Investigating the Role of Mycorrhizal Fungi and Phosphorus in Improving Gas Exchange and Increasing Fruit Weight of Bitter Melon (Momordica charantia) under Different Irrigation Stresses

Rate, determinants and clinical impact of percutaneous closure success of patent foramen ovale-related hypoxemia

Prone Position in ARDS: Are We Looking at a Half-Empty or Half-Full Glass?

Financial Implications of Noninvasive Positive Pressure Ventilation (NPPV)

Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology, and Surgical Intensive Care (APSIC), University Hospital of Geneva, Geneva, Switzerland. peter.suter@hcuge.chACUTE lung injury (ALI) and adult respiratory distress syndrome (ARDS) are characterized by the tendency of peripheral air spaces to collapse, particularly in dependent lung areas. The application of a positive end-expiratory pressure (PEEP) and an appropriate tidal volume (VT) is thought to prevent and reverse the collapse of airways and respiratory units in such patients. Other means to recruit alveoli include frequent position changes, e.g . from supine to prone. The introduction of specific inflation maneuvers, using either an intermittent high-tidal volume, or an elevated inspiratory (plateau) pressure, allows significant increases in end-inspiratory and end-expiratory lung volume, and an associated improvement in gas exchange. Clinical results obtained with such recruitment strategies are reported in the current issue of Anesthesiology by two groups of well-known clinical investigators. 1,2Both articles describe the effects of lung inflation in patients with ARDS, studied in the early or late phases of their disease. The advent of ventilatory techniques using lower VTto decrease ventilator-induced lung injury and improve outcome in ALI and ARDS 3,4has renewed interest in the requirement for, and the potential benefit of, periodic inflation maneuvers. It has indeed been shown that VTparticipates to a significant extent in the opening of collapsed or hypoventilated areas in such patients. 5Therefore, it is not surprising that with the new low VTapproach, an old intermittent inflation method, called sigh, 6would regain some credibility in ventilatory management. In the first of the two studies discussed here, Salvatore Grasso et al . reports the effects of a continuous 40-cm H2O inflation pressure applied for 3–5 s in 22 patients undergoing controlled mechanical ventilation (MV) with a VTof 6 ml/kg and a mean PEEP of 9 cm H2O. Pulmonary gas exchange, respiratory mechanics, and hemodynamics were assessed. The investigation was done at two different times during the evolution of ARDS, i.e. in early (1 to 2 days after beginning MV) or later phases (5–10 days after onset of MV). The results are clearcut: only in the early phase of the disease was a marked positive response in the Pao2/ Fio2ratio observed. Patients in the later phases of ARDS had smaller increases in oxygenation, which were associated with a significant decrease in cardiac output during the inflation maneuver. This difference may simply be related to respiratory mechanics; in the early phase of ARDS, the elastance of the lung and chest wall were lower, which means higher compliance values, and hence, larger increases in volume for a given change in distending pressure.In the second study, 2Nicolo Patroniti et al. describes thirteen ARDS patients intubated and breathing spontaneously, assisted by an inspiratory pressure support of 12 cm H2O and a PEEP of 11 cm H2O, resulting in a VTof 420 ml. A majority of these patients can be considered to be in an early phase of the disease. The recruitment maneuver applied was similar to that used by Patroniti et al. ; airway pressure was increased to a mean of 38 cm H2O for 3.6 s, resulting in a VTof 1,150 ml. This sigh produced marked improvements in gas exchange and expiratory lung volume and a decrease in respiratory drive. What can we learn from these two elegant investigations? First, the findings confirm that sustained inflation using a pressure of 30 to 45 cm H2O results in a marked improvement in arterial oxygenation and has no significant side effects. 7Second, the reader will not be surprised to see that in early ARDS, functional respiratory units can be inflated and recruited more easily than in later phases of the disease, and that the gain in arterial oxygenation is more impressive. Similar results have been shown for prone positioning where improvement in gas exchange is greater in patients with pulmonary edema or with early ARDS, as compared with late ARDS or pulmonary fibrosis. 8Third, it should not be forgotten that alveolar recruitment and pulmonary gas exchange depend largely on the level of PEEP applied during protective ventilatory strategies. 9In conclusion, the two articles on recruitment maneuvers published in this issue add important information for the clinician; however, a number of questions remain. For instance, further studies should explore which single or combined therapy, including higher PEEP levels, regular position changes, and intermittent inflation strategies achieves the greatest sustained improvement in lung function. In addition, the effects on outcome in ARDS patients, including end-points such as duration of mechanical ventilation, duration of stay in the intensive care unit, and hospital mortality, must be assessed. It seems likely that understanding the role of factors such as the underlying morphologic features of lung injury, the stage of ARDS, hemodynamic status, and tolerance to increased intrapulmonary pressure will be essential to determining optimal treatment strategies for individual patients.

Negative pressure ventilation (NPV) was applied for 6 to 8 h/day for 2 consecutive days in 13 patients with severe airflow limitation and chronic respiratory failure. After cessation of NPV, the mean arterial blood gases were improved in 10 patients, and this improvement was sustained for the nex 2 days in eight patients, for 3 days in seven patients, and was still present in four patients on the fourth day. Respiratory muscle strength improved in all patients, but there was no relationship between the increase in strength and sustained improvement in gas exchange. Ventilation and respiratory pattern were unchanged in all patients, but the mean VD/VT fell and VA rose while the VO2 and VCO2 fell. The ventilatory responses to hypoxia and hypercapnia increased in patients who demonstrated sustained improvement in blood gases. The mechanism underlying the sustained improvement in gas exchange following NPV is not clear but is likely multifactorial.

Mechanical ventilation has been the main treatment of pulmonary insufficiency, especially acute respiratory failure and acute respiratory distress syndrome CARDS), for the last 30 years. Because mechanical ventilation itself may cause or propagate lung injury, therapeutic strategies increasingly focus on the avoidance of these iatrogenic factors by including adjunct measures such as inhaled vasodilators, negative intravascular fluid balance, or prone positioning. It was almost 10 years after the clinical description of ARDS that Piehl and Brown (1) first described the benefit of positional changes to augment arterial oxygenation in five patients prone to develop respiratory failure. Their data were confirmed by a second, more extensive study by Douglas et al. (2), who also described a significant increase in Pao, in most, but not all, patients studied. Possible mechanisms to explain the improvements of gas exchange were discussed and included the redistribution of blood flow and/or ventilation, an increase in functional residual capacity, and changes in the ventrodorsal transpulmonary pressure gradient. Both papers were based on the theoretical work of Bryan (3), who advocated the prone position in mechanically ventilated patients in order to improve regional inflation of the dorsal portions of the lung. Douglas et al. (2) Piehl and Brown (1) supported the use of positional changes to improve pulmonary gas exchange, to decrease possibly toxic inspiratory concentrations of oxygen, a potential iatrogenic factor in the promotion of the lung injury. Despite the encouraging clinical results, prone position did not become an integral part of treatment of respiratory failure, possibly due to the technical problems and unpredictability of prone position. Clinical research focused instead on the development of new therapeutic strategies, e.g., ventilator modes and drugs to cope with acute respiratory failure and its high mortality. However, studies continued to investigate the interdependence of body position, gas exchange, regional ventilation, and blood flow.

This study aimed to measure the effectiveness of stingless bee Tetragonula cf. biroi pollination on the fruit formation of bitter melon Momordica charantia plants. We used hoods on the observed bitter melon plants. In the first hood, stingless bees are inserted to help pollinate 100 bitter melon plants, while in the other hoods, stingless bees are not inserted so that there is no assistance in pollinating the other 100 bitter melon plants. The method used is the focal sampling method for 25 days of observation. Based on the results of the study, stingless bee pollination assistance increased the percentage of the number of flowers that became fruit by 390%, the weight of seeds/fruit by 64%, number of seeds/fruit by 260%, fruit weight by 163%, fruit diameter by 91%, and fruit length by 86%. In addition to the size of the fruit, the shape of the bitter melon pollinated by bees is standard (long and straight). In contrast, the bitter melon that does not get pollination assistance grows with a bent shape resembling the letter "C." Bitter melon is an agricultural commodity that needs pollinating agents such as stingless bees because of its monoecy.

Bitter gourd has picked up noteworthy consideration for its pharmacological benefits. However, the impact of amino acids (AAs) dosage on growth, yield, and antioxidants is uncertain. In this study, we investigated the effects of foliar spraying bitter gourd with 100, 200, and 300 mg/L dosages of tryptophan (Trp), glutamine (Gln), and phenylalanine (Phe). The results revealed that Trp, at a dosage of 300 mg/L, produced the most substantial increase in plant length, followed by 300 mg/L Phe. Additionally, the highest values of the fresh dry weight of the plants, fresh weight of the first fruit, fruit number per plant, fresh weight of the fruits per plant, and total fruit output per hectare were seen at 300 mg/L of Trp, followed by 300 mg/L of Gln. Phe at 300 mg/L yielded the highest levels of total phenolics and total flavonoids, coupled with strong scavenging activity against 2,2-diphenyl-1-picrylhydrazyl. These outcomes show the potential of Trp and Gln foliar sprays to enhance bitter gourd growth, yield, and certain antioxidant compounds. These findings carry substantial implications for the enhancement of bitter gourd cultivation and quality. By revealing AA’s potential for improving bitter gourd, our research contributes to bolstering the agricultural sustainability of this remarkable crop.

Bitter melon (Momordica charantia L.) is well-known for its high protein, steroid, alkaloid, mineral, lipid, triterpene, and phenolic compound content, as well as its medicinal properties, particularly its anti-diabetic effects. To investigate the impact of elicitors on the morphology and phytochemical characteristics of bitter melon (Jounpouri cultivar) over two consecutive years (2018 and 2019), we conducted a field experiment. The study aimed to determine the effects of Ethrel, brassinosteroids (BRs), and k-carrageenan on yield and the production of anti-diabetic agents in M. charantia farm crops. The elicitors included ten levels, ranging from a control group to Ethrel (100, 300, and 600 mg l− 1), brassinosteroids (BRs) (0.1, 0.5, and 1 mg l− 1), and k-carrageenan (200, 400, and 600 mg l− 1). These characteristics included leaf area, leaf length, leaf width, fruit parameters, carbohydrate content, total phenols and flavonoid accumulation, antioxidant activity, total acid, ascorbic acid, momordicine, and charantin. Across both years, we observed the highest flavonoid accumulation and antioxidant activity in the Ethrel treatment group. Specifically, applying 0.5 mg l− 1 BRs and 300 mg l− 1 Ethrel led to an 18.8% and 14.8% increase in momordicine content, respectively. All elicitor treatments, particularly at 0.1 mg l− 1 BRs, significantly increased leaf area, leaf length, and leaf width compared to the control group in both cropping years. Additionally, the application of all elicitors resulted in increased fruit weight, dimensions, and yield over the two consecutive years. Notably, in 2018, 600 mg l− 1 Ethrel contributed to enhanced fruit weight and yield, while in 2019, 0.5 mg l− 1 BRs exhibited the same effect. Metabolic and physiological changes in bitter squash induced by employed elicitors over two different years (2018–2019) are strongly dependent on a variety of environmental factors such as temperature and rainfall. In conclusion, using BRs as an elicitor has the potential to optimize the health benefits of bitter melon by increasing the content of two bioactive molecules, momordicine and charantin.

We sought to know whether there is a further improvement in gas exchange when partial liquid ventilation (PLV) is added to high-frequency oscillatory ventilation (HFOV) in a piglet model of saline lavage-induced acute lung injury. Seven 7-9 day-old newborn piglets of mixed strain were treated with repeated saline lavage to achieve a uniform degree of acute lung injury. Then, HFOV were applied to the subject. Four animals received two consecutive doses (15 mL/kg) of perfluorodecalin at 30-min interval (PFC+HFOV group). The other three animals remained on HFOV alone (HFOV-only group). Repetitive lung lavage led to a significant acute aggravation in both gas exchange and hemodynamic parameters. Subsequent application of HFOV produced a significant rapid recovery in both gas exchange and hemodynamic parameters to near baseline levels. During and after perfluorodecalin dosing, there were no significant changes in gas exchange or hemodynamic parameters over time in both groups, and no significant differences in gas exchange or hemodynamic parameters between groups. We concluded that the addition of 30 mL/kg of perfluorodecalin to HFOV showed no detrimental effect on hemodynamics, but did not produce a significant improvement in gas exchange over a three-hour period.

Effects of Noninvasive Positive Pressure Ventilation on Gas Exchange and Sleep in COPD Patients

Horticultural plants such as the bitter gourd (Momordica charantia L., family Cucurbitaceae) have a special significance as a vegetable in the kitchen and offer health benefits. Bitter gourd is cultivated in several tropical regions of Asian countries and in parts of Africa, Central North America, South North Asia, Singapore, Japan, etc. The main objective of this study is to develop a modified and validated high performance method for the quantification of charantin. Bitter gourd is rich in various phytomolecules, including charantin as an antidiabetic agent. Charantin is one of these phytomolecules that acts as an antidiabetic agent in type 2 diabetics. Charantin has a high molecular weight so that it is easily digested when taken orally. A validated and modified high performance liquid chromatography method was used for the quantification of charantin in bitter gourd fruits. Bitter gourd plants transplanted in Kharif 2023 from Mandsaur University Nursery, Mandsaur Campus were used for modification of extraction parameters and for carrying out the validated protocol in Kharif 2023. The fruits were harvested 60-65 days after planting in June/July 2022. Charantin extraction was done using methanol in Soxhlet and analysis was done using modified high performance liquid chromatography for quantification. C18 columns as stationary phase and methanol:water (98:2) were used for separation and quantification of charantin. Validated method for the analysis and separation of charantin in dry powder of bitter gourd fruits. Analysis and quantification were performed using the methanolic extract and yielded a content of 200-600 ug/g dry fruit weight. The high charantin variety can be used for further breeding purposes or directly for product formulation and basic clinical trials if required.

Prone Position and COVID-19: Mechanisms and Effects.

Today, in meconium aspiration syndrome, treatment focuses on bronchoalveolar lavage, because it removes meconium and proinflammatory factors from airways. This technique might be more effective if different solutions were used such as saline solution, a protein-free surfactant, or a perfluorocarbon, because these would be less inhibited by meconium proteins. Pulmonary physiology research unit, Cruces Hospital. Prospective, randomized study. We studied 24 lambs (<6 days) on mechanical ventilation for 180 mins. Catheters were placed and femoral and pulmonary arteries pressures registered (systemic and pulmonary arterial pressures). Lambs were instilled with 20% meconium (3-5 mL/Kg) and were randomly assigned to one of the following groups (n = 6): control: only continuous mechanical ventilation; saline bronchoalveolar lavage: bronchoalveolar lavage with 30 mL/kg of saline solution; dilute surfactant bronchoalveolar lavage: bronchoalveolar lavage with 32 mL/kg of diluted surfactant (lucinactant, 10 mg/mL); or perfluorocarbon bronchoalveolar lavage: bronchoalveolar lavage with 30 mL/kg of perfluorocarbon. Blood gases, cardiovascular parameters, and pulmonary mechanics were assessed. Meconium instillation produced severe hypoxia, hypercapnia, acidosis, and pulmonary hypertension with impairment of pulmonary mechanics (p < .05). Lung lavage with dilute surfactant resulted in the resolution of pulmonary hypertension as well as better gas exchange and pulmonary mechanics than the control group (p < .05). Bronchoalveolar lavage with perfluorocarbon produced a transient improvement in gas exchange and ventilatory indices in comparison with control and saline bronchoalveolar lavage groups. In lambs with meconium aspiration syndrome, bronchoalveolar lavage with diluted lucinactant is an effective therapy producing significant improvements in gas exchange, pulmonary hypertension, and pulmonary mechanics. In addition, bronchoalveolar lavage with perfluorocarbon appears to confer some advantages over lavage with equal volumes of saline or no lavage.

Gas Exchange in Chronic Thromboembolism after Pulmonary Thromboendarterectomy