Heart-lung interactions during neurally adjusted ventilatory assist

Introduction Assist in unison to the patient’s inspiratory neural effort and feedback-controlled limitation of lung distension with neurally adjusted ventilatory assist (NAVA) may reduce the negative effects of mechanical ventilation on right ventricular function. Methods Heart–lung interaction was evaluated in 10 intubated patients with impaired cardiac function using esophageal balloons, pulmonary artery catheters and echocardiography. Adequate NAVA level identified by a titration procedure to breathing pattern (NAVAal), 50% NAVAal, and 200% NAVAal and adequate pressure support (PSVal, defined clinically), 50% PSVal, and 150% PSVal were implemented at constant positive end-expiratory pressure for 20 minutes each. Results NAVAal was 3.1 ± 1.1cmH2O/μV and PSVal was 17 ± 2 cmH20. For all NAVA levels negative esophageal pressure deflections were observed during inspiration whereas this pattern was reversed during PSVal and PSVhigh. As compared to expiration, inspiratory right ventricular outflow tract velocity time integral (surrogating stroke volume) was 103 ± 4%, 109 ± 5%, and 100 ± 4% for NAVAlow, NAVAal, and NAVAhigh and 101 ± 3%, 89 ± 6%, and 83 ± 9% for PSVlow, PSVal, and PSVhigh, respectively (p < 0.001 level-mode interaction, ANOVA). Right ventricular systolic isovolumetric pressure increased from 11.0 ± 4.6 mmHg at PSVlow to 14.0 ± 4.6 mmHg at PSVhigh but remained unchanged (11.5 ± 4.7 mmHg (NAVAlow) and 10.8 ± 4.2 mmHg (NAVAhigh), level-mode interaction p = 0.005). Both indicate progressive right ventricular outflow impedance with increasing pressure support ventilation (PSV), but no change with increasing NAVA level. Conclusions Right ventricular performance is less impaired during NAVA compared to PSV as used in this study. Proposed mechanisms are preservation of cyclic intrathoracic pressure changes characteristic of spontaneous breathing and limitation of right-ventricular outflow impedance during inspiration, regardless of the NAVA level.

Prognostic Relevance of Palliative Primary Tumor Removal in 37,793 Metastatic Colorectal Cancer Patients: A Population-Based, Propensity Score-Adjusted Trend Analysis

OBJECTIVE To assess whether palliative primary tumor resection in colorectal cancer patients with incurable stage IV disease is associated with improved survival. BACKGROUND There is a heated debate regarding whether or not an asymptomatic primary tumor should be removed in patients with incurable stage IV colorectal disease. METHODS Stage IV colorectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 1998 and 2009. Patients undergoing surgery to metastatic sites were excluded. Overall survival and cancer-specific survival were compared between patients with and without palliative primary tumor resection using risk-adjusted Cox proportional hazard regression models and stratified propensity score methods. RESULTS Overall, 37,793 stage IV colorectal cancer patients were identified. Of those, 23,004 (60.9%) underwent palliative primary tumor resection. The rate of patients undergoing palliative primary cancer resection decreased from 68.4% in 1998 to 50.7% in 2009 (P < 0.001). In Cox regression analysis after propensity score matching primary cancer resection was associated with a significantly improved overall survival [hazard ratio (HR) of death = 0.40, 95% confidence interval (CI) = 0.39-0.42, P < 0.001] and cancer-specific survival (HR of death = 0.39, 95% CI = 0.38-0.40, P < 0.001). The benefit of palliative primary cancer resection persisted during the time period 1998 to 2009 with HRs equal to or less than 0.47 for both overall and cancer-specific survival. CONCLUSIONS On the basis of this population-based cohort of stage IV colorectal cancer patients, palliative primary tumor resection was associated with improved overall and cancer-specific survival. Therefore, the dogma that an asymptomatic primary tumor never should be resected in patients with unresectable colorectal cancer metastases must be questioned.

Distribution of quality adjusted life expectancy: A systems approach

Statistical methods are developed which assess survival data for two attributes; (1) prolongation of life, (2) quality of life. Health state transition probabilities correspond to prolongation of life and are modeled as a discrete-time semi-Markov process. Imbedded within the sojourn time of a particular health state are the quality of life transitions. They reflect events which differentiate perceptions of pain and suffering over a fixed time period. Quality of life transition probabilities are derived from the assumptions of a simple Markov process. These probabilities depend on the health state currently occupied and the next health state to which a transition is made. Utilizing the two forms of attributes the model has the capability to estimate the distribution of expected quality adjusted life years (in addition to the distribution of expected survival times). The expected quality of life can also be estimated within the health state sojourn time making more flexible the assessment of utility preferences. The methods are demonstrated on a subset of follow-up data from the Beta Blocker Heart Attack Trial (BHAT). This model contains the structure necessary to make inferences when assessing a general survival problem with a two dimensional outcome. ^

Ajo nieve INTA : densidad de plantación y fertirrigación nitrogenada

Se estudió el efecto de tres densidades de plantación (20 (D20), 30 (D30) y 40 (D40) plantas m-2) y cinco dosis de fertilización nitrogenada (0 (N0), 75 (N75), 150 (N150), 225 (N225) y 300 (N300) kg de N ha-1), sobre el rendimiento y la calidad de ajo (Allium sativum L.) de la cultivar Nieve INTA (tipo blanco), bajo riego por goteo. Se realizó un ensayo en el INTA La Consulta, Mendoza, Argentina, en un suelo Torrifluvente típico franco arenoso profundo (Soil Taxonomy). Se utilizaron cintas de riego por goteo T-Tape 508-30, colocadas en el medio de la cama de plantación con un caudal de 2.7 L m-1 h-1. El máximo rendimiento (13 t ha-1) de ajo seco y limpio se logró con una densidad de plantación de 40 plantas m-2 y con dosis de 225 kg N ha-1. Las relaciones halladas entre los rendimientos de bulbos y las dosis de nitrógeno de 0, 75, 150, 225 y 300 kg N ha-1 fueron de tipo cuadrático (P < 0.001), con r2= 0.89; 0.91 y 0.84 para D 20, D30 y D40, respectivamente. Se encontró diferencias significativas (P < 0.05), con respecto a rendimiento, entre líneas externas e internas de la cama de plantación en la densidad de 40 000 plantas ha-1. La línea externa rindió más que la interna. Los porcentajes en peso de bulbos comerciales (C5+C6+C7) sobre el total de bulbos cosechados para las densidades D20, D30 y D40 fueron de 80.1 %; 66.7 % y 56.1 %, respectivamente.

Desarrollo de estándares de calidad para uvas Vitis vinifera L. cv. Malbec y Syrah

El objetivo del trabajo fue desarrollar estándares de calidad de uva basados en atributos físicos y químicos, capaces de predecir la calidad del vino. Se instaló una red de ensayos en Mendoza (Norte, Este y Valle de Uco), San Juan (Valle de Zonda), La Rioja (Chilecito), Catamarca y Salta (Valles Calchaquíes) (Argentina). Se ensayaron niveles de carga de uva (desbrote 30 y 50%, raleo 30 y 50% y testigo) en Malbec y Syrah. En la cosecha, las uvas fueron analizadas (tamaño baya, concentración azucarina, pH, antocianos, catequinas, taninos, fenoles totales) y vinificadas. Los vinos fueron analizados (alcohol, extracto seco, intensidad colorante, matiz, antocianos, catequinas, taninos, fenoles totales, color polimérico) y evaluados por un panel de degustadores. Empleando todos las variables de los vinos, mediante un análisis de componentes principales, se generaron dos índices que resumieron los atributos con mayor peso explicativo de la variabilidad observada (80%); ellos fueron: Riqueza Fenólica (RF, asociado a antocianos, taninos, catequinas, fenoles totales y concentración) y Peligro Oxidativo (PO, asociado a pH, matiz y tonalidad percibida). No existieron diferencias en cuanto a RF entre variedades ni entre niveles de producción de uva. Los vinos con RF mayor y PO menor se consideraron de mayor calidad. Las uvas cultivadas en zonas más frías tuvieron una mayor RF. En Malbec, las zonas frías y los bajos niveles productivos generaron un PO menor. Para cada variedad se desarrollaron predictores para RF y PO del vino. Se usó la regresión múltiple lineal paso a paso, seleccionando las variables de la uva con mayor poder predictivo. Se definieron las funciones de ajuste RFpred (Malbec R2 = 80%; Syrah R2 = 62%) y POpred (Malbec R2 = 80%; Syrah R2 = 62%). Los índices se tradujeron en estándares de calidad que mostraron concordancia entre uvas y vinos. La metodología puede ser válida para otras variedades tintas, pero debe ajustarse para cada caso. Los estándares permitirían asociar un precio a cada calidad y aumentar la transparencia del mercado.

Respiration and ingestion rates of calanoid copepod in the northern Benguela Current System measured ex situ during the RSS Discovery D356 cruise in 2010

Respiration rates of 16 calanoid copepod species from the northern Benguela upwelling system were measured on board RRS Discovery in September/October 2010 to determine their energy requirements and assess their significance in the carbon cycle. Copepod species were sampled by different net types. Immediately after the hauls, samples were sorted to species and stages (16 species; females, males and C5 copepodids) according to Bradford-Grieve et al. (1999). Specimens were kept in temperature-controlled refrigerators for at least 12 h before they were used in experiments. Respiration rates of different copepod species were measured onboard by optode respirometry (for details see Köster et al., 2008) with a 10-channel optode respirometer (PreSens Precision Sensing Oxy-10 Mini, Regensburg, Germany) under simulated in situ conditions in temperature-controlled refrigerators. Experiments were run in gas-tight glass bottles (12-13 ml). For each set of experiments, two controls without animals were measured under exactly the same conditions to compensate for potential bias. The number of animals per bottle depended on the copepods size, stage and metabolic activity. Animals were not fed during the experiments but they showed natural species-specific movements. Immediately after the experiments, all specimens were deep-frozen at - 80 °C for later dry mass determination (after lyophilisation for 48 h) in the home lab. The carbon content (% of dry mass) of each species was measured by mass-spectrometry in association with stable isotope analysis and body dry mass was converted to units of carbon. For species without available carbon data, the mean value of all copepod species (44% dry mass) was applied. For the estimation of carbon requirements of copepod species, individual oxygen consumption rates were converted to carbon units, assuming that the expiration of 1 ml oxygen mobilises 0.44 mg of organic carbon by using a respiratory quotient (RQ) of 0.82 for a mixed diet consisting of proteins (RQ = 0.8-1.0), lipids (RQ = 0.7) and carbohydrates (RQ = 1.0) (Auel and Werner, 2003). The carbon ingestion rates were calculated using the energy budget and the potential maximum ingestion rate approach. To allow for physiological comparisons of respiration rates of deep- and shallow-living copepod species without the effects of ambient temperature and different individual body mass, individual respiration rates were temperature- (15°C, Q10=2) and size-adjusted. The scaling coefficient of 0.76 (R2=0.556) is used for the standardisation of body dry mass to 0.3 mg (mean dry mass of all analysed copepods), applying the allometric equation R= (R15°C/M0.76)×0.30.76, where R is respiration and M is individual dry mass in mg.

Tie points and log-adjusted depth scales for ODP Leg 207 Sites

Multiple copies of Cretaceous black shales extending from the early Cenomanian to the end of the Santonian were recovered at five sites on Demerara Rise during Leg 207 of the Ocean Drilling Program. These sediments are primarily composed of laminated organic-rich claystones interbedded with coarser, lightly laminated foraminferal-bearing packstones and wackestones. The black shales represent the local expression of widespread organic-rich sedimentation in the Atlantic during the mid-Cretaceous. However, incomplete recovery prevented construction of continuous composite sections, resulting in uncertainties concerning the correct stratigraphic placement of individual cores. By combining high-resolution measurements of bulk density collected shipboard on the multisensor track with continuous downhole measurements of formation resistivity using the Formation MicroScanner, an equivalent logging depth scale was constructed for black shales recovered from Sites 1258, 1260, and 1261. The integrated depths approach centimeter-scale resolution and are supported by comparisons of coarser resolution natural gamma ray emissions collected on cores and through downhole logging operations. The new depths highlight the extent of both intra- and intercore gaps and provide an opportunity to further constrain temporal and spatial paleoceanographic changes captured in proxy records from these sediments.