Measurement Of iCa Research Articles

Exploring the Impact of State of Charge and Aging on the Entropy Coefficient of Silicon–Carbon Anodes

Due to its improved capacity compared to graphite, silicon is a promising candidate to handle the demands of high-energy batteries. With the introduction of new materials, further aspects of the battery system must be reconsidered. One of those aspects is the heat generation during the charging and discharging of a cell, which delivers important information for the development of cooling systems, the battery management system and the overall performance of the cell. Since the reversible heat presents an important contribution to the overall heat generation during cycling, the entropy coefficient is the main value that needs to be determined. This study evaluates the entropy coefficient of custom-produced 2032 coin half-cells with lithium counter electrodes, containing 45 wt% nanosilicon and 45 wt% carbon black. The potentiometric method, utilizing VR and self-discharge curves, produced reliable results, yielding entropy coefficient values between 95% SoC and 10% SoC during delithiation. These values of the entropy coefficient are consistently negative. Furthermore, ICA measurements identified two phase transitions during delithiation, with these transitions shifting to lower SoC as SoH decreases, impacting the slope of the entropy coefficient.

Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study

ObjectiveTo investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis.MethodsA total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups.ResultsPatients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05).ConclusionBoth AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.

Risk analysis of fluctuating hypercalcemia after leukapheresis in cellular therapy

Optimized management of citrate-induced hypocalcemia is required to provide safe leukapheresis. We prospectively analyzed subjects who underwent leukapheresis for cytotherapy, and evaluated serum ionized (iCa) concentrations before, at the end of, and 1 h after leukapheresis. During leukapheresis, calcium gluconate solution was continuously supplemented intravenously with hourly measurement of iCa. 76 patients including 49 lymphapheresis for chimeric antigen receptor T-cell therapy and 27 stem cell collections were enrolled. Median processing blood volume was 10 L (range, 6–15 L). Fluctuating hypercalcemia, in which the iCa concentration rose above its upper limit 1 h after leukapheresis, was observed in 58 subjects (76.3%). Multivariate analysis revealed that higher ratios of processing blood volume to body weight, more rapid calcium supplementation, and lower iCa concentration at the end of leukapheresis significantly increased elevation of serum iCa concentration by 1 h after leukapheresis. Based on multivariate analyses, we developed a formula and a diagram that accurately estimates serum iCa concentration 1 h post-leukapheresis. This suggests optimal targets for iCa concentration and calcium supplementation rates. In cases with high ratios of processing blood volume to body weight, slowing the rate of blood processing, rather than increasing calcium supplementation should safely alleviate hypocalcemia during leukapheresis without inducing hypercalcemia thereafter.

La ricerca degli anticorpi anti-insula pancreatica in immunofluorescenza è ancora necessaria nell'inquadramento diagnostico del diabete autoimmune?

Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus and autoantibody assays are increasingly available to clinicians. However, the quality of the scientific evidence supporting the use of these tests varies substantially. The aim of this review is to evaluate the state of the art of antibody diagnostics in type 1 diabetes mellitus (T1D), examine all available autoantibodies, their frequency of use and the most established combinations, including advantages and disadvantages of the related dosages and alternative methods of detection. The use of autoantibody tests in diabetes must be optimized based on age, type of patient and diagnostic suspicion suggested by the clinical picture. To date, the combination of islet cell antibodies now available with sensitive, specific, and automated methods, allows the identification of 95-98% of T1D cases and the positive predictive value of the combination of autoantibody markers (GADA, IA-2A, ZnT8A) immunometrically measured is much higher than that provided by the anti-islet cell antibodies (ICA) test in immunofluorescence (IIF). According to the current literature, it is increasingly clear that measurement of ICA in IIF is no longer recommended, as it could reasonably be replaced by the direct measurement of individual autoantibodies.

Association of Hypocalcemia With Mortality of Combat Casualties With Brain Injury and Polytrauma Transported by Critical Care Air Transport Teams.

Hypocalcemia at hospital presentation is associated with increased mortality in trauma patients with hemorrhagic shock. The 2019 updates to the Joint Trauma System Damage Control Resuscitation (DCR) Clinical Practice Guideline recommend calcium supplementation for ionized calcium (iCa) measurements <1.2 mmol/L. Ionized calcium goals for en route critical care (ERCC) following DCR are less defined, and the impact of in-flight hypocalcemia events among critically injured combat wounded is unknown. This study aimed to describe the association between hypocalcemia and mortality for combat-wounded with brain injury and polytrauma requiring transport by Critical Care Air Transport Teams (CCATT). We performed a secondary analysis of a retrospective cohort of patients with moderate-to-severe traumatic brain injury transported by CCATT out of combat theater between January 2007 and May 2014. Additional inclusion criteria included polytrauma and at least one documented in-flight iCa measurement. We categorized exposures based on the minimum in-flight iCa measurement as severe hypocalcemia (iCa <0.9 mmol/L), hypocalcemia (iCa 0.9-1.11 mmol/L), and never hypocalcemic (iCa ≥1.12 mmol/L). The primary outcome measure was mortality. We calculated descriptive statistics and performed multivariate logistic regression to assess the association between hypocalcemia and mortality. We analyzed 190 subjects, with a median age of 24 years (interquartile range [IQR] 21 to 29 years) and 97.7% male gender. Explosive injuries (82.1%) and gunshot wounds (6.3%) were the most common mechanisms of injury. The median injury severity score was 34 (IQR 27 to 43). During the flight, 11.6% of patients had severe hypocalcemia, and 39.5% had hypocalcemia. Among patients with any hypocalcemia measurement in-flight (n = 97), 41.2% had hypocalcemia on pre-flight iCa, 28.9% received blood products in-flight, and 23.7% received in-flight calcium supplementation. Only 32.4% of patients with hypocalcemia or severe hypocalcemia in the setting of vasopressor administration received in-flight calcium supplementation. There was no significant difference in mortality between severe hypocalcemia (9.1%), hypocalcemia (5.3%), and never hypocalcemic (3.2%) patients even after controlling for pre-flight variables. In-flight hypocalcemia events were common among critically ill combat-wounded polytrauma patients transported by CCATT but were not associated with differences in mortality. Future training should emphasize the need for calcium correction among ERCC patients requiring vasopressors. Future studies with larger sample sizes of patients receiving ERCC are needed to assess the association between in-flight calcium supplementation with clinical outcomes.

Morphometric Examinations of Internal Carotid Arteries of Patients with Hypertension and Patients with Type 2 Diabetes Mellitus: A Radio Anatomic Study Based on Computed Tomography Angiography Findings.

The aim of this study is to examine the relationship between the morphological features of A.carotis interna (ICA) and symptoms affecting cerebral blood circulation including type 2 diabetes mellitus (T2DM) and hypertension (HT). In this study, retrospective morphometric analysis of ICA measurements from 100 patients (45-60 years old) was performed on Computed Tomographic Angiography (CTA) images. The images were divided into four groups: patients with HT (group 1), patients with T2DM (group 2), patients with HT and T2DM (group 3), and healthy control group (group 4). Length and diameter measurements of the cervical, petrous, cavernous and terminal segments of the ICA were made by using 3D CTA images and recorded. The measurements of the male and female patients were compared by Mann Whitney-U test and the the groups were compared by using Kruskall Wallis H test. It was found that, there were statistically significant differences between male and female patients in terms of right and left petrous, cavernous and terminal segments of the ICA in Group 1, right and left cervical left cavernous in Group 3, left cervical, right and left petrous, cavernous and right cavernous in Group 4 (p 0.05). According to the Kruskall Wallis H test analysis results, it was determined that there was no statistically significant difference between the patients in 4 groups for all segment measurements (p 0.05). As a result; It was determined that ICA was more affected by hypertension than diabetes. In addition, we think that being knowledgeable of morphometric measurements of ICA will guide the radio-anatomical evaluations and increase the level of microanatomical knowledge in surgical treatment.

Serial monitoring of ionised calcium levels in plateletpheresis donors: A study from tertiary care oncology centre in India

BackgroundPlateletpheresis is a safe procedure, and the most common reaction is hypocalcemia which is transient and self-limiting, but it can have an impact on donor experience and donor return rate. AimTo serially monitor the ionized calcium levels of the plateletpheresis donors and to correlate with symptoms of hypocalcemia if any. MethodsIt was a prospective observational study in 126 healthy voluntary donors eligible for plateletpheresis as per the Departmental SOP and after taking written informed consent. Procedures were conducted on continuous flow centrifugation (CFC) and intermittent flow centrifugation (IFC) cell separators. Donor blood samples were collected in pre-heparinized syringes at different intervals to measure ionized calcium levels (iCa++) by venous blood gas analysis (Cobas 221). ResultsThere was a continuous and gradual decrease in iCa++ from start to 30–45 minutes during the procedure; while the levels showed a gradual increase at end of the procedure and reached near the baseline values after 15−30 min of completion of the procedure. The change in iCa++ was statistically significant at 30 min and 45 min (p < 0.05), which was correlated with symptoms of hypocalcemia observed in 32.5 % (41/126) of the donors. Females experienced more symptoms of hypocalcemia as compared to males (p < 0.01). Donors who underwent plateletpheresis on the IFC machine experienced more symptoms of hypocalcemia as compared to the CFC machine (p < 0.05). ConclusionFor donors with persistent symptoms of hypocalcemia which are unrelieved by procedural modifications (reducing blood return rate, citrate infusion rate, etc.) measurement of iCa++ and administration of oral calcium tablets may be considered.

Changes in the Relationship between Ionized and Total Calcium in Clinically Healthy Dairy Cows in the Period around Calving.

Simple SummaryHypocalcemia is a widespread problem in dairy cows in the first days after calving, which increases the risk for secondary diseases. In practice, the measurement of total blood serum or plasma calcium is widely used to diagnose hypocalcemia. The present study demonstrates a high discrepancy between total and ionized calcium specifically around calving, suggesting that only ionized calcium provides an accurate indication of the animal’s calcium status during that period. We developed an optimized model for prediction of ionized calcium from total calcium, non-esterified fatty acids, beta-hydroxybutyric acid, cholesterol, and phosphorous. However, the precision of that model is still unsatisfactory.We aimed to establish a model for prediction of iCa from tCa, using multivariable regressions with diverse blood constituents. Blood was taken from 14 cows at days −2, 0, 2, 4, 7, and 14 relative to parturition. Cows were clinically healthy, and no hypocalcaemia prophylaxis and treatment were applied. Total calcium and further parameters were determined from frozen serum. Ionized calcium, blood gases, and electrolytes were determined from heparin-stabilized blood samples. Linear regression between iCa and tCa was estimated. Precision improved only slightly using a multivariable model. Best precision was achieved when estimating the iCa:tCa ratio from other blood constituents. To identify the reason behind the poorly predictive value of tCa for iCa, the relative changes of iCa and tCa around calving were calibrated to the respective values of day −2 (=100%) for each cow. An increase in the iCa:tCa ratio was observed from 0.43 at day −2 to 0.48 at day 0, followed by a gradual decrease towards 0.43 at day 7. We conclude that routine measurement of iCa should be implemented in the diagnosis of hypocalcaemia. An optimized estimate of iCa from tCa with non-esterified fatty acids (NEFA), beta-hydroxybutyric acid, cholesterol, and phosphorous as co-predictors is still poorly satisfying.

Effect of pH and storage conditions on measured ionised calcium concentration in dogs and cats

BackgroundAerobic blood sample collection and processing results in increased serum pH and decreased ionised calcium (iCa) concentration. This prospective study aimed to determine the effect of pH and storage conditions...

Influence of Cycling Profile, Depth of Discharge and Temperature on Commercial LFP/C Cell Ageing: Cell Level Analysis with ICA, DVA and OCV Measurements

This paper uses several techniques to monitor the ageing of commercial LiFePO4 cells, which are cycled at 55 °C and −20 °C at various depths of discharge. Ageing at lower depth of discharge leads to higher capacity fading, as compared to higher depth of discharge. The highest capacity fading is observed using 50% depth of discharge for cycling at 55 °C, while the lowest capacity fading is observed for the cells aged at 100% depth of discharge when cycled at −20 °C. Using incremental capacity analysis and differential voltage analysis the capacity fading is monitored and underlying ageing mechanisms are described. The loss of lithium inventory and the loss of active material, especially on the cathode side, are the major degradation mechanisms for the cells. The first incremental capacity analysis peak of the discharge process can be used in our case to predict remaining life and cell capacity.

Agreement of intracranial vessel diameters measured on 2D and 3D digital subtraction angiography using an automatic windowing algorithm

Background and purposePrecise vessel measurement plays a major role in size selection of stents used for the treatment of intracranial aneurysms and became even more critical after the introduction of flow diverter stents. We assessed agreement between intracranial vessel diameters of aneurysm patients measured on 2D digital subtraction (2D DSA) and 3D volume rendering digital subtraction angiography (3D DSA) images using an automatic windowing algorithm. Materials and methodsTen patients with intracranial aneurysms were enrolled and 120 measurement points were selected on both 2D and 3D DSA images acquired by a biplane angiographic system. Automatic windowing was applied to the 3D DSA images. Inter-method agreement of vessel measurements on 2D and 3D DSA images was assessed by Bland Altman plots and intraclass correlation coefficients (ICC). Inter- and intra-rater agreement of measurements on 3D DSA images were assessed by ICCs. ResultsThe mean differences between measurements on 2D and 3D DSA images were 0.14mm for the ICA, and 0.18mm for the ACA and MCA, which is about the size of one 3D DSA image voxel. For ICA measurements, inter-method, inter-rater and intra-rater agreements were good or excellent (consistency and absolute ICC≥0.95). For ACA and MCA measurements, the inter-method, inter-rater and intra-rater agreements were also good or excellent (consistency ICC=0.94, 0.89 and 0.93, absolute ICC=0.83, 0.84 and 0.85 respectively). ConclusionsVessel diameters may be measured on 3D DSA images with sufficient reliability for clinical use when applying an automatic windowing algorithm.

Differences of Ionized Calcium Concentrations in Continuous Renal Replacement Therapy Among Three Analyzers

Abstract Continuous renal replacement therapy (CRRT) is a standard of care for critically ill patients according to the guidelines for Kidney Disease Improving Global Outcomes Clinical Practice. Within the CRRT dialysis instrument, blood requires anticoagulation with citrate with a goal to have ionized calcium (iCa) &lt;0.4 mmol/L. In our hospital system, nephrologists who manage the therapy rotate through these hospitals, although in each of the hospitals, instruments that measure iCa are different. The objective of this study was to demonstrate the differences in measurement by these instruments. Method Twelve patient samples were drawn in triplicate and compared in the three different analyzers: RAPIDPoint, Nova Biomedical, and GEM4000 analyzers. One of the analyzers uses whole blood while the other two measure iCa in plasma. In one of the facilities, samples were spun, decapped, sent to the automated line outlet, and tested after having been exposed to air, and thus an experiment in another facility decapped the specimens for an hour and retested. Results Postfilter iCa measurements ranged from 0.18 to 0.64 mmol/L; however, range was different for each of the instruments: The Nova measurements averaged 0.55 mmol/L (range 0.42-0.64), the Rapid Point 0.36 (0.28-0.45), and the GEM 0.30 (0.18-0.39). The average difference between results of the Nova and GEM was 0.25 mmol/L, between Nova and RAPIDPoint 0.19 mmol/L, and GEM and RAPIDPoint 0.06 mmol/L. The differences between the values measured 1 hour after the sample had been decapped were negligible. Conclusion This study demonstrates inconsistency among instruments when measuring iCa in CRRT blood samples. The Nova analyzer tends to give higher results while the Rapid Point and GEM are lower and with values closer together. Currently, there is no reference material or reference method established for low iCa in CRRT samples. This study helped our clinicians understand the differences that occur between the different analyzers for low levels of iCa in CRRT blood samples.

Calcium state estimation by total calcium: the evidence to end the never-ending story

Background Total blood calcium (TCa) is routinely used to diagnose and manage mineral and bone metabolism disorders. Numerous laboratories adjust TCa by albumin, though literature suggests there are some limits to this approach. Here we report a large retrospective study on agreement rate between ionized calcium (iCa) measurement and TCa or albumin-adjusted calcium measurements. Methods We retrospectively selected 5055 samples with simultaneous measurements of iCa, TCa, albumin and pH. We subgrouped our patients according to their estimated glomerular filtration rate (eGFR), albumin levels and pH. We analyzed each patient's calcium state with iCa as reference to determine agreement rate with TCa and albumin-adjusted calcium using Payne, Clase, Jain and Ridefelt formulas. Results The Payne formula performed poorly in patients with abnormal albumin, eGFR or pH levels. In patients with low albumin levels or blood pH disorders, Payne-adjusted calcium may overestimate the calcium state in up to 80% of cases. Similarly, TCa has better agreement with iCa in the case of hypoalbuminemia, but performed similarly to the Payne formula in patients with physiological albumin levels. The global agreement rate for Clase, Jain and Ridefelt formulas suggests significant improvement compared to Payne calcium adjustment but no significant improvement compared to TCa. Conclusions Total and albumin-adjusted calcium measurement leads to a misclassification of calcium status. Moreover, accurate calcium state determination depends on blood pH levels, whose measurement requires the same pre-analytical restrictions as iCa measurement. We propose that iCa should instead become the reference method to determine the real calcium state.

Comparison of arterial and venous blood-gas values in anesthetized Dorset cross-bred lambs (Ovis aries) using a point-of-care analyzer

ObjectiveTo determine the degree of agreement between arterial and venous blood gases in anesthetized lambs using a point-of-care analyzer. Study designProspective experimental study. AnimalsA group of 12 female Dorset cross-bred lambs, weighing 37.3 ± 7.4 kg (mean ± standard deviation). MethodsLambs were anesthetized with isoflurane for catheterization of the jugular vein and femoral artery, and blood samples were collected simultaneously for analysis of pH, PCO2, PO2, base excess (BE), bicarbonate (HCO3−), total carbon dioxide (tCO2), oxygen saturation (SO2), ionized calcium (iCa) and potassium (K+) using the Vet Scan i-STAT handheld analyzer. The Bland–Altman method was used to calculate agreement between arterial and venous measurements. ResultsStrong agreement was identified between arterial and venous pH (bias = 0.04; 95% limits of agreement = 0.02–0.06), K+ (bias = –0.1 and 95% limits of agreement = –0.8 to 0.5) and iCa (bias = 0.04; 95% limits of agreement = –0.08 to 0.0003). There was poor agreement for PO2 (bias = 168.0; 95% limits of agreement = 77.4–258.7) and SO2 (bias = 9.1; 95% limits of agreement = 2.8–15.3), as these values were higher in arterial blood than in venous blood. Moderate agreement was present for BE (bias = 1.7; 95% limits of agreement = –2.7 to 6.1), PCO2 (bias = –2.1; 95% limits of agreement = –7.5 to 3.4), HCO3− (bias = 1.1; 95% limits of agreement = –3.1 to 5.3) and tCO2 (bias = 1.0; 95% limits of agreement = –3.3 to 5.3). Conclusions and clinical relevanceVenous blood can be used for the measurement of pH, K+ and iCa in anesthetized Dorset cross-bred lambs. Arterial blood is required for accurate measurement of PO2, SO2, PCO2, HCO3−, tCO2 and BE to assess systemic blood oxygenation and pulmonary function in anesthetized Dorset cross-bred lambs.

Value of the 6-Hour Postoperative Ionized Calcium Slope in Predicting Post- Thyroidectomy Occurrence of Hypocalcemia

Objective: To determine the value of the 6-hour postoperative ionized Calcium (iCa) slope, versus 6-hour postoperative Calcium alone, in predicting the occurrence of hypocalcemia in patients who underwent thyroid surgery in a tertiary hospital in Metro Manila.&#x0D; Methods:&#x0D; Study Design: Retrospective Cross-Sectional Study&#x0D; Setting: Tertiary Private Hospital&#x0D; Subjects: Pre-operative and 6-hour postoperative ionized calcium determinations were analyzed in 59 patients of the ENT-HNS department in a tertiary hospital in Metro Manila who underwent thyroid surgery from January 2009 to December 2013.&#x0D; Results: The 6-hr postoperative iCa slope (difference between the pre-operative and 6-hour postoperative iCa levels) of ≥0.18 mmol/L correctly predicted 57.1% of patients who eventually developed hypocalcemia, with a specificity of 81.6%, and a positive predictive value of 63.2%. In contrast, the 6-hour postoperative iCa measurement identified only 23.8% (5 out of 21) patients who developed hypocalcemia.&#x0D; Conclusion: The 6-hr postoperative iCa slope increased the probability of identifying patients who developed hypocalcemia from 23.8% to 57.1%. However, as a single determination, this may not suffice to take the place of serial iCa measurements after thyroid surgery.&#x0D; Keywords: ionized calcium (iCa), hypocalcemia, thyroidectomy

Intracellular Calcium Levels in Patients with Type 2 Diabetes, First-Degree Relatives of Patients with Type 2 Diabetes, and Age-Matched Controls

Purpose: Measurement of Intracellular Calcium (iCa) levels in red blood cells in patients with predisposition to type 2 diabetes (T2D), such as the first-degree relatives of patients with T2D, in comparison with healthy individuals and patients with T2D. Materials and Methods: Our study comprised of three groups of 25 age-matched, 38-65 years-old persons (58% males): 1.) non-insulin treated T2D patient (body mass index (βμΙ) 28.3±3.4 kg/m2, HbA1c 7.5±1.6%) 2.) first-degree relatives of T2D patients (βμΙ 25.3±3.6 kg/m2, HbA1c 5.3±0.4%) 3.) healthy controls (βμΙ 24.3±3.4 kg/m2, HbA1c 4.9±0.5%). Measurement of iCa was conducted by the method of atomic resonance with the use of a spectrophotometer. Results: Lower levels of iCa were observed in the relatives of patients with T2D vs. the control group (0.39±0.16 vs. 0.48±0.3 mg/L, p=0.049) and in patients with T2D vs. the control group (0.33±0.21 vs. 0.48±0.3 mg/L, p=0.041). In contrast, iCa levels did not differ between patients with T2D and the first-degree relatives of patients with T2D (p=0.38). Conclusion: The comparison of iCa levels in the three groups shows a gradual decrease from control group to T2D patients. It is impressive that statistical analysis revealed significant differences between the first-degree relatives of patients with T2D and the control group, and between patients with T2D and the control group, but not between patients with T2D and the first-degree relatives of patients with T2D. It could be reasonably hypothesized that individuals with known predisposition for T2D have a defective genotype that negatively affects intracellular molecular signaling in which calcium is implicated. Disclosure I.F. Stergiou: None. T. Didangelos: None. K. Tziomalos: None. Z. Kontoninas: None. N. Raikos: None. T. Vyzantiadis: None. A.I. Hatzitolios: None.

Blunted shear-mediated dilation of the internal but not common carotid artery in response to lower body negative pressure

Shear-mediated dilation in peripheral conduit arteries is blunted with sympathetic nervous system (SNS) activation; however, the effect of SNS activation on shear-mediated dilation in carotid arteries is unknown. We hypothesized that SNS activation reduces shear-mediated dilation in common and internal carotid arteries (CCA and ICA, respectively), and this attenuation is greater in the ICA compared with the CCA. Shear-mediated dilation in the CCA and ICA were measured in nine healthy men (24 ± 1 yr) with and without SNS activation. Shear-mediated dilation was induced by 3 min of hypercapnia (end-tidal partial pressure of carbon dioxide +10 mmHg from individual baseline); SNS activity was increased with lower body negative pressure (LBNP; -20 mmHg). CCA and ICA measurements were made using Doppler ultrasound during hypercapnia with (LBNP) or without (Control) SNS activation. LBNP trials began with 5 min of LBNP with subjects breathing hypercapnic gas during the final 3 min. Shear-mediated dilation was calculated as the percent rise in peak diameter from baseline diameter. Sympathetic activation attenuated shear-mediated dilation in the ICA (Control vs. LBNP, 5.5 ± 0.7 vs. 1.8 ± 0.4%, P < 0.01), but not in the CCA (5.1 ± 1.2 vs. 4.2 ± 1.0%, P = 0.31). Moreover, absolute reduction in shear-mediated dilation via SNS activation was greater in the ICA than the CCA (-3.6 ± 0.7 vs. -0.9 ± 0.8%, P = 0.02). Our data indicate that shear-mediated dilation is attenuated during LBNP to a greater extent in the ICA compared with the CCA. These results potentially provide insight into the role of SNS activation on cerebral perfusion, as the ICA is a key supplier of blood to the brain. NEW & NOTEWORTHY We explored the effect of acute sympathetic nervous system (SNS) activation on shear-mediated dilation in the common and internal carotid arteries (CCA and ICA, respectively) in young healthy men. Our data demonstrate that hypercapnia-induced vasodilation of the ICA is attenuated during lower body negative pressure to a greater extent than the CCA. These data may provide novel information related to the role of SNS activation on cerebral perfusion in humans.

Estradiol up-regulates L-type Ca2+ channels via membrane-bound estrogen receptor/phosphoinositide-3-kinase/Akt/cAMP response element-binding protein signaling pathway

In long QT syndrome type 2, women are more prone than men to the lethal arrhythmia torsades de pointes. We previously reported that 17β-estradiol (E2) up-regulates L-type Ca2+ channels and current (ICa,L) (∼30%) in rabbit ventricular myocytes by a classic genomic mechanism mediated by estrogen receptor-α (ERα). In long QT syndrome type 2 (IKr blockade or bradycardia), the higher Ca2+ influx via ICa,L causes Ca2+ overload, spontaneous sarcoplasmic reticulum Ca2+ release, and reactivation of ICa,L that triggers early afterdepolarizations and torsades de pointes. The purpose of this study was to investigate the molecular mechanisms whereby E2 up-regulates ICa,L, which are poorly understood. H9C2 and rat myocytes were incubated with E2 ± ER antagonist, or inhibitors of downstream transcription factors, for 24 hours, followed by western blots of Cav1.2α1C and voltage-clamp measurements of ICa,L. Incubation of H9C2 cells with E2 (10-100 nM) increased ICa,L density and Cav1.2α1C expression, which were suppressed by the ER antagonist ICI182,780 (1 μM). Enhanced ICa,L and Cav1.2α1C expression by E2 was suppressed by inhibitors of phosphoinositide-3-kinase (Pi3K) (30 μM LY294002; P <.05) and Akt (5 μM MK2206) but not of mitogen-activated protein kinase (5 μM U0126) or protein kinase A (1 μM KT5720). E2 incubation increased p-CREB via the Pi3K/Akt pathway, reached a peak in 20 minutes (3-fold), and leveled off to 1.5-fold 24 hours later. Furthermore, a CREB decoy oligonucleotide inhibited E2-induced Cav1.2α1C expression, whereas membrane-impermeable E2 (E2-bovine serum albumin) was equally effective at Cav1.2α1C up-regulation as E2. Estradiol up-regulates Cav1.2α1C and ICa,L via plasma membrane ER and by activating Pi3K, Akt, and CREB signaling. The promoter regions of the CACNA1C gene (human-rabbit-rat) contain adjacent/overlapping binding sites for p-CREB and ERα, which suggests a synergistic regulation by these pathways.

Anticoagulation assessment methods in plasma exchange with regional citrate anticoagulation: evaluation of post-filter and filtered plasma ionized calcium.

To assess the possibility of using filtered plasma instead of postfilter ionized calcium (iCa) for the assessment of anticoagulation in plasma exchange (PE) with citrate anticoagulation. 140 PE treatments were performed using either 4% or 15% citrate at a comparable dose. Paired samples of postfilter blood and filtered plasma were taken for iCa measurements with a point-of-care analyzer. Anticoagulation was also assessed with a bedside clotting time and visual assessment of the circuit after procedures. In 490 paired samples, mean postfilter iCa was 0.39±0.14 mmol/L, and filtered plasma iCa was 0.33±0.11 mmol/L. Mean bedside clotting time was 18±7 minutes. Neither the postfilter (r=0.03, p=0.73) nor the filtered plasma iCa (r=0.09, p=0.25) correlated significantly with bedside clotting time. Bland-Altman analysis showed a modest agreement between filtered plasma and postfilter iCa values (mean difference -0.07mmol/L, upper and lower 95% limits of agreement 0.10 and -0.23mmol/L). Median visual assessment score was excellent at all three checkpoints. A modest agreement between filtered plasma and postfilter iCa values could be acceptable if only a confirmation of anticoagulant effect is required. Measuring filtered plasma instead of postfilter iCa would reduce blood loss with sampling, which could be important in some settings. .

Consolidative Technique Otoplasty: Comprehensive Approach in Combining Techniques.

This study aimed to present the long-term results of the consolidative technique otoplasty (CTO). Patient age, sex, duration of follow-up, and how the deformity (bilateral-unilateral) occurred were determined. The kind of anesthesia, duration of surgery, surgical techniques used during the operation were reported, and the preoperative and postoperative distances between the ear and head were measured at four points (SUP: The highest point of the helix; SCA: the concha superior sticking points; ICA: stick point of Concha at the inferior; and lobular). Early- and late-term complications were recorded in the postoperative period. A total of 63 (21M-42FM) patients whose average age of 21:41±8.96 (7-41), 119 ears (Right: 58/Left: 61) were operated on with this technique between 2013 and 2015. Mean follow-up was 18:22±9:42months. Anterior scoring was performed for three patients; concha resection was performed in 17 patients. Fifty-five patients were operated on as primary otoplasties and eight were secondary otoplasties. When the preoperative and postoperative SUP, SCA, ICA, and lobule measurements for both ears were compared, the postoperative values were found to be significantly decreased (p<0.001). This technique may be an alternative in the repairs of prominent ears, and it provides an intervention opportunity for all the anatomical structures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .