Blood Oxygen Research Articles

The influence of biological rhythms on the initial onset of status epilepticus in critically ill inpatients and the study of its predictive Model.

This study aims to explore the relationship between the circadian rhythms of critically ill patients and the incidence of Status Epilepticus (SE), and to develop a predictive model based on circadian rhythm indicators and clinical factors. We conducted a diurnal rhythm analysis of vital sign data from 4413 patients, discovering significant differences in the circadian rhythms of body temperature, blood oxygen saturation, and heart rate between the SE and non-SE groups, which were correlated with the incidence of SE. We also employed various machine learning algorithms to identify the ten most significant variables and developed a predictive model with strong performance and clinical applicability. Our research provides a new perspective and methodology for the study of biological rhythms in critically ill patients, offering new evidence and tools for the prevention and treatment of SE. Our findings are consistent or similar to some in the literature, while differing from or supplementing others. We observed significant differences in the vital signs of epileptic patients at different times of the day across various diagnostic time groups, reflecting the regulatory effects of circadian rhythms. We suggest heightened monitoring and intervention of vital signs in critically ill patients, especially during late night to early morning hours, to reduce the risk of SE and provide more personalized treatment plans.

Perfusion index and mean arterial pressure after return of spontaneous circulation in out-of hospital cardiac arrest (OHCA) and their relationship with perfusion and survival

Abstract Funding Acknowledgements None. Background Current guidelines for post-cardiac arrest care recommend targeting mean arterial pressure (MAP) to restore adequate perfusion indicated by adequate urine output (UO) and normal or decreasing lactate, avoiding hypotension (MAP < 65 mmHg). The peripheral perfusion index (PI) is the ratio of the pulsatile blood flow to the non-pulsatile blood flow measured peripherally by a standard pulse-oximeter, and it represents a promising non-invasive tool to assess perfusion. The goal of this study is to assess whether prehospital PI and MAP measurements are associated with lactate clearance (LC), adequate UO and 30-days survival with good neurological outcome. Methods A retrospective analysis of prospectively collected data (January 2018 - March 2023) in two cardiac arrest registries located in Italy and Belgium was performed. PI was automatically and continuously measured by the manual monitor/defibrillator. The mean PI value of each minute after ROSC was extracted from the monitor data report and the mean value of 30 min of PI monitoring (MPI30) was calculated and categorized in tertiles (MPI30 T1-T3). The lowest prehospital value for MAP recording was considered. LC was defined by a serum lactate level <2 mmol/L at 6 hours. Inadequate UO was defined as < 0.5mL/kg/h averaged at 12 hours. Neurological outcome was assessed with the Cerebral Performance Category (CPC) at 30 days. Results Out of the 397 OHCA patients admitted to the ICU after ROSC enrolled over the study period 206 had a MPI30 value available and were included in this study; MAP value was available in 186 patients. In the subgroup of patients with hypotension, patients with MPI30 in T1 showed higher incidence of inadequate UO at 12 hours (78.9% vs 25.8%, p<0.001). At multivariable logistic regression, after adjusting for MAP, shockable rhythm, age, and dosage of adrenaline administered, MPI30 was independently associated with inadequate UO (OR 0.68, 95% CI 0.50-0.91, p=0.01). Patients with hypotension and MPI30 in T1 showed lower LC at 6h (15.8% vs 43.4%, p=0.02) when compared to the remaining population. At multivariable Cox proportional-hazard regression, after correction for shockable rhythm, age, and total amount of adrenaline administered, patients with hypotension and MPI30 in T1 showed lower survival with CPC 1-2 at 30 days (HR 2.61, 95% CI 1.52-4.51, p=<0.001) when compared to patients without hypotension or with hypotension but MPI30 in T2-T3. No difference in LC, adequate UO and survival with good neurological outcome was found between patients with hypotension and MPI30 in T2-T3 compared to patients without hypotension. Conclusion PI is a useful indicator of perfusion in patients with hypotension after OHCA. Patients with hypotension and reduced PI showed higher incidence of inadequate UO and lower incidence of LC, as well as association with lower survival at 30 days with CPC 1-2.Lactate clearenceSurvival at 30days with CPC 1-2

Mapping interictal discharges using intracranial EEG-fMRI to predict postsurgical outcomes.

Various subjective and objective methods have been proposed to identify which interictal epileptiform discharge (IED)-related EEG-fMRI results are more likely to delineate seizure generating tissue in patients with drug-resistant focal epilepsy for the purposes of surgical planning. In this intracranial EEG-fMRI study, we evaluated the utility of these methods to localize clinically relevant regions pre-operatively and compared the extent of resection of these areas to post-operative outcome. Seventy patients admitted for intracranial video-EEG monitoring were recruited for a simultaneous intracranial EEG-fMRI study. For all analyses of blood oxygen level-dependent responses associated with IEDs, an experienced epileptologist identified the most Clinically Relevant brain activation cluster using available clinical information. The Maximum cluster (the cluster with the highest z-score) was also identified for all analyses and assigned to one of three confidence levels (low, medium, or high) based on the difference of the peak z-scores between the Maximum and Second Maximum cluster (the cluster with the second highest peak z-value). The distance was measured and compared between the peak voxel of the aforementioned clusters and the electrode contacts where the interictal discharge and seizure onset were recorded. In patients who subsequently underwent epilepsy surgery, the spatial concordance between the aforementioned clusters and the area of resection was determined and compared to post-operative outcome. We evaluated 106 different IEDs in 70 patients. Both subjective (identification of the Clinically Relevant cluster) and objective (Maximum cluster much more significant than the second maximum cluster) methods of culling non-localizing EEG-fMRI activation maps increased the spatial concordance between these clusters and the corresponding IED or seizure onset zone contacts. However, only the objective methods of identifying medium and high confidence maps resulted in a significant association between resection of the peak voxel of the Maximum cluster and post-operative outcome. Resection of this area was associated with good post-operative outcomes but was not sufficient for seizure freedom. On the other hand, we found that failure to resect the medium and high confidence Maximum clusters was associated with a poor post-surgical outcome (negative predictive value = 1.0, sensitivity = 1.0). Objective methods to identify higher confidence EEG-fMRI results are needed to localize areas necessary for good post-operative outcomes. However, resection of the peak voxel within higher confidence Maximum clusters is not sufficient for good outcomes. Conversely, failure to resect the peak voxel in these clusters is associated with a poor post-surgical outcome.

Perfusion index: could it be a new tool for early identification of pulmonary embolism severity?

Perfusion index (PI) is a promising indicator for monitoring peripheral perfusion. The present study aimed to compare the efficiency of PI and PESI score in estimating the 30-day mortality and treatment needs of patients diagnosed with pulmonary embolism in the emergency department. This study was prospective and observational. The demographic features of the patients, comorbidities, vital signs, PESI score, PI, treatment applied to the patient and airway management, right ventricular diameter/left ventricular diameter ratio, length of hospital stay, outcome, and 30-day mortality were recorded. A total of 94 patients were included. All patients' vital signs and PI values were recorded on admission. The mean pulse rate (p = 0.001) and shock index (p = 0.017) values of deceased patients were statistically significantly higher, while the mean PI (p = 0.034) was statistically significantly lower. PESI score and PI were statistically significant to predict the need for mechanical ventilation (PI, p = 0.004; PESI score, p < 0.001), inotropic treatment (PI, p = 0.047; PESI score p = 0.005), and thrombolytic therapy (PI, p = 0.035; PESI score p = 0.003). According to the ROC curve, the mortality prediction power of both PESI (AUC: 0.787, 95% CI 0.688-0.886, cutoff: 109.5, p < 0.001) and PI index (AUC: 0.668, 95% CI 0.543-0.793, cutoff: 1, p = 0.011) were determined as statistically significant. PI might be helpful in clinical practice as a tool that can be applied to predict mortality and treatment needs in PE.

Task-Dependent Brain Activity in Generalized Anxiety Disorder Determined By Bayesian Spatio-Temporal Single Case Model

Introduction: Data obtained from functional magnetic resonance imaging (fMRI) have a complex structure. Considering the special features of this type of data in analyses is of particular importance. Previous studies on generalized anxiety disorder (GAD) as a prevalent mental disorder using functional neuroimaging have had conflicting results. In this study, we apply a Bayesian spatiotemporal model to this type of data which considers both spatial and temporal dependence among regions which is one of the most essential features to consider. Methods: In this single-subject study, we analyze data from a patient with GAD and a healthy participant. Both participants are 24-year-old women who are assigned an emotion reactivity task (matching neutral and negative facial expressions) inside a scanner. The spatial Bayesian variable selection method is used to detect blood oxygen level-dependent activation in fMRI data. Results: Activation areas in neutral and negative facial expressions are provided for both participants by posterior probability map. The results of our study show a greater level of activity in the GAD participant in comparison to the healthy participant in responding to the negative matching task. Conclusion: the GAD patient showed more neural activity in response to negative facial expressions than the healthy participant in brain regions related to emotional response in the areas of the frontal Pole, middle frontal gyrus, insular cortex, and frontal orbital cortex. Moreover, the inferior frontal gyrus in the patient with GAD showed more reaction to negative emotional stimuli.

Porcine Model of Cerebral Ischemic Stroke Utilizing Intracortical Recordings for the Continuous Monitoring of the Ischemic Area

Purpose: Our aim was to use intracortical recording to enable the tracking of ischemic infarct development over the first few critical hours of ischemia with a high time resolution in pigs. We employed electrophysiological measurements to obtain quick feedback on neural function, which might be useful for screening, e.g., for the optimal dosage and timing of agents prior to further pre-clinical evaluation. Methods: Micro-electrode arrays containing 16 (animal 1) or 32 electrodes (animal 2–7) were implanted in the primary somatosensory cortex of seven female pigs, and continuous electrical stimulation was applied at 0.2 Hz to a cuff electrode implanted on the ulnar nerve. Ischemic stroke was induced after 30 min of baseline recording by injection of endothelin-1 onto the cortex adjacent to the micro-electrode array. Evoked responses were extracted over a moving window of 180 s and averaged across channels as a measure of cortical excitability. Results: Across the animals, the cortical excitability was significantly reduced in all seven 30 min segments following endothelin-1 injection, as compared to the 30 min preceding this intervention. This difference was not explained by changes in the anesthesia, ventilation, end-tidal CO2, mean blood pressure, heart rate, blood oxygenation, or core temperature, which all remained stable throughout the experiment. Conclusions: The animal model may assist in maturing neuroprotective approaches by testing them in an accessible model of resemblance to human neural and cardiovascular physiology and body size. This would constitute an intermediate step for translating positive results from rodent studies into human application, by more efficiently enabling effective optimization prior to chronic pre-clinical studies in large animals.

Pseudo-resting-state functional MRI derived from dynamic susceptibility contrast perfusion MRI can predict cognitive impairment in glioma.

Resting-state functional MRI (rs-fMRI) can be used to estimate functional connectivity (FC) between different brain regions, which may be of value for identifying cognitive impairment in patients with brain tumors. Unfortunately, neither rs-fMRI nor neurocognitive assessments are routinely assessed clinically, mostly due to limitations in exam time and cost. Since DSC perfusion MRI is often used clinically to assess tumor vascularity and similarly uses a gradient echo-EPI sequence for T2*sensitivity, we theorized a "pseudo-rs-fMRI" signal could be derived from DSC perfusion to simultaneously quantify FC and perfusion metrics, and these metrics can be used to estimate cognitive impairment in patients with brain tumors. N=24 consecutive patients with gliomas were enrolled in a prospective study that included DSC perfusion MRI, rs-fMRI, and neurocognitive assessment. Voxel-wise modeling of contrast bolus dynamics during DSC acquisition was performed and then subtracted from the original signal to generate a residual "pseudo-rs-fMRI" signal. Following the pre-processing of pseudo-rs-fMRI, full rs-fMRI, and a truncated version of the full rs-fMRI (first 100 timepoints) data, the default mode, motor, and language network maps were generated with atlas-based ROIs. Dice scores were calculated for the resting-state network maps from pseudo-rs-fMRI and truncated rs-fMRI using the full rs-fMRI maps as reference. Seed-to-voxel and ROI-to-ROI analyses were performed to assess FC differences between cognitively impaired and non-impaired patients. Dice scores for the group-level and patient-level (mean±SD) default mode, motor, and language network maps using pseudo-rs-fMRI were 0.905/0.689±0.118 (group/patient), 0.973/0.730±0.124, and 0.935/0.665±0.142, respectively. There was no significant difference in Dice scores between pseudo-rs-fMRI and the truncated rs-fMRI default mode (P=0.97) or language networks (P=0.30), but there was a difference in motor networks (P=0.02). A multiple logistic regression classifier applied to ROI-to-ROI FC networks using pseudo-rs-fMRI could identify cognitively impaired patients (Sensitivity=84.6%, Specificity=63.6%, ROC AUC=0.7762±0.0954 (SE), P=0.0221) and performance was not significantly different than full rs-fMRI predictions (AUC=0.8881±0.0733 (SE), P=0.0013, P=0.29 compared to pseudo-rs-fMRI). DSC perfusion MRI-derived pseudo-rs-fMRI data can be used to perform typical rs-fMRI FC analyses that may identify cognitive decline in patients with brain tumors while still simultaneously performing perfusion analyses.ABBREVIATIONS: AUC = Area under curve; BOLD = Blood oxygenation level dependent; FC = Functional connectivity; MNI = Montreal Neurological Institute; ROC = Receiver operating characteristic; Rs-fMRI = Resting-state functional MRI.

Considerations for implanting speech brain computer interfaces based on functional magnetic resonance imaging

Objective. Brain-computer interfaces (BCIs) have the potential to reinstate lost communication faculties. Results from speech decoding studies indicate that a usable speech BCI based on activity in the sensorimotor cortex (SMC) can be achieved using subdurally implanted electrodes. However, the optimal characteristics for a successful speech implant are largely unknown. We address this topic in a high field blood oxygenation level dependent functional magnetic resonance imaging (fMRI) study, by assessing the decodability of spoken words as a function of hemisphere, gyrus, sulcal depth, and position along the ventral/dorsal-axis. Approach. Twelve subjects conducted a 7T fMRI experiment in which they pronounced 6 different pseudo-words over 6 runs. We divided the SMC by hemisphere, gyrus, sulcal depth, and position along the ventral/dorsal axis. Classification was performed on in these SMC areas using multiclass support vector machine (SVM). Main results. Significant classification was possible from the SMC, but no preference for the left or right hemisphere, nor for the precentral or postcentral gyrus for optimal word classification was detected. Classification while using information from the cortical surface was slightly better than when using information from deep in the central sulcus and was highest within the ventral 50% of SMC. Confusion matrices where highly similar across the entire SMC. An SVM-searchlight analysis revealed significant classification in the superior temporal gyrus and left planum temporale in addition to the SMC. Significance. The current results support a unilateral implant using surface electrodes, covering the ventral 50% of the SMC. The added value of depth electrodes is unclear. We did not observe evidence for variations in the qualitative nature of information across SMC. The current results need to be confirmed in paralyzed patients performing attempted speech.

Evaluation of the Quality of Recovery from General Anesthesia in Dogs with Two Different Low Doses of Dexmedetomidine.

The purpose of this study was to evaluate the quality of recovery from general anesthesia with the administration of two low doses of dexmedetomidine in canine patients. For this blind randomized clinical trial study, 30 dogs undergoing general anesthesia for diagnostic procedures or elective surgery (ovariectomy/castration) were included. The patients were randomly divided into three groups, and at the end of anesthesia, they received a bolus of dexmedetomidine at 1 mcg/kg IV (D1), or a bolus of dexmedetomidine at 0.5 mcg/kg (D0.5), or a bolus of NaCl, in a total of 0.5 mL of solution for all three groups. After administration of the bolus, the anesthetist monitored the patients every 5 min by measuring heart rate, systolic and mean blood pressure, respiratory rate, and oxygen saturation. The quality of recovery was also assessed using 4 different scales. The extubation time, time of headlift, and standing position were also recorded. Both groups receiving dexmedetomidine had better awakening and a lower incidence of delirium when compared to saline administration. The heart rate was lower, while the systolic pressure was higher in the two groups D1 and D0.5 compared to the NaCl with a low presence of atrioventricular blocks. The extubation time resulted significantly higher in the D1 (17 ± 6 min) compared to the D0.5 (10 ± 4 min) and NaCl (8 ± 3 min) (p < 0.0001); the headlift time D1 (25 ± 10 min) resulted significantly longer than the NaCl group (11 ± 5 min) (p = 0.0023) but not than the D0.5 (18 ± 9 min). No significant differences were found among the three groups for standing positioning (D1 50 ± 18 min, D0.5 39 ± 22 min, NaCl 28 ± 17 min). The preventive administration of a bolus of dexmedetomidine at a dosage of 0.5 mcg/kg or 1 mcg/kg IV during the recovery phase improves the quality of recovery in patients undergoing general anesthesia.

Assessment of Hypoxia in Breast Cancer: Emerging Functional MR Imaging and Spectroscopy Techniques and Clinical Applications.

Breast cancer is one of the most prevalent forms of cancer affecting women worldwide. Hypoxia, a condition characterized by insufficient oxygen supply in tumor tissues, is closely associated with tumor aggressiveness, resistance to therapy, and poor clinical outcomes. Accurate assessment of tumor hypoxia can guide treatment decisions, predict therapy response, and contribute to the development of targeted therapeutic interventions. Over the years, functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) techniques have emerged as promising noninvasive imaging options for evaluating hypoxia in cancer. Such techniques include blood oxygen level-dependent (BOLD) MRI, oxygen-enhanced MRI (OE) MRI, chemical exchange saturation transfer (CEST) MRI, and proton MRS (1H-MRS). These may help overcome the limitations of the routinely used dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) techniques, contributing to better diagnosis and understanding of the biological features of breast cancer. This review aims to provide a comprehensive overview of the emerging functional MRI and MRS techniques for assessing hypoxia in breast cancer, along with their evolving clinical applications. The integration of these techniques in clinical practice holds promising implications for breast cancer management. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.

16 Effects of fiber supplementation during gestation on sow and piglet performance

Abstract Our objective was to determine the effects of fiber supplementation during gestation on sow and piglet performance. A total of 200 PIC Camborough P1+ sows were used. At breeding, sows were balanced by body weight (BW) within parity and randomly allotted to 1 of 2 dietary treatments, which consisted of 1) Control; corn-soybean meal gestation diet; and 2) Fiber; inclusion of soybean hulls in the formulation at a level to yield a dietary crude-fiber content 6%. Females were housed in individual stalls throughout the entire gestation. At d 90 of gestation, serum glucose, fecal dry matter, fecal volatile fat acids (acetate, propionate, butyrate, isovalerate, and valerate), urinary traits (color, turbidity, density, pH, and presence of nitrate or blood), and frequency of stereotypic behavior (sham chewing, teeth grinding, bar biting, and floor licking) was accessed. Perineal scoring was visually evaluated at d 105 and 110 of gestation. Farrowing traits (farrowing length, and number of piglets born alive, stillborn, and mummified fetuses) and piglet vitality (meconium presence, umbilical cord integrity, oxygenation, and heart rate) were individually monitored. Individual piglet BW was obtained within 12 h of birth and after 24 h for colostrum intake, and at weaning. Sow daily lactation feed intake was registered. Data were analyzed using generalized linear mixed models with the Glimmix procedure of SAS with sow serving as the experimental unit. There was no evidence (P &amp;gt; 0.10) for differences in sow BW at d1, d112 of gestation, and at weaning. Sows fed the greater fiber diet showed lower levels of post-prandial glucose (-6%; P &amp;lt; 0.10), darker urine (+33%; P &amp;lt; 0.10) with greater pH (+5%; P &amp;lt; 0.05), and greater levels of fecal butyrate (+62%; P &amp;lt; 0.05) and isovalerate (+15%; P &amp;lt; 0.10) at the end of gestation (d 90). Feces from sows fed the control diet were drier (P &amp;lt; 0.05) at d 90 of gestation. Fiber supplementation reduced the frequency of teeth grinding (-52%; P &amp;lt; 0.10), bar biting (-74%; P &amp;lt; 0.05), and floor licking (-65%; P 0.10) behaviors. There was no evidence for treatment differences (P &amp;gt; 0.10) for perineal scores. Piglet vitality was not affected by the treatments, except for a marginal increase in blood oxygen saturation for piglets from sows fed the greater fiber diet (+1%; P &amp;lt; 0.10). Treatment did not impact (P &amp;gt; 0.10) farrowing duration, number of total piglets born, born alive, stillborn, and mummified, nor average piglet birth weight and colostrum intake. Sows fed diet with fiber supplementation during gestation had a marginal increase in average daily feed intake during lactation (+0.50kg/d; P = 0.08), which resulted in improved piglet BW gain (P &amp;lt; 0.05) and weaning weights (+0.20kg; P &amp;lt; 0.05). In summary, providing increased level of fiber supplementation via soybean hulls to gestating diets did not impact sow reproductive performance. Beneficial effects were observed for welfare lactation feed intake, piglet BW gain and weaning weights.

Effects on the Physical Functioning of Two Exercise Interventions in Patients with Multiple Myeloma: A Pilot Feasibility Study.

Because of the high prevalence of bone destruction in patients with multiple myeloma (MM), physical exercise is oftentimes discouraged by healthcare providers. The goal of this prospective trial was to investigate the feasibility of two six-month exercise interventions in patients with MM (N = 42): a remotely prompted home-based walking intervention or a supervised strength training intervention. Physical function and pain were assessed with the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Short Form raw score, a six-minute walk test (6 MWT), a 30-second sit-to-stand test (30 SST), a timed up-and-go (TUG) test, a visual analog scale (VAS) for pain, handheld dynamometer tests, heart rate at rest, blood oxygen saturation at rest, and body mass index. No intervention-related serious adverse events were observed. Adverse events mostly affected the musculoskeletal system. In the resistance training group (n = 24), patients showed significant improvements in AM-PAC, TUG, 6 MWT, and 30 SST, with all effects but the 6 MWT sustained six months after the intervention. The walking group (n = 18) saw improvements in the AM-PAC, TUG, 6 MWT, and 30 SST, with a sustained change in the AM-PAC and TUG. This trial shows the feasibility of both exercise interventions with a sustained beneficial effect on the physical functioning of a six-month strength training intervention and, to a lesser extent, a six-month unsupervised walking intervention. A larger study building on these findings is currently underway.

Application of intranasal dexmedetomidine in magnetic resonance imaging of preterm infants: The ED50, efficacy and safety analysis.

Infants undergoing magnetic resonance imaging (MRI) often require pharmacological sedation. Dexmedetomidine serves as a novel sedative agent that induces a unique unconsciousness similar to natural sleep, and therefore has currently been used as the first choice for sedation in infants and young children. To determine the 50% effective dose (ED50) and 95% confidence interval (95%CI) of intranasal dexmedetomidine for MRI in preterm and term infants, and to observe the incidence of adverse events. To explore whether there were differences in ED50 and 95%CI, heart rate (HR) and blood oxygen saturation (SpO2), the induction time and wake-up time and the incidence of adverse events between the 2 groups, so as to provide guidance for clinical safe medication for the meanwhile. A total of 68 infants were prospectively recruited for MRI examination under drug sedation (1 week ≤ age ≤ 23 weeks or weight ≤ 5kg). The children were divided into 2 groups according to whether they had preterm birth experience (Preterm group, Atterm group). The Dixon up-and-down method was used to explore ED50. The basic vital signs of the 2 groups were recorded, and the heart rate and SpO2 were recorded every 5 minutes until the infants were discharged from the hospital. The induction time, wake-up time and adverse events were recorded. The ED50 (95%CI) of intranasal dexmedetomidine in the Preterm group and the Atterm group were 2.23 (2.03-2.66) μg/kg and 2.64 (2.49-2.83) μg/kg, respectively (P < .05). the wake-up time was longer in Preterm group (98.00min) than in Atterm group (81.00 min) (P < .05), the incidence of bradycardia in Preterm group was 3/33, which was higher than that in Atterm group (1/35). There was no difference in the induction time between the 2 groups (P > .05), and there was no significant difference in other adverse events. Intranasal dexmedetomidine can be safely used for sedation in preterm infants undergoing MRI. Compared with term infants, preterm infants have a lower dose of dexmedetomidine, a higher incidence of bradycardia, and a longer weak-up time.

Toxicological Effects of Commonly Used Mosquito Coil Smoke on Liver and Lung Function in Rats

The utilization of mosquito coils as a household-level strategy for mosquito control is widely practiced in malaria-endemic regions spanning Africa, Asia, and South America. However, the continuous application of mosquito coils has prompted significant apprehensions concerning environmental and health implications. This research aims to evaluate the potential hepatic and pulmonary toxicities associated with the inhalation of mosquito coil smoke in rat subjects over both sub-chronic and chronic durations. A questionnaire was used to make inquiries regarding the prevalent types and brands of mosquito coils employed, the manner in which they are used, the durations for which they are utilized. A total of twenty-four albino rats were categorized into three distinct groups: the control group and two exposed groups. These groups were subjected to distinct brands of mosquito coil smoke across two distinct exposure regimens – a sub-chronic exposure lasting 4 weeks and a chronic exposure spanning 12 weeks. Following the exposure periods, blood samples were collected for the analysis of serum-based and biochemical markers, including serum aspartate aminotransferase (AST), alanine aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), bilirubin, serum bicarbonate, and Lactate dehydrogenase (LDH), oxygen saturation, C-reactive protein, total protein, and microscopic analysis of lung tissue and liver tissue. The histopathological analysis of lung tissue was appropriately included. However, the analysis of liver tissue was omitted. The results demonstrated a significant elevation in the levels of these biochemical markers among the exposed rats in comparison to the control group. Concurrently, a decrease in blood oxygen saturation was noted in the exposed rats when contrasted with the control group. Conversely, the serum concentrations of high-sensitivity C-reactive protein, total protein, and alanine aminotransferase (ALT) did not exhibit notable differences in relation to the control group. Additionally, microscopic analysis of lung tissue indicated the presence of histopathological lesions in the exposed rats, suggesting a detrimental impact of mosquito coil smoke exposure in a time-dependent progression.

Assessing changes in regional cerebral hemodynamics in adults with a high-density full-head coverage time-resolved near-infrared spectroscopy device.

Cerebral oximeters have the potential to detect abnormal cerebral blood oxygenation to allow for early intervention. However, current commercial systems have two major limitations: (1)spatial coverage of only the frontal region, assuming that surgery-related hemodynamic effects are global and (2)susceptibility to extracerebral signal contamination inherent to continuous-wave near-infrared spectroscopy (NIRS). This work aimed to assess the feasibility of a high-density, time-resolved (tr) NIRS device (Kernel Flow) to monitor regional oxygenation changes across the cerebral cortex during surgery. The Flow system was assessed using two protocols. First, digital carotid compression was applied to healthy volunteers to cause a rapid oxygenation decrease across the ipsilateral hemisphere without affecting the contralateral side. Next, the system was used on patients undergoing shoulder surgery to provide continuous monitoring of cerebral oxygenation. In both protocols, the improved depth sensitivity of trNIRS was investigated by applying moment analysis. A dynamic wavelet filtering approach was also developed to remove observed temperature-induced signal drifts. In the first protocol ( years; five females, five males), hair significantly impacted regional sensitivity; however, the enhanced depth sensitivity of trNIRS was able to separate brain and scalp responses in the frontal region. Regional sensitivity was improved in the clinical study given the age-related reduction in hair density of the patients ( years; 14 females, 13 males). In five patients who received phenylephrine to treat hypotension, different scalp and brain oxygenation responses were apparent, although no regional differences were observed. The Kernel Flow has promise as an intraoperative neuromonitoring device. Although regional sensitivity was affected by hair color and density, enhanced depth sensitivity of trNIRS was able to resolve differences in scalp and brain oxygenation responses in both protocols.

Goal-Directed Fluid Therapy Using Normal Saline versus Ringer's Lactate in Pediatric Neurosurgical Patients: A Randomized Controlled Trial

Abstract Background Ringer's lactate (RL) and 0.9% sodium chloride (NS) are used intraoperatively in pediatric surgical patients. The fluid of choice in pediatric neurosurgical patients is still under research. Hence, we compared NS and RL intraoperatively with a primary objective of measuring the absolute difference in serum chloride concentrations (ΔCl-) after surgery from baseline. Secondary objectives included changes in other electrolytes, osmolarity, pH, creatinine, brain relaxation score (BRS), and neurological outcome at discharge using a modified Rankin scale (mRS). Methods This prospective randomized trial was conducted in American Society of Anesthesiologists status I to II children, aged 6 months to 14 years, after Institutional Ethical Committee approval and written informed consent. Forty patients were randomized in group-S (received 0.9% Saline) and group-R (received RL). The fluid administration was guided by Pleth Variability Index (target &lt;13%). Arterial blood samples were taken at the start of surgery, during tumor resection, and at the end of surgery. Results Twenty-one patients in NS and 19 patients in RL were enrolled. ΔCl- was 12 (9–16) mmol/L in NS group and 4 (2–15) mmol/L in RL group, p = 0.03. NS group developed more metabolic acidosis (6 [28.6%] vs. 0 [0.0%], p = 0.021). There was no difference in the other electrolytes, serum osmolarity, BRS, perioperative creatinine, and mRS between groups, p = 0.36, p = 0.096, p = 0.658, and p = 0.168, respectively. Conclusion Intraoperative use of NS causes derangement in chloride balance, leading to metabolic acidosis compared to RL in children undergoing neurosurgical procedures. However, there was no difference in the other parameters, including serum osmolarity, BRS, and mRS.

The ability of perfusion index and positional perfusion index variation to predict spinal anesthesia-induced hypotension in elderly patients: A prospective observational study

Background: Spinal anesthesia (SA) is a popular anesthetic technique for several surgeries; however, it is mostly associated with hypotension. The perfusion index (PI) can predict hypotension after spinal and general anesthesia. We aimed to evaluate the predictability of PI postural change, supine and sitting PI to post-SA hypotension in elderly patients.Methods: This study was conducted on 68 elderly patients aged >65 years, scheduled for elective orthopedic surgical operations under SA in supine position. PI, arterial oxygen saturation, blood pressure, and heart rate were initially recorded at sitting and supine positions then 5, 10, and 20 minutes after subarachnoid drug injection (in supine position). ΔPI=PI supine−PI sitting. The relative change in PI (rPI) =ΔPI/PI sitting× 100.Results: Hypotension occurred in 33.82% of patients. The Δ PI was 0.53±0.24, and the r PI was 14.18±6.41%. Δ PI at cut-off >0.6 and r PI at cut-off > 14%; could predict SA-induced hypotension with a sensitivity of 82.61 and 86.96%, respectively, and specificity of 88.89 and 77.78%, respectively. There was an insignificant difference between Δ PI and r PI and between r PI and baseline supine in predicting SA-induced severe hypotension. The prediction of SA-induced hypotension was higher with Δ PI than baseline sitting and baseline supine (P=0.002 and 0.027) and between r PI and baseline sitting (P=0.047).Conclusions: In elderly patients, the Δ PI has a higher predictive value for SA-induced hypotension than baseline sitting and baseline supine with comparable prediction ability between Δ PI and r PI.

Deglutition dynamics of patients with obstructive sleep apnea.

In the present study, we performed a detailed analysis of deglutitive dynamics during sleep in patients with obstructive sleep apnea (OSA) using a methodology developed by Sato etal. We hypothesized that the frequency of deglutition would decrease with increasing severity of OSA. The aim of this study is to clarify the involvement of deglutitive dynamics during sleep in OSA by investigating the correlations between deglutition and sleep parameters. This study included 30 adult patients with OSA. To analyze deglutition dynamics during sleep, surface electromyography recordings of the suprahyoid and thyrohyoid neck muscles, which are involved in deglutition, were performed simultaneous with conventional polysomnography. The "index of deglutition" was defined as the frequency of deglutition per hour of sleep. We examined correlations between this index and sleep parameters (apnea-hypopnea index [AHI], apnea index, hypopnea index, and lowest blood oxygen saturation). By analyzing the obtained polysomnography and electromyography waveforms, we identified two deglutition patterns with and without respiratory arousal during sleep. We found a significant negative correlation between the index of deglutition in sleep stage 1 and the AHI, with a correlation coefficient of -0.48. (p=0.02). In the current study, we distinguished deglutition during sleep with and without arousal. In addition we discovered a significant negative correlation between the index of deglutition in sleep stage 1 and the AHI. This new finding will provide a platform for future research on OSA in aspiration pneumonia.

Effects of the Use of Face Masks on the Vital Signs and Headache of Healthy Healthcare Workers During the COVID-19 Pandemic: A Hospital-Based Cross-Sectional Study

The study aimed to assess the impact of wearing protective facial masks (PFMs) on various health parameters of hospital staff amidst the COVID-19 pandemic. The aim of this study was to investigate the effects of wearing a face mask on blood oxygen saturation, heart rate, headache, fatigue, and shortness of breath in hospital staff during routine work shifts and COVID-19. In this study, participants from various clinical, administrative, and hospital cleaning professions who had at least one month of work experience were enrolled and their oxygen saturation (SpO2), heart rate (HR), and headache were measured during routine shifts with normal daily activities. The fatigue severity scale (FSS) and the modified Borg dyspnea scale were used to assess the participants. The significance level was set at 0.05. SpO2 and HR were lower at the end of the work shift than at the beginning (93.96 ±1.57 vs. 95.03 ± 1.7 and 82.1 ±11.83 vs. 83.93 ±12.31, respectively). According to the result of the Borg scale, 59.2% of the participants did not feel short of breath and 34.3% had “mild-moderate” shortness of breath. The total FSS (21.46 ± 2.31) showed that the participants did not fall into the “fatigued” category. The Kruskal-Wallis test showed no significant difference in Borg score, FSS, HR, and SpO2 participants with different mask types (P > 0.05). The result of the Kruskal-Wallis test also showed no significant difference in Borg score between the occupational groups (P = 0.073). The results showed that the frequency of pre-existing headaches had increased in 18.2% of the respondents. The findings indicated that wearing PFMs did not have a notable impact on oxygen levels and heart rate during the regular tasks of hospital staff. However, the use of PFMs led to the development of new headaches associated with PFMs or worsened existing headaches.

Silybin prevented avermectin-induced cardiotoxicity in carp by modulating oxidative stress, inflammation, endoplasmic reticulum stress, mitochondrial apoptosis, and autophagy

Avermectin is one of the widely used anthelmintics in aquaculture and exhibits substantial toxicity to aquatic organisms. Silybin is extensively used for its anti-inflammatory, antioxidant and anti-apoptotic biological properties. Heart is essential for the survival of fish and plays a vital role in pumping blood oxygen and nutrients. Residual avermectin in water poses harm to carp. However, there is still insufficient research on whether silybin can mitigate the toxicity of avermectin to carp heart tissues. In this research, we established a model involving carp subjected to acute avermectin exposure and administered diets containing silybin to explore the potential protective effects of silybin against avermectin-induced cardiotoxicity. The results revealed that avermectin induced oxidative stress, inflammation, endoplasmic reticulum (ER) stress, mitochondrial pathway apoptosis and autophagy in the cardiac tissues of carp. Compared with the avermectin group, silybin significantly reduced ROS accumulation in cardiac tissues, restored antioxidant enzyme activity, inhibited mRNA transcript levels of pro-inflammatory-related factors, and attenuated ER stress, mitochondrial pathway apoptosis and autophagy. Protein-protein interaction (PPI) analysis demonstrated that silybin mitigated avermectin-induced cardiac oxidative stress, inflammation, ER stress, mitochondrial pathway apoptosis and autophagy. Silybin exerted anti-inflammatory effects through the Nuclear Factor kappa B (NF-κB) pathway, antioxidant effects through the Nuclear factor erythroid 2-related factor 2 (Nrf2) - Kelch-like ECH-associated protein 1 (Keap1) pathway, alleviated cardiac ER stress through the Glucose-regulated protein 78 (GRP78)/Activating Transcription Factor 6 (ATF6)/C/EBP homologous protein (CHOP) axis, suppressed apoptosis through the mitochondrial pathway, and inhibited excessive autophagy initiation through the PTEN-induced putative kinase 1 (PINK1)/ Parkin RBR E3 ubiquitin protein ligase (PARKIN) signaling pathway. This study provided evidence supporting the protective effect of silybin against avermectin-induced cardiotoxicity in carp, highlighting its potential as a dietary additive to protect fish from adverse effects caused by avermectin exposure.