Physiological Changes Research Articles

Management of Pulmonary Hypertension during Pregnancy

Abstract: Pregnancy in patients with pulmonary arterial hypertension (PAH) is a high-risk condition associated with high morbidity and mortality. Patients with severe PAH are often advised against pregnancy. Still, those patients who pursue pregnancy require a dedicated and multidisciplinary approach since the progression of fetal growth will accompany significant hemodynamic changes, which can be challenging for patients with a poorly functioning right ventricle. In this article, we describe the approach to the unique cardiovascular, respiratory, hematologic, and social challenges that pregnant patients with PAH face throughout pregnancy. We discuss the impact of these physiologic changes on diagnostic studies commonly used in PAH and how to incorporate diagnostic data in making the diagnosis and risk stratifying pregnant patients with PAH. The pharmacologic challenges of pulmonary vasodilators in pregnancy are discussed as well. Pregnant patients with PAH are at particularly high risk of mortality around the time of delivery, and we discuss the multidisciplinary approach to the management of these patients, including the use of anesthesia, inotropic support, type of delivery, and postpartum care, providing clinicians with a practical approach to the management of this difficult condition.

Morphological and Physiological Changes of Hydroponic Lettuce Grown in Varying Potassium Concentrations and an Adaptive Lighting Control System

We investigated the growth dynamics of hydroponic lettuce (Lactuca sativa) driven by the influence that potassium (K+) has on crop growth. This study aimed to determine whether increased K+ concentrations under different daily light integrals (DLIs) in a hydroponic system will boost growth of greenhouse lettuce. This study was conducted within a controlled glass greenhouse environment with varying DLIs achieved by integrating an adaptive lighting control system over a 16-hour photoperiod. We used three K+ treatments of 200, 400, or 600 mg⋅L−1 K+ and six DLI lighting treatments of 11.1, 12.9, 14.6, 15.9, 16.9, and 17 mol⋅m−2⋅d−1. We found that increasing K+ did not increase shoot dry weight, leaf area, or specific leaf area with increasing DLIs. Although K+ and DLI had an interacting effect on the root dry weight fraction, leaf chlorophyll content, and quantum yield of photosystem II, the K+ treatments did not increase or decrease with increasing DLIs. The influencing factor was DLI, which led to increases in shoot dry weight and leaf area, whereas a decrease in specific leaf area was observed with increasing DLIs. Ultimately, adding supplemental concentrations of K+ did not enhance lettuce growth, nor did these effects show any increase with increasing DLIs.

A Case of Symptomatic Bradycardia After Valve Replacement.

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.

Strategies of invasive snail Pomacea canaliculata during hibernation in rice fields of south China: effects of body size, sex, and soil depth.

The invasive freshwater snail Pomacea canaliculata is an agricultural pest with a certain level of tolerance to abiotic stress. After the harvest of late rice, the snails usually burrow themselves into the soil surface layers to overwinter and pose a renewed threatto rice production in the following year. Revealing the response of snails to environmental stresses is crucial for developing countermeasures to control their damage and spread. In this study, we conducted a 120-day in situ experiment during the winter to investigate the survival and physiological changes of hibernating snails in 0-5 and 5-10 cmsoil depths, aiming to explore their overwintering strategies. Our results showed that 73.61%, 87.50%, and 90.28% of male, female, and juvenile snails survived after hibernation for 120 days in 0-10 cm soil depth, respectively. The differences in survival rates based on sex and size of snailspotentially reflect the countermeasures of snails to rapidly reproduce after hibernation. Simultaneously, the hibernating snails exhibited the ability to maintain a certain level of body weight. During this period, the snails increased their antioxidant enzyme activities to cope with oxidative stress, and enhanced their lipid storage. The hibernation survival of snails was not significantly affected by different soil depths, indicating that they have the potential to hibernate into deeper soils. Furthermore, snails were capable of increasing their contents of bound water and glycerol to cope with sudden cold spells during hibernation. Our findings emphasize the adaptive changes of P. canaliculata snails overwintering in paddy soils. In future studies, the vulnerabilitiesof P. canaliculata during hibernation (e.g. shell characteristics, nutrient reserves, and dehydration tolerance, etc.,) should be investigated to develop effective control methods for this period. © 2024 Society of Chemical Industry.

Exposure to neonicotinoid pesticides induces physiological disorders and affects color performance and foraging behavior in goldfish.

We investigated the effects of neonicotinoid pesticides (NEOs) on the spontaneous swimming and foraging behavior, as well as the morphological and physiological changes of goldfish. Most fish reared in thiamethoxam (THM)-sprayed rice fields showed the scales easily peeled off, and increased ascites. Some individuals showed decreased bio-defense activity and low plasma Ca2+. Similar changes were found in the exposure test to THM (1.0 and 20.0 μg/L) and dinotefuran (1.2 and 23.5 μg/L). Next, the effects of a low concentration of THM (1.0 μg/L) on the spontaneous swimming and foraging behavior of fish were examined. Fish exposed to THM for 1 week became restless and had increased the swimming performance, especially under natural light, white LED lighting and blue LED lighting. Goldfish exposed to THM had also increased intake of shiny white beads under green LED illumination. These results indicate that the exposure to NEO, even for a short period and at low levels, not only suppressed bio-defense activities and metabolic abnormalities, but also stress response, the swimming and foraging behavior of the fish are likely to be significantly suffered.

Computational modeling of the synergistic role of GCN2 and the HPA axis in regulating the integrated stress response in the central circadian timing system.

The circadian timing system and integrated stress response (ISR) systems are fundamental regulatory mechanisms that maintain body homeostasis. The central circadian pacemaker in the suprachiasmatic nucleus (SCN) governs daily rhythms through interactions with peripheral oscillators via the hypothalamus-pituitary-adrenal (HPA) axis. On the other hand, ISR signaling is pivotal for preserving cellular homeostasis in response to physiological changes. Notably, disrupted circadian rhythms are observed in cases of impaired ISR signaling. In this work, we examine the potential interplay between the central circadian system and the ISR, mainly through the SCN and HPA axis. We introduce a semimechanistic mathematical model to delineate SCN's capacity for indirectly perceiving physiological stress through glucocorticoid-mediated feedback from the HPA axis and orchestrating a cellular response via the ISR mechanism. Key components of our investigation include evaluating general control nonderepressible 2 (GCN2) expression in the SCN, the effect of physiological stress stimuli on the HPA axis, and the interconnected feedback between the HPA and SCN. Simulation revealed a critical role for GCN2 in linking ISR with circadian rhythms. Experimental findings have demonstrated that a Gcn2 deletion in mice leads to rapid re-entrainment of the circadian clock following jetlag as well as to an elongation of the circadian period. These phenomena are well replicated by our model, which suggests that both the swift re-entrainment and prolonged period can be ascribed to a reduced robustness in neuronal oscillators. Our model also offers insights into phase shifts induced by acute physiological stress and the alignment/misalignment of physiological stress with external light-dark cues. Such understanding aids in strategizing responses to stressful events, such as nutritional status changes and jetlag.NEW & NOTEWORTHY This study is the first theoretical work to investigate the complex interaction between integrated stress response (ISR) sensing and central circadian rhythm regulation, encompassing the suprachiasmatic nucleus (SCN) and hypothalamus-pituitary-adrenal (HPA) axis. The findings carry implications for the development of dietary or pharmacological interventions aimed at facilitating recovery from stressful events, such as jetlag. Moreover, they provide promising prospects for potential therapeutic interventions that target circadian rhythm disruption and various stress-related disorders.

Spatial transcriptomics at the brain-electrode interface in rat motor cortex and the relationship to recording quality

Study of the foreign body reaction to implanted electrodes in the brain is an important area of research for the future development of neuroprostheses and experimental electrophysiology. After electrode implantation in the brain, microglial activation, reactive astrogliosis, and neuronal cell death create an environment immediately surrounding the electrode that is significantly altered from its homeostatic state. Objective. To uncover physiological changes potentially affecting device function and longevity, spatial transcriptomics (ST) was implemented to identify changes in gene expression driven by electrode implantation and compare this differential gene expression to traditional metrics of glial reactivity, neuronal loss, and electrophysiological recording quality. Approach. For these experiments, rats were chronically implanted with functional Michigan-style microelectrode arrays, from which electrophysiological recordings (multi-unit activity, local field potential) were taken over a six-week time course. Brain tissue cryosections surrounding each electrode were then mounted for ST processing. The tissue was immunolabeled for neurons and astrocytes, which provided both a spatial reference for ST and a quantitative measure of glial fibrillary acidic protein and neuronal nuclei immunolabeling surrounding each implant. Main results. Results from rat motor cortex within 300 µm of the implanted electrodes at 24 h, 1 week, and 6 weeks post-implantation showed up to 553 significantly differentially expressed (DE) genes between implanted and non-implanted tissue sections. Regression on the significant DE genes identified the 6–7 genes that had the strongest relationship to histological and electrophysiological metrics, revealing potential candidate biomarkers of recording quality and the tissue response to implanted electrodes. Significance. Our analysis has shed new light onto the potential mechanisms involved in the tissue response to implanted electrodes while generating hypotheses regarding potential biomarkers related to recorded signal quality. A new approach has been developed to understand the tissue response to electrodes implanted in the brain using genes identified through transcriptomics, and to screen those results for potential relationships with functional outcomes.

Water and Brain Function - Effects of Hydration Status on Neurostimulation with Transcranial Magnetic Stimulation.

Neurostimulation/neurorecording are tools to study, diagnose, and treat neurologic/psychiatric conditions. Both techniques depend on volume conduction between scalp and excitable brain tissue. We examine how neurostimulation with TMS is affected by hydration status, a physiologic variable which can influence the volume of fluid spaces/cells, excitability and cellular/global brain functioning. Compared to dehydration, we expected rehydration to show signs of macroscopic and microscopic volume changes including decreased scalp-cortex distance (brain closer to stimulator) and astrocyte swelling-induced glutamate release. Normal healthy adult participants (32, 9 male) had common motor TMS measures taken in a repeated measures design from dehydrated (12-hour overnight fast/thirst) and rehydrated (identical dehydration protocol followed by rehydration with 1 L water in 1 hour) testing days. The target region was left primary motor cortex hand area. Response at the target muscle was recorded with electromyography. Urinalysis confirmed hydration status. Motor hotspot shifted in half of participants. Motor threshold decreased in rehydration, indicating increased excitability. Even after re-dosing/re-localizing TMS to the new threshold/hotspot, rehydration still showed evidence of increased excitability: recruitment curve measures generally shifted upwards and SICF was increased. SICI, LICI, LICF, and CSP were relatively unaffected. The hydration perturbations were mild/subclinical, based on the magnitude/speed and urinalysis. Motor TMS measures showed evidence of expected physiologic changes of osmotic challenges. Hydration may be a source of variability affecting techniques dependant on brain volumes/volume conduction. These concepts are important for researchers/clinicians using such techniques or dealing with the wide variety of disease processes involving water balance.

Salmonella Typhimurium alters galactitol metabolism under ciprofloxacin treatment to balance resistance and virulence.

Treatment of antibiotic resistance can significantly benefit from a deeper understanding of the interactions between drugs and genetics. The physiological responses and genetic mechanisms in antibiotic-exposed bacteria are not well understood. Traditional resistance studies, often retrospective, fail to capture the entire resistance development process and typically exhibit unpredictable dynamics. To explore how clinical isolates of S. Typhimurium respond to ciprofloxacin, we analyzed their adaptive responses. We found that S. Typhimurium RamA-mediated regulation disrupts microbial metabolism under ciprofloxacin exposure, affecting genes in the galactitol metabolic pathways. This disruption facilitates adaptive responses to drug therapy and enhances the efficiency of intracellular survival. A more comprehensive and integrated understanding of these physiological and genetic changes is crucial for improving treatment outcomes.

Feasibility of Delivering a 5-Day Normobaric Hypoxia Breathing in Healthy Volunteers in a Hospital Setting.

Beneficial effects of breathing at FIO2 < 0.21 on disease outcomes have been reported in previous preclinical and clinical studies. However, the safety and intra-hospital feasibility of breathing hypoxic gas for 5 d have not been established. In this study, we examined the physiologic effects of breathing a gas mixture with FIO2 as low as 0.11 in 5 healthy volunteers. All 5 subjects completed the study, spending 5 consecutive days in a hypoxic tent, where the ambient oxygen level was lowered in a stepwise manner over 5 d, from FIO2 of 0.16 on the first day to FIO2 of 0.11 on the fifth day of the study. All the subjects returned to an environment at room air on the sixth day. The subjects' SpO2 , heart rate, and breathing frequency were continuously recorded, along with daily blood sampling, neurologic evaluations, transthoracic echocardiography, and mental status assessments. Breathing hypoxia concentration dependently caused profound physiologic changes, including decreased SpO2 and increased heart rate. At FIO2 of 0.14, the mean SpO2 was 92%; at FIO2 of 0.13, the mean SpO2 was 93%; at FIO2 of 0.12, the mean SpO2 was 88%; at FIO2 of 0.11, the mean SpO2 was 85%; and, finally, at an FIO2 of 0.21, the mean SpO2 was 98%. These changes were accompanied by increased erythropoietin levels and reticulocyte counts in blood. All 5 subjects concluded the study with no adverse events. No subjects exhibited signs of mental status changes or pulmonary hypertension. Results of the current physiologic study suggests that, within a hospital setting, delivering FIO2 as low as 0.11 is feasible and safe in healthy subjects, and provides the foundation for future studies in which therapeutic effects of hypoxia breathing are tested.

RGB Color Model: Effect of Color Change on a User in a VR Art Gallery Using Polygraph

This paper presents computer and color vision research focusing on human color perception in VR environments. A VR art gallery with digital twins of original artworks is created for this experiment. In this research, the field of colorimetry and the application of the CMYK and RGB color models are applied. The inter-relationships of the two color models are applied to create a color modification of the VR art gallery environment using C# Script procedures. This color-edited VR environment works with a smooth change in color tone in a given time interval. At the same time, a sudden change in the color of the RGB environment is defined in this interval. This experiment aims to record a user’s reaction embedded in a VR environment and the effect of color changes on human perception in a VR environment. This research uses lie detector sensors that record the physiological changes of the user embedded in VR. Five sensors are used to record the signal. An experiment on the influence of the user’s color perception in a VR environment using lie detector sensors has never been conducted. This research defines the basic methodology for analyzing and evaluating the recorded signals from the lie detector. The presented text thus provides a basis for further research in the field of colors and human color vision in a VR environment and lays an objective basis for use in many scientific and commercial areas.

Effects of ashwagandha (Withania somnifera) root extract on aging-related changes in healthy geriatric dogs: A randomized, double-blinded placebo-controlled study.

This study aimed to explore the clinical potential of Withania somnifera/ashwagandha root extract (ARE) to mitigate age-related changes in healthy geriatric dogs. We hypothesized that ARE can reduce the effects of advancing age, including physiological changes, immune response decline and susceptibility to diseases, by its immunomodulatory effects. A randomized, double-blind, placebo-controlled trial was conducted in Telangana, India, from July 2022 to September 2022. Twenty apparently healthy dogs, aged 8 years or older, were enrolled. The dogs were divided into two groups to receive ARE (15mg/kg, once daily, orally) or a placebo control. Various parameters, including serum cortisol levels, haematological profiles, biochemical markers, antioxidant indicators and anti-inflammatory responses, were assessed at the initiation of study, day 30, and day 60. The erythrocyte count and haemoglobin levels were significantly increased with ARE (p<0.001), whereas leukocyte count decreased (p<0.05). Moreover, significant decreases in important markers of liver function (alanine aminotransferase, aspartate aminotransferase, albumin and globulin; p<0.001 at day 60), as well as kidney function markers (creatinine and blood urea nitrogen; p<0.001 at days 30 and 60), were observed in ARE-treated dogs compared to the placebo control group. In addition, the levels of markers of oxidative stress (superoxide dismutase, catalase, glutathione and malondialdehyde) were significantly modulated by ARE intervention, indicating strong antioxidant effects. Interestingly, serum cortisol levels reduced significantly with ARE (p<0.001). Compared to baseline, ARE significantly decreased key inflammatory markers, including interferon-γ, tumour necrosis factor-α, nuclear factor kappa light chain enhancer of activated B cells and interleukin-10 (p<0.001) levels at day 60. In conclusion, the findings of this study suggest that ARE has adaptogenic properties in healthy geriatric dogs by improving haematological and biochemical profiles, enhancing antioxidant defence, reducing stress and modulating inflammatory responses.

The SAGES masters program presents the 10 seminal articles for laparoscopic sleeve gastrectomy.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program includes eight distinct clinical pathways. The Bariatric Surgery Pathway focuses on three anchoring procedures, including the laparoscopic sleeve gastrectomy (LSG) which is the most commonly performed bariatric procedure in the United States. In this article, we present and discuss the top 10 seminal articles regarding the LSG. The literature was systematically searched to identify the most cited papers on LSG. The SAGES Metabolic and Bariatric Surgery committee reviewed the most cited article list, and using expert consensus elected the seminal articles deemed most pertinent to LSG. These articles were reviewed in detail by committee members and are presented here. The top 10 most cited sentinel papers on LSG focus on operative safety, outcomes, surgical technique, and physiologic changes after the procedure. A summary of each paper is presented, including expert appraisal and commentary. The seminal articles presented support the widespread acceptance and use of the LSG by bolstering the understanding of its mechanism of action and by demonstrating its safety and excellent patient outcomes. All bariatric surgeons should be familiar with these 10 landmark articles.

Aging drives cerebrovascular network remodeling and functional changes in the mouse brain

Aging is frequently associated with compromised cerebrovasculature and pericytes. However, we do not know how normal aging differentially impacts vascular structure and function in different brain areas. Here we utilize mesoscale microscopy methods and in vivo imaging to determine detailed changes in aged murine cerebrovascular networks. Whole-brain vascular tracing shows an overall ~10% decrease in vascular length and branching density with ~7% increase in vascular radii in aged brains. Light sheet imaging with 3D immunolabeling reveals increased arteriole tortuosity of aged brains. Notably, vasculature and pericyte densities show selective and significant reductions in the deep cortical layers, hippocampal network, and basal forebrain areas. We find increased blood extravasation, implying compromised blood-brain barrier function in aged brains. Moreover, in vivo imaging in awake mice demonstrates reduced baseline and on-demand blood oxygenation despite relatively intact neurovascular coupling. Collectively, we uncover regional vulnerabilities of cerebrovascular network and physiological changes that can mediate cognitive decline in normal aging.

The impact of pregnancy on sexual functioning in Polish women.

Sexual life of pregnant women alters during pregnancy due to the physiologic,' anatomic and hormonal changes in her body. Therefore, the aim of this study was to evaluate female sexual functioning after becoming pregnant. A prospective survey study including 148 pregnant women. An anonymous questionnaire including 60 inquiries concerning intimate relationship before and during pregnancy was performed. The following statistical test were used: Chi-square test of independence, Spearman's rank correlation coefficient and Wilcoxon test. The significance level of p = 0.05 was assumed. Most of the respondents were between 31 and 40years old (55%). Majority of them were married (86%). During pregnancy, slightly more than half of women had a moderate need for sexual intercourse (51%), a large percentage of them had a low need (32%), a high need for intercourse was declared by 17% of women. The correlation analysis showed a statistically significant relationship between women's education and the need for sex before pregnancy (p = 0.049). Respondents with higher degrees of education more often felt the need for intercourse before pregnancy. No correlation was found between education and the need for intercourse after pregnancy (p = 0.107). After becoming pregnant, 51% of women had less need for intercourse, 7% more, and 42% the same as before pregnancy, and these differences were statistically significant (p < 0.001). Also, a decreased satisfaction with sexual intercourse was reported during pregnancy (p < 0.001). After getting pregnant, the average number of intercourses decreased in majority (71%) of respondents, and differences in the number of intercourses before and during pregnancy were statistically significant (p < 0.001). Pregnancy has significant impact on woman's sexuality. After becoming pregnant majority of women declare less need for sexual intercourses, decreased number of intercourses with less satisfaction.

Combined transcriptomics and metabolomics analysis reveals salinity stress specific signaling and tolerance responses in the seagrass Zostera japonica.

Multiple regulatory pathways of Zostera japonica to salt stress were identified through growth, physiological, transcriptomic and metabolomic analyses. Seagrasses are marine higher submerged plants that evolved from terrestrial monocotyledons and have fully adapted to the high saline seawater environment during the long evolutionary process. As one of the seagrasses growing in the intertidal zone, Zostera japonica not only has the ability to quickly adapt to short-term salt stress but can also survive at salinities ranging from the lower salinity of the Yellow River estuary to the higher salinity of the bay, making it a good natural model for studying the mechanism underlying the adaptation of plants to salt stress. In this work, we screened the growth, physiological, metabolomic, and transcriptomic changes of Z. japonica after a 5-day exposure to different salinities. We found that high salinity treatment impeded the growth of Z. japonica, hindered its photosynthesis, and elicited oxidative damage, while Z. japonica increased antioxidant enzyme activity. At the transcriptomic level, hypersaline stress greatly reduced the expression levels of photosynthesis-related genes while increasing the expression of genes associated with flavonoid biosynthesis. Meanwhile, the expression of candidate genes involved in ion transport and cell wall remodeling was dramatically changed under hypersaline stress. Moreover, transcription factors signaling pathways such as mitogen-activated protein kinase (MAPK) were also significantly influenced by salt stress. At the metabolomic level, Z. japonica displayed an accumulation of osmolytes and TCA mediators under hypersaline stress. In conclusion, our results revealed a complex regulatory mechanism in Z. japonica under salt stress, and the findings will provide important guidance for improving salt resistance in crops.

The lived experiences of fatigue among patients receiving haemodialysis in Oman: a qualitative exploration

BackgroundFatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients’ quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.MethodsAn exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.ResultsFindings highlighted three themes: (i)“Inevitability of fatigue,” (ii)“Contributors to physical fatigue,” and (iii)“Contributors to mental fatigue.” Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.ConclusionsThis study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Remimazolam vs. propofol for general anaesthesia in elderly patients: a meta-analysis with trial sequential analysis.

Elderly patients comprise an increasing proportion of patients undergoing surgery, and they require special attention due to age-related physiological changes. Propofol is the traditional agent for anaesthesia, and recently, remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as an alternative to propofol in general anaesthesia. We aim to compare remimazolam vs. propofol for general anaesthesia in elderly patients regarding hypotension, induction characteristics, haemodynamics and recovery outcomes. Meta-analysis with sensitivity and trial sequential analyses (TSA) to assess inconsistencies. Risk ratios and mean differences with 95% confidence intervals (95% CIs) were computed using a random effects model. Subgroups and meta-regression according to anaesthesia methods were also performed. We systematically searched MEDLINE, Embase and Cochrane for randomised controlled trials (RCTs) up to January 1, 2024. Patients ay least 60 years old, comparing remimazolam vs. propofol for general anaesthesia. Eleven RCTs (947 patients) were included. Compared with propofol, remimazolam was associated with lower postinduction and intra-operative hypotension (RR 0.41, 95% CI 0.27 to 0.62, P < 0.001) and incidence of bradycardia (risk ratio 0.58, 95% CI 0.34 to 0.98, P = 0.04), with a higher heart rate (P = 0.01). The incidence of injection pain was lower (P < 0.001), but remimazolam was associated with a longer time to loss of consciousness (P < 0.001) and a higher bispectral index at loss of consciousness (P = 0.04). No differences were found for mean arterial pressure, emergence time, extubation time and incidence of emergence agitation. The TSA was consistent and achieved the required information size for hypotension. Remimazolam significantly reduced the risk of hypotension, bradycardia and injection pain, despite an increase in the time to loss of consciousness. Remimazolam appears to be an effective and well tolerated alternative to propofol in elderly patients undergoing general anaesthesia.

Educational Implications: Physiological Changes in Eye Movement Desensitization and Reprocessing Treatment for Post-Traumatic Stress Disorder

Despite more than three decades of research, the educational community's understanding of the mechanisms underlying Eye Movement Desensitization and Reprocessing treatment remains incomplete. This article critically examines the existing literature, focusing on the physiological mechanisms present when Eye Movement Desensitization and Reprocessing therapy is successfully administered. The review encompasses various research methodologies, including neuroimaging investigations tracking volumetric changes, shifts in relative brain activity across regions, and electroencephalographical alterations in brain function. Through this exploration, the authors underscore the necessity for future studies that delve into the mechanisms of action within children and adolescents and the transformations associated with treating complex post-traumatic stress disorder. The article will identify gaps in knowledge, emphasizing implications for educators and educational practices. A deeper understanding of these phenomena will provide insights for educators and the approaches used to address trauma-related issues in educational settings.

Assessment of Intraday Variations in Skin Indentation Resistance.

Information about the mechanical properties of skin and their changes with age and other conditions is important to help characterize skin physiology and pathological changes. One method to obtain this information is to measure the force required to indent the skin to a specified indentation depth (FORCE). This process measures the tissue's resistance to indentation or its compressibility and is related to the tissue's elastic modulus. Since such measurements are made in clinical and other settings at various times of day (TOD), it is useful to estimate the extent of intraday variations in FORCE that may be expected. This report focuses on this issue. FORCE was self-measured on the volar forearm, 5 cm distal to the antecubital fossa, every two hours from 08:00 to 24:00 hours on two consecutive days by 12 medical students (six females and six males) who were trained in the measurement process using an indentation device (SkinFibroMeter). Variability in FORCE versus TOD was analyzed using the nonparametric Friedman test and differences between genders by the nonparametric Wilcoxon test. Differences between the first day (day 1) and the second day (day 2) were tested at each TOD. The whole-body fat percentage (FAT%) and water percentage (H2O%) were determined for each participant via bioimpedance measurements at 50 KHz. The age and BMI of the combined group (mean ± SD) were 24.5 ± 1.5 years and 23.2 ± 3.3 kg/m2.The overall average FORCE (mean ± SD) for the day over the 16 hours was 84.1 ± 22.7 mN and for day 2, it was 83.4 ± 28.5 mN with no significant difference between day 1 and day 2. For females, the overall two-day average FORCE (mean ± SD) over the 16 hours was 81.8 ± 20.3 mN and for males, it was 85.7 ± 30.1 mN with no significant difference between them (p = 0.271). Overall, there was no statistically significant difference in FORCE among TOD (p = 0.568). FORCE was not correlated with either FAT%, HTO%, or BMI. The findings indicate no statistically significant variation in indentation force in females, males, or combined concerning the TODof the measurement or differences between consecutive days at corresponding times. This suggests that whether such measurements are done in a research setting or within a clinic, they can be done at various TODwith minimal expected variation for a given subject. However, an extension of these findings to persons with skin conditions or ages not herein evaluated must await further study.