics, wave absorption is accompanied by interference and diffraction. Assuming sub-nanometer ranges for the relevant parameters and a realistic angular spread for the antiproton beam, we find narrow-angle focusing effects that reproduce the classical channeling effect at a qualitative level. We also find that diffraction dominates over interference, although this may strongly depend on the target details.
The present knowledge of the antinucleons elastic scattering and annihilation processes in matter at low energies is limited to a few nuclei data in a small phase-space. Optical potential models are ...useful tools for modelling nuclear strong interaction of antinucleons with matter providing predictions at very low energies where data are missing. New calculations of elastic and annihilation cross sections for antiproton with nuclei using an optical potential of Woods-Saxon (WS) shape are presented. Preliminary predictions at low energies for carbon and calcium show clearly-measurable nuclear effects for nuclear elastic cross sections at large angles and momenta greater than 50 MeV/c. Some discrepancies in annihilation cross section comparing predictions and data are present using the same fitting parameters.
Lung regions excluded from mechanical insufflation are traditionally assumed to be spared from ventilation-associated lung injury. However, preliminary data showed activation of potential mechanisms ...of injury within these non-ventilated regions (e.g., hypoperfusion, inflammation).
In the present study, we hypothesized that non-ventilated lung injury (NVLI) may develop within 24 h of unilateral mechanical ventilation in previously healthy pigs, and we performed extended pathophysiological measures to profile NVLI. We included two experimental groups undergoing exclusion of the left lung from the ventilation with two different tidal volumes (15 vs 7.5 ml/kg) and a control group on bilateral ventilation. Pathophysiological alteration including lung collapse, changes in lung perfusion, lung stress and inflammation were measured. Lung injury was quantified by histological score.
Histological injury score of the non-ventilated lung is significantly higher than normally expanded lung from control animals. The histological score showed lower intermediate values (but still higher than controls) when the tidal volume distending the ventilated lung was reduced by 50%. Main pathophysiological alterations associated with NVLI were: extensive lung collapse; very low pulmonary perfusion; high inspiratory airways pressure; and higher concentrations of acute-phase inflammatory cytokines IL-6, IL-1β and TNF-α and of Angiopoietin-2 (a marker of endothelial activation) in the broncho-alveolar lavage. Only the last two alterations were mitigated by reducing tidal volume, potentially explaining partial protection.
Non-ventilated lung injury develops within 24 h of controlled mechanical ventilation due to multiple pathophysiological alterations, which are only partially prevented by low tidal volume.
The upgrade of the scintillating bars detector, used in the experiments of the ASACUSA Collaboration at the CERN Antiproton Decelerator is presented. The detector consists of several modules, each ...one made of ≈1m long scintillating bars, which allow the detection of the charged particles produced in the annihilations of antiprotons and antihydrogens. The mechanics, the electronic readout and the data acquisition system upgrade are described.
BACKGROUNDThe impact of acute unilateral injury on spontaneous electrical activity in both vagus nerves at the heart level is poorly understood. We investigated the immediate neuroelectrical response ...after right or left cardiac vagal nerve transection (VNTx) by recording spiking activity of each heart vagus nerve (VN).METHODSFourteen male Göttingen minipigs underwent sternotomy. Multi-electrode cuffs were implanted below the cut level to record vagal electroneurographic signals during electrocardiographic and hemodynamic monitoring, before and immediately after cardiac VNTx (left: L-cut, n = 6; right: R-cut, n = 8).RESULTSLeft cardiac VNTx significantly reduced multi-unit electrical activity (MUA) firing rate in the vagal stump (-30.7% vs pre-cut) and intact right VN (-21.8% vs pre-cut) at the heart level, without affecting heart rate, heart rate variability, or hemodynamics. In contrast, right cardiac VNTx did not acutely alter MUA in either VN but slightly increased (p < 0.022) the root mean square of successive RR interval differences (rMSSD), an index of parasympathetic outflow, without affecting hemodynamics.CONCLUSIONSOur study reveals an early left-lateralized pattern in vagal spiking activity following unilateral cardiac vagotomy. These findings enhance understanding of the neuroelectrical response to vagal injury and provide insights into preserving vagal outflow after unilateral cardiac vagotomy. Importantly, monitoring spiking activity of the cardiac right VN may predict onset of left vagal pathway injury, which is detrimental to cardiac patients and can occur as a complication of catheter ablation for atrial fibrillation.
The ASACUSA (the Atomic Spectroscopy And Collisions Using Slow Antiprotons) collaboration is planning to measure the cross sections of antiproton annihilations at kinetic energy 100 keV on targets of ...various mass numbers (C, Ni, Sn, and Pt) using the Antiproton Decelerator (AD) of CERN. No previous measurement exists in this region where the A-dependence of the cross section is expected to deviate from the A
(Batty et al, Nucl Phys A 689:721,
2001
) as reported by the Obelix collaboration. A beam profile monitor based on secondary electron emission with a grid of electrode pads fabricated on an FR4-type glass-epoxy circuit board was developed for this measurement. The advantage of this kind of detector is that it is simple, lightweight, and low cost. It was used to measure the spatial profile of 100-ns-long beam pulses containing > 6 × 10
4
antiprotons with an active area of 40 mm × 40 mm and a spatial resolution of 4 mm.
Cardiac involvement is a major determinant of prognosis in type 1 myotonic dystrophy (DM1), but limited information is available about myocardial remodeling and tissue changes. The aim of the study ...was to investigate cardiac magnetic resonance (CMR) findings and their prognostic significance in DM1.
We retrospectively identified all DM1 patients referred from a neurology unit to our CMR laboratory from 2009 to 2020.
Thirty-four patients were included (aged 45 ± 12, 62% male individuals) and compared with 68 age-matched and gender-matched healthy volunteers (43 male individuals, age 48 ± 15 years). At CMR, biventricular and biatrial volumes were significantly smaller (all P < 0.05), as was left ventricular mass (P < 0.001); left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were significantly lower (all P < 0.01). Five (15%) patients had a LVEF less than 50% and four (12%) a RVEF less than 50%. Nine patients (26%) showed mid-wall late gadolinium enhancement (LGE; 5 ± 2% of LVM), and 14 (41%) fatty infiltration. Native T1 in the interventricular septum (1041 ± 53 ms) was higher than for healthy controls (1017 ± 28 ms) and approached the upper reference limit (1089 ms); the extracellular volume was slightly increased (33 ± 2%, reference <30%). Over 3.7 years (2.0-5.0), 6 (18%) patients died of extracardiac causes, 5 (15%) underwent device implantation; 5 of 21 (24%) developed repetitive ventricular ectopic beats (VEBs) on Holter monitoring. LGE mass was associated with the occurrence of repetitive VEBs (P = 0.002). Lower LV stroke volume (P = 0.017), lower RVEF (P = 0.016), a higher LVMi/LVEDVI ratio (P = 0.016), fatty infiltration (P = 0.04), and LGE extent (P < 0.001) were associated with death.
DM1 patients display structural and functional cardiac abnormalities, with variable degrees of cardiac muscle hypotrophy, fibrosis, and fatty infiltration. Such changes, as evaluated by CMR, seem to be associated with the development of ventricular arrhythmias and a worse outcome.
