Universality in the merging dynamics of parametric active contours:a study in MRI based lung segmentation

Measurement of lung ventilation is one of the most reliable techniques in diagnosing pulmonary diseases. The time-consuming and bias-prone traditional methods using hyperpolarized H 3He and 1H magnetic resonance imageries have recently been improved by an automated technique based on 'multiple active contour evolution'. This method involves a simultaneous evolution of multiple initial conditions, called 'snakes', eventually leading to their 'merging' and is entirely independent of the shapes and sizes of snakes or other parametric details. The objective of this paper is to show, through a theoretical analysis, that the functional dynamics of merging as depicted in the active contour method has a direct analogue in statistical physics and this explains its 'universality'. We show that the multiple active contour method has an universal scaling behaviour akin to that of classical nucleation in two spatial dimensions. We prove our point by comparing the numerically evaluated exponents with an equivalent thermodynamic model. © IOP Publishing Ltd and Deutsche Physikalische Gesellschaft.

Comparison of the Cosmed K4 b2 and the Deltatrac II™ metabolic cart in measuring resting energy expenditure in adults

Background and Aims: The objective of the study was to compare data obtained from the Cosmed K4 b2 and the Deltatrac II™ metabolic cart for the purpose of determining the validity of the Cosmed K4 b2 in measuring resting energy expenditure. Methods: Nine adult subjects (four male, five female) were measured. Resting energy expenditure was measured in consecutive sessions using the Cosmed K4 b2, the Deltatrac II™ metabolic cart separately and the Cosmed K4 b2 and Deltatrac II™ metabolic cart simultaneously, performed in random order. Resting energy expenditure (REE) data from both devices were then compared with values obtained from predictive equations. Results: Bland and Altman analysis revealed a mean bias for the four variables, REE, respiratory quotient (RQ), VCO2, VO2 between data obtained from Cosmed K4 b2 and Deltatrac II™ metabolic cart of 268 ± 702 kcal/day, -0.0±0.2, 26.4±118.2 and 51.6±126.5 ml/min, respectively. Corresponding limits of agreement for the same four variables were all large. Also, Bland and Altman analysis revealed a larger mean bias between predicted REE and measured REE using Cosmed K4 b2 data (-194±603 kcal/day) than using Deltatrac™ metabolic cart data (73±197 kcal/day). Conclusions: Variability between the two devices was very high and a degree of measurement error was detected. Data from the Cosmed K4 b2 provided variable results on comparison with predicted values, thus, would seem an invalid device for measuring adults. © 2002 Elsevier Science Ltd. All rights reserved.

Effect of simvastatin on physiological and biological outcomes in patients undergoing esophagectomy: a randomised placebo controlled trial

OBJECTIVE: To test whether simvastatin improves physiological and biological outcomes in patients undergoing esophagectomy.

BACKGROUND: One-lung ventilation during esophagectomy is associated with inflammation, alveolar epithelial and systemic endothelial injury, and the development of acute lung injury (ALI). Statins that modify many of the underlying processes are a potential therapy to prevent ALI.

METHODS: We conducted a randomized double-blind placebo-controlled trial in patients undergoing esophagectomy. Patients received simvastatin 80 mg or placebo enterally for 4 days preoperatively and 7 days postoperatively. The primary end point was pulmonary dead space (Vd/Vt) at 6 hours after esophagectomy or before extubation. Inflammation was assessed by plasma cytokines and intraoperative exhaled breath condensate pH; alveolar type 1 epithelial injury was assessed by plasma receptor for advanced glycation end products and systemic endothelial injury by the urine albumin-creatinine ratio.

RESULTS: Thirty-nine patients were randomized; 8 patients did not undergo surgery and were excluded. Fifteen patients received simvastatin and 16 received placebo. There was no difference in Vd/Vt or other physiological outcomes. Simvastatin resulted in a significant decrease in plasma MCP-1 on day 3 and reduced exhaled breath condensate acidification. Plasma receptor for advanced glycation end products was significantly lower in the simvastatin-treated group, as was the urine albumin-creatinine ratio on day 7 postsurgery. ALI developed in 4 patients in the placebo group and no patients in the simvastatin group although this difference was not statistically significant (P = 0.1).

CONCLUSIONS: In this proof of concept study, pretreatment with simvastatin in esophagectomy decreased biomarkers of inflammation as well as pulmonary epithelial and systemic endothelial injury.

Aspirin as a potential treatment in sepsis or acute respiratory distress syndrome

Sepsis is a common condition that is associated with significant morbidity, mortality and health-care cost. Pulmonary and non-pulmonary sepsis are common causes of the acute respiratory distress syndrome (ARDS). The mortality from ARDS remains high despite protective lung ventilation, and currently there are no specific pharmacotherapies to treat sepsis or ARDS. Sepsis and ARDS are characterised by activation of the inflammatory cascade. Although there is much focus on the study of the dysregulated inflammation and its suppression, the associated activation of the haemostatic system has been largely ignored until recently. There has been extensive interest in the role that platelet activation can have in the inflammatory response through induction, aggregation and activation of leucocytes and other platelets. Aspirin can modulate multiple pathogenic mechanisms implicated in the development of multiple organ dysfunction in sepsis and ARDS. This review will discuss the role of the platelet, the mechanisms of action of aspirin in sepsis and ARDS, and aspirin as a potential therapy in treating sepsis and ARDS.

La désaturation cérébrale lors d’une chirurgie thoracique : son incidence et sa corrélation avec les complications post opératoires

La ventilation unipulmonaire (SLV; Single Lung Ventilation) pendant les chirurgies thoraciques entraîne des altérations cardio-pulmonaires et hémodynamiques importantes. L’objectif de ce projet de recherche consiste à étudier l’impact de la SLV sur l’oxymétrie cérébrale et sa relation avec les complications post opératoires. La première étude inclut vingt patients ayant subi une chirurgie thoracique nécessitant une SLV. L’oxymétrie a été mesurée à l’aide de l’oxymètre cérébral absolu FORESIGHTTM (CASMED, USA) afin d’étudier les changements de la saturation cérébrale absolue (SctO2) tout le long de la chirurgie. La SctO2 ainsi que les paramètres de monitorage standard (BIS, SpO2, pression sanguine, fréquence cardiaque) ont été notés à toutes les cinq minutes à partir de l’induction jusqu’au réveil. Une analyse sanguine (paO2, paCO2, Hb) a été effectuée à toutes les quinze minutes. La deuxième étude effectuée consistait d’étudier la relation entre la désaturation cérébrale en oxygène et les complications post opératoires. Pour cette fin, les scores Clavien et SOFA mesurant l’amplitude des complications, ont été établis pour chaque patient. Les données sont présentées sous forme de moyenne et de la médiane [1er quartile, 3ème quartile; min – max]. Les vingt patients de la première étude ont montré une valeur moyenne absolue de saturation cérébrale absolue (SctO2) de 80% avant l’induction. Durant la SLV, cette valeur a chuté jusqu’à 63% et est remontée à 71% directement après extubation. Tous ces patients ont subi une désaturation durant SLV de plus que 15% comparativement à la valeur de base et 70% ont eu une désaturation de plus de 20%. La désaturation n’a pas été corrélée avec aucun des paramètres de monitorage clinique standard comme la pression artérielle, les analyses des gaz artériels, la saturation périphérique ou la PaO2. La deuxième étude incluant trente autres patients aux vingt premiers, est venue confirmer les résultats de la première étude. De plus, une analyse de corrélation entre les valeurs minimales de SctO2 obtenues durant SLV et les complications post opératoires a été effectuée. Les patients avaient une SctO2 de base de 80%, qui a chuté jusqu’à 64% pendant la SLV pour récupérer à 71% avant la fin de la chirurgie. 82% des patients ont subi des désaturations de plus de 15% des valeurs initiales et 10% ont atteint des valeurs de SctO2 entre 45 et 55%. Les valeurs minimales de SctO2 observées durant la SLV corrélaient avec le score SOFA non respiratoire (R2=0,090, p=0,0287) ainsi qu’avec le score Clavien (R2=0,098, p=0,0201), mais ne corrélait avec aucun des paramètres cliniques standards (ex : SpO¬2, PaO2, PaCO2, Hb). En définissant une valeur seuil de SctO2=65%, le «Odds ratio» d’avoir une défaillance d’organe non respiratoire est de 2.37 (IC 95%=1,18 – 4,39, p=0,043) et d’avoir une complication classifiée supérieure à un score Clavien de 0 est de 3,19 (IC 95%=1,6 – 6,34, p=0,0272). Les chirurgies thoraciques avec une SLV sont associées à des chutes significatives de SctO2, et les valeurs minimales de SctO2 semblent avoir une corrélation positive avec les complications post opératoires.

Ventilación controlada por volumen vs. ventilación controlada por presión en pacientes sometidos a ventilación de un solo pulmón

El establecimiento de la ventilación de un solo pulmón (OLV) tiene varios inconvenientes como el incremento de las presiones de la vía aérea y aumento del shunt. Estos cambios pueden estar influenciados por el modo ventilatorio escogido. La ventilación controlada por presión (VCP) es un modo alternativo ampliamente usado en pacientes con falla respiratoria por sus características de aporte de flujo y presión. En este estudio la VCP fue usada en los pacientes que requerían OLV y sus efectos sobre las presiones en la vía aérea, oxigenación y estado hemodinámico fueron comparados con la ventilación controlado por volumen (VCV). Nosotros estudiamos 41 pacientes que requerian OLV. Después de ventilar los dos pulmones con volumen los pacientes fueron aleatorizados a uno de dos grupos. En el primer grupo (n=19) OLV fue iniciada con VCV y luego de transcurrido 30 minutos los pacientes fueron cambiados a VCP, donde se mantuvo la ventilación por el mismo tiempo. En el otro grupo (n=21) los pacientes iniciaron en VCP 30 minutos y luego fueron cambiados a VCV con una duración similar. Las presiones en la vía aérea, gases arteriales y variables hemodinámicas fueron medidos durante OLV en cada modo ventilatorio previo al cambio. Nosotros observamos que el inicio de OLV genera un incremento de la presión inspiratoria pico (PIP) (p=0.0002) y presión plateau (p=0.005). Este aumento es mayor en el grupo que fue VCV (p=0.008) que en el grupo que fue VCP (p=0.003). No hubo diferencia estadísticamente significativa en las otras varibles estudiadas entre los grupos. Nosotros concluimos que la VCP puede ser una alternativa a VCV en pacientes que requieren OLV porque disminuye las presiones en la vía aérea y aunque no mejora la oxigenación si puede minimizar el desarrollo de lesiones pulmonares inducidas por la ventilación en una población que es de alto riesgo para el desarrollo de la misma.

Role of midbrain in the control of breathing in anuran amphibians

The present study was designed to explore systematically the midbrain of unanesthetized, decerebrate anuran amphibians (bullfrogs), using chemical and electrical stimulation and midbrain transections to identify sites capable of exciting and inhibiting breathing. Ventilation was measured as fictive motor output from the mandibular branch of the trigeminal nerve and the laryngeal branch of the vagus nerve. The results of our transection studies suggest that, under resting conditions, the net effect of inputs from sites within the rostral half of the midbrain is to increase fictive breathing frequency, whereas inputs from sites within the caudal half of the midbrain have no net effect on fictive breathing frequency but appear to act on the medullary central rhythm generator to produce episodic breathing. The results of our stimulation experiments indicate that the principal sites in the midbrain that are capable of exciting or inhibiting the fictive frequency of lung ventilation, and potentially clustering breaths into episodes, appear to be those primarily involved in visual and auditory integration, motor functions, and attentional state.

Control of respiration in fish, amphibians and reptiles

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

DEVELOPMENT OF BLOOD-PRESSURE AND CARDIAC REFLEXES IN THE FROG PSEUDIS-PARADOXSUS

Systemic arterial blood pressure and heart rate (f(H)) were measured in unanesthetized, unrestrained larvae and adults of the paradoxical frog, Pseudis paradoxus from São Paulo State in Brazil. Four developmental groups were used, representing the complete transition from aquatic larvae to primarily air-breathing adults. f(H) (49-66 beats/min) was not significantly affected by development, whereas mean arterial blood pressure was strongly affected, being lowest in the stage 37-39 larvae (10 mmHg), intermediate in the stage 44-45 larvae (18 mmHg), and highest in the juveniles and adults (31 and 30 mmHg, respectively). Blood pressure was not significantly correlated with body mass, which was greatest in the youngest larvae and smallest in the juveniles. In the youngest larvae studied (stages 37-39), lung ventilation was infrequent, causing a slight decrease in arterial blood pressure but no change in heart rate. Lung ventilation was more frequent in stages 44-45 larvae and nearly continuous in juveniles and adults floating at the surface. Bradycardia during both forced and voluntary diving was observed in almost every advanced larva, juvenile, and adult but in only one of four young larvae. Developmentally related changes in blood pressure were not complete until metamorphosis, whereas diving bradycardia was present at an earlier stage.

Efeito da posição do prematuro no desmame da ventilação mecânica

Objective: the purpose of this study was to determine the effects of prone positioning on cardiorespiratory stability and weaning outcome of preterm infants during weaning from mechanical ventilation. Methods: from January to December 1999, a sample of 42 preterm infants, with birthweight < 2,000 g, mechanically ventilated in the first week of life, were randomly divided, in the beginning of the weaning process, in two groups according to the position: supine position (n = 21) or prone position (n = 21). Heart rate, respiratory rate, transcutaneous oxygen saturation and ventilatory parameters were recorded every one hour. Length of the weaning process and complications were also assessed. Results: in both groups the mean gestational age was 29 weeks, most of the patients presented very low birthweight and respiratory distress syndrome. The mean length of the weaning process was 2 days. There were no differences between the groups regarding respiratory rate, heart rate and transcutaneous oxygen saturation, however, oxygen desaturation episodes were more frequent in supine position (p = 0.009). Ventilatory parameters decreased faster and reintubation was less frequent in the prone group (4% versus 33%). No adverse effects of prone positioning were observed. Conclusion: these results suggest that prone position is a safe and beneficial procedure during the weaning from mechanical ventilation and may contribute to weaning success in preterm infants.

Estudo comparativo dos efeitos hemodinâmicos e ventilatórios da ventilação controlada a volume ou a pressão, em cães submetidos ao pneumoperitônio

BACKGROUND AND OBJECTIVES: Pressure controlled ventilation (PCV) is available in anesthesia machines, but there are no studies on its use during CO 2 pneumoperitoneum (CPP). This study aimed at evaluating pressure-controlled ventilation and hemodynamic and ventilatory changes during CPP, as compared to conventional volume controlled ventilation (VCV). METHODS: This study involved 16 dogs anesthetized with thiopental, fentanyl and pancuronium, which were randomly assigned to two groups: VC - volume controlled ventilation (n=8) and PC - pressure controlled ventilation (n=8). Hemodynamic and ventilatory parameters were monitored and recorded in 4 moments: M1 (before CPP), M2 (30 minutes after CPP = 10 mmHg), M3 (30 minutes after CPP=15 mmHg) and M4 (30 minutes after deflation). RESULTS: With CPP, there has been significant increase in tidal volume in PC group; there has been increase in airway pressures (peak and plateau), decrease in compliance with increase in CPP pressure, increase in heart rate, maintenance of mean blood pressure with higher values in the VC group in all stages; there was also increase in right atrium pressure with significant decrease after deflation, decrease in arterial pH with minor variations in PC group, greater arterial pCO 2 stability in PC group, and no significant changes in arterial pO 2. CONCLUSIONS: There were some differences in hemodynamic and ventilatory data between both ventilation control modes (VC and PC). It is possible to use pressure controlled ventilation during CPP, but the anesthesiologist must monitor and take a close look at alveolar ventilation, adjusting inspiratory pressure to ensure proper CO 2 elimination and oxygenation. © Sociedade Brasileira de Anestesiologia, 2005.

Metabolic, ventilatory, and hygric physiology of the gracile mouse opossum (Gracilinanus agilis)

We present the first complete study of basic laboratory-measured physiological variables (metabolism, thermoregulation, evaporative water loss, and ventilation) for a South American marsupial, the gracile mouse opossum (Gracilinanus agilis). Body temperature (Tb) was thermolabile below thermoneutrality (Tb = 33.5°C), but a substantial gradient between Tb and ambient temperature (Ta) was sustained even at Ta = 12°C (Tb = 30.6°C). Basal metabolic rate of 1.00 mL O2 g-1 h-1 at Ta = 30°C conformed to the general allometric relationship for marsupials, as did wet thermal conductance (5.7 mL O2 g-1 h-1 °C-1). Respiratory rate, tidal volume, and minute volume at thermoneutrality matched metabolic demand such that O2 extraction was 12.4%, and ventilation increased in proportion to metabolic rate at low T a. Ventilatory accommodation of increased metabolic rate at low Ta was by an increase in respiratory rate rather than by tidal volume or O2 extraction. Evaporative water loss at the lower limit of thermoneutrality conformed to that of other marsupials. Relative water economy was negative at thermoneutrality but positive below Ta = 12°C. Interestingly, the Neotropical gracile mouse opossums have a more positive water economy at low Ta than an Australian arid-zone marsupial, perhaps reflecting seasonal variation in water availability for the mouse opossum. Torpor occurred at low Ta, with spontaneous arousal when . T b > 20°C. Torpor resulted in absolute energy and water savings but lower relative water economy. We found no evidence that gracile mouse opossums differ physiologically from other marsupials, despite their Neotropical distribution, sympatry with placental mammals, and long period of separation from Australian marsupials. © 2009 by The University of Chicago. All rights reserved.

Mau Funcionamento do Sistema de Circulação Extracorpórea: Relato de Caso

Background and objectives: The introduction of extracorporeal circulation in clinical practice was decisive for the development of modern cardiovascular surgery. Addition of new procedures and equipment, however, brings inherent risks and complications. The objective of this report is to describe a malfunction of the oxygenation system and emphasize the importance of the interaction among the medical team members to prevent errors and complications. Case Report: During valve replacement and IVC correction surgery, we observed a darker shade of red in the blood on the exit of the oxygenator. Laboratory tests demonstrated severe acidosis and hypoxemia. The entire system was evaluated, but the cause of the malfunction was not found. Measures to reduce damage were successfully instituted. After the surgery, the whole system underwent technical evaluation. Conclusions: Interaction among the medical team members, early diagnosis, and immediate intervention were fundamental for a favorable outcome. © 2011 Elsevier Editora Ltda.

Ionotropic but not metabotropic glutamatergic receptors in the locus coeruleus modulate the hypercapnic ventilatory response in unanaesthetized rats

Aim: Central chemoreceptors are important to detect changes of CO2/H+, and the Locus coeruleus (LC) is one of the many putative central chemoreceptor sites. Here, we studied the contribution of LC glutamatergic receptors on ventilatory, cardiovascular and thermal responses to hypercapnia. Methods: To this end, we determined pulmonary ventilation (VE), body temperatures (Tb), mean arterial pressure (MAP) and heart rate (HR) of male Wistar rats before and after unilateral microinjection of kynurenic acid (KY, an ionotropic glutamate receptor antagonist, 10 nmol/0.1 μL) or α-methyl-4-carboxyphenylglycine (MCPG, a metabotropic glutamate receptor antagonist, 10 nmol/0.1 μL) into the LC, followed by 60 min of air breathing or hypercapnia exposure (7% CO2). Results: Ventilatory response to hypercapnia was higher in animals treated with KY intra-LC (1918.7 ± 275.4) compared with the control group (1057.8 ± 213.9, P < 0.01). However, the MCPG treatment within the LC had no effect on the hypercapnia-induced hyperpnea. The cardiovascular and thermal controls were not affected by hypercapnia or by the injection of KY and MCPG in the LC. Conclusion: These data suggest that glutamate acting on ionotropic, but not metabotropic, receptors in the LC exerts an inhibitory modulation of hypercapnia-induced hyperpnea. © 2013 Scandinavian Physiological Society.

Serotonergic neurons in the nucleus raphé obscurus are not involved in the ventilatory and thermoregulatory responses to hypoxia in adult rats

The medullary raphé is an important component of the central respiratory network, playing a key role in CO2 central chemoreception. However, its participation in hypoxic ventilatory responses is less understood. In the present study, we assessed the role of nucleus raphé obscurus (ROb), and specifically 5-HT neurons confined in the ROb, on ventilatory and thermoregulatory responses to hypoxia. Chemical lesions of the ROb were performed using either ibotenic acid (non-specific lesion; control animals received PBS) or anti-SERT-SAP (5-HT specific lesion; control animals received IgG-SAP). Ventilation (VE; whole body plethysmograph) and body temperature (Tb; data loggers) were measured during normoxia (21% O2, N2 balance) and hypoxia exposure (7% O2, N2 balance, 1h) in conscious adult rats. Ibotenic acid or anti-SERT-SAP-induced lesions did not affect baseline values of VE and Tb. Similarly, both lesion procedures did not alter the ventilatory or thermoregulatory responses to hypoxia. Although evidence in the literature suggests a role of the rostral medullary raphé in hypoxic ventilatory responses, under the present experimental conditions our data indicate that caudal medullary raphé (ROb) and its 5-HT neurons neither participate in the tonic maintenance of breathing nor in the ventilatory and thermal responses to hypoxia. © 2013 Elsevier B.V.