Reduction In Fluid Volume Research Articles

THE MINI-STEAMROLL: An Abbreviated Variation of the Steamroller Maneuver After Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment.

To describe a novel positioning maneuver for patients with rhegmatogenous retinal detachment after pneumatic retinopexy (PnR). Single-center prospective case series of primary rhegmatogenous retinal detachments referred to St. Michael's Hospital, Toronto, Canada, between 2021 and 2023. All patients underwent PnR. Baseline ultra-widefield fundus imaging and repeat imaging 10 minutes after the gas injection was performed. After PnR, patients were instructed to perform the mini-steamroll maneuver, which consists of a face-down position for 10 minutes followed by positioning to the retinal break. The reduction of subretinal fluid volume after the initial face-down position was evaluated with clinical examination and ultra-widefield imaging. Six patients who presented with primary bullous rhegmatogenous retinal detachment and a sizable superior break were enrolled. The mini-steamroll maneuver resulted in a rapid and significant reduction of subretinal fluid in all patients with bullous rhegmatogenous retinal detachment and large superior breaks, allowing subretinal fluid to be expressed into the vitreous cavity with 10 minutes of face-down positioning. One patient required a sequential PnR. Primary retinal reattachment was achieved in all cases. This approach was well-tolerated by patients. This case series demonstrates that the mini-steamroll maneuver may be a suitable alternative for patient positioning after PnR in certain cases. The mini-steamroll is a simpler positioning regimen with the potential benefits of direct-to-break and full steamroller maneuver.

Biochemical parameters and oral fluid microcrystallization in young patients who use a vape device

The study aims s are researching the negative effect of nicotine-containing vapes on physical and chemical parameters of oral fluid and morphotyping of dried oral fluid drop among young somatically healthy individuals. Material and methods. The study included 20 people between the ages of 18 and 24 years old, divided into 2 groups: the «Vape» group (n=12) human only nicotine-containing vape for at least 2 years and the «Control» group (n=8) not human nicotine in any form. pH, thiocyanate (rhodonide) concentrations, surface tension, oral fluid volume, hygiene indices and periodontal indices were studied. The morphotype of dried oral fluid drop was analyzed. Results. In the «Control» group in 3 cases gingivitis chronic K05.1 was diagnosed, and in the patients of the «Vape» group in 9 cases. It was found that the rhodonide content in the «Vape» group before «vaping» was higher than in the «Control» group and was Me= 1.31 mM/L and Me=0.58 mM/L respectively p=0.012. After vape application, the concentration of rhodonides in oral fluid increased in 1.16 times (p=0.0077), nitrite ions content from Me=0.09 mg/L to Me=0.32 mg/L (p=0.07), pH increased to Me=7.64; (LQ=7.45; HQ=7.67) (p=0.07) (p=0.07). The volume of RW in the Vape group remains 2.8 times smaller than in the Control group (p=0.012). The microcrystallization pattern of the oral fluid drop in the «Vape» group before «steaming» more often corresponded to type II A, and after «steaming» in 33.4% cases type III was determined, in 25% – type II B. Conclusions. Thus, in «vapers» of 18–24 years old statistically reliable reduction of oral fluid volume, high values of hygiene index shift of acid-base balance in the direction of alkalosis creates conditions in the oral cavity for the development of periodontal diseases and the emergence of cariesogenic situation. There was an increase in the concentration of rhodanide and nitrite ions, which in combination with other components of vape aerosols can be considered as procarcinogens, syncarcinogens and cocarcinogens. The change in the morphology of facies pattern, type of microcrystallization of oral fluid drop in the dynamics of vape use corresponds to the vector of changes observed in other inflammatory diseases of the oral cavity

Cryodehydration applied to bovine fetal hearts: A model for studying cardiac organogenesis.

The study aimed to standardize the cryodehydration technique for bovine fetal hearts, focusing on optimizing protocols for each developmental stage to preserve morphological characteristics. We analyzed 29 bovine fetal hearts categorized into early, middle, and late developmental stages. These hearts underwent cryodehydration until a 60%-70% reduction in original fluid volume was achieved. Biometric data were recorded and statistically analyzed using Pearson correlation tests for age versus weight and age versus number of cryodehydration sessions. Morphometric comparisons before and after cryodehydration were performed using paired t-tests. In Group I, hearts exhibited well-defined structures, including the atrium cordis, ventriculus cordis, auricula atrii, aorta, truncus pulmonalis, and ramus coronaries arteria, which were preserved in Groups II and III. Additionally, in Group I the heart had a conical or flat apex cordis, whereas those in Groups II and III had a more pronounced apex. The average number of cryodehydration sessions required was 9.38 (±1.2) days for Group I, 12.37 (±1.4) days for Group II, and 15 days for Group III. A positive correlation was found between age and sample weight, indicating that more developed hearts were heavier. Similarly, there was a positive correlation between gestational age and the number of cryodehydration sessions, suggesting that more advanced stages required more cryodehydration sessions. Paired t-tests demonstrated high statistical significance in the morphometric parameters before and after cryodehydration, indicating a loss of mass during dehydration. However, there was no alteration in the macroscopic structure of the hearts, which remained morphologically preserved. In conclusion, cryodehydration shows promise for preserving and analyzing the external morphological characteristics of bovine fetal cardiac development. It also provides lightweight, odorless, and easy-to-handle specimens ideal for detailed morphological studies and offers a unique perspective for investigating cardiac morphology in biological research contexts.

Latrogenic twin anemia: polycythemia sequence post-amnioreduction in twin-twin transfusion syndrome

We present a case of Iatrogenic twin anemia–polycythemia sequence (TAPS) post-amnioreduction in twin-twin transfusion syndrome at 32 gestational weeks. Slight middle cerebral artery (MCA) peak systolic velocity (PSV) discrepancy was present 3 days after the amnioreduction, with MCA PSV around 1.5 MoM of the doner and 1.0 MoM of the recipient. Eighteen days after the amnioreduction, though MCA PSV remained stable, placental dichotomy, starry-sky liver of the recipient and small amount of right pleural effusion of donor were noted. TAPS was diagnosed and postnatal examination of the twins and the placenta confirmed it. We conjectured that the decompression of the placenta after the sudden reduction of amniotic fluid volume may cause the patency of the tiny anastomoses, resulting in the TAPS.

Long-term observation of estimated fluid volume reduction after the initiation of ipragliflozin in patients with type 2 diabetes mellitus: a sub-analysis from a randomized controlled trial (PROTECT)

Backgrounds/AimRecent studies have shown that the addition of sodium-glucose co-transporter 2 (SGLT2) inhibitors gradually reduces the estimated fluid volume parameters in a broad range of patient populations, suggesting that this mediates the clinical benefits of SGLT2 inhibitors in preventing heart failure. Here, we sought to examine the long-term (24 months) effect of the SGLT2 inhibitor ipragliflozin on the estimated fluid volume parameters in patients with type 2 diabetes mellitus (T2DM).MethodsIn this prespecified sub-analysis of the PROTECT (Prevention of Atherosclerosis by SGLT2 Inhibitor: Multicenter, Randomized Controlled Study) trial, which was an investigator-initiated, multicenter, prospective, randomized, open-label, clinical trial primarily designed to evaluate the effect of ipragliflozin treatment administered for 24 months on carotid atherosclerosis in patients with T2DM, we evaluated serial changes in estimated plasma volume (ePV, %) calculated using the Straus formula and estimated extracellular volume (eEV, mL) calculated by the body surface area by 24 months following the initiation of 50-mg ipragliflozin once daily and compared them with those following standard care for T2DM (non-SGLT2 inhibitor use).ResultsThis sub-analysis included 464 patients (ipragliflozin, n = 232; control, n = 232), a full analysis set of the PROTECT trial. In an analysis using mixed-effects models for repeated measures, relative to the control group, ipragliflozin significantly reduced ePV by − 10.29% (95% confidence interval [CI] − 12.47% to − 8.11%; P < 0.001) at 12 months and − 10.76% (95% CI − 12.86% to − 8.67%; P < 0.001) at 24 months. Additionally, ipragliflozin significantly reduced eEV by − 190.44 mL (95% CI − 249.09 to − 131.79 mL; P < 0.001) at 12 months and − 176.90 mL (95% CI − 233.36 to − 120.44 mL; P < 0.001) at 24 months. The effects of ipragliflozin on these parameters over 24 months were mostly consistent across various patient clinical characteristics.ConclusionsThis prespecified sub-analysis from the PROTECT trial demonstrated that ipragliflozin treatment, compared with the standard care for T2DM, reduced two types of estimated fluid volume parameters in patients with T2DM, and the effect was maintained for 24 months. Our findings suggest that SGLT2 inhibitor treatment regulates clinical parameters incorporated into the calculating formulas analyzed and consequently fluid volume status for the long-term, and this may be at least partly associated with clinical benefits from chronic use of SGLT2 inhibitors.Trial registration Japan Registry of Clinical Trials, ID jRCT1071220089

Use of equine embryo-derived mesenchymal stromal cells and their extracellular vesicles as a treatment for persistent breeding-induced endometritis in susceptible mares

Persistent breeding induced endometritis (PBIE) is a significant cause of infertility in mares. The development of a safe, universal, readily available therapeutic to manage PBIE and facilitate an optimal uterine environment for embryo development and implantation would potentially improve pregnancy rates in susceptible mares. Mesenchymal stromal cells (MSCs) are being used increasingly as a therapeutic mediator for inflammatory conditions such as endometritis. Early gestation tissue provides a unique source of multipotent stem cells that exhibit immunomodulatory, proliferation, and differentiation properties. Extracellular vesicles (EVs) are nanometre sized, membrane enclosed structures released by cells that play a crucial role in mediating cellular communication through the shuttling of their cargo of bioactive molecules. This study involved two clinical trials aimed to utilise D32 embryo-derived mesenchymal stromal cells (EDMSCs) and their EVs as a potential therapeutic modality for PBIE in mares. The aim of Experiment 1 was to determine the efficacy of an intrauterine deposition of EDMSCs and their EVs 24 h prior to being challenged by intrauterine insemination with a dose of pooled dead sperm PBIE-susceptible (Troedsson and Woodward. Reproductive Biology. 2016;16:8-12) mares (n=5) in a controlled cross-over designedexperiment. In Experiment 2 a cohort of client-owned thoroughbred mares (n=37; 40 estrous cycles) from farms that were previously involved in a large-scale epidemiological study in which the average first cycle pregnancy rate in mares was 53.6% (Firth, et al. New Zealand Veterinary Journal. 2012;60:329-334) were utilized. The mares were identified as being susceptible to PBIE with a history of failing to become pregnant on >2 consecutive estrous cycles despite intense breeding management and use of a fertile stallion/s received intrauterine EDMSCs or their EVs 24 h prior to natural mating. A significant reduction in uterine fluid volume was observed at both 12 and 24 h after insemination in Experiment 1 when mares were pre-treated with either EDMSCs or their EVs compared to placebo (control) treatment (p>0.05). In Experiment 2, 9 of 19 (47%) mares treated with EDMSC and 13 of 20 (65%) mares treated with EVs prior to natural mating were pregnant after the first cycle, and 12 of 18 (67%) mares treated with EDMSCs and 15 of 19 (79%) mares treated with EVs had conceived by the end of the breeding season. These preliminary clinical studies are the first report of the use of EDMSCs or their EVs as a potential therapy for the management of PBIE in susceptible mares.

Guanylyl cyclase/natriuretic peptide receptor-A: Identification, molecular characterization, and physiological genomics.

The natriuretic peptides (NPs) hormone family, which consists mainly of atrial, brain, and C-type NPs (ANP, BNP, and CNP), play diverse roles in mammalian species, ranging from renal, cardiac, endocrine, neural, and vascular hemodynamics to metabolic regulations, immune responsiveness, and energy distributions. Over the last four decades, new data has transpired regarding the biochemical and molecular compositions, signaling mechanisms, and physiological and pathophysiological functions of NPs and their receptors. NPs are incremented mainly in eliciting natriuretic, diuretic, endocrine, vasodilatory, and neurological activities, along with antiproliferative, antimitogenic, antiinflammatory, and antifibrotic responses. The main locus responsible in the biological and physiological regulatory actions of NPs (ANP and BNP) is the plasma membrane guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA), a member of the growing multi-limbed GC family of receptors. Advances in this field have provided tremendous insights into the critical role of Npr1 (encoding GC-A/NPRA) in the reduction of fluid volume and blood pressure homeostasis, protection against renal and cardiac remodeling, and moderation and mediation of neurological disorders. The generation and use of genetically engineered animals, including gene-targeted (gene-knockout and gene-duplication) and transgenic mutant mouse models has revealed and clarified the varied roles and pleiotropic functions of GC-A/NPRA in vivo in intact animals. This review provides a chronological development of the biochemical, molecular, physiological, and pathophysiological functions of GC-A/NPRA, including signaling pathways, genomics, and gene regulation in both normal and disease states.

The relationship between Central Nervous System morphometry changes and key symptoms in Crohn’s disease

Alterations in grey matter volume (GMV) and cortical thickness (CT) in Crohn’s disease (CD) patients has been previously documented. However, the findings are inconsistent, and not a true representation of CD burden, as only CD patients in remission have been studied thus far. We investigate alterations in brain morphometry in patients with active CD and those in remission, and study relationships between brain structure and key symptoms of fatigue, abdominal pain, and extraintestinal manifestations (EIM). Magnetic Resonance Imaging brain scans were collected in 89 participants; 34 CD participants with active disease, 13 CD participants in remission and 42 healthy controls (HCs); Voxel based morphometry (VBM) assessed GMV and white matter volume (WMV), and surface-based analysis assessed cortical thickness (CT). We show a significant reduction in global cerebrospinal fluid (CSF) volume in CD participants compared with HCs, as well as, a reduction in regional GMV, WMV and CT in the left precentral gyrus (motor cortex), and an increase in GMV in the frontal brain regions in CD compared with HCs. Atrophy of the supplementary motor area (SMA) was associated with greater fatigue in CD. We also show alterations in brain structure in multiple regions in CD associated with abdominal pain and extraintestinal inflammations (EIMs). These brain structural alterations likely reflect neuroplasticity to a chronic systemic inflammatory response, abdominal pain, EIMs and fatigue. These findings will aid our understanding of the cross-linking between chronic inflammation, brain structural changes and key unexplained CD symptomatology like fatigue.

High-Enthalpy Geothermal Simulation with Continuous Localization in Physics

Simulation of heat production in high-enthalpy geothermal systems is associated with a complex physical process in which cold water invades steam-saturated control volumes. The fully implicit, fully coupled numerical strategy is commonly adopted to solve the governing system composed of mass and energy conservation equations. A conventional nonlinear solver is generally challenged by the strong nonlinearity present during phase transition because of a huge contrast of thermodynamics between hot steam and cool water. In the process of solution, due to the steam condensation, the reduction in fluid volume reduces the pressure in the control volume. This generates multiple local minima in the physical parameter space, which indicates the Newton initial guess should be carefully selected to guarantee the nonlinear convergence. Otherwise, the Newton iteration will approach a local minimum and the solution based on Newton’s update cannot converge and needs to be repeated for a smaller timestep. This problem brings simulation to the stalling behavior where a nonlinear solver wastes a lot of computations and performs at a very small timestep. To tackle this problem, we formulated continuous localization of Newton’s method based on an Operator-Based Linearization (OBL) approach. In OBL, the physical space can be parameterized in terms of operators with supporting points at different levels of resolution. During the simulation, the operator values at supporting points are obtained through reference physics and the remaining part of the space is interpolated. In this way, the nonlinear physical parameter space can be flexibly characterized with different degrees of accuracy. In our proposed approach, the nonlinear Newton iterations are performed in parameter space with different resolutions from coarse to fine. Specifically, the Newton solution under coarser resolution is taken as the initial guess for that under finer resolution. A coarser parameter space represents more linear physics, under which the nonlinear solver quickly converges to a localized solution near the true solution. With refinement in physics, the Newton iteration will approach the true solution and the stalling behaviour in the simulation is avoided. Therefore, a larger timestep can be utilized in the simulation compared with the conventional nonlinear solvers.

Hybrid nanofluid magnetohydrodynamic mixed convection in a novel W-shaped porous system

PurposeThis study aims to numerically examine the influence of various geometric parameters of a novel W-shaped porous cavity undergoing hybrid nanofluid-based magnetohydrodynamic mixed convection. The W-shaped cavity is modified from the classical trapezoidal cavity by constructing a triangular shape at its bottom. This cavity is isothermally active at the bottom, with different numbers and heights of the triangular peak (or undulation). The heated hybrid nanofluid (Cu–Al2O3–H2O) flow is cooled through the translating top wall. Inclined sidewalls are thermally insulated. To compare the impacts of change in geometric parameters, a square cavity under similar boundary conditions is also simulated. This study is carried out systematically addressing the various influences from a range of parameters like side angles (γ), number (m) and height (λ) of the bottom undulation, Reynolds number (Re), Richardson number (Ri), Darcy number (Da), Hartmann number (Ha), hybrid nanoparticles volume fraction (φ) on the overall thermal performance of the cavity.Design/methodology/approachApplying the finite volume approach, the transport equations involving multiphysical conditions like porous substance, hybrid nanofluid, magnetic field and shearing force are solved numerically by using a written FORTRAN-based code following the SIMPLE algorithm. The algebraic equations are solved over all the control volumes in an iterative process using the alternate direction implicit scheme and the tri-diagonal matrix algorithm. The converged solution of the iterative process is obtained when the relative error levels satisfy the convergence criterion of 10–8 and 10–10 for the maximum residuals and the mass defect, respectively.FindingsIt is revealed that an increase in the bottom undulation height always improves the thermal energy transfer despite the reduction of fluid volume. Thermal energy transfer significantly depends on the heating and cooling surface lengths, fluid volume in the cavity and the magnitude of the bottom undulation height of the W-shaped cavity. With the increase in bottom undulation height, effective heating length increases by ∼28%, which leads to a ∼15% reduction in the effective volume of the working fluid and a gain in heat transfer by ∼56.48%. In general, the overall thermal energy transport is improved by increasing Re, Ri and Da; whereas it is suppressed by increasing Ha.Research limitations/implicationsThere are many opportunities for future research experimentally or numerically, considering different curvature effects, orientations of the geometry, working fluids, boundary conditions, etc. Furthermore, this study could be extended by considering unsteady flow or turbulent flow.Practical implicationsIn many modern systems/processes pertaining to materials processing, continuous casting, food processing, chemical reactors, biomedical applications, etc. fine control in the transport process is a major concern. The findings of this analysis can effectively be useful for other applications for getting more control features in terms of achieving the operational objectives. The approach of the system analysis (considering geometrical size parameters to delve into the underlying transport physics) and the obtained simulated results presented in the work can usefully be applicable to similar thermal systems/devices such as materials processing, thermal mixing, chemical reactors, heat exchangers, etc.Originality/valueFrom the well-documented and vast pool of literature survey, it is understood that there exists no such investigation on the considered geometry and study. This study contributes a lot to understanding magnetic field moderated thermofluid flow of a hybrid nanofluid in a porous medium filled W-shaped cavity, in consideration of different geometrical shape parameters (undulation peak numbers at bottom wall, peak heights, side angles and heating and cooling length). Findings brought by this study provide great insights into the design and operation under various ranges of multiphysical thermofluid-flow processing phenomena.

Methanolic extract of Pycreus polystachyos possesses potent antidiarrheal activity that varies in male and female mice

Pycreus polystachyos is a well-known weed grown typically in ditches, grasslands, rice fields, etc. The whole plant is traditionally used against diarrhea. The present study was aimed to examine antidiarrheal of whole plant of Pycreus polystachyos in male and female mice model. Antidiarrheal activity was evaluated using two tests such as castor oil induced diarrhea and castor oil induced enteropooling at three extract concentrations- 100, 200 and 400 mg/kg.bw. Total flavonoids and tannins contents were also measured. The plant extract showed potent effect in prevention of castor oil induced diarrhea. Mice of both sexes showed greater effect than standard drug loperamide at 400 mg/kg.bw; the effect was substantially higher in male mice than female producing 64.77% and 38.04% in male and female respectively. Loperamide produced 35.28% and 33.70% inhibition in male and female mice respectively. In enteropooling test, both percent reduction in weight and volume of intestinal content were increased as doses of extract increased. Potent inhibition in intestinal fluid accumulation was evident from percent reduction in mean fluid volume. Male and female mice showed fluid reductions by 45.87% and 33.29% respectively while loperamide reduced it by 44.73% and 25.32%. Total flavonoids and tannins contents were found 13.44 mg Quercetin equivalent/g and 118.5 mg Gallic Acid equivalent/g respectively. The experiment endorses the folkloric use of P. polystachyos in diarrhea.

Prospective, Longitudinal Study: Daily Self-Imaging with Home OCT for Neovascular Age-Related Macular Degeneration

To validate the performance of the Notal Vision Home OCT (NVHO) system for daily self-imaging at home and characterize the retinal fluid dynamics of patients with neovascular age-related macular degeneration (nAMD). Prospective observational study. Fifteen participants who had at least 1 eye with nAMD and underwent anti-VEGF treatments. The participants performed daily self-imaging at home using NVHO for 3 months. The scans were uploaded to the cloud, analyzed using the Notal OCT Analyzer (NOA), evaluated by human experts for fluid presence, and compared with in-office OCT scans. Weekly self-scan rate, image quality, scan duration, agreement between NOA and human expert grading for fluid presence, agreement between NVHO and in-office OCT scans for fluid presence, central subfield thickness (CST) and retinal fluid volume, and the characteristics of fluid dynamics during the study and in response to treatments. The mean weekly scan frequency was 5.7 ± 0.9 scans per week, and 93% of the scans were eligible for NOA analyses. The median scan time was 42 seconds. The NOA and human experts agreed on the fluid status in 83% of the scans, and discrepancies were limited to trace amounts of fluid. The NVHO scans analyzed using NOA and the in-office OCT scans graded by human experts agreed on the fluid status in 96% of the cases. The CST and retinal fluid volume measurements using the home OCT and in-office OCT scans demonstrated a Pearson correlation coefficient of r= 0.90 and r= 0.92, respectively. Novel parameters, such as retinal fluid volume and area under the curve (AUC) of retinal fluid volume, demonstrated wide variations in fluid exudation and fluid load over time among the patients. Parameters such as the rate of reduction in fluid volume in the first week after treatment and AUC between treatments captured the speed and duration of the response to anti-VEGF agents. Daily home OCT imaging is feasible among patients with nAMD. It demonstrated good agreement with human expert grading for retinal fluid identification and excellent agreement with the in-clinic OCT scans. Home OCT allows for detailed graphical and mathematical analyses of retinal fluid volume trajectories, including novel parameters to inform clinical decision making.

Obstrução de cateter vesical de demora em pacientes com COVID-19

The aim was to describe the nursing interventions that should be implemented to minimize the time to change the Indwelling Bladder Catheter (CVD). Observational, descriptive study with a qualitative approach, of the experience report type, in which it was observed, in the Intensive Care Center for patients diagnosed with COVID-19, that critically ill patients presented CVD obstruction very often. The nurses' actions were related to CVD clearance due to hematuria, often without success, with the need to change the catheter more often than usual. Evidence shows that most acute kidney injuries (AKI) in individuals affected by SARS-CoV-2 are due to the acute tubular injury that they present in 80% of patients. This may be due to prolonged fluid volume reduction and hemodynamic states that decrease renal perfusion. The main nursing interventions aim to reduce the frequency of CVD exchanges and minimize the risk of infection. In care practice, it was possible to present the interventions to be implemented through the development of the nursing process in order to contribute to the reduction of risks of Health Care-Related Infections (HAI).

Changes of Gastric Secretion after Bolus and Slow Intravenous Administration of Bombesin and Neurotensin

Objectives:The aim of the present study was to evaluate the changes caused by intravenous administration of regulatory peptides, bombesin (BBS) and neurotensin (NT), on gastric secretion, serum gastrin, and plasma levels of bombesin-1ike immunoreactivity (BLI) and neurotensin. Materials and methods: Fourteen dogs underwent an upper gastrointestinal tract operation and a Pavlov pouch for the concentration of gastric fluids was formed. The experimental animals were divided into two groups. Peptides were given one month after the second operation and after fasting for 12 hours. In group A, the effects of BBS were studied after a rapid 1 ìg/kg body weight dose and a slow 30´ 0.5 ìg/kg body weight dose administration intravenously. Correspondingly to group B the effects of NT were studied in the same way. Results:The rapid intravenous infusion of BBS caused a very significant increase in gastrin levels, BLI in plasma, volume and HCl of the gastric fluids. The same results, plus a significant decrease in gastric pH, were observed following slow intravenous infusion of BBS. Concerning the NT, rapid administration caused a significant decrease in the volume of gastric fluids. Slow NT administration of caused a significant reduction in gastric fluid volume and in HCl. On the contrary, pH was significantly increased. Conclusion:Bombesin increases plasma gastrin levels and HCl secretion. Neurotensin administration causes a decrease in HCl secretion without affecting gastrin levels in plasma.

Differential Diagnosis and Prognosis of Fetuses with Bilateral Enlarged, Hyperechogenic Kidneys: Renal Volume and Amniotic Fluid Volume with Advancing Gestation

This study's objective was to identify prenatal criteria helping differential diagnosis of bilateral enlarged, hyperechogenic kidneys, especially looking at development of renal volume and amniotic fluid volume with increasing gestational age. Retrospective analysis (single-center database) of all bilateral enlarged, hyperechogenic kidneys between 2000-2018. Renal enlargement was defined as renal volume>90th percentile. Evaluation included development of renal and amniotic fluid volume during pregnancy and fetal outcome. 23 cases fulfilled the inclusion criteria. 12 pregnancies were terminated. For 11 continued pregnancies, longitudinal information on amniotic fluid volume and renal volume were available. 4 cases with oligohydramnios showed a progressive reduction; 6 cases with normal/increased amniotic fluid volume remained stable; in 1 case amniotic fluid volume normalized from initially being oligohydramnios. Regarding renal volume, 4 cases showed exponential enlargement, 3 cases linear progression; in 2 cases renal volume stabilized after initial progression; 2 cases showed initial progression and secondary regression. 4 fetuses survived: 3 autosomal dominant polycystic kidney diseases, 1 Bardet-Biedl syndrome. Progressive reduction of amniotic fluid volume with exponential increase of renal volume is highly suggestive for autosomal recessive polycystic kidney disease. Cases of autosomal dominant polycystic kidney disease show a linear progression of renal volume>90th percentile and mostly normal amniotic fluid volume.

Assessment and Impact of Intravenous Medication Fluid Administration in Critically Ill Patients With Acute Respiratory Failure.

Positive fluid balance early in critical illness is associated with poor outcomes. Reducing intravenous medication volume may mitigate volume overload. Objective: Assessment of fluid and medication administration and clinical outcomes in acute respiratory failure. Single-center, prospective observational study of hemodynamically stable adult patients in a medical intensive care unit (MICU) with acute respiratory failure. Median cumulative total intake volume was 12 890 (interquartile range [IQR] = 8654-22 221) mL (n = 27), and median cumulative intravenous medication volume was 3563 (IQR = 2371-9412) mL over the first 7 days. Medication volume accounted for 27.6% of aggregate fluid volume. Median daily intravenous medication volume administered was 591 (IQR = 339-1082) mL. Cumulative fluid volume was associated with reduced ventilator-free days (r2 = -0.393; P = 0.043), and cumulative fluid volumes during the first 3 and 7 days were associated with increased MICU length of stay (LOS ± standard error 0.73 ± 0.35 d/L, P = 0.047, and 0.38 ± 0.16 d/L, P = 0.021, respectively). Cumulative medication volume administered significantly reduced the likelihood of mechanical ventilator liberation (hazard ratio [HR] = 0.917; 95% CI: 0.854, 0.984; P = 0.016) and MICU discharge (HR = 0.911; 95% CI: 0.843, 0.985; P = 0.019). Small-volume infusion may decrease cumulative intravenous medication volume by 38%. Intravenous medication diluent contributes substantially to total fluid intake in patients with acute respiratory failure and is associated with poor outcomes. Reduction of intravenous medication fluid volume to improve clinical outcomes should be further investigated.

From non-alcoholic fatty liver disease to COVID­19: the present and prospects for the use of ursodeoxycholic acid

The clinical morphological manifestations of the course of non‑alcoholic fatty liver disease in patients, non‑alcohol drinkers, include steatohepatosis, non‑alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. There are four basic mechanisms in the pathogenesis of non‑alcoholic fatty liver disease: bile acid lipotoxicity, insulin resistance, systemic inflammation, increased oxidative stress and lipid peroxidation. Non‑alcoholic fatty liver disease increases the risk of onset, development and progression of the cardiovascular diseases independently from other predictors and manifestations of the metabolic syndrome. The complex treatment of patients with coronary heart disease, combined with the non‑alcoholic fatty liver disease includes diet, physical exercises, body mass reduction and drug therapy. The medications for this category of patients must be maximal safe and result in the improving of the clinical, laboratory and morphological parameters of liver. Ursodeoxycholic acid is one of the most effective medications with the mechanisms of action associated with the normalization of the hepatoenteric circulation of bile acids and a number of biologically active substances. It also possesses the cytoprotective and antiapoptotic action, affects the FXR­metabolic nuclear receptor, which plays an important role in the physiology of vascular pathology, is an important transcriptional regulator of bile acids, lipids and glucose metabolism. Ursodeoxycholic acid is able to suppress eosinophilic inflammation not only in the gastrointestinal tract. It improves histopathological changes in airway remodeling, that can be connected with the modulation of cytokines and inhibition of apoptosis of epithelial cells of the respiratory tract. Ursodeoxycholic acid can be potentially effective preparation for the reduction of fluid volume in pulmonary edema and prevention of lung damage caused by fat embolism syndrome. Moreover, its positive effects have been proved as regards the airway epithelial cells at cystic fibrosis. Taking into account that ursodeoxycholic acid inhibits pro‑inflammatory cytokines, has strong antioxidative properties and acts as a famous hepatoprotector, it can be effective in the treatment of coronavirus disease (COVID­19). In Ukraine Ursonost is available, it is one of the well‑known preparations containing ursodeoxycholic acid and advantageously distinguished by high quality and ease of dosing. It is bioequivalent to the reference drug due to the highest quality of the substance and modern production technology. The large evidence base on ursodeoxycholic acid allows the drug Ursonost to be considered as a drug with pronounced multipotent properties, thus it is indicated for the treatment of patients with non‑alcoholic and alcoholic fatty liver disease, especially in combination with the coronary heart disease, of conditions, associated with bile reflux (duodenogastric, duodenogastroesophageal reflux), biliary sludge, primary biliary cirrhosis, gallstone disease (for dissolving X‑ray negative stones) and other metabolic disorders. Ursonost preparation is available as 150 and 300 mg capsules, that facilitates the drug dosing depending on the body mass of a patient and a clinical situation.

Fibrous gels modelled as fluid-filled continua with double-well energy landscape.

Several biological materials are fibre networks infused with fluid, often referred to as fibrous gels. An important feature of these gels is that the fibres buckle under compression, causing a densification of the network that is accompanied by a reduction in volume and release of fluid. Displacement-controlled compression of fibrous gels has shown that the network can exist in a rarefied and a densified state over a range of stresses. Continuum chemo-elastic theories can be used to model the mechanical behaviour of these gels, but they suffer from the drawback that the stored energy function of the underlying network is based on neo-Hookean elasticity, which cannot account for the existence of multiple phases. Here we use a double-well stored energy function in a chemo-elastic model of gels to capture the existence of two phases of the network. We model cyclic compression/decompression experiments on fibrous gels and show that they exhibit propagating interfaces and hysteretic stress-strain curves that have been observed in experiments. We can capture features in the rate-dependent response of these fibrous gels without recourse to finite-element calculations. We also perform experiments to show that certain features in the stress-strain curves of fibrous gels predicted by our model can be found in the compression response of blood clots. Our methods may be extended to other tissues and synthetic gels that have a fibrous structure.

Brain volume changes in spontaneous intracranial hypotension: Revisiting the Monro-Kellie doctrine.

In the application of the Monro-Kellie doctrine in spontaneous intracranial hypotension, the brain tissue volume is generally considered as a fixed constant. Traditionally, cerebral venous dilation is thought to compensate for decreased cerebrospinal fluid. However, whether brain tissue volume is invariable has not yet been explored. The objective of this study is to evaluate whether brain tissue volume is fixed or variable in spontaneous intracranial hypotension patients using automatic quantitative methods. This retrospective and longitudinal study analyzed spontaneous intracranial hypotension patients between 1 January 2007 and 31 July 2015. Voxel-based morphometry was used to examine brain volume changes during and after the resolution of spontaneous intracranial hypotension. Brain structure volume was analyzed using Statistical Parametric Mapping version 12 and FMRIB Software Library v6.0. Post-treatment neuroimages were used as surrogate baseline measures. Forty-four patients with spontaneous intracranial hypotension were analyzed (mean [standard deviation] age, 37.8 [8.5] years; 32 female and 12 male). The whole brain tissue volume was decreased during spontaneous intracranial hypotension compared to follow-up (1180.3 [103.5] mL vs. 1190.4 [93.1] mL, difference: -10.1 mL [95% confidence interval: -18.4 to -1.8 mL], p = 0.019). In addition, ventricular cerebrospinal fluid volume was decreased during spontaneous intracranial hypotension compared to follow-up (15.8 [6.1] mL vs. 18.9 [6.9] mL, difference: -3.2 mL [95% confidence interval: -4.5 to -1.8 mL], p < 0.001). Longer anterior epidural cerebrospinal fluid collections, as measured by number of vertebral segments, were associated with greater reduction of ventricular cerebrospinal fluid volume (Pearson's r = -0.32, p = 0.036). The current study found the brain tissue volume and ventricular cerebrospinal fluid are decreased in spontaneous intracranial hypotension patients. The change in ventricular cerebrospinal fluid volume, but not brain tissue volume change, was associated with the severity of spinal cerebrospinal fluid leakage. These results challenge the assumption that brain tissue volume is a fixed constant.

Design and Baseline Characteristics of the Chlorthalidone in Chronic Kidney Disease (CLICK) Trial

Background: Hypertension often accompanies chronic kidney disease (CKD), and diuretics are widely prescribed to reduce blood pressure (BP). Chlorthalidone (CTD) is a thiazide-like diuretic and an effective antihypertensive drug, yet little data exist to support its use in treating hypertension in individuals with advanced CKD. Methods: Chlorthalidone in Chronic Kidney Disease (CLICK) is a phase II, single-institution, multicenter, double-blind randomized control trial to test the hypothesis that CTD improves BP, through reduction of extracellular fluid volume, and results in target organ protection in patients with stage 4 CKD and poorly controlled hypertension. After a single-blind placebo run-in for 2 weeks and confirmation of hypertension by 24-h ambulatory blood pressure (ABP), patients are randomized to either placebo or CTD 12.5 mg once daily (QD) followed by dose escalation. Randomization is stratified by prior loop diuretic use, and the double-blind phase lasts 12 weeks. With a total of 160 patients, the study will have ≥80% power to detect a 6 mm Hg difference in systolic 24-h ABP between the 2 treatment groups. Results: Between June 2016 and October 2019, 131 patients have been randomized. The baseline characteristics are as follows: average age 65.8 years, 79% men, 36% Black, 79% with diabetes, mean eGFR 23.2 mL/min/1.73 m², median urine albumin/creatinine ratio 923 mg/g, average number of BP medications 3.4, 60% on loop diuretics, and 24-h ABP averaged 141.7/73.8 mm Hg. Conclusion: Among patients with stage 4 CKD and uncontrolled hypertension, CLICK should answer the question whether CTD is safe and effective.