Changes In Bed Research Articles

Posthypoxic Changes in Rat Offspring under the Intestinal Wall Transformation

The aim of research is to study posthypoxic transformation of the colon wall using light and electron microscopy in an experimental model of rat offspring.
 Materials and methods. Chronic hypobaric hypoxia at different stages of pregnancy was simulated experimentally in 24 female white mongrel rats using a vacuum flow chamber with a rise to a height of 5000 m at a speed of 25 m/sec for 40 minutes. After delivery, the offspring were examined, subjected to hexenal anesthesia, and then removed from the experiment using decapitation. For light microscopy, resected sections of the small intestine and colon were stained with hematoxylin-eosin, and studied on Topic (Belgium, 2000) and Bio Blue (the Netherlands, 2013). Electron microscopic analysis was performed in a Morgagni 268D transmission electron microscope (FEI, USA).
 Results. Chronic hypoxia, simulated in the first trimester of pregnancy, led to significant changes in the intestinal mucosa in combination with the growth of the connective tissue component in the muscle layer. The risk of developing dynamic intestinal obstruction occurred in the offspring of all groups, this was supported by an increase in the fibrous tissue of the intestinal wall. Pronounced changes in the microcirculatory bed were detected in animals of groups II and III, as they were predisposed to develop pre-ulcer and ulcerative defects in the wall of the small intestine. At the submicroscopic level, it was detected that both adaptive and destructive processes occurred in the wall ultrastructure of the descending colon of the rat offspring after hypoxic exposure in the prenatal period in animals of all experimental groups. In the microcirculatory bed, there was an increased venous congestion, with the most pronounced changes observed in the third trimester.
 Conclusion. Thus, the study of hypoxia in the experiment allows investigating more about all the mechanisms of the pathological process and to translate theoretical knowledge into practical medicine.

Upper Troposphere Smoke Injection From Large Areal Fires

AbstractLarge areal fires, such as those ignited following a nuclear detonation, can inject smoke into the upper troposphere and lower stratosphere. Detailed fire simulations allow for assessment of how local weather interacts with these fires and affects smoke lofting. In this study, we employ the fire simulation package in the Weather Research and Forecasting (WRF‐Fire) model, Version 4.0.1, to explore how smoke lofting from a fire burning a homogeneous fuel bed changes with varying local winds, relative humidity, and atmospheric boundary‐layer stability for two different‐sized areal fires. The presence of moisture has the greatest influence on the results by raising the altitude of lofting, while faster wind speeds dampen lofting and lower the injection height. Stably stratified conditions inhibit plume propagation compared with neutrally stratified conditions, although the impact of stability is not as strong as that of moisture and winds. These findings highlight the importance of using an appropriate atmospheric profile when simulating large fires, as the local weather can have a meaningful influence on smoke lofting.

Prevention of inflammatory changes in the denture-bearing mucous membrane

Relevance. Advanced clinical and cytological studies have not been conducted yet to examine denture adhesive effect on the prevention of inflammatory changes in the mucous membrane of the prosthetic bed, and thus, the prevention of denture-related stomatitis. Purpose: to assess the clinical and functional condition of the oral mucosa beneath the denture during the adaptation period using a denture adhesive cream to prevent inflammation of the denture bed mucous membrane.Materials and methods. The study clinically and cytologically (washing, scraping) assessed the condition of oral mucosa beneath complete acrylic dentures on days 14-16 and 28-30 of the adaptation period in 15 fully edentulous patients (main group), who used an adhesive cream after they were delivered their dentures, and in 21 fully edentulous patients (control group) who did not use the cream during the denture adaptation period. All the patients were elderly.Results. At different times of the adaptation period, the study more frequently detected inflammatory changes in the denture-bearing mucosa in subjects who did not use the denture adhesive cream. The cytological study confirmed the results of the oral clinical examination, as, at the end of the adaptation period, the number of cellular elements and various microorganisms was significantly lower in the main group than in the controls, which proved the effectiveness of the denture adhesive cream for the prevention of denture stomatitis.Conclusions. Regardless of sex, patients with complete acrylic dentures, who used a denture adhesive cream, had a lower bacterial accumulation on the prosthetic bed and inflammatory changes during the adaptation period, which allowed us to recommend the adhesive cream for the prevention of denture stomatitis.

Роль кальцификации в патогенезе воспалительной реакции артериальной стенки (на примере сосудов шеи и головы взрослого населения)

Calcification provoked by inflammation accompanies many comorbid conditions (including atherosclerosis and fibromuscular dysplasia). What is more, they mutually aggravate each other. The aim of this study was to reveal the patterns of calcification of the arteries of the neck and head in patients with clinical manifestations of vascular disorders of varying severity in inflammatory and non-inflammatory diseases. Materials and methods. A total of 155 patients were examined (mean age 49.1 ± 16.3 years) using computed tomography. The subjects were divided into three groups according to the severity of functional changes in the arterial bed: 1) no vascular obstruction (n = 43); 2) arterial obstruction ≤ 50 % according to NASCET criteria (n = 55); 3) arterial obstruction > 50 % (n = 57). A visual analysis of atherosclerotic lesions of the vessels of the neck and head revealed that the calcification was a dystrophic type of intimal lesion in almost half of the cases (44 %). A visual analysis of stenosis caused by fibromuscular dysplasia showed that calcium deposition is not typical of this process. The absence of calcium phosphate deposition in this case was associated with genetic connective tissue abnormalities. Results. We created a flowchart representing the pathogenesis of artery wall calcification in chronic inflammation. In addition, we revealed previously not described in the literature links between the processes of osteoporosis, progression of biomineralization of atherosclerotic plaques, and decalcification of plaques, which allowed us to indirectly assess their degree of maturation. The results of the study indicate that artery calcification could be considered as a possible marker of the progression of atherosclerosis. For citation: Mal’kov O.A., Govorukhina A.A., Burykin Yu.G., Afineevskaya A.Yu. The Role of Calcification in the Pathogenesis of Inflammatory Reaction in the Arterial Wall (Exemplified by the Vessels of the Neck and Head in Adults). Journal of Medical and Biological Research, 2021, vol. 9, no. 4, pp. 435–443. DOI: 10.37482/2687-1491-Z081

Changes in stream power and morphological adjustments at the event-scale and high spatial resolution along an ephemeral gravel-bed channel

Sediment budgets and morphological channel adjustments are closely related to changes in stream power. In ephemeral channels, whose geomorphic response depends on the magnitude and frequency of hydrological events isolated in time, such relationships are often difficult to establish. This study sought to quantitatively relate morphological adjustments to stream power along different reference channel reaches for the period 2018–2020 in the Azohía Rambla, a Mediterranean gravel-bed ephemeral stream in southeastern Spain. Very high resolution digital terrain models (VHR DTM) (at 1 to 2.5 cm pixel size), combined with ortophotographs and 3D point clouds, generated via SfM photogrammetry and terrestrial laser scanning (TLS) for pre- and post-event stages, together with ground-based surveys were used to estimate the spatial variability of morphological sediment budgets and to assess channel bed mobility and changes in net sediment flux during the study period in two spatial scenarios: reference channel reaches (RCRs) and pilot bed survey areas (PBSAs). The hydraulic variables (flow velocity, Froude number, shear stress, mean stream power and energy gradient, among other) were estimated using a 1D hydrodynamic model calibrated with field information. The high resolution maps allowed a spatially-explicit analysis of stream power and transport efficiency in accordance with the areas of erosion and deposition in each RCR. The incision and bed armoring processes showed different trends according to the stream power (ω), cumulative excess energy (εc), and relative bed stability (RBS). The greatest morphological adjustments at the event scale coincided with ω values above 300 W m−2, εc higher than 3 MJ, and RBS below 0.5. The relationships between the mean stream power gradient at peak flood discharges and the changes in bed elevation verified the bed aggradation (an average surface raising of 0.17 to 0.22 m for δω/δs of −6.2 to −14.5 W m−2 m−1) during the major flood and bed scour (average surface lowering of 0.16 to 0.19 m for δω/δs of 5.8 to 10.6 W m−2 m−1) in the moderated events at the bankfull and sub-bankfull stages. Furthermore, this study contributes new relevant data to the scarce existing literature on the relationships between stream power and morphosedimentary adjustments in a fluvial system highly sensitive and resilient to climate change, as is the case of ephemeral gravel-bed channels.

Effect of the Shape and Position of the Bridge Pier on the Bed Changes in the Sharp 180-Degree Bend

Effect of the Shape and Position of the Bridge Pier on the Bed Changes in the Sharp 180-Degree Bend

Sequential forward mother wavelet selection method for mental workload assessment on N-back task using photoplethysmography signals

The increasing demands of a cognitive task require additional brain resources. This demand, known as mental workload, can lead to deteriorated task performance. Therefore, assessment of mental workload can provide a proper working environment to promote the working efficiency or improve safety in high-risk working environments for a subject. In this study, we present a novel sequential forward mother wavelet selection method for three levels of mental workload assessment on N-back task using photoplethysmography (PPG) signals, which non-invasively measures the blood volume changes in the microvascular bed of tissue from the skin surface with a low-cost opto-electronic technique. The proposed method was successfully applied to a PPG dataset, which was recorded from 22 healthy subjects during an N-back task using a wearable sensor. Instead of using only one mother wavelet, the features were extracted from effective mother wavelet combinations by means of a sequential forward mother wavelet selection method. In this three-class problem, the highest classification accuracy (CA) rates were achieved with 10 s (s) PPG signal segments compared with the 6 s, and 8 s PPG signal segments. For the 10 s PPG signals segments the highest CA was obtained as 76.67% for Subject 20 and the average CA for all subjects was obtained as 65.76%. Furthermore, the proposed method provided 3.59% CA improvement in average. We believed that the proposed method could ensure a great alternative to conventional mental workload assessment techniques.

The Association between Heavy Menstrual Bleeding and Depressive Symptoms in Adolescents

Introduction: Heavy menstrual bleeding (HMB) is a type of abnormal uterine bleeding (AUB) that affects 30% of women of reproductive age and up to 40% of adolescents. Furthermore, 10-40% of adolescents with HMB have an underlying inherited bleeding disorder like von Willebrand disease or platelet dysfunction, requiring management by pediatric hematologists. HMB has been described as more than 80 ml of blood loss during one cycle and clinically, it is defined by several parameters such as the length of each cycle, severity of soaking through pads or tampons, size of clots passed and pictorial blood loss assessment chart (PBAC) score. Studies in adult women show a significant impact of HMB on their psychosocial and financial health. However, little is known about the psychological effects of HMB in adolescent females. In the adolescent population, depression is twice as common in females as it is in males, likely due to a combination of biological and social differences. In this study, we examine the association between heavy menstrual bleeding and depressive symptoms in adolescent girls.Methods: We conducted a retrospective records review of adolescent females aged 10-21 years that were seen as new patients at the Adolescent Medicine and Young Women's Bleeding Disorders clinics at our institution between January 1, 2018 and March 31, 2020. Patients were included in the study if they had started menses, and had a doumented menstrual history as well as a completed Patient Health Questionnaire (PHQ-9), a validated screening tool for depression.Patients with a severe underlying chronic medical disorder (Including but not limited to end stage renal disease, Juvenile Rheumatoid Arthritis, Systemic Lupus Erythematosis, severe eating disorder, previously diagnosed bipolar disorder or psychotic disorders) were excluded. HMB was determined by either a PBAC score of >100 or the presence of two or more of the following criteria:Menses lasting >7daysSoaking through pad or tampon <1hrSoaking through bed clothes or changing pads at nightPassing large clotsLow ferritin < 15ng/ml (indicative of low iron stores)Anemia with Hemoglobin < 12g/dl not due to any other cause (e.g. dietary, immunosuppression, medication induced)Depression was determined by a PHQ-9 score of 9 or greater. The two variables were dichotomized, and a chi-square test of independence was performed to test the association with a significance level of p < 0.05.Results: A total of 203 records were reviewed after meeting inclusion and exclusion criteria. The mean age was 15.94 years (median 16, mode 16) with a range of 12-20years. 42 girls (20.7%) had a PHQ-9 score of >9 and 52 (25.6%) had HMB. Eighteen of the 42 patients (42.8%) with elevated PHQ-9 score had HMB and 34/52 patients (65.3%) with HMB had an elevated PHQ-9 score. Pearson's chi-square test of independence showed a significant relation between HMB and PHQ-9 score of 9 or more with χ 2 (1, n=203) = 8.2618, p = 0.004. After the application of Yates correction, the result was still significant with χ 2 = 7.1603 and p = 0.007.Discussion and Conclusions: This study shows a significant association in the adolescent population between heavy menstrual bleeding and moderate or severe depression as defined by the presence of a PHQ-9 score of 9 or more. This retrospective analysis does not establish causation, but demonstrates a clinically noteworthy finding that has not been described before. The PHQ-9 is used widely across this population to screen for depression, but it is also important to screen young women aged 10-21years for HMB as a contributing factor to depression followed by timely and appropriate management of both problems. Additionally, it may be worthwhile to evaluate all young women with HMB through additional methods to diagnose depression as this patient population appears to be at higher risk. Future prospective studies are needed to better characterize this association. DisclosuresNo relevant conflicts of interest to declare.

Vascular region-specific changes in arterial tone in rats with type 2 diabetes mellitus: Opposite responses of mesenteric and femoral arteries to acetylcholine and 5-hydroxytryptamine

AimsType 2 diabetes mellitus (T2DM) ranks in the top 10 causes of mortality worldwide. The key factor of T2DM vascular complications is endothelial dysfunction. It is characterized by the vessels motor activity disruption and endothelium-derived factors imbalance. The blood vessels morphological and molecular heterogeneity greatly affects the changes occurring in T2DM. Therefore, we conducted a comparative study of vascular bed changes occurring in T2DM. Main methodsMale Wistar rats were fed a high-fat diet for 20 weeks, followed by a single streptozotocin injection (20 mg/kg). T2DM was confirmed with an oral glucose tolerance test. Key findingsA dose-dependent contraction study showed an increase in third-order mesenteric arterioles response to serotonin but not to phenylephrine. These vessels also exhibited a decrease in acetylcholine-dependent relaxation and an increase in guanylate cyclase function. At the same time, the femoral arteries showed a tendency for increased acetylcholine-dependent relaxation. The blood plasma analysis revealed low bioavailable nitric oxide and high levels of endothelin-1 and ROS. SignificanceThis knowledge, in conjunction with the features of the T2DM course, can allow further targeted approaches development for the prevention and treatment of vascular complications occurring in the disease.

S2491 Diagnosis of Papillary Thyroid Carcinoma by Transesophageal Endoscopic Ultrasound-Guided Fine-Needle Biopsy (EUS-FNB)

Introduction: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) can be used as a diagnostic modality with tissue sampling of both intra- and extra-luminal lesions. EUS allows for a less invasive, real-time image-guided biopsy of adjacent extraluminal structures. We present EUS-guided FNB evaluation in a patient with suspected recurrent thyroid cancer and a suspicious portocaval lymph node (PCNL). Case Description/Methods: A 36-year-old male with recurrent papillary thyroid cancer that had been previously treated with total thyroidectomy and modified radical neck dissection and iodine ablation presents with intermittent dysphagia to solid foods and a pressure sensation in his mid-neck. He reported poor compliance with follow-up appointments, surveillance imaging, and post-treatment TSH-suppressive T4 therapy. CT neck showed non-specific bilateral nodular changes in the thyroidectomy bed which were thought to reflect postsurgical changes versus recurrent neoplasm. A whole-body PET/CT showed no substantial FDG uptake in the neck but rather increased uptake in a PCNL concerning for intra-abdominal metastases. Surface ultrasound-guided FNA (USG-FNA) of the left neck mass was non-diagnostic. As the lymph node was inaccessible by percutaneous biopsy, and previous USG-FNA of thyroid bed was non-diagnostic, a EUS guided biopsy of both, the left neck mass and PCNL was pursued. The EUS revealed a 12mm x 8mm mass in the thyroid resection bed. EUS-guided thyroid biopsy was performed from the level of the upper esophageal sphincter, with 5 passes of a 25 gauge SharkCoreTM needle (C-25-05 Medtronic, Dublin, Ireland). Two enlarged ( >1cm) hypoechoic PCNL with well-defined borders were identified with EUS. Using a 22 gauge SharkCoreTM needle biopsy, FNB x 3 was performed on the PCNL. The pathology from the left thyroid mass revealed papillary thyroid carcinoma, and the histopathology from the PCNL was a benign lymphoid sample. The patient did well on follow-up and had no periprocedural adverse events. By demonstrating recurrent cancer, without PCNL involvement. This allowed the patient to undergo local surgical resection. Discussion: The evaluation and management of suspicious lesions in the superior mediastinum have evolved since the inception of EUS. We demonstrate that EUS can be used in the evaluation of recurrent thyroid cancer when USG-FNA is not diagnostic. An additional advantage of EUS is the ability to sample suspicious lymph nodes adjacent to the GI tract at the same time.Figure 1.: EUS guided fine needle biopsy of the enlarged lymph node in the porta hepatis region (a) revealed a benign lymphoid sample (c). A 1.2 x 0.8 cm lesion found in the left thyroid bed on EUS (b) with EUS-FNB showing malignant cells diagnostic of papillary thyroid carcinoma (d).

Comparison of Intraocular Pressure before and after Laser in Situ Keratomileusis Measured with Applanation Tonometry, Non Contact Tonometry and Rebound Tonometry

Abstract Background Measurement of intraocular pressure (IOP) plays a central role throughout ophthalmology. It is part of routine ophthalmologic examinations and important in the management and follow-up of patients with glaucoma. While elevated IOP remains the most important risk factor for development and progression of open angle glaucoma, at least half of the population diagnosed with open angle glaucoma is asymptomatic. Objectives The aim of our study is to compare the accuracy of intraocular pressure measurement before and after Laser in situ keratomeulsis (LASIK) surgery using three different types of Tonometers: Goldmann Applanation tonometry (GAT), Non contact tonometry (NCT) and Rebound tonometry (I care), considering the change in the central corneal thickness (CCT). Patients and Methods In this study Eighty eyes of 40 patients with mean age of 27.00±6.00 years were scheduled for LASIK..Central corneal thickness before and after surgery was obtained by Ultrasound (US) pachymetry.IOP values were measured before and after surgery using three different types of Tonometers: Goldmann Applanation tonometry, Non contact tonometry and Rebound tonometry. Results The results revealed that lower post-operative IOP measurements using all techniques. The least affected technique was Non –contact with IOP change 16%, followed by GAT with IOP change 18%, and finally Rebound with IOP change 19 %, respectively. The percentage of change in CCT between pre- and post- LASIK surgery measured with the Ultrasound pachymetry was statistically highly significant. There was a clinical significant correlation between Percentage of tissue ablation (PTA) and IOP change for GAT, NCT and rebound tonometry. Also, there was a significant correlation between Residual stromal bed (RSB) and IOP change for GAT and NCT. There was no clinical significant correlation between Ablation depth (AD) and percentage of change of IOP measurements pre and post LASIK, except for IOP measured with GAT when AD &amp;lt; 40.00 µm. Conclusion Refractive surgery causes significant lowering of IOP as measured using Goldmann applanation tonometry, non contact tonometry and rebound tonometry. The least affected tonometry post LASIK is non contact tonometry. The reduction was correlated to the percentage of tissue ablated. The ideal method to measure IOP in post-LASIK patients would be a device that is free of corneal factors.

계곡형 토석류가 발생한 급경사 신기 계곡의 특성

In mountain gully, channelized debris flow is an important phenomenon in the process of topographical change. Social infrastructure as roads may be damaged by channelized debris flows, but there has been little information about their occurrence and movement to prepare for the risk of the debris flow. Most of the channelized debris flows occur during heavy rains in mountainous valleys that are difficult to access, so there are not many field data. In this study, the topographical characteristics of the catchment, the rainfall and runoff related to the debris flow, the sedimentary pattern and the cross-sectional change of the channel bed, and the underflow velocity of the gravel bed have been investigated and analyzed in the Singi gully where the channelized debris flows occurred. In the catchment, there was almost no sediment runoff because the vegetation combine with the debris landforms and covered the surface. Therefore, the obvious cause of the channelized debris flows is the collapse of the slope and bed of the gully. Even if the gravel, cobbles, and boulders of the channel bed were lost by debris flow, the thalweg change due to debris flow may not be significant because they are supplied from the gully side slope normally. After the gabion structures were installed, the debris flow increased the thalweg change, bed erosion and side slope of the gully. Various sedimentary structures in the gully were classified according to the factors supporting the sedimentation. The hypsometric curve of the gully reflects the debris landforms and vegetation characteristics of the watershed and the sediment runoff due to debris flow, etc. The relationship between the flow velocity and the hydraulic gradient was non-linear under the condition that the porous medium with gully bed gravels is saturated with water. These results may be used as basic data for channelized debris flow research.

Immunohistochemical features of the collagen’ formation in the uterus of fetuses with a gestational term of 21-28 weeks from mothers, whose pregnancy was complicated by preeclampsia of different stage of severity

In the following article we are going to provide the results of research on uterus’ structure in case of fetuses with a gestational term of 21-28 weeks from mothers, whose pregnancy was complicated by PE of different severity stage (15 cases) comparing to one in case of fetuses from mothers with a physiological pregnancy (15 cases). All fetuses have died intranatally as a result of an acute disorder in uterine-placental and uterine-fetal circulation. The research methods: macroscopic, organometric, histological, immunohistochemical, morphometric and statictical. By applying an organometric method we have revealed a probable decrease of indexes of weight, length and thickness of the uterine’ wall in case of fetuses from mothers with PE comparing to ones in case of fetuses from healthy mothers. The observative histological research had not revealed any significant changes in the strucutre of the organs’ wall in case of fetuses from the study groups. Thus, all organs were represented by mucous, muscular and serous membranes with a clear boundary between them. The comparative morphometric research had revealed the following features of the uterus’ wall structure in case of fetuses from mothers with PE. The indexes of thickness of all structural components of the organ’s wall were clearly decreased comparing to ones in case of fetuses from mothers with a physiological pregnancy. In the uterine endometrium of fetuses from mothers with PE of moderate stage of severity the features of proliferative (hormonal) activity are taking place, however, in the meanwhile, in case of organs of fetuses from mothers with PE of severe stage of severity we could notice a probable decrease of glands’ number as well as a lack of a proliferative activity in them (hypoplastic changes). By applying immunohistochemical method with using MCAT to CD 95 we have disclosed a probable increase of an apoptotic index in organs of fetuses from mothers with a complicated pregnancy towards one in case of fetuses from healthy mothers. Among the specific features of the uterine myometrium strucutre in case of fetuses from mothers with PE we could name the following ones: decrease of the vascular component percentage as well as increase growth of the connective tissue. Moreover, the structure of the connective tissue is represented mostly by the collagen of the III type, while, in case of organs of fetuses from healthy mothers the collagen of the I type prevails. In walls of the vessels of arterial type in case of uterus of fetuses from mothers with PE we could notice an increased glow of the collagen of the III type as well as a probable decrease of glow in case of collagen of the IV type. However, in case of organs’ vessels of fetuses from healthy mothers we could notice an increse of glow of the collagen of the IV type. There is a fact, which attracts an attention to it. Namely, all aforementioned changes in the uterine wall in case of fetuses from mothers with PE are minimally manifested, when the mild course of disease took place, and was maximally manifested in case of severe one. All changes in the uterus in case of fetuses from mothers with PE of different stage of severity, that were postulated above, could contribute to formation of glanduar hyperplasia, endometrial polyps, precancerous diseases as well as endometrial cancer in the subsequent ontogenesis, as well as it could lead to impaired pregnancy and infertility. All aforementioned changes in organs of fetuses from mothers, whose pregnancy was complicated by PE of different stage of severity, were connected with changes in the vascular bed of the mother-placenta-fetus system as well as with endocrine disorders, that take place in case of this pathology, in the organism of pregnant woman.

OCT-A PICTURE OF THE EYEFOOL IN CHRONIC RENAL FAILURE

Renal retinopathy is a severe late microvascular complication of CRF and one of the causes of blindness in the world among people of working age. OCT-A makes it possible to detect microvascular changes in the retina even in the absence of clinical manifestations of renal retinopathy on the fundus. Markers of changes in the microcirculatory bed of the retina in renal retinopathy arequalitative and quantitative changes in the foveal avascular zone and a decrease in the density of the capillary network, which increase with the progression of the disease.Keywords:Renal retinopathy, CRF, OCT, angiography, retinal changes

Nailfold Capillaroscopy by Digital Microscope in a Guatemalan Population with Systemic Sclerosis

The aim of this study is to determine the usefulness of the low-price digital microscope in the identification of vascular changes in the nail bed of patients with systemic sclerosis and its relationship with autoantibodies involved.

Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital

BackgroundThe COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak. MethodsThis is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, which resulted in a high number of critically ill patients. ResultsBetween March 1 and July 31, 2020, 822 patients were admitted to the adult non-cardiac ICUs with suspected (72%)/confirmed (38%) COVID-19. At the peak of the surge, 125 critically ill patients with COVID-19 were managed on single day. To accommodate these numbers, the bed capacity of 4 ICUs was increased internally from 58 to 71 beds (+40%) by cohorting 2 patients/room in selected rooms; forty additional ICUs beds were created in 2 general wards; one cardiac ICU was converted to managed non-COVID-19 general ICU patients and one ward was used as a stepdown for COVID-19 patients. To manage respiratory failure, 53 new ICU ventilators, 90 helmets for non-invasive ventilation and 47 high-flow nasal cannula machines were added to the existing capacity. Dedicated medical teams cared for the COVID-19 patients to prevent cross-contamination. The nurse-to-patient and RT-to-patient ratio remained mostly 1:1 and 1:6, respectively. One-hundred-ten ward nurses were up-skilled to care for COVID-19 and other ICU patients using tiered staffing model. Daily executive rounds were conducted to identify patients for transfer and at least 10 beds were made available for new COVID-19 admissions/day. The consumption of PPE increased multiple fold compared with the period preceding the pandemic. Regular family visits were not allowed and families were updated daily by videoconferencing and phone calls. ConclusionsOur ICU response to the COVID-19 pandemic required almost doubling ICU bed capacity and changing multiple aspects of ICU workflow to be able to care for high numbers of affected patients.

Antimicrobial Resistance of Coagulase-positive Staphylococcus Isolated From Healthy Crioulo Horses and Associated Risk Factors

Antimicrobial resistance (AMR) is a global concern that must be addressed from a one health perspective. Horses are companion animals and their contact with humans facilitates exchange of resistant bacteria. This study aimed to evaluate AMR of coagulase-positive Staphylococcus (CoPS), including Staphylococcus aureus, isolated from healthy Crioulo horses. Swab samples from nostrils (n = 214) and skin (n = 107) of 107 horses from Porto Alegre, South Brazil, were used for CoPS isolation. The isolates were evaluated for AMR and a multivariate logistic regression was applied to identify the risk factors associated to this outcome, using information on horses’ management and installations where they were maintained. A total of 143 CoPS were isolated from 79 horses (73.8%), of which 8 (5.6%) were S. aureus. The isolates showed resistance to seven of 10 tested antimicrobials and 38.5% (55/143) of them were resistant to at least one antimicrobial. One isolate (0.7%; 1/143) was classified as multidrug-resistant. Regarding S. aureus, 62.5 % (5/8) showed AMR, but none were methicillin-resistant. The risk factors associated with CoPS’ antimicrobial resistance were lower frequency of bed changing (OR = 6.40; P = .001) and nonaccumulation of bed materials (OR = 3.47; P = .002). The results point that healthy horses have antimicrobial-resistant CoPS and S. aureus in their microbiota, which may be of concern for animal and human health. Moreover, bed management was associated with AMR, which can serve as a guide for best practices to be adopted to avoid the occurrence of resistant bacteria in these animals.

Inhibitors of the sodium-glucose transporter type 2 and new possibilities for managing vascular age in patients with type 2 diabetes mellitus

The article discusses the pathophysiological mechanisms of the development of vascular aging as a combination of the influence on the body of genetic, environmental, regulatory, metabolic and other factors causing biochemical, enzymatic and cellular changes in the arterial vascular bed. The concept of “early vascular aging” and “healthy vascular aging” is defined depending on the ratio of the biological and chronological age of the vessels. The role of diabetes mellitus in increasing vascular stiffness, early vascular aging, as well as the progression of atherosclerotic cardiovascular diseases and their complications is considered in detail. Approaches to multifactorial management of vascular age in patients with type 2 diabetes (lifestyle modification with strategy of aggressive treatment of modifiers of atherosclerosis, rejection of bad habits, adherence to dietary recommendations and the use of modern organo- and vasoprotective antidiabetic drugs) are revealed. The mechanism of realization of vasoprotective effects of inhibitors of sodium-glucose transporter-2 (iNGLT-2) is described in detail. The results of completed large random ized trials EMPA-REG Outcome and EMPA-REG BP of the most studied representative of the IGLT-2 group, empagliflozin, are presented. It has been shown that due to their glucose and natriuretic effects, the ability to reduce body weight and blood pressure, improve myocardial metabolism and bioenergetics, decrease the activity of the sympathetic nervous system, as well as positive effects on vascular stiffness, NGLT-2 inhibitors are the drugs of choice in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases. This makes it possible to widely use this group of drugs for managing the vascular age of patients and represents a new opportunity in the prevention of vascular aging in T2DM.

АНГИОПУЛЬМОНОГРАФИЯ С НИТРОГЛИЦЕРИНОВЫМ ТЕСТОМ В ДИАГНОСТИКЕ ОСТРЫХ ИНФЕКЦИОННЫХ ДЕСТРУКЦИЙ ЛЕГКИХ

Objective. To develop a method for additional and differential diagnosis of acute infectious lung destruction (AILD) based on angiopulmonography with the nitroglycerin test. Methods. Angiopulmonography with the nitroglycerin test was used in 10 patients with suppurative diseasesof thelung and pleura for additional and differential diagnosis of AILD The method was used in such situations when chest computed tomography did not allow to determine unambiguously the presence and / or prevalence of necrosis of the lung parenchyma. Results. In 3 patients with the lung abscess, a clear restriction of the decay cavity was registered with the preservation of the main blood flow and weakening of the parenchymal phase of the blood circulation along the periphery of the destructive area. During the nitroglycerin test performance there was no change in the filling of the microvascular bed with contrast along the periphery of the decay cavity, which made it possible to determine the presence of parietal sequesters. According to the results of the study, the lung gangrene was diagnosed in 6 patients. At the same time, two variants of circulatory disorders were noted: the first - with preservation of the blood flow through the main vessels and with the absence of a parenchymal phase in the lesion focus, the second - with the violation of the main blood flow. In the affected area no change in blood flow was observed after the nitroglycerin test performance. Similar results of the study indicated the development of necrosis of the pulmonary parenchyma, which was subsequently confirmed during the operations performed. In the site of inflammatory infiltration of the pulmonary parenchyma with preserved main blood flow, the depletion of the parenchymal phase of blood circulation was determined, but after the nitroglycerin test, a pronounced enrichment of the vascular architecture to the parenchymal phase in the pneumonia affecting part of the lung was noted. Conclusion. It has been established that AILD is characterized by irreversible changes in the vascular bed of the lung parenchyma in the lesion focus. Angiopulmonography with the nitroglycerin test is considered to be an additional highly informative method improving the early and differential diagnosis of AILD in difficult clinical situations. What this paper adds It has been found out that during angiopulmonography the areas of pulmonary necrosis are characterized by the absence of a vascular pattern with or without disturbance of the blood flow through the segmental arteries. At the same time, in contrast to the foci of pneumonia, the nitroglycerin test is not accompanied by an evaluation of the filling of the pulmonary vascular bed in the affected area, i.e. blood supply disorders are irreversible. Thus, based on an assessment of the nature and reversibility of the blood flow disturbances in the affected lung, it is possible to carry out differential diagnosis of the early stages of acute infectious lung destruction (AILD) and pneumonia.

Hydrodynamics and sediment transport under a dam-break-driven swash: An experimental study

An experimental study is presented consisting of swash zone hydrodynamics, sediment transport flux estimates, and bed changes under a single dam-break-driven swash event over a steep (1:7), movable sand bed. The study provides resolved measurements of instantaneous water depths, cross-shore flow velocities, sheet flow and suspended sediment concentrations, and morphological response. An ensemble-averaging over 24 repetitions of the swash event allows convergence in the time-averaged measured swash quantities. The sand bed profile was re-constructed after each run with a re-smoothing procedure that allowed for minimum variations that are within the profiler system accuracy (<0.006 m). High-resolution measurements are employed to reconstruct the spatial-temporal evolution of the flow velocity field. Temporal extrapolation and spatial logarithmic/exponential fits are employed to fill velocity gaps in the measured data for the estimation of instantaneous and depth-integrated sediment flux. The spatial gradients of instantaneous sediment flux indicate that the sheet flow sediment dominates over the suspended load during the most relevant phases for sediment transport. Upon bore arrival and initial uprush, the relative contribution of the sheet flow load is larger than during the backwash phase and is decreasingly dominant onshore. Depth-integrated instantaneous sediment flux and total sediment transport estimates, based on two different approaches, are compared with equivalent total sediment transport estimates obtained from the observed morphological changes and the sediment continuity equation. The close agreement between the various approaches indicates that existing models and empirical estimates for the sheet load concentration profile can be used as first order estimates for sediment transport in the swash zone.