Blood Acid-base Status Research Articles

Correlation of nucleated red blood cell count with neonatal intensive care unit admission

Background: Perinatal asphyxia should be diagnosed, when baby goes on to develop hypoxic ischemic encephalopathy which has shown to be much more reliable indicator of long term handicap than any other perinatal markers like non reassuring FHR, Apgar score, meconium stained amniotic fluid and blood acid base status of fetus. Since NRBC is related to hematopoietic response to hypoxia it predicts the chance of neurological sequelae and NICU admission. The aim of our study to analyze the significant relationship of NRBC count and NICU admission.Methods: This was a retrospective comparative study conducted in department of OBG, Patna medical college and Hospital between December 2013 to November 2015 in tertiary care health centre. Umbilical cord blood samples were collected from 100 newborns with asphyxia at birth out of which 56 were admitted in NICU taken as study group and rest 44 asphyxiated babies were not admitted in NICU were taken as control group. NRBC per 100 WBC was counted in Cord blood sample from all babies.Results: This shows that average count of NRBC/100 WBC in the study with NICU admission was 27.37+7.25. Average count in the study group with no NICU admission was 23.93+6.04. The difference was statistically significant (p<0.05).Conclusions: This study concludes that NRBC count correlate well with fetal asphyxia and finally NICU admission. Early detection leads to decrease neurological morbidity and mortality among survivors.

Application of colloidal-hyperosmolar solution in the early postoperative period in patients after cardiosurgery

Objective. To substantiate the safety of the infusion drug Hecoton in the early postoperative period in patients after cardiac surgery.
 Materials and methods. The study involved 60 patients receiving infusions of 200 ml colloid-hyperosmolar solution Gecotone. The solution contains: hydroxyethyl starch 130/0.42 – 5 %, polyatomic alcohol xylitol – 5 %, sodium lactate – 1.5 % and electrolytes Na+, K+, Ca++, Mg++, Cl-. The total amount of sodium in the solution is 270 mmol/l, which is 2 times higher than its concentration in blood plasma. The amount of lactate is 133 mmol/l, which is 4 times higher than in isotonic polyelectrolyte solutions. The total osmolarity of the drug is 890 mOsm/l. Vital signs, hemodynamics, glucose, arterial blood gas and acid-base status was evaluated before, during and infusion of medication.
 Results and discussion. Gecoton infusions had no adverse effect on hemodynamic parameters. All changes were not statistically significant. The mean values of the patient’s body temperature were within the normal range. There was no case of temperature increase above 36.9 °C in all patients after administration of the drug. There was a slight, statistically unreliable increase in the mean glucose level (from 8.57±0.42 to 9.53±0.48 mmol/l), which was most likely due to response to the surgical stress. Dynamics of arterial blood gas and acid-base state shows that pH and PaCO2 practically did not change, decrease of PaO2 from 115.69±5.52 mm Hg to 110,79±4,83 mm Hg after the infusion of Gecotone, was statistically unreliable, the base excess showed little dynamics to increase (from -1.84±0.35 to -1.29±0.23 mmol/l) after administration of Gecotone.
 Conclusions. The use of the complex colloid-hyperosmolar infusion solution Gecotone in patients after cardiac surgery in the early postoperative period is safe.

Venous Blood Acid-Base Status in Show Jumper Horses Subjected to Different Physical Exercises

The aim of this study was to assess whether acid-base profile exhibits changes in regularly trained show jumping horses undergoing increasing exercise workloads. Seven female Italian saddle horses were subjected to three different physical exercise trials of increasing workload identified as three exercise phases (EPs). During EPI horses were subjected to a standardized exercise test consisting of 15 minutes of treadmill, during EPII horses were subjected to a show jumping test (height, 0.9–1.1 m; course length, 300 m), during EPIII horses underwent two jumping sessions carried out over two consecutive days. Blood samples were collected at rest (TPRE), after exercise (TPOST), and 30 minutes after the end of exercise (TPOST30). The values of pH, partial pressure of carbon dioxide (Pco2), partial pressure of oxygen (Po2), bicarbonate level (HCO3−), hemoglobin (Hb), and hematocrit (Hct) were measured. A significant effect of exercise workload and time (P < .001) on Po2, Pco2, HCO3−, Hb, and Hct values was found. The variation in the studied parameters resulted mostly reversible within TPOST30 in horses when subjected to EPI and EPII, whereas Po2, Hb, and Hct remained higher at TPOST30 than TPRE in horses when subjected to the second day of jumping section (EPIII) indicating a failure to recover. The results suggest that jumping sessions carried out over two consecutive days represent extra workload for horses, and this should be taken into account by veterinarian to prevent acid-base imbalance and for the maintenance of health and performance in equine athletes.

Effects of a moderate transition from 70% to 90% concentrate diet on early alterations in feeding behavior, rumen environment, reticulorumen motility, and blood acid–base status in beef heifers

The objective of this study was to determine the early responses to a moderate concentrate increase in cattle diets with regards to various behavioral and physiological responses in cattle. Eight ruminally cannulated Angus crossbred beef heifers were adapted to a 70% concentrate diet (T70) and then switched to a 90% concentrate diet (H90). Measurements of feeding behavior, ruminal pH and temperature, rumen motility, liquid passage rate, and blood acid–base status were conducted on T70 as well as first day (d1) and second day (d2) of high-grain H90feeding to monitor the beginning of the transition period. Ruminal pH was below 5.6 for longer on both days of H90 compared with T70, suggesting animals experienced subacute ruminal acidosis while switching from T70 to H90. Transitioning did not affect dry matter intake (DMI). Eating rate during meals was reduced on d1 and d2 H90 compared with T70. Ruminal contraction amplitude was reduced on both days of H90 feeding. Contraction duration was reduced on d1 H90, and returned to T70 values by d2 H90. Results indicated that a moderate transition to a finishing diet influenced feeding behavior and reduced rumen motility at the beginning time after transition, but did not influence voluntary DMI.

Targeting the Acidic Tumor Microenvironment: Unexpected Pro-Neoplastic Effects of Oral NaHCO3 Therapy in Murine Breast Tissue.

The acidic tumor microenvironment modifies malignant cell behavior. Here, we study consequences of the microenvironment in breast carcinomas. Beginning at carcinogen-based breast cancer induction, we supply either regular or NaHCO3-containing drinking water to female C57BL/6j mice. We evaluate urine and blood acid-base status, tumor metabolism (microdialysis sampling), and tumor pH (pH-sensitive microelectrodes) in vivo. Based on freshly isolated epithelial organoids from breast carcinomas and normal breast tissue, we assess protein expression (immunoblotting, mass spectrometry), intracellular pH (fluorescence microscopy), and cell proliferation (bromodeoxyuridine incorporation). Oral NaHCO3 therapy increases breast tumor pH in vivo from 6.68 ± 0.04 to 7.04 ± 0.09 and intracellular pH in breast epithelial organoids by ~0.15. Breast tumors develop with median latency of 85.5 ± 8.2 days in NaHCO3-treated mice vs. 82 ± 7.5 days in control mice. Oral NaHCO3 therapy does not affect tumor growth, histopathology or glycolytic metabolism. The capacity for cellular net acid extrusion is increased in NaHCO3-treated mice and correlates negatively with breast tumor latency. Oral NaHCO3 therapy elevates proliferative activity in organoids from breast carcinomas. Changes in protein expression patterns—observed by high-throughput proteomics analyses—between cancer and normal breast tissue and in response to oral NaHCO3 therapy reveal complex influences on metabolism, cytoskeleton, cell-cell and cell-matrix interaction, and cell signaling pathways. We conclude that oral NaHCO3 therapy neutralizes the microenvironment of breast carcinomas, elevates the cellular net acid extrusion capacity, and accelerates proliferation without net effect on breast cancer development or tumor growth. We demonstrate unexpected pro-neoplastic consequences of oral NaHCO3 therapy that in breast tissue cancel out previously reported anti-neoplastic effects.

Показатели кислотно-основного состояния артериальной пуповинной крови при самопроизвольных родах и кесаревом сечении

Показатели кислотно-основного состояния артериальной пуповинной крови при самопроизвольных родах и кесаревом сечении

Management of Phosgene-Induced Acute Lung Injury (ALI) by Personalized Protective PEEP-ECMO: What Can We Learn from Animal Bioassays?

Background: Phosgene (carbonyl dichloride) gas is an indispensable chemical intermediate used in numerous industrial processes. Acute lung injury (ALI) caused by accidental inhalation exposure to phosgene is characterized pulmonary edema being phenotypically manifested after an asymptomatic or more precisely phrased “clinical occult” period. Opposite to common clinical practice, protective treatment should be given preference to curative treatment. Treatment initiated already during the asymptomatic phase shortly after exposure requires prognostic endpoints preceding the lung edema for triage and re-triage. Treatment strategies need to be personalized and exposure-dose related. The objective of this post-hoc analysis of published data is to assess prognostic value of ventilation dead-space (Vd/Vt) and extravascular lung water index (EVLWI) to guide treatment by protective PEEP supplemented by venovenous (vv) ECMO. Methods: This paper aims to compare the overarching published framework from systematic toxicological research of phosgene in animal bioassays with the clinical evidence from four accidentally phosgenepoisoned workers admitted to hospital with life-threatening lung edema. Treatment focused on a combination of protective PEEP and ECMO to reverse phosgene-induced deterioration in lung mechanics by personalized mechanical ventilation. Endpoints selected for titration PEEP focused on endpoints indicative of decoupling cardiopulmonary and vascular functions. To better understand any cardiogenic and vascular disturbances, titration endpoints included calculated ventilation dead-space (Vd/Vt), measured extravascular lung water index (EVLWI), arterial blood gases and acid-base status, systemic vascular resistance index (SVRI), and cardiac index (CI). EVLWI and APACHE II criteria guided the course of treatment in adjusting plateau pressure (Pplat), positive end-expiratory pressure (PEEP), and driving pressure (ΔP). Results: Remarkable equivalence of human data and those from controlled inhalation studies with phosgene on rats and dogs was found. The endpoint of choice guiding PEEP ventilation and implementation of ECMO was EVLWI. This maker of lung edema precisely reflects the increased wet lung weights in animals. Conclusions: ECMO-supplemented PEEP not only mitigates hypoxemia at conditions of severe ARDS and it also provides a means to reduce driving and plateau pressures minimizing ventilatorassociated lung injury.

ENCEPHALOPATHY AND HYPERLACTATEMIA AS A COMPLICATION OF 5-FLUOROURACIL TREATMENT

Background. There is a wide spectrum of metabolic and toxic disorders that can cause acute encephalopathy in cancer patients. In routine clinical practice, hypoglycemia, vitamin B1 (thiamine) deficit, fulminant liver failure, uremia, severe hypoand hypernatremia should be primarily excluded. Central neurotoxicity associated with hyperammonemia in patients receiving 5-fluorouracil (5-FU) and oral fluoropyrimidines should be considered in differential diagnosis. In this case, the analysis of the blood acid-base status and the detection of B-type hyperlactatemia can facilitate the diagnosis of the cause of encephalopathy.Case description. We present two cases of hyperlactatemia and encephalopathy in stage IV cancer patients with continuous infusion of 5-FU via a portable infusion pump.Conclusion. Diagnosis of the frequent fluoropyrimidin-related adverse effects, such as myelosuppression, anorexia, diarrhea, mucositis, and palm-plantar syndrome, are routine and mastered by an oncologist at the very beginning of his/her professional activity. Specific fluoropyrimidinerelated encephalopathy or hyperlactatemia are difficult to suspect and recognize. We hope our description will be useful to prevent possible diagnostic errors.

Haemato-biochemical profile and acid-base status of Croatian spotted goats of different ages.

The aim of the present research was to determine the haemato-biochemical profile and blood acid–base status of Croatian spotted goats in a traditional Mediterranean production system. The 60 non-gravid female Croatian spotted goats of different ages were included in the research. They were divided into four groups of 15 goats according to age: group I – year old; group II – 2–3 years; group III – 3–6 years; and group IV – 7–10 years. Haematological parameters were determined in whole blood, biochemical parameters in serum and acid–base status in plasma by automatic analyser. Total leukocyte number (WBC), haemoglobin (HGB) and mean corpuscular volume (MCV) in the blood were the highest, while mean haemoglobin concentration in erythrocytes (MCHCs) was the lowest in yearlings compared to other groups. Concentrations of urea, Mg, Cl, non-esterified fatty acids (NEFAs) and lactate were the highest in yearlings. Concentrations of Ca, Na, total cholesterol, high-density lipoprotein (HDL), very low-density lipoprotein (VLDL) and beta hydroxybutyrate (BHB) as well as the activity of alanine aminotransferase (ALT) were higher in older goats compared to yearlings, while the opposite was determined for the activities of creatine kinase (CK) and alkaline phosphatase (ALP). Values of pH, the strong ion difference (SID), anion gap (AG) and values as well as the content of and total pressure of carbon dioxide () were higher in older goats compared to yearlings. The results obtained may help in monitoring the health and nutritional status and improve the management of Croatian spotted goats. Based on the results of the present study, the effect of age needs to be included in the model when preparing the reference values for the haemato-biochemical profile and acid–base status of goats.

Ventilatory sensitivity to ammonia in the Pacific hagfish (Eptatretus stoutii), a representative of the oldest extant connection to the ancestral vertebrates.

Ventilatory sensitivity to ammonia occurs in teleosts, elasmobranchs and mammals. Here, we investigated whether the response is also present in hagfish. Ventilatory parameters (nostril flow, pressure amplitude, velar frequency and ventilatory index, the last representing the product of pressure amplitude and frequency), together with blood and water chemistry, were measured in hagfish exposed to either high environmental ammonia (HEA) in the external sea water or internal ammonia loading by intra-vascular injection. HEA exposure (10 mmol l-1 NH4HCO3 or 10 mmol l-1 NH4Cl) caused a persistent hyperventilation by 3 h, but further detailed analysis of the NH4HCO3 response showed that initially (within 5 min) there was a marked decrease in ventilation (80% reduction in ventilatory index and nostril flow), followed by a later 3-fold increase, by which time plasma total ammonia concentration had increased 11-fold. Thus, hyperventilation in HEA appeared to be an indirect response to internal ammonia elevation, rather than a direct response to external ammonia. HEA-mediated increases in oxygen consumption also occurred. Responses to NH4HCO3 were greater than those to NH4Cl, reflecting greater increases over time in water pH and PNH3 in the former. Hagfish also exhibited hyperventilation in response to direct injection of isotonic NH4HCO3 or NH4Cl solutions into the caudal sinus. In all cases where hyperventilation occurred, plasma total ammonia and PNH3 levels increased significantly, while blood acid-base status remained unchanged, indicating specific responses to internal ammonia elevation. The sensitivity of breathing to ammonia arose very early in vertebrate evolution.

Effect of induced alkalosis on performance during a field-simulated BMX cycling competition

ObjectivesThe aim of the present study was to test the effect of sodium bicarbonate (NaHCO3−) ingestion on performance during a simulated competition on a Bicycle Motocross (BMX) track. DesignDouble-blind cross-over study. MethodsTwelve elite male BMX cyclists (age: 19.2±3.4 years; height: 174.2±5.3cm; body mass: 72.4±8.4kg) ingested either NaHCO3- (0.3g.kg−1 body weight) or placebo 90min prior to exercise. The cyclists completed three races in a BMX Olympic track interspersed with 15min of recovery. Blood samples were collected to assess the blood acid-base status. Performance, cardiorespiratory, heart rate variability (HRV) as well as subjective variables were assessed. ResultsThe main effect of condition (NaHCO3− vs. placebo) was observed in pH, bicarbonate concentration and base excess (p<0.05), with a significant blood alkalosis. No changes were found in time, peak velocity and time to peak velocity for condition (p>0.05). The HRV analysis showed a significant effect of NaHCO3− ingestion, expressed by the rMSSD30 (root mean square of the successive differences) (p<0.001). There was no effect of condition on oxygen uptake, carbon dioxide production, or pulmonary ventilation (p>0.05). Finally, there was no effect of condition for any subjective scale (p>0.05). ConclusionsWe present here the first field condition study to investigate the effect of bicarbonate ingestion over performance in BMX discipline. The results showed that NaHCO3−-induced alkalosis did not improve performance in a simulated BMX competition in elite BMX cyclists, although future studies should consider the effects of NaHCO3- on autonomic function as a component of recovery.

Определение кислотно-основного состояния пуповинной крови. Показания и техника

Определение кислотно-основного состояния пуповинной крови. Показания и техника

Evaluation of butorphanol–azaperone–medetomidine (BAM) in captive blesbok immobilization (Damaliscus pygargus phillipsi)

ObjectiveThe fixed-dose combination of butorphanol, azaperone and medetomidine (BAM; 30, 12 and 12 mg mL−1, respectively) with subsequent antagonism by naltrexone–atipamezole was evaluated for reversible immobilization of captive blesbok (Damaliscus pygargus phillipsi). Study designProspective, clinical trial. AnimalsSixteen blesbok (four males and twelve females), weighing 52.5−71.0 kg, were immobilized in South Africa. MethodsThe total dose of BAM ranged from 0.5 to 0.7 mL for females and 0.7 to 0.9 mL for males. In seven animals chosen randomly, 8000 units of hyaluronidase was added to the dart. Physiologic variables were recorded every 5 minutes beginning at 10−20 minutes after darting. Arterial blood samples were collected three times at 20, 30 and 40 minutes after darting for analysis of blood acid-base status. ResultsThe mean administered doses of BAM were as follows: butorphanol (0.34 ± 0.08 mg kg−1), azaperone (0.14 ± 0.03 mg kg−1) and medetomidine (0.14 ± 0.03 mg kg−1). The inductions were calm and smooth. The mean induction time was 9.6 ± 3.2 minutes with just BAM and 5.1 ± 0.8 minutes with BAM and hyaluronidase combination. Heart rate (45 ± 6 beats minute−1) and respiratory frequency (38 ± 4 breaths minute−1) were stable throughout immobilization. The mean arterial blood pressure for all animals was stable but elevated (137 ± 7 mmHg). Rectal temperature slightly increased over time but remained within an acceptable range. The recovery time after administering naltrexone and atipamezole was 4.8 ± 0.7 minutes. Conclusion and clinical relevanceThe BAM combination proved to be reliable and effective in blesbok.

Dietary acid load and renal function have varying effects on blood acid-base status and exercise performance across age and sex.

Diet composition influences acid-base status of the body. This may become more relevant as renal functional capacity declines with aging. We examined the effects of low (LD) versus high dietary acid load (HD) on blood acid-base status and exercise performance. Participants included 22 adolescents, 33 young adults (YA), and 33 elderly (EL), who followed a 7-day LD and HD in a randomized order. At the end of both diet periods the subjects performed a cycle ergometer test (3 × 10 min at 35%, 55%, 75%, and (except EL) until exhaustion at 100% of maximal oxygen uptake). At the beginning of and after the diet periods, blood samples were collected at rest and after all workloads. Oxygen uptake, respiratory exchange ratio (RER), and heart rate (HR) were monitored during cycling. In YA and EL, bicarbonate (HCO3-) and base excess (BE) decreased over the HD period, and HCO3-, BE, and pH were lower at rest after HD compared with LD. In YA and EL women, HCO3- and BE were lower at submaximal workloads after HD compared with LD. In YA women, the maximal workload was 19% shorter and maximal oxygen uptake, RER, and HR were lower after HD compared with LD. Our data uniquely suggests that better renal function is associated with higher availability of bases, which may diminish exercise-induced acidosis and improve maximal aerobic performance. Differences in glomerular filtration rate between the subject groups likely explains the larger effects of dietary acid load in the elderly compared with younger subjects and in women compared with men.

Blood acid-base status in impala (Aepyceros melampus) immobilised and maintained under total intravenous anaesthesia using two different drug protocols

BackgroundIn mammals, homeostasis and survival are dependent on effective trans-membrane movement of ions and enzyme function, which are labile to extreme acid-base changes, but operate efficiently within a narrow regulated pH range. Research in patients demonstrating a pH shifts outside the narrow regulated range decreased the cardiac output and systemic vascular resistance and altered the oxygen binding to haemoglobin. These cardiopulmonary observations may be applicable to the risks associated with anaesthesia and performance of wildlife ungulates on game farms. The aim of this study was to compare blood pH changes over time in impala immobilised and anaesthetised with two different drug protocols (P-TMP - immobilisation: thiafentanil-medetomidine; maintenance: propofol-ketamine-medetomidine; P-EME – immobilisation: etorphine-medetomidine; maintenance: etorphine-ketamine-medetomidine). Additionally, we discuss the resultant blood pH using both the Henderson-Hasselbalch and the Stewart approaches. Two data collection time points were defined, Time1 before maintenance of general anaesthesia and Time 2 at end of maintenance of general anaesthesia. We hypothesise that blood pH would not be different between drug protocols and would not change over time.ResultsSignificant differences were detected over time but not between the two drug protocols. Overall, the blood pH decreased over time from 7.37 ± 0.04 to 7.31 ± 0.05 (p = 0.001). Overall, over time arterial partial pressure of carbon dioxide changed from 51.3 ± 7.5 mmHg to 72.6 ± 12.4 mmHg (p < 0.001); strong ion difference from 44.6 ± 2.4 mEq/L to 46.9 ± 3.1 mEq/L (p < 0.001); anion gap from 15.0 ± 3.1 mEq/L to 10.9 ± 2.2 mEq/L (p < 0.001); and total weak acids from 16.1 ± 1.2 mmol/L to 14.0 ± 1.1 mmol/L (p < 0.001). The bicarbonate changed from 29.6 ± 2.7 mEq/L to 36.0 ± 4.1 mEq/L (p < 0.001); and lactate changed from 2.9 ± 1.5 mEq/L to 0.3 ± 0.03 mEq/L (p < 0.001) over time.ConclusionsThe profound increase in the partial pressure of carbon dioxide that worsened during the total intravenous anaesthesia in both protocols initiated a substantial metabolic compensatory response to prevent severe acidaemia. This compensation resulted in a clinically acceptable mild acidaemic state, which worsened over time but not between the protocols, in healthy impala. However, these important compensatory mechanisms require normal physiological function and therefore when immobilising ill or anorexic wild ungulates their acid-base status should be carefully assessed.

Identification of the Causes for Chronic Hypokalemia: Importance of Urinary Sodium and Chloride Excretion

BackgroundUncovering the correct diagnosis of chronic hypokalemia with potassium (K+) wasting from the kidneys or gut can be fraught with challenges. We identified clinical and laboratory parameters helpful for differentiating the causes of chronic hypokalemia. MethodsNormotensive patients referred to our tertiary academic medical center for the evaluation of chronic hypokalemia were prospectively enrolled over 5 years. Clinical features, laboratory examinations—including blood and spot urine electrolytes, acid-base status, biochemistries, and hormones—as well as genetic analysis, were determined. ResultsNinety-nine patients with chronic normotensive hypokalemia (serum K+ 2.8 ± 0.4 mmol/L, duration 4.1 ± 0.9 years) were enrolled. Neuromuscular symptoms were the most common complaints. Although Gitelman syndrome (n = 33), Bartter syndrome (n = 10), and distal renal tubular acidosis (n = 12) were the predominant renal tubular disorders, 44 patients (44%) were diagnosed with anorexia/bulimia nervosa (n = 21), surreptitious use of laxatives (n = 11), or diuretics (n = 12). Patients with gastrointestinal causes and surreptitious diuretics use exhibited a female predominance, lower body mass index, and less K+ supplementation. High urine K+ excretion (transtubular potassium gradient >3, urine K+/Cr >2 mmol/mmol) was universally present in patients with renal tubular disorders, but also found in >50% patients with gastrointestinal causes. Of interest, while urine sodium (Na+) and chloride (Cl−) excretions were high and coupled (urine Na+/Cl− ratio ∼1) in renal tubular disorders and “on” diuretics use, skewed or uncoupled urine Na+ and Cl− excretions were found in anorexia/bulimia nervosa and laxatives abuse (urine Na+/Cl− ratio: 5.0 ± 2.2, 0.4 ± 0.2, respectively) and low urine Na+ and Cl− excretions with fixed Na+/Cl− ratios (0.9 ± 0.2) when “off” diuretics. ConclusionBesides body mass index, sex, and blood acid-base status, integrated interpretation of the urine Na+:Cl− excretion and their ratio is important to make an accurate diagnosis and treatment plan for patients with chronic normotensive hypokalemia.

Procedural Xenon Sedation for Diagnostic Esophagogastroduodenoscopy

Using xenon-oxygen mixture for sedation is the useful approach. Material and Methods. We examined 18 healthy volunteers aged 25 to 39 years underwent esophagogastroduodenoscopy under sedation with xenon-oxygen mixture with xenon/oxygen ratio 70/30 %. A three-hole mask with inputs for endoscope, catheter, and gas mixture supply was used for inhalations. The duration of the inhalations was no more than 3 minutes. Patients’ satisfaction with anesthesia was evaluated with a questionnaire. We performed main hemodynamics parameters, heart rhythm variability and blood acid-base state monitoring during the procedure. All patients evaluated the anesthesia as satisfactory, none of the examined felt a foreign body during the esophagogastroduodenoscopy, there were no painful sensations and negative effects except excessive salivation. Results. Mask anesthesia with xenon-oxygen mixture with concentration of 70/30 % for 3 minutes during diagnostic esophagogastroduodenoscopy did not cause significant changes in blood pressure and heart rate, as well as basic parameters of acid-base state. Saturation and oxygen partial pressure of blood increased due to inhalation of hyperoxic mixture. Assessment of heart rhythm variability demonstrated significant increase in general spectrum capacity reflecting rise of cardiovascular system reserves, and decrease in low and high spectrum frequency ratio due to reduction of sympathetic activity. Conclusion. The obtained results allow to draw a conclusion about sufficient efficiency and safety of anesthesia with xenon during diagnostic esophagogastroduodenoscopy in healthy volunteers.

The metabolic consequences of repeated anoxic stress in the western painted turtle, Chrysemys picta bellii

The painted turtle is known for its extreme tolerance to anoxia, but it is unknown whether previous experience with anoxic stress might alter physiological performance during or following a test bout of anoxia. Repeatedly subjecting 25°C-acclimated painted turtles to 2h of anoxic stress every other day for 19days (10 submergence bouts total) caused resting levels of liver glycogen to decrease by 17% and liver citrate synthase (CS) and cytochrome oxidase (COX) activities to increase by 33% and 112%, respectively. When the repeatedly submerged turtles were studied during a subsequent anoxic stress test, liver COX and CS activities decreased during anoxia to the same levels of naïve turtles, which were unchanged, and remained there throughout metabolic recovery. There were no effects of the repeated anoxia treatment on any of the other measured variables, which included lactate dehydrogenase and phosphofructokinase activities in liver, skeletal muscle, and ventricle, blood acid-base status, hemoglobin, hematocrit and plasma ion (Na, K, Ca, Mg, Cl) and metabolite concentrations (lactate, glucose, free-fatty acids), before, during, or after the anoxic stress test. We conclude that although painted turtles can show a physiological reaction to repeated anoxic stress, the changes appear to have no measurable effect on anaerobic physiological performance or ability to recover from anoxia.

Soluble adenylyl cyclase is an acid-base sensor in epithelial base-secreting cells.

Blood acid-base regulation by specialized epithelia, such as gills and kidney, requires the ability to sense blood acid-base status. Here, we developed primary cultures of ray (Urolophus halleri) gill cells to study mechanisms for acid-base sensing without the interference of whole animal hormonal regulation. Ray gills have abundant base-secreting cells, identified by their noticeable expression of vacuolar-type H(+)-ATPase (VHA), and also express the evolutionarily conserved acid-base sensor soluble adenylyl cyclase (sAC). Exposure of cultured cells to extracellular alkalosis (pH 8.0, 40 mM HCO3 (-)) triggered VHA translocation to the cell membrane, similar to previous reports in live animals experiencing blood alkalosis. VHA translocation was dependent on sAC, as it was blocked by the sAC-specific inhibitor KH7. Ray gill base-secreting cells also express transmembrane adenylyl cyclases (tmACs); however, tmAC inhibition by 2',5'-dideoxyadenosine did not prevent alkalosis-dependent VHA translocation, and tmAC activation by forskolin reduced the abundance of VHA at the cell membrane. This study demonstrates that sAC is a necessary and sufficient sensor of extracellular alkalosis in ray gill base-secreting cells. In addition, this study indicates that different sources of cAMP differentially modulate cell biology.

The Relationship between Rostral Retraction of the Pannus and Outcomes at Cesarean Section.

Objective Maternal obesity presents several challenges at cesarean section. In an effort to routinely employ a transverse suprapubic skin incision, we often retract the pannus in a rostral direction using adhesive tape placed after induction of anesthesia and before surgical preparation of the skin. We sought to understand the association between taping and neonatal cord blood gases, Apgar scores, and time from skin incision to delivery of the neonate. Study Design This is a retrospective study, performed using prospectively collected anesthesiology records with data supplemented from the patients' medical records. Singleton pregnancies with morbid obesity (body mass index [BMI] > 40 kg/m(2)) between 37 and 42 weeks of gestation who delivered via nonurgent, scheduled cesarean delivery under regional (spinal, combined spinal-epidural, or epidural) anesthesia between March 2007 and March 2013 were identified. Maternal demographics including BMI, comorbidities, type of anesthesia, time intervals during the surgery, cord gas results, and Apgar scores were collected. The relationship between taping and blood acid-base status, Apgar scores, and interval from skin incision to delivery was investigated using appropriate statistical tests. Results There were 2,525 (27.5%) cesarean deliveries out of 9,189 total deliveries. Applying the described inclusion/exclusion criteria, 141 patients were identified (33 taped and 108 nontaped). There was no significant difference in BMI between the taped (51.9 kg/m(2)) and nontaped groups (47.4 kg/m(2)), p > 0.05. There was no difference in type of anesthesia (p > 0.05). The only significant difference between the taped and not-taped groups was the presence of chronic hypertension in the taped group (p = 0.03). There were no significant differences in cord blood gas values, Apgar scores, or skin incision to delivery interval (p > 0.05 for all outcomes). Conclusions Taping of the pannus at cesarean section is a safe intervention that is not associated with adverse neonatal outcomes. Furthermore, over a set of parturients with BMI > 40 kg/m(2), it does not hasten skin incision to delivery time.