Potentially modifiable predictors of mortality in patients treated with long-term oxygen therapy

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Predictors of first-year survival in patients with advanced COPD treated using long-term oxygen therapy

Little evidence-based guidance is available to aid clinicians in determining short-term prognoses in very severe COPD patients. Therefore, the present study was designed to provide a prospective assessment (1) of the mortality rates and (2) whether the baseline measurements may be determinants of 1-year mortality in hypoxemic COPD patients receiving long-term oxygen therapy (LTOT).Seventy-eight clinically stable patients with advanced COPD treated using LTOT were enrolled in a prospective cohort study. Outcome variable: first-year mortality. Baseline measurements: categorical variables: age (<60 or >= 60 years); gender; body mass index (<20 or >= 20 kg/m(2)); fat-free mass (FFM) index (<16 [men] and <15kg/m(2) [women]; baseline dyspnea index (BDI) (<= 3 or >3); and corticosteroid use. Continuous variables: smoking history; lung function; FFM; fat mass; hemoglobin; hematocrit; arterial blood gases; forearm muscle strength; St. George's Respiratory Questionnaire (SGRQ); and comorbidity score. By the end of 1-year of follow-up, 12 patients (15.4%) had died. Kaplan-Meier curves showed that BDI <= 3 was the only variable associated with higher mortality. Cox proportional hazards analysis revealed that tower PaO2 and SPO2, higher PaCO2 and SGRQ scores were associated with reduced survival. In the multivariate analysis, BDI remained predictive of mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.31-0.81), as did PaO2 (HR, 0.49; 95% CI, 0.26-0.95). These data suggest that readily available parameters as dyspnea intensity and hypoxemia severity may be useful in predicting first-year survival rates in advanced COPD patients receiving LTOT (C) 2007 Elsevier Ltd. All rights reserved.

Effects of twenty-four hour transport or twenty-four hour feed and water deprivation on physiologic and performance responses of feeder cattle

The objective of this study was to compare the effects of 24-h road transport or 24-h feed and water deprivation on acute-phase and performance responses of feeder cattle. Angus x Hereford steers (n = 30) and heifers (n = 15) were ranked by gender and BW (217 +/- 3 kg initial BW; 185 +/- 2 d initial age) and randomly assigned to 15 pens on d -12 of the experiment (3 animals/pen; 2 steers and 1 heifer). Cattle were fed alfalfa-grass hay ad libitum and 2.3 kg/animal daily (DM basis) of a corn-based concentrate throughout the experiment (d -12 to 28). on d 0, pens were randomly assigned to 1 of 3 treatments: 1) transport for 24 h in a livestock trailer for 1,200 km (TRANS), 2) no transport but feed and water deprivation for 24 h (REST), or 3) no transport and full access to feed and water (CON). Treatments were concurrently applied from d 0 to d 1. Total DMI was evaluated daily from d -12 to d 28. Full BW was recorded before treatment application (d -1 and 0) and at the end of experiment (d 28 and 29). Blood samples were collected on d 0, 1, 4, 7, 10, 14, 21, and 28. Mean ADG was greater (P < 0.01) in CON vs. TRANS and REST cattle but similar (P = 0.46) between TRANS and REST cattle (1.27, 0.91, and 0.97 kg/d, respectively; SEM = 0.05). No treatment effects were detected for DMI (P >= 0.25), but CON had greater G: F vs. TRANS (P < 0.01) and REST cattle (P = 0.08) whereas G: F was similar (P = 0.21) between TRANS and REST cattle. Plasma cortisol concentrations were greater (P <= 0.05) in REST vs. CON and TRANS cattle on d 1, 7, 14, and 28 and also greater (P = 0.02) in TRANS vs. CON cattle on d 1. Serum NEFA concentrations were greater (P < 0.01) in REST and TRANS vs. CON cattle on d 1 and greater (P < 0.01) in REST vs. TRANS cattle on d 1. Plasma ceruloplasmin concentrations were greater (P = 0.04) in TRANS vs. CON cattle on d 1, greater (P = 0.05) in REST vs. CON on d 4, and greater (P <= 0.05) in REST vs. TRANS and CON on d 14. Plasma haptoglobin concentrations were greater (P < 0.01) in TRANS vs. CON and REST cattle on d 1 and greater (P <= 0.05) for REST vs. TRANS and CON cattle on d 7. In conclusion, 24-h transport and 24-h nutrient deprivation elicited acute-phase protein reactions and similarly reduced feedlot receiving performance of feeder cattle. These results suggest that feed and water deprivation are major contributors to the acute-phase response and reduced feedlot receiving performance detected in feeder cattle transported for long distances.

Evaluation of a portable clinical analyzer for the determination of blood gas partial pressures, electrolyte concentrations, and hematocrit in venous blood samples collected from cattle, horses, and sheep

Objective To compare results reported for blood gas partial pressures, electrolyte concentrations, and Hct in venous blood samples collected from cattle, horses, and sheep and analyzed by use of a portable clinical analyzer (PCA) and reference analyzer (RA).Animals-Clinically normal animals (24 cattle, 22 horses, and 22 sheep).Procedures-pH; Pco(2); Po(2); total carbon dioxide concentration; oxygen saturation; base excess; concentrations of HCO(3)(-), Na(+), K(+), and ionized calcium; Hct; and hemoglobin concentration were determined with a PCA. Results were compared with those obtained for the same blood sample with an RA. Bias (mean difference) and variability (95% confidence interval) were determined for all data reported. Data were also subjected to analyses by Deming regression and Pearson correlation.Results-Analysis of Bland-Altman plots revealed good agreement between results obtained with the PCA and those obtained with the RA for pH and total carbon dioxide concentration in cattle, K(+) concentration in horses and sheep, and base excess in horses. Except for Na(+) concentration and Hct in horses and sheep, correlation was good or excellent for most variables reported.Conclusions and Clinical Relevance-Data from blood gas and electrolyte analyses obtained by use of the PCA can be used to evaluate the health status of cattle, horses, and sheep. Furthermore, the handheld PCA device may have a great advantage over the RA device as a result of the ability to analyze blood samples on farms that may be located far from urban centers. (Am J Vet Res 2010;71:515-521)

Effect of soccer training on the running speed and the blood lactate concentration at the lactate minimum test

Tegtbur et al. [23] devised a new method able to estimate the intensity at maximal lactate steady state termed lactate minimum test. According to Billat et al. [7], no studies have yet been published on the affect of training on highest blood lactate concentration that can be maintained over time without continual blood lactate accumulation. Therefore, the aim of the present study was to verify the effect of soccer training on the running speed and the blood lactate concentration (BLC) at the lactate minimum test (Lac(min)). Thirteen Brazilian male professional soccer players, all members of the same team playing at National level, volunteered for this study. Measurements were carried out before (pre) and after (post) eight weeks of soccer training. The Lac(min) test was adapted to the procedures reported by Tegtbur et al. [23]. The running speed at the Lac(min) test was taken when the gradient of the line was zero. Differences in running speed and blood lactate concentration at the Lac(min) test before (pre) and after (post) the training program were evaluated by Student's paired t-test. The training program increased the running speed at the Lac(min) test (14.94 +/- 0.21 vs. 15.44 +/- 0.42* km(.)h(-1)) and the blood lactate concentration (5.11 +/- 2.31 vs. 6.93 +/- 1.33* mmol(.)L(-1)). The enhance in the blood lactate concentration may be explained by an increase in the lactate/H+ transport capacity of human skeletal muscle verified by other authors.

Red blood cells from the South American rattlesnake (Crotalus durissus terrificus) regulate volume incompletely following osmotic shrinkage and swelling in vitro

The ability of rattlesnake (Crotalus durissus terrificus) red blood cells to volume regulate in vitro has been investigated. Blood was drawn through a catheter inserted in the dorsal aorta and equilibrated to gas mixtures of different composition. Cells shrunken osmotically by increasing the extracellular osmolarity from approximate to 291 mosm l(-1) (n = 3) to approximate to 632 mosm l(-1) (calculated) only partially regulated their volume back towards the original volume either at pH 7.51 +/- 0.05 (mean +/- S.D., n = 5) or pH 7.20 +/- 0.06 (mean +/- S.D., n = 3), There was no improvement of the regulatory volume increase at low haemoglobin oxygen saturation. The limited volume restoration was inhibited by separate additions of amiloride (10(-4) M) or DIDS (10(-4) M) suggesting involvement of the Na+/H+ and Cl-/HCO3- exchangers. Cells that were swollen osmotically by an approximate to 30% dilution of the extracellular medium also exhibited a limited ability to recover their volume. Therefore, these cells show little ability to volume regulate when exposed to in vitro conditions that shrink or swell the cell. (C) 2000 Elsevier B.V. All rights reserved.

Toxin jararhagin in low doses induces interstitial edema and increases the metabolic rate and red blood cells in mice

Jararhagin is a metalloproteinase from Bothrops jararaca responsible for hemorrhage, inflammation, necrosis and edema. Effects of low doses of the toxin were analyzed on the energy metabolism of mice as well as its physiological implications. Measures of O-2 consumption (VO2) were quantified after 4 and 24 h of the jarathagin administration during four weeks. Hematocrit and histology of the lungs were also analyzed after the end of the treatment. Results showed that animals that received subcutaneous doses of jararhagin had significant increase in VO2 from second (120 ng) and third weeks (60 ng) after 4 and 24 h, comparing to control, as well as in the number of erythrocytes after four weeks. Histology of the lungs showed interstitial edema within the alveolar septum. Results suggest that the jararhagin toxin caused an increase in VO2 and edema of intra-alveolar septum. The increase of the erythrocytes could be a physiological response to adjust the higher necessity of oxygen, due to diffusional abnormalities caused by the edema. Thus, low doses of jararhagin promote endothelial edema which lead to changes in several physiological conditions. (c) 2006 Elsevier Ltd. All rights reserved.

Physiological importance of the coronary arterial blood supply to the rattlesnake heart

The reptilian heart consists of a thick inner spongy myocardium that derives its oxygen and nutrient supply directly from the blood within the ventricular cavity, which is surrounded by a thin outer compact layer supplied by coronary arteries. The functional importance of these coronary arteries remains unknown. In the present study we investigate the effects of permanent coronary artery occlusion in the South American rattlesnake (Crotalus durissus) on the ability to maintain heart rate and blood pressure at rest and during short term activity. We used colored silicone rubber (Microfil) to identify the coronary artery distribution and interarterial anastomoses. The coronary circulation was occluded and the snakes were then kept for 4 days at 30 degrees C. Microfil injections verified that virtually all coronary arteries had successfully been occluded, but also made visible an extensive coronary supply to the outer compact layer in untreated snakes. Electrocardiogram (ECG), blood pressure (P(sys)) and heart rate (f(H)) were measured at rest and during enforced activity at day 1 and 4. Four days after occlusion of the coronary circulation, the snakes could still maintain a P(sys) and f(H) of 5.2 +/- 0.2 kPa and 58.2 +/- 2.2 beats min(-1), respectively, during activity and the ECG was not affected. This was not different from sham-operated snakes. Thus, while the outer compact layer of the rattlesnake heart clearly has an extensive coronary supply, rattlesnakes sustain a high blood pressure and heart rate during activity without coronary artery blood supply.

Survival of Ucides cordatus (Decapoda: Ocypodidae) megalopae during transport under different conditions of density and duration

Target areas for Ucides cordatus (Linnaeus, 1763) restocking programs are often located far from the laboratory where larval rearing is developed. During translocation, the larvae are submitted to highly stressful conditions due to handling, packing, and transport activities. The aim of the present study was to assess the mortality rates of U. cordatus megalopae caused by different transportation procedures. Megalopae at loading densities of 50, 150, and 300 ind.L-1 were packed in double polyethylene 12 x 25 cm plastic bags with 200 ml of marine water at salinity 30. The bags were filled with oxygen at a proportion of 1:2 parts of water and sealed tightly. The trepidations during transport were simulated by the use of a shaker device (800 vibrations/minute) over periods of three and six hours inside a dark container. The survivorship rates of larvae after simulation were compared to those obtained in control groups, which consisted of plastic vials with megalopae at a loading density of 50 ind.L-1 maintained at rest. Immediately after the two transport simulations, there was no significant difference in survivorship between the treatments and the control. However, 24 hours after simulation some of the tested densities resulted in significantly lower survivorships. The results demonstrated that U. cordatus megalopae can tolerate six hours of shaking during transportation, at high densities with minimal mortality.

Effect of L-arginine, dimercaptosuccinic acid (DMSA) and the association of L-arginine and DMSA on tissue lead mobilization and blood pressure level in plumbism

Lead (Pb)-induced hypertension is characterized by an increase in reactive oxygen species (ROS) and a decrease in nitric oxide (NO). In the present study we evaluated the effect of L-arginine (NO precursor), dimercaptosuccinic acid (DMSA, a chelating agent and ROS scavenger), and the association of L-arginine/DMSA on tissue Pb mobilization and blood pressure levels in plumbism. Tissue Pb levels and blood pressure evolution were evaluated in rats exposed to: 1) Pb (750 ppm, in drinking water, for 70 days), 2) Pb plus water for 30 more days, 3) Pb plus DMSA (50 mg kg-1 day-1, po), L-arginine (0.6%, in drinking water), and the combination of L-arginine/DMSA for 30 more days, and 4) their respective matching controls. Pb exposure increased Pb levels in the blood, liver, femur, kidney and aorta. Pb levels in tissues decreased after cessation of Pb administration, except in the aorta. These levels did not reach those observed in nonintoxicated rats. All treatments mobilized Pb from the kidney, femur and liver. Pb mobilization from the aorta was only effective with the L-arginine/DMSA treatment. Blood Pb concentrations in Pb-treated groups were not different from those of the Pb/water group. Pb increased blood pressure starting from the 5th week. L-arginine and DMSA treatments (4th week) and the combination of L-arginine/DMSA (3rd and 4th weeks) decreased blood pressure levels of intoxicated rats. These levels did not reach those of nonintoxicated rats. Treatment with L-arginine/DMSA was more effective than the isolated treatments in mobilizing Pb from tissues and in reducing the blood pressure of intoxicated rats.

Effects of aerobic endurance training status and specificity on oxygen uptake kinetics during maximal exercise

The main purpose of this study was to analyze the effects of exercise mode, training status and specificity on the oxygen uptake ((V)over dot O-2) kinetics during maximal exercise performed in treadmill running and cycle ergometry. Seven runners (R), nine cyclists (C), nine triathletes (T) and eleven untrained subjects (U), performed the following tests on different days on a motorized treadmill and on a cycle ergometer: (1) incremental tests in order to determine the maximal oxygen uptake ((V)over dot O-2max) and the intensity associated with the achievement of (V)over dot O-2max (I(V)over dot O-2max); and (2) constant work-rate running and cycling exercises to exhaustion at I(V)over dot O-2max to determine the effective time constant of the (V)over dot O-2 response (tau(V)over dot O-2). Values for (V)over dotO(2max) obtained on the treadmill and cycle ergometer [R=68.8 (6.3) and 62.0 (5.0); C=60.5 (8.0) and 67.6 (7.6); T=64.5 (4.8) and 61.0 (4.1); U=43.5 (7.0) and 36.7 (5.6); respectively] were higher for the group with specific training in the modality. The U group showed the lowest values for VO2max, regardless of exercise mode. Differences in tau(V)over dot O-2 (seconds) were found only for the U group in relation to the trained groups [R=31.6 (10.5) and 40.9 (13.6); C=28.5 (5.8) and 32.7 (5.7); T=32.5 (5.6) and 40.7 (7.5); U=52.7 (8.5) and 62.2 (15.3); for the treadmill and cycle ergometer, respectively]; no effects of exercise mode were found in any of the groups. It is concluded that tauVO(2) during the exercise performed at I(V)over dot O-2max is dependent on the training status, but not dependent on the exercise mode and specificity of training. Moreover, the transfer of the training effects on tau(V)over dotO(2) between both exercise modes may be higher compared with (V)over dot O-2max.

EXAFS investigation on Sb incorporation effects to electrical transport in SnO2 thin films deposited by sot-gel

The effect of Sb doping in SnO2 thin films prepared by the sol-gel dip-coating (SGDC) process is investigated. Electronic and structural properties are evaluated through synchrotron radiation measurements by EXAFS and XANES. These data indicate that antimony is in the oxidation state W, and replaces tin atoms (Sn4+), at a grain surface site. Although the substitution yields net free carrier concentration, the electrical conductivity is increased only slightly, because it is reduced by the high grain boundary scattering. The overall picture leads to a shortening of the grain boundary potential, where oxygen vacancies compensate for oxygen adsorbed species, decreasing the trapped charge at grain boundary. (c) 2007 Elsevier Ltd. All rights reserved.

The effects of ice-water storage on blood gas and acid-base measurements

Objective: To determine the effects of storage of arterial and venous blood samples in ice water on blood gas and acid-base measurements.Design: Prospective, in vitro, laboratory study.Setting: School of veterinary medicine.Subjects: Six healthy dogs.Measurements and main results: Baseline measurements of partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), pH, hemoglobin concentration (tHb), oxyhemoglobin saturation, and oxygen content (ContO(2)) were made. Bicarbonate (HCO3) and standard base excess (SBE) were calculated. Arterial and venous blood samples were separated into 1 and 3 mL samples, anaerobically transferred into 3 mL plastic syringes, and stored in ice water for 6 hours. Measurements were repeated at 15, 30 minutes, and 1, 2, 4, and 6 hours after baseline measurements. Arterial (a) PO2 increased significantly from baseline after 30 minutes of storage in the 1 mL samples and after 2 hours in the 3 mL samples. Venous (v) PO2 was significantly increased from baseline after 4 hours in the 1 mL samples and after 6 hours in the 3 mL samples. The pHa significantly decreased after 2 hours of storage in the 1 mL samples and after 4 hours in the 3 mL samples. In both the 1 and 3 mL samples, pHv decreased significantly only after 6 hours. Neither the arterial nor the venous PCO2 values changed significantly in the 1 mL samples and increased only after 6 hours in the 3 mL samples. No significant changes in tHb, ContO(2), SBE, or HCO3 were detected.Conclusions: the PO2 of arterial and venous blood increased significantly when samples were stored in plastic syringes in ice water. These increases are attributable to the diffusion of oxygen from and through the plastic of the syringe into the blood, which occurred at a rate that exceeded metabolic consumption of oxygen by the nucleated cells.

Hypoxic pulmonary vasoconstriction in reptiles: a comparative study of four species with different lung structures and pulmonary blood pressures

Low O-2 levels in the lungs of birds and mammals cause constriction of the pulmonary vasculature that elevates resistance to pulmonary blood flow and increases pulmonary blood pressure. This hypoxic pulmonary vasoconstriction (HPV) diverts pulmonary blood flow from poorly ventilated and hypoxic areas of the lung to more well-ventilated parts and is considered important for the local matching of ventilation to blood perfusion. In the present study, the effects of acute hypoxia on pulmonary and systemic blood flows and pressures were measured in four species of anesthetized reptiles with diverse lung structures and heart morphologies: varanid lizards (Varanus exanthematicus), caimans (Caiman latirostris), rattlesnakes (Crotalus durissus), and tegu lizards (Tupinambis merianae). As previously shown in turtles, hypoxia causes a reversible constriction of the pulmonary vasculature in varanids and caimans, decreasing pulmonary vascular conductance by 37 and 31%, respectively. These three species possess complex multicameral lungs, and it is likely that HPV would aid to secure ventilation-perfusion homogeneity. There was no HPV in rattlesnakes, which have structurally simple lungs where local ventilation-perfusion inhomogeneities are less likely to occur. However, tegu lizards, which also have simple unicameral lungs, did exhibit HPV, decreasing pulmonary vascular conductance by 32%, albeit at a lower threshold than varanids and caimans (6.2 kPa oxygen in inspired air vs. 8.2 and 13.9 kPa, respectively). Although these observations suggest that HPV is more pronounced in species with complex lungs and functionally divided hearts, it is also clear that other components are involved.

Anaerobic contribution during maximal anaerobic running test: correlation with maximal accumulated oxygen deficit

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)